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Background Type-1 diabetes (T1D) occurs following autoimmune-induced pancreatic beta cells death. Among several treatment modalities, mesenchymal stem cells (MSCs) transplantation is promising for autoimmune disorders due to immunomodulation, regeneration, and migration to damaged tissue upon systemic injection. This study assessed the safety and efficacy of intravenous injection of autologous bone marrow-derived MSCs in newly diagnosed T1D patients. Methods After receiving informed consent, 21 patients who met the study criteria were enrolled and randomly assigned to receive either MSCs or placebo. Each patient in the experimental group received two doses of MSCs and was followed for at least one-year post-transplantation. Results The results have shown that this transplantation is safe and significantly reduces the number of hypoglycemic episodes. MSCs transplantation improved glycated hemoglobin (HbA1c), shifted serum cytokine patterns from pro-inflammatory to anti-inflammatory, increased the number of regulatory T-cells in the peripheral blood, and improved quality of life. Early transplantation of MSCs significantly improved HbA1c and C-peptide levels and shifted pro-inflammatory cytokines to anti-inflammatory cytokines. Also, exercise combined with MSCs transplantation improved glycemic and immunologic indices. Conclusions Taken together, autologous MSC transplantation is safe and effective, and its early transplantation is a promising treatment in newly diagnosed T1D children suffering from hypoglycemic episodes. Trial registration : This clinical trial was registered at the Iranian Registry of Clinical Trials (IRCT) with the identifier IRCT ID: IRCT2016070428786N1 registered on August 20, 2016 (Retrospectively registered) ( https://en.irct.ir/trial/23256 ) and at the U.S. National Institutes of Health (ClinicalTrials.gov) with the related identifier NCT04078308 registered on September 6, 2019 (Retrospectively registered). ( https://clinicaltrials.gov/ct2/show/NCT04078308 ).

Introduction Neurological manifestations are rare in hyperlipidemia; however, extreme hypertriglyceridemia may cause “milky” blood and cerebrospinal fluid (CSF) and may compromise the central nervous system. We report an infant with familial hyperlipidemia who presented with seizures and unusual neuroimaging findings, including fat deposition in the cerebral vasculature and intracranial xanthomas. Case description A 2-month-old boy, previously healthy, presented with fever, followed by a focal seizure. His parents are consanguineous. His perinatal history and early development are unremarkable. Physical examination revealed no abnormal findings. During phlebotomy, the blood appeared lipemic with a distinctive ‘salmon-colored’ hue. Laboratory work-up revealed severe hypertriglyceridemia with normal pancreatic enzymes; other metabolic, hematologic, and infectious evaluations were unremarkable. Non-contrast brain CT and MRI showed fat within the dural venous sinuses and cortical veins, along with two extra-axial, fat-containing intracranial lesions in the left parietal and right frontal regions. The patient was treated with anticonvulsant medications, antiplatelet therapy, and a specialized low-fat formula, resulting in significant improvement in lipid levels and clinical stabilization. Discussion In severe hypertriglyceridemia causing visible lipemia of blood, blood viscosity increases and perfusion in the microcirculation can be impaired. Hyperviscosity and the toxic effect of lipid particles on the endothelium may lead to vascular injury in the brain. Accumulation of lipid in intracranial blood vessels can extravasate through the injured blood-brain barrier to CSF and brain parenchyma. Intracranial xanthoma, parenchymal hemorrhage and infarction are considered as the complications. Conclusions In infants presenting with seizures or stroke-like signs alongside lipemic blood, clinicians should consider hyperlipidemia-induced neurovascular injury. Neuroimaging signs such as fat-density vessels or lesions should prompt an evaluation for dyslipidemia.

