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Jackson J, Farajzadeh J, Turner R, Yukutake K, Baghdasaryan E, Denis ES, Barseghyan T, Herrera P, Begaj S, Pietruszka M, Valles-Ayoub Y. Prevalence of p.G87V and p.Gln298=Variations in LIPA Gene Within Middle Eastern Population Living Around Los Angeles. Genet Test Mol Biomarkers 2023; 27:319-324. [PMID: 37903030 DOI: 10.1089/gtmb.2023.0003] [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] [Indexed: 11/01/2023] Open
Abstract
Background: The LIPA gene encodes for lysosomal acid lipase (LAL), which catalyzes the hydrolysis of cholesterol esters and triglycerides. Variations in the LIPA gene impair LAL activity, predisposing patients to a rare metabolic disorder called LAL deficiency (LAL-D). The lack of functioning LAL promotes lipid accumulation and subsequent dyslipidemia, which can increase the likelihood of complications in both infants and adults. Although the worldwide prevalence is 1:500,000 births, the frequency in Mizrahi Jewish populations is projected to be as high as 1 in every 4200 births (Valles-Ayoub et al.) based on the LIPA p.G87V variant frequency among 162 individuals. Materials and Methods: This study was conducted to validate the previously reported prevalence of LAL-D in the Mizrahi Jewish population based on the pathogenic LIPA missense variants in exon 4 (c.260G>T; p.G87V) and exon 8 (c.894G>A; p.Gln298=) using a larger cohort of those with Middle Eastern ancestry living around Los Angeles. Among the 1184 individual samples sequenced, 660 self-reported as Mizrahi Jewish, while the remaining 524 came from other Middle Eastern groups labeled as "non-Jewish." Results: Of the 1184 samples, 22 alleles of the exon 4 variant were identified (1.85%), and 2 alleles of the exon 8 variant were identified (0.16%). For the exon 4 variant, 20 of 22 (90.9%) heterozygotes were Mizrahi Jewish, while 2 of 22 (9.09%) heterozygotes were "non-Jewish." For the exon 8 variant, 2 of 2 (100%) heterozygotes were Mizrahi Jewish. This suggests that the prevalence of LAL-D in this population is 1 in 900, which suggests that LAL-D may be 4.6% higher in the Mizrahi Jewish population in previous reports. Conclusion: These findings show increased prevalence of LIPA gene exon 4 variation p.G87V in the Middle East population when compared to the general population, indicating the need for prenatal screening in those of Mizrahi Jewish ancestry.
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Affiliation(s)
- Jayden Jackson
- Firmalab, Hollywood, California, USA
- California State University Channel Islands, Camarillo, California, USA
| | - Justin Farajzadeh
- Firmalab, Hollywood, California, USA
- Ultimate DX, Hollywood, California, USA
| | - Robert Turner
- California State University Channel Islands, Camarillo, California, USA
- Ultimate DX, Hollywood, California, USA
| | - Kevin Yukutake
- Ultimate DX, Hollywood, California, USA
- West Los Angeles, Culver City, California, USA
| | | | - Emily St Denis
- Firmalab, Hollywood, California, USA
- University of California Los Angeles, Los Angeles, USA
| | - Tigran Barseghyan
- Ultimate DX, Hollywood, California, USA
- University of California Santa Barbra, Santa Barbara, USA
| | | | - Sajo Begaj
- Firmalab, Hollywood, California, USA
- Ultimate DX, Hollywood, California, USA
| | - Marvin Pietruszka
- Firmalab, Hollywood, California, USA
- University of Southern California, Los Angeles, California, USA
| | - Yadira Valles-Ayoub
- Firmalab, Hollywood, California, USA
- Ultimate DX, Hollywood, California, USA
- California State University Northridge, Northridge, USA
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Asna Ashari K, Azari-Yam A, Shahrooei M, Ziaee V. Wolman disease presenting with hemophagocytic lymphohistiocytosis syndrome and a novel LIPA gene variant: a case report and review of the literature. J Med Case Rep 2023; 17:369. [PMID: 37641143 PMCID: PMC10463876 DOI: 10.1186/s13256-023-04116-4] [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: 06/10/2022] [Accepted: 08/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Wolman disease is a rare disease caused by the absence of functional liposomal acid lipase due to mutations in LIPA gene. It presents with organomegaly, malabsorption, and adrenal calcifications. The presentations can resemble hemophagocytic lymphohistiocytosis, the life threatening hyperinflammatory disorder. Since the disease is very rare, clinicians might not think of it when a patient presents with hemophagocytic lymphohistiocytosis, and the opportunity to treat it properly can be lost, thus leading to demise of the child. CASE PRESENTATION We present a 4.5-month-old Caucasian boy with fever, icterus, and hepatosplenomegaly who was treated according to presumed hemophagocytic lymphohistiocytosis disease. Wolman disease was diagnosed after the death of the child. There are some case reports in the literature presenting patients with Wolman disease primarily diagnosed as hemophagocytic lymphohistiocytosis, which we discuss in this review. The genetic analysis revealed after his demise was compatible with Wolman disease, introducing a novel mutation in LIPA gene: exon 4: NM_001127605: c. G353A (p.G118D), which converts the glycine amino acid to aspartic acid. CONCLUSIONS Considering the similarities in presentation of Wolman disease and hemophagocytic lymphohistiocytosis, the patient's life can be saved if special attention is paid to presenting features of a patient with suspected hemophagocytic lymphohistiocytosis, that is special attention to symptoms, findings on physical exams, laboratory values, and radiologic findings, and the proper treatment is urgently initiated. Reporting the novel mutations of Wolman disease can help geneticists interpret the results of their patients' genetic studies appropriately, leading to correct diagnosis and treatment.
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Affiliation(s)
- Kosar Asna Ashari
- Children's Medical Center, Pediatrics Center of Excellence, Dr Qarib St, Keshavarz Blvd, Tehran, 14194, Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
- Pediatric Rheumatology Society of Iran, Tehran, Iran
- Pediatrics Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aileen Azari-Yam
- Children's Medical Center, Pediatrics Center of Excellence, Dr Qarib St, Keshavarz Blvd, Tehran, 14194, Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shahrooei
- Department of Microbiology and Immunology, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, Leuven, Belgium
| | - Vahid Ziaee
- Children's Medical Center, Pediatrics Center of Excellence, Dr Qarib St, Keshavarz Blvd, Tehran, 14194, Iran.
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.
- Pediatric Rheumatology Society of Iran, Tehran, Iran.
- Pediatrics Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Hassall S, Smith DM, Rust S, Jones SA, Wittkowski A. "Why them, why me, why us?" The experiences of parents of children with lysosomal acid lipase deficiency: an interpretative phenomenological analysis study. Orphanet J Rare Dis 2022; 17:193. [PMID: 35550173 PMCID: PMC9097427 DOI: 10.1186/s13023-022-02335-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/26/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Lysosomal acid lipase deficiency (LALD) is an ultra-rare, inherited metabolic disease within the category of lysosomal storage disorders, affecting an infant's ability to metabolise cholesterol. Developments in treatment, including Enzyme Replacement Therapy, have proven successful, with some children living for a number of years with treatment, although the future still remains unknown. The aim of this study was to explore the lived experiences of parents of children with LALD. MAIN TEXT Participants were recruited from across the United Kingdom between 2020 and 2021. Eight parents (five mothers and three fathers) whose child had a confirmed diagnosis of LALD were interviewed. Data collected from the semi-structured interviews were audio-record, transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Three superordinate and nine subordinate themes emerged from the data: (1) Uncertainty-a double-edged sword (plunged into an uncertain world, living life with worry and walking the tightrope of stability), (2) Powerless against a shared battle with LALD (a helpless parent, a joint battle, protection against distress and a vulnerable parent needing help) and 3) Accepting a life with LALD (coming to terms with a diagnosis of LALD and a hidden condition). CONCLUSIONS The findings of this study highlight that the diagnosis of LALD proves to be a very challenging and emotionally distressing time in parents' lives, with increased uncertainty about what the future will hold for their child. This study signified the importance of healthcare pathways and service provisions to support parents and their children throughout diagnosis and beyond.
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Affiliation(s)
- S Hassall
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9NY, UK
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - D M Smith
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9NY, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - S Rust
- Royal Manchester Children's Hospital, Manchester, UK
| | - S A Jones
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9NY, UK
- Royal Manchester Children's Hospital, Manchester, UK
| | - A Wittkowski
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9NY, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.
- Manchester Academic Health Science Centre, Manchester, UK.
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Torres LD, Bonilha DQ, Diaz RG, de Carvalho RB, Montes CG. A rare case of lysosomal acid lipase deficiency diagnosed by endoscopy. Gastrointest Endosc 2022; 95:803-804. [PMID: 34922935 DOI: 10.1016/j.gie.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/13/2021] [Indexed: 12/11/2022]
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Witeck CDR, Schmitz AC, de Oliveira JMD, Porporatti AL, De Luca Canto G, Pires MMDS. Lysosomal acid lipase deficiency in pediatric patients: a scoping review. J Pediatr (Rio J) 2022; 98:4-14. [PMID: 33964214 PMCID: PMC9432115 DOI: 10.1016/j.jped.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Lysosomal acid lipase deficiency (LAL-D) is an underdiagnosed autosomal recessive disease with onset between the first years of life and adulthood. Early diagnosis is crucial for effective therapy and long-term survival. The objective of this article is to recognize warning signs among the clinical and laboratory characteristics of LAL-D in pediatric patients through a scope review. SOURCES Electronic searches in the Embase, PubMed, Livivo, LILACS, Web of Science, Scopus, Google Scholar, Open Gray, and ProQuest Dissertations and Theses databases. The dataset included observational studies with clinical and laboratory characteristics of infants, children and adolescents diagnosed with lysosomal acid lipase deficiency by enzyme activity testing or analysis of mutations in the lysosomal acid lipase gene (LIPA). The reference selection process was performed in two stages. The references were selected by two authors, and the data were extracted in June 2020. SUMMARY OF THE FINDINGS The initial search returned 1593 studies, and the final selection included 108 studies from 30 countries encompassing 206 patients, including individuals with Wolman disease and cholesteryl ester storage disease (CESD). The most prevalent manifestations in both spectra of the disease were hepatomegaly, splenomegaly, anemia, dyslipidemia, and elevated transaminases. CONCLUSIONS Vomiting, diarrhea, jaundice, and splenomegaly may be correlated, and may serve as a starting point for investigating LAL-D. Familial lymphohistiocytosis should be part of the differential diagnosis with LAL-D, and all patients undergoing upper gastrointestinal endoscopy should be submitted to intestinal biopsy.
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Affiliation(s)
- Camila da Rosa Witeck
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, SC, Brazil.
| | - Anne Calbusch Schmitz
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, SC, Brazil
| | - Júlia Meller Dias de Oliveira
- Universidade Federal de Santa Catarina, Centro Brasileiro de Pesquisas Baseadas em Evidências, Florianópolis, SC, Brazil
| | - André Luís Porporatti
- Universidade Federal de Santa Catarina, Centro Brasileiro de Pesquisas Baseadas em Evidências, Florianópolis, SC, Brazil
| | - Graziela De Luca Canto
- Universidade Federal de Santa Catarina, Centro Brasileiro de Pesquisas Baseadas em Evidências, Florianópolis, SC, Brazil
| | - Maria Marlene de Souza Pires
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, SC, Brazil; Universidade Federal de Santa Catarina, Laboratório de Pesquisa Clínica e Experimental- MENULab, Florianópolis, SC, Brazil; Universidade Federal de Santa Catarina, Departamento de Pediatria, Florianópolis, SC, Brazil
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Manka P, Baba HA, Wedemeyer H, Kahraman A. Diet-refractory NASH in an elderly woman. Gut 2021; 70:1924-1945. [PMID: 32694177 DOI: 10.1136/gutjnl-2020-320740] [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: 01/23/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Paul Manka
- Department for Gastroenterology and Hepatology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Hideo A Baba
- Institute of Pathology and Neuropathology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Heiner Wedemeyer
- Department for Gastroenterology and Hepatology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Alisan Kahraman
- Department for Gastroenterology and Hepatology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
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Affiliation(s)
- Hannah Hsu
- Department of Haematology, St George Public Hospital, Sydney, New South Wales, Australia
| | - Fernando Roncolato
- Department of Haematology, St George Public Hospital, Sydney, New South Wales, Australia
| | - Szu-Hee Lee
- Department of Haematology, St George Public Hospital, Sydney, New South Wales, Australia
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8
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Marín Andrés M, Ros Arnal I, Cebolla Sanz JJ, Pérez Delgado R, García Jiménez MC. [Lysosomal acid lipase deficiency: A rarely recognised cause of dyslipidaemia and liver dysfunction]. An Pediatr (Barc) 2021; 94:50-51. [PMID: 32736925 DOI: 10.1016/j.anpedi.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marta Marín Andrés
- Unidad de Neurometabolismo, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - Ignacio Ros Arnal
- Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Jorge Javier Cebolla Sanz
- Instituto de Investigación Sanitaria Aragón, Grupo de estudio de enfermedades metabólicas y neoplasias hematológicas, Zaragoza, España
| | - Raquel Pérez Delgado
- Unidad de Neurometabolismo, Hospital Universitario Miguel Servet, Zaragoza, España
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Abstract
Lysosomal acid lipase (LAL) deficiency, or cholesterol ester storage disease, is a disorder affecting the breakdown of cholesterol esters and triglycerides within lysosomes. Clinical findings include hepatomegaly, hepatic dysfunction, and dyslipidemia with a wide range of phenotypic variability and age of onset. The available clinical and molecular information of the patient presented herein was consistent with a diagnosis of LAL deficiency, but her LAL activity assay repeatedly showed normal or borderline low results. Her response to enzyme replacement therapy and demonstrable deficiency on a newer specific enzymatic assay ultimately confirmed her diagnosis of LAL deficiency.
