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Published in: Orphanet Journal of Rare Diseases 1/2012

Open Access 01-12-2012 | Research

Complement factor I deficiency: a not so rare immune defect. Characterization of new mutations and the first large gene deletion

Authors: María Alba-Domínguez, Alberto López-Lera, Sofía Garrido, Pilar Nozal, Ignacio González-Granado, Josefa Melero, Pere Soler-Palacín, Carmen Cámara, Margarita López-Trascasa

Published in: Orphanet Journal of Rare Diseases | Issue 1/2012

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Abstract

Background

Complement Factor I (CFI) is a serine protease with an important role in complement alternative pathway regulation. Complete factor I deficiency is strongly associated with severe infections. Approximately 30 families with this deficiency have been described worldwide.

Patients and methods

We have studied five new Spanish families suffering from CFI deficiency. From 19 screened people, 7 homozygous, 10 heterozygous and 2 healthy subjects were identified. Clinical, biochemical and genetic descriptions are included.

Results

Molecular studies demonstrated 4 novel mutations in the screened individuals; amongst them, we describe here the first great gene deletion reported in the CFI locus, which includes full exon 2 and part of the large intron 1.

Conclusion

CFI deficiency is possibly an underestimated defect and the eventual existence of this deficiency should be tested in those patients exhibiting low C3 and recurrent bacterial infections. We propose a simple diagnostic flowchart to help clinicians in the identification and correct diagnosis of such patients.
Appendix
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Literature
1.
go back to reference Botto M, Kirschfink M, Macor P, Pickering MC, Würzner R, Tedesco F: Complement in human diseases: Lessons from complement deficiencies. Mol Immunol. 2009, 46 (14): 2774-2783. 10.1016/j.molimm.2009.04.029.CrossRefPubMed Botto M, Kirschfink M, Macor P, Pickering MC, Würzner R, Tedesco F: Complement in human diseases: Lessons from complement deficiencies. Mol Immunol. 2009, 46 (14): 2774-2783. 10.1016/j.molimm.2009.04.029.CrossRefPubMed
2.
go back to reference Degn SE, Jensenius JC, Thiel S: Disease-causing mutations in genes of the complement system. Am J Hum Genet. 2011, 88 (6): 689-705. 10.1016/j.ajhg.2011.05.011.PubMedCentralCrossRefPubMed Degn SE, Jensenius JC, Thiel S: Disease-causing mutations in genes of the complement system. Am J Hum Genet. 2011, 88 (6): 689-705. 10.1016/j.ajhg.2011.05.011.PubMedCentralCrossRefPubMed
3.
go back to reference Sullivan KE, Winkelstein JA:Primary Immunodeficiency Diseases: a molecular and genetic approach. Genetically Determined Deficiencies of the Complement System 2nd edition. Edited by: Ochs HD, Smith CIE, Puck JM. New York: Oxford University Press; 2007:589-608. Sullivan KE, Winkelstein JA:Primary Immunodeficiency Diseases: a molecular and genetic approach. Genetically Determined Deficiencies of the Complement System 2nd edition. Edited by: Ochs HD, Smith CIE, Puck JM. New York: Oxford University Press; 2007:589-608.
4.
go back to reference Roversi P, Johnson S, Caesar JJ, McLean F, Leath KJ, Tsiftsoglou SA, Morgan BP, Harris CL, Sim RB, Lea SM: Structural basis for complement factor I control and its disease-associated sequence polymorphisms. Proc Natl Acad Sci U S A. 2011, 108 (31): 12839-12844. 10.1073/pnas.1102167108.PubMedCentralCrossRefPubMed Roversi P, Johnson S, Caesar JJ, McLean F, Leath KJ, Tsiftsoglou SA, Morgan BP, Harris CL, Sim RB, Lea SM: Structural basis for complement factor I control and its disease-associated sequence polymorphisms. Proc Natl Acad Sci U S A. 2011, 108 (31): 12839-12844. 10.1073/pnas.1102167108.PubMedCentralCrossRefPubMed