This study assessed the efficacy and safety of a biosimilar Laronidase (CinnaGen Company, Iran), compared to the reference Laronidase (Aldurazyme, BioMarin, USA) in maintaining urinary glycosaminoglycan (uGAG) levels in mucopolysaccharidosis type I (MPS I) patients. In this phase III, open-label, single-sequence, and cross-over study, MPS I patients received Aldurazyme for 12 weeks, followed by Laronidase (CinnaGen) for another 12 weeks. The primary outcome was the assessment of mean uGAG levels at the final visits of each medication administration. The secondary outcomes included the assessment of 6-minute walking test (6MWT), predicted forced vital capacity (FVC), enzyme activity assay, and adverse events (AEs). Twelve patients with mean (standard deviation [SD]) age of 10.25 ± 3.11 years were included in the study. The mean (± SD) uGAG level was 220.47 ± 177.13 CPC unit/g creatinine at the end of Aldurazyme treatment and changed to 270.02 ± 111.55 CPC unit/g creatinine at the end of Laronidase (CinnaGen) treatment, with variable patient responses. The mean 6MWT and predicted FVC improved by almost 30 m and 13%, respectively. Post-infusion enzyme activity levels showed similar patterns between Aldurazyme and Laronidase (CinnaGen), with no detectable activity before the infusion. A total of 30 AEs were reported during the trial. In the first time period (receiving Aldurazyme), AEs were reported for seven patients (58.33%), and in the subsequent time period (receiving Laronidase (CinnaGen)), AEs were reported for six patients (50%). Among all, nasopharyngitis was the most common reported AE. In conclusion, the biosimilar Laronidase was shown to have a comparable efficacy and safety profile compared with the reference Laronidase. Clinical Trial Registration: Clinicaltrials.gov: NCT06406153; First registration: 09/05/2024.

Due to its rare incidence, pituitary adenoma requires high vigilance and suspicion. Therefore, physicians should consider this differential diagnosis and perform the necessary workup, such as an overnight or standard dexamethasone suppression test and brain magnetic resonance imaging (MRI), to rule it out if sudden hormonal changes without any other explanation are observed in children.

Objective Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome (APECED) is a rare autosomal recessive systemic autoimmune disease caused by mutations in the autoimmune regulator ( AIRE) gene. Incidence of this genetic disorder is estimated at 1/90,000–200,000 worldwide and 1/6500–9000 in genetically isolated populations such as Iran. Here, we investigated AIRE gene mutations in eight independent Iranian non-Jewish families. Methods We sequenced the coding regions of the AIRE gene and documented mutations which were further confirmed in respective parents. Results In total, 11 cases from 8 independent families were recruited. Mucosal candidiasis, Addison’s disease and hypoparathyroidism were the most common clinical manifestations in these patients. One novel homozygous splice acceptor mutation (c.308-1G>C), and one novel heterozygous stop-gain mutation (c.1496delC) combined with a known heterozygous c.232T>C missense mutation were found. Moreover, we observed previously described splice donor (c.1095+2T>A), frameshift (c.967-979del), stop-gain (c.415C>T), and missense (c.62C>T) mutations among the patients. All results were co-segregated in parents. Conclusion Here, we reported two novel mutations in the AIRE gene leading to APECED. Our data could provide insight into the phenotypic and genotypic spectrum of APECED in the non-Jewish Iranian population. These findings, in addition to future functional assays, can elucidate disease-causing mechanisms related to the AIRE gene and assist in genetic counseling and diagnosis.

Premature pubarche (PP) is the appearance of sexual hair in children before puberty. The PP phenotype may attribute to nonclassic congenital adrenal hyperplasia (NC-CAH). In this study, we investigated the role of CYP21A2 gene variants in patients with PP in the Iranian population. Forty patients (13 males and 27 females), clinically diagnosed with PP, were analyzed for molecular testing of CYP21A2 gene variants. Direct sequencing was performed for the samples. Also, gene dosage analysis was performed for the cases. Fourteen patients (35%) had a mutation of p.Gln318X and p.Val281Leu, out of which 10% had regulatory variants. Approximately 10% of the patients were homozygous (NC-CAH). 78.5% (11/14) of patients had trimodular RCCX of which 5 patients had two copies of CYP21A1P pseudogene. The prevalence of p.Val281Leu was higher than p.Gln318X in PP patients. In conclusion, CYP21A2 variant detection has implications in the genetic diagnosis of PP phenotype. The genetic characterization of the CYP21A2 gene is important for characterizing the variable phenotype of carriers and genetic counseling of PP and NC-CAH patients.

