Jian-She Wang

Fudan University · Children’s Hospital of Fudan University

Background Clinical studies on progressive familial intrahepatic cholestasis (PFIC) type 5 caused by mutations in NR1H4 are limited. Methods New patients with biallelic NR1H4 variants from our center and all patients from literature were retrospectively analyzed. Results Three new patients were identified to be carrying five new variants. Liver p...

Exome sequencing (ES) has identified biallelic kinesin family member 12 (KIF12) mutations as underlying neonatal cholestatic liver disease. We collected information on onset and progression of this entity. Among consecutively referred pediatric patients at our centers, diagnostic ES identified 4 patients with novel, biallelic KIF12 variants using t...

Background and Aims Alagille syndrome (ALGS) is characterized by chronic cholestasis with associated pruritus and extrahepatic anomalies. Maralixibat, an ileal bile acid transporter inhibitor, is the first-approved pharmacologic therapy for cholestatic pruritus in ALGS. Since long-term placebo-controlled studies are not feasible or ethical in child...

Background The identification of vanishing bile duct syndrome (VBDS) is still challenging before liver biopsy. This study tried to explore non-invasive biomarkers for identification of VBDS among children with acute cholestatic hepatitis. Methods Between January 2017 and December 2021, 192 children underwent native-liver biopsy for acute cholestat...

Background Progressive familial intrahepatic cholestasis (PFIC) is a group of rare cholestatic liver diseases characterised by intractable pruritus, elevated serum bile acids (sBAs), and progressive liver damage. NAPPED (NAtural course and Prognosis of PFIC and Effect of biliary Diversion) is a large retrospective database investigating the natural...

Background and Aims We asked if comprehensive bile acid profiling could provide insights into the physiopathology of ABCB4-mutated patients and evaluated the prognostic value of taurine-conjugated tetrahydroxylated bile acid (tauro-THBA) in cholestasis. Methods Serum bile acid profiles were evaluated in 13 ABCB4-mutated patients with 65 healthy co...

Biallelic MYO5B variants have been associated with familial intrahepatic cholestasis (FIC) with low serum gamma-glutamyltransferase (GGT). Intronic or synonymous variants outside of canonical splice sites (hereinafter referred to as noncanonical variants) with uncertain significance were identified in MYO5B posing a challenge in clinical interpreta...

Real-world evidence (RWE) analytics continue to advance natural history comparisons in rare diseases. The Global Alagille Alliance (GALA) is the largest global clinical research database for Alagille syndrome (ALGS). Maralixibat (MRX) is an ileal bile acid transporter inhibitor approved by the FDA for the treatment of cholestatic pruritus in patien...

Background and aims: A recent study suggested that administration of ursodeoxycholic acid (UDCA) at dosages usually employed clinically may reduce rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A recent surge of SARS-CoV-2 omicron infection in China allowed study of whether UDCA administration reduced susceptibili...

We report the clinical and genetic features of a Han Chinese boy who presented with disease suspect for Alagille syndrome (ALGS). Multiple genetic analyses (panel sequencing, multiplex-ligation-dependent probe amplification, and whole genome sequencing) failed to uncover a causative variant. Optical genomic mapping detected a reciprocal translocati...

Background: Neonatal sclerosing cholangitis (NSC) is a rare and severe autosomal recessive inherited liver disease with mutations in DCDC2, commonly requiring liver transplantation (LT) for decompensated biliary cirrhosis in childhood. Methods: The information of four Chinese patients with NSC caused by mutations in DCDC2 from Children's Hospita...

Δ4-3-oxosteroid 5β-reductase (AKR1D1) deficiency presents with neonatal cholestasis and liver failure in early infancy and features high levels of 3-oxo- Δ4- bile acids in urine. Genetic analysis is needed for definitive diagnosis, because in the neonatal period it can be difficult to distinguish a primary from secondary enzyme deficiency. By re-an...

Background The liver manifestations of Alagille syndrome (ALGS) are highly variable, and factors affecting its prognosis are poorly understood. We asked whether the composition of bile acids in ALGS patients with good clinical outcomes differs from that in patients with poor outcomes and whether bile acids could be used as prognostic biomarkers.Met...

Objective: To investigate the clinical efficacy of liver transplantation in the treatment of acute liver in children with NBAS gene deficiency disease and their outcome. Methods: This retrospective study enrolled children with NBAS gene deficiency who were admitted to the Children's Hospital of Fudan University for liver transplantation from Januar...

