The first Molecular genetics analysis of individuals suffering from nephropatic cystinosis in the Southwestern Iran
Primer análisis genético molecular en personas que padecen cistinosis nefropática en el sudoeste de Irán
Sepideh Shahkaramia, sepideh shahkaramia, Hamid Galehdarib, hamid Galehdaric, Ali Ahmadzadeha, ali ahmadzadeha, Mahnaz Babaahmadid, Mahnaz Babaahmadid, Mohammad Pedrama, Mohammad Pedrama
a Research Center for Thalassemia and Hemoglobinopathy, Jondishapour University of Medical Sciences, Ahvaz, Iran,
b Department of Genetics, Faculty of Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran,
c Department of Genetics, Faculty of Sciences, Shahid Chamran University of Ahvaz, ahvaz, Iran,
d Toxicology Research Center, Jondishapour University of Medical Sciences, Ahvaz, Iran,
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"identificador" => "affa" ] ] ] 9 => array:3 [ "nombre" => "Mohammad" "apellidos" => "Pedram" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => " Research Center for Thalassemia and Hemoglobinopathy, Jondishapour University of Medical Sciences, Ahvaz, Iran, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Department of Genetics, Faculty of Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Department of Genetics, Faculty of Sciences, Shahid Chamran University of Ahvaz, ahvaz, Iran, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => " Toxicology Research Center, Jondishapour University of Medical Sciences, Ahvaz, Iran, " "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Primer análisis genético molecular en personas que padecen cistinosis nefropática en el sudoeste de Irán" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11558_16025_36022_en_t111558i.jpg" "Alto" => 1965 "Ancho" => 2161 "Tamanyo" => 917989 ] ] "descripcion" => array:1 [ "en" => "Clinical findings in patients with cystinosis" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Cystinosis is a rare autosomal recessive metabolic disorder with an incidence rate of 1 per 100,000-200,000 of the world population.<span class="elsevierStyleSup">1</span> No official statistics has been released on the incidence of cystinosis in Iran; however, according to an extrapolated statistics, a frequency of 1 per 130,000 has been estimated in the Middle East. The disease is characterized by increasing levels of intracellular cystine in leucocytes and first described by Schneider et al, in 1960s, as a lysosomal storage disorder.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Cystinosis is classified into three clinical forms according to the age of onset and severity. The most severe form is called ‘infantile’ or ‘nephropatic’ cystinosis, which results in poor growth and kidney complications in infants, known as renal Fanconi syndrome.<span class="elsevierStyleSup">3</span> The two less severe variants are ‘intermediate’ or ‘juvenile’ form with milder renal manifestations and ‘ocular’ or ‘adult’ form without affecting the kidneys.<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">Nephropatic form patients are usually asymptomatic at the time of birth, but they demonstrate symptoms such as acidosis, vomiting, dehydration, hypophosphatemic rickets, and poor growth at the age of 6-12 months.<span class="elsevierStyleSup">1,3</span> Administration of cysteamine in form of oral medication or eye drops, which helps to deplete cystine from lysosomes, along with renal transplantation has a dramatic effect on ameliorating the disease.<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">The three types of cystinosis are actually caused by the accumulation of crystal form cystine in lysosomes and impaired cystine export from lysosome to cytosol as a result of the absence or dysfunction in cystine transporter protein, the cystinosin. Cystinosin is a protein with 367 amino acid and 7 transmembrane domains, which is primarily expressed in lysosomal membrane.<span class="elsevierStyleSup">6,7</span> This protein is encoded by the <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene locating on the 17p13.<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">Some available evidences point to the <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> as the only gene, which is responsible for clinical manifestations of the disease. To date, more than 90 various mutations have been described in different parts of the <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span><span class="elsevierStyleItalic"> </span>gene including exons, splicing sites and the gene promoter.