ALEXANDER AUGUSTO DE LIMA JORGE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/42 - Laboratório de Hormônios e Genética Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/25 - Laboratório de Endocrinologia Celular e Molecular, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/42 - Laboratório de Hormônios e Genética Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/25 - Laboratório de Endocrinologia Celular e Molecular, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Diagnosis, Genetics, and Therapy of Short Stature in Children: A Growth Hormone Research Society International Perspective(2019) COLLETT-SOLBERG, Paulo F.; AMBLER, Geoffrey; BACKELJAUW, Philippe F.; BIDLINGMAIER, Martin; BILLER, Beverly M. K.; BOGUSZEWSKI, Margaret C. S.; CHEUNG, Pik To; CHOONG, Catherine Seut Yhoke; COHEN, Laurie E.; COHEN, Pinchas; DAUBER, Andrew; DEAL, Cheri L.; GONG, Chunxiu; HASEGAWA, Yukihiro; HOFFMAN, Andrew R.; HOFMAN, Paul L.; HORIKAWA, Reiko; JORGE, Alexander A. L.; JUUL, Anders; KAMENICKY, Peter; KHADILKAR, Vaman; KOPCHICK, John J.; KRISTROM, Berit; LOPES, Maria de Lurdes A.; LUO, Xiaoping; MILLER, Bradley S.; MISRA, Madhusmita; NETCHINE, Irene; RADOVICK, Sally; RANKE, Michael B.; ROGOL, Alan D.; ROSENFELD, Ron G.; SAENGER, Paul; WIT, Jan M.; WOELFLE, JoachimThe Growth Hormone Research Society (GRS) convened a Workshop in March 2019 to evaluate the diagnosis and therapy of short stature in children. Forty-six international experts participated at the invitation of GRS including clinicians, basic scientists, and representatives from regulatory agencies and the pharmaceutical industry. Following plenary presentations addressing the current diagnosis and therapy of short stature in children, breakout groups discussed questions produced in advance by the planning committee and reconvened to share the group reports. A writing team assembled one document that was subsequently discussed and revised by participants. Participants from regulatory agencies and pharmaceutical companies were not part of the writing process. Short stature is the most common reason for referral to the pediatric endocrinologist. History, physical examination, and auxology remain the most important methods for understanding the reasons for the short stature. While some long-standing topics of controversy continue to generate debate, including in whom, and how, to perform and interpret growth hormone stimulation tests, new research areas are changing the clinical landscape, such as the genetics of short stature, selection of patients for genetic testing, and interpretation of genetic tests in the clinical setting. What dose of growth hormone to start, how to adjust the dose, and how to identify and manage a suboptimal response are still topics to debate. Additional areas that are expected to transform the growth field include the development of long-acting growth hormone preparations and other new therapeutics and diagnostics that may increase adult height or aid in the diagnosis of growth hormone deficiency.
conferenceObject X-Linked Central Precocious Puberty Associated with MECP2 defects(2022) CANTON, Ana; TINANO, Flavia; GUASTI, Leonardo; MONTENEGRO, Luciana; RYAN, Fiona; SHEARS, Deborah; MELO, Maria Edna; GOMES, Larissa; PIANA, Mariana; BRAUNER, Raja; ESPINO, Rafael; ESCRIBANO-MUNOZ, Arancha; PAGANONI, Alyssa; KORBONITS, Marta; SERAPHIM, Carlos Eduardo; FARIA, Aline; COSTA, Silvia; KREPISCHI, Ana Cristina; JORGE, Alexander; DAVID, Alessia; ARGENTE, Jesus; MENDONCA, Berenice; BRITO, Vinicius; HOWARD, Sasha; LATRONICO, Ana Claudia- Diagnosis of TBC1D32-associated conditions: Expanding the phenotypic spectrum of a complex ciliopathy(2023) HARRIS, Sarah C.; CHONG, Karen; CHITAYAT, David; GILMORE, Kelly L.; JORGE, Alexander A. L.; FREIRE, Bruna L.; LERARIO, Antonio; SHANNON, Patrick; COPE, Heidi; GALLENTINE, William B.; GUYADER, Gwenal Le; BILAN, Frederic; LETARD, Pascaline; DAVIS, Erica E.; VORA, Neeta L.Exome sequencing is a powerful tool in prenatal and postnatal genetics and can help identify novel candidate genes critical to human development. We describe seven unpublished probands with rare likely pathogenic variants or variants of uncertain significance that segregate with recessive disease in TBC1D32, including four fetal probands in three unrelated pedigrees and three pediatric probands in unrelated pedigrees. We also report clinical comparisons with seven previously published patients. Index probands were identified through an ongoing prenatal exome sequencing study and through an online data sharing platform (Gene Matcher (TM)). A literature review was also completed. TBC1D32 is involved in the development and function of cilia and is expressed in the developing hypothalamus and pituitary gland. We provide additional data to expand the phenotype correlated with TBC1D32 variants, including a severe prenatal phenotype associated with life-limiting congenital anomalies.
