Dano fotoinduzido no sistema endolisossomal: modulação da autofagia e metabolismo de lipídios em células de câncer colorretal / Endo-lysosomal system photodamage: modulation of autophagy and lipid metabolism in colorectal cancer cells

O câncer colorretal (CCR) é o terceiro câncer mais diagnosticado em humanos. O CCR causou mais de 900.000 mortes em 2020 e foi estimado, para o período entre 2020 - 2025, um incremento de 13.5 % no número de casos novos de acordo com a plataforma Web Global Cancer Observatory. A Terapia Fotodinâmica (PDT) é uma alternativa terapêutica promissora. Conhecer as vias de sinalização de morte celular, assim como, as respostas associadas com a resistência ao dano foto-oxidativo, são relevantes para incrementar a eficiência da PDT. Neste trabalho, investigamos como as células de adenocarcinoma colorretal HT 29 respondem ao dano fotoinduzido gerado pelo fotossensibilizador (FS) meso-tetrafenilporfirina dissulfônado (TPPS2a), uma molécula que é ativada pela irradiação com luz em 522 nm. Como esperado, após irradiação (2.1 J cm-2) foi verificado que com o incremento do TPPS2a houve diminuição da viabilidade celular. A concentração do FS escolhida para darmos seguimento ao estudo foi a necessária para reduzir em 30 % a sobrevida celular (DL30; 148 nM). Abordagens moleculares nos permitiram identificar que nas células fotossensibilizadas a redução na maturação da catepsina D (CTSD, 55 %) e da catepsina B (CTSB, 52 %) contribuem com a disfunção endolisossomal. Além disso, comprovamos que as células fotossensibilizadas tiveram, pela menor quantidade de CTSD ativa, o processamento da prosaposina (PSAP) significativamente afetado. Células coletadas após 24 horas de irradiação expressaram 7 vezes mais PSAP do que as amostras dos grupos controle, sugerindo que as reações de oxidação causadas pelo TPPS2a podem ocasionar o acúmulo de glicoesfingolipídios nos endossomos e nos lisossomos, mimetizando o fenótipo observado em doenças de armazenamento lisossomal. Imagens de células HT 29 com expressão estável da proteína LGALS3 fusionada ao marcador EFGP mostraram que, após 24 horas de irradiação, as células não ativaram a lisofagia para remover os endossomos e os lisossomos danificados. A ausência do recrutamento da LGALS3 também apontou que as membranas dos endossomos e dos lisossomos não apresentam rupturas permanentes que permitam a passagem de uma molécula de 26 kDa. Experimentos complementares de análise da expressão proteica dos marcadores autofágicos LC3-II e p62/SQSTM1 (referida como p62) confirmaram o bloqueio do fluxo autofágico nas células fotosenssibilizadas. Pelo envolvimento do sistema endolisossomal no tráfego de membranas e no fluxo de lipídios, o aumento da transcrição da Hidroximetilglutaril-CoA reductase (HMGCR) (≈ 1.6 vezes) uma enzima envolvida na síntese de novo do colesterol - sugeriu que a disfunção dos endossomos e dos lisossomos altera a distribuição de colesterol. Não obstante, para manter a homeostase lipídica nas células fotossensibilizadas este não foi o único mecanismocompensatório acionado, uma vez que houve um incremento sutil; porém, significativo (1.2 vezes) na transcrição da ceramidase ácida (ASAH1). Em conjunto, nossos dados apontam que a fotossensibilização com TPPS2a constitui uma ferramenta promissora para causar dano no sistema endolisossomal, inibindo a autofagia e permitindo o estudo das respostas metabólicas em células expostas a estresse oxidativo

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in humans. CRC caused more than 900,000 deaths in 2020 and it was estimated for the period 2020 - 2025, an increase of 13.5 % in the number of new cases according to the Global Cancer Observatory Web platform. Photodynamic Therapy (PDT) is a promising therapeutic alternative. Understandings of cell death signaling pathways as well as the adaptive responses associated with resistance to photo-oxidative damage are relevant to optimize the effectiveness of PDT. For this purpose, in this research, we investigated how HT-29 colorectal adenocarcinoma cells respond to photosensitization reactions generated by TPPS2a, a molecule activated by irradiation with light at 522 nm. PS concentrations displayed increased inhibitory effect on cell viability after irradiation (2.1 J cm-2). The lethal dose selected to photosensibilize cells was the TPPS2a concentration able to reduce 30 % of cell survival (LD30; 148 nM). By molecular methods, we observed a reduction in cathepsin D (CTSD, 55 %) and cathepsin B (CTSB, 52 %) maturation, depletion that may contribute to endo-lysosomal dysfunction in photosensitized cells. It is widely known that endo-lysosomal cathepsins are crucial in protein turnover and degradation. Thus, we focused on the consequence of CTSD reduction. Literature data indicate that CTSD plays a key role in prosaposin (PSAP) processing to the four saposins (SAPs) that are required in glycosphingolipids breakdown. In fact, our results in photosensitized cells showed that, due to the lower amount of active CTSD, PSAP processing was significantly affected. Cells collected after irradiation expressed 7 times more PSAP than cells from the control groups. This data suggest that oxidative photodamage induced by TPPS2a may result in glycosphingolipid-accumulating endosomes and lysosomes, phenotype which mimics lysosomal storage diseases. Furthermore, we monitored by fluorescence microscopy a form of selective autophagy which detects and removes damaged endosomes and lysosomes known as lysophagy. Images of HT-29 cells expressing Galectin 3/LGALS3 fused to EFGP showed that photosensitized cells did not activate lysophagy. The absence of LGALS3 recruitment also indicated that the membranes of endosomes and lysosomes do not present ruptures which allow the passage of proteins with a molecular weight up to at least 26 kDa. Protein expression analysis of the autophagic markers LC3-II and p62/SQSTM1 (referred as p62) confirmed autophagic flux blockade in cells challenged with photoactivated TPPS2a. The endo-lysosomal system plays a key role in membrane trafficking and lipid flux. At the transcriptional level, 1.6-fold increase in gene expression of Hydroxymethylglutaryl-CoA reductase (HMGCR) - an enzyme involved in the synthesis de novo of cholesterol - indicated that endosomes and lysosomes dysfunction alters the distribution of cholesterol in cellschallenged with photoactivated TPPS2a. However, to maintain lipid homeostasis in photosensitized cells, this was not the only compensatory mechanism triggered, since there was a slightly increase (1.2-fold) in the transcription of acid ceramidase (ASAH1). Taken together, our data showed that photosensitization with TPPS2a constitutes a promising tool to damage the endolysosomal system, to inhibit autophagy and to study metabolic responses in cells exposed to oxidative stress

