1
|
Miclea D, Osan S, Bucerzan S, Stefan D, Popp R, Mager M, Puiu M, Zimbru C, Chirita-Emandi A, Alkhzouz C. Copy number variation analysis in 189 Romanian patients with global developmental delay/intellectual disability. Ital J Pediatr 2022; 48:207. [PMID: 36585697 PMCID: PMC9801529 DOI: 10.1186/s13052-022-01397-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 12/13/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Developmental delay and intellectual disability represent a common pathology in general population, involving about 3% of the pediatric age population, the genetic etiology being often involved. The aim of this study was to determine the clinically relevant copy number variants in patients diagnosed with global developmental delay/intellectual disability in our population, using the chromosomal microarray analysis. METHODS We analyzed 189 patients diagnosed with global developmental delay/intellectual disability, presented in Clinical Emergency Hospital for Children, Cluj-Napoca. The patients were completely clinically investigated, including dysmorphic and internal malformations evaluation, psychiatric, neuropsychological and metabolic evaluation, standard karyotyping. Genomic analysis was done using chromosomal microarray analysis. RESULTS Pathogenic findings (including uniparental disomy) and variants of unknown significance were detected in 53 of 189 patients (28.04%). Pathogenic copy number variants and uniparental disomy were observed in 35 of 189 patients (18.51%). Two patients presented uniparental disomy for chromosome 15, one with clinical phenotype of Prader-Willi syndrome and the other with clinical phenotype with Angelman syndrome. Within the category of pathogenic findings, the recurrent copy number variants were seen in 21 of 35 patients (60%). CONCLUSIONS The increased percentage of pathogenic structural variants observed in patients with global developmental delay/intellectual disability analyzed by chromosomal microarray technique supports its use in patients with a non-specific phenotype such as these neurodevelopmental disorders. The high percentage of recurrent pathogenic variants between these findings is a finding that support their initial evaluation when a genetic testing algorithm could be a useful option.
Collapse
Affiliation(s)
- Diana Miclea
- grid.411040.00000 0004 0571 5814Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur Street, No 6, 400349 Cluj-Napoca, Romania ,Emergency Clinical Hospital for Children, Pasteur Street, No 6, 400349 Cluj-Napoca, Romania
| | - Sergiu Osan
- grid.411040.00000 0004 0571 5814Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur Street, No 6, 400349 Cluj-Napoca, Romania
| | - Simona Bucerzan
- Emergency Clinical Hospital for Children, Pasteur Street, No 6, 400349 Cluj-Napoca, Romania ,grid.411040.00000 0004 0571 5814Department of Mother and Child, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Delia Stefan
- grid.411040.00000 0004 0571 5814Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur Street, No 6, 400349 Cluj-Napoca, Romania
| | - Radu Popp
- grid.411040.00000 0004 0571 5814Department of Molecular Sciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, Pasteur Street, No 6, 400349 Cluj-Napoca, Romania
| | - Monica Mager
- Emergency Clinical Hospital for Children, Pasteur Street, No 6, 400349 Cluj-Napoca, Romania ,grid.411040.00000 0004 0571 5814Department of Neuroscience, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Puiu
- grid.22248.3e0000 0001 0504 4027“Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Cristian Zimbru
- grid.6992.40000 0001 1148 0861Polytechnic University, Timisoara, Romania
| | - Adela Chirita-Emandi
- grid.22248.3e0000 0001 0504 4027“Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Camelia Alkhzouz
- Emergency Clinical Hospital for Children, Pasteur Street, No 6, 400349 Cluj-Napoca, Romania ,grid.411040.00000 0004 0571 5814Department of Mother and Child, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
2
|
Lazea C, Bucerzan S, Crisan M, Al-Khzouz C, Miclea D, Şufană C, Cismaru G, Grigorescu-Sido P. Cardiovascular manifestations in Marfan syndrome. Med Pharm Rep 2021; 94:S25-S27. [PMID: 34527904 DOI: 10.15386/mpr-2223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Marfan syndrome (MFS) is an autosomal dominant inherited disease of the connective tissue with multiorgan involvement (skeleton, cardiovascular, eyes, skin, lungs). Cardiovascular involvement is variable and represents the major cause of morbidity and mortality in Marfan syndrome. We provide a comprehensive description of cardiovascular manifestations in Marfan syndrome, genotype-phenotype correlations and assessment of cardiovascular abnormalities and complications.
Collapse
Affiliation(s)
- Cecilia Lazea
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Simona Bucerzan
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | | | - Camelia Al-Khzouz
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Diana Miclea
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Crina Şufană
- Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Gabriel Cismaru
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Cardiology Rehabilitation Department, Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | | |
Collapse
|
3
|
Abstract
Background and aim The lysosomal storage diseases are a group of monogenic diseases with multisystemic impairment and chronic progression induced by the deficiency of lysosomal acid hydrolases involved in the breakdown of various macromolecules. The accumulation occurs in the macrophages of the reticule-endothelial system and causes enlargement and functional impairment. The mainly involved organs are the brain, liver, spleen, bones, joints, airways, lungs, and heart. The aim of this study was to evaluate early symptoms, signs and the delay in the diagnosis of different lysosomal diseases. Methods The medical documentation of 188 patients with lysosomal storage disorders, aged 1-70 years, were analyzed. All these patients were specifically diagnosed, by enzyme and molecular assay. Results The age of clinical signs onset varies in different type of lysosomal diseases, from the first months of life or early childhood in severe form, to adulthood in attenuated forms. The delay between the clinical signs onset and specific diagnosis ranged from 0.5 months to 57.91 years. Conclusions The lysosomal storage diseases are rare diseases with childhood onset, but these early signs and symptoms are not recognized and are often taken into account when the vital organs damage becomes manifest.