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Affiliation(s)
- Joseph J. Shen
- Department of Pediatrics, UCSF Fresno, Fresno
- Medical Genetics and Metabolism, Valley Children's Hospital, Madera
| | - Jessica L. Davis
- Department of Pathology, University of California San Francisco, San Francisco, CA
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Xinying Hong
- Department of Chemistry, University of Washington, Seattle, WA
| | | | - Michael H. Gelb
- Department of Chemistry, University of Washington, Seattle, WA
| | - Grace E. Kim
- Department of Pathology, University of California San Francisco, San Francisco, CA
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Cooper JA, Church HJ, Wu HY. Cholestane-3β, 5α, 6β-triol: Further insights into the performance of this oxysterol in diagnosis of Niemann-Pick disease type C. Mol Genet Metab 2020; 130:77-86. [PMID: 32178982 DOI: 10.1016/j.ymgme.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/22/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
In recent years the oxysterol species cholestane-3β, 5α, 6β-triol (C-triol) has found application as a diagnostic biomarker for Niemann-Pick disease type C. Other studies have described increased C-triol in patients with Niemann-Pick disease type A/B and milder increases in lysosomal acid lipase deficiency (LALD), whereas they note normal C-triol levels in Smith-Lemli-Opitz syndrome (SLOS) and familial hypercholesterolaemia (FH) patients. Herein, we review data collected in our laboratory during method evaluation along with 5 years of routine analysis and present findings which differ from those reported by other groups with respect to LALD, SLOS and FH in particular, whilst providing further evidence regarding the clinical sensitivity and specificity of this biomarker, which are difficult to accurately assess. All of our Wolman disease (severe LALD) patients have demonstrated gross elevations of C-triol at diagnosis, with reduction to normal levels after induction of enzyme replacement therapy. In diagnostic specimens from SLOS patients we observed very low or undetectable C-triol levels whereas in post-therapeutic SLOS patients demonstrated normalised levels; we also describe a homozygous FH patient in which C-triol is significantly elevated. Upon investigation, we found that C-triol was formed artefactually from cholesterol during our sample preparation, i.e. this is a false positive of analytical origin; at present it is unclear whether similar effects occur during sample preparation in other laboratories. Our data demonstrates clinical sensitivity of 100% during routine application to diagnostic specimens; this is in keeping with other estimates, yet in a small proportion of patients diagnosed prior to C-triol measurement, either by Filipin staining of fibroblasts or molecular genetics, we have observed normal C-triol concentrations. Clinical specificity of C-triol alone is 93.4% and 95.3% when performed in conjunction with lysosomal enzymology. These performance statistics are very similar to those achieved with Filipin staining of cultured fibroblasts in the 5 years preceding introduction of C-triol to routine use in our laboratory. It is increasingly apparent to us that although this analyte is a very useful addition to the diagnostic tools available for NPC, with considerable advantages over more invasive and time-consuming methods, the interpretation of results is complex and should be undertaken only in light of clinical details and results of other analyses including enzymology for lysosomal acid lipase and acid sphingomyelinase.
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Affiliation(s)
- J A Cooper
- Willink Biochemical Genetics Laboratory, Manchester University NHS Foundation Trust, United Kingdom
| | - H J Church
- Willink Biochemical Genetics Laboratory, Manchester University NHS Foundation Trust, United Kingdom
| | - H Y Wu
- Willink Biochemical Genetics Laboratory, Manchester University NHS Foundation Trust, United Kingdom.
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11
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Kohli R, Ratziu V, Fiel MI, Waldmann E, Wilson DP, Balwani M. Initial assessment and ongoing monitoring of lysosomal acid lipase deficiency in children and adults: Consensus recommendations from an international collaborative working group. Mol Genet Metab 2020; 129:59-66. [PMID: 31767214 DOI: 10.1016/j.ymgme.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/21/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lysosomal acid lipase (LAL) deficiency is an ultra-rare, progressive, autosomal recessive disorder. Functional mutations in LIPA, the gene that encodes LAL, result in accumulation of cholesteryl esters and triglycerides in hepatocytes and in the macrophages of the intestines, vascular endothelial system, and numerous other organs. LAL deficiency has a broad clinical spectrum; children and adults can present with dyslipidemia, liver enzyme elevations, hepatosplenomegaly, hepatic steatosis, liver fibrosis and/or cirrhosis, and vascular disease, which may lead to significant morbidity and premature mortality in some patients. Given the systemic involvement and the wide range of healthcare specialists who manage patients with LAL deficiency, there is a need for guidelines to assess and monitor disease involvement. OBJECTIVES To provide a set of recommendations for the initial assessment and ongoing monitoring of patients with LAL deficiency to help physicians in various disciplines effectively manage the disease based on the observed presentation and progression in each case. METHODS A group of internationally recognized healthcare specialists with expertise in clinical genetics, pathology, hepatology, gastroenterology, cardiology, and lipidology convened to develop an evidence-based consensus of best practices for the initial assessment and ongoing monitoring of children and adults with LAL deficiency, regardless of treatment status; infants with LAL deficiency have been excluded from these guidelines because they require specialized care. RESULTS The authors present guidance for the assessment and monitoring of patients with LAL deficiency based on age and disease manifestations that include the hepatic, cardiovascular, and gastrointestinal systems. A schedule for ongoing monitoring of disease progression is provided. In addition, the need to establish an interdisciplinary and integrated care team to optimize the approach to managing this systemic disease is highlighted. CONCLUSIONS There is currently no published guidance on the assessment and monitoring of patients with LAL deficiency. These consensus recommendations for the initial assessment and ongoing monitoring of children and adults with LAL deficiency are intended to help improve the management of these patients.
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Affiliation(s)
- Rohit Kohli
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Vlad Ratziu
- Department of HepaGastroenterology, Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France
| | - Maria Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, NY, New York, USA
| | - Elisa Waldmann
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Don P Wilson
- Division of Pediatric Endocrinology & Diabetes, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Manisha Balwani
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai Hospital, NY, New York, USA.
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12
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Abstract
BACKGROUND Lysosomal acid lipase deficiency (LAL-D), also known as cholesteryl ester storage disease or Wolman disease, is a multi-systemic autosomal recessive genetic disorder caused by mutations in the lysosomal acid lipase gene (LIPA). CASE A 14-year-old female patient was diagnosed as LAL-D with the findings of hepatomegaly, splenomegaly, elevated liver enzyme levels, and abnormal lipid profile. Her sister had similar laboratory and ultrasonographic findings. Both siblings had a homozygous c.894 G > A mutation in the LIPA gene, and their parents were heterozygous for this mutation. CONCLUSIONS This case is one of the similar reports in the literature regarding clinical, biochemical, and genetic findings. It is well-known that LAL-D has overlapping clinical manifestations, and early diagnosis is quite challenging. Therefore, most patients die in the first year of life. After the determination of novel mutations in LAL-D patients, it is thought that LAL-D can present with heterogeneous signs and symptoms.
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Affiliation(s)
- Berrak Bilginer Gürbüz
- Divisions of Pediatric Metabolism, Adana City Education and Training Hospital, Adana, Turkey
| | - İlker Güney
- Divisions ofMedical Genetics, Adana City Education and Training Hospital, Adana, Turkey
| | - Fatma Derya Bulut
- Divisions of Pediatric Metabolism, Adana City Education and Training Hospital, Adana, Turkey
| | - Okan Dilek
- Divisions of Radiology, Adana City Education and Training Hospital, Adana, Turkey
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13
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Cohen JL, Burfield J, Valdez-Gonzalez K, Samuels A, Stefanatos AK, Yudkoff M, Pedro H, Ficicioglu C. Early diagnosis of infantile-onset lysosomal acid lipase deficiency in the advent of available enzyme replacement therapy. Orphanet J Rare Dis 2019; 14:198. [PMID: 31412917 PMCID: PMC6692931 DOI: 10.1186/s13023-019-1129-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/12/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lysosomal acid lipase deficiency (LAL-D) is an autosomal recessive disorder that can present as a severe, infantile form also known as Wolman disease. We sought to determine the outcomes and clinical needs of infants diagnosed with LAL-D, treated with enzyme replacement therapy (ERT). METHODS A chart review was conducted on two infantile-onset LAL-D patients to determine clinical outcomes based on laboratory results, abdominal imaging, growth and dietary records, cardiology, endocrinology, ophthalmology, hematology, and neurocognitive evaluations. RESULTS Two patients, both diagnosed and treated before 6 months old, demonstrated clinical improvement following weekly ERT. They required dosage increases to optimize growth and symptomatology. Both received a formula low in long chain triglycerides and high in medium chain triglycerides, an intervention that allowed significant catch-up growth. Patient 1 required treatment for partial adrenal insufficiency and hypothyroidism. Both patients demonstrated reduction in liver and spleen size and varying degrees of improved liver function. Neither experienced serious adverse reactions to ERT. CONCLUSION ERT has led to longer and healthier survival of affected infants. It is imperative that dietary interventions and systemic clinical care become integral to the management. Continued evidence of survival and clinical improvement in this population, coupled with available mass spectrometry enzyme assay from dried blood spots, raises the question of this rare and possibly underdiagnosed disorder's candidacy for newborn screening.
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Affiliation(s)
- Jennifer L. Cohen
- Division of Human Genetics, Department of Pediatrics, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Jessica Burfield
- Division of Human Genetics, Department of Pediatrics, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | | | - Angela Samuels
- Hackensack University Medical Center, 30 Prospect Ave, Hackensack, NJ 07601 USA
| | - Arianna K. Stefanatos
- Division of Human Genetics, Department of Pediatrics, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Marc Yudkoff
- Division of Human Genetics, Department of Pediatrics, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Helio Pedro
- Hackensack University Medical Center, 30 Prospect Ave, Hackensack, NJ 07601 USA
| | - Can Ficicioglu
- Division of Human Genetics, Department of Pediatrics, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
- Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
- Division of Metabolism (Biochemical Genetics), The Children’s Hospital of Philadelphia, 3501 Civic center Blvd #9054, Philadelphia, PA 19104 USA
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Cebolla JJ, Irún P, Mozas P, Giraldo P. Evaluation of two approaches to lysosomal acid lipase deficiency patient identification: An observational retrospective study. Atherosclerosis 2019; 285:49-54. [PMID: 31004967 DOI: 10.1016/j.atherosclerosis.2019.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Lysosomal acid lipase deficiency (LALD) leads to the accumulation of cholesteryl esters and/or triglycerides (TG) in lysosomes due to the lack of the enzyme codified by the LIPA gene. The most common symptoms are dyslipidaemia and hypertransaminasemia, together with manifestations common to other lysosomal storage disorders (LSDs), including visceromegalies and elevated plasma biomarkers. Alteration of the lipid-liver profile (LLP) has been widely applied as a criterion for LALD screening, but the usefulness of biomarkers has not yet been explored. Our purpose was to explore the utility of plasma chitotriosidase activity (ChT) and CCL18/PARC concentration in addition to LLP to identify LALD patients in an observational retrospective study of two different sample collections. METHODS Biological samples refining: Collection 1 (primary hypercholesterolemia suspected) included unrelated individuals with hyperlipidaemia and without LDLR, APOB and PCSK9 gene mutations (Set 1), and Collection 2 (LSD suspected) included individuals without definitive LSD diagnosis (Set 2). We assessed plasma LLP (total cholesterol and its fractions, TG concentration and transaminases activities), as well as plasma ChT and CCL18/PARC. All subjects with anomalous LLP and/or biomarker levels were LIPA sequenced. RESULTS Twenty-four subjects showed altered LLP and/or biomarkers. We identified two LALD patients (one homozygous and one compound heterozygous) and one carrier of a novel LIPA variant. CONCLUSIONS The measurement of plasma ChT and CCL18/PARC combined with LLP will be a useful approach to identifying LALD patients in retrospective LALD patient studies.
