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Zidi W, Hadj-Taieb S, Kraoua I, Hachicha M, Seboui H, Monastiri K, Becher SB, Turki I, Sanhaji H, Tebib N, Kaabachi N, Feki M, Allal-Elasmi M. Single-center experience of congenital disorders of glycosylation syndrome screening in Tunisia: A retrospective study over a 15-year period (2007-2021). Arch Pediatr 2024; 31:124-128. [PMID: 38262859 DOI: 10.1016/j.arcped.2023.10.003] [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] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND We report the results gathered over 15 years of screening for congenital disorders of glycosylation syndrome (CDGS) in Tunisia according to clinical and biochemical characteristics. METHODS Our laboratory received 1055 analysis requests from various departments and hospitals, for children with a clinical suspicion of CDGS. The screening was carried out through separation of transferrin isoforms by capillary zone electrophoresis. RESULTS During the 15-year period, 23 patients were diagnosed with CDGS (19 patients with CDG-Ia, three patients with CDG-IIx, and one patient with CDG-X). These patients included 13 boys and 10 girls aged between 3 months and 13 years, comprising 2.18 % of the total 1055 patients screened. The incidence for CDGS was estimated to be 1:23,720 live births (4.21 per 100,000) in Tunisia. The main clinical symptoms related to clinical disease state in newborn and younger patients were psychomotor retardation (91 %), cerebellar atrophy (91 %), ataxia (61 %), strabismus (48 %), dysmorphic symptoms (52 %), retinitis pigmentosa, cataract (35 %), hypotonia (30 %), and other symptoms. CONCLUSION In Tunisia, CDGS still remains underdiagnosed or misdiagnosed. The resemblance to other diseases, especially neurological disorders, and physicians' unawareness of the existence of these diseases are the main reasons for the underdiagnosis. In routine diagnostics, the screening for CDGS by biochemical tests is mandatory to complete the clinical diagnosis.
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Affiliation(s)
- Wiem Zidi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rabta Hospital, Laboratory of Biochemistry, LR99ES11 Tunis, Tunisia
| | - Sameh Hadj-Taieb
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rabta Hospital, Laboratory of Biochemistry, LR99ES11 Tunis, Tunisia
| | - Ichraf Kraoua
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; National Institute of Neurology Mongi-Ben Hamida, Service of Child Neurology, UR12SP24, Tunis, Tunisia
| | | | - Hassen Seboui
- Farhat Hached Hospital, Service of Neonatology, Sousse, Tunisia
| | - Kamel Monastiri
- Fattouma Bourguiba Hospital, Service of Neonatology, Monastir, Tunisia
| | - Saayda Ben Becher
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Children's Hospital Bechir Hamza, Service of Pediatric, de Tunis, Tunisia
| | - Ilhem Turki
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; National Institute of Neurology Mongi-Ben Hamida, Service of Child Neurology, UR12SP24, Tunis, Tunisia
| | - Haifa Sanhaji
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rabta Hospital, Laboratory of Biochemistry, LR99ES11 Tunis, Tunisia
| | - Neji Tebib
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rabta Hospital, Service of Pediatrics, LR12SP02 Tunis, Tunisia
| | - Naziha Kaabachi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rabta Hospital, Laboratory of Biochemistry, LR99ES11 Tunis, Tunisia
| | - Moncef Feki
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rabta Hospital, Laboratory of Biochemistry, LR99ES11 Tunis, Tunisia
| | - Monia Allal-Elasmi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Rabta Hospital, Laboratory of Biochemistry, LR99ES11 Tunis, Tunisia.
