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Giraldo P, López de Frutos L, Cebolla JJ. Recommendations for overcoming challenges in the diagnosis of lysosomal acid lipase deficiency. Expert Opin Orphan Drugs 2022. [DOI: 10.1080/21678707.2022.2131393] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Pilar Giraldo
- Hematology. Hospital Quironsalud. Zaragoza. SPAIN
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG). Zaragoza. SPAIN
- Grupo de Investigación en Enfermedades Metabólicas y Hematológicas Raras (GIIS-012). Instituto de Investigación Sanitaria Aragón (ISS Aragón). SPAIN
| | - Laura López de Frutos
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG). Zaragoza. SPAIN
- Grupo de Investigación en Enfermedades Metabólicas y Hematológicas Raras (GIIS-012). Instituto de Investigación Sanitaria Aragón (ISS Aragón). SPAIN
| | - Jorge J Cebolla
- Grupo de Investigación en Enfermedades Metabólicas y Hematológicas Raras (GIIS-012). Instituto de Investigación Sanitaria Aragón (ISS Aragón). SPAIN
- Departamento de Bioquímica, Biología Molecular y Celular. Universidad de Zaragoza. SPAIN
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del Villar-Guerra P, Reig C, Irún P, Moreno B, Giraldo P, Cebolla JJ. A novel mutation in two Spanish children with Niemann Pick disease: description of genotype, sphingomyelinase activity, phenotype and review. Anales de Pediatría (English Edition) 2021. [DOI: 10.1016/j.anpede.2020.08.001] [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: 10/23/2022] Open
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Andrade-Campos MM, de Frutos LL, Cebolla JJ, Serrano-Gonzalo I, Medrano-Engay B, Roca-Espiau M, Gomez-Barrera B, Pérez-Heredia J, Iniguez D, Giraldo P. Identification of risk features for complication in Gaucher's disease patients: a machine learning analysis of the Spanish registry of Gaucher disease. Orphanet J Rare Dis 2020; 15:256. [PMID: 32962737 PMCID: PMC7507684 DOI: 10.1186/s13023-020-01520-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/24/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Since enzyme replacement therapy for Gaucher disease (MIM#230800) has become available, both awareness of and the natural history of the disease have changed. However, there remain unmet needs such as the identification of patients at risk of developing bone crisis during therapy and late complications such as cancer or parkinsonism. The Spanish Gaucher Disease Registry has worked since 1993 to compile demographic, clinical, genetic, analytical, imaging and follow-up data from more than 400 patients. The aims of this study were to discover correlations between patients' characteristics at diagnosis and to identify risk features for the development of late complications; for this a machine learning approach involving correlation networks and decision trees analyses was applied. RESULTS A total of 358 patients, 340 type 1 Gaucher disease and 18 type 3 cases were selected. 18% were splenectomyzed and 39% had advanced bone disease. 81% of cases carried heterozygous genotype. 47% of them were diagnosed before the year 2000. Mean age at diagnosis and therapy were 28 and 31.5 years old (y.o.) respectively. 4% developed monoclonal gammopathy undetermined significance or Parkinson Disease, 6% cancer, and 10% died before this study. Previous splenectomy correlates with the development of skeletal complications and severe bone disease (p = 0.005); serum levels of IgA, delayed age at start therapy (> 9.5 y.o. since diagnosis) also correlates with severe bone disease at diagnosis and with the incidence of bone crisis during therapy. High IgG (> 1750 mg/dL) levels and age over 60 y.o. at diagnosis were found to be related with the development of cancer. When modelling the decision tree, patients with a delayed diagnosis and therapy were the most severe and with higher risk of complications. CONCLUSIONS Our work confirms previous observations, highlights the importance of early diagnosis and therapy and identifies new risk features such as high IgA and IgG levels for long-term complications.
