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Niemann-Pick tipo C (NPC) é uma doença de depósito lisossomal, ocasionada por alterações no tráfico de colesterol não esterificado, decorrente de alterações bialélicas nos genes NPC1 ou NPC2, ambos definindo uma doença autossômica recessiva, progressiva e irreversível, caracterizada por manifestações viscerais, neurológicas e psiquiátricas, não necessariamente combinadas. Com o propósito de descrever as características fenotípicas e genotípicas de pacientes com NPC, objetivou-se relatar dados demográficos, formas clínicas classificadas por idade, sinais e sintomas neurológicos e psiquiátricos, achados de ressonância magnética (RM) de encéfalo e ultrassonografia de abdome, assim como teste de filipin, mutações observadas e o tratamento com N-butyldeoxynojirimycin (Miglustat). De uma casuística de 12 pacientes atendidos entre 2000-2014, por revisão de prontuários, no Ambulatório de Neurogenética do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, havia 7 mulheres e 5 homens, idade média de 20 anos (entre 2 e 42), sendo dez pacientes da etnia branca e dois mulatos, procedentes de 3 estados brasileiros: São Paulo, Mato Grosso do Sul e Minas Gerais. As formas clínicas identificadas foram infantil, juvenil e adulto. A idade do primeiro sintoma neurológico ocorreu entre 1 e 27 anos (media 9,5). Dentre os achados viscerais, dois pacientes encontravam-se assintomáticos, os demais apresentaram icterícia prolongada/colestase, hepatomegalia e esplenomegalia. Todos os pacientes apresentaram em diferentes momentos da evolução manifestações neuropsiquiátricas, tais como: paralisia do olhar vertical, ataxia/quedas, epilepsia, mioclonias, distonia, disartria, disfagia, fraqueza muscular, espasticidade, declínio cognitivo/demência, sintomas psicóticos, atraso escolar, distúrbio de comportamento, cataplexia gelástica e hipotonia neonatal. A idade de diagnóstico variou de 0 a 41 anos, com uma média de 14,5 anos. O tempo entre a idade do primeiro sintoma neurológico e o diagnóstico da doença variou de 0 a 14 anos, tempo médio de 5,3 anos. O teste de Filipin demonstrou seis resultados positivos e seis variantes. A RM de encéfalo apresentou três diferentes tipos de alteração: atrofia cerebral em 6 casos, atrofia cerebelar e desmielinização em 7. A ultrassonografia de Abdome resultou em três alterações: hepatomegalia em 8, esplenomegalia em 10 e hepatoesplenomegalia em 8. O resultado do teste genético molecular em 11 pacientes evidenciou alterações no gene NPC1 e uma paciente não possuía o resultado. A mutação c.3104C>T foi a mais frequente, em oito pacientes; c.3548G>A, de significado incerto, em um paciente, e, as demais mutações encontradas: c.3493G>A, c.3019C>G. O tratamento com N-butyl deoxynojirimycin (Miglustat) foi realizado por todos os pacientes, o tempo entre o diagnóstico e o início da medicação variou de 0 a 9 anos, média de 2,9 anos. Concluímos que o registro da doença NPC deve ser feito através de uma coleta de dados detalhada e contínua, pois sua heterogeneidade fenotípica e genotípica sugerem um número subestimado de casos, não só por sua raridade, mas também pelo desconhecimento da doença, já que há poucos grupos estudados e publicados. O seu reconhecimento precoce, associado ao adequado manejo clínico, podem retardar a progressão implacável da doença e aumentar a expectativa de vida dos pacientes. / Niemann-Pick type C (NPC) is a lysosomal storage disease caused by abnormal unesterified cholesterol trafficking, resulting from biallelic changes in NPC1 or NPC2 genes, both defining an autosomal recessive progressive and irreversible disease characterized by visceral, neurological and psychiatric manifestations, not necessarily combined. In order to describe the phenotypic and genotypic characteristics of patients with NPC, this work aimed to report demographic data, clinical forms classified by age, neurological and psychiatric signs and symptoms, brain magnetic resonance imaging (MRI) and abdominal ultrasound findings, Filipin test, the gene mutations, and the treatment with N-butyldeoxynojirimycin (Miglustat). A series of 12 patients were studied, treated between 2000-2014, by review of medical records of the Neurogenetics Clinic at the Hospital of Clinics, Ribeirão Preto Medical School, Brazil. There were 7 women and 5 men, mean age 20 years (from 2 to 42); 10 caucasian and 2 mulattos, coming from three Brazilian states: São Paulo, Mato Grosso do Sul and Minas Gerais. Infantile, Juvenile and adult clinical forms were identified. The age of the first neurological or psichiatric symptoms occurred between 1 and 27 years (mean 9.5). Among the visceral findings, two patients were asymptomatic, and the others had prolonged jaundice / cholestasis, hepatomegaly and splenomegaly. All patients had at different times of evolution symptoms, such as paralysis of vertical gaze, ataxia/falls, epilepsy, myoclonus, dystonia, dysarthria, dysphagia, muscle weakness, spasticity, cognitive