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Motte E, Rothenbuhler A, Gaillard S, Lahlou N, Teinturier C, Coutant R, Linglart A. Mitotane (op'DDD) restores growth and puberty in nine children with Cushing's disease. Endocr Connect 2018; 7:1280-1287. [PMID: 30352417 PMCID: PMC6240149 DOI: 10.1530/ec-18-0215] [Citation(s) in RCA: 5] [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: 08/30/2018] [Accepted: 10/10/2018] [Indexed: 11/19/2022]
Abstract
To investigate whether low-dose mitotane (up to 2 g/day) could be a temporary therapeutic alternative to transsphenoidal surgery (TSS) in pediatric Cushing's disease (CD). Twenty-eight patients with CD aged 12.2 years (± 2.2) were referred to our center. We compared nine patients treated with mitotane alone for at least 6 months to 13 patients cured after surgery. Primary outcomes were changes in growth velocity, BMI and pubertal development. The following results were obtained: (1) Mitotane improved growth velocity z-scores (-3.8 (±0.3) vs -0.2 (±0.6)), BMI z-scores (2.1 (±0.5) vs 1.2 (±0.5) s.d.) and pubertal development. After 1 year on mitotane, the mean BMI z-score was not significantly different in both groups of patients. (2) Control of cortisol secretion was delayed and inconsistent with mitotane used as monotherapy. (3) Side effects were similar to those previously reported, reversible and dose dependent: unspecific digestive symptoms, concentration or memory problems, physical exhaustion, adrenal insufficiency and hepatitis. (4) In one patient, progressive growth of a pituitary adenoma was observed over 40 months of mitotane treatment, allowing selective adenomectomy by TSS. In conclusions, low-dose mitotane can restore growth velocity and pubertal development and decrease BMI in children with CD, even without optimal control of cortisol secretion. It may promote pituitary tumor growth thus facilitating second-line TSS. However, given its possibly life-threatening side effects (transient adrenal insufficiency and hepatitis), and in the absence of any reliable follow-up procedures, this therapy may be difficult to manage and should always be initiated and monitored by specialized teams.
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Affiliation(s)
- Emmanuelle Motte
- UFR des Sciences de la Santé, Simone Veil, Université Versailles St-Quentin en Yvelines, Montigny le Bretonneux, France
- Assistance Publique Hôpitaux de Paris (APHP), Department of Endocrinology and Diabetes for Children, Bicêtre Paris-Sud, Le Kremlin Bicêtre, France
- Correspondence should be addressed to E Motte:
| | - Anya Rothenbuhler
- Assistance Publique Hôpitaux de Paris (APHP), Department of Endocrinology and Diabetes for Children, Bicêtre Paris-Sud, Le Kremlin Bicêtre, France
- APHP, Plateforme d’Expertise Maladies Rares Paris Sud, Bicêtre Paris Sud Hospital, Le Kremlin Bicêtre, France
| | | | - Najiba Lahlou
- APHP, Department of Hormonal Biology, Cochin Hospital, Paris, France
| | - Cécile Teinturier
- Assistance Publique Hôpitaux de Paris (APHP), Department of Endocrinology and Diabetes for Children, Bicêtre Paris-Sud, Le Kremlin Bicêtre, France
- APHP, Plateforme d’Expertise Maladies Rares Paris Sud, Bicêtre Paris Sud Hospital, Le Kremlin Bicêtre, France
| | - Régis Coutant
- Department of Pediatric Endocrinology, Angers University Hospital, Angers, France
| | - Agnès Linglart
- Assistance Publique Hôpitaux de Paris (APHP), Department of Endocrinology and Diabetes for Children, Bicêtre Paris-Sud, Le Kremlin Bicêtre, France
- APHP, Plateforme d’Expertise Maladies Rares Paris Sud, Bicêtre Paris Sud Hospital, Le Kremlin Bicêtre, France
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Briet C, Pereda A, Le Stunff C, Motte E, de Dios Garcia-Diaz J, de Nanclares GP, Dumaz N, Silve C. Mutations causing acrodysostosis-2 facilitate activation of phosphodiesterase 4D3. Hum Mol Genet 2018; 26:3883-3894. [PMID: 29016851 DOI: 10.1093/hmg/ddx271] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/08/2017] [Indexed: 01/21/2023] Open
Abstract
Type 2 acrodysostosis (ACRDYS2), a rare developmental skeletal dysplasia characterized by short stature, severe brachydactyly and facial dysostosis, is caused by mutations in the phosphodiesterase (PDE) 4D (PDE4D) gene. Several arguments suggest that the mutations should result in inappropriately increased PDE4D activity, however, no direct evidence supporting this hypothesis has been presented, and the functional consequences of the mutations remain unclear. We evaluated the impact of four different PDE4D mutations causing ACRDYS2 located in different functional domains on the activity of PDE4D3 expressed in Chinese hamster ovary cells. Three independent approaches were used: the direct measurement of PDE activity in cell lysates, the evaluation of intracellular cAMP levels using an EPAC-based (exchange factor directly activated by cAMP) bioluminescence resonance energy transfer sensor , and the assessment of PDE4D3 activation based on electrophoretic mobility. Our findings indicate that PDE4D3s carrying the ACRDYS2 mutations are more easily activated by protein kinase A-induced phosphorylation than WT PDE4D3. This occurs over a wide range of intracellular cAMP concentrations, including basal conditions, and result in increased hydrolytic activity. Our results provide new information concerning the mechanism whereby the mutations identified in the ACRDYS2 dysregulate PDE4D activity, and give insights into rare diseases involving the cAMP signaling pathway. These findings may offer new perspectives into the selection of specific PDE inhibitors and possible therapeutic intervention for these patients.
