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Martino F, Barilla' F, Martino E, Placanica G, Paravati V, Bassareo PP. Nailfold capillaroscopy reveals early peripheral microcirculation abnormalities in children affected by heterozygous familial hypercholesterolemia. Microvasc Res 2023; 148:104545. [PMID: 37146675 DOI: 10.1016/j.mvr.2023.104545] [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: 03/08/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND nailfold capillaroscopy (NCF) is a non-invasive imaging technique to seek peripheral microcirculation abnormalities in children and adults. Familial hypercholesterolemia is a genetic disorder caused by mutations capable of increasing blood levels of low-density lipoproteins cholesterol (LDL-C), thus triggering early atherosclerosis. The study aims at evaluating peripheral microcirculation in children with heterozygous familial hypercholesterolemia (HeFH) by means of NFC in comparison with healthy peers and at searching for possible correlations between these abnormalities and patients' lipid panel. METHODS thirty-six HeFH patients were enrolled (13 males and 23 females. Mean age 8 ± 3 years; age range 3-13 years). They had increased levels of total cholesterol (237.9 ± 34.2 mg/dl) and LDL-C (154.2 ± 37.6 mg/dl). Both values were ≥95th gender and age specific centile. All the subjects in the study underwent NFC. RESULTS In 69.4 % of HeFH children nailfold capillaries were tortuous (p < 0.00001 compared to healthy controls). In 41.6 % the number of capillaries was markedly reduced (<7 capillaries/mm). The mean number of capillaries was 8.4 ± 2.6/mm in HeFH and 12.2 ± 1.4/mm in healthy controls (p < 0.00001). In 100 % of the sample size capillary blood flow was slowed down (p < 0.00001). In 50 % of the sample size a blood "sludge" phenomenon was seen (p < 0.00001). No gender differences were detected. Sludge phenomenon was seen only in those with LDL-C over 99th centile (p < 0.00001). CONCLUSION NCF allows the identification of an early peripheral microvascular dysfunction in HeFH children which is similar to that already seen in atherosclerotic disease. Prompt identification of these capillary abnormalities may be crucial in implementing early prevention measures.
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Affiliation(s)
- Francesco Martino
- Sapienza University of Rome, Department of Internal Medicine, Anaesthesiology, and Cardiovascular Sciences, 00161 Rome, Italy
| | - Francesco Barilla'
- Department of Systems Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Eliana Martino
- Sapienza University of Rome, Department of Internal Medicine, Anaesthesiology, and Cardiovascular Sciences, 00161 Rome, Italy
| | - Giuseppe Placanica
- Department of Cardiovascular, Nephrological, Anaesthesiological, and Geriatric Sciences, Sapienza University of Rome, 00133 Rome, Italy
| | - Vincenzo Paravati
- Sapienza University of Rome, Department of Internal Medicine, Anaesthesiology, and Cardiovascular Sciences, 00161 Rome, Italy
| | - Pier Paolo Bassareo
- University College of Dublin, School of Medicine, Mater Misericordiae University Hospital and Children's Health Ireland at Crumlin, Dublin, Ireland.
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Abstract
PURPOSE To report the first case describing choroidal neovascularization in long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency. METHODS Case report including multimodal imaging discussion. RESULTS A 21-year-old woman affected by LCHAD deficiency (confirmed by 1528 G>C homozygous mutation) was referred to our department for progressive visual decline in both eyes. Best-corrected visual acuities were 20/40 and 20/1,000 in the right and left eye, respectively. Ultra-widefield imaging, fluorescein angiography, structural optical coherence tomography, and optical coherence tomography angiography revealed the presence of macular and midperipheral chorioretinal atrophy complicated by a choroidal neovascularization in the left eye. CONCLUSION Ocular changes in LCHAD deficiency are long-term complications and severely affect the quality of life of patients. We report for the first time the evidence that choroidal neovascularization could complicate ocular changes accelerating the progressive vision impairment.
