Acquired Partial Lipodystrophy Research Articles

Serum levels of adiponectin differentiate generalized lipodystrophies from anorexia nervosa.

The differential diagnosis of lipodystrophy involves other disorders characterized by severe fat loss and may be sometimes challenging. Owing to the rarity of lipodystrophy, it is relevant to search for tools and assays that differentiate it from other diseases that may mimic it. We conducted a study on leptin and high molecular weight (HMW) adiponectin serum concentrations in a series of patients diagnosed with lipodystrophy and compared them with those found in anorexia nervosa, one of the illnesses that may be cause of a missed diagnosis of lipodystrophy. Leptin and HMW adiponectin serum concentrations were measured in six patients diagnosed with generalized lipodystrophy (GL), six with progeroid syndromes (PS), 13 with familial partial lipodystrophy type 1 (FPLD1, Kobberling syndrome), 10 with familial partial lipodystrophy type 2 (FPLD2, Dunnigan syndrome), 18 with acquired partial lipodystrophy (APL) and 12 affected by anorexia nervosa (AN). Measurements were compared to those obtained in 12 normal weight healthy subjects. Serum leptin concentrations were reduced to a similar degree in GL, PS and AN, proportionally to the extent of fat loss. Serum concentrations of HMW adiponectin were found extremely low in patients with GL and PS, while comparable to normal weight subjects in patients with AN. Serum HMW adiponectin can be regarded as a useful tool to discriminate between generalized lipodystrophy syndromes (including PS) and AN.

Eponyms that honor Jewish dermatologists: A celebration and a remembrance, Part three: Jewish physicians who practiced during the Holocaust and in its aftermath

Part III of this contribution continues to celebrate the many contributions that Jewish physicians have made to advance the specialty of dermatology, as reflected by eponyms that honor their names. Part I covered the years before 1933, a highly productive period of creativity by Jewish dermatologists, especially in Germany and Austria. The lives of 17 Jewish physicians and their eponyms were described in Part I. Part II focused on the years of 1933 to 1945, when the Nazis rose to power in Europe, and how their anti-Semitic genocidal policies affected leading Jewish dermatologists caught within the Third Reich. Fourteen Jewish physicians and their eponyms are discussed in Part II. Part III continues the remembrance of the Holocaust era by looking at the careers and eponyms of an additional 13 Jewish physicians who contributed to dermatology during the period of 1933 to 1945. Two of these 13 physicians, pathologist Ludwig Pick (1868-1944) and neurologist Arthur Simons (1877-1942), perished in the Holocaust. They are remembered by the following eponyms of interest to dermatologists: Lubarsch-Pick syndrome, Niemann-Pick disease, and Barraquer-Simons syndrome. Four of the 13 Jewish physicians escaped the Nazis: Felix Pinkus (1868-1947), Herman Pinkus (1905-1985), Arnault Tzanck (1886-1954), and Erich Urbach (1893-1946). Eponyms that honor their names include nitidus Pinkus, fibroepithelioma of Pinkus, Tzanck test, Urbach-Wiethe disease, Urbach-Koningstein technique, Oppenheim-Urbach disease, and extracellular cholesterinosis of Karl-Urbach. The other seven Jewish physicians lived outside the reach of the Nazis, in either Canada, the United States, or Israel. Their eponyms are discussed in this contribution. Part III also discusses eponyms that honor seven contemporary Jewish dermatologists who practiced dermatology after 1945 and who continue the nearly 200 years of Jewish contribution to the development of the specialty. They are A. Bernard Ackerman (1936-2008), Irwin M. Braverman, Sarah Brenner, Israel Chanarin, Maurice L. Dorfman, Dan Lipsker, and Ronni Wolf. Their eponyms are Ackerman syndrome, Braverman sign, Brenner sign, Chanarin-Dorfman syndrome, Lipsker criteria of the Schnitzler syndrome, and Wolf's isotopic response.

