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Akinci G, Alyaarubi S, Patni N, Alhashmi N, Al-Shidhani A, Prodam F, Gagne N, Babalola F, Al Senani A, Muniraj K, Elsayed SM, Beghini M, Saydam BO, Allawati M, Vaishnav MS, Can E, Simsir IY, Sorkina E, Dursun F, Kamrath C, Cavdar U, Chakraborty PP, Dogan OA, Al Hosin A, Al Maimani A, Comunoglu N, Hamed A, Huseinbegovic T, Scherer T, Curtis J, Brown RJ, Topaloglu H, Simha V, Wabitsch M, Tuysuz B, Oral EA, Akinci B, Garg A. Metabolic and other morbid complications in congenital generalized lipodystrophy type 4. Am J Med Genet A 2024; 194:e63533. [PMID: 38234231 PMCID: PMC11060913 DOI: 10.1002/ajmg.a.63533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024]
Abstract
Morbidity and mortality rates in patients with autosomal recessive, congenital generalized lipodystrophy type 4 (CGL4), an ultra-rare disorder, remain unclear. We report on 30 females and 16 males from 10 countries with biallelic null variants in CAVIN1 gene (mean age, 12 years; range, 2 months to 41 years). Hypertriglyceridemia was seen in 79% (34/43), hepatic steatosis in 82% (27/33) but diabetes mellitus in only 21% (8/44). Myopathy with elevated serum creatine kinase levels (346-3325 IU/L) affected all of them (38/38). 39% had scoliosis (10/26) and 57% had atlantoaxial instability (8/14). Cardiac arrhythmias were detected in 57% (20/35) and 46% had ventricular tachycardia (16/35). Congenital pyloric stenosis was diagnosed in 39% (18/46), 9 had esophageal dysmotility and 19 had intestinal dysmotility. Four patients suffered from intestinal perforations. Seven patients died at mean age of 17 years (range: 2 months to 39 years). The cause of death in four patients was cardiac arrhythmia and sudden death, while others died of prematurity, gastrointestinal perforation, and infected foot ulcers leading to sepsis. Our study highlights high prevalence of myopathy, metabolic abnormalities, cardiac, and gastrointestinal problems in patients with CGL4. CGL4 patients are at high risk of early death mainly caused by cardiac arrhythmias.
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Affiliation(s)
- Gulcin Akinci
- Department of Pediatric Neurology, University of Health Sciences, Izmir Faculty of Medicine, Behcet Uz Children’s Hospital, Izmir, Turkey
| | | | - Nivedita Patni
- Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nadia Alhashmi
- Clinical and Biochemical Genetics Department, Child Health Department, Royal Hospital, Muscat, Oman
| | | | - Flavia Prodam
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Nancy Gagne
- Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Funmbi Babalola
- The Hospital for Sick Children, Department of Pediatrics, Toronto, ON, Canada
| | - Aisha Al Senani
- National Diabetes and Endocrine Center, Royal Hospital, Muscat, Oman
| | - Kavitha Muniraj
- Samatvam Diabetes Endocrinology and Medical Center, Bangalore, India
| | - Solaf M. Elsayed
- Medical Genetics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marianna Beghini
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria
| | | | | | - Madhumati S Vaishnav
- Samatvam Diabetes Endocrinology and Medical Center, Bangalore, India
- Indian Institute of Science, Center for Nano Science and Engineering, Bangalore, India
| | - Ender Can
- Division of Pediatric Neurology, Gaziantep Children’s Hospital, Gaziantep, Turkey
| | | | - Ekaterina Sorkina
- Endocrinology Research Centre, Moscow, Russia
- Clinical Research Facility, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Fatma Dursun
- Department of Pediatric Endocrinology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Clemens Kamrath
- Centre of Child and Adolescent Medicine, Department of General Pediatrics and Neonatology, Justus-Liebig-University Giessen, Germany
| | - Umit Cavdar
- Division of Endocrinology, Katip Celebi University, Izmir, Turkey
| | - Partha P. Chakraborty
- Department of Endocrinology and Metabolism, Medical College Hospital, Kolkata, India
| | - Ozlem Akgun Dogan
- Department of Pediatric Genetics, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | | | | | - Nil Comunoglu
- Department of Pathology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ahmed Hamed
- Child Health Department, Royal Hospital, Muscat, Oman
| | - Tea Huseinbegovic
- Division of Endocrinology, Department of Internal Medicine, Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Scherer
- Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria
| | - Jacqueline Curtis
- The Hospital for Sick Children, Department of Pediatrics, Toronto, ON, Canada
| | - Rebecca J. Brown
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Haluk Topaloglu
- Department of Pediatric Neurology, Yeditepe University, Istanbul, Turkey
| | - Vinaya Simha
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Center Ulm, Ulm, Germany
| | - Beyhan Tuysuz
- Department of Pediatric Genetics, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Elif A. Oral
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Baris Akinci
- DEPARK, Dokuz Eylul University, Izmir, Turkey
- Izmir Biomedicine and Genome Center, Izmir, Turkey
| | - Abhimanyu Garg
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX, USA
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Hoff FW, Xing C, Garg A. A Novel Subtype of Acquired Generalized Lipodystrophy Associated With Subcutaneous Panniculitis-Like T-cell Lymphoma. JCEM Case Rep 2024; 2:luae069. [PMID: 38681964 PMCID: PMC11055395 DOI: 10.1210/jcemcr/luae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Indexed: 05/01/2024]
Abstract
Acquired generalized lipodystrophy (AGL) is an extremely rare disease that is characterized by loss of body fat affecting nearly all parts of the body. It is often associated with autoimmune diseases or panniculitis, whereas in other patients the underlying etiology is unclear. We report a 52-year-old male individual who was diagnosed with subcutaneous panniculitis-like T-cell lymphoma (SPTCL) that spontaneously went into remission. Years later he developed new subcutaneous nodules most concerning for relapse SPTCL or lupus panniculitis, followed by onset of hemophagocytic lymphohistiocytosis (HLH) that was treated with allogeneic stem cell transplantation. Notably, around the same time, he also developed generalized subcutaneous fat loss of both upper and lower extremities, chest, abdomen, and face that persisted after treatment of the HLH. Whole exome sequencing was performed to search for pathogenic variants that are associated with SPTCL, including those in hepatitis A virus cellular receptor 2 (HAVCR2), but did not detect any potential disease-causing variant. Our report brings to the attention a novel subtype of panniculitis-variety of AGL. Whether generalized loss of subcutaneous fat in this patient is due to lymphoma-associated panniculitis or due to development of adipose tissue-directed autoantibodies as a paraneoplastic "autoimmune" manifestation of SPTCL remains unclear.
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Affiliation(s)
- Fieke W Hoff
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Chao Xing
- McDermott Center for Human Growth and Development, Department of Bioinformatics, O’Donnell School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Abhimanyu Garg
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine and the Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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3
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Agarwal AK, Tunison K, Horton JD, Garg A. Regulated regeneration of adipose tissue in lipodystrophic Agpat2-null mice partially ameliorates hepatic steatosis. iScience 2024; 27:109517. [PMID: 38623324 PMCID: PMC11016861 DOI: 10.1016/j.isci.2024.109517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 01/22/2024] [Accepted: 03/14/2024] [Indexed: 04/17/2024] Open
Abstract
Both humans and mice with congenital generalized lipodystrophy due to AGPAT2 deficiency develop diabetes mellitus, insulin resistance, and hepatic steatosis, which have been attributed to the near total loss of adipose tissue (AT). Here, we show that regulated AT regeneration in doxycycline (dox)-fed Tg-AT-hAGPAT2;mAgpat2-/- mice partially ameliorates hepatic steatosis at 12 weeks of age and causes reduced expression of genes involved in hepatic de novo lipogenesis despite partial (∼30-50%) AT regeneration compared to that in wild-type mice. Compared to chow-fed Tg-AT-hAGPAT2;mAgpat2-/- mice, those fed dox diet had markedly reduced serum insulin levels, suggesting an improvement in insulin resistance. Interestingly, the fasting plasma glucose levels in dox-fed Tg-AT-hAGPAT2;mAgpat2-/- mice were no different than those in chow-fed wild-type mice. Indirect calorimetry revealed normalization in the energy balance of dox-fed Tg-AT-hAGPAT2;mAgpat2-/- mice compared to that in chow-fed mice. This study's findings suggest that partial AT regeneration in lipodystrophic mice can ameliorate metabolic derangements.
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Affiliation(s)
- Anil K. Agarwal
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Katie Tunison
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jay D. Horton
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Abhimanyu Garg
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
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Cohn E, Mastacouris N, Palma G, Strunk A, Garg A. New-onset anxiety in paediatric patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024. [PMID: 38577863 DOI: 10.1111/jdv.19994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Affiliation(s)
- E Cohn
- Northwell Health, New Hyde Park, New York, USA
| | | | - G Palma
- Northwell Health, New Hyde Park, New York, USA
| | - A Strunk
- Northwell Health, New Hyde Park, New York, USA
| | - A Garg
- Northwell Health, New Hyde Park, New York, USA
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Agarwal AK, Garg A. Phospholipid biosynthetic pathways and lipodystrophies: a novel syndrome due to PLAAT3 deficiency. Nat Rev Endocrinol 2024; 20:128-129. [PMID: 38191657 DOI: 10.1038/s41574-023-00950-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Anil K Agarwal
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX, USA
| | - Abhimanyu Garg
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX, USA.
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Agarwal AK, Tunison K, Vale G, McDonald JG, Li X, Horton JD, Garg A. Adipose-specific overexpression of human AGPAT2 in mice causes increased adiposity and mild hepatic dysfunction. iScience 2024; 27:108653. [PMID: 38274405 PMCID: PMC10809107 DOI: 10.1016/j.isci.2023.108653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/11/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024] Open
Abstract
AGPAT2, a critical enzyme involved in the biosynthesis of phospholipids and triacylglycerol (TAG), is highly expressed in adipose tissue (AT). Whether overexpression of AGPAT2 in AT will result in increased TAG synthesis (obesity) and its metabolic complications remains unknown. We overexpressed human AGPAT2 specifically in AT using the adiponectin promoter and report increased mass of subcutaneous, gonadal, and brown AT in wild-type mice. Unexpectedly, overexpression of hAGPAT2 did not change the pattern of phospholipid or TAG concentration of the AT depots. Although there is an increase in liver weight, plasma aspartate aminotransferase, and plasma insulin at various time points of the study, it did not result in significant liver dysfunction. Despite increased adiposity in the Tg-AT-hAGPAT2;mAgpat2+/+ mice, there was no significant increase in TAG concentration of AT. Therefore, this study suggests a role of AGPAT2 in the generation of AT, but not for adipocyte TAG synthesis.
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Affiliation(s)
- Anil K. Agarwal
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Katie Tunison
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Goncalo Vale
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jeffrey G. McDonald
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Xilong Li
- Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jay D. Horton
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Abhimanyu Garg
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
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7
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Hoff FW, Xing C, Simha V, Agarwal AK, Zhang X, Lekkala L, Vaishnav MS, Vuitch F, Garg A. Early-onset diabetes mellitus as a presenting feature of Werner's syndrome in an Indian family. Mol Genet Genomic Med 2024; 12:e2299. [PMID: 37815015 PMCID: PMC10767583 DOI: 10.1002/mgg3.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) in children and adolescents is typically caused by type 1 DM, followed by type 2 DM and maturity-onset diabetes of the young (MODY). We report an unusual Asian Indian family in which three members presented with DM at ages 15, 20, and 30, but not fitting the typical clinical picture of type 1 DM, type 2 DM, or MODY. The primary objective was to elucidate the molecular genetic basis of DM in this family. METHODS The proband, a 22-year-old man, had short stature, gray hair, osteoporosis, and markedly reduced subcutaneous fat on the body, especially on the extremities along with acanthosis nigricans, and developed myxoid malignant peripheral nerve sheath tumor. Detailed family history revealed multiple loops of consanguinity. The proband underwent whole-genome sequencing, and seven relatives underwent whole-exome sequencing. RESULTS The proband and three additional family members were found to have the homozygous c.561A>G nucleotide variant of WRN RecQ-like helicase (WRN) gene consistent with the diagnosis of Werner's syndrome. The c.561A>G variant induces a new splicing site on exon 6 resulting in a truncated WRN protein, p.Lys187Trpfs*13. CONCLUSION Our report brings to attention the onset of DM during childhood or early adulthood in patients with Werner's syndrome who typically develop type 2 DM around the age of 30-40 years. Presence of consanguinity among parents, dysmorphic features, and malignancy should prompt consideration of diagnosis of Werner's syndrome.
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Affiliation(s)
- Fieke W. Hoff
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Chao Xing
- McDermott Center for Human Growth and DevelopmentUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Vinaya Simha
- Division of EndocrinologyMayo ClinicRochesterMinnesotaUSA
| | - Anil K. Agarwal
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine and the Center for Human NutritionUniversity of Texas Southwestern Medical CenterTexasDallasUSA
| | - Xunzhi Zhang
- McDermott Center for Human Growth and DevelopmentUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Leena Lekkala
- Samatvam Endocrinology Diabetes Center, Jnana Sanjeevini Diabetes Hospital and Medical CenterBengaluruIndia
| | - Madhumati S. Vaishnav
- Samatvam Endocrinology Diabetes Center, Jnana Sanjeevini Diabetes Hospital and Medical CenterBengaluruIndia
- Center for Nano Science and Engineering, Indian Institute of ScienceBengaluruIndia
| | - Frank Vuitch
- Department of PathologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Abhimanyu Garg
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine and the Center for Human NutritionUniversity of Texas Southwestern Medical CenterTexasDallasUSA
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Agarwal AK, Tunison K, Vale G, McDonald JG, Li X, Scherer PE, Horton JD, Garg A. Regulated adipose tissue-specific expression of human AGPAT2 in lipodystrophic Agpat2-null mice results in regeneration of adipose tissue. iScience 2023; 26:107806. [PMID: 37752957 PMCID: PMC10518674 DOI: 10.1016/j.isci.2023.107806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
Genetic loss of Agpat2 in humans and mice results in congenital generalized lipodystrophy with near-total loss of adipose tissue and predisposition to develop insulin resistance, diabetes mellitus, hepatic steatosis, and hypertriglyceridemia. The mechanism by which Agpat2 deficiency results in loss of adipose tissue remains unknown. We studied this by re-expressing human AGPAT2 (hAGPAT2) in Agpat2-null mice, regulated by doxycycline. In both sexes of Agpat2-null mice, adipose-tissue-specific re-expression of hAGPAT2 resulted in partial regeneration of both white and brown adipose tissue (but only 30%-50% compared with wild-type mice), which had molecular signatures of adipocytes, including leptin secretion. Furthermore, the stromal vascular fraction cells of regenerated adipose depots differentiated ex vivo only with doxycycline, suggesting the essential role of Agpat2 in adipocyte differentiation. Turning off expression of hAGPAT2 in vivo resulted in total loss of regenerated adipose tissue, clear evidence that Agpat2 is essential for adipocyte differentiation in vivo.
