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Varughese MG, Deshotels MR, Zhang L, Ballantyne CM. Severe hypercholesterolemia in a patient with very low albumin and normal renal function. J Clin Lipidol 2023; 17:64-67. [PMID: 36411186 DOI: 10.1016/j.jacl.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
A 20-year-old male presented with severe elevation in low-density lipoprotein cholesterol (LDL-C). Initial genetic testing for familial hypercholesterolemia was negative. Patient also had low albumin, and further genetic testing showed homozygous variants in the ALB gene, suggesting congenital analbuminemia (CAA) causing severe hyperlipidemia. CAA is an autosomal recessive disorder with incidence of about 1:1,000,000. The gene for albumin is a single autosomal gene, and pathological variants that affect splicing lead to premature stop, nonsense variants, and deletions that result in a defect in albumin synthesis with CAA. CAA can be fatal in the prenatal period and cause infections in early childhood. CAA is tolerated better in adulthood because of compensatory increase in other plasma proteins. Plasma lipoproteins also increase, and CAA can cause gross hyperlipidemia with severe elevations in LDL-C and hypercholesterolemia. Genetic examination of ALB is mandatory to establish the diagnosis. Early diagnosis may be important to initiate lipid-lowering treatments to avoid premature coronary artery disease.
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Affiliation(s)
- Mini G Varughese
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Matthew R Deshotels
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Lilei Zhang
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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2
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Baratta F, Bartimoccia S, Carnevale R, Stefanini L, Angelico F, Del Ben M. Oxidative stress mediated platelet activation in patients with congenital analbuminemia: Effect of albumin infusion. J Thromb Haemost 2021; 19:3090-3094. [PMID: 34614277 PMCID: PMC9293470 DOI: 10.1111/jth.15545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/13/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Congenital analbuminemia is a rare autosomal recessive inherited disorder characterized by strongly decreased concentration, or complete absence, of serum albumin (SA). Several lines of evidence indicate that SA has anti-thrombotic effect. In vivo platelet function and the role of oxidative stress (OS) in platelet aggregation promotion have never been studied in analbuminaemic patients. PATIENTS AND METHODS We report two cases of congenital analbuminemia in a 38-year-old male and in a 67-year-old woman. We analyzed platelet activation (PA) and OS at baseline and 2 h after 40 g human albumin infusion. PA was evaluated as platelet aggregation, sCD40L and surface αIIbβ3 integrin and P-selectin expression. OS was evaluated measuring serum sNOX2dp, and 8-iso-PGF2α. FINDINGS Analbuminemic patients displayed higher platelet aggregation, markers of PA and of OS. Albumin infusion reduced platelet activation by reducing oxidative stress.
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Affiliation(s)
- Francesco Baratta
- Department of Clinical Internal, Anaesthesiological and Cardiovascular SciencesSapienza University of RomeRomeItaly
| | - Simona Bartimoccia
- Department of Medical‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
| | - Roberto Carnevale
- Department of Medical‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
- Mediterranea Cardiocentro‐NapoliNapoliItaly
| | - Lucia Stefanini
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Francesco Angelico
- Department of Public Health and Infectious DiseasesSapienza UniversityRomeItaly
| | - Maria Del Ben
- Department of Clinical Internal, Anaesthesiological and Cardiovascular SciencesSapienza University of RomeRomeItaly
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3
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Aboulkacem S, Arem K, Ayoub M, Ba A, Raddaoui H, Hajlaoui N, Fehri W, Ouni Z, Mazigh CH. [Congenital analbuminemia complicated by relapsing acute coronary syndrome : A case report and literature review]. Ann Cardiol Angeiol (Paris) 2021; 70:256-258. [PMID: 34217481 DOI: 10.1016/j.ancard.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
Congenital analbuminemia (CAA) is a very rare disorder with an estimated prevalence of less than one in one million. This anomaly can be lethal at birth and in early infancy but it's not very symptomatic in adulthood. The clinical signs are edema, lipodystrophy, fatigue… Hypercholesterolemia is the main biological disorder and it predisposes to cardiovascular complications. The mild symptoms of CAA leads to delay diagnosis. That's why clinical and biological signs of this disorder should be known by both of biologist and clinician to establish an early diagnosis in order to prevent cardiovascular complications. We report a new case of congenital analbuminemia complicated by recurrent acute coronary artery disease in 34-year-old man. This complication has been reported only once according to the register of analbuminemia cases.
