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Jurina A, Delimar V, Giljević Z, Filipec Kanižaj T, Matković A, Vidović D, Jurjević N, Vidjak V, Duić Ž, Ćuk M, Japjec M, Dujmović T, Radeljak A, Kardum Paro MM, Vučić-Lovrenčić M, Starešinić M. Fragility spinal fractures among cirrhotic liver transplant candidates in Croatia. Injury 2024; 55:111171. [PMID: 37952477 DOI: 10.1016/j.injury.2023.111171] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/21/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Existing data on fragility spinal fractures prevalence in liver transplant candidates are scarce and inconsistent. This may be due to other comorbidities, besides hepatic osteodystrophy (HO), that contribute to bone loss and fragility fracture prevalence in chronic liver disease (CLD). OBJECTIVES The aim of this study was to investigate the prevalence of spinal thoracic and lumbar fragility fractures among cirrhotic, non-chronic kidney disease (CKD), non-diabetic liver transplant candidates and to explore their relationship with clinical characteristics, laboratory markers and dual-energy x-ray absorptiometry (DXA) results. MATERIAL AND METHODS This cross-sectional observational study was conducted at Merkur University Hospital, Croatia, between February 2019 and May 2023. Adult patients with liver cirrhosis referred for liver transplantation were included. Patients with acute infection, CKD, diabetes mellitus, malignancies, inflammatory bone diseases and those on corticosteroid or antiresorptive therapy were excluded. Clinical, laboratory and radiological assessment was carried out and patients were accordingly allocated into non-fractured and fractured group for the purpose of statistical analysis. RESULTS A total of 90 patients were included in the study. There was 123 fractures, 87 (70.7 %) in the thoracic and 36 (29.3 %) in the lumbar region. Eighty-nine (72.4 %) fractures were grade 1, 31 (25.2 %) were grade 2 and 3 (2.4 %) were grade 3. Patients in the fractured group were significantly older (p < 0.001). No significant differences between fractured and non-fractured group according to laboratory and DXA parameters were noted. Subgroup with lumbar fractures had significantly lower bone mineral density values at L1-L4 region. Statistically significant negative correlation between bone specific alkaline phosphatase (BALP) and hip total BMD (rho = -0.414, p < 0.001) and spine total BMD (rho = -0.258, p = 0.014) values was found. CONCLUSION Present study confirmed detrimental impact of CLD and HO on bone strength. DXA measurement correlated with the presence of lumbar fragility fractures. A combination of standard X-ray imaging and DXA is needed for adequate bone evaluation in pretransplant period and BALP could be useful for detecting HO in CLD. Searching for other risk factors and implementing bone turnover markers and additional imaging techniques for bone loss evaluation in liver transplant candidates is needed.
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Affiliation(s)
- Andrija Jurina
- Division of general and sport traumatology and orthopaedics, Department of surgery, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Valentina Delimar
- Special Hospital for Medical Rehabilitation Krapinske Toplice, Gajeva 2, 49217 Krapinske Toplice, Croatia.
