Evaluation of an Interactive Visualization Tool for the Interpretation of Pediatric Laboratory Test Results - Hirschmann, Johannes; Sedlmayr, Brita; Zierk, Jakob; Rauh, Manfred; Metzler, Markus; Prokosch, Hans-Ulrich; Toddenroth, Dennis (Studies in health technology and informatics, 2017)
The physiological age-related development of pediatric laboratory results interferes with pathological derangements, which can complicate the interpretation of test results. Recently proposed continuous reference intervals (RIs) promise to be beneficial, although their clinical use may depend on graphical presentations. To estimate the clinical utility of continuous RIs, we developed and evaluated an interactive visualization tool, and examined the differentiation of hemoglobinopathies that is attainable based on the underlying innovative RI model. The implemented web application allows users to easily enter laboratory test results, and displays various visualizations in conjunction with the corresponding RIs, such as charts and personalized Z-scores. To evaluate the usability of the visualization tool, we conducted concurrent think-aloud sessions with four physicians, who were prompted to solve a set of typical interpretation tasks, and acquired additional information through a questionnaire including the System Usability Scale (SUS). We used 85 de-identified clinical cases for an exemplified assessment of how well model-based interpretations of blood count parameters reproduced previously diagnosed hemoglobinopathies. Usability tests as well as questionnaire responses indicated that the developed tool was well received by the physicians. Results from the think-aloud evaluation revealed only minor problems and the tool reached an average SUS score of 86.9, suggesting good usability. Hemoglobinopathy discrimination depended on the considered subtype, although the overall performance of the novel method rivaled the one of the conventional approach. The interactive visualization of innovative continuous reference intervals demonstrated promising results, which justifies further testing on the path towards clinical routine.
EVALuna2:193

Evaluation of five multisteroid LC-MS/MS methods used for routine clinical analysis: Comparable performance was obtained for nine analytes - Braun, Valentin; Ceglarek, Uta; Gaudl, Alexander; Gawinecka, Joanna; Müller, Daniel; Rauh, Manfred; Weber, Matthias; Seger, Christoph (Clinical Chemistry and Laboratory Medicine, 2023)
A mass spectrometry (LC-MS/MS)-based interlaboratory comparison study was performed for nine steroid analytes with five participating laboratories. The sample set contained 40 pooled samples of human serum generated from preanalyzed leftovers. To obtain a well-balanced distribution across reference intervals of each steroid, the leftovers first underwent a targeted mixing step. All participants measured a sample set once using their own multianalyte protocols and calibrators. Four participants used in-house developed measurement platforms, including IVD-CE certified calibrators, which were used by three participants; the 5th lab used the whole LC-MS kit from an IVD manufacturer. All labs reported results for 17-hydroxyprogesterone, androstenedione, cortisol, and testosterone, and four labs reported results for 11-deoxycortisol, corticosterone, cortisone, dehydroepiandrosterone sulfate (DHEAS), and progesterone. Good or acceptable overall comparability was found in Bland-Altmann and Passing-Bablok analyses. Mean bias against the overall mean remained less than ±10 » % except for DHEAS, androstenedione, and progesterone at one site and for cortisol and corticosterone at two sites (max. -18.9 » % for androstenedione). The main analytical problems unraveled by this study included a bias not previously identified in proficiency testing, operator errors, non-supported matrix types and higher inaccuracy and imprecision at lower ends of measuring intervals. This study shows that intermethod comparison is essential for monitoring the validity of an assay and should serve as an example of how external quality assessment could work in addition to organized proficiency testing schemes.
CRIS-Team Scopus Importer:2023-12-15
Keywords: endocrinology; laboratory medicine; LC-MS/MS; method comparison; steroid measurement