5.
go back to reference Nilsson SC, Sim RB, Lea SM, Fremeaux-Bacchi V, Blom AM: Complement Factor I in health and disease. Mol Immunol. 2011, 48 (14): 1611-1620. 10.1016/j.molimm.2011.04.004.CrossRefPubMed Nilsson SC, Sim RB, Lea SM, Fremeaux-Bacchi V, Blom AM: Complement Factor I in health and disease. Mol Immunol. 2011, 48 (14): 1611-1620. 10.1016/j.molimm.2011.04.004.CrossRefPubMed
6.
go back to reference Tsiftsoglou SA, Arnold JN, Roversi P, Crispin MD, Radcliffe C, Lea SM, Dwek RA, Rudd PM, Sim RB: Human complement factor I glycosylation: structural and functional characterisation of the N-linked oligosaccharides. Biochim Biophys Acta. 2006, 1764 (11): 1757-1766. 10.1016/j.bbapap.2006.09.007.CrossRefPubMed Tsiftsoglou SA, Arnold JN, Roversi P, Crispin MD, Radcliffe C, Lea SM, Dwek RA, Rudd PM, Sim RB: Human complement factor I glycosylation: structural and functional characterisation of the N-linked oligosaccharides. Biochim Biophys Acta. 2006, 1764 (11): 1757-1766. 10.1016/j.bbapap.2006.09.007.CrossRefPubMed
7.
go back to reference Fearon DT: Purification of C3b inactivator and demonstration of its two polypeptide chain structure. J Immunol. 1977, 119: 1248-1252.PubMed Fearon DT: Purification of C3b inactivator and demonstration of its two polypeptide chain structure. J Immunol. 1977, 119: 1248-1252.PubMed
8.
go back to reference Goldberger G, Arnaout MA, Aden D, Kay R, Rits M, Colten HR: Biosynthesis and postsynthetic processing of human C3b/C4b inactivator (factor I) in three hepatoma cell lines. J Biol Chem. 1984, 259: 6492-6497.PubMed Goldberger G, Arnaout MA, Aden D, Kay R, Rits M, Colten HR: Biosynthesis and postsynthetic processing of human C3b/C4b inactivator (factor I) in three hepatoma cell lines. J Biol Chem. 1984, 259: 6492-6497.PubMed
9.
go back to reference Goldberger G, Bruns GA, Rits M, Edge MD, Kwiatkowski DJ: Human complement factor I: analysis of cDNA-derived primary structure and assignment of its gene to chromosome 4. J Biol Chem. 1987, 262 (21): 10065-10071.PubMed Goldberger G, Bruns GA, Rits M, Edge MD, Kwiatkowski DJ: Human complement factor I: analysis of cDNA-derived primary structure and assignment of its gene to chromosome 4. J Biol Chem. 1987, 262 (21): 10065-10071.PubMed
10.
go back to reference Shiang R, Murray JC, Morton CC, Buetow KH, Wasmuth JJ, Olney AH, Sanger WG, Goldberger G: Mapping of the human complement factor I gene to 4q25. Genomics. 1989, 4 (1): 82-86. 10.1016/0888-7543(89)90318-2.CrossRefPubMed Shiang R, Murray JC, Morton CC, Buetow KH, Wasmuth JJ, Olney AH, Sanger WG, Goldberger G: Mapping of the human complement factor I gene to 4q25. Genomics. 1989, 4 (1): 82-86. 10.1016/0888-7543(89)90318-2.CrossRefPubMed
11.
go back to reference Sadallah S, Gudat F, Laissue JA, Spath PJ, Schifferli JA: Glomerulonephritis in a patient with complement factor I deficiency. Am J Kidney Dis. 1999, 33 (6): 1153-1157. 10.1016/S0272-6386(99)70155-1.CrossRefPubMed Sadallah S, Gudat F, Laissue JA, Spath PJ, Schifferli JA: Glomerulonephritis in a patient with complement factor I deficiency. Am J Kidney Dis. 1999, 33 (6): 1153-1157. 10.1016/S0272-6386(99)70155-1.CrossRefPubMed
12.
