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Tenorio-Castano J, Gómez ÁSA, Coronado M, Rodríguez-Martín P, Parra A, Pascual P, Cazalla M, Gallego N, Arias P, Morales AV, Nevado J, Lapunzina P. Lamb-Shaffer syndrome: 20 Spanish patients and literature review expands the view of neurodevelopmental disorders caused by SOX5 haploinsufficiency. Clin Genet 2023; 104:637-647. [PMID: 37702321 DOI: 10.1111/cge.14423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/14/2023]
Abstract
Lamb-Shaffer Syndrome (LSS; OMIM #616803; ORPHA #313892; ORPHA #313884) is an infrequent genetic disorder that affects multiple aspects of human development especially those related to the development of the nervous system. LSS is caused by variants in the SOX5 gene. At the molecular level, SOX5 gene encodes for a transcription factor containing a High Mobility Group (HMG) DNA-Binding domain with relevant functions in brain development in different vertebrate species. Clinical features of Lamb-Shaffer syndrome may include intellectual disability, delayed speech and language development, attention deficits, hyperactivity, autism spectrum disorder, visual problems and seizures. Additionally, patients with the syndrome may present distinct facial dimorphism such as a wide mouth with full lips, small chin, broad nasal bridge, and deep-set eyes. Other physical features that have been reported in some patients include short stature, scoliosis, and joint hypermobility. Here, we report the clinical and molecular characterization of a Spanish LSS cohort of new 20 patients and review all the patients published so far which amount for 111 patients. The most frequent features included developmental delay, intellectual disability, visual problems, poor speech development and facial dysmorphic features. Strikingly, pain insensitivity and hypermetropia seems to be more frequent than previously reported, based on the frequency seen in the Spanish cohort. Eighty-three variants have been reported so far, single nucleotide variants (SNV) and copy number variants represent 47% and 53%, respectively, from the total of variants reported. Similarly to previous reports, the majority of the SNVs variants of the novel patients reported herein fall in the HMG domain of the protein. However, new variants, affecting other functional domains, were also detected. In conclusion, LLS is a rare genetic disorder mostly characterized by a wide range of developmental and neurological symptoms. Early diagnosis would allow to start of care programs, clinical follow up, prospective studies and appropriate genetic counseling, to promote clinical and social improvement to have profound lifelong benefits for patients and their families. Further research is needed to better understand the underlying mechanisms of the syndrome related to SOX5 haploinsufficiency.
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Affiliation(s)
- Jair Tenorio-Castano
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-IdIPAZ, Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | | | - Mónica Coronado
- Department of Radiology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Alejandro Parra
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-IdIPAZ, Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Patricia Pascual
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-IdIPAZ, Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Mario Cazalla
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-IdIPAZ, Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Natalia Gallego
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-IdIPAZ, Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Pedro Arias
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-IdIPAZ, Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Aixa V Morales
- Instituto Cajal, Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain
| | - Julián Nevado
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-IdIPAZ, Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Pablo Lapunzina
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-IdIPAZ, Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
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2
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Vera-Zambrano A, Lago-Docampo M, Gallego N, Franco-Gonzalez JF, Morales-Cano D, Cruz-Utrilla A, Villegas-Esguevillas M, Fernández-Malavé E, Escribano-Subías P, Tenorio-Castaño JA, Perez-Vizcaino F, Valverde D, González T, Cogolludo A. Novel Loss of Function KCNA5 Variants in Pulmonary Arterial Hypertension. Am J Respir Cell Mol Biol 2023. [PMID: 36917789 DOI: 10.1165/rcmb.2022-0245oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Reduced expression and/or activity of Kv1.5 channels (encoded by KCNA5) is a common hallmark in human or experimental pulmonary arterial hypertension (PAH). Likewise, genetic variants in KCNA5 have been found in PAH patients, but their functional consequences and potential impact on the disease are largely unknown. Herein, we aimed to characterize the functional consequences of 7 KCNA5 variants found in a cohort of PAH patients. Potassium currents were recorded by patch-clamp technique in HEK293 cells transfected with WT or mutant Kv1.5 cDNA. Flow cytometry, western blot and confocal microscopy techniques were used for measuring protein expression and cell apoptosis in HEK293 and human pulmonary artery smooth muscle cells (hPASMC). KCNA5 variants found in PAH patients (namely, p.Arg184Pro and p.Gly384Arg) resulted in a clear loss of potassium channel function as assessed by electrophysiological and molecular modelling analyses. The p.Arg184Pro variant also resulted in a pronounced reduction of Kv1.5 expression. Transfection with p.Arg184Pro or p.Gly384Arg variants decreased apoptosis of hPASMCs compared with the WT, demonstrating that KCNA5 dysfunction in both variants affects cell viability. Thus, in addition to affecting channel activity, both variants were associated with impaired apoptosis, a crucial process linked to the disease. The estimated prevalence of dysfunctional KCNA5 variants in the PAH population analyzed was around 1 %. Our data indicate that some KCNA5 variants found PAH patients have critical consequences for channel function supporting the idea that KCNA5 pathogenic variants may be a causative or contributing factor for PAH.
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Affiliation(s)
- Alba Vera-Zambrano
- Universidad Complutense de Madrid Facultad de Medicina, 70697, Pharmacology and Toxicology, Madrid, Comunidad de Madrid, Spain.,Universidad Autonoma de Madrid Facultad de Medicina, 70695, Biochemistry, Madrid, Spain.,Instituto de Investigaciones Biomedicas Alberto Sols, 70694, Madrid, Spain
| | - Mauro Lago-Docampo
- Universidad de Vigo, 16784, CINBIO, Vigo, Spain.,Galicia Sur Health Research Institute, 589689, Rare Diseases and Pediatric Medicine, Vigo, Spain
| | - Natalia Gallego
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain.,CIBERER, Centro de Investigación en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain.,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | | | - Daniel Morales-Cano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Experimental Pathology of Atherosclerosis Laboratory, Madrid, Spain.,Aarhus University, 1006, Clinical Medicine, Aarhus, Denmark
| | - Alejandro Cruz-Utrilla
- 12th of October University Hospital Pulmonary Hypertension Unit, 542774, Department of Cardiology, Madrid, Spain.,CIBERCV, 553232, Madrid, Comunidad de Madrid, Spain
| | - Marta Villegas-Esguevillas
- Universidad Complutense de Madrid Facultad de Medicina, 70697, Pharmacology and Toxicology, Madrid, Comunidad de Madrid, Spain.,CIBERES, 568067, Madrid, Comunidad de Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, 559924, Madrid, Comunidad de Madrid, Spain
| | - Edgar Fernández-Malavé
- Department of Immunology, Ophthalmology and ENT, Complutense University School of Medicine and 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Pilar Escribano-Subías
- Hospital Universitario 12 de Octubre, 16473, Pulmonary Hypertension Unit. Cardiology Department, Madrid, Comunidad de Madrid, Spain.,CIBERCV, 553232, Madrid, Comunidad de Madrid, Spain
| | - Jair Antonio Tenorio-Castaño
- Institute of Medical and Molecular Genetics (INGEMM-IdiPaz), Madrid, Spain.,CIBERER, 366599, Madrid, Spain.,ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Francisco Perez-Vizcaino
- Universidad Complutense de Madrid Facultad de Medicina, 70697, Pharmacology and Toxicology, Madrid, Comunidad de Madrid, Spain.,CIBERES, 568067, Madrid, Comunidad de Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, 559924, Madrid, Comunidad de Madrid, Spain
| | - Diana Valverde
- Universidad de Vigo, 16784, CINBIO, Vigo, Spain.,Galicia Sur Health Research Institute, 589689, Rare Diseases and Pediatric Medicine, Vigo, Spain
| | - Teresa González
- Universidad Autonoma de Madrid Facultad de Medicina, 70695, Biochemistry, Madrid, Spain.,Instituto de Investigaciones Biomedicas Alberto Sols, 70694, Madrid, Spain
| | - Angel Cogolludo
- Universidad Complutense de Madrid Facultad de Medicina, 70697, Pharmacology and Toxicology, Madrid, Comunidad de Madrid, Spain.,CIBERES, 568067, Madrid, Comunidad de Madrid, Spain.,Instituto de Investigacion Sanitaria Gregorio Maranon, 559924, Madrid, Comunidad de Madrid, Spain;
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Álvarez LFG, Tenorio-Castaño J, Poletta FA, Santos-Simarro F, Arias P, Gallego N, Orioli IM, Mundlos S, Castilla EE, Martínez-Glez V, Martínez-Frías ML, Ruiz-Pérez VL, Nevado J, Lapunzina P. A large, ten-generation family with autosomal dominant preaxial polydactyly/triphalangeal thumb: Historical, clinical, genealogical, and molecular studies. Am J Med Genet A 2023; 191:100-107. [PMID: 36308343 DOI: 10.1002/ajmg.a.62994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/05/2022] [Accepted: 08/19/2022] [Indexed: 12/14/2022]
Abstract
We present a large, ten-generation family of 273 individuals with 84 people having preaxial polydactyly/triphalangeal thumb due to a pathogenic variant in the zone of polarizing activity regulatory sequence (ZRS) within the exon 5 of LMBR1. The causative change maps to position 396 of the ZRS, located at position c.423 + 4909C > T (chr7:156791480; hg38; LMBR1 ENST00000353442.10; rs606231153 NG_009240.2) in the intron 5 of LMBR1. The first affected individual with the disorder was traced back to mid-1700, when some settlers and workers established in Cervera de Buitrago, a small village about 82 km North to Madrid. Clinical and radiological studies of most of the affected members have been performed for 42 years (follow-up of the family by LFGA). Molecular studies have confirmed a pathogenic variant in the ZRS that segregates in this family. To the best of our knowledge, this is the largest family with preaxial polydactyly/triphalangeal thumb reported so far.