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Affiliation(s)
- Jorge J Cebolla
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), GIIS-012, Zaragoza, 50009, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), CB/06/07/1036, Instituto de Salud Carlos III (ISCIII), Hospital Universitario Miguel Servet, Zaragoza, 50009, Spain; Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, 50008, Spain; Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, 50009, Spain.
| | - Pilar Irún
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), CB/06/07/1036, Instituto de Salud Carlos III (ISCIII), Hospital Universitario Miguel Servet, Zaragoza, 50009, Spain
| | - Pilar Mozas
- Departamento de Bioquímica, Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, 50009, Spain
| | - Pilar Giraldo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), GIIS-012, Zaragoza, 50009, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), CB/06/07/1036, Instituto de Salud Carlos III (ISCIII), Hospital Universitario Miguel Servet, Zaragoza, 50009, Spain; Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y Otras Lisosomales (FEETEG), Zaragoza, 50008, Spain
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15
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Cappuccio G, Donti TR, Hubert L, Sun Q, Elsea SH. Opening a window on lysosomal acid lipase deficiency: Biochemical, molecular, and epidemiological insights. J Inherit Metab Dis 2019; 42:509-518. [PMID: 30684275 PMCID: PMC8564860 DOI: 10.1002/jimd.12057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 07/31/2018] [Accepted: 12/11/2018] [Indexed: 11/08/2022]
Abstract
Lysosomal acid lipase deficiency (LAL-D) is a multi-organ autosomal recessive disease caused by mutations in LIPA. We reviewed data from 681 samples (white blood cells [WBC] n = 625, fibroblasts = 30, liver = 4, amniocytes = 13, chorionic villus = 9) received for analysis of lysosomal acid lipase (LAL) activity over a 15-year period. LIPA sequencing was performed in 49 patients with reduced (n = 26) or deficient (n = 23) LAL activity. The Exome Aggregation Consortium and Genome Aggregation Database dataset were used for LAL-D prevalence calculations. LAL WBC activity was reduced in 67 patients (10.72%) and deficient in 37 (5.92%). The average of LAL activity ± margin of error (CI 95%) was 19.32 ± 0.86 pmol/min/mg for reduced activity patients and 5.90 ± 1.42 pmol/min/mg for deficient patients. The average age at diagnosis for LAL-D was 23.6 years with several patients older than age 30. The correlation between the age at diagnosis and LAL activity showed a significant moderate direct correlation (Pearson's r = 0.46, P < 0.005). Homozygous or compound heterozygous mutations were identified in 9 out of 23 patients with deficient results (detection rate 39.1%). The average LAL activity in molecularly confirmed patients was 4.02 ± 2.02 pmol/min/mg protein, while in molecularly negative patients was 13.886 ± 1.49 pmol/min/mg (P < 0.0001). Twenty-two different mutations were identified including two novel variants (c.309C>A and c.856G>C). A carrier frequency of approximately 1 in 350 was inferred. LAL activity in WBC is a validated tool for LAL-D diagnosis. Higher residual enzymatic activity might result in a milder phenotype leading to diagnosis delay. A cut-off below 12 pmol/min/mg protein might be useful to discriminate patients with LIPA mutations.
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Affiliation(s)
- Gerarda Cappuccio
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Taraka R. Donti
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Leroy Hubert
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Qin Sun
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Sarah H. Elsea
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
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Kuloglu Z, Kansu A, Selbuz S, Kalaycı AG, Şahin G, Kirsaclioglu CT, Demirören K, Dalgıç B, Kasırga E, Önal Z, İşlek A. The Frequency of Lysosomal Acid Lipase Deficiency in Children With Unexplained Liver Disease. J Pediatr Gastroenterol Nutr 2019; 68:371-376. [PMID: 30540705 DOI: 10.1097/mpg.0000000000002224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Evidence suggests that lysosomal acid lipase deficiency (LAL-D) is often underdiagnosed because symptoms may be nonspecific. We aimed to investigate the prevalence of LAL-D in children with unexplained liver disease and to identify demographic and clinical features with a prospective, multicenter, cross-sectional study. METHODS Patients (aged 3 months-18 years) who had unexplained transaminase elevation, unexplained hepatomegaly or hepatosplenomegaly, obesity-unrelated liver steatosis, biopsy-proven cryptogenic fibrosis and cirrhosis, or liver transplantation for cryptogenic cirrhosis were enrolled. A Web-based electronic data collection system was used. LAL activity (nmol/punch/h) was measured using the dried blood spot method and classified as LAL-D (<0.02), intermediate (0.02-0.37) or normal (> 0.37). A second dried blood spot sample was obtained from patients with intermediate LAL activity for confirmation of the result. RESULTS A total of 810 children (median age 5.6 years) from 795 families were enrolled. The reasons for enrollment were unexplained transaminase elevation (62%), unexplained organomegaly (45%), obesity-unrelated liver steatosis (26%), cryptogenic fibrosis and cirrhosis (6%), and liver transplantation for cryptogenic cirrhosis (<1%). LAL activity was normal in 634 (78%) and intermediate in 174 (21%) patients. LAL-D was identified in 2 siblings aged 15 and 6 years born to unrelated parents. Dyslipidemia, liver steatosis, and mild increase in aminotransferases were common features in these patients. Moreover, the 15-year-old patient showed growth failure and microvesicular steatosis, portal inflammation, and bridging fibrosis in the liver biopsy. Based on 795 families, 2 siblings in the same family were identified as LAL-D cases, making the prevalence of LAL-D in this study population, 0.1% (0.125%-0.606%). In the repeated measurement (76/174), LAL activity remained at the intermediate level in 38 patients. CONCLUSIONS Overall, the frequency of LAL-D patients in this study (0.1%) suggests that LAL-D seems to be rare even in the selected high-risk population.
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Affiliation(s)
- Zarife Kuloglu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara
| | - Suna Selbuz
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara
| | - Ayhan G Kalaycı
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University, School of Medicine, Samsun
| | - Gülseren Şahin
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Dr. Sami Ulus Children's Hospital, Ankara
| | - Ceyda Tuna Kirsaclioglu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Turkish Republic Health Ministry, Ankara Child Health Diseases, Haematology Oncology Training and Research Hospital, Ankara
| | - Kaan Demirören
- Department of of Pediatric Gastroenterology, Hepatology and Nutrition, Yuzuncu Yıl University, Faculty of Medicine, Van
| | - Buket Dalgıç
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Gazi University University, Faculty of Medicine, Ankara
| | - Erhun Kasırga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Celal Bayar University Faculty of Medicine, Manisa
| | - Zerrin Önal
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Medical Sciences, Bakırkoy Dr Sadi Konuk Research and Training Center, İstanbul
| | - Ali İşlek
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Atatürk University, Faculty of Medicine, Erzurum, Turkey
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17
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Carter A, Brackley SM, Gao J, Mann JP. The global prevalence and genetic spectrum of lysosomal acid lipase deficiency: A rare condition that mimics NAFLD. J Hepatol 2019; 70:142-150. [PMID: 30315827 DOI: 10.1016/j.jhep.2018.09.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Lysosomal acid lipase deficiency (LAL-D) is an autosomal recessive condition that may present in a mild form (cholesteryl ester storage disease [CESD]), which mimics non-alcoholic fatty liver disease (NAFLD). It has been suggested that CESD may affect 1 in 40,000 and is under-diagnosed in NAFLD clinics. Therefore, we aimed to estimate the prevalence of LAL-D using analysis of genetic variation in LIPA. METHODS MEDLINE and EMBASE were systematically searched for previously reported disease variants and prevalence estimates. Previous prevalence estimates were meta-analysed. Disease variants in LIPA were annotated with allele frequencies from gnomAD and combined with unreported major functional variants found in humans. Pooled ethnicity-specific prevalences for LAL-D and CESD were calculated using the Hardy-Weinberg equation. RESULTS Meta-analysis of existing genetic studies estimated the prevalence of LAL-D as 1 per 160,000 (95% CI 1 per 65,025-761,652) using the allele frequency of c.894G>A in LIPA. A total of 98 previously reported disease variants in LIPA were identified, of which 32/98 were present in gnomAD, giving a prevalence of 1 per 307,482 (95% CI 257,672-366,865). Wolman disease was associated with more loss-of-function variants than CESD. When this was combined with 22 previously unreported major functional variants in LIPA identified in humans, the pooled prevalence of LAL-D was 1 per 177,452 (95% CI 149,467-210,683) with a carrier frequency of 1 per 421. The prevalence is lowest in those of East Asian, South Asian, and Finnish ancestry. CONCLUSION Using 120 disease variants in LIPA, these data can reassure clinicians that LAL-D is an ultra-rare disorder. Given the therapeutic capability of sebelipase alpha, investigation for LAL-D might be included in second-line metabolic screening in NAFLD. LAY SUMMARY Lysosomal Acid Lipase Deficiency (LAL-D) is a rare genetic condition that can cause severe liver disease, but it is difficult to diagnose and sometimes can look like simple fatty liver. It was not clear how common LAL-D was and whether many cases were being missed. To study this, we searched for all genetic mutations that could cause LAL-D, calculated how common those mutations were, and added them up. This let us estimate that LAL-D affects roughly 1 in 175,000 people. We conclude that LAL-D is a very rare condition, but it is treatable so may be included in a 'second-line' of tests for causes of fatty liver.
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Affiliation(s)
- Anna Carter
- Manchester University Foundation Trust, Manchester, United Kingdom
| | - Simon Mark Brackley
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - Jiali Gao
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - Jake Peter Mann
- University of Cambridge, Department of Paediatrics, Cambridge, United Kingdom; University of Cambridge, Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, United Kingdom.
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Gómez-Duarte C, García V, Botero V, Aristizabal A, Echeverri G, Pachajoa H. Deficiencia de lipasa ácida lisosomal, una patología infrecuente. GAC MED MEX 2019; 155:291-297. [PMID: 31219466 DOI: 10.24875/gmm.18004024] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 07/18/2018] [Indexed: 11/17/2022] Open
Abstract
Lysosomal acid lipase deficiency is a genetic disease with a low prevalence and high morbidity and mortality in children and adults. It is characterized by an alteration of lipid metabolism, which generates cholesterol and triglyceride esters deposits in the body. Its clinical presentation depends on enzymatic activity. This condition should be suspected in patients with lipid or liver alterations after ruling out other diagnoses. Currently, there is the option of using a recombinant enzyme, which can improve lipid and liver parameters, as well as disease progression. Establishing a timely diagnosis in order to initiate specific treatment early is imperative for the prevention of morbidity and mortality. The purpose of this work is to perform a review of the literature about lysosomal acid lipase deficiency and to guide about its pathophysiology, clinical manifestations, diagnosis and treatment.