| | - Zlatko Giljević
- Division of Endocrinology, Department of internal medicine, Zagreb University Hospital Centre, Kišpatićeva 12, 10000 Zagreb, Croatia; School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Tajana Filipec Kanižaj
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia; Division of Gastroenterology, Department of internal medicine, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Andro Matković
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Dinko Vidović
- Sestre milosrdnice University Hospital Centre, Clinic of Traumatology, Draškovićeva 19, 10000 Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10000 Zagreb, Croatia
| | - Nikolina Jurjević
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Vinko Vidjak
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia; Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Željko Duić
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia; Department of Gynaecology and Obstretrics, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Mario Ćuk
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia; Department of Pediatrics, Zagreb University Hospital Centre, Kišpatićeva 12, Rebro 10000 Zagreb, Croatia
| | - Mladen Japjec
- Division of general and sport traumatology and orthopaedics, Department of surgery, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Tomislav Dujmović
- Division of general and sport traumatology and orthopaedics, Department of surgery, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Andrea Radeljak
- Department of Clinical Chemistry and Laboratory Medicine, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Mirjana Marjana Kardum Paro
- Department of Clinical Chemistry and Laboratory Medicine, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Marijana Vučić-Lovrenčić
- Department of Clinical Chemistry and Laboratory Medicine, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia
| | - Mario Starešinić
- Division of general and sport traumatology and orthopaedics, Department of surgery, Merkur University Hospital, Zajčeva 19, 10000 Zagreb, Croatia; School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
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Koruga N, Pušeljić S, Babić M, Ćuk M, Roić AC, Vrtarić V, Koruga AS, Rončević A, Tomac V, Rotim T, Turk T, Kretić D, Pušeljić N, Nađ R, Serdarušić I. First Reported Case of Gabriele-de Vries Syndrome with Spinal Dysraphism. Children 2023; 10:children10040623. [PMID: 37189872 DOI: 10.3390/children10040623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023]
Abstract
Gabriele-de Vries syndrome is a rare autosomal dominant genetic disease caused by de novo pathogenic variants in the Yin Yang 1 (YY1) gene. Individuals with this syndrome present with multiple congenital anomalies, as well as a delay in development and intellectual disability. Herein, we report the case of a newborn male patient with a novel de novo pathogenic variant in the Guanine Nucleotide-Binding Protein, Alpha Stimulating (GNAS) gene, which was identified by whole-exome sequencing. Our patient suffered from a large open spinal dysraphism which was treated surgically immediately after birth. During the follow-up, facial dysmorphism, bladder and bowel incontinence, and mildly delayed motor and speech development were observed. Congenital central nervous system disorders were also confirmed radiologically. In this case report, we present our diagnostic and treatment approaches to this patient. To our knowledge, this is the first reported case of Gabriele-de Vries syndrome presenting with spinal dysraphism. Extensive genetic evaluation is the cornerstone in treatment of patients with suspected Gabriele-de Vries syndrome. However, in cases with potentially life-threatening conditions, surgery should be strongly considered.
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Ninković D, Mustapić Ž, Bartoniček D, Benjak V, Ćuk M, Buljević AD, Grčić BF, Fumić K, Grizelj R, Lehman I, Ramadža DP, Sarnavka V, Slaviček J, Kastelić JS, Barišić N, Barić I. The Therapeutic Hypothermia in Treatment of Hyperammonemic Encephalopathy due to Urea Cycle Disorders and Organic Acidemias. Klin Padiatr 2019; 231:74-79. [PMID: 30870873 DOI: 10.1055/a-0855-4001] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hyperammonemic encephalopathy in newborns with urea cycle disorders and certain organic acidurias can cause severe brain injury, coma and death. Standard therapy includes protein restriction, nitrogen-scavenging drugs, prevention of catabolism and hemodialysis. Neuroprotective hypothermia as part of the treatment has been reported only 3 times. It has been suggested that mild systemic hypothermia can contribute to better neurological outcomes in hyperammonemic encephalopathy. However, the limited experience precludes accurate conclusions on safety and efficacy. METHODS Whole body therapeutic hypothermia was included in the standard treatment of hyperammonemic encephalopathy in 4 neonates with urea cycle disorder or organic aciduria. RESULTS Two patients survived the initial crisis. One patient has a developmental quotient of 0.8, while the other shows severe developmental delay. The cooling protocol had to be discontinued in 3 patients due to the otherwise untreatable complications (hypotension and hemorrhage). CONCLUSION The efficacy and safety of therapeutic hypothermia in the treatment of neonatal hyperammonemic encephalopathy depend on various factors, requiring further evaluation.