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Affiliation(s)
| | - Jair Tenorio-Castaño
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-Idipaz, Institute of Medical and Molecular Genetics, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Fernando A Poletta
- ECLAMC at CEMIC (Center for Medical Education and Clinical Research) and CONICET (National Council for Scientific and Technical Investigation), Buenos Aires, Argentina
- ECLAMC (Latin American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil
- Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando Santos-Simarro
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-Idipaz, Institute of Medical and Molecular Genetics, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Pedro Arias
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-Idipaz, Institute of Medical and Molecular Genetics, Madrid, Spain
| | - Natalia Gallego
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-Idipaz, Institute of Medical and Molecular Genetics, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Iêda Maria Orioli
- ECLAMC at CEMIC (Center for Medical Education and Clinical Research) and CONICET (National Council for Scientific and Technical Investigation), Buenos Aires, Argentina
- ECLAMC (Latin American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil
- Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stefan Mundlos
- Institute of Medical and Human Genetics, Charité Universitätsmedizin, Berlin, Germany
- Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Eduardo E Castilla
- ECLAMC at CEMIC (Center for Medical Education and Clinical Research) and CONICET (National Council for Scientific and Technical Investigation), Buenos Aires, Argentina
- ECLAMC (Latin American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil
- Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Víctor Martínez-Glez
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-Idipaz, Institute of Medical and Molecular Genetics, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | | | - Víctor L Ruiz-Pérez
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
- Instituto de Investigaciones Biomédicas Alberto Sols, IIB-UAM, Madrid, Spain
| | - Julián Nevado
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-Idipaz, Institute of Medical and Molecular Genetics, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
| | - Pablo Lapunzina
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
- INGEMM-Idipaz, Institute of Medical and Molecular Genetics, Madrid, Spain
- ITHACA, European Reference Network, Brussels, Belgium
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4
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Cruz Utrilla A, Gallego N, Tenorio-Castano J, Guillen I, Torrent-Vernetta A, Moya A, Labrandero C, Garrido-Lestache E, Moreno A, Escribano-Subias P, Del Cerro MJ. Genetic background of pediatric PAH in Spain and its clinical implications: data from the REHIPED Spanish Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The genetic background of pulmonary arterial hypertension (PAH) in the Spanish pediatric population could be different from the genetic background described in other countries. Besides, clinical implications of a positive genetic result in the PAH pediatric population are not fully understood yet, and could result in the “reclassification” of patients from one PAH group to another type among the current pediatric classification.
Material and methods
Patients under 19 years at diagnosis included in the REHIPED registry from January 2011 to December 2021 were included. Clinical variables and genetical results were recorded. Succesive NGS panels involving up to 35 genes were used. After the results of the genetic testing, we analyzed differences in survival, and if patients “moved” to another category in the current Nice classification.
Results
In the selected cohort of 98 patients (56.1% female), median age at diagnosis was 7.1 years (IQr 1.5–14.7), and ethnicity as follows: Caucasian (81.6%), Romani (8.2%), others (10.2%) (Table 1). Before the genetic testing, patients had been classified as Idiopathic (53.1%), Congenital Heart Disease-PAH (30.6%), Heritable (5.1%), Pulmonary veno-oclusive disease (PVOD) 6.1%, and Multisystemic disorder associated with PAH (5.1%). Pathogenic or likely pathogenic variants were found in 44 of the screened patients (44.9%): BMPR2 (12 cases), EIF2AK4 (9), TBX4 (n=4), MECP2 (n=3), KCNK3 (n=2), FOXF1 (n=2), NFU1 (N=4), ACVRL1 (n=1), BMPR1B (n=1), CLBCI (n=1), GBE1 (n=1), GDF2 (n=1), SOX17 (n=1), VHL (n=1), and digenic pathogenic variant in ABCC8/SMAD1 (n=1). After genetic analysis, 28 patients (28.6%) were “reclassified” (Fig. 1, panel A), with HPAH, PVOD and multisystemic disorders increasing up to 18.4%, 8.2%, and 12.2%, respectively. Worse Survival from death or lung transplantation was observed in heritable PVOD and multisystemic disorders (Fig. 1, panel B).
Conclusions
The Spanish pediatric PAH population showed higher prevalence of EIF2AK4 than other pediatric registries. Genetic testing resulted in the “reclassification” of a significant number of patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Rio Hortega grant from the Spanish Ministry of Science and Innovation (Instituto de Salud Carlos III).
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Affiliation(s)
- A Cruz Utrilla
- University Hospital 12 de Octubre, Pulmonary Hypertension Unit, Department of Cardiology , Madrid , Spain
| | - N Gallego
- Hospital La Paz, Instituto de Genética Médica y Molecular (INGEMM) , Madrid , Spain
| | - J Tenorio-Castano
- Hospital La Paz, Instituto de Genética Médica y Molecular (INGEMM) , Madrid , Spain
| | - I Guillen
- Hospital Universitario Virgen del Rocio, Pediatric cardiology Unit, Department of Pediatrics , Sevilla , Spain
| | - A Torrent-Vernetta
- University Hospital Vall d'Hebron, Pediatric Pneumology and Lung transplant Unit, Department of Pediatrics , Barcelona , Spain
| | - A Moya
- Hospital Universitario y Politecnico La Fe, Pediatric Cardiology Unit, Department of Pediatrics , Valencia , Spain
| | - C Labrandero
- University Hospital La Paz, Pediatric Cardiology Unit, Department of Pediatrics , Madrid , Spain
| | - E Garrido-Lestache
- Hospital Universitario Ramon y Cajal, Pediatric Cardiology Unit, Department of Pediatrics , Madrid , Spain
| | - A Moreno
- University Hospital Vall d'Hebron, Pediatric Pneumology and Lung transplant Unit, Department of Pediatrics , Barcelona , Spain
| | - P Escribano-Subias
- University Hospital 12 de Octubre, Pulmonary Hypertension Unit, Department of Cardiology , Madrid , Spain
| | - M J Del Cerro
- Hospital Universitario Ramon y Cajal, Pediatric Cardiology Unit, Department of Pediatrics , Madrid , Spain
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Cardoso LCDA, Parra A, Gil CR, Arias P, Gallego N, Romanelli V, Kantaputra PN, Lima L, Llerena Júnior JC, Arberas C, Guillén-Navarro E, Nevado J, Tenorio-Castano J, Lapunzina P. Clinical Spectrum and Tumour Risk Analysis in Patients with Beckwith-Wiedemann Syndrome Due to CDKN1C Pathogenic Variants. Cancers (Basel) 2022; 14:cancers14153807. [PMID: 35954470 PMCID: PMC9367242 DOI: 10.3390/cancers14153807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
Beckwith-Wiedemann syndrome spectrum (BWSp) is an overgrowth disorder caused by imprinting or genetic alterations at the 11p15.5 locus. Clinical features include overgrowth, macroglossia, neonatal hypoglycaemia, omphalocele, hemihyperplasia, cleft palate, and increased neoplasm incidence. The most common molecular defect observed is hypomethylation at the imprinting centre 2 (KCNQ1OT1:TSS DMR) in the maternal allele, which accounts for approximately 60% of cases, although CDKN1C pathogenic variants have been reported in 5-10% of patients, with a higher incidence in familial cases. In this study, we examined the clinical and molecular features of all cases of BWSp identified by the Spanish Overgrowth Registry Initiative with pathogenic or likely pathogenic CDKN1C variants, ascertained by Sanger sequencing or next-generation sequencing, with special focus on the neoplasm incidence, given that there is scarce knowledge of this feature in CDKN1C-associated BWSp. In total, we evaluated 21 cases of BWSp with CDKN1C variants; 19 were classified as classical BWS according to the BWSp scoring classification by Brioude et al. One of our patients developed a mediastinal ganglioneuroma. Our study adds evidence that tumour development in patients with BWSp and CDKN1C variants is infrequent, but it is extremely relevant to the patient's follow-up and supports the high heterogeneity of BWSp clinical features associated with CDKN1C variants.
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Affiliation(s)
- Leila Cabral de Almeida Cardoso
- INGEMM-Instituto de Genética Médica y Molecular, Instituto de Investigación Sanitaria Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Alejandro Parra
- INGEMM-Instituto de Genética Médica y Molecular, Instituto de Investigación Sanitaria Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, 28046 Madrid, Spain
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, 28046 Madrid, Spain
- ITHACA-European Reference Network, Hospital La Paz, 28046 Madrid, Spain
| | - Cristina Ríos Gil
- INGEMM-Instituto de Genética Médica y Molecular, Instituto de Investigación Sanitaria Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, 28046 Madrid, Spain
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, 28046 Madrid, Spain
- ITHACA-European Reference Network, Hospital La Paz, 28046 Madrid, Spain
| | - Pedro Arias
- INGEMM-Instituto de Genética Médica y Molecular, Instituto de Investigación Sanitaria Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Natalia Gallego
- INGEMM-Instituto de Genética Médica y Molecular, Instituto de Investigación Sanitaria Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, 28046 Madrid, Spain
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, 28046 Madrid, Spain
- ITHACA-European Reference Network, Hospital La Paz, 28046 Madrid, Spain
| | | | - Piranit Nik Kantaputra
- Department of Orthodontics and Pediatric Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Leonardo Lima
- Instituto Fernandes Figueira IFF/FIOCRUZ, Rio de Janeiro 22250-020, Brazil
| | | | - Claudia Arberas
- Hospital de Niños Dr. Ricardo Gutiérrez, Sección Genética Médica Gallo 1330, C1425EFD CABA, Argentina
| | - Encarna Guillén-Navarro
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, 28046 Madrid, Spain
- Sección Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, El Palmar, 30120 Murcia, Spain
| | - Julián Nevado
- INGEMM-Instituto de Genética Médica y Molecular, Instituto de Investigación Sanitaria Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, 28046 Madrid, Spain
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, 28046 Madrid, Spain
- ITHACA-European Reference Network, Hospital La Paz, 28046 Madrid, Spain
| | | | - Jair Tenorio-Castano
- INGEMM-Instituto de Genética Médica y Molecular, Instituto de Investigación Sanitaria Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, 28046 Madrid, Spain
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, 28046 Madrid, Spain
- ITHACA-European Reference Network, Hospital La Paz, 28046 Madrid, Spain
| | - Pablo Lapunzina
- INGEMM-Instituto de Genética Médica y Molecular, Instituto de Investigación Sanitaria Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, 28046 Madrid, Spain
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, 28046 Madrid, Spain
- ITHACA-European Reference Network, Hospital La Paz, 28046 Madrid, Spain
- Correspondence: or ; Tel.: +34-91-727-72-17; Fax: +34-91-207-10-40
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Cruz-Utrilla A, Gallego N, Torrent-Vernetta A, Guillén I, Escribano Subias MP, del Cerro Marín MJ. Prevalencia de variantes genéticas en la hipertensión arterial pulmonar tras la reparación de D-transposición de grandes vasos. Registro REHIPED. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Cruz-Utrilla A, Gallego N, Torrent-Vernetta A, Guillén I, Escribano Subias MP, Del Cerro Marín MJ. Prevalence of genetic variants in pediatric pulmonary arterial hypertension associated with corrected D-transposition of the great arteries. The REHIPED registry. Rev Esp Cardiol (Engl Ed) 2022; 75:448-450. [PMID: 35058221 DOI: 10.1016/j.rec.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/05/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Alejandro Cruz-Utrilla
- Unidad de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Natalia Gallego
- Instituto de Genética Médica y Molecular (INGEMM), IdiPaz, Hospital Universitario La Paz, Madrid, Spain; Centro Nacional de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Spain; ITHACA, European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Bruselas, Belgium
| | - Alba Torrent-Vernetta
- Centro Nacional de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Spain; Sección de Alergología, Neumología Pediátrica y Fibrosis Quística, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Inmaculada Guillén
- Servicio de Cardiología Pediátrica, Departamento de Pediatría, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - María Pilar Escribano Subias
- Unidad de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain
| | - María Jesús Del Cerro Marín
- Servicio de Cardiología Pediátrica, Departamento de Pediatría, Hospital Universitario Ramón y Cajal, Madrid, Spain
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8
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Santurtún M, Mediavilla-Martinez E, Vega AI, Gallego N, Heath KE, Tenorio JA, Lapunzina P, Riancho-Zarrabeitia L, Riancho JA. Pain and health-related quality of life in patients with hypophosphatasemia with and without ALPL gene mutations. Front Endocrinol (Lausanne) 2022; 13:965476. [PMID: 36072928 PMCID: PMC9442670 DOI: 10.3389/fendo.2022.965476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Low serum alkaline phosphatase levels are the hallmark of hypophosphatasia, a disorder due to pathogenic variants of the ALPL gene. However, some patients do not carry ALPL variants and the cause of low alkaline phosphatase remains unknown. We aimed to determine health-related quality of life in adults with low alkaline phosphatase and explore the differences between patients with and without ALPL mutations. METHODS We studied 35 adult patients with persistently low alkaline phosphatase unrelated to secondary acquired causes who had ALPL sequenced, and 35 controls of similar age. Three questionnaires about body pain (Brief Pain Inventory, BPI), physical disability (Health Assessment Questionnaire Disability Index, HAQ-DI), and health-related quality of life (36-item Short-Form Health Survey, SF-36) were delivered by telephone interviews. RESULTS The mean BPI intensity and interference scores were higher in the patient group (p=0.04 and 0.004, respectively). All domains of the HAQ instrument tended to score better in the control group, with significant differences in the "reach" score (p=0.037) and the overall mean score (0.23 vs 0.09; p=0.029). Patients scored worse than controls in several SF-36 dimensions (Role physical, p=0.039; Bodily pain p=0.046; Role emotional, p=0.025). Patients with and without pathogenic variants scored similarly across all tests, without between-group significant differences. CONCLUSIONS Patients with persistently low levels of alkaline phosphatase have significantly worse scores in body pain and other health-related quality of life dimensions, without differences between patients with and without pathogenic variants identified in ALPL gene. This is consistent with the latter ones carrying mutations in regulatory regions.