- Prevalence of Deleterious Variants in MC3R in Patients With Constitutional Delay of Growth and Puberty(2023) DUCKETT, Katie; WILLIAMSON, Alice; KINCAID, John W. R.; RAINBOW, Kara; CORBIN, Laura J.; MARTIN, Hilary C.; EBERHARDT, Ruth Y.; HUANG, Qin Qin; HURLES, Matthew E.; HE, Wen; BRAUNER, Raja; DELANEY, Angela; DUNKEL, Leo; GRINSPON, Romina P.; HALL, Janet E.; HIRSCHHORN, Joel N.; HOWARD, Sasha R.; LATRONICO, Ana C.; JORGE, Alexander A. L.; MCELREAVEY, Ken; MERICQ, Veronica; MERINO, Paulina M.; PALMERT, Mark R.; PLUMMER, Lacey; REY, Rodolfo A.; REZENDE, Raissa C.; SEMINARA, Stephanie B.; SALNIKOV, Kathryn; BANERJEE, Indraneel; LAM, Brian Y. H.; PERRY, John R. B.; TIMPSON, Nicholas J.; CLAYTON, Peter; CHAN, Yee-Ming; ONG, Ken K.; O'RAHILLY, StephenContext The melanocortin 3 receptor (MC3R) has recently emerged as a critical regulator of pubertal timing, linear growth, and the acquisition of lean mass in humans and mice. In population-based studies, heterozygous carriers of deleterious variants in MC3R report a later onset of puberty than noncarriers. However, the frequency of such variants in patients who present with clinical disorders of pubertal development is currently unknown. Objective This work aimed to determine whether deleterious MC3R variants are more frequently found in patients clinically presenting with constitutional delay of growth and puberty (CDGP) or normosmic idiopathic hypogonadotropic hypogonadism (nIHH). Methods We examined the sequence of MC3R in 362 adolescents with a clinical diagnosis of CDGP and 657 patients with nIHH, experimentally characterized the signaling properties of all nonsynonymous variants found and compared their frequency to that in 5774 controls from a population-based cohort. Additionally, we established the relative frequency of predicted deleterious variants in individuals with self-reported delayed vs normally timed menarche/voice-breaking in the UK Biobank cohort. Results MC3R loss-of-function variants were infrequent but overrepresented in patients with CDGP (8/362 [2.2%]; OR = 4.17; P = .001). There was no strong evidence of overrepresentation in patients with nIHH (4/657 [0.6%]; OR = 1.15; P = .779). In 246 328 women from the UK Biobank, predicted deleterious variants were more frequently found in those self-reporting delayed (aged & GE;16 years) vs normal age at menarche (OR = 1.66; P = 3.90E-07). Conclusion We have found evidence that functionally damaging variants in MC3R are overrepresented in individuals with CDGP but are not a common cause of this phenotype.
- Novel SUZ12 mutations in Weaver-like syndrome(2018) IMAGAWA, Eri; ALBUQUERQUE, Edoarda V. A.; ISIDOR, Bertrand; MITSUHASHI, Satomi; MIZUGUCHI, Takeshi; MIYATAKE, Satoko; TAKATA, Atsushi; MIYAKE, Noriko; BOGUSZEWSKI, Margaret C. S.; BOGUSZEWSKI, Cesar L.; LERARIO, Antonio M.; FUNARI, Mariana A.; JORGE, Alexander A. L.; MATSUMOTO, NaomichiSUZ12 is a core component of polycomb repressive complex 2 (PRC2) along with EZH2 and EED. Recently, germline mutations in the SUZ12, EZH2 and EED genes have been reported in Weaver syndrome (WS) or Weaver-like syndrome, suggesting a functional link between PRC2 deficits and WS. However, only one case of a SUZ12 mutation presenting with Weaver-like syndrome has been reported. Here, we report a missense and a frameshift mutation in SUZ12 (c.1797A>C; p.Gln599His and c.844_845del; p.Ala282Glnfs*7), both of which are novel, in two individuals. Their clinical features included postnatal overgrowth, increased bifrontal diameter, large ears, round face, horizontal chin crease and skeletal anomalies, but did not fulfill the WS diagnostic criteria. These data provide strong evidence that SUZ12 mutations cause Weaver-like syndrome.