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19
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Cunha-Silva M, Mazo DFC, Corrêa BR, Lopes TM, Arrelaro RC, Ferreira GL, Rabello MI, Sevá-Pereira T, Escanhoela CAF, Almeida JRS. Lysosomal Acid Lipase Deficiency Leading to Liver Cirrhosis: a Case Report of a Rare Variant Mutation. Ann Hepatol 2019; 18:230-235. [PMID: 31113597 DOI: 10.5604/01.3001.0012.7930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/22/2017] [Indexed: 02/04/2023]
Abstract
Lysosomal acid lipase deficiency is a poorly diagnosed genetic disorder, leading to accumulation of cholesterol esters and triglycerides in the liver, with progression to chronic liver disease, dyslipidemia, and cardiovascular complications. Lack of awareness on diagnosis of this condition may hamper specific treatment, which consists on enzymatic replacement. It may prevent the progression of liver disease and its complications. We describe the case of a 53-year-old Brazilian man who was referred to our center due to the diagnosis of liver cirrhosis of unknown etiology. He was asymptomatic and had normal body mass index. He had dyslipidemia, and family history of myocardial infarction and stroke. Abdominal imaging tests showed liver cirrhosis features and the presence of intrahepatic calcifications. Initial investigation of the etiology of the liver disease was not elucidated, but liver biopsy showed microgoticular steatosis and cholesterol esters deposits in Kuppfer cells. The dosage of serum lysosomal acid lipase was undetectable and we found the presence of a rare homozygous mutation in the gene associated with the lysosomal acid lipase deficiency, (allele c.386A > G homozygous p.H129R).
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Affiliation(s)
- Marlone Cunha-Silva
- Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.
| | - Daniel F C Mazo
- Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil; Department of Gastroenterology, University of Sao Paulo School of Medicine (FMUSP), Sao Paulo, Brazil
| | - Bárbara R Corrêa
- Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Tirzah M Lopes
- Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Raquel C Arrelaro
- Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Gabriel L Ferreira
- Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marcello I Rabello
- Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Tiago Sevá-Pereira
- Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Cecilia A F Escanhoela
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Jazon R S Almeida
- Department of Gastroenterology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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20
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Draijer LG, Bosch AM, Wiegman A, Sjouke B, Benninga MA, Koot BGP. Screening for lysosomal acid lipase deficiency: A retrospective data mining study and evaluation of screening criteria. Atherosclerosis 2018; 278:174-179. [PMID: 30286343 DOI: 10.1016/j.atherosclerosis.2018.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Lysosomal acid lipase deficiency (LAL-D) is a lysosomal storage disorder. In severe cases, it can cause life-threatening organ failure due to lipid substrates accumulation. However, mild phenotypes of this disorder are increasingly recognized. The aim of this study is to determine the number of missed LAL-D patients in a large pediatric hospital population. METHODS In a retrospective data mining study, the medical files of children, who visited the outpatient clinic at a university hospital between 2000 and 2016, with high plasma low density lipoprotein cholesterol (LDL-C) levels, were evaluated. Previously developed LAL-D screening criteria, with lipid and alanine aminotransferase (ALT) values adjusted for children, were used to analyze which children are suspect for LAL-D. For suspicion of LAL-D, at least 3 out of 5 screening criteria had to be met. Subsequently data on presentation and follow-up were collected to determine if the clinical picture was compatible with LAL-D. RESULTS We identified 2037 children with high LDL-C levels. Of those, 36 children complied with ≥3 screening criteria. Thirty-one of those had an underlying disorder other than LAL-D that explained the abnormalities and, in the 5 remaining children, ALT and lipid levels normalized spontaneously, thus excluding LAL-D. CONCLUSIONS This study shows that retrospective data mining is unlikely to yield a significant number of LAL-D cases in children. The screening algorithm adjusted for children seems useful and accurate in the selection of children for further testing, suggesting it can be applied prospectively, although further validation is warranted.
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Affiliation(s)
- Laura G Draijer
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, the Netherlands.
| | - Annet M Bosch
- Department of Pediatrics, Division of Metabolic Disorders, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, the Netherlands
| | - Albert Wiegman
- Department of Pediatrics, Division of Metabolic Disorders, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, the Netherlands
| | - Barbara Sjouke
- Department of Internal Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, the Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, the Netherlands
| | - Bart G P Koot
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, the Netherlands
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21
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Abstract
BACKGROUND We describe the differential diagnosis of an obese 12-year-old boy of Mexican origin who presented with a 6-year history of abnormal lipid profile and elevated liver transaminase levels. METHODS The patient underwent routine clinical testing, an abdominal ultrasound and, ultimately, a liver biopsy. Based on the histologic findings, a serum leukocyte lysosomal acid lipase (LAL) assay and DNA sequencing of the lipase A (LIPA) gene were performed. RESULTS Liver biopsy revealed diffuse microvesicular steatosis with clusters of foamy histiocytes in the lobules and portal areas. Our differential diagnosis included nonalcoholic fatty liver disease; medication-induced hepatotoxicity; glycogenic hepatopathy; medium-chain acyl coenzyme A dehydrogenase or long-chain acyl coenzyme A dehydrogenase deficiency; and lysosomal storage disorders, including Niemann-Pick disease and lysosomal acid lipase deficiency (LAL-D). Serum LAL activity was absent, and DNA sequencing confirmed homozygous mutation in LIPA. CONCLUSIONS Although it occurs rarely, LAL-D should be considered in the differential diagnosis of microvesicular steatosis for a timely diagnosis.
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Affiliation(s)
- Ashwin S Akki
- Department of Pathology, Montefiore Medical Center, Bronx, NY
| | - Sun M Chung
- Department of Pathology, Montefiore Medical Center, Bronx, NY
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22
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Reynolds TM, Mewies C, Hamilton J, Wierzbicki AS. Identification of rare diseases by screening a population selected on the basis of routine pathology results-the PATHFINDER project: lysosomal acid lipase/cholesteryl ester storage disease substudy. J Clin Pathol 2018; 71:608-613. [PMID: 29358478 DOI: 10.1136/jclinpath-2017-204727] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/09/2017] [Revised: 11/27/2017] [Accepted: 12/13/2017] [Indexed: 01/04/2023]
Abstract
AIMS Lysosomal acid lipase deficiency (LALD) is an autosomal recessive disorder of cholesterol ester storage associated with hepatic disease, cirrhosis and accelerated atherosclerosis. Its prevalence in the general population, patients with dyslipidaemia and raised transaminases is unclear. This study attempted to identify the prevalence of LALD from patients with abnormal results in laboratory databases. METHODS Electronic laboratory databases were interrogated to identify from clinical biochemistry records patients with a phenotype of low high-density lipoprotein-cholesterol (≤0.85 mmol/L; 33 mg/dL) and with elevated alanine or aspartate transaminases (≥60 IU/L) on one occasion or more over a 3-year time interval. Patients were recalled, and a dried blood spot sample was collected for lysosomal acid lipase determination by a fluorimetric enzyme assay. Histopathology databases of liver biopsies were interrogated for patients with features of 'microvesicular cirrhosis' or 'cryptogenic cirrhosis' in the report. Histological blocks were sampled, and samples were analysed by next-generation sequencing for the presence of mutations in the LAL gene. RESULTS Samples were obtained from 1825 patients with dyslipidaemia and elevated transaminases. No cases of LALD were identified. Liver biopsies were obtained from six patients. DNA extraction was successful from four patients. Two patients were homozygous for the LAL c.46A>C;p.Thr16Pro unclassified variant in exon 2. CONCLUSIONS Pathology databases hold routine information that can be used to identify patients with specific patterns of results or those who had biopsies to allow targeted testing for possible causes of disease. Biochemical screening suggests that the gene frequency of LAL deficiency in adults is less than 1 in 100.
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Affiliation(s)
- Timothy M Reynolds
- Department of Chemical Pathology, Queen's Hospital, Burton, UK
- Division of Health Sciences, Wolverhampton University, Wolverhampton, UK
| | - Clare Mewies
- Department of Chemical Pathology, Queen's Hospital, Burton, UK
| | - John Hamilton
- Biochemistry Department, Queen Elizabeth University Hospital Laboratory, Glasgow, UK
| | - Anthony S Wierzbicki
- Department of Metabolic Medicine/Chemical Pathology, Guy's & St Thomas' Hospitals, London, UK
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Affiliation(s)
- Irit Krause
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Hila Gavrieli
- Ben Gurion University of the Negev, Beer-Sheva, Israel
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24
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Botero V, Garcia VH, Gomez-Duarte C, Aristizabal AM, Arrunategui AM, Echeverri GJ, Pachajoa H. Lysosomal Acid Lipase Deficiency, a Rare Pathology: The First Pediatric Patient Reported in Colombia. Am J Case Rep 2018; 19:669-672. [PMID: 29884776 PMCID: PMC6024709 DOI: 10.12659/ajcr.908808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/03/2018] [Accepted: 03/07/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lysosomal acid lipase deficiency is a rare genetic metabolic lipid storage disease, with a high morbidity, and mortality, in children and adults. It is characterized by a mutation in the LIPA gene that causes an alteration of lipid metabolism, resulting in deposits of cholesterol esters and triglycerides in organs such as the liver, blood vessels, and gastrointestinal tract. Lysosomal acid lipase deficiency is predominantly caused by the mutation c.894G>A, seen in approximately 50-70% of patients. Our objective is to report the first pediatric case of lysosomal acid lipase deficiency in a pediatric patient in Colombia. CASE REPORT The patient is a 14-year-old boy with isolated hepatomegaly since 6 years of age without a family history of dyslipidemia. In the pediatric control, laboratory exams revealed dyslipidemia, and a hepatic biopsy was performed, revealing severe fibrosis with septation and grade 3 microvesicular steatosis (>75%). He was referred to our center and was suspected to have lysosomal acid lipase deficiency. Enzymatic activity was measured, showing absent activity. Confirmatory diagnosis with genetic sequencing showed a pathological homozygous mutation of c.894G>A. CONCLUSIONS Lysosomal acid lipase deficiency can manifest as early- or late-onset, with variable and severe signs and symptoms. The late-onset form has a broad spectrum of manifestations with mild symptoms, leading to under-diagnosis, which increases the actual disease burden. Early diagnosis is essential to initiate enzyme replacement therapy, since the natural disease course can be changed. More studies should be conducted in Latin America to evaluate the prevalence of the disease.
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Affiliation(s)
- Verónica Botero
- Department of Pediatric Gastroenterology and Hepatology, Valle del Lili Foundation, Cali, Valle del Cauca, Colombia
| | - Victor H. Garcia
- Center for Research on Advanced Surgery and Transplants (CICAT), Icesi University, Cali, Valle del Cauca, Colombia
| | - Catalina Gomez-Duarte
- Center for Research on Advanced Surgery and Transplants (CICAT), Icesi University, Cali, Valle del Cauca, Colombia
| | - Ana M. Aristizabal
- Center for Research on Advanced Surgery and Transplants (CICAT), Icesi University, Cali, Valle del Cauca, Colombia
| | - Ana M. Arrunategui
- Department of Pathology, Valle del Lili Foundation, Cali, Valle del Cauca, Colombia
| | - Gabriel J. Echeverri
- Department of Transplant Surgery, Colombiana de Trasplantes, Barranquilla, Atlantico, Colombia
| | - Harry Pachajoa
- Department of Genetics, Valle del Lili Foundation, Cali, Valle del Cauca, Colombia
- Center for Research on Congenital Anomalies and Rare Diseases (CIACER), Icesi University, Cali, Valle del Cauca, Colombia
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Vázquez-Frias R, García-Ortiz JE, Valencia-Mayoral PF, Castro-Narro GE, Medina-Bravo PG, Santillán-Hernández Y, Flores-Calderón J, Mehta R, Arellano-Valdés CA, Carbajal-Rodríguez L, Navarrete-Martínez JI, Urbán-Reyes ML, Valadez-Reyes MT, Zárate-Mondragón F, Consuelo-Sánchez A. Mexican consensus on lysosomal acid lipase deficiency diagnosis. Rev Gastroenterol Mex (Engl Ed) 2018; 83:51-61. [PMID: 29287906 DOI: 10.1016/j.rgmx.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/20/2017] [Revised: 07/09/2017] [Accepted: 08/16/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Lysosomal acid lipase deficiency (LAL-D) causes progressive cholesteryl ester and triglyceride accumulation in the lysosomes of hepatocytes and monocyte-macrophage system cells, resulting in a systemic disease with various manifestations that may go unnoticed. It is indispensable to recognize the deficiency, which can present in patients at any age, so that specific treatment can be given. The aim of the present review was to offer a guide for physicians in understanding the fundamental diagnostic aspects of LAL-D, to successfully aid in its identification. METHODS The review was designed by a group of Mexican experts and is presented as an orienting algorithm for the pediatrician, internist, gastroenterologist, endocrinologist, geneticist, pathologist, radiologist, and other specialists that could come across this disease in their patients. An up-to-date review of the literature in relation to the clinical manifestations of LAL-D and its diagnosis was performed. The statements were formulated based on said review and were then voted upon. The structured quantitative method employed for reaching consensus was the nominal group technique. RESULTS A practical algorithm of the diagnostic process in LAL-D patients was proposed, based on clinical and laboratory data indicative of the disease and in accordance with the consensus established for each recommendation. CONCLUSION The algorithm provides a sequence of clinical actions from different studies for optimizing the diagnostic process of patients suspected of having LAL-D.
