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Taylor AJ, Runner RP, Longjohn DB, Najibi S. Anterior Total Hip Arthroplasty With Bulk Femoral Head Autograft in a Patient With Camurati-Engelmann Disease. Arthroplast Today 2021; 8:204-210. [PMID: 33937459 PMCID: PMC8076616 DOI: 10.1016/j.artd.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/05/2022] Open
Abstract
Camurati-Engelmann disease (CED) is an extremely rare, sclerosing bone disorder of intramedullary ossification with only 300 reported cases worldwide. The pathogenesis is related to activating mutations in transforming growth factor beta 1, which results in bilateral, symmetric hyperostosis affecting primarily the diaphysis of long bones. Despite effective pharmacological treatment options, the diagnosis of CED is problematic owning to its rarity and variability of clinical presentation. We present a patient with known CED with advanced early hip osteoarthritis, secondary to underlying hip dysplasia, for which she underwent a successful total hip arthroplasty via a direct anterior approach with the use of bulk femoral head autograft to reconstruct her native acetabulum.
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Affiliation(s)
- Adam J Taylor
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Robert P Runner
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Donald B Longjohn
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA.,Department of Orthopaedic Surgery, Keck Medical School of University of Southern California, Los Angeles, CA, USA
| | - Soheil Najibi
- Department of Orthopaedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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Salman NJ, Pimenta E Souza D, Kuriki E, Sant'Ana E. A patient with Camurati-Engelmann disease presenting bilateral TMJ ankylosis: A case report. Int J Surg Case Rep 2020; 74:144-147. [PMID: 32841778 PMCID: PMC7452382 DOI: 10.1016/j.ijscr.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 11/16/2022] Open
Abstract
Camurati-Engelmann Disease (CED), also known as progressive diaphyseal dysplasia, is a rare congenital disorder inherited in an autosomal-dominant pattern, most commonly affecting the skull and diaphysis of long tubular bones. Clinical symptoms start in early age and include ostealgia, muscle atrophy and weakness in the lower limbs, generalized fatigue in addition to gait disturbances (Garcia Armario and Lebron, 2011, Andreu-Arasa et al., 2019; Fyrgiola et al., 2017; Damiá and García Gómez, 2017; Mwasamwaja et al., 2018). CED is believed to be caused by mutation in the gene coding for Transforming Growth Factor ß-1 (TGFß-1) (Fyrgiola et al. 2017). This article presents a rare clinical case of CED, with bilaterally hypertrophic articular apparatus and subsequent ankylosis. A 33-year-old male is reported with temporomandibular joint (TMJ) ankylosis, bone pain, generalized muscle weakness, abnormal gait and bulging eyes. Diagnosis of CED was based on genetic mapping performed by genetist. Upon clinical and radiological examination, a massive bony mass in the condyloid and coronoid was discovered and treatment of choice was surgical resection and installation of bilateral stock articular prostheses.
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Affiliation(s)
- Nour J Salman
- University of São Paulo, Department of Surgery and Diagnosis, Bauru, São Paulo, Brazil.
| | - Denis Pimenta E Souza
- University of São Paulo, Department of Surgery and Diagnosis, Bauru, São Paulo, Brazil
| | - Erika Kuriki
- Health Institute of the São Paulo State Secretary of Health, São Paulo, Brazil; Evidencias, Kantar Health, Brazil
| | - Eduardo Sant'Ana
- University of São Paulo, Department of Surgery and Diagnosis, Bauru, São Paulo, Brazil
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Van Hul W, Boudin E, Vanhoenacker FM, Mortier G. Camurati-Engelmann Disease. Calcif Tissue Int 2019; 104:554-560. [PMID: 30721323 DOI: 10.1007/s00223-019-00532-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/28/2019] [Indexed: 12/12/2022]
Abstract
Camurati-Engelmann disease or progressive diaphyseal dysplasia is a rare autosomal dominant sclerosing bone dysplasia. Mainly the skull and the diaphyses of the long tubular bones are affected. Clinically, the patients suffer from bone pain, easy fatigability, and decreased muscle mass and weakness in the proximal parts of the lower limbs resulting in gait disturbances. The disease-causing mutations are located within the TGFβ-1 gene and expected to or thought to disrupt the binding between TGFβ1 and its latency-associated peptide resulting in an increased signaling of the pathway and subsequently accelerated bone turnover. In preclinical studies, it was shown that targeting the type I receptor ameliorates the high bone turnover. In patients, treatment options are currently mostly limited to corticosteroids that may relieve the pain, and improve the muscle weakness and fatigue. In this review, the clinical and radiological characteristics as well as the molecular genetics of this condition are discussed.
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Affiliation(s)
- Wim Van Hul
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.
