Characterization of four Latin American families confirms previous findings and reveals novel features of acid-labile subunit deficiency.

OBJECTIVE: Acid-labile subunit deficiency (ACLSD), caused by inactivating mutations in both IGFALS gene alleles, is characterized by marked reduction in IGF-I and IGFBP-3 levels associated with mild growth retardation. The aim of this study was to expand the known phenotype and genetic characteristics of ACLSD by reporting data from four index cases and their families. DESIGN: Auxological data, biochemical and genetic studies were performed in four children diagnosed with ACLSD and all available relatives. METHODS: Serum levels of IGF-I, IGFBP-3, acid-labile subunit (ALS), and in vitro ternary complex formation (ivTCF) were determined. After sequencing the IGFALS gene, pathogenicity of novel identified variants was evaluated by in vitro expression in transfected Chinese hamster ovarian (CHO) cells. ALS protein was detected in patients' sera and CHO cells conditioned media and lysates by Western immunoblot (WIB). RESULTS: Four index cases and four relatives were diagnosed with ACLSD. The following variants were found: p.Glu35Glyfs*17, p.Glu35Lysfs*87, p.Leu213Phe, p.Asn276Ser, p.Leu409Phe, p.Ala475Val and p.Ser490Trp. ACLSD patients presented low IGF-I and low or undetectable levels of IGFBP-3 and ALS. Seven out of 8 patients did not form ivTCF. CONCLUSIONS: This study confirms previous findings in ACLSD, such as the low IGF-I and a more severe reduction in IGFBP-3 levels, and a gene dosage effect observed in heterozygous carriers (HC). In addition, father-to-son transmission (father compound heterozygous and mother HC), preservation of male fertility, and marginal ALS expression with potential involvement in preserved responsiveness to rhGH treatment, are all novel aspects, not previously reported in this condition.

Assessment of pathogenicity of natural IGFALS gene variants by in silico bioinformatics tools and in vitro functional studies.

Acid-labile subunit (ALS) is essential for stabilization of IGF-I and IGFBP-3 in ternary complexes within the vascular system. ALS deficient (ALS-D) patients and a subset of children with idiopathic short stature (ISS), presenting IGFALS gene variants, show variable degree of growth retardation associated to IGF-I and IGFBP-3 deficiencies. The aim of this study was to evaluate the potential pathogenicity of eleven IGFALS variants identified in ALS-D and ISS children using in silico and in vitro approaches. We were able to classify seven of these variants as pathogenic since they present impaired synthesis (p.Glu35Lysfs*87, p.Glu35Glyfs*17, p.Asn276Ser, p.Leu409Phe, p.Ser490Trp and p.Cys540Arg), or partial impairment of synthesis and lack of secretion (p.Leu213Phe). We also observed significant reduction of secreted protein for variants p.Ala330Asp, Ala475Val and p.Arg548Trp, while still retaining their ability to form ternary complexes. These findings provide an approach to test the pathogenicity of IGFALS gene variants.

Heterozygous IGFALS gene variants in idiopathic short stature and normal children: impact on height and the IGF system.

BACKGROUND: In acid-labile subunit (ALS)-deficient families, heterozygous carriers of IGFALS gene mutations are frequently shorter than their wild-type relatives, suggesting that IGFALS haploinsufficiency could result in short stature. We have characterized IGFALS gene variants in idiopathic short stature (ISS) and in normal children, determining their impact on height and the IGF system. PATIENTS AND METHODS: In 188 normal and 79 ISS children levels of IGF-1, IGFBP-3, ALS, ternary complex formation (TCF) and IGFALS gene sequence were determined. RESULTS: In sum, 9 nonsynonymous or frameshift IGFALS variants (E35Gfs*17, G83S, L97F, R277H, P287L, A330D, R493H, A546V and R548W) were found in 10 ISS children and 6 variants (G170S, V239M, N276S, R277H, G506R and R548W) were found in 7 normal children. If ISS children were classified according to the ability for TCF enhanced by the addition of rhIGFBP-3 (TCF+), carriers of pathogenic IGFALS gene variants were shorter and presented lower levels of IGF-1, IGFBP-3 and ALS in comparison to carriers of benign variants. In ISS families, subjects carrying pathogenic variants were shorter and presented lower IGF-1, IGFBP-3 and ALS levels than noncarriers. CONCLUSIONS: These findings suggest that heterozygous IGFALS gene variants could be responsible for short stature in a subset of ISS children with diminished levels of IGF-1, IGFBP-3 and ALS.

Early manifestations in multiple-low-dose streptozotocin-induced diabetes in mice.

OBJECTIVE: Administration of multiple low doses of streptozotocin (mld-SZ) to mice results in the development of autoimmune diabetes. Hyperglycemia does not develop until a few days after the last injection. In this study, we explored immune-related alterations found in the very early stages of this diabetic syndrome and the capacity of mononuclear spleen cells (MSs) from mld-SZ mice to impair insulin secretion. METHODS: Mice injected with mld-SZ were used as an animal model of type 1 diabetes. MSs were isolated from control and mld-SZ mice at days 4, 6, 9, 12, and 16 after the first injection of the diabetogenic drug. MSs were transferred to normal syngeneic recipients or were cocultured with dispersed rat islet cells as an in vitro insulin secretion study. RESULTS: MSs from mld-SZ mice were able to diminish insulin secretion when transferred to normal syngeneic recipients and presented anti-beta-cell immune aggression when cocultured with dispersed rat islet cells as early as day 4 after mld-SZ administration. This capacity persisted throughout the experimental period. As early as 6 days after mld-SZ, islets showed insulitis followed by cell death with progressive severity. Hyperglycemia and diminished insulin secretion from perifused pancreatic islets only appeared at day 9 after mld-SZ. CONCLUSIONS: This study suggests that transferred or cocultured MSs from mld-SZ mice exert a functional immune aggression against beta cells at a very early stage, before donor mice develop impaired insulin secretion and hyperglycemia.

Glucagon secretion and alpha-cell sensitivity to somatostatin in genetically diabetic mice C57BL/KsJ-mdb

En estudios previos en ratones C57BL/ KsJ mdb/mdb, observamos alteraciones en la secreción de insulina inducida por glucosa, y un menor efecto inhibitorio de la somatostatina sobre la secreción de insulina. En el presente trabajo se estudiaron los patrones de secreción de glucagon bajo estimulación con arginina-glucosa, en perfusión de cortes de páncreas de ratones con diabetes genética de 20 a 90 días de vida. También se investigó si las células alfa presentaban una disminuida sensibilidad a la somatostatina. Los resultados muestran que: a) en ratones mdb/mdb de 20 a 90 días, los patrones de secreción de glucagon presentan hipersecreción basal y un primer pico disminuido; b) la somatostatina inhibe la secreción estimulada de glucagon por debajo de los valores basales en ratones mdb/mdb de 20 a 30 días de edad. En estadios posteriores (40 a 90 días de vida), la somatostatina ejerce un menor efecto inhibitorio, ya que los niveles de glucagon permanecen por en cima de los valores basales. Esto puede indicar un progresivo deterioro en la sensibilidad de las células alfa a la somatostatina, hecho que fue previamente observado para las células beta