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Gariballa N, Mohamed F, Badawi S, Ali BR. The double whammy of ER-retention and dominant-negative effects in numerous autosomal dominant diseases: significance in disease mechanisms and therapy. J Biomed Sci 2024; 31:64. [PMID: 38937821 PMCID: PMC11210014 DOI: 10.1186/s12929-024-01054-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024] Open
Abstract
The endoplasmic reticulum (ER) employs stringent quality control mechanisms to ensure the integrity of protein folding, allowing only properly folded, processed and assembled proteins to exit the ER and reach their functional destinations. Mutant proteins unable to attain their correct tertiary conformation or form complexes with their partners are retained in the ER and subsequently degraded through ER-associated protein degradation (ERAD) and associated mechanisms. ER retention contributes to a spectrum of monogenic diseases with diverse modes of inheritance and molecular mechanisms. In autosomal dominant diseases, when mutant proteins get retained in the ER, they can interact with their wild-type counterparts. This interaction may lead to the formation of mixed dimers or aberrant complexes, disrupting their normal trafficking and function in a dominant-negative manner. The combination of ER retention and dominant-negative effects has been frequently documented to cause a significant loss of functional proteins, thereby exacerbating disease severity. This review aims to examine existing literature and provide insights into the impact of dominant-negative effects exerted by mutant proteins retained in the ER in a range of autosomal dominant diseases including skeletal and connective tissue disorders, vascular disorders, neurological disorders, eye disorders and serpinopathies. Most crucially, we aim to emphasize the importance of this area of research, offering substantial potential for understanding the factors influencing phenotypic variability associated with genetic variants. Furthermore, we highlight current and prospective therapeutic approaches targeted at ameliorating the effects of mutations exhibiting dominant-negative effects. These approaches encompass experimental studies exploring treatments and their translation into clinical practice.
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Affiliation(s)
- Nesrin Gariballa
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box: 15551, Al-Ain, United Arab Emirates
| | - Feda Mohamed
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box: 15551, Al-Ain, United Arab Emirates
- ASPIRE Precision Medicine Research Institute Abu Dhabi, United Arab Emirates University, Abu Dhabi, United Arab Emirates
| | - Sally Badawi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box: 15551, Al-Ain, United Arab Emirates
| | - Bassam R Ali
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box: 15551, Al-Ain, United Arab Emirates.
- ASPIRE Precision Medicine Research Institute Abu Dhabi, United Arab Emirates University, Abu Dhabi, United Arab Emirates.
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2
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Coetzer KC, Zöllner E, Moosa S. Genetic basis of osteogenesis imperfecta from a single tertiary centre in South Africa. Eur J Hum Genet 2023:10.1038/s41431-023-01509-3. [PMID: 38102329 DOI: 10.1038/s41431-023-01509-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/23/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
Osteogenesis imperfecta (OI) is a clinically heterogeneous disorder characterised by skeletal fragility and an increased fracture incidence. It occurs in approximately one in every 15-20,000 births and is known to vary considerably in its severity. This report aimed to use next-generation sequencing (NGS) technology to identify disease genes and causal variants in South African patients with clinical-radiological features of OI. A total of 50 affected individuals were recruited at Tygerberg Hospital's Medical Genetics clinic. Patients were selected for a gene panel test (n = 39), a single variant test (n = 1) or exome sequencing (ES) (n = 12, 7 singletons, 1 affected duo, and 1 trio), depending on funding eligibility. An in-house genomic bioinformatics pipeline was developed for the ES samples using open-source software and tools. This study's 100% diagnostic yield was largely attributable to an accurate clinical diagnosis. A causal variant in COL1A1 or COL1A2 was identified in 94% of this patient cohort, which is in line with previous studies. Interestingly, this study was the first to identify the common South African pathogenic FKBP10 variant in a patient of mixed ancestry, adding to what was previously known about this variant in our population. Additionally, a recurrent variant in COL1A2: c.1892G>T was discovered in 27 individuals (25 from three large unrelated families and two further individuals), facilitating the establishment of local testing for this variant in South African patients.
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Affiliation(s)
- Kimberly Christine Coetzer
- Division of Molecular Biology and Human Genetics, Stellenbosch University Faculty of Medicine, and Health Sciences, Tygerberg, 7505, Cape Town, South Africa
| | - Ekkehard Zöllner
- Department of Paediatrics, Stellenbosch University Faculty of Medicine, and Health Sciences, Tygerberg, 7505, Cape Town, South Africa
| | - Shahida Moosa
- Division of Molecular Biology and Human Genetics, Stellenbosch University Faculty of Medicine, and Health Sciences, Tygerberg, 7505, Cape Town, South Africa.
- Medical Genetics, Tygerberg Hospital, Tygerberg, 7505, Cape Town, South Africa.
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Sałacińska K, Pinkier I, Rutkowska L, Chlebna-Sokół D, Jakubowska-Pietkiewicz E, Michałus I, Kępczyński Ł, Salachna D, Wieczorek-Cichecka N, Piotrowicz M, Chilarska T, Jamsheer A, Matusik P, Wilk M, Petriczko E, Giżewska M, Stecewicz I, Walczak M, Rybak-Krzyszkowska M, Lewiński A, Gach A. NGS analysis of collagen type I genes in Polish patients with Osteogenesis imperfecta: a nationwide multicenter study. Front Endocrinol (Lausanne) 2023; 14:1149982. [PMID: 37810882 PMCID: PMC10556695 DOI: 10.3389/fendo.2023.1149982] [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: 01/23/2023] [Accepted: 08/18/2023] [Indexed: 10/10/2023] Open
Abstract
Osteogenesis imperfecta (OI) is a rare genetic disorder of the connective tissue. It presents with a wide spectrum of skeletal and extraskeletal features, and ranges in severity from mild to perinatal lethal. The disease is characterized by a heterogeneous genetic background, where approximately 85%-90% of cases have dominantly inherited heterozygous pathogenic variants located in the COL1A1 and COL1A2 genes. This paper presents the results of the first nationwide study, performed on a large cohort of 197 Polish OI patients. Variants were identified using a next-generation sequencing (NGS) custom gene panel and multiplex ligation probe amplification (MLPA) assay. The following OI types were observed: 1 (42%), 2 (3%), 3 (35%), and 4 (20%). Collagen type I pathogenic variants were reported in 108 families. Alterations were observed in α1 and α2 in 70% and 30% of cases, respectively. The presented paper reports 97 distinct causative variants and expands the OI database with 38 novel pathogenic changes. It also enabled the identification of the first glycine-to-tryptophan substitution in the COL1A1 gene and brought new insights into the clinical severity associated with variants localized in "lethal regions". Our results contribute to a better understanding of the clinical and genetic aspects of OI.
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Affiliation(s)
- Kinga Sałacińska
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Iwona Pinkier
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Lena Rutkowska
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Danuta Chlebna-Sokół
- Department of Bone Metabolic Diseases, University Centre of Paediatric, Medical University of Lodz, Lodz, Poland
| | | | - Izabela Michałus
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Łukasz Kępczyński
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Dominik Salachna
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | | | - Małgorzata Piotrowicz
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Tatiana Chilarska
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Aleksander Jamsheer
- Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Matusik
- Department of Pediatrics, Pediatric Obesity and Metabolic Bone Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Małgorzata Wilk
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Elżbieta Petriczko
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Maria Giżewska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Iwona Stecewicz
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | | | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Agnieszka Gach
- Department of Genetics, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
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Kumar A, Saikia UK, Bhuyan AK, Baro A, Prasad SG. Zoledronic Acid Treatment in Infants and Toddlers with Osteogenesis Imperfecta is Safe and Effective: A Tertiary Care Centre Experience. Indian J Endocrinol Metab 2023; 27:255-259. [PMID: 37583407 PMCID: PMC10424114 DOI: 10.4103/ijem.ijem_268_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/30/2022] [Accepted: 10/29/2022] [Indexed: 08/17/2023] Open
Abstract
Context Osteogenesis imperfecta (OI) is a genetic disorder of the extracellular matrix of bone characterized by low bone mass manifesting as frequent fractures, delayed motor development, pain, and impaired quality of life. The intravenous bisphosphonate, pamidronate is an established treatment for OI. Recently, zoledronic acid (ZA) has been used for the management of OI. Aim To assess the efficacy and safety of ZA in children below five years of age with OI. Settings and Design A hospital-based prospective observational study. Methods and Material Patients with OI aged less than five years attending our centre were treated with intravenous ZA at a dose of 0.05 mg/kg every six months. Subjects were closely monitored for clinical and biochemical variables, adverse events, and new-onset fractures. The response to therapy was assessed by monitoring clinical variables including the degree of bony pains, number of fractures, height/length standard deviation score (SDS), and motor developmental milestones. All patients were analysed at baseline and at the end of two years for biochemical parameters and clinical severity score (CSS) as proposed by Aglan et al. with modifications. Results After two years of treatment, OI patients showed a significant decline in the rate of fractures (p < 0.001), improvement in ambulation (p = 0.005), alleviation of pain (p < 0.001), and improvement in height SDS (p < 0.05). There was a significant improvement in CSS after two years of therapy. Apart from mild flu-like symptoms and mild asymptomatic hypocalcaemia immediately post-infusion, no other adverse effect was noted. Conclusion ZA therapy in infants and children below five years of age with OI was effective and safe and a more convenient alternative to pamidronate.
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Affiliation(s)
- Angad Kumar
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Uma K. Saikia
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Ashok K. Bhuyan
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Abhamoni Baro
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Surendra G. Prasad
- Department of Endocrinology, Gauhati Medical College and Hospital, Guwahati, Assam, India
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Ross J, Bowden MR, Yu C, Diaz-Thomas A. Transition of young adults with metabolic bone diseases to adult care. Front Endocrinol (Lausanne) 2023; 14:1137976. [PMID: 37008909 PMCID: PMC10064010 DOI: 10.3389/fendo.2023.1137976] [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: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
As more accurate diagnostic tools and targeted therapies become increasingly available for pediatric metabolic bone diseases, affected children have a better prognosis and significantly longer lifespan. With this potential for fulfilling lives as adults comes the need for dedicated transition and intentional care of these patients as adults. Much work has gone into improving the transitions of medically fragile children into adulthood, encompassing endocrinologic conditions like type 1 diabetes mellitus and congenital adrenal hyperplasia. However, there are gaps in the literature regarding similar guidance concerning metabolic bone conditions. This article intends to provide a brief review of research and guidelines for transitions of care more generally, followed by a more detailed treatment of bone disorders specifically. Considerations for such transitions include final adult height, fertility, fetal risk, heritability, and access to appropriately identified specialists. A nutrient-dense diet, optimal mobility, and adequate vitamin D stores are protective factors for these conditions. Primary bone disorders include hypophosphatasia, X-linked hypophosphatemic rickets, and osteogenesis imperfecta. Metabolic bone disease can also develop secondarily as a sequela of such diverse exposures as hypogonadism, a history of eating disorder, and cancer treatment. This article synthesizes research by experts of these specific disorders to describe what is known in this field of transition medicine for metabolic bone diseases as well as unanswered questions. The long-term objective is to develop and implement strategies for successful transitions for all patients affected by these various conditions.
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Affiliation(s)
- Jordan Ross
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, United States
- *Correspondence: Jordan Ross,
| | - Michelle R. Bowden
- Division of General Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
- Le Bonheur Children’s Hospital, Memphis, TN, United States
| | - Christine Yu
- Endocrinology Division, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Alicia Diaz-Thomas
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, United States
- Le Bonheur Children’s Hospital, Memphis, TN, United States
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6
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Chen J, Xiang Q, Xiao X, Xu B, Xie H, Wang H, Yang M, Liu S. Carrying both COL1A2 and FBN2 gene heterozygous mutations results in a severe skeletal clinical phenotype: an affected family. BMC Med Genomics 2022; 15:154. [PMID: 35804365 PMCID: PMC9270787 DOI: 10.1186/s12920-022-01296-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background Osteogenesis imperfecta (OI) is the most common monogenic disease of the skeletal system and is usually caused by mutations in the COL1A1 or COL1A2 genes. Congenital contractural arachnodactyly syndrome (CCA) is an autosomal dominant hereditary disease of connective tissue. To date, the FBN2 gene is the only gene reported to cause CCA. Researchers found that COL1A2 and FBN2 are both involved in the extracellular matrix organization pathway. These findings suggest that these two genes play an important role in a similar mechanism and may trigger a synergistic effect. Methods Trio-whole-exome sequencing (Trio-WES) was performed to analyse the underlying genetic cause of a proband with OI in a Chinese family. Sanger sequencing was used to validate the mutations in 3 members of the family with OI with varying degrees of severity of skeletal abnormalities and the members with no clinical signs. Result A c.3304G > C mutation in the COL1A2 gene (p.Gly1102Arg) and a novel c.4108G > T mutation in the FBN2 gene (p.Glu1370*) were detected in the proband, an affected member of the family. The affected individuals with both mutations present a more severe phenotype, while affected individuals present a milder phenotype if only the mutation in COL1A2 is detected (c.3304G > C). The unaffected individual in this family did not have any mutations in the COL1A2 gene or FBN2 gene. Conclusion Our study is the first clinical report to indicate that patients carrying concomitant mutations in both the COL1A2 and FBN2 genes may present with more severe skeletal abnormalities. Furthermore, our study suggests the possibility of synergistic effects between the COL1A2 and FBN2 genes. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01296-8.
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Affiliation(s)
- Jing Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, Section 3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Qinqin Xiang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, Section 3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Xiao Xiao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, Section 3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Bocheng Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, Section 3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Hanbing Xie
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, Section 3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - He Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, Section 3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Mei Yang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, Section 3, Renminnan Road, Chengdu, 610041, Sichuan, China.
| | - Shanling Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No. 20, Section 3, Renminnan Road, Chengdu, 610041, Sichuan, China.
