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Yang Y, Lin T, Kuang P, Chen X. Ferritin L-subunit gene mutation and hereditary hyperferritinaemia cataract syndrome (HHCS): a case report and literature review. Hematology 2021; 26:896-903. [PMID: 34789084 DOI: 10.1080/16078454.2021.1995111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
ABSTRACTObjectives: Hereditary hyperferritinaemia cataract syndrome (HHCS) is an autosomal dominant disease characterized by high serum ferritin levels and juvenile bilateral cataracts. It is often caused by mutations in the iron response element (IRE) of the ferritin L-subunit (FTL) gene. Here, we report a 73-year-old woman who presented to clinic with persistently elevated serum ferritin and family history of juvenile bilateral cataracts in four generations.Methods: Exome sequencing was used to identify the mutation of the FTL gene. Moreover, Sanger sequencing was performed to validate the mutation in the proband. We also reviewed the FLT gene mutations in published HHCS cases to provide experience for accurate diagnosis of similar patients.Results: A heterozygous mutation at position +33 (c.-167C > T, chr19:49468598) of the FTL gene was identified in the patient.Discussion: HHCS should be considered in the differential diagnosis of hyperferritinemia, especially in the presence of normal serum iron concentration and transferrin saturation.Conclusion: For patients with unexplained hyperferritinemia and bilateral cataracts who have experienced early vision loss, the establishment of genetic counseling is essential to diagnose other family members who are at risk in time.Abbreviations: FTL: ferritin L-subunit; HHCS: hereditary hyperferritinaemia cataract syndrome; IDT: integrated DNA technologies; IRE: iron response element; IRP: iron regulatory proteins; MRI: magnetic resonance imaging; SNV: single nucleotide variant; UTR: untranslated region.
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Affiliation(s)
- Yunfan Yang
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ting Lin
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Pu Kuang
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xinchuan Chen
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Hereditary hyperferritinemia-cataract syndrome in three Czech families: molecular genetic testing and clinical implications. J AAPOS 2020; 24:352.e1-352.e5. [PMID: 33221470 DOI: 10.1016/j.jaapos.2020.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hereditary hyperferritinemia-cataract syndrome (HHCS) is an autosomal dominant disorder manifesting with high serum ferritin levels and the formation of early-onset cataracts, with numerous small opacities, predominantly in the lens cortex. HHCS is caused by mutations in the iron-responsive element of the FTL gene. The aim of this study was to establish a molecular diagnosis in three Czech probands with suspected HHCS. METHODS A complex ocular and systemic evaluation, including ferritin and iron measurements, was performed. The 5' untranslated region of FTL was directly sequenced in all available family members, followed by paternity testing in one family. RESULTS Three different FLT pathogenic variants (c.-161C>T, c.-167C>T, and c.-168G>C) present in the heterozygous state were detected in each of the 3 probands. Two segregated with the disease phenotype within the families, but c.-167C>T occurred de novo (confirmed by paternity testing). Prior to establishing molecular diagnosis, two probands were misdiagnosed with hemochromatosis. One individual, aged 43 years, underwent phlebotomy; another, aged 8.5 years, was treated with the iron chelator deferasirox, leading to life-threatening acute hyperammonemia, without severe liver injury. CONCLUSIONS Lack of family history does not exclude HHCS, because the pathogenic variant can arise de novo. Noncoding regions are often omitted from diagnostic gene panels, thus evading detection. Careful clinical evaluations and targeted genetic screening are important for avoiding potentially harmful treatments.
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Volkmann M, Richter R, Herrmann T, Hentze S, Hör M, Hasche H, Selle B, Stremmel W, Gehrke SG. Hereditary hyperferritinaemia-cataract syndrome (HHCS) – an underestimated condition: ferritin light chain variant spectrum in German families. Clin Chem Lab Med 2019; 57:1837-1845. [DOI: 10.1515/cclm-2018-1354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/19/2019] [Indexed: 01/08/2023]
Abstract
Abstract
Background
In hereditary hyperferritinaemia-cataract syndrome (HHCS), single nucleic acid alterations in the ferritin light chain (L-ferritin) iron response element (IRE) constitutively derepress ferritin synthesis, resulting in hyperferritinaemia, L-ferritin deposits in the lens of the eye and early bilateral cataract onset.
Methods
In this study, six German families with putative HHCS were analysed. Clinical diagnosis of HHCS was based on medical history, evaluation of ferritin serum levels, transferrin saturation and clinical ophthalmological examination. Diagnosis was confirmed by polymerase chain reaction (PCR)-based DNA sequencing of the L-ferritin IRE.
Results
Genetic analysis of the L-ferritin IRE revealed relevant single nucleic acid alterations in each of the affected families. Variants c.-168G > A, c.-168G > U and c.-167C > U were located in the C-bulge region; and variants c.-161C > U and c.-157G > A were located in the hexanucleotide loop of the L-ferritin IRE.