SAT080 Partnering With Medical Genetics To Provide Molecular Diagnosis In Atypical Diabetes

Abstract Disclosure: M.C. Foss de Freitas: Advisory Board Member; Self; PTC Therapeutics. C. Chase: None. M. Henry: None. A. Neidert: None. G. Narla: Advisory Board Member; Self; HERA Biolabs. Consulting Fee; Self; RAPPTA Therapeutics. Owner/Co-Owner; Self; RAPPTA Therapeutics. W. Uhlmann: None. K. Lee: None. E.A. Oral: Consulting Fee; Self; Regeneron Pharmaceuticals, Aegerion Pharmaceuticals, Ionis Pharmaceuticals Inc., Third Rock Ventures, Rejuvenate Inc. Grant Recipient; Self; Regeneron Pharmaceuticals, Aegerion Pharmaceuticals, Ionis Pharmaceuticals Inc., Novo Nordisk, Fractyl Laboratories, Rhythm Pharmaceuticals, GID Dynamics. Other; Self; Aegerion Pharmaceuticals. Uncovering genetic alterations causing rare and atypical phenotypes related to diabetes mellitus is becoming increasingly possible with next-generation sequencing. Our Atypical Diabetes Program formed a partnership with the Division of Genetic Medicine, creating a specialized Atypical Diabetes Genetics Clinic to provide genetic counseling and clinical diagnostic testing to patients with rare forms of diabetes and other metabolic diseases. Between 10/2019 and 07/2022, 82 patients were seen (42±12 years old; 76.3% female). Indications for referral varied: 32 (39.0%) were referred for suspected monogenic obesity, 31 (37.8%) for familial partial lipodystrophy (FPLD), 10 (12.2%) for MODY, 7 (8.5%) for familial dyslipidemia (FD), 4 (4.9%) for acquired partial lipodystrophy (APL), and 14 (17.1%) for other indications including concern for acquired generalized or partial lipodystrophy, adrenomyeloneuropathy, Alport syndrome, GIST, hemochromatosis, hypothyroidism and hypogonadism, immune dysregulation, laminopathy, multisystem health problems/congenital anomalies, Prader-Willi syndrome, renal glycosuria, and TAR syndrome. Fourteen (17.1%) patients were referred for multiple indications. Results from 64 patients who underwent genetic testing revealed 4 positive molecular findings (all in patients with lipodystrophy), confirming a pathogenic LMNA variant detected on research testing in one and revealing previously unknown molecular etiologies in three (a previously described likely pathogenic LMNA variant, a novel likely pathogenic PPARG variant, and a previously described homozygous pathogenic MFN2 variant). Clinical management was altered, aiming for a more personalized approach in patients with these new findings, and two are participating in clinical trials for their condition. Cascade testing for family members is now being pursued. Sixteen patients had variants of uncertain significance (VUS); in one of these cases, in silico prediction suggesting that the detected SH2B variant could be pathogenic has enabled enrollment in a Phase 2 study with setmelanotide. For other identified VUS, we are undertaking functional and biological studies using our novel translational platform, which was established to contribute evidence for possible variant reclassification. Deeper sequencing strategies are being considered for patients with negative results, with most of our patients participating in an NIH funded network study for Rare and Atypical Diabetes (RADIANT). In our early experience, partnering with a medical genetics team to provide molecular testing for rare forms of diabetes and other metabolic conditions can lead to precise molecular diagnosis and set the stage for deeper testing and improved clinical care while driving novel discovery work. Presentation: Saturday, June 17, 2023

Progressive Lipodystrophy: topical laser treatment with Endolift® procedure using Eufoton® LASEmaR®1500 1470-nm wavelength

Lipodystrophies are a group of rare disorders of diverse aetiology characterised by variable body fat loss. The loss of body fat may affect nearly the entire body (generalised), only certain body regions (partial) or small areas under the skin (localised). Body fat loss can result from underlying genetic defects, autoimmune mechanisms, or drugs. Progressive lipodystrophy is a chronic, inflammatory, degenerative disease of the connective tissue. It leads to the blockage of the circulation and lymphatic drainage, followed by an accumulation of toxins, which promote hyperplasia of the fat cells. As a consequence, connective tissue rigidity promotes skin dimpling or orange skin. This study was designed to evaluate the efficiency of Endolift®, a novel minimally invasive outpatient laser procedure, for the treatment of Progressive Lipodystrophy. 30 women showing cellulite, in the range of 20 to 55 y-o, were enrolled for this study. Patients have undergone a single treatment under tumescent anaesthesia. Treatment was performed using the Endolift® procedure, consisting of the device Eufoton® LASEmaR® 1500. In addition, a 1470-nm wavelength laser was utilised, lead by micro-optical fibres of different calibres directly inside the skin. This treatment aims to destroy and remove degenerative connective tissue and promote neocollagenesis. Optimal results were obtained by 23 patients, 5 had good results, and 2 reported moderate results. No side effect was recorded. Adipocytolysis was performed on 6 patients and we removed 50 to 350 ml of fat. Even after 3 years, 80% of patients maintain significant results. These data show that Endolift® laser treatment represents one of the most effective treatments for removing Progressive Lipodystrophy.

