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1.
Br J Ophthalmol ; 108(2): 238-243, 2024 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-36596664

RESUMO

AIMS: To evaluate the safety and effectiveness of intravitreal dexamethasone (DEX) implant in patients with active uveitis due to ocular toxocariasis (OT). METHODS: Seventy-eight patients with OT were recruited in this retrospective study, including 51 patients in DEX group treated with intravitreal DEX implant and 27 patients in control group without intervention. The reduction of vitreous haze scores (VHS), the best-corrected visual acuity (BCVA) changes, intraocular pressure (IOP) and cataract progression and formation were recorded at baseline (V0), 1 (V1), 3 (V3) and 6 months (V6) after treatment in DEX group, and V0 and V6 in control group. RESULTS: There was no change in VHS and BCVA in control group between V0 and V6. Better VHS (p=0.001) and BCVA (p=0.022) was achieved in DEX group; the rate of VHS=0 was 0%, 67.4%, 42.9% and 44.9% at V0, V1, V3 and V6, respectively (p<0.001), and the mean BCVA was improved from logMAR 1.5±0.9 to 1.2±0.9 at V1, 1.4±1.0 at V3 and 1.4±1.2 at V6. A favourable BCVA at V1 was associated with older age (p=0.038) and uninvolved macula (p=0.000) in DEX group. No significant difference in IOP elevation ≥10 mm Hg, cataract progression and formation between groups. More eyes needed retinal surgery in control group (p<0.001). CONCLUSIONS: This was the first study to investigate use of intravitreal DEX implant in OT patients, which can efficiently reduce ocular inflammation and improve BCVA in macular uninvolved patients.


Assuntos
Catarata , Edema Macular , Síndrome de Quebra de Nijmegen , Oclusão da Veia Retiniana , Toxocaríase , Humanos , Animais , Dexametasona/uso terapêutico , Glucocorticoides/uso terapêutico , Estudos Retrospectivos , Síndrome de Quebra de Nijmegen/complicações , Edema Macular/tratamento farmacológico , Resultado do Tratamento , Oclusão da Veia Retiniana/tratamento farmacológico , Catarata/complicações , Injeções Intravítreas , Implantes de Medicamento
2.
BMC Pediatr ; 23(1): 189, 2023 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-37085783

RESUMO

BACKGROUND: Nijmegen Breakage Syndrome (NBS) is a rare autosomal recessive DNA repair disorder that increases risk of hematological malignancy. Primary gastric malignancies are exceedingly rare in pediatric patients and not typically high on the differential of abdominal pain. CASE PRESENTATION: A 14-year-old male with NBS presented with persistent abdominal pain and was diagnosed with primary Hodgkin disease of the stomach. CONCLUSIONS: In pediatric patients with predisposition to malignancies, such as those with underlying chromosome instability disorders, all symptoms must be carefully considered.


Assuntos
Doença de Hodgkin , Síndrome de Quebra de Nijmegen , Masculino , Humanos , Criança , Adolescente , Síndrome de Quebra de Nijmegen/complicações , Síndrome de Quebra de Nijmegen/diagnóstico , Síndrome de Quebra de Nijmegen/genética , Doença de Hodgkin/complicações , Doença de Hodgkin/diagnóstico , Genótipo
3.
Lancet Neurol ; 21(10): 899-910, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36115362