<span class="elsevierStyleSup">9,10</span> It is probable that some disease-causing mutations occur more frequently in certain geographic regions. For instance, a 57kb deletion has been reported as the most common mutation in northern parts of Europe.<span class="elsevierStyleSup">10</span> Moreover, a relatively large set of pathogenic point mutations, deletions, and insertions have been defined as the molecular genetics cause of the disease,<span class="elsevierStyleSup">9</span> however, little is known about the mutation spectrum of the <span class="elsevierStyleItalic">CTNS</span> gene in the Middle East, especially in Iran. The only accessible data of Iranian NC patients are three ‘clinical’ reports.<span class="elsevierStyleSup">11-13</span></p><p class="elsevierStylePara">Accordingly, the aim of this investigation was to screen the mutations of <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span><span class="elsevierStyleItalic"> </span>gene and its promoter in a number of Iranian patients with Nephropatic Cystinosis.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleBold"> </span></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleBold">METHODOLOGY</span></span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleBold">Patient’s history</span></span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Twenty-five individuals (14 males and 11 females) were collected from 24 unrelated families with age range of 7 month to 11 year old. The patients were from Arabian and Persian ethnic groups of Iran. We should mention here that one patient (P11) came of a family with cross-marriages between Arabian and Persian parents. Twenty of patients (80%) were from first cousin parents, three cases (12%) from second cousin parents, and two (8%) from a non-consanguineous marriage. Patients with the following criteria were considered as cases of cystinosis: i) signs and symptoms of Fanconi syndrome and ii) Presence of cystine crystals in cornea using slit lamp. The most common clinical features in the patients were growth retardation (100%), presence of cystine crystal in cornea (100%), rickets (88%) and polyuria-polydipsia (84%). The most frequent laboratory data were glucosuria (100%), renal tubular acidosis (96%), proteinuria (88%) and hyposthenuria (84%) (Table 1).</p><p class="elsevierStylePara">After obtaining the informed consent of all voluntary families, blood samples were collected from individuals with Nephropatic Cystinosis and their parents who were attending Abuzar Paediatrics Hospital of Jondi Shapour Medical Science University of Ahvaz (southwestern Iran).</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleBold">Molecular genetic analysis</span></span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Genomic DNA was extracted from EDTA-anticoagulated samples by standard procedures. Initially, the genomic DNA of the patients were screened for the most common large 57kb deletion as has been described previously.<span class="elsevierStyleSup">14</span></p><p class="elsevierStylePara">The polymerase chain reaction (PCR) was carried out by a set of self- designed primers using primer3out software (www.primer3out.com) for exons 3-12. The primer sequences are available by request. The promoter region of the <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene was amplified with previously reported primer pair.<span class="elsevierStyleSup">15</span> Direct sequencing of the PCR products were carried out using ABI automated sequencer 3700 in accordance with the manufacture’s instruction.  Sequence analysis was performed with chromas software and NCBI-Blast.</p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleBold"> </span></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleBold">RESULTS</span></span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">GAP-PCR was carried out in all samples to detect the 57kb deletion in <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene. None of the NC patients showed mentioned large deletion in homozygous or heterozygous status. It means that all of patients present the 266 bp fragment which is related to D17S829 marker; therefore the 423 bp specific fragment was not detected because this fragment is only generated in the case of deletion.