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Affiliation(s)
- Anil K. Agarwal
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Katie Tunison
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Goncalo Vale
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jeffrey G. McDonald
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Xilong Li
- Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Philipp E. Scherer
- Touchstone Center for Diabetes Research, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jay D. Horton
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Molecular Genetics, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Abhimanyu Garg
- Section of Nutrition and Metabolic Diseases, Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA
- Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX 75390, USA
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9
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Ververi A, Babatseva E, Mitsiakos G, Karagiannopoulou G, Malakozi M, Patsatsi A, Diamanti E, Garg A. Restrictive dermopathy due to ZMPSTE24 deficiency. Clin Dysmorphol 2023; 32:92-94. [PMID: 36876346 PMCID: PMC10037671 DOI: 10.1097/mcd.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Restrictive dermopathy (RD) (OMIM 275210) is a rare, lethal genodermatosis belonging to the group of laminopathies. It is caused by biallelic variants in ZMPSTE24 , which is involved in lamin A post-translational processing or, less frequently, by monoallelic variants in LMNA , leading to accumulation of truncated prelamin A protein (Navarro et al., 2004 ; Navarro et al., 2005 ). The main characteristics of RD include intrauterine growth retardation (IUGR), reduced fetal movement, premature rupture of membranes, translucent rigid skin, dysmorphic features and joint contractures. The prognosis is poor with all reported cases resulting in stillbirth or neonatal death (Navarro et al., 2014 ). Herein we report a neonate born to healthy, non-consanguineous parents from Greece. The pregnancy was uneventful until the 32nd week, when a routine scan showed severe fetal growth restriction with normal Doppler flows. The female proband was born at 33 weeks of gestation by caesarean section, due to premature rupture of membranes, as well as anhydramnios, IUGR, fetal hypokinesia and distress. Her birth weight was 1.36 kg (5th centile, −1.6SD), length was 41 cm (14th centile) and head circumference was 29 cm (14th centile). Apgar score was 4 and 8 at the 1st and 5th minutes, respectively. She required immediate intubation and admission to the neonatal intensive care unit. She had a large fontanelle, short palpebral fissures, a small pinched nose, low-set dysplastic ears and an open, O-shaped mouth (Fig. 1 ). She had multiple joint contractures. Her skin was rigid and translucent and progressively developed erosions and scaling. She did not have eyebrows or eyelashes. She had severe lung hypoplasia and died of respiratory insufficiency on the 22nd day of life.
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Affiliation(s)
- Athina Ververi
- 2nd Neonatal Department and Neonatal Intensive Care Unit
- Genetic Unit, 1st Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital
| | | | | | - Georgia Karagiannopoulou
- Pathology Department, School of Medicine, Aristotle University of Thessaloniki, AHEPA General Hospital
| | | | - Aikaterini Patsatsi
- 2nd Department of Dermatology and Venereology, School of Medicine, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital
| | | | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition; UT Southwestern Medical Center, Dallas, Texas, USA
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10
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Mandel-Brehm C, Vazquez SE, Liverman C, Cheng M, Quandt Z, Kung AF, Parent A, Miao B, Disse E, Cugnet-Anceau C, Dalle S, Orlova E, Frolova E, Alba D, Michels A, Oftedal BE, Lionakis MS, Husebye ES, Agarwal AK, Li X, Zhu C, Li Q, Oral E, Brown R, Anderson MS, Garg A, DeRisi JL. Autoantibodies to Perilipin-1 Define a Subset of Acquired Generalized Lipodystrophy. Diabetes 2023; 72:59-70. [PMID: 35709010 PMCID: PMC9797316 DOI: 10.2337/db21-1172] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
Acquired lipodystrophy is often characterized as an idiopathic subtype of lipodystrophy. Despite suspicion of an immune-mediated pathology, biomarkers such as autoantibodies are generally lacking. Here, we used an unbiased proteome-wide screening approach to identify autoantibodies to the adipocyte-specific lipid droplet protein perilipin 1 (PLIN1) in a murine model of autoimmune polyendocrine syndrome type 1 (APS1). We then tested for PLIN1 autoantibodies in human subjects with acquired lipodystrophy with two independent severe breaks in immune tolerance (including APS1) along with control subjects using a specific radioligand binding assay and indirect immunofluorescence on fat tissue. We identified autoantibodies to PLIN1 in these two cases, including the first reported case of APS1 with acquired lipodystrophy and a second patient who acquired lipodystrophy as an immune-related adverse event following cancer immunotherapy. Lastly, we also found PLIN1 autoantibodies to be specifically enriched in a subset of patients with acquired generalized lipodystrophy (17 of 46 [37%]), particularly those with panniculitis and other features of autoimmunity. These data lend additional support to new literature that suggests that PLIN1 autoantibodies represent a marker of acquired autoimmune lipodystrophies and further link them to a break in immune tolerance.
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Affiliation(s)
- Caleigh Mandel-Brehm
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
| | - Sara E. Vazquez
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
- Diabetes Center, University of California, San Francisco, San Francisco, CA
| | - Christopher Liverman
- Department of Pathology, University of California, San Francisco, San Francisco, CA
| | - Mickie Cheng
- Diabetes Center, University of California, San Francisco, San Francisco, CA
| | - Zoe Quandt
- Diabetes Center, University of California, San Francisco, San Francisco, CA
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Andrew F. Kung
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
| | - Audrey Parent
- Diabetes Center, University of California, San Francisco, San Francisco, CA
| | - Brenda Miao
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
- Diabetes Center, University of California, San Francisco, San Francisco, CA
| | - Emmanuel Disse
- Endocrinology Diabetology and Nutrition Department, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
- ImmuCare, Cancer Institute of Hospices Civils de Lyon (IC-HCL), Lyon, France
| | - Christine Cugnet-Anceau
- Endocrinology Diabetology and Nutrition Department, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
- ImmuCare, Cancer Institute of Hospices Civils de Lyon (IC-HCL), Lyon, France
| | - Stéphane Dalle
- ImmuCare, Cancer Institute of Hospices Civils de Lyon (IC-HCL), Lyon, France
- Dermatology Department, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Elizaveta Orlova
- Endocrinology Research Centre, Institute of Paediatric Endocrinology, Moscow, Russia
| | - Elena Frolova
- National Medical Research Center of Children’s Health, Moscow, Russia
| | - Diana Alba
- Diabetes Center, University of California, San Francisco, San Francisco, CA
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Aaron Michels
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Bergithe E. Oftedal
- University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Michail S. Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Eystein S. Husebye
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science and K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway
| | - Anil K. Agarwal
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Xilong Li
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX
| | - Chengsong Zhu
- Department of Immunology, UT Southwestern Medical Center, Dallas, TX
| | - Quan Li
- Department of Immunology, UT Southwestern Medical Center, Dallas, TX
| | - Elif Oral
- Division of Metabolism, Endocrinology & Diabetes and Caswell Diabetes Institute, University of Michigan, Ann Arbor, MI
| | - Rebecca Brown
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Mark S. Anderson
- Diabetes Center, University of California, San Francisco, San Francisco, CA
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA
- Chan Zuckerberg Biohub, San Francisco, CA
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Garg A, Keng WT, Chen Z, Sathe AA, Xing C, Kailasam PD, Shao Y, Lesner NP, Llamas CB, Agarwal AK, Mishra P. Autosomal recessive progeroid syndrome due to homozygosity for a TOMM7 variant. J Clin Invest 2022; 132:e156864. [PMID: 36282599 PMCID: PMC9711873 DOI: 10.1172/jci156864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
Multiple genetic loci have been reported for progeroid syndromes. However, the molecular defects in some extremely rare forms of progeria have yet to be elucidated. Here, we report a 21-year-old man of Chinese ancestry who has an autosomal recessive form of progeria, characterized by severe dwarfism, mandibular hypoplasia, hyperopia, and partial lipodystrophy. Analyses of exome sequencing data from the entire family revealed only 1 rare homozygous missense variant (c.86C>T; p.Pro29Leu) in TOMM7 in the proband, while the parents and 2 unaffected siblings were heterozygous for the variant. TOMM7, a nuclear gene, encodes a translocase in the outer mitochondrial membrane. The TOMM complex makes up the outer membrane pore, which is responsible for importing many preproteins into the mitochondria. A proteomic comparison of mitochondria from control and proband-derived cultured fibroblasts revealed an increase in abundance of several proteins involved in oxidative phosphorylation, as well as a reduction in abundance of proteins involved in phospholipid metabolism. We also observed elevated basal and maximal oxygen consumption rates in the fibroblasts from the proband as compared with control fibroblasts. We concluded that altered mitochondrial protein import due to biallelic loss-of-function TOMM7 can cause severe growth retardation and progeroid features.
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Affiliation(s)
- Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Wee-Teik Keng
- Medical Genetics Department, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | | | | | - Chao Xing
- McDermott Center for Human Growth and Development, and
- Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Yanqiu Shao
- McDermott Center for Human Growth and Development, and
| | | | | | - Anil K. Agarwal
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Prashant Mishra
- Children’s Medical Center Research Institute
- Department of Pediatrics and
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
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12
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Oral EA, Garg A, Tami J, Huang EA, O'Dea LSL, Schmidt H, Tiulpakov A, Mertens A, Alexander VJ, Watts L, Hurh E, Witztum JL, Geary RS, Tsimikas S. Assessment of efficacy and safety of volanesorsen for treatment of metabolic complications in patients with familial partial lipodystrophy: Results of the BROADEN study: Volanesorsen in FPLD; The BROADEN Study. J Clin Lipidol 2022; 16:833-849. [PMID: 36402670 DOI: 10.1016/j.jacl.2022.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/15/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Volanesorsen, an antisense oligonucleotide, is designed to inhibit hepatic apolipoprotein C-III synthesis and reduce plasma apolipoprotein C-III and triglyceride concentrations. OBJECTIVE The present study assessed efficacy and safety of volanesorsen in patients with familial partial lipodystrophy (FPLD) and concomitant hypertriglyceridemia and diabetes. METHODS BROADEN was a randomized, placebo-controlled, phase 2/3, 52-week study with open-label extension and post-treatment follow-up periods. Patients received weekly subcutaneous volanesorsen 300 mg or placebo. The primary endpoint was percent change from baseline in fasting triglycerides at 3 months. Secondary endpoints included relative percent change in hepatic fat fraction (HFF), visceral adiposity, and glycated hemoglobin levels. RESULTS Forty patients (11 men, 29 women) were enrolled, majority of whom were aged <65 years (mean, 47 years) and White. Least squares mean (LSM) percent change in triglycerides from baseline to 3 months was -88% (95% CI, -134 to -43) in the volanesorsen group versus -22% (95% CI, -61 to 18) in the placebo group, with a difference in LSM of -67% (95% CI, -104 to -30; P=0.0009). Volanesorsen induced a significant LSM relative reduction in HFF of 53% at month 12 versus placebo (observed mean [SD]: 9.7 [7.65] vs. 18.0 [8.89]; P=0.0039). No statistically significant changes were noted in body volume measurements (fat, liver, spleen, visceral/subcutaneous adipose tissue) or glycated hemoglobin. Serious adverse events in patients assigned to volanesorsen included 1 case each of sarcoidosis, anaphylactic reaction, and systemic inflammatory response syndrome. CONCLUSION In BROADEN, volanesorsen significantly reduced serum triglyceride levels and hepatic steatosis in patients with FPLD.
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Affiliation(s)
- Elif A Oral
- Metabolism, Endocrinology and Diabetes Division and Brehm Center for Diabetes, University of Michigan, Ann Arbor, MI, USA (Dr Oral).
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX, USA (Dr Garg)
| | - Joseph Tami
- Ionis Pharmaceuticals, Carlsbad, CA, USA (Drs Tami, Alexander, Watts, Geary, and Tsimikas)
| | - Eric A Huang
- Akcea Therapeutics, Inc., Boston, MA, USA (Drs Huang, O'Dea, and Hurh)
| | - Louis St L O'Dea
- Akcea Therapeutics, Inc., Boston, MA, USA (Drs Huang, O'Dea, and Hurh)
| | - Hartmut Schmidt
- University Hospital Muenster, Muenster, Germany (Dr Schmidt)
| | - Anatoly Tiulpakov
- Endocrinology Research Centre, Moscow, Russian Federation (Dr Tiulpakov)
| | - Ann Mertens
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism, and Ageing, KU Leuven, Leuven, Belgium (Dr Mertens)
| | - Veronica J Alexander
- Ionis Pharmaceuticals, Carlsbad, CA, USA (Drs Tami, Alexander, Watts, Geary, and Tsimikas)
| | - Lynnetta Watts
- Ionis Pharmaceuticals, Carlsbad, CA, USA (Drs Tami, Alexander, Watts, Geary, and Tsimikas)
| | - Eunju Hurh
- Akcea Therapeutics, Inc., Boston, MA, USA (Drs Huang, O'Dea, and Hurh)
| | - Joseph L Witztum
- School of Medicine, University of California San Diego, San Diego, CA, USA (Drs Witztum and Tsimikas)
| | - Richard S Geary
- Ionis Pharmaceuticals, Carlsbad, CA, USA (Drs Tami, Alexander, Watts, Geary, and Tsimikas)
| | - Sotirios Tsimikas
- Ionis Pharmaceuticals, Carlsbad, CA, USA (Drs Tami, Alexander, Watts, Geary, and Tsimikas); School of Medicine, University of California San Diego, San Diego, CA, USA (Drs Witztum and Tsimikas)
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13
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Vasandani C, Li X, Sekizkardes H, Brown RJ, Garg A. Phenotypic differences among Familial Partial Lipodystrophy due to LMNA or PPARG variants. J Endocr Soc 2022; 6:bvac155. [DOI: 10.1210/jendso/bvac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Context
Despite several reports of familial partial lipodystrophy, type 2 (FPLD2) due to heterozygous LMNA variants and FPLD3 due to PPARG variants, the phenotypic differences among them remain unclear.
