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Info x Medical centre & contacts Prof. Miriam Zacchia Prof Zacchia practices in Naples, Italy. She is highly rated in 4 conditions, her top areas of expertise are Bardet-Biedl syndrome, Alport syndrome, low potassium level, nephrogenic diabetes insipidus and kidney transplant. Her clinical research consists of co-authoring 66 peer reviewed articles in the past 15 years. About us : Qualifica : Professore Associato Settore scientifico disciplinare : MED/14 Dipartimento di afferenza : Dipartimento di Scienze Mediche Traslazionali Telefono : 0815666650 E-mail : miriam.zacchia@unicampania.it Pubblicazioni : https://iris.unicampania.it/simple-search?location=&query=&filtername=author&filtertype=authority&filterquery=rp00036&rpp=1000&sort_by=bi_sort_2_sort&order=desc ​ Miriam Zacchia, M.D.,Ph.D, is a Junior Nephrologist at the Department of Translational Medical Sciences of the University of Campania, L. Vanvitelli (Naples, IT). She has been trained in basic research and molecular biology at Yale University, CT (USA), focusing her studies on the cell signalling regulating renal citrate transport. ​ Currently, Dr. Zacchia takes care of patients with genetic kidney diseases of the Nephrology, especially rare syndromic ciliopathies, as Bardet-Biedl Syndrome. ​ Her research interests are mainly focused on the genetic basis of hereditary kidney diseases (including glomerulopathies, tubulopathies, ciliopathies and CAKUT). In addition, her studies aim to improve the understanding of the pathophysiology of kidney dysfunction in Bardet-Biedl syndrome, by using multiple approaches, as metabolomics and proteomics studies of patients’ urine samples and experimental models of disease.

