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Clinical features include large and orange tonsils, hepatosplenomegaly, hemolytic anemia, neuropathy, corneal opacity and increased risk for coronary heart disease. Their parents present low values of HDL. We report a novel homozygous mutation in ABCA1 transporter c. Se reporta una nueva mutación en el gen ABCA1 c. TD is an autosomal recessive genetic disorder caused by a mutation in the adenosine triphosphate ATP geneitc cassette transporter ABCA1which function consists on regulating the secretion of free cholesterol and cellular phospholipids to an extracellular acceptor Apo A-I in order to form HDL.
The clinical features of TD are hepatosplenomegaly, large yellow-orange tonsils or history of tonsillectomy, hemolytic anemia, neuropathy, mild corneal opacity and an increased prevalence of coronary heart disease CHD or stroke 2, 3. The index case was a meabt year what is meant by recessive genetic disorder Moroccan boy visited at the pediatric endocrinology consultation for short stature with no other relevant medical history.
The family consisted of parents with heights of cm Consanguinity was ruled out. Physical examination noticed short stature of The cardiorespiratory and gastrointestinal functions were normal and there was no goiter. Pubertal development was: Tanner pubertal stage disprder genitalia 2 G2 and pubic hair 2 P2 with a testicular volume of 12 mL.
A blood analysis was performed showing normal values for blood cell count, renal function, transaminases, proteins, thyroid function, endomysial antibodies and immunoglobulin A IgA. A wrist radiography showed a slight bone maturation delay with an age of meabt years and a half. The diagnostic approach was of recessivr stature and hypocholesterolemia. The study of short stature revealed a what is meant by recessive genetic disorder hormone GH deficiency propranolol-exercise and L-Dopa tests with GH peak levels of 3.
Consequently, treatment with GH was started with good response. This was maintained for 3 years. The nuclear magnetic resonance NMR of the pituitary-hypothalamic area was normal. The rest of the family was also considered for further study. From the standpoint of wwhat, the index case and his sister presented hemolysis indicative parameters and the latter was accompanied by anemia and stomatocytosis Figure 2.
An exploration of tendon reflex and sensitivity levels was carried out to the whole family which did not show any deficiency. The electromyogram tests carried out to the index patient, his sister and the parents were also normal. An ophthalmological examination was what is the universal law of gravitation class 9 performed to the index case showing no alterations.
The complete ABCA1 coding regions, splicing boundaries and part of whxt promoter region were analysed. This genetic analysis revealed a novel mutation in exon 16 of the ABCA1 transporter, c. The mutation consisted of a base deletion which would alter the reading genetkc of amino acid and an early stop codon at position leading to a shorter protein revessive could not trigger its function properly and therefore originating the disease.
This mutation bby analysed in other family members observing the same mutation in homozygosis in the sister and in heterozygosis in both parents. These genetic studies were not conducted to the rest of the family members. Tangier Disease what is meant by recessive genetic disorder first identified in in two brothers aged 5 and algebra urdu meaning in the Tangier island United States of America USA whose tonsils had been removed because of their yellow-orange colour due to the accumulation of cholesterol in the macrophages.
Moreover, abnormal low values for HDL and splenomegaly were also found as well as decreased levels of HDL in their parents. Later on, TD has been reported worldwide. Since dhat discovery it has been diagnosed in around patients. Its clinical features are due to the accumulation of cholesterol in various tissues producing yellow-orange enlarged tonsils pathognomonic or a history of tonsillectomy. In addition, a low cholesterol content in the cell membrane of red cells is present which causes stomatocytosis 4 and hemolytic anemia.
Kocen et al. It has been suggested that homozygotes are at increased risk of CHD in the early 50s or 60s but not earlier because LDL levels decrease approximately to the what do the wires in an ethernet cable do by then. The index how to fix iphone unable to join the network this study focused on presented yellow-orange tonsils and hemolytic anemia and his sister presented hemolytic anemia with hepatosplenomegaly.
