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Vaisbich MH, de Cillo ACP, Silva BCC, DÁlva CB, de Carvalho ÉH, de Almeida JMCM, Marques LLM, Ribeiro M, da Silva MBM, de Medeiros PFV, Mendes PH. Real-world data of Brazilian adults with X-linked hypophosphatemia (XLH) treated with burosumab and comparison with other worldwide cohorts. Mol Genet Genomic Med 2024; 12:e2387. [PMID: 38337160 PMCID: PMC10858313 DOI: 10.1002/mgg3.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/23/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Disease-related variants in PHEX cause XLH by an increase of fibroblast growth factor 23 (FGF23) circulating levels, resulting in hypophosphatemia and 1,25(OH)2 vitamin D deficiency. XLH manifests in early life with rickets and persists in adulthood with osseous and extraosseous manifestations. Conventional therapy (oral phosphate and calcitriol) improves some symptoms, but evidence show that it is not completely effective, and it can lead to nephrocalcinosis (NC) and hyperparathyroidism (HPT). Burosumab (anti-FGF23 antibody) has shown to be effective and safety in the clinical trials. METHODS The current real-world collaborative study evaluated genetic, clinical and laboratory data of XLH Brazilian adult patients treated with burosumab. RESULTS Nineteen unrelated patients were studied. Patients reported pain, limb deformities and claudication, before burosumab initiation. 78% of them were previously treated with conventional therapy. The severity of the disease was moderate to severe (15 patients with score >5). At the baseline, 3 patients presented NC (16.7%) and 12 HPT (63%). After 16 ± 8.4 months under burosumab, we observed a significant: increase in stature (p = 0.02), in serum phosphate from 1.90 ± 0.43 to 2.67 ± 0.52 mg/dL (p = 0.02); in TmP/GFR from 1.30 ± 0.46 to 2.27 ± 0.64 mg/dL (p = 0.0001), in 1,25 (OH)2 D from 50.5 ± 23.3 to 71.1 ± 19.1 pg/mL (p = 0.03), and a decrease in iPTH from 86.8 ± 37.4 pg/mL to 66.5 ± 31.1 (p = 0.002). Nineteen variants were found (10 novel). HPT tended to develop in patients with truncated PHEX variants (p = 0.06). CONCLUSIONS This study confirms the efficacy and safety of burosumab on XLH adult patients observed in clinical trials. Additionally, we observed a decrease in iPTH levels in patients with moderate to severe HPT at the baseline.
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Affiliation(s)
| | | | - Bárbara Campolina C. Silva
- Hospital Felício Rocho, Osteometabolism Unit of Santa Casa de Belo HorizonteProfessor of Medicine at University Center of Belo Horizonte – UNIBHBelo HorizonteBrazil
| | | | - Érico Higino de Carvalho
- Instituto de Medicina Integrada Professor Fernado Figueira, recifeFederal University of PernambucoRecifeBrazil
| | | | | | - Marcia Ribeiro
- Genetic Unit of Federal University of Rio de JaneiroRio de JaneiroBrazil
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Martins C, de Medeiros PFV, Leistner-Segal S, Dridi L, Elcioglu N, Wood J, Behnam M, Noyan B, Lacerda L, Geraghty MT, Labuda D, Giugliani R, Pshezhetsky AV. Back Cover, Volume 40, Issue 8. Hum Mutat 2019. [DOI: 10.1002/humu.23893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Carla Martins
- Department of Biochemistry and Molecular Medicine; Université de Montréal; Montreal Quebec Canada
- Research Center, CHU Sainte-Justine; Université de Montréal; Montreal Quebec Canada
| | | | - Sandra Leistner-Segal
- Department of Genetics, UFRGS; Medical Genetics Service, Hospital de Clínicas de Porto Alegre-HCPA, and Brazilian National Institute of Population Medical Genetics-INAGEMP; Porto Alegre Brazil
| | - Larbi Dridi
- Research Center, CHU Sainte-Justine; Université de Montréal; Montreal Quebec Canada
| | - Nursel Elcioglu
- Department of Pediatric Genetics; Marmara University Hospital; Istanbul Turkey
| | - Jill Wood
- Jonah's Just Begun-Foundation to Cure Sanfilippo Inc; Brooklyn New York USA
| | - Mahdiyeh Behnam
- Medical Genetics Center of Genome; Isfahan Islamic Republic of Iran
| | - Bilge Noyan
- Department of Pediatric Genetics; Marmara University Hospital; Istanbul Turkey
| | - Lucia Lacerda
- Biochemical Genetics Unit; Institute of Medical Genetics Jacinto Magalhães, Centro Hospitalar do Porto; Porto Portugal
| | - Michael T. Geraghty