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Affiliation(s)
- Dorotea Ninković
- Klinika za pedijatriju, Sveuciliste u Zagrebu Medicinski fakultet, Zagreb, Croatia
| | - Željka Mustapić
- Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | - Dorotea Bartoniček
- Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | - Vesna Benjak
- Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | - Mario Ćuk
- Klinika za pedijatriju, Sveuciliste u Zagrebu Medicinski fakultet, Zagreb, Croatia.,Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | | | - Boris Filipović Grčić
- Klinika za pedijatriju, Sveuciliste u Zagrebu Medicinski fakultet, Zagreb, Croatia.,Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | - Ksenija Fumić
- Klinika za laboratorijsku dijagnostiku, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | - Ruža Grizelj
- Department of Pediatrics, University Hospital Centre Zagreb, Univeristy of Zagreb Medical School, Zagreb, Croatia
| | - Ivan Lehman
- Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | - Danijela Petković Ramadža
- Klinika za pedijatriju, Sveuciliste u Zagrebu Medicinski fakultet, Zagreb, Croatia.,Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | - Vladimir Sarnavka
- Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | - Jasna Slaviček
- Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | | | - Nina Barišić
- Klinika za pedijatriju, Sveuciliste u Zagrebu Medicinski fakultet, Zagreb, Croatia.,Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
| | - Ivo Barić
- Klinika za pedijatriju, Sveuciliste u Zagrebu Medicinski fakultet, Zagreb, Croatia.,Klinika za pedijatriju, Klinicki Bolnicki Centar Zagreb, Zagreb, Croatia
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Ninković D, Sarnavka V, Bašnec A, Ćuk M, Ramadža DP, Fumić K, Kušec V, Santer R, Barić I. Hyperinsulinism-hyperammonemia syndrome: a de novo mutation of the GLUD1 gene in twins and a review of the literature. J Pediatr Endocrinol Metab 2016; 29:1083-8. [PMID: 27383869 DOI: 10.1515/jpem-2016-0086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 05/09/2016] [Indexed: 01/25/2023]
Abstract
Hyperinsulinism-hyperammonemia (HI/HA) syndrome is a rare autosomal dominant disease characterized by recurrent hypoglycemia and persistent mild elevation of plasma ammonia. HI/HA syndrome is one of the more common forms of congenital hyperinsulinism (CHI), caused by activating mutations within the GLUD1 gene that encodes the mitochondrial enzyme glutamate dehydrogenase (GDH). We report here on monozygotic twin girls presented with fasting- and protein-induced hypoglycemia and mild persistent hyperammonemia. Genetic analysis revealed that both girls were heterozygous for a novel missense mutation within exon 11 [c.1499A>T, p.(R443W)] of the GLUD1 gene. Despite early treatment with diazoxide and a low protein diet, they both developed non-hypoglycemic seizures in early childhood followed by cognitive impairment. In addition to their clinical course, a review of the literature on HI/HA syndrome is provided.
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Ramadža DP, Ćuk M, Zibar K, Barić M, Sarnavka V, Bilić K, Fumić K, Vuković J, Pušeljić S, Ćorić M, Padovan RŠ, Kralik M, Barić I. [Lysosomal acid lipase deficiency in children: our experience and a novel possibility of enzyme replacement therapy]. Lijec Vjesn 2015; 137:81-7. [PMID: 26065284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lysosomal acid lipase deficiency is an autosomal recessive disorder with two distinct clinical phenotypes. Wolman disease is rapidly progressive with onset in early infancy. Complete enzyme deficiency results in massive accumulation of cholesterol esters and triglycerides in intestines, liver, spleen and other monocyte-macrophage system cells causing malabsorption, hepatosplenomegaly, liver failure and death in early infancy. Cholesterol ester storage disease may be diagnosed in childhood or later in life. It is characterized by chronic course and variable progression. Main features are variously expressed hepatopathy, including cirrhosis and liver failure, hypercholesterolemia and premature atherosclerosis. Characteristic is pathohistological finding of microvesicular steatosis and fibrosis and patognomonic are typical cholesterol ester crystals. Diagnosis is confirmed by enzyme assay and/or gene analysis. Until recently treatment was symptomatic. Ongoing clinical trials of enzyme replacement therapy have shown very promising results. We are presenting an infant with Wolman disease and two children with cholesterol ester storage disease with the aim to raise awareness about this disease and to start optimal care early.
