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de Frutos F, Diez-Lopez C, García-Romero E, Gondra L, Madariaga L, Ariceta G, García-Castaño A, Melilli E, Herrador L, Triguero-Llonch L, Gran F, Rosenfeld L, Llatjos R, Comin-Colet J, González-Costello J. Dilated Cardiomyopathy With Concomitant Salt-Losing Renal Tubulopathy Caused by Heterozygous RRAGD Gene Variant. Circ Genom Precis Med 2024; 17:e004336. [PMID: 38372174 DOI: 10.1161/circgen.123.004336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Affiliation(s)
- Fernando de Frutos
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., L.R., J.C.-C., J.G.-C.)
- Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., J.C.-C., J.G.-C.)
| | - Carles Diez-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., L.R., J.C.-C., J.G.-C.)
- Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., J.C.-C., J.G.-C.)
| | - Elena García-Romero
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., L.R., J.C.-C., J.G.-C.)
- Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., J.C.-C., J.G.-C.)
| | - Leire Gondra
- Pediatric Nephrology Department, Cruces University Hospital, Universidad del Pais Vasco/Euskal Herriko Unibertsitatea (L.G., L.M.)
- Biocruces Health Research Institute, Barakaldo (L.G., L.M., A.G.-C.)
| | - Leire Madariaga
- Pediatric Nephrology Department, Cruces University Hospital, Universidad del Pais Vasco/Euskal Herriko Unibertsitatea (L.G., L.M.)
- Biocruces Health Research Institute, Barakaldo (L.G., L.M., A.G.-C.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (L.M., A.G.-C.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Madrid (L.M., A.G.-C.)
| | | | - Alejandro García-Castaño
- Biocruces Health Research Institute, Barakaldo (L.G., L.M., A.G.-C.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (L.M., A.G.-C.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Madrid (L.M., A.G.-C.)
| | - Edoardo Melilli
- Renal Transplant Unit, Department of Nephrology (E.M.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat
| | - Lorena Herrador
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., L.R., J.C.-C., J.G.-C.)
- Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., J.C.-C., J.G.-C.)
| | - Laura Triguero-Llonch
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., L.R., J.C.-C., J.G.-C.)
- Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., J.C.-C., J.G.-C.)
| | - Ferran Gran
- Department of Pediatric Cardiology, University Hospital Vall d'Hebron (F.G.)
| | - Laia Rosenfeld
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., L.R., J.C.-C., J.G.-C.)
| | - Roger Llatjos
- Department of Pathology (R.L.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat
| | - Josep Comin-Colet
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., L.R., J.C.-C., J.G.-C.)
- Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., J.C.-C., J.G.-C.)
- Department of Clinical Sciences, School of Medicine, University of Barcelona (J.C.-C., J.G.-C.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain (J.C.-C., J.G.-C.)
| | - José González-Costello
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., L.R., J.C.-C., J.G.-C.)
- Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona (F.d.F., C.D.-L., E.G.-R., L.H., L.T.-L., J.C.-C., J.G.-C.)
- Department of Clinical Sciences, School of Medicine, University of Barcelona (J.C.-C., J.G.-C.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain (J.C.-C., J.G.-C.)
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García-Castaño A, Madariaga L, Gómez-Conde S, González P, Grau G, Rica I, de Nanclares GP, De la Hoz AB, Aguayo A, Martínez R, Urrutia I, Gaztambide S, Castaño L. Genetic profile of a large Spanish cohort with hypercalcemia. Front Endocrinol (Lausanne) 2024; 15:1297614. [PMID: 38586466 PMCID: PMC10998451 DOI: 10.3389/fendo.2024.1297614] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/27/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction The disorders in the metabolism of calcium can present with manifestations that strongly suggest their diagnosis; however, most of the time, the symptoms with which they are expressed are nonspecific or present only as a laboratory finding, usually hypercalcemia. Because many of these disorders have a genetic etiology, in the present study, we sequenced a selection of 55 genes encoding the principal proteins involved in the regulation of calcium metabolism. Methods A cohort of 79 patients with hypercalcemia were analyzed by next-generation sequencing. Results The 30% of our cohort presented one pathogenic or likely pathogenic variant in genes associated with hypercalcemia. We confirmed the clinical diagnosis of 17 patients with hypocalciuric hypercalcemia (pathogenic or likely pathogenic variants in the CASR and AP2S1 genes), one patient with neonatal hyperparathyroidism (homozygous pathogenic variant in the CASR gene), and another patient with infantile hypercalcemia (two pathogenic variants in compound heterozygous state in the CYP24A1 gene). However, we also found variants in genes associated with primary hyperparathyroidism (GCM2), renal hypophosphatemia with or without rickets (SLC34A1, SLC34A3, SLC9A3R1, VDR, and CYP27B1), DiGeorge syndrome (TBX1 and NEBL), and hypophosphatasia (ALPL). Our genetic study revealed 11 novel variants. Conclusions Our study demonstrates the importance of genetic analysis through massive sequencing to obtain a clinical diagnosis of certainty. The identification of patients with a genetic cause is important for the appropriate treatment and identification of family members at risk of the disease.