Fanconi- Bickel Syndrome (FBS) is a rare type of glycogen storage disease (GSD) Characterized by hepatomegaly, proximal renal tubular acidosis (RTA) and marked growth retardation. We report a case of FBS presenting with diabetic ketoacidosis and transient neonatal diabetes. A female infant, product of consanguineous marriage presented with diabetic ketoacidosis at age 33 days, and was treated as neonatal diabetes with insulin. At age 14 months, insulin was discontinued. She presented with short stature, hepatomegaly, RTA and hypophosphatemic rickets at age 4 and (FBS) was diagnosed. Diagnosis was confirmed by mutation analysis, showing mutation in SLC2 A2 gene. In conclusion,: neonatal diabetes or diabetic ketoacidosis may be the first presentation of infants with FBS.

Phenylketonuria (PKU) is an inborn error of amino acid metabolism with an autosomal recessive inheritance caused in most cases by mutations in the phenylalanine hydroxylase (PAH) gene. PKU has wide allelic heterogeneity. Here we report a novel heterozygous substitution (c.1223G>T (p.Arg408Leu)) in the PAH gene in an Iranian PKU family. The patient was 19-yr-old female with diagnosis of moderate PKU referred to Department of Medical Genetics, Tehran University of Medical Sciences, Tehran, Iran for genetic counseling/analysis in April 2015. We used PCR-Sequencing to identify any sequence variations in the PAH gene.

The phenylalanine hydroxylase (PAH) locus has high linkage disequilibrium. Haplotypes related to this locus may thus be considered sufficiently informative for genetic diagnosis and carrier screening using multi-allelic markers. In this study, we present an efficient method for haplotype analysis of PAH locus using multiplexing dyes. In addition, we explain how to resolve the dye shift challenge in multiplex short tandem repeat (STR) genotyping. One hundred family trios were included in this descriptive study. The forward primer of a tetra-nucleotide STR and the reverse primer of a variable number tandem repeat (VNTR) were labeled with three different non-overlapping dyes 5-carboxyfluorescein (FAM), 6-carboxy-N,N,N',N'-tetramethylrhodamine (HEX) and 6-carboxy-N,N,N',N'-tetramethylrhodamine (TAMRA). The polymerase chain reaction (PCR) products from each family trio were multiplexed for capillary electrophoresis and results were analyzed using Peak Scanner software. Multiplexing trio products decreased the cost significantly. The TAMRA labeled products had a significant predictable shift (migrated at a slower electrophoretic rate) relative to the HEX and FAM labeled products. Through our methodology we achieve, the less inter-dye shift than intra-dye shift variance. Correcting the dye shift in the labeled products, according to the reference allele size, significantly decreased the inter-dye variability (P<0.001). Multiplexing trio products helps to detect and resolve the dye shift accurately in each family, which otherwise would result in diagnostic error. The dye system of FAM, HEX and TAMRA is more feasible and cheaper than other dye systems.

Mucopolysaccharidosis VI is a rare autosomal recessive disorder caused by the deficiency of enzyme Arylsulfatase B. The enzyme deficiency leads to the accumulation of dermatan sulfate in connective tissue which causes manifestations related to MPS VI. Up to now, three different disease causing variants are reported in Iranian patients. In this study, we scanned ARSB gene of 13 Iranian patients from 12 families in whom all parents were consanguineous and from the same ethnicity except one family that were not consanguineous but co-ethnic. We found six not previously reported disease causing variants. We extracted DNA from peripheral blood samples of patients that were previously confirmed as MPS VI by clinical, biochemical and enzymatic assays including berry-spot test and fluorimetry, followed by PCR and direct sequencing. Computational approaches were used to analyze novel variants in terms of their impact on the protein structure. 11 disease causing variants and 15 polymorphisms were found. Six disease causing variants were novel and five were previously reported of which three were in Iranian population. Four of patients, who were unrelated, two by two had the same disease causing variant and polymorphisms, which indicates a possible founder effect. Our study also implicates genotype–phenotype correlation. Computational structural modeling indicated these disease causing variants might affect structural stability and function of the protein. Data of this study confirms the existence of mutational heterogeneity in the ARSB between Iranian patients. Disease causing variants with high frequency can be used in the prenatal diagnosis and genetic counseling. Also, the existence of the same variants and polymorphisms in some of the unrelated patients indicates a possible founder effect.