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Affiliation(s)
- Marcio M Andrade-Campos
- Grupo Español de Enfermedades de Depósito Lisosomal, Sociedad Española de Hematología y Hemoterapia, (GEEDL), Zaragoza, Spain
- Hospital del Mar Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain
| | - Laura López de Frutos
- Grupo Español de Enfermedades de Depósito Lisosomal, Sociedad Española de Hematología y Hemoterapia, (GEEDL), Zaragoza, Spain
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain
- Grupo de Investigación en Enfermedades Metabólicas y Hematológicas Raras (GIIS-012), Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Jorge J Cebolla
- Grupo de Investigación en Enfermedades Metabólicas y Hematológicas Raras (GIIS-012), Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
- Departamento de Bioquímica, Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza, Spain
| | - Irene Serrano-Gonzalo
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain
- Grupo de Investigación en Enfermedades Metabólicas y Hematológicas Raras (GIIS-012), Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Blanca Medrano-Engay
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain
- Grupo de Investigación en Enfermedades Metabólicas y Hematológicas Raras (GIIS-012), Instituto Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Mercedes Roca-Espiau
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain
- Centro de Imagen. Vivo, Zaragoza, Spain
| | | | - Jorge Pérez-Heredia
- Instituto de Biocomputación y Física de Sistemas Complejos (BIFI), Zaragoza, Spain
| | - David Iniguez
- Kampal Solutions, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Biocomputación y Física de Sistemas Complejos (BIFI), Zaragoza, Spain
| | - Pilar Giraldo
- Grupo Español de Enfermedades de Depósito Lisosomal, Sociedad Española de Hematología y Hemoterapia, (GEEDL), Zaragoza, Spain.
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain.
- Grupo de Investigación en Enfermedades Metabólicas y Hematológicas Raras (GIIS-012), Instituto Investigación Sanitaria Aragón, Zaragoza, Spain.
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Del Villar-Guerra P, Reig C, Irún P, Moreno B, Giraldo P, Cebolla JJ. [A novel mutation in two spanish children with the Niemann Pick disease: Description of genotype, acid sphingomyelinase activity, phenotype and review]. An Pediatr (Barc) 2020; 94:327-330. [PMID: 32778503 DOI: 10.1016/j.anpedi.2020.03.021] [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: 10/27/2019] [Revised: 03/22/2020] [Accepted: 03/26/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - Celia Reig
- Servicio de Pediatría, Complejo Asistencial de Segovia, Segovia, España
| | - Pilar Irún
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Instituto Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
| | - Blanca Moreno
- Servicio de Pediatría, Complejo Asistencial de Segovia, Segovia, España
| | - Pilar Giraldo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Instituto Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
| | - Jorge J Cebolla
- Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, España
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López de Frutos L, García-González E, García-Rodríguez B, González-Irazabal Y, Lahoz C, Irún P, Cebolla JJ, Giraldo P. Serum protein profile analysis in lysosomal storage disorders patients. Clin Chim Acta 2020; 510:430-436. [PMID: 32745579 DOI: 10.1016/j.cca.2020.07.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/11/2020] [Accepted: 07/29/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Serum protein electrophoresis (SPE) is a well-established technique to identify alterations in plasma protein profiles, caused by diseases as multiple myeloma (MM). In addition, it could be a cost-effective technique to discover new plasma biomarkers. Relation between MM and lysosomal storage diseases (LSDs) as Gaucher disease has been set out but, it has not been evaluated on other LSDs nor the utility of the SPE as first step on LSDs biomarkers discovery projects. MATERIALS AND METHODS Stored plasma samples at diagnosis from several LSDs patients underwent analysis. Quality control was checked prior to the SPE was analyzed by capillary electrophoresis. The analysis for monoclonal spikes and the differences between each fraction on patients' samples vs the control data previously published, were evaluated. Furthermore, immunoprotein quantification and free light chains ratio were done by nephelometry and turbidimetry. RESULTS Seventy-five samples of LSD patients at diagnosis, were assessed. The frequency of the MGUS on LSDs patients was not higher than in general population whereas one lysosomal acid lipase deficiency infant showed increased IgA and kappa deviation. Regarding to the usefulness of SPE in biomarkers discovery, statistically significant differences were observed on SPE fractions between LSDs and healthy population. DISCUSSION The evaluation of SPE fractions can be a useful tool to understand pathophysiologic aspects in LDSs and, to simplify new marker discovery projects. In some of them, the MGUS appearance is a risk factor for the MM development despite its frequency is not increased on the studied LSDs at diagnosis.
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Affiliation(s)
- Laura López de Frutos
- GIIS-012. Instituto de Investigación Sanitaria Aragón (IIS Aragón), Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Zaragoza 50009, Spain; Fundación para el Estudio y la Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza 50009, Spain.