Collapse
Affiliation(s)
- Camelia Alkhzouz
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| | - Diana Miclea
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| | - Simona Bucerzan
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| | - Cecilia Lazea
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| | - Ioana Nascu
- Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| | - Paula Grigorescu Sido
- Center of Expertise for Rare Diseases Lysosomal Diseases, Clinical Emergency Hospital for Children, Cluj, Romania
| |
Collapse
|
4
|
Bucerzan S, Alkhzouz C, Crisan M, Miclea D, Asavoaie C, Ilies R, Grigorescu-Sido P. Diagnostic, treatment and outcome possibilities in achondroplasia. Med Pharm Rep 2021; 94:S22-S24. [PMID: 34527903 DOI: 10.15386/mpr-2222] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Achondroplasia is a common form of chondrodysplasia. It is transmitted by autosomal dominant trait. The disease is determined by mutations in receptor-3 gene of the fibroblast growth factor. The most frequent mutations are c.1138G>A and c.1183G>C; c.1138A. The diagnosis can usually be made on the basis of clinical characteristics and specific features on radiographs. It is not necessary to perform molecular testing in every child with a clinical diagnosis of achondroplasia.The aim of this study is to establish the diagnostic, treatment and outcome possibilities in patients with achondroplasia in our care. Method The study group consisted of 27 patients with achondroplasia. The method consisted of: clinical and radiological examinations. The DNA analasys was performed by PCR-RFLP technique. Results 80 patients were diagnosed with bone dysplasia; 24 of them were diagnosed (on clinical and radiological basis) with achondroplasia. Out of this group, 16 patients were identified as heterozygotes for G1138A mutation in FGFR3 gene; 3 patients undergoing treatment with somatotropic hormone; the growth rate is improving from 0.1 cm/month to 0.5 cm/month. Conclusions In achondroplasia diagnosis is based on clinical and radiological criteria. It is the first study that reports the prevelance of this mutation in Romania.
Collapse
Affiliation(s)
- Simona Bucerzan
- First Pediatric Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Camelia Alkhzouz
- First Pediatric Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mirela Crisan
- Emergency Clinical Hospital for Children, First Pediatric Clinic Cluj-Napoca, Romania
| | - Diana Miclea
- Medical Genetic Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Carmen Asavoaie
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Roxana Ilies
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Paula Grigorescu-Sido
- First Pediatric Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
5
|
Miclea D, Alkhzouz C, Bucerzan S, Grigorescu-Sido P. Genetic testing in pediatric endocrine pathology. Med Pharm Rep 2021; 94:S15-S18. [PMID: 34527901 DOI: 10.15386/mpr-2220] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In genetic endocrine diseases, genetic testing is necessary for a precise diagnosis, which will provide a better knowledge of the evolution and prognosis and also indicate the adequate therapy, targeting the precise etiopathogenesis of the disease. Genetic testing in endocrinology is often based on classical cytogenetic techniques, molecular cytogenetic analysis or molecular biology techniques. Genetic testing in disorders of sex development includes the karyotype and SRY gene analysis and depending on the presence of associated clinical signs and on the observations at paraclinical examination, these tests will be followed by chromosomal array techniques and NGS sequencing. In short stature, the decision to perform a genetic test is taken depending on clinical, paraclinical and imaging signs. In case of a short stature associated with a low weight/length for gestational age, genetic testing is proposed to evaluate a Russell-Silver syndrome or if the short stature is associated with other clinical signs (e.g. intellectual disability), chromosomal analysis by microarray is proposed. If the short stature is disproportionate, it is indicated to perform a next generation sequencing (NGS) of a panel of genes involved in skeletal dysplasia. If an endocrine cause for short stature is observed at the hormonal evaluation, it is indicated to test a panel of genes involved in these pathways. In genetic obesity, depending on clinical signs associated to obesity, it will be a more targeted genetic testing. If obesity is associated with intellectual disability or other nonspecific neurological changes, a chromosomal analysis by microarray will be indicated. If monogenic obesity is suspected, NGS testing will be indicated (as genes panel or whole exome or genome analysis). Genetic testing in endocrine diseases brings an etiological diagnosis, but a favorable cost-benefit ratio derives from an adequate indication of these tests, generally proposed in expert centers for rare endocrine diseases.
Collapse
Affiliation(s)
- Diana Miclea
- Molecular Sciences Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Medical Genetics Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Camelia Alkhzouz
- Medical Genetics Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.,Mother and Child Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Bucerzan
- Medical Genetics Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.,Mother and Child Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paula Grigorescu-Sido
- Mother and Child Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
6
|
Miclea D, Szucs A, Mirea A, Stefan DM, Nazarie F, Bucerzan S, Lazea C, Grama A, Pop TL, Farcas M, Zaharie G, Matyas M, Mager M, Vintan M, Popp R, Alkhzouz C. Diagnostic Usefulness of MLPA Techniques for Recurrent Copy Number Variants Detection in Global Developmental Delay/Intellectual Disability. Int J Gen Med 2021; 14:4511-4515. [PMID: 34429637 PMCID: PMC8378908 DOI: 10.2147/ijgm.s320033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/15/2021] [Indexed: 02/05/2023] Open
Abstract
Background Genetic testing has become a standardized practice in the diagnosis of patients with global developmental delay/intellectual disability (GDD/ID). The aim of this study is to observe the frequency of recurrent copy number variations (CNVs) in patients diagnosed with GDD/ID, using MLPA technique. Methods A total of 501 paediatric patients with GDD/ID were analysed using SALSA MLPA probemix P245 Microdeletion Syndromes-1A, and the technical steps were performed according to the MRC Holland MLPA general protocol. Results Twenty-five of 501 patients (5%) were diagnosed with a microdeletion/microduplication syndrome. Amongst them, 7 of 25 (30%) with clinical suggestion have a confirmed diagnosis, for the other cases the clinical features were not evocative for a specific syndrome. Conclusion This study showed that in cases with a specific clinical diagnosis the MLPA technique could be a useful alternative, less expensive and more efficient to indicate as first intention of a targeted diagnostic test, as it is the case of Williams syndrome, Prader–Willi syndrome or DiGeorge syndrome.
Collapse
Affiliation(s)
- Diana Miclea
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Adriana Szucs
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Andreea Mirea
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Delia-Maria Stefan
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Florina Nazarie
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Emergency Clinical Hospital for Children, Cluj-Napoca, Romania
| | - Simona Bucerzan
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania.,Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cecilia Lazea
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania.,Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alina Grama
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania.,Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tudor Lucian Pop
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania.,Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marius Farcas
- County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Gabriela Zaharie
- Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Melinda Matyas
- Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,County Emergency Clinical Hospital, Cluj-Napoca, Romania
| | - Monica Mager
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania.,Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mihaela Vintan
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania.,Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Popp
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Camelia Alkhzouz
- Emergency Clinical Hospital for Children, Cluj-Napoca, Romania.,Department of Mother and Child, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
7
|
Alkhzouz C, Bucerzan S, Miclaus M, Mirea AM, Miclea D. 46,XX DSD: Developmental, Clinical and Genetic Aspects. Diagnostics (Basel) 2021; 11:1379. [PMID: 34441313 PMCID: PMC8392837 DOI: 10.3390/diagnostics11081379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/26/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Differences in sex development (DSD) in patients with 46,XX karyotype occur by foetal or postnatal exposure to an increased amount of androgens. These disorders are usually diagnosed at birth, in newborns with abnormal genitalia, or later, due to postnatal virilization, usually at puberty. Proper diagnosis and therapy are mostly based on the knowledge of normal development and molecular etiopathogenesis of the gonadal and adrenal structures. This review aims to describe the most relevant data that are correlated with the normal and abnormal development of adrenal and gonadal structures in direct correlation with their utility in clinical practice, mainly in patients with 46,XX karyotype. We described the prenatal development of structures together with the main molecules and pathways that are involved in sex development. The second part of the review described the physical, imaging, hormonal and genetic evaluation in a patient with a disorder of sex development, insisting more on patients with 46,XX karyotype. Further, 95% of the etiology in 46,XX patients with disorders of sex development is due to congenital adrenal hyperplasia, by enzyme deficiencies that are involved in the hormonal synthesis pathway. The other cases are explained by genetic abnormalities that are involved in the development of the genital system. The phenotypic variability is very important in 46,XX disorders of sex development and the knowledge of each sign, even the most discreet, which could reveal such disorders, mainly in the neonatal period, could influence the evolution, prognosis and life quality long term.
