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Regnier M, Flammier S, Boutaba M, Ndongo AA, Servais A, Schaefer F, Levtchenko E, Bacchetta J, Bertholet-Thomas A. Worldwide disparities in access to treatment and investigations for nephropathic cystinosis: a 2023 perspective. Pediatr Nephrol 2024; 39:1113-1123. [PMID: 37978055 PMCID: PMC10899370 DOI: 10.1007/s00467-023-06179-3] [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: 05/23/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Nephropathic cystinosis (NC) is a rare lysosomal disease, leading to early kidney failure and extra-renal comorbidities. Its prognosis strongly relies on early diagnosis and treatment by cysteamine. Developing economies (DEing) face many challenges when treating patients for rare and chronic diseases. The aim here is to evaluate the access to investigations and treatment in DEing, and to assess for potential inequalities with Developed Economies (DEed). METHODS In this international cross-sectional study, a questionnaire on access, price and reimbursement of genetic, biological analyses, and treatment was sent to nephrology centers worldwide during 2022. RESULTS A total of 109 centers responded, coming from 49 countries and managing 741 patients: 43 centers from 30 DEing and Economies in transition (TrE), and 66 from 19 DEed. In 2022, genetics availability was 63% in DEing and 100% in DEed, whereas intra leukocytes cystine levels (IL-CL) were available for 30% of DEing patients, and 94% of DEed patients, both increasing over the last decade, as has access to immediate release cysteamine and to cysteamine eye drops in DEing. However, delayed released cysteamine can be delivered to only 7% vs. 74% of patients from DEing and DEed, respectively, and is still poorly reimbursed in DEing. CONCLUSIONS Over the last decade, access to investigations (namely genetics and IL-CL) and to cysteamine have improved in DEing and TrE. However, discrepancies remain with DEed: access to delayed released cysteamine is limited, and reimbursement is still profoundly insufficient, therefore limiting their current use.
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Affiliation(s)
- Maitena Regnier
- Centre de Référence Des Maladies Rénales Rares Néphrogones, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon & Université Claude-Bernard, Lyon 1, Lyon, France
- Service de Néphrologie, Rhumatologie Et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Boulevard Pinel, 69677, Bron Cedex, France
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France
| | - Sacha Flammier
- Centre de Référence Des Maladies Rénales Rares Néphrogones, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon & Université Claude-Bernard, Lyon 1, Lyon, France
- Service de Néphrologie, Rhumatologie Et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Boulevard Pinel, 69677, Bron Cedex, France
| | - Mounia Boutaba
- Department of Pediatrics A, Hussein Dey University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Aliou Abdoulaye Ndongo
- Pediatric Unit, Aristide Le Dantec Hospital Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - Aude Servais
- Service de Néphrologie Et Maladies Métaboliques Adulte Hôpital Necker 149, Paris, France
| | - Franz Schaefer
- Division of Pediatric Nephrology, University Children's Hospital Heidelberg, Heidelberg, Germany
- International Pediatric Nephrology Association (IPNA), C/o Nationwide Children's Center for Faculty Development (ED-5081), 700 Children's Drive, Columbus, OH 43205, USA
- European Rare Kidney Disease Reference Network (ERK-Net) Project Office, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany
| | - Elena Levtchenko
- Division of Pediatric Nephrology, Department of Pediatrics, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Justine Bacchetta
- Centre de Référence Des Maladies Rénales Rares Néphrogones, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon & Université Claude-Bernard, Lyon 1, Lyon, France
- Service de Néphrologie, Rhumatologie Et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Boulevard Pinel, 69677, Bron Cedex, France
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France
- European Rare Kidney Disease Reference Network (ERK-Net) Project Office, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany
- ORKID : Filière Orphan Kidney Diseases, Montpellier, France
- Diagnostic Et Traitements Des Maladies Osseuses, INSERM 1033 Physiopathologie, Paris, France
| | - Aurélia Bertholet-Thomas
- Centre de Référence Des Maladies Rénales Rares Néphrogones, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon & Université Claude-Bernard, Lyon 1, Lyon, France.
- Service de Néphrologie, Rhumatologie Et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Boulevard Pinel, 69677, Bron Cedex, France.
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France.
- European Rare Kidney Disease Reference Network (ERK-Net) Project Office, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany.
- ORKID : Filière Orphan Kidney Diseases, Montpellier, France.
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Joseph MW, Stein DR, Stein AC. Gastrointestinal challenges in nephropathic cystinosis: clinical perspectives. Pediatr Nephrol 2024:10.1007/s00467-023-06211-6. [PMID: 38393360 DOI: 10.1007/s00467-023-06211-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 02/25/2024]
Abstract
Gastrointestinal (GI) sequelae, such as vomiting, hyperacidity, dysphagia, dysmotility, and diarrhea, are nearly universal among patients with nephropathic cystinosis. These complications result from disease processes (e.g., kidney disease, cystine crystal accumulation in the GI tract) and side effects of treatments (e.g., cysteamine, immunosuppressive therapy). GI involvement can negatively impact patient well-being and jeopardize disease outcomes by compromising drug absorption and patient adherence to the strict treatment regimen required to manage cystinosis. Given improved life expectancy due to advances in kidney transplantation and the transformative impact of cystine-depleting therapy, nephrologists are increasingly focused on addressing extra-renal complications and quality of life in patients with cystinosis. However, there is a lack of clinical data and guidance to inform GI-related monitoring, interventions, and referrals by nephrologists. Various publications have examined the prevalence and pathophysiology of selected GI complications in cystinosis, but none have summarized the full picture or provided guidance based on the literature and expert experience. We aim to comprehensively review GI sequelae associated with cystinosis and its treatments and to discuss approaches for monitoring and managing these complications, including the involvement of gastroenterology and other disciplines.
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Affiliation(s)
- Mark W Joseph
- Pediatric Nephrology, Oregon Health & Science University and OHSU Doernbecher Children's Hospital, Portland, OR, USA.
| | - Deborah R Stein
- Pediatric Nephrology, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
| | - Adam C Stein
- Gastroenterology, Northwestern University and Northwestern Medicine, Chicago, IL, USA
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Lashilola S, Xu W, Azimpour K, McCarthy M, Carlot S, Game D, van der Voort J. Impact of compliance to oral cysteamine treatment on the costs of Kidney failure in patients with nephropathic cystinosis in the United Kingdom. BMC Nephrol 2023; 24:351. [PMID: 38031005 PMCID: PMC10688492 DOI: 10.1186/s12882-023-03392-y] [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: 11/17/2022] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Nephropathic Cystinosis (NC), a rare disease characterised by intra-lysosomal accumulation of cystine, results in progressive kidney failure (KF). Compliance to lifelong oral cysteamine, the only therapy, is often compromised. The relationship between compliance and costs of NC has not been previously formally assessed. The present study evaluates the impact of compliance on lifetime (direct) costs of treating KF in NC patients in the United Kingdom. METHODS A three-state (KF-free, post-KF, death) partitioned survival model was developed for hypothetical 'Good Compliance' (GC) and 'Poor Compliance' (PC) cohorts. Survival in the KF-free state was determined by a published regression function of composite compliance score (CCS). The CCS is a summation of annual compliance scores (ACS) over treatment duration prior to KF. ACSs are indexed on annual (average) leukocyte cystine levels (LCL). The Poor Compliance cohort was defined to reflect NC patients in a previous study with a mean LCL of 2.35 nmols nmol half-cystine/mg protein over the study period - and an estimated mean ACS of 1.64 over a 13.4 year treatment duration. The Good Compliance cohort was assumed to have an ACS of 2.25 for 21 years. Major KF costs were evaluated - i.e., dialysis, kidney transplants, and subsequent monitoring. RESULTS The mean CCS was 47 for the GC and 22 for the PC cohort respectively, corresponding to estimated lifetime KF costs of £92,370 and £117,830 respectively - i.e., a cost saving of £25,460/patient, or £1,005/patient for every 1-unit improvement in CCS. CONCLUSION This analysis indicates that lifetime costs of KF in NC can be reduced through improved treatment compliance with oral cysteamine.