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Affiliation(s)
- Alejandro García-Castaño
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Leire Madariaga
- Pediatric Nephrology Department, Biobizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Sara Gómez-Conde
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Pedro González
- Endocrinology and Nutrition Department, Biobizkaia Health Research Institute, Hospital Universitario Cruces, EndoERN, Barakaldo, Bizkaia, Spain
| | - Gema Grau
- Pediatric Endocrinology Department, Biobizkaia Health Research Institute, Hospital Universitario Cruces, EndoERN, Barakaldo, Bizkaia, Spain
| | - Itxaso Rica
- Pediatric Endocrinology Department, Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Gustavo Pérez de Nanclares
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Ana Belén De la Hoz
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Aníbal Aguayo
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Rosa Martínez
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Inés Urrutia
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | - Sonia Gaztambide
- Endocrinology and Nutrition Department, Biobizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
| | | | - Luis Castaño
- Biobizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), CIBERDEM, CIBERER, EndoERN, Barakaldo, Bizkaia, Spain
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Cañueto J, Muñoz-Couselo E, Cardona-Machado C, Becerril-Andrés S, Martín-Vallejo J, Serra-Guillén C, Soria A, Serrano-Domingo JJ, Ortiz-Velez C, Lostes J, García-Castaño A, Puig S, Fernández de Misa R, Medina J, Aguado C, Ayala de Miguel P, Navarro-Navarro I, Masferrer E, Delgado M, Bellido-Hernández L, Sanmartin O. Efficacy and safety of cemiplimab in the treatment of advanced cutaneous squamous cell carcinoma: A multicentre real-world retrospective study from Spain and systematic review of the published data. J Eur Acad Dermatol Venereol 2024. [PMID: 38308557 DOI: 10.1111/jdv.19821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Affiliation(s)
- J Cañueto
- Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - E Muñoz-Couselo
- Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - C Cardona-Machado
- Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - S Becerril-Andrés
- Dermatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - J Martín-Vallejo
- Departamento de Estadística, Universidad de Salamanca y Unidad de Bioestadistica del IBSAL, Salamanca, Spain
| | - C Serra-Guillén
- Dermatology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - A Soria
- Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - C Ortiz-Velez
- Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Lostes
- Medical Oncology, Hospital Vall d'Hebron, Barcelona, Spain
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - A García-Castaño
- Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - S Puig
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, IDIBAPS, CIBERER, Barcelona, Spain
| | - R Fernández de Misa
- Dermatology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - J Medina
- Medical Oncology, Hospital Virgen de la Salud, Toledo, Spain
| | - C Aguado
- Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - E Masferrer
- Dermatology, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - M Delgado
- Medical Oncology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - L Bellido-Hernández
- Medical Oncology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - O Sanmartin
- Dermatology, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain
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Sainz de Los Terreros Errea A, Madariaga L, García-Castaño A. Hypercalcemia in patients with mutations in NR3C2 and SCNN1B. Med Clin (Barc) 2023; 161:458-459. [PMID: 37596163 DOI: 10.1016/j.medcli.2023.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/20/2023]
Affiliation(s)
| | - Leire Madariaga
- Sección de Nefrología Pedíátrica, IIS Biocruces Bizkaia, Universidad del País Vasco UOV/EHU, Ciberdem/Ciberer/Endo-ERN, Hospital Universitario Cruces, Barakaldo, Bizkaia, España
| | - Alejandro García-Castaño
- Laboratorio de Investigación, IIS Biocruces Bizkaia, Ciberdem/Ciberer/Endo-ERN Hospital Universitario Cruces, Barakaldo, Bizkaia, España
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García-Castaño A, Gómez-Conde S, Gondra L, Herrero M, Aguirre M, de la Hoz AB, Castaño L, Madariaga L. Genotypic variability in patients with clinical diagnosis of Bartter syndrome type 3. Sci Rep 2023; 13:12587. [PMID: 37537162 PMCID: PMC10400606 DOI: 10.1038/s41598-023-38179-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023] Open
Abstract
Bartter syndrome (BS) is a salt-losing hereditary tubulopathy characterized by hypokalemic metabolic alkalosis with secondary hyperaldosteronism. Confirmatory molecular diagnosis may be difficult due to genetic heterogeneity and overlapping of clinical symptoms. The aim of our study was to describe the different molecular findings in patients with a clinical diagnosis of classic BS. We included 27 patients (26 families) with no identified pathogenic variants in CLCNKB. We used a customized Ion AmpliSeq Next-Generation Sequencing panel including 44 genes related to renal tubulopathies. We detected pathogenic or likely pathogenic variants in 12 patients (44%), reaching a conclusive genetic diagnosis. Variants in SLC12A3 were found in 6 (Gitelman syndrome). Median age at diagnosis was 14.6 years (range 0.1-31), with no history of prematurity or polyhydramnios. Serum magnesium level was low in 2 patients (33%) but urinary calcium excretion was normal or low in all, with no nephrocalcinosis. Variants in SLC12A1 were found in 3 (BS type 1); and in KCNJ1 in 1 (BS type 2). These patients had a history of polyhydramnios in 3 (75%), and the mean gestational age was 34.2 weeks (SD 1.7). The median age at diagnosis was 1.8 years (range 0.1-6). Chronic kidney disease and nephrocalcinosis were present in 1 (25%) and 3 (75%) patients, respectively. A variant in CLCN5 was found in one patient (Dent disease), and in NR3C2 in another patient (Geller syndrome). Genetic diagnosis of BS is heterogeneous as different tubulopathies can present with a similar clinical picture. The use of gene panels in these diseases becomes more efficient than the study gene by gene with Sanger sequencing.
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Affiliation(s)
- Alejandro García-Castaño
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- CIBERDEM, CIBERER, Endo-ERN, Madrid, Spain
| | - Sara Gómez-Conde
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- CIBERDEM, CIBERER, Endo-ERN, Madrid, Spain
- Pediatric Department, University of the Basque Country UPV/EHU, Bizkaia, Spain
| | - Leire Gondra
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- CIBERDEM, CIBERER, Endo-ERN, Madrid, Spain
- Pediatric Department, University of the Basque Country UPV/EHU, Bizkaia, Spain
- Pediatric Nephrology Department, Cruces University Hospital, Plaza de Cruces, 48903, Barakaldo, Bizkaia, Spain
| | - María Herrero
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Pediatric Nephrology Department, Cruces University Hospital, Plaza de Cruces, 48903, Barakaldo, Bizkaia, Spain
| | - Mireia Aguirre
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Pediatric Nephrology Department, Cruces University Hospital, Plaza de Cruces, 48903, Barakaldo, Bizkaia, Spain
| | - Ana-Belén de la Hoz
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- CIBERDEM, CIBERER, Endo-ERN, Madrid, Spain
| | - Luis Castaño
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- CIBERDEM, CIBERER, Endo-ERN, Madrid, Spain
- Pediatric Department, University of the Basque Country UPV/EHU, Bizkaia, Spain
| | - Leire Madariaga
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
- CIBERDEM, CIBERER, Endo-ERN, Madrid, Spain.