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Affiliation(s)
- Maite Santurtún
- Departamento de Enfermería, Hospital Padre Meni, Universidad de Cantabria, Santander, Spain
| | | | - Ana I. Vega
- Servicio de Genética, Hospital UM Valdecila, Santander, Spain
| | - Natalia Gallego
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Instituto de Genética Médica y Molecular, Hospital U Lapaz, Instituto de Investigación Sanitaria La Paz (IDIPAZ), Madrid, Spain
- ERN-ITHACA, Brussels, Belgium
| | - Karen E. Heath
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Instituto de Genética Médica y Molecular, Hospital U Lapaz, Instituto de Investigación Sanitaria La Paz (IDIPAZ), Madrid, Spain
- ERN-ITHACA, Brussels, Belgium
| | - Jair A. Tenorio
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Instituto de Genética Médica y Molecular, Hospital U Lapaz, Instituto de Investigación Sanitaria La Paz (IDIPAZ), Madrid, Spain
- ERN-ITHACA, Brussels, Belgium
| | - Pablo Lapunzina
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Instituto de Genética Médica y Molecular, Hospital U Lapaz, Instituto de Investigación Sanitaria La Paz (IDIPAZ), Madrid, Spain
- ERN-ITHACA, Brussels, Belgium
| | - Leyre Riancho-Zarrabeitia
- Servicio de Reumatología, Hospital U Sierrallana Torrelavega, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - José A. Riancho
- Departamento de Medicina y Psiquiatría, Servicio de Medicina Interna, Hospital Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
- *Correspondence: José A. Riancho,
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9
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Hernandez Gonzalez I, Ochoa-Parra N, Tenorio-Castano J, Perez-Olivares C, Cruz-Utrilla A, Palomino-Doza J, Lago-Docampo M, Gallego N, Valverde D, Lapunzina P, Escribano-Subias P. Novel genetic and molecular pathways in pulmonary arterial hypertension associated with connective tissue disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
PAH is a severe complication of CTD, with remarkable morbidity and mortality. SSc is most commonly associated with PAH, but it can be present in other CTD. Despite major advances in PAH therapy, survival in CTD-PAH remains poor. Furthermore, the molecular and genetic basis of PAH in CTD are not well established.
Purpose
This study aimed to screen for genetic defects in a cohort of patients with CTD-PAH.
Methods
Since November 2011, genetic testing is offered to all patients with idiopathic, hereditable and associated forms of PAH, and PVOD included in a national registry of PAH. A PAH-specific panel of 35 genes was designed.
Results
During enrolling, 79 patients were recruited: 59 SSc, 11 SLE and 9 other. 69 female, mean age 55,6±1,9 years, mean PVR 8,6±0,5 WU and mean DLCO 47,5±2%. Disease-associated variants were observed in 9 patients: 4 pathogenic/likely pathogenic in 4 different genes (TBX4, ABCC8, KCNA5 and GDF2/BMP9) and 5 VUS in 4 genes (ABCC8, NOTCH3, TOPBP1 and CTCFL). Clinical characteristics of patients with pathogenic/likely pathogenic variants and variant analyses are shown in Tables 1 and 2.
Patient 1 is a Caucasian female with mixed CTD, diagnosed with PAH at 58 years of age. She has a frameshift pathogenic variant in TBX4. Pulmonary function test (PFT) ruled out interstitial lung disease (ILD), but a reduction in DLCO was observed (61% of predicted).
Two patients carry variants in ABCC8. Patient 2 is a Caucasian female with SSc, diagnosed with PAH at 27 years of age. She carries a splicing variant in ABCC8, classified as likely pathogenic. Her mother was diagnosed with PAH associated with a repaired ASD at 61 years of age. In the genetic testing, no variants were observed in PAH genes. DLCO was 71% of predicted, without signs of ILD. Patient 3 is a Caucasian male, with clinical suspicion of PVOD associated with SSc and HIV infection. PAH was diagnosed at 57 years of age. He presented a missense variant in ABCC8, located in a gating regulatory region, and classified as VUS. Her sister was also diagnosed with PVOD associated with SSc at 48 years of age. No blood or tissue samples are available. In patient 3, DLCO was 22% of predicted value. CT scan showed the typical triad of PVOD.
Patient 4 is a Latin American female with SLE, diagnosed with PAH at 25 years of age. She presented a pathogenic nonsense variant in GDF2/BMP9.
Patient 5 is a Caucasian female with SSc, diagnosed with PAH at 70 years of age. She presented a pathogenic variant in KCNA5.
Patients 6–9 have SSc-PAH and carry VUS in NOTCH1, CTCFL, CTCFL and TOPBP1, respectively.
Conclusions
We demonstrate the practical diagnostic utility of genetic testing with a panel in CTD-PAH. The discovery of rare variants in these patients forces us to take a comprehensive approach and accurate genetic counseling. Further research is still necessary to confirm these findings and help to provide a personalized medicine approach to these patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This project was founded by project “Bases Genético Moleculares de la Medicina de Precisiόn en la Hipertensiόn Arterial Pulmonar”. Funder: Instituto Carlos III. Ministerio de Economía y Competitividad.
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Affiliation(s)
| | - N Ochoa-Parra
- University Hospital 12 de Octubre, Cardiology. Pulmonary Hypertension Unit, Madrid, Spain
| | - J Tenorio-Castano
- University Hospital La Paz, Institute of Medical and Molecular Genetics (INGEMM)-IdiPAZ, Madrid, Spain
| | - C Perez-Olivares
- University Hospital 12 de Octubre, Cardiology. Pulmonary Hypertension Unit, Madrid, Spain
| | - A Cruz-Utrilla
- University Hospital 12 de Octubre, Cardiology. Pulmonary Hypertension Unit, Madrid, Spain
| | - J Palomino-Doza
- University Hospital 12 de Octubre, Cardiology. Pulmonary Hypertension Unit, Madrid, Spain
| | | | - N Gallego
- University Hospital La Paz, Institute of Medical and Molecular Genetics (INGEMM)-IdiPAZ, Madrid, Spain
| | | | - P Lapunzina
- University Hospital La Paz, Institute of Medical and Molecular Genetics (INGEMM)-IdiPAZ, Madrid, Spain
| | - P Escribano-Subias
- University Hospital 12 de Octubre, Cardiology. Pulmonary Hypertension Unit, Madrid, Spain
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10
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Cruz Utrilla A, Gallego N, Cristo Ropero MJ, Perez Olivares-Delgado C, Tenorio Castano JA, Lapunzina P, Lopez Meseguer M, Martinez Menaca A, Arribas-Ynsaurriaga F, Escribano Subias P. BMPR2 variants in pulmonary arterial hypertension. Are they really worrisome? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary arterial hypertension (PAH) is a rare and severe disease. The discovery of the gene encoding Bone Morphogenetic Protein Receptor Type 2 (BMPR2) in 2000 was the first evidence of an association between genetics and PAH. BMPR2 mutation carriers are younger and have higher haemodynamic severity, determining higher risk than sporadic cases. In the last few years, novel genetic variants have been identified. The risk of mortality of the currently known mutations is scarce.
Purpose
To describe the role of gene variants regarding long-term survival in a cohort of PAH patients.
Methods
We included patients diagnosed with PAH between January 2011-December 2020, following the ESC/ERC Guidelines recommendations. At least one genetic study was available in included individuals. Pulmonary venooclusive disease, PAH associated with congenital heart disease, or connective tissue disorders were excluded. Three groups were compared: no mutation, BMPR2 carriers and other genetic variants. Comparison of qualitative and quantitative variables was done by Chi-square test and ANOVA test, respectively. Crude and adjusted Log-rank test was performed for the evaluation of mortality.