Barraquer-Simons Syndrome: An Unusual Form of Acquired Partial Lipodystrophy in a Child with Lupus Nephritis

Barraquer-Simons Syndrome: An Unusual Form of Acquired Partial Lipodystrophy in a Child with Lupus Nephritis

Lipodystrophy for the Diabetologist—What to Look For

Genetic or acquired lipodystrophies are characterized by selective loss of body fat along with predisposition towards metabolic complications of insulin resistance, such as diabetes mellitus, hypertriglyceridemia, hepatic steatosis, polycystic ovarian syndrome, and acanthosis nigricans. In this review, we discuss the various subtypes and when to suspect and how to diagnose lipodystrophy. The four major subtypes are autosomal recessive, congenital generalized lipodystrophy (CGL); acquired generalized lipodystrophy (AGL), mostly an autoimmune disorder; autosomal dominant or recessive familial partial lipodystrophy (FPLD); and acquired partial lipodystrophy (APL), an autoimmune disorder. Diagnosis of lipodystrophy is mainly based upon physical examination findings of loss of body fat and can be supported by body composition analysis by skinfold measurements, dual-energy x-ray absorptiometry, and whole-body magnetic resonance imaging. Confirmatory genetic testing is helpful in the proband and at-risk family members with suspected genetic lipodystrophies. The treatment is directed towards the specific comorbidities and metabolic complications, and there is no treatment to reverse body fat loss. Metreleptin should be considered as the first-line therapy for metabolic complications in patients with generalized lipodystrophy and for prevention of comorbidities in children. Metformin and insulin therapy are the best options for treating hyperglycemia and fibrates and/or fish oil for hypertriglyceridemia. Lipodystrophy should be suspected in lean and muscular subjects presenting with diabetes mellitus, hypertriglyceridemia, non-alcoholic fatty liver disease, polycystic ovarian syndrome, or amenorrhea. Diabetologists should be aware of lipodystrophies and consider genetic varieties as an important subtype of monogenic diabetes.

Adipocyte-specific CDK7 ablation leads to progressive loss of adipose tissue and metabolic dysfunction.

Adipose tissue regulates whole-body energy homeostasis. Both lipodystrophy and obesity, the extreme and opposite aspects of adipose tissue dysfunction, result in metabolic disorders: insulin resistance and hepatic steatosis. Cyclin-dependent kinases (CDKs) have been reported to be involved in adipose tissue development and functions. Using adipose tissue-specific knockout mice, here we demonstrate that the deletion of CDK7 in adipose tissue results in progressive lipodystrophy, insulin resistance, impaired adipokine secretion and downregulation of fat-specific genes, which are aggravated on high-fat diet and during ageing. Our studies suggest that CDK7 is a key regulatory component of adipose tissue maintenance and systemic energy homeostasis.