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Affiliation(s)
- R Vázquez-Frias
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, México
| | - J E García-Ortiz
- Centro de Investigación Biomédica de Occidente, CMNO-IMSS, Guadalajara, Jalisco, México
| | - P F Valencia-Mayoral
- Dirección de Planeación, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, México
| | - G E Castro-Narro
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - P G Medina-Bravo
- Departamento de Endocrinología, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, México
| | - Y Santillán-Hernández
- Departamento de Genética, Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México, México
| | - J Flores-Calderón
- Servicio de Gastroenterología, Hospital de Pediatría «Dr. Silvestre Frenk Freund», Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
| | - R Mehta
- Departamento de Endocrinología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | - L Carbajal-Rodríguez
- Departamento de Medicina Interna, Instituto Nacional de Pediatría, Ciudad de México, México
| | - J I Navarrete-Martínez
- Departamento de Genética, Hospital Central Sur de Alta Especialidad de Petróleos Mexicanos, Ciudad de México, México
| | - M L Urbán-Reyes
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, México
| | - M T Valadez-Reyes
- Departamento de Imagenología, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, México
| | - F Zárate-Mondragón
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Ciudad de México, México
| | - A Consuelo-Sánchez
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, México.
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Abstract
Genetic causes of liver disease lead to a wide range of presentations, from mildly abnormal liver tests to acute liver failure. This article discusses the indications for testing and what to test for hereditary hemochromatosis, progressive familial intrahepatic cholestasis, benign recurrent intrahepatic cholestasis, lysosomal acid lipase deficiency, Gilbert syndrome, alpha-1 antitrypsin deficiency, and Wilson disease.
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Affiliation(s)
- Emily A Schonfeld
- Transitions of Care, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Center for Liver Disease, 1305 York Avenue, 4th Floor, New York, NY 10021, USA
| | - Robert S Brown
- Transitions of Care, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, Center for Liver Disease, 1305 York Avenue, 4th Floor, New York, NY 10021, USA.
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Abstract
INTRODUCTION With the growing obesity epidemic, nonalcoholic fatty liver disease (NAFLD) is rapidly becoming one of the leading causes of liver disease worldwide. Although obesity is a main risk factor for the development of NAFLD, it can also develop in lean subjects and can be encountered in different clinical setting and in association with an array of genetic, metabolic, nutritional, infectious and drug-induced disorders. Areas covered: This article discusses causes of fatty liver in non-obese subjects focusing on Lysosomal acid lipase deficiency (LAL-D), a commonly overlooked disorder reviewing its prevalence, genetics, pathogenesis, clinical features, diagnosis and treatment. It will also review other causes of non-alcoholic fatty liver disease, which can be encountered in the absence of obesity and metabolic syndrome. Expert commentary: Although the prevalence of LAL-D has been estimated in the range of 1 in 40,000 and 1 in 300,000, this estimate is much more than the identified cases reported in the literature, which suggests that that the disease may be considerably under-diagnosed. There is a pressing need to educate clinicians about the disease, especially with the development of new promising therapeutic modalities.
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Affiliation(s)
- Hassan H A-Kader
- a Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics , The University of Arizona , Tucson , AZ , USA
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Pisciotta L, Tozzi G, Travaglini L, Taurisano R, Lucchi T, Indolfi G, Papadia F, Di Rocco M, D'Antiga L, Crock P, Vora K, Nightingale S, Michelakakis H, Garoufi A, Lykopoulou L, Bertolini S, Calandra S. Molecular and clinical characterization of a series of patients with childhood-onset lysosomal acid lipase deficiency. Retrospective investigations, follow-up and detection of two novel LIPA pathogenic variants. Atherosclerosis 2017; 265:124-132. [PMID: 28881270 DOI: 10.1016/j.atherosclerosis.2017.08.021] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/05/2017] [Accepted: 08/22/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Childhood/Adult-onset Lysosomal Acid Lipase Deficiency (LAL-D) is a recessive disorder due to loss of function variants of LAL, the enzyme which hydrolyses cholesteryl esters, derived from internalized apoB containing lipoproteins. The disease is characterized by multi-organ involvement including the liver, spleen, intestine and cardiovascular system. The aim of this study was the clinical and molecular characterization of 14 (13 unrelated) previously unreported patients with childhood-onset LAL-D. METHODS Data collected included clinical and laboratory investigations, liver imaging, liver biopsy and LIPA gene analysis. The response to lipid-lowering medications, liver transplantation and enzyme replacement therapy (ERT) was reported for some patients. RESULTS LAL-D was suspected at 4.4 ± 3.3 years of age for the presence of hepatomegaly, elevated serum transaminases and hypercholesterolemia, and was confirmed by liver biopsy/imaging and LAL assay. The follow up period ranged from 3 to 40 years (mean 7.8 ± 4.0 years in 13 cases). Patients treated with statins with or without ezetimibe showed 28% reduction of plasma LDL-cholesterol without a tangible effect on liver enzymes; some patients receiving ERT showed normalized lipoprotein profile and transaminase levels. The common c.894G > A variant was observed in homozygosity or compound heterozygosity in 10 patients. We found seven previously reported variants: p.(Trp140*), p.(Arg218*), p.(Gly266*), p.(Thr288Ile), p.(Leu294Ser), p.(His295Tyr) and p.(Gly342Arg) and two novel variants: p.(Asp345Asn), affecting the LAL catalytic triad, and c.229+3A > C, affecting splicing. Homozygosity for p.(Thr288Ile) or c.229+3A > C was associated with a severe phenotype. CONCLUSIONS This study provides additional data on the features of childhood-onset LAL-D and describes two novel pathogenic variants of the LIPA gene.
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Affiliation(s)
| | - Giulia Tozzi
- Laboratory of Molecular Medicine, Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lorena Travaglini
- Laboratory of Molecular Medicine, Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roberta Taurisano
- Metabolism Division, Department of Pediatrics Specialist, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Tiziano Lucchi
- Department of Internal Medicine and Medical Specialities, IRCSS Ca' Granda, Milan, Italy
| | - Giuseppe Indolfi
- Paediatric and Liver Unit, Meyer Children's University-Hospital, Florence, Italy
| | - Francesco Papadia
- University Pediatric Hospital Giovanni XXIII, O.U. Metabolic and Genetic Diseases, Bari, Italy
| | - Maja Di Rocco
- IRCCS Institute Giannina Gaslini, Department of Pediatrics, Unit of Rare Diseases, Genoa, Italy
| | - Lorenzo D'Antiga
- Pediatric Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Patricia Crock
- John Hunter Children Hospital, Discipline of Paediatrics and Child Health, University of Newcastle, Newcastle, Australia
| | - Komal Vora
- John Hunter Children Hospital, Discipline of Paediatrics and Child Health, University of Newcastle, Newcastle, Australia
| | - Scott Nightingale
- John Hunter Children Hospital, Discipline of Paediatrics and Child Health, University of Newcastle, Newcastle, Australia
| | - Helen Michelakakis
- Department of Enzymology and Cellular Function, Institute of Child Health, Athens, Greece
| | - Anastasia Garoufi
- 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Lilia Lykopoulou
- 1st Department of Pediatrics, University of Athens, Aghia Sofia Children's Hospital, Athens, Greece
| | | | - Sebastiano Calandra
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy.
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Pericleous M, Kelly C, Wang T, Livingstone C, Ala A. Wolman's disease and cholesteryl ester storage disorder: the phenotypic spectrum of lysosomal acid lipase deficiency. Lancet Gastroenterol Hepatol 2017; 2:670-679. [PMID: 28786388 DOI: 10.1016/s2468-1253(17)30052-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 02/07/2023]
Abstract
Lysosomal acid lipase deficiency is a rare, autosomal recessive condition caused by mutations in the gene encoding lysosomal acid lipase (LIPA) that result in reduced or absent activity of this essential enzyme. The severity of the resulting disease depends on the nature of the underlying mutation and magnitude of its effect on enzymatic function. Wolman's disease is a severe disorder that presents during infancy, resulting in failure to thrive, hepatomegaly, and hepatic failure, and an average life expectancy of less than 4 months. Cholesteryl ester storage disorder arises later in life and is less severe, although the two diseases share many common features, including dyslipidaemia and transaminitis. The prevalence of these diseases has been estimated at one in 40 000 to 300 000, but many cases are undiagnosed and unreported, and awareness among clinicians is low. Lysosomal acid lipase deficiency-which can be diagnosed using dry blood spot testing-is often misdiagnosed as non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), hereditary dyslipidaemia, or cryptogenic cirrhosis. There are no formal guidelines for treatment of these patients, and treatment options are limited. In this Review we appraise the existing literature on Wolman's disease and cholesteryl ester storage disease, and discuss available treatments, including enzyme replacement therapy, oral lipid-lowering therapy, stem-cell transplantation, and liver transplantation.
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Affiliation(s)
- Marinos Pericleous
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Claire Kelly
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Tim Wang
- Department of Clinical Biochemistry, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; School of Biosciences and Medicine, University of Surrey, Guildford, Surrey, UK
| | - Callum Livingstone
- Department of Clinical Biochemistry, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; School of Biosciences and Medicine, University of Surrey, Guildford, Surrey, UK
| | - Aftab Ala
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK.
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Wierzbicka-Rucińska A, Jańczyk W, Ługowska A, Lebensztejn D, Socha P. Diagnostic and therapeutic management of children with lysosomal acid lipase deficiency (LAL-D). Review of the literature and own experience. Dev Period Med 2017; 20:212-215. [PMID: 27941191] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Lysosomal acid lipase deficiency may present at any age (in infants, children and adults). Its presenting features commonly include elevated serum transaminase activity levels, hypercholesterolemia, fatty liver, progressive liver fibrosis, and cirrhosis. Nonspecific clinical manifestations can lead to a delay in the diagnosis of both children and adults. The early development of fibrosis and cirrhosis suggests that the lysosomal accumulation of cholesterol esters and triglycerides in the liver is a potent inducer of fibrosis. Elevated levels of low-density lipoprotein-cholesterol or low levels of high-density lipoprotein-cholesterol with elevated transaminase activity should raise the suspicion of lysosomal acid lipase deficiency in the diagnostic workup. Still, some patients may not present with abnormal triglyceride and cholesterol concentrations. Early onset LAL-D has a different clinical presentation, with acute symptoms, including liver failure, and can be confused with many other metabolic conditions or with lymphohistiocytosis. The dried blood spot test enables rapid diagnosis and should be widely applied when the cause of liver disease remains unknown.
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Affiliation(s)
| | - Wojciech Jańczyk
- Gastroenterology, Hepatology and Eating Disorders, Children's Health Memorial Institute, Warsaw, Poland
| | - Agnieszka Ługowska
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Dariusz Lebensztejn
- Department of Pediatrics, Gastroenterology and Allergology, Medical University of Bialystok, Poland
| | - Piotr Socha
- Gastroenterology, Hepatology and Eating Disorders, Children's Health Memorial Institute, Warsaw, Poland
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Bay L, Canero Velasco C, Ciocca M, Cotti A, Cuarterolo M, Fainboim A, Fassio E, Galoppo M, Pinero F, Rozenfeld P. Liver disease and dyslipidemia as a manifestation of lysosomal acid lipase deficiency (LAL-D). Clinical and diagnostic aspects, and a new treatment. An update. ARCH ARGENT PEDIATR 2017; 115:287-293. [PMID: 28504497 DOI: 10.5546/aap.2017.eng.287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 08/22/2016] [Accepted: 11/28/2016] [Indexed: 12/20/2022]
Abstract
Lysosomal acid lipase deficiency (LAL-D) is still a little recognized genetic disease with significant morbidity and mortality in children and adults. This document provides guidance on when to suspect LAL-D and how to diagnose it. It is recommended to add lysosomal acid lipase deficiency to the List of differential diagnoses of sepsis, oncological diseases, storage diseases, persistent diarrhea, chronic malnutrition, and hemophagocytic lymphohistiocytosis. It should also be considered in young patients with dyslipidemia and atherosclerosis as well as diseases associated with fatty liver and/or hepatomegaly. LAL-D should be suspected in patients with hepatomegaly, hyperlipidemia and /or elevated transaminases found during routine checks or testing for other conditions, and in patients with cryptogenic cirrhosis. At present, there is the option of a specific enzyme replacement treatment.
