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Cancela ML, Laizé V, Conceição N, Kempf H, Murshed M. Keutel Syndrome, a Review of 50 Years of Literature. Front Cell Dev Biol 2021; 9:642136. [PMID: 33996798 PMCID: PMC8117146 DOI: 10.3389/fcell.2021.642136] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Keutel syndrome (KS) is a rare autosomal recessive genetic disorder that was first identified in the beginning of the 1970s and nearly 30 years later attributed to loss-of-function mutations in the gene coding for the matrix Gla protein (MGP). Patients with KS are usually diagnosed during childhood (early onset of the disease), and the major traits include abnormal calcification of cartilaginous tissues resulting in or associated with malformations of skeletal tissues (e.g., midface hypoplasia and brachytelephalangism) and cardiovascular defects (e.g., congenital heart defect, peripheral pulmonary artery stenosis, and, in some cases, arterial calcification), and also hearing loss and mild developmental delay. While studies on Mgp -/- mouse, a faithful model of KS, show that pathologic mineral deposition (ectopic calcification) in cartilaginous and vascular tissues is the primary cause underlying many of these abnormalities, the mechanisms explaining how MGP prevents abnormal calcification remain poorly understood. This has negative implication for the development of a cure for KS. Indeed, at present, only symptomatic treatments are available to treat hypertension and respiratory complications occurring in the KS patients. In this review, we summarize the results published in the last 50 years on Keutel syndrome and present the current status of the knowledge on this rare pathology.
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Affiliation(s)
- M. Leonor Cancela
- Centre of Marine Sciences (CCMAR), University of Algarve, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal
- Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Vincent Laizé
- Centre of Marine Sciences (CCMAR), University of Algarve, Faro, Portugal
| | - Natércia Conceição
- Centre of Marine Sciences (CCMAR), University of Algarve, Faro, Portugal
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Faro, Portugal
- Algarve Biomedical Center, University of Algarve, Faro, Portugal
| | - Hervé Kempf
- UMR 7365 CNRS-Université de Lorraine, IMoPA, Vandoeuvre-lès-Nancy, France
| | - Monzur Murshed
- Department of Medicine and Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Shriners Hospital for Children, Montreal, QC, Canada
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Nollet L, Van Gils M, Verschuere S, Vanakker O. The Role of Vitamin K and Its Related Compounds in Mendelian and Acquired Ectopic Mineralization Disorders. Int J Mol Sci 2019; 20:ijms20092142. [PMID: 31052252 PMCID: PMC6540172 DOI: 10.3390/ijms20092142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 12/11/2022] Open
Abstract
Ectopic mineralization disorders comprise a broad spectrum of inherited or acquired diseases characterized by aberrant deposition of calcium crystals in multiple organs, such as the skin, eyes, kidneys, and blood vessels. Although the precise mechanisms leading to ectopic calcification are still incompletely known to date, various molecular targets leading to a disturbed balance between pro- and anti-mineralizing pathways have been identified in recent years. Vitamin K and its related compounds, mainly those post-translationally activated by vitamin K-dependent carboxylation, may play an important role in the pathogenesis of ectopic mineralization as has been demonstrated in studies on rare Mendelian diseases, but also on highly prevalent disorders, like vascular calcification. This narrative review compiles and summarizes the current knowledge regarding the role of vitamin K, its metabolism, and associated compounds in the pathophysiology of both monogenic ectopic mineralization disorders, like pseudoxanthoma elasticum or Keutel syndrome, as well as acquired multifactorial diseases, like chronic kidney disease. Clinical and molecular aspects of the various disorders are discussed according to the state-of-the-art, followed by a comprehensive literature review regarding the role of vitamin K in molecular pathophysiology and as a therapeutic target in both human and animal models of ectopic mineralization disorders.
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Affiliation(s)
- Lukas Nollet
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Matthias Van Gils
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium.
- Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium.
| | - Shana Verschuere
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium.
- Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium.
| | - Olivier Vanakker
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium.
- Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium.