Monkeypox is a zoonotic disease. Since the first human monkeypox case was detected in 1970, it has been prevalent in some countries in central and western Africa. Since May 2022, monkeypox cases have been reported in more than 96 non-endemic countries and regions worldwide. As of September 14, 2022, there have been more than 58,200 human monkeypox...

Objective To report a case of glycogen storage disease (GSD) type Ia misdiagnosed as multiple acyl-coenzyme a dehydrogenase deficiency (MADD) by mass spectrometry.MethodsA 7 months old boy was admitted to our hospital for elevated transaminase levels lasting more than 1 month. His blood biochemistry showed hypoglycemia, metabolic acidosis, hyperlip...

Background & Aims: Bile salt export pump (BSEP) deficiency frequently necessitates liver transplantation in childhood. In contrast to two predicted protein truncating mutations (PPTMs), homozygous p.D482G or p.E297G mutations are associated with relatively mild phenotypes, responsive to surgical interruption of the enterohepatic circulation (siEHC)...

Purpose: The study aimed to define the genotypic and phenotypic spectrum of reversible acute liver failure (ALF) of infancy resulting from biallelic pathogenic TRMU variants and to determine the role of cysteine supplementation in its treatment. Methods: Individuals with biallelic (likely) pathogenic variants in TRMU were studied through an inte...

Background: Alagille syndrome (ALGS) is a multisystem disorder, characterized by cholestasis. Existing outcome data are largely derived from tertiary centers and real-world data are lacking. This study aimed to elucidate the natural history of liver disease in a contemporary, international, cohort of children with ALGS. Methods: Multicenter retr...

BACKGROUND Mannosyl-oligosaccharide glucosidase (MOGS) deficiency is an extremely rare type of congenital disorder of glycosylation (CDG), with only 12 reported cases. Its clinical, genetic, and glycomic features are still expanding. Our aim is to update the novel clinical and glycosylation features of 2 previously reported patients with MOGS-CDG....

Objective To investigate the distribution of aetiologies and outcomes in neonates with prolonged neonatal jaundice. Design An observational study. Setting Multiple tertiary centres from the China Neonatal Genome Project. Patients Term infants with jaundice lasting more than 14 days or preterm infants with jaundice lasting more than 21 days were...

Background Patients with acid sphingomyelinase deficiency (ASMD) may be referred to a hepatologist for liver manifestations. This study summarized the liver manifestations of patients with ASMD in the early disease course. Methods This study enrolled ASMD patients diagnosed by genetic tests between July 2016 and December 2020 in a national pediatr...

Objective: To explore the clinical features of hepatocerebral mitochondrial DNA depletion syndrome (MDS). Methods: The clinical data of 6 hepatocerebral MDS patients diagnosed in the Jinshan Hospital of Fudan University from January 2012 to December 2019 were retrospectively collected and analyzed. Related literature published before January 2020 w...

Objectives To understand the epidemiological and clinical characteristics of pediatric SARS-CoV-2 infection during the early stage of Omicron variant outbreak in Shanghai. Methods This study included local COVID-19 cases <18 years in Shanghai referred to the exclusively designated hospital by the end of March 2022 since emergence of Omicron epidem...

Background and aims: Alagille syndrome (ALGS) type 2 caused by mutations in NOTCH2 has genotypic and phenotypic heterogeneity. Diagnosis in some atypical patients with isolated hepatic presentation could be missed. Methods: By using 2,087 patients with pediatric liver manifestations, NOTCH2 allele frequencies, in-silico prediction, protein domai...

TMEM67 (mecklin or MKS3) locates in the transition zone of cilia. Dysfunction of TMEM67 disrupts cilia‐related signaling and leads to developmental defects of multiple organs in humans. Typical autosomal recessive TMEM67 defects cause partial overlapping phenotypes, including abnormalities in the brain, eyes, liver, kidneys, bones, and so forth. Ho...

The liver manifestations of Alagille syndrome (ALGS) are highly variable, and factors affecting its prognosis are poorly understood. We asked whether or not the composition of bile acids in ALGS patients with good clinical outcomes differs from those with poor outcomes, and whether bile acids could be used as prognostic biomarkers. Blood for bile a...

Background: TMEM199-congenital disorder of glycosylation (TMEM199-CDG) is a rare autosomal recessive inherited disease characterized by chronically elevated serum transaminase, decreased serum ceruloplasmin, steatosis and/or fibrosis, TMEM199 mutation, reduced level of TMEM199 protein, and abnormal protein glycosylation. Methods: The information of...