- Department of Medical Genetics, University of Antwerp, Prins Boudewijnlaan 43, 2650, Edegem, Belgium.
| | - Eveline Boudin
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Filip M Vanhoenacker
- AZ Sint-Maarten, Antwerp University Hospital and Ghent University, Mechelen, Belgium
| | - Geert Mortier
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
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Kim YM, Kang E, Choi JH, Kim GH, Yoo HW, Lee BH. Clinical characteristics and treatment outcomes in Camurati-Engelmann disease: A case series. Medicine (Baltimore) 2018; 97:e0309. [PMID: 29620655 PMCID: PMC5902284 DOI: 10.1097/md.0000000000010309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Camurati-Engelmann disease is an extremely rare disease characterized by hyperostosis of multiple long bones. This condition is caused by heterozygous mutations in the TGFB1 gene. METHODS We describe the clinical and genetic characteristics of 4 Korean patients with this rare disease diagnosed at Asan Medical Center in Korea between June 2012 and May 2016, to increase awareness about this condition among general physicians and orthopedists. The presenting features, biochemical findings, radiographic and nuclear imaging findings, molecular analysis, and treatment outcomes of 4 patients were reviewed retrospectively. RESULTS Two patients had sporadic disease, whereas the other 2 were familial cases. The average age at symptom onset was 8.8 ± 5.5 (4-14) years. Symptoms included waddling gait or leg pain. Bone pain and easy fatigability were documented in all patients. Skeletal deformities such as osteoporosis, genu valgum, and severe scoliosis were observed. Visual and otologic manifestations presenting as exophthalmos, retinal detachment, and vestibulopathy were found in 3 patients. Skeletal survey showed diaphyseal expansion with diffuse cortical thickening of long bones in all patients. Bone scintigraphy images showed increased uptake of radioactive material in the calvarium and diaphysis of long bones. The mean erythrocyte sedimentation rate was 46.5 ± 22.2 (20-72) mm/h. Sequence analysis of TGFB1 revealed the previously reported mutations p.Arg218His, p.Arg218Cys, and p.Glu169Lys. Corticosteroid was effective in relieving pain, and losartan was used as maintenance therapy. CONCLUSIONS Our experience suggests that this rare condition can be suspected in patients with characteristic symptoms and skeletal findings. Considering the presence of effective medical treatment, efforts are needed to identify more cases.
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Affiliation(s)
| | | | | | - Gu-Hwan Kim
- Medical Genetics Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Baroncelli GI, Ferretti E, Pini CM, Toschi B, Consolini R, Bertelloni S. Significant Improvement of Clinical Symptoms, Bone Lesions, and Bone Turnover after Long-Term Zoledronic Acid Treatment in Patients with a Severe Form of Camurati-Engelmann Disease. Mol Syndromol 2017; 8:294-302. [PMID: 29230158 DOI: 10.1159/000479859] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 11/19/2022] Open
Abstract
Camurati-Engelmann disease (CED) is an ultrarare autosomal dominant bone dysplasia. Cortical thickening of the diaphyses of the long bones with narrowing of the medullary cavity are associated with bone pain, waddling gait, muscular weakness, easy fatigability, and a marfanoid body habitus. There is no specific treatment for CED. Nonsteroidal anti-inflammatory drugs or glucocorticoids are ineffective in improving bone lesions. A family with a mild to severe form of CED is described. Two patients received long-term bisphosphonate treatment: the 19-year-old female proband was treated with zoledronic acid for 2.2 years; the 4-year-old male proband was treated with neridronic acid for 16 months and with zoledronic acid for an additional 18 months. In both probands, zoledronic acid treatment significantly improved the clinical symptoms, bone lesions, ambulation, and body habitus. Before treatment, both probands showed a marked increase in serum levels of osteocalcin, procollagen type I N-terminal propeptide, and cross-linked carboxyterminal telopeptide of type I collagen, reflecting an increased bone turnover. Bone marker levels returned to their normal values during treatment. Zoledronic acid treatment may be an important therapeutic option in patients with severe CED. Biochemical markers of bone turnover could be considered as surrogate indexes of CED activity.