- Pediatric Department, University of the Basque Country UPV/EHU, Bizkaia, Spain.
- Pediatric Nephrology Department, Cruces University Hospital, Plaza de Cruces, 48903, Barakaldo, Bizkaia, Spain.
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6
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Gómez-Conde S, García-Castaño A, Aguirre M, Herrero M, Gondra L, García-Pérez N, García-Ledesma P, Martín-Penagos L, Dall'Anese C, Ariceta G, Castaño L, Madariaga L. Molecular aspects and long-term outcome of patients with primary distal renal tubular acidosis. Pediatr Nephrol 2021; 36:3133-3142. [PMID: 33881640 DOI: 10.1007/s00467-021-05066-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/06/2020] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Primary distal renal tubular acidosis (dRTA) is a rare genetic disorder caused by impaired distal mechanisms of urinary acidification. Most cases are secondary to pathogenic variants in ATP6V0A4, ATP6V1B1, and SLC4A1 genes, which encode transporters regulating acid-base balance in the collecting duct. METHODS Retrospective study of molecular and clinical data from diagnosis and long-term follow-up (10, 20, and 40±10 years) of 16 patients with primary dRTA diagnosed in childhood. RESULTS Molecular analyses revealed nine patients had ATP6V0A4 pathogenic variants, five in ATP6V1B1, and two in SLC4A1. A novel intragenic deletion and a common ATP6V0A4 gene variant (c.1691 + 2dupT) in ATP6V0A4 occurred in two-thirds of these patients, suggesting a founder effect. Median age at diagnosis was 3.25 months (IQR 1, 13.5), which was higher in the SLC4A1 group. Median SDS height at diagnosis was -1.02 (IQR -1.79, 0.14). Delayed clinical diagnosis was significantly related to growth failure (P = 0.01). Median SDS height at 20 years follow-up was -1.23 (IQR -1.71, -0.48), and did not significantly improve from diagnosis (P = 0.76). Kidney function declined over time: at last follow-up, 43% had moderate to severe chronic kidney disease (CKD). Adequate metabolic control was not related to CKD development. Incidence of sensorineural hearing loss (SNHL) was high in ATP6V1B1 patients, though not universal. Patients harboring ATP6V0A4 variants also developed SNHL at a high rate (80%) over time. CONCLUSIONS Patients with dRTA can develop moderate to severe CKD over time with a high frequency despite adequate metabolic control. Early diagnosis ameliorates long-term height prognosis.
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Affiliation(s)
| | - Alejandro García-Castaño
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,CIBERDEM, CIBERER, Endo-ERN, Madrid, Spain
| | - Mireia Aguirre
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Pediatric Nephrology Department, Cruces University Hospital, Barakaldo, Spain
| | - María Herrero
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Pediatric Nephrology Department, Cruces University Hospital, Barakaldo, Spain
| | - Leire Gondra
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Pediatric Nephrology Department, Cruces University Hospital, Barakaldo, Spain.,Pediatric Department, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Nélida García-Pérez
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Pediatric Department, University of the Basque Country UPV/EHU, Leioa, Spain.,Pediatric Nephrology Department, Basurto University Hospital, Bilbao, Spain
| | | | - Luis Martín-Penagos
- Nephrology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Gema Ariceta
- Pediatric Nephrology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Castaño
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,CIBERDEM, CIBERER, Endo-ERN, Madrid, Spain.,Pediatric Department, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Leire Madariaga
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain. .,CIBERDEM, CIBERER, Endo-ERN, Madrid, Spain. .,Pediatric Nephrology Department, Cruces University Hospital, Barakaldo, Spain. .,Pediatric Department, University of the Basque Country UPV/EHU, Leioa, Spain.
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7
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Manzano J, Martín-Liberal J, Fernandez-Morales L, Benítez G, Medina J, Quindós M, García-Castaño A, Fernández O, Vilchez Simo R, Majem M, Bellido Hernández L, Ayala de Miguel P, Campos B, Espinosa E, Macías Cerrolaza J, Gil-Arnaiz I, Lorente D, Martínez-Fernández A, Martín-Sánchez E, Cerezuela-Fuentes P. 1088P Adjuvant dabrafenib plus trametinib (DT) treatment completion in patients with resected melanoma in Spain: A retrospective observational study (GEM 1901 - DESCRIBE-AD). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1473] [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] Open
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8
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Gómez-Conde S, García-Castaño A, Aguirre M, Herrero M, Gondra L, Castaño L, Madariaga L. Hereditary distal renal tubular acidosis: Genotypic correlation, evolution to long term, and new therapeutic perspectives. Nefrologia 2021; 41:383-390. [PMID: 36165107 DOI: 10.1016/j.nefroe.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/14/2020] [Indexed: 06/16/2023] Open
Abstract
Distal renal tubular acidosis (DRTA) is a rare disease resulting from a failure in the normal urine acidification process at the distal tubule and collecting duct level. It is characterised by persistent hyperchloremic metabolic acidosis, with a normal anion gap in plasma, in the presence of high urinary pH and low urinary excretion of ammonium. To date, 5 genes whose mutations give rise to primary DRTA have been described. Alterations in the ATP6V1B1 and ATP6V0A4 genes are inherited recessively and are associated with forms of early onset and, in many cases, with neurosensorial deafness. Pathogenic variants in the SLC4A1 gene are habitually inherited dominantly and give rise to milder symptoms, with a later diagnosis and milder electrolytic alterations. Nonetheless, evolution to nephrocalcinosis and lithiasis, and the development of chronic kidney disease in the medium to long term has been described in a similar manner in all 3 groups. Lastly, recessive forms of DTRA associated to mutations in the FOXI1 and WDR72 genes have also been described. The clinical management of DTRA is based on bicarbonate or citrate salts, which do not succeed in correcting all cases of the metabolic alterations described and, thus, the consequences associated with them. Recently, a new treatment based on slow-release bicarbonate and citrate salts has received the designation of orphan drug in Europe for the treatment of DTRA.