go back to reference González-Rubio C, Ferreira-Cerdán A, Ponce IM, Arpa J, Fontán G, López-Trascasa M: Complement factor I deficiency associated with recurrent meningitis coinciding with menstruation. Arch Neurol. 2001, 58 (11): 1923-1928. 10.1001/archneur.58.11.1923.CrossRefPubMed González-Rubio C, Ferreira-Cerdán A, Ponce IM, Arpa J, Fontán G, López-Trascasa M: Complement factor I deficiency associated with recurrent meningitis coinciding with menstruation. Arch Neurol. 2001, 58 (11): 1923-1928. 10.1001/archneur.58.11.1923.CrossRefPubMed
13.
go back to reference Abarrategui-Garrido C, Martínez-Barricarte R, López-Trascasa M, de Córdoba SR, Sánchez-Corral P: Characterization of complement factor H-related (CFHR) proteins in plasma reveals novel genetic variations of CFHR1 associated with atypical hemolytic uremic syndrome. Blood. 2009, 114 (19): 4261-4271. 10.1182/blood-2009-05-223834.CrossRefPubMed Abarrategui-Garrido C, Martínez-Barricarte R, López-Trascasa M, de Córdoba SR, Sánchez-Corral P: Characterization of complement factor H-related (CFHR) proteins in plasma reveals novel genetic variations of CFHR1 associated with atypical hemolytic uremic syndrome. Blood. 2009, 114 (19): 4261-4271. 10.1182/blood-2009-05-223834.CrossRefPubMed
14.
go back to reference de Goicoechea Jorge E, Harris CL, Esparza-Gordillo J, Carreras L, Arranz EA, Garrido CA, López-Trascasa M, Sánchez-Corral P, Morgan BP, de Rodríguez Córdoba S: Gain-of-function mutations in complement factor B are associated with atypical hemolytic uremic syndrome. Proc Natl Acad Sci U S A. 2007, 104 (1): 240-245. 10.1073/pnas.0603420103.CrossRef de Goicoechea Jorge E, Harris CL, Esparza-Gordillo J, Carreras L, Arranz EA, Garrido CA, López-Trascasa M, Sánchez-Corral P, Morgan BP, de Rodríguez Córdoba S: Gain-of-function mutations in complement factor B are associated with atypical hemolytic uremic syndrome. Proc Natl Acad Sci U S A. 2007, 104 (1): 240-245. 10.1073/pnas.0603420103.CrossRef
15.
go back to reference Rother U: A new screening test for C3 nephritis factor based on a stable cell bound convertase on sheep erythrocytes. J Immunol Methods. 1982, 51 (1): 101-107. 10.1016/0022-1759(82)90386-6.CrossRefPubMed Rother U: A new screening test for C3 nephritis factor based on a stable cell bound convertase on sheep erythrocytes. J Immunol Methods. 1982, 51 (1): 101-107. 10.1016/0022-1759(82)90386-6.CrossRefPubMed
16.
go back to reference Ponce-Castro IM, González-Rubio C, Delgado-Cerviño EM, Abarrategui-Garrido C, Fontán G, Sánchez-Corral P, López-Trascasa M: Molecular characterization of Complement Factor I deficiency in two Spanish families. Mol Immunol. 2008, 45 (10): 2764-2771. 10.1016/j.molimm.2008.02.008.CrossRefPubMed Ponce-Castro IM, González-Rubio C, Delgado-Cerviño EM, Abarrategui-Garrido C, Fontán G, Sánchez-Corral P, López-Trascasa M: Molecular characterization of Complement Factor I deficiency in two Spanish families. Mol Immunol. 2008, 45 (10): 2764-2771. 10.1016/j.molimm.2008.02.008.CrossRefPubMed
17.
go back to reference Le Quintrec M, Lionet A, Kamar N, Karras A, Barbier S, Buchler M, Fakhouri F, Provost F, Fridman WH, Thervet E, Legendre C, Zuber J, Frémeaux-Bacchi V: Complement mutation-associated de novo thrombotic microangiopathy following kidney transplantation. Am J Transplant. 2008, 8 (8): 1694-1701. 10.1111/j.1600-6143.2008.02297.x.CrossRefPubMed Le Quintrec M, Lionet A, Kamar N, Karras A, Barbier S, Buchler M, Fakhouri F, Provost F, Fridman WH, Thervet E, Legendre C, Zuber J, Frémeaux-Bacchi V: Complement mutation-associated de novo thrombotic microangiopathy following kidney transplantation. Am J Transplant. 2008, 8 (8): 1694-1701. 10.1111/j.1600-6143.2008.02297.x.CrossRefPubMed