Mutación novel en el Síndrome Sanfilippo B. Presentación de un caso / A novel mutation in Sanfilippo Syndrome type B. Case report

Introducción: El Síndrome Sanfilippo B es un error innato en el metabolismo lisosomal, con herencia autosómica recesiva. Se caracteriza por facie ligeramente tosca, deterioro neurológico progresivo y poca repercusión somática, provocado por mutaciones en el gen NAGLU, cuyo locus es 17q21.2. La incidencia internacionalmente es muy baja y en Cuba solo se han diagnosticado siete pacientes desde 1985. Objetivo: Describir las manifestaciones clínicas, bioquímicas y moleculares de un paciente cubano diagnosticado con Síndrome Sanfilippo B. Presentación de Caso: Se describió un paciente de 13 años, cuyas principales manifestaciones clínicas fueron: facie ligeramente tosca, sinofris, alteraciones de conducta y deterioro neurológico progresivo. El trastorno del sueño fue ocasional y frecuente las infecciones respiratorias. Se demostró la presencia de colitis ulcerativa y pólipo intestinal. Se confirmó excreción aumentada de heparán sulfato y disminución de la actividad enzimática N-acetil αD-glucosaminidasa. Se identificó la mutación c.640dupC en el gen NAGLU en homocigosis en el paciente y ambos padres resultaron ser portadores. Conclusiones: Predominaron las alteraciones de conducta, deterioro neurológico progresivo e infecciones respiratorias en el caso reportado; siendo la colitis ulcerativa y el pólipo intestinal un hallazgo no descrito anteriormente para esta enfermedad. Los estudios cromatográficos y enzimáticos resultaron positivos para Sanfilippo B. El genotipo de este paciente resultó ser homocigótico para una nueva variante alélica patogénica en el gen NAGLU. Se demostró la segregación mendeliana de la mutación en la familia(AU)

Introduction: Sanfilippo syndrome type B is an autosomal recessive lysosomal storage disease. The frequent clinical manifestations include slightly coarse facial features, progressive neurodegeneration and mild somatic repercussion caused by mutations in the NAGLU gene, whose locus is 17q21.2. The worldwide incidence is very low and only seven patients have been diagnosed in Cuba since 1985. Objective: To describe clinical, biochemical and molecular characteristics of a Cuban patient with the diagnosis of Sanfilippo Syndrome type B. Case presentation: A 13 years old patient was described. The main clinical manifestations included mild coarse facie, synophrys, behavior disturbances, and progressive neurologic deterioration. Intermittent sleep disturbance and frequent upper respiratory infections were identified. Ulcerative colitis and intestinal polyp were demonstrated. Increased excretion of heparan sulfate and very low N-acetyl α-Dglucosaminidase activity were confirmed. In addition, the presence of mutation c.640dupC in NAGLU gene was identified. The patient had homozygous genotype and both parents were heterozygous. Conclusions: Behavioral alterations, progressive neurological deterioration and respiratory infections predominated in the reported case. Other findings such as ulcerative colitis and intestinal polyps were not previously described in this disease. The chromatographic and enzymatic studies were positive for Sanfilippo type B. This patient's genotype was found to be homozygous for a novel pathogenic allelic variant in the NAGLU gene. Mendelian segregation of the mutation in the family was demonstrated(AU)

Linfangiectasia intestinal en un paciente afectado de síndrome de Sanfilippo B / Intestinal lymphangiectasia in a patient with Sanfilippo B syndrome

La mucopolisacaridosis tipo III B es una enfermedad de depósito lisosomal causada por la deficiencia de la enzima N-acetil-alfa-d-glucosaminidasa, implicada en el catabolismo del heparán sulfato, que produce su acúmulo en diversos tejidos. Se presenta a un paciente de 8 años, afectado de mucopolisacaridosis tipo III B, con historia de diarrea crónica y hallazgos endoscópicos e histológicos compatibles con linfangiectasia intestinal. Tras tratamiento dietético con restricción de ácidos grasos de cadena larga y rica en triglicéridos de cadena media, presentó mejoría clínica, mantenida hasta la actualidad.La patogenia de la diarrea crónica en pacientes con mucopolisacaridosis tipo III B es aún desconocida. Debe investigarse la presencia de linfangiectasia intestinal en estos pacientes e iniciar, en caso de confirmarse, un tratamiento dietético adecuado para mejorar así su calidad de vida.