Bardet-Biedl CLINICAL REGISTRY Clinical REGISTRY INVESTIGATING CRIBBS (For english speakers) ​ Because BBS is relatively rare and individuals with the disease are spread out across the world, no single medical center has the expertise to fully address the needs of individuals with BBS or to develop much needed new treatments. CRIBBS serves as a valuable tool to learn more about BBS and its impact on the health of a person. Information gathered in CRIBBS will be used to help families better understand the condition, to help healthcare providers provide timely preventative and comprehensive care, and to foster scientific efforts in understanding this complex disorder. ​ ​ ​ ​ Frequently Asked Questions : Why is a BBS registry important ? Bardet-Biedl Syndrome (BBS) is thought to affect approximately 2,500 people in the United States. Because BBS is relatively rare and individuals with the disease are spread out across the world, no single medical center has the expertise to fully address the needs of individuals with BBS or to develop much needed new treatments. CRIBBS serves as a valuable tool to learn more about BBS and its impact on the health of a person. Information gathered in CRIBBS will be used to help families better understand the condition, to help healthcare providers provide timely preventative and comprehensive care, and to foster scientific efforts in understanding this complex disorder. ​ How do I register for CRIBBS ? Clicking on this registration link will bring you to the registration page. You will be asked several simple questions so that we can contact you. We will not request confidential information such as social security numbers or driver’s license numbers. ​ What information will I have to provide to participate in CRIBBS ? Bardet-Biedl Syndrome (BBS) affects each person differently. To better understand how BBS affects you specifically, a member of our team will conduct a telephone interview that takes 90 to 120 minutes. In addition, we will ask you to complete two written assessment forms at your leisure. We will also ask you to sign medical release forms that allow us to obtain medical records from your healthcare providers. We will not ask for confidential information such as social security numbers or driver’s license numbers. ​ Who can see my information ? Your privacy is important to us. Your health information will be assigned a study number that will replace any information that may identify you. Medical records will be stored in a secured location and only individuals directly involved in CRIBBS will have access your information. Your information will not be shared with private organizations, such as insurance companies. Information will be compiled using the study identification numbers and shared with researchers and scientists trying to better understand BBS. ​ How often will the CRIBBS research staff contact me ? One important purpose of the registry is to monitor the ongoing health of individuals with BBS over time. As such, we will contact you annually to get an update on your health. In addition, you will be asked to repeat the two written assessments completed upon CRIBBS enrollment and we will contact your healthcare providers to obtain updated health records. If at any time, you wish to withdraw participation from CRIBBS, you are free to do so and you will no longer be contacted by CRIBBS staff. ​ Will I be contacted about participating in research studies ? Yes, we will alert you if researchers are seeking volunteers for research studies. We will not give your name or contact information to the researcher, but we will provide you the contact information for the researcher and provide you a brief summary of the study. ​ How does participation in CRIBBS help me or my child ? Participation in CRIBBS will help us learn more about the many ways BBS impacts the life and health of individuals. We will share this information through publications for the public and in professional journals. We believe that such knowledge will spark the interest of scientists, private industry, and government agencies to foster high quality care and the development of new and effective treatment strategies for individuals with BBS. ​ Comment référer mon enfant/moi-même à la clinique BBS ? En cliquant sur ce lien , vous accéderez au questionnaire de référencement. Veuillez télécopier le 715-387-5244, envoyer un courriel ( suda.sonia@marshfieldclinic.org ) ou envoyer le formulaire dûment rempli à : Sonia Suda 1000 N Oak Ave - GR3 Marshfield, WI 54449 ​ ​ ​ ​ PARTICIPATE IN THE COHORT PARTICIPATE IN THE COHORT COBBALT COhorte Bardet-Biedl et Alström Translationnelle (In France) ​ The principle is to collect clinical data from as many patients as possible in order to better understand the natural history of the disease in its most classic manifestations (vision, weight, renal function) but also to be able to identify rarer or even unknown manifestations. A quality of life study is also being carried out as well as the collection of biological samples for research purposes. ​ The promotion of the study is under the responsibility of the University Hospital of Strasbourg and the principal investigator is Pr Hélène Dollfus. The collection of consent for the study (signature for participation) must be done on site (for the moment, a compulsory visit to Strasbourg), but afterwards the data over 5 years can be collected remotely. This study is very important because it will allow to identify the criteria on which future clinical trials can be based and also to identify more precisely the known or still poorly known characteristics of the disease and also the needs of the patients. The team of the University Hospital of Strasbourg is counting on the participation of all and awaits your call at 06 35 34 09 00 or 03 69 55 19 62 or your message at cobbalt@chru-strasbourg.fr or nathalie.goetz@chru-strasbourg.fr in order to inform you at best. Reference Centre for Rare Diseases in Ophthalmological Genetics CARGO - IGMA1, Place de l'Hôpital 67091 STRASBOURG Cedex. ​ FOR MORE INFORMATION CONTACT US

связаться с нами Для этого заболевания характерна ассоциация с ожирением, пигментным ретинитом, постаксиальной полидактилией, поликистозом почек, гипогенитализмом и трудностями в обучении, которые обычно возникают через несколько лет после начала заболевания. Клиническая картина может быть различной, хотя у многих пациентов в течение болезни проявляются почти все признаки. Пигментный ретинит является единственным постоянным признаком после детского возраста. BBS также связан с другими тяжелыми признаками, включая диабет, гипертонию, врожденные пороки сердца и болезнь Гиршпрунга. ​ Синдром Барде-Бидля (СББ) описан на сайте :https://www.gsdinternational.com/ru/conditions/bardet-biedl-syndrome-bbs ​

El síndrome de Bardet-Biedl (SBB) es una enfermedad genética multisistémica poco frecuente en población caucásica (está estimada 1/150.000), caracterizada por una pronunciada variabilidad fenotípica y una gran heterogeneidad genética. Pertenece al grupo de las ciliopatías, causadas por defectos en la estructura y/o función ciliar. El trastorno se trasmite principalmente de manera autosómica recesiva pero se ha detectado herencia oligogénica en algunos casos. Hasta ahora, se han identificado mutaciones en 24 genes diferentes. Este trastorno está caracterizado por una combinación de síntomas clínicos: obesidad, retinopatía pigmentaria, polidactilia post-axial, riñones poliquísticos, hipogenitalismo y trastornos de aprendizaje, muchos de los cuales aparecen muchos años después de la aparición de la enfermedad. La expresión clínica es variable pero muchos de los pacientes manifiestan la mayoría de los síntomas clínicos durante el curso de enfermedad. La retinopatía pigmentaria es el único síntoma clínico constante después la infancia. El SBB puede también estar asociado con otras manifestaciones graves incluida diabetes, hipertensión, cardiopatía congénita y enfermedad de Hirschsprung . El amplio espectro clínico observado en el SBB está asociado a una significativa heterogeneidad genética. Contactador