18.
go back to reference Vyse TJ, Morley BJ, Bartok I, Theodoridis EL, Davies KA, Webster AD, Walport MJ: The molecular basis of hereditary complement factor I deficiency. J Clin Invest. 1996, 97 (4): 925-933. 10.1172/JCI118515.PubMedCentralCrossRefPubMed Vyse TJ, Morley BJ, Bartok I, Theodoridis EL, Davies KA, Webster AD, Walport MJ: The molecular basis of hereditary complement factor I deficiency. J Clin Invest. 1996, 97 (4): 925-933. 10.1172/JCI118515.PubMedCentralCrossRefPubMed
19.
go back to reference Baracho GV, Nudelman V, Isaac L: Molecular characterization of homozygous hereditary factor I deficiency. Clin Exp Immunol. 2003, 131 (2): 280-286. 10.1046/j.1365-2249.2003.02077.x.PubMedCentralCrossRefPubMed Baracho GV, Nudelman V, Isaac L: Molecular characterization of homozygous hereditary factor I deficiency. Clin Exp Immunol. 2003, 131 (2): 280-286. 10.1046/j.1365-2249.2003.02077.x.PubMedCentralCrossRefPubMed
20.
go back to reference Fremeaux-Bacchi V, Dragon-Durey MA, Blouin J, Vigneau C, Kuypers D, Boudailliez B, Loirat C, Rondeau E, Fridman WH: Complement factor I: a susceptibility gene for atypical haemolytic uraemic syndrome. J Med Genet. 2004, 41 (6): e84-10.1136/jmg.2004.019083.PubMedCentralCrossRefPubMed Fremeaux-Bacchi V, Dragon-Durey MA, Blouin J, Vigneau C, Kuypers D, Boudailliez B, Loirat C, Rondeau E, Fridman WH: Complement factor I: a susceptibility gene for atypical haemolytic uraemic syndrome. J Med Genet. 2004, 41 (6): e84-10.1136/jmg.2004.019083.PubMedCentralCrossRefPubMed
21.
go back to reference Bexborn F, Andersson PO, Chen H, Nilsson B, Ekdahl KN: The tick-over theory revisited: formation and regulation of the soluble alternative complement C3 convertase (C3(H2O)Bb). Mol Immunol. 2008, 45 (8): 2370-2379. 10.1016/j.molimm.2007.11.003.PubMedCentralCrossRefPubMed Bexborn F, Andersson PO, Chen H, Nilsson B, Ekdahl KN: The tick-over theory revisited: formation and regulation of the soluble alternative complement C3 convertase (C3(H2O)Bb). Mol Immunol. 2008, 45 (8): 2370-2379. 10.1016/j.molimm.2007.11.003.PubMedCentralCrossRefPubMed
22.
go back to reference Zipfel PF, Skerka C: Complement regulators and inhibitory proteins. Nat Rev Immunol. 2009, 9 (10): 729-740.PubMed Zipfel PF, Skerka C: Complement regulators and inhibitory proteins. Nat Rev Immunol. 2009, 9 (10): 729-740.PubMed
23.
go back to reference Notarangelo LD, Fischer A, Geha RS, Casanova JL, Chapel H, Conley ME, Cunningham-Rundles C, Etzioni A, Hammartröm L, Nonoyama S, Ochs HD, Puck J, Roifman C, Seger R, Wedgwood J, International Union of Immunological Societies Expert Committee on Primary Immunodeficiencies: Primary immunodeficiencies: 2009 update. J Allergy Clin Immunol. 2009, 124 (6): 1161-1178. 10.1016/j.jaci.2009.10.013.PubMedCentralCrossRefPubMed Notarangelo LD, Fischer A, Geha RS, Casanova JL, Chapel H, Conley ME, Cunningham-Rundles C, Etzioni A, Hammartröm L, Nonoyama S, Ochs HD, Puck J, Roifman C, Seger R, Wedgwood J, International Union of Immunological Societies Expert Committee on Primary Immunodeficiencies: Primary immunodeficiencies: 2009 update. J Allergy Clin Immunol. 2009, 124 (6): 1161-1178. 10.1016/j.jaci.2009.10.013.PubMedCentralCrossRefPubMed
24.