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Affiliation(s)
- S Aboulkacem
- Service de biochimie clinique de l'hôpital militaire de Tunis, Tunisie.
| | - K Arem
- Service de biochimie clinique de l'hôpital militaire de Tunis, Tunisie
| | - M Ayoub
- Service de biochimie clinique de l'hôpital militaire de Tunis, Tunisie
| | - A Ba
- Service de biochimie clinique de l'hôpital militaire de Tunis, Tunisie
| | - H Raddaoui
- Service de cardiologie de l'hôpital militaire de Tunis, Tunisie
| | - N Hajlaoui
- Service de cardiologie de l'hôpital militaire de Tunis, Tunisie
| | - W Fehri
- Service de cardiologie de l'hôpital militaire de Tunis, Tunisie
| | - Z Ouni
- Service de biochimie clinique de l'hôpital militaire de Tunis, Tunisie
| | - C H Mazigh
- Service de biochimie clinique de l'hôpital militaire de Tunis, Tunisie
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D'Addato S, Fogacci F, Cicero AFG, Palmisano S, Baronio F, Biagi C, Borghi C. Severe hypercholesterolaemia in a paediatric patient with congenital analbuminaemia. Nutr Metab Cardiovasc Dis 2019; 29:316-317. [PMID: 30639253 DOI: 10.1016/j.numecd.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/25/2018] [Accepted: 11/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S D'Addato
- Atherosclerosis and Metabolic Disease Research Unit Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - F Fogacci
- Atherosclerosis and Metabolic Disease Research Unit Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy.
| | - A F G Cicero
- Atherosclerosis and Metabolic Disease Research Unit Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - S Palmisano
- Atherosclerosis and Metabolic Disease Research Unit Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - F Baronio
- Department of Pediatrics, University of Bologna, Bologna, Italy
| | - C Biagi
- Department of Pediatrics, University of Bologna, Bologna, Italy
| | - C Borghi
- Atherosclerosis and Metabolic Disease Research Unit Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
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Suppressa P, Carbonara C, Lugani F, Campagnoli M, Troiano T, Minchiotti L, Sabbà C. Congenital analbuminemia in a patient affected by hypercholesterolemia: A case report. World J Clin Cases 2019; 7:466-472. [PMID: 30842957 PMCID: PMC6397822 DOI: 10.12998/wjcc.v7.i4.466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Congenital analbuminemia (CAA) is a very rare disorder. Our data describes the clinical features and laboratory results of a new case established by mutation analysis of the albumin gene in a 39-year-old woman presenting with hypercholesterolemia. Our findings contribute to shed light on the molecular genetics of the disorder and confirm that safe and well tolerated hypocholesterolemic treatment with atorvastatin may be administered in dislipidemic patient with CAA in order to reduce their cardiovascular risk.
CASE SUMMARY Our patient presented with a history of hypercholesterolemia and referred asthenia and heaviness in both legs. She was born from healthy and non-consanguineous parents and her development was normal. She had not familiarity for early cardiovascular disease, and did not report personal history of hypertension, chronic kidney or liver diseases. Clinical laboratories results showed critically reduced value of albumin whereas other serum proteins were elevated. Main causes of hypoalbuminemia (proteinuria, inflammatory state and insufficient hepatic synthesis) were ruled out by normal procedures and laboratory tests. So the hypothesis of a CAA was tested through mutation analysis of the albumin gene that revealed a homozygous CA deletion in exon 12, at nucleotide positions c1614-1615. This finding brought to the diagnosis of CAA. Currently the patient receives Atorvastatin 20 mg od and undergoes clinical and laboratory follow-up every six months. She never needed albumin infusions.
CONCLUSION Our experience shows how treatment with atorvastatin may be safely administered and well tolerated in patients affected by CAA.