Mucopolysaccharidosis type IIIB is a lysosomal storage disease caused by a deficiency of the N-acetyl-alpha-d-glucosaminidase enzyme involved in the catabolism of heparan sulfate, causing its accumulation in various tissues. We present an 8-year-old patient with mucopolysaccharidosis type IIIB, with a history of chronic diarrhea and endoscopic and histological findings compatible with intestinal lymphangiectasia. After a dietary treatment with a low-fat diet supplemented with medium-chain triglyceride, our patient presents clinical improvement until today. The pathogenesis of chronic diarrhea in patients with mucopolysaccharidosis type IIIB is still unknown. The presence of intestinal lymphangiectasia in these patients should be investigated, and appropriate dietary treatment should be initiated, if confirmed, to improve their quality of life.

Mecanismo de acción de la terapia celular en enfermedades hereditarias / Mechanism of action of cell therapy in hereditary diseases

Los trastornos heredados del metabolismo son enfermedades graves de la infancia que cursan con un gran deterioro cognitivo y del desarrollo psicomotor. La fisiopatología del progresivo deterioro del sistema nervioso suele estar asociada a una severa neuroinflamación y desmielinización, y como consecuencia, neurodegeneración. Por el momento no tienen cura y precisan de actitudes terapéuticas precoces y agresivas, que conllevan altas tasas de mortalidad y, muy frecuentemente, escasos grados de mejoría funcional y supervivencia. El trasplante de médula ósea y de células mesenquimales de médula ósea son terapias de elección y experimentales que consiguen mejorar el curso de estas enfermedades mediante diferentes mecanismos de acción: remplazo de enzima deficiente, intercambio de membranas y regulación del proceso inflamatorio.

Inherited metabolism disorders are serious childhood diseases that lead to significant cognitive impairment and regression of psychomotor development. The pathophysiology of the neural progressive deterioration is usually associated with severe neuroinflammation and demyelination, and as a consequence, neurodegeneration. At the moment they have no adequate treatment and require early and aggressive therapeutic approaches, which entail high mortality rates and, very frequently, low degrees of functional improvement and survival. Bone marrow transplantation and bone marrow mesenchymal cells grafts are therapeutic and experimental therapies that improve the course of these diseases through different mechanisms of action: enzyme replacement, membrane exchange and regulation of the inflammatory process.

Enfermedad de Gaucher: caso clínico / Gaucher's disease: a clinical case

La enfermedad de Gaucher es una patología de depósito lisosomal, autosómica recesiva, con mutación en el gen GBA, que afecta principalmente al hígado, bazo, huesos y a la médula ósea. Es una enfermedad rara con baja incidencia mundial. Existen 3 tipos; el tipo I es el más frecuente en la población pediátrica, y el tipo III es el de peor pronóstico y presenta manifestaciones neurológicas. El diagnóstico se realiza con el tamizaje prenatal de enfermedades de depósito, más específicamente de mutaciones GBA. El diagnóstico definitivo se realiza al detectar ß-glucocerebrosidasa, y los estudios genéticos para la tipificación del gen afectado: en el tipo 1 mutación N370S y mutaciones L444P o D409H en tipo 2 y 3. El tratamiento se realiza con terapia de reemplazo enzimático o con la terapia de reducción de sustrato. Describimos en este artículo a un paciente preescolar del Hospital Enrique Garcés, con cuadro respiratorio, hepato-esplenomegalia y afectación de las tres líneas celulares sanguíneas.

Gaucher's disease is an autosomal recessive lysosomal storage pathology, with mutation in the GBA gene, which mostly affects the liver, spleen, bone and bone marrow. It is a rare disease with low global incidence. There are 3 types: type I is the most frequent in the pediatric population, and type III has the worst prognosis and presents neurological manifestations. Diagnosis is made with prenatal screening of storage diseases, and more specifically GBA1 mutations. The definitive diagnosis is made by detecting ß-glucocerebrosidase, and genetic studies for the detarmination of the affected gene, in type 1 mutation N370S and L444P mutations or D409H in type 2 and 3. The treatment is enzyme replacement therapy or substrate reduction therapy. This article describes a preschool patient of Enrique Garcés Hospital, with respiratory symptoms, hepato-splenomegaly and involvement of the three blood cell lines.

Birth of a healthy baby after preimplantation genetic diagnosis in a carrier of mucopolysaccharidosis type II: The first case in Korea / 대한생식의학회지

Mucopolysaccharidosis type II (MPS II) is a rare X-linked recessive lysosomal storage disease caused by mutation of the iduronate-2-sulfatase gene. The mutation results in iduronate-2-sulfatase deficiency, which causes the progressive accumulation of heparan sulfate and dermatan sulfate in cellular lysosomes. The phenotype, age of onset, and symptoms of MPS II vary; accordingly, the disease can be classified into either the early-onset type or the late-onset type, depending on the age of onset and the severity of the symptoms. In patients with severe MPS II, symptoms typically first appear between 2 and 5 years of age. Patients with severe MPS II usually die in the second decade of life although some patients with less severe disease have survived into their fifth or sixth decade. Here, we report the establishment of a preimplantation genetic diagnosis (PGD) strategy using multiplex nested polymerase chain reaction, direct sequencing, and linkage analysis. Unaffected embryos were selected via the diagnosis of a single blastomere, and a healthy boy was delivered by a female carrier of MPS II. This is the first successful application of PGD in a patient with MPS II in Korea

Detection of swainsonine and calystegines in Convolvulaceae species from the semiarid region of Pernambuco / Detecção de swainsonina e calisteginas em espécies de Convolvulaceae da região semiárida de Pernambuco

