@article {394, title = {Clinical report: A patient with a late diagnosis of cerebrotendinous xanthomatosis and a response to treatment.}, journal = {Am J Med Genet A}, volume = {173}, year = {2017}, month = {2017 Aug}, pages = {2275-2279}, abstract = {

Cerebrotendinous xanthomatosis (CTX) is a rare, autosomal recessive, inborn error of bile acid metabolism characterized by diarrhea in infancy, juvenile cataracts in childhood, tendon xanthomas developing in the second to third decades of life, and progressive neurologic dysfunction in adulthood. The condition is caused by mutations in the CYP27A1 gene that result in decreased production of chenodeoxycholic acid (CDCA) and elevated levels of cholestanol and bile alcohols. We present a 36-year-old male of Han ethnicity who developed xanthomas of his Achilles tendons and suffered neurocognitive declines and gait deterioration in his second decade. The diagnosis of CTX was confirmed by marked elevation of the serum cholestanol level. Sequencing of CYP27A1 showed a paternally inherited splice mutation, c.446 + 1G>T, and a maternally inherited nonsense mutation, c.808C>T, predicting p.(Arg270*). Despite the advanced disease in this patient, treatment with CDCA reduced the xanthoma size and improved his cognition and strength, and the patient made significant gains in his ambulation and coordination. We report this case to illustrate the potential benefits of therapy in patients with CTX who have advanced disease at the time of diagnosis.

}, keywords = {Achilles Tendon, Adult, Bile Acids and Salts, Chenodeoxycholic Acid, Cholestanetriol 26-Monooxygenase, Cholestanol, Codon, Nonsense, Humans, Male, Xanthomatosis, Cerebrotendinous}, issn = {1552-4833}, doi = {10.1002/ajmg.a.38314}, author = {Alhariri, Ahmad and Hamilton, Katherine and Oza, Vikash and Cordoro, Kelly and Sobreira, Nara L and Malloy, Mary and Slavotinek, Anne} } @article {20, title = {ACOX2 deficiency: A disorder of bile acid synthesis with transaminase elevation, liver fibrosis, ataxia, and cognitive impairment.}, journal = {Proc Natl Acad Sci U S A}, volume = {113}, year = {2016}, month = {2016 Oct 04}, pages = {11289-11293}, abstract = {

Acyl CoA Oxidase 2 (ACOX2) encodes branched-chain acyl-CoA oxidase, a peroxisomal enzyme believed to be involved in the metabolism of branched-chain fatty acids and bile acid intermediates. Deficiency of this enzyme has not been described previously. We report an 8-y-old male with intermittently elevated transaminase levels, liver fibrosis, mild ataxia, and cognitive impairment. Exome sequencing revealed a previously unidentified homozygous premature termination mutation (p.Y69*) in ACOX2 Immunohistochemistry confirmed the absence of ACOX2 expression in the patient{\textquoteright}s liver, and biochemical analysis showed marked elevation of intermediate bile acids upstream of ACOX2. These findings define a potentially treatable inborn error of bile acid biosynthesis caused by ACOX2 deficiency.

}, keywords = {Ataxia, Bile Acids and Salts, Child, Cognitive Dysfunction, Homozygote, Humans, Infant, Infant, Newborn, Liver, Liver Cirrhosis, Loss of Function Mutation, Male, Mutation, Oxidation-Reduction, Oxidoreductases, Transaminases}, issn = {1091-6490}, doi = {10.1073/pnas.1613228113}, author = {Vilarinho, S{\'\i}lvia and Sari, Sinan and Mazzacuva, Francesca and Bilguvar, Kaya and Esendagli-Yilmaz, G{\"u}ldal and Jain, Dhanpat and Akyol, G{\"u}len and Dalgi{\c c}, Buket and G{\"u}nel, Murat and Clayton, Peter T and Lifton, Richard P} } @article {81, title = {Mutations in the nuclear bile acid receptor FXR cause progressive familial intrahepatic cholestasis.}, journal = {Nat Commun}, volume = {7}, year = {2016}, month = {2016 Feb 18}, pages = {10713}, abstract = {

Neonatal cholestasis is a potentially life-threatening condition requiring prompt diagnosis. Mutations in several different genes can cause progressive familial intrahepatic cholestasis, but known genes cannot account for all familial cases. Here we report four individuals from two unrelated families with neonatal cholestasis and mutations in NR1H4, which encodes the farnesoid X receptor (FXR), a bile acid-activated nuclear hormone receptor that regulates bile acid metabolism. Clinical features of severe, persistent NR1H4-related cholestasis include neonatal onset with rapid progression to end-stage liver disease, vitamin K-independent coagulopathy, low-to-normal serum gamma-glutamyl transferase activity, elevated serum alpha-fetoprotein and undetectable liver bile salt export pump (ABCB11) expression. Our findings demonstrate a pivotal function for FXR in bile acid homeostasis and liver protection.

}, keywords = {ATP Binding Cassette Transporter, Subfamily B, Member 11, ATP-Binding Cassette Transporters, Bile Acids and Salts, Cholestasis, Intrahepatic, Female, Humans, Male, Mutation, Receptors, Cytoplasmic and Nuclear, Young Adult}, issn = {2041-1723}, doi = {10.1038/ncomms10713}, author = {Gomez-Ospina, Natalia and Potter, Carol J and Xiao, Rui and Manickam, Kandamurugu and Kim, Mi-Sun and Kim, Kang Ho and Shneider, Benjamin L and Picarsic, Jennifer L and Jacobson, Theodora A and Zhang, Jing and He, Weimin and Liu, Pengfei and Knisely, A S and Finegold, Milton J and Muzny, Donna M and Boerwinkle, Eric and Lupski, James R and Plon, Sharon E and Gibbs, Richard A and Eng, Christine M and Yang, Yaping and Washington, Gabriel C and Porteus, Matthew H and Berquist, William E and Kambham, Neeraja and Singh, Ravinder J and Xia, Fan and Enns, Gregory M and Moore, David D} }