RESUMO

BACKGROUND: Anti-NMDA receptor (NMDAR) encephalitis is associated with a post-acute stage that is not well known. We aimed to describe the clinical features of this stage, similarities with schizophrenia spectrum disorders, and the factors that predict cognitive-psychiatric outcomes and could serve as prognostic biomarkers. METHODS: In this prospective cohort study, participants (aged 12-60 years) with anti-NMDAR encephalitis during the post-acute stage visited Hospital Clínic de Barcelona (Barcelona, Spain) on three occasions (at study entry [V1], at 6 months [V2], and at 12 months [V3]) and underwent comprehensive neuropsychiatric evaluations. Similar evaluations were done in a group of age-matched participants with schizophrenia spectrum disorders and a group of age-matched and sex-matched healthy participants also recruited from Hospital Clínic de Barcelona. We analysed differences between and within groups in the longitudinal follow-up using multilevel linear mixed-effect models, adjusting for group, age, sex, and socioeconomic status to control for possible confounding. FINDINGS: Between Jan 1, 2017, and Sept 30, 2020, 82 participants were recruited, 28 (34%) with anti-NMDAR encephalitis, 27 (33%) with schizophrenia spectrum disorders, and 27 (33%) healthy participants. Although, by V1 (median 4 months [IQR 3-7] from disease onset), many acute-stage symptoms in participants with anti-NMDAR encephalitis had resolved (acute stage median modified Rankin Scale [mRS] score 5 [IQR 4-5] vs V1 mRS score 2 [1-2]; p<0·0001), 25 (89%) participants showed deficits in at least one cognitive domain. In this group, 15 (68%) of 22 cognitive domain variables were impaired at V1, whereas only eight (36%) were altered at V3 (p=0·016). In participants with schizophrenia spectrum disorders, 11 (50%) of 22 variables (all shared with participants with anti-NMDAR encephalitis) were impaired at V1, without changes at V3. Two acute-stage features of anti-NMDAR encephalitis (ie, decreased consciousness and no improvement within the first 4 weeks of treatment) predicted cognitive domain outcomes, and a visuospatial task (ie, serial biases) at V1 showed potential in predicting learning and memory outcomes. At V1, all psychiatric symptom clusters were similarly altered in participants with anti-NMDAR encephalitis and in those with schizophrenia spectrum disorders, but only those in individuals with anti-NMDAR encephalitis subsequently improved (p=0·031). The greatest cognitive-psychiatric improvement in participants with anti-NMDAR encephalitis occurred between V1 and V2. During this interval, four (14%) participants with anti-NMDAR encephalitis would have met the diagnostic criteria of schizophrenia if CSF antibody findings had not been investigated. INTERPRETATION: The cognitive-psychiatric symptoms of anti-NMDAR encephalitis in the post-acute stage resembled those of stabilised schizophrenia, but only those in participants with anti-NMDAR encephalitis progressively improved, predominantly during V1-V2. These findings are important for clinical trials on anti-NMDAR encephalitis and suggest that prompt cognitive-psychosocial rehabilitation might be a valuable intervention. FUNDING: Instituto Salud Carlos III, NEURON Network of European Funding for Neuroscience Research, National Alliance for Research in Schizophrenia and Affective Disorders, and la Caixa Health-Research Foundation.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato , Síndrome de Quebra de Nijmegen , Esquizofrenia , Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Biomarcadores , Humanos , Síndrome de Quebra de Nijmegen/complicações , Estudos Prospectivos , Esquizofrenia/complicações
4.
Ann Agric Environ Med ; 29(2): 207-214, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35767752

RESUMO

INTRODUCTION AND OBJECTIVE: Nijmegen breakage syndrome (NBS) is a rare chromosomal instability disorder. The majority of patients carry founder mutation in the NBN gene (c.657_661del5). Characteristic features of the NBS include progressive microcephaly, dysmorphic facial features, immunodeficiency, and high predisposition to malignancy with cumulative cancer incidence by the age of 20 years, and amounted to over 70%. The aim of study is to present the latest methods of diagnosis, potential cancer risk factors and treatment of lymphoid malignancies in children with NBS. REVIEW METHODS: To review the evidence using PubMed and Google Scholar search which included articles published between 2009-2021, focusing on articles published between 2013-2021. ABBREVIATED DESCRIPTION OF THE STATE OF KNOWLEDGE: The average delay in diagnosis of NBS ranges from 4-5 years. Neonatal screening of T-cell excision circles (TRECs) and kappa-deleting recombination excision circles (KRECs) seems favourable in NBS. There are no specific protocols for the treatment of lymphoid malignancies in children with NBS, and full- dose chemotherapy is the most frequently applied method. Reducing the doses of chemotherapy does not significantly reduce the toxicity. Main cause of death is cancer progression and treatment-related mortality mostly associated with infectious complications. Patients with diagnosed cancer who received haematopoietic stem cell transplantation (HSCT) had significantly higher 20-year OS than those who did not (42.7% vs. 30.3%). SUMMARY: Further meta-analysis is essential to establish the best monitoring and treatment regimen in patients with NBS and lymphoid malignancies.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Neoplasias , Síndrome de Quebra de Nijmegen , Adulto , Criança , Genótipo , Humanos , Recém-Nascido , Neoplasias/genética , Síndrome de Quebra de Nijmegen/complicações , Síndrome de Quebra de Nijmegen/diagnóstico , Síndrome de Quebra de Nijmegen/genética , Adulto Jovem
5.
J Neuroophthalmol ; 42(3): 378-383, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35421036