Numerous plant species worldwide including some Ipomoea (Convolvulaceae) and Sida (Malvaceae) species in Brazil cause lysosomal storage disease in herbivores and are known to contain swainsonine and calystegines as the main toxic compounds. The aim of this work was to determine swainsonine and calystegines concentrations in species of Convolvulaceae from the semiarid region of Pernambuco. Seven municipalities in the Moxotó region were visited and nine species were collected and screened for the presence of swainsonine and calystegines using an HPLC-APCI-MS method. The presence and concentration of these alkaloids within the same and in different species were very variable. Seven species are newly reported here containing swainsonine and/or calystegines. Ipomoea subincana contained just swainsonine. Ipomoea megapotamica, I. rosea and Jacquemontia corymbulosa contained swainsonine and calystegines. Ipomoea sericosepala, I. brasiliana, I. nil, I. bahiensis and I. incarnata contained just calystegines. The discovery of six Ipomoea species and one Jacquemontia species containing toxic polyhydroxy alkaloids reinforces the importance of this group of poisonous plants to ruminants and horses in the semiarid region of Pernambuco. Epidemiological surveys should be conducted to investigate the occurrence of lysosomal storage disease associated to these new species.(AU)

Numerosas espécies de plantas em todo o mundo, incluindo algumas espécies de Ipomoea (Convolvulaceae) e Sida (Malvaceae) no Brasil, causam doença de armazenamento lisossomal em herbívoros e são conhecidas por conterem swainsonina e calisteginas como princípios tóxicos. O objetivo deste trabalho foi determinar a concentração de swainsonina e calisteginas em espécies de Convolvulaceae da região semiárida de Pernambuco. Sete municípios na região do Sertão do Moxotó foram visitados, onde foram coletadas amostras das folhas de nove espécies de Convolvulaceae para avaliação da presença de swainsonina e calisteginas utilizando-se cromatografia líquida com espectrometria de massa. A presença e concentração destes alcaloides nas folhas de plantas da mesma espécie e dentre as espécies foram muito variáveis. Seis novas espécies de Ipomoea e uma espécie de Jacquemontia contendo swainsonina e/ou calisteginas são relatadas neste estudo. Ipomoea subincana continha apenas swainsonina. Ipomoea megapotamica, I. rosea e Jacquemontia corymbulosa continham swainsonina e calisteginas. Ipomoea sericosepala, I. brasiliana, I. nil, I. bahiensis e I. incarnata continham apenas calisteginas. A descoberta de novas espécies de Ipomoea e Jacquemontia contendo alcaloides polihidroxílicos tóxicos reforçam a importância deste grupo de plantas tóxicas para ruminantes e equinos na região semiárida de Pernambuco. Pesquisas epidemiológicas devem ser realizadas para investigar a ocorrência de doença de depósito lisossomal associada a essas novas espécies.(AU)

Galactosialidosis: nueva mutación de novo en el gen CTSA en un paciente afecto de la forma infantil tardía / Galactosialidosis: a new "de novo" mutation in CTSA gene in a patient with late infantile galactosialidosis

La galactosialidosis (OMIM #256540) es una enfermedad metabólica lisosomal causada por mutaciones en el gen CTSA, que codifica la proteína protectora catepsina A. La pérdida de función de dicha proteína causa, secundariamente, un déficit combinado de dos enzimas, beta-galactosidasa y neuraminidasa. Se expone el caso de un paciente que presentó manifestaciones clínicas compatibles con el subtipo infantil tardío de galactosialidosis. El análisis bioquímico mostró déficits de las dos enzimas implicadas, mientras que el estudio molecular reveló dos mutaciones: una nueva mutación nunca antes descrita, p.His475Pro (c.1424 A>C), y una mutación previamente reportada, p.Arg441Cys (c.1321C>T), localizadas en los exones 15 y 14, respectivamente.

Galactosialidosis (OMIM #256540) is an autosomal recessive lysosomal storage disorder caused by mutations in the CTSAgene, which encodes the protective protein cathepsin A. The loss of function of this protein causes a secondarily deficiency of beta-galactosidase and N-acetyl-α-neuraminidase enzymes activities. We describe the clinical, biochemical and molecular analysis of a case report with a phenotype compatible with the late infantile form. The biochemical analysis reveled deficiencies of beta-galactosidase and neuraminidase activities in dried blood spot and fibroblasts and the molecular study showed two missense mutations in the CTSA gene: a previously reported mutation, p.Arg441Cys (c.1321C>T), and a novel mutation, p.His475Pro (c.1424 A>C), located in exons 14 and 15, respectively.

A novel GLA mutation in a Korean boy with an early cardiac manifestation of Fabry disease

Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by the deficiency of α-galactosidase A. Patients with classical FD present acroparesthesia, hypohidrosis, cornea verticillata, disseminated angiokeratoma, and microalbuminuria in childhood, and develop life-threatening renal, cardiac, and cerebrovascular complications typically after the fourth decade of life. To date, more than 700 mutations responsible for FD have been identified in the human GLA gene. Herein, we report a novel GLA mutation, c.1117_1141del25 (p.Gly373Profs*10), identified in an 11-year-old Korean boy with FD presenting early cardiac and neurologic manifestation and in other affected family members. The boy had acroparesthesia, hypohidrosis, cornea verticillata, and left ventricular hypertrophy. His mother and sister also had acroparesthesia. Two males on the mother's side had similar pain and died of unknown causes. The plasma α-galactosidase A activity (4.1 nmol/hr/mg protein) of the patient was markedly lower than the mean value of the controls. The plasma level of globotriaosylsphingosine was elevated in the patient and all the carriers. We concluded the novel GLA mutation c.1117_1141del25 is a pathogenic mutation for FD, probably related to the early cardiac manifestation of FD.