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Erbaş İM, İlgün Gürel D, Manav Kabayeğit Z, Koç A, Ünüvar T, Abacı A, Böber E, Anık A. Clinical, genetic characteristics and treatment outcomes of children and adolescents with osteogenesis imperfecta: a two-center experience. Connect Tissue Res 2022; 63:349-358. [PMID: 34107839 DOI: 10.1080/03008207.2021.1932853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Osteogenesis imperfecta (OI), is a heritable, heterogeneous connective tissue disorder, characterized by fragile bones. There are conflicting results about genotype-phenotype correlations and efficiency of bisphosphonate treatment in this disorder. AIM We aimed to evaluate the clinical, genetic characteristics, and long-term follow-up results of children and adolescents with OI. MATERIALS AND METHODS A two-center retrospective study was conducted using demographic, clinical, and genetic data obtained from the medical records of the patients. RESULTS Twenty-nine patients (62% male, median age; 3.6 years) with OI diagnosis from 26 families were included in the study. Thirteen different variants (nine were novel) were described in 16 patients in COL1A1, COL1A2, and P3H1 genes. Our siblings with homozygous P3H1 variants had a severe phenotype with intrauterine and neonatal fractures. Twenty-two patients were treated with bisphosphonates (17 of them with pamidronate, five with alendronate) with a median duration of 3.0 (1.6-4.8) years. Eleven patients (50%) suffered from fractures after the treatment. Haploinsufficiency variants in COL1A1 caused a milder skeletal phenotype with less fracture count and better treatment outcomes than structural variants. When compared with the anthropometric measurements at the initial diagnosis time, height Z-scores were lower on the last clinical follow-up (p = 0.009). CONCLUSIONS We could not find an obvious genotype-phenotype correlation in Turkish OI patients with COL1A1 or COL1A2 variants. Treatment with pamidronate was effective in reducing fracture counts, without any long-term adverse effects.
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Affiliation(s)
- İbrahim Mert Erbaş
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Deniz İlgün Gürel
- Department of Pediatrics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Zehra Manav Kabayeğit
- Department of Medical Genetics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Altuğ Koç
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Tolga Ünüvar
- Division of Pediatric Endocrinology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Ayhan Abacı
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ece Böber
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ahmet Anık
- Division of Pediatric Endocrinology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
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Chen P, Tan Z, Qiu A, Yin S, Zhou Y, Dong Z, Qiu Y, Xu J, Li K, Dong L, Shek HT, Liu J, Yeung EHK, Gao B, Cheung KMC, To MKT. Patient-reported outcomes in a Chinese cohort of osteogenesis imperfecta unveil psycho-physical stratifications associated with clinical manifestations. Orphanet J Rare Dis 2022; 17:249. [PMID: 35765008 PMCID: PMC9238011 DOI: 10.1186/s13023-022-02394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Osteogenesis imperfecta (OI) is a rare congenital disorder of the skeletal system, inflicting debilitating physical and psychological distress on patients and caregivers. Over the decades, much effort has been channeled towards understanding molecular mechanisms and developing new treatments. It has recently become more apparent that patient-reported outcome measurements (PROM) during treatment, healing and rehabilitation are helpful in facilitating smoother communication, refining intervention strategies and achieving higher quality of life. To date, systematic analyses of PROM in OI patients remain scarce. Results Here, utilizing a PROM Information System, we report a cross-sectional and longitudinal study in a southern Chinese cohort of 90 OI patients, covering both the child and adult age-groups. In the child group where both self and parental surveys were obtained, we identified two clusters of comparable sizes showing different outlooks in physical mobility and emotional experiences. One cluster (Cluster 1) is more negative about themselves than the other (Cluster 2). A concordance of 84.7% between self and parental assessments was recorded, suggesting the stability and validity of PROM-based stratification. Clinical subtyping, deformity, leg length discrepancy, and limited joint mobility were significantly associated with this stratification, with Cluster 1 showing higher percentages of severe phenotypes than Cluster 2. Since OI is a genetic disorder, we performed genetic testing on 72 of the 90 patients, but found no obvious association between genotypes and the PROM stratification. Analyses of longitudinal data suggested that patients tended to stay in the same psychological state, in both clusters. Adult patients also showed a continuous spectrum of self-evaluation that matches their clinical manifestations. Conclusion By systematically analyzing patient-reported outcomes, our study demonstrated the link between the sociopsychological wellbeing of OI patients, and their clinical manifestations, which may serve as the basis for evaluating clinical interventions and help achieve better patient-centric medical practices. The lack of genotype-PROM association may be due to the diverse mutational spectrum in OI, which warrants further investigation when a larger sample size is available. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02394-7.
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Affiliation(s)
- Peikai Chen
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China. .,School of Biomedical Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong.
| | - Zhijia Tan
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China.,Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Anmei Qiu
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Shijie Yin
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Yapeng Zhou
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Zhongxin Dong
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Yan Qiu
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Jichun Xu
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Kangsen Li
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Lina Dong
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Hiu Tung Shek
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Jingwen Liu
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Eric H K Yeung
- Department of Physiotherapy, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Bo Gao
- School of Biomedical Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kenneth Man Chee Cheung
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China.,Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Michael Kai-Tsun To
- Department of Orthopedics and Traumatology, The University of Hong Kong-Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China. .,Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong.
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Yang L, Liu B, Dong X, Wu J, Sun C, Xi L, Cheng R, Wu B, Wang H, Tong S, Wang D, Luo F. Clinical severity prediction in children with osteogenesis imperfecta caused by COL1A1/2 defects. Osteoporos Int 2022; 33:1373-1384. [PMID: 35044492 PMCID: PMC9106613 DOI: 10.1007/s00198-021-06263-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/03/2021] [Indexed: 12/03/2022]
Abstract
UNLABELLED Osteogenesis imperfecta (OI) is a genetic disease with an estimated prevalence of 1 in 13,500 and 1 in 9700. The classification into subtypes of OI is important for prognosis and management. In this study, we established a clinical severity prediction model depending on multiple features of variants in COL1A1/2 genes. INTRODUCTION Ninety percent of OI cases are caused by pathogenic variants in the COL1A1/COL1A2 gene. The Sillence classification describes four OI types with variable clinical features ranging from mild symptoms to lethal and progressively deforming symptoms. METHODS We established a prediction model of the clinical severity of OI based on the random forest model with a training set obtained from the Human Gene Mutation Database, including 790 records of the COL1A1/COL1A2 genes. The features used in the prediction model were respectively based on variant-type features only, and the optimized features. RESULTS With the training set, the prediction results showed that the area under the receiver operating characteristic curve (AUC) for predicting lethal to severe OI or mild/moderate OI was 0.767 and 0.902, respectively, when using variant-type features only and optimized features for COL1A1 defects, 0.545 and 0.731, respectively, for COL1A2 defects. For the 17 patients from our hospital, prediction accuracy for the patient with the COL1A1 and COL1A2 defects was 76.5% (95% CI: 50.1-93.2%) and 88.2% (95% CI: 63.6-98.5%), respectively. CONCLUSION We established an OI severity prediction model depending on multiple features of the specific variants in COL1A1/2 genes, with a prediction accuracy of 76-88%. This prediction algorithm is a promising alternative that could prove to be valuable in clinical practice.
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Affiliation(s)
- Lin Yang
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Bo Liu
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, 201102, China
- Division of Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Xinran Dong
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Jing Wu
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Chengjun Sun
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Li Xi
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Ruoqian Cheng
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Bingbing Wu
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Huijun Wang
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Shiyuan Tong
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 201102, China
| | - Dahui Wang
- Division of Orthopedics, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
| | - Feihong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
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10
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Somatic mutations in collagens are associated with a distinct tumor environment and overall survival in gastric cancer. BMC Cancer 2022; 22:139. [PMID: 35120467 PMCID: PMC8815231 DOI: 10.1186/s12885-021-09136-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background Gastric cancer is a heterogeneous disease with poorly understood genetic and microenvironmental factors. Mutations in collagen genes are associated with genetic diseases that compromise tissue integrity, but their role in tumor progression has not been extensively reported. Aberrant collagen expression has been long associated with malignant tumor growth, invasion, chemoresistance, and patient outcomes. We hypothesized that somatic mutations in collagens could functionally alter the tumor extracellular matrix. Methods We used publicly available datasets including The Tumor Cancer Genome Atlas (TCGA) to interrogate somatic mutations in collagens in stomach adenocarcinomas. To demonstrate that collagens were significantly mutated above background mutation rates, we used a moderated Kolmogorov-Smirnov test along with combination analysis with a bootstrap approach to define the background accounting for mutation rates. Association between mutations and clinicopathological features was evaluated by Fisher or chi-squared tests. Association with overall survival was assessed by Kaplan-Meier and the Cox-Proportional Hazards Model. Gene Set Enrichment Analysis was used to interrogate pathways. Immunohistochemistry and in situ hybridization tested expression of COL7A1 in stomach tumors. Results In stomach adenocarcinomas, we identified individual collagen genes and sets of collagen genes harboring somatic mutations at a high frequency compared to background in both microsatellite stable, and microsatellite instable tumors in TCGA. Many of the missense mutations resemble the same types of loss of function mutations in collagenopathies that disrupt tissue formation and destabilize cells providing guidance to interpret the somatic mutations. We identified combinations of somatic mutations in collagens associated with overall survival, with a distinctive tumor microenvironment marked by lower matrisome expression and immune cell signatures. Truncation mutations were strongly associated with improved outcomes suggesting that loss of expression of secreted collagens impact tumor progression and treatment response. Germline collagenopathy variants guided interpretation of impactful somatic mutations on tumors. Conclusions These observations highlight that many collagens, expressed in non-physiologically relevant conditions in tumors, harbor impactful somatic mutations in tumors, suggesting new approaches for classification and therapy development in stomach cancer. In sum, these findings demonstrate how classification of tumors by collagen mutations identified strong links between specific genotypes and the tumor environment. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09136-1.
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11
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Tüysüz B, Elkanova L, Uludağ Alkaya D, Güleç Ç, Toksoy G, Güneş N, Yazan H, Bayhan AI, Yıldırım T, Yeşil G, Uyguner ZO. Osteogenesis imperfecta in 140 Turkish families: Molecular spectrum and, comparison of long-term clinical outcome of those with COL1A1/A2 and biallelic variants. Bone 2022; 155:116293. [PMID: 34902613 DOI: 10.1016/j.bone.2021.116293] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a clinically and genetically heterogeneous group of diseases characterized by increased bone fragility and deformities. Although most patients with OI have heterozygous mutations in COL1A1 or COL1A2, 17 genes have been reported to cause OI, most of which are autosomal recessive (AR) inherited, during the last years. The aim of this study is to determine the mutation spectrum in Turkish OI cohort and to investigate the genotype-phenotype correlation. METHODS 150 patients from 140 Turkish families with OI phenotype were included in this study. Mutations in OI-related genes were identified using targeted gene panel, MLPA analysis for COL1A1 and whole exome sequencing. 113 patients who had OI disease-causing variants were followed for 1-20 years. RESULTS OI disease-causing variants were detected in 117 families, of which 62.4% in COL1A1/A2, 35.9% in AR-related genes. A heterozygous variant in IFITM5 and a hemizygous in MBTPS2 were also described, one in each patient. Eighteen biallelic variants (13 novel) were identified in nine genes (FKBP10, P3H1, SERPINF1, TMEM38B, WNT1, BMP1, CRTAP, FAM46A, MESD) among which FKBP10, P3H1 and SERPINF1 were most common. The most severe phenotypes were in patients with FKBP10, SERPINF1, CRTAP, FAM46A and MESD variants. P3H1 patients had moderate, while BMP1 had the mild phenotype. Clinical phenotypes were variable in patients with WNT1 and TMEM38B mutations. We also found mutations in ten genes (PLS3, LRP5, ANO5, SLC34A1, EFEMP2, PRDM5, GORAB, OCRL1, TNFRSF11B, DPH1) associated with diseases presenting clinical features which overlap OI, in eleven families. CONCLUSION We identified disease-causing mutations in 83.6% in a large Turkish pediatric OI cohort. 40 novel variants were described. Clinical features and long-term follow-up findings of AR inherited OI types and especially very rare biallelic variants were presented for the first time. Unlike previously reported studies, the mutations that we found in P3H1 were all missense, causing a moderate phenotype.
