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[Glycogenosis type III and Crohn disease with associated ankylopoietic spondylitis and secondary amyloidosis. An unusual coincidence].

We present a member of a family with glycogen deposit disease (GDD) type III (Forbes-Cori's disease) confirmed postmortem through enzymatic analysis of the hepatic and muscular tissues, coinciding with a Crohn's disease associated to ankylopoietic spondylitis, with final development of an extended secondary amiloidosis, all of these diagnosis established in life of the patient and verified in necropsy. We comment this rare finding, the absence of similar cases in the bibliography and the fortuitous nature of this association given the impossibility to suggest another relationship.

Adult↗

Fetal akinesia sequence caused by glycogenosis type VII.

We report on the autopsy study of a premature boy with multiple joint contractures who died soon after birth of severe lung hypoplasia. Muscle histology showed PAS-positive vacuoles, and electronmicroscopy revealed massive subsarcolemmal and intermyofibrillar accumulation of glycogen. Biochemical analysis of fresh-frozen muscle tissue disclosed increased glycogen content and a complete lack of phosphofructokinase (PFK) activity. The brain showed focal cerebral and diffuse cerebellar white matter gliosis, and patchy loss of internal granular and Purkinje cells in the cerebellar cortex. The spinal cord was normal. This report describes the first case of PFK deficiency, presenting as a lethal fetal akinesia sequence.

Abnormalities, Multiple↗

[Glycogenosis type II; acid alpha-glucosidase deficiency].

Knowledge of the general enzymology of lysosomal acid alpha-glucosidase (acid maltase) including that of the intracellular processing mechanism and of the cDNA sequence has advanced recently. Genetic heterogeneity of the mRNA of acid alpha-glucosidase deficient patients has also been reported. Referring to these recent advances, and based on our previously reported results, the pathologic aspects of the disease are reviewed. Heterogeneity of the enzyme molecules themselves and their characteristics in various tissues are also demonstrated.

Glucan 1,4-alpha-Glucosidase↗

Type II glycogenosis and thyroxine binding globulin deficiency in the same family.

An eight-member family is presented with two female members suffering from the juvenile form of acid maltase deficiency (AMD), the diagnosis confirmed by biochemical study of muscle. Biochemical leucocyte investigation revealed reduced a-glucosidase activity in both patients, a brother and the parents. Endocrinological study of the family disclosed reduced levels of thyroxine binding globulin (TBG) in the father and the three daughters. We consider the co-existence of AMD and TBG deficiency interesting, as thyroxine seems to play a role in the activation of acid maltase.

Adult↗

Glycogen storage disease in skeletal muscle. Morphological, ultrastructural and biochemical aspects in 10 cases.

We analyzed clinical, histological and biochemical findings in 10 patients with glycogen storage disease in skeletal muscle. Four patients were deficient in acid-alpha-glucosidase (Glycogenosis type II), three of them with late infantile onset and one patient adult form. Five patients, two of them siblings, were deficient in myophosphorylase (glycogenosis type V, McArdle's disease). One patient was a newborn with phosphofructokinase deficiency (glycogenosis type VII, Tarui's disease). Of the study of our cases we would like to outline the following features: in the glycogenosis type II the deposit is fundamentally intralysosomal in the late infantile form, storage of mucopolysaccharides and deposit in interstitial fibroblasts were found, while in the adult form glycogen storage is minimal. In the glycogenosis type V the storage of glycogen is free and of a small amount. In two patients we have observed enzymatic activity in regenerating fibres. In glycogenosis type VII the storage is free, of considerable quantity and the interstitial cells are also affected; no storage is observed in the satellite cells.

Adolescent↗

Effect of liver transplantation on hepatic glucose metabolism in a patient with type I glycogen storage disease.

BACKGROUND: In type I glycogenosis, mutation of the glucose-6-phosphatase gene results in absent glucose-6-phosphatase activity in liver cells leading to fasting hypoglycemia. Liver transplantation is expected to normalize glucose homeostasis. METHODS: Endogenous glucose production (6,6 2H2 glucose) was measured after an overnight fast and during exogenous 13C-labeled glycerol infusion in a patient with glycogenosis type I 24 months after liver transplantation and in a group of healthy subjects. RESULTS: Compared with healthy subjects, the glycogenosis patient had normal fasting glucose production and glucose and insulin concentrations after liver transplantation, but mildly elevated plasma glucagon concentrations. Gluconeogenesis from exogenous glycerol (13C glucose synthesis) was similar and did not lead to enhancement of glucose production in both healthy controls and the patient. CONCLUSIONS: Liver glucoregulatory function is restored by orthotopic liver transplantation in type I glycogenosis.