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Clinical MANIFESTATIONS visual disturbance Yeux Almost all children with Bardet-Biedl Syndrome suffer from decreased vision, most often starting around the age of 5-6 years. It starts with a decrease and then a gradual loss of vision at night or when the light is a little dim. The child sees very little in the dark, but this may go unnoticed when he is small. ​ The field of vision gradually narrows at the sides, giving the impression of looking through an increasingly narrow tube (so-called "tubular vision"). The quality of vision deteriorates greatly during adolescence. Sometimes, other ocular manifestations may be associated with it: blurred distance vision (myopia) or distorted vision (astigmatism), both of which can be corrected with glasses, opacification of the crystalline lens (cataract) leading to a progressive decrease in vision, the appearance of abnormal jerky eye movements (nystagmus), problems with colour distinction, etc. Eventually, central vision can also be affected, making the patient visually impaired. ​ The visual disturbances characteristic of Bardet-Biedl syndrome are due to an impairment of the retina, called retinopathy pigmentosa. The retina is the surface of the back of the eye that receives images, much like a photographic film, and transmits them to the brain in the form of electrical signals. OVERWEIGHT Poids Despite a normal birth weight, affected children are almost always significantly overweight from the first year of life. This overweight often evolves into severe obesity, especially in the trunk area. Sometimes the height is smaller than average. ABNORMALITIES OF TOES & FINGERS Doigts There are often, but not in all cases, malformations of the toes and fingers that are smaller than normal (brachydactyly). There are often six fingers and/or six toes instead of five, with the supernumerary finger(s) located next to the fifth finger (the little finger). This is called postaxial polydactyly. In addition, some children have two or more fingers joined together, i.e. not well separated, and connected by a membrane (webbed fingers or syndactyly). ABNORMALITIES OF the genital organs Organes génitaux In boys, the genitals, penis and testicles, are often abnormally small (hypogonadism). In girls, malformations of the genital organs are also possible. The vagina may be closed by a partition, which causes the uterus to expand, often detected before birth (hydrometrocolpos). KIDNEY AND URINARY DEFORMITIES Reins Malformations of the kidneys and urinary tract are very common. They can be serious and, in a significant number of cases, lead to malfunction of the kidneys, whose function is to filter the blood and allow waste products to be eliminated through urine. ​ In people with Bardet-Biedl syndrome, the progressive reduction in kidney function, known as chronic kidney failure, may require the use of an artificial kidney and lead to a kidney transplant. One of the consequences of this kidney damage is an increase in blood pressure (hypertension), which occurs in more than half of adults. Even if there are no kidney malformations, problems can occur in regulating the amount of water in the body. This is manifested by an increase in the volume of urine (regardless of the volume of liquid absorbed), with a frequent need to urinate, as well as by intense thirst (this is called diabetes insipidus). intellectual deficiency & PSYCHOLOGICAL DISORDERS Intellect The intellectual deficit is not always present. When it does exist, it is moderate or rarely severe. Most often, it is limited to learning difficulties that can be aggravated by vision problems. Affected children may also have a delay in language acquisition (they speak later than others), as well as phonation disorders (abnormal way of producing sounds). There may also be hearing loss (hearing loss), which is often mild and goes unnoticed. Psychological or behavioural disorders may appear in some people in the course of their lives. These disorders include emotional instability, frequent tantrums, inappropriate or uninhibited behaviour (with no idea of what is or is not done), with more rarely obsessive-compulsive behaviour (i.e. repetitive actions, such as washing hands very frequently). However, these disorders only affect a few patients and it is not always clear whether they are directly linked to the syndrome. OTHER MANIFESTATIONS Autres Diabetes (too high blood sugar levels) can also set in, as in many obese people. It initially manifests itself by intense tiredness, thirst and hunger, but over time it can lead to serious complications such as kidney failure, an increased risk of heart attacks and infections, nerve damage that can cause loss of feeling in the hands and feet, etc. It can be treated with medication. Very rarely, incoordination of movements can occur, manifesting itself as abnormalities in staggering gait or poorly coordinated hand movements. In rare cases there are malformations of the heart, in particular communication between the different chambers (atria or ventricles) or narrowing of the heart valves (valvular stenoses). Long-term (chronic) constipation, when present, may be due to Hirschsprung's disease, which is a lack of contraction of the large intestine (colon) which leads to its dilation.