Evaluation of hard palate and cleft morphology in neonates with Pierre Robin Sequence and Cleft Palate Only - Willershausen, Ines; Krautkremer, Nils; Ströbel, Armin; Abu-Tair, Tariq; Paulsen, Friedrich; Strobel, Karin; Kopp, Markus; May, Matthias; Uder, Michael; Krautkremer, Franziska; Gölz, Lina (Orthodontics & Craniofacial Research, 2024)
Objectives: This study aimed to establish a fully digital measurement protocol for standardizing the description of hard palate and cleft morphology in neonates with an isolated cleft palate (CPO) and Pierre Robin sequence (PRS). Materials and Methods: A total of 20 digitized plaster models of neonates with CPO and 20 digitized plaster models of neonates with PRS were retrospectively investigated. For the control group, the hard palate was segmented from 21 pre-existing 1.5 T MRI datasets of neonates and exported as an STL file. The digital models were marked with predefined reference points by three raters. Distance, angular, and area measurements were performed using Blender and MeshLab. Results: Neonates with CPO (20.20 ± 2.33 mm) and PRS (21.41 ± 1.81 mm) had a significantly shorter hard palate than the control group (23.44 ± 2.24 mm) (CPO vs. control: P <.001; PRS vs. control: P =.014). Notably, neonates with PRS (33.05 ± 1.95 mm) demonstrated a significantly wider intertuberosity distance than those with CPO (30.52 ± 2.28 mm) (P =.012). Furthermore, there were also significant differences measured between the cleft and control groups (25.22 ± 2.50 mm) (P <.001). Conclusions: The data from this study demonstrate the feasibility of using MRI datasets to generate digital models of the hard palate. The presence of a cleft palate leads to pronounced adaptations of the total palatal surface area, dorsal width, and length of the hard palate. Mandibular retrognathia and altered tongue position in PRS, as opposed to CPO, might further impact palatal morphology and intertuberosity distance.
CRIS-Team Scopus Importer:2024-05-31
Keywords: cleft palate only; digital orthodontics; MRI; paediatric radiology; Pierre Robin sequence

EVALUATION OF OPTOACOUSTIC IMAGING FOR ANALYSIS OF PLACENTAL VILLOUS VASCULARIZATION - Hübner, Hanna; Knieling, Ferdinand; Faschingbauer, Florian; Rübner, Matthias; Kehl, Sven; Beckmann, Matthias; Rascher, Wolfgang; Hartner, Andrea; Fahlbusch, Fabian (2018)
EVALuna2:208000

Evaluation of plasma trace element and mineral status in children and adolescents with phenylketonuria using data from inductively-coupled-plasma atomic emission and mass spectrometric analysis - Knerr, Ina; Blessing, Holger; Seyferth, Stefan; Watling, R J; Chaudhri, Anwar (Annals of Nutrition and Metabolism, 2013)
Background: Phenylketonuria (PKU) is caused by a severe phenylalanine hydroxylase deficiency; the mainstay of treatment is a low-phenylalanine diet. A diet which is so restrictive is associated with a risk of nutritional deficiencies. We investigated plasma concentrations for 46 elements, including minerals and trace elements. Methods: We enrolled 20 children and adolescents with PKU and 20 matched controls. Multi-elementary quantification was carried out by solution-based inductively coupled plasma atomic emission spectroscopy (ICP-AES) and ICP mass spectrometry (ICP-MS). Results: With the exception of manganese and aluminium, no significant differences were found for element levels between PKU patients and controls. As a trend, manganese levels were lower in PKU patients than in control subjects (p < 0.05) but were within the reference range. There was a positive linear relationship between manganese and tyrosine levels in subjects with PKU (r = 0.2295, p < 0.05). If detectable, potentially toxic elements were only identified in ultra-trace quantities in plasma samples of either group; aluminium levels were found to be slightly higher in PKU subjects than in controls (p < 0.01). Conclusion: The combination of ICP-AES and ICP-MS data is a useful diagnostic tool for element quantification at a high analytical rate and for monitoring bio-element status, e.g. in patients on a restrictive diet. Copyright © 2013 S. Karger AG, Basel.