A clinical case of Barraquer-Simons syndrome

Barraquer-Simons syndrome (SBS) belongs to the groupof lipodystrophy with complex etiology and pathophysiology and is characterized by progressive loss of subcutaneous fat, presumably related to autoimmune destruction of adipocytes. SBS is frequently associated with autoimmune disorders. Its first signs are found in childhood or puberty. It is characterized by gradual onset from the face with subsequent extension of the pathological process downwards without the involvement of the lower extremities. At the same time, there is a clear delimitation between the lipodystrophic and unaffected zones. The diagnosis of SBS is mainly based on clinical manifestations. Laboratory work-upis needed mostly to clarify any concomitant disorders.
 We describe a rare clinical case of the Barraquer-Simons syndrome in a 61-year-old woman, associated with chronic glomerulonephritis and C3-hypocomplementemia. The disease manifested at the age of 11 years with the fat loss in the face area. No familial history of SBS could be identified. Among the concomitant diseases, chronic glomerulonephritis and bilateral retinal angiopathy are of particular interest. The laboratory assessments showed proteinuria and microhematuria in the urine analysis and decreased C3 component of the complement in blood chemistry analysis. The skin pathology was represented by atrophy of the skin and soft tissues in the face, neck, upper limbs and trunk areas, with a clear delimitation in the upper third of the thighs, where normal subcutaneous fat was preserved. There was pronounced skin hypotrophy in the face area, with face disfiguration resembling a "dead man's face". To diagnose the Barraquer-Simons syndrome, in addition to the assessment of clinical manifestations, we used non-invasive diagnostic methods and the results of histological examination of a skin biopsy samples (the description of the specimen is given).
 Patients with SBS should be followed upwith the monitoring of their clinical and biochemical profiles and need an in-depth comprehensive examination by medical specialists to identify and treat their concomitant disorders.

Complement Factor D (adipsin) Levels Are Elevated in Acquired Partial Lipodystrophy (Barraquer-Simons syndrome).

Complement overactivation has been reported in most patients with Barraquer–Simons syndrome (BSS), a rare form of acquired partial lipodystrophy. Complement Factor D (FD) is a serine protease with a crucial role in the activation of the alternative pathway of the complement system, which is mainly synthesized by adipose tissue. However, its role in the pathogenesis of BSS has not been addressed. In this study, plasma FD concentration was measured in 13 patients with BSS, 20 patients with acquired generalized lipodystrophy, 22 patients with C3 glomerulopathy (C3G), and 50 healthy controls. Gene expression and immunohistochemistry studies were assayed using atrophied adipose tissue from a patient with BSS. We found significantly elevated FD levels in BSS cases compared with the remaining cohorts (p < 0.001). There were no significant differences in FD levels between sexes but FD was strongly and directly associated with age in BSS (r = 0.7593, p = 0.0036). A positive correlation between FD and C3 was seen in patients with C3G, characterized by decreased FD levels due to chronic C3 consumption, but no correlation was detected for BSS. Following mRNA quantification in the patient’s adipose tissue, we observed decreased CFD and C3 but elevated C5 transcript levels. In contrast, the increased FD staining detected in the atrophied areas reflects the effects of persistent tissue damage on the adipose tissue, thus providing information on the ongoing pathogenic process. Our results suggest that FD could be a reliable diagnostic biomarker involved in the pathophysiology of BSS by promoting unrestrained local complement system activation in the adipose tissue environment.

Long Term Effects of Leptin on Hepatic Fibrosis in Generalized Lipodystrophy

Lipodystrophy syndromes are caused by deficiency of adipose tissue leading to severe insulin resistance, hypertriglyceridemia, and non-alcoholic fatty liver disease (NAFLD), which may progress to cirrhosis. Advanced fibrosis/cirrhosis was previously thought to be irreversible; however, eradication of hepatitis C or long-term viral suppression of hepatitis B can reverse cirrhosis. Metreleptin treatment in patients with lipodystrophy improves liver transaminases and NAFLD activity score (NAS) after a mean of 2 years, but the latter improvements were due to lower inflammation and steatosis, with no change in fibrosis. The long-term effects of metreleptin in subjects with advanced fibrosis are unknown. We analyzed 24 subjects with advanced fibrosis (NAS stage 3 or 4) prior to metreleptin. Seven had liver biopsies both before and after ≥ 3 years of metreleptin with mean treatment duration 7.8±2.9 years. Five of six subjects with stage 3 fibrosis at baseline had improved fibrosis scores after metreleptin, and 0 of 1 with stage 4 fibrosis improved. 17 patients (8 with stage 3, 9 stage 4) did not have follow up biopsies after ≥3 years. Of these 17, 4 (all stage 4) died from end stage liver disease, and 1 (stage 3) from other causes. There was no clinical indication for repeat biopsy in 6 patients (2 stage 3, 4 stage 4). 6 were lost to follow up. Of the 24 patients with advanced fibrosis, 13 had congenital generalized lipodystrophy (CGL), 7 had acquired generalized lipodystrophy (AGL), 3 had familial partial lipodystrophy (FPL) and 1 had acquired partial lipodystrophy (APL). Of the 5 subjects with improvement in their fibrosis score, 2 had AGL, 2 had CGL, and one had a novel FPL mutation (1). Of the two patients that did not improve, one had FPL and one had CGL. In conclusion, subjects with stage 3 fibrosis due to lipodystrophy may have regression of fibrosis after long-term metreleptin treatment. This improvement may be secondary to near-elimination of the inciting factors (excess nutrient intake leading to ectopic lipid storage in the liver), analogous to clearance of Hepatitis C infection. However, additional data is needed to determine if metreleptin can reverse fibrosis in subjects with stage 4 fibrosis.