| | - Elena García-González
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza 50009, Spain
| | | | | | - Carlos Lahoz
- Fundación para el Estudio y la Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza 50009, Spain
| | - Pilar Irún
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), IISCIII, Instituto de Investigación Sanitaria Aragón (IIS Aragón). Zaragoza 50009, Spain
| | - Jorge J Cebolla
- GIIS-012. Instituto de Investigación Sanitaria Aragón (IIS Aragón), Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Zaragoza 50009, Spain; Departamento de Bioquímica, Biología Molecular y Celular, Universidad de Zaragoza, Zaragoza 50009, Spain
| | - Pilar Giraldo
- Fundación para el Estudio y la Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza 50009, Spain
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Irún P, Cebolla JJ, López de Frutos L, De Castro-Orós I, Roca-Espiau M, Giraldo P. LC-MS/MS analysis of plasma glucosylsphingosine as a biomarker for diagnosis and follow-up monitoring in Gaucher disease in the Spanish population. ACTA ACUST UNITED AC 2020; 58:798-809. [DOI: 10.1515/cclm-2019-0949] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/03/2020] [Indexed: 11/15/2022]
Abstract
AbstractBackgroundGaucher disease (GD), caused by a deficiency in acid β-glucosidase, leads to the accumulation of glucosylsphingosine (GluSph), which has been used as a powerful biomarker for the diagnosis and follow-up of GD. Our aim was to perform the first retrospective study of GluSph in Spanish patients, analyzing its relationship with classical biomarkers and other parameters of disease and its utility regarding treatment monitoring.MethodsClassical biomarkers were evaluated retrospectively by standard methods in a total of 145 subjects, including 47 GD patients, carriers, healthy controls and patients suffering from other lysosomal lipidoses. GluSph was also measured using a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method developed as part of the present study.ResultsThe optimized method presented intra- and inter-assay variations of 3.1 and 11.5%, respectively, overall recovery higher than 96% and linearity up to plasma concentrations of 1000 ng/mL with 100% specificity and sensitivity. Only GD patients displayed GluSph levels above 5.4 ng/mL at diagnosis and this was significantly correlated with the classical biomarkers chitotriosidase (r = 0.560) and the chemokine CCL18/PARC (CCL18/PARC) (ρ = 0.515), as well as with the Spanish magnetic resonance imaging index (S-MRI, r = 0.364), whereas chitotriosidase correlated with liver volume (r = 0.372) and CCL18/PARC increased in patients with bone manifestations (p = 0.005). GluSph levels decreased with treatment in naïve patients.ConclusionsPlasma GluSph is the most disease-specific biomarker for GD with demonstrated diagnostic value and responsiveness to therapy. GluSph in the present series of patients failed to demonstrate better correlations with clinical characteristics at onset than classical biomarkers.
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Affiliation(s)
- Pilar Irún
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Jorge J. Cebolla
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, Spain
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain
| | - Laura López de Frutos
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain
| | - Isabel De Castro-Orós
- Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, Spain
| | - Mercedes Roca-Espiau
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain
- Centro de Diagnóstico por Imagen Dra Roca, Zaragoza, Spain
| | - Pilar Giraldo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Zaragoza, Spain
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Roca-Espiau M, Andrade-Campos M, Cebolla JJ, López de Frutos L, Medrano-Engay B, López-Royo MP, Giraldo P. Muscle-tendon weakness contributes to chronic fatigue syndrome in Gaucher's disease. J Orthop Surg Res 2019; 14:383. [PMID: 31752949 PMCID: PMC6873505 DOI: 10.1186/s13018-019-1452-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/22/2019] [Accepted: 10/31/2019] [Indexed: 01/31/2023] Open
Abstract
Background Chronic fatigue (CFg) is a prevalent symptom in Gaucher disease (GD) at diagnosis (79%) and remains in a quarter of patients after years of therapy. Bone abnormalities are present in over 70% and peripheral neuropathy in about 11% of the patients, which contributes to the disabling and debilitating complications. Our hypothesis is that other factors such as muscle-tendinous weakness could have influence in the development of CFg. Methods We have evaluated the fiber structure and elasticity of muscle-tendinous unit by strain-elastography (S-ELA) and analyzed their influence in the CFg. S-ELA study was performed in Achilles tendon in 25 type 1 and two type 3 GD patients, all of them with fatigue and were on enzymatic replacement therapy for mean 13 years; simultaneously, bone marrow burden by MRI and calcaneus ultrasound densitometry were evaluated. Blood cell counts, plasma biomarkers, GBA1 genotyping, and SF36 quality of life scale (QoL) were also performed. Statistical analysis: descriptive and comparative test. Results All patients showed a normal Achilles tendinous structure. Abnormal stiff grade 2–3 was found in 17/27 (62.9%); in 11/27 (40.7%) of patients, the alteration was bilateral. There were no correlations between the S-ELA results to other variables; nevertheless, a significant correlation between the degree of tendon hardness and the low score on the QoL scales (p = 0.0035) was found. The S-ELA is a sensitive painless, fast, and low cost method to detect muscle-tendinous subclinical dysfunction that could contribute to CFg in GD. The identification of subclinical tendon alteration would be a sign of alarm, focused on the risk of development of bone complications. Conclusion Intratendinous alteration in strain-elastography is an independent variable in GD patients with persistent fatigue.