- Department of Pathology and Laboratry Medicine, Children's Hospital of Eastern Ontario; Ottawa Canada
| | - Damian Labuda
- Research Center, CHU Sainte-Justine; Université de Montréal; Montreal Quebec Canada
| | - Roberto Giugliani
- Department of Genetics, UFRGS; Medical Genetics Service, Hospital de Clínicas de Porto Alegre-HCPA, and Brazilian National Institute of Population Medical Genetics-INAGEMP; Porto Alegre Brazil
| | - Alexey V. Pshezhetsky
- Department of Biochemistry and Molecular Medicine; Université de Montréal; Montreal Quebec Canada
- Research Center, CHU Sainte-Justine; Université de Montréal; Montreal Quebec Canada
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Martins C, de Medeiros PFV, Leistner-Segal S, Dridi L, Elcioglu N, Wood J, Behnam M, Noyan B, Lacerda L, Geraghty MT, Labuda D, Giugliani R, Pshezhetsky AV. Molecular characterization of a large group of Mucopolysaccharidosis type IIIC patients reveals the evolutionary history of the disease. Hum Mutat 2019; 40:1084-1100. [PMID: 31228227 DOI: 10.1002/humu.23752] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/02/2018] [Revised: 02/27/2019] [Accepted: 03/23/2019] [Indexed: 12/22/2022]
Abstract
Mucopolysaccharidosis type IIIC (MPSIIIC) is a severe, rare autosomal recessive disorder caused by variants in the heparan-α-glucosaminide N-acetyltransferase (HGSNAT) gene which result in lysosomal accumulation of heparan sulfate. We analyzed clinical presentation, molecular defects and their haplotype context in 78 (27 novel) MPSIIIC cases from 22 countries, the largest group studied so far. We describe for the first time disease-causing variants in the patients from Brazil, Algeria, Azerbaijan, and Iran, and extend their spectrum within Canada, Colombia, Turkey, and the USA. Six variants are novel: two missense, c.773A>T/p.N258I and c.1267G>T/p.G423W, a nonsense c.164T>A/p.L55*, a splice-site mutation c.494-1G>A/p.[P165_L187delinsQSCYVTQAGVRWHHLGSLQALPPGFTPFSYLSLLSSWNC,P165fs], a deletion c.1348delG/p.(D450fs) and an insertion c.1479dupA/p.(Leu494fs). The missense HGSNAT variants lacked lysosomal targeting, enzymatic activity, and likely the correct folding. The haplotype analysis identified founder mutations, p.N258I, c.525dupT, and p.L55* in the Brazilian state of Paraiba, c.493+1G>A in Eastern Canada/Quebec, p.A489E in the USA, p.R384* in Poland, p.R344C and p.S518F in the Netherlands and suggested that variants c.525dupT, c.372-2G>A, and c.234+1G>A present in cis with c.564-98T>C and c.710C>A rare single-nucleotide polymorphisms, have been introduced by Portuguese settlers in Brazil. Altogether, our results provide insights into the origin, migration roots and founder effects of HGSNAT disease-causing variants, and reveal the evolutionary history of MPSIIIC.
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Affiliation(s)
- Carla Martins
- Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Sandra Leistner-Segal
- Department of Genetics, UFRGS, Medical Genetics Service, Hospital de Clínicas de Porto Alegre-HCPA, and Brazilian National Institute of Population Medical Genetics-INAGEMP, Porto Alegre, Brazil
| | - Larbi Dridi
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Nursel Elcioglu
- Department of Pediatric Genetics, Marmara University Hospital, Istanbul, Turkey
| | - Jill Wood
- Jonah's Just Begun-Foundation to Cure Sanfilippo Inc, Brooklyn, New York, USA
| | - Mahdiyeh Behnam
- Medical Genetics Center of Genome, Isfahan, Islamic Republic of Iran
| | - Bilge Noyan
- Department of Pediatric Genetics, Marmara University Hospital, Istanbul, Turkey
| | - Lucia Lacerda
- Biochemical Genetics Unit, Institute of Medical Genetics Jacinto Magalhães, Centro Hospitalar do Porto, Porto, Portugal
| | - Michael T Geraghty
- Department of Pathology and Laboratry Medicine, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Damian Labuda
- Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Roberto Giugliani
- Department of Genetics, UFRGS, Medical Genetics Service, Hospital de Clínicas de Porto Alegre-HCPA, and Brazilian National Institute of Population Medical Genetics-INAGEMP, Porto Alegre, Brazil
| | - Alexey V Pshezhetsky
- Department of Biochemistry and Molecular Medicine, Université de Montréal, Montreal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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