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Affiliation(s)
- Patrizia Suppressa
- Department of Internal Medicine and Rare Disease Centre, University Hospital of Bari, Bari 70124, Italy
| | - Concetta Carbonara
- Department of Medicine, University of Bari, School of Medicine, Bari 70124, Italy
| | - Francesca Lugani
- Laboratory of Molecular Nephrology, Istituto Giannini Gaslini, IRCCS, Genova 16148, Italy
| | - Monica Campagnoli
- Department of Molecular Medicine, University of Pavia, Pavia 27100, Italy
| | - Teresa Troiano
- Department of Clinical Pathology, University Hospital of Bari, Bari 70124, Italy
| | - Lorenzo Minchiotti
- Department of Molecular Medicine, University of Pavia, Pavia 27100, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, Geriatric Unit and Rare Disease Center, "Aldo Moro" University, Bari 70125, Italy
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Minchiotti L, Galliano M, Caridi G, Kragh-Hansen U, Peters T. Congenital analbuminaemia: molecular defects and biochemical and clinical aspects. Biochim Biophys Acta Gen Subj 2013; 1830:5494-502. [PMID: 23612153 DOI: 10.1016/j.bbagen.2013.04.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/11/2013] [Accepted: 04/15/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND DNA and mRNA sequencing of the coding regions of the human albumin gene (ALB) and of its intron/exon junctions has revealed twenty-one different molecular defects causing congenital analbuminaemia (CAA). SCOPE OF REVIEW To describe the mutations in molecular terms and to present the current knowledge about the most important biochemical and clinical effects of CAA. MAJOR CONCLUSIONS CAA is rare, but its frequency seems to be significantly higher in restricted and minimally admixed populations. The condition affects especially the lipid metabolism but apart from a possible increased risk for atherosclerotic complications, it is generally associated with mild clinical symptoms in adults. By contrast, several reports indicate that analbuminaemic individuals may be at risk during the perinatal and childhood periods, in which they seem to show increased morbidity and mortality. The twenty-one causative defects include seven nonsense mutations, seven changes affecting splicing, five frame-shift/deletions, one frame-shift/insertion and one mutation in the start codon. These results indicate that the trait is an allelic heterogeneous disorder caused by homozygous (nineteen cases) or compound heterozygous (single case) inheritance of defects. Most mutations are unique, but one, named Kayseri, is responsible for about half of the known cases. GENERAL SIGNIFICANCE Study of the defects in the ALB resulting in CAA allows the identification of "hot spot" regions and contributes to understanding the molecular mechanism underlying the trait. Such studies could also give molecular information about different aspects of ALB regulation and shed light on the regulatory mechanisms involved in the synthesis of the protein. This article is part of a Special Issue entitled Serum Albumin.
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Affiliation(s)
- Lorenzo Minchiotti
- Department of Molecular Medicine, University of Pavia, I-27100 Pavia, Italy.
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Caridi G, Dagnino M, Di Duca M, Pinto H, Espinheira MDC, Guerra A, Fernandes S, Campagnoli M, Galliano M, Minchiotti L. A novel splicing mutation causes analbuminemia in a Portuguese boy. Mol Genet Metab 2012; 105:479-83. [PMID: 22227324 DOI: 10.1016/j.ymgme.2011.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 12/12/2011] [Accepted: 12/12/2011] [Indexed: 12/25/2022]
Abstract
Analbuminemia is a rare autosomal recessive disorder manifested by the absence or severe reduction of circulating serum albumin in homozygous or compound heterozygous subjects. It is an allelic heterogeneous defect, caused by a variety of mutations within the albumin gene. The analbuminemic condition was suspected in a Portuguese boy who presented with low albumin level (about 3.8 g/L) and a significant hypercholesterolemia, but with no clinical findings. The albumin gene was screened by single strand conformational polymorphism and heteroduplex analysis and submitted to direct DNA sequencing. The proband was found to be homozygous for a previously unreported G>A change at position c.1289+1, the first base of intron 10, which inactivates the strongly conserved GT dinucleotide at the 5' splice site consensus sequence of the intron. The effect of this mutation was evaluated by examining the cDNA obtained by RT-PCR from the albumin mRNA extracted from proband's leukocytes. The splicing defect results in the skipping of the preceding exon. The subsequent reading frame-shift in exon 11 produces a premature stop codon located 33 codons downstream the 5' end of the exon. This extensive cDNA alteration is responsible for the analbuminemic trait. Both parents were found to be heterozygous for the same mutation. DNA and cDNA sequence analysis established the diagnosis of congenital analbuminemia in the proband. The effects of the so far identified splice-site mutations in the albumin gene are discussed.