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Affiliation(s)
| | - Weiwei Xu
- Real World Insights, IQVIA, Amsterdam, the Netherlands.
| | - Khashayar Azimpour
- Global Health Economics and Outcome Research, Chiesi, Boston, United States
| | - Michael McCarthy
- Health Economics and Outcomes Research, MAP Patient Access, Cambridge, UK
| | - Sara Carlot
- Global Rare Diseases Business Unit, Chiesi Farmaceutici S.p.A, Parma, Italy
| | - David Game
- Department of Nephrology, Guy's Hospital, London, UK
| | - Judith van der Voort
- Department of Paediatric Nephrology, University Hospital of Wales, Cardiff, Wales
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Bjerre A, Aase SA, Radtke M, Siva C, Gudmundsdottir H, Forsberg B, Woldseth B, Brackman D. The effects of transitioning from immediate release to extended release cysteamine therapy in Norwegian patients with nephropathic cystinosis: a retrospective study. Pediatr Nephrol 2023; 38:3671-3679. [PMID: 37219641 PMCID: PMC10514171 DOI: 10.1007/s00467-023-06005-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Nephropathic cystinosis is a rare lysosomal storage disorder in which accumulation of cystine and formation of crystals particularly impair kidney function and gradually lead to multi-organ dysfunction. Lifelong therapy with the aminothiol cysteamine can delay the development of kidney failure and the need for transplant. The purpose of our long-term study was to explore the effects of transitioning from immediate release (IR) to extended release (ER) formulation in Norwegian patients in routine clinical care. METHODS We retrospectively analysed data on efficacy and safety in 10 paediatric and adult patients. Data were obtained from up to 6 years before and 6 years after transitioning from IR- to ER-cysteamine. RESULTS Mean white blood cell (WBC) cystine levels remained comparable between the different treatment periods (1.19 versus 1.38 nmol hemicystine/mg protein) although most patients under ER-cysteamine underwent dose reductions. For the non-transplanted patients, the mean estimated glomerular filtration rate (eGFR) change/year was more pronounced during ER-treatment (- 3.39 versus - 6.80 ml/min/1.73 m2/year) possibly influenced by individual events, such as tubulointerstitial nephritis and colitis. Growth measured by Z-height score tended to develop positively. Four of seven patients reported improvement of halitosis, one reported unchanged and two reported worsened symptoms. Most adverse drug reactions (ADRs) were of mild severity. One patient developed two serious ADRs and switched back to IR-formulation. CONCLUSIONS The results from this long-term retrospective study indicate that switching from IR- to ER-cysteamine was feasible and well tolerated under routine clinical practice. ER-cysteamine allowed satisfactory disease control over the long period considered. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Anna Bjerre
- Department for Specialised Paediatrics, Oslo University Hospital, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Sonja Amdal Aase
- Department of Paediatric and Adolescent Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Maria Radtke
- Department of Nephrology, St Olav's University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norge
| | - Christian Siva
- Paediatric Department, Vestfold Hospital, Tønsberg, Norway
| | | | | | - Berit Woldseth
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Damien Brackman
- Children and Adolescents Clinic, Haukeland University Hospital, Bergen, Norway
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Langman CB. Long-term clinical benefits of delayed-release cysteamine bitartrate capsules in patients with nephropathic cystinosis (response to "A comparison of immediate release and delayed release cysteamine in 17 patients with nephropathic cystinosis"). Orphanet J Rare Dis 2023; 18:162. [PMID: 37353838 DOI: 10.1186/s13023-023-02724-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/14/2023] [Indexed: 06/25/2023] Open
Abstract
The aim of this letter to the editor is to summarize the results from three clinical trial programs evaluating delayed-release cysteamine bitartrate (DR-CYS), which demonstrated the long-term clinical benefits in patients with nephropathic cystinosis when dosed every 12 h. The authors of "A comparison of immediate release and delayed release cysteamine in 17 patients with nephropathic cystinosis" presented recommendations altering the dosage and dosing scheme from what has been previously approved by the FDA for DR-CYS. In this letter to the editor, we critique the authors' aforementioned article as it is a retrospective analysis of a small number of patients and does not follow the dosing recommendation by the FDA for equivalent dosing of DR-CYS to immediate-release cysteamine bitartrate (IR-CYS). In addition, the article does not include study data to properly support the authors' suggestion of increased dosing effects and benefits. We present a summary of the results from the DR-CYS clinical trial program and evidence of the rigor from which the clinical data for DR-CYS were generated and recommendation for usage as prescribed.
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Affiliation(s)
- Craig B Langman
- Division of Kidney Diseases, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, The Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Elkhateeb N, Selim R, Soliman NA, Atia FM, Abouelwoun II, Elmonem MA, Helmy R. Clinical and neurophysiological characterization of early neuromuscular involvement in children and adolescents with nephropathic cystinosis. Pediatr Nephrol 2022; 37:1555-66. [PMID: 34791528 DOI: 10.1007/s00467-021-05343-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Nephropathic cystinosis is a rare autosomal recessive lysosomal storage disorder characterized by kidney and extra-renal complications due to the accumulation of cystine crystals in various tissues and organs. Herein, we describe the early neuromuscular complications in a cohort of pediatric nephropathic cystinosis patients. METHODS We prospectively evaluated the clinical, biochemical, and neurophysiological data of 15 cystinosis patients. Neurophysiological evaluation was performed to confirm or exclude presence of neuropathy and/or myopathy. RESULTS Patients' age ranged between 20 and 216 months at time of examination. Nine patients were males. Three patients had early abnormal neurophysiological features consistent with neuromuscular involvement (clinically asymptomatic proximal myopathy with a patchy distribution in one patient and isolated asymptomatic sensory nerve conduction changes in two patients). A fourth patient had mixed abnormal motor and sensory axonal neuropathic changes associated with overt clinical features (predominantly motor symptoms). Patients with abnormal neuromuscular features were significantly older in age than the unaffected group (P = 0.005) and had a diagnosis of cystinosis with subsequent cysteamine therapy at a significantly older age than the unaffected group (P = 0.027 and 0.001, respectively). CONCLUSIONS We expanded the recognized phenotypes of cystinosis neuromuscular complications with early proximal skeletal myopathy and symptomatic motor and sensory axonal neuropathy. Early asymptomatic neuromuscular complications could develop in pediatric patients and would require neurophysiological studies for early detection prior to development of overt clinical manifestations. Prompt diagnosis and timely initiation of cysteamine therapy with recommended dose can delay the development of neuromuscular complications. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Erfidan G, Alaygut D, Özdemir Şimşek Ö, Arslansoyu Çamlar S, Mutlubaş F, Kasap Demir B. A Bartter syndrome patient presenting with severe growth retardation: Answers. Pediatr Nephrol 2022; 37:1043-1047. [PMID: 34999984 DOI: 10.1007/s00467-021-05384-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Gökçen Erfidan
- Department of Pediatric Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Gaziler Street No-1 35180, Yenişehir, Konak, Izmir, Turkey.