Spontaneous poisoning by Sida carpinifolia (Malvaceae) in horses / Intoxicação natural por Sida carpinifolia em equinos

Sida carpinifolia poisoning causes a chronic neurodegenerative disorder associated with lysosomal storage by indolizidine alkaloids (swainsonine). The epidemiological, clinical, pathological and lectin histochemistry findings of an outbreak of natural poisoning by S. carpinifolia in horses in Rio Grande do Sul state, Brazil, are described. Five horses from a total of 15 that were kept on native pasture with large amounts of S. carpinifolia presented during 90 days clinical signs of progressive weight loss, incoordination, stiff gait and ramble, in addition to exacerbated reactions and locomotion difficulty after induced movement. Four horses died, and one of them was submitted for necropsy. At necropsy, no significant gross lesions were observed. Histological findings observed in the central nervous system were characterized by swollen neurons with cytoplasm containing multiple microvacuoles; these abnormalities were more severe in the thalamus, hippocampus, cerebellum and pons. Using lectin histochemistry, the pons and hippocampus sections stained positive for commercial lectin Con-A, sWGA and WGA. This study aimed to detail S. carpinifolia poisoning in horses to be included in the differential diagnoses of neurological diseases of horses.(AU)

A intoxicação por Sida carpinifolia é uma desordem neurodegenerativa crônica associada ao acúmulo lisossomal pelo alcaloide indolizidínico, denominado swainsonina. Descrevem-se os achados epidemiológicos, clínicos, patológicos e de lectina-histoquímica de um surto de intoxicação natural por S. carpinifolia em equinos no Rio Grande do Sul, Brasil. De um total de 15 equinos, cinco equinos mantidos em campo nativo com grande quantidade de S. carpinifolia apresentaram sinais clínicos de emagrecimento progressivo, incoordenação, andar rígido e deambulação, além de dificuldade de locomoção com reações exacerbadas após estímulos ao movimento em um período de 90 dias de evolução clínica. Quatro equinos vieram a óbito e um foi submetido ao exame de necropsia. À necropsia, não foram observadas lesões macroscópicas. Os achados histológicos observados no sistema nervoso central caracterizaram-se por aumento de tamanho dos neurônios, com citoplasma contendo microvacúolos; tais alterações foram observadas com maior intensidade em tálamo, hipocampo, cerebelo e ponte. Na lectina-histoquímica, fragmentos de ponte e hipocampo marcaram positivamente para as lectinas comerciais Con-A, sWGA e WGA. Este trabalho visa alertar a ocorrência da intoxicação por S. carpinifolia em equinos, a qual deve ser incluída como diagnóstico diferencial dentre as doenças neurológicas de equinos.(AU)

A second reported malignancy in a patient with Morquio syndrome

Morquio syndrome is a rare lysosomal storage disease that affects multiple organ systems. However, it is rarely associated with malignancy. We present the case of a 30-year old man with Morquio syndrome associated with gastric adenocarcinoma. This case also demonstrates two other findings that have not been previously described in patients with Morquio syndrome - malrotation of brainstem and cerebellum, without clinical neurologic deficit, and persistence of fetal lobulation in the kidneys.

ANÁLISIS DE LA β -GALACTOSILCERAMIDASA LEUCOCITARIA EN PACIENTES COLOMBIANOS CON SOSPECHA CLÍNICA DE ENFERMEDAD DE KRABBE, UN TAMIZAJE DE ALTO RIESGO / ANALYSIS OF β -GALACTOSILCERAMIDASE LEUKOCYTAL IN COLOMBIAN IN PATIENTS WITH SUSPECT CLINIC OF KRABBE DISEASE, A HIGH - RISK SCREENING / ANÁLISE DE β -GALACTOSILCERAMIDASE LEUKOCYTAL EM COLOMBIANO EM PACIENTES COM SUSPEITA CLINICA DA DOENÇA DE KRABBE, UMA BLINDAGEM DE ALTO RISCO HUMANOS PLACENTA

La Enfermedad de Krabbe (EK), es un desorden del metabolismo de esfingolípidos de herencia autosómica recesiva causada por la deficiencia de β-galactosilceramidasa (β-Galsil) (E.C. 3.2.1.46), defecto enzimático que causa un cuadro neurodegenerativo, hipertonía muscular y espasticidad, convulsiones, pérdida de la audición y en un 85% de los casos la muerte temprana, entre otros hallazgos. La incidencia de la EK documentada para Estados Unidos y Europa es de 1:100.000 recién nacidos, pero estudios recientes han demostrado valores mayores de 1:22.000 aproximadamente en New York. En América Latina los informes son escasos, con reportes de tamizaje de alto riesgo en Brasil y casos aislados en México, ofreciendo un panorama de subdiagnóstico importante, situación a la que no es ajena Colombia, donde no hay en la literatura referentes a la enfermedad. Se presenta entonces a la comunidad científica, un estudio de valores de actividad y de referencia para la enzima β-Galactosilceramidasa leucocitaria, a partir de 259 muestras de 110 individuos sanos y 149 pacientes con compromiso neurodegenerativo (CND). La valoración enzimática involucró dos métodos (Colorimétrico y Fluorométrico) de punto final que permitieron establecer un rango de referencia para β-Galsil en técnica Colorimétrica: 2,04-14,93 nmol/mgprot/h y en técnica fluorométrica: 0,3-4,21 nmol/mgprot/h. El estudio de tamizaje permitió identificar un paciente afectado con enfermedad de Krabbe quien presentó valores de actividad expresados en nmol/mgprot/h de 1,85 y 0,034, en forma correspondiente para las técnicas antes descritas. Un hallazgo final que permite validar los dos métodos estandarizados para el diagnóstico de la enfermedad y establecer valores de referencia en población colombiana.