Evaluation of ventricular septal defects using high pitch computed tomography angiography of the chest in children with complex congenital heart defects below one year of age - Nau, David; Wüst, Wolfgang; Rompel, Oliver; Hammon, Matthias; Glöckler, Martin; Toka, Okan; Dittrich, Sven; Rueffer, André; Cesnjevar, Robert; Lell, Michael M.; Uder, Michael; May, Matthias (Journal of Cardiovascular Computed Tomography, 2019)
Background: Aim of this study was to assess the accuracy of ventricular septal defects (VSD) using high pitch computed tomography angiography (CTA) of the chest in children below 1 year of age, compared to the intraoperative findings and echocardiography. Methods: Out of 154 patients that underwent Dual-Source CTA of the chest using a high-pitch protocol at low tube voltages (70–80 kV), 55 underwent surgical repair of a VSD (median age 8 days, range 1–348 days). The margins of the VSDs and their relation to the surrounding structures were reproduced by en-face views using multiplanar reformations (MPR). Absolute diameter, normalized area and relative area compared to the aortic valve annulus were used for discrimination between restrictive and non-restrictive defects. Localization was classified into four subtypes. The results were compared to two-dimensional echocardiography and intraoperative findings. Results: Median absolute size of VSDs did not differ significantly between CTA-measurements (10.8 mm, range 2.8–18.1 mm) and intraoperative findings (12.0 mm, 3.0–25.0 mm, p = 0.09). Echocardiographic values were significantly lower (9.6 mm, 3.0–18.5 mm, both p < 0.01). The classification of the location and orientation matched the intraoperative situs in 96.4% of all cases using CT and in 87.3% using echocardiography. Echocardiography missed the relation to valves in 11% of all cases. Pre-interventional sensitivity and specificity for detection of a VSD were 97.2/98.9% compared to echocardiography. Median radiation dose was 0.32 mSv (range 0.12–2.00 mSv) and differed significantly between second and third generation Dual-Source CT (0.43 vs. 0.22 mSv, p = 0.003). Conclusion: Size and subtype of VSDs can be accurately assessed by CTA of the chest in patients with complex congenital heart defects at a very low radiation dose.
CRIS-Team Scopus Importer:2019-10-22
Keywords: Computed tomography angiography; Congenital heart defect; Dual-source; High pitch; Ventricular septal defect

Every CFTR variant counts – Target-capture based next-generation-sequencing for molecular diagnosis in the German CF Registry - Ahting, Simone; Nährlich, Lutz; Held, Inka; Henn, Constance; Krill, Angelika; Landwehr, Kerstin; Meister, Jochen; Nährig, Susanne; Nolde, Anna; Remke, Katharina; Ruppel, Renate; Sauer-Heilborn, Annette; et al. (Journal of Cystic Fibrosis, 2023)
Background: In times of genotype guided therapy options, a total of 3.2 % of people with CF (pwCF) in the German CF Registry[1] only have one or no CFTR-variant detected after genetic analysis. Additionally, genetic data in the Registry can be documented as free text and can therefore be prone to error. In order to allow the greatest possible amount of pwCF access to modern therapies, we conducted a re-evaluation of free text entries and established a custom-whole-CFTR-locus NGS-approach for all pwCF who remained without genetic confirmation afterwards. Methods: To this end, we assembled 731 free text variants of 655 pwCF in the German CF Registry. All variants were evaluated using ClinVar, HGMD and CFTR1/2, corrected in the Registries’ database and uploaded to ClinVar. PwCF whose diagnosis remained uncertain as well as additional pwCF or pwCFTR-RD that were assembled through a nationwide call for testing of unclear cases were offered genetic analysis. Samples were analysed using a target-capture based NGS-custom-design-panel covering the entire CFTR-locus. Results: Evaluation of free text variants led to the discovery of 43 variants not formerly reported in the context of CF. The Registries’ dropdown list was extended by 497 variants and over 500 pwCF were provided with their most up-to-date genotype. Samples of 47 pwCF/pwCFTR-RD were sequenced via NGS with an overall success rate of 61.7 %, resulting in implementation of entire CFTR-genotyping into routine diagnostics. Conclusion: Entire CFTR-genotyping can greatly increase the genetic diagnostic rate of pwCF/pwCFTR-RD and should be considered after inconspicuous CFTR screening panels in CFTR-diagnostics.
CRIS-Team Scopus Importer:2023-11-03
Keywords: Cystic fibrosis; Diagnostics; Genetics; Genotyping; Next-generation-sequencing