conferenceObject CLINICAL AND MOLECULAR ANALYSIS OF PUBERTAL CONTROL IN A COHORT OF SILVER-RUSSELL AND TEMPLE SYNDROMES PATIENTS(2017) CANTON, Ana; HARBISON, Madeleine D.; HABIB, Walid Abi; SALEM, Jennifer; BLAISE, Annick; GEOFFRON, Sophie; GIABICANI, Eloise; JORGE, Alexander A. L.; BRIOUDE, Frederic; NETCHINE, Irene- Diagnosis and management of Silver-Russell syndrome: first international consensus statement(2017) WAKELING, Emma L.; BRIOUDE, Frederic; LOKULO-SODIPE, Oluwakemi; O'CONNELL, Susan M.; SALEM, Jennifer; BLIEK, Jet; CANTON, Ana P. M.; CHRZANOWSKA, Krystyna H.; DAVIES, Justin H.; DIAS, Renuka P.; DUBERN, Beatrice; ELBRACHT, Miriam; GIABICANI, Eloise; GRIMBERG, Adda; GRONSKOV, Karen; HOKKEN-KOELEGA, Anita C. S.; JORGE, Alexander A.; KAGAMI, Masayo; LINGLART, Agnes; MAGHNIE, Mohamad; MOHNIKE, Klaus; MONK, David; MOORE, Gudrun E.; MURRAY, Philip G.; OGATA, Tsutomu; PETIT, Isabelle Oliver; RUSSO, Silvia; SAID, Edith; TOUMBA, Meropi; TUMER, Zeynep; BINDER, Gerhard; EGGERMANN, Thomas; HARBISON, Madeleine D.; TEMPLE, I. Karen; MACKAY, Deborah J. G.; NETCHINE, IreneThis Consensus Statement summarizes recommendations for clinical diagnosis, investigation and management of patients with Silver-Russell syndrome (SRS), an imprinting disorder that causes prenatal and postnatal growth retardation. Considerable overlap exists between the care of individuals born small for gestational age and those with SRS. However, many specific management issues exist and evidence from controlled trials remains limited. SRS is primarily a clinical diagnosis; however, molecular testing enables confirmation of the clinical diagnosis and defines the subtype. A 'normal' result from a molecular test does not exclude the diagnosis of SRS. The management of children with SRS requires an experienced, multidisciplinary approach. Specific issues include growth failure, severe feeding difficulties, gastrointestinal problems, hypoglycaemia, body asymmetry, scoliosis, motor and speech delay and psychosocial challenges. An early emphasis on adequate nutritional status is important, with awareness that rapid postnatal weight gain might lead to subsequent increased risk of metabolic disorders. The benefits of treating patients with SRS with growth hormone include improved body composition, motor development and appetite, reduced risk of hypoglycaemia and increased height. Clinicians should be aware of possible premature adrenarche, fairly early and rapid central puberty and insulin resistance. Treatment with gonadotropin-releasing hormone analogues can delay progression of central puberty and preserve adult height potential. Long-term follow up is essential to determine the natural history and optimal management in adulthood.
- Clinical and Genetic Characterization of Familial Central Precocious Puberty(2023) TINANO, Flavia Rezende; CANTON, Ana Pinheiro Machado; MONTENEGRO, Luciana R.; LEAL, Andrea de Castro; FARIA, Aline G.; SERAPHIM, Carlos E.; BRAUNER, Raja; JORGE, Alexander A.; MENDONCA, Berenice B.; ARGENTE, Jesus; BRITO, Vinicius N.; LATRONICO, Ana ClaudiaContext Central precocious puberty (CPP) can have a familial form in approximately one-quarter of the children. The recognition of this inherited condition increased after the identification of autosomal dominant CPP with paternal transmission caused by mutations in the MKRN3 and DLK1 genes. Objective We aimed to characterize the inheritance and estimate the prevalence of familial CPP in a large multiethnic cohort; to compare clinical and hormonal features, as well as treatment response to GnRH analogs (GnRHa), in children with distinct modes of transmission; and to investigate the genetic basis of familial CPP. Methods We retrospectively studied 586 children with a diagnosis of CPP. Patients with familial CPP (n = 276) were selected for clinical and genetic analysis. Data from previous studies were grouped, encompassing sequencing of MKRN3 and DLK1 genes in 204 patients. Large-scale parallel sequencing was performed in 48 individuals from 34 families. Results The prevalence of familial CPP was estimated at 22%, with a similar frequency of maternal and paternal transmission. Pedigree analyses of families with maternal transmission suggested an autosomal dominant inheritance. Clinical and hormonal features, as well as treatment response to GnRHa, were similar among patients with different forms of transmission of familial CPP. MKRN3 loss-of-function mutations were the most prevalent cause of familial CPP, followed by DLK1 loss-of-function mutations, affecting, respectively, 22% and 4% of the studied families; both affected exclusively families with paternal transmission. Rare variants of uncertain significance were identified in CPP families with maternal transmission. Conclusion We demonstrated a similar prevalence of familial CPP with maternal and paternal transmission. MKRN3 and DLK1 loss-of-function mutations were the major causes of familial CPP with paternal transmission.