Objectives
To compare the body fat distribution, metabolic parameters, and prevalence of metabolic complications between FPLD3 and FPLD2.
Design
A retrospective, cross-sectional comparison.
Settings
Patients from two tertiary referral centers - UT Southwestern Medical Center and the National Institute of Diabetes and Digestive and Kidney Diseases.
Patients
A total of 196 females and 59 males with FPLD2 (age 2-86 years) and 28 females and 4 males with FPLD3 (age 9-72 years).
Main Outcome Measures
Skinfold thickness, regional body fat by dual energy X-ray absorptiometry (DXA), metabolic variables and prevalence of diabetes mellitus and hypertriglyceridemia.
Results
Compared to FPLD2 subjects, FPLD3 subjects had significantly increased prevalence of hypertriglyceridemia (66% vs. 84%) and diabetes (44% vs. 72%); and had higher median fasting serum triglycerides (208 vs. 255 mg/dL), and mean hemoglobin A1c (6.4% vs. 7.5%). Compared to FPLD2 subjects, FPLD3 subjects also had significantly higher mean upper limb fat (21% vs. 27%) and lower limb fat (16% vs. 21%) on DXA and increased median skinfold thickness at the anterior thigh (5.8 vs.11.3 mm); calf (4 vs. 6 mm); triceps (5.5 vs. 7.5 mm); and biceps (4.3 vs. 6.8 mm).
Conclusions
Compared to FPLD2, FPLD3 subjects have milder lipodystrophy but develop more severe metabolic complications, suggesting that remaining adipose tissue in FPLD3 subjects may be dysfunctional or those with mild metabolic disease are under-recognized.
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Affiliation(s)
- Chandna Vasandani
- The Division of Nutrition and Metabolic Diseases and the Center for Human Nutrition, Department of Internal Medicine, UT Southwestern Medical Center , Dallas, Texas
| | - Xilong Li
- Department of Population and Data Sciences, UT Southwestern Medical Center , Dallas, Texas
| | - Hilal Sekizkardes
- National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, Maryland
| | - Rebecca J Brown
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland
| | - Abhimanyu Garg
- The Division of Nutrition and Metabolic Diseases and the Center for Human Nutrition, Department of Internal Medicine, UT Southwestern Medical Center , Dallas, Texas
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14
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Vinay V, Abdullah Y, Garg A, Verma P, Singh GK, Sharma A. The master impersonator: Pulmonary tuberculosis mimicking diffuse cystic lung disease - A mini case series of a rare presentation. J Family Med Prim Care 2022; 11:6590-6592. [PMID: 36618188 PMCID: PMC9810886 DOI: 10.4103/jfmpc.jfmpc_331_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/23/2022] [Accepted: 05/10/2022] [Indexed: 11/11/2022] Open
Abstract
Pulmonary tuberculosis has diverse clinical presentations. Cysts in the lung can arise due to large number of causes out of which tuberculosis is very rare. We report two immunocompetent cases of pulmonary tuberculosis who presented with multiple cysts in the lung parenchyma. The diagnosis was confirmed by the transbronchial lung cryobiopsy in first case and by analysis of bronchoalveolar lavage fluid in the second. Both had spontaneous pneumothorax which was treated with chest drain and pleurodesis. Both showed an excellent response to anti-tubercular therapy and steroids. Tuberculosis presenting as cystic lung disease is atypical and rare.
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Affiliation(s)
- V Vinay
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Yasir Abdullah
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Abhimanyu Garg
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Paras Verma
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Gaurav Kumar Singh
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Amit Sharma
- Department of TB and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India,Address for correspondence: Dr. Amit Sharma, Room No 208, 2nd Floor, National Institute of Tuberculosis and Respiratory Diseases (NITRD), Sri Aurobindo Marg (Near Qutab Minar), New Delhi - 110 030, India. E-mail:
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Abstract
PURPOSE OF REVIEW Genetic or acquired lipodystrophies are characterized by selective loss of body fat along with predisposition towards metabolic complications of insulin resistance, such as diabetes mellitus, hypertriglyceridemia, hepatic steatosis, polycystic ovarian syndrome, and acanthosis nigricans. In this review, we discuss the various subtypes and when to suspect and how to diagnose lipodystrophy. RECENT FINDINGS The four major subtypes are autosomal recessive, congenital generalized lipodystrophy (CGL); acquired generalized lipodystrophy (AGL), mostly an autoimmune disorder; autosomal dominant or recessive familial partial lipodystrophy (FPLD); and acquired partial lipodystrophy (APL), an autoimmune disorder. Diagnosis of lipodystrophy is mainly based upon physical examination findings of loss of body fat and can be supported by body composition analysis by skinfold measurements, dual-energy x-ray absorptiometry, and whole-body magnetic resonance imaging. Confirmatory genetic testing is helpful in the proband and at-risk family members with suspected genetic lipodystrophies. The treatment is directed towards the specific comorbidities and metabolic complications, and there is no treatment to reverse body fat loss. Metreleptin should be considered as the first-line therapy for metabolic complications in patients with generalized lipodystrophy and for prevention of comorbidities in children. Metformin and insulin therapy are the best options for treating hyperglycemia and fibrates and/or fish oil for hypertriglyceridemia. Lipodystrophy should be suspected in lean and muscular subjects presenting with diabetes mellitus, hypertriglyceridemia, non-alcoholic fatty liver disease, polycystic ovarian syndrome, or amenorrhea. Diabetologists should be aware of lipodystrophies and consider genetic varieties as an important subtype of monogenic diabetes.
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Affiliation(s)
- Nivedita Patni
- Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8537, USA.
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16
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Sarodaya V, Gohil B, White A, Garg A. 950 Successful Relaunching of NELA at an Inner-City District General Hospital: Need for Multidisciplinary Approach. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction
The national case ascertainment rate for National Emergency Laparotomy Audit (NELA) over 179 hospitals is 84.5%. Our hospital is one of the few hospitals despite being eligible, had not submitted any data to the NELA for the past three years.
Method
We retrospectively collected data for all the patients that underwent laparotomy for a period of 2 years. The mean age of patients was 58 years. We found 83 patients who fit NELA inclusion criteria from January 2020 to November 2021.
Results
The 83 patients were divided into low risk (<5%) and high risk (>5%) and further analysed. The overall mortality was higher than the national (24% v/s 9.3%). Areas of excellent performance against NELA standards (i.e., > 80% compliance) included Consultant's involvement in theatres, Surgeons in 96.9% cases and Anaesthetist in 88.9% cases compared to National average of 96.9% and 93.9% respectively. Areas with poor compliance were Geriatrics involvement pre-operatively (14.7%) when compared to national average (24.7%). Pre-op assessment was done in 48% cases approximately half of national average of 84%. Post operatively 81.4% of the high-risk patients were directly admitted to ITU which was the same as the national average of 85%.
Conclusion
There were various factors which resulted in a low compliance rate. NELA is a useful audit for the comparison of national care. It allows for reflective practice at local level with aim to deliver a uniform standard of care.
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Affiliation(s)
- V Sarodaya
- Barts Health NHS Trust , London , United Kingdom
| | - B Gohil
- Barts Health NHS Trust , London , United Kingdom
| | - A White
- Barts Health NHS Trust , London , United Kingdom
| | - A Garg
- Barts Health NHS Trust , London , United Kingdom
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17
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Gohil B, Sarodaya V, White A, Garg A. 574 The Successful Resurrection of NELA in a District General Hospital. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
The NELA requirements of data collection is known to be mandatory. Our DGH had three years of noncompliance. We present an executed plan in the collection of retrospective and prospective process to achieve national standard.
Method
A new structural setup with anaesthetic and surgical teams was formalised. A recruitment of 13 foundation doctors was made and each were induced to NELA with a teaching session. Allocation of 15–20 hospital numbers with a primary deadline of seven days to achieve full entry was expected. A formal NELA certificate and recognition for taking part from the divisional director was issued. A prospective strategy was initiated with patient ownership from the joint anaesthetic and surgical team involved. A NELA login with local access was setup, plus paper format readily available for rare access situations. A two-email reminder system with further escalation process was introduced if entry was incomplete. The escalation being contact from the clinical lead / divisional director. This information was highlighted at a local meeting plus a familiarity of the NELA database was ensured.
Results
A large proportion of the retrospective data has been collected over a short time period due to a clear incentivised scheme. Prospectively there has not been any escalation emails needed since the new setup.
Conclusion
Areas of problems were identified with a wide range of solutions being put forward. A multi collaborative approach was needed plus positive cooperation from the clinical lead, clinical director, and the divisional director to ensure the successful new era.
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Affiliation(s)
- B Gohil
- Newham University Hospital , London , United Kingdom
| | - V Sarodaya
- Newham University Hospital , London , United Kingdom
| | - A White
- Newham University Hospital , London , United Kingdom
| | - A Garg
- Newham University Hospital , London , United Kingdom
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18
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Costa S, Sampaio L, Berta Sousa A, Xing C, Agarwal AK, Garg A. Face-sparing Congenital Generalized Lipodystrophy Type 1 Associated With Nonclassical Congenital Adrenal Hyperplasia. J Clin Endocrinol Metab 2022; 107:2433-2438. [PMID: 35857714 PMCID: PMC9387702 DOI: 10.1210/clinem/dgac406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Congenital generalized lipodystrophy, type 1 (CGL1), due to biallelic pathogenic variants in AGPAT2, is characterized by the near total loss of body fat from the face, trunk, and extremities. Patients develop premature diabetes, hypertriglyceridemia, hepatic steatosis, and polycystic ovary syndrome. However, sparing of the facial fat and precocious pubertal development has not been previously reported in CGL1. CASE DESCRIPTION We report a 21-year-old woman of European descent with CGL1 who had sparing of the facial fat and premature thelarche at birth with premature pubarche and menstrual bleeding at age 3 years. Her serum 17-OH progesterone level rose to 1000 ng/dL (30.26 nmol/L) after cosyntropin stimulation test, suggestive of nonclassical congenital adrenal hyperplasia (NCAH) due to 21-hydroxylase deficiency. Hydrocortisone replacement therapy from age 3.5 to 10 years resulted in cessation of menstruation and growth of pubic hair, and a reduction of breast size. Sanger and whole-exome sequencing revealed compound heterozygous variants c.493-1G>C; p.(Leu165_Gln196del), and c.del366_588+534; p.(Leu123Cysfs*55) in AGPAT2 plus c.806G>C; p.(Ser269Thr) and c.844G>T; p.(Val282Leu) in CYP21A2. She developed diabetes at age 13 requiring high-dose insulin and had 7 episodes of acute pancreatitis due to extreme hypertriglyceridemia in the next 5 years. Metreleptin therapy was initiated at age 18 and after 3 years, she had remission of diabetes and hypertriglyceridemia; however, menstrual irregularity and severe hirsutism did not improve. CONCLUSION Concomitant NCAH in this CGL1 patient was associated with precocious pubertal development and sparing of facial fat. Metreleptin therapy drastically improved her hyperglycemia and hyperlipidemia but not menstrual irregularity and hirsutism.
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Affiliation(s)
- Sara Costa
- Paediatric Endocrine Unit, Department of Pediatrics, Hospital de Santa Maria/CHULN, 1649-035 Lisbon, Portugal
| | - Lurdes Sampaio
- Paediatric Endocrine Unit, Department of Pediatrics, Hospital de Santa Maria/CHULN, 1649-035 Lisbon, Portugal
| | - Ana Berta Sousa
- Genetics Service, Department of Pediatrics, Hospital de Santa Maria/CHULN, 1649-035 Lisbon, Portugal
| | - Chao Xing
- Eugene McDermott Center for Human Growth and Development, Department of Bioinformatics, and Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas 75390-8591, USA
| | - Anil K Agarwal
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas 75390-8537, USA
| | - Abhimanyu Garg
- Correspondence: Abhimanyu Garg, MD, Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8537, USA.
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19
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Pham JP, Glasenhardt K, Garg A, Frew JW. Interpretation of comorbidity risk in hidradenitis suppurativa: comparing odds ratio and 'number needed to be exposed'. J Eur Acad Dermatol Venereol 2022; 36:e1004-e1006. [PMID: 35793407 DOI: 10.1111/jdv.18403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J P Pham
- St Vincent's Hospital Sydney, Victoria, NSW, Australia.,University of New South Wales Sydney, Sydney, NSW, Australia
| | - K Glasenhardt
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - A Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York, USA
| | - J W Frew
- University of New South Wales Sydney, Sydney, NSW, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool, Sydney, Australia
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20
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Meseguer Estornell F, Rivera Egea R, Bori Arnal L, Valera Cerdá M, Giménez Rodríguez C, Garg A, Meseguer Escrivá M. P-028 Microfluidics as a methodology for sperm selection. A prospective functional study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is microfluidics an optimal technique to improve the sperm selection process in comparison with standard techniques like Density Gradient Centrifugation or Swim-up?
Summary answer
A significant increase in sperm quality was obtained when microfluidics was compared to density gradient centrifugation but improvement evidence regarding swim-up is not yet demonstrated.
What is known already
Assisted reproduction clinics for in vitro fertilization treatments have developed several techniques to perform sperm selection, being density gradient centrifugation (DGC) and swim-up the most widely used. However, sperm selection is a procedure that requires bulky and expensive equipment, long waiting times and gamete manipulation, which results in cellular stress. The SwimCount Harvester is a microfluidic-based device capable of performing sperm selection and overcoming the problems of other sorting systems. In our study, we analyzed several sperm quality parameters between these three sperm selection techniques.