| | - Demet Alaygut
- Department of Pediatric Nephrology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Özgür Özdemir Şimşek
- Department of Pediatric Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Gaziler Street No-1 35180, Yenişehir, Konak, Izmir, Turkey
| | - Seçil Arslansoyu Çamlar
- Department of Pediatric Nephrology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Fatma Mutlubaş
- Department of Pediatric Nephrology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Belde Kasap Demir
- Department of Pediatric Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Gaziler Street No-1 35180, Yenişehir, Konak, Izmir, Turkey
- Department of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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van Stein C, Klank S, Grüneberg M, Ottolenghi C, Grebe J, Reunert J, Harms E, Marquardt T. A comparison of immediate release and delayed release cysteamine in 17 patients with nephropathic cystinosis. Orphanet J Rare Dis 2021; 16:387. [PMID: 34521447 PMCID: PMC8438894 DOI: 10.1186/s13023-021-01991-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background Nephropathic cystinosis is a rare and severe metabolic disease leading to an accumulation of cystine in lysosomes which especially harms kidney function. A lifelong therapy with the aminothiol cysteamine can delay the development of end-stage renal disease and the necessity of kidney transplantation. The purpose of our study was to compare the effectiveness of immediate-release and delayed-release cysteamine on cystine and cysteamine levels as well as assessing the onset of adverse effects. Methods We retrospectively analysed cystine and cysteamine levels of 17 patients after a single dose of immediate-release cysteamine (Cystagon®, Mylan Pharmaceuticals, Canonsburg, PA and Recordati Pharma GmbH) as well as a single dose of delayed-release cysteamine (Procysbi®; Horizon Pharma USA and Chiesi Farmaceutici S.p.A., Parma, Italy) respectively. Data were collected during a period of three years in the context of optimizing the individual treatment regimens. The dose of DR-cysteamine was reduced to 70% of the equivalent dose of IR-cysteamine. The efficacy of both formulas in depleting white blood cells’ cystine levels and their side effects were compared. Results Immediate (IR)- and delayed-release (DR) cysteamine effectively decreased intracellular cystine levels under the target value of 0.5 nmol cystine/mg protein, while fewer side effects occurred under DR-cysteamine. Mean maximum levels of cysteamine were reached after 60 min with IR-cysteamine and after 180 min with DR-cysteamine. Conclusion A therapy with DR-cysteamine is as effective as IR-cysteamine while less side effects were reported. Our data show that DR-cysteamine should be dosed higher than 70% of the equivalent dose of IR-cysteamine in order to decrease cystine levels over an extended period of time. Moreover, our data suggest increasing the dosing scheme of Procysbi® to three times daily, to prevent a rapid decrease and achieve a steadier decline in cystine levels. Due to the more convenient dosing scheme, DR-cysteamine might ameliorate therapy adherence and improve patients’ quality of life.
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Affiliation(s)
- Christina van Stein
- Department of General Pediatrics, Metabolic Diseases, University of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Sabrina Klank
- Department of General Pediatrics, Metabolic Diseases, University of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Marianne Grüneberg
- Department of General Pediatrics, Metabolic Diseases, University of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Chris Ottolenghi
- UMR 1163, Université Paris Descartes, Sorbonne Paris Cité, Institut IMAGINE, 24 Boulevard du Montparnasse, 75015, Paris, France.,Biochimie Métabolique et Protéomique, Hôpital Necker - Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France
| | - Jürgen Grebe
- Department of General Pediatrics, Metabolic Diseases, University of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Janine Reunert
- Department of General Pediatrics, Metabolic Diseases, University of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Erik Harms
- Department of General Pediatrics, Metabolic Diseases, University of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Thorsten Marquardt
- Department of General Pediatrics, Metabolic Diseases, University of Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
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Gaillard S, Roche L, Lemoine S, Deschênes G, Morin D, Vianey-Saban C, Acquaviva-Bourdain C, Ranchin B, Bacchetta J, Kassai B, Nony P, Bodénan E, Laudy V, Rouges C, Zarrabian S, Subtil F, Mercier C, Cochat P, Bertholet-Thomas A. Adherence to cysteamine in nephropathic cystinosis: A unique electronic monitoring experience for a better understanding. A prospective cohort study: CrYSTobs. Pediatr Nephrol 2021; 36:581-589. [PMID: 32901297 DOI: 10.1007/s00467-020-04722-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In nephropathic cystinosis (NC), adherence to cysteamine remains challenging; poor adherence is worsening the disease progression with a decline of kidney function and increase of extrarenal morbidities. Our objective was to describe adherence to cysteamine in NC patients, using electronic monitoring systems. METHODS Patients with confirmed NC, aged > 4 years and receiving oral cysteamine (short acting or delayed release formulation as standard of care) from 3 French reference centers, were included. Adherence to treatment was primarily assessed as the percentage of days with a good adherence score, adherence score rating from 0 (poor) to 2 (good). A descriptive analysis was performed after 1-year follow-up. RESULTS Seventeen patients (10 girls, median age: 13.9 (5.4-33.0) years) were included. Median age at diagnosis was 17.0 (3.0-76.9) months and age at start of cysteamine was 21.0 (15.5-116.3) months. Median daily dose of cysteamine was 1.05 (0.55-1.63) g/m2/day. Over the year, the median percentage of days with a good adherence score was 80 (1-99)% decreasing to 68 (1-99)% in patients > 11 years old. The median of average number of hours covered by treatment in a day was 22.5 (6.1-23.9) versus 14.9 (9.2-20.5) hours for delayed release versus short acting cysteamine. CONCLUSION Our data are the first describing a rather good adherence to cysteamine, decreasing in adolescents and adults. We described a potential interest of the delayed release formulation. Our data highlight the need for a multidisciplinary approach including therapeutic education and individualized approaches in NC patients transitioning to adulthood. Graphical abstract.
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Affiliation(s)
- Segolene Gaillard
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Department of Clinical Epidemiology, CHU-Lyon, F-69677, Bron, France. .,Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France.