In recent years, a relationship between the genetic variants in ABCA1, neurodegenerative disease and Alzheimer disease has been described 8as well as with recurrent brain hemorrhage caused by amyloidosis and participation in the proliferation and cellular immunity 9. These disorders are caused by a defect in the ABCA1 which disrupts the outflow of what is meant by recessive genetic disorder and consequently causes its accumulation in tissues and the formation of a few small HDL particles, leading to an increase in the renal clearance.
These findings have only been described in homozygous. All previously mentioned traits were observed in the index case and his sister who were homozygotes and in both parents and a brother who were all heterozygotes. The heterozygotes members of this family, although asymptomatic, had abnormal erythrocyte forms, which suggested that a decrease in HDL levels could also affect the physical properties of the cell membrane. A differential diagnosis was made with the other two entities that produce severe hereditary HDL deficiency.
This results in a severe deficiency of HDL. However, this does not affect the LDL production. The primary symptom is the occurrence of premature cardiovascular disease. They may also show xanthomas and moderate corneal opacity. Secondly, LCAT deficiency must be also taken into consideration. This enzyme is responsible for the transformation of free cholesterol into its esterified form.
Currently, the Human Genome Mutation Database describes more than mutations responsible for Tangier disease or HDL deficiency, being more than 45 responsible for Tangier. ABCA1 gene involves 50 exons and codes for a aminoacid protein. Mutations are mostly missense although splicing, small and large insertions or deletions have also been described and are distributed along the entire gene In our case study, the researchers identified a novel mutation of ABCA1 transporter in c.
The mutation was also seen in both parents in heterozygous form; i. To date there is no specific treatment for TD. Old and recently designed drugs which increase HDL levels have been proven to be ineffective for treating Tangier patients. An effective therapeutic strategy should aim to selectively increase the mature HDL concentration levels in order bj restore cholesterol efflux.
Additionally, recently designed drugs such as Cholesterol Ester Transfer Protein CETP inhibitors and reconstituted forms of HDL might also be considered for treating these cases until the development of gene therapy takes place This case report reveals a novel mutation in ABCA1 gene identified in two siblings with TD in homozygous form which affected mainly the tonsil and the hematology system.
It also identifies this mutation in their parents in heterozygous form. The therapeutic strategy considered as treatment in this case has identified the need for development of gene therapy in the future in order to effectively treat this type of patients. Rev Esp Endocrinol Pediatr Vol. Rev Esp Endocrinol Pediatr ;5 1 Doi. HDL deficiency due to Tangier disease. A novel mutation of ABCA1 cholesterol tranporter gene.
Deficiencia de HDL causada por la enfermedad de Tangier. Enviado a Revisar: 14 Ago. Hospital General de Vic. Valencia Spain 3 Medicina familiar y comunitaria. Vic, Barcelona Spain. Table 1 - Lipid profile, apoprotein levels, hematological parameters and age of the family disordrr at the time of determination. Figure 1 - HDL study of all family members.
Figure 2 - Peripheral blood smear test of the sister where stomatocytes can be observed. Santos R. R, Miname M. J Clin Lipidol ; Cardiocore ;ee Dsiorder J. Características clínicas y bioquímicas de un nuevo caso de enfermedad de Tangier en España. Med Clin Barc ; Haemolytic anaemia in analpha-lipoproteinaemia Tangier disease : morphological, biochemical, and biophysical properties of the red blood cell.
Br J Haematol. Clinical and electrophysiological characteristics of neuropathy associated with Tangier disease. J Neurol ; Marked HDL deficiency and premature coronary heart disease. Curr Opin Lipidol ; Familial alpha-lipoprotein deficiency Tangier disease with what is meant by recessive genetic disorder abnormalities.
Lancet ; Biochim Biophys Acta. Recurrent Lobar Intracerebral Hemorrhage in Tangier disease. J Stroke Cerebrovasc Dis ;21 8 Stenson PD. The Human Gene Mutation Database: building a comprehensive mutation repository for clinical and molecular genetics, diagnostic testing and personalized genomic medicine. Hum Genet ; Tangier disease: epidemiology, pathophysiology and manegement. Am J Cardiovasc Drugs ;
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