Study design, size, duration
This was a prospective, cohort and observational study including 111 semen samples from patients and donors (mean age 33,7±9,3 years) between February 2021 and January 2022. The semen sample from each patient or donor was divided into two volumes, one part, the sperm selection was performed using the SwimCount Harvester and the other part using DGC or Swim-up. These sperm selection techniques were used to isolate sperm based on fluid dynamics and cell motility.
Participants/materials, setting, methods
Fresh ejaculate and sperm selected samples from each patient were analyzed according to the 2010 WHO-criteria to assess concentration, motility, morphology and vitality, using automatic image analysis. The excessive histone retention indicating defective chromatin compaction was assessed using aniline blue staining. Sperm chromatin fragmentation (SCF) was assessed by TUNEL on at least 20.000 sperm using flow cytometry. Kruskal-Wallis test was performed in order to assess statistical differences of the variables between the sperm selection methods.
Main results and the role of chance
The SwimCount Harvester was compared to DGC (n = 95). Ejaculated sperm yielded an average concentration of 53,2±34,2x106/mL. After DGC and SwimCount Harvester, the sperm concentration was 11,1±8,8 and 12,5±11,2x106/mL, respectively. The motility of fresh sperm sample improved from 41,9±10,4% to 71,6±10,6% after DGC and 76,8±10,0% after SwimCount Harvester (P < 0,05). The percentage of normal sperm increased from 2,1±1,2%, for the fresh samples, to 3,5±1,4% and 4,2±1,6% for the samples processed by DGC and microfluidics, respectively (P < 0,05). The percentage of live sperm increased from 74,0±8,1% and 77,5±8,7% in fresh sperm and after DGC, respectively to 85,9±9,0% after using microfluidics (P < 0,05). In the same way, the normal sperm chromatine structure percentage increased from 67,4±7,5% to 75,4±7,9% for the sperm samples selected by DGC and 77,7±8,9% when the SwimCount Harvester was used (P < 0,05). A decrease in SCF was observed from 12,9±8,4% in samples selected by DGC to 10,4±5,1% in raw samples (P > 0,05). However, after sperm selection using SwimCount Harvester, SCF fell to 4,6±4,1%, showing significant differences between both sperm selection methods (P < 0,05). Similar results were obtained for oligozoospermic samples (n = 6). When the SwimCount Harvester was compared with the Swim-up (n = 10), non-significant improvements were observed for all the parameters studied due to the reduced sample size.
Limitations, reasons for caution
The database of samples processed using swim-up and oligozoospermic samples is too small to draw reliable conclusions. Although significantly better results are obtained in sperm samples selected by the SwimCount Harvester with respect to DGC, a clinical study using the microfluidic device in assisted reproduction cycles has to be performed.
Wider implications of the findings
The SwimCount Harvester, in addition to significantly improving sperm selection and quality, is a reliable alternative to integrate numerous laboratory steps into a single automated procedure, reducing workload, the amount of culture media and equipment used, gamete handling and the stress that produces. Moreover, microfluidics may eliminate inter-laboratory variability.
Trial registration number
This project has received funding from the Eurostars-2 joint program with co-funding from CDTI and the European Union's Horizon 2020 Research and Innovation Framework Program E! 113740/ CIIP-20201009.
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Affiliation(s)
| | - R Rivera Egea
- IVIRMA Global, Andrology Laboratory , Valencia, Spain
| | - L Bori Arnal
- IVIRMA Global and IVI Foundation, Research Laboratory , Valencia, Spain
| | - M.Á Valera Cerdá
- IVIRMA Global and IVI Foundation, Research Laboratory , Valencia, Spain
| | | | - A Garg
- IVIRMA Global and IVI Foundation, Research Laboratory , Valencia, Spain
| | - M Meseguer Escrivá
- IVIRMA Global and IVI Foundation, Embriology and Research Laboratory , Valencia, Spain
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Viloria Samochin T, Valera M, Garg A, Bori L, Romany L, Aparicio-Ruiz B, Meseguer M. P-224 The sex of the human embryos affects the oxidation profile of the spent culture media. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Study question
Is the oxidative status of the spent culture media used in ICSI treatments related to embryo sex and newborn characteristics?
Summary answer
Female embryos produce higher levels of oxidative stress in the culture media than male embryos.
What is known already
Sex-associated differences in embryo development have previously been observed. Studies suggest that male embryos have a faster pre-implantation development, higher morphological grading and lower glucose consumption (Nasiri et al, 2018). The thermochemiluminiscence (TCL) assay quantifies the oxidative status of biological samples by catalyzing an oxidative reaction through heating and counting the photons emitted per second. TCL parameters are directly correlated to the content of oxidant agents in the sample. Previous analysis used TCL assay to relate higher oxidative metabolism in embryos with higher viability. Analysis of spent culture media with TCL could be a potential biomarker for embryo sex prediction.
Study design, size, duration
Prospective observational study over 86 transferred blastocysts (all single embryo transfer) that reached life-birth, belonging to ICSI treatments, including autologous and oocyte donation, performed in a single fertility clinic during three consecutive years. The oxidative status of the spent culture media was analyzed and compared with the characteristics of the newborns.
Participants/materials, setting, methods
Embryo cohorts were cultured in individual wells in an Embryoscope incubator, using single-step Gems culture media (Genea Biomedx). The best embryo of the cohort was selected for transfer using morphologic (ASEBIR) and morphokinetic criteria (KID Score algorithmTM, Vitrolife, (KS)). Spent culture media was analyzed in the Fertissimo TCL Analyzer (Carmel Diagnostics, Israel) and oxidation parameters were compared with the sex, weight and height of the newborns through ANOVA, C2 and Pearsons Correlation coefficient (PCC) tests.
Main results and the role of chance
The sex ratio of the embryos (male to female) resulted 59.3%. The sex ratio was increasingly higher the better morphological classification: C = 16.7%, B = 56.0%, A: 73.3%. KS did not give significantly different scores to the embryos depending on their sex: average KS (female)=6.78 vs average KS (male)=7.03, P = 0.621. No correlation was found between KS or the morphological classification and the weight and height of the babies: PCC (KS-height)=0.158, P = 0.349; PCC (KS-weight)=0.082, P = 0.569; average newborn height: C = 51.67±1.15cm, B = 50.57±3.48cm, A = 50.92±1.95cm, P = 0.791, average newborn weight: C = 3,386.00±459.11g, B = 3,283.35±658.12g, A = 3,229.07±732.13g, P = 0.877. TCL ratio (slope of the time curve of photon emission, representing the level of oxidant agents in the sample) was statistically significantly higher in the culture media of female embryos than of male embryos: Ratio (female)=119.54±13.37 vs Ratio (male)=111.62±15.80, P = 0.017. No statistically significant difference was found in the TCL Ratio between the three morphological classes, although the tendency of the data is towards lower levels with increasing morphological classification: Ratio (C)=120.40±14.43, ratio (B)=116.32±14.39 and ratio (A)=111.27±16.62, P = 0.237. No correlation was found between the TCL parameters and the weight and height of the newborn: PCC (Ratio-height)=-0.173, P = 0.198; PCC (Ratio-weight) 0.036, P = 0.753.
Limitations, reasons for caution
Patient demographics, habits and male sperm characteristics were not considered for the analysis, but might impact embryo characteristics and intrauterine development of the fetus. A larger scale study should be performed to validate results.
Wider implications of the findings
The differential oxidative load embryos exert over the culture medium might be related to a glucose consumption-associated sex dimorphism. Measuring the oxidative status of the culture medium could serve as a non-invasive biomarker for embryo sex selection. This technique could be an interesting option in carriers of sex-linked diseases.
Trial registration number
not applicable
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Affiliation(s)
| | - M.Á Valera
- IVI Foundation-IIS La Fe, Research and Innovation , Valencia, Spain
| | - A Garg
- IVI RMA Valencia, IVF Laboratory , Valencia, Spain
| | - L Bori
- IVI Foundation-IIS La Fe, Research and Innovation , Valencia, Spain
| | - L Romany
- IVI RMA Valencia, IVF Laboratory , Valencia, Spain
| | | | - M Meseguer
- IVI RMA Valencia, IVF Laboratory , Valencia, Spain
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22
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Yadav R, Parikh S, Panchal H, Patel A, Garg A, Shah K, Basu P, Patel V, Ganta S, Ravichandran S, Banerjee D. 34P Efficacy and toxicity analysis of imatinib in newly diagnosed patients of chronic myeloid leukaemia: 18-years’ experience at a single large-volume centre. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Affiliation(s)
- Nivedita Patni
- Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Western University, London, Ontario, Canada
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas, USA
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24
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Badkhane S, Singh S, Dixit R, Garg A. T2 Dark Lesions of the Musculoskeletal System: A Pictorial Essay. Hong Kong Journal of Radiology 2022. [DOI: 10.12809/hkjr2117258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- S Badkhane
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - S Singh
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - R Dixit
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - A Garg
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
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25
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Garg A, Garg S, Pandey P, Shukla AK, Janadri S, Kori ML, Lodhi S. Fabrication and Evaluation of Carboxy Methyl Cellulose Anchored Dextran Bioinspired Hydrogel for Effective Delivery of Piroxicam. Indian J Pharm Sci 2022. [DOI: 10.36468/pharmaceutical-sciences.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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26
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van Heerwaarde AA, Klomberg RCW, van Ravenswaaij-Arts CMA, Ploos van Amstel HK, Toekoen A, Jessurun F, Garg A, van der Kaay DCM. Approach to Diagnosing a Pediatric Patient With Severe Insulin Resistance in Low- or Middle-income Countries. J Clin Endocrinol Metab 2021; 106:3621-3633. [PMID: 34318892 PMCID: PMC8864731 DOI: 10.1210/clinem/dgab549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Indexed: 11/19/2022]
Abstract
Diabetes mellitus (DM) in children is most often caused by impaired insulin secretion (type 1 DM). In some children, the underlying mechanism for DM is increased insulin resistance, which can have different underlying causes. While the majority of these children require insulin dosages less than 2.0 U/kg/day to achieve normoglycemia, higher insulin requirements indicate severe insulin resistance. Considering the therapeutic challenges in patients with severe insulin resistance, early diagnosis of the underlying cause is essential in order to consider targeted therapies and to prevent diabetic complications. Although rare, several disorders can attribute to severe insulin resistance in pediatric patients. Most of these disorders are diagnosed through advanced diagnostic tests, which are not commonly available in low- or middle-income countries. Based on a case of DM with severe insulin resistance in a Surinamese adolescent who was later confirmed to have autosomal recessive congenital generalized lipodystrophy, type 1 (Berardinelli-Seip syndrome), we provide a systematic approach to the differential diagnosis and work-up. We show that a thorough review of medical history and physical examination generally provide sufficient information to diagnose a child with insulin-resistant DM correctly, and, therefore, our approach is especially applicable to low- or middle-income countries.
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Affiliation(s)
- Alise A van Heerwaarde
- Department of Pediatrics, Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Renz C W Klomberg
- Department of Pediatrics, Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Conny M A van Ravenswaaij-Arts
- Department of Pediatrics, Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Aartie Toekoen
- Department of Pediatrics, Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Fariza Jessurun
- Department of Pediatrics, Academic Pediatric Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Abhimanyu Garg
- Division of Nutrition, and Metabolic Diseases, Department of Internal Medicine, Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX, USA
- Dr. Abhimanyu Garg, UT Southwestern Medical Center, Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, Center for Human Nutrition, Dallas, TX 75390, USA.
| | - Daniëlle C M van der Kaay
- Department of Pediatric Endocrinology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, The Netherlands
- Correspondence: Dr. Daniëlle C. M. van der Kaay, Erasmus Medical Center – Sophia Children’s Hospital, Department of Pediatrics; PO 2060; 3000 CB Rotterdam, The Netherlands.
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Garg A, Rao-Melacini P, Quinn R, Ainsworth C, Belley-Cote E, Cairns J, Cantor W, Dzavik V, Gomez RM, Kedev S, Lavi S, Stankovic G, Jolly S. TOTAL risk score for predicting safe very early discharge in patients with ST-elevation myocardial infarction (STEMI). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Previously validated risk scores for identifying low-risk patients after ST-segment elevation myocardial infarction (STEMI) have led to acceptance of the safety and feasibility of discharge after 48–72 hours of hospitalization, reducing hospital length of stay and costs. With ongoing improvements in outcomes, it may be possible to select patients who are safe to discharge very early (24–48 hours) but this has never been evaluated.
Purpose
We sought to develop and validate a novel risk score for identifying low-risk patients suitable for very early discharge (≤48 hours of hospitalization) post-STEMI.
Methods
We derived a novel risk score using data from patients enrolled in the Trial of Routine Aspiration Thrombectomy with PCI versus PCI alone in Patients with STEMI (TOTAL). The TOTAL database was randomly divided into a derivation cohort with 2/3 of the composite events and non-events and remaining 1/3 as the internal validation cohort. Using the derivation cohort, we identified risk factors for cardiovascular death (CV) or non-fatal cardiac arrest by performing a univariate and multivariable stepwise regression analysis of baseline clinical and angiographic characteristics. Each co-variate was assigned an integer score based on regression coefficients and the novel TOTAL risk score was developed by adding points from each risk factor profile. We externally validated the TOTAL score using data from the Radial versus Femoral Access for Coronary Intervention (RIVAL) trial.
Results
The TOTAL derivation cohort included 6331 participants with 287 events (CV death/cardiac arrest). Twelve independent risk-factors associated with risk of CV death and non-fatal cardiac arrest at 1 year were selected and weighted for the TOTAL risk score (Table 1). In the TOTAL validation cohort (n=3166), patients with a TOTAL score of 0–4 points (n=779 (24.6%)) were categorized as very low risk with only a 0.1% risk of CV death/cardiac arrest observed within 24 hours of hospitalization, and no further events observed between 24 hours and 30 days post-STEMI. In the RIVAL validation dataset (n=1451), patients with a TOTAL score of 0–4 points (n=737 (50.7%)) had a 0.3% risk of CV death/cardiac arrest within 24 hours, with no further events observed between 24 hours and 72 hours of hospitalization.
