Phenotypes and ATP7B gene variants in 316 children with Wilson disease / 中华儿科杂志

Objectives: To summarize the clinical phenotypes and the variation spectrum of ATP7B gene in Chinese children with Wilson's disease (WD) and to investigate their significance for early diagnosis. Methods: Retrospective analysis was performed on the clinical data of 316 children diagnosed as WD in Guangzhou Women and Children's Medical Center during the period from January 2010 to June 2021. The general situations, clinical manifestations, lab test results, imaging examinations, and ATP7B gene variant characteristics were collected. The patients were divided into asymptomatic WD group and symptomatic WD group based on the presence or absence of clinical symptoms at the time that WD diagnosis was made. The χ2 test, t test or Mann-Whitney U test were used to compare the differences between groups. Results: Among the 316 children with WD, 199 were males and 117 were females, with the age of 5.4 (4.0, 7.6) years at diagnosis; 261 cases (82.6%) were asymptomatic with the age of 4.9 (3.9, 6.4) years; whereas 55 cases (17.4%) were symptomatic with the age of 9.6 (7.3, 12.0) years. The main symptoms invloved liver, kidney, nervous system, or skin damage. Of all the patients, 95.9% (303/316) had abnormal liver function at diagnosis; 98.1% (310/316) had the serum ceruloplasmin lever lower than 200 mg/L; 97.7% (302/309) had 24-hour urine copper content exceeding 40 μg; only 7.4% (23/310) had positive corneal K-F rings, 8.2% (23/281) had abnormal MRI signals in the lenticular nucleus, and all of them had symptoms of damage in liver, kidney or nervous system. Compared with the group of symptomatic WD, asymptomatic group had higher levels of serum alanine aminotransferase and lower levels ceruloplasmin and 24-hour urine copper [(208±137) vs. (72±78) U/L, (55±47) vs. (69±48) mg/L, 103 (72, 153) vs. 492 (230, 1 432) μg; t=9.98, -1.98, Z=-4.89, all P<0.001]. Among the 314 patients completing genetic sequencing, a total of 107 mutations in ATP7B gene were detected, of which 10 are novel variants, and 3 cases (1.0%) had large heterozygous deletion (exons 10 to exon 11) in ATP7B gene. The percentage of missense mutation in asymptomatic WD children was significantly higher than that in symptomatic WD (81.5% (422/518) vs. 69.1% (76/110), χ²=8.47, P<0.05). WD patients carrying homozygous variant of c.2 333G>T had significantly low levels of ceruloplasmin than those not carrying this variant ((23±5) vs. (61±48) mg/L, t=-2.34, P<0.001). Conclusions: The elevation of serum ALT is an important clue for early diagnosis of WD in children, while serum ceruloplasmin and 24-hour urine copper content are specific markers for early diagnosis of WD. In order to confirm the diagnosis of WD, it is necessary to combine the Sanger sequencing with multiplex ligation-dependent probe amplification or other testing technologies.

Characteristics of DUOXA2 gene mutation in children with congenital hypothyroidism / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the characteristics of DUOXA2 gene mutation and the genotype-phenotype relationship in children with congenital hypothyroidism (CH) in Guangzhou, China.</p><p><b>METHODS</b>A total of 20 CH patients with suspected thyroid dyshormonogenesis who had no DUOX2 gene mutation were enrolled. These patients who were born between 2011 and 2012 were screened and diagnosed with CH in the Guangzhou Newborn Screening Center. PCR and direct sequencing were used to analyze DUOXA2 gene mutation.</p><p><b>RESULTS</b>Among the 20 patients, 2 had p.Y246X/p.Y246X homozygous mutation; 4 had monoallelic heterozygous mutation, among whom 2 carried the known pathogenic mutation c.413-414insA, 1 carried p.Y246X, and 1 carried a novel mutation, p.G79R. Reevaluation was performed at the age of 2-3 years, and the results showed that the two patients with p.Y246X/p.Y246X homozygous mutation were manifested as transient and mild permanent CH, respectively. Among the four patients with monoallelic heterozygous mutation, the one who carried p.Y246X mutation was manifested as typical permanent CH, and the other three were manifested as transient CH.</p><p><b>CONCLUSIONS</b>DUOXA2 gene mutation is a common molecular pathogenic basis for CH children with suspected thyroid dyshormonogenesis in Guangzhou, and most of them are manifested as transient CH. There is no association between DUOXA2 genotypes and phenotypes. The novel mutation p.G79R is probably a pathogenic mutation.</p>

