Retinitis pigmentosa, hypertension, and uraemia in Werner's syndrome. Report of a case, with necropsy findings

Model Systems to Study the Mechanism of Vascular Aging

Cardiovascular diseases are the leading cause of death globally. Within cardiovascular aging, arterial aging holds significant importance, as it involves structural and functional alterations in arteries that contribute substantially to the overall decline in cardiovascular health during the aging process. As arteries age, their ability to respond to stress and injury diminishes, while their luminal diameter increases. Moreover, they experience intimal and medial thickening, endothelial dysfunction, loss of vascular smooth muscle cells, cellular senescence, extracellular matrix remodeling, and deposition of collagen and calcium. This aging process also leads to overall arterial stiffening and cellular remodeling. The process of genomic instability plays a vital role in accelerating vascular aging. Progeria syndromes, rare genetic disorders causing premature aging, exemplify the impact of genomic instability. Throughout life, our DNA faces constant challenges from environmental radiation, chemicals, and endogenous metabolic products, leading to DNA damage and genome instability as we age. The accumulation of unrepaired damages over time manifests as an aging phenotype. To study vascular aging, various models are available, ranging from in vivo mouse studies to cell culture options, and there are also microfluidic in vitro model systems known as vessels-on-a-chip. Together, these models offer valuable insights into the aging process of blood vessels.

Werner syndrome through the lens of tissue and tumour genomics

Werner syndrome (WS) is the canonical adult human progeroid ('premature aging') syndrome. Patients with this autosomal recessive Mendelian disorder display constitutional genomic instability and an elevated risk of important age-associated diseases including cancer. Remarkably few analyses of WS patient tissue and tumors have been performed to provide insight into WS disease pathogenesis or the high risk of neoplasia. We used autopsy tissue from four mutation-typed WS patients to characterize pathologic and genomic features of WS, and to determine genomic features of three neoplasms arising in two of these patients. The results of these analyses provide new information on WS pathology and genomics; provide a first genomic characterization of neoplasms arising in WS; and provide new histopathologic and genomic data to test several popular models of WS disease pathogenesis.

[A report of a case with Werner's syndrome suffering from end-stage renal failure]

A 54-year-old man was found to have hypertension at age 32, and a diagnosis of Werner's Syndrome was made at age 36 when he was examined for hyperlipidemia. Diabetes mellitus was found at age 42. Proteinuria appeared at age 49, and microscopic hematuria was seen at age 50. At age 51, serum creatinin level began to rise and atrophy of bilateral kidneys was observed by abdominal CT. There after, the renal function gradually worsened. At age 53, the serum creatinin level rose to 8.3 mg/dl, and systemic edema as well as loss of appetite appeared, resulting in the initiation of hemodialysis. In Werner's syndrome, though arteriosclerosis arises frequently, case reports with chronic renal failure are extremely rare. To investigate the cause of the renal dysfunction, renal biopsy was performed and the samples were histologically examined, revealing the presence of hypertensive glomerular changes. It is, thus, conceivable that hypertension had played a major role in the progression of renal failure in this case.

Darier's disease and retinitis pigmentosa; is there a pathogenetic relationship?

Two brothers with Darier's disease and concomitant retinitis pigmentosa are reported. To our knowledge, these are the first cases with this combination of symptoms described in the literature. The dermatological conditions occurring with retinitis pigmentosa are reviewed. A disturbance in retinoids or retinoid binding proteins as a possible cause of both diseases is discussed.

Corneal metastatic calcification in Werner's syndrome

We examined twin sisters with a clinical picture typical of Werner's syndrome. Both had undergone bilateral cataract extraction, one at 39 and one at 36 years of age, and had subsequently developed bilateral corneal metastatic calcification within a period of one to two years. In one twin, this keratopathy was associated with hypercalcemia. Each of the twins underwent penetrating keratoplasty in one eye, which was complicated by recurrence of metastatic calcification in a previously normal and clear corneal graft.

Werner's syndrome: twenty-four cases with a review of the Japanese medical literature

Twenty-four cases of Werner's syndrome were studied to define the clinical manifestations in comparison with those found in a clinical review of 153 cases in the Japanese medical literature. The conspicuous characteristics of the 24 patients were short stature, stocky trunk with thin limbs, low body weight, bird-like or "masked" face, early graying or loss of hair, high-pitched or hoarse voice, bilateral cataracts, and various scleroderma-like signs. Three signs not stressed previously were hyperreflexia, flat feet, and irregular dental development. The onsets and incidences of these manifestations during the seven-year serial study are described.

Age-related changes in auto- and natural antibody in the Werner syndrome

To assess the immunologic disturbance in WErner syndrome, antibodies to "intrinsic" (auto)antigens (anti-DNA antibodies and rheumatoid factors) and "natural" antibodies to "extrinsic" antigens (hemagglutinins for sheep red cells and antibodies against ABO blood type antigens) were measured in serum samples from 16 patients with Werner syndrome and compared with those from 150 healthy persons ranging in age from less than a year to 98. Employing a sensitive solid-phase radioimmunoassay, we found that the levels of both anti-double-stranded and anti-single-stranded DNA antibodies in the IgG class gradually increased with age in normal donors; a more abrupt increase with age was observed in those with Werner syndrome, although they lacked any complication of renal disease and hypocomplementemia. The titers of rheumatoid factor detected by sensitized sheep cell agglutination also gradually rose in normal persons and patients with Werner syndrome. In contrast, the titers of natural antibodies declined with age in both groups. These disturbances in antibody production suggested that Werner syndrome expresses an accelerated form of aging in immunologic aspect.

Retinal dystrophy combined with alopecia

Retinitis pigmentosa or pigmentary retinal dystrophy is the most important group among the tapeto-retinal dystrophies. The degenerative process found in the retina has, in many cases, a corresponding counterpart in other parts of the body, most commonly in the CNS. Combinations of retinal dystrophy, and for instance, deafness or mental retardation are well known. Also combinations of retinal dystrophy and metabolic dyscrasia have been reported. Only few reports on the combination of retinal dystrophy and dermatological affections have been found. We have found two cases of almost total alopecia combined with retinal dystrophy. Since we have succeeded in finding a few similar cases in the literature we consider this apparently rare combination worth a somewhat closer analysis as it might constitute a specific entity.

Werner's syndrome: autopsy report of one case, with a review of pathologic findings reported in the literature

The autopsy findings in a 29-year-old male with Werner's syndrome are presented, with a review of similar data on 17 autopsy cases reported in the literature. The pathologic findings in this new case were scleroderma-like skin atrophy, arteriosclerosis, and atrophy of the endocrine glands (including the genital organs). In the reported cases of Werner's syndrome, as in the present example, the authors were unable to identify any responsible organ or system. However, they suggest that connective tissue, widely distributed throughout the entire body, may play an important role. The possible abnormal metabolism of connective tissue in Werner's syndrome deserves further study.