| | - Laurent Roche
- Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique, F-69324, Lyon, France
| | - Sandrine Lemoine
- Service de Néphrologie, Dialyse, Hypertension artérielle, Hôpital Edouard Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France
| | - Georges Deschênes
- APHP, Hôpital Robert Debré, Service de néphrologie pédiatrique, Paris, France
| | - Denis Morin
- CHU Montpellier, Service de néphrologie et endocrinologie pédiatrique, Montpellier, France
| | - Christine Vianey-Saban
- Hospices Civils de Lyon, Service Biochimie et Biologie Moléculaire, UF Maladies Héréditaires du Métabolisme, F-69500, Bron, France
| | - Cécile Acquaviva-Bourdain
- Hospices Civils de Lyon, Service Biochimie et Biologie Moléculaire, UF Maladies Héréditaires du Métabolisme, F-69500, Bron, France
| | - Bruno Ranchin
- Hospices Civils de Lyon, Service de Néphrologie Pédiatrique, et centre de référence maladies rénales et phosphocalciques rares- Néphrogones- Filière ORKiD -69500, Bron, France
| | - Justine Bacchetta
- Hospices Civils de Lyon, Service de Néphrologie Pédiatrique, et centre de référence maladies rénales et phosphocalciques rares- Néphrogones- Filière ORKiD -69500, Bron, France
| | - Behrouz Kassai
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Department of Clinical Epidemiology, CHU-Lyon, F-69677, Bron, France.,Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France
| | - Patrice Nony
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Department of Clinical Epidemiology, CHU-Lyon, F-69677, Bron, France.,Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France
| | - Eurielle Bodénan
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Department of Clinical Epidemiology, CHU-Lyon, F-69677, Bron, France
| | - Valérie Laudy
- Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Department of Clinical Epidemiology, CHU-Lyon, F-69677, Bron, France.,Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France
| | - Cécile Rouges
- CHU Montpellier, Centre d'Investigation Clinique, Inserm CIC 1411, F-69500, Bron, Montpellier, France
| | - Setareh Zarrabian
- Centre d'Investigation Clinique - CIC 1426 Hôpital Robert Debre - Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Fabien Subtil
- Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique, F-69324, Lyon, France
| | - Catherine Mercier
- Université de Lyon, F-69000, Lyon, Université Lyon 1; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique, F-69324, Lyon, France
| | - Pierre Cochat
- Hospices Civils de Lyon, Service de Néphrologie Pédiatrique, et centre de référence maladies rénales et phosphocalciques rares- Néphrogones- Filière ORKiD -69500, Bron, France
| | - Aurélia Bertholet-Thomas
- Hospices Civils de Lyon, Service de Néphrologie Pédiatrique, et centre de référence maladies rénales et phosphocalciques rares- Néphrogones- Filière ORKiD -69500, Bron, France
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Machuca-Gayet I, Quinaux T, Bertholet-Thomas A, Gaillard S, Claramunt-Taberner D, Acquaviva-Bourdain C, Bacchetta J. Bone Disease in Nephropathic Cystinosis: Beyond Renal Osteodystrophy. Int J Mol Sci 2020; 21:ijms21093109. [PMID: 32354056 PMCID: PMC7246679 DOI: 10.3390/ijms21093109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/02/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022] Open
Abstract
Patients with chronic kidney disease (CKD) display significant mineral and bone disorders (CKD-MBD) that induce significant cardiovascular, growth and bone comorbidities. Nephropathic cystinosis is an inherited metabolic disorder caused by the lysosomal accumulation of cystine due to mutations in the CTNS gene encoding cystinosin, and leads to end-stage renal disease within the second decade. The cornerstone of management relies on cysteamine therapy to decrease lysosomal cystine accumulation in target organs. However, despite cysteamine therapy, patients display severe bone symptoms, and the concept of “cystinosis metabolic bone disease” is currently emerging. Even though its exact pathophysiology remains unclear, at least five distinct but complementary entities can explain bone impairment in addition to CKD-MBD: long-term consequences of renal Fanconi syndrome, malnutrition and copper deficiency, hormonal disturbances, myopathy, and intrinsic/iatrogenic bone defects. Direct effects of both CTNS mutation and cysteamine on osteoblasts and osteoclasts are described. Thus, the main objective of this manuscript is not only to provide a clinical update on bone disease in cystinosis, but also to summarize the current experimental evidence demonstrating a functional impairment of bone cells in this disease and to discuss new working hypotheses that deserve future research in the field.
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Affiliation(s)
- Irma Machuca-Gayet
- Pathophysiology, Diagnosis and Treatment of Bone Diseases, INSERM UMR 1033, 69008 Lyon, France; (I.M.-G.); (T.Q.); (D.C.-T.)
| | - Thomas Quinaux
- Pathophysiology, Diagnosis and Treatment of Bone Diseases, INSERM UMR 1033, 69008 Lyon, France; (I.M.-G.); (T.Q.); (D.C.-T.)
- Centre de Référence des Maladies Rénales Rares, Centre de Référence des Maladies Rares du Calcium et du Phosphore, Hôpital Femme Mère Enfant, 69500 Bron, France;
| | - Aurélia Bertholet-Thomas
- Centre de Référence des Maladies Rénales Rares, Centre de Référence des Maladies Rares du Calcium et du Phosphore, Hôpital Femme Mère Enfant, 69500 Bron, France;
| | - Ségolène Gaillard
- INSERM CIC 1407, CNRS UMR 5558 and Service de Pharmacotoxicologie Clinique, Hospices Civils de Lyon, 69500 Bron, France;
| | - Débora Claramunt-Taberner
- Pathophysiology, Diagnosis and Treatment of Bone Diseases, INSERM UMR 1033, 69008 Lyon, France; (I.M.-G.); (T.Q.); (D.C.-T.)
| | | | - Justine Bacchetta
- Pathophysiology, Diagnosis and Treatment of Bone Diseases, INSERM UMR 1033, 69008 Lyon, France; (I.M.-G.); (T.Q.); (D.C.-T.)
- Centre de Référence des Maladies Rénales Rares, Centre de Référence des Maladies Rares du Calcium et du Phosphore, Hôpital Femme Mère Enfant, 69500 Bron, France;
- Faculté de Médecine Lyon Est, Université de Lyon, 69008 Lyon, France
- Correspondence: ; Tel.: +33-4-27-85-61-30
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11
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Gaillard S, Roche L, Deschênes G, Morin D, Vianey-Saban C, Acquaviva-Bourdain C, Nony P, Subtil F, Mercier C, Cochat P, Bertholet-Thomas A, Cornu C, Kassai B. Collaboration between academics, small pharmaceutical company and patient organizations in the development of a new formulation of cysteamine in nephropathic cystinosis: A successful story. Therapie 2020; 75:169-173. [PMID: 32248985 DOI: 10.1016/j.therap.2020.02.008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/15/2019] [Indexed: 11/19/2022]
Abstract
Rare diseases usually concern small and disseminated population. Implementing clinical research with the right design, outcomes measures and the recruitment of patients are challenges. Collaborations, training and multidisciplinary approach are often required. In this article, we provide an overview of a successful collaboration in nephropathic cystinosis (NC), focusing on what was the key of success, the interactions between academics, the pharmaceutical company and patients organizations. NC is considered as a very rare disease. In 2010, a new formulation of cysteamine, the only available treatment to improve renal outcome of the disease, was proposed by a small American company. Studies were implemented in France under the coordination of an expert of the disease and the clinical investigation center of Lyon. The collaboration resulted in a good recruitment and retention of the patients in the study and most of all in the availability of the new formulation in France. Patients could have facilitated the research by being involved in the early stages of the studies. Involving patients and public early in the process is particularly important in rare diseases as the patient is a great source of knowledge and has his own expectations. Priorities of research, design, conduct and reporting of clinical trials can be defined in collaboration with adults but also with young patients or public, the first concerned in rare diseases. This concept is still to be developed and improved especially with paediatric patients.