RESUMO

BACKGROUND: To study the effect of greater occipital nerve (GON) block on migraine-associated photophobia levels. Photophobia is one of the most bothersome symptoms reported by migraine patients. Studies investigating the impact of migraine treatment on this symptom are scarce. METHODS: This is an observational prospective case-control study. Patients with migraine and photophobia attending a Headache Clinic were recruited. Cases were defined as patients in whom GON block was performed, following usual clinical practice guidelines. All patients were evaluated with the Hospital Anxiety and Depression Scale, the Migraine Specific Quality of Life Questionnaire, the Utah Photophobia Symptom Impact Scale (UPSIS-12), and the Korean Photophobia Questionnaire (KUMC-8); both in the first visit (V1) and one week after (V2). RESULTS: Forty-one patients were recruited, 28 (68.3%) cases and 13 (31.7%) controls. At V1, there were no significant differences in the median [p25-p75] score of UPSIS-12 in cases vs controls (32.0 [21.0-34.0] vs 30.5 [22.0-37.0], P = 0.497) or KUMC-8 (6.5 [5.5-7.0] vs 7.0 [6.0-8.0], P = 0.463). At V2, cases experimented a significant improvement in UPSIS-12 of -5.5 [-8.8 to -1.3] and in KUMC-8 of -0.5 [-2.0 to 0], whereas there were no significant changes in the control group. Migraine with aura patients presented higher UPSIS-12 score at V1 (33.5 [24.5-37.0] vs 26.0 [16.0-35.0]) and lesser improvement at V2 after GON block compared with migraine without aura patients (-4.0 [-6.0 to -1.0] vs -8.0 [-17.0 to -2.0]), although statistical significance was not achieved ( P = 0.643 and P = 0.122, respectively). There was no significant variation in the remaining scales. CONCLUSIONS: Greater occipital nerve block improves migraine-associated photophobia, measured with UPSIS-12 and KUMC-8. Patients without aura may exhibit a greater improvement. Physicians could consider GON block for management of photophobia in migraine patients.


Assuntos
Transtornos de Enxaqueca , Bloqueio Nervoso , Síndrome de Quebra de Nijmegen , Estudos de Casos e Controles , Humanos , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/terapia , Síndrome de Quebra de Nijmegen/complicações , Fotofobia/complicações , Qualidade de Vida
6.
J Clin Res Pediatr Endocrinol ; 14(2): 251-257, 2022 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34544220

RESUMO

Nijmegen breakage syndrome (NBS) is a rare autosomal recessive disease, affecting mainly patients of Slavic origin. It is caused by a defect in the NBN gene, resulting in defective nibrin protein formation. This leads to chromosomal instability, which predisposes to cancer, with lymphoid malignancies predominating. Nibrin is also involved in gonadal development and its disfunction in females with NBS frequently results in a pure gonadal dysgenesis (PGD) causing hypergonadotropic hypogonadism. However, only a few ovarian tumors in NBS patients have been reported to date. We describe the first case of a girl with NBS with PGD, who developed metachronous bilateral ovarian germ cell tumors (dysgerminoma and gonadoblastoma). Pathogenesis of PGD, neoplastic transformation and therapeutic approach in females with NBS are discussed.


Assuntos
Disgenesia Gonadal , Gonadoblastoma , Hipogonadismo , Síndrome de Quebra de Nijmegen , Neoplasias Ovarianas , Feminino , Disgenesia Gonadal/complicações , Disgenesia Gonadal/genética , Gonadoblastoma/complicações , Gonadoblastoma/genética , Humanos , Hipogonadismo/genética , Síndrome de Quebra de Nijmegen/complicações , Síndrome de Quebra de Nijmegen/diagnóstico , Síndrome de Quebra de Nijmegen/genética , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/genética
7.
Pan Afr Med J ; 35: 85, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32537088