Evidenzbasierte Arzneimittelinformation für den pädiatrischen Notfall - Neubert, Antje; Gramlich, Ursula; Rascher, Wolfgang; Ittner, Karl Peter (Notarzt, 2023)
CRIS-Team Scopus Importer:2023-03-03

Evidenzbasierte Off-label-Anwendung von Arzneimitteln bei Kindern und Jugendlichen - Male, Christoph; Neubert, Antje; Grytli, Helene; Gradwohl, Christina; Strommer, Barbara; Lagler, Florian B.; Rascher, Wolfgang; Halvorsen, Thomas; De Wildt, Saskia N.; Van Der Zanden, Tjitske M. (Monatsschrift Kinderheilkunde, 2022)
In spite of an improved regulatory framework to facilitate development of drugs for children, there are still large deficits in available drugs for many pediatric therapeutic areas and, in particular for the youngest age groups. Therefore, many drugs must be used off-label for children and consequently without pediatric product information. Off-label use is associated with increased risks of inadequate dosing, lack of efficacy or adverse effects. Off-label use implies an increased responsibility for prescribers to rely on the best-available evidence for using age-appropriate doses and assessing the benefits and risks. This responsibility cannot be left to the individual prescriber as the few existing data from academic studies are of heterogeneous quality and not readily available. The international consortium of pediatric formularies is a collaboration of currently four European countries (The Netherlands, Germany, Austria, Norway), which builds on the Dutch Kinderformularium. The consortium provides drug information for children and adolescents based on best-available evidence; the information is compiled by systematic search, critical appraisal, expert review, international harmonization, and periodic updating, and is transparently referenced. The information is freely available for users on web-based platforms in the respective national language. The international consortium of pediatric formularies provides the basis for off-label drug use in children and adolescents, by providing the best-available evidence for choosing age-appropriate doses and weighing the benefits versus the risks.
CRIS-Team Scopus Importer:2022-02-11
Keywords: Authorization; Benefit-risk assessment; Drug prescriptions; Formulary; Information services

Evolving pituitary hormone deficits in primarily isolated GHD: a review and experts' consensus. - Binder, Gerhard; Schnabel, Dirk; Reinehr, Thomas; Pfaeffle, Roland; Dörr, Helmuth-Günther; Bettendorf, Markus; Hauffa, Berthold P.; Wölfle, Joachim (Molecular and Cellular Pediatrics, 2020)
Isolated growth hormone deficiency (GHD) is defined by growth failure in combination with retarded bone age, low serum insulin-like growth factor-1, and insufficient GH peaks in two independent GH stimulation tests. Congenital GHD can present at any age and can be associated with significant malformations of the pituitary-hypothalamic region or the midline of the brain. In rare instances, genetic analysis reveals germline mutations of transcription factors involved in embryogenesis of the pituitary gland and the hypothalamus. Acquired GHD is caused by radiation, inflammation, or tumor growth. In contrast to organic GHD, idiopathic forms are more frequent and remain unexplained.There is a risk of progression from isolated GHD to combined pituitary hormone deficiency (> 5% for the total group), which is clearly increased in children with organic GHD, especially with significant malformation of the pituitary gland. Therefore, it is prudent to exclude additional pituitary hormone deficiencies in the follow-up of children with isolated GHD by clinical and radiological observations and endocrine baseline tests. In contrast to primary disorders of endocrine glands, secondary deficiency is frequently milder in its clinical manifestation. The pituitary hormone deficiencies can develop over time from mild insufficiency to severe deficiency. This review summarizes the current knowledge on diagnostics and therapy of additional pituitary hormone deficits occurring during rhGH treatment in children initially diagnosed with isolated GHD. Although risk factors are known, there are no absolute criteria enabling exclusion of children without any risk of progress to combined pituitary hormone deficiency. Lifelong monitoring of the endocrine function of the pituitary gland is recommended in humans with organic GHD. This paper is the essence of a workshop of pediatric endocrinologists who screened the literature for evidence with respect to evolving pituitary deficits in initially isolated GHD, their diagnosis and treatment.
EVALuna2:385043
Keywords: Isolated GHD; Combined pituitary hormone deficiency; Organic GHD; Pituitary gland malformation; Acquired GHD