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Affiliation(s)
- Ségolène Gaillard
- Hospices civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, department of clinical epidemiology, CHU-Lyon, 69677 Bron, France; Université de Lyon 1, 69000 Lyon, France.
| | - Laurent Roche
- Université de Lyon 1, 69000 Lyon, France; CNRS, UMR 5558, laboratoire de biométrie et biologie évolutive, 69622 Villeurbanne, France; Hospices civils de Lyon, service de biostatistiques, 69324 Lyon, France
| | - Georges Deschênes
- AP-HP, hôpital Robert-Debré, service de néphrologie pédiatrique, 75019 Paris, France
| | - Denis Morin
- CHU Montpellier, service de néphrologie et endocrinologie pédiatrique, 34295 Montpellier, France
| | - Christine Vianey-Saban
- Hospices civils de Lyon, service biochimie et biologie moléculaire, UF maladies héréditaires du métabolisme, 69500 Bron, France
| | - Cécile Acquaviva-Bourdain
- Hospices civils de Lyon, service biochimie et biologie moléculaire, UF maladies héréditaires du métabolisme, 69500 Bron, France
| | - Patrice Nony
- Hospices civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, department of clinical epidemiology, CHU-Lyon, 69677 Bron, France; Université de Lyon 1, 69000 Lyon, France
| | - Fabien Subtil
- Université de Lyon 1, 69000 Lyon, France; Hospices civils de Lyon, service de biostatistiques, 69324 Lyon, France
| | - Catherine Mercier
- Université de Lyon 1, 69000 Lyon, France; Hospices civils de Lyon, service de biostatistiques, 69324 Lyon, France
| | - Pierre Cochat
- Hospices civils de Lyon, service de néphrologie pédiatrique, et centre de référence maladies rénales et phosphocalciques rares - Néphrogones - Filière ORKiD, 69500 Bron, France
| | - Aurélia Bertholet-Thomas
- Hospices civils de Lyon, service de néphrologie pédiatrique, et centre de référence maladies rénales et phosphocalciques rares - Néphrogones - Filière ORKiD, 69500 Bron, France
| | - Catherine Cornu
- Hospices civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, department of clinical epidemiology, CHU-Lyon, 69677 Bron, France; Université de Lyon 1, 69000 Lyon, France
| | - Behrouz Kassai
- Hospices civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, department of clinical epidemiology, CHU-Lyon, 69677 Bron, France; Université de Lyon 1, 69000 Lyon, France
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12
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Csorba A, Maka E, Maneschg OA, Szabó A, Szentmáry N, Csidey M, Resch M, Imre L, Knézy K, Nagy ZZ. Examination of corneal deposits in nephropathic cystinosis using in vivo confocal microscopy and anterior segment optical coherence tomography: an age-dependent cross sectional study. BMC Ophthalmol 2020; 20:73. [PMID: 32102651 DOI: 10.1186/s12886-020-01336-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Presence of corneal cystine crystals is the main ocular manifestation of cystinosis, although controversial findings concerning the corneal layer with the highest density have been reported. The aim of this study was the analysis of the characteristics of crystal arrangement in different corneal layers and the assessment of corneal morphological changes with age. Methods A cross sectional study was carried out in three children and three adults who had nephropathic cystinosis and corneal cystine depositions. All patients underwent a comprehensive ophthalmological examination including best corrected distance visual acuity, slit-lamp examination, in vivo confocal microscopy and anterior segment optical coherence tomography. An evaluation of the depth of crystal deposits and crystal density in different corneal layers was also performed. Due to the low number of subjects no statistical comparison was performed. Results Anterior segment optical coherence tomography images revealed deposition of hyperreflective crystals from limbus to limbus in each patient. Crystals appeared as randomly oriented hyperreflective, elongated structures on in vivo confocal microscopy images in all corneal layers except the endothelium. In children the deposits occurred predominantly in the anterior stroma, while in adults, the crystals were mostly localized in the posterior corneal stroma with the depth of crystal deposition showing an increasing tendency with age (mean depth of crystal density was 353.17 ± 49.23 μm in children and it was 555.75 ± 25.27 μm in adults). Mean crystal density of the epithelium was 1.47 ± 1.17 (median: 1.5; interquartile range: 0.3–2.4). Mean crystal density of the anterior and posterior stroma of children and adults was 3.37 ± 0.34 (median: 3.4; interquartile range: 3.25–3.55) vs. 1.23 ± 0.23 (median: 1.2; interquartile range: 1.05–1.35) and 0.76 ± 0.49 (median: 0.7; interquartile range: 0.4–1.15) vs. 3.63 ± 0.29 (median: 3.7; interquartile range: 3.45–3.8), respectively. Endothelium had intact structure in all cases. Some hexagonal crystals were observed in two subjects. Conclusions In vivo confocal microscopy and anterior segment optical coherence tomography confirmed an age-related pattern of crystal deposition. In children, crystals tend to locate anteriorly, while in adults, deposits are found posteriorly in corneal stroma.
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Papizh S, Serzhanova V, Filatova A, Skoblov M, Tabakov V, van den Heuvel L, Levtchenko E, Prikhodina L. CTNS mRNA molecular analysis revealed a novel mutation in a child with infantile nephropathic cystinosis: a case report. BMC Nephrol 2019; 20:400. [PMID: 31672123 PMCID: PMC6822415 DOI: 10.1186/s12882-019-1589-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/23/2019] [Accepted: 10/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cystinosis is an autosomal recessive lysosomal storage disorder characterized by accumulation of cystine in lysosomes throughout the body. Cystinosis is caused by mutations in the CTNS gene that encodes the lysosomal cystine carrier protein cystinosin. CTNS mutations result in either complete absence or reduced cystine transporting function of the protein. The diagnosis of nephropathic cystinosis is generally based on measuring leukocyte cystine level, demonstration of corneal cystine crystals by the slit lamp examination and confirmed by genetic analysis of the CTNS gene. CASE PRESENTATION A boy born to consanguineous Caucasian parents had the characteristic clinical features of the infantile nephropathic cystinosis including renal Fanconi syndrome (polydipsia/polyuria, metabolic acidosis, hypokalemia, hypophosphatemia, low molecular weight proteinuria, glycosuria, cystine crystals in the cornea) and elevated WBC cystine levels. Initially we performed RFLP analysis of the common in the Northern European population 57-kb deletion of proband's DNA, then a direct Sanger sequencing which revealed no mutations in the coding part of the CTNS gene. To confirm the diagnosis we performed RT-PCR analysis of total RNA obtained from patient-derived fibroblasts in combination with cDNA sequencing. This revealed the skipping of exon 4 and exon 5 in the CTNS in our patient. Therefore, we detected a novel 9-kb homozygous deletion in the CTNS gene at genomic DNA level, spanning region from intron 3 to intron 5. In order to identify the inheritance pattern of the deletion we analyzed DNA of proband's mother and father. Both parents were found to be heterozygous carriers of the CTNS mutation. CONCLUSIONS Analysis of CTNS gene transcript allowed to identify a large homozygous deletion in the patient with infantile nephropathic cystinosis. Mutational detection at RNA level may be an efficient tool to establish the genetic defect in some cystinosis patients.