Clinical features and StAR gene mutations in children with congenital lipoid adrenal hyperplasia / 中国当代儿科杂志

This article reported the clinical manifestations, steroid profiles and adrenal ultrasound findings in two unrelated Chinese girls with lipoid congenital adrenal hyperplasia (LCAH). Direct DNA sequencing and restriction fragment length polymorphism (RFLP) analysis were used to identify the mutations of steroidogenic acute regulatory protein (StAR) gene. The two patients with 46,XX karyotype, presented hyperpigmentation, growth retardation, and hyponatremia. Steroid profiles analysis revealed elevated plasma adrenocorticotrophic hormone levels, decreased or normal serum cortisol levels and low levels of androgens. Ultrasound examinations revealed that enlarged adrenals in patient 1 and normal adrenals in patient 2. Direct DNA sequencing of StAR gene showed a reported homozygous for c.772C>T(p.Q258X) in patient 1. Compound heterozygous for c.367G>A(p.E123K) and IVS4+2T>A (both novel mutations) were found in patient 2, inherited from her mother and father respectively. The amino acid of mutant position of the novel p.E123K was highly conserved in ten different species and was predicted to have impacts on the structure and function of StAR protein by the PolyPhen-2 prediction software. RFLP analysis revealed three bands (670, 423 and 247 bp) in patient 2 and her father and two bands (423 and 247 bp) in her mother and 50 controls. It is concluded that LCAH should be considered in girls with early onset of adrenal insufficiency and that steroid profiles, karyotype analysis, adrenal ultrasound and StAR gene analysis may be helpful for the definite diagnosis of LCAH.

Identification of a novel pathogenic mutation in PDHA1 gene for pyruvate dehydrogenase complex deficiency / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the molecular genetic mechanism and genetic diagnosis of pyruvate dehydrogenase complex deficiency (PHD), and to provide a basis for genetic counseling and prenatal genetic diagnosis of PHD.</p><p><b>METHODS</b>Polymerase chain reaction (PCR) was performed to amplify the 11 exons and exon junction of the PDHA1 gene from a child who was diagnosed with PHD based on clinical characteristics and laboratory examination results. The PCR products were sequenced to determine the mutation. An analysis of amino acid conservation and prediction of protein secondary and tertiary structure were performed using bioinformatic approaches to identify the pathogenicity of the novel mutation.</p><p><b>RESULTS</b>One novel duplication mutation, c.1111_1158dup48bp, was found in the exon 11 of the PDHA1 gene of the patient. No c.1111_1158dup48bp mutation was detected in the sequencing results from 50 normal controls. The results of protein secondary and tertiary structure prediction showed that the novel mutation c.1111 _1158dup48bp led to the duplication of 16 amino acids residues, serine371 to phenylalanine386, which induced a substantial change in protein secondary and tertiary structure. The conformational change was not detected in the normal controls.</p><p><b>CONCLUSIONS</b>The novel duplication mutation c.1111_1158dup48bp in the PDHA1 gene is not due to gene polymorphisms but a possible novel pathogenic mutation for PHD.</p>