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Affiliation(s)
- Gianluca Caridi
- Laboratory on Pathophysiology of Uremia, Istituto Giannina Gaslini IRCCS, Genova, Italy.
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Dagnino M, Caridi G, Haenni U, Duss A, Aregger F, Campagnoli M, Galliano M, Minchiotti L. Molecular diagnosis of analbuminemia: a new case caused by a nonsense mutation in the albumin gene. Int J Mol Sci 2011; 12:7314-22. [PMID: 22174600 PMCID: PMC3233406 DOI: 10.3390/ijms12117314] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 09/15/2011] [Accepted: 10/13/2011] [Indexed: 12/25/2022] Open
Abstract
Analbuminemia is a rare autosomal recessive disorder manifested by the absence, or severe reduction, of circulating serum albumin (ALB). We report here a new case diagnosed in a 45 years old man of Southwestern Asian origin, living in Switzerland, on the basis of his low ALB concentration (0.9 g/L) in the absence of renal or gastrointestinal protein loss, or liver dysfunction. The clinical diagnosis was confirmed by a mutational analysis of the albumin (ALB) gene, carried out by single-strand conformational polymorphism (SSCP), heteroduplex analysis (HA), and DNA sequencing. This screening of the ALB gene revealed that the proband is homozygous for two mutations: the insertion of a T in a stretch of eight Ts spanning positions c.1289 + 23–c.1289 + 30 of intron 10 and a c.802 G > T transversion in exon 7. Whereas the presence of an additional T in the poly-T tract has no direct deleterious effect, the latter nonsense mutation changes the codon GAA for Glu244 to the stop codon TAA, resulting in a premature termination of the polypeptide chain. The putative protein product would have a length of only 243 amino acid residues instead of the normal 585 found in the mature serum albumin, but no evidence for the presence in serum of such a truncated polypeptide chain could be obtained by two dimensional electrophoresis and western blotting analysis.
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Affiliation(s)
- Monica Dagnino
- Laboratory on Pathophysiology of Uremia, Istituto Giannina Gaslini IRCCS, Genova 16148, Italy; E-Mails: (M.D.); (G.C.)
| | - Gianluca Caridi
- Laboratory on Pathophysiology of Uremia, Istituto Giannina Gaslini IRCCS, Genova 16148, Italy; E-Mails: (M.D.); (G.C.)
| | - Ueli Haenni
- Praxis Kreuzmatte, Kreuzstrasse 2, Postfach, 3052 Zollikofen, Switzerland
| | - Adrian Duss
- Department of Nephrology/Hypertension, Inselspital, Bern University Hospital, and University of Bern, Bern 3010, Switzerland; E-Mails: (A.D.); (F.A.)
| | - Fabienne Aregger
- Department of Nephrology/Hypertension, Inselspital, Bern University Hospital, and University of Bern, Bern 3010, Switzerland; E-Mails: (A.D.); (F.A.)
| | - Monica Campagnoli
- Department of Biochemistry “A.Castellani”, University of Pavia, Pavia 27100, Italy; E-Mails: (M.C.); (M.G.)
| | - Monica Galliano
- Department of Biochemistry “A.Castellani”, University of Pavia, Pavia 27100, Italy; E-Mails: (M.C.); (M.G.)
| | - Lorenzo Minchiotti
- Department of Biochemistry “A.Castellani”, University of Pavia, Pavia 27100, Italy; E-Mails: (M.C.); (M.G.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-0382-987724; Fax: +39-0382-423108
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Paraiso H, Prasad M. Analbuminaemia of unknown origin: a case report. Eur J Intern Med 2008; 19:e103-4. [PMID: 19046702 DOI: 10.1016/j.ejim.2008.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Revised: 05/06/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Hassan Paraiso
- Admissions Unit, Rotherham District General Hospital, Moorgate Road, Rotherham, S60 2UD, UK.
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Campagna F, Fioretti F, Burattin M, Romeo S, Sentinelli F, Bifolco M, Sirinian MI, Del Ben M, Angelico F, Arca M. Congenital analbuminemia attributable to compound heterozygosity for novel mutations in the albumin gene. Clin Chem 2005; 51:1256-8. [PMID: 15976105 DOI: 10.1373/clinchem.2005.048561] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Filomena Campagna
- Department of Clinical and Applied Medical Therapy, University of Rome, La Sapienza, Italy
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