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Affiliation(s)
- Sara Gómez-Conde
- Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Bizkaia, Spain
| | - Alejandro García-Castaño
- Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Bizkaia, Spain; CIBERDEM, CIBERER, Endo-ERN
| | - Mireia Aguirre
- Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Bizkaia, Spain; Sección de Nefrología Pediátrica, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - María Herrero
- Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Bizkaia, Spain; Sección de Nefrología Pediátrica, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Leire Gondra
- Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Bizkaia, Spain; Sección de Nefrología Pediátrica, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Departamento de Pediatría, Universidad del País Vasco UPV/EHU, Barakaldo, Bizkaia, Spain
| | - Luis Castaño
- Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Bizkaia, Spain; CIBERDEM, CIBERER, Endo-ERN; Sección de Endocrinología Pediátrica, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Departamento de Pediatría, Universidad del País Vasco UPV/EHU, Barakaldo, Bizkaia, Spain
| | - Leire Madariaga
- Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Bizkaia, Spain; CIBERDEM, CIBERER, Endo-ERN; Sección de Nefrología Pediátrica, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Departamento de Pediatría, Universidad del País Vasco UPV/EHU, Barakaldo, Bizkaia, Spain.
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9
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Mesia R, Iglesias L, Lambea J, Martínez-Trufero J, Soria A, Taberna M, Trigo J, Chaves M, García-Castaño A, Cruz-Hernández JJ. Correction to: SEOM clinical guidelines for the treatment of head and neck cancer (2020). Clin Transl Oncol 2021; 23:1001. [PMID: 33709222 DOI: 10.1007/s12094-021-02582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- R Mesia
- Institut Català d'Oncologia, Badalona, Spain.
| | - L Iglesias
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, 12 de Octubre, Madrid, Spain
| | - J Lambea
- Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - J Martínez-Trufero
- Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Soria
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Taberna
- Institut Català d'Oncologia, Hospitalet de Llobregat, Spain
| | - J Trigo
- Servicio de Oncología Médica, Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - M Chaves
- Servicio de Oncología Médica, Hospital Virgen de Valme, Seville, Spain
| | - A García-Castaño
- Servicio de Oncología Médica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J J Cruz-Hernández
- Servicio de Oncología Médica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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10
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García-Castaño A, Madariaga L, Antón-Gamero M, Mejia N, Ponce J, Gómez-Conde S, Pérez de Nanclares G, De la Hoz AB, Martínez R, Saso L, Martínez de LaPiscina I, Urrutia I, Velasco O, Aguayo A, Castaño L, Gaztambide S. Novel variant in the CNNM2 gene associated with dominant hypomagnesemia. PLoS One 2020; 15:e0239965. [PMID: 32997713 PMCID: PMC7527205 DOI: 10.1371/journal.pone.0239965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
The maintenance of magnesium (Mg2+) homeostasis is essential for human life. The Cystathionine-β-synthase (CBS)-pair domain divalent metal cation transport mediators (CNNMs) have been described to be involved in maintaining Mg2+ homeostasis. Among these CNNMs, CNNM2 is expressed in the basolateral membrane of the kidney tubules where it is involved in Mg2+ reabsorption. A total of four patients, two of them with a suspected disorder of calcium metabolism, and two patients with a clinical diagnosis of primary tubulopathy were screened for mutations by Next-Generation Sequencing (NGS). We found one novel likely pathogenic variant in the heterozygous state (c.2384C>A; p.(Ser795*)) in the CNNM2 gene in a family with a suspected disorder of calcium metabolism. In this family, hypomagnesemia was indirectly discovered. Moreover, we observed three novel variants of uncertain significance in heterozygous state in the other three patients (c.557G>C; p.(Ser186Thr), c.778A>T; p.(Ile260Phe), and c.1003G>A; p.(Asp335Asn)). Our study shows the utility of Next-Generation Sequencing in unravelling the genetic origin of rare diseases. In clinical practice, serum Mg2+ should be determined in calcium and PTH-related disorders.
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Affiliation(s)
| | - Leire Madariaga
- Paediatric Nephrology Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, University of the Basque Country (UPV-EHU), Bizkaia, Spain
| | | | - Natalia Mejia
- Faculty of Medicine, University of Los Andes, Bogotá, Colombia
| | - Jenny Ponce
- Paediatric Department, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, Peru
| | | | - Gustavo Pérez de Nanclares
- Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, Bizkaia, Spain
| | | | - Rosa Martínez
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Bizkaia, Spain
| | - Laura Saso
- Biocruces Bizkaia Health Research Institute, Bizkaia, Spain
| | | | - Inés Urrutia
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Bizkaia, Spain
| | - Olaia Velasco
- Biocruces Bizkaia Health Research Institute, Bizkaia, Spain
| | - Aníbal Aguayo
- Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, Bizkaia, Spain
| | - Luis Castaño
- Endocrinology and Nutrition Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, University of the Basque Country (UPV-EHU), Bizkaia, Spain
| | - Sonia Gaztambide
- Endocrinology and Nutrition Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, CIBERDEM, CIBERER, University of the Basque Country (UPV-EHU), Bizkaia, Spain
- * E-mail:
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11
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Holgado Martín E, Blasco Cordellat A, García-Castaño A, Villatoro R, Guix Arnau M. 1871P Overcoming barriers in opioid-induced constipation management. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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García-Castaño A, González-Barrallo I, Rubio VC, Martínez JM, Mozo JM, Mujika K, Tarruella MM, Aguado de La Rosa C, Suárez MC, Palacio I, Osterloh L, Fernandez AM. 1118P Retrospective analysis of safety in elderly BRAF V600 mutation-positive advanced melanoma patients treated with dabrafenib (D) and trametinib (T) and correlation with non-elderly patients. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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13
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García-Castaño A, Perdomo-Ramirez A, Vall-Palomar M, Ramos-Trujillo E, Madariaga L, Ariceta G, Claverie-Martin F. Novel compound heterozygous mutations of CLDN16 in a patient with familial hypomagnesemia with hypercalciuria and nephrocalcinosis. Mol Genet Genomic Med 2020; 8:e1475. [PMID: 32869508 PMCID: PMC7667358 DOI: 10.1002/mgg3.1475] [Citation(s) in RCA: 5] [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: 06/13/2020] [Revised: 07/13/2020] [Accepted: 08/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background Familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC) is an autosomal recessive tubulopathy characterized by excessive urinary wasting of magnesium and calcium, bilateral nephrocalcinosis, and progressive chronic renal failure in childhood or adolescence. FHHNC is caused by mutations in CLDN16 and CLDN19, which encode the tight‐junction proteins claudin‐16 and claudin‐19, respectively. Most of these mutations are missense mutations and large deletions are rare. Methods We examined the clinical and biochemical features of a Spanish boy with early onset of FHHNC symptoms. Exons and flanking intronic segments of CLDN16 and CLDN19 were analyzed by direct sequencing. We developed a new assay based on Quantitative Multiplex PCR of Short Fluorescent Fragments (QMPSF) to investigate large CLDN16 deletions. Results Genetic analysis revealed two novel compound heterozygous mutations of CLDN16, comprising a missense mutation, c.277G>A; p.(Ala93Thr), in one allele, and a gross deletion that lacked exons 4 and 5,c.(840+25_?)del, in the other allele. The patient inherited these variants from his mother and father, respectively. Conclusions Using direct sequencing and our QMPSF assay, we identified the genetic cause of FHHNC in our patient. This QMPSF assay should facilitate the genetic diagnosis of FHHNC. Our study provided additional data on the genotypic spectrum of the CLDN16 gene.