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Affiliation(s)
- Beyhan Tüysüz
- Department of Pediatric Genetics, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey.
| | - Leyla Elkanova
- Department of Pediatric Genetics, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Dilek Uludağ Alkaya
- Department of Pediatric Genetics, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Çağrı Güleç
- Department of Medical Genetics, Istanbul University, Medical Faculty, Istanbul, Turkey
| | - Güven Toksoy
- Department of Medical Genetics, Istanbul University, Medical Faculty, Istanbul, Turkey
| | - Nilay Güneş
- Department of Pediatric Genetics, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Genetics, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - A Ilhan Bayhan
- Department of Orthopedics and Traumatology, University of Health Sciences Turkey, Baltalimani Bone Diseases Training and Research Center, Istanbul, Turkey
| | - Timur Yıldırım
- Department of Orthopedics and Traumatology, University of Health Sciences Turkey, Baltalimani Bone Diseases Training and Research Center, Istanbul, Turkey
| | - Gözde Yeşil
- Department of Medical Genetics, Bezmialem University, Istanbul, Turkey
| | - Z Oya Uyguner
- Department of Medical Genetics, Istanbul University, Medical Faculty, Istanbul, Turkey
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12
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Sałacińska K, Pinkier I, Rutkowska L, Chlebna-Sokół D, Jakubowska-Pietkiewicz E, Michałus I, Kępczyński Ł, Salachna D, Jamsheer A, Bukowska-Olech E, Jaszczuk I, Jakubowski L, Gach A. Novel Mutations Within Collagen Alpha1(I) and Alpha2(I) Ligand-Binding Sites, Broadening the Spectrum of Osteogenesis Imperfecta - Current Insights Into Collagen Type I Lethal Regions. Front Genet 2021; 12:692978. [PMID: 34306033 PMCID: PMC8301378 DOI: 10.3389/fgene.2021.692978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a rare genetic disorder demonstrating considerable phenotypic and genetic heterogeneity. The extensively studied genotype-phenotype correlation is a crucial issue for a reliable counseling, as the disease is recognized at increasingly earlier stages of life, including prenatal period. Based on population studies, clusters in COL1A1 and COL1A2 genes associated with the presence of glycine substitutions leading to fatal outcome have been distinguished and named as "lethal regions." Their localization corresponds to the ligand-binding sites responsible for extracellular interactions of collagen molecules, which could explain high mortality associated with mutations mapping to these regions. Although a number of non-lethal cases have been identified from the variants located in lethal clusters, the mortality rate of mutations has not been updated. An next generation sequencing analysis, using a custom gene panel of known and candidate OI genes, was performed on a group of 166 OI patients and revealed seven individuals with a causative mutations located in the lethal regions. Patients' age, ranging between 3 and 25 years, excluded the expected fatal outcome. The identification of non-lethal cases caused by mutations located in lethal domains prompted us to determine the actual mortality caused by glycine substitutions mapping to lethal clusters and evaluate the distribution of all lethal glycine mutations across collagen type I genes, based on records deposited in the OI Variant Database. Finally, we identified six glycine substitutions located in lethal regions of COL1A1 and COL1A2 genes, of which four are novel. The review of all mutations in the dedicated OI database, revealed 33 distinct glycine substitutions in two lethal domains of COL1A1, 26 of which have been associated with a fatal outcome. Similarly, 109 glycine substitutions have been identified in eight lethal clusters of COL1A2, of which 51 have been associated with a fatal manifestation. An analysis of all glycine substitutions leading to fatal phenotype, showed that their distribution along collagen type I genes is not regular, with 17% (26 out of 154) of mutations reported in COL1A1 and 64% (51 out of 80) in COL1A2 corresponding to localization of the lethal regions.
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Affiliation(s)
- Kinga Sałacińska
- Department of Genetics, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Iwona Pinkier
- Department of Genetics, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Lena Rutkowska
- Department of Genetics, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Danuta Chlebna-Sokół
- Department of Bone Metabolic Diseases, University Centre of Paediatric, Medical University of Łódź, Łódź, Poland
| | | | - Izabela Michałus
- Department of Paediatric Propedeutics and Bone Metabolic Diseases, Medical University of Łódź, Łódź, Poland
| | - Łukasz Kępczyński
- Department of Genetics, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Dominik Salachna
- Department of Genetics, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Aleksander Jamsheer
- Department of Medical Genetics, Poznan University of Medical Sciences, Poznań, Poland.,Centers for Medical Genetics GENESIS, Poznań, Poland
| | | | - Ilona Jaszczuk
- Department of Cancer Genetics with Cytogenetics, Medical University of Lublin, Lublin, Poland
| | - Lucjusz Jakubowski
- Department of Genetics, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Agnieszka Gach
- Department of Genetics, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
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13
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Duangchan T, Tawonsawatruk T, Angsanuntsukh C, Trachoo O, Hongeng S, Kitiyanant N, Supokawej A. Amelioration of osteogenesis in iPSC-derived mesenchymal stem cells from osteogenesis imperfecta patients by endoplasmic reticulum stress inhibitor. Life Sci 2021; 278:119628. [PMID: 34015290 DOI: 10.1016/j.lfs.2021.119628] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 12/20/2022]
Abstract
AIM Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder primarily caused by mutations in COL1A1 or COL1A2, which encode type I collagen. These mutations affect the quantity and/or quality of collagen composition in bones, leading to bone fragility. Currently, there is still a lack of treatment that addresses disease-causing factors due to an insufficient understanding of the pathological mechanisms involved. MAIN METHODS Induced pluripotent stem cells (iPSCs) were generated from OI patients with glycine substitution mutations in COL1A1 and COL1A2 and developed into mesenchymal stem cells (iPS-MSCs). OI-derived iPS-MSCs underwent in vitro osteogenic induction to study cell growth, osteogenic differentiation capacity, mRNA expression of osteogenic and unfolded protein response (UPR) markers and apoptosis. The effects of 4-phenylbutyric acid (4-PBA) were examined after treatment of OI iPS-MSCs during osteogenesis. KEY FINDINGS OI-derived iPS-MSCs exhibited decreased cell growth and impaired osteogenic differentiation and collagen expression. Expression of UPR genes was increased, which led to an increase in apoptotic cell death. 4-PBA treatment decreased apoptotic cells and reduced expression of UPR genes, including HSPA5, XBP1, ATF4, DDIT3, and ATF6. Osteogenic phenotypes, including RUNX2, SPP1, BGLAP, and IBPS expression, as well as calcium mineralization, were also improved. SIGNIFICANCE MSCs differentiated from disease-specific iPSCs have utility as a disease model for identifying disease-specific treatments. In addition, the ER stress-associated UPR could be a pathogenic mechanism associated with OI. Treatment with 4-PBA alleviated OI pathogenesis by attenuating UPR markers and apoptotic cell death.
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Affiliation(s)
- Thitinat Duangchan
- Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Tulyapruek Tawonsawatruk
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Chanika Angsanuntsukh
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Objoon Trachoo
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Narisorn Kitiyanant
- Stem Cell Research Group, Institute of Molecular Biosciences, Mahidol University, Phutthamonthon, Nakhon Pathom 73170, Thailand
| | - Aungkura Supokawej
- Department of Clinical Microscopy, Faculty of Medical Technology, Mahidol University, Phutthamonthon, Nakhon Pathom 73170, Thailand.
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14
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Intracellular and Extracellular Markers of Lethality in Osteogenesis Imperfecta: A Quantitative Proteomic Approach. Int J Mol Sci 2021; 22:ijms22010429. [PMID: 33406681 PMCID: PMC7795927 DOI: 10.3390/ijms22010429] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a heritable disorder that mainly affects the skeleton. The inheritance is mostly autosomal dominant and associated to mutations in one of the two genes, COL1A1 and COL1A2, encoding for the type I collagen α chains. According to more than 1500 described mutation sites and to outcome spanning from very mild cases to perinatal-lethality, OI is characterized by a wide genotype/phenotype heterogeneity. In order to identify common affected molecular-pathways and disease biomarkers in OI probands with different mutations and lethal or surviving phenotypes, primary fibroblasts from dominant OI patients, carrying COL1A1 or COL1A2 defects, were investigated by applying a Tandem Mass Tag labeling-Liquid Chromatography-Tandem Mass Spectrometry (TMT LC-MS/MS) proteomics approach and bioinformatic tools for comparative protein-abundance profiling. While no difference in α1 or α2 abundance was detected among lethal (type II) and not-lethal (type III) OI patients, 17 proteins, with key effects on matrix structure and organization, cell signaling, and cell and tissue development and differentiation, were significantly different between type II and type III OI patients. Among them, some non-collagenous extracellular matrix (ECM) proteins (e.g., decorin and fibrillin-1) and proteins modulating cytoskeleton (e.g., nestin and palladin) directly correlate to the severity of the disease. Their defective presence may define proband-failure in balancing aberrances related to mutant collagen.
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15
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Infante A, Gener B, Vázquez M, Olivares N, Arrieta A, Grau G, Llano I, Madero L, Bueno AM, Sagastizabal B, Gerovska D, Araúzo‐Bravo MJ, Astigarraga I, Rodríguez CI. Reiterative infusions of MSCs improve pediatric osteogenesis imperfecta eliciting a pro-osteogenic paracrine response: TERCELOI clinical trial. Clin Transl Med 2021; 11:e265. [PMID: 33463067 PMCID: PMC7805402 DOI: 10.1002/ctm2.265] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a rare genetic disease characterized by bone fragility, with a wide range in the severity of clinical manifestations. The majority of cases are due to mutations in the COL1A1 or COL1A2 genes, which encode type I collagen. Mesenchymal stem cells (MSCs), as the progenitors of the osteoblasts, the main type I collagen secreting cell type in the bone, have been proposed and tested as an innovative therapy for OI with promising but transient outcomes. METHODS To overcome the short-term effect of MSCs therapy, we performed a phase I clinical trial based on reiterative infusions of histocompatible MSCs, administered in a 2.5-year period, in two pediatric patients affected by severe and moderate OI. The aim of this study was to assess the safety and effectiveness of this cell therapy in nonimmunosuppressed OI patients. The host response to MSCs was studied by analyzing the sera from OI patients, collected before, during, and after the cell therapy. RESULTS We first demonstrated that the sequential administration of MSCs was safe and improved the bone parameters and quality of life of OI patients along the cell treatment plus 2-year follow-up period. Moreover, the study of the mechanism of action indicated that MSCs therapy elicited a pro-osteogenic paracrine response in patients, especially noticeable in the patient affected by severe OI. CONCLUSIONS Our results demonstrate the feasibility and potential of reiterative MSCs infusion for two pediatric OI and highlight the paracrine response shown by patients as a consequence of MSCs treatment.
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Affiliation(s)
- Arantza Infante
- Stem Cells and Cell Therapy LaboratoryBiocruces Bizkaia Health Research InstituteCruces University HospitalBarakaldoSpain
| | - Blanca Gener
- Stem Cells and Cell Therapy LaboratoryBiocruces Bizkaia Health Research InstituteCruces University HospitalBarakaldoSpain
- Service of GeneticsCruces University HospitalBarakaldoSpain
| | - Miguel Vázquez
- Department of PediatricsBiocruces Bizkaia Health Research InstituteCruces University HospitalBarakaldoSpain
| | - Nerea Olivares
- Department of Biochemistry, Immunology UnitCruces University HospitalBarakaldoSpain
| | - Arantza Arrieta
- Department of Biochemistry, Immunology UnitCruces University HospitalBarakaldoSpain
| | - Gema Grau
- Department of PediatricsBiocruces Bizkaia Health Research InstituteCruces University HospitalBarakaldoSpain
| | - Isabel Llano
- Service of GeneticsCruces University HospitalBarakaldoSpain
| | - Luis Madero
- Department of Pediatric Hematology, Oncology and Stem CellsNiño Jesús University Children´s HospitalMadridSpain
| | - Ana Maria Bueno
- Department of Orthopedic SurgeryGetafe University HospitalMadridSpain
| | | | - Daniela Gerovska
- Computational Biology and Systems Biomedicine Research GroupBiodonostia Health Research InstituteDonostiaSpain
| | - Marcos J Araúzo‐Bravo
- Computational Biology and Systems Biomedicine Research GroupBiodonostia Health Research InstituteDonostiaSpain
| | - Itziar Astigarraga
- Department of PediatricsBiocruces Bizkaia Health Research InstituteCruces University HospitalBarakaldoSpain
- Department of PediatricsBasque Country University UPV/EHULeioaSpain
| | - Clara I. Rodríguez
- Stem Cells and Cell Therapy LaboratoryBiocruces Bizkaia Health Research InstituteCruces University HospitalBarakaldoSpain
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Karguppikar MB, Ekbote V, Khadilkar A, Khadilkar V. Comprehensive evaluation of bone health using DXA and pQCT in an Indian boy with osteogenesis imperfecta. BMJ Case Rep 2020; 13:13/12/e236169. [PMID: 33318265 PMCID: PMC7737019 DOI: 10.1136/bcr-2020-236169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We present a 9-year-old male child having history of fractures on trivial trauma with a family history of the same. He was treated for osteogenesis imperfecta (OI; zolendronate, calcium and vitamin D) and showed clinical improvement. On evaluating his bone health using dual energy X-ray absorptiometry and peripheral quantitative CT, we found that the child had bone density within the reference range but a smaller bone mass for his height, low muscle mass and thin bones with a lower strength strain index in comparison with healthy children. Our case suggests that treatment with bisphosphonates results in increase in bone density; however, bones remain thin and the lean body mass in these children may also be low. Controlled physical activity to improve muscle health and newer approaches to improve bone geometry would result in better bone health in children with OI.
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Affiliation(s)
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India,Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India,Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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17
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Intarak N, Budsamongkol T, Theerapanon T, Chanamuangkon T, Srijunbarl A, Boonprakong L, Porntaveetus T, Shotelersuk V. Tooth ultrastructure of a novel COL1A2 mutation expanding its genotypic and phenotypic spectra. Oral Dis 2020; 27:1257-1267. [PMID: 32989910 DOI: 10.1111/odi.13657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To investigate tooth ultrastructure and mutation of two patients in a family affected with osteogenesis imperfecta (OI) type IV and dentinogenesis imperfecta (DGI). METHODS Mutations were detected by whole exome and Sanger sequencing. The permanent second molar obtained from the proband (DGI1) and the primary first molar from his affected son (DGI2) were studied for their color, roughness, mineral density, hardness, elastic modulus, mineral content, and ultrastructure, compared to the controls. RESULTS Two novel missense COL1A2 variants, c.752C > T (p.Ser251Phe) and c.758G > T (p.Gly253Val), were identified in both patients. The c.758G > T was predicted to be the causative mutation. Pulp cavities of DGI1 (permanent teeth) were obliterated while those of DGI2 (primary teeth) were wide. The patients' teeth had darker and redder colors; reduced dentin hardness; decreased, disorganized, and scattered dentinal tubules and collagen fibers; and irregular dentinoenamel junction (DEJ), compared to controls. Lacunae-like structures were present in DGI2. CONCLUSIONS We reported the novel causative mutation, c.758G > T (p.Gly253Val), in COL1A2 for OI type IV and DGI. The DGI dentin demonstrated inferior mechanical property and ultrastructure, suggesting severe disturbances of dentin formation. These could contribute to fragility and prone to infection of DGI teeth. This study expands phenotypic and genotypic spectra of COL1A2 mutations.