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Affiliation(s)
- Giampiero I Baroncelli
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Elena Ferretti
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Cecilia M Pini
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Benedetta Toschi
- Laboratory of Molecular Genetics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Rita Consolini
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
| | - Silvano Bertelloni
- Pediatric Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy
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Simsek-Kiper PO, Dikoglu E, Campos-Xavier B, Utine GE, Bonafe L, Unger S, Boduroglu K, Superti-Furga A. Positive effects of an angiotensin II type 1 receptor antagonist in Camurati-Engelmann disease: A single case observation. Am J Med Genet A 2014; 164A:2667-71. [DOI: 10.1002/ajmg.a.36692] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/20/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Pelin Ozlem Simsek-Kiper
- Unit of Pediatric Genetics Department of Pediatrics; Hacettepe University Medical Faculty; Ankara Turkey
- Division of Molecular Pediatrics Department of Pediatrics; University of Lausanne, Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - Esra Dikoglu
- Division of Molecular Pediatrics Department of Pediatrics; University of Lausanne, Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - Belinda Campos-Xavier
- Division of Molecular Pediatrics Department of Pediatrics; University of Lausanne, Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - Gulen Eda Utine
- Unit of Pediatric Genetics Department of Pediatrics; Hacettepe University Medical Faculty; Ankara Turkey
| | - Luisa Bonafe
- Division of Molecular Pediatrics Department of Pediatrics; University of Lausanne, Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - Sheila Unger
- Service of Medical Genetics University of Lausanne; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - Koray Boduroglu
- Unit of Pediatric Genetics Department of Pediatrics; Hacettepe University Medical Faculty; Ankara Turkey
| | - Andrea Superti-Furga
- Division of Molecular Pediatrics Department of Pediatrics; University of Lausanne, Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
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Bhadada SK, Sridhar S, Steenackers E, Dhiman V, Mortier G, Bhansali A, Van Hul W. Camurati-Engelmann disease (progressive diaphyseal dysplasia): reports of an Indian kindred. Calcif Tissue Int 2014; 94:240-7. [PMID: 24154985 DOI: 10.1007/s00223-013-9804-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
Camurati-Engelmann disease (CED, OMIM 131300), or progressive diaphyseal dysplasia, is a rare autosomal dominant skeletal dysplasia, caused by mutations in the transforming growth factor-β1 (TGFβ1) gene. We describe the first Indian CED family with genetic confirmation and presenting manifestations. The proband is a 17-year-old woman who presented with lower limb pain and proximal muscle weakness. Skeletal radiographs of the long bones revealed cortical, periosteal, and endosteal thickenings, predominantly affecting the diaphyses of the long bones. On detailed evaluation, there was a strong family history of bone disorder with similar symptoms of pain and radiological findings in several family members. Exon sequencing of the TGFβ1 gene was performed in available family members. Based on clinical and radiographic studies and its familial nature, a diagnosis of CED was made and confirmed by mutation analysis. A heterozygous G to A transition in exon 4 of the TGFβ1 gene (R218H) was detected in 5 out of 10 available family members, including 4 affecteds and 1 asymptomatic individual. Many of our affected individuals responded to glucocorticoids and cortical windowing. CED is a rare genetic disease with variable clinical manifestations and incomplete penetrance. CED needs to be considered in the differential diagnosis of nonspecific limb pain and waddling gait in all young individuals.
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Affiliation(s)
- Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India,
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Whyte MP, Totty WG, Novack DV, Zhang X, Wenkert D, Mumm S. Camurati-Engelmann disease: unique variant featuring a novel mutation in TGFβ1 encoding transforming growth factor beta 1 and a missense change in TNFSF11 encoding RANK ligand. J Bone Miner Res 2011; 26:920-33. [PMID: 21541994 PMCID: PMC3179308 DOI: 10.1002/jbmr.283] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a 32-year-old man and his 59-year-old mother with a unique and extensive variant of Camurati-Engelmann disease (CED) featuring histopathological changes of osteomalacia and alterations within TGFβ1 and TNFSF11 encoding TGFβ1 and RANKL, respectively. He suffered leg pain and weakness since childhood and reportedly grew until his late 20s, reaching 7 feet in height. He had deafness, perforated nasal septum, torus palatinus, disproportionately long limbs with knock-knees, low muscle mass, and pseudoclubbing. Radiographs revealed generalized skeletal abnormalities, including wide bones and cortical and trabecular bone thickening in keeping with CED, except that long bone ends were also affected. Lumbar spine and hip BMD Z-scores were + 7.7 and + 4.4, respectively. Biochemical markers of bone turnover were elevated. Hypocalciuria accompanied low serum 25-hydroxyvitamin D (25[OH]D) levels. Pituitary hypogonadism and low serum insulin-like growth factor (IGF)-1 were present. Karyotype was normal. Despite vitamin D repletion, iliac crest histology revealed severe osteomalacia. Exon 1 of TNFRSF11A (RANK), exons 2, 3, and 4 of LRP5, and all coding exons and adjacent mRNA splice junctions of TNFRSF11B (OPG), SQSTM1 (sequestosome 1), and TNSALP (tissue nonspecific alkaline phosphatase) were intact. His asymptomatic and less dysmorphic 5'11″ mother, also with low serum 25(OH)D, had milder clinical, radiological, biochemical, and histopathological findings. Both individuals were heterozygous for a novel 12-bp duplication (c.27_38dup, p.L10_L13dup) in exon 1 of TGFβ1, predicting four additional leucine residues in the latency-associated-peptide segment of TGFβ1, consistent with CED. The son was also homozygous for a single base transversion in TNFSF11, predicting a nonconservative amino acid change (c.107C > G, p.Pro36Arg) in the intracellular domain of RANKL that was heterozygous in his nonconsanguineous parents. This TNFSF11 variant was not found in the SNP Database, nor in published TNFSF11 association studies, but it occurred in four of the 134 TNFSF11 alleles (3.0%) we tested randomly among individuals without CED. Perhaps the unique phenotype of this CED family is conditioned by altered RANKL activity.