Results
361 were finally included. The most frequent gene variant was BMPR2. Among the eight other gene variants, there were 2 cases of KCKN3, 2 of ACVRL1, and 1 case of KCNA5, TBX4, CPS1, and GDF2.
BMPR2 and the rest of mutation carriers were younger at diagnosis and had worse haemodynamic parameters than non-carriers. Nevertheless, these patients tended to perform higher distances in the 6-minute walk test. Interestingly, BMPR2 patients had higher DLCO values at diagnosis (table).
After 104.1±77.2 months of follow-up, there was a tendency for BMPR2 carriers toward lower crude free survival of mortality or lung transplantation. Nevertheless, this survival benefit disappears when adjusted by age (Table, figure).
Conclusions
The diagnostic yields of genetic analysis for pathogenic or likely pathogenic variants in idiopathic PAH are approximately 11%. BMPR2 is the most frequent causal gene. These patients are associated with marked haemodynamic impairment. Nevertheless, its younger age probably determines the better long-term results regarding mortality or lung transplantation observed when comparing these results with sporadic patients or those carrying other mutations.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Rio Hortega grant. Instituto de Salud Carlos III (ISCIII), Ministry of Science and Innovation, Spanish Government.
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Affiliation(s)
- A Cruz Utrilla
- University Hospital 12 de Octubre, Pulmonary Hypertension Unit. Cardiology Department, Madrid, Spain
| | - N Gallego
- Hospital La Paz, Instituto de Genética Médica y Molecular (INGEMM), Madrid, Spain
| | - M J Cristo Ropero
- University Hospital 12 de Octubre, Pulmonary Hypertension Unit. Cardiology Department, Madrid, Spain
| | - C Perez Olivares-Delgado
- University Hospital 12 de Octubre, Pulmonary Hypertension Unit. Cardiology Department, Madrid, Spain
| | - J A Tenorio Castano
- Hospital La Paz, Instituto de Genética Médica y Molecular (INGEMM), Madrid, Spain
| | - P Lapunzina
- Hospital La Paz, Instituto de Genética Médica y Molecular (INGEMM), Madrid, Spain
| | - M Lopez Meseguer
- University Hospital Vall d'Hebron, Pneumology Department, Barcelona, Spain
| | - A Martinez Menaca
- University Hospital Marques de Valdecilla, Pneumology Department, Santander, Spain
| | | | - P Escribano Subias
- University Hospital 12 de Octubre, Pulmonary Hypertension Unit. Cardiology Department, Madrid, Spain
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11
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Cruz Utrilla A, Gallego N, Torrent A, Garrido-Lestache E, Guillen I, Arias S, Moya A, Mendoza A, Espin J, Rodriguez Vazquez MM, Playan-Escribano J, Labrandero C, Tenorio Castano JA, Escribano Subias P, Del Cerro MJ. Genetic background in pediatric pulmonary arterial hypertension. Should we change the current recommendations for genetic testing? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary arterial hypertension (PAH) is a rare and severe disease, genetically predisposed in a high proportion of patients. PAH is subclassified in different subtypes depending on the underlying condition. Gene variants are more frequent among heritable or idiopathic forms. Nevertheless, pathogenic variants have been described across the entire spectrum of this disease. Evidence regarding genetics in pediatric PAH is scarce [1].
Purpose
Our aim is to describe the prevalence of significant gene mutations among a pediatric PAH cohort and to define specific data in the different subtypes.
Methods
Samples for genetic studies were obtained from blood tests of patients included in the Spanish National Registry of Pediatric Pulmonary Hypertension (REHIPED). Guardians signed informed consent before the inclusion in the study. Qualitative variables were compared by Chi-square test. Quantitative variables were assessed by Kruskal-Wallis, considering the asymmetric distribution of variables. STATA 14.0 was used for analyses.
Results
Sixty four patients were included between 2011 and 2021. Median age of the entire sample was 7.1 years (2.0–12.6) and 42.2% of them were male. There were significant differences in the age at diagnosis and race between the different included groups (table). Pathogenic or likely pathogenic variants were more frequent in familial pulmonary venooclusive disease (PVOD) and familial PAH cases. A similar percentage of mutations were found in idiopathic cases and in PAH associated with congenital heart disease (Figure). Gene variants in the gene encoding the bone morphogenetic protein receptor type 2 (BMPR2) were the most frequent mutations in the PAH familial cohort and there was also the most frequent finding in congenital heart disease and sporadic PAH, in conjunction with the TBX4 gene. Homozygous or compound heterozygous EIF2AK4 (eukaryotic translation initiation factor 2 a kinase 4) mutations were found in all the patients diagnosed with PVOD. Heritable PAH and PVOD cases were diagnosed more frequently after family screening.
Conclusions
This study shows a comparable proportion of pathogenic-likely pathogenic gene mutations in patients diagnosed of pulmonary arterial hypertension associated with congenital heart disease and idiopathic cases, with similar distribution of specific genes. BMPR2 and TBX 4 were the most frequent gene variants in this pediatric PAH population. BMPR2 and EIF2AK4 are the most common mutations in familial PAH and PVOD subtypes, respectively.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ACU holds a Rio Hortega Grant from the Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation.JAT and NG hold grants from FEDER (Federaciόn Española de Enfermedades Raras) and from the FCHP. Table 1. Characteristics of PAH subtypesFigure 1. PAH and ACMG classification.
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Affiliation(s)
- A Cruz Utrilla
- University Hospital 12 de Octubre, Pulmonary Hypertension Unit. Cardiology Department, Madrid, Spain
| | - N Gallego
- Hospital La Paz, Instituto de Genética Médica y Molecular (INGEMM), Madrid, Spain
| | - A Torrent
- University Hospital Vall d'Hebron, Department of Pediatric Pulmonology, Barcelona, Spain
| | - E Garrido-Lestache
- University Hospital Ramon y Cajal de Madrid, Department of Pediatric Cardiology, Madrid, Spain
| | - I Guillen
- University Hospital Virgen del Rocio, Department of Pediatric Cardiology, Seville, Spain
| | - S Arias
- Hospital Universitario Infanta Cristina, Department of pediatric cardiology, Badajoz, Spain
| | - A Moya
- University Hospital La Fe, Department of pediatric Cardiology, Valencia, Spain
| | - A Mendoza
- University Hospital 12 de Octubre, Department of pediatric cardiology, Madrid, Spain
| | - J Espin
- Hospital Universitario Virgen Arrixaca, Department of pediatric cardiology, Murcia, Spain
| | - M M Rodriguez Vazquez
- University Hospital Virgen de las Nieves, Department of Pediatric cardiology, Granada, Spain
| | | | - C Labrandero
- University Hospital La Paz, Department of Pediatric Cardiology, Madrid, Spain
| | - J A Tenorio Castano
- Hospital La Paz, Instituto de Genética Médica y Molecular (INGEMM), Madrid, Spain
| | - P Escribano Subias
- University Hospital 12 de Octubre, Pulmonary Hypertension Unit. Cardiology Department, Madrid, Spain
| | - M J Del Cerro
- University Hospital Ramon y Cajal de Madrid, Department of Pediatric Cardiology, Madrid, Spain
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12
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Cruz-Utrilla A, Gallego N, Segura de la Cal T, Tenorio-Castaño J, Arribas-Ynsaurriaga F, Escribano Subias P. The role of genetics in pulmonary arterial hypertension associated with congenital heart disease. Rev Esp Cardiol (Engl Ed) 2021; 74:884-886. [PMID: 33972189 DOI: 10.1016/j.rec.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Alejandro Cruz-Utrilla
- Unidad de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Natalia Gallego
- Instituto de Medicina y Genética Médica (INGEMM)-IdiPAZ, Hospital Universitario La Paz-UAM, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability (ITHACA), Bruselas, Belgium
| | - Teresa Segura de la Cal
- Unidad de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jair Tenorio-Castaño
- Instituto de Medicina y Genética Médica (INGEMM)-IdiPAZ, Hospital Universitario La Paz-UAM, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability (ITHACA), Bruselas, Belgium
| | | | - Pilar Escribano Subias
- Unidad de Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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13
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Tenorio-Castaño JA, Arias P, Fernández-Jaén A, Lay-Son G, Bueno-Lozano G, Bayat A, Faivre L, Gallego N, Ramos S, Butler KM, Morel C, Hadjiyannakis S, Lespinasse J, Tran-Mau-Them F, Santos-Simarro F, Pinson L, Martínez-Monseny AF, O'Callaghan Cord MDM, Álvarez S, Stolerman ES, Washington C, Ramos FJ, The S O G R I Consortium, Lapunzina P. Tenorio syndrome: Description of 14 novel cases and review of the clinical and molecular features. Clin Genet 2021; 100:405-411. [PMID: 34196401 DOI: 10.1111/cge.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
Tenorio syndrome (TNORS) (OMIM #616260) is a relatively recent disorder with very few cases described so far. Clinical features included macrocephaly, intellectual disability, hypotonia, enlarged ventricles and autoimmune diseases. Molecular underlying mechanism demonstrated missense variants and a large deletion encompassing RNF125, a gene that encodes for an U3 ubiquitin ligase protein. Since the initial description of the disorder in six patients from four families, several new patients were diagnosed, adding more evidence to the clinical spectrum. In this article, we described 14 additional cases with deep phenotyping and make an overall review of all the cases with pathogenic variants in RNF125. Not all patients presented with overgrowth, but instead, most patients showed a common pattern of neurodevelopmental disease, macrocephaly and/or large forehead. Segregation analysis showed that, though the variant was inherited in some patients from an apparently asymptomatic parent, deep phenotyping suggested a mild form of the disease in some of them. The mechanism underlying the development of this disease is not well understood yet and the report of further cases will help to a better understanding and clinical characterization of the syndrome.