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Affiliation(s)
- Narin Intarak
- Genomics and Precision Dentistry Research Unit, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Thunyaporn Budsamongkol
- Genomics and Precision Dentistry Research Unit, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.,Geriatric Dentistry and Special Patients Care Program, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Thanakorn Theerapanon
- Excellence Center in Regenerative Dentistry, Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Theerapat Chanamuangkon
- Biomaterial Testing Center, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Anucharte Srijunbarl
- Dental Materials R&D Center, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Lawan Boonprakong
- Oral Biology Research Center, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Thantrira Porntaveetus
- Genomics and Precision Dentistry Research Unit, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
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18
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Rodriguez Celin M, Kruger KM, Caudill A, Nagamani SC, Harris GF, Smith PA. A Multicenter Study of Intramedullary Rodding in Osteogenesis Imperfecta. JB JS Open Access 2020; 5:e20.00031. [PMID: 32984750 PMCID: PMC7489747 DOI: 10.2106/jbjs.oa.20.00031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Osteogenesis imperfecta (OI), a heritable connective tissue disorder with wide clinical variability, predisposes to recurrent fractures and bone deformity. Management requires a multidisciplinary approach in which intramedullary rodding plays an important role, especially for moderate and severe forms. We investigated the patterns of surgical procedures in OI in order to establish the benefits of rodding. The main hypothesis that guided this study was that rodded participants with moderate and severe OI would have lower fracture rates and better mobility. METHODS With data from the Linked Clinical Research Centers, we analyzed rodding status in 558 individuals. Mobility and fracture data in OI Types III and IV were compared between rodded and non-rodded groups. Univariate regression analyses were used to test the association of mobility outcomes with various covariates pertinent to rodding. RESULTS Of the individuals with OI, 42.1% had undergone rodding (10.7% of those with Type I, 66.4% with Type III, and 67.3% with Type IV). Rodding was performed more frequently and at a younger age in femora compared with tibiae. Expanding intramedullary rods were used more frequently in femora. In Type III, the rate of fractures per year was significantly lower (p ≤ 0.05) for rodded bones. In Type III, the mean scores on the Gillette Functional Assessment Questionnaire (GFAQ) and Brief Assessment of Motor Function (BAMF) were higher in the rodded group. However, Type-IV non-rodded subjects had higher mean scores in nearly all mobility outcomes. OI type, the use of expanding rods in tibiae, and anthropometric measurements were associated with mobility outcomes scores. CONCLUSIONS Current practice in 5 orthopaedic centers with extensive experience treating OI demonstrates that most individuals with moderate and severe types of OI undergo rodding procedures. Individuals with severe OI have improved mobility outcomes and lower fracture rates compared with their non-rodded peers, which suggests that early bilateral rodding benefits OI Type III. Our analysis showed a change in practice patterns in the final years of the study in the severe forms, with earlier and more simultaneous rodding procedures performed. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Karen M. Kruger
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois
- Orthopaedic Rehabilitation and Engineering Center, Marquette University, Milwaukee, Wisconsin
| | - Angela Caudill
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois
| | - Sandesh C.S. Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | | | | | - Gerald F. Harris
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois
- Orthopaedic Rehabilitation and Engineering Center, Marquette University, Milwaukee, Wisconsin
| | - Peter A. Smith
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois
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19
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Zhytnik L, Simm K, Salumets A, Peters M, Märtson A, Maasalu K. Reproductive options for families at risk of Osteogenesis Imperfecta: a review. Orphanet J Rare Dis 2020; 15:128. [PMID: 32460820 PMCID: PMC7251694 DOI: 10.1186/s13023-020-01404-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Osteogenesis Imperfecta (OI) is a rare genetic disorder involving bone fragility. OI patients typically suffer from numerous fractures, skeletal deformities, shortness of stature and hearing loss. The disorder is characterised by genetic and clinical heterogeneity. Pathogenic variants in more than 20 different genes can lead to OI, and phenotypes can range from mild to lethal forms. As a genetic disorder which undoubtedly affects quality of life, OI significantly alters the reproductive confidence of families at risk. The current review describes a selection of the latest reproductive approaches which may be suitable for prospective parents faced with a risk of OI. The aim of the review is to alleviate suffering in relation to family planning around OI, by enabling prospective parents to make informed and independent decisions. Main body The current review provides a comprehensive overview of possible reproductive options for people with OI and for unaffected carriers of OI pathogenic genetic variants. The review considers reproductive options across all phases of family planning, including pre-pregnancy, fertilisation, pregnancy, and post-pregnancy. Special attention is given to the more modern techniques of assisted reproduction, such as preconception carrier screening, preimplantation genetic testing for monogenic diseases and non-invasive prenatal testing. The review outlines the methodologies of the different reproductive approaches available to OI families and highlights their advantages and disadvantages. These are presented as a decision tree, which takes into account the autosomal dominant and autosomal recessive nature of the OI variants, and the OI-related risks of people without OI. The complex process of decision-making around OI reproductive options is also discussed from an ethical perspective. Conclusion The rapid development of molecular techniques has led to the availability of a wide variety of reproductive options for prospective parents faced with a risk of OI. However, such options may raise ethical concerns in terms of methodologies, choice management and good clinical practice in reproductive care, which are yet to be fully addressed.
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Affiliation(s)
- Lidiia Zhytnik
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.
| | - Kadri Simm
- Institute of Philosophy and Semiotics, Faculty of Arts and Humanities, University of Tartu, Tartu, Estonia.,Centre of Ethics, University of Tartu, Tartu, Estonia
| | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia.,Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Institute of Genomics, University of Tartu, Tartu, Estonia.,COMBIVET ERA Chair, Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - Maire Peters
- Competence Centre on Health Technologies, Tartu, Estonia.,Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Aare Märtson
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.,Department of Traumatology and Orthopaedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.,Department of Traumatology and Orthopaedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
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20
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Machol K, Hadley TD, Schmidt J, Cuthbertson D, Traboulsi H, Silva RC, Citron C, Khan S, Citron K, Carter E, Brookler K, Shapiro JR, Steiner RD, Byers PH, Glorieux FH, Durigova M, Smith P, Bober MB, Sutton VR, Lee BH, Nagamani SCS, Raggio C. Hearing loss in individuals with osteogenesis imperfecta in North America: Results from a multicenter study. Am J Med Genet A 2020; 182:697-704. [PMID: 31876392 PMCID: PMC7385724 DOI: 10.1002/ajmg.a.61464] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/05/2019] [Indexed: 12/16/2022]
Abstract
Hearing loss (HL) is an extra-skeletal manifestation of the connective tissue disorder osteogenesis imperfecta (OI). Systematic evaluation of the prevalence and characteristics of HL in COL1A1/COL1A2-related OI will contribute to a better clinical management of individuals with OI. We collected and analyzed pure-tone audiometry data from 312 individuals with OI who were enrolled in the Linked Clinical Research Centers and the Brittle Bone Disorders Consortium. The prevalence, type, and severity of HL in COL1A1/COL1A2-related OI are reported. We show that the prevalence of HL in OI is 28% and increased with age in Type I OI but not in Types III and IV. Individuals with OI Types III and IV are at a higher risk to develop HL in the first decade of life when compared to OI Type I. We also show that the prevalence of SNHL is higher in females with OI compared to males. This study reveals new insights regarding prevalence of HL in OI including a lower general prevalence of HL in COL1A1/COL1A2-related OI than previously reported (28.3 vs. 65%) and high prevalence of SNHL in females. Our data support the need in early routine hearing evaluation in all types of OI that can be adjusted to the severity of the skeletal disease.
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Affiliation(s)
- Keren Machol
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - Trevor D Hadley
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Jake Schmidt
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | | | - Henri Traboulsi
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - Rodrigo C Silva
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - Chloe Citron
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Sobiah Khan
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Kate Citron
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Erin Carter
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Kenneth Brookler
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jay R Shapiro
- Department of Bone and Osteogenesis Imperfecta, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Medicine at Uniformed Services, University of the Health Sciences, Bethesda, Maryland
| | - Robert D Steiner
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Pediatrics and Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon
| | - Peter H Byers
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle
- Department of Pathology, Division of Medical Genetics, University of Washington, Seattle
| | - Francis H Glorieux
- Shriner's Hospital for Children and McGill University, Montreal, Quebec, Canada
| | - Michaela Durigova
- Shriner's Hospital for Children and McGill University, Montreal, Quebec, Canada
| | - Peter Smith
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, Illinois
| | - Michael B Bober
- Division of Orthogenetics, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Vernon R Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - Brendan H Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - Sandesh C S Nagamani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston, Texas
| | - Cathleen Raggio
- Department of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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21
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Ibrahim S, Strange AP, Aguayo S, Shinawi A, Harith N, Mohamed-Ibrahim N, Siddiqui S, Parekh S, Bozec L. Phenotypic Properties of Collagen in Dentinogenesis Imperfecta Associated with Osteogenesis Imperfecta. Int J Nanomedicine 2019; 14:9423-9435. [PMID: 31819441 PMCID: PMC6897053 DOI: 10.2147/ijn.s217420] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Dentinogenesis imperfecta type 1 (OIDI) is considered a relatively rare genetic disorder (1:5000 to 1:45,000) associated with osteogenesis imperfecta. OIDI impacts the formation of collagen fibrils in dentin, leading to morphological and structural changes that affect the strength and appearance of teeth. However, there is still a lack of understanding regarding the nanoscale characterization of the disease, in terms of collagen ultrastructure and mechanical properties. Therefore, this research presents a qualitative and quantitative report into the phenotype and characterization of OIDI in dentin, by using a combination of imaging, nanomechanical approaches. Methods For this study, 8 primary molars from OIDI patients and 8 primary control molars were collected, embedded in acrylic resin and cut into longitudinal sections. Sections were then demineralized in 37% phosphoric acid using a protocol developed in-house. Initial experiments demonstrated the effectiveness of the demineralization protocol, as the ATR-FTIR spectral fingerprints showed an increase in the amide bands together with a decrease in phosphate content. Structural and mechanical analyses were performed directly on both the mineralized and demineralized samples using a combination of scanning electron microscopy, atomic force microscopy, and Wallace indentation. Results Mesoscale imaging showed alterations in dentinal tubule morphology in OIDI patients, with a reduced number of tubules and a decreased tubule diameter compared to healthy controls. Nanoscale collagen ultrastructure presented a similar D-banding periodicity between OIDI and controls. Reduced collagen fibrils diameter was also recorded for the OIDI group. The hardness of the (mineralized) control dentin was found to be significantly higher (p<0.05) than that of the OIDI (mineralized) dentine. Both the exposed peri- and intratubular dentinal collagen presented bimodal elastic behaviors (Young’s moduli). The control samples presented a stiffening of the intratubular collagen when compared to the peritubular collagen. In case of the OIDI, this stiffening in the collagen between peri- and intratubular dentinal collagen was not observed and the exposed collagen presented overall a lower elasticity than the control samples. Conclusion This study presents a systematic approach to the characterization of collagen structure and properties in OIDI as diagnosed in dentin. Structural markers for OIDI at the mesoscale and nanoscale were found and correlated with an observed lack of increased elastic moduli of the collagen fibrils in the intratubular OIDI dentin. These findings offer an explanation of how structural changes in the dentin could be responsible for the failure of some adhesive restorative materials as observed in patients affected by OIDI.
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Affiliation(s)
- Salwa Ibrahim
- Department of Paediatric Dentistry, UCL Eastman Dental Institute, University College London, London, UK
| | - Adam P Strange
- Department of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK
| | - Sebastian Aguayo
- Department of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK.,School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Albatool Shinawi
- Department of Paediatric Dentistry, UCL Eastman Dental Institute, University College London, London, UK
| | - Nabilah Harith
- Department of Paediatric Dentistry, UCL Eastman Dental Institute, University College London, London, UK
| | - Nurjehan Mohamed-Ibrahim
- Department of Paediatric Dentistry, UCL Eastman Dental Institute, University College London, London, UK
| | - Samera Siddiqui
- Department of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London, UK
| | - Susan Parekh
- Department of Paediatric Dentistry, UCL Eastman Dental Institute, University College London, London, UK
| | - Laurent Bozec
- Faculty of Dentistry, University of Toronto, Toronto, Canada
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22
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Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the current understanding of the molecular mechanisms and natural history of osteogenesis imperfecta, and to describe the development of new treatments for this disorder. RECENT FINDINGS The introduction of next-generation sequencing technology has led to better understanding of the genetic cause of osteogenesis imperfecta and enabled cost-effective and timely diagnosis via expanded gene panels and exome or genome sequencing. Clinically, despite genetic heterogeneity, different forms of osteogenesis imperfecta share similar features that include connective tissue and systemic manifestations in addition to bone fragility. Thus, the goals of treatment in osteogenesis imperfecta extend beyond decreasing the risk of fracture, to include the maximization of growth and mobility, and the management of extraskeletal complications. The standard of care in pediatric patients is bisphosphonates therapy. Ongoing preclinical studies in osteogenesis imperfecta mouse models and clinical studies in individuals with osteogenesis imperfecta have been instrumental in the development of new and targeted therapeutic approaches, such as sclerostin inhibition and transforming growth factor-β inhibition. SUMMARY Osteogenesis imperfecta is a skeletal dysplasia characterized by bone fragility and extraskeletal manifestations. Better understanding of the mechanisms of osteogenesis imperfecta will enable the development of much needed targeted therapies to improve the outcome in affected individuals.