Collapse
Affiliation(s)
- Camelia Alkhzouz
- Mother and Child Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.A.); (S.B.)
- Genetic Department, Clinical Emergency Hospital for Children Cluj-Napoca, 400370 Cluj-Napoca, Romania; (M.M.); (A.-M.M.)
| | - Simona Bucerzan
- Mother and Child Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.A.); (S.B.)
- Genetic Department, Clinical Emergency Hospital for Children Cluj-Napoca, 400370 Cluj-Napoca, Romania; (M.M.); (A.-M.M.)
| | - Maria Miclaus
- Genetic Department, Clinical Emergency Hospital for Children Cluj-Napoca, 400370 Cluj-Napoca, Romania; (M.M.); (A.-M.M.)
| | - Andreea-Manuela Mirea
- Genetic Department, Clinical Emergency Hospital for Children Cluj-Napoca, 400370 Cluj-Napoca, Romania; (M.M.); (A.-M.M.)
| | - Diana Miclea
- Mother and Child Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.A.); (S.B.)
- Molecular Science Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| |
Collapse
|
8
|
Lazea C, Bucerzan S, Al-Khzouz C, Zimmermann A, Vesa ȘC, Nașcu I, Creț V, Crișan M, Asăvoaie C, Miclea D, Grigorescu-Sido P. Cardiac Manifestations in a Group of Romanian Patients with Gaucher Disease Type 1 (a Monocentric Study). Diagnostics (Basel) 2021; 11:diagnostics11060989. [PMID: 34072542 PMCID: PMC8227770 DOI: 10.3390/diagnostics11060989] [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: 04/06/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
Gaucher disease (GD), one of the most common lysosomal disorders, is characterised by clinical heterogeneity. Cardiac involvement is rare and refers to pulmonary hypertension (PH), valvular abnormalities and myocardial infiltrative damage. The aim of this study was to evaluate cardiac involvement in a group of Romanian GD patients. Phenotypic and genotypic characterisation was carried out in 69 patients with GD type 1. Annual echocardiography and electrocardiography were performed to assess pulmonary pressure, morphology and function of the valves and electrocardiographic changes. Nine patients (13%) exhibited baseline echocardiographic signs suggesting PH. Mitral regurgitation was present in 33 patients (48%) and aortic regurgitation in 11 patients (16%). One patient presented aortic stenosis. Significant valvular dysfunction was diagnosed in 10% of patients. PH was associated with greater age (p < 0.001), longer time since splenectomy (p = 0.045) and longer time between clinical onset and the start of enzyme replacing therapy (p < 0.001). Electrocardiographic changes were present in five patients (7%).
Collapse
Affiliation(s)
- Cecilia Lazea
- 1st Pediatric Discipline, Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinic Pediatrics I, Emergency Pediatric Hospital, 400370 Cluj-Napoca, Romania; (S.B.); (C.A.-K.)
- Correspondence: ; Tel.: +40-744-353-764
| | - Simona Bucerzan
- 1st Pediatric Discipline, Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinic Pediatrics I, Emergency Pediatric Hospital, 400370 Cluj-Napoca, Romania; (S.B.); (C.A.-K.)
- Department of Genetic Diseases, Emergency Pediatric Hospital, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400370 Cluj-Napoca, Romania
| | - Camelia Al-Khzouz
- 1st Pediatric Discipline, Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinic Pediatrics I, Emergency Pediatric Hospital, 400370 Cluj-Napoca, Romania; (S.B.); (C.A.-K.)
- Department of Genetic Diseases, Emergency Pediatric Hospital, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400370 Cluj-Napoca, Romania
| | - Anca Zimmermann
- 1st Clinic and Polyclinic of Internal Medicine, Medical Clinic 2, Clinic of Worms, Department of Diabetology and Endocrinology, University Medical Center, 55131 Mainz, Germany;
| | - Ștefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Ioana Nașcu
- Emergency Pediatric Hospital, 400370 Cluj-Napoca, Romania; (I.N.); (V.C.); (M.C.); (C.A.)
| | - Victoria Creț
- Emergency Pediatric Hospital, 400370 Cluj-Napoca, Romania; (I.N.); (V.C.); (M.C.); (C.A.)
| | - Mirela Crișan
- Emergency Pediatric Hospital, 400370 Cluj-Napoca, Romania; (I.N.); (V.C.); (M.C.); (C.A.)
| | - Carmen Asăvoaie
- Emergency Pediatric Hospital, 400370 Cluj-Napoca, Romania; (I.N.); (V.C.); (M.C.); (C.A.)
