RESUMO
OBJECTIVE: Familial partial lipodystrophy due to LMNA (lamin A/C) mutations is a rare disorder characterized by a selective loss of adipose tissue and insulin resistance. Dyslipidemia and severe diabetes often occur during its evolution. Only isolated and contradictory case reports have been published on the obstetrical prognosis in lipodystrophy. The aim of our study was to compare the fertility and occurrence of obstetrical complications of women with familial partial lipodystrophy due to LMNA (lamin A/C) mutations with those of nonaffected relatives, women from the general population, and women with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: Data were obtained from clinical follow-up of seven families with patients exhibiting mutations in LMNA (five R482W, one R482Q, one R439C) (14 affected among 48 women). RESULTS: The mean number of live children per woman was 1.7 in affected patients vs. 2.8 in nonaffected relatives. Fifty-four percent of LMNA-mutated women exhibited a clinical phenotype of PCOS, 28% suffered from infertility, 50% experienced at least one miscarriage, 36% developed gestational diabetes, and 14% experienced eclampsia and fetal death. Mean blood leptin level was significantly lower in LMNA-mutated patients than in nonaffected relatives (5.0 +/- 3.8 ng/ml vs 14.3 +/- 3.6; P < 0.001) despite similar body mass index (21.0 +/- 4.2 vs 22.4 +/- 2.2; P = 0.49). CONCLUSION: In these LMNA-linked lipodystrophic patients, the prevalence of PCOS, infertility, and gestational diabetes was higher than in the general population. Moreover, the prevalence of gestational diabetes and miscarriages was higher in lipodystrophic LMNA-mutated women than previously reported in PCOS women with similar body mass index. Women with lipodystrophies due to LMNA mutations are at high risk of infertility, gestational diabetes, and obstetrical complications and require reinforced gynecological and obstetrical care.
Assuntos
Fertilidade/fisiologia , Infertilidade Feminina/epidemiologia , Lamina Tipo A/genética , Lipodistrofia Parcial Familiar/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Diabetes Gestacional/epidemiologia , Família , Feminino , Seguimentos , Humanos , Infertilidade Feminina/genética , Lipodistrofia Parcial Familiar/sangue , Lipodistrofia Parcial Familiar/complicações , Lipodistrofia Parcial Familiar/genética , Mutação , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/genética , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/genética , Estudos RetrospectivosRESUMO
PURPOSE: To make a point about monogenic insulin resistance syndromes. CURRENT KNOWLEDGE AND KEY POINTS: Extreme insulin resistance syndromes are rare entities. The clinical and biological presentation is similar to that one of metabolic syndrome. Polycystic ovaries syndrome, non-alcoholic liver steatosis, acanthosis nigricans and overall, lipo-atrophic syndrome must be sought. Genetically determined forms are mainly linked to mutations of the insulin receptor gene and to lipoatrophic syndrome-linked mutations. The three syndromes related to mutations of the insulin receptor gene are Type A syndrome, first described by Kahn in young women, whereas leprechaunism and Rabson-Mendenhall syndromes are of neonatal onset. Main insulin resistance syndromes associated with lipo-atrophy are 1) Berardinelli-Seip or congenital generalized lipo-atrophic syndrome linked to mutations of seipin or AGPAT2 gene, 2) Dunnigan or partial familial lipoatrophic syndrome linked to mutations of lamin A/C, or sometimes PPAR gamma gene, and 3) acro-mandibular dysplasia and Köbberling syndrome. FUTURE PROSPECTS AND PROJECTS: In conclusion, an early onset of insulin resistance, especially in association with lipodystrophy must suggest a monogenic insulin resistance syndrome. Outstanding advances in insulin resistance pheno- and genotype identification, despite incomplete yet, offers a better understanding of insulin resistance, atherosclerosis and ageing mechanisms, that should lead to therapeutic improvement.
Assuntos
Resistência à Insulina/genética , Receptor de Insulina/genética , Diagnóstico Diferencial , Humanos , Mutação , Prognóstico , SíndromeRESUMO
Synthetic gene delivery vectors have shown promise in several organs, including brain and lung. Tumor cell targeting, however, is still hindered by their low efficacy. A linear polyethylenimine (L-PEI, Exgen 500) was found to be effective in vivo. Our first attempts to use L-PEI for intratumoral gene delivery were not successful, presumably because of poor diffusion of the complexes within the tumor mass after injection with a syringe. Here we show that L-PEI-mediated transfection can be strongly enhanced when the complexes are delivered slowly into a solid tumor mass, using a micropump. Furthermore, L-PE/DNA complexes actively transfect pseudocystic tumor cells when injected into the cyst cavity. In both cases L-PEI induced a significant and long-lasting (> or =15 days) expression of the reporter gene. Finally, even though systemic delivery of L-PEI/DNA complexes leads to high levels of expression in the lung, this method is not adapted for transfection of subcutaneous tumors implanted in the thigh nor for transfection of lung metastases. Altogether, these results show that L-PEI has promising features for transfection of tumor cells, provided that the mode of delivery is adapted.