A comprehensive study of mutation and phenotypic heterogeneity of childhood mitochondrial leukodystrophies

OBJECTIVE

Mitochondrial leukodystrophies (MLs) are mainly caused by impairments of the mitochondrial respiratory chains. This study reports the mutation and phenotypic spectrum of a cohort of 41 pediatric patients from 39 distinct families with MLs among 320 patients with a molecular diagnosis of leukodystrophies.

METHODS

This study summarizes the clinical, imaging, and molecular data of these patients for five years.

RESULTS

The three most common symptoms were neurologic regression (58.5%), pyramidal signs (58.5%), and extrapyramidal signs (43.9%). Because nuclear DNA mutations are responsible for a high percentage of pediatric MLs, whole exome sequencing was performed on all patients. In total, 39 homozygous variants were detected. Additionally, two previously reported mtDNA variants were identified with different levels of heteroplasmy in two patients. Among 41 mutant alleles, 33 (80.4%) were missense, 4 (9.8%) were frameshift (including 3 deletions and one duplication), and 4 (9.8%) were splicing mutations. Oxidative phosphorylation in 27 cases (65.8%) and mtDNA maintenance pathways in 8 patients (19.5%) were the most commonly affected mitochondrial pathways. In total, 5 novel variants in PDSS1, NDUFB9, FXBL4, SURF1, and NDUSF1 were also detected. In silico analyses showed how each novel variant may contribute to ML pathogenesis.

CONCLUSIONS

The findings of this study suggest whole-exome sequencing as a strong diagnostic genetic tool to identify the causative variants in pediatric MLs. In comparison between oxidative phosphorylation (OXPHOS) and mtDNA maintenance groups, brain stem and periaqueductal gray matter (PAGM) involvement were more commonly seen in OXPHOS group (P value of 0.002 and 0.009, respectively), and thinning of corpus callosum was observed more frequently in mtDNA maintenance group (P value of 0.042).

Detection of HSV-1, HSV-2 and VZV Isolated from Cerebrospinal Fluid Samples of Children Suspected to Encephalitis

Background

Encephalitis is an uncommon, serious brain infection that can cause fatality among children. The cause of most encephalitis remained unknown, yet viruses are the most well-known infectious agents that cause encephalitis. This study aimed to determine varicella-zoster virus (VZV) and herpes simplex virus type 1, 2 (HSV1/2) among individuals who are under 5 years of age in Iran.

Materials and Methods

In this study, 149 cerebrospinal fluid samples of suspected patients of encephalitis were analyzed with some symptoms, such as seizure, fever, nausea loss of consciousness, and dizziness from Mofid Children's Hospital in Tehran, Iran. Then, the molecular evaluation of samples was performed using multiplex Polymerase Chain Reaction (PCR) for detecting HSV1/2 and VZV.

Results

The mean age of the patients was 1.8 years. Also, 63.4% of children were male and 36.6% were female. Out of 149 tested samples, 11 (7.3%) showed the viral DNA for one of the herpes viruses (7.3%). Nine samples were HSV1 positive (6.0%) and two samples were VZV positive (1.3%). Fever and vomiting were the most frequent symptoms. The mean ± standard deviation (SD) WBC and counts in cerebrospinal fluid (CSF)-positive samples, and all included samples were 298.8 ± 552.7 cells/μL and 131.1 ± 474.6 cells/μL, respectively.

Conclusions

Although viral encephalitis is considered a threat to children's health, with accurate diagnosis and appropriate antiviral drugs, death and neurological complications in children can be prevented.

Incidence of Pediatric Multiple Sclerosis in Iran within 2000-2019

OBJECTIVES

Due to a lack of data on pediatric multiple sclerosis (MS) epidemiology in Iran, this study aimed to determine the incidence rate of pediatric MS in Iran.

MATERIALS & METHODS

 All the data of the patients with MS registered in the Ministry of Health and Medical Education of Iran for 20 years were collected in this study; those born in 1982 and diagnosed with the disease and treated since 2000 were included in this study. Therefor The collected variables were patients' age at the time of diagnosis, gender, year of diagnosis, urban or rural residency, and province of residence. Additionally, age-specific incidence rates per 100,000 of the population were calculated.

RESULTS

This study was performed on 4544 cases of pediatric MS within 2000-2019, of which 997 patients (21.9%) were male. The mean age of the patients with MS at the time of diagnosis was 14.3±4.6 years, and 4414 children (97.1%) lived in urban areas. The incidence rate of pediatric MS in Iran during 20 years increased from 0.26 per 100,000 of the population in 2000 to 1.53 in 2019.

CONCLUSION

The incidence of pediatric MS in Iran is high, and the development of diagnostic practices in the past decade in Iran has contributed to the detection of this high incidence.

How Antiepileptics May Change the Serum Level of Vitamin D, Calcium, and Phosphorus in Children with Epilepsy

Objective

Studies have shown vitamin (Vit) D deficiency and bone disease in long-term use of antiepileptics, especially in young individuals. This study aimed to determine the relationship between antiepileptic drugs and the level of Vit D, calcium (Ca), and phosphorus (P) in children with epilepsy at the Shohada Hospital from 2016 to 2017.