RESUMO

Nijmegen Breakage Syndrome (NBS) is a rare autosomalrecessive DNA repair disorder characterized by genomic instability andincreased risk of haematopoietic malignancies observed in morethan 40% of the patients by the time they are 20 years old. The underlying gene, NBS1, is located on human chromosome 8q21 and codes for a protein product termed nibrin, Nbs1 or p95. Over 90% of patients are homozygous for a founder mutation: a deletion of five base pairs which leads to a frame shift and protein truncation. Nibrin (NBN) plays an important role in the DNA damage response (DDR) and DNA repair. DDR is a crucial signalling pathway in apoptosis and senescence. Cardinal symptoms of Nijmegen breakage syndrome are characteristic: microcephaly, present at birth and progressive with age, dysmorphic facial features, mild growth retardation, mild-to-moderate intellectual disability, and, in females, hypergonadotropic hypogonadism. Combined cellular and humoral immunodeficiency with recurrent sino-pulmonary infections, a strong predisposition to develop malignancies (predominantly of lymphoid origin) and radiosensitivity are other integral manifestations of the syndrome. The diagnosis of NBS is initially based on clinical manifestations and is confirmed by genetic analysis. Prenatal molecular genetic diagnosis is possible if disease-causing mutations in both alleles of the NBN gene are known. No specific therapy is available for NBS; however, hematopoietic stem cell transplantation may be one option for some patients. Prognosis is generally poor due to the extremely high rate of malignancies. We present here a case of Nijmegen breakage syndrome associated with Hodgkin lymphomas and Combined variable immunodeficiency.


Assuntos
Imunodeficiência de Variável Comum/etiologia , Linfoma não Hodgkin/etiologia , Síndrome de Quebra de Nijmegen/diagnóstico , Proteínas de Ciclo Celular/genética , Criança , Feminino , Humanos , Síndrome de Quebra de Nijmegen/complicações , Síndrome de Quebra de Nijmegen/genética , Proteínas Nucleares/genética
8.
Aging (Albany NY) ; 12(12): 12342-12375, 2020 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-32564008

RESUMO

BACKGROUND: Nibrin, as part of the NBN/MRE11/RAD50 complex, is mutated in Nijmegen breakage syndrome (NBS), which leads to impaired DNA damage response and lymphoid malignancy. RESULTS: Telomere length (TL) was markedly reduced in homozygous patients (and comparably so in all chromosomes) by ~40% (qPCR) and was slightly reduced in NBS heterozygotes older than 30 years (~25% in qPCR), in accordance with the respective cancer rates. Humanized cancer-free NBS mice had normal TL. Telomere elongation was inducible by telomerase and/or alternative telomere lengthening but was associated with abnormal expression of telomeric genes involved in aging and/or cell growth. Lymphoblastoid cells from NBS patients with long survival times (>12 years) displayed the shortest telomeres and low caspase 7 activity. CONCLUSIONS: NBS is a secondary telomeropathy. The two-edged sword of telomere attrition enhances the cancer-prone situation in NBS but can also lead to a relatively stable cellular phenotype in tumor survivors. Results suggest a modular model for progeroid syndromes with abnormal expression of telomeric genes as a molecular basis. METHODS: We studied TL and function in 38 homozygous individuals, 27 heterozygotes, one homozygous fetus, six NBS lymphoblastoid cell lines, and humanized NBS mice, all with the same founder NBN mutation: c.657_661del5.


Assuntos
Proteínas de Ciclo Celular/genética , Síndrome de Quebra de Nijmegen/complicações , Proteínas Nucleares/genética , Progéria/genética , Homeostase do Telômero/genética , Telômero/patologia , Adolescente , Animais , Linhagem Celular Tumoral , Criança , Pré-Escolar , Modelos Animais de Doenças , Feminino , Heterozigoto , Homozigoto , Humanos , Lactente , Cariotipagem , Masculino , Camundongos , Camundongos Transgênicos , Síndrome de Quebra de Nijmegen/genética , Síndrome de Quebra de Nijmegen/patologia , Progéria/patologia , Telomerase/metabolismo , Adulto Jovem
9.
Am J Med Genet A ; 182(6): 1378-1386, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32212377

RESUMO

DNA double-strand breaks (DSBs) are highly toxic DNA lesions that can lead to chromosomal instability, loss of genes and cancer. The MRE11/RAD50/NBN (MRN) complex is keystone involved in signaling processes inducing the repair of DSB by, for example, in activating pathways leading to homologous recombination repair and nonhomologous end joining. Additionally, the MRN complex also plays an important role in the maintenance of telomeres and can act as a stabilizer at replication forks. Mutations in NBN and MRE11 are associated with Nijmegen breakage syndrome (NBS) and ataxia telangiectasia (AT)-like disorder, respectively. So far, only one single patient with biallelic loss of function variants in RAD50 has been reported presenting with features classified as NBS-like disorder. Here, we report a long-term follow-up of an unrelated patient with facial dysmorphisms, microcephaly, skeletal features, and short stature who is homozygous for a novel variant in RAD50. We could show that this variant, c.2524G > A in exon 15 of the RAD50 gene, induces aberrant splicing of RAD50 mRNA mainly leading to premature protein truncation and thereby, most likely, to loss of RAD50 function. Using patient-derived primary fibroblasts, we could show abnormal radioresistant DNA synthesis confirming pathogenicity of the identified variant. Immunoblotting experiments showed strongly reduced protein levels of RAD50 in the patient-derived fibroblasts and provided evidence for a markedly reduced radiation-induced AT-mutated signaling. Comparison with the previously reported case and with patients presenting with NBS confirms that RAD50 mutations lead to a similar, but distinctive phenotype.