ON-GOING RESEARCH The research Unit, including the Section of Nephrology of the University of Campania L. Vanvitelli (Naples) and its partner Biogem Scarl, a research centre in Ariano Irpino, is working on several lines of research: The construction of a database of Italian BBS patients Patients with the clinical diagnosis of BBS, those suspected of having BBS are referred to the clinic dedicated to rare kidney disorders. Basic medical examinations, genetic analysis and follow-up exams are guaranteed for adult patients with a multi-disciplinary management, according to the patients’ needs which include : Ophtalmologists, endocrinologists, neurologists & geneticists. Clinical studies Observational analysis of metabolic parameters and renal function over time; correlation of clinical data with genotype. Analysis of BMI, the estimated glomerular filtration rate slope per year. Translational studies Proteomics and metabolomics analysis of patients’ urine, to find biomarkers of disease and also to decipher the pathophysiology of the disease. Pre-clinical studies The development of cellular and mice models of BBS to elucidate aberrant downstream signalling pathways of BBS genetic mutations.

Bardet-Biedl RESOURCES

The DISEASE SWEDISH POLISH PORTUGUESE SPANISH RUSSIAN GERMANY Bardet-Biedl Syndrome is a genetic disease caused by a change (mutation) in a gene. To date, there are at least twenty-four different genes that may be responsible for this disease. These are genes BBS1 to BBS24. Bardet-Biedl most often combines obesity, vision problems, finger abnormalities, and in some cases kidney and genital abnormalities. Learning difficulties are often present. Other malformations (of the heart, for example) may be associated, but more rarely. Bardet-Biedl Syndrome affects both boys and girls and usually begins at birth and is not contagious. The manifestations and severity of the syndrome vary considerably from person to person. Bardet-Biedl syndrome is a rare disease whose prevalence (number of people affected in a population at a given time) is between 1 in 100,000 and 1 in 160,000 for the populations of Europe and North America. This syndrome is much more common in certain isolated populations such as the Bedouin populations of Kuwait where the prevalence is estimated at 1 in 13,500. TRANSMISSION In most cases of BBS, both parents carry a normal gene and a defective recessive gene. Although the parents have a copy of the defective gene and are called carriers of the disease, they are not affected by the presence of the defective gene. For a recessive disease to occur, the child must inherit two defective copies of the gene, one from each parent. The child from each pregnancy has a one in four chance of being affected. If a newborn child is not affected, there is a 2 in 3 chance that it will carry the defective BBS gene. Because the syndrome is rare, it is unlikely that a carrier will have affected children unless their partner is also a carrier. GENETIC To date (2022), mutations in 24 BBS genes have been identified in 85% of BBS patients. There are still more genes to be found, as 15% of patients do not have a mutation in one of the identified BBS genes. ​ Some genes are more common than others: 38% of patients have mutations in the BBS1 gene and in the BBS10 gene. However, patients with mutations in the same BBS gene can have very different symptoms of the syndrome: one person may be born with extra fingers, while another person with the same mutation may not have extra fingers at all. The genes involved in this syndrome 'control' the production of proteins that play a role in the cilia of cells. Cells have cilia that function like antennae, capturing and transmitting information about the state of their environment. When these cilia are defective (which is the case when genes are mutated), certain functions are also altered. ​ In particular, cilia play an important role in vision and kidney function, which explains the visual deficit and possible kidney abnormalities in Bardet-Biedl syndrome. Much research is underway to understand the role of the cilia in all manifestations of the disease. CLINICAL MANIFESTATIONS The clinical manifestations of Bardet-Biedl syndrome are multiple and vary considerably from person to person. Therefore, not all patients have all of the symptoms described below. Visual disturbance Learn more Overweight Learn more Abnormalities of toes and fingers Learn more Abnormalities of the genital organs Learn more Kidney and urinary tract deformities Learn more Intellectual deficiency and psychological disorders Learn more Other manifestations Learn more HOW CAN THE SYMPTOMS BE EXPLAINED The genes involved in this syndrome "control" the production of proteins that play a role in the cells' eyelashes. The cells have lashes that function like antennae, capturing and transmitting information about the state of their environment. When these cilia are defective (which is the case when genes are mutated), certain functions are also altered. In particular, cilia play an important role in vision and kidney function, which explains the visual deficit and possible kidney abnormalities in Bardet-Biedl syndrome. A great deal of research is underway to understand the role of the cilia in all manifestations of the disease. ​ If left untreated, the various manifestations can worsen, in particular kidney damage and obesity. Obesity, which is resistant to the usual diet and measures, can be complicated by diabetes and excess lipids in the blood (hyperlipidemia), heart and joint problems. In addition, retinal abnormality leads to a severe reduction in vision, and even blindness between the ages of 15 and 30. Indeed, the field of vision gradually reduces and central vision can sometimes end up being reduced. Early treatment can limit the worsening of symptoms. WHAT IS ITS EVOLUTION ?