Conclusion
The TOTAL risk score identified a very low risk subset of patients for whom early discharge, 24–48 hours post-STEMI, is likely safe. These findings have the potential to change practice and support early discharge after STEMI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Garg
- McMaster University, Hamilton, Canada
| | | | - R Quinn
- McMaster University, Hamilton, Canada
| | | | - E Belley-Cote
- Population Health Research Institute, Hamilton, Canada
| | - J Cairns
- University of British Columbia, Vancouver, Canada
| | - W Cantor
- Southlake Regional Health Centre, Newmarket, Canada
| | - V Dzavik
- Peter Munk Cardiac Centre, Toronto, Canada
| | | | - S Kedev
- University of St Cyril and Methodius, Skopje, North Macedonia
| | - S Lavi
- Western University, London, Canada
| | - G Stankovic
- University Clinical Center of Serbia, Belgrade, Serbia
| | - S Jolly
- Population Health Research Institute, Hamilton, Canada
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Garg A, Bari L, Valera MA, Fernandez EI, Rocha JC, Quiñonero A, Domínguez F, Meseguer M. O-121 Exploring non-invasive methods to predict Ploidy Status: Combination of blastocyst morphology image analysis and proteomic profiles by using Artificial Neural Networks. Hum Reprod 2021. [DOI: 10.1093/humrep/deab126.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is the blastocyst morphology image analysis combined with the protein content of spent embryo culture medium a suitable way to predict embryo ploidy?
Summary answer
Morphological variables from blastocyst image analysis combined with IL-6 or MMP-1 concentration in spent culture medium showed more than 80% of accuracy for euploidy prediction.
What is known already
An artificial intelligence model based on the proteomic profile of euploid embryos and morphological data from blastocyst time-lapse images has been recently published (Bori et al., 2020). The most promising artificial neural network (ANN) algorithm considered 20 morphological variables extracted from image analysis and two proteins detected in embryo culture medium (MMP-1 and IL-6). The overall success rate on blind test data was 72.7% for live birth prediction. The main aim of the present study was to check if the same morphological variables combined with MMP-1 or IL-6 with a cost-effective technique could discriminate between euploid and aneuploid embryos.
Study design, size, duration
This prospective study included 120 embryos from the preimplantation genetic testing for aneuploidies (PGT-A) program. A single blastocyst image was obtained for each embryo and their spent culture medium was collected on the day 5/6 of embryo development (day of trophectoderm biopsy). Morphological variables were extracted for all the blastocyst. On the other hand, we quantified IL-6 levels of 67 embryos and MMP-1 levels of 53 embryos. Resulting parameters were used to predict PGT-A results.
Participants/materials, setting, methods
Blastocyst images were imported into Matlab software and segmented into regions of interest. We obtained 20 mathematical variables related to measurements of areas, number of pixels and texture analysis. Chromosome analysis was performed using next-generation sequence technology. In parallel, 20 µL of spent culture medium from each blastocyst was analyzed with ELISA kits (IL-6 or MMP-1). Protein concentrations and morphological variables were used as input data for an ANN associated with genetic algorithms.
Main results and the role of chance
The euploid rate for the set of embryos included in the IL-6 group was 51.4%. The ANN was trained with 49 embryos and blind tested with 18 embryos. Following results correspond to euploidy prediction on the blind test. The sensitivity, specificity, accuracy and area under the ROC curve (AUC) were: 0.56, 0.78, 0.67 and 0.72 considering only IL-6 values; 0.88, 0.78, 0.83 and 0.61 considering IL-6 values and blastocyst morphological data extracted from the image analysis. The euploid rate for the set of embryos included in the MMP-1 group was 51.9%. The ANN was trained with 39 embryos and blind tested with 14 embryos. Following results correspond to euploidy prediction on the blind test. The sensitivity, specificity, accuracy and AUC were: 0.71, 0.57, 0.64 and 0.67 considering only MMP-1 values; 0.86, 0.86, 0.86 and 0.61 considering MMP-1 values and morphological data extracted from the image analysis.
Limitations, reasons for caution
The detection limit in protein quantification is the main limitation of our study. The small number of embryos and the specific culture medium used should be considered for the model application.
Wider implications of the findings
Our preliminary results showed that blastocyst morphology and embryo secretomics could be useful for euploidy prediction by using artificial intelligence techniques. These findings may contribute to the emerging era of non-invasive preimplantation genetic testing (ni-PGT-A).
Trial registration number
not applicable
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Affiliation(s)
- A Garg
- IVIRMA, Research laboratory, Valencia, Spain
| | - L Bari
- IVIRMA, Research laboratory, Valencia, Spain
| | - M A Valera
- IVIRMA, Research laboratory, Valencia, Spain
| | - E I Fernandez
- Universidade Estadual Paulista UNESP, Faculdade de Ciências e Letras - Câmpus de Assis, São Paulo, Brazil
| | - J C Rocha
- Universidade Estadual Paulista UNESP, Faculdade de Ciências e Letras - Câmpus de Assis, São Paulo, Brazil
| | - A Quiñonero
- IVIRMA Foundation, Innovation, Valencia, Spain
| | - F Domínguez
- IVIRMA Foundation, Innovation, Valencia, Spain
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Coates LC, Soriano E, Corp N, Bertheussen H, Callis-Duffin K, Barbosa Campanholo C, Chau J, Eder L, Fernandez D, Fitzgerald O, Garg A, Gladman DD, Goel N, Grieb S, Helliwell P, Husni ME, Jadon D, Katz A, Laheru D, Latella J, Leung YY, Lindsay C, Lubrano E, Mazzuoccolo L, Mcdonald R, Mease PJ, O’sullivan D, Ogdie A, Olsder W, Schick L, Steinkoenig I, De Wit M, Van der Windt D, Kavanaugh A. OP0229 THE GROUP FOR RESEARCH AND ASSESSMENT OF PSORIASIS AND PSORIATIC ARTHRITIS (GRAPPA) TREATMENT RECOMMENDATIONS 2021. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4091] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Since the 2015 GRAPPA treatment recommendations were published, therapeutic options and management strategies for psoriatic arthritis (PsA) have advanced considerably.Objectives:The goal of the GRAPPA recommendations update is to develop high quality, evidence-based recommendations for the treatment of PsA, including related conditions and comorbidities.Methods:GRAPPA rheumatologists, dermatologists and patient research partners (PRPs) updated overarching principles for the management of adults with PsA by consensus. Principles considering use of biosimilars and tapering/discontinuing of therapy were added to this update. Systematic literature searches based on data publicly available from three databases (MEDLINE, EMBASE, and Cochrane CENTRAL) were conducted from the end of the previous recommendations’ searches through August 2020. Additional abstract searches were performed for conference presentations in 2017-2020. Searches covered PsA treatments (peripheral arthritis, axial arthritis, enthesitis, dactylitis, skin, and nail disease). Additional searches were performed for related conditions (uveitis and IBD) and comorbidities evaluating their impact on safety and treatment outcomes. Individual groups assessed the risk of bias and applied the GRADE system to generate strong or conditional recommendations for therapies within the domain groups and for the management of comorbidities and related conditions. These recommendations were then incorporated into an overall treatment schema.Results:Updated, evidence-based treatment recommendations are shown (Table 1). Since 2015, many new medications have been incorporated. Additional results for older medications, such as methotrexate, have been published across PsA domains. Based on the evidence, the treatment recommendations developed by individual groups were incorporated into the overall schema including principles for management of arthritis, spondylitis, enthesitis, dactylitis, skin, and nail disease in PsA, and associated conditions (Figure 1). Choice of therapy for an individual should ideally address all of the domains that impact on that patient, supporting shared decision making with the patient involved. Additional consideration in the recommendations was given to key associated conditions and comorbidities as these often impact on therapy choice.Conclusion:These GRAPPA treatment recommendations provide up to date, evidence-based guidance to providers who manage and treat adult patients with PsA. These recommendations are based on domain-based strategy for PsA and supplemented by overarching principles developed by consensus of GRAPPA members.IndicationStrongForConditional ForConditionalAgainstStrongAgainstInsufficient evidencePeripheral Arthritis DMARD NaïvecsDMARDs, TNFi, PDE4i, IL-12/23i, IL-17i, IL-23i, JAKiNSAIDs, oral CS, IA CS,IL-6i,Peripheral Arthritis DMARD IRTNFi, IL-12/23i, IL-17i, IL-23i, JAKiPDE4i, other csDMARD, NSAIDs, oral CS, IA CS,IL-6i,Peripheral ArthritisbDMARD IRTNFi, IL-17i, IL-23i, JAKi,NSAIDs, oral CS, IA CS, IL-12/23i, PDE4i, CTLA-4-IgIL-6i,Axial arthritis, Biologic NaïveNSAIDs, Physiotherapy, simple analgesia, TNFi, IL-17i, JAKiCS SIJ injections, bisphosphonatescsDMARDs, IL-6i,IL-12/23i, IL-23iAxial PsA, Biologic IRNSAIDs, Physiotherapy, simple analgesia, TNFi, IL-17i, JAKi csDMARDs, IL-6i,IL-12/23i, IL-23iEnthesitisTNFi, IL-12/23i, IL-17i, PDE4i, IL-23i, JAKiNSAIDs, physiotherapy, CS injections, MTXIL-6i,Other csDMARDsDactylitisTNFi IL-12/23i, IL-17i, IL-23i, JAKi, PDE4iNSAIDs, CS injections, MTXOther csDMARDsPsoriasisTopicals, phototherapy, csDMARDs, TNFi, IL-12/23i, IL-17i, IL-23i, PDE4i, JAKi AcitretinNail psoriasisTNFi, IL12/23i, IL17i, IL23i, PDE4iTopical CS, tacrolimus and calcipotriol combination or individual therapies, Pulsed dye laser, csDMARDs, acitretin, JAKiTopical Cyclosporine / Tazarotene, Fumarate, Fumaric Acid Esters, UVA and UVB Phototherapy, AlitretinoinIBDTNFi (not ETN), IL-12/23i, JAKiIL-17iUveitisTNFi (not ETN)Disclosure of Interests:Laura C Coates Speakers bureau: AbbVie, Amgen, Biogen, Celgene, Gilead, Eli Lilly, Janssen, Medac, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Pfizer, and Novartis, Enrique Soriano Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb,GSK, Genzyme, Janssen, Lilly, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb,GSK, Genzyme, Janssen, Lilly, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Grant/research support from: AbbVie, Janssen, Novartis Pharma, Pfizer, Roche, and UCB, Nadia Corp: None declared, Heidi Bertheussen Consultant of: Pfizer, Kristina Callis-Duffin Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Lilly, Janssen, Novartis, Pfizer, Sienna Biopharmaceuticals, Stiefel Laboratories, UCB, Ortho Dermatologics, Inc, Regeneron Pharmaceuticals, Inc., Anaptys Bio, Boehringer Ingelheim., Cristiano Barbosa Campanholo Speakers bureau: AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, and UCB, Jeffrey Chau: None declared, Lihi Eder Consultant of: Abbvie, UCB, Janssen, Eli Lily, Pfizer, Novartis, Grant/research support from: Abbvie, UCB, Janssen, Eli Lily, Pfizer, Novartis, Daniel Fernandez Consultant of: Abbvie, UCB, Roche, Janssen, Pfizer, Amgen and Brystol, Grant/research support from: Abbvie, UCB, Roche, Janssen, Pfizer, Amgen and Brystol, Oliver FitzGerald Speakers bureau: AbbVie, Janssen and Pfizer Inc, Consultant of: BMS, Celgene, Eli Lilly, Janssen and Pfizer Inc, Grant/research support from: AbbVie, BMS, Eli Lilly, Novartis and Pfizer Inc, Amit Garg Consultant of: Abbvie, Amgen, Asana Biosciences, Bristol Myers Squibb, Boehringer Ingelheim, Incyte, InflaRx, Janssen, Pfizer, UCB, Viela Biosciences, Grant/research support from: Abbvie, Dafna D Gladman Consultant of: Abbvie, Amgen, BMS, Eli Lilly, Galapagos, Gilead, Jansen, Novartis, Pfizer and UCB, Grant/research support from: Abbvie, Amgen, Eli Lilly, Jansen, Novartis, Pfizer and UCB, Niti Goel: None declared, Suzanne Grieb: None declared, Philip Helliwell Speakers bureau: Janssen, Novartis, Pfizer, Consultant of: Eli Lilly, M Elaine Husni Consultant of: Abbvie, Amgen, Janssen, Novartis, Lilly, UCB, Regeneron, and Pfizer, Deepak Jadon Speakers bureau: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Healthcare Celltrion, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Healthcare Celltrion, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Grant/research support from: AbbVie, Amgen, Celgene, Eli Lilly, Gilead, Healthcare Celltrion, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB, Arnon Katz: None declared, Dhruvkumar Laheru: None declared, John Latella: None declared, Ying Ying Leung Speakers bureau: Novartis, AbbVie, Eli Lilly, Janssen, Consultant of: Pfizer and Boehringer Ingelheim, Grant/research support from: Pfizer and conference support from AbbVie, Christine Lindsay Shareholder of: Amgen, Employee of: Aurinia pharmaceuticals, Ennio Lubrano Speakers bureau: Alfa-Sigma, Abbvie, Galapagos, Janssen Cilag, Lilly., Consultant of: Alfa-Sigma, Abbvie, Galapagos, Janssen Cilag, Lilly., Luis Mazzuoccolo Speakers bureau: Abbvie, Amgen, Novartis, Elli Lilly, Jansen, Consultant of: Abbvie, Amgen, Novartis, Elli Lilly, Jansen, Roland McDonald: None declared, Philip J Mease Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Galapagos, Gilead Sciences, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN and UCB, Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead Sciences, Janssen, Novartis, Pfizer, SUN and UCB, Denis O’Sullivan: None declared, Alexis Ogdie Consultant of: AbbVie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, and Pfizer, Grant/research support from: Novartis and Pfizer and Amgen, Wendy Olsder: None declared, Lori Schick: None declared, Ingrid Steinkoenig: None declared, Maarten de Wit Consultant of: AbbVie, BMS, Celgene, Janssen, Lilly, Novartis, Pfizer, Roche, Danielle van der Windt: None declared, Arthur Kavanaugh Speakers bureau: AbbVie, Amgen, BMS, Eli Lilly, Gilead Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Gilead Janssen, Novartis, Pfizer, UCB
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González-Hódar L, McDonald JG, Vale G, Thompson BM, Figueroa AM, Tapia PJ, Robledo F, Agarwal AK, Garg A, Horton JD, Cortés V. Decreased caveolae in AGPAT2 lacking adipocytes is independent of changes in cholesterol or sphingolipid levels: A whole cell and plasma membrane lipidomic analysis of adipogenesis. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166167. [PMID: 33989739 DOI: 10.1016/j.bbadis.2021.166167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/19/2021] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Adipocytes from lipodystrophic Agpat2-/- mice have impaired adipogenesis and fewer caveolae. Herein, we examined whether these defects are associated with changes in lipid composition or abnormal levels of caveolae-associated proteins. Lipidome changes were quantified in differentiated Agpat2-/- adipocytes to identify lipids with potential adipogenic roles. METHODS Agpat2-/- and wild type brown preadipocytes were differentiated in vitro. Plasma membrane was purified by ultracentrifugation. Number of caveolae and caveolae-associated proteins, as well as sterol, sphingolipid, and phospholipid lipidome were determined across differentiation. RESULTS Differentiated Agpat2-/- adipocytes had decreased caveolae number but conserved insulin signaling. Caveolin-1 and cavin-1 levels were equivalent between Agpat2-/- and wild type adipocytes. No differences in PM cholesterol and sphingolipids abundance were detected between genotypes. Levels of phosphatidylserine at day 10 of differentiation were increased in Agpat2-/- adipocytes. Wild type adipocytes had increased whole cell triglyceride, diacylglycerol, phosphatidylglycerol, phosphatidic acid, lysophosphatidylcholine, lysophosphatidylethanolamine, and trihexosyl ceramide, and decreased 24,25-dihydrolanosterol and sitosterol, as a result of adipogenic differentiation. By contrast, adipogenesis did not modify whole cell neutral lipids but increased lysophosphatidylcholine, sphingomyelin, and trihexosyl ceramide levels in Agpat2-/- adipocytes. Unexpectedly, adipogenesis decreased PM levels of main phospholipids in both genotypes. CONCLUSION In Agpat2-/- adipocytes, decreased caveolae is not associated with changes in PM cholesterol nor sphingolipid levels; however, increased PM phosphatidylserine content may be implicated. Abnormal lipid composition is associated with the adipogenic abnormalities of Agpat2 -/- adipocytes but does not prevent insulin signaling.