go back to reference Bonnin AJ, Zeitz HJ, Gewurz A: Complement factor I deficiency with recurrent aseptic meningitis. Arch Intern Med. 1993, 153 (11): 1380-1383. 10.1001/archinte.1993.00410110078012.CrossRefPubMed Bonnin AJ, Zeitz HJ, Gewurz A: Complement factor I deficiency with recurrent aseptic meningitis. Arch Intern Med. 1993, 153 (11): 1380-1383. 10.1001/archinte.1993.00410110078012.CrossRefPubMed
25.
go back to reference Genel F, Sjöholm AG, Skattum L, Truedsson L: Complement factor I deficiency associated with recurrent infections, vasculitis and immune complex glomerulonephritis. Scand J Infect Dis. 2005, 37 (8): 615-618. 10.1080/00365540510034536.CrossRefPubMed Genel F, Sjöholm AG, Skattum L, Truedsson L: Complement factor I deficiency associated with recurrent infections, vasculitis and immune complex glomerulonephritis. Scand J Infect Dis. 2005, 37 (8): 615-618. 10.1080/00365540510034536.CrossRefPubMed
26.
go back to reference Nilsson SC, Trouw LA, Renault N, Miteva MA, Genel F, Zelazko M, Marquart H, Muller K, Sjöholm AG, Truedsson L, Villoutreix BO, Blom AM: Genetic, molecular and functional analyses of complement factor I deficiency. Eur J Immunol. 2009, 39 (1): 310-323. 10.1002/eji.200838702.CrossRefPubMed Nilsson SC, Trouw LA, Renault N, Miteva MA, Genel F, Zelazko M, Marquart H, Muller K, Sjöholm AG, Truedsson L, Villoutreix BO, Blom AM: Genetic, molecular and functional analyses of complement factor I deficiency. Eur J Immunol. 2009, 39 (1): 310-323. 10.1002/eji.200838702.CrossRefPubMed
27.
go back to reference Grumach AS, Leitão MF, Arruk VG, Kirschfink M, Condino-Neto A: Recurrent infections in partial complement factor I deficiency: evaluation of three generations of a Brazilian family. Clin Exp Immunol. 2006, 143 (2): 297-304. 10.1111/j.1365-2249.2005.02988.x.PubMedCentralCrossRefPubMed Grumach AS, Leitão MF, Arruk VG, Kirschfink M, Condino-Neto A: Recurrent infections in partial complement factor I deficiency: evaluation of three generations of a Brazilian family. Clin Exp Immunol. 2006, 143 (2): 297-304. 10.1111/j.1365-2249.2005.02988.x.PubMedCentralCrossRefPubMed
28.
go back to reference Ochs HD, Wedgwood RJ, Frank MM, Heller SR, Hosea SW: The role of complement in the induction of antibody responses. Clin Exp Immunol. 1983, 53 (1): 208-216.PubMedCentralPubMed Ochs HD, Wedgwood RJ, Frank MM, Heller SR, Hosea SW: The role of complement in the induction of antibody responses. Clin Exp Immunol. 1983, 53 (1): 208-216.PubMedCentralPubMed
29.
go back to reference Licht C, Fremeaux-Bacchi V: Hereditary and acquired complement dysregulation in membranoproliferative glomerulonephritis. Thromb Haemost. 2009, 101 (2): 271-278.PubMed Licht C, Fremeaux-Bacchi V: Hereditary and acquired complement dysregulation in membranoproliferative glomerulonephritis. Thromb Haemost. 2009, 101 (2): 271-278.PubMed
30.
go back to reference Levy Y, George J, Yona E, Shoenfeld Y: Partial lipodystrophy, mesangiocapillary glomerulonephritis, and complement dysregulation. An autoimmune phenomenon. Immunol Res. 1998, 18 (1): 55-60.PubMed Levy Y, George J, Yona E, Shoenfeld Y: Partial lipodystrophy, mesangiocapillary glomerulonephritis, and complement dysregulation. An autoimmune phenomenon. Immunol Res. 1998, 18 (1): 55-60.PubMed
31.