Establishment of an expert panel for BBS led by 3 doctors (Helen May-Simera, Carsten Bergmann, Metin Cetiner) : An expert committee is being set up from various doctors and representatives of the patient group in order to coordinate current research aspects for BBS in Germany. In addition to 2 representatives of the patient group, a nephrologist, a human geneticist, an ophthalmologist and a microbiologist are represented in this committee. ​ Research for the immune system with BBS led by doctor Wartsen : At the end of 2021, a new research project was launched at the University Hospital in Bonn to investigate the thesis that BBS sufferers have a stronger immune system than non-affected people and as a result are less susceptible to everyday illnesses such as flu. In May 2022, this research project will be presented to the BBS Germany patient group at a Zoom meeting. ​ Neocyst Project : NEOCYST is a research project on cystic kidney disease in children. It is implemented by a network of clinicians, geneticists and scientists. The project is funded by the Federal Ministry of Education and Research (BMBF) and supported by the Society for Paediatric Nephrology (GPN). ​ The NEOCYST study aims to gain a better understanding of cystic kidney disease and Bardet-Biedl syndrome. The knowledge gained should be used to improve : Targeted diagnosis, sound advice and and lead to the development of future therapeutic approaches. Opportunities for participation Patients of all ages who have been diagnosed with BBS can participate. Participation in the project is based on a detailed questionnaire. The questionnaire is to be filled in by the treating physician. Patient data are stored and collected in a pseudonymised form, so that no conclusions can be drawn about the individual person. ​ NEOCYST contact for interested parties Dr. Metin Cetiner, University Hospital Essen Hufelandstraße 55, 45147 Essen Mail: Metin.Cetiner@uk-essen.de

Bardet-Biedls Syndrom (BBS) kännetecknas av en kombination av synnedsättning, övervikt, extra fingrar och/eller tår, små könsorgan, nedsatt njurfunktion och inlärningssvårigheter. Andra symtom förekommer också. ​ Bardet-Biedls syndrom ingår i en grupp sjukdomar som kallas ciliopatier och orsakas av en skada i de primära cilierna. En primär cilie är ett orörligt utskott, ett slags antenn på cellytan som samordnar många funktioner som är av betydelse för cellfunktioner som rörelse, syn, känsel och cellsignalering. Störd ciliefunktion kan leda till avvikelser i fosterutvecklingen och ge missbildningar i många olika organ. Hos ungefär 80 procent av alla med Bardet-Biedls syndrom har det varit möjligt att påvisa en sjukdomsframkallande mutation. De vanligaste mutationerna finns i BBS1 (23 procent), BBS2 (8 procent) och BBS10 (20 procent). ​ Hittills (2022) finns mutationer rapporterade i 24 olika gener, som alla är inblandade i tillverkning eller reglering av proteiner som är av betydelse för normal cilieformation och funktion. ​ Kontakta oss