LOS ASPECTOS DEL FACTOR MASCULINO EN LA ESTERILIDAD

This study are describe the diverse genetic causes of masculine infertility, the cromossomic and molecular alteration that may happen in patients with oligo or azoospermia. Its also pretends to revise the tecniques of pre-implantational diagnosis avaliable nowadays. The study is centered in genetic aspects of the masculine factor in the couples infertility. The importance of this study is in the ethic duty of analysing case by case, when to opt for intra-citoplasmatic injection of spermatozoons (ICIS), it because a significative fraction of person with idiopatic oligo or azoospermia have genetic alterations in their spermatozoons or spermatogonias, and there is a great probability of the child to have a genetic disease. This way, the (ICIS) is not a good way to the coupler wich face this problem.Describe las causas genéticas diversas de la esterilidad masculina, las alteraciones cromosómicas y moleculares que pueden pasar en pacientes con oligo o azoospermia. Además proyecta tambiém una revisión de las tecnicas de diagnóstico pre-implantacional disponible actualmente. El estudio se centra en aspectos genéticos del factor masculino en la esterilidad de las parejas. La importancia de este estudio consiste en un deber ético de analizar caso por caso, cuándo optar para la inyección del intra-citoplasmatic de espermatozoos (ICIS), él porque una fracción significativa de individuos con oligo o azoospermia tiene alteraciones genéticas en su espermatozoos o spermatogonias y hay una gran probabilidad del niño para tener una enfermedad genética. De esta manera, el (ICIS) no es una manera buena para que las parejas enfrenten este problema.Descreve diversas causas genéticas de infertilidade masculina, as alterações cromossômicas e moleculares que podem estar presentes em pacientes com oligo ou azoospermia idiopática. Faz, também, uma revisão das técnicas de diagnóstico pré-implantacional disponíveis atualmente. O estudo está centrado nos aspectos genéticos do fator masculino da infertilidade de casais. Sua importância consiste no dever ético de se analisar caso a caso, quando se opta por técnicas de injeção intra-citoplasmática de espermatozóides (ICSI), porque uma significativa fração dos indivíduos com oligo ou azoospermia idiopática, apresentam alterações genéticas em seus espermatozóides ou outras células do epitélio germinativo. A probabilidade da criança apresentar doença genética é grande. Deste modo, a ICSI não é a opção mais indicada para casais que enfrentam este problema

Estratégias de tratamento para os erros inatos do metabolismo

Recent advances in the diagnosis and treatment of inborn errors of metabolism (IEM) have improved substantially the prognosis for many of these conditions. In the clinical practice it is important to recognize this pathology mainly in an acute situation, when the early intervention is essential. In this article, we presented some therapeutic strategies for IEM that should be used to improve their prognose.Recentes avanços no diagnóstico e tratamento dos erros inatos do metabolismo têm melhorado substancialmente o prognóstico de muitos pacientes com estas condições. Na pratica médica é importante o diagnóstico precoce destas patologias, especialmente em um paciente agudamente enfermo, para que um tratamento adequado e rápido seja instituído. Neste artigo, apresentamos várias estratégias terapêuticas para alguns erros inatos do metabolismo, que devem ser utilizadas no sentido de melhorar o seu prognóstico

Detecção de X-ALD em pacientes de alto risco : uma abordagem clínico-laboratorial

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Novel Patient Cell-Based HTS Assay for Identification of Small Molecules for a Lysosomal Storage Disease