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Affiliation(s)
- Jair Antonio Tenorio-Castaño
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Overgrowth Syndromes Laboratory, INGEMM, Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario la Paz, Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Ithaca, European Reference Network, Brussels, Belgium
| | - Pedro Arias
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Overgrowth Syndromes Laboratory, INGEMM, Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario la Paz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | - Guillermo Lay-Son
- Unidad de Genética, División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de, Chile
| | - Gloria Bueno-Lozano
- Unit of Clinical Genetics, Service of Paediatrics, School of Medicine, University Hospital 'Lozano Blesa, University of Zaragoza, CIBERER-GCV02 and ISS-Aragón, Zaragoza, Spain
| | - Allan Bayat
- Department of Pediatrics, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Laurence Faivre
- Ithaca, European Reference Network, Brussels, Belgium.,Centre de Référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU Dijon, Dijon, France.,UMR1231 GAD, Inserm - Université Bourgogne-Franche Comté, Dijon, France
| | - Natalia Gallego
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Overgrowth Syndromes Laboratory, INGEMM, Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario la Paz, Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Ithaca, European Reference Network, Brussels, Belgium
| | - Sergio Ramos
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Overgrowth Syndromes Laboratory, INGEMM, Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario la Paz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Kameryn M Butler
- Cytogenetics Laboratory, Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Chantal Morel
- University Health Network, Fred A. Litwin Family Centre in Genetic Medicine, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stasia Hadjiyannakis
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - James Lespinasse
- Service de Cytogenetique, Centre Hospitalier de Chambéry, Chambéry, France
| | - Frederic Tran-Mau-Them
- UF6254 Innovation en Diagnostic Genomique des Maladies Rares Bat, Pôle de Biologie, CHU, Dijon, France
| | - Fernando Santos-Simarro
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Ithaca, European Reference Network, Brussels, Belgium.,Clinical Genetics section, INGEMM, Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario la Paz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Lucile Pinson
- Départment de Génétique Médicale, Maladies Rares et Médecine Personnalisée, CHU de Montpellier, Montpellier, France
| | - Antonio Federico Martínez-Monseny
- Clinical Genetics section, Department of Genetic and Molecular Medicine and Pediatric Institute of Rare Diseases (IPER), Hospital Sant Joan de Déu, Barcelona, Spain.,Department of Pediatric Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - María Del Mar O'Callaghan Cord
- Clinical Genetics section, Department of Genetic and Molecular Medicine and Pediatric Institute of Rare Diseases (IPER), Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sara Álvarez
- NIMGENETICS, Calle de Anabel Segura, Madrid, Spain
| | - Elliot S Stolerman
- Cytogenetics Laboratory, Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Camerun Washington
- Cytogenetics Laboratory, Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Feliciano J Ramos
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Unit of Clinical Genetics, Service of Paediatrics, School of Medicine, University Hospital 'Lozano Blesa, University of Zaragoza, CIBERER-GCV02 and ISS-Aragón, Zaragoza, Spain.,Unit of Pediatric Endocrinology, Service of Paediatrics, University Hospital Lozano Blesa, Zaragoza, Spain
| | - The S O G R I Consortium
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Overgrowth Syndromes Laboratory, INGEMM, Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario la Paz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Pablo Lapunzina
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain.,Overgrowth Syndromes Laboratory, INGEMM, Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario la Paz, Universidad Autónoma de Madrid (UAM), Madrid, Spain.,Ithaca, European Reference Network, Brussels, Belgium
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14
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Pienkos S, Gallego N, Condon DF, Cruz-Utrilla A, Ochoa N, Nevado J, Arias P, Agarwal S, Patel H, Chakraborty A, Lapunzina P, Escribano P, Tenorio-Castaño J, de Jesús Pérez VA. Novel TNIP2 and TRAF2 Variants Are Implicated in the Pathogenesis of Pulmonary Arterial Hypertension. Front Med (Lausanne) 2021; 8:625763. [PMID: 33996849 PMCID: PMC8119639 DOI: 10.3389/fmed.2021.625763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pulmonary arterial hypertension (PAH) is a rare disease characterized by pulmonary vascular remodeling and right heart failure. Specific genetic variants increase the incidence of PAH in carriers with a family history of PAH, those who suffer from certain medical conditions, and even those with no apparent risk factors. Inflammation and immune dysregulation are related to vascular remodeling in PAH, but whether genetic susceptibility modifies the PAH immune response is unclear. TNIP2 and TRAF2 encode for immunomodulatory proteins that regulate NF-κB activation, a transcription factor complex associated with inflammation and vascular remodeling in PAH. Methods: Two unrelated families with PAH cases underwent whole-exome sequencing (WES). A custom pipeline for variant prioritization was carried out to obtain candidate variants. To determine the impact of TNIP2 and TRAF2 in cell proliferation, we performed an MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] assay on healthy lung pericytes transfected with siRNA specific for each gene. To measure the effect of loss of TNIP2 and TRAF2 on NF-kappa-beta (NF-κB) activity, we measured levels of Phospho-p65-NF-κB in siRNA-transfected pericytes using western immunoblotting. Results: We discovered a novel missense variant in the TNIP2 gene in two affected individuals from the same family. The two patients had a complex form of PAH with interatrial communication and scleroderma. In the second family, WES of the proband with PAH and primary biliary cirrhosis revealed a de novo protein-truncating variant in the TRAF2. The knockdown of TNIP2 and TRAF2 increased NF-κB activity in healthy lung pericytes, which correlated with a significant increase in proliferation over 24 h. Conclusions: We have identified two rare novel variants in TNIP2 and TRAF2 using WES. We speculate that loss of function in these genes promotes pulmonary vascular remodeling by allowing overactivation of the NF-κB signaling activity. Our findings support a role for WES in helping identify novel genetic variants associated with dysfunctional immune response in PAH.
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Affiliation(s)
- Shaun Pienkos
- Division of Pulmonary and Critical Care Medicine and Department of Medicine, Stanford University, Stanford, CA, United States
| | - Natalia Gallego
- Medical and Molecular Genetics Institute (INGEMM), IdiPaz, Hospital Universitario La Paz, Madrid, Spain
- CIBERER, Centro de Investigación en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - David F. Condon
- Division of Pulmonary and Critical Care Medicine and Department of Medicine, Stanford University, Stanford, CA, United States
| | - Alejandro Cruz-Utrilla
- Pulmonary Hypertension Unit, Department of Cardiology, Hospital Universitario Doce de Octubre, Madrid, Spain
- Centro de Investigación Biomedica en Red en Enfermedades Cardiovasculares, Instituto de Salud Carlos III (CIBERCV), Madrid, Spain
| | - Nuria Ochoa
- Pulmonary Hypertension Unit, Department of Cardiology, Hospital Universitario Doce de Octubre, Madrid, Spain
- Centro de Investigación Biomedica en Red en Enfermedades Cardiovasculares, Instituto de Salud Carlos III (CIBERCV), Madrid, Spain
| | - Julián Nevado
- Medical and Molecular Genetics Institute (INGEMM), IdiPaz, Hospital Universitario La Paz, Madrid, Spain
- CIBERER, Centro de Investigación en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
- Intellectual Disability, TeleHealth, Autism and Congenital Anomalies (ITHACA), European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Pedro Arias
- Medical and Molecular Genetics Institute (INGEMM), IdiPaz, Hospital Universitario La Paz, Madrid, Spain
- CIBERER, Centro de Investigación en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
- Intellectual Disability, TeleHealth, Autism and Congenital Anomalies (ITHACA), European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Stuti Agarwal
- Division of Pulmonary and Critical Care Medicine and Department of Medicine, Stanford University, Stanford, CA, United States
| | - Hiral Patel
- Division of Pulmonary and Critical Care Medicine and Department of Medicine, Stanford University, Stanford, CA, United States
| | - Ananya Chakraborty
- Division of Pulmonary and Critical Care Medicine and Department of Medicine, Stanford University, Stanford, CA, United States
| | - Pablo Lapunzina
- Medical and Molecular Genetics Institute (INGEMM), IdiPaz, Hospital Universitario La Paz, Madrid, Spain
- CIBERER, Centro de Investigación en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
- Intellectual Disability, TeleHealth, Autism and Congenital Anomalies (ITHACA), European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Pilar Escribano
- Pulmonary Hypertension Unit, Department of Cardiology, Hospital Universitario Doce de Octubre, Madrid, Spain
- Centro de Investigación Biomedica en Red en Enfermedades Cardiovasculares, Instituto de Salud Carlos III (CIBERCV), Madrid, Spain
| | - Jair Tenorio-Castaño
- Medical and Molecular Genetics Institute (INGEMM), IdiPaz, Hospital Universitario La Paz, Madrid, Spain
- CIBERER, Centro de Investigación en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
- Intellectual Disability, TeleHealth, Autism and Congenital Anomalies (ITHACA), European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability, Brussels, Belgium
| | - Vinicio A. de Jesús Pérez
- Division of Pulmonary and Critical Care Medicine and Department of Medicine, Stanford University, Stanford, CA, United States
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15
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Marcén R, Gallego N, Orofino L, Sabater J, Pascual J, Teruel JL, Liaño F, Ortuño J. Influence of cyclosporin A (CyA) on renal handling of urate. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Ansari-Pour N, Moñino Y, Duque C, Gallego N, Bedoya G, Thomas MG, Bradman N. Palenque de San Basilio in Colombia: genetic data support an oral history of a paternal ancestry in Congo. Proc Biol Sci 2016; 283:20152980. [PMID: 27030413 DOI: 10.1098/rspb.2015.2980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/29/2016] [Indexed: 11/12/2022] Open
Abstract
The Palenque, a black community in rural Colombia, have an oral history of fugitive African slaves founding a free village near Cartagena in the seventeenth century. Recently, linguists have identified some 200 words in regular use that originate in a Kikongo language, with Yombe, mainly spoken in the Congo region, being the most likely source. The non-recombining portion of the Y chromosome (NRY) and mitochondrial DNA were analysed to establish whether there was greater similarity between present-day members of the Palenque and Yombe than between the Palenque and 42 other African groups (for all individuals,n= 2799) from which forced slaves might have been taken. NRY data are consistent with the linguistic evidence that Yombe is the most likely group from which the original male settlers of Palenque came. Mitochondrial DNA data suggested substantial maternal sub-Saharan African ancestry and a strong founder effect but did not associate Palenque with any particular African group. In addition, based on cultural data including inhabitants' claims of linguistic differences, it has been hypothesized that the two districts of the village (Abajo and Arriba) have different origins, with Arriba founded by men originating in Congo and Abajo by those born in Colombia. Although significant genetic structuring distinguished the two from each other, no supporting evidence for this hypothesis was found.
