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Observational Study
. 2019 Jul 11;20(1):123.
doi: 10.1186/s12881-019-0857-0.

Oxysterol/chitotriosidase based selective screening for Niemann-Pick type C in infantile cholestasis syndrome patients

Anna V Degtyareva  1   2 , Tatiana Y Proshlyakova  3 , Marina S Gautier  1 , Dmitry N Degtyarev  1   2 , Elena A Kamenets  3 , Galina V Baydakova  3 , Denis V Rebrikov  4   5 , Ekaterina Y Zakharova  3
Affiliations
Observational Study

Oxysterol/chitotriosidase based selective screening for Niemann-Pick type C in infantile cholestasis syndrome patients

Anna V Degtyareva et al. BMC Med Genet. .

Abstract

Background: Niemann-Pick disease type C (NP-C) is an inherited neurodegenerative disease (1 per 100 000 newborns) caused by NPC proteins impairment that leads to unesterified cholesterol accumulation in late endosomal/lysosomal compartments. To date the NP-C diagnostics is usually based on cholesterol detection in fibroblasts using an invasive and time-consuming Filipin staining and we need more arguments to widely introduce oxysterols as a biomarkers in NP-C.

Methods: Insofar as NP-C represents about 8% of all infant cholestases, in this prospective observational study we tried to re-assess the specificity plasma oxysterol and chitotriosidase as a biochemical screening markers of NP-C in children with cholestasis syndrome of unknown origin. For 108 patients (aged from 2 weeks to 7 years) the levels of cholestane-3β,5α,6β-triol (C-triol) and chitotriosidase (ChT) were measured. For patients with elevated C-triol and/or ChT the NPC1 and NPC2 genes were Sanger-sequenced and 47 additional genes (from the custom liver damage panel) were NGS-sequenced.

Results: Increased C-triol level (> 50 ng/ml) was detected in 4 (of 108) infants with cholestasis syndrome of unknown origin, with following molecular genetic NP-C diagnosis for one patient. Plasma cholesterol significantly correlates with C-triol (p < 0.05). NGS of high C-triol infants identified three patients with mutations in JAG1 (Alagille syndrome) and ABCB11 (Byler disease) genes. Increased ChT activity was detected in 8 (of 108) patients with various aetiologies, including NP-C, Byler disease and biliary atresia.

Conclusion: Combined analysis of ChT activity and C-triol levels is an effective method for identifying NP-C.

Keywords: Biomarker; Chitotriosidase; Cholestasis; Niemann-pick disease type C; Oxysterol; Screening, NPC1, NPC2, JAG1, ABCB11, LARS.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of C-triol concentration and ChT activity. Footnote: The red-shaded data point signifies the NP-C patient
Fig. 2
Fig. 2
Correlation analysis between C-triol and blood cholesterol levels. Footnote: The solid red lines are the least-squares regression lines; the dotted red lines represent the 95% confidence interval
See this image and copyright information in PMC

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