| | - Diana Miclea
- Department of Medical Genetics, “Iuliu Hațieganu” University of Medicine and Pharmacy, Emergency Pediatric Hospital, 400012 Cluj-Napoca, Romania;
| | - Paula Grigorescu-Sido
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| |
Collapse
|
9
|
Alkhzouz C, Cabau G, Lazea C, Asavoaie C, Bucerzan S, Mirea AM, Farcas M, Miclaus Jnr M, Popp R, Miclea D. Skeletal Abnormalities and VDR1 Gene Polymorphisms in Mucopolysaccharidosis Patients. Pharmgenomics Pers Med 2021; 14:349-358. [PMID: 33889011 PMCID: PMC8056862 DOI: 10.2147/pgpm.s295241] [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] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022]
Abstract
Introduction Articular and bone damage, which is so disabling in Mucopolysaccharidosis (MPS), requires attention as to the explanatory bias of the pathogenetic mechanisms identified to date. The vitamin D receptor (VDR) has been investigated in many studies in correlation with bone metabolism, osteoporosis, and the impaired bone mineral density associated with certain polymorphisms of the VDR gene. Aim This study aims to observe whether there is an association between clinical features, phospho-calcium metabolism parameters and the VDR gene polymorphisms in patients with MPS. Patients and Method We evaluated six patients with MPS type I, 20 patients with MPS type II, two patients with MPS types IIIA and IIIB and three patients with MPS type IVB. In these patients, phospho-calcium metabolism, markers of bone formation, bone radiographs and bone densitometry were evaluated, as were four polymorphisms of the VDR gene (ApaI, BsmI, FokI and TaqI). Results There was a deficiency in 25 hydroxy vitamin D in MPS type I patients at the final evaluation and in MPS type II patients, both at ERT initiation and at the last evaluation. The analysed polymorphisms were not associated with modified calcium-phosphor levels, but some differences were observed regarding the level of 25 OH vitamin D. Thus, in the case of AA polymorphism, all patients have a 25 OH vitamin D deficiency, and one patient with the AA genotype and three with Aa have a 25 OH vitamin D deficiency and secondary hyperparathyroidism due to this deficiency (four patients), all of them having the Bb phenotype. Conclusion In MPS patients, vitamin D deficiency is observed, as it is in some patients with secondary hyperparathyroidism, which indicates vitamin D supplementation to protect bone metabolism. There are no obvious correlations between VDR polymorphism and bone metabolism in MPS patients.
Collapse
Affiliation(s)
- Camelia Alkhzouz
- Department of Medical Genetics, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georgiana Cabau
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cecilia Lazea
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,First Pediatric Clinic, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Carmen Asavoaie
- First Pediatric Clinic, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Simona Bucerzan
- Department of Medical Genetics, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Marius Farcas
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Miclaus Jnr
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Popp
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Miclea
- Department of Medical Genetics, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
10
|
Bucerzan S, Miclea D, Lazea C, Asavoaie C, Kulcsar A, Grigorescu-Sido P. 16q24.3 Microduplication in a Patient With Developmental Delay, Intellectual Disability, Short Stature, and Nonspecific Dysmorphic Features: Case Report and Review of the Literature. Front Pediatr 2020; 8:390. [PMID: 32760686 PMCID: PMC7373721 DOI: 10.3389/fped.2020.00390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
Abstract
We describe the case of a seven-year-old female patient who presented in our service with severe developmental delay, intellectual disability, facial dysmorphism, and femur fracture, observed in the context of very low bone mineral density. Array-based single nucleotide polymorphism (SNP array) analysis identified a 113 kb duplication involving the morbid OMIM genes: ANKRD11 (exon1), RPL13, and PGN genes. ANKRD11 deletions are frequently described in association with KBG syndrome, the duplications being less frequent (one case described before). The exome sequencing was negative for pathogenic variants or of uncertain significance in genes possibly associated with this phenotype. The patient presented subtle signs of KBG syndrome. It is known that the phenotype of KBG syndrome has a wide clinical spectrum, this syndrome being often underdiagnosed due to overlapping features with other conditions, also characterized by multiple congenital anomalies and intellectual disability. The particularity of this case is represented by the very low bone mineral density in a patient with 16q24.3 duplication. ANKRD11 haploinsufficiency is known to be associated with skeletal involvement, such as short stature, or delayed bone age. An effect on bone density has been observed only in experimental studies on mice with induced missense mutations in the ANKRD11 gene. This CNV also involved the duplication of the very conserved RPL13 gene, which could have a role for the skeletal phenotype of this patient, knowing the high level of gene expression in bone tissue and also the association with spondyloepimetaphyseal dysplasia Isidor Toutain type, in case of splicing mutations.
Collapse
Affiliation(s)
- Simona Bucerzan
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Children's Emergency Clinical Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Diana Miclea
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Children's Emergency Clinical Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Cecilia Lazea
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Children's Emergency Clinical Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Carmen Asavoaie
- Children's Emergency Clinical Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Andrea Kulcsar
- Children's Emergency Clinical Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | | |
Collapse
|
11
|
Micleaa D, Al-Khzouza C, Osan S, Bucerzan S, Cret V, Popp RA, Puiu M, Chirita-Emandi A, Zimbru C, Ghervan C. Genomic study via chromosomal microarray analysis in a group of Romanian patients with obesity and developmental disability/intellectual disability. J Pediatr Endocrinol Metab 2019; 32:667-674. [PMID: 31150357 DOI: 10.1515/jpem-2018-0439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 04/01/2019] [Indexed: 01/29/2023]
Abstract
Background Obesity with developmental disability/intellectual disability (DD/ID) is the most common association in syndromic obesity. Genomic analysis studies have allowed the decipherment of disease aetiology, both in cases of syndromic obesity as well as in cases of isolated or syndromic DD/ID. However, more data are needed to further elucidate the link between the two. The aim of this pangenomic study was to use single nucleotide polymorphism (SNP) array technology to determine the copy number variant (CNV) type and frequency associated with both obesity and DD/ID. Methods Thirty-six patients were recruited from the Clinical Emergency Hospital for Children, in Cluj-Napoca, Romania during the period 2015-2017. The main inclusion criterion was a diagnosis that included both obesity and DD/ID. Genomic analysis via SNP array technology was performed. Results Out of the 36 patients, 12 (33%) presented CNVs with a higher degree of pathogenicity (A group) and 24 (66%) presented benign CNVs (B group). The SNP array results for the A group were as follows: pathogenic CNVs in 8/12 patients (67%); variants of unknown significance (VOUS) in 2/12 patients (16%); and uniparental disomy (UPD) in 2/12 patients (16%). Conclusions Some of these CNVs have already been observed in patients with both obesity and DD/ID, but the others were noticed only in DD/ID patients and have not been described until now in association with obesity.