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Karafyllis I, Nuoffer JM, Michelis JP, Chilver-Stainer L. Untreated Classic Galactosemia: A Rare Cause of Adult-Onset Progressive Cerebellar Ataxia - A Case Report. Case Rep Neurol 2024; 16:55-62. [PMID: 38444718 PMCID: PMC10914380 DOI: 10.1159/000536679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Identifying the underlying etiology of nonfamilial adult-onset progressive cerebellar ataxia is often challenging because neurologists must consider almost all nongenetic and genetic causes of ataxia. Case Presentation A 39-year-old woman was hospitalized for progressive ataxia with pyramidal and cognitive dysfunction after a right arm shaking and coordination problem deteriorated progressively over 1.5 years. The patient's medical history included amenorrhea, cataracts, developmental delays, consanguinity of the parents, motor coordination issues, and diarrhea and vomiting in infancy. An important finding that enabled us to solve the diagnostic conundrum was the elevated carbohydrate-deficient transferrin levels in the lack of alcohol-related symptoms, which also occur in untreated carbohydrate metabolism disorders, sometimes with ataxia as a leading symptom. The decreased erythrocyte galactose-1-phosphate uridyltransferase (GALT) enzyme activity and the elevated erythrocyte galactose-1-phosphate (Gal-1P) concentration led to the final diagnosis of galactosemia, a rare metabolic disorder. The patient's condition stayed stable with strict adherence to lactose-free and galactose-restricted diets, regular physiotherapy, and speech therapy, despite attempts to control the crippling tremor. Conclusion This case highlights the importance of considering rare diseases based on unexplained clinical and laboratory findings. Newborn screening does not change the long-term complications of early-treated classical galactosemia. A small percentage of these patients develop ataxia tremor syndrome.
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Affiliation(s)
- Ioannis Karafyllis
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Neurology, Cantonal Hospital Olten, Olten, Switzerland
| | - Jean-Marc Nuoffer
- Department of Pediatric Endocrinology, Diabetology and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- University Institute of Clinical Chemistry, University of Bern, Bern, Switzerland
| | - Joan-Philipp Michelis
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lara Chilver-Stainer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Ferrao K, Ali N, Mehta KJ. Iron and iron-related proteins in alcohol consumers: cellular and clinical aspects. J Mol Med (Berl) 2022; 100:1673-1689. [PMID: 36214835 PMCID: PMC9691479 DOI: 10.1007/s00109-022-02254-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/25/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 01/05/2023]
Abstract
Alcohol-associated liver disease (ALD) is one of the most common chronic liver diseases. Its pathological spectrum includes the overlapping stages of hepatic steatosis/steatohepatitis that can progress to liver fibrosis and cirrhosis; both are risk factors for hepatocellular carcinoma. Moreover, ALD diagnosis and management pose several challenges. The early pathological stages are reversible by alcohol abstinence, but these early stages are often asymptomatic, and currently, there is no specific laboratory biomarker or diagnostic test that can confirm ALD etiology. Alcohol consumers frequently show dysregulation of iron and iron-related proteins. Examination of iron-related parameters in this group may aid in early disease diagnosis and better prognosis and management. For this, a coherent overview of the status of iron and iron-related proteins in alcohol consumers is essential. Therefore, here, we collated and reviewed the alcohol-induced alterations in iron and iron-related proteins. Reported observations include unaltered, increased, or decreased levels of hemoglobin and serum iron, increments in intestinal iron absorption (facilitated via upregulations of duodenal divalent metal transporter-1 and ferroportin), serum ferritin and carbohydrate-deficient transferrin, decrements in serum hepcidin, decreased or unaltered levels of transferrin, increased or unaltered levels of transferrin saturation, and unaltered levels of soluble transferrin receptor. Laboratory values of iron and iron-related proteins in alcohol consumers are provided for reference. The causes and mechanisms underlying these alcohol-induced alterations in iron parameters and anemia in ALD are explained. Notably, alcohol consumption by hemochromatosis (iron overload) patients worsens disease severity due to the synergistic effects of excess iron and alcohol.
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Affiliation(s)
- Kevin Ferrao
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Najma Ali
- GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kosha J Mehta
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.