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Affiliation(s)
- Mercedes Roca-Espiau
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain.,Radiologic Centre CEMEDI, Zaragoza, Spain
| | - Marcio Andrade-Campos
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain.,Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Departamento de Hematología, Hospital del Mar, Barcelona, Spain
| | - Jorge J Cebolla
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain.,Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, Spain
| | - Laura López de Frutos
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain.,Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Blanca Medrano-Engay
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain.,Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Maria-Pilar López-Royo
- Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,iPhysio Group, Universidad San Jorge, Zaragoza, Spain
| | - Pilar Giraldo
- Fundación Española Estudio y Tratamiento de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain. .,Grupo de Investigación en Enfermedad de Gaucher (GIIS-012), Unidad de Investigación Traslacional, Fundación Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.
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López de Frutos L, Cebolla JJ, Irún P, Köhler R, Giraldo P. Web-Based Bioinformatics Predictors: Recommendations to Assess Lysosomal Cholesterol Trafficking Diseases-Related Genes. Methods Inf Med 2019; 58:50-59. [PMID: 31277084 DOI: 10.1055/s-0039-1692463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The growing number of genetic variants of unknown significance (VUS) and availability of several in silico prediction tools make the evaluation of potentially deleterious gene variants challenging. MATERIALS AND METHODS We evaluated several programs and software to determine the one that can predict the impact of genetic variants found in lysosomal storage disorders (LSDs) caused by defects in cholesterol trafficking best. We evaluated the sensitivity, specificity, accuracy, precision, and Matthew's correlation coefficient of the most common software. RESULTS Our findings showed that for exonic variants, only MutPred1 reached 100% accuracy and generated the best predictions (sensitivity and accuracy = 1.00), whereas intronic variants, SROOGLE or Human Splicing Finder (HSF) generated the best predictions (sensitivity = 1.00, and accuracy = 1.00). DISCUSSION Next-generation sequencing substantially increased the number of detected genetic variants, most of which were considered to be VUS, creating a need for accurate pathogenicity prediction. The focus of the present study is the importance of accurately predicting LSDs, with majority of previously unreported specific mutations. CONCLUSION We found that the best prediction tool for the NPC1, NPC2, and LIPA variants was MutPred1 for exonic regions and HSF and SROOGLE for intronic regions and splice sites.
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Affiliation(s)
- Laura López de Frutos
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Unidad de Investigación Traslacional (GIIS012), Hospital Universitario Miguel Servet, Zaragoza, Spain.,Fundación para el Estudio y la Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain
| | - Jorge J Cebolla
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Unidad de Investigación Traslacional (GIIS012), Hospital Universitario Miguel Servet, Zaragoza, Spain.,Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, Spain
| | - Pilar Irún
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Unidad de Investigación Traslacional (GIIS012), Hospital Universitario Miguel Servet, Zaragoza, Spain.,Centro de Investigación Biomédica en Red (CIBER), Zaragoza, Spain
| | - Ralf Köhler
- Fundación Agencia Aragonesa para la Investigación y el Desarrollo (ARAID), Zaragoza, Spain
| | - Pilar Giraldo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Unidad de Investigación Traslacional (GIIS012), Hospital Universitario Miguel Servet, Zaragoza, Spain.,Fundación para el Estudio y la Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, Spain
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Consuelo-Sánchez A, Vázquez-Frias R, Reyes-De La Rosa A, Acosta-Rodríguez-Bueno CP, Ortal-Vite MP, Cebolla JJ. Mutations identified in a cohort of Mexican patients with lysosomal acid lipase deficiency. Ann Hepatol 2019; 18:646-650. [PMID: 31182375 DOI: 10.1016/j.aohep.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/08/2018] [Revised: 07/16/2018] [Accepted: 07/30/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Lysosomal acid lipase deficiency (LAL-D) is an autosomal recessive disease caused by mutations in the LIPA gene, located on the long arm of chromosome 10 (10q23.31). Up until now, more than 59 mutations have been described and which are the cause of a very wide clinical spectrum. The goal of this study was to identify the mutations present in Mexican pediatric patients with a diagnosis of LAL-D. MATERIALS AND METHODS A cross-sectional study was carried out which included all the pediatric patients with LAL-D treated in a tertiary hospital in Mexico from January 2000 to June 2017. RESULTS Sixteen patients with LAL-D were identified with a disease phenotype marked by the accumulation of cholesteryl esters. Eight distinct variants in the LIPA gene sequence were found, four pathogenic variants and four probably pathogenic. In six individuals, the variants were found in the homozygous state and ten were compound heterozygous. The eight variants were inverted, with five found on exon 4 and the others on exons 2, 8 and 10. The variant c.386A>G;p.His129Arg was the most common, being found in six of the 16 individuals (37.5%), making it much more frequent than what had previously been reported in the literature in proportion to the rest of the variants. The mutation known as E8SJM, which has been the mostly frequently found at the international level, was not the most common among this group of Mexican patients. In conclusion, Mexican patients present a different frequency of mutations associated with LAL-D in comparison to European populations.