Collapse
Affiliation(s)
- Diana Micleaa
- Department of Molecular Sciences, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Camelia Al-Khzouza
- Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.,Department of Pediatrics 1, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sergiu Osan
- Department of Molecular Sciences, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Bucerzan
- Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.,Department of Pediatrics 1, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Victoria Cret
- Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Radu Anghel Popp
- Department of Molecular Sciences, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Puiu
- "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
| | | | - Cristian Zimbru
- "Victor Babeş" University of Medicine and Pharmacy, Timişoara, Romania
| | - Cristina Ghervan
- Department of Endocrinology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,County Clinical Emergency Hospital, Cluj-Napoca, Romania
| |
Collapse
|
12
|
Zimmermann A, Popp RA, Rossmann H, Bucerzan S, Nascu I, Leucuta D, Weber MM, Grigorescu-Sido P. Gene variants of osteoprotegerin, estrogen-, calcitonin- and vitamin D-receptor genes and serum markers of bone metabolism in patients with Gaucher disease type 1. Ther Clin Risk Manag 2018; 14:2069-2080. [PMID: 30498352 PMCID: PMC6207091 DOI: 10.2147/tcrm.s177480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose Osteopathy/osteoporosis in Gaucher disease type 1 (GD1) shows variable responses to enzyme replacement therapy (ERT); the pathogenesis is incompletely understood. We aimed to investigate the effects of several gene variants on bone mineral density (BMD) and serum markers of bone metabolism in GD1. Patients and methods Fifty adult Caucasian patients with GD1/117 controls were genotyped for gene variants in the osteoprotegerin (TNFRSF11B; OPG), estrogen receptor alpha, calcitonin receptor (CALCR), and vitamin D receptor (VDR) genes. In patients and 50 matched healthy controls, we assessed clinical data, serum markers of bone metabolism, and subclinical inflammation. BMD was measured for the first time before/during ERT (median 6.7 years). Results Forty-two percent of patients were splenectomized. ERT led to variable improvements in BMD. Distribution of gene variants was comparable between patients/controls. The AA genotype (c.1024+283G>A gene variant; VDR gene) was associated with lower Z scores before ERT vs GA (P=0.033), was encountered in 82.3% of patients with osteoporosis and was more frequent in patients with pathological fractures. Z score increases during ERT were higher in patients with the CC genotype (c.9C>G variant, TNFRSF11B; OPG gene; P=0.003) compared with GC (P=0.003). The CC genotype (c.1340T>C variant, CALCR gene) was associated with higher Z scores before ERT than the TT genotype (P=0.041) and was absent in osteoporosis. Osteocalcin and OPG were lower in patients vs controls; beta crosslaps, interleukin-6, and ferritin were higher. Conclusions We suggest for the first time a protective role against osteoporosis in GD1 patients for the CC genotype of the c.9C>G gene variant in the TNFRSFB11 (OPG) gene and for the CC genotype of the c.1340T>C gene variant (CALCR gene), while the AA genotype of the c.1024+283G>A gene variant in the VDR gene appears as a risk factor for lower BMDs. Serum markers suggest decreased osteosynthesis, reduced inhibition of osteoclast activation, increased bone resorption, and subclinical inflammation during ERT.
Collapse
Affiliation(s)
- Anca Zimmermann
- Department of Endocrinology and Metabolic Diseases, 1st Clinic and Polyclinic of Internal Medicine, University of Mainz, Mainz, Germany,
| | - Radu A Popp
- Department of Medical Genetics, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Heidi Rossmann
- Institute for Clinical Chemistry and Laboratory Medicine, University of Mainz, Mainz, Germany
| | - Simona Bucerzan
- Center of Genetic Diseases, 1st Pediatric Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Nascu
- Center of Genetic Diseases, 1st Pediatric Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel Leucuta
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Matthias M Weber
- Department of Endocrinology and Metabolic Diseases, 1st Clinic and Polyclinic of Internal Medicine, University of Mainz, Mainz, Germany,
| | - Paula Grigorescu-Sido
- Center of Genetic Diseases, 1st Pediatric Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
13
|
Bucerzan S, Miclea D, Popp R, Alkhzouz C, Lazea C, Pop IV, Grigorescu-Sido P. Clinical and genetic characteristics in a group of 45 patients with Turner syndrome (monocentric study). Ther Clin Risk Manag 2017; 13:613-622. [PMID: 28496331 PMCID: PMC5422538 DOI: 10.2147/tcrm.s126301] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction Recent years have seen a shift in perspective on Turner syndrome, as it is no longer considered a significant disability due to therapeutic advances. The delay of diagnosis and the underdiagnosis are common in Turner syndrome, especially because of the great phenotypic variability and lack of firm diagnostic criteria. Aim Our first aim was to assess the clinical and the cytogenetic characteristics and growth rate in growth hormone (GH)-treated patients as compared to those with spontaneous growth. The second aim was to analyze the Y chromosomal sequences. Materials and methods We analyzed 45 patients diagnosed with Turner syndrome in Genetic Pathology Centre of Cluj Emergency Children’s Hospital. We carried out a study of the clinical features, the correlations between the karyotype and the phenotype, and we also made a research of Y chromosome sequences. Results The average age at diagnosis was 8.9±5.4 years. A significant association was observed between the number of external phenotypical abnormalities and internal malformations (r=0.45), particularly the cardiovascular ones (r=0.44). Patients treated with GH showed improvement in growth rate, with final stature significantly better than in untreated patients; benefits following treatment were greater if diagnosis was made before the age of 5 years. Thirteen percent of patients experienced spontaneous and complete puberty, whereas 30% experienced incomplete puberty. Patients with the 45,X genotype had a greater stature deficit and a higher incidence of cardiac malformations, compared with patients with 45,X/46,XX mosaic karyotype. Y chromosome sequences were found in only one patient, who subsequently underwent gonadectomy. Conclusion The importance of this study resides, to the best of our knowledge, in the fact that the largest group of patients in Romania was analyzed and assessed. To draw firm conclusions on the most valuable clinical indicators for Turner syndrome diagnosis in clinical practice, studies on large groups of patients should be conducted.
Collapse
Affiliation(s)
- Simona Bucerzan
- Emergency Hospital for Children, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Miclea
- Emergency Hospital for Children, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Popp
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Camelia Alkhzouz
- Emergency Hospital for Children, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cecilia Lazea
- Emergency Hospital for Children, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Victor Pop
- Department of Molecular Sciences, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paula Grigorescu-Sido
- Emergency Hospital for Children, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
14
|
Bucerzan S, Popp RA, Vlad RM, Lazea C, Nicolaescu R, Grigorescu-Sido P. Evaluation of c677t and a1298c polymorphism of the methylenetetrahydrofolate reductase gene as a maternal risk factor for trisomy 21 (a monocentric study). REV ROMANA MED LAB 2017. [DOI: 10.1515/rrlm-2017-0003] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Aim: To assess the risk for trisomy 21 in children, depending on the polymorphisms C677T and A1298C of the methylenetetrahydrofolate reductase (MTHFR) gene in mothers.
Methods: For 93 mothers who have children with trisomy 21 and 202 mothers of healthy children (control group), genotyping of MTHFR polymorphisms C677T and A1298C was performed.
Results: For each polymorphism, three genotypes were identified (normal homozygous, heterozygous and mutant homozygous). For the polymorphism C677T, the frequencies of the three genotypes (CC, CT and TT) were 50.5%, 40.8% and 8.6% in mothers of children with trisomy 21, versus 42.6%, 46% and 11.4% in mothers of healthy children, with no statistically significant differences. The frequency of the polymorphism A1298C was not statistically significant between the two groups for the genotype (AA) (48.4% vs 56.4%) or the genotype (AC) (39.8% vs 38.6%), but the genotype TT was more frequent in mothers of children with trisomy 21 (11.8% vs 4.9%; p = 0.033; OR = 2.57).