Protein Arginine Methyltransferase PRMT5 Regulates Fatty Acid Metabolism and Lipid Droplet Biogenesis in White Adipose Tissues.

The protein arginine methyltransferase 5 (PRMT5) is an emerging regulator of cancer and stem cells including adipogenic progenitors. Here, a new physiological role of PRMT5 in adipocytes and systemic metabolism is reported. Conditional knockout mice were generated to ablate the Prmt5 gene specifically in adipocytes (Prmt5AKO). The Prmt5AKO mice exhibit sex‐ and depot‐dependent progressive lipodystrophy that is more pronounced in females and in visceral (than subcutaneous) white fat. The lipodystrophy and associated energy imbalance, hyperlipidemia, hepatic steatosis, glucose intolerance, and insulin resistance are exacerbated by high‐fat‐diet. Mechanistically, Prmt5 methylates and releases the transcription elongation factor SPT5 from Berardinelli‐Seip congenital lipodystrophy 2 (Bscl2, encoding Seipin) promoter, and Prmt5AKO disrupts Seipin‐mediated lipid droplet biogenesis. Prmt5 also methylates Sterol Regulatory Element‐Binding Transcription Factor 1a (SREBP1a) and promotes lipogenic gene expression, and Prmt5AKO suppresses SREBP1a‐dependent fatty acid metabolic pathways in adipocytes. Thus, PRMT5 plays a critical role in regulating lipid metabolism and lipid droplet biogenesis in adipocytes.

Immunological features of patients affected by Barraquer-Simons syndrome

BackgroundC3 hypocomplementemia and the presence of C3 nephritic factor (C3NeF), an autoantibody causing complement system over-activation, are common features among most patients affected by Barraquer-Simons syndrome (BSS), an acquired form of partial lipodystrophy. Moreover, BSS is frequently associated with autoimmune diseases. However, the relationship between complement system dysregulation and BSS remains to be fully elucidated. The aim of this study was to provide a comprehensive immunological analysis of the complement system status, autoantibody signatures and HLA profile in BSS. Thirteen subjects with BSS were recruited for the study. The circulating levels of complement components, C3, C4, Factor B (FB) and Properdin (P), as well as an extended autoantibody profile including autoantibodies targeting complement components and regulators were assessed in serum. Additionally, HLA genotyping was carried out using DNA extracted from peripheral blood mononuclear cells.ResultsC3, C4 and FB levels were significantly reduced in patients with BSS as compared with healthy subjects. C3NeF was the most frequently found autoantibody (69.2% of cases), followed by anti-C3 (38.5%), and anti-P and anti-FB (30.8% each). Clinical data showed high prevalence of autoimmune diseases (38.5%), the majority of patients (61.5%) being positive for at least one of the autoantibodies tested. The HLA allele DRB1*11 was present in 54% of BSS patients, and the majority of them (31%) were positive for *11:03 (vs 1.3% allelic frequency in the general population).ConclusionsOur results confirmed the association between BSS, autoimmunity and C3 hypocomplementemia. Moreover, the finding of autoantibodies targeting complement system proteins points to complement dysregulation as a central pathological event in the development of BSS.