</p><p class="elsevierStylePara">Direct sequencing of the entire gene demonstrated pathogenic mutations in 14 patients. Two patients were compound heterozygous for the c.1017G<span class="elsevierStyleBold"><span class="elsevierStyleBold">></span></span>A (leading to the G339R amino acid exchange) and the 681G>A mutation, which leads to an<span class="elsevierStyleBold"><span class="elsevierStyleBold"> </span></span>aberrant splice site. Nine other patients were homozygous for the 681G>A mutation. One patient was homozygous for an unreported insertion of two nucleotides (CT), which we term as ‘c.153-155insCT’ (Figure 1).</p><p class="elsevierStylePara">Accordingly, it is obvious that parents were heterozygous for that mutation. Furthermore, two other patients showed the second novel mutation c.923G>A in this study (Figure 2).</p><p class="elsevierStylePara">No mutation was observed in the remaining cases.<span class="elsevierStyleSup">11</span> A summary of all identified mutations were depicted in Table 2.</p><p class="elsevierStylePara">In addition, a number of SNPs were found in coding exons and promoter region of the <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene (Table 3). Also we have identified an unreported SNP in the <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene promoter in one patient and her healthy brother. Both children were heterozygous for the SNP at position -3779 (C>T) prior to the starting of nucleotide at position +1.</p><p class="elsevierStylePara">A total of 98 healthy non-related individuals (55 and 43 with Arabian and Persian background, respectively) were screened for the two novel mutations found in the survey. None of healthy samples were carrier of mentioned changes on genomic level.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleBold">DISCUSSION</span></span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">In current study, we investigated 25 patients from 24 unrelated families in the southwest of Iran, a region with plenty of diverse ethnic groups and mixed population, which is characterized by the vast range of consanguineous marriage. According to the previous report, the overall rate of consanguineous marriage in Iran is 38.6%, while, first cousin marriages (27.9%) is the most common form. Interestingly, significant differences were reported in prevalence and patterns of consanguinity, among ethnic/religious populations and geographical regions within the same ethnic groups.<span class="elsevierStyleSup">16</span> </p><p class="elsevierStylePara">Initially, we searched for the 57kb deletion encompassing <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene causative for fully disrupted gene function. The deletion breakpoints of this deletion extend from within exon 10 of <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene and an adjacent upstream region (in <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CARKL/SHPK</span></span><span class="elsevierStyleItalic"> </span>genes).<span class="elsevierStyleSup">17</span> None of investigated individuals showed the mentioned deletion. Moreover, recent reports from Saudi Arabia and our neighboring country, Turkey, confirm the lack of this deletional mutation in cystinosis patients as well.<span class="elsevierStyleSup">18,19</span> Therefore, we suggest the possibility of the absence of 57kb deletion in Middle East, at least in Iranian cystinosis patients. This large deletion seems to be specific to European population.<span class="elsevierStyleSup">20</span> It is evident that the occurrence of the 57kb deletion is associated with the most severe form of cystinosis.<span class="elsevierStyleSup">21,22</span> Recently, Freed et al. have demonstrated the extension of this deletion even into <span class="elsevierStyleItalic">TRPV1</span> gene which leads to the transcription dysregulation in peripheral blood mononuclear cells isolated from cystinosis patients. It can be speculated that the involvement of <span class="elsevierStyleItalic">TRPV1</span>gene may have consequences in cystinosis pathophysiology.