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Affiliation(s)
- Lila González-Hódar
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, 8331150, Chile
| | - Jeffrey G McDonald
- Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States; Department of Molecular Genetics, University of Texas Southwestern Medical Center, Dallas, TX 75390-9046, United States
| | - Goncalo Vale
- Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Bonne M Thompson
- Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Ana-María Figueroa
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, 8331150, Chile
| | - Pablo J Tapia
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, 8331150, Chile
| | - Fermín Robledo
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, 8331150, Chile
| | - Anil K Agarwal
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, TX 75390, United States
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Center for Human Nutrition, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, TX 75390, United States
| | - Jay D Horton
- Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States; Department of Molecular Genetics, University of Texas Southwestern Medical Center, Dallas, TX 75390-9046, United States; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9046, United States.
| | - Víctor Cortés
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, 8331150, Chile.
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Abstract
Statins are recommended for first-line management of elevated cholesterol in the primary and secondary prevention of atherosclerotic cardiovascular disease. Statins may occasionally be associated with mild transaminase elevations but can also result in life-threatening liver injury. Atorvastatin is the most common cause of clinically significant liver injury in this drug class. We report a case of severe, asymptomatic liver injury in a hepatocellular pattern in a 71-year-old man occurring within 3 months of switching from simvastatin to high-intensity atorvastatin therapy. Hepatitis improved rapidly with cessation of atorvastatin and did not recur after resuming simvastatin.
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Affiliation(s)
- Amit Saha
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abhimanyu Garg
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Dallas Veterans Affairs Medical Center, Dallas, TX, USA
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Wadhwa A, Vasandani C, Garg A. Novel Heterozygous LMNA Variants Causing Familial Partial Lipodystrophy, Dunnigan Variety. J Endocr Soc 2021. [PMCID: PMC8089313 DOI: 10.1210/jendso/bvab048.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Familial partial lipodystrophy (FPLD) is a rare, mostly autosomal dominant disorder characterized by selective loss of subcutaneous fat from the extremities. Patients with FPLD are predisposed to insulin resistance, dyslipidemia, diabetes mellitus, cardiac abnormalities (coronary heart disease [CHD], cardiomyopathy and conduction system disorders) and hepatic steatosis. FPLD2 (the Dunnigan variety) is the most common subtype which is caused by heterozygous variants in the lamin A/C (LMNA) gene. Over 50 LMNA causal variants have been reported in patients with FPLD2, with p.R482W and p.R482Q comprising ~75% of the families. We report 5 novel LMNA variants (c.722T>C, p.L241P; c.848A>G, p.N283S; c.1396A>G, p.N466D; c.1543A>G, p.K515E; c.1744C>A, p.R582S) in 5 families, where a female proband presented to us with moderately-severe FPLD, from among a total cohort of 264 FPLD2 families, with 259 families harboring other known pathogenic LMNA variants. The p.L241P variant was found in a 62-year-old female with a body mass index (BMI) of 28 kg/m2. She had hypertriglyceridemia. She is adopted and has two offsprings, who have not yet been examined and genotyped. The p.N283S variant was found in two males and two females from the same family (Age 40–74 y; BMI 18–45 kg/m2). Of these, only the 74-year-old female proband had clinical lipodystrophy, diabetes and hypertriglyceridemia. The other three subjects did not have lipodystrophy. Thus, this variant did not segregate with the phenotype of lipodystrophy in this family likely due to low penetrance or reduced clinical expressivity. The p.N466D variant was found in a 53-year-old female (BMI 26 kg/m2) who had diabetes and hypertriglyceridemia. The p.K515E variant was found in 4 females and 1 male who belonged to the same family (Age 29–62 y; BMI 19–26 kg/m2). All of them had lipodystrophy and hypertriglyceridemia and three of them had diabetes. The p.R582S variant was found in 3 males and one female who belonged to the same family (Age 19–76 y; BMI 16–30 kg/m2). All of them had lipodystrophy but only two of them had diabetes and hypertriglyceridemia. Eight of them had hypertension, three had CHD, one of them had acute pancreatitis and another one had a stroke. None of these patients had cardiomyopathy, cardiac conduction system defects or myopathy. In conclusion, we report genotype-phenotype relationship of 5 novel LMNA variants in patients presenting with FPLD2, with variable prevalence of diabetes, hypertriglyceridemia hypertension and CAD. None of these variants are associated with cardiomyopathy or myopathy or progeroid features. Our report adds to the allelic and clinical heterogeneity associated with LMNA variants.
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Affiliation(s)
| | | | - Abhimanyu Garg
- University Texas Southwest Medical Center, Dallas, TX, USA
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Patni N, Garg A, Xing C. Diet-Responsive Hypercholesterolemia With Cardiofaciocutaneous Syndrome Type 3. J Endocr Soc 2021. [PMCID: PMC8266036 DOI: 10.1210/jendso/bvab048.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Molecular basis of diet responsive hypercholesterolemia remains unclear. We report diet-responsive severe hypercholesterolemia in a young female with cardiofaciocutaneous syndrome type 3 (CFC3) due to a heterozygous pathogenic MAP2K1 variant, suggesting a role of common MAPK variants in LDL-cholesterol (LDL-C) response to diet. Clinical case: A 3-year-old Caucasian female with CFC3 (macrocephaly, frontal bossing, wide nasal root with depressed bridge, anteverted nares, low set fleshy ears, congenital pulmonic valve stenosis, postnatal growth deficiency, hypotonia, and neurocognitive impairment) due to a de novo heterozygous c.389A>G, p.Tyr130Cys pathogenic variant in MAP2K1, presented with extremely elevated serum total cholesterol of 446 mg/dL, triglycerides of 239 mg/dL, HDL-cholesterol of 53 mg/dL, LDL-C of 335 mg/dL (normal range < 110 mg/dL) and serum apolipoprotein B level 219 mg/dL (normal range < 90 mg/dL). Her LDL-C was 252 mg/dL a year ago and 215 mg/dL one month prior to presentation. Reducing total dietary fat to 20–25% of total energy and saturated fat to <6% of total energy over the next 4 months lowered LDL-C to 104 mg/dL. However, her weight decreased by 0.5 kg and liberalization of fat intake again increased LDL-C to 222 mg/dL. Her father has mildly elevated LDL-C of 160 mg/dL and her mother had normal LDL-C of 80 mg/dL. Her plasma phytosterol levels were normal and she had ApoE3/E3 genotype. Targeted genetic testing of the patient and parents showed a benign heterozygous LDL receptor (LDLR) variant c.2242G>A; p.Asp748Asn, (Minor allele frequency 0.00008) in the patient and her father. Whole exome sequencing of the patient and both parents showed no known disease-causing variants in LDLR, APOB, PCSK9, LDLRAP1, APOE, STAP1, LIPA, ABCG5, ABCG8 and other known hyperlipidemia-related genes. There are no previous reports of hypercholesterolemia in patients with CFC3. MAP2K1 stimulates various MAP kinases upon wide variety of extra- and intracellular signal and is involved in cell proliferation, differentiation, transcription regulation and development. Previous studies of the relationship between p42/44MAPK activation and LDLR expression in human hepatoma HepG2-derived cell line showed that that activation of the Raf-1/MEK/p42/44MAPK cascade induces LDLR expression and modulation of the Raf-1 kinase signal strength can determine LDLR expression levels. Thus, extent of MAPK activation can alter signaling of LDLR, resulting in hypercholesterolemia. Conclusion: Our case report suggests that MAP2K1 may play a significant role in LDLR signaling, and some MAP2K1 variants may be associated with diet-responsive hypercholesterolemia. Larger studies are required to assess dietary response to LDL-C in subjects with MAP2K1 variants.
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Affiliation(s)
| | | | - Chao Xing
- UT Southwestern Medical Center, Dallas, TX, USA
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Salame N, Urbanski M, Siira M, Garg A, Kavalieratos D, Patzer R, Chen S, Orenstein L. 357 Qualitative study of pain experiences among patients with hidradenitis suppurativa. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wright S, Strunk A, Garg A. Trends in body mass index before and after diagnosis of hidradenitis suppurativa. Br J Dermatol 2021; 185:74-79. [DOI: 10.1111/bjd.19713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 12/19/2022]
Affiliation(s)
- S. Wright
- Department of DermatologyDonald and Barbara Zucker School of Medicine at Hofstra/Northwell New Hyde Park NY USA
| | - A. Strunk
- Department of DermatologyDonald and Barbara Zucker School of Medicine at Hofstra/Northwell New Hyde Park NY USA
| | - A. Garg
- Department of DermatologyDonald and Barbara Zucker School of Medicine at Hofstra/Northwell New Hyde Park NY USA
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Machado MO, Lu JD, Brar R, Kirby JS, Garg A, Lowes ML, Piguet V, Alavi A. Hidradenitis suppurativa odour and drainage scale: a novel method for evaluating odour and drainage in patients with hidradenitis suppurativa. Br J Dermatol 2021; 184:772-774. [PMID: 33205398 DOI: 10.1111/bjd.19686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/15/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- M O Machado
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J D Lu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - R Brar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - A Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, NY, USA
| | - M L Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - V Piguet
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - A Alavi
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Kumar A, Singh MB, Garg A, Vishnu VY. Systemic lupus erythematosus presenting with holocord myelitis. J Postgrad Med 2021; 67:33-35. [PMID: 33380595 PMCID: PMC8098870 DOI: 10.4103/jpgm.jpgm_716_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 07/28/2020] [Accepted: 09/05/2020] [Indexed: 11/09/2022] Open
Abstract
This is a report of a case of a 25-year-old woman, who presented with a rapidly progressive sensory-motor flaccid quadriparesis which had developed over a few days along with bladder and bowel involvement. She had a past history of photosensitive rash and joint pains along with mild-to-moderate grade fever; for which she had never been evaluated. Serological markers for systemic lupus erythematosus (SLE) were strongly positive and helped in establishing the diagnosis of SLE-related holocord myelitis. High-dose intravenous glucocorticoid followed by intravenous pulse cyclophosphamide was used to treat her and there was a significant improvement. In this case report, the diagnosis of SLE was made for the first time in a patient presenting with holocord myelitis.
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Affiliation(s)
- A Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - MB Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - A Garg
- Department of Neuro-radiology, All India Institute of Medical Sciences, New Delhi, India
| | - VY Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Garg A, Mishra SK, Dubey S, Singh VP, Kuchay MS, Mithal A. Low-dose ACTH test for evaluation of hypothalamus-pituitary-adrenal axis preoperatively and 3-month follow-up in non-functioning pituitary adenomas. J Endocrinol Invest 2020; 43:1769-1777. [PMID: 32436184 DOI: 10.1007/s40618-020-01292-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peri-operative glucocorticoids are routinely administered to patients undergoing trans-sphenoidal surgery for non-functional pituitary adenomas (NFPA) irrespective of hypothalamus-pituitary-adrenal (HPA) axis status. PURPOSE Evaluation of HPA axis before and 12 weeks after endoscopic trans-sphenoidal adenomectomy (E-TSA) utilizing low-dose (1 μg) ACTH stimulation test (LDACTH) to determine the need for glucocorticoid administration in patients with NFPA. We also determined the factors that can predict occurrence of hypocortisolism at 12 weeks after surgery. METHODS Sixty-three consecutive patients with NFPA requiring surgical excision were enrolled in this study. Glucocorticoids were administered to patients with demonstrable hypocortisolism [preoperative peak cortisol < 16 μg/dL during LDACTH test, postoperative day 3 (POD-3) 0800 hrs Cortisol < 8 μg/dL or stimulated cortisol (LDACTH) < 16 μg/dL at 12 weeks]. RESULTS Hypocortisolism was present in 43 patients (68.2%) pre-operatively and persisted in 33 patients (52.4%) on POD-3. Thirty-three patients (52.4%) had hypocortisolism at 12 weeks after surgery. Eleven patients (17.4%) did not require glucocorticoids during the entire study period and 30 patients (47.6%) did not require glucocorticoids after 3 months. None of the patients developed adrenal crisis during the study. Hypocortisolism on the third post-operative day was the single significant predictor of hypocortisolism at 12 weeks after the surgery. There was a significant correlation between POD-3 0800 hrs cortisol ≥ 8μg/dL and stimulated cortisol (LDACTH) ≥16μg/dL at 12 weeks (r = 0.62, p < 0.0001). POD-3 0800 hrs cortisol ≥ 8 μg/dL had 73% sensitivity and 79% specificity in predicting eucortisolism at 12 weeks. CONCLUSIONS HPA function is preserved in significant proportion of NFPA patients undergoing E-TSA. Perioperative glucocorticoids should be given only in patients with demonstrable preoperative hypocortisolism on 1 μg ACTH test. Postoperative day 3 0800 hrs cortisol is a reasonable predictor of HPA axis status at 12 weeks after surgery.
