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El-Anwar N, El-Shabrawi M, Shahin OO, Abdel Kareem R, Salama AM, Baroudy S. Health-related quality of life and cognitive function in children with Crigler-Najjar syndrome type 1. Paediatr Int Child Health 2024; 44:18-23. [PMID: 38334259 DOI: 10.1080/20469047.2024.2309727] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The aim of the study was to assess the health-related quality of life (HRQOL) and cognitive function in patients with Crigler-Najjar syndrome (CNS) type I and its impact on their lives. METHODS Twenty-one patients diagnosed with CNS type I aged 1 month to 18 years in the Paediatric Hepatology Unit of Cairo University Children's Hospital were enrolled in this cross-sectional observational study. The patients' health-related quality of life (HRQOL) was assessed using the World Health Organization Quality Of Life BREF questionnaire (WHOQOL-BREF) and the Short Form 36 Health Survey Questionnaire (SF-36). Cognitive function was assessed using the Stanford-Binet Intelligence Scale: Fifth Edition (SB5). RESULTS All patients had a history of admission to a neonatal intensive care unit, 17 were managed by phototherapy only and 5 also underwent exchange transfusion. According to the WHOQOL questionnaire, 11 cases (52.4%) had a low QOL score, and 7 of 13 patients had an average score for their total IQ test. Cases with poor compliance to phototherapy had statistically significantly lower QOL scores (p=0.001), while, according to the SF36 survey, cases who received exchange transfusion had statistically significantly higher cognitive function (p=0.03). There was a positive correlation between the neurological effect as a complication of the disease and poor physical QOL. CONCLUSION Paediatric patients with CNS have significantly lower HRQOL, especially physically, psychologically and environmentally. It is recommended that assessment of HRQOL should be a routine part of follow-up in CNS patients. Patients whose HRQOL is affected receive regular psychiatric counselling, social support and rehabilitation.Abbreviations: CNS: Crigler-Najjar syndrome; HRQOL: health-related quality of life; IQ: intelligence quotient; NICU: neonatal intensive care unit; QOL: quality of life; SB5: Stanford-Binet intelligence scale: 5th edition; SF-36: Short Form 36 Health Survey Questionnaire; UDGT: uridine diphosphate glucuronosyl transferase; UGT1A1: uridine 5'-diphosphate glucuronosyltransferase; WHOQOL-BREF: World Health Organization Quality of Life Brief Version.
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Affiliation(s)
- Noha El-Anwar
- Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mortada El-Shabrawi
- Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ola Omar Shahin
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reem Abdel Kareem
- Paediatrics department, Ministry of Health and Population, Cairo, Egypt
| | | | - Sherif Baroudy
- Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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Pranty AI, Wruck W, Adjaye J. Free Bilirubin Induces Neuro-Inflammation in an Induced Pluripotent Stem Cell-Derived Cortical Organoid Model of Crigler-Najjar Syndrome. Cells 2023; 12:2277. [PMID: 37759499 PMCID: PMC10527749 DOI: 10.3390/cells12182277] [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: 07/17/2023] [Revised: 08/30/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Bilirubin-induced neurological damage (BIND), which might progress to kernicterus, occurs as a consequence of defects in the bilirubin conjugation machinery, thus enabling albumin-unbound free bilirubin (BF) to cross the blood-brain barrier and accumulate within. A defect in the UGT1A1 enzyme-encoding gene, which is directly responsible for bilirubin conjugation, can cause Crigler-Najjar syndrome (CNS) and Gilbert's syndrome. We used human-induced pluripotent stem cell (hiPSC)-derived 3D brain organoids to model BIND in vitro and unveil the molecular basis of the detrimental effects of BF in the developing human brain. Healthy and patient-derived iPSCs were differentiated into day-20 brain organoids, and then stimulated with 200 nM BF. Analyses at 24 and 72 h post-treatment point to BF-induced neuro-inflammation in both cell lines. Transcriptome, associated KEGG, and Gene Ontology analyses unveiled the activation of distinct inflammatory pathways, such as cytokine-cytokine receptor interaction, MAPK signaling, and NFκB activation. Furthermore, the mRNA expression and secretome analysis confirmed an upregulation of pro-inflammatory cytokines such as IL-6 and IL-8 upon BF stimulation. This novel study has provided insights into how a human iPSC-derived 3D brain organoid model can serve as a prospective platform for studying the etiology of BIND kernicterus.
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Affiliation(s)
- Abida Islam Pranty
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany; (A.I.P.); (W.W.)
| | - Wasco Wruck
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany; (A.I.P.); (W.W.)
| | - James Adjaye
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany; (A.I.P.); (W.W.)
