Achados oftalmológicos na doença de Gaucher tipo III: caso clínico / Ophthalmologic findings in Gaucher's disease type III: case report

Resumo Relata-se um caso de uma paciente com doença de Guacher tipo III, com mutação no Exon9, 1246G>A e 1251G>C, buscando investigar a suspeita de glaucoma, descrever os achados oftalmológicos, como acumulo de glicolipideo em região pré- retiniana e investigar a possível correlação com a diminuição da camada de fibras nervosas.

Abstract We report a case of a patient with Guacher's disease type III, with mutation in Exon9, 1246G> A and 1251G> C, seeking to investigate the suspected glaucoma, to describe the ophthalmological findings, as glycolipid accumulation in the pre-retinal region and to investigate The possible correlation with the decrease of the layer of nerve fibers.

confirmed case of Gaucher disease type-1 in an Omani patient

Gaucher Disease is a rare hereditary disorder, with small clusters among some ethnic groups mainly in Eastern Europe. The disease can be found in other parts of the world too. Due to the small number of cases, the non-specific symptoms, and signs, and the difficulty in obtaining confirmatory tests, some sporadic cases might be misdiagnosed, or discovered at later, stages, especially in areas where cases are infrequent, and no family members were previously diagnosed with the condition. Here I report the case of a young Omani female, who has a confirmed diagnosis of Gaucher disease

Los haplotipos colombianos de la mutación N370S causante de a enfermedad de Gaucher pueden provenir de un haplotipo ancestral común / Colombian haplotypes of the Gaucher disease-causing N370S mutation may originate from a possible common ancestral haplotype

Introducción. La enfermedad de Gaucher es una condición panétnica, caracterizada por la acumulación de glucosilceramida en los macrófagos. La causa principal de esta enfermedad en algunos países occidentales, incluido Colombia, es la mutación N370S, en el gen de la glucocerebrosidasa localizado en 1q21. Objetivo. Determinar el grado de asociación entre la mutación N370S y los alelos de cinco microsatélites cercanos al sitio de la mutación en nueve pacientes colombianos Gaucher tipo 1, procedentes del altiplano cundiboyacense. Materiales y métodos. A partir del ADN de los pacientes, sus familiares cercanos y 30 individuos control, los loci: D1S305, D1S2624, D1S2777, ITG6.6.2 y 5GC3.2 fueron amplificados mediante reacción en cadena de la polimerasa. Las frecuencias alélicas por microsatélite fueron calculadas en pacientes y controles y 11 haplotipos N370S fueron inferidos y se determinó el grado de desequilibrio de ligamiento entre los alelos de cada haplotipo con la mutación N370S. Resultados. Se encontró un haplotipo consenso N370S compuesto por los alelos 222-314- 260-301-172 (pares de bases) que corresponden a los microsatélites: 5GC3.2 ITG6.6.2, D1S2777 D1S2624 y D1S305 respectivamente. Hubo desequilibrio de ligamiento significativo entre los alelos de 222, 314, 260 y 301 pares de bases y la mutación N370S. Conclusión. Una fracción conservada del haplotipo pudo haber estado asociada la mutación en un cromosoma ancestral al grupo de pacientes, cuya procedencia étnica es aún desconocida.

Introduction. Gaucher disease is a pan-ethnic condition characterised by glucosylceramide accumulation in macrophages due to glucocerebrosidase deficiency. Its gene, GBA, has been mapped to 1q21 and mutation N370S is the main cause of the disease in western populations, including Colombia. Objective. To asses the degree of association between N370S mutation and the alleles of five microsatellites near the mutation site in the GBA locus in nine Colombian Gaucher patients, from the Cundinamarca-Boyacá region. Materials and methods. DNA from patients bearing the N370S mutation, their closest relatives, and 30 controls was taken to PCR-amplify the markers: D1S305, D1S2624, D1S2777, ITG6.6.2 and 5GC3.2. Allele frequencies were calculated, haplotypes inferred and linkage disequilibrium levels between marker alleles and N370S were also estimated Results. Eleven N370S chromosomes were obtained. A consensus N370S haplotype consisting of the alleles: 222-314-260-301-172 (base pairs) was identified. Each allele corresponding to markers 5GC3.2, ITG6.6.2, D1S277, D1S2624 and D1S305, respectively. There was statistically significant linkage disequilibrium between the alleles of 222, 314, 260, 301 base pairs and the N370S mutation.Conclusion. A conserved fraction of the haplotypes suggests that N370S may be present among patients and stem from a single ancestral chromosome for which the ethnic origin is still unclear.

