Characterization of eleven novel mutations (M45L, R119H, 544delG, G145V, H154Y, C184Y, D289V, 862+5A, 1172delC, R411X, E459K) in the tissue-nonspecific alkaline phosphatase (TNSALP) gene in patients with severe hypophosphatasia. Mutations in brief no. 217. Online

Hypophosphatasia is a rare inherited disorder characterized by defective bone mineralization and deficiency of serum and tissue liver/ bone/kidney tissue alkaline phosphatase (L/B/K ALP) activity. We report the characterization of tissue-nonspecific alkaline phosphatase (TNSALP) gene mutations in a series of 9 families affected by severe hypophosphatasia. Fourteen distinct mutations were found, 3 of which were previously reported in the North American or Japanese populations. Seven of the 11 new mutations were missense mutations (M45L, R119H, G145V, C184Y and H154Y, D289V, E459K), the four others were 2 single nucleotide deletions (544delG and 1172delC), a mutation affecting donor splice site (862 + 5A) and a nonsense mutation (R411X).     

Large Family With Maturity-Onset Diabetes of the Young and a Novel V121I Mutation in HNF4A

Maturity-onset diabetes of the young (MODY) is a subtype of early-onset diabetes mellitus which is characterized by autosomal dominant inheritance. Several genes are known to induce MODY : HNF4A/MODY1, GCK/MODY2, TCF1/MODY3, IPF1/MODY4, TCF2/MODY5 and NEUROD1/MODY6. We studied a Swiss family with 13 diabetic patients over 3 generations. The average age at diagnosis was 35 +/- 15 years (7 subjects before 30). In addition, 2 individuals had an abnormal oral glucose tolerance. The mutation present in this family was located in the DNA binding domain of HNF4A, a strongly conserved region across almost all species, and segregated in all the MODY patients. Identification of this missense mutation allowed for presymptomatic diagnosis in the younger generations and will improve medical follow-up of the predisposed individuals.     

Spontaneous and ligand-induced endocytosis of CD23 (Fc epsilon receptor II) from the surface of B lymphocytes generates a 16-kDa intracellular fragment.

It has been reported that the 45-kDa low-affinity Fc epsilon receptor (Fc epsilon RII) on B cells is cleaved spontaneously from the cell surface to release soluble fragments. This study demonstrates an additional fate of the Fc epsilon RII. 125I-labeled CD23+ B cells were cultured for 24 h at 37 degrees C. After lysis, cell extracts were immunoprecipitated with CD23 monoclonal antibodies. Using this methodology, we demonstrated that an increasing amount of the labeled Fc epsilon RII becomes progressively resistant to externally applied trypsin, indicating that a fraction of the cell surface receptors are internalized. In parallel, a labeled 16-kDa material, recognized by CD23 monoclonal antibodies directed to the lectin-like domain of the Fc epsilon-RII appears inside the cells. Chloroquine does not affect internalization of the Fc epsilon RII, but completely abolishes the formation of the intracellular fragment, suggesting that the receptor is processed by proteolytic cleavage in acidic organelle. In addition, the internalization is enhanced in the presence of CD23 monoclonal antibodies. These data demonstrate that Fc epsilon RII can be internalized by ligand-induced endocytosis and subsequently cleaved in an intracellular compartment. These results also support the view that the Fc epsilon RII is involved in antigen focusing and antigen presentation.     

Activity-dependent control of bulk endocytosis by protein dephosphorylation in central nerve terminals

Bulk endocytosis is the process by which nerve terminals retrieve large amounts of synaptic vesicle membrane during periods of strong stimulation intensity. The process is rapidly activated and is most probably calcium dependent in a similar manner to synaptic vesicle exocytosis. This article briefly summarizes the current knowledge of bulk endocytosis with respect to its activation, kinetics and molecular mechanism. It also presents recent data from our laboratory showing that the dephosphorylation of a group of endocytosis proteins called the dephosphins by the Ca²⁺-dependent protein phosphatase calcineurin is key to the activity-dependent stimulation of the process. Possible downstream effectors of calcineurin are discussed such as the large GTPase dynamin I and its phosphorylation-dependent interaction partner syndapin I.     