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Affiliation(s)
- Claire Briet
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Endocrinology, Diabetology and Nutrition, Mitovasc Institute, CHU Angers, France
| | - Arrate Pereda
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Molecular (Epi)Genetics Laboratory, BioAraba National Health Institute, OSI Araba-Txagorritxu, E-01009 Vitoria-Gasteiz, Spain
| | - Catherine Le Stunff
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Emmanuelle Motte
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Université Versailles - St Quentin, UFR des Sciences de la santé Simone Veil, Versailles, Paris, France
| | - Juan de Dios Garcia-Diaz
- Clinical Genetics Unit, Department of Internal Medicine, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Guiomar Perez de Nanclares
- Molecular (Epi)Genetics Laboratory, BioAraba National Health Institute, OSI Araba-Txagorritxu, E-01009 Vitoria-Gasteiz, Spain
| | - Nicolas Dumaz
- INSERM U976, Institut de Recherche sur la Peau, Hôpital Saint Louis, Paris, France
| | - Caroline Silve
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Centre de Référence des Maladies Rares du Métabolisme du Phosphore et du Calcium/Filière de Santé Maladies Rares OSCAR, Assistance Publique Hôpitaux de Paris, Paris, France.,Service de Biochimie et Génétique Moléculaires, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
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Soreze Y, Motte E, Dell'Orto V, Yousef N, De Luca D. Use of neurally adjusted ventilator assist in postsurgical hemidiaphragmatic paralysis. Arch Dis Child Fetal Neonatal Ed 2018; 103:F86-F87. [PMID: 29092910 DOI: 10.1136/archdischild-2017-313570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Yohan Soreze
- Division of Paediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, South Paris University Hospitals, APHP, Paris, France
| | - Emmanuelle Motte
- Division of Paediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, South Paris University Hospitals, APHP, Paris, France
| | - Valentina Dell'Orto
- Division of Paediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, South Paris University Hospitals, APHP, Paris, France
| | - Nadya Yousef
- Division of Paediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, South Paris University Hospitals, APHP, Paris, France
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, "A. Béclère" Medical Centre, South Paris University Hospitals, APHP, Paris, France
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Motte E, Le Stunff C, Briet C, Dumaz N, Silve C. Modulation of signaling through GPCR-cAMP-PKA pathways by PDE4 depends on stimulus intensity: Possible implications for the pathogenesis of acrodysostosis without hormone resistance. Mol Cell Endocrinol 2017; 442:1-11. [PMID: 27908835 DOI: 10.1016/j.mce.2016.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 08/30/2016] [Revised: 11/25/2016] [Accepted: 11/26/2016] [Indexed: 12/30/2022]
Abstract
In acrodysostosis without hormone resistance, a disease caused by phosphodiesterase (PDE)-4D mutations, increased PDE activity leads to bone developmental defects but with normal renal responses to PTH. To identify potential mechanisms for these disparate responses, we compared the effect of PDE activity on hormone signaling through the GPCR-Gsα-cAMP-PKA pathway in cells from two lineages, HEK-293 cells stably overexpressing PTH1R (HEKpthr) and human dermal fibroblasts, including studies evaluating cAMP levels using an Epac-based BRET-sensor for cAMP (CAMYEL). For ligand-induced responses inducing strong cAMP accumulation, the inhibition of PDE4 activity resulted in relatively small further increases. In contrast, when ligand-induced cAMP accumulation was of lesser intensity, the inhibition of PDE4 had a more pronounced effect. Similar results were obtained evaluating downstream events (cellular CREB phosphorylation and CRE-luciferase activity). Thus, the ability of PDE4 to modulate signaling through GPCR-cAMP-PKA pathways can depend on the cell type and stimulus intensity.