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Aboutara N, Müller A, Jungen H, Szewczyk A, van Rüth V, Bertram F, Püschel K, Heinrich F, Iwersen-Bergmann S. Investigating the use of PEth, CDT and MCV to evaluate alcohol consumption in a cohort of homeless individuals- A comparison of different alcohol biomarkers. Forensic Sci Int 2021; 331:111147. [PMID: 34920332 DOI: 10.1016/j.forsciint.2021.111147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022]
Abstract
In a cohort including individuals with suspected high alcohol consumption, the concentrations of the indirect alcohol biomarkers carbohydrate-deficient transferrin (CDT) and mean corpuscular volume (MCV) and the direct alcohol biomarker phosphatidylethanol (PEth) were investigated. Blood alcohol concentration (BAC) was analysed as a marker for acute alcohol ingestion. In addition to questions about subjective alcohol consumption behaviour, 147 homeless persons underwent a physical examination with blood sampling. BAC, PEth, CDT and MCV were determined in the blood samples. Special focus was on the comparison of PEth and CDT for indicating excessive alcohol consumption. BAC was measured above 0.1‰ in 39 blood samples (0.1-2.5‰, median 0.75‰). PEth was detected in all of them. Overall, PEth was positive (≥10 ng/ml) in 104 samples (71%) (11-5687 ng/ml, median 650 ng/ml) with 68 (46%) being above the cut-off for excessive alcohol consumption (210 ng/ml). In 26 subjects PEth was the only positive alcohol biomarker. CDT was ≥ 1.7% in 66 cases (47%) (1.8-22.2%, median 4.4%) and ≥ 2.5% in 52 (35%) cases. MCV was elevated (≥95 fl) in 58 subjects (39%). CDT and PEth concentrations showed a significant positive correlation (spearman's correlation coefficient ρ = 0.77, p < 0.001). PEth concentrations were significantly higher in samples that were also CDT positive than solely PEth positive (p = 0.004). PEth did not indicate excessive alcohol consumption (< 210 ng/ml) in eight and two cases in which CDT was ≥ 1.7% and ≥ 2.5%, respectively. On the other hand, CDT was< 1.7% and< 2.5% in ten and 18 cases, respectively, in which PEth was above cut-off for excessive alcohol consumption. Taking the self-reports of the participants into consideration, PEth's sensitivity for detecting excessive alcohol consumption was 100% (10 ng/ml) and 94% (210 ng/ml) and CDT's was 88% (1.7%) and 75% (2.5%). In individuals of the investigated cohort unusually high concentrations of the alcohol consumption markers PEth and CDT were quantified, which proves the assumption of chronic excessive alcohol consumption in parts of the cohort. PEth was the marker that was positive most often and was more sensitive for excessive alcohol consumption than CDT.
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Affiliation(s)
- Nadine Aboutara
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany.
| | - Alexander Müller
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Hilke Jungen
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Anne Szewczyk
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Victoria van Rüth
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Franziska Bertram
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Fabian Heinrich
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Stefanie Iwersen-Bergmann
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
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Kunutsor SK, Kremer D, Eisenga MF, Gruppen EG, de Borst MH, Muller Kobold AC, Kootstra-Ros JE, Dullaart RPF, Bakker SJL. Self-reported alcohol consumption, carbohydrate deficient transferrin and risk of cardiovascular disease: The PREVEND prospective cohort study. Clin Chim Acta 2021; 520:1-7. [PMID: 34048731 DOI: 10.1016/j.cca.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Self-reported alcohol consumption is an established risk factor for cardiovascular disease (CVD). Carbohydrate deficient transferrin (CDT) is an established objective marker of excessive alcohol consumption, but data on its prospective association with CVD are lacking. We aimed to evaluate the associations of self-reported alcohol consumption and CDT (expressed as %CDT, a more reliable marker than absolute CDT levels) with CVD risk. MATERIALS AND METHODS In the PREVEND prospective study of 5,206 participants (mean age, 53 years; 47.7% males), alcohol consumption by self-reports, absolute CDT measured using the Siemens nephelometric assay and %CDT calculated as the percentage of total transferrin concentrations, were assessed at baseline. Alcohol consumption was classified into 5 categories: abstention (reference), light, light-moderate, moderate and heavy alcohol consumption.Hazard ratios (HRs) (95% confidence intervals [CI]) for first CVD events were estimated. RESULTS Mean (SD) of %CDT was 1.59 (0.54) %. During a median follow-up of 8.3 years, 326 first CVD events were recorded. Compared with abstainers, the multivariable-adjusted HRs (95% CIs) of CVD for light, light-moderate, moderate and heavy alcohol consumption were 0.66 (0.46-0.95), 0.83 (0.62-1.11), 0.83 (0.61-1.14) and 0.80 (0.48-1.36), respectively. Light alcohol consumption was associated with reduced coronary heart disease risk 0.62 (0.40-0.96), whereas light-moderate alcohol consumption was associated with reduced stroke risk 0.45 (0.24-0.83). The association of %CDT with CVD risk was not significant. CONCLUSIONS Our findings confirm the established association between self-reported light to moderate alcohol consumption and reduced CVD risk. However, %CDT within the normal reference range may not be a risk indicator for CVD.
