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Niemann-Pick Type C-2 Disease: Identification by Analysis of Plasma Cholestane-3β,5α,6β-Triol and Further Insight into the Clinical Phenotype

  • J. Reunert
  • A. S. Lotz-Havla
  • G. Polo
  • F. Kannenberg
  • M. Fobker
  • M. Griese
  • E. Mengel
  • A. C. Muntau
  • P. Schnabel
  • O. Sommerburg
  • I. Borggraefe
  • A. Dardis
  • A. P. Burlina
  • M. A. Mall
  • G. Ciana
  • B. Bembi
  • A. B. Burlina
  • T. MarquardtEmail author
Research Report
Part of the JIMD Reports book series (JIMD, volume 23)

Abstract

Introduction: Niemann-Pick type C disease is a rare disorder caused by impaired intracellular lipid transport due to mutations in either the NPC1 or the NPC2 gene. Ninety-five % of NPC patients show mutations in the NPC1 gene. A much smaller number of patients suffer from NPC2 disease and present respiratory failure as one of the most frequent symptoms. Several plasma oxysterols are highly elevated in NPC1 and can be used as a biomarker in the diagnosis of NPC1.

Methods: Plasma cholestane-3β,5α,6β-triol was evaluated as biomarker for NPC2 by GC/MS and LC-MS/MS analysis. The diagnosis was confirmed by Sanger sequencing and filipin staining.

Results: We report three NPC2 patients with typical respiratory problems and a detailed description of the nature of the lung disease in one of them. All patients had elevated levels of plasma cholestane-3β,5α,6β-triol. In two of these patients, the positive oxysterol result led to a rapid diagnosis of NPC2 by genetic analysis. The phenotype of the third patient has been described previously. In this patient a cholestane-3β,5α,6β-triol concentration markedly above the reference range was found.

Conclusions: Measurement of plasma cholestane-3β,5α,6β-triol enables to discriminate between controls and NPC1 and NPC2 patients, making it a valuable biomarker for the rapid diagnosis not only for NPC1 but also for NPC2 disease.

The measurement of oxysterols should be well kept in mind in the differential diagnosis of lysosomal diseases, as the elevation of oxysterols in plasma may speed up the diagnosis of NPC1 and NPC2.

Keywords

Cholestane-3β,5α,6β-triol Niemann-Pick type C disease NPC2 Oxysterols Pulmonary alveolar proteinosis 

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Copyright information

© SSIEM and Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • J. Reunert
    • 1
  • A. S. Lotz-Havla
    • 2
  • G. Polo
    • 3
  • F. Kannenberg
    • 4
  • M. Fobker
    • 4
  • M. Griese
    • 5
  • E. Mengel
    • 6
  • A. C. Muntau
    • 2
  • P. Schnabel
    • 7
    • 11
  • O. Sommerburg
    • 8
    • 11
  • I. Borggraefe
    • 2
  • A. Dardis
    • 9
  • A. P. Burlina
    • 10
  • M. A. Mall
    • 8
    • 11
  • G. Ciana
    • 9
  • B. Bembi
    • 9
  • A. B. Burlina
    • 3
  • T. Marquardt
    • 1
    Email author
  1. 1.Department of PediatricsUniversity Hospital of MuensterMuensterGermany
  2. 2.Dr. von Hauner Children’s HospitalLudwig Maximilians UniversityMunichGermany
  3. 3.Division of Metabolic Diseases, Department of Woman and Child HealthUniversity Hospital of PaduaPaduaItaly
  4. 4.Center of Laboratory MedicineUniversity Hospital of MuensterMuensterGermany
  5. 5.Pediatric Pulmonology, Dr. von Hauner Children’s HospitalLudwig Maximilians University, Member of the German Center for Lung Research (DZL)MunichGermany
  6. 6.Villa Metabolica, Center for Pediatric and Adolescent MedicineUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
  7. 7.Department of General PathologyUniversity Hospital of HeidelbergHeidelbergGermany
  8. 8.Department of Translational Pulmonology and Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis CenterUniversity of HeidelbergHeidelbergGermany
  9. 9.Regional Coordinator Centre for Rare DiseasesUniversity Hospital Santa Maria della MisericordiaUdineItaly
  10. 10.Neurological Unit, St. Bassiano HospitalBassano del GrappaItaly
  11. 11.Translational Lung Research Center Heidelberg (TLRC), Member of German Center for Lung Research (DZL)University of HeidelbergHeidelbergGermany

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