Wolman disease with novel mutation of LIPA gene in a Chinese infant / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the clinical characteristics of Wolman disease and diagnostic methods using enzymatic and molecular analysis.</p><p><b>METHOD</b>Lysosomal acid lipase activity was measured using 4-methylumbelliferyl oleate in the leukocytes of an infant suspected of Wolman disease and LIPA gene mutational analysis was performed by PCR and direct sequencing in the proband and his parents. After the diagnosis was confirmed, the clinical, biochemical, radiological and histopathological findings in this case of Wolman disease were retrospectively reviewed.</p><p><b>RESULT</b>The sixteen-day-old boy was failing to thrive with progressive vomiting, abdominal distention and hepatosplenomegaly. Abdominal X-ray revealed adrenal calcifications which were confirmed on abdominal CT scan. Xanthomatosis were observed on enlarged liver, spleen and lymph nodes during abdominal surgery. Liver and lymph node biopsy showed foamy histiocytes. The lysosomal acid lipase activity in leukocytes was 3.5 nmol/(mg·h) [control 35.5 - 105.8 nmol/(mg·h)]. Serum chitotriosidase activity was 315.8 nmol/(ml·h) [control 0 - 53 nmol/(ml·h)]. The patient was homozygote for a novel insert mutation allele c.318 ins T, p. Phe106fsX4 in exon 4 on LIPA gene. His both parents were carriers of the mutation.</p><p><b>CONCLUSION</b>The clinical features of Wolman disease include early onset of vomiting, abdominal distention, growth failure, hepatosplenomegaly and bilateral adrenal calcification after birth. A plain abdominal X-ray film should be taken to check for the typical pattern of adrenal calcification in suspected cases of Wolman disease. The enzymatic and molecular analyses of lysosomal acid lipase can confirm the diagnosis of Wolman disease.</p>

Enzymatic diagnosis and clinical characteristics of 52 children with mucopolysaccharidosis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To explore the incidence of various types of mucopolysaccharidosis (MPS) and their clinical characteristics.</p><p><b>METHODS</b>A total of 75 children highly suspected as having MPS underwent quantitative and electrophoretic analysis of urinary glycosaminoglycans (GAGs) and enzymatic analysis of seven types of MPS from January 2009 to December 2011. Fluorescence assay was used to measure the activities of α-L-iduronidase, iduronate-2-sulfatase, α-N-acetylglucosaminidase, galactosamine-6-sulfatase, β-galactosidase, arylsulfatase B and β-glucuronidase in the white blood cells.</p><p><b>RESULTS</b>A total of 52 cases were confirmed with MPS based on clinical, radiological, and enzymatic examinations. The 52 cases, with a mean age of 4.0 ± 2.2 years, included 5 cases of MPS I (10%), 20 cases of MPS II (38%), 20 cases of MPS IVA (38%), 6 cases of MPS VI (12%) and 1 case of MPS VII (2%). No MPS IV B cases or MPS IIIB cases were found. Compared with healthy children of the same age, the GAG/Cr ratio was significantly elevated in 50 confirmed cases of MPS (two MPS IVA cases having no increased ratio). All children with increased urinary GAGs had a confirmed diagnosis of MPS. The age of onset was between 1 and 2 years after birth in most cases, and often complicated by hernia and valvular heart disease. Children with MPS I, MPS II, and MPS VI presented with ugly and unsmooth face, short stature, joint stiffness, and limitation of motion, while children with MPS IVA presented with short stature, skeletal dysplasia, and joint laxity.</p><p><b>CONCLUSIONS</b>Type IVA and type II are the most common in MPS cases, followed by type VI and type I. MPS children are characterized by special appearances including ugly and unsmooth facial appearance, short stature and skeletal dysplasia. Quantitative analysis of urinary GAG, as a simple, rapid, and reliable method, is recommended for screening of MPS.</p>