Assuntos
Hidrolases Anidrido Ácido/genética , Ataxia Telangiectasia/genética , Distúrbios no Reparo do DNA/genética , Proteínas de Ligação a DNA/genética , Transtornos do Crescimento/genética , Microcefalia/genética , Síndrome de Quebra de Nijmegen/genética , Alelos , Ataxia Telangiectasia/complicações , Ataxia Telangiectasia/patologia , Proteínas de Ciclo Celular/genética , Criança , Pré-Escolar , Quebras de DNA de Cadeia Dupla , Distúrbios no Reparo do DNA/complicações , Distúrbios no Reparo do DNA/patologia , Feminino , Transtornos do Crescimento/complicações , Transtornos do Crescimento/patologia , Humanos , Lactente , Recém-Nascido , Proteína Homóloga a MRE11/genética , Microcefalia/complicações , Microcefalia/patologia , Síndrome de Quebra de Nijmegen/complicações , Síndrome de Quebra de Nijmegen/patologia , Proteínas Nucleares/genética , Linhagem
10.
Gynecol Endocrinol ; 35(11): 999-1002, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31187634

RESUMO

Background: Nijmegen breakage syndrome (NBS) is an autosomal recessive disorder leading to chromosomal instability and an array of symptoms, including characteristic facial features (bird-like face), predisposition to malignancies, as well as hypergonadotropic hypogonadism. This case report discusses the diagnostic process and management of a 23-year-old Polish female patient who was admitted to hospital with symptoms of secondary amenorrhea and clinical features corresponding to NBS. Methods: Clinical examination, per-rectal ultrasound, laboratory diagnostics (including serum concentrations of FSH, LH, estradiol, testosterone, and TSH), as well as SSCP analysis and classic karyotyping were performed. Results: During hormonal evaluation elevated serum concentration of FSH and LH and decreased serum concentration of estradiol were measured. The genetic testing revealed translocation 7;14 (t(7;14)) and inversion 7 in 22% of examined cells which confirmed the initial hypothesis of NBS. The diagnosis was finally verified by identifying a Slavic founder mutation, c.657_661del5, on both allels of the NBN gene. Furthermore, hormonal serum evaluation conducted after four weeks allowed the patient to be diagnosed with premature ovarian insufficiency (POI) suspected earlier on the grounds of preliminary examinations (ultrasound imaging and laboratory tests). Conclusions: Chromosomal instability resulting from a mutation present in Nijmegen breakage syndrome patients might be a causative factor of premature ovarian insufficiency. Therefore, females diagnosed with NBS should undergo additional diagnostic procedures in order to determine further management and treatment.


Assuntos
Síndrome de Quebra de Nijmegen/complicações , Insuficiência Ovariana Primária/etiologia , Feminino , Humanos , Adulto Jovem
11.
Pediatrics ; 142(4)2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30209074

RESUMO

Nijmegen breakage syndrome (NBS) is a rare autosomal recessive disease characterized by microcephaly, growth retardation, severe immunodeficiency, and predisposition to lymphoid malignancy. In this report, we describe a case of a 9-year-old boy, previously diagnosed with NBS and symptoms of dyspnea, dry cough, and fever. Despite initial recognition of pneumonia, there was no response to broad spectrum antimicrobial treatment, negative results from microbiological tests, and unclear changes in lung imaging were observed. Therefore, further diagnostics were focused on suspected lymphoid malignancy and involved lung biopsy. Unexpectedly, histopathological examination revealed noncaseating granulomas. The introduction of systemic steroids resulted in significant improvement of the patient's clinical condition. This is the first description of primary pulmonary noncaseating granulomas without nodular involvement in a child with NBS.