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Affiliation(s)
- Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
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Chiplunkar S, Bindu PS, Nagappa M, Panikulam BB, Arvinda HR, Govindaraj P, Srinivas Bharath MM, Gayathri N, Jessiena Ponmalar JN, Mathuranath PS, Sinha S, Taly AB. Novel magnetic resonance imaging findings in a patient with short chain acyl CoA dehydrogenase deficiency. Metab Brain Dis 2017; 32:967-970. [PMID: 28374236 DOI: 10.1007/s11011-017-0005-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/09/2016] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
Reports on magnetic resonance imaging findings in patients with short chain acyl -Coenzyme A dehydrogenase (SCAD) deficiency, an autosomal recessive disorder caused by mutations in the acyl-Coenzyme A dehydrogenase (ACADS), are limited. Many asymptomatic carriers of ACAD variants have also been described necessitating careful evaluation of clinical and biochemical findings for an accurate diagnosis. Here we report a an infant with short chain acyl -Coenzyme A dehydrogenase (SCAD) deficiency diagnosed based on the characteristic biochemical findings and confirmed by genetic testing. He presented with refractory seizures and neuro regression at 4 months of age. His metabolic work up revealed elevated butyryl carnitine in plasma and ethyl malonic acid in urine. Magnetic resonance imaging of the brain showed cortical and basal ganglia signal changes with cortical swelling. Serial scans showed progression of the lesions resulting in cystic leukomalacia with brain atrophy. Exome sequencing revealed a novel homozygous nonsense variation, c.1146C > G (p.Y382Ter) in exon ten of ACADS which was further validated by Sanger sequencing. Both parents were heterozygous carriers. Follow up at 15 months showed gross psychomotor retardation and refractory seizures despite being on optimal doses of anti-epileptic medications, carnitine and multivitamin supplementation. This report expands the phenotypic and genotypic spectrum of SCAD deficiency.
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Affiliation(s)
- Shwetha Chiplunkar
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- Neuromuscular Laboratory-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Parayil Sankaran Bindu
- Neuromuscular Laboratory-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Madhu Nagappa
- Neuromuscular Laboratory-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Bobby Baby Panikulam
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Hanumanthapura R Arvinda
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Periyasamy Govindaraj
- Neuromuscular Laboratory-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - M M Srinivas Bharath
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Narayanappa Gayathri
- Neuromuscular Laboratory-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - J N Jessiena Ponmalar
- Neuromuscular Laboratory-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Pavagada S Mathuranath
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Arun B Taly
- Neuromuscular Laboratory-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Llorca-Cardeñosa A, Català-Mora J, García-Cazorla A, Meavilla S, Castejón-Ponce E. Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency: A case report. Arch Soc Esp Oftalmol 2016; 91:236-239. [PMID: 26896063 DOI: 10.1016/j.oftal.2016.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 06/05/2023]
Abstract
CLINICAL CASE A five-year-old patient, with a diagnosis of long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, was referred for an ophthalmological examination. He had a history of acute metabolic crises precipitated by intercurrent infections,as well as rhabdomyolysis. The fundoscopic examination revealed a peripapillary chorioretinal atrophy and a diffuse granular appearance of the macular retinal pigment epithelium. Best corrected visual acuity was 6/6 in both eyes, and he had a normal electroretinography test. DISCUSSION We perform a review of the literature and recent findings in relation to this disease through the description of a clinical case in order to improve the knowledge of this uncommon disorder.
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Affiliation(s)
- A Llorca-Cardeñosa
- Máster en Oftalmología Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - J Català-Mora
- Sección de Retina y Vítreo, Departamento de Oftalmología Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - A García-Cazorla
- Departamento de Neuropediatría, Unidad de Enfermedades Metabólicas, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - S Meavilla
- Sección de Gastroenterología, Hepatología y Nutrición Infantil, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - E Castejón-Ponce
- Sección de Gastroenterología, Hepatología y Nutrición Infantil, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
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O'Brien JS, Ho MW, Veath ML, Wilson JF, Myers G, Opitz JM, ZuRhein GM, Spranger JW, Hartmann HA, Haneberg B, Grosse FR. Juvenile GM 1 gangliosidosis: clinical, pathological, chemical and enzymatic studies. Clin Genet 2008; 3:411-34. [PMID: 4650864 DOI: 10.1111/j.1399-0004.1972.tb01476.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Hwang EH, Yamashita A, Takemori H, Taki J, Nakajima K, Bunko H, Nakamura S, Ikeda T, Tonami N. Absent myocardial I-123 BMIPP uptake in a family. Ann Nucl Med 1996; 10:445-8. [PMID: 9006733 DOI: 10.1007/bf03164809] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 72-year-old woman with hypertension showed no sign of myocardial accumulation of 123I-BMIPP, and 201Tl and 123I-MIBG scintigraphy demonstrated normal findings. Electrocardiography showed left axis deviation with inverted T waves in leads I, aVL, V2-6 and QT prolongation. Coronary arteriography, two dimensional echo cardiography and laboratory data showed no abnormality. Her 66-year-old sister with non-insulin-dependent diabetes mellitus also had no myocardial BMIPP uptake, but had normal 201Tl finding. ECG and chest film findings were normal. Laboratory data indicated slightly high fasted blood glucose, triglyceride and total cholesterol. Four sons of a 72-year-old woman also underwent BMIPP scintigraphy. No BMIPP uptake was also observed in her 2nd son (49 years old) and his electrocardiogram showed QT prolongation. Since these rare findings indicating no myocardial BMIPP uptake were seen in a family, we suspected that a hereditary myocardial metabolic abnormality accounted for them.