Krabbe disease is a disorder of autosomal recessive sphingolipid metabolism caused by deficiency β-galactosylceramidase (β-Galsil) (EC3.2.1.46), an enzymatic defect that causes a hurt neurodegenerative, muscular hypertonia and Spasticity, convulsions, hearing loss and in 85% of cases early death, among other findings. The incidence documented for "Krabbe disease" in the United States and Europe is 1:100.000 newborns, but recent studies have shown values greater than 1:22.000 in New York. In Latin America, reports are limited, with reports of high-risk screening in Brazil and isolated cases in Mexico, providing an important underdiagnosis scenario, a situation that is not unknown in Colombia, where there is no literature on the disease. A study of activity and reference values for β-galactosylceramidase enzyme leukocytal, was then presented to the scientific community, from 259 samples from 110 healthy people and 149 patients with neurodegenerative compromise. The enzymatic evaluation involved two methods (Colorimetric and Fluorometric) that allowed the establishment of a reference range for β-Galsil in Colorimetric technique: 2.04-14.93 nmol/mgprot/h and in fluorometric technique: 0.3-4.21 nmol/mgprot/h. The screening study allowed the identification of a patient with Krabbe disease who presented activity values expressed in nmol/mgprot/h of 1.85 and 0.034, correspondingly to the techniques described above. A final finding that allows to validate the two standardized methods for the diagnosis of the disease and to establish reference values in Colombian population.

A doença de Krabbe é uma desordem do metabolismo de esfingolípidos autossômicos recessivos causada pela deficiência β-galactosilceramidase (β-Galsil) (EC 3.2.1.46), um defeito enzimático que causa uma neurodegenerativa relatório, hipertonia muscular e espasticidade, convulsões, perda auditiva e em 85% Dos casos de morte precoce, entre outros. A incidência da doença de Krabbe documentado para os Estados Unidos e na Europa é de 1:100.000 recém-nascidos, mas estudos recentes têm mostrado valores maiores do que cerca de 1:22.000, em Nova York. Na América Latina, os relatórios são escassos, com relatos de rastreio de alto risco no Brasil e casos isolados no México, proporcionando um cenário importante subdiagnóstico, a situação não é desconhecida em que a Colômbia, não há literatura Onde sobre a doença. Um estudo de atividade e valores de referência para a enzima β-galactosilceramidase leucocital, foi então apresentado comunidade científica, de 259 amostras de 110 indivíduos saudáveis e​ 149 pacientes com comprometimento neurodegenerativo. A avaliação enzimática envolveu dois métodos (Colorimétrico e Fluorométrico) que permitiram o estabelecimento de uma gama de referência para β-Galsil na técnica Colorimétrica: 2,04-14,93 nmol /mgprot/h e na técnica fluorométrica: 0,3-4,21nmol/mgprot/h. O estudo de triagem permitiu a identificação de um paciente com doença de Krabbe que apresentou valores de atividade expressados ​em nmol / mgprot / h de 1,85 e 0,034, correspondente ao das técnicas descritas acima. Uma conclusão final que valida os dois métodos padronizados para o diagnóstico da doença e estabelecer valores de referência na população colombiano.

Informe de evaluación científica basada en la evidencia disponible: examen genético molecular / Scientific evaluation report based on available evidence: molecular genetic examination

INTRODUCCIÓN: Las enfermedades de depósito lisosomal son un grupo heterogéneo de errores metabólicos poco frecuentes, congénitos, de origen genético, caracterizados por la deficiencia funcional de los lisosomas y por la acumulación intralisosomal de sustratos. Se han caracterizado cerca de 50 desórdenes metabólicos de este origen, causados por alteraciones genéticas a nivel enzimático, de receptores, proteínas activadoras, de membrana o transportadora, causando la acumulación lisosomal de sustratos, específicos para cada enfermedad. La acumulación es progresiva, causando finalmente el deterioro funcional celular y tisular. Varios de estos desórdenes afectan el sistema nervioso central, y la mayoría de los pacientes tienen disminución de la esperanza de vida y morbilidad asociada. Para efectos del presente informe de evaluación se consideraron las patologías Mucopolisacaridosis I; Mucopolisacaridosis II; Mucopolisacaridosis VI; Enfermedad de Gaucher y Enfermedad de Fabry. TECNOLOGÍAS SANITARIAS EVALUADAS: Examen genético molecular: secuenciación y/o genotipificación. EFICACIA DE LAS INTERVENCIONES: La intervención es eficaz, cumpliendo con lo dispuesto en la letra a), del artículo 2, del decreto supremo N°13, de 2017, del Ministerio de Salud, que aprueba Reglamento que Establece el Proceso destinado a determinar los Diagnósticos y Tratamientos de Alto Costo con Sistema de Protección Financiera, según lo establecido en los artículos 7° Y 8° de la ley N° 20.850. ANÁLISIS ECONÓMICO: El costo total de implementación de los exámenes es de $ 2.037.565 anuales en el año 2018 y hasta $ 6.883.384 en el 2022. CONCLUSIÓN: Para dar cumplimiento al artículo 28° del Reglamento que establece el proceso destinado a determinar los diagnósticos y tratamientos de alto costo con Sistema de Protección Financiera, según lo establecido en los artículos 7°y 8° de la ley N°20.850, aprobado por el decreto N°13 del Ministerio de Salud, se concluye que el presente informe de evaluación se considera no favorable, de acuerdo a lo establecido en el Título III. de las Evaluaciones Favorables de la Norma Técnica N° 0192 de este mismo ministerio.