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Affiliation(s)
- Luisa Bay
- Consultora, Hospital Nacional de Pediatría J. P. Garrahan, Ciudad Autónoma de Buenos Aires.
| | - Cristina Canero Velasco
- Sección Hepatología Infantil, Hospital Municipal de Niños de San Justo, Provincia de Buenos Aires
| | - Mirta Ciocca
- Hepatología y Trasplante Hepático Pediátrico, Hospital Alemán, Ciudad Autónoma de Buenos Aires
| | - Andrea Cotti
- Sección Nutrición Infantil, Hospital Universitario Austral, Pilar, Provincia de Buenos Aires
| | - Miriam Cuarterolo
- Hepatología, Hospital de Pediatría J. P. Garrahan, Ciudad Autónoma de Buenos Aires
| | - Alejandro Fainboim
- Hospital de Día Polivalente, Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires
| | - Eduardo Fassio
- Sección Hígado, Vías Biliares y Páncreas, Hospital Nacional Prof. Alejandro Posadas, El Palomar, Provincia de Buenos Aires
| | - Marcela Galoppo
- Unidad 4, Hepatología, Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires
| | - Federico Pinero
- Hepatología y Trasplante Hepático, Unidad de Hígado, Hospital Universitario Austral, Pilar, Provincia de Buenos Aires
| | - Paula Rozenfeld
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), Departamento de Ciencias Biológicas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), La Plata, Provincia de Buenos Aires
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Camarena C, Aldamiz-Echevarria LJ, Polo B, Barba Romero MA, García I, Cebolla JJ, Ros E. Update on lysosomal acid lipase deficiency: Diagnosis, treatment and patient management. Med Clin (Barc) 2017; 148:429.e1-429.e10. [PMID: 28285817 DOI: 10.1016/j.medcli.2016.12.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 10/20/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 01/01/2023]
Abstract
Lysosomal acid lipase deficiency (LALD) is an ultra-rare disease caused by a congenital disorder of the lipid metabolism, characterized by the deposition of cholesterol esters and triglycerides in the organism. In patients with no enzyme function, the disease develops during the perinatal period and is invariably associated with death during the first year of life. In all other cases, the phenotype is heterogeneous, although most patients develop chronic liver diseases and may also develop an early cardiovascular disease. Treatment for LALD has classically included the use of supportive measures that do not prevent the progression of the disease. In 2015, regulatory agencies approved the use of a human recombinant LAL for the treatment of LALD. This long-term enzyme replacement therapy has been associated with significant improvements in the hepatic and lipid profiles of patients with LALD, increasing survival rates in infants with a rapidly progressive disease. Both the severity of LALD and the availability of a specific treatment highlight the need to identify these patients in clinical settings, although its low prevalence and the existing clinical overlap with other more frequent pathologies limit its diagnosis. In this paper we set out practical recommendations to identify and monitor patients with LALD, including a diagnostic algorithm, along with an updated treatment.
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Affiliation(s)
- Carmen Camarena
- Servicio de Hepatología Infantil, Hospital La Paz, Madrid, España
| | - Luis J Aldamiz-Echevarria
- Unidad de Enfermedades Metabólicas Pediátricas, Hospital Universitario Cruces, Bilbao, España; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, España; CSUR de Enfermedades Metabólicas Congénitas, Ministerio de Sanidad, Madrid, España
| | - Begoña Polo
- Servicio de Gastroenterología y Hepatología Pediátrica, Hospital La Fe, Valencia, España
| | - Miguel A Barba Romero
- Servicio de Medicina Interna, Complejo Hospitalario y Universitario de Albacete, Universidad de Castilla-La Mancha, Albacete, España
| | - Inmaculada García
- Unidad de Enfermedades Metabólicas Pediátricas, Hospital Miguel Servet, Zaragoza, España
| | - Jorge J Cebolla
- Instituto de Investigación Sanitaria Aragón, Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Zaragoza, España; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Emilio Ros
- Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, España; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España.
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Poinsot P, Collardeau Frachon S, Restier L, Sérusclat A, Di Filippo M, Charrière S, Moulin P, Lachaux A, Peretti N. Childhood/adult-onset lysosomal acid lipase deficiency: A serious metabolic and vascular phenotype beyond liver disease-four new pediatric cases. J Clin Lipidol 2017; 11:167-177.e3. [PMID: 28391883 DOI: 10.1016/j.jacl.2016.11.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/09/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The childhood/adult-onset lysosomal acid lipase deficiency (LALD; late-onset LALD) is a rare genetic disease. Children present severe fatty liver disease with early cirrhosis. Before enzyme replacement therapy, statins were the standard treatment to improve the severe dyslipidemia. However, late-onset LALD should be considered as a systemic metabolic disease: chronic hyper-low-density lipoprotein and hypo-high-density lipoprotein cholesterolemia induces early atherosclerosis in addition to the liver morbidity. OBJECTIVE To assess 4 new pediatric cases of late-onset LALD with an evaluation of hepatic, metabolic, and vascular evolution under statin. METHODS Four patients were retrospectively described. Anthropometric data (weight, height, and body mass index) and laboratory data (LIPA mutations, acid lipase residual activity, liver and lipid profile, and homeostatic model assessment index) were collected. Liver histology was assessed by the noninvasive tests FibroScan and FibroTest and confirmed by liver biopsy. Vascular impact was followed up by carotid intima-media thickness (cIMT) assessment. RESULTS The 4 cases of late-onset LALD came from 2 families, each with a boy (aged 8.6 and 11 years at diagnosis) and a girl (aged 10.6 and 13 years at diagnosis). Treatment with statins was performed for 8 and 5 years, respectively, from diagnosis. Statins decreased the low-density lipoprotein cholesterol mean value of 40%. All children showed significant liver fibrosis (F3 [n = 3]; F2 [n = 1]). cIMT showed the following for all children: abnormal measures without improvement and atherosclerotic plaques. One child developed a deleterious metabolic phenotype with obesity and insulin resistance (homeostatic model assessment = 3.08) associated with higher mean hepatic transaminases (149 vs 98, 88, and 61 IU/L) and increased mean cIMT values (raising from 0.47 to 0.5 mm vs 0.43 and 0.43 mm). CONCLUSION Late-onset LALD is a rare metabolic disease with a larger impact than liver disease. Our work shows the importance of having a global metabolic view and to evaluate the cardiovascular impact of the new enzymatic treatment.
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Affiliation(s)
- Pierre Poinsot
- Univ Lyon, Hospices Civils de Lyon, Service d'Hépathologie, Gastro-entérologie et Nutrition Pédiatrique, Hopital Femme Mere Enfant, Bron, France.
| | - Sophie Collardeau Frachon
- Univ Lyon, Hospices Civils de Lyon, Centre de Pathologie Est, Groupement Hospitalier Est, Bron, France
| | - Lioara Restier
- Univ Lyon, Hospices Civils de Lyon, Service d'Hépathologie, Gastro-entérologie et Nutrition Pédiatrique, Hopital Femme Mere Enfant, Bron, France
| | - André Sérusclat
- Univ Lyon, Hospices Civils de Lyon, Service d'Imagerie Médicale, Hôpital Louis Pradel, Bron, France
| | - Mathilde Di Filippo
- Univ Lyon, Hospices Civils de Lyon, Centre de Biologie Est, Groupement Hospitalier Est, Bron, France; Univ Lyon, CarMeN Laboratory, INSERM U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Charles Merieux Medical School, Oullins, France
| | - Sybil Charrière
- Univ Lyon, CarMeN Laboratory, INSERM U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Charles Merieux Medical School, Oullins, France; Univ Lyon, Hospices Civils de Lyon, Service Diabétologie, Endocrinologie, Maladies Métaboliques et Nutrition, Hôpital Louis Pradel, Bron, France; Univ Lyon, Faculté de Médecine Lyon-Est, Lyon, France
| | - Philippe Moulin
- Univ Lyon, CarMeN Laboratory, INSERM U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Charles Merieux Medical School, Oullins, France; Univ Lyon, Hospices Civils de Lyon, Service Diabétologie, Endocrinologie, Maladies Métaboliques et Nutrition, Hôpital Louis Pradel, Bron, France; Univ Lyon, Faculté de Médecine Lyon-Est, Lyon, France
| | - Alain Lachaux
- Univ Lyon, Hospices Civils de Lyon, Service d'Hépathologie, Gastro-entérologie et Nutrition Pédiatrique, Hopital Femme Mere Enfant, Bron, France; Univ Lyon, Faculté de Médecine Lyon-Est, Lyon, France
| | - Noel Peretti
- Univ Lyon, Hospices Civils de Lyon, Service d'Hépathologie, Gastro-entérologie et Nutrition Pédiatrique, Hopital Femme Mere Enfant, Bron, France; Univ Lyon, CarMeN Laboratory, INSERM U1060, INRA U1397, Université Claude Bernard Lyon 1, INSA Lyon, Charles Merieux Medical School, Oullins, France; Univ Lyon, Faculté de Médecine Lyon-Est, Lyon, France
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Valayannopoulos V, Mengel E, Brassier A, Grabowski G. Lysosomal acid lipase deficiency: Expanding differential diagnosis. Mol Genet Metab 2017; 120:62-66. [PMID: 27876313 DOI: 10.1016/j.ymgme.2016.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 08/09/2016] [Revised: 11/08/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
The differential diagnoses for metabolic liver diseases may be challenging in clinical settings, which represents a critical issue for disorders such as lysosomal acid lipase deficiency (LAL-D). LAL-D is caused by deficient activity of the LAL enzyme, resulting in the accumulation of cholesteryl esters and triglycerides throughout the body, predominately in the liver, spleen, gastrointestinal tract, and blood vessel walls. LAL-D is a progressive, multi-organ disease with early mortality and significant morbidity characterized by a combination of hepatic dysfunction and dyslipidemia. Evidence suggests LAL-D may be substantially underdiagnosed or misdiagnosed, which is critical given that disease progression can be unpredictable, with liver failure and/or accelerated atherosclerosis potentially contributing to early mortality. However, given the development of a simple diagnostic test and recently approved treatment, LAL-D should be incorporated into the differential diagnosis in relevant clinical settings. LAL-D can be diagnosed using an LAL enzyme-based biochemical test, thereby allowing for active monitoring of patients to detect potential disease complications and consider treatment options including diet, lipid-lowering medication, and treatment with sebelipase alfa, a recombinant enzyme replacement therapy shown to provide clinical benefit and improve disease-relevant markers in clinical trials. To illustrate the complexity of diagnosing LAL-D, this manuscript will describe the path to diagnosing LAL-D in a series of patient cases in which LAL-D was diagnosed as well as in patients where other diseases, such as Gaucher disease and Niemann-Pick disease, were initially suspected.
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Affiliation(s)
- Vassili Valayannopoulos
- Hôpital Necker, Enfants Malades, Paris, France; Sanofi Genzyme Corporation, Cambridge, MA, USA.
| | - Eugen Mengel
- Villa Metabolica, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Anais Brassier
- Hôpital Necker, Enfants Malades, Paris, France; Sanofi Genzyme Corporation, Cambridge, MA, USA
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Guardamagna O, Guaraldi F. Lysosomal Acid Lipase Deficiency: Could Dyslipidemia Drive the Diagnosis? Curr Pediatr Rev 2017; 13:232-242. [PMID: 29332587 DOI: 10.2174/1573396314666180111144514] [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: 05/05/2017] [Revised: 07/07/2017] [Accepted: 11/11/2017] [Indexed: 11/22/2022]
Abstract
LAL-deficiency (LAL-D) is a rare and systemic condition, secondary to LIPA gene mutations, responsible for lysosomal accumulation of cholesteryl esters and triglycerides, whose manifestations are very heterogeneous in terms of the age of onset, severity and the type of clinical and radiological manifestations. Dyslipidemia, hepatomegaly and hepatosteatosis with increased levels of transaminases are the most common features. The increased risk of premature atherosclerosis and cardiovascular disorders, secondary to a generalized alteration of lipid profile and lipoprotein dysfunction associated with LAL-D, has been increasingly pointed out. Therefore, medical awareness towards LAL-deficiency should be increased, since this condition has to be considered in the differential diagnosis of pediatric conditions manifested with dyslipidemia and hepatic accumulation of intracellular products. On the other hand, early patient identification and management remain challenging.