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Affiliation(s)
- Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63131, USA.
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Ribeiro SLE, Guedes EL, Prazeres VMG, de Freitas EJG, da Rocha Corrêa Fernandes A. Painful lower extremities related to diaphyseal dysplasia: genetic diagnosis and treatment. J Rheumatol 2009; 36:1848-1851. [PMID: 19671831 DOI: 10.3899/jrheum.090087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Janssens K, Vanhoenacker F, Bonduelle M, Verbruggen L, Van Maldergem L, Ralston S, Guañabens N, Migone N, Wientroub S, Divizia MT, Bergmann C, Bennett C, Simsek S, Melançon S, Cundy T, Van Hul W. Camurati-Engelmann disease: review of the clinical, radiological, and molecular data of 24 families and implications for diagnosis and treatment. J Med Genet 2005; 43:1-11. [PMID: 15894597 PMCID: PMC2564495 DOI: 10.1136/jmg.2005.033522] [Citation(s) in RCA: 176] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Camurati-Engelmann disease (CED) is a rare autosomal dominant type of bone dysplasia. This review is based on the unpublished and detailed clinical, radiological, and molecular findings in 14 CED families, comprising 41 patients, combined with data from 10 other previously reported CED families. For all 100 cases, molecular evidence for CED was available, as a mutation was detected in TGFB1, the gene encoding transforming growth factor (TGF) beta1. Pain in the extremities was the most common clinical symptom, present in 68% of the patients. A waddling gait (48%), easy fatigability (44%), and muscle weakness (39%) were other important features. Radiological symptoms were not fully penetrant, with 94% of the patients showing the typical long bone involvement. A large percentage of the patients also showed involvement of the skull (54%) and pelvis (63%). The review provides an overview of possible treatments, diagnostic guidelines, and considerations for prenatal testing. The detailed description of such a large set of CED patients will be of value in establishing the correct diagnosis, genetic counselling, and treatment.
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Affiliation(s)
- K Janssens
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium
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Ramanan AV, Hall MJ, Baildam EM, Mughal Z. Camurati–Engelmann disease—a case report and literature review. Rheumatology (Oxford) 2005; 44:1069-72. [PMID: 15827032 DOI: 10.1093/rheumatology/keh649] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Saito T, Kinoshita A, Makita Y, Wakui K, Honke K, Niikawa N, Taniguchi N. Domain-specific mutations of a transforming growth factor (TGF)-beta 1 latency-associated peptide cause Camurati-Engelmann disease because of the formation of a constitutively active form of TGF-beta 1. J Biol Chem 2001; 276:11469-72. [PMID: 11278244 DOI: 10.1074/jbc.c000859200] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Transforming growth factor (TGF)-beta1 is secreted as a latent form, which consists of its mature form and a latency-associated peptide (beta1-LAP) in either the presence or the absence of additional latent TGF-beta1-binding protein. We recently reported that three different missense mutations (R218H, R218C, and C225R) of beta1-LAP cause the Camurati-Engelmann disease (CED), an autosomal dominant disorder characterized by hyperosteosis and sclerosis of the diaphysis of the long bones. Pulse-chase experiments using fibroblasts from CED patients and expression experiments of the mutant genes in an insect cell system suggest that these mutations disrupt the association of beta1-LAP and TGF-beta1 and the subsequent release of the mature TGF-beta1. Furthermore, the cell growth of fibroblasts from a CED patient and mutant gene-transfected fibroblasts was suppressed via TGF-beta1. The growth suppression observed was attenuated by neutralizing antibody to TGF-beta1 or by treatment of dexamethasone. On the other hand, the proliferation of human osteoblastic MG-63 cells was accelerated by coculture with CED fibroblasts. These data suggest that the domain-specific mutations of beta1-LAP result in a more facile activation of TGF-beta1, thus causing CED.
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Affiliation(s)
- T Saito
- Department of Biochemistry, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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