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Affiliation(s)
- Vittoria Rossi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston TX, USA
| | - Brendan Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston TX, USA
- Texas Children’s Hospital, Houston TX, USA
| | - Ronit Marom
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston TX, USA
- Texas Children’s Hospital, Houston TX, USA
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23
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Zhytnik L, Maasalu K, Pashenko A, Khmyzov S, Reimann E, Prans E, Kõks S, Märtson A. COL1A1/2 Pathogenic Variants and Phenotype Characteristics in Ukrainian Osteogenesis Imperfecta Patients. Front Genet 2019; 10:722. [PMID: 31447884 PMCID: PMC6696896 DOI: 10.3389/fgene.2019.00722] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 07/10/2019] [Indexed: 11/25/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a hereditary bone disorder caused by defects of type I collagen. Although up to 90% of patients harbor pathogenic variants in the COL1A1/2 gene, which codes for collagen α1/2 chains, the spectrum of OI genotypes may differ between populations, and there is academic controversy around OI genotype-phenotype correlations. In the current study, 94 Ukrainian OI families were interviewed. Clinical and genealogical information was collected from patients in spoken form, and their phenotypes were described. To identify the spectrum of collagen I pathogenic variants, COL1A1/2 mutational analysis with Sanger sequencing was performed on the youngest affected individual of every family. Of the 143 patients investigated, 67 (46.85%) had type I OI, 24 (16.78%) had type III, 49 (34.27%) had type IV, and III (2.10%) had type V. The mean number of fractures suffered per patient per year was 1.32 ± 2.88 (type I 0.50 ± 0.43; type III 3.51 ± 6.18; type IV 1.44 ± 1.77; and type 5 0.77 ± 0.23). 87.23% of patients had skeletal deformations of different severity. Blue sclera, dentinogenesis imperfecta, and hearing loss were present in 87%, 55%, and 22% of patients, respectively. COL1A1/2 pathogenic variants were harbored by 60 patients (63.83%). 27 pathogenic variants are described herein for the first time. The majority of the pathogenic variants were located in the COL1A1 gene (76.19%). Half (49.21%) of the pathogenic variants were represented by structural variants. OI phenotype severity was highly correlated with type of collagen I defect. The current article presents an analysis of the clinical manifestations and COL1A1/2 mutational spectrum of 94 Ukrainian OI families with 27 novel COL1A1/2 pathogenic variants. It is hoped that this data and its analysis will contribute toward the increased understanding of the phenotype development and genetics of the disorder.
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Affiliation(s)
- Lidiia Zhytnik
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
| | - Andrey Pashenko
- Department of Pediatric Orthopedics, Sytenko Institute of Spine and Joint Pathology, AMS Ukraine, Kharkiv, Ukraine
| | - Sergey Khmyzov
- Department of Pediatric Orthopedics, Sytenko Institute of Spine and Joint Pathology, AMS Ukraine, Kharkiv, Ukraine
| | - Ene Reimann
- Centre of Translational Medicine, University of Tartu, Tartu, Estonia.,Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Sulev Kõks
- Perron Institute for Neurological and Translational Science, QEII Medical Centre, Nedlands, WA, Australia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
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24
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Semler O, Rehberg M, Mehdiani N, Jackels M, Hoyer-Kuhn H. Current and Emerging Therapeutic Options for the Management of Rare Skeletal Diseases. Paediatr Drugs 2019; 21:95-106. [PMID: 30941653 DOI: 10.1007/s40272-019-00330-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Increasing knowledge in the field of rare diseases has led to new therapeutic approaches in the last decade. Treatment strategies have been developed after elucidation of the underlying genetic alterations and pathophysiology of certain diseases (e.g., in osteogenesis imperfecta, achondroplasia, hypophosphatemic rickets, hypophosphatasia and fibrodysplasia ossificans progressiva). Most of the drugs developed are specifically designed agents interacting with the disease-specific cascade of enzymes and proteins involved. While some are approved (asfotase alfa, burosumab), others are currently being investigated in phase III trials (denosumab, vosoritide, palovarotene). To offer a multi-disciplinary therapeutic approach, it is recommended that patients with rare skeletal disorders are treated and monitored in highly specialized centers. This guarantees the greatest safety for the individual patient and offers the possibility of collecting data to further improve treatment strategies for these rare conditions. Additionally, new therapeutic options could be achieved through increased awareness, not only in the field of pediatrics but also in prenatal and obstetric specialties. Presenting new therapeutic options might influence families in their decision of whether or not to terminate a pregnancy with a child with a skeletal disease.
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Affiliation(s)
- Oliver Semler
- Centre for Rare Skeletal Diseases in childhood, Children's Hospital, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany. .,Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.
| | - Mirko Rehberg
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany
| | - Nava Mehdiani
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany
| | - Miriam Jackels
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany.,Centre for Prevention and Rehabilitation, Unireha, University of Cologne, Cologne, Germany
| | - Heike Hoyer-Kuhn
- Children's and Adolescent's Hospital, University of Cologne, Cologne, Germany
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25
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Kruger KM, Caudill A, Rodriguez Celin M, Nagamani SCS, Shapiro JR, Steiner RD, Bober MB, Hart T, Cuthbertson D, Krischer J, Byers PH, Durigova M, Glorieux FH, Rauch F, Sutton VR, Lee B, Rush ET, Smith PA, Harris GF. Mobility in osteogenesis imperfecta: a multicenter North American study. Genet Med 2019; 21:2311-2318. [PMID: 30918359 DOI: 10.1038/s41436-019-0491-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/07/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Osteogenesis imperfecta (OI) is a genetic connective tissue disorder that causes bone fragility. Phenotypic severity influences ability to walk, however, little is known about ambulatory characteristics of individuals with OI, especially in more severe forms. The purpose of this work was to characterize mobility in OI using standard clinical assessment tools and determine if patient characteristics could be used to predict mobility outcomes. METHODS We collected mobility data at five clinical sites to analyze the largest cohort of individuals with OI (n = 491) to date. Linear mixed models were developed to explore relationships among subject demographics and mobility metrics. RESULTS Results showed minor limitations in the mild group while the more severe types showed more significant limitations in all mobility metrics analyzed. Height and weight were shown to be the most significant predictors of mobility. Relationships with mobility and bisphosphonates varied with OI type and type used (oral/IV). CONCLUSION These results are significant to understanding mobility limitations of specific types of OI and beneficial when developing rehabilitation protocols for this population. It is important for physicians, patients, and caregivers to gain insight into severity and classification of the disease and the influence of disease-related characteristics on prognosis for mobility.
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Affiliation(s)
- Karen M Kruger
- Orthopaedic Rehabilitation and Engineering Center, Marquette University, Milwaukee, WI, USA. .,Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA.
| | - Angela Caudill
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA
| | | | - Sandesh C S Nagamani
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Jay R Shapiro
- Department of Bone and Osteogenesis Imperfecta, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Medicine at Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Robert D Steiner
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Pediatrics and Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Michael B Bober
- Division of Medical Genetics, Alfred I du Pont Hospital for Children, Wilmington, DE, USA
| | - Tracy Hart
- Osteogenesis Imperfecta Foundation, Gaithersburg, MD, USA
| | | | - Jeff Krischer
- College of Medicine, University of South Florida, Tampa, FL, USA
| | - Peter H Byers
- Departments of Medicine and Pathology, Division of Medical Genetics, University of Washington, Seattle, WA, USA
| | - Michaela Durigova
- Shriner's Hospital for Children and McGill University, Montreal, QC, Canada
| | - Francis H Glorieux
- Shriner's Hospital for Children and McGill University, Montreal, QC, Canada
| | - Frank Rauch
- Shriner's Hospital for Children and McGill University, Montreal, QC, Canada
| | - V Reid Sutton
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Brendan Lee
- Baylor College of Medicine, Houston, TX, USA.,Texas Children's Hospital, Houston, TX, USA
| | - Eric T Rush
- Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Peter A Smith
- Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA
| | - Gerald F Harris
- Orthopaedic Rehabilitation and Engineering Center, Marquette University, Milwaukee, WI, USA.,Motion Analysis Laboratory, Shriners Hospitals for Children, Chicago, IL, USA
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26
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Maioli M, Gnoli M, Boarini M, Tremosini M, Zambrano A, Pedrini E, Mordenti M, Corsini S, D'Eufemia P, Versacci P, Celli M, Sangiorgi L. Genotype-phenotype correlation study in 364 osteogenesis imperfecta Italian patients. Eur J Hum Genet 2019; 27:1090-1100. [PMID: 30886339 PMCID: PMC6777444 DOI: 10.1038/s41431-019-0373-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 02/06/2019] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a rare genetic disorder of the connective tissue and 90% of cases are due to dominant mutations in COL1A1 and COL1A2 genes. To increase OI disease knowledge and contribute to patient follow-up management, a homogeneous Italian cohort of 364 subjects affected by OI types I–IV was evaluated. The study population was composed of 262 OI type I, 24 type II, 39 type III, and 39 type IV patients. Three hundred and nine subjects had a type I collagen affecting function mutations (230 in α1(I) and 79 in α2(I)); no disease-causing changes were noticed in 55 patients. Compared with previous genotype–phenotype OI correlation studies, additional observations arose: a new effect for α1- and α2-serine substitutions has been pointed out and heart defects, never considered before, resulted associated to quantitative mutations (P = 0.043). Moreover, some different findings emerged if compared with previous literature; especially, focusing the attention on the lethal form, no association with specific collagen regions was found and most of variants localized in the previously reported “lethal clusters” were causative of OI types I–IV. Some discrepancies have been highlighted also considering the “50–55 nucleotides rule,” as well as the relationship between specific collagen I mutated region and the presence of dentinogenesis imperfecta and/or blue sclera. Despite difficulties still present in defining clear rules to predict the clinical outcome in OI patients, this study provides new pieces for completing the puzzle, also thanks to the inclusion of clinical signs never considered before and to the large number of OI Italian patients.
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Affiliation(s)
- Margherita Maioli
- Department of Medical Genetics and Rare Orthopaedic Diseases, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Maria Gnoli
- Department of Medical Genetics and Rare Orthopaedic Diseases, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Manila Boarini
- CLIBI Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Morena Tremosini
- Department of Medical Genetics and Rare Orthopaedic Diseases, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Anna Zambrano
- Department of Pediatrics, Center for Congenital Osteodystrophy - Sapienza University, Rome, Italy
| | - Elena Pedrini
- Department of Medical Genetics and Rare Orthopaedic Diseases, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marina Mordenti
- CLIBI Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Serena Corsini
- Department of Medical Genetics and Rare Orthopaedic Diseases, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Patrizia D'Eufemia
- Department of Pediatrics, Center for Congenital Osteodystrophy - Sapienza University, Rome, Italy
| | - Paolo Versacci
- Department of Pediatrics, Sapienza University, Rome, Italy
| | - Mauro Celli
- Department of Pediatrics, Center for Congenital Osteodystrophy - Sapienza University, Rome, Italy
| | - Luca Sangiorgi
- Department of Medical Genetics and Rare Orthopaedic Diseases, and CLIBI Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Zhytnik L, Maasalu K, Duy BH, Pashenko A, Khmyzov S, Reimann E, Prans E, Kõks S, Märtson A. De novo and inherited pathogenic variants in collagen-related osteogenesis imperfecta. Mol Genet Genomic Med 2019; 7:e559. [PMID: 30675999 PMCID: PMC6418448 DOI: 10.1002/mgg3.559] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/27/2018] [Accepted: 12/13/2018] [Indexed: 01/10/2023] Open
Abstract
Background Osteogenesis imperfecta (OI) is a rare genetic bone fragility disorder. In the current study, differences between the genotypes and phenotypes of de novo and inherited collagen‐related OI were investigated. Methods A comparative analysis was performed of the genotypes and phenotypes of 146 unrelated inherited and de novo collagen I OI cases from Estonia, Ukraine, and Vietnam. Mutational analysis of the subjects and all available parents were performed with Sanger sequencing. Results Results showed that 56.16% of the OI cases were caused by de novo pathogenic variants. The proportion of OI types OI1, OI4, and OI3 among subjects with inherited OI was 45.31%, 46.88%, and 7.81%, respectively. Among subjects with de novo OI, the proportions of OI types (OI1, OI4, and OI3) were almost equal. Both inherited and de novo OI pathogenic variants occurred more often in the COL1A1 gene than in the COL1A2. The majority of de novo cases were missense pathogenic variants, whereas inherited OI was mostly caused by loss of function pathogenic variants. Conclusion In summary, there were significant differences between the phenotypes and genotypes of subjects with de novo and inherited OI. These findings may promote the further understanding of OI etiology, and assist with diagnostics procedures, as well as with family planning.