Small molecules have been identified as potential therapeutic agents for lysosomal storage diseases (LSDs), inherited metabolic disorders caused by defects in proteins that result in lysosome dysfunctional. Some small molecules function assisting the folding of mutant misfolded lysosomal enzymes that are otherwise degraded in ER-associated degradation. The ultimate result is the enhancement of the residual enzymatic activity of the deficient enzyme. Most of the high throughput screening (HTS) assays developed to identify these molecules are single-target biochemical assays. Here we describe a cell-based assay using patient cell lines to identify small molecules that enhance the residual arylsulfatase A (ASA) activity found in patients with metachromatic leukodystrophy (MLD), a progressive neurodegenerative LSD. In order to generate sufficient cell lines for a large scale HTS, primary cultured fibroblasts from MLD patients were transformed using SV40 large T antigen. These SV40 transformed (SV40t) cells showed to conserve biochemical characteristics of the primary cells. Using a specific colorimetric substrate para-nitrocatechol sulfate (pNCS), detectable ASA residual activity were observed in primary and SV40t fibroblasts from a MLD patient (ASA-I179S) cultured in multi-well plates. A robust fluorescence ASA assay was developed in high-density 1,536-well plates using the traditional colorimetric pNCS substrate, whose product (pNC) acts as “plate fluorescence quencher” in white solid-bottom plates. The quantitative cell-based HTS assay for ASA generated strong statistical parameters when tested against a diverse small molecule collection. This cell-based assay approach can be used for several other LSDs and genetic disorders, especially those that rely on colorimetric substrates which traditionally present low sensitivity for assay-miniaturization. In addition, the quantitative cell-based HTS assay here developed using patient cells creates an opportunity to identify therapeutic small molecules in a disease-cellular environment where potentially disrupted pathways are exposed and available as targets

Potential Disease-Modifying Effects of Lithium Carbonate in Niemann-Pick Disease, Type C1

Background: Niemann-Pick disease type C1 (NP-C1) is a rare, autosomal-recessive neurodegenerative disorder with no United States Food and Drug Administration (FDA)-approved drug. Lithium has been shown to have considerable neuroprotective effects for neurological disorders such as bipolar disorder, Alzheimer’s disease and stroke and has been tested in many clinical trials. However, the pharmacological effect of lithium on NP-C1 neurodegenerative processes has not been investigated. The aim of this study was to provide an initial evaluation of the safety and feasibility of lithium carbonate in patients with NP-C1.Methods: A total of 13 patients diagnosed with NP-C1 who met the inclusion criteria received lithium orally at doses of 300, 600, 900, or 1,200 mg daily. The dose was reduced based on tolerance or safety observations. Plasma 7-ketocholesterol (7-KC), an emerging biomarker of NP-C1, was the primary endpoint. Secondary endpoints included NPC Neurological Severity Scores (NNSS) and safety.Results: Of the 13 patients with NP-C1 (12–33 years) enrolled, three withdrew (discontinuation of follow-up outpatient visits). The last observed post-treatment values of 7-KC concentrations (128 ng/ml, SEM 20) were significantly lower than pretreatment baselines values (185 ng/ml, SEM 29; p = 0.001). The mean NNSS was improved after lithium treatment at 12 months (p = 0.005). Improvement in swallowing capacity was observed in treated patients (p = 0.014). No serious adverse events were recorded in the patients receiving lithium.Conclusion: Lithium is a potential therapeutic option for NP-C1 patients. Larger randomized and double-blind clinical trials are needed to further support this finding.Clinical Trial Registration:ClinicalTrials.gov, NCT03201627

Heterozygous Variants in KMT2E Cause a Spectrum of Neurodevelopmental Disorders and Epilepsy.