Ocular Findings in Mucolipidosis Type II

PURPOSE: To report ocular findings of a mucolipidosis type II patient with novel mutation. CASE SUMMARY: A 10-year-old boy visited our pediatric genetic metabolic clinic for evaluation of his overall developmental delay and short stature. The boy was diagnosed with mucolipidosis type II (I-cell disease) using plasma enzyme assay and DNA sequencing of the GNPTAB gene mutation. An ophthalmologic investigation was then performed, and a depressed nasal bridge, broad nose, and swelling in the upper lid of both eyes were noted. The best corrected visual acuity was 0.32 and 0.1 and the intraocular pressure was 35 mmHg and 24 mmHg in the right and left eyes, respectively. The anterior chamber angles of both eyes were normal and mild cornea opacity in both eyes was observed. Fundus examination revealed retinal atrophy with folds in both eyes, as well as optic disc edema and optic atrophy in the right and left eyes, respectively. Atherosclerotic changes in the retinal vessels and cystoid macular edema in the left eye were observed, and ocular ultrasound revealed increased posterior sclera thickness in both eyes. CONCLUSIONS: Ocular manifestations of mucolipidosis type II are not currently well-known, and differentiation from other metabolic disorders may be difficult. An ophthalmic work-up can assist in diagnosis, and regular ophthalmic examinations should be used to maintain visual function in mucolipidosis patients.

Asociación de melanocitosis dérmica con enfermedades lisosomales / Association of dermal melanocytosis with lysosomal storage diseases

Introducción: la melanocitosis dérmica incluye un espectro de lesiones de piel que abarca la mancha mongólica, entre otras lesiones. Las enfermedades lisosomales son afecciones de base genética que se caracterizan por la acumulación de metabolitos insolubles parciamente degradados en los compartimentos lisosomales, debido a una determinada deficiencia enzimática. Las deficiencias de b-galactosidasa y de a-L-iduronidasa provocan la gangliosidosis GM1 y la mucopolisacaridosis tipo I respectivamente, ambas presentando similitudes en su presentación clínica. La asociación de la melanocitosis dérmica con las enfermedades lisosomales es poco común y mal entendida. Objetivo: reportar dos pacientes con esta rara asociación. Casos clínicos: dos varones de 3 y 9 meses sin antecedentes prenatales ni perinatales a destacar y antecedentes de infecciones respiratorias reiteradas. Se presentaron con retraso del desarrollo, hipotonía central y trastorno deglutorio. Al examen se constató hepatomegalia, fascies tosca y melanosis dérmica extensa. Los estudios permitieron diagnosticar al paciente de 3 meses mucopolisacaridosis Tipo I y al de 9 meses gangliosidosis GM1. Discusión: no se conoce exactamente la causa de esta asociación. Se plantea que sería el resultado de la acumulación de gangliósidos y heparán sulfato que estimularían al receptor del factor de crecimiento neuronal de tipo tirosinquinasa, deteniendo la migración de los melanocitos en la dermis. Por lo tanto la melanosis dérmica aberrante, en el contexto clínico adecuado, puede ser un signo que facilite el diagnóstico de una enfermedad lisosomal subyacente.

Introduction: dermal melanocytosis includes a spectrum of skin lesions, mongolian spots being one of them. Lysosomal storage diseases are characterized by the accumulation of partially degraded insoluble metabolites in lysosomal compartments due to enzyme deficiency. Deficiency in b-galactosidosisis is the cause of GM1 gangliosidosis and deficiency in a-L-iduronidasa of mucopolysaccharidosis type I. Both have similar clinical presentations. Association of dermal melanocytosis and lysosomal storage diseases is uncommon and misunderstood. Objective: to report the case of two patients with this rare association. Clinical cases: the study presents two boys, 3 and 9 months old, with no remarkable family, pregnancy or delivery history. Both had repeated respiratory tract infections. They presented with developmental delay, central hypotonia and swallowing disorder. Upon clinical examination they showed hepatomegaly, coarse facies and extensive dermal melanocytosis. They were diagnosed with GM1 gangliosidosis and mucopolysaccharidosis type I. Discussion: the cause of this association is not well known. It is hypothesized that accumulation of gangliosides and heparan sulfates stimulates tyrosine-kinase neuronal growth factor receptor, stopping dermal melanocytosis migration. Therefore extensive dermal melanocytosis, in an appropriate clinical setting, may contribute to diagnosing lysosomal storage diseases.