Assuntos
Granuloma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Síndrome de Quebra de Nijmegen/diagnóstico por imagem , Criança , Granuloma/complicações , Granuloma/terapia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Masculino , Síndrome de Quebra de Nijmegen/complicações , Síndrome de Quebra de Nijmegen/terapia
12.
Eur J Med Genet ; 59(3): 126-32, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26826318

RESUMO

Nijmegen breakage syndrome (NBS, MIM #251260) is an autosomal recessive chromosomal instability disorder. Majority of patients affected are of Slavic origin and share the same founder mutation of 657del5 within the NBN gene encoding protein involved in DNA double-strand breaks repair. Clinically, this is characterized by a microcephaly, immunodeficiency and a high incidence of pediatric malignancies, mostly lymphomas and leukemias. Anticancer treatment among patients with NBS is challenging because of a high risk of life threatening therapy-related toxicity including severe infections, bone marrow failure, cardio- and nephrotoxicity and occurrence of secondary cancer. Based on systemic review of available literature and the Polish acute lymphoblastic leukemia database we concluded that among patients with NBS, these who suffered from clinically proven severe immunodeficiency are at risk of the complications associated with oncological treatment. Thus, in this group it reasonable to reduce chemotherapy up to 50% especially concerning anthracyclines methotrexate, alkylating agents and epipodophyllotoxines, bleomycin and radiotherapy should be omitted. Moreover, infection prophylaxis using intravenous immunoglobulin supplementation together with antifungal and antibacterial agent is recommended. To replace radiotherapy or some toxic anticancer agents targeted therapy using monoclonal antibodies and kinase inhibitors or bone marrow transplantation with reduced-intensity conditioning should be considered in some cases, however, this statement needs further studies.


Assuntos
Leucemia Linfoide/diagnóstico , Leucemia Linfoide/terapia , Linfoma/diagnóstico , Linfoma/terapia , Síndrome de Quebra de Nijmegen/genética , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transplante de Medula Óssea , Predisposição Genética para Doença , Humanos , Imunoterapia/efeitos adversos , Imunoterapia/métodos , Infecções/etiologia , Leucemia Linfoide/epidemiologia , Leucemia Linfoide/etiologia , Linfoma/epidemiologia , Linfoma/etiologia , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Síndrome de Quebra de Nijmegen/complicações , Síndrome de Quebra de Nijmegen/diagnóstico , Síndrome de Quebra de Nijmegen/terapia , Fenótipo , Radioterapia/efeitos adversos , Radioterapia/métodos , Risco , Resultado do Tratamento
14.
Pediatr Blood Cancer ; 61(8): 1469-71, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24619942

RESUMO

Nijmegen breakage syndrome (NBS) is an autosomal recessive chromosomal instability disorder characterized by a high incidence of pediatric hematologic malignancies. Majority of patients affected are of Slavic origin and share the same founder mutation of 657del5 within the NBN gene encoding protein involved in DNA double-strand breaks (DSB) repair. We report a case of a pediatric patient with NBS, who developed t(9;11)/AF9-MLL-positive AML as a second malignancy after successful treatment of T-NHL. The coexistence of NBN and MLL mutations suggests that the profound dysfunction of NBN may promote alterations of MLL that is mediated by error-prone non-homologous end joining pathway particularly in patients treated with DNA topoisomerase II inhibitors.


Assuntos
Cromossomos Humanos Par 11/genética , Leucemia Monocítica Aguda/etiologia , Síndrome de Quebra de Nijmegen , Translocação Genética , Adolescente , Proteínas de Ciclo Celular/genética , Feminino , Histona-Lisina N-Metiltransferase , Humanos , Leucemia Monocítica Aguda/genética , Proteína de Leucina Linfoide-Mieloide/genética , Síndrome de Quebra de Nijmegen/complicações , Síndrome de Quebra de Nijmegen/genética , Proteínas Nucleares/genética
15.
Ital J Pediatr ; 39: 59, 2013 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-24044622

RESUMO

We report on pediatric patient with Nijmegen breakage syndrome (NBS), a rare DNA repair disorder characterized by microcephaly, immunodeficiency and predisposition to malignant lymphomas, who developed juvenile idiopathic arthritis (JIA)-like polyarthritis. In patients with primary immunodeficiencies (PID), septic arthritis due to pyogenic bacteria or mycoplasmal arthritis are the most common osteoarticular manifestations. In certain PID, chronic, non-infectious arthritis resembling rheumatoid arthritis may occur. In our patient microbiologic cultures of synovial fluid including Mycoplasma spp. were negative. At first, because of suspected mycoplasmal arthritis we used macrolides and doxycycline combined with hydroxychloroquine but without therapeutic response. However, the use of rituximab led to remission of her polyarthritis lasting for 9 months. Autoimmune features were rarely reported in NBS. An occurrence of JIA-like, chronic polyarthritis in NBS, a DNA repair disorder characterized by decreased tolerance of immunosuppressive drugs such as methotrexate and a high natural risk for lymphomas, makes therapeutic approach even more complex.