Mucopolysaccharidosis VII: report of a case and review of the literature / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics and diagnosis of mucopolysaccharidosis VII.</p><p><b>METHOD</b>The clinical and biochemical features of an infant with mucopolysaccharidosis VII confirmed by enzyme assay were analyzed.</p><p><b>RESULT</b>The 2 month-old male infant showed hydrops fetalis, mental retardation, coarse face, corneal clouding, hepatosplenomegaly, hernias, Alder-Reilly granules in the leucocytes and decreased platelet (32 × 10(9)/L). The biochemical markers showed urinary glycosaminoglycans (GAG) (532.8 mg/L, controls < 70.0 mg/L). The ratio of GAG/creatinine was 161.3 (controls: 26.2 ± 11.7). Serum chitotriosidase activity was 315.8 nmol/(ml·h) [control < 53 nmol/(ml·h)]. Beta-glucuronidase activity was deficient in isolated leukocytes.</p><p><b>CONCLUSION</b>Severe form of mucopolysaccharidosis VII exhibited characteristics of hydrops fetalis, hepatosplenomegaly, coarse face, thrombocytopenia and Alder-Reilly granules in the leucocytes. The measurements of GAG in urinary and beta glucuronidase in leucocytes are critical to diagnosis and deferential diagnosis.</p>

Influence of total nucleated cell dose on the efficacy of cord blood transplantation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the influence of cord blood total nucleated cell (TNC) dose on the efficacy of cord blood transplantation in children.</p><p><b>METHODS</b>Thirty-four children with hematological disease received cord blood transplantation. They were assigned to 3 groups according to the infused TNC dose: TNC>10 x 10(7)/kg (n=7), 10 x10(7)/kg>TNC> or =7 x 10(7)/kg (n=9) and TNC<7 x 10(7)/kg (n=18). The rates of graft and rejection of hematopoietic stem cells and the efficacy of transplantation were examined in the three groups.</p><p><b>RESULTS</b>All 7 children in the group infused with TNC >10 x 10(7)/kg got a long-term stable engraftment. The median time of absolute neutrophil count >0.5 x 10(9)/L was 14.8 days (range 12-20 days) and platelets >50 x10(9)/L was 52.3 days (range 26-86 days). They survived in a disease-free state. Of the 9 children in the group infused with TNC between 10 x 10(7)/kg and 7 x 10(7)/kg, 7 got engraftment. The median time of absolute neutrophil count >0.5 x 10(9)/L was 16.4 days (range 11-30 days) and platelets >50 x 10(9)/L was 63.7 days (range 34-140 days). Four children got a long-term stable engraftment and survived in a disease-free state. Two children with beta-thalassemia major had secondary rejection after engraftment and autologous hematopoitic recovery. One child died after engraftment and one child died in the early period after transplantation. Of the 18 children in the group infused with TNC<7 x 10(7)/kg, 16 children got engraftment. The median time of absolute neutrophil count >0.5 x 10(9)/L was 19.5 days (range 10-29 days) and platelets >50 x 10(9)/L was 70.1 days (range 41-116 days). Eight children had a long-term stable engraftment and survived in a disease-free state. Two children with beta-thalassemia major had secondary rejection after engraftment and autologous hematopoitic recovery. Six children died after engraftment. Two children had graft failure.</p><p><b>CONCLUSIONS</b>TNC dose is an important influencing factor for hematopoietic stem cell engraftment in cord blood transplantation. An increased TNC dose may improve the success of cord blood transplantation.</p>

Effect of intra-bone marrow infusion of allogeneic mesenchymal stem cells on reconstruction of marrow mesenchymal stem cells in rat HSCT models / 中国实验血液学杂志