Conclusion: Women with genotype CC for the polymorphism A1298C of the MTHFR gene have a 2.57 times higher risk of offspring with trisomy 21.
Collapse
Affiliation(s)
- Simona Bucerzan
- University of Medicine and Pharmacy „Iuliu Hațieganu”, Centre of Genetic Diseases, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Radu Anghel Popp
- University of Medicine and Pharmacy „Iuliu Hațieganu”, Medical Genetics Department, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Raluca Maria Vlad
- Carol Davila University of Medicine and Pharmacy, Department of Pediatrics, Grigore Alexandrescu Emergency Pediatric Hospital, Bucharest, Romania
| | - Cecilia Lazea
- University of Medicine and Pharmacy „Iuliu Hațieganu”, Medical Genetics Department, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| | - Radu Nicolaescu
- Radiology and Medical Imaging Laboratory, Fundeni Clinical Institute, Bucharest, Romania
| | - Paula Grigorescu-Sido
- University of Medicine and Pharmacy „Iuliu Hațieganu”, Centre of Genetic Diseases, Emergency Pediatric Hospital, Cluj-Napoca, Romania
| |
Collapse
|
15
|
Alkhzouz C, Lazea C, Bucerzan S, Nascu I, Kiss E, Denes CL, Grigorescu-Sido P. Clinical and Genetic Characteristics of Romanian Patients with Mucopolysaccharidosis Type II. JIMD Rep 2017; 33:19-25. [PMID: 27351199 PMCID: PMC5413445 DOI: 10.1007/8904_2016_535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Mucopolysaccharidosis type II (MPS II, Hunter syndrome) is a rare X-linked disorder caused by deficiency of iduronate-2-sulfatase (I2S) enzyme, which leads to the accumulation of partially digested glycosaminoglycans (GAGs) in the lysosomes and induces multisystemic alteration (coarse facial features; skeletal dysplasia; hepatosplenomegaly; joint stiffness and contractures; heart, lung, vision, and hearing disability; profound neurological decline).The purpose of this study is to present the clinical and genetic characteristics of Romanian patients with Hunter syndrome and the genotype-phenotype correlation. MATERIAL AND METHODS 15 unrelated patients, with MPS II ranging from mild (4 subjects) to severe phenotype (11 subjects) aged 2 to 20 years, were evaluated clinically, cognitive development, enzyme assay and molecular analysis. RESULTS The molecular analysis of the 15 unrelated Romanian MPS II patients has identified 15 different mutations (2 major genetic defects (13%) and 13 minor genetic defects (87%)): microdeletions and point mutations (missense, nonsense), seven of them described for the first time-deletion encompassing 3 to exon 7; c823G>T, pD275Y; c.1600A>C (pN534H); c.102_10delAG (p.D5Cfs*11); c.448_471del (p.P150_P157del); c.421delA (p.I141Yfs*72); and c.419-1G>C. The major genetic defects were correlated with a severe course of disease. CONCLUSION This is the first study on the clinical and molecular characterization of the MPS II Romanian patients. This study supports the evidence of the mutational heterogeneity of the I2S gene as well as the difficulty to correlate genotype and phenotype in the patients with MPS II.
Collapse
Affiliation(s)
- Camelia Alkhzouz
- 1st Department of Pediatrics, Iuliu Haţieganu University of Medicine and Pharmacy, 68, Motilor street, 400370, Cluj-Napoca, Romania.
| | - Cecilia Lazea
- 1st Department of Pediatrics, Iuliu Haţieganu University of Medicine and Pharmacy, 68, Motilor street, 400370, Cluj-Napoca, Romania
| | - Simona Bucerzan
- 1st Department of Pediatrics, Iuliu Haţieganu University of Medicine and Pharmacy, 68, Motilor street, 400370, Cluj-Napoca, Romania
| | - Ioana Nascu
- 1st Department of Pediatrics, Iuliu Haţieganu University of Medicine and Pharmacy, 68, Motilor street, 400370, Cluj-Napoca, Romania
| | - Eva Kiss
- 1st Department of Pediatrics, Iuliu Haţieganu University of Medicine and Pharmacy, 68, Motilor street, 400370, Cluj-Napoca, Romania
| | - Carmencita Lucia Denes
- 1st Department of Pediatrics, Iuliu Haţieganu University of Medicine and Pharmacy, 68, Motilor street, 400370, Cluj-Napoca, Romania
| | - Paula Grigorescu-Sido
- 1st Department of Pediatrics, Iuliu Haţieganu University of Medicine and Pharmacy, 68, Motilor street, 400370, Cluj-Napoca, Romania
| |
Collapse
|
16
|
Zimmermann A, Popp RA, Al-Khzouz C, Bucerzan S, Naşcu I, Leucuta D, Galle PR, Grigorescu-Sido P. Cholelithiasis in Patients with Gaucher Disease type 1: Risk Factors and the Role of ABCG5/ABCG8 Gene Variants. JGLD 2016; 25:447-455. [DOI: 10.15403/jgld.2014.1121.254.zim] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background & Aim: Patients with Gaucher disease type 1 (GD1) show an altered lipid profile and a certain degree of insulin resistance, which might contribute to cholelithiasis (CL) and could possibly be associated with ABCG5/ABCG8 gene variants. We aimed to investigate the prevalence of CL in Caucasian adult patients with GD1 and the possible risk factors, including gene variants of the ABCG5/ABCG8 genes.
Methods: 61 Caucasian patients with GD1 (38 female/23male), aged 18-62 years and 61 healthy subjects matched for age, gender and BMI, without CL, for comparison of lipid profiles. Data before start of enzyme replacement therapy (ERT) were recorded: clinical, haematological, severity parameters, splenectomy, genotype. Fasting lipid profiles before ERT, glycemia, insulinaemia, HOMA-IR at the last visit were documented. Genotyping for the gene variants D19H, Y54C, T400K, A632V (ABCG8); Q604E (ABCG5) was performed.
Results: CL occurred in 45.9% of patients. Risk factors were: age, family history of CL, higher BMI values, LDL-cholesterol (LDL-C), disease severity, splenectomy. A specific dyslipidemia was found in patients vs. controls. Total serum cholesterol (TC) and LDL-C were higher in patients with CL than in those without; no obvious influence of insulin-resistance to lithogenesis was found. Patients with the GG genotype of D19H and the CC genotype of T400K (ABCG8 gene) had significantly higher levels of TC and LDL-C.