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Affiliation(s)
- A Garg
- Division of Endocrinology and Diabetes, Medanta-The Medicity, Gurugram, Haryana, India
| | - S K Mishra
- Division of Endocrinology and Diabetes, Medanta-The Medicity, Gurugram, Haryana, India.
| | - S Dubey
- Division of Neurosciences, Medanta-The Medicity, Gurugram, Haryana, India
| | - V P Singh
- Division of Neurosciences, Medanta-The Medicity, Gurugram, Haryana, India
| | - M S Kuchay
- Division of Endocrinology and Diabetes, Medanta-The Medicity, Gurugram, Haryana, India
| | - A Mithal
- Division of Endocrinology and Diabetes, Medanta-The Medicity, Gurugram, Haryana, India
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Seth N, Kumar J, Garg A, Singh I, Meher R. Computed tomographic analysis of the prevalence of International Frontal Sinus Anatomy Classification cells and their association with frontal sinusitis. J Laryngol Otol 2020; 134:1-8. [PMID: 33054871 DOI: 10.1017/s0022215120002066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To determine the radiological prevalence of frontal cells according to the International Frontal Sinus Anatomy Classification in patients undergoing computed tomography of the paranasal sinuses for clinical symptoms of chronic rhinosinusitis, and to examine the association between cell classification and frontal sinusitis development. METHODS A total of 180 (left and right) sides of 90 patients were analysed. The prevalence of each International Frontal Sinus Anatomy Classification cell was assessed. Logistic regression analysis was used to compare the distribution of various cells in patients with and without frontal sinusitis. RESULTS The agger nasi cell was the most commonly occurring cell, seen in 95.5 per cent of patients. The prevalence rates for supra agger cells, supra agger frontal cells, supra bullar frontal cells, supra bullar cells, supra-orbital ethmoid cells and frontal septal cells were 33.3 per cent, 22.2 per cent, 21.1 per cent, 36.1 per cent, 39.4 per cent and 21.1 per cent, respectively. There was no significant difference in the occurrence of any of the cell types in patients with frontal sinusitis compared to those without (p > 0.05). CONCLUSION The presence of any of the International Frontal Sinus Anatomy Classification cells was not significantly associated with frontal sinusitis.
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Affiliation(s)
- N Seth
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research ('GIPMER') and Guru Nanak Eye Centre ('GNEC') Hospitals, New Delhi, India
| | - J Kumar
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research ('GIPMER') and Guru Nanak Eye Centre ('GNEC') Hospitals, New Delhi, India
| | - A Garg
- Department of Radiodiagnosis, Maulana Azad Medical College and Associated Lok Nayak Hospital, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research ('GIPMER') and Guru Nanak Eye Centre ('GNEC') Hospitals, New Delhi, India
| | - I Singh
- Department of Otorhinolaryngology, Maulana Azad Medical College and Associated Lok Nayak Hospital, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research ('GIPMER') and Guru Nanak Eye Centre ('GNEC') Hospitals, New Delhi, India
| | - R Meher
- Department of Otorhinolaryngology, Maulana Azad Medical College and Associated Lok Nayak Hospital, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research ('GIPMER') and Guru Nanak Eye Centre ('GNEC') Hospitals, New Delhi, India
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Tapia PJ, Figueroa AM, Eisner V, González-Hódar L, Robledo F, Agarwal AK, Garg A, Cortés V. Absence of AGPAT2 impairs brown adipogenesis, increases IFN stimulated gene expression and alters mitochondrial morphology. Metabolism 2020; 111:154341. [PMID: 32810486 DOI: 10.1016/j.metabol.2020.154341] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Biallelic loss of function variants in AGPAT2, encoding 1-acylglycerol-3-phosphate O-acyltransferase 2, cause congenital generalized lipodystrophy type 1, a disease characterized by near total loss of white adipose tissue and metabolic complications. Agpat2 deficient (Agpat2-/-) mice completely lacks both white and interscapular brown adipose tissue (iBAT). The objective of the present study was to characterize the effects of AGPAT2 deficiency in brown adipocyte differentiation. METHODS Preadipocytes obtained from newborn (P0.5) Agpat2-/- and wild type mice iBAT were differentiated into brown adipocytes, compared by RNA microarray, RT-qPCR, High-Content Screening (HCS), western blotting and electron microscopy. RESULTS 1) Differentiated Agpat2-/- brown adipocytes have fewer lipid-laden cells and lower abundance of Pparγ, Pparα, C/ebpα and Pgc1α, both at the mRNA and protein levels, compared those to wild type cells. Prmd16 levels were equivalent in both, Agpat2-/- and wild type, while Ucp1 was only induced in wild type cells, 2) These differences were not due to lower abundance of preadipocytes, 3) Differentiated Agpat2-/- brown adipocytes are enriched in the mRNA abundance of genes participating in interferon (IFN) type I response, whereas genes involved in mitochondrial homeostasis were decreased, 4) Mitochondria in differentiated Agpat2-/- brown adipocytes had altered morphology and lower mass and contacting sites with lipid droplets concomitant with lower levels of Mitofusin 2 and Perlipin 5. CONCLUSION AGPAT2 is necessary for normal brown adipose differentiation. Its absence results in a lower proportion of lipid-laden cells, increased expression of interferon-stimulated genes (ISGs) and alterations in mitochondrial morphology, mass and fewer mitochondria to lipid droplets contacting sites in differentiated brown adipocytes.
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Affiliation(s)
- Pablo J Tapia
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Ana-María Figueroa
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Verónica Eisner
- Department of Cellular and Molecular Biology, School of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile.
| | - Lila González-Hódar
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Fermín Robledo
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Anil K Agarwal
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States of America.
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States of America.
| | - Víctor Cortés
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
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Kirby JS, Hereford B, Thorlacius L, Villumsen B, Ingram JR, Garg A, Butt M, Esmann S, King T, Tan J, Jemec GBE. Validation of global item for assessing impact on quality of life of patients with hidradenitis suppurativa. Br J Dermatol 2020; 184:681-687. [PMID: 32602129 DOI: 10.1111/bjd.19344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease. The HS core outcome set calls for a patient global assessment (PtGA). OBJECTIVES To assess the validity, reliability and responsiveness of a candidate single-item PtGA for HS-specific health-related quality of life (HRQoL). METHODS Cognitive debriefing interviews were conducted with patients with HS in Denmark and the USA. A cross-sectional observational study was done with adults with HS in the USA and Denmark. Candidate PtGA item, demographic items and multiple patient-reported scales - the Hidradenitis Suppurativa Quality of Life (HiSQOL), Dermatology Life Quality Index (DLQI) and numerical rating scale (NRS) for pain - were concurrently administered to evaluate convergent and known-groups validity. Scales with a single-item assessment of change were readministered 24-72 h later, to evaluate reliability and responsiveness. RESULTS After cognitive debriefing, the candidate PtGA for HS-specific HRQoL was finalized with five response levels. Convergent validity of the PtGA was supported by significant correlations with HiSQOL score [r = 0·79, 95% confidence interval (CI) 0·75-0·82] and DLQI (r = 0·78, 95% CI 0·74-0·82). The PtGA displayed known-groups validity with DLQI score bands based on significance of an anova (P < 0·001). Good test-retest reliability was supported by the intraclass correlation coefficient (0·82, 95% CI 0·78-0·85) for those who reported stable HS. Responsiveness was assessed by differences in PtGA score against a patient-reported assessment of change, which showed significant differences towards improvement. CONCLUSIONS The single-item PtGA exhibits reliability, validity and responsiveness in assessing HS-specific HRQoL in HS, making it a good provisional tool for HS clinical research.
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Affiliation(s)
- J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - B Hereford
- Penn State College of Medicine, Hershey, PA, USA
| | - L Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, and Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - B Villumsen
- The Patients' Association HS Denmark, Copenhagen, Denmark
| | - J R Ingram
- Division of Infection and Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK
| | - A Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, NY, USA
| | - M Butt
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - S Esmann
- Department of Dermatology, Zealand University Hospital, Roskilde, and Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - T King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - J Tan
- Department of Medicine, University of Western Ontario, Windsor, ON, Canada
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, and Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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Van Mol P, Franken A, Dooms C, Yserbyt J, Testelmans D, Meersseman P, Hermans G, Wauters J, Gunst J, Nackaerts K, Vansteenkiste J, Garg A, Lambrechts D, Wauters E. LBA78 A microsimulation model to assess the impact of SARS-CoV-2 on cancer outcomes, healthcare organization and economic burden. Ann Oncol 2020. [PMCID: PMC7506428 DOI: 10.1016/j.annonc.2020.08.2319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hussain I, Jin RR, Baum HBA, Greenfield JR, Devery S, Xing C, Hegele RA, Carranza-Leon BG, Linton MF, Vuitch F, Wu KHC, Precioso DR, Oshima J, Agarwal AK, Garg A. Multisystem Progeroid Syndrome With Lipodystrophy, Cardiomyopathy, and Nephropathy Due to an LMNA p.R349W Variant. J Endocr Soc 2020; 4:bvaa104. [PMID: 32939435 PMCID: PMC7485795 DOI: 10.1210/jendso/bvaa104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/21/2020] [Indexed: 12/30/2022] Open
Abstract
Background Pathogenic variants in lamin A/C (LMNA) cause a variety of progeroid disorders including Hutchinson-Gilford progeria syndrome, mandibuloacral dysplasia, and atypical progeroid syndrome. Six families with 11 patients harboring a pathogenic heterozygous LMNA c.1045C>T; p.R349W variant have been previously reported to have partial lipodystrophy, cardiomyopathy, and focal segmental glomerulosclerosis (FSGS), suggesting a distinct progeroid syndrome. Methods We report 6 new patients with a heterozygous LMNA p.R349W variant and review the phenotype of previously reported patients to define their unique characteristics. We also performed functional studies on the skin fibroblasts of a patient to seek the underlying mechanisms of various clinical manifestations. Results Of the total 17 patients, all 14 adults with the heterozygous LMNA p.R349W variant had peculiar lipodystrophy affecting the face, extremities, palms, and soles with variable gain of subcutaneous truncal fat. All of them had proteinuric nephropathy with FSGS documented in 7 of them. Ten developed cardiomyopathy, and 2 of them died early at ages 33 and 45 years. Other common features included premature graying, alopecia, high-pitched voice, micrognathia, hearing loss, and scoliosis. Metabolic complications, including diabetes mellitus, hypertriglyceridemia, and hepatomegaly, were highly prevalent. This variant did not show any abnormal splicing, and no abnormal nuclear morphology was noted in the affected fibroblasts. Conclusions The heterozygous LMNA p.R349W variant in affected individuals has several distinct phenotypic features, and these patients should be classified as having multisystem progeroid syndrome (MSPS). MSPS patients should undergo careful assessment at symptom onset and yearly metabolic, renal, and cardiac evaluation because hyperglycemia, hypertriglyceridemia, FSGS, and cardiomyopathy cause major morbidity and mortality.
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Affiliation(s)
- Iram Hussain
- Division of Endocrinology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ruilin Raelene Jin
- Department of Clinical Genomics, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Howard B A Baum
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jerry R Greenfield
- Department of Endocrinology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Sophie Devery
- Department of Clinical Genomics, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Chao Xing
- Eugene McDermott Center for Human Growth and Development, Department of Population and Data Sciences, and Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Robert A Hegele
- Department of Medicine, Western University, London, Ontario, Canada
| | - Barbara G Carranza-Leon
- Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Macrae F Linton
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Frank Vuitch
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kathy H C Wu
- Department of Clinical Genomics, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Débora Rossi Precioso
- Physician Sarah Network of Rehabilitation Hospitals (Unit Belo Horizonte), Internal Medicine, Preoperative Outpatient Clinic, Osteometabolism, Belo Horizonte, Brazil
| | - Junko Oshima
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Anil K Agarwal
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, and Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, and Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas, USA
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Garg A, El-Shanti H, Xing C, Zhou Z, Abujbara M, Al-Rashed K, El-Khateeb M, Ajlouni K, Agarwal AK. A Novel Syndrome With Short Stature, Mandibular Hypoplasia, and Osteoporosis May Be Associated With a PRRT3 Variant. J Endocr Soc 2020; 4:bvaa088. [PMID: 32803092 PMCID: PMC7417871 DOI: 10.1210/jendso/bvaa088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022] Open
Abstract
Context Despite considerable progress in elucidating the molecular basis of various progeroid syndromes, some rare patients remain unexplained. Objective To elucidate molecular genetic basis of a novel autosomal recessive progeroid syndrome. Participants A 24-year-old male and his 18-year-old sister with short stature, mandibular hypoplasia, pointed nose, shrill voice, severe osteoporosis, and short eyebrows and their unaffected siblings and parents belonging to a consanguineous Arab family. Results Using exome and Sanger sequencing, we report a novel homozygous p.Glu394Lys disease-causing variant in proline-rich transmembrane protein 3 (PRRT3). PRRT3 belongs to the family of proline-rich proteins containing several repeats of a short proline-rich sequence, but its function remains to be determined. Preliminary observations showing colocalization of Prrt3 and synaptophysin support its role in vesicle exocytosis. Consistent with the highest messenger ribonucleic acid expression of PRRT3 in the pituitary, both the patients had mild growth hormone deficiency but had near normal reproductive development. Conclusions We conclude that the homozygous p.Glu394Lys variant in PRRT3 may be associated with a novel autosomal recessive, progeroid syndrome with short stature, mandibular hypoplasia, osteoporosis, short eyebrows, and mild growth hormone (GH) deficiency. Our findings extend the spectrum of progeroid syndromes and elucidate important functions of PRRT3 in human biology, including secretion of GH from the pituitary.