Early diagnosis of Niemann-Pick disease type C (NP-C) in neonatal cholestasis is still challenging because splenomegaly is non-specific and oxysterol profiling studies also have a relatively low specificity. This study explores a method for identifying infants with a high clinical suspicion of NP-C in neonatal cholestasis. We reviewed the clinical...

Background and Aims The aim was to determine if liver biochemistry indices can be used as biomarkers to help differentiate patients with neonatal Dubin–Johnson syndrome (nDJS) from those with biliary atresia (BA). Methods Patients with genetically-confirmed nDJS or cholangiographically confirmed BA were retrospectively enrolled and randomly assign...

6岁患儿主诉“腹部膨隆2个月”，表现为大量腹腔积液、间断右上腹痛。腹腔积液化验示漏出液、门脉高压性。CT示肝密度不均，肝静脉未显影，下腔静脉肝内段狭窄。病理示肝窦淤血、扩张，内见纤维素样物质。依据临床、CT表现及相关检查除外感染、代谢、免疫、肿瘤性疾病，结合患儿“一点红”服用史，诊断吡咯烷生物碱所致的肝窦阻塞综合征。予对症及那屈肝素钙、去纤苷、华法林抗凝治疗，腹腔积液渐减少，肝静脉显影。治疗3个月腹腔积液消失，下腔静脉恢复正常。.

X-linked MAGT1 deficiency with increased susceptibility to EBV-infection and N-linked glycosylation defect (XMEN) disease is a primary immunodeficiency caused by loss-of-function variants in the MAGT1 gene. Only two patients from one family have been diagnosed with XMEN in China. In this study, we retrospectively analyzed the genetic, clinical, and...

Background Fabry disease (FD) remains poorly recognized, especially in children in China. Considering the diversity and nonspecific clinical manifestations accompanying with life-threatening aspect of this disease, methods to improve effective screening and management of the suspects are needed. This study aims to explore how it can be done effecti...

Background: Real-world evidence (RWE) analytics continue to advance natural history comparisons in rare diseases. GALA is the largest global clinical research database for Alagille syndrome (ALGS). Maralixibat (MRX) is an ileal bile acid transporter inhibitor being studied in ALGS. A pre-specified analysis plan applied novel analytical techniques t...

Background & Aims Biallelic pathogenic variants in MYO5B cause microvillus inclusion disease (MVID), or familial intrahepatic cholestasis (FIC). The reported FIC patients are scarce and so the genotype-phenotype correlation has not been fully characterized. This study aimed to report more MYO5B-associated FIC patients and correlate genotypes to phe...

Background: Biallelic variants in HSD3B7 cause 3β-hydroxy-Δ5-C27-steroid oxidoreductase (HSD3B7) deficiency, a life-threatening but treatable liver disease. The goal of this study was to obtain detailed information on the correlation between the genotype and phenotype of HSD3B7 deficiency and to report on responses to primary bile acid therapy. M...

Background Early diagnosis of Niemann-Pick disease type C (NP-C) is the key for reduction of organ damage since a medical treatment is available now. However, early detection of patients with a high clinical suspicion of NP-C in neonatal cholestasis is still challenging. Plasma oxysterol studies demonstrate a relatively low specificity for NP-C in...

Progressive familial intrahepatic cholestasis type 1 (PFIC1) results from biallelic pathogenic variants in ATP8B1. This study sought second pathogenic variants in ATP8B1 by whole-genome sequencing (WGS) in 4 unrelated low-GGT cholestasis patients in whom clinical suspicion of PFIC1 was high and gene-panel or Sanger sequencing had identified only on...

SLC35A2-CDG is a rare type of X-linked CDG with more than 60 reported cases. We retrospectively analyzed clinical phenotypes and SLC35A2 genotypes of four cases of SLC35A2-CDG from four unrelated families of Han ethnicity in China. All patients had infantile onset epilepsies that were completely or partly resistant to multiple anti-epileptic medica...

Background: Acute liver failure (ALF) can be a primary presentation of Wilson disease (WD). Mortality rates are high in WD with ALF (WDALF). Predictions of mortality in WDALF vary by model and are sometimes contradictory, perhaps because few patients are studied or WD diagnoses are questionable. Aim: To determine the outcomes among well-document...