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Affiliation(s)
| | - Ana Perdomo-Ramirez
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Mònica Vall-Palomar
- Fisiopatologia Renal, Centro de Investigaciones en Bioquímica y Biología Molecular (CIBBIM), Vall d'Hebron Institut de Recerca (VHIR, Barcelona, Spain
| | - Elena Ramos-Trujillo
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Leire Madariaga
- Biocruces Bizkaia Research Institute, Barakaldo, Bizkaia, Spain.,Pediatric Nephrology Department, Cruces University Hospital, UPV/EHU, Barakaldo, Spain
| | - Gema Ariceta
- Fisiopatologia Renal, Centro de Investigaciones en Bioquímica y Biología Molecular (CIBBIM), Vall d'Hebron Institut de Recerca (VHIR, Barcelona, Spain.,Servicio de Nefrología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departamento de Pediatría, Universitat Autònoma de Barcelona, Bellaterra (Barcelona), Spain
| | - Felix Claverie-Martin
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
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14
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García-Castaño A, Madariaga L, Pérez de Nanclares G, Vela A, Rica I, Gaztambide S, Martínez R, Martinez de LaPiscina I, Urrutia I, Aguayo A, Velasco O, Castaño L. Response to Letter to the Editor: "Forty-One Individuals with Mutations in the AVP-NPII Gene Associated with Familial Neurohypophyseal Diabetes Insipidus. J Clin Endocrinol Metab 2020; 105:5835887. [PMID: 32392319 DOI: 10.1210/clinem/dgaa255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Leire Madariaga
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
- UPV/EHU, Leioa, Spain
| | - Gustavo Pérez de Nanclares
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
| | - Amaia Vela
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
- UPV/EHU, Leioa, Spain
| | - Itxaso Rica
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
| | - Sonia Gaztambide
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
- UPV/EHU, Leioa, Spain
| | - Rosa Martínez
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
| | | | - Inés Urrutia
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
| | - Anibal Aguayo
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
| | - Olaia Velasco
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
| | - Luis Castaño
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
- UPV/EHU, Leioa, Spain
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15
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García-Castaño A, Madariaga L, Pérez de Nanclares G, Vela A, Rica I, Gaztambide S, Martínez R, Martinez de LaPiscina I, Urrutia I, Aguayo A, Velasco O, Castaño L. Forty-One Individuals With Mutations in the AVP-NPII Gene Associated With Familial Neurohypophyseal Diabetes Insipidus. J Clin Endocrinol Metab 2020; 105:5735194. [PMID: 32052034 DOI: 10.1210/clinem/dgaa069] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/07/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Familial neurohypophyseal diabetes insipidus is a rare disease produced by a deficiency in the secretion of antidiuretic hormone and is caused by mutations in the arginine vasopressin gene. OBJECTIVE Clinical, biochemical, and genetic characterization of a group of patients clinically diagnosed with familial neurohypophyseal diabetes insipidus, 1 of the largest cohorts of patients with protein neurophysin II (AVP-NPII) gene alterations studied so far. DESIGN The AVP-NPII gene was screened for mutations by PCR followed by direct Sanger sequencing in 15 different unrelated families from Spain. RESULTS The 15 probands presented with polyuria and polydipsia as the most important symptoms at the time of diagnosis. In these patients, the disease was diagnosed at a median of 6 years of age. We observed 11 likely pathogenic variants. Importantly, 4 of the AVP-NPII variants were novel (p.(Tyr21Cys), p.(Gly45Ser), p.(Cys75Tyr), p.(Gly88Cys)). CONCLUSIONS Cytotoxicity seems to be due to consequences common to all the variants found in our cohort, which are not able to fold correctly and pass the quality control of the ER. In concordance, we found autosomal dominant familial neurohypophyseal diabetes insipidus in the 15 families studied.