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Bayramoğlu A, Saritemur M, Tasdemir S, Omeroglu M, Erdem HB, Sahin I. A rare cause of dyspnea in emergency medicine: Keutel syndrome. Am J Emerg Med 2015; 34:935.e3-5. [PMID: 26462901 DOI: 10.1016/j.ajem.2015.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 09/06/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Atıf Bayramoğlu
- Emergency Department of Medical Faculty, Ataturk University, Erzurum, Turkey.
| | - Murat Saritemur
- Emergency Department of Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Sener Tasdemir
- Medical Genetics Department of Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Mevlana Omeroglu
- Emergency Department of Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Haktan Bagis Erdem
- Medical Genetics Department of Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Ibrahim Sahin
- Medical Genetics Department of Medical Faculty, Ataturk University, Erzurum, Turkey
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Cancela ML, Laizé V, Conceição N. Matrix Gla protein and osteocalcin: from gene duplication to neofunctionalization. Arch Biochem Biophys 2014; 561:56-63. [PMID: 25068814 DOI: 10.1016/j.abb.2014.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/04/2014] [Accepted: 07/15/2014] [Indexed: 12/31/2022]
Abstract
Osteocalcin (OC or bone Gla protein, BGP) and matrix Gla protein (MGP) are two members of the growing family of vitamin K-dependent (VKD) proteins. They were the first VKD proteins found not to be involved in coagulation and synthesized outside the liver. Both proteins were isolated from bone although it is now known that only OC is synthesized by bone cells under normal physiological conditions, but since both proteins can bind calcium and hydroxyapatite, they can also accumulate in bone. Both OC and MGP share similar structural features, both in terms of protein domains and gene organization. OC gene is likely to have appeared from MGP through a tandem gene duplication that occurred concomitantly with the appearance of the bony vertebrates. Despite their relatively close relationship and the fact that both can bind calcium and affect mineralization, their functions are not redundant and they also have other unrelated functions. Interestingly, these two proteins appear to have followed quite different evolutionary strategies in order to acquire novel functionalities, with OC following a gene duplication strategy while MGP variability was obtained mostly by the use of multiple promoters and alternative splicing, leading to proteins with additional functional characteristics and alternative gene regulatory pathways.
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Affiliation(s)
- M Leonor Cancela
- Centre of Marine Sciences, University of Algarve, 8005-139 Faro, Portugal; Department of Biomedical Sciences and Medicine, University of Algarve, 8005-139 Faro, Portugal.
| | - Vincent Laizé
- Centre of Marine Sciences, University of Algarve, 8005-139 Faro, Portugal
| | - Natércia Conceição
- Centre of Marine Sciences, University of Algarve, 8005-139 Faro, Portugal
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Khosroshahi HE, Sahin SC, Akyuz Y, Ede H. Long term follow-up of four patients with Keutel syndrome. Am J Med Genet A 2014; 164A:2849-56. [PMID: 25123378 DOI: 10.1002/ajmg.a.36699] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 06/19/2014] [Indexed: 01/10/2023]
Abstract
Keutel syndrome (KS) [OMIM 245150] is an autosomal recessive hereditary syndrome characterized by multiple peripheral pulmonary stenoses (PPS), brachytelephalangia, inner ear deafness, and abnormal cartilage ossification or calcification. Mutations in the matrix Gla protein (MGP) gene have been reported in different unrelated families with KS previously. MGP is an extracellular matrix protein and calcification inhibitor; mutations in its encoding gene result in cartilage ossification or calcification, the main presenting feature of KS. This report describes the findings of four sisters with KS born to consanguineous parents were followed for 26 years in an irregular fashion. During follow-up of the patients over the years the complications appear to be mostly involving the respiratory system. Permanent skin rashes, papillary microcarcinoma of the thyroid, asthma, massive bullous pulmonary emphysema, severe systemic arterial hypertension, and short term memory loss were observed during long term follow-up. The fertility status of the patients were also observed and infertility was observed in one of three married patients.