Disease course and treatment effects of a JAK inhibitor in a patient with CANDLE syndrome

BackgroundCANDLE syndrome (an acronym for Chronic Atypical Neutrophilic Dermatosis with Lipodystrophy and Elevated Temperature) is a recently described rare autosomal recessive disorder charaterized by systemic autoinflammation. Clinical manifestations include presentation in the first year of life, episodes of fever accompanied by erythematous skin lesions, progressive lipodystrophy, violaceous periorbital swelling and failure to thrive. This syndrome is caused by loss of function mutations and malfunction of the immunoproteasome complex. Most patients have biallelic mutations in the PSMB8 gene that encodes the β5i catalytic subunit of the immunoproteasome. Examples of digenic inheritance have been also described in CANDLE. CANDLE patients have strong type I interferon gene expression signature and they are responsive to treatment with JAK inhibitors. However, possible serious side-effects remain a concern. Here, we report another patient with CANDLE whose disease activity was well controlled by the treatment with baricitinib.Case presentationWe report a Bulgarian patient of the Turkish ancestry who carries biallelic mutations in the PSMB8 gene: p.Ala92Val and p.Lys105Gln. The pathogenic variant p.Ala92Val has not been previously described in patients with CANDLE. We also comment on the unusual feature in this patient, nephrolithiasis, that has not been described in other patients, however it might be related to the positive family history for kidney stones. We have treated the patient with the JAK inhibitor baricitinib for the past year and we observed a significant amelioration of his inflammatory episodes, skin and joint manifestations, and improvements in physical activities and growth. The treatment with glucocorticoids (GC) was completely discontinued. No side effects have been observed, however they remain in consideration for a life-long therapy of this disease.ConclusionsCANDLE should be suspected in patients with early-onset systemic inflammatory disease and prominent skin manifestations. Molecular testing can confirm the clinical diagnosis and is very important in guiding therapies. Treatment with JAK inhibitors is highly efficacious and appears to be safe in children with CANDLE and other intereforonopathies.

Hyaluronic acid fillers for correcting midface volume deficit in Barraquer-Simons syndrome.

Barraquer-Simons syndrome (BSS) or acquired partial lipodystrophy is a disorder of loss of subcutaneous fat from the upper part of the body. The resulting cosmetic disfigurement causes significant psychological distress in the affected individuals. Fillers, autologous fat transplant or cosmetic surgeries can be used to correct the volume deficit. The authors report a case of a young woman, who presented with gradual loss of subcutaneous fat from the face, upper limbs, and trunk. On evaluation, she had low complement C3 levels, but there were no features to suggest any metabolic complication. She was diagnosed with BSS. Her volume deficit in the midface area was managed with hyaluronic acid (HA) filler. The treatment has resulted in the correction of her facial volume loss immediately following the procedure with a maintained effect at follow-up visits. She experienced no major adverse events. Hyaluronic acid filler is safe and effective for the management of volume loss in BSS. It gives a long lasting result and an added self-confidence to the patient.

AN UNUSUAL CASE OF ACQUIRED PARTIAL LIPODYSTROPHY PRESENTING WITH ACANTHOSIS NIGRICANS.

About 250 patients with acquired partial lipodystrophy (Barraquer-Simons) syndrome have been reported so far. It is characterized by the loss of adipose tissue from the face and upper extremities, and accumulated fat in the rest of the body. The disease usually starts in females during childhood or adolescence, and usually after a febrile illness. Fat loss often comes into view in months or years. We present a 23-year-old female patient with acquired partial lipodystrophy , which is rarely seen.

Recurrent fevers, progressive lipodystrophy, and annular plaques in a child

KEY TEACHING POINTS.

A subset of patients with acquired partial lipodystrophy developing severe metabolic abnormalities