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Affiliation(s)
- Naser Ansari-Pour
- Faculty of New Sciences and Technology, University of Tehran, Tehran, Iran
| | | | | | - Natalia Gallego
- School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Gabriel Bedoya
- Universidad de Antioquia UdeA, Calle 70 No 52-21 Medellín, Colombia
| | - Mark G Thomas
- Department of Genetics, Evolution and Environment, University College London, London, UK
| | - Neil Bradman
- Henry Stewart Group, 29/30 Little Russell Street, London, UK
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17
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Such Belenguer L, Parra G, Gallego N, Soler C, Such-Miquel L, Guerrero J, Alberola A, Brines L, Del Canto I, Chorro FJ. Effect of chronic exercise and ATP-sensitive potassium channel blockade on the spectral characteristics evolution of ventricular fibrillation in acute regional ischemia. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Mauricio MD, Brines Ferrando L, Aldasoro M, Parra G, Marchio P, Gallego N, Soler C, Such-Miquel L, Vila JM. Effects of exercise training on adrenergic and cholinergic responses of rabbit carotid artery. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Salinas M, Santana E, Chico J, Barrau V, Yelmo S, Gallego N, Poyo S, Gracia R. P-941 - Factor structure of the MCMI-III in a psychiatric patients sample. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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Florez JC, Price AL, Campbell D, Riba L, Parra MV, Yu F, Duque C, Saxena R, Gallego N, Tello-Ruiz M, Franco L, Rodríguez-Torres M, Villegas A, Bedoya G, Aguilar-Salinas CA, Tusié-Luna MT, Ruiz-Linares A, Reich D. Strong association of socioeconomic status with genetic ancestry in Latinos: implications for admixture studies of type 2 diabetes. Diabetologia 2009; 52:1528-36. [PMID: 19526211 PMCID: PMC3113605 DOI: 10.1007/s00125-009-1412-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 05/07/2009] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes is more prevalent in US American minority populations of African or Native American descent than it is in European Americans. However, the proportion of this epidemiological difference that can be ascribed to genetic or environmental factors is unknown. To determine whether genetic ancestry is correlated with diabetes risk in Latinos, we estimated the proportion of European ancestry in case-control samples from Mexico and Colombia in whom socioeconomic status had been carefully ascertained. METHODS We genotyped 67 ancestry-informative markers in 499 participants with type 2 diabetes and 197 controls from Medellín (Colombia), as well as in 163 participants with type 2 diabetes and 72 controls from central Mexico. Each participant was assigned a socioeconomic status scale via various measures. RESULTS Although European ancestry was associated with lower diabetes risk in Mexicans (OR [95% CI] 0.06 [0.02-0.21], p = 2.0 x 10(-5)) and Colombians (OR 0.26 [0.08-0.78], p = 0.02), adjustment for socioeconomic status eliminated the association in the Colombian sample (OR 0.64 [0.19-2.12], p = 0.46) and significantly attenuated it in the Mexican sample (OR 0.17 [0.04-0.71], p = 0.02). Adjustment for BMI did not change the results. CONCLUSIONS/INTERPRETATION The proportion of non-European ancestry is associated with both type 2 diabetes and lower socioeconomic status in admixed Latino populations from North and South America. We conclude that ancestry-directed search for genetic markers associated with type 2 diabetes in Latinos may benefit from information involving social factors, as these factors have a quantitatively important effect on type 2 diabetes risk relative to ancestry effects.
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Affiliation(s)
- J. C. Florez
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Simches Research Building, CPZN 5.250, 185 Cambridge Street, Boston, MA 02114, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - A. L. Price
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - D. Campbell
- The Galton Laboratory, Department of Genetics, Evolution and Environment, University College London, Wolfson House, 4 Stephenson Way, London NW1 2HE, UK
| | - L. Riba
- Unidad de Biología Molecular y Medicina Genómica, Instituto de Investigaciones Biomédicas, UNAM / Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección 16, Tlalpan, 14000 Mexico D.F., Mexico
| | - M. V. Parra
- Laboratorio de Genética Molecular, Universidad de Antioquía, Medellín, Colombia
| | - F. Yu
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - C. Duque
- Laboratorio de Genética Molecular, Universidad de Antioquía, Medellín, Colombia
| | - R. Saxena
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - N. Gallego
- Laboratorio de Genética Molecular, Universidad de Antioquía, Medellín, Colombia
| | - M. Tello-Ruiz
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - L. Franco
- Laboratorio de Genética Molecular, Universidad de Antioquía, Medellín, Colombia
| | - M. Rodríguez-Torres
- Unidad de Biología Molecular y Medicina Genómica, Instituto de Investigaciones Biomédicas, UNAM / Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección 16, Tlalpan, 14000 Mexico D.F., Mexico
| | - A. Villegas
- Laboratorio de Genética Molecular, Universidad de Antioquía, Medellín, Colombia
| | - G. Bedoya
- Laboratorio de Genética Molecular, Universidad de Antioquía, Medellín, Colombia
| | - C. A. Aguilar-Salinas
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - M. T. Tusié-Luna
- Unidad de Biología Molecular y Medicina Genómica, Instituto de Investigaciones Biomédicas, UNAM / Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Sección 16, Tlalpan, 14000 Mexico D.F., Mexico
| | - A. Ruiz-Linares
- The Galton Laboratory, Department of Genetics, Evolution and Environment, University College London, Wolfson House, 4 Stephenson Way, London NW1 2HE, UK
- Laboratorio de Genética Molecular, Universidad de Antioquía, Medellín, Colombia
| | - D. Reich
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
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Franco-Hincapié L, Duque CE, Parra MV, Gallego N, Villegas A, Ruiz-Linares A, Bedoya G. [Association between polymorphism in uncoupling proteins and type 2 diabetes in a northwestern Colombian population]. Biomedica 2009; 29:108-118. [PMID: 19753844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The uncoupling proteins belong to the family of anion transporting proteins which uncouple the ATP production from the mitochondrial respiration, cause proton leakage through the inner mitochondrial membrane, and release energy as heat. Although uncoupling protein function has not been well established, specific polymorphisms in these proteins have been associated with type 2 diabetes mellitus, obesity and insulin resistance. OBJECTIVE The association was assessed between the polymorphisms in uncoupling protein genes 1, 2 and 3 genes and type 2 diabetes mellitus. MATERIALS AND METHODS In a northwestern Colombian population, 545 diabetes cases and 449 controls were investigated for presence of 14 polymorphisms in uncoupling protein genes (3826A/G, ID 45, 2723T/A, 1957G/A, 866G/A, and 55C/T) by PCR and PCR-RFLP. Single associations were evaluated by chi-square test, and bayesian logistic regression analysis was done including as covariates the individual admixture estimates obtained by 54 informative markers for European, African and Amerind ancestry. RESULTS Association between type 2 diabetes mellitus and the polymorphisms 3826A (OR=0.78; 95% CI = 0.63-0.97; p = 0.02) and 55 C (OR = 1.41; 95% CI = 1.04-1.92; p = 0.03) and the haplotype D45, 866G, 1957G, 2723T, and 55C (OR = 1.26; 95% CI = 1.02-1.56; p = 0.03) were found. These associations remained after adjustment using individual genetic admixture estimates. CONCLUSION Some alleles of uncoupling protein genes 1, 2 and 3, and their haplotypes confer risk to type 2 diabetes in a northwestern Colombian population.
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Quereda C, Pascual J, García-López F, Alcázar R, Aljama P, Amenábar JJ, Arias M, Barrio V, Fernández-Rodríguez A, Fernández Juárez G, Fernández-Lucas M, Gallego N, Hernández D, Gómez-Alamillo C, Maduell F, Martínez Castelao A, Marcén R, Matesanz R, Martín de Francisco AL, Orte L, Liaño F, Luño J, Ortuño J, Pérez García R, Praga M, Saracho R, Selgas R, Rivera M, Rodríguez Pérez JC, Teruel JL, Tato A, Torres A, Valdés F. [Clinical research based nephrology (bases for the constitution of an Evidence Based Nephrology Group in the Spanish Society of Nephrology)]. Nefrologia 2006; 26:163-72. [PMID: 16808254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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23
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Tabernero G, Teruel JL, Fernández Lucas M, López Mateos M, Gallego N, Ortuño J. [Chronic renal failure secondary to hyperoxaluria following small bowel syndrome]. Nefrologia 2006; 26:489-92. [PMID: 17058863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
A 70-year-old woman was admitted in the Department of Nephrology because of renal insufficiency. Six years previously, as consequence of a venous mesenteric thrombosis, she underwent an extense intestinal resection with subsequent short intestine syndrome. Five years after the surgery an increase in the creatinine concentration was observed (1.4 mg/dl). One year later, it increased up to 3.1 mg/dl and the patient was remitted to our Department. The radiological study revealed calcifications on both kidney silhouettes. In the next year, renal function worsened and the calcifications increased. Coinciding with the beginning of the chronic hemodialysis treatment she suffered a renal colic with passage of a calcium oxalate stone.
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Affiliation(s)
- G Tabernero
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid
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Abstract
Hyperuricaemia is a frequent side-effect of cyclosporin A (CyA) therapy in renal transplant patients, and gout arthritis is the cause of considerable morbidity among these patients. However, neither the potential predisposing factors nor the mechanisms of hyperuricaemia have been clearly elucidated. It has been reported that hyperuricaemia in patients on CyA is associated with a lowered glomerular filtration rate, or with a reduced urate clearance, due to an increase in the net tubular urate reabsorption or to a decrease in secretion. These conclusions are mostly supported by measurements of the basal clearance rate and fractional excretion of urate, but more precise studies of renal handling of urate by the renal tubule have seldom been performed. The purpose of our study was to investigate the prevalence of hyperuricaemia in our population of renal transplant patients, as well as the risk factors involved. Furthermore, we have evaluated the mechanism of hyperuricaemia by a combined pyrazinamide and probenecid test allowing a better evaluation of urate transport processes than pyrazinamide alone.