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Affiliation(s)
- Emmanuelle Motte
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Catherine Le Stunff
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Claire Briet
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Nicolas Dumaz
- INSERM U976, Institut de Recherche sur la Peau, Hôpital Saint Louis, Paris, France
| | - Caroline Silve
- INSERM U1169, Université Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France; Centre de Référence des Maladies Rares du Métabolisme du Phosphore et du Calcium, Assistance Publique Hôpitaux de Paris, Paris, France; Service de Biochimie et Génétique Moléculaires, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France.
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Le Stunff C, Tilotta F, Sadoine J, Le Denmat D, Briet C, Motte E, Clauser E, Bougnères P, Chaussain C, Silve C. Knock-In of the Recurrent R368X Mutation of PRKAR1A that Represses cAMP-Dependent Protein Kinase A Activation: A Model of Type 1 Acrodysostosis. J Bone Miner Res 2017; 32:333-346. [PMID: 27589370 DOI: 10.1002/jbmr.2987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/19/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
Abstract
In humans, activating mutations in the PRKAR1A gene cause acrodysostosis 1 (ACRDYS1). These mutations result in a reduction in PKA activation caused by an impaired ability of cAMP to dissociate mutant PRKAR1A from catalytic PKA subunits. Two striking features of this rare developmental disease are renal resistance to PTH and chondrodysplasia resulting from the constitutive inhibition of PTHR1/Gsa/AC/cAMP/PKA signaling. We developed a knock-in of the recurrent ACRDYS1 R368X PRKAR1A mutation in the mouse. No litters were obtained from [R368X]/[+] females (thus no homozygous [R368X]/[R368X] mice). In [R368X]/[+] mice, Western blot analysis confirmed mutant allele heterozygous expression. Growth retardation, peripheral acrodysostosis (including brachydactyly affecting all digits), and facial dysostosis were shown in [R368X]/[+] mice by weight curves and skeletal measurements (μCT scan) as a function of time. [R368X]/[+] male and female mice were similarly affected. Unexpected, however, whole-mount skeletal preparations revealed a striking delay in mineralization in newborn mutant mice, accompanied by a decrease in the height of terminal hypertrophic chondrocyte layer, an increase in the height of columnar proliferative prehypertrophic chondrocyte layer, and changes in the number and spatial arrangement of proliferating cell nuclear antigen (PCNA)-positive chondrocytes. Plasma PTH and basal urinary cAMP were significantly higher in [R368X]/[+] compared to WT mice. PTH injection increased urinary cAMP similarly in [R368X]/[+] and WT mice. PRKACA expression was regulated in a tissue (kidney not bone and liver) manner. This model, the first describing the germline expression of a PRKAR1A mutation causing dominant repression of cAMP-dependent PKA, reproduced the main features of ACRDYS1 in humans. It should help decipher the specificity of the cAMP/PKA signaling pathway, crucial for numerous stimuli. In addition, our results indicate that PRKAR1A, by tempering intracellular cAMP levels, is a molecular switch at the crossroads of signaling pathways regulating chondrocyte proliferation and differentiation. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Catherine Le Stunff
- INSERM U1169, University Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Francoise Tilotta
- EA 2496 Laboratory Orofacial Pathologies, Imagery and Biotherapies, Dental School and Life imaging Platform (PIV), University Paris Descartes Sorbonne Paris Cité, Montrouge, France
| | - Jérémy Sadoine
- EA 2496 Laboratory Orofacial Pathologies, Imagery and Biotherapies, Dental School and Life imaging Platform (PIV), University Paris Descartes Sorbonne Paris Cité, Montrouge, France
| | - Dominique Le Denmat
- EA 2496 Laboratory Orofacial Pathologies, Imagery and Biotherapies, Dental School and Life imaging Platform (PIV), University Paris Descartes Sorbonne Paris Cité, Montrouge, France
| | - Claire Briet
- INSERM U1169, University Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Emmanuelle Motte
- INSERM U1169, University Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Eric Clauser
- INSERM U970, University Paris Descartes, Paris Centre de Recherche Cardiovasculaire (PARCC), Paris, France
| | - Pierre Bougnères
- INSERM U1169, University Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Catherine Chaussain