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Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol BS10 5NB, UK.
| | - Daan Kremer
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Michele F Eisenga
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Eke G Gruppen
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Martin H de Borst
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen and University Medical Center, Groningen, the Netherlands
| | - Jenny E Kootstra-Ros
- Department of Laboratory Medicine, University of Groningen and University Medical Center, Groningen, the Netherlands
| | - Robin P F Dullaart
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
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Sakran JV, Mehta A, Matar MM, Wilson DA, Kent AJ, Anton RF, Fakhry SM. The Utility of Carbohydrate-Deficient Transferrin in Identifying Chronic Alcohol Users in the Injured Patient: Expanding the Toolkit. J Surg Res 2020; 257:92-100. [PMID: 32818790 DOI: 10.1016/j.jss.2020.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/21/2020] [Accepted: 07/17/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Alcohol use remains abundant in patients with traumatic injury. Previous studies have suggested that serum carbohydrate-deficient transferrin (%dCDT) levels, relative to blood alcohol levels (BALs), may better differentiate episodic binge drinkers from sustained heavy consumers in admitted patients with traumatic injury. We characterized %dCDT levels and BAL levels to differentiate binge drinkers from sustained heavy consumers in admitted trauma patients and their associations with outcomes. METHODS This prospective, cross-sectional, observational study assessed %dCDT and BAL levels in admitted male and female patients with traumatic injury (≥18 y) at an American College of Surgeons Committee on Trauma level-1 center from July 2014 to June 2016. We designated patients with %dCDT levels ≥1.7% (CDT+) as chronic alcohol users and dichotomized acutely intoxicated patients using three different BAL-level thresholds. Primary outcomes included in-hospital complications, along with prolonged ventilation and intensive care unit length of stay, both defined as the top decile. Secondary outcomes included rates of drug or alcohol withdrawal and all-cause mortality. Analyses were adjusted for clinical factors. RESULTS We studied 715 patients (77.5% men, 60.6% ≤ 40 y of age, median Injury Severity Score: 14, 41.7% motor vehicle crashes, 17.9% gunshot wounds, 11.1% falls). While 31.0% were CDT+, 48.7% were BAL>0. After adjusting for CDT levels, BAL levels >0, >100, or >200 were not associated with adverse outcomes. However, CDT+ relative to patients with CDT were associated with complications (adjusted odds ratio: 1.96 [1.24-3.09]), prolonged ventilation days (3.23 [1.08-9.65]), and prolonged intensive care unit stays (2.83 [1.20-6.68]). CONCLUSIONS In this 2-year prospective, cross-sectional, and observational study, we found that %dCDT levels, relative to BAL levels, may better stratify admitted patients with traumatic injury into acute versus chronic alcohol users, identifying those at higher risk for in-hospital complications.
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Affiliation(s)
- Joseph V Sakran
- Johns Hopkins Hospital, Department of Surgery, Baltimore, Maryland.