go back to reference Dragon-Durey MA, Loirat C, Cloarec S, Macher MA, Blouin J, Nivet H, Weiss L, Fridman WH, Frémeaux-Bacchi V: Anti-Factor H autoantibodies associated with atypical hemolytic uremic syndrome. J Am Soc Nephrol. 2005, 16 (2): 555-563. 10.1681/ASN.2004050380.CrossRefPubMed Dragon-Durey MA, Loirat C, Cloarec S, Macher MA, Blouin J, Nivet H, Weiss L, Fridman WH, Frémeaux-Bacchi V: Anti-Factor H autoantibodies associated with atypical hemolytic uremic syndrome. J Am Soc Nephrol. 2005, 16 (2): 555-563. 10.1681/ASN.2004050380.CrossRefPubMed
32.
go back to reference Sánchez-Corral P, Melgosa M: Advances in understanding the aetiology of atypical Haemolytic Uraemic Syndrome. Br J Haematol. 2010, 150 (5): 529-542. 10.1111/j.1365-2141.2010.08295.x.CrossRefPubMed Sánchez-Corral P, Melgosa M: Advances in understanding the aetiology of atypical Haemolytic Uraemic Syndrome. Br J Haematol. 2010, 150 (5): 529-542. 10.1111/j.1365-2141.2010.08295.x.CrossRefPubMed
34.
go back to reference Strobel S, Hoyer PF, Mache CJ, Sulyok E, Liu WS, Richter H, Oppermann M, Zipfel PF, Józsi M: Functional analyses indicate a pathogenic role of factor H autoantibodies in atypical haemolytic uraemic syndrome. Nephrol Dial Transplant. 2010, 25 (1): 136-144. 10.1093/ndt/gfp388.CrossRefPubMed Strobel S, Hoyer PF, Mache CJ, Sulyok E, Liu WS, Richter H, Oppermann M, Zipfel PF, Józsi M: Functional analyses indicate a pathogenic role of factor H autoantibodies in atypical haemolytic uraemic syndrome. Nephrol Dial Transplant. 2010, 25 (1): 136-144. 10.1093/ndt/gfp388.CrossRefPubMed
35.
go back to reference Kavanagh D, Pappworth IY, Anderson H, Hayes CM, Moore I, Hunze EM, Bennaceur K, Roversi P, Lea S, Strain L, Ward R, Plant N, Nailescu C, Goodship TH, Marchbank KJ: Factor I autoantibodies in patients with atypical hemolytic uremic syndrome: disease-associated or an epiphenomenon?. Clin J Am Soc Nephrol. 2012, 7 (3): 417-426. 10.2215/CJN.05750611.PubMedCentralCrossRefPubMed Kavanagh D, Pappworth IY, Anderson H, Hayes CM, Moore I, Hunze EM, Bennaceur K, Roversi P, Lea S, Strain L, Ward R, Plant N, Nailescu C, Goodship TH, Marchbank KJ: Factor I autoantibodies in patients with atypical hemolytic uremic syndrome: disease-associated or an epiphenomenon?. Clin J Am Soc Nephrol. 2012, 7 (3): 417-426. 10.2215/CJN.05750611.PubMedCentralCrossRefPubMed
36.
go back to reference Moore I, Strain L, Pappworth I, Kavanagh D, Barlow PN, Herbert AP, Schmidt CQ, Staniforth SJ, Holmes LV, Ward R, Morgan L, Goodship TH, Marchbank KJ: Association of factor H autoantibodies with deletions of CFHR1, CFHR3, CFHR4, and with mutations in CFH, CFI, CD46, and C3 in patients with atypical hemolytic uremic syndrome. Blood. 2010, 115 (2): 379-387. 10.1182/blood-2009-05-221549.PubMedCentralCrossRefPubMed Moore I, Strain L, Pappworth I, Kavanagh D, Barlow PN, Herbert AP, Schmidt CQ, Staniforth SJ, Holmes LV, Ward R, Morgan L, Goodship TH, Marchbank KJ: Association of factor H autoantibodies with deletions of CFHR1, CFHR3, CFHR4, and with mutations in CFH, CFI, CD46, and C3 in patients with atypical hemolytic uremic syndrome. Blood. 2010, 115 (2): 379-387. 10.1182/blood-2009-05-221549.PubMedCentralCrossRefPubMed
Metadata
Title
Complement factor I deficiency: a not so rare immune defect. Characterization of new mutations and the first large gene deletion
Authors
María Alba-Domínguez
Alberto López-Lera
Sofía Garrido
Pilar Nozal
Ignacio González-Granado
Josefa Melero
Pere Soler-Palacín
Carmen Cámara
Margarita López-Trascasa
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Orphanet Journal of Rare Diseases / Issue 1/2012
Electronic ISSN: 1750-1172
DOI
https://doi.org/10.1186/1750-1172-7-42

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