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Affiliation(s)
| | - Leire Madariaga
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
- UPV/EHU, Leioa, Spain
| | - Gustavo Pérez de Nanclares
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
| | - Amaia Vela
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
- UPV/EHU, Leioa, Spain
| | - Itxaso Rica
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
| | - Sonia Gaztambide
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
- UPV/EHU, Leioa, Spain
| | - Rosa Martínez
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
| | | | - Inés Urrutia
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
| | - Anibal Aguayo
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
| | - Olaia Velasco
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
| | | | - Luis Castaño
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, Barakaldo, Spain
- UPV/EHU, Leioa, Spain
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Bahíllo-Curieses MP, López-Casillas P, García-Castaño A. Familiar hypocalciuric hypercalcemia: Biochemical and genetic characterization of a family. Med Clin (Barc) 2020; 156:525-526. [PMID: 32115198 DOI: 10.1016/j.medcli.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 11/18/2022]
Affiliation(s)
- M Pilar Bahíllo-Curieses
- Servicio de Pediatría, Endocrinología Pediátrica, Hospital Clínico Universitario, Valladolid, España.
| | - Pablo López-Casillas
- Servicio de Pediatría, Endocrinología Pediátrica, Hospital Clínico Universitario, Valladolid, España
| | - Alejandro García-Castaño
- Biocruces Bizkaia Research Institute, Barakaldo, Bizkaia, España; Enfermedades raras Centro de Investigación Biomédica en Red (CIBERER), España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), España
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Martínez de LaPiscina I, Hernández-Ramírez LC, Portillo N, Gómez-Gila AL, Urrutia I, Martínez-Salazar R, García-Castaño A, Aguayo A, Rica I, Gaztambide S, Faucz FR, Keil MF, Lodish MB, Quezado M, Pankratz N, Chittiboina P, Lane J, Kay DM, Mills JL, Castaño L, Stratakis CA. Rare Germline DICER1 Variants in Pediatric Patients With Cushing's Disease: What Is Their Role? Front Endocrinol (Lausanne) 2020; 11:433. [PMID: 32714280 PMCID: PMC7351020 DOI: 10.3389/fendo.2020.00433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022] Open
Abstract
Context: The DICER1 syndrome is a multiple neoplasia disorder caused by germline mutations in the DICER1 gene. In DICER1 patients, aggressive congenital pituitary tumors lead to neonatal Cushing's disease (CD). The role of DICER1 in other corticotropinomas, however, remains unknown. Objective: To perform a comprehensive screening for DICER1 variants in a large cohort of CD patients, and to analyze their possible contribution to the phenotype. Design, setting, patients, and interventions: We included 192 CD cases: ten young-onset (age <30 years at diagnosis) patients were studied using a next generation sequencing panel, and 182 patients (170 pediatric and 12 adults) were screened via whole-exome sequencing. In seven cases, tumor samples were analyzed by Sanger sequencing. Results: Rare germline DICER1 variants were found in seven pediatric patients with no other known disease-associated germline defects or somatic DICER1 second hits. By immunohistochemistry, DICER1 showed nuclear localization in 5/6 patients. Variant transmission from one of the parents was confirmed in 5/7 cases. One patient had a multinodular goiter; another had a family history of melanoma; no other patients had a history of neoplasms. Conclusions: Our findings suggest that DICER1 gene variants may contribute to the pathogenesis of non-syndromic corticotropinomas. Clarifying whether DICER1 loss-of-function is disease-causative or a mere disease-modifier in this setting, requires further studies. Clinical trial registration: ClinicalTrials.gov: NCT00001595.
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Affiliation(s)
- Idoia Martínez de LaPiscina
- Section on Endocrinology, Metabolism, Nutrition and Renal Diseases, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, Barakaldo, Spain
| | - Laura C. Hernández-Ramírez
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Nancy Portillo
- Section on Endocrinology, Metabolism, Nutrition and Renal Diseases, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, Barakaldo, Spain
- Pediatric Endocrinology Service, Alto Deba Hospital, Arrasate, Spain
| | - Ana L. Gómez-Gila
- Pediatric Endocrinology Service, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Inés Urrutia
- Section on Endocrinology, Metabolism, Nutrition and Renal Diseases, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, Barakaldo, Spain
| | - Rosa Martínez-Salazar
- Section on Endocrinology, Metabolism, Nutrition and Renal Diseases, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, Barakaldo, Spain
| | - Alejandro García-Castaño
- Section on Endocrinology, Metabolism, Nutrition and Renal Diseases, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, Barakaldo, Spain
| | - Aníbal Aguayo
- Section on Endocrinology, Metabolism, Nutrition and Renal Diseases, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, Barakaldo, Spain
| | - Itxaso Rica
- Section on Endocrinology, Metabolism, Nutrition and Renal Diseases, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, Barakaldo, Spain
- Pediatric Endocrinology Service, Cruces University Hospital, Barakaldo, Spain
| | - Sonia Gaztambide
- Section on Endocrinology, Metabolism, Nutrition and Renal Diseases, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, Barakaldo, Spain
- Endocrinology Service, Cruces University Hospital, Barakaldo, Spain
| | - Fabio R. Faucz
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Margaret F. Keil
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Maya B. Lodish
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, United States
- Division of Pediatric Endocrinology, Department of Pediatrics, Mission Hall, University of California, San Francisco, San Francisco, CA, United States
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Nathan Pankratz
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Prashant Chittiboina
- Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - John Lane
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Denise M. Kay
- Newborn Screening Program, Wadsworth Center, New York State Department of Health, Albany, NY, United States
| | - James L. Mills
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Luis Castaño
- Section on Endocrinology, Metabolism, Nutrition and Renal Diseases, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV/EHU, CIBERER, CIBERDEM, Barakaldo, Spain
- *Correspondence: Luis Castaño
| | - Constantine A. Stratakis
- Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD, United States
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18
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Urrutia I, Martínez R, Rica I, Martínez de LaPiscina I, García-Castaño A, Aguayo A, Calvo B, Castaño L. Negative autoimmunity in a Spanish pediatric cohort suspected of type 1 diabetes, could it be monogenic diabetes? PLoS One 2019; 14:e0220634. [PMID: 31365591 PMCID: PMC6668821 DOI: 10.1371/journal.pone.0220634] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/19/2019] [Indexed: 12/19/2022] Open
Abstract
Objective Monogenic diabetes can be misdiagnosed as type 1 or type 2 diabetes in children. The right diagnosis is crucial for both therapeutic choice and prognosis and influences genetic counseling. The main objective of this study was to search for monogenic diabetes in Spanish pediatric patients suspected of type 1 diabetes with lack of autoimmunity at the onset of the disease. We also evaluated the extra value of ZnT8A in addition to the classical IAA, GADA and IA2A autoantibodies to improve the accuracy of type 1 diabetes diagnosis. Methods Four hundred Spanish pediatric patients with recent-onset diabetes (mean age 8.9 ± 3.9 years) were analyzed for IAA, GADA, IA2A and ZnT8A pancreatic-autoantibodies and HLA-DRB1 alleles. Patients without autoimmunity and those with only ZnT8A positive were screened for 12 monogenic diabetes genes by next generation sequencing. Results ZnT8A testing increased the number of autoantibody-positive patients from 373 (93.3%) to 377 (94.3%). An isolated positivity for ZnT8A allowed diagnosing autoimmune diabetes in 14.8% (4/27) of pediatric patients negative for the rest of the antibodies tested. At least 2 of the 23 patients with no detectable autoimmunity (8%) carried heterozygous pathogenic variants: one previously reported missense variant in the INS gene (p.Gly32Ser) and one novel frameshift variant (p.Val264fs) in the HNF1A gene. One variant of uncertain significance was also found. Carriers of pathogenic variants had HLA-DRB1 risk alleles for autoimmune diabetes and clinical characteristics compatible with type 1 diabetes except for the absence of autoimmunity. Conclusion ZnT8A determination improves the diagnosis of autoimmune diabetes in pediatrics. At least 8% of pediatric patients suspected of type 1 diabetes and with undetectable autoimmunity have monogenic diabetes and can benefit from the correct diagnosis of the disease by genetic study.