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Affiliation(s)
- Ornella Guardamagna
- Department of Public Health and Pediatric Sciences, University of Turin, I-10126, Turin, Italy
| | - Federica Guaraldi
- Department of Public Health and Pediatric Sciences, University of Turin, I-10126, Turin, Italy
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Himes RW, Barlow SE, Bove K, Quintanilla NM, Sheridan R, Kohli R. Lysosomal Acid Lipase Deficiency Unmasked in Two Children With Nonalcoholic Fatty Liver Disease. Pediatrics 2016; 138:e20160214. [PMID: 27624512 DOI: 10.1542/peds.2016-0214] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/24/2022] Open
Abstract
Lysosomal acid lipase deficiency (LAL-D) is a classic lysosomal storage disorder characterized by accumulation of cholesteryl ester and triglyceride. Although it is associated with progressive liver injury, fibrosis, and end-stage liver disease in children and adolescents, LAL-D frequently presents with nonspecific signs that overlap substantially with other, more common, chronic conditions like nonalcoholic fatty liver disease (NAFLD), metabolic syndrome, and certain inherited dyslipidemias. We present 2 children with NAFLD who achieved clinically significant weight reduction through healthy eating and exercise, but who failed to have the anticipated improvements in aminotransferases and γ-glutamyl transferase. Liver biopsies performed for these "treatment failures" demonstrated significant microvesicular steatosis, prompting consideration of coexisting metabolic diseases. In both patients, lysosomal acid lipase activity was low and LIPA gene testing confirmed LAL-D. We propose that LAL-D should be considered in the differential diagnosis when liver indices in patients with NAFLD fail to improve in the face of appropriate body weight reduction.
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Affiliation(s)
- Ryan W Himes
- Section of Gastroenterology and Hepatology, Department of Pediatrics and
| | - Sarah E Barlow
- Section of Gastroenterology and Hepatology, Department of Pediatrics and
| | - Kevin Bove
- Department of Pathology, Cincinnati Children's Hospital and
| | - Norma M Quintanilla
- Department of Pathology and Immunology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; and
| | | | - Rohit Kohli
- Section of Gastroenterology and Hepatology, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
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Baratta F, Pastori D, Polimeni L, Tozzi G, Violi F, Angelico F, Del Ben M. Does Lysosomial Acid Lipase Reduction Play a Role in Adult Non-Alcoholic Fatty Liver Disease? Int J Mol Sci 2015; 16:28014-21. [PMID: 26602919 PMCID: PMC4691032 DOI: 10.3390/ijms161226085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 10/13/2015] [Revised: 11/06/2015] [Accepted: 11/17/2015] [Indexed: 12/15/2022] Open
Abstract
Lysosomal Acid Lipase (LAL) is a key enzyme involved in lipid metabolism, responsible for hydrolysing the cholesteryl esters and triglycerides. Wolman Disease represents the early onset phenotype of LAL deficiency rapidly leading to death. Cholesterol Ester Storage Disease is a late onset phenotype that occurs with fatty liver, elevated aminotransferase levels, hepatomegaly and dyslipidaemia, the latter characterized by elevated LDL-C and low HDL-C. The natural history and the clinical manifestations of the LAL deficiency in adults are not well defined, and the diagnosis is often incidental. LAL deficiency has been suggested as an under-recognized cause of dyslipidaemia and fatty liver. Therefore, LAL activity may be reduced also in non-obese patients presenting non-alcoholic fatty liver disease (NAFLD), unexplained persistently elevated liver transaminases or with elevation in LDL cholesterol. In these patients, it could be indicated to test LAL activity. So far, very few studies have been performed to assess LAL activity in representative samples of normal subjects or patients with NAFLD. Moreover, no large study has been carried out in adult subjects with NAFLD or cryptogenic cirrhosis.
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Affiliation(s)
- Francesco Baratta
- Department of Internal Medicine and Medical Specialities and Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences-Sapienza University, Rome 00185, Italy.
| | - Daniele Pastori
- Department of Internal Medicine and Medical Specialities and Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences-Sapienza University, Rome 00185, Italy.
| | - Licia Polimeni
- Department of Internal Medicine and Medical Specialities and Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences-Sapienza University, Rome 00185, Italy.
| | - Giulia Tozzi
- Unit for Neuromuscular and Neurodegenerative Diseases, Children's Hospital and Research Institute "Bambino Gesù", Rome 00165, Italy.
| | - Francesco Violi
- Department of Internal Medicine and Medical Specialities, Sapienza University, Rome 00185, Italy.
| | - Francesco Angelico
- Department of Public Health and Infectious Diseases, Sapienza University, Policlinico Umberto I, I Clinica Medica, Viale del Policlinico 155, Rome 00161, Italy.
| | - Maria Del Ben
- Department of Internal Medicine and Medical Specialities, Sapienza University, Rome 00185, Italy.
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Pajares S, Arias A, García-Villoria J, Macías-Vidal J, Ros E, de las Heras J, Girós M, Coll MJ, Ribes A. Cholestane-3β,5α,6β-triol: high levels in Niemann-Pick type C, cerebrotendinous xanthomatosis, and lysosomal acid lipase deficiency. J Lipid Res 2015; 56:1926-35. [PMID: 26239048 PMCID: PMC4583089 DOI: 10.1194/jlr.m060343] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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: 06/25/2015] [Revised: 07/22/2015] [Indexed: 01/21/2023] Open
Abstract
Niemann-Pick type C (NPC) is a progressive neurodegenerative disease characterized by lysosomal/endosomal accumulation of unesterified cholesterol and glycolipids. Recent studies have shown that plasma cholestane-3β,5α,6β-triol (CT) and 7-ketocholesterol (7-KC) could be potential biomarkers for the diagnosis of NPC patients. We aimed to know the sensitivity and specificity of these biomarkers for the diagnosis of NPC compared with other diseases that can potentially lead to oxysterol alterations. We studied 107 controls and 122 patients including 16 with NPC, 3 with lysosomal acid lipase (LAL) deficiency, 8 with other lysosomal diseases, 5 with galactosemia, 11 with cerebrotendinous xanthomatosis (CTX), 3 with Smith-Lemli-Opitz, 14 with peroxisomal biogenesis disorders, 19 with unspecific hepatic diseases, 13 with familial hypercholesterolemia, and 30 with neurological involvement and no evidence of an inherited metabolic disease. CT and 7-KC were analyzed by HPLC-ESI-MS/MS as mono-dimethylglycine derivatives. Levels of 7-KC were high in most of the studied diseases, whereas those of CT were only high in NPC, LAL, and CTX patients. Consequently, although CT is a sensitive biomarker of NPC disease, including those cases with doubtful filipin staining, it is not specific. 7-KC is a very unspecific biomarker.
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Affiliation(s)
- Sonia Pajares
- Sección de Errores Congénitos del Metabolismo, Servicio de Bioquímica y Genética Molecular, Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), and Ciber Enfermedades Raras (CIBERER) Instituto de Salud Carlos III, Hospital Clinic, Barcelona, Spain
| | - Angela Arias
- Sección de Errores Congénitos del Metabolismo, Servicio de Bioquímica y Genética Molecular, Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), and Ciber Enfermedades Raras (CIBERER) Instituto de Salud Carlos III, Hospital Clinic, Barcelona, Spain
| | - Judit García-Villoria
- Sección de Errores Congénitos del Metabolismo, Servicio de Bioquímica y Genética Molecular, Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), and Ciber Enfermedades Raras (CIBERER) Instituto de Salud Carlos III, Hospital Clinic, Barcelona, Spain
| | - Judit Macías-Vidal
- Sección de Errores Congénitos del Metabolismo, Servicio de Bioquímica y Genética Molecular, Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), and Ciber Enfermedades Raras (CIBERER) Instituto de Salud Carlos III, Hospital Clinic, Barcelona, Spain
| | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, IDIBAPS, and Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN) Instituto de Salud Carlos III, Hospital Clinic, Barcelona, Spain
| | - Javier de las Heras
- Division of Pediatric Metabolism, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - Marisa Girós
- Sección de Errores Congénitos del Metabolismo, Servicio de Bioquímica y Genética Molecular, Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), and Ciber Enfermedades Raras (CIBERER) Instituto de Salud Carlos III, Hospital Clinic, Barcelona, Spain
| | - Maria J. Coll
- Sección de Errores Congénitos del Metabolismo, Servicio de Bioquímica y Genética Molecular, Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), and Ciber Enfermedades Raras (CIBERER) Instituto de Salud Carlos III, Hospital Clinic, Barcelona, Spain
| | - Antonia Ribes
- Sección de Errores Congénitos del Metabolismo, Servicio de Bioquímica y Genética Molecular, Institut d’Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), and Ciber Enfermedades Raras (CIBERER) Instituto de Salud Carlos III, Hospital Clinic, Barcelona, Spain
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Affiliation(s)
- Douglas Moodie
- Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street MC, 19345-C, Houston, Texas, 77030, USA
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Gómez-Nájera M, Barajas-Medina H, Gallegos-Rivas MC, Mendez-Sashida P, Goss KA, Sims KB, Tripuraneni R, Valles-Ayoub Y. New diagnostic method for lysosomal acid lipase deficiency and the need to recognize its manifestation in infants (Wolman disease). J Pediatr Gastroenterol Nutr 2015; 60:e22-4. [PMID: 24048164 DOI: 10.1097/mpg.0000000000000175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Mariana Gómez-Nájera
- *Hospital de Ginecopediatria #48 IMSS, León, Guanajuato, México †Unidad Médica de Alta Especialidad 1, IMSS, Leon, Guanajuato, México ‡Center for Human Genetics, Massachusetts General Hospital §Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston ||Synageva BioPharma Corp, Lexington, MA ¶HIBM Research Group, Los Angeles, CA
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Ramadža DP, Ćuk M, Zibar K, Barić M, Sarnavka V, Bilić K, Fumić K, Vuković J, Pušeljić S, Ćorić M, Padovan RŠ, Kralik M, Barić I. [Lysosomal acid lipase deficiency in children: our experience and a novel possibility of enzyme replacement therapy]. Lijec Vjesn 2015; 137:81-7. [PMID: 26065284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lysosomal acid lipase deficiency is an autosomal recessive disorder with two distinct clinical phenotypes. Wolman disease is rapidly progressive with onset in early infancy. Complete enzyme deficiency results in massive accumulation of cholesterol esters and triglycerides in intestines, liver, spleen and other monocyte-macrophage system cells causing malabsorption, hepatosplenomegaly, liver failure and death in early infancy. Cholesterol ester storage disease may be diagnosed in childhood or later in life. It is characterized by chronic course and variable progression. Main features are variously expressed hepatopathy, including cirrhosis and liver failure, hypercholesterolemia and premature atherosclerosis. Characteristic is pathohistological finding of microvesicular steatosis and fibrosis and patognomonic are typical cholesterol ester crystals. Diagnosis is confirmed by enzyme assay and/or gene analysis. Until recently treatment was symptomatic. Ongoing clinical trials of enzyme replacement therapy have shown very promising results. We are presenting an infant with Wolman disease and two children with cholesterol ester storage disease with the aim to raise awareness about this disease and to start optimal care early.
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Santillán-Hernández Y, Almanza-Miranda E, Xin WW, Goss K, Vera-Loaiza A, Mora MTGDL, Piña-Aguilar RE. Novel LIPA mutations in Mexican siblings with lysosomal acid lipase deficiency. World J Gastroenterol 2015; 21:1001-8. [PMID: 25624737 PMCID: PMC4299316 DOI: 10.3748/wjg.v21.i3.1001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/12/2014] [Accepted: 09/29/2014] [Indexed: 02/06/2023] Open
Abstract
Lysosomal acid lipase (LAL) deficiency is an under-recognized lysosomal disease caused by deficient enzymatic activity of LAL. In this report we describe two affected female Mexican siblings with early hepatic complications. At two months of age, the first sibling presented with alternating episodes of diarrhea and constipation, and later with hepatomegaly, elevated transaminases, high levels of total and low-density lipoprotein cholesterol, and low levels of high-density lipoprotein. Portal hypertension and grade 2 esophageal varices were detected at four years of age. The second sibling presented with hepatomegaly, elevated transaminases and mildly elevated low-density lipoprotein and low high-density lipoprotein at six months of age. LAL activity was deficient in both patients. Sequencing of LIPA revealed two previously unreported heterozygous mutations in exon 4: c.253C>A and c.294C>G. These cases highlight the clinical continuum between the so-called Wolman disease and cholesteryl ester storage disease, and underscore that LAL deficiency represents a single disease with a degree of clinical heterogeneity.
