Article ; Online: Genotype-phenotype Description of Vitamin D-dependent Rickets 1A: CYP27B1 p.(Ala129Thr) Variant Induces a Milder Disease.
The Journal of clinical endocrinology and metabolism
2022 Volume 108, Issue 4, Page(s) 812–826
Abstract: ... in 19 families (homozygous state in 58% [11/19]). The partial loss-of-function variation p.(Ala129Thr ...
Abstract | Introduction: Vitamin D-dependent rickets type 1A (VDDR1A) is a rare genetic disease associated with loss-of-function variations in the gene encoding the vitamin D-activating enzyme 1α-hydroxylase (CYP27B1). Phenotype-genotype correlation is unclear. Long-term outcome data are lacking. The objective of this study was to describe characteristics and outcomes to search for a phenotype-genotype correlation. Methods: We retrospectively collected clinical data, genetic features, and outcomes from 24 genetically confirmed cases from 10 French centers; results are presented as median (min-max). Results: Clinical symptoms at diagnosis (age, 1.5 [0.5-8.7] years) were mainly bone and neurological abnormalities, and laboratory data showed hypocalcemia (1.97 [1.40-2.40] mmol/L), hypophosphatemia (-3.4 [-13.4 to (-)0.2] SD score for age), low 25OHD and low 1,25(OH)2D3, secondary hyperparathyroidism with PTH at 6.6 (1.3-13.7) times the upper limit for normal (ULN; PTH expressed as ULN to homogenize data presentation), and increased alkaline phosphatase (1968 [521-7000] IU/L). Bone radiographs were abnormal in 83% of patients. We identified 17 variations (11 missense, 3 frameshift, 2 truncating, and 1 acceptor splice site variations) in 19 families (homozygous state in 58% [11/19]). The partial loss-of-function variation p.(Ala129Thr) was associated with a milder phenotype: older age at diagnosis, higher serum calcium (2.26 vs 1.85 mmol/L), lower PTH (4.7 vs 7.5 ULN), and lower alkaline phosphatase (759 vs 2082 IU/L). Patients were treated with alfacalcidol. Clinical (skeletal, neurological), biochemical, and radiological outcomes were satisfactory, and complications occurred if there was bad adherence. Conclusion: Overall, our findings highlight good outcomes under substitutive treatment and the need of a closer follow-up of eyes, teeth, kidneys, and blood pressure in VDDR1A. |
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MeSH term(s) | Humans ; 25-Hydroxyvitamin D3 1-alpha-Hydroxylase/genetics ; Alkaline Phosphatase/genetics ; Alkaline Phosphatase/therapeutic use ; Retrospective Studies ; Rickets/genetics ; Familial Hypophosphatemic Rickets/diagnosis ; Vitamin D/therapeutic use ; Phenotype ; Genotype |
Chemical Substances | 25-Hydroxyvitamin D3 1-alpha-Hydroxylase (EC 1.14.15.18) ; Alkaline Phosphatase (EC 3.1.3.1) ; Vitamin D (1406-16-2) ; CYP27B1 protein, human (EC 1.14.15.18) |
Language | English |
Publishing date | 2022-11-02 |
Publishing country | United States |
Document type | Journal Article |
ZDB-ID | 3029-6 |
ISSN | 1945-7197 ; 0021-972X |
ISSN (online) | 1945-7197 |
ISSN | 0021-972X |
DOI | 10.1210/clinem/dgac639 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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