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Affiliation(s)
- Inés Urrutia
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV-EHU, Bizkaia, Spain
- CIBERDEM, CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Martínez
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV-EHU, Bizkaia, Spain
- CIBERDEM, CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Itxaso Rica
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV-EHU, Bizkaia, Spain
- CIBERDEM, CIBERER, Instituto de Salud Carlos III, Madrid, Spain
- Pediatric Endocrinology Service, Cruces University Hospital, Osakidetza, Bizkaia, Spain
| | - Idoia Martínez de LaPiscina
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV-EHU, Bizkaia, Spain
- CIBERDEM, CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro García-Castaño
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV-EHU, Bizkaia, Spain
- CIBERDEM, CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Anibal Aguayo
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV-EHU, Bizkaia, Spain
- CIBERDEM, CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Begoña Calvo
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV-EHU, Bizkaia, Spain
| | - Luis Castaño
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, UPV-EHU, Bizkaia, Spain
- CIBERDEM, CIBERER, Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
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García-Castaño A, Madariaga L, Pérez de Nanclares G, Ariceta G, Gaztambide S, Castaño L. Novel mutations associated with inherited human calcium-sensing receptor disorders: A clinical genetic study. Eur J Endocrinol 2019; 180:59-70. [PMID: 30407919 DOI: 10.1530/eje-18-0129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/11/2018] [Accepted: 09/06/2018] [Indexed: 11/08/2022]
Abstract
Objective Molecular diagnosis is a useful diagnostic tool in calcium metabolism disorders. The calcium-sensing receptor (CaSR) is known to play a central role in the regulation of extracellular calcium homeostasis. We performed clinical, biochemical and genetic characterization of sequence anomalies in this receptor in a cohort of 130 individuals from 82 families with suspected alterations in the CASR gene, one of the largest series described. Methods The CASR gene was screened for mutations by polymerase chain reaction followed by direct Sanger sequencing. Results Presumed CaSR-inactivating mutations were found in 65 patients from 26 families. These patients had hypercalcemia (median: 11.3 mg/dL) but normal or abnormally high parathyroid hormone (PTH) levels (median: 52 pg/mL). On the other hand, presumed CaSR-activating mutations were detected in 17 patients from eight families. These patients had a median serum calcium level of 7.4 mg/dL and hypoparathyroidism (median: PTH 13 pg/mL). Further, common polymorphisms previously associated with high blood ionized calcium levels were found in 27 patients (median calcium: 10.6 mg/dL; median PTH: 65 pg/mL) with no other alterations in CASR. Overall, we found 30 different mutations, of which, 14 have not been previously reported (p.Ala26Ser, p.Cys60Arg, p.Lys119Ile, p.Leu123Met, p.Glu133Val, p.Gly222Glu, p.Phe351Ile, p.Cys542Tyr, p.Cys546Gly, p.Cys677Tyr, p.Ile816Val, p.Ala887Asp, p.Glu934*, p.Pro935_Gln945dup). Conclusions Patients with CASR mutations may not fit the classic clinical pictures of hypercalcemia with hypocalciuria or hypocalcemia with hypercalciuria. Molecular studies are important for confirming the diagnosis and distinguishing it from other entities. Our genetic analysis confirmed CaSR disorders in 82 patients in the study cohort.
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Affiliation(s)
| | - Leire Madariaga
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, UPV/EHU, Barakaldo, Spain
| | - Gustavo Pérez de Nanclares
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, UPV/EHU, Barakaldo, Spain
| | - Gema Ariceta
- Hospital Universitario Materno-Infantil Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Sonia Gaztambide
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, UPV/EHU, Barakaldo, Spain
| | - Luis Castaño
- Biocruces Bizkaia Health Research Institute, CIBERDEM, CIBERER, Barakaldo, Spain
- Hospital Universitario Cruces, UPV/EHU, Barakaldo, Spain
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20
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García-Castaño A, Madariaga L, Azriel S, Pérez de Nanclares G, Martínez de LaPiscina I, Martínez R, Urrutia I, Aguayo A, Gaztambide S, Castaño L. Identification of a novel large CASR deletion in a patient with familial hypocalciuric hypercalcemia. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180114. [PMID: 30530875 PMCID: PMC6280130 DOI: 10.1530/edm-18-0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/14/2018] [Indexed: 11/08/2022] Open
Abstract
Familial hypocalciuric hypercalcemia type I is an autosomal dominant disorder caused by heterozygous loss-of-function mutations in the CASR gene and is characterized by moderately elevated serum calcium concentrations, low urinary calcium excretion and inappropriately normal or mildly elevated parathyroid hormone (PTH) concentrations. We performed a clinical and genetic characterization of one patient suspected of familial hypocalciuric hypercalcemia type I. Patient presented persistent hypercalcemia with normal PTH and 25-hydroxyvitamin D levels. The CASR was screened for mutations by PCR followed by direct Sanger sequencing and, in order to detect large deletions or duplications, multiplex ligation-dependent probe amplification (MLPA) was used. One large deletion of 973 nucleotides in heterozygous state (c.1733-255_2450del) was detected. This is the first large deletion detected by the MLPA technique in the CASR gene.