Assuntos
Artrite/tratamento farmacológico , Artrite/etiologia , Síndrome de Quebra de Nijmegen/complicações , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticorpos Monoclonais Murinos/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite/diagnóstico por imagem , Artrite/genética , Criança , Doença Crônica , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Síndrome de Quebra de Nijmegen/genética , Síndrome de Quebra de Nijmegen/fisiopatologia , Radiografia , Doenças Raras , Medição de Risco , Rituximab , Índice de Gravidade de Doença , Resultado do Tratamento
16.
Int J Hematol ; 97(1): 37-42, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23266960

RESUMO

The XCIND syndrome is named after distinct hypersensitivity to ionizing (X-ray) irradiation, cancer susceptibility, immunodeficiency, neurological abnormality, and double-strand DNA breakage. The disorders comprising XCIND syndrome are usually inherited in an autosomal recessive manner. Ataxia telangiectasia (A-T) is one such disease, and is caused by biallelic germline mutation of the Ataxia telangiectasia mutated (ATM) gene. Heterozygous carriers of the ATM mutation, who do not show A-T-like clinical symptoms, are estimated to comprise 1 % of the population. Thus, understanding the biological basis of XCIND, including A-T, should help shed light on the pathogenesis of genetic diseases with cancer susceptibility.


Assuntos
Doenças Genéticas Inatas/complicações , Neoplasias/etiologia , Animais , Ataxia Telangiectasia/complicações , Proteínas Mutadas de Ataxia Telangiectasia , Proteínas de Ciclo Celular/genética , Proteínas de Ciclo Celular/metabolismo , Proteínas de Ligação a DNA/genética , Proteínas de Ligação a DNA/metabolismo , Suscetibilidade a Doenças , Humanos , Síndrome de Quebra de Nijmegen/complicações , Proteínas Serina-Treonina Quinases/genética , Proteínas Serina-Treonina Quinases/metabolismo , Imunodeficiência Combinada Severa/complicações , Proteínas Supressoras de Tumor/genética , Proteínas Supressoras de Tumor/metabolismo , Raios X/efeitos adversos
17.
Orphanet J Rare Dis ; 7: 13, 2012 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-22373003

RESUMO

Nijmegen breakage syndrome (NBS) is a rare autosomal recessive syndrome of chromosomal instability mainly characterized by microcephaly at birth, combined immunodeficiency and predisposition to malignancies. Due to a founder mutation in the underlying NBN gene (c.657_661del5) the disease is encountered most frequently among Slavic populations. The principal clinical manifestations of the syndrome are: microcephaly, present at birth and progressive with age, dysmorphic facial features, mild growth retardation, mild-to-moderate intellectual disability, and, in females, hypergonadotropic hypogonadism. Combined cellular and humoral immunodeficiency with recurrent sinopulmonary infections, a strong predisposition to develop malignancies (predominantly of lymphoid origin) and radiosensitivity are other integral manifestations of the syndrome. The NBN gene codes for nibrin which, as part of a DNA repair complex, plays a critical nuclear role wherever double-stranded DNA ends occur, either physiologically or as a result of mutagenic exposure. Laboratory findings include: (1) spontaneous chromosomal breakage in peripheral T lymphocytes with rearrangements preferentially involving chromosomes 7 and 14, (2) sensitivity to ionizing radiation or radiomimetics as demonstrated in vitro by cytogenetic methods or by colony survival assay, (3) radioresistant DNA synthesis, (4) biallelic hypomorphic mutations in the NBN gene, and (5) absence of full-length nibrin protein. Microcephaly and immunodeficiency are common to DNA ligase IV deficiency (LIG4 syndrome) and severe combined immunodeficiency with microcephaly, growth retardation, and sensitivity to ionizing radiation due to NHEJ1 deficiency (NHEJ1 syndrome). In fact, NBS was most commonly confused with Fanconi anaemia and LIG4 syndrome. Genetic counselling should inform parents of an affected child of the 25% risk for further children to be affected. Prenatal molecular genetic diagnosis is possible if disease-causing mutations in both alleles of the NBN gene are known. No specific therapy is available for NBS, however, hematopoietic stem cell transplantation may be one option for some patients. Prognosis is generally poor due to the extremely high rate of malignancies.