Biópsia hepática como método diagnóstico para intoxicação por plantas que contém swainsonina / Liver biopsy as diagnostic method for poisoning by swainsonina-containing plants

Neste trabalho objetivou-se avaliar a técnica de biópsia hepática como um teste de valor diagnóstico para intoxicações por plantas que contém swainsonina. Para isso, reproduziu-se experimentalmente a doença com as folhas secas de Ipomoea marcellia contendo 0,02% de swainsonina em caprinos. O Grupo I foi constituído por 6 caprinos que receberam a planta misturada a ração na dose de 4g/kg (0,8mg de swainsonina/kg) até a observação dos primeiros sinais clínicos neurológicos. Outros dois caprinos que não receberam a planta na dieta constituíram o grupo controle (Grupo II). Foram realizadas biópsias hepáticas pela técnica percutânea cega com agulha de Menghini, no dia zero e com intervalos semanais nos caprinos do experimento. As biópsias hepáticas foram fixadas em formol tamponado 10%, processadas rotineiramente, coradas pela hematoxilina-eosina e histoquímica de lectinas. Vacuolização hepatocelular similar àquelas descritas em caso de doença de depósito lisossomal foram identificadas em todos os caprinos do Grupo I no 7º dia de experimento nas amostras coradas pela hematoxilina-eosina. Em relação à histoquímica de lectinas, marcações consistentes foram obtidas com as lectinas Concanavalia ensiformis (Con-A) e Triticum vulgaris (WGA). Concluiu-se que a avaliação histológica rotineira de biópsias hepáticas pode ser usada no diagnóstico de intoxicações por plantas que contem swainsonina, mesmo em caprinos que não apresentam sinais clínicos, e que a histoquímica de lectinas pode ser usada como método diagnóstico complementar.

With the aim to investigate the use of hepatic biopsies for the diagnosis of poisoning by swainsonine-containing plants, dry leaves of Ipomoea marcellia containing 0.02% of swainsonine were administered to goats. Group I, with six goats, ingested 4g/kg of dry plant (0.8mg of swainsonina/kg) daily until the observation of the first neurologic signs. Two goats that did not receive the plant were used as control (Group II). Hepatic biopsies with the Menghini needle were performed by the percutaneous technique at day zero and at weekly intervals after the start of the administration of I. marcellia. Biopsy samples were fixed in 10% formaline, processed routinely, and stained by hematoxilin-eosin and by lectins histochemistry. Hepatocellular vacuolization similar to those described in cases of lysosomal storage disease were identified in all goats of Group I from the seven day of plant consumption in the samples satained with hematoxylin-eosin. Using lectin histochemistry, consistent labellings were observed with Concanavalia ensiformis (Con-A) e Triticum vulgaris (WGA). It is concluded that routinely histological evaluation of liver biopsies can be used in the diagnosis of poisoning by swainsonine containing plants, even in goats without clinical signs, and lectin histochemistry which can be used as supplementary diagnostic method.

Albuminuria en paciente con Enfermedad de Morquio Tipo A. Reporte de un caso / Albuminuria in patient with MorquioÆs disease Type A. A case report

La Enfermedad de Morquio (MPS IV-A) es producida por dos defectos enzimáticos diferentes. Desde que la terapia de sustitución enzimática (TSE) se encuentra disponible para algunas EDL y en desarrollo para otras, este grupo de patologías han despertado un gran interés en la comunidad científica debido a que la misma parecería una alternativa terapéutica prometedora para cambiar el curso evolutivo de los pacientes afectados. Se presenta un caso con presencia de albuminuria

Morquio's disease (MPS IV-A) is produced by two different enzymatic defects. Since enzymatic replacement therapy (ERT) is available for some LDD and others under development, this group of diseases have created great interest within the scientific community due to the fact that promising therapeutic alternative will be available to change disese course of affected patient. We present a case with albuminuria.

Substrate reduction therapy in three patients with Gaucher disease

PURPOSE: Gaucher disease (GD) is the most common lysosomal storage disease caused by beta-glucocerebrosidase (GBA) deficiency. Oral substrate reduction therapy with miglustat (Zavesca®) was approved for the treatment of adults with GD type 1, for whom enzyme replacement therapy (ERT) is unsuitable or not a therapeutic option. In this study, we report the effect of miglustat (Zavesca®) in three Korean GD patients. MATERIALS AND METHODS: Clinical findings comprising age at diagnosis, presenting signs, laboratory findings at diagnosis, GBA activity and mutations, and clinical courses of the three patients were reviewed. RESULTS: Miglustat was administered to three patients who reported allergic reactions during intravenous imiglucerase infusions. One patient withdrew after 15 months of miglustat administration owing to continuous elevation of disease biomarker levels (chitotriosidase, acid phosphatase, and angiotensin-converting enzyme). Poor adherence to medication was suspected but was denied by the patient. In the other two patients, platelet count and levels of hemoglobin and other biomarkers remained stable during miglustat administration. However, they suffered from severe diarrhea and weight loss, which led to miglustat discontinuation after 1 and 12 months of administration. CONCLUSION: Our study shows that although miglustat is suggested to GD patients as an alternative treatment to ERT, significant adverse reactions may lead to discontinuation of miglustat. In addition, it is difficult to monitor the drug adherence.

Long-term clinical course of a patient with mucopolysaccharidosis type IIIB / 소아과

Mucopolysaccharidosis type III (MPS III) is a rare genetic disorder caused by lysosomal storage of heparan sulfate. MPS IIIB results from a deficiency in the enzyme alpha-N-acetyl-D-glucosaminidase (NAGLU). Affected patients begin showing behavioral changes, progressive profound mental retardation, and severe disability from the age of 2 to 6 years. We report a patient with MPS IIIB with a long-term follow-up duration. He showed normal development until 3 years. Subsequently, he presented behavioral changes, sleep disturbance, and progressive motor dysfunction. He had been hospitalized owing to recurrent pneumonia and epilepsy with severe cognitive dysfunction. The patient had compound heterozygous c.1444C>T (p.R482W) and c.1675G>T (p.D559Y) variants of NAGLU. Considering that individuals with MPS IIIB have less prominent facial features and skeletal changes, evaluation of long-term clinical course is important for diagnosis. Although no effective therapies for MPS IIIB have been developed yet, early and accurate diagnosis can provide important information for family planning in families at risk of the disorder.