- High-throughput splicing assays identify missense and silent splice-disruptive POU1F1 variants underlying pituitary hormone deficiency(2021) GERGICS, Peter; SMITH, Cathy; BANDO, Hironori; JORGE, Alexander A. L.; ROCKSTROH-LIPPOLD, Denise; VISHNOPOLSKA, Sebastian A.; CASTINETTI, Frederic; MAKSUTOVA, Mariam; CARVALHO, Luciani Renata Silveira; HOPPMANN, Julia; MAYER, Julian Martinez; ALBAREL, Frederique; BRASLAVSKY, Debora; KESELMAN, Ana; BERGADA, Ignacio; MARTI, Marcelo A.; SAVEANU, Alexandru; BARLIER, Anne; JAMRA, Rami Abou; GUO, Michael H.; DAUBER, Andrew; NAKAGUMA, Marilena; MENDONCA, Berenice B.; JAYAKODY, Sajini N.; OZEL, A. Bilge; FANG, Qing; MA, Qianyi; LI, Jun Z.; BRUE, Thierry; MILLAN, Maria Ines Perez; ARNHOLD, Ivo J. P.; PFAEFFLE, Roland; KITZMAN, Jacob O.; CAMPER, Sally A.Pituitary hormone deficiency occurs in similar to 1:4,000 live births. Approximately 3% of the cases are due to mutations in the alpha isoform of POU1F1, a pituitary-specific transcriptional activator. We found four separate heterozygous missense variants in unrelated individuals with hypopituitarism that were predicted to affect a minor isoform, POU1F1 beta, which can act as a transcriptional repressor. These variants retain repressor activity, but they shift splicing to favor the expression of the beta isoform, resulting in dominant-negative loss of function. Using a high-throughput splicing reporter assay, we tested 1,070 single-nucleotide variants in POU1F1. We identified 96 splice-disruptive variants, including 14 synonymous variants. In separate cohorts, we found two additional synonymous variants nominated by this screen that co-segregate with hypopituitarism. This study underlines the importance of evaluating the impact of variants on splicing and provides a catalog for interpretation of variants of unknown significance in POU1F1.
- Outcomes in growth hormone-treated Noonan syndrome children: impact of PTPN11 mutation status(2022) JORGE, Alexander A. L.; EDOUARD, Thomas; MAGHNIE, Mohamad; PIETROPOLI, Alberto; KELEPOURIS, Nicky; ROMANO, Alicia; ZENKER, Martin; HORIKAWA, ReikoIntroductionMutations in PTPN11 are associated with Noonan syndrome (NS). Although the effectiveness of growth hormone therapy (GHT) in treating short stature due to NS has been previously demonstrated, the effect of PTPN11 mutation status on the long-term outcomes of GHT remains to be elucidated. MethodsThis analysis included pooled data from the observational American Norditropin Studies: Web-Enabled Research Program (NCT01009905) and the randomized, double-blinded GHLIQUID-4020 clinical trial (NCT01927861). Pediatric patients with clinically diagnosed NS and confirmed PTPN11mutation status were eligible for inclusion. The effectiveness analysis included patients who were GHT-naive and pre-pubertal at GHT start. Growth outcomes and safety were assessed over 4 years of GHT (Norditropin (R), Novo Nordisk A/S). ResultsA total of 69 patients were included in the effectiveness analysis (71% PTPN11 positive). The proportion of females was 32.7 and 30.0% in PTPN11-positive and negative patients, respectively, and mean age at GHT start was 6.4 years in both groups. Using general population reference data, after 4 years of GHT, the mean (s.d.) height SD score (HSDS) was -1.9 (1.1) and -1.7 (0.8) for PTPN11-positive and PTPN11-negative patients, respectively, with no statistical difference observed between groups. The mean (s.d.) change in HSDS at 4 years was +1.3 (0.8) in PTPN11-positive patients and +1.5 (0.7) in PTPN11-negative patients (no significant differences between groups). Safety findings were consistent with previous analyses. ConclusionsGHT resulted in improved growth outcomes over 4 years in GHT-naive, pre-pubertal NS patients, irrespective of PTPN11 mutation status.