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Affiliation(s)
| | - Leire Madariaga
- Biocruces Bizkaia Health Research InstituteCIBERDEM, CIBERER, Barakaldo, Spain.,Hospital Universitario CrucesUPV/EHU, Barakaldo, Spain
| | | | - Gustavo Pérez de Nanclares
- Biocruces Bizkaia Health Research InstituteCIBERDEM, CIBERER, Barakaldo, Spain.,Hospital Universitario CrucesUPV/EHU, Barakaldo, Spain
| | | | - Rosa Martínez
- Biocruces Bizkaia Health Research InstituteCIBERDEM, CIBERER, Barakaldo, Spain
| | - Inés Urrutia
- Biocruces Bizkaia Health Research InstituteCIBERDEM, CIBERER, Barakaldo, Spain
| | - Aníbal Aguayo
- Biocruces Bizkaia Health Research InstituteCIBERDEM, CIBERER, Barakaldo, Spain.,Hospital Universitario CrucesUPV/EHU, Barakaldo, Spain
| | - Sonia Gaztambide
- Biocruces Bizkaia Health Research InstituteCIBERDEM, CIBERER, Barakaldo, Spain.,Hospital Universitario CrucesUPV/EHU, Barakaldo, Spain
| | - Luis Castaño
- Biocruces Bizkaia Health Research InstituteCIBERDEM, CIBERER, Barakaldo, Spain.,Hospital Universitario CrucesUPV/EHU, Barakaldo, Spain
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21
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Madariaga L, García-Castaño A, Ariceta G, Martínez-Salazar R, Aguayo A, Castaño L. Variable phenotype in HNF1B mutations: extrarenal manifestations distinguish affected individuals from the population with congenital anomalies of the kidney and urinary tract. Clin Kidney J 2018; 12:373-379. [PMID: 31198537 PMCID: PMC6543961 DOI: 10.1093/ckj/sfy102] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 05/07/2018] [Indexed: 01/15/2023] Open
Abstract
Background Mutations in hepatocyte nuclear factor 1B (HNF1B) have been associated with congenital anomalies of the kidney and urinary tract (CAKUT) in humans. Diabetes and other less frequent anomalies have also been described. Variable penetrance and intrafamilial variability have been demonstrated including severe prenatal phenotypes. Thus, it is important to differentiate this entity from others with similar clinical features and perform confirmatory molecular diagnosis. Methods This study reports the results of HNF1B screening in a cohort of 60 patients from 58 unrelated families presenting with renal structural anomalies and/or non-immune glucose metabolism alterations, and other minor features suggesting HNF1B mutations. Results This study identified a pathogenic variant in 23 patients from 21 families. The most frequent finding was bilateral cystic dysplasia or hyperechogenic kidneys (87% of patients). Sixty percent of them also fulfilled the criteria for impaired glucose metabolism, and these were significantly older than those patients with an HNF1B mutation but without diabetes or prediabetes (14.4 versus 3.3 years, P < 0.05). Furthermore, patients with HNF1B mutations had higher frequency of pancreatic structural anomalies and hypomagnesaemia than patients without mutations (P < 0.001 and P = 0.003, respectively). Hyperuricaemia and increased liver enzymes were detected in some patients as well. Conclusions Renal anomalies found in patients with HNF1B mutations are frequently unspecific and may resemble those found in other renal pathologies (CAKUT, ciliopathies). Active searching for extrarenal minor features, especially pancreatic structural anomalies or hypomagnesaemia, could support the indication for molecular diagnosis to identify HNF1B mutations.
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Affiliation(s)
- Leire Madariaga
- Pediatric Nephrology Department, Cruces University Hospital, UPV/EHU, Barakaldo, Spain.,Biocruces Health Research Institute, Barakaldo, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Alejandro García-Castaño
- Biocruces Health Research Institute, Barakaldo, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Gema Ariceta
- Pediatric Nephrology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona UAB, Barcelona, Spain
| | - Rosa Martínez-Salazar
- Biocruces Health Research Institute, Barakaldo, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Aníbal Aguayo
- Biocruces Health Research Institute, Barakaldo, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Luis Castaño
- Pediatric Nephrology Department, Cruces University Hospital, UPV/EHU, Barakaldo, Spain.,Biocruces Health Research Institute, Barakaldo, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
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Martínez-Amador N, Martínez-Rodríguez I, García-Castaño A, Jiménez-Bonilla J, Quirce R, Banzo I. Unexpected breast metastasis from cutaneous melanoma on 18F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2018. [DOI: 10.1016/j.remnie.2018.03.008] [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: 10/28/2022]
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23
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Vega-Villegas ME, Rivera F, García-Castaño A, López-Brea M, López-Muñoz A, De-Juan A, Collado A, Del-Valle A, Rama J, Sanz-Ortiz J. Prognostic factors for survival with primary site preservation (SPP) in patients with resectable locally advanced squamous cell carcinoma (R-LA-SCC) of larynx and hypopharynx treated with induction chemotherapy (IC) followed by radiotherapy (RT) in an organ preservation setting. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - F. Rivera
- H.U.Marqués de Valdecilla, Santander, Spain
| | | | | | | | - A. De-Juan
- H.U.Marqués de Valdecilla, Santander, Spain
| | - A. Collado
- H.U.Marqués de Valdecilla, Santander, Spain
| | | | - J. Rama
- H.U.Marqués de Valdecilla, Santander, Spain
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