Case Study

Effective NSAID treatment indicates that hyperprostaglandinism is affecting the clinical severity of childhood hypophosphatasia

HJ Girschick¹ , P Schneider² , I Haubitz¹ , O Hiort³ , H Collmann⁴ , M Beer⁵ , YS Shin⁶ and HW Seyberth⁷

¹  Children's Hospital, University of Würzburg, Germany

²  Clinic for Nuclear Medicine, University of Würzburg, Germany

³  Children's Hospital, University of Lübeck, Germany

⁴  Section of Pediatric Neurosurgery, University of Würzburg, Germany

⁵  Dept. of Radiology, Section of Pediatric Radiology, University of Würzburg, Germany

⁶  Children's Hospital, University of Munich, Germany

⁷  Children's Hospital, University of Marburg, Germany

author email corresponding author email

Orphanet Journal of Rare Diseases 2006, 1:24doi:10.1186/1750-1172-1-24

Published:	28 June 2006

Abstract

Background

Hypophosphatasia (HP) is an inborn error of bone metabolism characterized by a genetic defect in the gene encoding the tissue-nonspecific alkaline phosphatase (TNSALP). There is a lack of knowledge as to how the variability and clinical severity of the HP phenotype (especially pain and walking impairment) are related to metabolic disturbances or impairments, subsequent to the molecular defect.

Methods

We analyzed the changes in clinical symptoms and the prostaglandin (PG) metabolism in response to treatment with non-steroidal anti-inflammatory drugs (NSAIDs) in six children affected by childhood HP. In addition, by exposing HP fibroblasts to pyridoxal phosphate and/or calcium pyrophosphate in vitro, we analyzed whether the alterations in PG levels are sequelae related to the metabolic defect.

Results

Childhood HP patients, who often complain about pain in the lower limbs without evident fractures, have systemic hyperprostaglandinism. Symptomatic anti-inflammatory treatment with NSAIDs significantly improved pain-associated physical impairment. Calcium pyrophosphate, but not pyridoxal phosphate, induced cyclooxygenase-2 (COX-2) gene expression and PG production in HP and normal fibroblasts in vitro.

Conclusion

Clinical features of childhood HP related to pain in the lower legs may be, at least in part, sequelae related to elevated PG levels, secondary to the primary metabolic defect. Consequently, NSAID treatment does improve the clinical features of childhood HP.