| | - Ambar Mehta
- Johns Hopkins University, School of Medicine, Baltimore, Maryland; NewYork-Presbyterian, Columbia University Medical Center, Department of Surgery, New York, New York
| | - Maher M Matar
- The Ottawa Hospital, Department of Surgery, Ottawa, Ontario, Canada
| | - Dulaney A Wilson
- Medical University of South Carolina, Department of Surgery, Charleston, South Carolina
| | - Alistair J Kent
- Johns Hopkins Hospital, Department of Surgery, Baltimore, Maryland
| | - Raymond F Anton
- Medical University of South Carolina, Department of Surgery, Charleston, South Carolina; Charleston Alcohol Research Center, Charleston, South Carolina
| | - Samir M Fakhry
- Reston Hospital Center, Department of Surgery, Reston, Virginia
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Gudowska M, Gindzienska-Sieskiewicz E, Gruszewska E, Cylwik B, Sierakowski S, Szmitkowski M, Chrostek L. Independence of carbohydrate-deficient isoforms of transferrin and cyclic citrullinated peptides in rheumatoid arthritis. Rev Bras Reumatol Engl Ed 2017; 57:185-189. [PMID: 28535888 DOI: 10.1016/j.rbre.2016.01.005] [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] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 01/05/2016] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess the relationship between the two types of posttranslational modifications of proteins in RA: glycosylation on the example of carbohydrate-deficient transferrin and citrullination by means of autoantibodies to cyclic citrullinated peptides. METHODS The study was carried out in 50 RA patients. CDT was measured using N Latex CDT immunonephelometric test, the results were presented in absolute and relative units. Anti-CCP were measured using the chemiluminescent method and rheumatoid factor by immunoturbidimetric method. RESULTS 80% of RA patients were positive for anti-CCP, 70% for RF and 62% for both, anti-CCP and RF. The level of %CDT was significantly elevated, but absolute CDT level was not changed. The mean absolute CDT concentration was higher in anti-CCP positive patients than that in anti-CCP negative. CDT (absolute and relative concentration) did not correlate with anti-CCP and RF. However, serum RF significantly correlated with anti-CCP. %CDT did not correlate with anti-CCP, but absolute level correlated with anti-CCP only in anti-CCP negative and RF negative patients. CDT did not correlate with RF, but solely with anti-CCP in anti-CCP negative patients. Anti-CCP correlated with DAS 28 only in anti-CCP negative RA, but CDT (absolute and relative units) correlated with DAS 28 in all patients and in anti-CCP positive RA. CONCLUSIONS These results suggest that the changes in CDT and anti-CCP concentrations are not associated with oneself and indicate on the independence of these posttranslational modifications in rheumatoid arthritis. Only the alterations in transferrin glycosylation reflected the activity of RA.
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Affiliation(s)
- Monika Gudowska
- Medical University of Białystok, Department of Biochemical Diagnostics, Białystok, Poland
| | | | - Ewa Gruszewska
- Medical University of Białystok, Department of Biochemical Diagnostics, Białystok, Poland
| | - Bogdan Cylwik
- Medical University of Białystok, Department of Pediatric Laboratory Diagnostics, Białystok, Poland
| | - Stanislaw Sierakowski
- Medical University of Białystok, Department of Rheumatology and Internal Diseases, Białystok, Poland
| | - Maciej Szmitkowski
- Medical University of Białystok, Department of Biochemical Diagnostics, Białystok, Poland
| | - Lech Chrostek
- Medical University of Białystok, Department of Biochemical Diagnostics, Białystok, Poland.
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Helander A, Stödberg T, Jaeken J, Matthijs G, Eriksson M, Eggertsen G. Dolichol kinase deficiency (DOLK-CDG) with a purely neurological presentation caused by a novel mutation. Mol Genet Metab 2013; 110:342-4. [PMID: 23890587 DOI: 10.1016/j.ymgme.2013.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/30/2013] [Accepted: 07/01/2013] [Indexed: 01/05/2023]
Abstract
A 4-month old boy presented with multiple epileptic seizure types including West syndrome. Screening for infectious and structural etiologies showed normal results. A metabolic investigation was undertaken to investigate the cause of his neurological disease. Screening for congenital disorders of glycosylation (CDG) by HPLC analysis of serum carbohydrate-deficient transferrin (CDT) showed a type 1 pattern with 18% disialotransferrin (reference < 2%) and 2% asialotransferrin (reference 0). An undiagnosed 10-year old sister with a similar clinical history with infantile spasms at age 4 months, intellectual disability and an autism spectrum disorder, also showed a type 1 CDT pattern. Both siblings lacked dysmorphic features and extra-cerebral symptoms. The boy had cytotoxic edema of the thalamus and mesencephalon on MRI at age 7 months, whereas the girl had normal MRI at age 8 months. Phosphomannomutase (PMM) and phosphomannose isomerase (MPI) activities in cultured fibroblasts were normal, excluding PMM2-CDG and MPI-CDG. Fibroblast lipid-linked oligosaccharide analysis was also normal, suggesting an early defect in glycan assembly. Sequence analysis of the dolichol kinase gene revealed a homozygous new missense mutation (p.M1?; c.2 T > C) in both siblings. In conclusion, two siblings were demonstrated to suffer from DOLK-CDG (MIM 610768) and to be homozygous for a new mutation. They presented with West syndrome and so far show a purely neurological phenotype.
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Affiliation(s)
- Anders Helander
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Karolinska University Laboratory, Stockholm, Sweden.
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