UPDATE ON NEPHROPATHIC CYSTINOSIS

被引:29
作者
SCHNEIDER, JA
KATZ, B
MELLES, RB
机构
[1] University of California at San Diego, La Jolla, 92093-0609, CA
[2] Pacific Presbyterian Medical Center, San Francisco, 94115, CA
[3] The Smith-Kettlewell Eye Research Institute, San Francisco, 94115, CA
[4] University of California at San Francisco, San Francisco, 94121, CA
关键词
CYSTINOSIS; LYSOSOMES; TRANSPORT; CYSTEAMINE; FANCONI SYNDROME;
D O I
10.1007/BF00858644
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
The cystine that accumulates within cystinotic lysosomes comes primarily from proteins which have been degraded within this organelle. The individual amino acids have specific transport mechanisms to exit the lysosome. The lysosomal cystine transporter is defective in all types of cystinosis. When cells from patients with nephropathic and benign cystinosis were fused, the defect was not corrected and the cystine level remained elevated. This strongly indicates that the genetic defects are allelic (i.e., on the same chromosome). Cysteamine is a weak base which enters the cystinotic lysosome and reacts with cystine forming a mixed disulfide of half-cystine and cysteamine. This mixed disulfide rapidly exists the lysosome via the transport system for cationic amino acids which is normal in cystinosis. Because of the success of renal transplantation, many cystinosis patients are alive in their twenties and even early thirties. Unfortunately, these patients have developed damage to other organs including thyroid, eye, central nervous system, pancreas, and muscle. Cysteamine and its analog, phosphocysteamine, are very beneficial to cystinosis patients, especially when started early in life. These drugs may prevent the need for transplantation. It is too early to know if they will prevent damage to other organs.
引用
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页码:645 / 653
页数:9
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