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44
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Porto AF. Lysosomal acid lipase deficiency: diagnosis and treatment of Wolman and Cholesteryl Ester Storage Diseases. Pediatr Endocrinol Rev 2014; 12 Suppl 1:125-132. [PMID: 25345094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lysosomal acid lipase (LAL) is responsible for the hydrolysis of cholesterol esters and triglycerides. LAL is coded by the LIPA gene on chromosome 10q23.31. Its deficiency leads to two autosomal recessive disorders, Wolman disease (WD) and Cholesteryl Ester Storage Disease (CESD). WD has an estimated incidence of 1 in 500,000 live births and is the result of a complete loss of LAL and presents in infancy with vomiting, diarrhea, poor weight gain and hepatomegaly subsequently leading to death. CESD is the result of partial loss of LAL and its presentation is more variable. Patients may be asymptomatic or present with nonspecific gastrointestinal symptoms, hepatomegaly, elevated transaminases and dystipidemia which may be confused with the diagnosis of Non-alcoholic Fatty Liver Disease. CESD is currently underdiagnosed and has an estimated prevalence as high as I in 40,000 individuals. Radiologic findings in WD is calcification of the adrenal glands. Hepatomegaly is noted on CT scan in both WD and CESD. MRI may demonstrate accumulation of cholesterol esters and may be useful to study effects of potential medical therapies. The diagnosis of WD and CESD is based on LIPA gene sequencing and the measurement of LAL levels in peripheral blood leukocytes. Treatment of LAL deficiency is currently limited to control of cholesterol levels and to prevent premature atherosclerosis. Use of enzyme replacement therapy with recombinant human LAL in short-term studies has shown to be safe and effective.
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Reiner Ž, Guardamagna O, Nair D, Soran H, Hovingh K, Bertolini S, Jones S, Ćorić M, Calandra S, Hamilton J, Eagleton T, Ros E. Lysosomal acid lipase deficiency--an under-recognized cause of dyslipidaemia and liver dysfunction. Atherosclerosis 2014; 235:21-30. [PMID: 24792990 DOI: 10.1016/j.atherosclerosis.2014.04.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [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: 12/20/2013] [Revised: 04/04/2014] [Accepted: 04/05/2014] [Indexed: 12/15/2022]
Abstract
Lysosomal acid lipase deficiency (LAL-D) is a rare autosomal recessive lysosomal storage disease caused by deleterious mutations in the LIPA gene. The age at onset and rate of progression vary greatly and this may relate to the nature of the underlying mutations. Patients presenting in infancy have the most rapidly progressive disease, developing signs and symptoms in the first weeks of life and rarely surviving beyond 6 months of age. Children and adults typically present with some combination of dyslipidaemia, hepatomegaly, elevated transaminases, and microvesicular hepatosteatosis on biopsy. Liver damage with progression to fibrosis, cirrhosis and liver failure occurs in a large proportion of patients. Elevated low-density lipoprotein cholesterol levels and decreased high-density lipoprotein cholesterol levels are common features, and cardiovascular disease may manifest as early as childhood. Given that these clinical manifestations are shared with other cardiovascular, liver and metabolic diseases, it is not surprising that LAL-D is under-recognized in clinical practice. This article provides practical guidance to lipidologists, endocrinologists, cardiologists and hepatologists on how to recognize individuals with this life-limiting disease. A diagnostic algorithm is proposed with a view to achieving definitive diagnosis using a recently developed blood test for lysosomal acid lipase. Finally, current management options are reviewed in light of the ongoing development of enzyme replacement therapy with sebelipase alfa (Synageva BioPharma Corp., Lexington, MA, USA), a recombinant human lysosomal acid lipase enzyme.
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Affiliation(s)
- Željko Reiner
- University Hospital Center, School of Medicine, University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
| | - Ornella Guardamagna
- Department of Public and Health Sciences, Medical School, University of Turin, Piazza Polonia 94, I-10126 Turin, Italy
| | - Devaki Nair
- Department of Clinical Biochemistry, Royal Free Hospital NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Handrean Soran
- Cardiovascular Trials Unit, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands
| | - Stefano Bertolini
- Department of Internal Medicine, University of Genoa, Viale Benedetto XV n. 6, 16132 Genoa, Italy
| | - Simon Jones
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, St. Mary's Hospital, Oxford Road, Manchester M13 9WL, UK
| | - Marijana Ćorić
- University Hospital Center, School of Medicine, University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Sebastiano Calandra
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, I-41125 Modena, Italy
| | - John Hamilton
- Biochemistry Department, Yorkhill Hospital, Glasgow, G3 8SJ, UK
| | - Terence Eagleton
- Synageva BioPharma Corp., 33 Hayden Ave., Lexington, MA 02421, USA
| | - Emilio Ros
- Lipid Clinic, Endocrinology & Nutrition Service, Institut d'Investigations Biomèdiques August Pi Sunyer, Hospital Clínic, C. Villarroel, 170, 08036 Barcelona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carloss III (ISCIII), Spain.
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Abstract
Lysosomal acid lipase (LAL) deficiency is a rare autosomal recessive disorder which causes two distinct clinical phenotypes: Wolman's disease and cholesterol ester storage disease. LAL hydrolyses LDL-derived triglycerides and cholesterol esters to glycerol or cholesterol and free fatty acids. Its deficiency leads to accumulation of intracellular triglycerides and/or cholesterol esters. In early onset LAL deficiency, clinical manifestations start in the first few weeks of life with persistent vomiting, failure to thrive, hepatosplenomegaly, liver dysfunction and hepatic failure. Adrenal calcification is a striking feature but is present in only about 50% of cases. We report a case of an infant presenting with vomiting, diarrhoea, hepatosplenomegaly and poor weight gain that was subsequently diagnosed as Wolman's disease. He was entered into a clinical trial for LAL replacement therapy. This case reinforces that early onset LAL deficiency should be considered in a baby presenting with failure to thrive, gastrointestinal symptoms and hepatosplenomegaly.
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Affiliation(s)
| | - Amit Saha
- Department of Paediatrics & Neonatology, Maidstone and Tunbridge Wells Hospitals NHS Trust, Pembury, Kent, UK
| | - Roshni Vara
- Department of Paediatric Inherited Metabolic Diseases, Evelina Children's Hospital, London, UK
| | - Bim Bhaduri
- Department of Paediatrics, Maidstone and Tunbridge Wells, Kent, UK
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47
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Civallero G, De Mari J, Bittar C, Burin M, Giugliani R. Extended use of a selective inhibitor of acid lipase for the diagnosis of Wolman disease and cholesteryl ester storage disease. Gene 2014; 539:154-6. [PMID: 24508470 DOI: 10.1016/j.gene.2014.02.003] [Citation(s) in RCA: 23] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/28/2014] [Accepted: 02/04/2014] [Indexed: 02/01/2023]
Abstract
Lysosomal acid lipase (LAL) deficiency produces two well defined inborn disorders, Wolman disease (WD) and cholesteryl ester storage disease (CESD). WD is a severe, early-onset condition involving massive storage of triglycerides and cholesteryl esters in the liver, with death usually occurring before one year of life. CESD is a more attenuated, later-onset disease that leads to a progressive and variable liver dysfunction. Diagnosis of LAL deficiency is mainly based on the enzyme assay of LAL activity in fibroblasts. Recently, a selective acid lipase inhibitor was used for the determination of enzyme activity in dried-blood filter paper (DBFP) samples. To extend and to validate these studies, we tested LAL activity with selective inhibition on DBFP samples, leukocytes and fibroblasts. Our results showed a clear discrimination between patients with LAL deficiency and healthy controls when using DBFP, leukocytes or fibroblasts (p<0.001). Deficiency of LAL was also demonstrated in individuals referred to our laboratory with suspected clinical diagnosis of WD, CESD, and Niemann-Pick type B. We conclude that the assay of LAL using selective inhibitor is a reliable and useful method for the identification of LAL deficiency, not only in DBFP samples but also in leukocytes and fibroblasts. This is important as enzyme replacement therapy for LAL deficiency is currently being developed, making the correct diagnosis a critical issue.
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Affiliation(s)
- G Civallero
- Medical Genetics Service, HCPA, Porto Alegre, Brazil; Department of Genetics, UFRGS, Porto Alegre, Brazil.
| | - J De Mari
- Medical Genetics Service, HCPA, Porto Alegre, Brazil
| | | | - M Burin
- Medical Genetics Service, HCPA, Porto Alegre, Brazil
| | - R Giugliani
- Medical Genetics Service, HCPA, Porto Alegre, Brazil; Department of Genetics, UFRGS, Porto Alegre, Brazil; INAGEMP, Porto Alegre, Brazil
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Affiliation(s)
- Poonam Shenoy
- Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India
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49
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Dairaku T, Iwamoto T, Nishimura M, Endo M, Ohashi T, Eto Y. A practical fluorometric assay method to measure lysosomal acid lipase activity in dried blood spots for the screening of cholesteryl ester storage disease and Wolman disease. Mol Genet Metab 2014; 111:193-6. [PMID: 24295952 DOI: 10.1016/j.ymgme.2013.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/10/2013] [Accepted: 11/10/2013] [Indexed: 12/20/2022]
Abstract
Fluorometric measurements of 4-methylumbelliferone (4-MU) are generally used to screen lysosomal storage diseases (LSDs) using dried blood spots (DBSs). However, in DBS, it is difficult to measure lysosomal acid lipase (LAL) activity due to the influence of other lipases in whole blood. Recently, Hamilton used a fluorometric enzyme assay with 4-MU derivatives to measure the LAL activity in DBS. This method requires mercury chloride as stopping reagent, and the fluorescence intensity of 4-MU was measured at an acidic pH. We report a revised method to measure the LAL activity without using toxic mercury chloride and to measure the fluorescence intensity of 4-MU at a basic pH. For this measurement, we established a more practical method that does not require mercury chloride. The LAL activity in DBS was measured in 51 normal controls, seven obligate carriers and seven patients with CESD. The average LAL activities ± SD in the DBS from the normal, obligate carriers and CESD patients were 0.68 ± 0.2 (range: 0.3-1.08), 0.21 ± 0.1 (range: 0.11-0.41) and 0.02 ± 0.02 (range: 0-0.06) nmol/punch/h, respectively. There was a significant difference between the normal and the CESD. Our method does not require toxic mercury chloride and is an appropriate revised enzyme assay using DBS for screening patients with CESD.
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Affiliation(s)
- Takenori Dairaku
- Advanced Clinical Research Center, Southern TOHOKU Research Institute for Neuroscience, Fukushima, Japan
| | - Takeo Iwamoto
- Division of Biochemistry, Core Research Facilities, The Jikei University School of Medicine, Tokyo, Japan
| | - Minami Nishimura
- Advanced Clinical Research Center, Southern TOHOKU Research Institute for Neuroscience, Fukushima, Japan
| | - Masahiro Endo
- Advanced Clinical Research Center, Southern TOHOKU Research Institute for Neuroscience, Fukushima, Japan
| | - Toya Ohashi
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan; Department of Gene Therapy, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshikatu Eto
- Advanced Clinical Research Center, Southern TOHOKU Research Institute for Neuroscience, Fukushima, Japan.
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Abstract
Cholesteryl ester storage disease (CESD) is an autosomal recessive lysosomal storage disorder caused by a variety of mutations of the LIPA gene. These cause reduced activity of lysosomal acid lipase, which results in accumulation of cholesteryl esters in lysosomes. If enzyme activity is very low/absent, presentation is in infancy with failure to thrive, malabsorption, hepatosplenomegaly and rapid early death (Wolman disease). With higher but still low enzyme activity, presentation is later in life with hepatic fibrosis, dyslipidaemia and early atherosclerosis.Identification of this rare disorder is difficult as it is essential to assay leucocyte acid phosphatase activity. An assay using specific inhibitors has now been developed that facilitates measurement in dried blood spots. Treatment of CESD has until now been limited to management of the dyslipidaemia, but this does not influence the liver effects. A new enzyme replacement therapy (Sebelipase) has now been developed that could change treatment options for the future.
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