Ewing Sarcoma-Diagnosis, Treatment, Clinical Challenges and Future Perspectives - Zoellner, Stefan K.; Amatruda, James E.; Bauer, Sebastian; Collaud, Stephane; De Alava, Enrique; Dubois, Steven G.; Hardes, Jendrik; Hartmann, Wolfgang; Kovar, Heinrich; Metzler, Markus; Shulman, David S.; Streitbuerger, Arne; et al. (Journal of Clinical Medicine, 2021)
Ewing sarcoma, a highly aggressive bone and soft-tissue cancer, is considered a prime example of the paradigms of a translocation-positive sarcoma: a genetically rather simple disease with a specific and neomorphic-potential therapeutic target, whose oncogenic role was irrefutably defined decades ago. This is a disease that by definition has micrometastatic disease at diagnosis and a dismal prognosis for patients with macrometastatic or recurrent disease. International collaborations have defined the current standard of care in prospective studies, delivering multiple cycles of systemic therapy combined with local treatment; both are associated with significant morbidity that may result in strong psychological and physical burden for survivors. Nevertheless, the combination of non-directed chemotherapeutics and ever-evolving local modalities nowadays achieve a realistic chance of cure for the majority of patients with Ewing sarcoma. In this review, we focus on the current standard of diagnosis and treatment while attempting to answer some of the most pressing questions in clinical practice. In addition, this review provides scientific answers to clinical phenomena and occasionally defines the resulting translational studies needed to overcome the hurdle of treatment-associated morbidities and, most importantly, non-survival.
CRIS-Team WoS Importer:2021-05-21

Exercise Field Testing in Children: A New Approach for Age-Appropriate Evaluation of Cardiopulmonary Function - Schöffl, Isabelle; Ehrlich, Benedikt; Stanger, Simon; Rottermann, Kathrin; Dittrich, Sven; Schöffl, Volker (Pediatric Cardiology, 2020)
Based on the wide range of problems to effectively perform cardiopulmonary testing in young children, this study strives to develop a new cardiopulmonary exercise test for children using a mobile testing device worn in a backpack in order to test children during their natural movement habits, namely, running outdoors. A standard cardiopulmonary exercise ramp test on a cycle ergometer was performed by a group of twenty 7–10-year-old children. The results were compared with a self-paced incremental running test performed using a mobile cardiopulmonary exercise measuring device in an outdoor park. The children were able to reach significantly higher values for most of the cardiopulmonary exercise variables during the outdoor test and higher. Whereas a plateau in V ˙ O 2 was reached by 25% of the children during the outdoor test, only 75% were able to reach a reasonable VT2, let alone V ˙ O 2peak, during the bicycle test. The heart rate at VT1, the O2-pulse, and the OUES were comparable between both tests. OUES was also positively correlated with V ˙ O 2peak in both tests. Testing children outdoors using a mobile cardiopulmonary exercise unit represents an alternative to standard exercise testing, but without the added problems of exercise equipment like treadmills or bicycles. It allows for individualized exercise testing with the aim of standardized testing durations instead of standardized testing protocols. The running speeds determined during the outdoor tests may then be used to develop age-adapted testing protocols for treadmill testing.
CRIS-Team Scopus Importer:2020-05-19
Keywords: Cardiopulmonary function in children; Mobile spiroergometry; Outdoor testing; Pediatric cardiology; VO