This study was aimed to investigate the effect of intra-bone marrow (IBM) injection of allogeneic mesenchymal stem cells (MSCs) on reconstruction of bone marrow MSCs (BM-MSCs) in rats that received hematopoietic stem cell transplantation (HSCT), and to detect the donor MSCs in the hosts for clarifying the effect mechanism of donor MSCs. Wistar female rats conditioned with lethal dose 60Co gamma-ray irradiation were co-transplanted with F344 female fetal and neonatal peripheral blood (FNPB) and BrdU-labeled MSCs separated from bone marrow mononuclear cells of F344 male rats. The donor MSCs were infused by IBM injection in bilateral tibia or intravenous injection (IV), while the FNPB were all via IBM route. The survival rate, engraftment level of HSCs and recovery of BM-MSCs of recipients were monitored. The ratio of BrdU-labeled MSCs in recipient rats was calculated by immunofluorescence assay (IFA) and the Y chromosomes were examined by PCR. The results showed that the recipient rats of the two co-transplantation groups were all alive at day 60 after transplantation. There was no significant difference between these two groups on the survival rates or the engraftment levels of HSCs, but each of them was much better than that of the FNPB group. At day 30 after transplantation, the proliferation ability of recipients' BM-MSCs was still below normal, while that of the FNPB (IBM)+MSC (IBM) group was the best of all the experiment groups (p<0.01). At 60 days, the donor MSCs coexisted with host MSCs in only a few recipient rats examined by IFA, while the Y chromosomes could be detected in all the recipient rats in the two cotransplantation groups. It is concluded that the infusion of allogeneic MSCs can accelerate the recovery of HSCT recipients' BM-MSCs. The IBM route is safe and more effective than intravenous infusion.

Relationship between growth disorders and iron overload in children with beta-thalassemia major / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the status of growth and development and the relationship between growth disorders and iron overload in children with beta-thalassemia major.</p><p><b>METHODS</b>Fifty children with beta-thalassemia major and who received blood transfusion therapy regularly (age: 9 months-17 years) were enrolled. They were subjected to a thorough history taking, clinical examinations, and laboratory examinations, including complete blood count, alanine transferasa (ALT) and serum ferritin. The physical growth parameters, such as height and weight, were compared with the reference values of Chinese children.</p><p><b>RESULTS</b>Twenty-four patients (48%) were of short stature with height under the 3th percentile. Among them, 15 cases presented with their height and weight both under the 3th percentile. Spontaneous sex development was seen in 7 cases out of 21 over 10-year-old patients. No sex development was found in 4 out of 8 patients who were over 14 years old. The patients with a height under the 10th percentile (n=31) had higher serum ferritin levels (8239.2+/-5865.5 mg/L vs 5028.1+/-3885.7 mg/L; P<0.05) and lower hemoglobin levels (68.2+/-12.3 g/L vs 79.7+/-14.5 g/L; P<0.05) as well as hepatomegaly when compared with those patients with a height over the 10th percentile (n=19). Serum ferritin levels in 20 patients with a weight under the 10th percentile were significantly higher than those in 30 patients with a height over the 10th percentile (9165.5+/-6042.5 mg/L vs 5567.3+/-4447.3 mg/L; P<0.05).</p><p><b>CONCLUSIONS</b>Short stature, low weight and sex development delay are common in children with beta-thalassemia major. This may be related to iron overload.</p>

Biological characteristics of bone marrow-derived mesenchymal stem cells and their relationship with immunosuppressive therapy in children with aplastic anemia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the biological characteristics of bone marrow-derived mesenchymal stem cells (MSC) in children with aplastic anemia (AA) and evaluate the relationship of biological characteristics of MSC with the efficacy of immunosuppressive therapy (IST).</p><p><b>METHODS</b>Bone marrow-derived MSC were cultured and isolated from 29 children with AA and 5 normal controls. Seventeen out of the 29 cases received IST. Surface markers and cell cycle of MSC at passage 3 were analyzed by flow cytometry. The inhibition of lymphocyte proliferation by MSC was evaluated and TGF-beta 1 level in the supernatant of MSC was detected using ELISA.</p><p><b>RESULTS</b>Growth abnormality of MSC was found in 16 children with AA (55%), characterized by deficiency and poor proliferation of MSC, and was frequently seen in patients with severe AA or in patients with more prolonged disease course or in patients with radiation/chemotherapy-induced AA. Surface markers, cell cycle and TGF-beta 1 level in the supernatant of MSC at passage 3 and the inhibition of lymphocyte proliferation by MSC in the AA group were similar to those in the control group. Eight out of nine patients with normal MSC growth achieved complete remission (CR) but only 2 out of 8 patients with abnormal MSC growth achieved CR following IST ( P<0.01).</p><p><b>CONCLUSIONS</b>Bone marrow-derived MSC growth abnormality occurs in most of children with AA. MSC abnormality may affect adversely hematological recovery following IST.</p>