Background Biallelic variants in HSD3B7 cause 3β-hydroxy-Δ⁵-C27-steroid oxidoreductase (HSD3B7) deficiency, a life-threatening but treatable liver disease. Genetic and correlated clinical information is limited. We retrospectively reviewed the records of 39 unrelated patients with genetically confirmed HSD3B7 deficiency. Results In this cohort, 44...

Alagille syndrome (ALGS) is generally thought of as a pediatric cholestatic liver disease, but spontaneous bleeds are a major cause of death. Here, we investigated bleeding in patients and a mouse model for ALGS (Jag1Ndr/Ndr mice) and asked whether phenotypes identified in mice could be detected in patients non-invasively. Jag1Ndr/Ndr mice spontane...

Background Deficiency of oxysterol 7α-hydroxylase, encoded by CYP7B1, is associated with fatal infantile progressive intrahepatic cholestasis and hereditary spastic paraplegia type 5. Most reported patients with CYP7B1 mutations presenting with liver disease in infancy have died of liver failure. However, it was recently reported that two patients...

Background and Aims Mutations in ATPase phospholipid transporting 8B1 (ATP8B1) can lead to familial intrahepatic cholestasis type 1 (FIC1) deficiency, or progressive familial intrahepatic cholestasis type 1. The rarity of FIC1 deficiency has largely prevented a detailed analysis of its natural history, effects of predicted protein truncating mutati...

With the economic development and living standards improvement, various chronic viral liver diseases in children is decreasing year by year, and the liver diseases related to heredity, environment and living habits is increasing. Although liver disease in children is relatively rare and is not the main cause of childhood mortality, chronic liver di...

Background CYP27A1 is the disease-causing gene of cerebrotendinous xanthomatosis (CTX). As a treatable lipid storage disease, early treatment can improve the prognosis. However, CTX patients reported in the literature are mostly adult patients; the phenotype spectrum of CTX in the infantile population remains elusive. Objective We aimed to investi...

To understand the epidemiological and clinical features of the symptomatic and asymptomatic pediatric cases of COVID-19, we carried out a prospective study in Shanghai during the period of January 19 to April 30, 2020. A total of 49 children (mean age 11.5 ± 5.12 years) confirmed with SARS-CoV-2 infection were enrolled in the study, including 11 (2...

Objective: To investigate the clinical phenotype and genotype of transient infantile hypertriglyceridemia (HTGTI). Methods: The clinical data of two HTGTI children, diagnosed at Children's Hospital of Fudan University from July 2019 to January 2020, were collected and analyzed retrospectively. The literature up to 25th January 2020 were searched in...

The PYGL gene is the only established gene known to cause glycogen storage disease type VI (GSD6), which is a rare autosomal recessive disorder associated with hepatomegaly, elevated hepatic transaminases, and hypoglycemia. We performed extended bioinformatics analysis on the exome sequencing data of five patients who were clinically diagnosed as/h...

We studied the pathological consequence of long-term hypercholanemia caused by NTCP deficiency, and found that NTCP deficiency leads to gallbladder abnormalities in both mice and humans, thereby pointing to a potentially underappreciated cause for gallbladder diseases encountered by physicians in the clinic.

Background: Children with chronic cholestatic liver diseases have a high risk of malnutrition. However, nutritional management in China has received little attention, and there has been limited evidence regarding improving these practices. This study aimed to evaluate the feeding status of chronic cholestatic children aged 6-24 months and to explo...

Background and Aims: Alagille Syndrome (ALGS) is a rare multisystem disorder and one of the most common inherited causes of neonatal cholestasis. Prior ALGS studies largely come from tertiary liver centers and therefore select for the most severely affected cholestatic patients. As a result, the full spectrum of ALGS liver involvement remains uncle...

Aim NBAS associated‐disease had a wide phenotypic spectrum including infantile liver failure syndrome type 2 (ILFS2, OMIM #616483), short stature with optic nerve atrophy and Pelger‐Huët anomaly (SOPH) syndrome (OMIM #614800), and combined phenotype overlapping ILFS2 and SOPH syndrome. The mutation spectra of NBAS and its genotype‐phenotype correla...

Objectives: To explore the significance of sodium taurocholate cotransporting polypeptide (NTCP) deficiency and its clinical features in Chinese children presenting with isolated persistent hypercholanemia. Methods: The exon and adjacent regions of SLC10A1, the gene encoding NTCP, were sequenced in 33 Chinese children presenting with isolated hy...