Exhausted Lag-3+ CD4+ T cells are increased in pediatric Inflammatory Bowel Disease. - Schnell, Alexander; Aicher, Carmen; Schnegelsberg, Philipp; Schwarz, Benedikt; Schmidt, Hannah; Allabauer, Ida; Rueckel, Aline; Regensburger, Adrian; Wölfle, Joachim; Hörning, André (Clinical and Experimental Immunology, 2025)
T cells are one of the main drivers of inflammatory bowel diseases (IBD). Infliximab (IFX) is used in the treatment of IBD as an anti-inflammatory drug to induce remission by neutralizing TNFα. We determined the individual chemokine/homing receptor and cytokine profile in pediatric IBD patients before and during IFX therapy to identify predictive biomarkers for therapy success. Peripheral blood CD4+ cells from pediatric patients with IBD were immunomagnetically isolated and either directly analyzed by FACS for cell distribution and chemokine/homing receptor expression or evaluated for cytokine production after in-vitro-stimulation. Twenty-one responders (RS) and 21 non-responders (NRS) were recruited. Before IFX therapy, flow cytometry revealed decreased percentages of naïve conventional T cells in pediatric IBD patients. The proportions of CD62-L+ T cells were decreased in both CD and UC therapy responders. The cytokine profile of T cells was highly altered in IBD patients compared to healthy controls (HC). During IFX therapy, the frequencies of conventional memory and regulatory memory T cells expanded in both cohorts. IFX response was marked by a decrease of α4β7+ and IFNγ+ memory T cells in both CD and UC. In contrast, frequencies of Lag-3+ T cells proved to be significantly increased in NRS. These observations were irrespective of the underlying disease. T cells of pediatric IBD patients display an activated and rather Th1/Th17-shifted phenotype. The increased expression of the checkpoint molecule Lag-3 on T cells of NRS resembles a more exhausted phenotype than in RS and HC which appeared to be a relevant predictive marker for therapy failure.
EVALuna2:582625

Exome sequencing implicates a novel heterozygous missense variant in DSTYK in autosomal dominant lower urinary tract dysfunction and mild hereditary spastic paraparesis. - Vidic, Clara; Zaniew, Marcin; Jurga, Szymon; Thiele, Holger; Reutter, Heiko Martin; Hilger, Alina C. (Molecular and Cellular Pediatrics, 2021)
INTRODUCTION: DSTYK encodes dual serine/threonine and tyrosine protein kinase. DSTYK has been associated with autosomal-dominant congenital anomalies of the kidney and urinary tract and with autosomal-recessive hereditary spastic paraplegia type 23. Here, we report a father and his two dizygotic twin sons carrying a novel heterozygous missense variant in DSTYK, presenting with early onset lower urinary tract dysfunction due to dysfunctional voiding. Moreover, in the later course of the disease, both sons presented with bilateral spasticity in their lower limbs, brisk reflexes, and absence seizures. MATERIALS AND METHODS: Exome sequencing in the affected father and his affected sons was performed. The sons presented clinically with urinary hesitancy, dysfunctional voiding, and night incontinence till adolescence, while the father reported difficulty in voiding. In the sons, cystoscopy excluded urethral valves and revealed hypertrophy of the bladder neck and trabeculated bladder. Additionally, both sons were diagnosed with absence epilepsy in early childhood. Filtering of exome data focused on rare (MAF < 0.01%), autosomal-dominant variants, predicted to be deleterious, residing in highly conserved regions of the exome. RESULTS: Exome analysis identified a novel, heterozygous missense variant (c.271C>A (p.Leu91Met)) in DSTYK segregating with the disease. In silico prediction analyses uniformly rated the variant to be deleterious suggesting the variant to be disease-causing in the family. CONCLUSION: To the best of our knowledge, this is the first report of early onset dysfunctional voiding, seizures, and bilateral spasticity of the lower limbs associated with a novel heterozygous dominant missense variant in DSTYK.
EVALuna2:490519
Keywords: DSTYK; Functional urinary bladder disturbance; HSP23; Hereditary spastic paraparesis; Epilepsy; CAKUT

