A Brazilian Rare-Disease Center's Experience with Glucosylsphingosine (lyso-Gb1) in Patients with Gaucher Disease: Exploring a Novel Correlation with IgG Levels in Plasma and a Biomarker Measurement in CSF.

Gaucher disease (GD, OMIM 230800) is one of the most common lysosomal disorders, being caused by the deficient activity of the enzyme acid ß-glucocerebrosidase (Gcase). Three clinical forms of Gaucher's disease (GD) are classified based on neurological involvement. Type 1 (GD1) is non-neuronopathic, while types 2 (GD2) and 3 (GD3) are neuronopathic forms. Gcase catalyzes the conversion of glucosylceramide (GlcCer) into ceramide and glucose. As GlcCer accumulates in lysosomal macrophages, it undergoes deacylation to become glycosylsphingosine (lyso-Gb1), which has shown to be a useful and reliable biomarker for the diagnosis and monitoring of treated and untreated patients with GD. Multiple myeloma (MM) is one of the leading causes of cancer-related death among patients with GD and monoclonal gammopathy of undetermined significance (MGUS) is a non-neoplastic condition that can be a telltale sign of a B clonal proliferation caused by the chronic activation of B cells. This study aimed to quantify Lyso-Gb1 levels in dried blood spots (DBS) and cerebrospinal fluid (CSF) as biomarkers for Gaucher disease (GD) and discuss the association of this biomarker with other clinical parameters. This is a mixed-methods study incorporating both cross-sectional and longitudinal elements within a cohort design with a convenience-sampling strategy. Data collection took place from January 2012 to March 2023. Lyso-Gb1 extraction from DBS involved the use of a methanol-acetonitrile-water mixture, followed by incubation and centrifugation. Analysis was performed using UPLC-MS/MS with MassLynx software version 4.2 and the control group for the DBS measurements included general newborns. CSF Lyso-Gb1 was extracted using ethyl acetate, analyzed by UPLC-MS/MS with a calibration curve, and expressed in pmol/L. Lysosomal activity in CSF was assessed by measuring chitotriosidase (Cht), and other lysosomal enzyme activities were assessed as previously described in the literature. Patients with metachromatic leukodystrophy (MLD) were used as controls. Thirty-two treated patients (twenty-nine GD1 and three GD3, all on ERT except for one GD type on SRT with eliglustat) and three untreated patients (one GD1, one GD2, and one GD3) were included. When analyzing only the treated GD1 group, a significant correlation was found between lyso-Gb1 and age (rho = -0.447, p = 0.001), ChT, and IgG levels (rho = 0.73, p < 0.001; and rho = 0.36, p = 0.03, respectively). Five GD1 patients (three females, mean age 40 years) also had their CSF collected and analyzed. The average measurement of lyso-Gb1 in CSF was 94 pmol/L (range: 57.1-157.9 pmol/L) versus <6.2 pmol/L in the control group (MLD). This is the first time, to the best of our knowledge, that lyso-Gb1 has been associated with IgG levels. While this finding reflects a risk for MGUS or MM and not only chronic plasma B-cell activation, it still requires further studies. Moreover, the analysis of CSF lyso-Gb1 levels in GD1 patients was demonstrated to be significantly higher than the control group. This raises the hypothesis that CSF lyso-Gb1 may serve as a valuable indicator for neurological involvement in GD, providing insights into the potential implications for neurological manifestations in GD, including GD1. The correlation between lyso-Gb1 and ChT levels in treated GD1 patients further underscores the interconnectedness of lysosomal markers and their relevance in monitoring.

Psychosine remodels model lipid membranes at neutral pH.

ß-Galactosylsphingosine or psychosine (PSY) is a single chain sphingolipid with a cationic group, which is degraded in the lysosome lumen by ß-galactosylceramidase during sphingolipid biosynthesis. A deficiency of this enzyme activity results in Krabbe's disease and PSY accumulation. This favors its escape to extralysosomal spaces, with its pH changing from acidic to neutral. We studied the interaction of PSY with model lipid membranes in neutral conditions, using phospholipid vesicles and monolayers as classical model systems, as well as a complex lipid mixture that mimics the lipid composition of myelin. At pH 7.4, when PSY is mainly neutral, it showed high surface activity, self-organizing into large structures, probably lamellar in nature, with a CMC of 38 ±â€¯3 µM. When integrated into phospholipid membranes, PSY showed preferential partition into disordered phases, shifting phase equilibrium. The presence of PSY reduces the compactness of the membrane, making it more easily compressible. It also induces lipid domain disruption in vesicles composed of the main myelin lipids. The surface electrostatics of lipid membranes was altered by PSY in a complex manner. A shift to positive zeta potential values evidenced its presence in the vesicles. Furthermore, the increase of surface potential and surface water structuring observed may be a consequence of its location at the interface of the positively charged layer. As Krabbe's disease is a demyelinating process, PSY alteration of the membrane phase state, lateral lipid distribution and surface electrostatics appears important to the understanding of myelin destabilization at the supramolecular level.

Krabbe disease: the importance of early diagnosis to prognosis / Doença de Krabbe: a importância do diagnóstico precoce para seu prognóstico

Krabbe disease (globoid cell leukodystrophy) is an inherited recessive autosomal leukodystrophy caused by deficiency of the enzyme galactocerebrosidase. The lack of this enzyme leads to the build-up of galactolipids that will promote the death of oligodendrocytes and the demyelination of the central and peripheral nervous systems. There are two clinical forms: early onset and late onset. This article reports a case of late onset Krabbe disease and discusses the importance of early diagnosis for its prognosis.

Doença de Krabbe (leucodistrofia de células globoides) é uma leucodistrofia de herança autossômica recessiva causada pela deficiência da enzima galactocerebrosidase. A falta dessa enzima leva ao acúmulo de galactolipídeos que irão promover a morte dos oligodendrócitos e a desmielinização do sistema nervoso central e periférico. Possui duas formas clínicas: de início precoce e de aparecimento tardio. O presente artigo relata um caso da apresentação tardia da doença de Krabbe e discute a importância do diagnóstico precoce para o seu prognóstico.

Confiabilidad y validez de la versión chilena de la Hare PCL-R / Chilean version of Hare PCL-R: a study of reliability and validity

Antecedentes. En Chile, al igual que en otros países latinoamericanos, diversas modificaciones judiciales y el interés de los profesionales en sistematizar sus métodos de evaluación en psicopatía promovieron la traducción, adaptación y revisión de las propiedades psicométricas de la Hare Psychopathy Checklist Revised (PCL-R). Objetivo. Evaluar aspectos de la confiabilidad y validez de la versión chilena del PCL-R en población forense masculina chilena. Material y métodos. Se realizó traducción y retrotraducción de la escala con la autorización del autor y editorial; se constituyó una muestra de 293 sujetos varones penados que aceptaron participar en la investigación. Entre otros análisis, se contrastó el diagnóstico obtenido a ciegas con la PCL-R con el aportado por el equipo técnico de Gendarmería de Chile. Resultados. La congruencia interna medida con Alfa de Cronbach fue la siguiente: total =0,91; F1= 0,86; F2 = 0,87; F3 = 0,67; F4= 0,77. Valor Kappa ambos tipos de evaluaciones = 0,804; p < 0,001. Se obtuvo significativa asociación entre condición psicópata y reincidente (OR = 12,8; 95 % IC = 5; 33). El análisis factorial confirmatorio resultó compatible con el modelo de cuatro factores. Conclusión. Los resultados orientan a sostener la validez de la versión chilena de la PCL-R y la solución de cuatro factores para el constructo de Psicopatía medido con el instrumento.