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Affiliation(s)
- Svetlana Papizh
- Department of hereditary and acquired kidney diseases, Research and Clinical Institute for Pediatrics at the Pirogov Russian National Research Medical University, 125412, Taldomskaya st., 2, Moscow, Russia.
| | | | | | - Mikhail Skoblov
- Research Centre for Medical Genetics, 115522, Russia, Moscow
| | | | - Lambert van den Heuvel
- Department of Pediatrics/Pediatric Nephrology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Elena Levtchenko
- Department of Pediatrics/Pediatric Nephrology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Larisa Prikhodina
- Department of hereditary and acquired kidney diseases, Research and Clinical Institute for Pediatrics at the Pirogov Russian National Research Medical University, 125412, Taldomskaya st., 2, Moscow, Russia
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14
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Biswas S, Sornalingam K. The Ocular Status of Cystinosis Patients Receiving a Hospital Pharmacy-Made Preparation of Cysteamine Eye Drops: A Case Series. Ophthalmol Ther 2018; 8:125-136. [PMID: 30519924 PMCID: PMC6393247 DOI: 10.1007/s40123-018-0156-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction Infantile nephropathic cystinosis (INC) is an autosomal recessive lysosomal disorder in which patients develop deposits of cystine crystals in their kidneys and corneas from a young age. Methods We conducted a retrospective analysis of children with INC seen by ophthalmologists at the Manchester Royal Eye Hospital between 2002 and 2018, to evaluate clinical findings, symptoms and treatment. Results Twenty-two children diagnosed with INC from age 0 (prenatally) to 11 years were assessed. All evaluable patients had corneal cystine crystal deposits, and 15 had mild to moderate photophobia. Ten patients had other ocular conditions including blepharitis/chalzion (n = 6), swollen optic nerve (n = 3), punctate epitheliopathy (n = 3), corneal scarring (n = 1),and elevated intraocular pressure (n = 2). Confocal imaging identified nerve abnormalities in two patients (enlarged corneal nerve + abnormal-looking tortuous nerves in one patient and beaded nerves in the sub-basal plexus in the other), both of whom had significant crystal deposition in the anterior stroma. Visual acuity was relatively unaffected. All 22 patients were receiving oral cysteamine, and 21 were applying cysteamine eye drops (galenic preparation of 0.55% concentration, compounded by a hospital pharmacy). Recommended application frequency was at least eight times per day in all patients with dosing information available. Conclusions This case series of patients with INC highlights the consistent pattern of corneal cystine crystal deposition, which is universally present from a young age in this condition, and the high incidence of photophobia even in young children. Corneal manifestations of INC persisted despite frequent administration of the hospital pharmacy-made eye drop preparation. Reasons for this lack of efficacy may include the lag period between diagnosis and first prescription of cysteamine eye drops and the difficulty in maintaining rigorous compliance with this treatment. In addition, the challenge for patients of maintaining optimal storage conditions may adversely affect the stability and efficacy of cysteamine within this preparation. Funding Editorial assistance was funded by Orphan Europe Ltd.
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Affiliation(s)
- Susmito Biswas
- Manchester Royal Eye Hospital, Manchester Academic Health Science Centre, Manchester, UK.
| | - Krishanthy Sornalingam
- Manchester Royal Eye Hospital, Manchester Academic Health Science Centre, Manchester, UK
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Bertholet-Thomas A, Claramunt-Taberner D, Gaillard S, Deschênes G, Sornay-Rendu E, Szulc P, Cohen-Solal M, Pelletier S, Carlier MC, Cochat P, Bacchetta J. Teenagers and young adults with nephropathic cystinosis display significant bone disease and cortical impairment. Pediatr Nephrol 2018; 33:1165-72. [PMID: 29435659 DOI: 10.1007/s00467-018-3902-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/08/2018] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bone impairment appears to be a novel complication of nephropathic cystinosis despite cysteamine therapy. Its exact underlying pathophysiology is nevertheless unclear. The objective of this study was to evaluate bone status among patients included in the French Crystobs study. METHODS In addition to clinical data, bone status was evaluated using biomarkers (ALP, PTH, 25-D, 1-25D, FGF23), DXA (spine and total body), and high-resolution peripheral quantitative computed tomography (HR-pQCT) at the tibia and radius. Results were compared to age- and gender-matched healthy controls (1:2 basis) from the local reference cohorts. RESULTS At a median age of 22.5 (10.2-34.6) years, 10 patients with nephropathic cystinosis were included (2 receiving conservative therapies, 2 undergoing hemodialysis, 6 with a past of renal transplantation); 7 out of 10 patients complained of a bone symptom (past of fracture, bone deformations, and/or bone pain). Biochemicals and spine DXA did not show any significant abnormalities. Using HR-pQCT, significant decreases in cortical parameters (e.g., cortical thickness 850 (520-1100) versus 1225 (480-1680) μm; p < 0.05) and total volumetric bone mineral density (290 (233-360) versus 323 (232-406) mg/cm3; p < 0.05) were observed in cystinotic patients in comparison to controls at the tibia. There were no differences for trabecular parameters. Similar results were observed at the radius. CONCLUSIONS In this pilot study, bone impairment (rather cortical than trabecular) is a significant clinical problem in nephropathic cystinosis; 70% of patients displayed significant bone symptoms, during teenage or young adulthood. This new complication should be known by physicians because of its potential dramatic impact on quality of life.
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16
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Flockerzi E, Daas L, Schlötzer-Schrehardt U, Zimpfer A, Bohle R, Seitz B. Ocular changes in nephropathic cystinosis: The course of the gold-dust. Int Ophthalmol 2019; 39:1413-8. [PMID: 29916124 DOI: 10.1007/s10792-018-0954-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Cystinosis is an autosomal recessive inherited lysosomal storage disease with an incidence of 1:100.000 up to 1:200.000 caused by a gene mutation of a lysosomal transport protein resulting in deposition of cystine in lysosomes in all cells and tissues. In the cornea, crystalline, gold-dust deposition of cystine leads to visual impairment, recurrent erosions, photophobia, epiphora and blepharospasmus. Standard therapy is topical and systemic application of cysteamine which may resolve the accumulated cystine crystals. PATIENT AND METHODS This is a case report of a thirty-one-year-old patient who already underwent renal transplantation because of nephropathic cystinosis. Visual impairment by cystine crystal deposition was aggravated by a central avascular pannus formation in his right eye. Penetrating keratoplasty was performed in intention to improve the patient's visual acuity and life quality. RESULTS After penetrating keratoplasty in the right eye, there was only a slight visual improvement. OCT scans of the macula revealed intraretinal cystine crystals and a cystoid macular edema, which was treated with a bevacizumab injection. Transmission electron microscopy of the excised cornea revealed spiky intracorneal inclusions and confocal in vivo microscopy of the left eye allowed detailed visualization of the cystine crystal deposition. CONCLUSIONS There is a variability of ocular manifestations of nephropathic cystinosis. Ophthalmologists have a central role in the early diagnosis of cystinosis as mostly the first manifestation are cystine crystals in the cornea. Penetrating keratoplasty may be one of the therapeutical options. Nevertheless, the patient has to be informed about the limited prognosis because of the persisting underlying disease.
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Abstract
OBJECTIVES To summarize available clinical evidence for cysteamine bitartrate preparations in the treatment of nephropathic cystinosis as identified through a systematic literature review (SLR). METHODS We searched MEDLINE, MEDLINE In-Process and Embase using Ovid with a predefined search strategy through 19 January 2016. All publicly available clinical reports on the use of delayed-release (DR) cysteamine bitartrate (Procysbi 1 ) or immediate-release (IR) cysteamine bitartrate (Cystagon 2 ) in patients with cystinosis were included. RESULTS We identified a total of 103 publications and 10 trial records. Of these, 9 studies describe DR cysteamine bitartrate (n = 267 patients), 42 describe IR cysteamine bitartrate (n = 1,427 patients) and in 53 studies the exact preparation was not specified (n = 906 patients). The vast majority of the studies used a non-randomized study design, with randomized clinical trials (RCTs) being scarce (1 study comparing DR and IR formulation) and case reports (n = 49) being the most common study design representing 47% of the total. CONCLUSION A substantial evidence base for cysteamine bitartrate in the treatment of nephropathic cystinosis was identified. However, the majority of the evidence was of relatively low quality, with evidence levels of 3 or 4.