We delineate a KMT2E-related neurodevelopmental disorder on the basis of 38 individuals in 36 families. This study includes 31 distinct heterozygous variants in KMT2E (28 ascertained from Matchmaker Exchange and three previously reported), and four individuals with chromosome 7q22.2-22.23 microdeletions encompassing KMT2E (one previously reported). Almost all variants occurred de novo, and most were truncating. Most affected individuals with protein-truncating variants presented with mild intellectual disability. One-quarter of individuals met criteria for autism. Additional common features include macrocephaly, hypotonia, functional gastrointestinal abnormalities, and a subtle facial gestalt. Epilepsy was present in about one-fifth of individuals with truncating variants and was responsive to treatment with anti-epileptic medications in almost all. More than 70% of the individuals were male, and expressivity was variable by sex; epilepsy was more common in females and autism more common in males. The four individuals with microdeletions encompassing KMT2E generally presented similarly to those with truncating variants, but the degree of developmental delay was greater. The group of four individuals with missense variants in KMT2E presented with the most severe developmental delays. Epilepsy was present in all individuals with missense variants, often manifesting as treatment-resistant infantile epileptic encephalopathy. Microcephaly was also common in this group. Haploinsufficiency versus gain-of-function or dominant-negative effects specific to these missense variants in KMT2E might explain this divergence in phenotype, but requires independent validation. Disruptive variants in KMT2E are an under-recognized cause of neurodevelopmental abnormalities

Juvenile GM2 Gangliosidosis: A Model for Investigation of Small-molecule Therapies for Lysosomal Storage Diseases

Juvenile GM2 gangliosidosis (jGM2) is a group of inherited neurodegenerative diseases caused by deficiency of lysosomal β-hexosaminidase A (Hex A) resulting in GM2 ganglioside accumulation in brain. Like many other lysosomal storage diseases (LSDs), no specific treatment currently exists. In order to establish clinical outcomes for the investigation of potential therapies for jGM2, I collected comprehensive information on the natural history of the condition by studying retrospective and prospectively a cohort of 21 patients with the disease, and reviewing previously published reports of 134 patients. Several symptoms at disease onset, symptom latencies, and the survival curve were described. Genotype-phenotype correlations and neuroradiological findings were also studied. Based on pre-clinical results in animal models, we studied substrate reduction therapy (SRT), with miglustat, in a phase I/II clinical trial to assess its pharmacokinetics (PK), safety, tolerability in infantile and jGM2. Miglustat showed a PK profile similar to the one found in adult patients. The drug was found to be safe and well-tolerated in patients with jGM2, with diarrhea and weight loss being the most common drug-related adverse events. The analysis of efficacy showed that SRT was unable to arrest the full neurological progression of the condition; however, relative stabilization of cognitive function was noted, which was consistent with brain MRI findings. Because of the limited efficacy obtained with SRT, enzyme-enhancement therapy was considered to be an attractive alternative therapy for the late onset forms of GM2 gangliosidosis. Screening of a FDA-approved library of approved therapeutic compounds resulted in the identification of pyrimethamine, as a potential pharmacological chaperone for mutant forms of Hex A. Relative enhancements of enzyme activity and protein levels were observed in patient cells treated with therapeutic concentrations of drug. Applying the same principles, ambroxol was identified as a potential PC for mutant glucocerebrosidase (GCC), the lysosomal enzyme that when deficient causes Gaucher disease (GD). Significant increases of residual mutant GCC were observed in cultured patients cells with type 1 GD. In conclusion, principles developed in the course of studies on jGM2 were shown to be useful for the investigation of novel small-molecule therapies for LSDs, associated with significant neurodegeneration.Ph

Treatment strategies for inborn erros of metabolism

Recentes avanços no diagnóstico e tratamento dos erros inatos do metabolismo têm melhorado substancialmente o prognóstico de muitos pacientes com estas condições. Na pratica médica é importante o diagnóstico precoce destas patologias, especialmente em um paciente agudamente enfermo, para que um tratamento adequado e rápido seja instituído. Neste artigo, apresentamos várias estratégias terapêuticas para alguns erros inatos do metabolismo, que devem ser utilizadas no sentido de melhorar o seu prognóstico.Recent advances in the diagnosis and treatment of inborn errors of metabolism (IEM) have improved substantially the prognosis for many of these conditions. In the clinical practice it is important to recognize this pathology mainly in an acute situation, when the early intervention is essential. In this article, we presented some therapeutic strategies for IEM that should be used to improve their prognose