ABSTRACTPurpose/Aim of the study: Acquired partial lipodystrophy (APL) is a rare disease characterized by selective loss of adipose tissue. In this study, we aimed to present a subset of patients with APL, who developed severe metabolic abnormalities, from our national lipodystrophy registry.Materials and Methods: Severe metabolic abnormalities were defined as: poorly controlled diabetes (HbA1c above 7% despite treatment with insulin more than 1 unit/kg/day combined with oral antidiabetics), severe hypertriglyceridemia (triglycerides above 500 mg/dL despite treatment with lipid-lowering drugs), episodes of acute pancreatitis, or severe hepatic involvement (biopsy-proven non-alcoholic steatohepatitis (NASH)).Results: Among 140 patients with all forms of lipodystrophy (28 with APL), we identified 6 APL patients with severe metabolic abnormalities. The geometric mean for age was 37 years (range: 27–50 years; 4 females and 2 males). Five patients had poorly controlled diabetes despite treatment with high-dose insulin combined with oral antidiabetics. Severe hypertriglyceridemia developed in five patients, of those three experienced episodes of acute pancreatitis. Although all six patients had hepatic steatosis at various levels on imaging studies, NASH was proven in two patients on liver biopsy. Our data suggested that APL patients with severe metabolic abnormalities had a more advanced fat loss and longer disease duration.Conclusions: We suggest that these patients represent a potential subgroup of APL who may benefit from metreleptin or investigational therapies as standard treatment strategies fail to achieve a good metabolic control.

Acquired partial lipodystrophy and C3 glomerulopathy: Dysregulation of the complement system as a common mechanism

The activation of the alternative pathway of the complement is involved in the development of several renal diseases, such as atypical haemolytic uraemic syndrome and C3 glomerulopathy. In C3 glomerulopathy, a high percentage of patients have circulating levels of the autoantibody called C3NeF, which causes systemic dysregulation of the complement system. In some cases, the presence of this antibody has been related with abnormalities of adipose tissue, causing acquired partial lipodystrophy (Barraquer–Simons syndrome). Acquired partial lipodystrophy is an extremely rare disorder affecting the distribution of subcutaneous adipose tissue and that mainly onsets during childhood. These patients, in addition to possibly presenting with all the metabolic disorders associated with the adipose tissue defect, present with C3 hypocomplementemia and C3NeF and 25% have developed C3 glomerulopathy. Although it has been known for some time how the dysregulation of the complement system affects the kidneys, it remains unknown how it exactly affects adipose tissue; nevertheless, the relationship is quite clear. In this paper, we describe the connection between the complement system with the biology of the adipose tissue and its pathogenesis reflected from acquired partial lipodystrophy.

Acquired Partial Lipodystrophy with Autoimmune Thyroiditis

Lipodystrophies are a group of rare diseases characterized by selective loss of adipose tissue. Lipodystrophies have been classified on the basis of whether the disease is familial or acquired, or whether the adipose tissue loss is generalized, partial or localized. Acquired partial lipodystrophy, also known as Barraquer-Simons syndrome or cephalothoracic lipodystrophy, is a rare form of lipodystrophy, of which etiopathogenesis has been closely linked with autoimmunity. Acquired partial lipodystrophy is typically characterized by symmetrical loss of fat from face, neck, upper extremities and trunk with spared or increased adiposity in the lower body. There is a growing body of evidence which suggests that autoimmunity plays a role in the etiopathogenesis of acquired partial lipodystrophy. Here, we report a very rare case of acquired partial lipodystrophy accompanied by autoimmune thyroiditis. Thus, we highlight the rarity of the condition and review the available literature on the subject.

Lipodistrofia parcial adquirida y glomerulopatía C3: la desregulación del sistema del complemento como mecanismo común

The activation of the alternative pathway of the complement is involved in the development of several renal diseases, such as atypical haemolytic uremic syndrome and C3 glomerulopathy. In C3 glomerulopathy, a high percentage of patients have circulating levels of the autoantibody called C3NeF, which causes systemic dysregulation of the complement system. In some cases, the presence of this antibody has been related with abnormalities of adipose tissue, causing acquired partial lipodystrophy (Barraquer-Simons syndrome). Acquired partial lipodystrophy is an extremely rare disorder affecting the distribution of subcutaneous adipose tissue and that mainly onsets during childhood. These patients, in addition to possibly presenting with all the metabolic disorders associated with the adipose tissue defect, present with C3 hypocomplementemia and C3NeF and 25% have developed C3 glomerulopathy. Although it has been known for some time how the dysregulation of the complement system affects the kidneys, it remains unknown how it exactly affects adipose tissue; nevertheless, the relationship is quite clear. In this paper, we describe the connection between the complement system with the biology of the adipose tissue and its pathogenesis reflected from acquired partial lipodystrophy.