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Affiliation(s)
- Alejandra Consuelo-Sánchez
- Department of Gastroenterology and Nutrition, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
| | - Rodrigo Vázquez-Frias
- Department of Gastroenterology and Nutrition, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | - María P Ortal-Vite
- Department of Gastroenterology and Nutrition, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Jorge J Cebolla
- Group of Haematological and Metabolic Diseases, Translational Research Unit, Miguel Servet University Hospital, Zaragoza, Spain
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Cebolla JJ, Irún P, Mozas P, Giraldo P. Evaluation of two approaches to lysosomal acid lipase deficiency patient identification: An observational retrospective study. Atherosclerosis 2019; 285:49-54. [PMID: 31004967 DOI: 10.1016/j.atherosclerosis.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 08/23/2018] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Lysosomal acid lipase deficiency (LALD) leads to the accumulation of cholesteryl esters and/or triglycerides (TG) in lysosomes due to the lack of the enzyme codified by the LIPA gene. The most common symptoms are dyslipidaemia and hypertransaminasemia, together with manifestations common to other lysosomal storage disorders (LSDs), including visceromegalies and elevated plasma biomarkers. Alteration of the lipid-liver profile (LLP) has been widely applied as a criterion for LALD screening, but the usefulness of biomarkers has not yet been explored. Our purpose was to explore the utility of plasma chitotriosidase activity (ChT) and CCL18/PARC concentration in addition to LLP to identify LALD patients in an observational retrospective study of two different sample collections. METHODS Biological samples refining: Collection 1 (primary hypercholesterolemia suspected) included unrelated individuals with hyperlipidaemia and without LDLR, APOB and PCSK9 gene mutations (Set 1), and Collection 2 (LSD suspected) included individuals without definitive LSD diagnosis (Set 2). We assessed plasma LLP (total cholesterol and its fractions, TG concentration and transaminases activities), as well as plasma ChT and CCL18/PARC. All subjects with anomalous LLP and/or biomarker levels were LIPA sequenced. RESULTS Twenty-four subjects showed altered LLP and/or biomarkers. We identified two LALD patients (one homozygous and one compound heterozygous) and one carrier of a novel LIPA variant. CONCLUSIONS The measurement of plasma ChT and CCL18/PARC combined with LLP will be a useful approach to identifying LALD patients in retrospective LALD patient studies.
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Affiliation(s)
- Jorge J Cebolla
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), GIIS-012, Zaragoza, 50009, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), CB/06/07/1036, Instituto de Salud Carlos III (ISCIII), Hospital Universitario Miguel Servet, Zaragoza, 50009, Spain; Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, 50008, Spain; Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, 50009, Spain.
| | - Pilar Irún
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), CB/06/07/1036, Instituto de Salud Carlos III (ISCIII), Hospital Universitario Miguel Servet, Zaragoza, 50009, Spain
| | - Pilar Mozas
- Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, 50009, Spain
| | - Pilar Giraldo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), GIIS-012, Zaragoza, 50009, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), CB/06/07/1036, Instituto de Salud Carlos III (ISCIII), Hospital Universitario Miguel Servet, Zaragoza, 50009, Spain; Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, 50008, Spain
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Castro Narro GE, Gamboa Domínguez A, Consuelo Sánchez A, Salazar Martínez A, Agramonte Hevia J, Cebolla JJ, Cuellar Mendoza ME, Díaz Hernández HA. Combined Hepatocellular-Cholangiocarcinoma in a Patient With Cirrhosis Due to Cholesteryl Ester Storage Disease. Hepatology 2019; 69:1838-1841. [PMID: 30372535 DOI: 10.1002/hep.30331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/22/2018] [Indexed: 12/07/2022]
Affiliation(s)
- Graciela Elia Castro Narro
- Department of Gastroenterology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Armando Gamboa Domínguez
- Department of Pathology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Alejandra Consuelo Sánchez
- Department of Gastroenterology and Nutrition, Infantile Hospital of Mexico Federico Gomez, Mexico City, Mexico
| | - Abel Salazar Martínez
- Department of Pediatrics, Central Hospital Ignacio Morones Prieto, San Luis Potosi, Mexico
| | | | - J J Cebolla
- Translational Research Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Héctor Adrián Díaz Hernández
- Department of Gastroenterology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
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12
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Affiliation(s)
- Pilar Giraldo
- Traslational Research Unit, Aragon Institute of Health Research (IISAragon), Zaragoza, Spain