Adolescent↗

[Clinical aspects of hepatic glycogenoses].

Hepatic glycogenosis, heterogeneous in their type, appear in children as an hepatomegaly discovered during manifestations of hypoglycemia and/or growth disorders, sometimes in the course of a systematic physical examination. A usually late puberty determines a transient aggravation of the height insufficiency. Persistence of a marked hepatomegaly and the development of lever adenomas are characteristic of type I glycogenosis. There, the metabolic imbalance (hyperlipoproteinemia and hyperuricemia, especially), lead to severe vascular and renal complications. Haematologic and sometimes infectious disorders may be added. In type III glycogenosis, the danger depends less on the liver fibrosis, usually minimal, than on the frequently associated cardio-vascular involvement. Type VI glycogenosis, usually have a favorable course. Current therapeutic progresses and a better care should result in a marked improvement of the evolution in type I and probably type III.

Glycogen Storage Disease↗

[Molecular pathology of hepatic glycogen storage disease].

Recent advances of molecular analyses of hepatic glycogen storage diseases have made some progress in understanding of glycogen metabolism. Glucose-6-phosphatase has been shown to comprise at least five different polypeptides, the catalytic subunit, a regulatory Ca2+ binding protein, three transport proteins (glucose-6-phosphate, phosphate/pyrophosphate, glucose). A defect of these protein could cause type I glycogenosis. Only cDNAs of the regulatory Ca2+ binding protein and glucose transport protein were cloned. In type III glycogenosis, using monospecific antibody, correlation of biochemical defects with myopathy and cardiomyopathy was investigated. In type VI glycogenosis, the cDNA of liver phosphorylase was cloned, which will be useful for delineating the molecular defect involved in the disease and family analysis. In type VIII glycogenosis, phosphorylase kinase deficiency, only subunits of muscle type (alpha, beta, gamma, delta) were cloned and clonings of hepatic type subunits were waited. In the near feature, hepatic glycogen storage disease and glycogen metabolism were reevaluated from the points of molecular defects.

Cloning, Molecular↗

[Sequential cellular and molecular changes during hepatocarcinogenesis].

Oncogenic agents may hit at least four different types of target cells in the liver, namely the hepatocytes, the cholangiolar cells, the sinusoidal endothelial and the perisinusoidal cells. All of these cell types may give rise to neoplasms which develop from phenotypically altered preneoplastic cell populations via various intermediate stages to benign and/or malignant neoplasms. The manifestation of hepatocellular neoplasms induced by chemicals, radiation or viruses in different species including primates is regularly preceded by focal metabolic and morphological alterations which emerge in the liver parenchyma long before the neoplasms appear. The predominant sequence of metabolic changes leads from a focal excessive storage of glycogen (glycogenosis) through intermediate stages, in which the glycogenosis is frequently replaced by a lipidosis, to glycogen-poor hepatocellular carcinomas. The early hepatocellular glycogenosis is due to a disturbance in glycogen breakdown, which is associated with a dysfunction of signal transduction and glucose transport. During progression from the preneoplastic hepatocellular glycogenosis to glycogen-poor hepatocellular neoplasms a fundamental shift in carbohydrate metabolism takes place, gradually redirecting metabolites such as glucose-6-phosphate toward alternative metabolic pathways such as the pentose phosphate pathway and glycolysis. Studies on about 70 resected or explanted livers from patients bearing hepatocellular carcinomas or suffering from cirrhosis provided evidence for focal changes in glycogen metabolism similar to those observed in laboratory animals. An alternative sequence of cellular changes involving oncocytes and amphophilic cell populations rich in mitochondria and sometimes also peroxisomes has been observed in rats after administration of non-genotoxic hepatocarcinogens, particularly peroxisomal proliferators, and in woodchucks during hepadnaviral hepatocarcinogenesis. Our observations suggest fundamental changes in the cellular energy metabolism during hepatocarcinogenesis, which are most probably due to a disturbance in signal transduction pathways and may be causally linked to neoplastic cell conversion.

Animals↗

Human microsomal glucose-6-phosphatase system.

The discovery of glucose-6-phosphatase (EC 3.1.3.9) and of its physiological function in releasing glucose from the liver are discussed briefly. The identification by the Coris of glucose-6-phosphatase deficiency as the underlying defect in certain cases of glycogenosis (type I glycogenosis; von Gierke disease) is described. Characteristics of the catalyst, with a focus on its multiplicity of functions and multicomponent character, are considered with an emphasis on the human liver enzyme. Pioneering studies from the author's laboratory leading to the characterization of two variants of type I glycogenosis, types Ib and Ic, are described.

Glucose-6-Phosphatase↗