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Affiliation(s)
- Lidiia Zhytnik
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
| | - Binh Ho Duy
- Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Andrey Pashenko
- Department of Pediatric Orthopedics, Sytenko Institute of Spine and Joint Pathology, AMS Ukraine, Kharkiv, Ukraine
| | - Sergey Khmyzov
- Department of Pediatric Orthopedics, Sytenko Institute of Spine and Joint Pathology, AMS Ukraine, Kharkiv, Ukraine
| | - Ene Reimann
- Centre of Translational Medicine, University of Tartu, Tartu, Estonia.,Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Tartu, Estonia
| | - Sulev Kõks
- Centre for Comparative Genomics, Murdoch University, Perth, Australia.,Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, Australia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Tartu, Estonia
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28
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Hald JD, Folkestad L, Swan CZ, Wanscher J, Schmidt M, Gjørup H, Haubek D, Leonhard CH, Larsen DA, Hjortdal JØ, Harsløf T, Duno M, Lund AM, Jensen JEB, Brixen K, Langdahl B. Osteogenesis imperfecta and the teeth, eyes, and ears-a study of non-skeletal phenotypes in adults. Osteoporos Int 2018; 29:2781-2789. [PMID: 30143849 DOI: 10.1007/s00198-018-4663-x] [Citation(s) in RCA: 24] [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: 01/22/2018] [Accepted: 08/12/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED Osteogenesis imperfecta (OI) is a disease causing bone fragility; however, it potentially affects all organs with a high content of collagen, including ears, teeth, and eyes. The study is cross-sectional and compares non-skeletal characteristics in adults with OI that clinicians should be aware of when caring for patients with OI. INTRODUCTION Osteogenesis imperfecta (OI) is a hereditary connective tissue disorder. The skeletal fragility is pronounced; however, OI leads to a number of extra-skeletal symptoms related to the ubiquity of collagen type 1 throughout the human body. The vast majority of knowledge is derived from studies performed in the pediatric population. Thus, we aimed to investigate the nature and prevalence of ophthalmologic, odontologic, and otologic phenotypes in an adult population with OI. METHODS The study population comprises 85 Danish OI patients (age 44.9 ± 15.9 years). Fifty-eight patients had OI type I, 12 OI type III, and 15 OI type IV according to the classification by Sillence. Audiometric evaluations and dental examinations were performed in 62 and 73 patients, respectively. Ophthalmologic investigations were performed in 64 patients, including measurements of the central corneal thickness. RESULTS All patients, except two, had corneal thickness below the normal reference value. Patients with OI type I and patients with a quantitative collagen defect had thinner corneas compared to patients with OI type III and other patients with a qualitative collagen defect. One patient in this cohort was diagnosed with and treated for acute glaucoma. Dentinogenesis imperfecta was diagnosed in one fourth of the patients, based on clinical and radiographic findings. This condition was predominately seen in patients with moderate to severe OI. Hearing loss requiring treatment was found in 15 of 62 patients, of whom three were untreated. The most prevalent type of hearing loss (HL) was sensorineural hearing loss, whereas conductive HL was solely seen in patients with OI type III. The patients with the most severe degrees of HL were patients with mild forms of OI. Age was associated with increased HL. CONCLUSION Although significant health problems outside the skeleton are frequent in adult patients with OI, the patients are not consistently monitored and treated for their symptoms. Clinicians treating adult patients with OI should be aware of non-skeletal health issues and consider including regular interdisciplinary check-ups in the management plan for adult OI patients.
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Affiliation(s)
- J D Hald
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, DK-8200, Aarhus N, Denmark.
| | - L Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - C Z Swan
- Department of Otorhinolaryngology and Head & Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J Wanscher
- Department of ENT Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - M Schmidt
- Section for Pediatric Dentistry, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
| | - H Gjørup
- Centre of Oral Health in Rare Diseases, Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - D Haubek
- Section for Pediatric Dentistry, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
| | - C-H Leonhard
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - D A Larsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - J Ø Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - T Harsløf
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, DK-8200, Aarhus N, Denmark
| | - M Duno
- Centre for Inherited Metabolic Diseases, Departments of Paediatrics and Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - A M Lund
- Centre for Inherited Metabolic Diseases, Departments of Paediatrics and Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - J-E B Jensen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | - K Brixen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - B Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, DK-8200, Aarhus N, Denmark
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Cyclic bisphosphonate therapy reduces pain and improves physical functioning in children with osteogenesis imperfecta. BMC Musculoskelet Disord 2018; 19:344. [PMID: 30249227 PMCID: PMC6154399 DOI: 10.1186/s12891-018-2252-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with osteogenesis imperfecta (OI) experience pain and impaired physical functioning. The longitudinal effect of cyclic bisphosphonate treatment on these symptoms has not been described. We serially evaluated pain and functioning in pediatric patients with OI treated with intravenous bisphosphonate therapy. METHODS Pain and physical functioning were assessed at multiple time-points over two infusion cycles in 22 OI patients (median age 10 years [range 2-21 years]; 8 girls) receiving cyclic intravenous bisphosphonate therapy. Pain was assessed using the FACES® visual analogue scale; physical functioning, including self-care, was assessed using the PedsQL™ Generic Core inventory. RESULTS Pain scores decreased significantly immediately following infusion and remained reduced at 4 weeks post-infusion, increasing before and decreasing again after subsequent infusion (F = 25.00, p < 0.001). Physical functioning scaled scores improved 4 weeks after infusion and declined before subsequent infusion across patients (F = 10.87, p = 0.007). Exploratory analyses indicated significantly different effects between mild and moderate-severe OI types for pain, but not for physical functioning. No fractures occurred during the study. CONCLUSION In children with OI, cyclic intravenous bisphosphonate therapy transiently reduces pain and improves functional abilities. Pain relief occurs immediately following infusion with functional improvements observed 4 weeks later. Both pain and physical functioning return to pretreatment levels by the subsequent infusion.
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30
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Gistelinck C, Kwon RY, Malfait F, Symoens S, Harris MP, Henke K, Hawkins MB, Fisher S, Sips P, Guillemyn B, Bek JW, Vermassen P, De Saffel H, Witten PE, Weis M, De Paepe A, Eyre DR, Willaert A, Coucke PJ. Zebrafish type I collagen mutants faithfully recapitulate human type I collagenopathies. Proc Natl Acad Sci U S A 2018; 115:E8037-E8046. [PMID: 30082390 PMCID: PMC6112716 DOI: 10.1073/pnas.1722200115] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The type I collagenopathies are a group of heterogeneous connective tissue disorders, that are caused by mutations in the genes encoding type I collagen and include specific forms of osteogenesis imperfecta (OI) and the Ehlers-Danlos syndrome (EDS). These disorders present with a broad disease spectrum and large clinical variability of which the underlying genetic basis is still poorly understood. In this study, we systematically analyzed skeletal phenotypes in a large set of zebrafish, with diverse mutations in the genes encoding type I collagen, representing different genetic forms of human OI, and a zebrafish model resembling human EDS, which harbors a number of soft connective tissues defects, typical of EDS. Furthermore, we provide insight into how zebrafish and human type I collagen are compositionally and functionally related, which is relevant in the interpretation of human type I collagen-related disease models. Our studies reveal a high degree of intergenotype variability in phenotypic expressivity that closely correlates with associated OI severity. Furthermore, we demonstrate the potential for select mutations to give rise to phenotypic variability, mirroring the clinical variability associated with human disease pathology. Therefore, our work suggests the future potential for zebrafish to aid in identifying unknown genetic modifiers and mechanisms underlying the phenotypic variability in OI and related disorders. This will improve diagnostic strategies and enable the discovery of new targetable pathways for pharmacological intervention.
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Affiliation(s)
- Charlotte Gistelinck
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195
| | - Ronald Y Kwon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195
| | - Fransiska Malfait
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium
| | - Sofie Symoens
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium
| | - Matthew P Harris
- Department of Genetics, Harvard Medical School, Boston, MA 02115
- Department of Orthopaedic Research, Boston Children's Hospital, Boston, MA 02115
| | - Katrin Henke
- Department of Genetics, Harvard Medical School, Boston, MA 02115
- Department of Orthopaedic Research, Boston Children's Hospital, Boston, MA 02115
| | - Michael B Hawkins
- Department of Genetics, Harvard Medical School, Boston, MA 02115
- Department of Orthopaedic Research, Boston Children's Hospital, Boston, MA 02115
| | - Shannon Fisher
- Department of Pharmacology & Experimental Therapeutics, Boston University School of Medicine, Boston, MA 02115
| | - Patrick Sips
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium
| | - Brecht Guillemyn
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium
| | - Jan Willem Bek
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium
| | - Petra Vermassen
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium
| | - Hanna De Saffel
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium
| | - Paul Eckhard Witten
- Biology Department, Research Group Evolutionary Developmental Biology, Ghent University, 9000 Ghent, Belgium
| | - MaryAnn Weis
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195
| | - Anne De Paepe
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium
| | - David R Eyre
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195
| | - Andy Willaert
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium;
| | - Paul J Coucke
- Center for Medical Genetics Ghent, Ghent University, 9000 Ghent, Belgium
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Kanno J, Saito-Hakoda A, Kure S, Fujiwara I. Responsiveness to pamidronate treatment is not related to the genotype of type I collagen in patients with osteogenesis imperfecta. J Bone Miner Metab 2018; 36:344-351. [PMID: 28528406 DOI: 10.1007/s00774-017-0840-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 04/05/2017] [Indexed: 12/01/2022]
Abstract
Osteogenesis imperfecta (OI) is a heritable disorder characterized by increased bone fragility, low bone mass, dentinogenesis imperfecta, and blue sclerae. Most patients with OI have a mutation in either COL1A1 or COL1A2, which encode type I collagen. We screened these genes in Japanese patients with OI and compared their genotype and phenotype, focusing on the clinical response to treatment with pamidronate. Sequencing analysis of the genes in 19 families revealed 15 mutations, of which ten were missense mutations, thee were nonsense mutations, and two were frameshift mutations. Each of the 15 mutations was found in unrelated families, even though the patients were from a contiguous region surrounding our hospital. Substitutions of serine for glycine were the commonest mutation in both genes; notably, dentinogenesis imperfecta and fractures at birth were detected with higher frequencies in patients with this substitution when compared with other genotypes. The Z score of the bone mineral density of patients with this substitution was also lower than that of patients with other genotypes. Pamidronate treatment significantly increased the Z score in all patients, and increases in the Z score did not correlate with the OI types, causative genes, or genotype. In conclusion, the efficacy of pamidronate treatment does not seem to be related to the genotype of type I collagen in patients with OI.
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Affiliation(s)
- Junko Kanno
- Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Akiko Saito-Hakoda
- Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Ikuma Fujiwara
- Department of Pediatric Endocrinology and Environmental Medicine, Tohoku University School of Medicine, Sendai, Japan
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32
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Yang Q, Xu H, Luo J, Zhang Q, Xie B, Yi S, Rong X, Wang J, Qin Z, Jiang T, Lin L, Zuo Y, Fan X. A novel variant of osteogenesis imperfecta type IV and low serum phosphorus level caused by a Val94Asp mutation in COL1A1. Mol Med Rep 2018; 17:4433-4439. [PMID: 29344653 PMCID: PMC5802218 DOI: 10.3892/mmr.2018.8436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/22/2017] [Indexed: 11/08/2022] Open
Abstract
Osteogenesis imperfecta (OI) is a rare congenital disorder characterized by bone fragility and fractures, and associated with bone deformity, short stature, dentin, ligament and blue-gray eye sclera. OI is caused by a heterozygous mutation in collagen α-1(I) chain (COL1A1) or collagen α-2(I) chain (COL1A2) genes that encode α chains of type I collagen. Collagen α chain peptide contains an N-propeptide, which has a role in assembly and processing of collagen. Point mutations in the N-propeptide domain appear to trigger OI. In the present study, a novel heterozygous missense mutation, c.281T>A (p.Val94Asp), was identified in the von Willebrand C domain of N-terminal of type I collagen in an individual with type IV OI. The majority of N-terminal mutations are associated with OI/Ehlers-Danlos syndrome (EDS); however, in the present study, the affected individual did not suffer from EDS and the level of serum phosphorus of the patient was low (0.67 mmol/l). A number of clinical phenotypes were observed at the same variation site or in the same region on the polypeptide chain of COL1A, which suggests that additional genetic and environmental factors may influence the severity of OI. The present study may provide insight into the phenotype-genotype association in collagen-associated diseases and improve clinical diagnosis of OI.
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Affiliation(s)
- Qi Yang
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Hong Xu
- Nanning Region Center for Disease Prevention and Control, Nanning, Guangxi 530023, P.R. China
| | - Jinsi Luo
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Qinle Zhang
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Bobo Xie
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Sheng Yi
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Xiuliang Rong
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Jin Wang
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Zailong Qin
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Tingting Jiang
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Li Lin
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Yangjin Zuo
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
| | - Xin Fan
- Genetic and Metabolic Central Laboratory, Guangxi Maternal and Child Health Hospital, Nanning, Guangxi 530023, P.R. China
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Abstract
PURPOSE OF REVIEW Here we summarize the diagnosis of osteogenesis imperfecta, discuss newly discovered genes involved in osteogenesis imperfecta, and review the management of this disease in children and adults. RECENT FINDINGS Mutations in the two genes coding for collagen type I, COL1A1 and COL1A2, are the most common cause of osteogenesis imperfecta. In the past 10 years, defects in at least 17 other genes have been identified as responsible for osteogenesis imperfecta phenotypes, with either dominant or recessive transmission. Intravenous bisphosphonate infusions are the most widely used medical treatment. This has a marked effect on vertebra in growing children and can lead to vertebral reshaping after compression fractures. However, bisphosphonates are less effective for preventing long-bone fractures. At the moment, new therapies are under investigation. SUMMARY Despite advances in the diagnosis and treatment of osteogenesis imperfecta, more research is needed. Bisphosphonate treatment decreases long-bone fracture rates, but such fractures are still frequent. New antiresorptive and anabolic agents are being investigated but efficacy and safety of these drugs, especially in children, need to be better established before they can be used in clinical practice.