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13
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López de Frutos L, Cebolla JJ, Irún P, Köhler R, Giraldo P. The erythrocyte osmotic resistance test as screening tool for cholesterol-related lysosomal storage diseases. Clin Chim Acta 2018; 480:161-165. [PMID: 29447902 DOI: 10.1016/j.cca.2018.02.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/15/2018] [Accepted: 02/12/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Erythrocyte volume regulation and membrane elasticity are essential for adaptation to osmotic and mechanical stress, and life span. Here, we evaluated whether defective cholesterol trafficking caused by the rare lysosomal storages diseases (LSDs), Niemann-Pick type C (NPC) and Lysosomal acid lipase (LAL) deficiency (LALD) impairs these properties. Moreover, we tested whether measurements of cholesterol membrane content and osmotic resistance serve as a screening test for these LSDs. METHODS Patients were genotyped for mutations in NPC1, NPC2, or LIPA genes. We measured LSD plasma biomarkers and LAL activity. Red blood cells (RBC) membrane cholesterol content was evaluated in 73 subjects. Osmotic resistance tests (ORT) were conducted in 121 blood samples from LSD suspected patients and controls. RESULTS We did not find statistically significant differences between RBC cholesterol content between subjects and controls. However, the ORT, particularly at 0.49% (w/v) hypotonic sodium chloride solution, revealed a significant higher osmotic resistance in LSDs patients than in controls. We established a cut-off value of ≤51% of haemolysis with sensibility and specificity values of 80% and 70%, respectively. CONCLUSIONS NPC and LALD do not alter cholesterol content in the RBC membrane but increase osmotic resistance. Therefore, ORT serves as screening test for the studied LSDs.
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Affiliation(s)
- Laura López de Frutos
- Instituto de Investigación Sanitaria Aragón (IIS Aragón) GIIS-012, Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Zaragoza 50009, Spain; Fundación para el Estudio y la Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza 50009, Spain.
| | - Jorge J Cebolla
- Instituto de Investigación Sanitaria Aragón (IIS Aragón) GIIS-012, Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Zaragoza 50009, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) U-752, Zaragoza 50009, Spain; Universidad de Zaragoza, Departamento de Bioquímica, Biología Molecular y Celular, Zaragoza 50009, Spain
| | - Pilar Irún
- Instituto de Investigación Sanitaria Aragón (IIS Aragón) GIIS-012, Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Zaragoza 50009, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) U-752, Zaragoza 50009, Spain
| | - Ralf Köhler
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) U-752, Zaragoza 50009, Spain; Fundación Agencia Aragonesa para la Investigación y el Desarrollo (ARAID), Zaragoza 50009, Spain
| | - Pilar Giraldo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón) GIIS-012, Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Zaragoza 50009, Spain; Fundación para el Estudio y la Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza 50009, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) U-752, Zaragoza 50009, Spain
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14
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Camarena C, Aldamiz-Echevarria LJ, Polo B, Barba Romero MA, García I, Cebolla JJ, Ros E. Update on lysosomal acid lipase deficiency: Diagnosis, treatment and patient management. Med Clin (Barc) 2017; 148:429.e1-429.e10. [PMID: 28285817 DOI: 10.1016/j.medcli.2016.12.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 01/01/2023]
Abstract
Lysosomal acid lipase deficiency (LALD) is an ultra-rare disease caused by a congenital disorder of the lipid metabolism, characterized by the deposition of cholesterol esters and triglycerides in the organism. In patients with no enzyme function, the disease develops during the perinatal period and is invariably associated with death during the first year of life. In all other cases, the phenotype is heterogeneous, although most patients develop chronic liver diseases and may also develop an early cardiovascular disease. Treatment for LALD has classically included the use of supportive measures that do not prevent the progression of the disease. In 2015, regulatory agencies approved the use of a human recombinant LAL for the treatment of LALD. This long-term enzyme replacement therapy has been associated with significant improvements in the hepatic and lipid profiles of patients with LALD, increasing survival rates in infants with a rapidly progressive disease. Both the severity of LALD and the availability of a specific treatment highlight the need to identify these patients in clinical settings, although its low prevalence and the existing clinical overlap with other more frequent pathologies limit its diagnosis. In this paper we set out practical recommendations to identify and monitor patients with LALD, including a diagnostic algorithm, along with an updated treatment.