Effect of bone marrow mesenchymal stem cell infusion on hemato-poiesis in mice with aplastic anemia / 中国实验血液学杂志

To explore the effects of infusion with human mesenchymal stem cells from bone marrow on bone marrow hematopoietic function and survival in mice with aplastic anemia (AA), immuno-mediated aplastic anemia mice model was established according to Yao's method. Thirty BALB/c female mice were divided into AA model group, MSC group and radiation group. In MSC group, 1 x 10(6) MSC was infused by intravenous injection at 3 days after establishment of model. The changes of blood count, the number of nuclear cells in a single thigh-bone, colony-forming units (CFU), pathological features of bone marrow and survival rate of mice were observed in all groups. The results showed that the number of white blood cells in peripheral blood of AA model group at day 7 after establishment of model was (0.65 +/- 0.05) x 10(9)/L, which was significantly lower than those in MSC group and radiation alone group, respectively. Pancytopenia was found in all three groups at day 10. At day 14 the pancytopenia was continued in AA model group while it was less severe in MSC and radiation groups. In MSC group the number of nucleated cells in single thigh bone and pathological slice as well as CFU-GM were significantly higher than those in AA model group, respectively. The survival rate of mice in MSC group was 80.0% which was higher than that of group in AA model (18.2%, p < 0.01). There were no significant differences between MSC group and radiation alone group in bone marrow hematopoiesis and survival rate. It is concluded that MSC infusion reduces the degree of bone marrow failure and improve survival of immuno-mediated AA mice model.

Expression of HLA-DRB1*15 genotype in children with acquired aplastic anemia and its relation to effect of immunosuppressive therapy / 中国实验血液学杂志

This study was purpose to investigate the frequency of HLA-DRB1*15 expression in children with aplastic anemia (AA) and its relation to effect of immunosuppressive therapy. HLA-DR genotypes were detected by SSP-PCR in 40 patients with acquired aplastic anemia and 107 normal controls, and the expressions of HLA-DR gene in AA patients and normal controls were compared. 32 out of 40 patients were treated with immunosuppressive therapy, which included antilymphocyte globulin combining with cyclosporine or cyclosporine alone, the relation of HLA-DRB1*15 expression to efficacy of immunosuppressive therapy and relapse of AA was explored. The results showed that the mean age of the patients was 9.0 years with a ratio of male to female 1.5:1. The frequency of HLA-DRB1*15 genotype expression in patients with idiopathic aplastic anemia was 51.5% (17/33), which was markedly higher than that of healthy controls (20.6%, p<0.01). All of 7 patients with second acquired aplastic anemia showed negative expression of HLA-DRB1*15. The rates of all responses, including complete remission and partial remission (CR+PR), and CR to immunosuppressive therapy in 16 patients who bared HLA-DRB1*15 were 93.8% and 87.5% respectively, which were higher significantly than those of patients without bearing HLA-DRB1*15 (56.3% and 31.3%, p<0.01). Relapse occurred in 5 patients who bared HLA-DRB1*15 genotype. It is concluded that the frequency of HLA-DRB1*15 genotype expression in children with AA is significantly higher than that in normal controls, and the immunosuppressive therapy for patients bared HLA-DRB1*15 shows favourable effect with high incidence of complete remission.