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Affiliation(s)
- Goran Medic
- a Horizon Pharma Europe BV , Utrecht , The Netherlands
- b Unit of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
| | | | - Andreas Karabis
- c Real World Strategy & Analytics , Mapi Group , Houten , The Netherlands
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18
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Bertholet-Thomas A, Berthiller J, Tasic V, Kassai B, Otukesh H, Greco M, Ehrich J, de Paula Bernardes R, Deschênes G, Hulton SA, Fischbach M, Soulami K, Saeed B, Valavi E, Cobenas CJ, Hacihamdioglu B, Weiler G, Cochat P, Bacchetta J. Worldwide view of nephropathic cystinosis: results from a survey from 30 countries. BMC Nephrol 2017; 18:210. [PMID: 28673276 PMCID: PMC5496396 DOI: 10.1186/s12882-017-0633-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 08/05/2016] [Accepted: 06/21/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Nephropathic cystinosis is a rare inherited metabolic disorder leading to progressive renal failure and extra-renal comorbidity. The prognosis relies on early adherence to cysteamine treatment and symptomatic therapies. Developing nations [DiN] experience many challenges for management of cystinosis. The aim of this study was to assess the management characteristics in DiN compared with developed nations [DeN]. METHODS A questionnaire was sent between April 2010 and May 2011 to 87 members of the International Pediatric Nephrology Association, in 50 countries. RESULTS A total of 213 patients were included from 41 centres in 30 nations (109 from 17 DiN and 104 from 13 DeN). 7% of DiN patients died at a median age of 5 years whereas no death was observed in DeN. DiN patients were older at the time of diagnosis. In DiN, leukocyte cystine measurement was only available in selected cases for diagnosis but never for continuous monitoring. More patients had reached end-stage renal disease in DiN (53.2 vs. 37.9%, p = 0.03), within a shorter time of evolution (8 vs. 10 yrs., p = 0.0008). The earlier the cysteamine treatment, the better the renal outcome, since the median renal survival increased up to 16.1 [12.5-/] yrs. in patients from DeN treated before the age of 2.5 years of age (p = 0.0001). However, the renal survival was not statistically different between DeN and DiN when patients initiated cysteamine after 2.5 years of age. The number of transplantations and the time from onset of ESRD to transplantation were not different in DeN and DiN. More patients were kept under maintenance dialysis in DiN (26% vs.19%, p = 0.02); 79% of patients from DiN vs. 45% in DeN underwent peritoneal dialysis. CONCLUSIONS Major discrepancies between DiN and DeN in the management of nephropathic cystinosis remain a current concern for many patients living in countries with limited financial resources.
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Affiliation(s)
- Aurélia Bertholet-Thomas
- Centre de référence des maladies rénales rares Néphrogones, hôpital Femme–Mère–Enfant, Hospices Civils de Lyon & Université Claude-Bernard Lyon 1, Lyon, France
| | - Julien Berthiller
- 0000 0001 2163 3825grid.413852.9Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France
- Epidémiologie, Pharmacologie, Investigation Clinique CIC 1407 Inserm, Information médicale, Mère-Enfant–Bron, Bron, France
- 0000 0001 2150 7757grid.7849.2Université Lyon 1, Equipe d’Accueil 4129, Lyon, France
| | - Velibor Tasic
- Medical School, University Children’s Hospital, Skopje, Macedonia
| | - Behrouz Kassai
- 0000 0001 2163 3825grid.413852.9Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France
- Epidémiologie, Pharmacologie, Investigation Clinique CIC 1407 Inserm, Information médicale, Mère-Enfant–Bron, Bron, France
- 0000 0001 2150 7757grid.7849.2Université Lyon 1, Equipe d’Accueil 4129, Lyon, France
| | | | - Marcella Greco
- 0000 0001 0727 6809grid.414125.7Division of Nephrology and Dialysis, Children’s Hospital Bambino Gesù, IRCCS, Roma, Italy
| | - Jochen Ehrich
- 0000 0000 9529 9877grid.10423.34Children’s Hospital, Hannover Medical School, Hannover, Germany
| | | | - Georges Deschênes
- 0000 0004 1788 6194grid.469994.fService de néphrologie pédiatrique, Hôpital Robert Debré, Université Sorbonne Paris, Paris, France
| | - Sally-Ann Hulton
- 0000 0004 0399 7272grid.415246.0Birmingham Children’s Hospital, Birmingham, England
| | - Michel Fischbach
- 0000 0004 0593 6932grid.412201.4Service de néphrologie pédiatrique, Hôpital Hautepierre, Strasbourg, France
| | - Kenza Soulami
- Pediatric Nephrology, 295 Bd Abdelmoumen, Casablanca, Morocco
| | | | - Ehsan Valavi
- 0000 0000 9296 6873grid.411230.5Department of Nephrology, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Gabrielle Weiler
- 0000 0000 9402 6172grid.414148.cDivision of nephrology, Children’s hospital of Eastern Ontario, Ottawa, Canada
| | - Pierre Cochat
- Centre de référence des maladies rénales rares Néphrogones, hôpital Femme–Mère–Enfant, Hospices Civils de Lyon & Université Claude-Bernard Lyon 1, Lyon, France
| | - Justine Bacchetta
- Centre de référence des maladies rénales rares Néphrogones, hôpital Femme–Mère–Enfant, Hospices Civils de Lyon & Université Claude-Bernard Lyon 1, Lyon, France
- Centre de référence des maladies rénales rares - Néphrogones, Hôpital Femme–Mère-Enfant, 59, boulevard Pinel, 69677 Bron cedex, France
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19
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Abstract
Cystinosis is a rare autosomal recessive metabolic disorder characterized by the accumulation of cystine in lysosomes, which results from defects in the carrier-mediated transport protein encoded by the CTNS gene. Infantile nephropathic cystinosis (INC) is one of the major complications of cystinosis. It is characterized by findings of Fanconi's syndrome within the first year of life. Here we report two patients with INC presenting with signs of Fanconi's syndrome and describe a novel CTNS mutation.