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Affiliation(s)
- Carmen Camarena
- Servicio de Hepatología Infantil, Hospital La Paz, Madrid, España
| | - Luis J Aldamiz-Echevarria
- Unidad de Enfermedades Metabólicas Pediátricas, Hospital Universitario Cruces, Bilbao, España; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, España; CSUR de Enfermedades Metabólicas Congénitas, Ministerio de Sanidad, Madrid, España
| | - Begoña Polo
- Servicio de Gastroenterología y Hepatología Pediátrica, Hospital La Fe, Valencia, España
| | - Miguel A Barba Romero
- Servicio de Medicina Interna, Complejo Hospitalario y Universitario de Albacete, Universidad de Castilla-La Mancha, Albacete, España
| | - Inmaculada García
- Unidad de Enfermedades Metabólicas Pediátricas, Hospital Miguel Servet, Zaragoza, España
| | - Jorge J Cebolla
- Instituto de Investigación Sanitaria Aragón, Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Zaragoza, España; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Emilio Ros
- Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, España; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España.
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Oliván-Viguera A, Lozano-Gerona J, López de Frutos L, Cebolla JJ, Irún P, Abarca-Lachen E, García-Malinis AJ, García-Otín ÁL, Gilaberte Y, Giraldo P, Köhler R. Inhibition of Intermediate-Conductance Calcium-Activated K Channel (KCa3.1) and Fibroblast Mitogenesis by α-Linolenic Acid and Alterations of Channel Expression in the Lysosomal Storage Disorders, Fabry Disease, and Niemann Pick C. Front Physiol 2017; 8:39. [PMID: 28197106 PMCID: PMC5281581 DOI: 10.3389/fphys.2017.00039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/13/2017] [Indexed: 01/02/2023] Open
Abstract
The calcium/calmodulin-gated KCa3.1 channel regulates normal and abnormal mitogenesis by controlling K+-efflux, cell volume, and membrane hyperpolarization-driven calcium-entry. Recent studies suggest modulation of KCa3.1 by omega-3 fatty acids as negative modulators and impaired KCa3.1 functions in the inherited lysosomal storage disorder (LSD), Fabry disease (FD). In the first part of present study, we characterize KCa3.1 in murine and human fibroblasts and test the impact of omega-3 fatty acids on fibroblast proliferation. In the second, we study whether KCa3.1 is altered in the LSDs, FD, and Niemann-Pick disease type C (NPC). Our patch-clamp and mRNA-expression studies on murine and human fibroblasts show functional expression of KCa3.1. KCa currents display the typical pharmacological fingerprint of KCa3.1: Ca2+-activation, potentiation by the positive-gating modulators, SKA-31 and SKA-121, and inhibition by TRAM-34, Senicapoc (ICA-17043), and the negative-gating modulator, 13b. Considering modulation by omega-3 fatty acids we found that α-linolenic acid (α-LA) and docosahexanenoic acid (DHA) inhibit KCa3.1 currents and strongly reduce fibroblast growth. The α-LA-rich linseed oil and γ-LA-rich borage oil at 0.5% produce channel inhibition while α-LA/γ-LA-low oils has no anti-proliferative effect. Concerning KCa3.1 in LSD, mRNA expression studies, and patch-clamp on primary fibroblasts from FD and NPC patients reveal lower KCa3.1-gene expression and membrane expression than in control fibroblasts. In conclusion, the omega-3 fatty acid, α-LA, and α-LA/γ-LA-rich plant oils, inhibit fibroblast KCa3.1 channels and mitogenesis. Reduced fibroblast KCa3.1 functions are a feature and possible biomarker of cell dysfunction in FD and NPC and supports the concept that biased lipid metabolism is capable of negatively modulating KCa3.1 expression.