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Affiliation(s)
- Abhimanyu Garg
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hatem El-Shanti
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.,The National Center for Diabetes, Endocrinology and Genetics, and School of Medicine, University of Jordan, Amman, Jordan
| | - Chao Xing
- McDermott Center for Human Growth and Development, Department of Population and Data Sciences, and Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Zhengyang Zhou
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Mousa Abujbara
- The National Center for Diabetes, Endocrinology and Genetics, and School of Medicine, University of Jordan, Amman, Jordan
| | - Khadeja Al-Rashed
- The National Center for Diabetes, Endocrinology and Genetics, and School of Medicine, University of Jordan, Amman, Jordan
| | - Mohammed El-Khateeb
- The National Center for Diabetes, Endocrinology and Genetics, and School of Medicine, University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center for Diabetes, Endocrinology and Genetics, and School of Medicine, University of Jordan, Amman, Jordan
| | - Anil K Agarwal
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition, UT Southwestern Medical Center, Dallas, Texas, USA
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Vasandani C, Li X, Sekizkardes H, Adams-Huet B, Brown RJ, Garg A. Diagnostic Value of Anthropometric Measurements for Familial Partial Lipodystrophy, Dunnigan Variety. J Clin Endocrinol Metab 2020; 105:5810271. [PMID: 32193531 PMCID: PMC7202860 DOI: 10.1210/clinem/dgaa137] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/18/2020] [Indexed: 01/17/2023]
Abstract
CONTEXT Familial partial lipodystrophy, Dunnigan variety (FPLD2) is a rare autosomal dominant disorder resulting from LMNA causal variants, which is characterized by loss of subcutaneous fat from the extremities and predisposition to metabolic complications. The diagnostic value of various anthropometric measurements for FPLD2 remains unknown. OBJECTIVE To determine specificity and sensitivity of anthropometric measurements for the diagnosis of FPLD2. METHODS We measured skinfold thickness and regional body fat by dual energy X-ray absorptiometry (DXA) in 50 adult females and 6 males with FPLD2 at UT Southwestern and compared their data with the sex- and age-matched controls from the National Health and Nutrition Examination Survey (NHANES) 1999-2010. We further compared data from 1652 unaffected females from the Dallas Heart Study and 23 females with FPLD2 from the National Institutes of Health with the NHANES data. RESULTS The DXA-derived lower limb fat (%) had the best specificity (0.995) and sensitivity (1.0) compared with the upper limb fat, truncal fat, the ratio of lower limb to truncal fat, and triceps skinfold thickness for adult females with FPLD2. The lower limb fat below 1st percentile of NHANES females had a false-positive rate of 0.0054 and a false negative rate of 0. The diagnostic value of anthropometric parameters could not be determined for males with FPLD2 due to small sample size. CONCLUSIONS The lower limb fat (%) is the best objective anthropometric measure for diagnosing FPLD2 in females. Women with below the 1st percentile lower limb fat should undergo genetic testing for FPLD2, especially if they have metabolic complications.
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Affiliation(s)
- Chandna Vasandani
- The Division of Nutrition and Metabolic Diseases and the Center for Human Nutrition, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Xilong Li
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Hilal Sekizkardes
- National Institute of Child Health and Human Development, National Institutes of Health, Bathesda, Maryland
| | - Beverley Adams-Huet
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Rebecca J Brown
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Abhimanyu Garg
- The Division of Nutrition and Metabolic Diseases and the Center for Human Nutrition, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
- Correspondence: Abhimanyu Garg, M.D., Division of Nutrition and Metabolic Diseases, Department of Internal Medicine and the Center for Human Nutrition, 5323 Harry Hines Boulevard, Dallas, TX 75390-8537. E-mail:
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46
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Wright S, Strunk A, Garg A. 414 Incidence of depression among patients with hidradenitis suppurativa. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vo D, Phan A, Tran T, Nguyen V, Le T, Garg A, Okada S, Le P. Physicochemical and electrochemical properties of sulfolane – Carbonate electrolytes for sodium-ion conduction. J Mol Liq 2020. [DOI: 10.1016/j.molliq.2020.112982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gupta R, Das MK, Mohanan PP, Deb PK, Parashar SK, Chopra HK, Shrivastava S, Guha S, Goswami KC, Yadav R, Alagesan R, Amuthan V, Bansal M, Chakraborty RN, Chakraborti N, Chandra S, Chatterjee A, Chatterjee D, Chatterjee SS, Dutta AL, De A, Garg A, Garg VK, Goyal A, Goyal NK, Govind SC, Gupta VK, Hasija PK, Jabir A, Jain P, Jain V, Jayagopal PB, Kasliwal RR, Katyal VK, Kerkar PG, Khan AK, Khanna NN, Mandal M, Majumder B, Mishra SS, Meena CB, Naik N, Narain VS, Pancholia AK, Pathak LA, Ponde CK, Raghu K, Ray S, Roy D, Sarma D, Shanmugasundarum S, Singh BP, Tyagi S, Vijayaraghavan G, Wander GS, Wardhan H, Nanda NC. Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19. Indian Heart J 2020; 72:145-150. [PMID: 32768012 PMCID: PMC7250084 DOI: 10.1016/j.ihj.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 01/08/2023] Open
Abstract
An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.
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Affiliation(s)
- Rakesh Gupta
- JROP Institute of Echocardiography, Ultrasound & Vascular Doppler, JROP Healthcare Pvt. Ltd., C-1/16, Ashok Vihar-II, Delhi, 110052, India; JROP Charak Heart City, MD City Hospital, Model Town Northex, Delhi, 110009, India.
| | - Mrinal Kanti Das
- C K Birla Group of Hospitals (BMB and CMRI), Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - S K Parashar
- Metro Heart Hospital, Lajpat Nagar, New Delhi, India
| | | | | | - Santanu Guha
- Calcutta Medical College Hospital, Kolkata, West Bengal, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | | | - V Amuthan
- Jeyalakshmi Heart Center, Madurai, Tamilnadu, India
| | - M Bansal
- Medanta, The Medicity, New Delhi, India
| | - R N Chakraborty
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - N Chakraborti
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - S Chandra
- King George's Medical University, Lucknow, India
| | | | - D Chatterjee
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | | | - A De
- Apollo Gleneagles Hospital, Kolkata, India
| | - A Garg
- Jaipur Heart Institute, Jaipur, India
| | - V K Garg
- R D Gardi Medical College, Ujjain, India
| | - A Goyal
- Bani Park Hospital, Jaipur, India
| | - N K Goyal
- BLK Superspeciality Hospital, New Delhi, India
| | | | - V K Gupta
- Kishori Ram Hospital & Diabetes Care Centre, Bhatinda, India
| | | | - A Jabir
- Lisie Hospital Kochi, Kerala, India
| | - P Jain
- Lifeline Superspeciality Hospital, Jhansi, India
| | - V Jain
- Choithram Hospital &R.C., Indore, India
| | | | | | | | | | | | | | - M Mandal
- NRS Medical College, Kolkata, India
| | - B Majumder
- R.G. Kar Medical College & Hospital, Kolkata, India
| | - S S Mishra
- Hi-Tech Medical College and Hospital, Bhubaneshwar, India
| | - C B Meena
- SMS Medical College, Jaipur, Rajasthan
| | | | - V S Narain
- King George's Medical University, Lucknow, India
| | | | - L A Pathak
- Nanavati Heart Institute, Nanavati Superspeciality Hospital, Mumbai, India
| | - C K Ponde
- PD Hinduja National Hospital & RC, Mumbai, India
| | - K Raghu
- Care Hospital, Hyderabad, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - D Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - D Sarma
- Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | | | | | - S Tyagi
- GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, India
| | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - N C Nanda
- University of Alabama at Birmingham, Birmingham, AL, USA
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Nelson CA, Ahmad Z, Garg A. SAT-572 Extremely Elevated Plasma Lipoprotein X Level Secondary to Alcoholic Cholestasis. J Endocr Soc 2020. [PMCID: PMC7208779 DOI: 10.1210/jendso/bvaa046.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Marked elevations of plasma lipoprotein X (Lp-X) levels have been reported in patients with cholestasis due to primary biliary cirrhosis, pancreatic cancer, hepatitis C, and quetiapine. We now report a patient with extreme elevation of plasma Lp-X due to alcohol-induced cholestasis.
Case Presentation
A 44 year-old African American male presented with painless jaundice and fatigue for one week. He denied nausea, vomiting, diarrhea, change in stool or urine color, or weight loss. He consumes 720-1080 mL of beer (2-3 cans) every night and admitted to heavier alcohol consumption in the past. On physical examination he had scleral icterus and hepatomegaly but no xanthomas or xanthelasmas.
His serum total cholesterol was 1,126 mg/dL (normal range, 120-199 mg/dL), triglycerides were 238 mg/dL (50-150 mg/dL), calculated LDL-cholesterol was 1,072 mg/dL (<100 mg/dL), and HDL-cholesterol was 6 mg/dL (>39 mg/dL). His serum AST, 162 IU/L (10-50 IU/L); ALT, 79 IU/L (10-50 IU/L); alkaline phosphatase, 1,058 IU/L (40-129 IU/L); total bilirubin, 18.8 mg/dL (0.2-1.3 mg/dL); direct bilirubin, 13.5 mg/dL (0-0.3 mg/dL); and gamma glutamyl transferase, 4,583 IU/L (8-61 IU/L) were markedly elevated. His blood alcohol level was 34 mg/dL (not detected), sodium 124 mmol/L (135-145 mmol/L), and platelet count was 84,000/µL (150,000-459,000/µL). His TSH 2.89 µIU/mL (0.4-4.5 µIU/mL), UA without proteinuria, HBV immunized, HCV negative, and anti-mitochondrial antibody negative. CT abdomen revealed hepatic steatosis and gallbladder swelling without evidence of obstruction. MRCP showed cirrhosis without primary sclerosing cholangitis. Serum lipoprotein electrophoresis confirmed the presence of Lp-X. On day 3 of hospitalization, his cholestasis improved and his serum total bilirubin 10.0 mg/dL, direct bilirubin 7.4 mg/dL, AST 108 IU/L, ALT 66 IU/L, and alkaline phosphatase 663 IU/L had improved. The patient was advised to abstain from all alcohol consumption. Telephone follow up 2 months later with his wife revealed that he had stopped drinking alcohol and that his jaundice had resolved.
Conclusions
Although alcohol-induced cholestasis is a well-recognized entity, such presentation with extreme elevations of Lp-X has not been previously reported. In such patients, it is important to establish whether extreme hypercholesterolemia is due to LDL or Lp-X since, as opposed to LDL, Lp-X elevations are not considered to be atherogenic.
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Affiliation(s)
| | - Zahid Ahmad
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abhimanyu Garg
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Patni N, Garg A. MON-695 Multiple Recurrent Lipomatoses with Thiazolidinedione Therapy in Familial Partial Lipodystrophy, Dunnigan Variety (FPLD2). J Endocr Soc 2020. [PMCID: PMC7208106 DOI: 10.1210/jendso/bvaa046.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: FPLD2, a rare autosomal dominant disorder due to heterozygous missense mutations in LMNA, is characterized by gradual loss of subcutaneous (sc) fat from the limbs starting during late childhood and predisposition to metabolic complications, such as diabetes, dyslipidemia and hepatic steatosis. Some patients, especially females, accumulate excess sc fat in the chin, neck, supraclavicular and perineal regions. We report disfiguring and disabling lipomatoses in unusual locations with thiazolidinedione therapy in two women with FPLD2. Clinical Cases: A 57-year-old white female with FPLD2, due to heterozygous p.R482Q LMNA mutation, developed recurrent large lipomatoses in the axillae at age 33 years, and later in the posterior neck (buffalo hump), mons pubis and above sacrum. She developed diabetes at age 30 and was started on pioglitazone 45 mg daily, which was switched to rosiglitazone 8 mg daily at age 43 years. Supra-sacral lipomatoses were approximately 40 cm X 20 cm bilaterally and continued to grow despite lipectomy and multiple liposuctions. Rosiglitazone was stopped at age 56 years, and she reported no further increase in the size of lipomatoses. Her other medications included colesevelam, atorvastatin, metformin, glimepiride, lisinopril, losartan, hydrochlorothiazide, aspirin, insulin and dulaglutide. Her 54-year-old younger sister with FPLD2 (heterozygous p.R482Q LMNA mutation) was treated with lisinopril, metoprolol, atorvastatin, liraglutide, and insulin glargine and aspart, but no history of taking thiazolidinediones, and she never developed any lipomatoses. Another 43-year-old white female with FPLD2, due to heterozygous p.S583L LMNA mutation, was noticed to have lipomatous deposits in the axillae, medial gluteal region, labia and perineal regions. She developed diabetes mellitus at age 36 years and took metformin for 6 years and pioglitazone 30 mg daily for one year before she noticed the lipomatoses. Her other medications included atorvastatin, aldactone and vitamin D3. Pioglitazone was stopped and after one year, she reported reduction in the size of lipomatoses. Conclusion: Thiazolidinediones are selective peroxisomal proliferator-activated receptor-γ agonists and induce weight gain by increasing fat mass, especially subcutaneous depots. Our cases suggest that thiazolidinediones can cause undesired growth of non-lipodystrophic adipose tissue in patients with FPLD2 and thus should be avoided.
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