Background & Aims ABCB11 deficiency presenting in infancy is believed generally to manifest as persistent / progressive cholestasis. We describe a group of patients with biallelic ABCB11 variants whose disorder manifested as transient neonatal cholestasis (TNC). Methods Neonatal intrahepatic cholestasis in 68 children (31 male) with biallelic pred...

The Progressive Familial Intrahepatic Cholestasis (PFIC) disease spectrum encompasses a variety of genetic diseases that affect the bile production and the secretion of bile acids. Typically, the first presentation of these diseases is in early childhood, frequently followed by a severe course necessitating liver transplantation before adulthood. E...

Background For many children with intrahepatic cholestasis and high-serum gamma-glutamyl transferase (GGT) activity, a genetic aetiology of hepatobiliary disease remains undefined. We sought to identify novel genes mutated in children with idiopathic high-GGT intrahepatic cholestasis, with clinical, histopathological and functional correlations. M...

Mutations in the MYO5B gene cause in some patients low gamma‐glutamyltransferase (low‐GGT) cholestatic liver disease (CLD) and in other patients microvillus inclusion disease (MVID, a congenital diarrheal and malabsorption disorder). Overlap of symptoms occurs but more MVID patients present cholestasis than CLD patients present diarrhea. Clinical o...

1例主诉为"黄疸，瘙痒，排陶土样便2个月余"的患儿就诊于复旦大学附属金山医院儿科，经过相关实验室检查、基因分析和病理学检查，诊断为药物相关性胆管消失综合征，经熊去氧胆酸、考来烯胺、甲泼尼龙等治疗7个月，患儿肝功能恢复正常。儿童药物相关性胆管消失综合征临床较为罕见。.

Background and aims: In about 20% of children with cholestasis and normal or low serum gamma-glutamyltransferase (GGT) activity, no etiology is identified. We sought new genes implicated in pediatric hepatobiliary disease. Methods: We conducted whole exome sequencing in 69 children evaluated at our center from 2011 to 2018 who had low-GGT choles...

Background: We ask if plasma bile acid profiles can be used to monitor the effectiveness of partial internal biliary diversion (PIBD) for treating uncontrolled cholestasis in progressive familial intrahepatic cholestasis type 2 (PFIC2) patients. Methods: Plasma bile acids were profiled in 3 cases of ATP-binding cassette, sub-family B member 11 (...

Background: A recent cluster of pneumonia cases in China was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report the screening and diagnosis of corona virus disease 2019 (COVID-19) in our hospital. Methods: Developed a procedure for the identification of children cases with COVID-19 in outpatient and emergency d...

We first described the 2019 novel coronavirus infection in 10 children occurring in areas other than Wuhan. The coronavirus diseases in children are usually mild and epidemiological exposure is a key clue to recognize pediatric case. Prolonged virus shedding is observed in respiratory tract and feces at the convalescent stage.

Background & aims: Mutations in ABCB11 can cause deficiency of the bile salt export pump (BSEP), leading to cholestasis and end-stage liver disease. The rarity of the disease has prevented determination of associations between genotype and either natural history or the effect of surgical biliary diversion (SBD) on long-term outcome (liver transpla...

Background Children with chronic cholestatic liver diseases have a high risk of malnutrition. However, nutritional management does not receive attention with limited evidence to improve these practices. This study aimed to evaluate feeding status of children with chronic cholestatic liver disease, aged 6-24 months, and to explore the experiences of...

NGLY1 deficiency is the first and only autosomal recessive congenital disorder of N-linked deglycosylation (NGLY1-CDDG). To date, no patients with NGLY1 deficiency has been reported from mainland China or East Asia in English literature. Here, we present six patients with a diagnosis of NGLY1-CDDG on the basis of clinical phenotype, genetic testing...

Background: Children with chronic cholestatic liver diseases have a high risk of malnutrition. However, nutritional management in China has received little attention, and there has been limited evidence regarding improving these practices. This study aimed to evaluate the feeding status of chronic cholestatic children aged 6-24 months and to explor...

收治并确诊4例经典型半乳糖血症患儿，均表现为低γ-谷氨酰转移酶型胆汁淤积，转氨酶轻度升高且天冬氨酸转氨酶>丙氨酸转氨酶，伴贫血、低蛋白血症及严重低血糖，血乳酸升高。均有凝血异常，2例为急性肝衰竭；3例有一过性甲状腺功能减低；1例有白内障；1例有脑白质弥漫性异常。.