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Affiliation(s)
- Telma Palomo
- aBone and Mineral Unit, Division of Endocrinology, Universidade Federal de São Paulo, Brazil bAcademic Unit of Bone Metabolism, University of Sheffield, Sheffield, United Kingdom
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Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a heritable skeletal disorder characterized by bone fragility and short stature that is usually due to mutations in 1 of the 2 genes that code for collagen type I α-chains. The association between hip dysplasia and OI has not been systematically investigated. In this single-center study, we retrospectively reviewed all cases of OI associated with hip dysplasia to describe clinical characteristics and the effect of therapy. METHODS We reviewed the charts of 687 patients with OI who were seen at the Shriners Hospital for Children in Montreal between 1999 and 2013 to identify patients with a diagnosis of hip dysplasia. Clinical characteristics and the course after therapeutic interventions were extracted from the charts. RESULTS Hip dysplasia was diagnosed in 8 hips of 5 patients (4 boys, 1 girl; age at diagnosis ranged between 3 wk and 27 mo old). The prevalence of hip dysplasia and OI was therefore 0.87% (per patient). In 4 of the 5 patients (80%), OI was caused by mutations affecting the C-propeptide of collagen type I, which is otherwise rare in OI. Among the 26 patients with C-propeptide mutations followed at our institution, 4 (15%) had hip dysplasia. Pavlik harness treatment was attempted in 2 patients (3 hips) but was not effective in either case and resulted in avascular necrosis of 1 hip. Femoral varus derotational shortening osteotomies using a telescopic rod were performed in all 8 hips along with a closed reduction in 4 hips and an open reduction in 4 hips. Concomitant pelvic osteotomies were performed in 2 hips (1 patient). Surgery resulted in redislocation of 1 hip; all other surgically treated hips remained reduced. CONCLUSIONS Clinical screening for hip dysplasia is difficult in OI owing to the bowing of the proximal femur and the risk of causing fractures. OI patients with positive C-propeptide mutation should therefore be screened for hip dysplasia by use of ultrasound. Presence of a C-propeptide mutation appears to be a risk factor for hip dysplasia (80%). It appears that Pavlik harness treatment is not useful in children with OI. The usual treatment of children with OI who pull to stand or started walking with femoral deformity is femoral osteotomy and rodding. In case of associated hip dysplasia with a dislocation, open reduction of the hip and a possible concomitant pelvic osteotomy appears to be a valid management option. LEVEL OF EVIDENCE Level IV.
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Mäkitie RE, Kämpe AJ, Taylan F, Mäkitie O. Recent Discoveries in Monogenic Disorders of Childhood Bone Fragility. Curr Osteoporos Rep 2017; 15:303-310. [PMID: 28646443 DOI: 10.1007/s11914-017-0388-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review summarizes our current knowledge on primary osteoporosis in children with focus on recent genetic findings. RECENT FINDINGS Advances in genetic research, particularly next-generation sequencing, have found several genetic loci that associate with monogenic forms of inherited osteoporosis, widening the scope of primary osteoporosis beyond classical osteogenesis imperfecta. New forms of primary osteoporosis, such as those related to WNT1, PLS3, and XYLT2, have identified defects outside the extracellular matrix components and collagen-related pathways, in intracellular cascades directly affecting bone cell function. Primary osteoporosis can lead to severe skeletal morbidity, including abnormal longitudinal growth, compromised bone mass gain, and noticeable fracture tendency beginning at childhood. Early diagnosis and timely care are warranted to ensure the best achievable bone health. Future research will most likely broaden the spectrum of primary osteoporosis, hopefully provide more insight into the genetics governing bone health, and offer new targets for treatment.
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Affiliation(s)
- Riikka E Mäkitie
- Folkhälsan Institute of Genetics, University of Helsinki, P. O. Box 63, FIN-00014, Helsinki, Finland
| | - Anders J Kämpe
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fulya Taylan
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Outi Mäkitie
- Folkhälsan Institute of Genetics, University of Helsinki, P. O. Box 63, FIN-00014, Helsinki, Finland.
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Abstract
Identifying children most susceptible to clinically significant fragility fractures (low trauma fractures or vertebral compression fractures) or recurrent fractures is an important issue facing general pediatricians and subspecialists alike. Over the last decade, several imaging technologies, including dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, have become useful to identify abnormal bone mineralization in children and in adolescents. This review aimed to summarize the latest literature on the utility of these modalities as they pertain to use in pediatrics. In addition, we review several disease states associated with poor bone health and increased fracture risk in children, and discuss the implications of low bone mineral density in these patients. Finally, we will highlight the gaps in knowledge with regard to pediatric bone health and make recommendations for future areas of research.
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Affiliation(s)
- Halley Wasserman
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Catherine M Gordon
- Divisions of Adolescent Medicine and Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Hoyer-Kuhn H, Bartz-Seel J, Blickheuser R, v. Deimling U, Stücker R, Wirth T, Wolf J, Wollinsky KH, Semler O. Diagnostik und Therapie der Osteogenesis imperfecta. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0189-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marom R, Lee YC, Grafe I, Lee B. Pharmacological and biological therapeutic strategies for osteogenesis imperfecta. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:367-383. [PMID: 27813341 DOI: 10.1002/ajmg.c.31532] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by bone fragility, low bone mass, and bone deformities. The majority of cases are caused by autosomal dominant pathogenic variants in the COL1A1 and COL1A2 genes that encode type I collagen, the major component of the bone matrix. The remaining cases are caused by autosomal recessively or dominantly inherited mutations in genes that are involved in the post-translational modification of type I collagen, act as type I collagen chaperones, or are members of the signaling pathways that regulate bone homeostasis. The main goals of treatment in OI are to decrease fracture incidence, relieve bone pain, and promote mobility and growth. This requires a multi-disciplinary approach, utilizing pharmacological interventions, physical therapy, orthopedic surgery, and monitoring nutrition with appropriate calcium and vitamin D supplementation. Bisphosphonate therapy, which has become the mainstay of treatment in OI, has proven beneficial in increasing bone mass, and to some extent reducing fracture risk. However, the response to treatment is not as robust as is seen in osteoporosis, and it seems less effective in certain types of OI, and in adult OI patients as compared to most pediatric cases. New pharmacological treatments are currently being developed, including anti-resorptive agents, anabolic treatment, and gene- and cell-therapy approaches. These therapies are under different stages of investigation from the bench-side, to pre-clinical and clinical trials. In this review, we will summarize the recent findings regarding the pharmacological and biological strategies for the treatment of patients with OI. © 2016 Wiley Periodicals, Inc.
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Hald JD, Folkestad L, Harsløf T, Lund AM, Duno M, Jensen JB, Neghabat S, Brixen K, Langdahl B. Skeletal phenotypes in adult patients with osteogenesis imperfecta-correlations with COL1A1/COL1A2 genotype and collagen structure. Osteoporos Int 2016; 27:3331-3341. [PMID: 27256333 DOI: 10.1007/s00198-016-3653-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/24/2016] [Indexed: 11/25/2022]
Abstract
UNLABELLED Osteogenesis imperfecta (OI) is characterized by a high fracture rate and great heterogeneity. This cross-sectional study presents skeletal investigations and protein analyses in 85 adult OI patients. We find significant differences in bone mass, architecture, and fracture rate that correlate well with the underlying biochemical and molecular abnormalities. INTRODUCTION OI is a hereditary disease characterized by compromised connective tissue predominantly caused by mutations in collagen type 1 (COL-1) encoding genes. Widespread symptoms reflect the ubiquity of COL-1 throughout the body. The purpose of this study was to improve our understanding of clinical manifestations by investigating anthropometry and skeletal phenotypes (DXA, HRpQCT) in an adult OI population and compare the findings to underlying COL-1 genotype and structure. METHODS The study comprised 85 OI patients aged 45 (19-78) years, Sillence type I (n = 58), III (n = 12), and IV (n = 15). All patients underwent DXA, HRpQCT, spine X-ray, biochemical testing, and anthropometry. COL1A1 and COL1A2 were sequenced and 68 OI causing mutations identified (46 in COL1A1, 22 in COL1A2). Analysis of COL-1 structure (quantitative/qualitative defect) by SDS-PAGE was performed in a subset (n = 67). RESULTS A qualitative collagen defect predisposed to a more severe phenotype with reduced aBMD, more fractures, and affected anthropometry compared to patients with a quantitative COL-1 defect (p < 0.05). HRpQCT revealed significant differences between patients with OI type I and IV. Patients with type I had lower vBMD (p < 0.005), thinner cortexes (p < 0.001), and reduced trabecular number (p < 0.005) compared to patients with type IV indicating that HRpQCT may distinguish type I from type IV better than DXA. CONCLUSION The defective collagen in patients with OI has pronounced effects on the skeleton. The classical OI types based on the clinical classification show profound differences in bone mass and architecture and the differences correlate well with the underlying biochemical and molecular collagen abnormalities.
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Affiliation(s)
- J D Hald
- Department of Endocrinology and Metabolism, Aarhus University Hospital, Tage Hansensgade 2, Aarhus C, Denmark.
| | - L Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - T Harsløf
- Department of Endocrinology and Metabolism, Aarhus University Hospital, Tage Hansensgade 2, Aarhus C, Denmark
| | - A M Lund
- Centre for Inherited Metabolic Diseases, Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - M Duno
- Centre for Inherited Metabolic Diseases, Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - J B Jensen
- Department of Endocrinology, Hvidovre Hospital, Hvidovre, Denmark
| | - S Neghabat
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - K Brixen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - B Langdahl
- Department of Endocrinology and Metabolism, Aarhus University Hospital, Tage Hansensgade 2, Aarhus C, Denmark
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Hamza RT, Abdelaziz TH, Elakkad M. Anthropometric and nutritional parameters in Egyptian children and adolescents with osteogenesis imperfecta. Horm Res Paediatr 2016; 83:311-20. [PMID: 25766874 DOI: 10.1159/000374111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/09/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Patients with osteogenesis imperfecta (OI) present with various degrees of short stature and nutritional disorders. Thus, we aimed to evaluate anthropometric and nutritional parameters in OI children and their variability among various types. METHODS Eighty-four patients with OI (types I, II, and IV) were subjected to the following anthropometric measurements: standing height (Ht), sitting height (SH), arm span, weight (Wt), and head circumference (HC), with calculation of Ht, SH, Wt, body mass index (BMI), and HC standard deviation scores (SDSs), and relative arm span. Triceps skinfold thickness (TSFT), subscapular skinfold thickness (SSFT), and mid upper arm circumference (MUAC) were measured, as well as dietary intake of macronutrients and calcium; also, energy requirements were calculated. RESULTS Ht SDS was reduced in OI-III and OI-IV compared to OI-I; SH SDS was reduced in OI-III compared to OI-I. HC SDS was more increased in OI-III than in OI-I and OI-IV. BMI SDS correlated with TSFT, SSFT, and MUAC. OI-III patients had the highest percentage of energy intake. The frequency of low macronutrient and calcium intake was highest in OI-III, while the frequency of low fat intake was highest in OI-I. CONCLUSIONS Anthropometric and nutritional parameters differ among OI types. Assessment of anthropometric measurements and nutritional status in OI patients is important.
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Affiliation(s)
- Rasha Tarif Hamza
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Cross-sectional and longitudinal growth patterns in osteogenesis imperfecta: implications for clinical care. Pediatr Res 2016; 79:489-95. [PMID: 26539664 DOI: 10.1038/pr.2015.230] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 08/12/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is strikingly limited information on linear growth and weight in the different types of osteogenesis imperfecta (OI). Here, we define growth patterns further with the intent of implementing appropriate adaptations proactively. METHODS We report cross-sectional anthropometric data for 343 subjects with different OI types (144 children, 199 adults). Longitudinal height data for 36 children (18 girls, 18 boys) with OI type I and 10 children (8 girls, 2 boys) with OI type III were obtained. RESULTS In all cases, the height Z-scores were negatively impacted, and final height Z-scores were impacted the most. In type I, the growth velocities taper near puberty, and there is a blunted pubertal growth spurt. The growth velocities of children with type III decelerate before age 5 y; poor growth continues without an obvious pubertal growth spurt. Obesity is a concern for all patients with OI, with type III patients being the most affected. CONCLUSION The linear growth patterns, in addition to the marked increase in weight over time, indicate a need for lifestyle modifications early in childhood, especially a need for weight control. Further definition of the anthropometric measures in OI enables patients to begin modifications as early as possible.
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Abstract
Osteogenesis imperfecta (OI) is a rare disorder of type 1 collagen with 13 currently identified types attributable to inherited abnormalities in type 1 collagen amount, structure, or processing. The disease is characterized by an increased susceptibility to bony fracture. In addition to the skeletal phenotype, common additional extraskeletal manifestations include blue sclerae, dentinogenesis imperfecta, vascular fragility, and hearing loss. Medical management is focused on minimizing the morbidity of fractures, pain, and bone deformities by maximizing bone health. Along with optimizing Vitamin D status and calcium intake and physical/occupational therapy, individualized surgical treatment may be indicated. Pharmacological therapy with bisphosphonate medications is now routinely utilized for moderate to severe forms and appears to have a good safety profile and bone health benefits. New therapies with other anti-resorptives as well as anabolic agents and transforming growth factor (TGF)β antibodies are in development. Other potential treatment modalities could include gene therapy or mesenchymal cell transplant. In the future, treatment choices will be further individualized in order to reduce disease morbidity and mortality.
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Affiliation(s)
- Inas H Thomas
- Section of Pediatric Endocrinology, School of Medicine, University of Michigan, 1500 E. Medical Center Dr., D1205 MPB, SPC 5718, Ann Arbor, MI, 48109, USA.
| | - Linda A DiMeglio
- Section of Pediatric Endocrinology/Diabetology, School of Medicine, Indiana University, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN, 46202-5225, USA.