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Affiliation(s)
- R Marcén
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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Abstract
OBJECTIVE To study the etiology, clinical spectrum. image findings, management and outcome of children with renovascular hypertension (RVH). MATERIAL AND METHODS Twenty children (aged 5 days to 15 years) were studied and treated for RVH during 1977-1998. In 14 cases hypertension was found during a routine examination. Six cases had heart failure and/or hypertensive encephalopathy. Diagnosis was made with aortography. Post-captopril renography and Doppler ultrasonography were obtained in 8 patients and spiral computed tomography angiography in 2. Treatment consisted of surgery (8 patients), percutaneous transluminal angioplasty (PTA) (5) or antihypertensive drugs only (8). RESULTS Initial blood pressure was 62 +/- 31 mmHg > 95th percentile for systolic and 44 +/- 22 mmHg for diastolic blood pressure. Twelve children had unilateral and 8 had bilateral arterial stenosis. In 3 cases lesions were intrarenal. RVH was due to fibromuscular dysplasia (7 patients) and associated to middle aortic syndrome (5). neurofibromatosis (3), William's syndrome (2). Takayasu's arteritis (1) and pheochromocytoma (1). Treatment of choice was decided depending on the size of the child and location and severity of the stenosis. At the end of the follow-up (78 +/- 49 months), 9 patients are normotensive without medication and 7 are normotensive with drugs. Three patients have died, 2 for unrelated causes and I for cardiac failure; 1 child was lost to the follow-up. CONCLUSIONS Although symptoms are relatively uncommon. renovascular disease is a frequent cause of severe hypertension in childhood. Non-invasive diagnostic techniques appear useful as screening methods. Treatment by surgery or PTA is successful if patients are carefully selected.
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Affiliation(s)
- R Estepa
- Department of Nephrology, Hospital Ramon y Cajal, Madrid, Spain
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Gallego N, Estepa R, Tellería D, San Millán JL, Belanger A, Ortuño J. Angiotensin I converting enzyme gene polymorphism and reflux nephropathy in children. Nephron Clin Pract 2001; 89:231-2. [PMID: 11549909 DOI: 10.1159/000046074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Estepa R, Gallego N, Orte L, Belanger A, Aracil E, Ortuño J. Pediatric renovascular hypertension. Pediatr Nephrol 2001; 16:529-31. [PMID: 11420923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Ariceta G, Gallego N, López-Fernández Y, Vallo A, Quintela MJ, Rodríguez Soriano J. [Long-term prognosis of childhood IgA nephropathy in adult life]. Med Clin (Barc) 2001; 116:361-4. [PMID: 11333668 DOI: 10.1016/s0025-7753(01)71831-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To evaluate long-term prognosis in a group of children with IgA nephropathy and to analyse which clinical factors were associated with progression to chronic renal failure in adulthood. PATIENTS AND METHOD Retrospective study. 58 young adults with IgA nephropathy diagnosed at 10.6(SD 2.9) years old and studied after a follow-up of 11.8 (SD 2.9) years. RESULTS Relapses of macroscopic hematuria and proteinuria were the most frequent symptoms at onset (75.9%). In 25.9% of patients high plasmatic IgA levels were also detected. Most cases had grade I (44.8%)or grade II (44.8%) histological lesions at diagnosis. At the last control, clinical remision was observed in 21 patients (36.2%) and 50% of the whole group remained with abnormal urine. 8 patients(13.8%) reached terminal renal failure. Mean renal survival (defined as glomerular filtration rate above 50 ml/min/1.73 m2)was 100, 93.3 and 81.1% at 5, 10 and 15 years of evolution, respectively. CONCLUSIONS About 14% of children with IgA nephropathy had long-term renal bad prognosis. Hypertension at onset, plasma creatinine elevation and proteinuria during adolescence were significant risk factors associated with chronic renal failure during adulthood. Minimal lesions at IgA nephropathy diagnosis in children did not exclude long-term poor prognosis.
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Affiliation(s)
- G Ariceta
- Sección de Nefrología Pediátrica, Departamento de Pediatría, Hospital de Cruces, Vizcaya, Madrid
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Abstract
BACKGROUND The outcome for children with acute renal failure (ARF) may be poor. However, relatively few published studies have considered prognosis of these patients. METHODS We prospectively studied, from 1978 to 1998, 92 such children without heart disease to try to identify risk factors for mortality. RESULTS Forty five per cent of children with tumours, shock, and other causes died compared with none of those with a primary urinary tract related problem. ARF did not seem to be the cause of death in any case. Univariate analysis showed that in the non-primary urinary problem group (55 cases), patients with hypotension, high values of BUN or creatinine, or who needed mechanical ventilation or dialysis, had a poor outcome. Multivariate analysis showed that probability of death can be estimated using the following score: -0.02 + 0.28 (hypotension) + 0.19 (ventilation) + 0.27 (dialysis) + 0.01 (BUN). CONCLUSIONS Mortality of patients with ARF was related to aetiology, the need for dialysis and/or ventilator use, hypotension, and BUN values.
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Affiliation(s)
- N Gallego
- Servicio de Nefrología, Hospital Ramón y Cajal, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain.
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Gallego N, Estepa R, Mampaso F, García-S F, Reche A, Ortuño J. Tubulointerstitial nephritis and asymptomatic uveitis. J Nephrol 2000; 13:373-6. [PMID: 11063142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
We describe a case of a 10 year-old boy who had fever, weakness, anorexia, weight loss and general malaise. No other remarkable symptoms were present. He had been treated with Aspirin and Ibuprofen. Deterioration of renal function, glucosuria, proteinuria, anemia and increased erythrocyte sedimentation rate were detected. After 7 days observation with no treatment, renal function worsened, glucosuria increased and fever persisted. A renal biopsy was performed and acute tubulointerstitial nephritis was diagnosed. The most common aetiologies of this entity were excluded. An ophthalmologic study revealed bilateral anterior uveitis, therefore the patient was diagnosed as having tubulointerstitial nephritis with uveitis. The child improved on corticosteroid therapy, but uveitis relapsed when treatment was stopped.
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Affiliation(s)
- N Gallego
- Department of Nephrology, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain.
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Gonzalo A, Mampaso F, Bárcena R, Gallego N, Ortuño J. Membranous nephropathy associated with hepatitis B virus infection: long-term clinical and histological outcome. Nephrol Dial Transplant 1999; 14:416-8. [PMID: 10069200 DOI: 10.1093/ndt/14.2.416] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- A Gonzalo
- Servicio de Nefrologia, Hospital Ramon y Cajal, Madrid, Spain
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Aguilera A, Rivera M, Gallego N, Nogueira J, Ortuno J. Sonographic appearance of the juvenile nephronophthisis-cystic renal medulla complex. Nephrol Dial Transplant 1997; 12:625-6. [PMID: 9075164 DOI: 10.1093/ndt/12.3.625] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Marcén R, Gallego N, Teruel JI, Estepa MR, Oreofino L, Ortuño J. Hyperuricaemia in renal transplant patients on cyclosporin. Nephrol Dial Transplant 1996; 11:2378-80. [PMID: 8941630 DOI: 10.1093/oxfordjournals.ndt.a027193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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34
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Navarro JF, Quereda C, Quereda C, Gallego N, Antela A, Mora C, Ortuno J. Nephrogenic diabetes insipidus and renal tubular acidosis secondary to foscarnet therapy. Am J Kidney Dis 1996; 27:431-4. [PMID: 8604715 DOI: 10.1016/s0272-6386(96)90369-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Foscarnet is used as therapy of cytomegalovirus (CMV) infection in immunosuppressed subjects. We present a patient with human immunodeficiency virus infection under treatment with foscarnet for CMV retinitis who complained of thirst and polyuria. Laboratory data showed hypernatremia with increased plasma osmolality and metabolic hyperchloremic acidosis. A water deprivation test demonstrated a nephrogenic diabetes insipidus. Other laboratory studies, including urine pH, anion gap, titratable acidity, and bicarbonate, showed a distal tubular acidification defect. All abnormalities were transient, with recovery a few days after foscarnet withdrawal. No cases of renal acidosis, and only one case of nephrogenic diabetes insipidus, has been previously reported as a complication of foscarnet treatment. Our patient developed both nephrogenic diabetes insipidus and renal tubular acidosis with a temporal pattern that demonstrated a link between foscarnet therapy and these abnormalities.
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Affiliation(s)
- J F Navarro
- Department of Nephrology, Hospital Ramon y Cajal, Madrid, Spain
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35
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Marcén R, Gallego N, Orofino L, Gámez C, Estepa MR, Sabater J, Teruel JL, Ortuño J. Impairment of tubular secretion of urate in renal transplant patients on cyclosporine. Nephron Clin Pract 1995; 70:307-13. [PMID: 7477618 DOI: 10.1159/000188609] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The prevalence of hyperuricemia was investigated in 214 kidney allograft recipients, 81 were on azathioprine and steroids and 133 on cyclosprine (CyA) and low-dose steroids or on triple therapy. All had stable renal function, serum creatinine < 2.5 mg/dl, and a follow-up between 12 and 120 months. At the time of the study, blood and urine samples were obtained to perform tests of renal function. The renal handling of urate was evaluated by a combined pyrazinamide and probenecid test in 35 selected patients (12 normouricemic on azathioprine, 9 normouricemic on CyA and 14 hyperuricemic on CyA). The prevalence of hyperuricemia was higher in the group of patients on CyA (19.7 vs. 66.9%, p < 0.001), as well as the concentration of serum urate (6.1 +/- 1.9 vs. 7.6 +/- 1.7, p < 0.001), and serum creatinine (1.2 +/- 0.3 vs. 1.4 +/- 0.4, p < 0.001). In patients on CyA, multivariate analysis showed that the most important predictive variables of hyperuricemia were: serum creatinine, FEurate, diuretic use and CyA blood levels (r = 0.73, p < 0.0001). Thirteen patients on CyA (9.9%) had at least one episode of gouty arthritis. Those patients were older than the hyperuricemic patients without gout (45.7 +/- 6.7 vs. 37.1 +/- 13.5 years, p < 0.01), had worse renal function (serum creatinine 1.9 +/- 0.4 vs. 1.5 +/- 0.4 mg/dl, p < 0.01), and higher prevalence of hypertension (100 vs. 63.1%, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Marcén
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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36
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Abstract
The rate of progression of renal failure was analyzed in 19 patients with biopsy-proven chronic primary glomerular diseases, by the slope (regression coefficient) of the linear regression of reciprocal serum creatinine on time. The relative importance of proteinuria, sex, underlying disease and components of arterial pressure (systolic, diastolic and mean) was tested using stepwise multiple linear regression, the dependent variable being the slope of progression. We found that the only variable significantly related with slopes of progression was arterial pressure. Hypertension was found in 14 of the 19 patients. There was a significant linear relationship (p < 0.05) between mean arterial pressure and slopes of progression. Notwithstanding, the best fit to the data follows a quadratic function (p < 0.001 for mean arterial pressure), which corresponds to a negative parabolic curve. Therefore, either low or high values of mean arterial pressure were associated with faster mean progression rates. Thus, an accurate approach of this relationship fits a nonlinear regression model.