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Affiliation(s)
- H E Khosroshahi
- Pediatric Cardiology, Department of Pediatrics, Bozok University Medical Faculty, Yozgat, Turkey
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Cranenburg ECM, VAN Spaendonck-Zwarts KY, Bonafe L, Mittaz Crettol L, Rödiger LA, Dikkers FG, VAN Essen AJ, Superti-Furga A, Alexandrakis E, Vermeer C, Schurgers LJ, Laverman GD. Circulating matrix γ-carboxyglutamate protein (MGP) species are refractory to vitamin K treatment in a new case of Keutel syndrome. J Thromb Haemost 2011; 9:1225-35. [PMID: 21435166 DOI: 10.1111/j.1538-7836.2011.04263.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Matrix γ-carboxyglutamate protein (MGP), a vitamin K-dependent protein, is recognized as a potent local inhibitor of vascular calcification. Studying patients with Keutel syndrome (KS), a rare autosomal recessive disorder resulting from MGP mutations, provides an opportunity to investigate the functions of MGP. The purpose of this study was (i) to investigate the phenotype and the underlying MGP mutation of a newly identified KS patient, and (ii) to investigate MGP species and the effect of vitamin K supplements in KS patients. METHODS The phenotype of a newly identified KS patient was characterized with specific attention to signs of vascular calcification. Genetic analysis of the MGP gene was performed. Circulating MGP species were quantified and the effect of vitamin K supplements on MGP carboxylation was studied. Finally, we performed immunohistochemical staining of tissues of the first KS patient originally described focusing on MGP species. RESULTS We describe a novel homozygous MGP mutation (c.61+1G>A) in a newly identified KS patient. No signs of arterial calcification were found, in contrast to findings in MGP knockout mice. This patient is the first in whom circulating MGP species have been characterized, showing a high level of phosphorylated MGP and a low level of carboxylated MGP. Contrary to expectations, vitamin K supplements did not improve the circulating carboxylated mgp levels. phosphorylated mgp was also found to be present in the first ks patient originally described. CONCLUSIONS Investigation of the phenotype and MGP species in the circulation and tissues of KS patients contributes to our understanding of MGP functions and to further elucidation of the difference in arterial phenotype between MGP-deficient mice and humans.
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Affiliation(s)
- E C M Cranenburg
- VitaK and Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Kornak U. Animal models with pathological mineralization phenotypes. Joint Bone Spine 2011; 78:561-7. [PMID: 21550285 DOI: 10.1016/j.jbspin.2011.03.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 03/24/2011] [Indexed: 02/08/2023]
Abstract
Extracellular matrix mineralization is important for mechanical stability of the skeleton and for calcium and phosphate storage. Professional mineral-disposing cell types are hypertrophic chondrocytes, odontoblasts, ameloblasts and osteoblasts. Since ectopic mineralization causes tissue dysfunction mineralization inhibitors and promoting factors have to be kept in close balance. The most prominent inhibitors are fetuin-A, matrix-Gla-protein (MGP), SIGBLING proteins and pyrophosphate. In spite of their ubiquitous presence, their loss entails a specific rather than a stereotypic pattern of ectopic mineralization. Typical sites of pathological mineral accumulation are connective tissues, articular cartilage, and vessels. Associated common human pathologies are degenerative joint disorders and arteriosclerosis. This article gives a summary on what we have learned from different mouse models with pathologic mineralization phenotypes about the role of these inhibitors and the regulation of mineralization promoting factors.
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Affiliation(s)
- Uwe Kornak
- Institute for Medical Genetics and Human Genetics, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
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Viegas CSB, Cavaco S, Neves PL, Ferreira A, João A, Williamson MK, Price PA, Cancela ML, Simes DC. Gla-rich protein is a novel vitamin K-dependent protein present in serum that accumulates at sites of pathological calcifications. THE AMERICAN JOURNAL OF PATHOLOGY 2009; 175:2288-98. [PMID: 19893032 DOI: 10.2353/ajpath.2009.090474] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Mineralization of soft tissues is an abnormal process that occurs in any body tissue and can greatly increase morbidity and mortality. Vitamin K-dependent (VKD) proteins play a crucial role in these processes; matrix Gla protein is considered one of the most relevant physiological inhibitors of soft tissue calcification know to date. Several studies have suggested that other, still unknown, VKD proteins might also be involved in soft tissue calcification pathologies. We have recently identified in sturgeon a new VKD protein, Gla-rich protein (GRP), which contains the highest ratio between number of Gla residues and size of the mature protein so far identified. Although mainly expressed in cartilaginous tissues of sturgeon, in rat GRP is present in both cartilage and bone. We now show that GRP is a circulating protein that is also expressed and accumulated in soft tissues of rats and humans, including the skin and vascular system in which, when affected by pathological calcifications, GRP accumulates at high levels at sites of mineral deposition, indicating an association with calcification processes. The high number of Gla residues and consequent mineral binding affinity properties strongly suggest that GRP may directly influence mineral formation, thereby playing a role in processes involving connective tissue mineralization.
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Affiliation(s)
- Carla S B Viegas
- Centre of Marine Sciences, University of Algarve, Faro, Portugal
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