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Styrkarsdottir U, Thorleifsson G, Eiriksdottir B, Gudjonsson SA, Ingvarsson T, Center JR, Nguyen TV, Eisman JA, Christiansen C, Thorsteinsdottir U, Sigurdsson G, Stefansson K. Two Rare Mutations in the COL1A2 Gene Associate With Low Bone Mineral Density and Fractures in Iceland. J Bone Miner Res 2016; 31:173-9. [PMID: 26235824 DOI: 10.1002/jbmr.2604] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 07/16/2015] [Accepted: 07/27/2015] [Indexed: 01/10/2023]
Abstract
We conducted a genome-wide association study of low bone mineral density (BMD) at the hip and spine utilizing sequence variants found through whole-genome sequencing of 2636 Icelanders. We found two rare missense mutations, p.Gly496Ala and p.Gly703Ser, in the COL1A2 gene that associate with measures of osteoporosis in Icelanders. Mutations in COL1A2 are known to cause the autosomal dominant disorder osteogenesis imperfecta. Both variants associate with low BMD and with osteoporotic fractures. p.Gly496Ala (frequency of 0.105%) shows the strongest association with low BMD at the spine (p = 1.8 × 10(-7) , odds ratio [OR] = 4.61 [95% confidence interval (CI) 2.59, 8.18]), whereas p.Gly703Ser (frequency of 0.050%) is most strongly associated with low BMD at the hip (p = 1.9 × 10(-8) , OR = 9.34 [95% CI 4.28, 20.3]). Association with fractures was p = 2.2 × 10(-5) , OR = 3.75 (95% CI 2.03, 6.93) and p = 0.0023, OR = 4.32 (95% CI 1.69, 11.1), respectively. The carriers of these variants do not have signs of osteogenesis imperfecta other than low BMD, demonstrating that similar mutations in COL1A2 can affect skeletal phenotypes in more than one way.
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Affiliation(s)
| | | | | | | | - Thorvaldur Ingvarsson
- Department of Orthopedic Surgery, Akureyri Hospital, Akureyri, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jacqueline R Center
- Garvan Institute of Medical Research, Sydney, Australia.,St. Vincent's Hospital, Sydney, Australia.,University of New South Wales (UNSW), Sydney, Australia
| | - Tuan V Nguyen
- Garvan Institute of Medical Research, Sydney, Australia.,University of New South Wales (UNSW), Sydney, Australia
| | - John A Eisman
- Garvan Institute of Medical Research, Sydney, Australia.,St. Vincent's Hospital, Sydney, Australia.,University of New South Wales (UNSW), Sydney, Australia.,University of Notre Dame Australia (UNDA), Sydney, Australia
| | | | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Gunnar Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Endocrinology and Metabolism, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Kari Stefansson
- deCODE genetics/Amgen, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Otaify GA, Aglan MS, Ibrahim MM, Elnashar M, El Banna RAS, Temtamy SA. Zoledronic acid in children with osteogenesis imperfecta and Bruck syndrome: a 2-year prospective observational study. Osteoporos Int 2016; 27:81-92. [PMID: 26138583 DOI: 10.1007/s00198-015-3216-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/16/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED Treatment with zoledronic acid (ZA) over 2 years, among 33 children with osteogenesis imperfecta (OI) and five Bruck syndrome cases, showed reduction in fracture rates, pain, and improvement in bone mineral density (BMD) and motor milestones of development. This is the first study reporting the use of bisphosphonates in patients with Bruck syndrome (BS). INTRODUCTION OI and BS are genetic disorders that result in bone fragility and reduced BMD. There is little literature describing the efficacy and safety of ZA in this population. In this study, we assess the response to treatment with ZA at six monthly intervals in Egyptian children with OI and BS for a period of 2 years. METHODS Thirty-three patients with OI and five patients with BS were treated with 0.1 mg/kg ZA intravenously every 6 months for 2 years during which they were followed up using different parameters. A clinical severity score (CSS) was applied to the patients before and 2 years after the start of therapy. Comparison of disease severity and response to ZA treatment between autosomal-dominant (AD) and autosomal-recessive (AR) OI patients was also done. RESULTS After 6 months of treatment, OI and BS patients showed a significant increase in BMD Z-scores (P < 0.003 in the spine and P < 0.004 in the hip), together with a significant drop in fracture rate (P < 0.001), relief of pain (P < 0.001), and improvement in ambulation (P < 0.001). CSS was significantly reduced after 2 years of treatment in both OI and BS patients. AR-OI patients were more severely affected than AD-OI patients and showed more significant improvement. CONCLUSION Zoledronic acid proved to be safe and effective in the treatment of OI and BS. The biannual infusion protocol was convenient to patients. There was a positive correlation between disease severity and benefits of the treatment. The use of the CSS proved to be of value in the assessment of the degree of severity in OI, and with some modifications, it was a valuable tool for the assessment of response to treatment.
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Affiliation(s)
- G A Otaify
- Department of Clinical Genetics, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt.
| | - M S Aglan
- Department of Clinical Genetics, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - M M Ibrahim
- Department of Biochemical Genetics, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - M Elnashar
- Department of Medical Studies, Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
| | - R A S El Banna
- Department of Biological Anthropology, Medical Division, National Research Centre, Cairo, Egypt
| | - S A Temtamy
- Department of Clinical Genetics, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
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Kocijan R, Muschitz C, Haschka J, Hans D, Nia A, Geroldinger A, Ardelt M, Wakolbinger R, Resch H. Bone structure assessed by HR-pQCT, TBS and DXL in adult patients with different types of osteogenesis imperfecta. Osteoporos Int 2015; 26:2431-40. [PMID: 25956285 DOI: 10.1007/s00198-015-3156-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
UNLABELLED Bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) was assessed in adult patients with mild, moderate, and severe osteogenesis imperfecta (OI). The trabecular bone score (TBS), bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), and dual X-ray and laser (DXL) at the calcaneus were likewise assessed in patients with OI. Trabecular microstructure and BMD in particular were severely altered in patients with OI. INTRODUCTION OI is characterized by high fracture risk but not necessarily by low BMD. The main purpose of this study was to assess bone microarchitecture and BMD at different skeletal sites in different types of OI. METHODS HR-pQCT was performed in 30 patients with OI (mild OI-I, n = 18 (41.8 [34.7, 55.7] years) and moderate to severe OI-III-IV, n = 12 (47.6 [35.3, 58.4] years)) and 30 healthy age-matched controls. TBS, BMD by DXA at the lumbar spine and hip, as well as BMD by DXL at the calcaneus were likewise assessed in patients with OI only. RESULTS At the radius, significantly lower trabecular parameters including BV/TV (p = 0.01 and p < 0.0001, respectively) and trabecular number (p < 0.0001 and p < 0.0001, respectively) as well as an increased inhomogeneity of the trabecular network (p < 0.0001 and p < 0.0001, respectively) were observed in OI-I and OI-III-IV in comparison to the control group. Similar results for trabecular parameters were found at the tibia. Microstructural parameters were worse in OI-III-IV than in OI-I. No significant differences were found in cortical thickness and cortical porosity between the three subgroups at the radius. The cortical thickness of the tibia was thinner in OI-I (p < 0.001), but not OI-III-IV, when compared to controls. CONCLUSIONS Trabecular BMD and trabecular bone microstructure in particular are severely altered in patients with clinical OI-I and OI-III-IV. Low TBS and DXL and their significant associations to HR-pQCT parameters of trabecular bone support this conclusion.
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Affiliation(s)
- R Kocijan
- Medical Department II, St. Vincent Hospital Vienna, Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.
| | - C Muschitz
- Medical Department II, St. Vincent Hospital Vienna, Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - J Haschka
- Medical Department II, St. Vincent Hospital Vienna, Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - D Hans
- Department of Bone and Joint Diseases, Center for Bone Diseases, Lausanne University Hospital, Lausanne, Swizerland
| | - A Nia
- Medical Department II, St. Vincent Hospital Vienna, Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - A Geroldinger
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - M Ardelt
- Department of General, Visceral and Vascular Surgery, University of Jena, Jena, Germany
| | - R Wakolbinger
- Medical Department II, St. Vincent Hospital Vienna, Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | - H Resch
- Medical Department II, St. Vincent Hospital Vienna, Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria
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Maasalu K, Nikopensius T, Kõks S, Nõukas M, Kals M, Prans E, Zhytnik L, Metspalu A, Märtson A. Whole-exome sequencing identifies de novo mutation in the COL1A1 gene to underlie the severe osteogenesis imperfecta. Hum Genomics 2015; 9:6. [PMID: 25958000 PMCID: PMC4429824 DOI: 10.1186/s40246-015-0028-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/30/2015] [Indexed: 12/31/2022] Open
Abstract
Background Osteogenesis imperfecta (OI) comprises a clinically and genetically heterogeneous group of connective tissue disorders, characterized by low bone mass, increased bone fragility, and blue-gray eye sclera. OI often results from missense mutations in one of the conserved glycine residues present in the Gly-X-Y sequence repeats of the triple helical region of the collagen type I α chain, which is encoded by the COL1A1 gene. The aim of the present study is to describe the phenotype of OI II patient and a novel mutation, causing current phenotype. Results We report an undescribed de novo COL1A1 mutation in a patient affected by severe OI. After performing the whole-exome sequencing in a case parent–child trio, we identified a novel heterozygous c.2317G > T missense mutation in the COL1A1 gene, which leads to p.Gly773Cys transversion in the triple helical domain of the collagen type I α chain. The presence of the missense mutation was confirmed with the Sanger sequencing. Conclusions Hereby, we report a novel mutation in the COL1A1 gene causing severe, life threatening OI and indicate the role of de novo mutation in the pathogenesis of rare familial diseases. Our study underlines the importance of exome sequencing in disease gene discovery for families where conventional genetic testing does not give conclusive evidence.
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Affiliation(s)
- Katre Maasalu
- Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia. .,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia.
| | - Tiit Nikopensius
- Estonian Genome Centre, University of Tartu, Riia 23b, Tartu, 51010, Estonia. .,Institute of Molecular and Cell Biology, University of Tartu, Riia 23b, Tartu, 51010, Estonia.
| | - Sulev Kõks
- Department of Pathophysiology, University of Tartu, Ravila 19, Tartu, 50411, Estonia.
| | - Margit Nõukas
- Estonian Genome Centre, University of Tartu, Riia 23b, Tartu, 51010, Estonia. .,Institute of Molecular and Cell Biology, University of Tartu, Riia 23b, Tartu, 51010, Estonia.
| | - Mart Kals
- Estonian Genome Centre, University of Tartu, Riia 23b, Tartu, 51010, Estonia.
| | - Ele Prans
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23b, Tartu, 51010, Estonia.
| | - Lidiia Zhytnik
- Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
| | - Andres Metspalu
- Estonian Genome Centre, University of Tartu, Riia 23b, Tartu, 51010, Estonia. .,Institute of Molecular and Cell Biology, University of Tartu, Riia 23b, Tartu, 51010, Estonia. .,Estonian Biocentre, Riia 23b, 51010, Tartu, Estonia.
| | - Aare Märtson
- Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia. .,Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia.
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Lippross S, Beckmann R, Streubesand N, Ayub F, Tohidnezhad M, Campbell G, Kan YW, Horst F, Sönmez TT, Varoga D, Lichte P, Jahr H, Pufe T, Wruck CJ. Nrf2 deficiency impairs fracture healing in mice. Calcif Tissue Int 2014; 95:349-61. [PMID: 25096517 DOI: 10.1007/s00223-014-9900-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
Abstract
Oxidative stress plays an important role in wound healing but data relating oxidative stress to fracture healing are scarce. Nuclear factor erythroid 2-related factor 2 (Nrf2) is the major transcription factor that controls the cellular defence essential to combat oxidative stress by regulating the expression of antioxidative enzymes. This study examined the impact of Nrf2 on fracture healing using a standard closed femoral shaft fracture model in wild-type (WT) and Nrf2-knockout (Nrf2-KO)-mice. Healing was evaluated by histology, real-time RT-PCR, µCT and biomechanical measurements. We showed that Nrf2 expression is activated during fracture healing. Bone healing and remodelling were retarded in the Nrf2-KO compared to the WT-mice. Nrf2-KO-mice developed significantly less callus tissue compared to WT-mice. In addition, biomechanical testing demonstrated lower strength against shear stress in the Nrf2-KO-group compared to WT. The expression of vascular endothelial growth factor (VEGF) and osteocalcin is reduced during fracture healing in Nrf2-KO-mice. Taken together, our results demonstrate that Nrf2 deficiency in mice results in impaired fracture healing suggesting that Nrf2 plays an essential role in bone regeneration. Pharmacological activation of Nrf2 may have therapeutic potential for the enhancement of fracture healing.
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Affiliation(s)
- Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany,
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Abstract
Osteogenesis imperfecta (OI), also called "brittle bone disease," is a rare heterozygous connective tissue disorder that is caused by mutations of genes that affect collagen. Osteogenesis imperfecta is characterized by decreased bone mass, bone fragility, and skin hyperlaxity. The phenotype present is determined according to the mutation on the affected gene as well as the type and location of the mutation. Osteogenesis imperfecta is neither preventable nor treatable. Osteogenesis imperfecta is classified into 11 types to date, on the basis of their clinical symptoms and genetic components. This article discusses the definition of the disease, the classifications on the basis of its clinical features, incidence, etiology, and pathogenesis. In addition, phenotype, natural history, diagnosis and management of this disease, recurrence risk, and, most importantly, the implications for the neonatal nurse and management for the family are discussed.
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Abstract
Osteogenesis imperfecta (OI) is a genetic bone fragility disorder characterized by low bone mass, skeletal deformity, and variable short stature. OI is predominantly caused by dominant mutations affecting type 1 collagen synthesis, with a number of other genes implicated in OI over recent years. The clinical severity of OI can vary greatly, even within families who share a common mutation. Optimal management of OI requires a multidisciplinary approach involving pediatrician, endocrinologist (bone and mineral physician), rehabilitation specialist, orthopedic surgeon, dentist, geneticist, social worker/psychologist, physiotherapist, and occupational therapist. Bisphosphonate therapy remains the mainstay of medical treatment in OI and has been shown to decrease bone pain, enhance well-being, improve muscle strength and mobility and decrease fracture incidence. Novel therapies are beginning to emerge as more is understood about the signaling pathways involved in bone formation. The following summarizes the diagnosis, genetic heterogeneity and management of OI in pediatric practice.
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Affiliation(s)
- A Biggin
- Institute of Endocrinology and Diabetes, Children's Hospital Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia,
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