<span class="elsevierStyleSup">17</span> Accordingly, and because of <span class="elsevierStyleItalic">CARKL</span> gene removing in the mutation and its impaired role in phosphorylation of sedoheptolose -that presumably will effects on the cell redox system-, we postulate that 57kb deletion positive patients may have different clinical presentation in comparison with deletion negative individuals including the present study subjects. However, a large number of cystinosis patients should be investigated in both phenotypic and genotypic assays to confirm this hypothesis.</p><p class="elsevierStylePara">The outstanding outcome of this study is identification of two novel mutations in <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene, as well as a novel SNP in promoter of the gene. One patient and her healthy brother showed the same changes in the gene promoter. These findings lead us toward this hypothesis that mentioned SNP might have no effect on the gene expression. Further studies could clarify our supposition.</p><p class="elsevierStylePara">However, one of the novel detected mutations is c.153-155insCT, which creates a premature stop codon at codon 56 that leads to the production of a truncated form of cystinosin. This mutation was only observed in a 17-month-old sample with Persian background, but not in any individuals coming from Arabian families. Therefore, we speculate that the stated mutation may occur frequently in other regions of Iran with unmixed ethnicities.</p><p class="elsevierStylePara">The second novel mutation, c.923G>A, was detected only in two individuals with Arabian background; one was homozygous and the other one was compound heterozygous for the mutation (Table 2).</p><p class="elsevierStylePara">Interestingly, Kiehntopf, Shotelersuk and their colleagues have heretofore reported two missense mutations at the same codon of 308 in exon 11 of <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span>gene, in accordance with our findings.<span class="elsevierStyleSup">23,24</span> Kiehntopf reported a transversion of G>T at this codon that results in the amino acid exchange of Glycine to valine.<span class="elsevierStyleSup">23</span> Shotelersuk et al. found a missense mutation of‘c.922GGG>AGG’, which substitutes Glycin by Arginine.<span class="elsevierStyleSup">24</span> Here, we found a transitional mutation G>A, with the same consequence regarding the amino acid level (Figure 3). Hence, the novelty is on the altered nucleotide and amino acid, but not on the position of amino acid.</p><p class="elsevierStylePara">One patient was homozygous for the mutation c.18-21delGACT, which most likely occurs in European population.<span class="elsevierStyleSup">23</span> It is wondering that the most common mutation in present study is the 681G>A, which has recently been reported from cystinosis affected individuals of Saudi Arabia.<span class="elsevierStyleSup">18</span> Therefore, migration and/or ethnicity could be the explanation for occurrence of related mutations in Iran and Saudi Arabia, leading to the concept of possible founder mutations in Middle East. Nevertheless, this suggestion has to be verified in a larger sample size.</p><p class="elsevierStylePara">Furthermore, we could not find any mutation in 44% (n=11) of our subjects, this is in consistence with a number of previous mutation surveys which revealed no apparent mutation in the <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene in some cystinosis patients.<span class="elsevierStyleSup">16,24-26</span> Regarding to the heterogeneous population structure in the southwestern Iran, probability of mutation diversity among Iranian cystinotic patients is expected in comparison to other populations. This diversity will be reflecting in possible existence of other forms of the <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene mutations like splice site mutations in our individuals. This kind of mutation is not detectable by DNA analysis, exclusively. Therefore, it is likely that a remarkable number of cases in the present study need to be analyzed on the RNA level.</p><p class="elsevierStylePara">In the case of observing no mutation in patients’ mRNA in future supplementary studies and considering the uncertified role of <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span><span class="elsevierStyleItalic"> </span>as the only gene related to the disease, it could be postulated that other unknown mechanisms might be involved in the pathogenesis of the nephropatic cystinosis at least in Iranian patients.