Conclusion: Patients with GD1 showed an increased prevalence of CL, which was associated with common and disease-specific risk factors. Starting ERT soon after clinical onset and avoiding splenectomy might reduce the risk of CL in GD1.
Abbreviations: ABC: ATP-binding cassette; CL: cholelithiasis; ERT: enzyme replacement therapy; GBA1: acid-beta-glucosidase gene; GD1: Gaucher disease type 1; HOMA-IR: homeostasis model-assessment insulin resistance; HDL-C: HDL-cholesterol; LDL-C: LDL-cholesterol; MN: multiples of normal; PCR-RFLP: polymerase chain reaction-restriction fragment length polymorphism; SSI: severity score index; TC: total cholesterol; TG: triglycerides.
Collapse
|
17
|
Bocsa C, Asavoaie C, Bucerzan S, Nascu I, Brumboiu I, Al-Khzouz C. Ultrasonographic evaluation of the median nerve at the level of the carpal tunnel outlet and mid forearm in patients with type II Mucopolysaccharidosis. Med Ultrason 2016; 18:36-41. [PMID: 26962552 DOI: 10.11152/mu.2013.2066.181.cob] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIMS The ultrasonographic (US) evaluation of the median nerve at the level of the carpal tunnel outlet (CTO) and mid forearm in pediatric patients with mucopolysaccharidosis type II (MPS II) and comparison with healthy subjects. MATERIAL AND METHOD Fifteen children with MPS II and 44 healthy children were included in the study and they were divided into three age groups. The cross-sectional area, the appearance of the nerve, and the ratio of the cross-sectional areas were evaluated by US. RESULTS At the level of the CTO the mean area of the nerve was increased in all MPS II groups compared with the correspondent healthy age groups and the differences were statistically significant (p<0.01). At the level of the mid forearm the differences were statistically significant only for the first age group. Other US findings at the level of the CTO in the MPS II groups were represented by hypoechogenicity (86.67 % on the right and 93.33% on the left), thickened fascicles (80% bilaterally), irregular contour (53.33% bilaterally) and the presence of the Doppler signal including the nerve (26.67 % on the right and 33.33 % on the left). The CTO/mid forearm cross-sectional area ratio was higher in all MPS II age groups and the differences were statistically significant (p<0.001). CONCLUSION In patients with MPS II there are significant US changes in the size and aspect of the median nerve.
Collapse
Affiliation(s)
- Corina Bocsa
- "Interservisan" Medical and Surgical Centre, Cluj-Napoca, Romania
| | - Carmen Asavoaie
- Emergency Children Hospital, 1st Pediatric Clinic, Department of Radiology and Imaging,Cluj-Napoca, Romania.
| | - Simona Bucerzan
- Emergency Children Hospital, 1st Pediatric Clinic, Department of Genetics, Cluj-Napoca, Romania
| | - Ioana Nascu
- Emergency Children Hospital, 1st Pediatric Clinic, Department of Genetics, Cluj-Napoca, Romania
| | - Irina Brumboiu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Epidemiology and Primary Health Care Cluj-Napoca, Romania
| | - Camelia Al-Khzouz
- Emergency Children Hospital, 1st Pediatric Clinic, Department of Genetics, Cluj-Napoca, Romania
| |
Collapse
|
18
|
Lazea C, Grigorescu-Sido P, Popp R, Legendre M, Amselem S, Al-Khzouz C, Bucerzan S, Creţ V, Crişan M, Brad C. The c.301_302delAG PROP1 gene mutation in Romanian patients with multiple pituitary hormone deficiency. J Pediatr Endocrinol Metab 2015; 28:993-8. [PMID: 25581745 DOI: 10.1515/jpem-2014-0289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/24/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To establish the frequency of the c.301_302 delAG mutation of the PROP1 gene in Romanian patients with multiple pituitary hormone deficiency (MPHD). SUBJECTS AND METHODS Somatic assessment, hormonal test, bone age, magnetic resonance imaging of the pituitary gland, and molecular diagnosis were performed in 26 patients with MPHD (7 patients with familial form of MPHD and 19 patients with sporadic form of MPHD). RESULTS The c.301_302delAG mutation was detected in the homozygous state in 10 patients belonging to 5 unrelated families (7 patients with familial history of MPHD and 3 patients with sporadic form of MPHD). Those 10 patients presented variable pituitary hormone deficiency and pituitary morphology. CONCLUSIONS The c.301_302delAG homozygous genotype had a high frequency of 38% (10/26), reaching 100% (7/7) in group with familial cases of MPHD and 16% (3/19) in group with sporadic forms of MPHD.
Collapse
|
19
|
Zimmermann A, Rossmann H, Alkhzouz C, Bucerzan S, Nascu I, Weber MM, Grigorescu-Sido P. Dynamic changes of insulin resistance in patients with Gaucher disease type I (GD) under enzyme replacement therapy (ERT). Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372114] [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: 10/25/2022]
|
20
|
Zimmermann A, Rossmann H, Alkhzouz C, Bucerzan S, Nascu I, Weber MM, Grigorescu-Sido P. Early metabolic alterations and cardiovascular risk in patients with classic congenital adrenal hyperplasia (CAH). Are they reversible by life-style intervention? Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372078] [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: 10/25/2022]
|
21
|
Zimmermann A, Grigorescu-Sido P, Rossmann H, Lackner KJ, Drugan C, Al Khzouz C, Bucerzan S, Naşcu I, Zimmermann T, Leucuţa D, Weber MM. Dynamic changes of lipid profile in Romanian patients with Gaucher disease type 1 under enzyme replacement therapy: a prospective study. J Inherit Metab Dis 2013; 36:555-63. [PMID: 22976766 DOI: 10.1007/s10545-012-9529-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 07/22/2012] [Accepted: 07/30/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dyslipidemia in Gaucher disease includes reduced total, low-density lipoprotein (LDL)-, and high-density lipoprotein (HDL)-cholesterol (C). No prospective analysis of lipid profile changes in treatment-naïve patients under enzyme replacement therapy (ERT) is available. METHODS We analyzed lipid profile changes during ERT in a prospective controlled manner. Twelve treatment-naïve patients, Gaucher disease type 1 (GD1), 29.5 ± 12.9 years, 4M/8F. Diagnosis was made by enzymatic measurement and mutational analysis. Total-, LDL-, and HDL-C, triglycerides (TG), and LDL subfractions were assessed before the start of ERT with imiglucerase and biannually for 3 years. Patients were matched with healthy controls before and after 3 years of ERT. RESULTS At baseline, we found severely reduced HDL-C concentrations (23.6 ± 5.4 mg/dl) and enhanced LDL/HDL ratios (3.1 ± 0.7). HDL-C increased after 6 months (29.2 ± 5.7, p = 0.023), LDL/HDL ratio decreased after 30 months (2.5 ± 0.5, p = 0.039). TG, even not consistently enhanced at baseline (128 ± 31.3 mg/dl), yet higher than in controls (p < 0.001), decreased after 18 months, being comparable with controls after 3 years of ERT. Small, dense LDL (mg/dl) increased continuously without significant difference to controls. After 3 years of ERT, only reduced HDL-C concentrations persisted as a potentially atherogenic alteration; however, mean concentrations markedly improved (42.9 ± 8.3 mg/dl, p < 0.001). Lipid parameters correlated with six markers of disease severity. CONCLUSIONS This is the first prospective controlled study regarding lipid profile dynamics during ERT (glucocerebrosidase) in initially treatment-naïve GD1 patients. The most important changes were reduced HDL-C and enhanced LDL/HDL ratio. Their dynamics during ERT and correlations with markers of disease activity suggest that they can be considered markers of disease severity and follow-up in Gaucher patients under treatment.
