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Rapini N, Delvecchio M, Mucciolo M, Ruta R, Rabbone I, Cherubini V, Zucchini S, Cianfarani S, Prandi E, Schiaffini R, Bizzarri C, Piccini B, Maltoni G, Predieri B, Minuto N, Di Paola R, Giordano M, Tinto N, Grasso V, Russo L, Tiberi V, Scaramuzza A, Frontino G, Maggio MC, Musolino G, Piccinno E, Tinti D, Carrera P, Mozzillo E, Cappa M, Iafusco D, Bonfanti R, Novelli A, Barbetti F. The changing landscape of neonatal diabetes mellitus in Italy between 2003-2022. J Clin Endocrinol Metab 2024:dgae095. [PMID: 38408297 DOI: 10.1210/clinem/dgae095] [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: 11/08/2023] [Revised: 01/29/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
CONTEXT In the last decade Sanger method of DNA sequencing has been replaced by next generation sequencing (NGS). NGS is valuable in conditions characterized by high genetic heterogeneity such as neonatal diabetes mellitus (NDM). OBJECTIVE To compare results of genetic analysis of patients with NDM and congenital severe insulin resistance (c.SIR) identified in Italy in 2003-2012 (Sanger) versus 2013-2022 (NGS). METHODS We reviewed clinical and genetic records of 104 cases with diabetes onset before 6 months of age (NDM+c.SIR) of the Italian dataset. RESULTS Fiftyfive patients (50 NDM + 5 c.SIR) were identified during 2003-2012 and 49 (46 NDM + 3 c.SIR) in 2013-2022. Twenty-year incidence was 1:103,340 (NDM) and 1:1,240,082 (c.SIR) live births. Frequent NDM/c.SIR genetic defects (KCNJ11, INS, ABCC8, 6q24, INSR) were detected in 41 and 34 probands during 2003-2012 and 2013-2022, respectively. We identified a pathogenic variant in rare genes in a single proband (GATA4) (1/42 or 2.4%) during 2003-2012 and in 8 infants (RFX6, PDX1, GATA6, HNF1B, FOXP3, IL2RA, LRBA, BSCL2) during 2013-2022 (8/42 or 19%, p= 0.034 vs 2003-2012). Notably, five among rare genes were recessive. Swift and accurate genetic diagnosis led to appropriate treatment: patients with autoimmune NDM (FOXP3, IL2RA, LRBA), were subjected to bone marrow transplant; patients with pancreas agenesis/hypoplasia (RFX6, PDX1) were supplemented with pancreatic enzymes and the individual with lipodystrophy caused by BSCL2 was started on metreleptin. CONCLUSIONS NGS substantially improved diagnosis and precision therapy of monogenic forms of neonatal diabetes and congenital SIR in Italy.
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Affiliation(s)
- Novella Rapini
- Monogenic Diabetes Clinic, Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maurizio Delvecchio
- Metabolic Disorder and Diabetes Unit, "Giovanni XXIII" Children Hospital, Bari, Italy
- Unit of Pediatrics, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mafalda Mucciolo
- Translational Cytogenomics Research Unit, Laboratory of Medical Gentics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rosario Ruta
- Translational Cytogenomics Research Unit, Laboratory of Medical Gentics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ivana Rabbone
- Department of Health Sciences, Division of Pediatrics, University of Eastern Piedmont, Novara, Italy
| | - Valentino Cherubini
- Pediatric Endocrinology and Diabetology Unit, Department of Women's and Children's Health Azienda Ospedaliero Universitaria delle Marche, G. Salesi Hospital, Ancona, Italy
| | - Stefano Zucchini
- Pediatric Endocrine Unit, University Hospital of Bologna Sant'Orsola-Malpighi, Bologna, Italy
| | - Stefano Cianfarani
- Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Elena Prandi
- Pediatrics Clinic, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Riccardo Schiaffini
- Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Carla Bizzarri
- Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Barbara Piccini
- Endocrinology and Diabetology Unit, Meyer University children's hospital IRCCS, Florence, Italy
| | - Giulio Maltoni
- Pediatric Endocrine Unit, University Hospital of Bologna Sant'Orsola-Malpighi, Bologna, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Minuto
- Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Rossella Di Paola
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mara Giordano
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Laboratory of Genetics, "Maggiore della Carità" Hospital, Novara, Italy
| | - Nadia Tinto
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II/CEINGE Advanced Biotechnologies Franco Salvatore, Naples, Italy
| | - Valeria Grasso
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Lucia Russo
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Tiberi
- Pediatric Endocrinology and Diabetology Unit, Department of Women's and Children's Health Azienda Ospedaliero Universitaria delle Marche, G. Salesi Hospital, Ancona, Italy
| | - Andrea Scaramuzza
- Diabetes and Endocrine Service, Pediatric Unit, ASST Cremona, Maggiore Hospital, Cremona, Italy
| | - Giulio Frontino
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS Ospedale San Raffaele
| | | | - Gianluca Musolino
- Growth disorders, Endocrinology and Diabetology Clinic, Filippo del Ponte Pediatric Hospital, ASST Sette Laghi, Varese, Italy
| | - Elvira Piccinno
- Metabolic Disorder and Diabetes Unit, "Giovanni XXIII" Children Hospital, Bari, Italy
| | - Davide Tinti
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Paola Carrera
- San Raffaele Scientific Institute, Center for Omics sciences @OSR, Genomics for the Diagnosis of Human Pathologies, Milan, Italy
- San Raffaele Scientific Institute, Laboratory of Molecular Genetics and Cytogenetics, Milan, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Marco Cappa
- Research Area for Innovative Therapies in Endocrinopathies, Bambino Gesù Children's Hospital, IRCCS
| | - Dario Iafusco
- Department of Pediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Pediatric Diabetology Unit, Diabetes Research Institute, IRCCS Ospedale San Raffaele and Vita Salute San Raffaele University, Milan, Italy
| | - Antonio Novelli
- Translational Cytogenomics Research Unit, Laboratory of Medical Gentics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabrizio Barbetti
- Monogenic Diabetes Clinic, Endocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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