- EA 2496 Laboratory Orofacial Pathologies, Imagery and Biotherapies, Dental School and Life imaging Platform (PIV), University Paris Descartes Sorbonne Paris Cité, Montrouge, France.,Assistance Publique-Hôpitaux de Paris (AP-HP) Odontology Department Bretonneau, Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.,Centre de Référence des Maladies Rares du Métabolisme du Phosphore et du Calcium and Filière de Santé Maladies Rares OSCAR, AP-HP, Paris, France
| | - Caroline Silve
- INSERM U1169, University Paris Sud, Hôpital Bicêtre, Le Kremlin Bicêtre, France.,Centre de Référence des Maladies Rares du Métabolisme du Phosphore et du Calcium and Filière de Santé Maladies Rares OSCAR, AP-HP, Paris, France.,Service de Biochimie et Génétique Moléculaire, Hôpital Cochin, AP-HP, Paris, France
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Castinetti F, Guignat L, Giraud P, Muller M, Kamenicky P, Drui D, Caron P, Luca F, Donadille B, Vantyghem MC, Bihan H, Delemer B, Raverot G, Motte E, Philippon M, Morange I, Conte-Devolx B, Quinquis L, Martinie M, Vezzosi D, Le Bras M, Baudry C, Christin-Maitre S, Goichot B, Chanson P, Young J, Chabre O, Tabarin A, Bertherat J, Brue T. Ketoconazole in Cushing's disease: is it worth a try? J Clin Endocrinol Metab 2014; 99:1623-30. [PMID: 24471573 DOI: 10.1210/jc.2013-3628] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The use of ketoconazole has been recently questioned after warnings from the European Medicine Agencies and the Food and Drug Administration due to potential hepatotoxicity. However, ketoconazole is frequently used as a drug to lower circulating cortisol levels. Several pharmacological agents have recently been approved for the treatment of Cushing's disease (CD) despite limited efficacy or significant side effects. Ketoconazole has been used worldwide for more than 30 years in CD, but in the absence of a large-scale study, its efficacy and tolerance are still under debate. PATIENTS AND METHODS We conducted a French retrospective multicenter study reviewing data from patients treated by ketoconazole as a single agent for CD, with the aim of clarifying efficacy and tolerance to better determine the benefit/risk balance. RESULTS Data from 200 patients were included in this study. At the last follow-up, 49.3% of patients had normal urinary free cortisol (UFC) levels, 25.6% had at least a 50% decrease, and 25.4% had unchanged UFC levels. The median final dose of ketoconazole was 600 mg/d. Forty patients (20%) received ketoconazole as a presurgical treatment; 40% to 50% of these patients showed improvement of hypertension, hypokalemia, and diabetes, and 48.7% had normal UFC before surgery. Overall, 41 patients (20.5%) stopped the treatment due to poor tolerance. Mild (<5N, inferior to 5-fold normal values) and major (>5N, superior to 5-fold normal values) increases in liver enzymes were observed in 13.5% and 2.5% of patients, respectively. No fatal hepatitis was observed. CONCLUSIONS Ketoconazole is an effective drug with acceptable side effects. It should be used under close liver enzyme monitoring. Hepatotoxicity is usually mild and resolves after drug withdrawal.
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Affiliation(s)
- Frederic Castinetti
- Aix Marseille Université, Hopital de la Timone (F.C., M.P., I.M., B.C.-D., T.B.), Service d'Endocrinologie, 13005, Marseille, France; Hôpital Cochin Service d'Endocrinologie et Maladies Métaboliques (L.G., L.Q., C.B., J.B.), 75014, Paris, France; Centre Hospitalier Universitaire (CHU) de Bordeaux Hôpital du Haut Lévêque Service d'Endocrinologie-Diabétologie et Maladies Métaboliques (P.G., A.T.), 33600 Pessac, France; CHU de Grenoble Hôpital Albert Michallon Service d'Endocrinologie-Diabétologie-Nutrition (M.Mu., M.Ma., O.C.), 38043, Grenoble, France; Université Paris-Sud Service d'Endocrinologie et Maladies de la Reproduction (P.K., P.Ch., J.Y.), 94270, Le Kremlin Bicetre, France; CHU de Nantes Hôpital G & R Laënnec St-Herblain Endocrinologie, Maladies Métaboliques et Nutrition (D.D., M.L.B.), 44093, Nantes, France; Hôpital Larrey Service d'Endocrinologie-Maladies Métaboliques-Nutrition (P.Ca., D.V.), 31400, Toulouse, France; CHU de Strasbourg Hôpital de Hautepierre (F.L., B.G.), Service de Médecine Interne et de Nutrition, 67100 Strasbourg, France; Assistance Publique-Hôpitaux de Paris, Hôpital St-Antoine Service d'Endocrinologie-Diabétologie et Médecine de la Reproduction (B.Do., S.C.-M.), 75012, Paris, France; Centre Hospitalier Regional Universitaire de Lille Hôpital Claude Huriez, Service d'Endocrinologie Métabolisme (M.C.V.), 59000 Lille, France; Hôpital Avicenne Service d'Endocrinologie, Diabétologie, et Maladies Métaboliques (H.B.), 93000 Bobigny, France; CHU de Reims Hôpital Robert Debré (B.De.), Service d'Endocrinologie-Diabète-Nutrition, 51092, Reims, France; Hôpital Neuro-cardiologique Fédération d'Endocrinologie du Pôle Est (G.R.), 39500 Bron, France; and Hôpital de Bicêtre Endocrinologie Pédiatrique (E.M.), 94270, Le Kremlin Bicetre, France