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Affiliation(s)
- Hakan Doneray
- Department of Pediatrics, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mohammed Aldahmesh
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gulsah Yilmaz
- Department of Pediatrics, Atatürk University School of Medicine, Erzurum, Turkey
| | - Emine Cinici
- Department of Ophtalmology, Erzurum Region Trainig and Research Hospital, Erzurum, Turkey
| | - Zerrin Orbak
- Department of Pediatrics, Atatürk University School of Medicine, Erzurum, Turkey
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20
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Ahlenstiel-Grunow T, Kanzelmeyer NK, Froede K, Kreuzer M, Drube J, Lerch C, Pape L. Switching from immediate- to extended-release cysteamine in nephropathic cystinosis patients: a retrospective real-life single-center study. Pediatr Nephrol 2017; 32:91-97. [PMID: 27350621 DOI: 10.1007/s00467-016-3438-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/28/2016] [Accepted: 05/16/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Nephropathic cystinosis is a rare lysosomal storage disease which is characterized by the accumulation of free cystine in lysosomes and subsequent intracellular crystal formation of cystine throughout the body. If not treated with cysteamine, a cystine-depleting agent, end-stage renal disease will develop early, followed by multiple organ failure as the disease progresses. The established cysteamine formulation requires a strict dosing regimen at 6-h intervals. An extended release (ER) twice-daily formulation has recently been developed. The aim of our study was to evaluate the implementation and outcomes of this option in routine care. METHODS All pediatric cystinosis patients' records in Hannover Medical School were screened, and data on cysteamine therapy, tolerability, dosing, estimated glomerular filtration rates (eGFR), white blood cell cystine levels, and proton pump inhibitor (PPI) use were extracted for the period January 2014 to January 2016. RESULTS The median age of the 12 patients enrolled in the study was 12.5 (range 1-18) years. At the end of the study period ten of these patients received ER-cysteamine. There were no additional side effects. Halitosis/bad breath was often subjectively judged as improved or eliminated, and PPI use could be stopped in one of three patients. The main reasons for switching to the ER formulation were difficult night-time administration and uncontrolled disease. Mean eGFR values remained stable with a median of 67 ml/min/1.73 m2 before and after the transition. White blood cell (WBC) cystine values remained low after the switch (1 nmol/mg protein before and after transition; p = 0.64). CONCLUSIONS In this single-center cohort, the switch from IR- to ER-cysteamine was safe and effective over the short term and provided advantages in terms of frequency of administration and less halitosis/bad breath. The long-term benefit of this option needs to be evaluated in future studies.
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Affiliation(s)
- Thurid Ahlenstiel-Grunow
- Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Nele K Kanzelmeyer
- Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Kerstin Froede
- Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Martin Kreuzer
- Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Jens Drube
- Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Christian Lerch
- Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Lars Pape
- Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
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21
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Ivanova EA, Elmonem MA, Bongaerts I, Luyten T, Missiaen L, van den Heuvel LP, Levtchenko EN, Bultynck G. Ca(2+) signalling in human proximal tubular epithelial cells deficient for cystinosin. Cell Calcium 2016; 60:282-7. [PMID: 27451386 DOI: 10.1016/j.ceca.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/25/2016] [Accepted: 07/03/2016] [Indexed: 11/17/2022]
Abstract
Nephropathic cystinosis is an autosomal recessive lysosomal storage disorder caused by loss-of-function mutations in the CTNS gene coding for the lysosomal cystine transporter, cystinosin. Recent studies have demonstrated that, apart from cystine accumulation in the lysosomes, cystinosin-deficient cells, especially renal proximal tubular epithelial cells are characterized by abnormal vesicle trafficking and endocytosis, possible lysosomal dysfunction and perturbed intracellular signalling cascades. It is therefore possible that Ca(2+) signalling is disturbed in cystinosis, as it has been demonstrated for other disorders associated with lysosomal dysfunction, such as Gaucher, Niemann-Pick type C and Alzheimer's diseases. In this study we investigated ATP-induced, IP3-induced and lysosomal Ca(2+) release in human proximal tubular epithelial cells derived from control and cystinotic patients. No major dysregulation of intracellular Ca(2+) dynamics was found, although ATP-induced Ca(2+) release appeared slightly sensitized in cystinotic cells compared to control cells. Hence, these subtle changes in Ca(2+) signals elicited by agonists may contribute to the pathogenesis of the disease.
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Affiliation(s)
- Ekaterina A Ivanova
- KU Leuven and UZ Leuven, Department of Pediatric Nephrology & Growth and Regeneration, Leuven, Belgium
| | - Mohamed A Elmonem
- KU Leuven and UZ Leuven, Department of Pediatric Nephrology & Growth and Regeneration, Leuven, Belgium; Cairo University, Faculty of Medicine, Department of Clinical and Chemical Pathology, Cairo, Egypt.
| | - Inge Bongaerts
- KU Leuven and UZ Leuven, Department of Pediatric Nephrology & Growth and Regeneration, Leuven, Belgium
| | - Tomas Luyten
- KU Leuven, Laboratory of Molecular and Cellular Signalling, Department of Cellular and Molecular Medicine, Leuven, Belgium
| | - Ludwig Missiaen
- KU Leuven, Laboratory of Molecular and Cellular Signalling, Department of Cellular and Molecular Medicine, Leuven, Belgium
| | - Lambertus P van den Heuvel
- KU Leuven and UZ Leuven, Department of Pediatric Nephrology & Growth and Regeneration, Leuven, Belgium; Radboud University Medical Center, Department of Pediatric Nephrology, Nijmegen, The Netherlands
| | - Elena N Levtchenko
- KU Leuven and UZ Leuven, Department of Pediatric Nephrology & Growth and Regeneration, Leuven, Belgium
| | - Geert Bultynck
- KU Leuven, Laboratory of Molecular and Cellular Signalling, Department of Cellular and Molecular Medicine, Leuven, Belgium
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22
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Osman NM, Sanosi AA. Bartter syndrome associated with nephropathic cystinosis. Sudan J Paediatr 2016; 16:93-98. [PMID: 28096565 PMCID: PMC5237842] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Bartter syndrome is a rare inherited defect in the thick ascending limb of the loop of Henle. It is characterized by low potassium levels (hypokalaemia), increased blood pH (alkalosis) and normal to low blood pressure. There are three types of Bartter syndrome: neonatal, the classic type and Gitelman syndrome. Nephropathic cystinosis is an autosomal recessive disorder characterized by accumulation of free cystine in lysosomes due to disorder of lysosomal transport that can lead to end stage renal failure within 10 years and multiorgan impairment. We report a 5 year 9 month old child with Bartter syndrome associated with nephropathic cystinosis, hypothyroidism and rickets. Hitherto, only a handful of similar cases have been reported in the literature.
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23
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Chkioua L, Khedhiri S, Grissa O, Aloui C, Turkia HB, Ferchichi S, Miled A, Froissart R, Acquaviva C, Laradi S. Genetic basis of cystinosis in Tunisian patients: Identification of novel mutation in CTNS gene. Meta Gene 2015; 5:144-9. [PMID: 26266097 DOI: 10.1016/j.mgene.2015.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 12/24/2022] Open
Abstract
Nephropathic cystinosis (NC) is an autosomal recessive disorder characterized by defective transport of cystine across the lysosomal membrane and resulting in renal, ophthalmic, and other organ abnormalities. Mutations in the CTNS gene cause a deficiency of the transport protein, cystinosin. This study was performed to investigate mutations of the CTNS gene in three Tunisian families with NC. Polymerase chain reaction (PCR), ARMS multiplex PCR and direct sequencing were performed for molecular characterization of the CTNS gene in 3 unrelated Tunisian patients and their parents. Based on family history, prenatal diagnosis (PND) was performed in fetal DNA isolated from chorionic villi obtained at 10-12 weeks of gestation. None of the patients showed the most common 57-kb deletion in heterozygous or homozygous status. One patient was homozygous for the previously reported mutation c.1515G > A (p.G308R). One patient presented the novel gross deletion of 20,327 bp. One was homozygote for the previously reported mutation c.771_793del (p.Gly258Serfs*30). In addition, eight polymorphisms were identified in the 3 patients and their parents. The prenatal diagnosis in one family showed that the fetus DNA was heterozygous for the c.771_793del (p.Gly258Serfs*30) mutation. This study expands the mutational and population spectrum of NC, representing the first molecular diagnosis of NC in Tunisian population. The mutation screening of the CTNS gene was used for prenatal diagnosis to prevent and/or limit this inheritable disease in our country where the families are particularly large and have a high rate of consanguinity.
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