Assuntos
Síndrome de Quebra de Nijmegen , Adolescente , Adulto , Proteínas de Ciclo Celular/genética , Pré-Escolar , Instabilidade Cromossômica/genética , Feminino , Genes Recessivos , Humanos , Hipogonadismo/genética , Hipogonadismo/patologia , Síndromes de Imunodeficiência/genética , Síndromes de Imunodeficiência/fisiopatologia , Microcefalia/genética , Microcefalia/patologia , Neoplasias/genética , Neoplasias/patologia , Síndrome de Quebra de Nijmegen/complicações , Síndrome de Quebra de Nijmegen/genética , Síndrome de Quebra de Nijmegen/patologia , Síndrome de Quebra de Nijmegen/fisiopatologia , Proteínas Nucleares/genética , Adulto Jovem
19.
Br J Haematol ; 155(4): 468-76, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21923652

RESUMO

Children with chromosomal instability syndromes have an increased risk of developing lymphoma and leukaemia. The treatment of these malignancies is hampered by therapy-associated toxicity and infectious complications. This retrospective analysis evaluated the therapy outcome of 38 children with Ataxia teleangiectasia or Nijmegen-breakage syndrome with acute lymphoblastic leukaemia (ALL, n = 9), Non-Hodgkin lymphoma (NHL, n = 28) and Hodgkin lymphoma (HL, n = 1). All patients with NHL or ALL were treated in accordance to Berlin-Frankfurt-Münster (BFM)- or Co-operative study group for childhood ALL (CoALL)-oriented chemotherapy schedules. 22 patients received significantly reduced-intensity chemotherapy. After a median follow-up of 3·7 years the 10-year overall survival was 58%. Dosage-reduction of chemotherapeutic drugs seemed to have no disadvantages and reduced toxic side effects. On the other hand, reduced-intensity chemotherapy did not prevent second malignancies, which occurred in ten patients with a 10-year incidence of 25%. After individual treatment approaches three of these patients with second malignancies were in complete clinical remission for more than 5 years. We conclude that BFM- or CoALL-oriented chemotherapy is effective and can be administered in children with AT or NBS. Moreover, we show that even second lymphoid malignancies can successfully be treated in these patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/genética , Síndrome de Quebra de Nijmegen/complicações , Adolescente , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Humanos , Linfoma não Hodgkin/patologia , Masculino , Síndrome de Quebra de Nijmegen/genética , Síndrome de Quebra de Nijmegen/patologia , Estudos Retrospectivos
20.
Klin Oczna ; 113(4-6): 153-5, 2011.
Artigo em Polonês | MEDLINE | ID: mdl-21913446

RESUMO

UNLABELLED: Nijmegen Breakage Syndrome (NBS) is a genomic instability disease caused by inherited mutations in the NBN/NBS1 gene. The clinical symptoms of NBS are: primary microcephaly, characteristic facial appearance, recurring respiratory tract infections caused by immune deficiency and extremely high risk of cancer development at early age. PURPOSE: The aim of the study was to assess the vision organ in patients with NBS. MATERIAL AND METHODS: Ophthalmological examination of 10 NBS patients was performed. The visual acuity, refractive errors, anterior and posterior segment of the eye ball test, tonometry and biometry were assessed. RESULTS: Serious pathology of the sight organ in the study group were found, including upward slanting of the palpebral fissures, reduced visual acuity, small eyes, small cornea diameter, lens opacity, refractive errors. CONCLUSIONS: The patients with Nijmegen breakage syndrome have significant sight organ abnormalities. These pathologies require long-term ophthalmologic care.


Assuntos
Oftalmopatias/diagnóstico , Oftalmopatias/etiologia , Síndrome de Quebra de Nijmegen/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Doenças do Cristalino/diagnóstico , Doenças do Cristalino/etiologia , Masculino , Síndrome de Quebra de Nijmegen/diagnóstico , Doenças Retinianas/diagnóstico , Doenças Retinianas/etiologia , Fatores de Risco , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Adulto Jovem
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