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Linglart A, Menguy C, Couvineau A, Auzan C, Gunes Y, Cancel M, Motte E, Pinto G, Chanson P, Bougnères P, Clauser E, Silve C. Recurrent PRKAR1A mutation in acrodysostosis with hormone resistance. N Engl J Med 2011; 364:2218-26. [PMID: 21651393 DOI: 10.1056/nejmoa1012717] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The skeletal dysplasia characteristic of acrodysostosis resembles the Albright's hereditary osteodystrophy seen in patients with pseudohypoparathyroidism type 1a, but defects in the α-stimulatory subunit of the G-protein (GNAS), the cause of pseudohypoparathyroidism type 1a, are not present in patients with acrodysostosis. We report a germ-line mutation in the gene encoding PRKAR1A, the cyclic AMP (cAMP)-dependent regulatory subunit of protein kinase A, in three unrelated patients with acrodysostosis and resistance to multiple hormones. The mutated subunit impairs the protein kinase A response to stimulation by cAMP; this explains our patients' hormone resistance and the similarities of their skeletal abnormalities with those observed in patients with pseudohypoparathyroidism type 1a.
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Affiliation(s)
- Agnès Linglart
- INSERM Unité 986, Hôpital St. Vincent de Paul, Paris, France
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Loh ML, Samson Y, Motte E, Moreau LA, Dalton V, Waters S, Sallan SE, Gilliland DG. Translocation (2;8)(p12;q24) associated with a cryptic t(12;21)(p13;q22) TEL/AML1 gene rearrangement in a child with acute lymphoblastic leukemia. Cancer Genet Cytogenet 2000; 122:79-82. [PMID: 11106815 DOI: 10.1016/s0165-4608(00)00293-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a case of childhood acute lymphoblastic leukemia with the simultaneous occurrence of a t(2;8)(p12;q24) typically associated with mature B cell or Burkitt leukemia, and a t(12;21)(p13;q22) exclusively associated with pre-B cell ALL. The lymphoblasts were characterized as L2 morphology by the French-American-British classification. However, there were atypical morphologic findings for L2 ALL, including vacuolization in some cells. The lymphoblasts were periodic acid-Schiff positive and myeloperoxidase negative. Immunophenotypic analysis revealed that the majority of lymphoblasts were TdT+, CD10+, CD19+, CD20-, and cytoplasmic mu+. These features were consistent with an immature pre-B cell leukemia phenotype with some characteristics of a mature B-cell leukemia. A t(2;8)(p12;q24)(p12;q24), characteristic of mature B-cell leukemia or Burkitt type leukemia, was detected by conventional cytogenetics with no other cytogenetic abnormalities. However, diagnostic peripheral blood and bone marrow specimens demonstrated simultaneous occurrence of a cryptic t(12;21)(p13;q22) by both FISH and RT-PCR. The simultaneous occurrence of these translocations in a pediatric patient have implications for the pathogenesis of leukemias with t(2;8)(p12;q24) as well as t(12;21)(p12;q22). Analysis of additional cases of leukemia with translocations involving the MYC locus on 8q24 will be required to determine the frequency of association with the cryptic t(12;21)(p13;22), and the prognostic significance of the simultaneous occurrence of the translocations.
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MESH Headings
- Base Sequence
- Child, Preschool
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 2/genetics
- Chromosomes, Human, Pair 21/genetics
- Chromosomes, Human, Pair 8/genetics
- Core Binding Factor Alpha 2 Subunit
- DNA, Complementary/chemistry
- DNA, Complementary/genetics
- Female
- Humans
- In Situ Hybridization, Fluorescence
- Oncogene Proteins, Fusion/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Sequence Analysis, DNA
- Translocation, Genetic
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Affiliation(s)
- M L Loh
- Division of Hematology-Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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