- Zayed Centre for Research into Rare Diseases in Children (ZCR), University College London (UCL)—EGA Institute for Women’s Health, 20 Guilford Street, London WC1N 1DZ, UK
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Xiong QF, Zhong YD, Feng XN, Zhou H, Liu DX, Wu XP, Yang YF. [Study on spectrum of UGT1A1 mutations in connection with inherited non-hemolytic unconjugated hyperbilirubinemia]. Zhonghua Gan Zang Bing Za Zhi 2018; 26:898-902. [PMID: 30669781 DOI: 10.3760/cma.j.issn.1007-3418.2018.12.005] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective: To compare and analyze patient's general condition, changes in laboratory parameters, and the spectrum of UGT1A1 mutations in patients with inherited non-hemolytic unconjugated hyperbilirubinemia. Methods: A retrospective study was conducted at Nanjing Second Hospital from January 2015 to July 2018 and patients' demographic characteristics, liver function test, and UGT1A1 gene were analyzed. The categorical variable data were compared by χ (2) test. The normal distribution continuous variable data were compared by t-test and the non-normal distribution continuous variable data were compared using Mann-Whitney U test. Results: Of the 51 patients with inherited non-hemolytic unconjugated hyperbilirubinemia, 44 (86.3%) were Gilbert's syndrome (GS) and seven (13.7%) were Crigler-Najjar syndrome type II (CNS- II). The male to female ratio was 2.9:1 and the average age was 36.11 ± 13.17 years. Six variant types were detected: C. -40_-39insTA, C. -3279T > G, c.211G > A (p.G71R), c.686C > A (p.P229Q), c.1091C > T (p.P364L), c.1456T > G (P.Y486D). Among them, c.211G > A accounted for 58.82% (30/51), c.-40_-39insTA accounted for 27.5% (14/51), and c.1456T > G accounted for 25.5% (13/51). The total bilirubin(TB) and unconjugated bilirubin (UCB) in CNS-II patients were significantly higher than GS patients[155.91 (130 ~ 207) vs. 38.25(29 ~ 52.15) μmol/L, U = 0, P < 0.01; 144.13 (120.8 ~ 197) vs. 30.00 (21.7 ~ 46.75) μmol/L, U = 0.00, P < 0.01, respectively]. Exon mutations of c.1091C > T and c.1456T > G were statistically significant(P < 0.01).There were no differences in age, TB, UCB, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) between the c.211G > A homozygous variants and heterozygous variants (P > 0.05). Conclusion: The common pathogenic mutations of UGT1A1 gene were c.211G > A, c.-40_-39insTA, c.1456T > G. c.211G > A. The mutation has little effect on the level of total bilirubin, but c.1091C > T, c.1456T > G mutations has great influence on the level of total bilirubin.
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Affiliation(s)
- Q F Xiong
- Liver Disease Department, Nanjing Second Hospital, Affiliated to Nanjing University of Chinese Medicine, Nanjing 210003, China
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Itoh S. [ Crigler-Najjar syndrome]. Ryoikibetsu Shokogun Shirizu 2001:519-21. [PMID: 11462547] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- S Itoh
- Department of Pediatrics, Kagawa Medical University
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Lucey JF, Suresh GK, Kappas A. Crigler-Najjar syndrome, 1952-2000: learning from parents and patients about a very rare disease and using the internet to recruit patients for studies. Pediatrics 2000; 105:1152-3. [PMID: 10790478 DOI: 10.1542/peds.105.5.1152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- J F Lucey
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT 05405, USA.
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Gourley GR. Bilirubin metabolism and kernicterus. Adv Pediatr 1997; 44:173-229. [PMID: 9265971] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Neonatal jaundice continues to be a common problem. Kernicterus, although rare, continues to be a very real concern in both full-term and preterm infants. The diagnosis of kernicterus requires not only bilirubin staining in a characteristic pattern in the brain but also neuronal damage. With careful pathologic evaluation, kernicterus should be distinguishable from the brain damage associated with asphyxia and hypoxia. Early hospital discharge is a risk factor for the development of kernicterus. Combining the use of traditional phototherapy from above and a fiberoptic blanket from below has improved the effectiveness of phototherapy. Clinical trials with SnMP as an inhibitor of heme oxygenase appear encouraging; no adverse effects were noted, except for mild, occasional photosensitization manifest by erythema in babies receiving phototherapy. One theoretical toxicity of inhibitors of heme oxygenase involves the recent observation that carbon monoxide (CO) is a neurotransmitter in certain regions of the brain, possibly comparable to nitric oxide (NO), and the consequences of such inhibition are unknown. More research is needed to improve our understanding about the entry of bilirubin into the brain, the predilection of bilirubin for certain brain regions, and the cytotoxicity of bilirubin. In the United States, there is currently no generally accepted method to predict hyperbilirubinemia or kernicterus. Brain stem auditory evoked responses and MRI can both be used effectively to monitor the effects of severe hyperbilirubinemia.