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Affiliation(s)
- A Gonzalo
- Servicio de Nefrologia, Hospital Ramon y Cajal, Madrid, España
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37
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Gallego N, Gallego A, Pascual J, Liaño F, Estepa R, Ortuño J. Prognosis of children with acute renal failure: a study of 138 cases. Nephron Clin Pract 1993; 64:399-404. [PMID: 8341385 DOI: 10.1159/000187361] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Acute renal failure (ARF) in children has a poor prognosis in spite of modern therapeutic techniques. For this reason, it would be useful to have prognostic indicators early in the course of the disease, in order to identify those patients that could benefit most from aggressive treatment. In an attempt to establish valid prognostic factors, we prospectively studied 138 cases of ARF in children. We examined age, sex, etiology of ARF, previous surgery, prerenal origin, clinical situation of the patient when first seen by the nephrologist and complications. All these variables were statistically analyzed individually by univariate tests and, except for sex and complications, also by multiple regression analysis. Median age of the patients was 26 months. The etiology of ARF was nephropathy in 16, tumor in 14, cardiopathy in 85 and other causes in 23 cases. For analysis, patients were divided into patients with and without prerenal ARF. In the prerenal group, mortality-related factors were hypotension, need for ventilatory support, age less than 1 month and serum values of creatinine. In the nonprerenal ARF group, the need for assisted ventilation and the need for dialysis correlate positively with the mortality, while an exclusive nephrological etiology was associated with less probability of death.
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Affiliation(s)
- N Gallego
- Department of Neprhology, Hospital Ramón y Cajal Madrid, Spain
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Liaño F, Gallego A, Pascual J, García-Martín F, Teruel JL, Marcén R, Orofino L, Orte L, Rivera M, Gallego N. Prognosis of acute tubular necrosis: an extended prospectively contrasted study. Nephron Clin Pract 1993; 63:21-31. [PMID: 8446248 DOI: 10.1159/000187139] [Citation(s) in RCA: 149] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The ability to predict the outcome in acute tubular necrosis (ATN) remains elusive despite considerable efforts. Accurate prediction is a crucial priority and has large economical and ethical implications, mainly to judge when treatment is futile and further efforts only prolong miserable agony. To analyze the influence of risk factors in the prognosis of ATN, we applied, in an initial phase, a prospective protocol of demographic data, cause of renal failure, diuresis, need of dialysis and clinical conditions in 228 patients using multiple linear and logistic regression models. In a control phase with 100 consecutive patients, we checked the accuracy of the results previously obtained, evaluating further the overall population of 328 patients in a synthetic phase. Finally, the validation of the equations obtained was verified in 25 patients from another hospital. As a complement of this 4-phase study, detailed statistical comparisons between both linear and logistic multiple regression models were undertaken. Correlation between probability of death obtained with equations from the initial phase applied to control patients and real evolution of these patients, survival or death, was excellent. The study of the synthetic phase revealed coma, assisted respiration, hypotension, oliguria and jaundice as having an independent positive influence on mortality and nephrotoxic etiology and normal consciousness on good prognosis. For the linear model, the same cut-off point of discriminant score (0.9) above which there were no chances for survival could be established in the 4 phases. With the logistic model, it only was found at later phases. The multiple linear was better than the logistic regression model in terms of better correlation with real mortality, better sensitivity and specificity intervals, easier use of discriminant cut-off point and better adjustment of distribution of standardized residuals to expected normal function. Early prognosis of ATN is possible and can be given using simple clinical features. A discriminant score allows to distinguish patients without chances for survival. The multiple linear is better than the logistic regression model in the prediction of the outcome in ATN.
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Affiliation(s)
- F Liaño
- Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain
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39
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Quereda C, Soria C, Gallego N, Sabater J, Pascual J, Orofino L, Ortuno J. Urinary acidification response to furosemide administration in patients on low-dose cyclosporine therapy. Am J Nephrol 1993; 13:107-14. [PMID: 8342575 DOI: 10.1159/000168599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The response of urinary acidification parameters and electrolytes to furosemide administration was prospectively studied in 9 psoriatic patients treated with a low-dose cyclosporine A schedule (initial dose: 5 mg/kg body weight) before beginning cyclosporine A, after 3 months on cyclosporine A and 1 month after cyclosporine A withdrawal. The test was also performed in 29 psoriatic patients after 3 months on 5 mg/kg body weight cyclosporine A treatment. There were no significant differences between before and after cyclosporine A treatment regarding furosemide-induced changes in urinary volume, sodium or potassium excretion. Contrarily, the post-furosemide urinary pH decrease and ammonium and titrable acid increase were significantly lower in cyclosporine-A-treated patients. Five of the 29 studied patients showed abnormal furosemide tests (17%). These patients had lower total serum CO2, urea and creatinine but similar serum potassium and fractional potassium excretion. We conclude that some patients treated with low-dose cyclosporine A therapy develop an abnormal tubular distal response to furosemide administration, suggesting an alteration in the H(+)-ATPase pump or a voltage-dependent mechanism.
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Affiliation(s)
- C Quereda
- Nephrology Department, Hospital Ramon y Cajal, Madrid, Spain
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Quereda C, Soria C, Gallego N, Sabater J, Bermejo M, Pascual J, Ortuño J. Subclinical impairment of distal renal acidification induced by low-dose cyclosporin A therapy. Transpl Int 1992. [DOI: 10.1111/tri.1992.5.s1.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Quereda C, Soria C, Gallego N, Sabater J, Bermejo M, Pascual J, Ortuño J. Subclinical impairment of distal renal acidification induced by low-dose cyclosporin A therapy. Transplant International Official Journal of the European Society for Organ Transplantation 1992; 5 Suppl 1:S529-31. [PMID: 14621867 DOI: 10.1007/978-3-642-77423-2_155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Twenty-nine psoriasis patients on 5 mg/kg cyclosporin A (CyA) therapy were studied for 3 months using the furosemide test. Five of them (17%) showed an abnormal renal acidification capacity after furosemide administration: The urinary pH did not sink under 5.3 after furosemide, while the ammonium and titrable acid levels were significantly low. There were no significant differences from controls regarding the serum potassium or fractional potassium excretion. Nevertheless, the transtubular potassium gradient was lower in patients with an abnormal furosemide test result. We conclude that some patients treated with a low dose CyA therapy developed an abnormality in the distal tubular acidification.
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Affiliation(s)
- C Quereda
- Nephrology Department, Hospital Ramon y Cajal, Madrid, Spain
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43
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Teruel JL, Lasunción MA, Castañón MA, Gallego N, Herrera E, Ortuño J. [Treatment of homozygotic familial hypercholesterolemia with continuous apheresis of low density lipoproteins]. Med Clin (Barc) 1991; 97:738-40. [PMID: 1800863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A boy of 8 years 4 months of age was diagnosed as having homozygotic familial hypercholesterolemia and commenced treatment with an apheresis technique of low density lipoproteins. This procedure consists in the extracorporeal elimination of low density lipoproteins by fixing the same in a cellulose column with dextran-sulphate. Each session lasts between 90-150 minutes and is carried out weekly. Prior to initiation of the treatment, the total plasmatic concentration of cholesterol was 24 mml/l (930 mg/dl), low density lipoprotein ligated cholesterol 22.6 mmol/l (876 mg/dl) and high density lipoprotein ligated cholesterol 0.98 mmol/l (38 mg/dl). Following 8 weeks of treatment total cholesterol and low density lipoprotein ligated cholesterol were 10 mmol/l (394 mg/dl) and 8.6 mmol/l (335 mg/dl) respectively upon commencing the treatment and 4.7 mmol/l (184 mg/dl) and 3 mmol/l (118 mg/dl) upon completion of the same. This is the first time in Spain that treatment with this technique has been used in homozygotic familial hypercholesterolemia.
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Affiliation(s)
- J L Teruel
- Servicio de Nefrología, Hospital Ramón y Cajal, Madrid
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44
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Abstract
A 7-year-old boy with a history of recurrent acute renal failure and macroscopic haematuria is reported. A renal biopsy performed during the first episode of renal function deterioration showed mesangial glomerulonephritis with C3 mesangial deposits. Macroscopic haematuria associated with respiratory infections recurred four times over the next 14 months, each time in association with acute derangement of renal function. A second biopsy showed acute interstitial nephritis and similar glomerular abnormalities. Retrospectively, a causal relationship between the ingestion of paracetamol and the appearance of the symptoms was observed. No derangement of renal function was present in subsequent episodes of macroscopic haematuria following removal of the offending drug. This is a case of drug-induced acute interstitial nephritis superimposed on a glomerular disease, and suggests the importance of recognizing this association.
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Affiliation(s)
- N Gallego
- Department Nephrology, Hospital Ramón Cajal, Madrid, Spain
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Affiliation(s)
- P Ros
- Servicio de Pediatría, Hospital Ramón y Cajal, Madrid, Spain
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46
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Gallego N. [Course of the incidence of membranoproliferative glomerulonephritis in the population of children in Spain]. Med Clin (Barc) 1989; 92:736-7. [PMID: 2666778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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47
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Teruel JL, Gallego N. [Does an idiopathic hematuria really exist?]. Med Clin (Barc) 1988; 91:19-22. [PMID: 3050305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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48
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Matesanz R, Quereda C, Liaño F, Gallego N, Ortuño J. [Home hemodialysis: the course in 100 patients treated at home]. Med Clin (Barc) 1988; 90:325-8. [PMID: 3374188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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49
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Gonzalo A, Mampaso F, Gallego N, Quereda C, Fierro C, Ortuño J. Clinical significance of IgM mesangial deposits in the nephrotic syndrome. Nephron Clin Pract 1985; 41:246-9. [PMID: 4058625 DOI: 10.1159/000183591] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We have studied 32 patients with idiopathic nephrotic syndrome aged from 3 to 59 years. The clinical course of 20 patients with IgM mesangial deposits was compared with that of 12 patients without glomerular immune deposits. The presence of IgM deposits seems to be unrelated to any particular clinical onset, histological pattern on light microscopy, therapy response, or clinical course in our relatively short follow-up. The conclusion from this study is that IgM mesangial deposition is not a marker for response to therapy in patients with idiopathic nephrotic syndrome.
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50
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Boronat F, Pérez Bustamante I, Mayayo T, Gallego N, Romero C. [Thoracic ectopic right kidney associated with Down syndrome and a serious heart abnormality]. Actas Urol Esp 1982; 6:33-6. [PMID: 6211061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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