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Belužić R, Ćuk M, Pavkov T, Fumić K, Barić I, Mudd S, Jurak I, Vugrek O. A single mutation at Tyr143 of human S-adenosylhomocysteine hydrolase renders the enzyme thermosensitive and affects the oxidation state of bound cofactor nicotinamide-adenine dinucleotide. Biochem J 2006; 400:245-53. [PMID: 16872278 PMCID: PMC1652816 DOI: 10.1042/bj20060749] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recently, we have described the first human case of AdoHcyase (S-adenosylhomocysteine hydrolase) deficiency. Two point mutations in the AdoHcyase gene, the missense mutation p.Y143C (AdoHcyase in which Tyr143 is replaced by cysteine) and the truncation mutation p.W112stop (AdoHcyase in which Trp112 is replaced by opal stop codon) were identified [Barić, Fumić, Glenn, Cuk, Schulze, Finkelstein, James, Mejaski-Bosnjak, Pazanin, Pogribny et al. (2004) Proc. Natl. Acad. Sci. U.S.A. 101, 4234-4239]. To elucidate the molecular and catalytic properties of AdoHcyase, we have made recombinant wild-type and mutant p.Y143C (AdoHcyase in which Tyr143 is replaced by cysteine) enzymes for a comparative analysis. The catalytic rates of p.Y143C protein in the directions of S-adenosylhomocysteine synthesis or hydrolysis are decreased from 65% to 75%. Further, the oxidation states of coenzyme NAD differ between mutant and wild-type protein, with an increased NADH accumulation in the mutant p.Y143C enzyme of 88% NADH (wild-type contains 18% NADH). Quantitative binding of NAD is not affected. Native polyacrylamide gel electrophoresis showed, that mutant p.Y143C subunits are able to form the tetrameric complex as is the wild-type enzyme. CD analysis showed that the p.Y143C mutation renders the recombinant protein thermosensitive, with an unfolding temperature significantly reduced by 7 degrees C compared with wild-type protein. Change of Glu115 to lysine in wild-type protein causes a change in thermosensitivity almost identical with that found in the p.Y143C enzyme, indicating that the thermosensitivity is due to a missing hydrogen bond between Tyr143 and Glu115. We emphasize involvement of this particular hydrogen bond for subunit folding and/or holoenyzme stability. In summary, a single mutation in the AdoHcyase affecting both the oxidation state of bound co-factor NAD and enzyme stability is present in a human with AdoHcyase deficiency.
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Affiliation(s)
- Robert Belužić
- *Division of Molecular Medicine, Institute Ruđer Bošković, Bijenička 54, 10000 Zagreb, Croatia
| | - Mario Ćuk
- †Department of Pediatrics, School of Medicine, University Hospital Center, 10000 Zagreb, Croatia
| | - Tea Pavkov
- ‡Institute of Chemistry, Structural Biology, Karl-Franzens-University, 8010 Graz, Austria
| | - Ksenija Fumić
- §Clinical Institute of Laboratory Diagnosis, University Hospital Center, Zagreb 10000, Croatia
| | - Ivo Barić
- †Department of Pediatrics, School of Medicine, University Hospital Center, 10000 Zagreb, Croatia
| | - S. Harvey Mudd
- ∥Laboratory of Molecular Biology, National Institute of Mental Health, Bethesda, MD 20892-9663, U.S.A
| | - Igor Jurak
- ¶Division of Viral Infections, Robert Koch Institute, D-10963 Berlin, Germany
| | - Oliver Vugrek
- *Division of Molecular Medicine, Institute Ruđer Bošković, Bijenička 54, 10000 Zagreb, Croatia
- To whom correspondence should be addressed (email )
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Radošević-Stašsić B, Trobonjača Z, Ćuk M, Ravlić-Gulan J, Mrakovčić-Šutić I, Rukavina D. Liver regeneration in MHC class I deficient and NK 1.1. depleted mice. Immunol Lett 1997. [DOI: 10.1016/s0165-2478(97)85975-5] [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: 11/25/2022]
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