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Affiliation(s)
- E H Hwang
- Department of Radiology, Tsuruga City Hospital, Fukui, Japan
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Abstract
We studied the effect of chenodeoxycholic acid in 17 patients with cerebrotendinous xanthomatosis. Before treatment, all subjects were symptomatic, with Achilles tendon xanthomas (in 15 of 17), cataracts (in 12 of 17), dementia (in 13 of 17), pyramidal-tract signs (in all 17), cerebellar dysfunction (in 13 of 17), mild peripheral neuropathy (in 7 of 17), electroencephalographic abnormalities (in 10 of 13), and abnormal cerebral computerized axial tomographic scans (in 10 of 12). After at least one year of chenodeoxycholic acid treatment (750 mg per day), dementia cleared in 10 subjects, and pyramidal and cerebellar signs disappeared in 5 and improved in another 8. Peripheral neuropathy was no longer detected in six. The electroencephalogram became normal in five and showed fewer abnormalities in another three subjects. Cerebral computerized axial tomographic scans improved in seven patients; the changes included the disappearance of a cerebellar xanthoma in one case. Concomitantly, mean plasma cholestanol levels declined threefold, and abnormal bile acid synthesis was suppressed. We conclude that long-term therapy with chenodeoxycholic acid may correct the biochemical abnormalities and arrest and possibly reverse the progression of cerebrotendinous xanthomatosis.
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Hill SC, Hoeg JM, Dwyer AJ, Vucich JJ, Doppman JL. CT findings in acid lipase deficiency: wolman disease and cholesteryl ester storage disease. J Comput Assist Tomogr 1983; 7:815-8. [PMID: 6886132 DOI: 10.1097/00004728-198310000-00011] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Acid lipase deficiency leads to the abnormal accumulation of cholesteryl esters and triglycerides in many tissues. It is manifested clinically in two forms: Wolman disease, which is usually fatal in infancy, and cholesteryl ester storage disease (CESD), which is clinically milder. One case of each is presented. In the patient with Wolman disease, computed tomography (CT) showed an enlarged liver of diminished density and enlarged adrenals with cortical calcification. Computed tomography of the patient with CESD showed an enlarged liver of normal density and normal adrenals. In vitro CT density is inversely related to cholesterol content. However, CT is unreliable in assessing liver cholesterol in these patients due to their poor nutrition and concomitant changes in liver glycogen and fat.
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Abstract
In nine patients with cerebrotendinous xanthomatosis (CTX), computed tomography (CT) demonstrated diffuse white matter hypodensity above and below the tentorium. This was attributed to sterol infiltration with secondary demyelination. In one patient, a focal right cerebellar hypodense lesion reflected a true xanthoma. These findings suggest that the neurologic symptoms, no matter how longstanding, result from metabolic encephalopathy rather than irreversible destruction of brain tissue by xanthomas.
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Walter E, Petersen D. [Radiological findings in lipoid proteinosis (author's transl)]. ROFO-FORTSCHR RONTG 1981; 135:156-60. [PMID: 6212306 DOI: 10.1055/s-2008-1056851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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12
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Schaub J, Janka GE, Christomanou H, Sandhoff K, Permanetter W, Hübner G, Meister P. Wolman's disease: clinical, biochemical and ultrastructural studies in an unusual case without striking adrenal calcification. Eur J Pediatr 1980; 135:45-53. [PMID: 7449788 DOI: 10.1007/bf00445892] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A case of Wolman's disease is described in a German infant who died at the age of 4 months. Hepatosplenomegaly, abdominal distention, gastrointestinal symptoms, dyserythropoietic changes in the bone marrow, but not adrenal calcification on X-ray were present. Stored lipid material could be demonstrated in liver, spleen, intestine, adrenals, thymus, kidneys, blood cells, but not in the central nervous system. Cholesterylesters and triglycerides were markedly increased in liver and spleen. Lysosomal acid lipase was found to be decreased in leucocytes and liver to less than 10% of normal, when measured with synthetic and natural substrates.
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Genereux GP. Lipids in the lungs: radiologic-pathologic correlation. J Can Assoc Radiol 1970; 21:2-15. [PMID: 5469067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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