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Affiliation(s)
- Aida Oliván-Viguera
- Biomedical Signal Interpretation and Computational Simulation Group, Aragón Institute for Engineering Research (I3A), University of ZaragozaZaragoza, Spain; Instituto de Investigación Sanitaria AragónZaragoza, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and NanomedicineZaragoza, Spain
| | - Javier Lozano-Gerona
- Instituto de Investigación Sanitaria AragónZaragoza, Spain; Aragón Institute of Health SciencesZaragoza, Spain; Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de ZaragozaZaragoza, Spain
| | - Laura López de Frutos
- Instituto de Investigación Sanitaria AragónZaragoza, Spain; Spanish Foundation for the Study and Treatment of Gaucher Disease and Other Lysosomal DisordersZaragoza, Spain
| | - Jorge J Cebolla
- Instituto de Investigación Sanitaria AragónZaragoza, Spain; Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de ZaragozaZaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades RarasZaragoza, Spain
| | - Pilar Irún
- Instituto de Investigación Sanitaria AragónZaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades RarasZaragoza, Spain
| | - Edgar Abarca-Lachen
- Faculty of Health Sciences, Universidad San Jorge Villanueva de Gállego, Spain
| | | | - Ángel Luis García-Otín
- Instituto de Investigación Sanitaria AragónZaragoza, Spain; Aragón Institute of Health SciencesZaragoza, Spain
| | | | - Pilar Giraldo
- Instituto de Investigación Sanitaria AragónZaragoza, Spain; Aragón Institute of Health SciencesZaragoza, Spain; Spanish Foundation for the Study and Treatment of Gaucher Disease and Other Lysosomal DisordersZaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades RarasZaragoza, Spain
| | - Ralf Köhler
- Instituto de Investigación Sanitaria AragónZaragoza, Spain; Aragón Institute of Health SciencesZaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades RarasZaragoza, Spain; Aragón Agency for Research and DevelopmentZaragoza, Spain
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16
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Gervas-Arruga J, Cebolla JJ, Irun P, Perez-Lopez J, Plaza L, Roche JC, Capablo JL, Rodriguez-Rey JC, Pocovi M, Giraldo P. Increased glycolipid storage produced by the inheritance of a complex intronic haplotype in the α-galactosidase A (GLA) gene. BMC Genet 2015; 16:109. [PMID: 26334996 PMCID: PMC4558912 DOI: 10.1186/s12863-015-0267-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/25/2015] [Indexed: 01/25/2023] Open
Abstract
Background Accumulation of galactosphingolipids is a general characteristic of Fabry disease, a lysosomal storage disorder caused by the deficient activity of α-galactosidase A encoded by the GLA gene. Although many polymorphic GLA haplotypes have been described, it is still unclear whether some of these variants are causative of disease symptoms. We report the study of an inheritance of a complex intronic haplotype (CIH) (c.-10C > T, c.369 + 990C > A, c.370-81_370-77delCAGCC, c.640-16A > G, c.1000-22C > T) within the GLA gene associated with Fabry-like symptoms and galactosphingolipid accumulation. We analysed α-Gal A activity in plasma, leukocytes and skin fibroblasts in patients, and measured accumulation of galactosphingolipids by enzymatic methods and immunofluorescence techniques. Additionally, we evaluated GLA expression using quantitative PCR, EMSA, and cDNA cloning. Results CIH carriers had an altered GLA expression pattern, although most of the carriers had high residual enzyme activity in plasma, leukocytes and in skin fibroblasts. Nonetheless, CIH carriers had significant galactosphingolipid accumulation in fibroblasts in comparison with controls, and also glycolipid deposits in renal tubules and glomeruli. EMSA assays indicated that the c.-10C > T variant in the promoter affected a nuclear protein binding site. Conclusions Thus, inheritance of the CIH caused an mRNA deregulation altering the GLA expression pattern, producing a tissue glycolipid storage. Electronic supplementary material The online version of this article (doi:10.1186/s12863-015-0267-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Javier Gervas-Arruga
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Zaragoza, Spain. .,Translational Research Unit, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain. .,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain. .,Biochemistry and Molecular and Cellular Biology Department, Universidad de Zaragoza, Zaragoza, Spain.
| | - Jorge J Cebolla
- Translational Research Unit, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain. .,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain. .,Biochemistry and Molecular and Cellular Biology Department, Universidad de Zaragoza, Zaragoza, Spain.
| | - Pilar Irun
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Zaragoza, Spain. .,Translational Research Unit, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain. .,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain. .,Biochemistry and Molecular and Cellular Biology Department, Universidad de Zaragoza, Zaragoza, Spain.
| | - Javier Perez-Lopez
- Molecular Biology Department, Cantabria University and IFIMAV, Santander, Spain.
| | - Luis Plaza
- Anatomic Pathology Department, Miguel Servet University Hospital, Zaragoza, Spain.
| | - Jose C Roche
- Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain.
| | - Jose L Capablo
- Neurology Department, Miguel Servet University Hospital, Zaragoza, Spain.
| | - Jose C Rodriguez-Rey
- Molecular Biology Department, Cantabria University and IFIMAV, Santander, Spain.
| | - Miguel Pocovi
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain. .,Biochemistry and Molecular and Cellular Biology Department, Universidad de Zaragoza, Zaragoza, Spain.
| | - Pilar Giraldo
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Zaragoza, Spain. .,Translational Research Unit, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain. .,Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.
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