High frequency of mutation G377S in Brazilian type 3 Gaucher disease patients

Gaucher disease (GD), the most prevalent lysosome storage disorder, presents an autosomal recessive mode of inheritance. It is a paradigm for therapeutic intervention in medical genetics due to the existence of effective enzyme replacement therapy. We report here the analysis of GD in 262 unrelated Brazilian patients, carried out in order to establish the frequency of the most common mutations and to provide prognostic information based on genotype-phenotype correlations. Among 247 type 1 GD patients, mutation N370S was detected in 47 percent of all the alleles, but N370S/N370S homozygosity was found in only 10 percent of the patients, a much lower frequency than expected, suggesting that most individuals presenting this genotype may not receive medical attention. Recombinant alleles were detected at a high frequency: 44 percent of the chromosomes bearing mutation L444P had other mutations derived from the pseudogene sequence, present in 25 percent of patients. Three neuronopathic type 2 patients were homozygous for L444P, all presenting additional mutations (E326K or recombinant alleles) that probably lead to the more severe phenotypes. Six children, classified as type 1 GD patients, had a L444P/L444P genotype, showing that neuronopathic symptoms may only manifest later in life. This would indicate the need for a higher treatment dose during enzyme replacement therapy. Finally, mutation G377S was present in 4 homozygous type 1 patients and also in compound heterozygosity in 5 (42 percent) type 3 patients. These findings indicate that G377S cannot be unambiguously classified as mild and suggest an allele-dose effect for this mutation.

Upregulation of Proinflammatory Cytokines in the Fetal Brain of the Gaucher Mouse

Gaucher disease is caused by a deficiency of glucocerebrosidase. Patients with Gaucher disease are divided into three major phenotypes: chronic nonneuronopathic, acute neuronopathic, and chronic neuronopathic, based on symptoms of the nervous system, the severity of symptoms, and the age of disease onset. The characteristics of patients with acute neuronopathic- and chronic neuronopathic-type Gaucher disease include oculomotor abnormalities, bulbar signs, limb rigidity, seizures and occasional choreoathetoid movements, and neuronal loss. However, the mechanisms leading to the neurodegeneration of this disorder remain unknown. To investigate brain dysfunction in Gaucher disease, we studied the possible role of inflammation in neurodegeneration during development of Gaucher disease in a mouse model. Elevated levels of the proinflammatory cytokines, IL-1alpha, IL-1beta, IL-6, and TNF-alpha, were detected in the fetal brains of Gaucher mice. Moreover, the levels of secreted nitric oxide and reactive oxygen species in the brains of Gaucher mice were higher than in wild-type mice. Thus, accumulated glucocerebroside or glucosylsphingosine, caused by glucocerebrosidase deficiency, may mediate brain inflammation in the Gaucher mouse via the elevation of proinflammatory cytokines, nitric oxide, and reactive oxygen species.

Excreçäo de oligossacarídeos em indivíduos com Doença de Gaucher tipo 1 / Oligosaccharide excretion in subjects with Gaucher Disease type 1

Foi avaliada a excreçäo urinária de oligossacarídeos em pacientes portadores da doença de Gaucher tipo 1 (DG1) comparando-a com aquela de indivíduos normais com o objetivo de se estabelecer um método de identificaçäo para estes pacientes. Amostras de urina foram dessalificadas por cromatografia de gel-filtraçäo e aplicadas em placas de cromatografia de camada delgada (CCD) para a identificaçäo dos oligossacarídeos através de suas bandas correspondentes. Foi observado que a excreçäo de oligossacarídeos na urina, representada por 5 bandas que foram visualizdas após borrifar a placa com uma soluçäo composta por 0,25 porcento de orcinol em ácido sulfúrico 20 porcento, foram identificadas somente nos pacientes com DG1 mas näo nos indivíduos normais. O método foi considerado suficientemente sensível para identificar os indivíduos com o distúrbio, além disso a CCD é uma técnica útil para a detecçäo da DG1, considerando ser um teste feito na urina e com custos relativamente baixos. O problema do método parece ser o tempo necessário para a preparaçäo das amostras

Terapia génica y sus perspectivas clínicas en ortopedia / Gene therapy and its clinical perspectives in orthopaedics

La terapia génica se refiere a la transferencia de genes a individuos con fines terapéuticos. Esta técnica se ha desarrollado durante los últimos 10 años y tiene aplicaciones en todas las áreas de la medicina. Originalmente dirigida al tratamiento de padecimientos congénitos, actualmente también se estudian sus posibles aplicaciones en el tratamiento de padecimientos adquiridos. Presentamos los conceptos generales de la terapia génica y sus posibles aplicaciones en ortopedia como futuras opciones terapéuticas