</p><p class="elsevierStylePara">Nevertheless, the present data extend the mutation spectrum of the <span class="elsevierStyleItalic"><span class="elsevierStyleItalic">CTNS</span></span> gene in NC patients and could be basically used for the prenatal or preimplatation genetic diagnosis in the region. One of the most important causes of the increased rate of rare autosomal recessive disorders like cystinosis in Iran is the relatively large number of consanguineous marriages. Therefore, to prevent and/or limit these inheritable diseases, genetic counseling before marriage, prenatal diagnosis in carriers and also in suspicious families is suggested.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Acknowledgment</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic"> </span></span></p><p class="elsevierStylePara">We thank the deputy research center of Ahvaz medical School of Jundishapur University and Research center of thalassemia and hemoglobinopathies of Ahvaz medical School of Jundishapur University for supporting this work.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors declare that there is no conflict of interest associated with this manuscript.</p><p class="elsevierStylePara"><a href="grande/11558_16025_36022_en_t111558i.jpg" class="elsevierStyleCrossRefs"><img src="11558_16025_36022_en_t111558i.jpg" alt="Clinical findings in patients with cystinosis"></img></a></p><p class="elsevierStylePara">Table 1. Clinical findings in patients with cystinosis</p><p class="elsevierStylePara"><a href="grande/11558_16025_36023_en_t211558i.jpg" class="elsevierStyleCrossRefs"><img src="11558_16025_36023_en_t211558i.jpg" alt="Patients with CTNS gene mutation"></img></a></p><p class="elsevierStylePara">Table 2. Patients with CTNS gene mutation</p><p class="elsevierStylePara"><a href="grande/11558_16025_36024_en_t311558i.jpg" class="elsevierStyleCrossRefs"><img src="11558_16025_36024_en_t311558i.jpg" alt="Summary of all detected SNP’s in the individuals being diagnosed with NC"></img></a></p><p class="elsevierStylePara">Table 3. Summary of all detected SNP’s in the individuals being diagnosed with NC</p><p class="elsevierStylePara"><a href="grande/11558_16025_36025_en_f111558i.jpg" class="elsevierStyleCrossRefs"><img src="11558_16025_36025_en_f111558i.jpg" alt="Autoradiogram"></img></a></p><p class="elsevierStylePara">Figure 1. Autoradiogram</p><p class="elsevierStylePara"><a href="grande/11558_16025_36026_en_f211558i.jpg" class="elsevierStyleCrossRefs"><img src="11558_16025_36026_en_f211558i.jpg" alt="Autoradiogram"></img></a></p><p class="elsevierStylePara">Figure 2. Autoradiogram</p><p class="elsevierStylePara"><a href="grande/11558_16025_36027_en_f311558i.jpg" class="elsevierStyleCrossRefs"><img src="11558_16025_36027_en_f311558i.jpg" alt="The amino acid and DNA sequencing of exon 11"></img></a></p><p class="elsevierStylePara">Figure 3. The amino acid and DNA sequencing of exon 11</p>" "pdfFichero" => "P1-E550-S4065-A11558-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436011" "palabras" => array:1 [ 0 => "Molecular characterization" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436013" "palabras" => array:1 [ 0 => "Nephropatic cystinosis" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436015" "palabras" => array:1 [ 0 => "CTNS gene" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436017" "palabras" => array:1 [ 0 => "Iranian" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436019" "palabras" => array:1 [ 0 => "Novel mutation" ] ] ] "es" => array:5 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436012" "palabras" => array:1 [ 0 => "Cistinosis nefropática" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436014" "palabras" => array:1 [ 0 => "Gen CTNS" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436016" "palabras" => array:1 [ 0 => "Paciente iraní" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436018" "palabras" => array:1 [ 0 => "Mutación no descrita" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436020" "palabras" => array:1 [ 0 => "Determinación molecular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Objetivos:</span> La cistinosis nefropática (CN) es una rara enfermedad metabólica que se debe a la mutación del gen <span class="elsevierStyleItalic">CNTS</span>, para que el que ya se han registrado más de 90 mutaciones diferentes. El estudio se realizó para investigar las mutaciones del gen <span class="elsevierStyleItalic">CTNS </span>y su promotor en un determinado número de pacientes iraníes con CN.