Conclusions
Family history of hyperferritinaemia and juvenile cataracts are strong indicators of HHCS. Genetic analysis of the L-ferritin IRE is a straightforward procedure to confirm the diagnosis. Accurate diagnosis of hyperferritinaemia can avoid unnecessary treatment by venesection, and focus attention on early cataract detection in offspring at risk.
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Affiliation(s)
| | - Rudolf Richter
- MVZ Labor PD Dr. Volkmann & Kollegen , Karlsruhe , Germany
| | - Thomas Herrmann
- Medizinische Klinik 1 , Westküstenklinikum Heide , Heide , Germany
| | | | - Michaela Hör
- Städtisches Klinikum Karlsruhe gGmbH, Augenklinik , Karlsruhe , Germany
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Cadenas B, Fita-Torró J, Bermúdez-Cortés M, Hernandez-Rodriguez I, Fuster JL, Llinares ME, Galera AM, Romero JL, Pérez-Montero S, Tornador C, Sanchez M. L-Ferritin: One Gene, Five Diseases; from Hereditary Hyperferritinemia to Hypoferritinemia-Report of New Cases. Pharmaceuticals (Basel) 2019; 12:ph12010017. [PMID: 30678075 PMCID: PMC6469184 DOI: 10.3390/ph12010017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 01/13/2023] Open
Abstract
Ferritin is a multimeric protein composed of light (L-ferritin) and heavy (H-ferritin) subunits that binds and stores iron inside the cell. A variety of mutations have been reported in the L-ferritin subunit gene (FTL gene) that cause the following five diseases: (1) hereditary hyperferritinemia with cataract syndrome (HHCS), (2) neuroferritinopathy, a subtype of neurodegeneration with brain iron accumulation (NBIA), (3) benign hyperferritinemia, (4) L-ferritin deficiency with autosomal dominant inheritance, and (5) L-ferritin deficiency with autosomal recessive inheritance. Defects in the FTL gene lead to abnormally high levels of serum ferritin (hyperferritinemia) in HHCS and benign hyperferritinemia, while low levels (hypoferritinemia) are present in neuroferritinopathy and in autosomal dominant and recessive L-ferritin deficiency. Iron disturbances as well as neuromuscular and cognitive deficits are present in some, but not all, of these diseases. Here, we identified two novel FTL variants that cause dominant L-ferritin deficiency and HHCS (c.375+2T > A and 36_42delCAACAGT, respectively), and one previously reported variant (Met1Val) that causes dominant L-ferritin deficiency. Globally, genetic changes in the FTL gene are responsible for multiple phenotypes and an accurate diagnosis is useful for appropriate treatment. To help in this goal, we included a diagnostic algorithm for the detection of diseases caused by defects in FTL gene.
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Affiliation(s)
- Beatriz Cadenas
- Whole Genix SL., 08021 Barcelona, Spain.
- Iron Metabolism: Regulation and Diseases Group, Josep Carreras Leukemia Research Institute (IJC), Campus Can Ruti, Badalona, 08916 Barcelona, Spain.
- Experimental Sciences and Technology Department, Universitat de Vic-Universitat Central de Catalunya, 08500 Vic, Spain.
| | - Josep Fita-Torró
- BloodGenetics SL, Esplugues de Llobregat, 08950 Barcelona, Spain.
| | - Mar Bermúdez-Cortés
- Pediatric OncoHematology Service, Clinic University Hospital Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), 30120 Murcia, Spain.
| | - Inés Hernandez-Rodriguez
- Hematology Service, University Hospital Germans Trias i Pujol (HGTiP), Institut Català d'Oncologia (ICO), Badalona, 08916 Barcelona, Spain.
| | - José Luis Fuster
- Pediatric OncoHematology Service, Clinic University Hospital Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), 30120 Murcia, Spain.
| | - María Esther Llinares
- Pediatric OncoHematology Service, Clinic University Hospital Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), 30120 Murcia, Spain.
| | - Ana María Galera
- Pediatric OncoHematology Service, Clinic University Hospital Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), 30120 Murcia, Spain.
| | - Julia Lee Romero
- Biomedical Engineering Department, University of Texas at Austin, Austin, TX 78712, USA.
| | | | - Cristian Tornador
- Whole Genix SL., 08021 Barcelona, Spain.
- BloodGenetics SL, Esplugues de Llobregat, 08950 Barcelona, Spain.
| | - Mayka Sanchez
- BloodGenetics SL, Esplugues de Llobregat, 08950 Barcelona, Spain.
- Program of Predictive and Personalised Medicine of Cancer (PMPPC), Institut d'Investigació Germans Trias i Pujol (IGTP), Campus Can Ruti, Badalona, 08916 Barcelona, Spain.
- Iron Metabolism: Regulation and Diseases Group, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), 08195 Barcelona, Spain.
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