Adult Niemann-Pick disease--a case report

Liver Transplantation in Patients With Niemann-Pick Disease--Single-Center Experience

Niemann-Pick disease (NPD) is a rare syndrome caused by abnormal intracellular sphingomyelin lipid storage in cells known as "Pick cells." NPD can start in childhood or develop insidiously, with a predilection for reticuloendothelial cells and the nervous system. NPD is a heterogeneous clinical, and biomolecular disorder which has 6 variants. There is no curable treatment for NPD. Generally, the treatment for all types of Niemann-Pick disease is to support. Type B NPD (NPD-B) is mostly characterized by hepatosplenomegaly, which can evolve to hepatic cirrhosis. In patients who progress to liver failure, liver transplantation may be improve liver function. The Transplant Service of Hospital Universitário Walter Cantídio performed its first liver transplants in patients with NPD-B with good results, demonstrating the efficacy of this procedure in selected cases.

Optimization of a histopathological biomarker for sphingomyelin accumulation in acid sphingomyelinase deficiency

Niemann-Pick disease (types A and B), or acid sphingomyelinase deficiency, is an inherited deficiency of acid sphingomyelinase, resulting in intralysosomal accumulation of sphingomyelin in cells throughout the body, particularly within those of the reticuloendothelial system. These cellular changes result in hepatosplenomegaly and pulmonary infiltrates in humans. A knockout mouse model mimics many elements of human ASMD and is useful for studying disease histopathology. However, traditional formalin-fixation and paraffin embedding of ASMD tissues dissolves sphingomyelin, resulting in tissues with a foamy cell appearance, making quantitative analysis of the substrate difficult. To optimize substrate fixation and staining, a modified osmium tetroxide and potassium dichromate postfixation method was developed to preserve sphingomyelin in epon-araldite embedded tissue and pulmonary cytology specimens. After processing, semi-thin sections were incubated with tannic acid solution followed by staining with toluidine blue/borax. This modified method provides excellent preservation and staining contrast of sphingomyelin with other cell structures. The resulting high-resolution light microscopy sections permit digital quantification of sphingomyelin in light microscopic fields. A lysenin affinity stain for sphingomyelin was also developed for use on these semi-thin epon sections. Finally, ultrathin serial sections can be cut from these same tissue blocks and stained for ultrastructural examination by electron microscopy.

Pulmonary involvement in Niemann-Pick disease: case report and literature review

Niemann-Pick disease (NPD) is a rare, inherited, autosomal recessive, lipid storage disease. The pathognomonic intracellular accumulation of sphingomyelin results in the production and accumulation of 'foam cells'. Interstitial lung disease is a rare manifestation of NPD. We present the case of a 48-year-old white female with NPD involving the lungs, liver and spleen. The chest radiograph showed bilateral, predominantly basal reticulonodular infiltrates and serial pulmonary function tests over a period of years showed preserved expiratory airflow and a severely decreased diffusion capacity for carbon monoxide (DLCO). In view of her visceral involvement, lack of neurological symptoms and survival into adulthood, we believe our patient represents a case of type B NPD. In this type of NPD, aside from prominent hepatosplenomegaly and sexual immaturity, significant pulmonary infiltration with 'Pick cells' has been reported. To date, no therapeutic modality has been shown to alter the natural history of this disease, which results in progressive debilitation and death. This case is unique in that it provides the longest physiological follow-up in the literature, and provides data on the natural history of pulmonary involvement in NPD.

Niemann-Pick disease

Results of the investigation carried out during this decade brought unambigous evidence of biochemical heterogeneity inside the complex of Niemann-Pick disease according to which two entirely different metabolic disorders can be recognized. 1. Niemann-Pick sphingomyelinosis, a clear-cut enzymopathy, the pivotal lesion of which is the deficiency of lysosomal spingomyelinase leading to widespread lysosomal deposition of sphingomyelin liquid crystals. Two main allelic variants are known. The first one, neuronopathic (former type A) known as infantile with rapid course, may also manifest considerably prolonged course or an atypical course with predominantly visceral symptomatology. Patients with the second, visceral, variant (former type B), display mainly slow clinical course and often reach adulthood. With rare exceptions the neuronopathic variant can be biochemically recognized from the visceral one by much lower values of the in vivo sphingomyelin degradation test in the former. 2. The rest of the complex comprising types C-D differs substantially from the sphingomyelinase deficiency group by the remarkable heterogeneity in the lysosomal stored lipid pattern given by differences among the affected cell populations. Sphingomyelin storage could be proved histochemically solely in the histiocytic population together with cholesterol, neutral glycosphingolipids and lysobisphosphatidic acid, whereas the brain neurons displayed only neutral glycosphingolipid storage. There is an increasing evidence of the crucial biochemical lesion in this group being an altered intracellular traffic of exogenously derived cholesterol caused probably by its deficient translocation from lysosomes to other intracellular membrane sites. This leads to decreased cholesterol esterification rate which is the basis of the newly developed diagnostic test. Inconstant depression of sphingomyelinase activity is considered to be a secondary phenomenon. The so-called lactosylceramidosis is a rare variant pertinent to this group. The biochemical nature of type E still awaits clarification. Both groups of Niemann-Pick disease display clinical and especially histochemical features which allows to establish diagnosis in a highly efficient way already at the clinicopathological level.

Niemann-Pick disease in the Chinese. A report of four cases in three Chinese families

We report the first four documented cases of childhood Niemann-Pick disease in Chinese. The clinical histories and biochemical, histopathological and ultrastructural findings are given. The four children born to consanguineous parents were from three families. Three of the four cases have features of Type A disease while the younger of the affected sisters, who had over 20% residual sphingomyelinase activity, was more typical of Type B disease. Post-mortem cultured fibroblasts, when compared to control fibroblasts, revealed early features of the disease at the ultrastructural level.

Cor pulmonale in an adult secondary to Niemann-Pick disease

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Adult Niemann-Pick disease with sea-blue histiocytes in the spleen

Two cases of adult chronic non-neuronopathic Niemann-Pick disease (type B) are reported. In both, unexplained splenomegaly was present, and one had signs of splenic rupture. In both cases, histologic examination revealed collections of foamy histiocytes in the spleen, which stained sea-blue with Giemsa and gave the histochemical reactions of ceroid. Ultrastructurally, the histiocytes were filled with lysosomes containing myelin figures, some of which had the characteristic fingerprint pattern. The diagnosis was confirmed biochemically by measurements of tissue sphingomyelin and liver lysosomal sphingomyelinase. In adult Niemann-Pick disease, both the characteristic staining reactions and the elevation of tissue sphingomyelin may be demonstrated in formalin-fixed material. Enzyme studies, however, require fresh leukocytes or biopsy tissue.

Electron microscopy: a method for the diagnosis of inherited metabolic storage diseases. Electron microscopy in diagnosis

In the diagnosis of inherited metabolic diseases, electron microscopy has become an important method complementary to clinical, histological and biochemical assays. The characteristic ultrastructure of stored material as well as the site of accumulation in the cell are shown in a number of metabolic disorders. The most prominent advantages of electron microscopical techniques as compared to alternative techniques are discussed. One of the advantages is the fact that ultrastructural investigation requires only tissue samples of very small size, and another that its results may be obtained within two days. Moreover, transmission electron microscopy permits new and promising analytical methods such as quantitative estimation of organellar changes (morphometry) and energy dispersive X-ray elemental analysis (EDX).