<span class="elsevierStyleBold"> Métodos:</span> Para la determinación molecular del gen <span class="elsevierStyleItalic">CTNS </span>en 25 pacientes con CN procedentes de 24 familias iraníes no emparentadas, se han llevado a cabo análisis con reacción en cadena de la polimerasa y con secuenciación directa.<span class="elsevierStyleBold"> Resultados:</span> Ninguno de los pacientes mostró deleción de 57-kb ni heterocigócita ni homocigótica. Uno resultó homocigoto para una mutación no descrita que se denominó «c.153-155insCT», mientras que otro de los casos resultó homocigoto y otro heterocigoto compuesto para una segunda mutación no descrita, c.923G>A. Además, se detectaron otras tres mutaciones conocidas c.18–21delGACT, c.1017G<span class="elsevierStyleBold">></span>A y c.681G>A en 11 pacientes. En el resto de los pacientes (44 %, n = 11) no se observaron mutaciones aparentes.<span class="elsevierStyleBold"> Conclusión:</span> Los datos de este estudio muestran un fundamento para la detección de transportadores moleculares y el diagnóstico prenatal de un porcentaje relativamente elevado de pacientes iraníes que sufren CN, al menos en el sudoeste de Irán, donde la etnia árabe es una de las comunes en la región.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Objective:</span> Nephropatic Cystinosis (NC) is a rare metabolic disorder due to mutation in the<span class="elsevierStyleItalic"><span class="elsevierStyleItalic"> </span></span><span class="elsevierStyleItalic">CTNS</span><span class="elsevierStyleItalic"> </span>gene in which more than 90 different mutations have already been reported so far. This study was performed to investigate mutations of the <span class="elsevierStyleItalic">CTNS</span><span class="elsevierStyleItalic"> </span>gene and its promoter in a number of Iranian patients with NC. <span class="elsevierStyleBold">Methods:</span> Polymerase chain reaction and direct sequencing were performed for molecular characterization of the <span class="elsevierStyleItalic">CTNS</span><span class="elsevierStyleItalic"> </span>gene in 25 patients from 24 unrelated Iranian families with NC. <span class="elsevierStyleBold">Results:</span> None of the patients showed the 57kb deletion in heterozygous or homozygous manner. One was homozygous for a novel mutation, which was termed as ‘c.153-155insCT’, while one of the cases was homozygous and another was compound heterozygous for the second novel mutation c.923G>A. Moreover three known mutations c.18–21delGACT, c.1017G<span class="elsevierStyleBold">></span>A, and c.681G>A in 11 of the patients were detected. No apparent mutation was observed in the rest of patients (44%, n=11). <span class="elsevierStyleBold">Conclusion:</span> The present data exhibit a fundament for molecular carrier detection and prenatal diagnosis of a relatively large percentage of Iranian patients suffering from NC, at least in the Southwestern Iran, where Arab ethnicity is one of the common ethnicities of the region.</p> <p class="elsevierStylePara"><span class="elsevierStyleBold"> </span></p>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11558_16025_36022_en_t111558i.jpg" "Alto" => 1965 "Ancho" => 2161 "Tamanyo" => 917989 ] ] "descripcion" => array:1 [ "en" => "Clinical findings in patients with cystinosis" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11558_16025_36023_en_t211558i.jpg" "Alto" => 1824 "Ancho" => 2169 "Tamanyo" => 823718 ] ] "descripcion" => array:1 [ "en" => "Patients with CTNS gene mutation" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11558_16025_36024_en_t311558i.jpg" "Alto" => 2359 "Ancho" => 2164 "Tamanyo" => 1188157 ] ] "descripcion" => array:1 [ "en" => "Summary of all detected SNP’s in the individuals being diagnosed with NC" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11558_16025_36025_en_f111558i.jpg" "Alto" => 457 "Ancho" => 1018 "Tamanyo" => 124043 ] ] "descripcion" => array:1 [ "en" => "Autoradiogram" ] ] 4 => array:8 [ "identificador" => "fig5" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11558_16025_36026_en_f211558i.jpg" "Alto" => 458 "Ancho" => 1002 "Tamanyo" => 115204 ] ] "descripcion" => array:1 [ "en" => "Autoradiogram" ] ] 5 => array:8 [ "identificador" => "fig6" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11558_16025_36027_en_f311558i.jpg" "Alto" => 1457 "Ancho" => 2099 "Tamanyo" => 264744 ] ] "descripcion" => array:1 [ "en" => "The amino acid and DNA sequencing of exon 11" ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003300000003/v0_201502091549/X2013251413003252/v0_201502091549/en/main.assets" "Apartado" => array:4 [ "identificador" => "35441" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003300000003/v0_201502091549/X2013251413003252/v0_201502091549/en/P1-E550-S4065-A11558-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413003252?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 8 | 16 |
| 2024 October | 51 | 42 | 93 |
| 2024 September | 57 | 31 | 88 |
| 2024 August | 59 | 46 | 105 |
| 2024 July | 44 | 26 | 70 |
| 2024 June | 64 | 42 | 106 |
| 2024 May | 56 | 32 | 88 |
| 2024 April | 57 | 44 | 101 |
| 2024 March | 42 | 24 | 66 |
| 2024 February | 35 | 36 | 71 |
| 2024 January | 33 | 20 | 53 |
| 2023 December | 34 | 26 | 60 |
| 2023 November | 42 | 31 | 73 |
| 2023 October | 70 | 29 | 99 |
| 2023 September | 72 | 32 | 104 |
| 2023 August | 102 | 38 | 140 |
| 2023 July | 45 | 30 | 75 |
| 2023 June | 38 | 28 | 66 |
| 2023 May | 52 | 36 | 88 |
| 2023 April | 34 | 45 | 79 |
| 2023 March | 52 | 14 | 66 |
| 2023 February | 40 | 22 | 62 |
| 2023 January | 37 | 25 | 62 |
| 2022 December | 64 | 27 | 91 |
| 2022 November | 51 | 36 | 87 |
| 2022 October | 71 | 44 | 115 |
| 2022 September | 37 | 22 | 59 |
| 2022 August | 46 | 40 | 86 |
| 2022 July | 22 | 112 | 134 |
| 2022 June | 35 | 33 | 68 |
| 2022 May | 39 | 37 | 76 |
| 2022 April | 36 | 58 | 94 |
| 2022 March | 61 | 58 | 119 |
| 2022 February | 35 | 32 | 67 |
| 2022 January | 42 | 32 | 74 |
| 2021 December | 40 | 41 | 81 |
| 2021 November | 25 | 33 | 58 |
| 2021 October | 43 | 43 | 86 |
| 2021 September | 44 | 42 | 86 |
| 2021 August | 54 | 32 | 86 |
| 2021 July | 86 | 34 | 120 |
| 2021 June | 49 | 29 | 78 |
| 2021 May | 49 | 37 | 86 |
| 2021 April | 86 | 35 | 121 |
| 2021 March | 58 | 42 | 100 |
| 2021 February | 33 | 21 | 54 |
| 2021 January | 38 | 17 | 55 |
| 2020 December | 23 | 16 | 39 |
| 2020 November | 37 | 16 | 53 |
| 2020 October | 32 | 14 | 46 |
| 2020 September | 18 | 7 | 25 |
| 2020 August | 42 | 9 | 51 |
| 2020 July | 32 | 12 | 44 |
| 2020 June | 30 | 26 | 56 |
| 2020 May | 50 | 12 | 62 |
| 2020 April | 30 | 15 | 45 |
| 2020 March | 38 | 13 | 51 |
| 2020 February | 47 | 17 | 64 |
| 2020 January | 39 | 24 | 63 |
| 2019 December | 54 | 20 | 74 |
| 2019 November | 31 | 30 | 61 |
| 2019 October | 21 | 13 | 34 |
| 2019 September | 28 | 17 | 45 |
| 2019 August | 20 | 18 | 38 |
| 2019 July | 35 | 26 | 61 |
| 2019 June | 15 | 11 | 26 |
| 2019 May | 29 | 22 | 51 |
| 2019 April | 37 | 56 | 93 |
| 2019 March | 33 | 24 | 57 |
| 2019 February | 26 | 14 | 40 |
| 2019 January | 27 | 22 | 49 |
| 2018 December | 75 | 38 | 113 |
| 2018 November | 137 | 26 | 163 |
| 2018 October | 75 | 13 | 88 |
| 2018 September | 63 | 23 | 86 |
| 2018 August | 46 | 22 | 68 |
| 2018 July | 55 | 19 | 74 |
| 2018 June | 48 | 14 | 62 |
| 2018 May | 48 | 14 | 62 |
| 2018 April | 58 | 9 | 67 |
| 2018 March | 67 | 8 | 75 |
| 2018 February | 45 | 7 | 52 |
| 2018 January | 49 | 8 | 57 |
| 2017 December | 52 | 11 | 63 |
| 2017 November | 53 | 13 | 66 |
| 2017 October | 41 | 7 | 48 |
| 2017 September | 44 | 11 | 55 |
| 2017 August | 36 | 16 | 52 |
| 2017 July | 38 | 16 | 54 |
| 2017 June | 44 | 10 | 54 |
| 2017 May | 40 | 17 | 57 |
| 2017 April | 48 | 13 | 61 |
| 2017 March | 32 | 34 | 66 |
| 2017 February | 47 | 16 | 63 |
| 2017 January | 35 | 15 | 50 |
| 2016 December | 61 | 19 | 80 |
| 2016 November | 73 | 9 | 82 |
| 2016 October | 127 | 21 | 148 |
| 2016 September | 166 | 2 | 168 |
| 2016 August | 234 | 10 | 244 |
| 2016 July | 204 | 9 | 213 |
| 2016 June | 142 | 0 | 142 |
| 2016 May | 134 | 0 | 134 |
| 2016 April | 89 | 0 | 89 |
| 2016 March | 84 | 0 | 84 |
| 2016 February | 117 | 0 | 117 |
| 2016 January | 106 | 0 | 106 |
| 2015 December | 134 | 0 | 134 |
| 2015 November | 86 | 0 | 86 |
| 2015 October | 84 | 0 | 84 |
| 2015 September | 79 | 0 | 79 |
| 2015 August | 84 | 0 | 84 |
| 2015 July | 66 | 0 | 66 |
| 2015 June | 49 | 0 | 49 |
| 2015 May | 48 | 0 | 48 |
| 2015 April | 5 | 0 | 5 |
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