Materials & Methods

In this case-control study, 60 consecutive children with epilepsy at the Shohada Hospital from 2016 to 2017 under treatment with anticonvulsions for more than six months were enrolled as the case group. The level of Vit D, Ca, and P was determined in the case group and compared with 60 children without seizure as the control group.

Results

The mean Ca and P were alike across the groups (P > 0.05). The mean Vit D3 level was 31.3 and 40 in the case and control groups, respectively, with significant difference (P=0.0001). The mean Ca and P were alike across the types of drug in the case group (P > 0.05); however, the mean Vit D3 level was lower in the case versus control group with significant difference (P=0.040).

Conclusion

Totally, according to the obtained results, it may be concluded that treatment with antiepileptic drugs, especially stimulant type, is related to the lower Vit D3 level, but not to the Ca and P levels.

Pachyonychia congenita: a case report of a successful treatment with rosuvastatin in a patient with a KRT6A mutation

Pachyonychia congenita (PC) is a rare autosomal dominant disorder characterized by nail dystrophy and palmoplantar keratoderma with severe plantar pain affecting quality of life. There is no effective treatment. Heterozygous mutations in the keratin genes KRT6A, KRT6B, KRT6C, KRT16 and KRT17 have been reported as a cause of PC. Herein we present a female patient with an amino acid substitution mutation in KRT6A (c.1381G>A, p.Glu461Lys in exon 7) and classic features of PC associated with oral leucokeratosis and follicular hyperkeratosis. We also demonstrate successful treatment of the patient with rosuvastatin. A 3.6-mm reduction in plantar callosity thickness was demonstrated by sonography. Our patient also experienced significant pain relief that allowed her to increase physical activity (Children's Dermatology Life Quality Index score dropped nine points following treatment). Collectively, these improvements suggest that rosuvastatin may offer a promising treatment for PC. What's already known about this topic? Pachyonychia congenita (PC) is an autosomal dominant disease characterized by nail dystrophy and painful plantar keratoderma. Keratolytics, emollients, retinoids and steroids have been used for treatment but with limited benefits. What does this study add? A patient with PC who had a KRT6A mutation was treated with rosuvastatin with significant improvement in plantar hyperkeratosis and pain. Statins could be a promising treatment for PC with long-term safety, but further studies are needed.

Hopkins Syndrome in a 14 Year Old Boy; a Case Report

Hopkins syndrome (HS) is a flaccid paralysis resembling poliomyelitis that has been seen in some children who are recovering from an acute episode of asthma. This syndrome should be suspected based on clinical findings even before the occurrence of characteristic breathing patterns and epilepsy. We report a 14-year-old boy who had experienced an episode of HS.

PA01.72. Evaluation of DB14201 on prevention of development of streptozotocin induced diabetes mellitus in wistar rats

Purpose:

Study is part of an ongoing reverse pharmacology approach in new drug development for diabetes. It was designed to determine the potential of DB14201 to prevent the development of Streptozotocin induced Diabetes Mellitus in Wistar rats.

Method:

35 female Wistar rats were randomized and allocated to different groups on the basis of body weight. G1 served as non diabetic control (Negative Control) and G2 served as Diabetic control (Vehicle Control) and received 10 ml/kg of Milli Q water. G3 and G4 were treated with 500mg/kg and 250mg/kg of DB14201 respectively. All the groups were treated orally for 21 days using disposable syringes tipped with an oral gavage needle. At the end of dosing period, hyperglycemia was induced in G2,G3 and G4 rats by intra peritoneal injection of streptozotocin (STZ) 55 mg/kg in citrate buffer (pH 4.5). Fasting blood glucose level was estimated before induction of diabetes and on 2nd & 7th days post induction. All animals were observed daily for mortality and clinical signs of toxicity throughout the experimental period. Body weight of each animal was recorded daily throughout the experimental period. On the 8th day post STZ injection, animals were killed by cervical dislocation. Their pancreatic tissues were quickly removed. Tissues were washed in normal saline and visible clots were removed to minimize blood contamination. Part of the pancreatic tissue was sent for histological evaluation. With second part of tissue, homogenates was prepared and stored at 70 A°C until the determination of biochemical parameters and enzyme activity.

Result:

Findings of this study strongly demonstrate that DB14201 treatment have prominent role in the prevention of STZ induced diabetes mellitus.

Conclusion:

Result clearly indicates the prophylactic as well as therapeutic potential of DB14201 in this experimental model. DB14201 at the dose of 500mg/kg was found to be more promising.

[Papillon-Lefèvre syndrome and recurrent infections]

Seven cases of Papillon-Lefevre syndrome are described, 4 children and their mother with two other relatives on the mother's side. An immune defect was suspected because six of the seven had a history of severe pyogenic infections, but the results of the tests were not the same in the three individuals tested. In one patient no immune defect was detected but in the other two the response of lymphocytes to candida and to streptokinase and streptodornase was reduced.