Mesure de l''impédance vasculaire par effet Doppler chez des patients hémodialysés

L'objet de ce travail a été de rechercher une grandeur hémodynamique fiable permettant une évaluation des conditions circulatoires au sein des fistules artérioveineuses et la détection de dysfonctionnements circulatoires, de développer un système permettant la mesure non invasive de l'impédance vasculaire du membre supérieur, puis d'évaluer cette mesure chez le volontaire sain et chez l'insuffisant rénal porteur de fistule artérioveineuse radiale fonctionnelle ou pathologique. Quatorze patients insuffisants rénaux chroniques hémodialysés porteurs de fistules artérioveineuses radiales (FAV) fonctionnelles (groupe HDN), cinq patients porteurs de FAV présentant une anomalie fonctionnelle (groupe HDP) et seize volontaires sains (groupe VS) ont été inclus dans ce travail. L'évaluation de l'impédance (amplitude exprimée en dynes secondes par centimètre cube) était réalisée à partir de l'obtention des vélocités sanguines par Doppler ultrasonore et détermination de la pression artérielle et de la fréquence cardiaque aux deux bras des patients inclus. L'appareil Doppler Multidop X4 DWL par l'intermédiaire d'une carte d'acquisition et de conversion analogique numérique autorisait l'acquisition de ces données dont le traitement sous Labview permettait d'obtenir l'amplitude et la phase de l'impédance vasculaire pour les six premières harmoniques. Concernant le membre sans fistule, les amplitudes pour chaque harmonique du spectre de l'impédance vasculaire humérale étaient plus faibles dans le groupe VS que dans le groupe de patients dialysés (p ≤ 0, 04). Une différence existait pour la phase des harmoniques 1 (p = 0,0003) et 4 (p = 0,0044) entre les groupes VS et les patients dialysés. De plus pour les harmoniques 1 et 4 il existait une différence entre les groupes HDP et HDN (p < 0,002). Chez les patients porteurs de fistule, une différence significative était observée entre le membre sans fistule et celui avec fistule que ce soit pour l'amplitude (p < 0,0001) pour les trois premières harmoniques avec un retard de phase plus important sur le membre sans FAV. La mesure de l'impédance vasculaire au membre supérieur est donc possible par une méthode non-invasive. Cette méthode à permis de mettre en évidence des différences de comportement vasculaire sur le membre sans FAV entre les sujets sains et les hémodialysés et entre les deux bras. En revanche, aucune différence n'a été trouvée entre les FAV fonctionnelles et pathologiques.     

Three-year outcomes from the CRADLE study in de novo pediatric kidney transplant recipients receiving everolimus with reduced tacrolimus and early steroid withdrawal

CRADLE was a 36-month multicenter study in pediatric (≥1 to <18 years) kidney transplant recipients randomized at 4 to 6 weeks posttransplant to receive everolimus + reduced-exposure tacrolimus (EVR + rTAC; n = 52) with corticosteroid withdrawal at 6-month posttransplant or continue mycophenolate mofetil + standard-exposure TAC (MMF + sTAC; n = 54) with corticosteroids. The incidence of composite efficacy failure (biopsy-proven acute rejection [BPAR], graft loss, or death) at month 36 was 9.8% vs 9.6% (difference: 0.2%; 80% confidence interval: −7.3 to 7.7) for EVR + rTAC and MMF + sTAC, respectively, which was driven by BPARs. Graft loss was low (2.1% vs 3.8%) with no deaths. Mean estimated glomerular filtration rate at month 36 was comparable between groups (68.1 vs 67.3 mL/min/1.73 m²). Mean changes (z-score) in height (0.72 vs 0.39; P = .158) and weight (0.61 vs 0.82; P = .453) from randomization to month 36 were comparable, whereas growth in prepubertal patients on EVR + rTAC was better (P = .050) vs MMF + sTAC. The overall incidence of adverse events (AEs) and serious AEs was comparable between groups. Rejection was the leading AE for study drug discontinuation in the EVR + rTAC group. In conclusion, though AE-related study drug discontinuation was higher, an EVR + rTAC regimen represents an alternative treatment option that enables withdrawal of steroids as well as reduction of CNIs for pediatric kidney transplant recipients. ClinicalTrials.gov: NCT01544491.     

Hypophosphatasia: molecular testing of 19 prenatal cases and discussion about genetic counseling

OBJECTIVE: We studied hypophosphatasia (HP) mutations in 19 cases prenatally detected by ultrasonography without familial history of HP. We correlated the mutations with the reported ultrasound signs, and discussed genetic counseling with regard to the particular dominantly inherited prenatal benign form of HP. METHOD: The coding sequence of the tissue nonspecific alkaline phosphatase (TNSALP) gene was analyzed by DNA sequencing, and 3D modeling was used to locate the mutated amino acids with regard to the functional domains of TNSALP. RESULTS: Although reported ultrasound signs were heterogeneous, two mutated alleles were found in 18 of the 19 cases studied, indicating recessive transmission of the disease. Functional domains of TNSALP were affected by 74% of missense mutations. In all the cases, including one with only a heterozygous mutation, molecular, biological, and familial data do not corroborate the hypothesis of prenatal benign HP. The mutation c.1133A>T observed in the prenatal benign form of HP and common in USA was not found in this series. CONCLUSION: The results point out the prenatally detectable allelic heterogeneity of HP. The nature of the detected mutations and the evidence of recessive inheritance do not support these cases being affected with prenatal benign HP.