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Affiliation(s)
- G R Gourley
- Department of Pediatrics, University of Wisconsin School of Medicine, Madison, USA
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Scheig R. Neonatal jaundice. Am Fam Physician 1974; 10:158-64. [PMID: 4414786] [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: 01/10/2023]
MESH Headings
- Albumins/metabolism
- Bile Ducts/abnormalities
- Bilirubin/metabolism
- Breast Feeding/adverse effects
- Crigler-Najjar Syndrome
- Erythroblastosis, Fetal/complications
- Exchange Transfusion, Whole Blood
- Female
- Galactosemias
- Hepatitis A/complications
- Humans
- Hyperbilirubinemia, Hereditary
- Infant, Newborn
- Infant, Newborn, Diseases/complications
- Infections/complications
- Jaundice, Neonatal/chemically induced
- Jaundice, Neonatal/classification
- Jaundice, Neonatal/genetics
- Jaundice, Neonatal/metabolism
- Kernicterus/prevention & control
- Milk, Human/analysis
- Phenobarbital/therapeutic use
- Phototherapy
- Pregnancy
- Pregnanediol/analysis
- Virus Diseases/complications
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LEVYMDE L, PORTELA R. [A FURTHER CASE OF CRIGLER-NAJJAR DISEASE]. Rev Port Pediatr Pueric 1965; 28:25-33. [PMID: 14293207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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SALAZARDESOUSA C. A CASE OF CRIGLER-NAJJAR'S DISEASE TREATED BY LIGHT IRRADIATION. Clin Pediatr (Bologna) 1964; 46:797-806. [PMID: 14266399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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SCHELLONG G. [OBSERVATIONS ON FAMILIAL NONHEMOLYTIC JAUNDICE ( CRIGLER-NAJJAR SYNDROME)]. Monatsschr Kinderheilkd (1902) 1964; 112:249-50. [PMID: 14203502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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DELNON I, KUENZLI H. [CRITICAL OBSERVATIONS ON THE ARIAS-STELLA SYNDROME]. Gynaecologia 1964; 158:77-88. [PMID: 14204948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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COHEN A. [FAMILIAL NON-HEMOLYTIC JAUNDICE WITH KERNICTERUS: CRIGLER-NAJJAR DISEASE]. ARCH ARGENT PEDIATR 1963; 59:136-46. [PMID: 14219465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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MCMAIN PB, McISAAC WM, MERCER RD, REYNOLDS HA. Congenital nonhemolytic jaundice ( Crigler-Najjar syndrome): report of a case. Cleve Clin J Med 1963; 30:97-101. [PMID: 13932187 DOI: 10.3949/ccjm.30.2.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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LELONG M. [Familial simple cholemia or Gilbert's disease. Its relation to Crigler-Najjar disease]. Cah Coll Med Hop Paris 1962; 3:677-80. [PMID: 13929515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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SALVIOLI GP. [Considerations on a case of congenital nonhemolytic familial jaundice of the Crigler-Najjar type]. Clin Pediatr (Bologna) 1962; 44:588-99. [PMID: 13991245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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FERREIRA CA. [The so-called Arias-Stella "syndrome"]. An Bras Ginecol 1962; 53:319-22. [PMID: 13892530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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BERNHEIM M, FRANCOIS R, BERTHELON MA, BERTRAND J, QUINCY C. [Crigler-Najjar disease. Clinical and biological study of a case]. Pediatrie 1962; 17:129-48. [PMID: 13868173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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ALICINO R, PERSICO L. [The J. Arias-Stella syndrome in the diagnosis of ectopic pregnancy]. Riv Ostet Ginecol Prat 1961; 43:716-28. [PMID: 13860428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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LELONG M, COLIN J, ALAGILLE D, GENTIL C, BRETAGNE J, HOULLEMARE L. [Non-hemolytic familial jaundice with nuclear jaundice (Crigler-Najjar disease)]. Arch Fr Pediatr 1961; 18:272-5. [PMID: 13760687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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GABRIELSEN G. [Metrorrhagia and the Arias Stella syndrome]. Gynecol Obstet (Paris) 1960; 59:390-400. [PMID: 13702813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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CRIGLER JF, NAJJAR VA. Congenital familial nonhemolytic jaundice with kernicterus; a new clinical entity. AMA Am J Dis Child 1952; 83:259-60. [PMID: 14884759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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STRANSKY E. [Congenital, familial, non-hemolytic jaundice]. Ann Paediatr 1950; 175:301-7. [PMID: 14790452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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