Collapse
Affiliation(s)
- Anca Zimmermann
- Department of Endocrinology and Metabolic Diseases, 1st Clinic of Internal Medicine, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Zimmermann A, Popp RA, Rossmann H, Al Khzouz C, Bucerzan S, Nascu I, Weber MM, Grigorescu Sido P. FokI polymorphism of VDR and bone mineral density in patients with M. Gaucher. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336672] [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: 10/27/2022]
|
23
|
Zimmermann A, Rossmann H, Al Khzouz C, Bucerzan S, Nascu I, Weber MM, Grigorescu-Sido P. Early metabolic alterations in patients with classic 21-hydroxylase deficiency: lipid and carbohydrate metabolism, adipokine profile, oxidative stress and subclinical inflammation. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336654] [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: 10/27/2022]
|
24
|
Zimmermann A, Grigorescu-Sido P, AlKhzouz C, Patberg K, Bucerzan S, Schulze E, Zimmermann T, Rossmann H, Geiss HC, Lackner KJ, Weber MM. Alterations in lipid and carbohydrate metabolism in patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Horm Res Paediatr 2010; 74:41-9. [PMID: 20395657 DOI: 10.1159/000313368] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [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] [Received: 03/30/2009] [Accepted: 09/23/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Classic 21-hydroxylase deficiency (21HD) presents some traits of the metabolic syndrome. AIM To characterize discrete alterations of lipid and carbohydrate metabolism in children and young adults with classic 21HD, which could predict early atherogenesis. PATIENTS AND METHODS Twenty-seven Caucasian patients with classic 21HD (4-31 years); 27 sex-, age- and BMI-matched controls. Clinical parameters, hormonal status and genotype were assessed in all patients. Lipid parameters, including relative (%) and absolute (mg/dl) small-dense low-density lipoproteins subfractions (sd-LDL) were measured in patients and controls. Oral glucose tolerance tests were performed in both groups. RESULTS sd-LDL (%) was significantly higher in patients than controls (39.7 +/- 5.9 vs. 35.5 +/- 5.7%; p = 0.008). The same applies for absolute sd-LDL (mg/dl) (42.6 +/- 11.9 vs. 36.4 +/- 7.5; p = 0.029). HDL-cholesterol was lower in patients (p = 0.032). Fasting glucose and insulin were significantly higher in patients. Similar differences were noticed for HOMA-IR (p = 0.001), IRI (p = 0.001) and HOMA-B (p = 0.002). IRI correlated directly and significantly with the total hydrocortisone dose and the duration of treatment. Fasting glucose correlated with absolute sd-LDL. No obvious differences were seen between clinical forms or genotype groups. CONCLUSIONS Substitution therapy should be adapted particularly at young ages to prevent early atherogenesis and cardiovascular risk in later life.
Collapse
Affiliation(s)
- Anca Zimmermann
- 1st Medical Clinic, Department of Endocrinology and Metabolic Diseases, Johannes Gutenberg University of Mainz, Mainz, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Grigorescu-Sido P, Drugan C, Alkhzouz C, Zimmermann A, Coldea C, Denes C, Grigorescu MD, Cret V, Bucerzan S. Baseline characteristics and outcome in Romanian patients with Gaucher disease type 1. Eur J Intern Med 2010; 21:104-13. [PMID: 20206881 DOI: 10.1016/j.ejim.2009.11.005] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 10/25/2009] [Accepted: 11/15/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM To present clinical and genetic characteristics of all Romanian patients with Gaucher disease type 1, in whom specific diagnosis has been confirmed by enzymatic and molecular methods and to analyze their outcome with and without enzymatic replacement therapy (ERT). PATIENTS, METHODS There are fifty patients (F/M - 1.63/1) with Gaucher disease type 1. Clinical status, haemoglobin, thrombocytes, hepatic/splenic volume, bone mineral density and severity score were assessed at baseline and every six months thereafter. Thirty-nine patients (78%) received imiglucerase (44.4+/-13.6 U/kg/2 weeks) for 3.1+/-1.4 years. RESULTS Based on general prevalence data, our group represents 22.7% of the expected total number of patients with Gaucher disease type 1 in Romania. Mean age was 15.5 years at clinical onset and 28.9 years at confirmation of diagnosis. The genotype N370S/L444P was frequent in our group (35.9% of alleles). Anaemia, thrombocytopenia, splenomegaly and bone disease were present at 38%, 70%, 100% and 84%, respectively. Mean values for haemoglobin, thrombocytes, hepatic volume and chitotriosidase normalized after 0.5, 1.5, 2.5 and 3 years of ERT, respectively. Splenomegaly regressed from 14.4 x N (normal) to 3.06 x N over four years of treatment. Bone disease was ameliorated under ERT, yet bone mineral density worsened in patients treated with 30 U/kg/2 weeks. CONCLUSIONS The genotype N370S/L444P is frequent in our patients, in line with the severe phenotypes. ERT improved haematological parameters and visceromegaly, without a clear benefit for bone mineral density. To attain therapeutic goals, an early treatment start with optimal dosage is mandatory.
Collapse
Affiliation(s)
- Paula Grigorescu-Sido
- 1st Pediatric Clinic, Center of Genetic Diseases, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj, Romania
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Zimmermann A, Grigorescu Sido P, Schulze E, AlKhzouz C, Patberg K, Bucerzan S, Weber M. Atherogene Veränderungen des Lipid- und Kohlenhydratmetabolismus bei Patienten mit klassischem 21-Hydroxylase Mangel. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221879] [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: 10/20/2022]
|