decline/dementia, psychotic symptoms, school delay, disorders behavior, gelastic cataplexy and neonatal hypotonia. Age at diagnosis ranged from 0 to 41 years, with a mean of 14.5 years. The interval between the first signs of the disease and the onset of treatment ranged from zero to 14 years, with an average of 5.3 years. Filipin test resulted six positive and six variant form. The MRI scans showed three different types of changes: brain atrophy in 6 cases, cerebellar atrophy in 7 and demyelination in 7. Abdominal ultrasound revealed 8 patients with hepatomegaly, 10 with splenomegaly and 8 hepatosplenomegaly. The results of the molecular genetic testing on 11 patients showed changes in NPC1 gene and a patient did not have the result. Mutation c.3104C>T was more frequent in eight patients; c.3548G>A, of uncertain significance in a patient, and other mutations found: c.3493G>A and c.3019C>G. Treatment with N-butyl deoxynojirimycin (Miglustat) was carried by all patients; the time between diagnosis and beginning of the treatment ranged from 0 to 9, with an average of 2.9 years. We conclude that NPC disease registry should be done through a collection of detailed and continuous data because their phenotypic and genotypic heterogeneity suggest an underestimated number of cases, not only for its rarity but also by unawareness about the disease, and the fact that there are few published studies. The early recognition, coupled with appropriate clinical management, may slow the progression of the disease and increase life expectancy of patients.

<p>  </p> <p>Niemann-Pick Type C (NPC) disease is a rare lysosomal storage disorder that occurs in about 1/89,000 to 1/120,000 live births and is characterized by an aberrant accumulation of cholesterol within the late endosome/lysosome of cells. Symptoms of this disease include splenomegaly, neurological deterioration, and often death before adulthood. Mutations in the membrane bound NPC1 or luminal NPC2 proteins lead to a decrease in cholesterol efflux within the lysosomes by which excess cholesterol crystallizes within membranes resulting in cell death. It has been demonstrated that increasing the amount of the lysosomal specific phospholipid Bis(monoacylglycerol)phosphate (BMP), also known as Lysobisphosphatidic acid (LBPA), in cells increases the rate of cholesterol transport in <em>npc1</em>-/- cells, but not in <em>npc</em>2-/- cells, indicating a strong synergistic relationship between the NPC2 protein and the lysosomal membranes. Increasing the amount of phosphatidyl glycerol (PG), a hypothesized precursor to BMP, has also shown an increase in cholesterol egress. While it is hypothesized that the increase in cholesterol clearance in the latter is due to the biosynthesis of LBPA from PG, there is no study to directly confirm this phenomenon. Therefore, we set out to synthesize diastereochemically pure PG containing isotopically labeled oleyl acyl chains to examine LBPA levels using lipidomic analysis of <em>npc1-/-</em> cells post treatment with PG. </p> <p>Initially, efforts centered around the use of phosphoramidite methodology commonly encountered in DNA oligonucleotide synthesis. While this route proved to be successful in making PG in modest yield (52%), reproducibility of this route with consistent yields was hindered due to the use of tetrabutylammonium fluoride (TBAF) in the final global deprotection step. Thus, we set out to discover a phosphorylated intermediate that did not require TBAF in the final step or contain easily hydrolysable protecting groups. It was discovered that H-phosphonate methodology using diphenyl phosphite for phosphorylation of the glycerol headgroup and backbone proved to be robust enough for PG synthesis. In this strategy, PG can be isolated in two steps from the final protected intermediate by first oxidizing the H-phosphonate from PIII to PV followed by deprotection of the glycerol head group under acidic conditions. Additionally, the H-phosphonate strategy also allowed us to omit headgroup modification prior to phosphorylation which reduced the number of synthetic steps from 11 steps to 7 steps. As a result, we were able to synthesize diastereochemically pure PG more consistently than the previous route in 75% yield. The route was further modified further to incorporate asymmetric acyl chains allowing the selective installation of a labeled acyl chain on the <em>sn</em>-1 or <em>sn</em>-2 positions of the phosphoglycerol backbone. The results from the lipidomic experiments indicate that increased LBPA concentrations in cells rise upon incubation with labeled PG. Additionally, increases in lyso-PG and acyl-PG are also observed leading to several hypotheses on how LBPA might be synthesized from PG. Future directions on this effort include identification of phospholipid species made from PG containing asymmetrically labeled acyl chains.  Synthesis of photoaffinity labeled PG is also underway to determine the protein partners involved in PG metabolism.</p>