Exome sequencing in individuals with cardiovascular laterality defects identifies potential candidate genes - Breuer, Katinka; Riedhammer, Korbinian M.; Mueller, Nicole; Schaidinger, Birthe; Dombrowsky, Gregor; Dittrich, Sven; Zeidler, Susanne; Bauer, Ulrike M. M.; Westphal, Dominik S.; Meitinger, Thomas; Dakal, Tikam Chand; Hitz, Marc-Phillip; et al. (European journal of human genetics, 2022)
The birth prevalence of laterality defects is about 1.1/10,000 comprising different phenotypes ranging from situs inversus totalis to heterotaxy, mostly associated with complex congenital heart defects (CHD) and situs abnormalities such as intestinal malrotation, biliary atresia, asplenia, or polysplenia. A proportion of laterality defects arise in the context of primary ciliary dyskinesia (PCD) accompanied by respiratory symptoms or infertility. In this study, exome sequencing (ES) was performed in 14 case-parent trios/quattros with clinical exclusion of PCD prior to analysis. Moreover, all cases and parents underwent detailed clinical phenotyping including physical examination, echocardiography by a skilled paediatric cardiologist and abdominal ultrasound examinations not to miss mildly affected individuals. Subsequent survey of the exome data comprised filtering for monoallelic de novo, rare biallelic, and X-linked recessive variants. In two families, rare variants of uncertain significance (VUS) in PKD1L1 and ZIC3 were identified. Both genes have been associated with laterality defects. In two of the remaining families, biallelic variants in LMBRD1 and DNAH17, respectively, were prioritized. In another family, an ultra-rare de novo variant in WDR47 was found. Extensive exome survey of 2,109 single exomes of individuals with situs inversus totalis, heterotaxy, or isolated CHD identified two individuals with novel monoallelic variants in WDR47, but no further individuals with biallelic variants in DNAH17 or LMBRD1. Overall, ES of 14 case-parent trios/quattros with cardiovascular laterality defects identified rare VUS in two families in known disease-associated genes PKD1L1 and ZIC3 and suggests DNAH17, LMBRD1, and WDR47 as potential genes involved in laterality defects.
CRIS-Team WoS Importer:2022-05-13

Exome Survey and Candidate Gene Re-Sequencing Identifies Novel Exstrophy Candidate Genes and Implicates LZTR1 in Disease Formation - Köllges, Ricarda; Stegmann, Jil; Schneider, Sophia; Waffenschmidt, Lea; Fazaal, Julia; Breuer, Katinka; Hilger, Alina Christine; Dworschak, Gabriel C.; Mingardo, Enrico; Rösch, Wolfgang; Hofmann, Aybike; Neissner, Claudia; et al. (Biomolecules, 2023)
Background: The bladder exstrophy-epispadias complex (BEEC) is a spectrum of congenital abnormalities that involves the abdominal wall, the bony pelvis, the urinary tract, the external genitalia, and, in severe cases, the gastrointestinal tract as well. Methods: Herein, we performed an exome analysis of case-parent trios with cloacal exstrophy (CE), the most severe form of the BEEC. Furthermore, we surveyed the exome of a sib-pair presenting with classic bladder exstrophy (CBE) and epispadias (E) only. Moreover, we performed large-scale re-sequencing of CBE individuals for novel candidate genes that were derived from the current exome analysis, as well as for previously reported candidate genes within the CBE phenocritical region, 22q11.2. Results: The exome survey in the CE case-parent trios identified two candidate genes harboring de novo variants (NR1H2, GKAP1), four candidate genes with autosomal-recessive biallelic variants (AKR1B10, CLSTN3, NDST4, PLEKHB1) and one candidate gene with suggestive uniparental disomy (SVEP1). However, re-sequencing did not identify any additional variant carriers in these candidate genes. Analysis of the affected sib-pair revealed no candidate gene. Re-sequencing of the genes within the 22q11.2 CBE phenocritical region identified two highly conserved frameshift variants that led to early termination in two independent CBE males, in LZTR1 (c.978_985del, p.Ser327fster6) and in SLC7A4 (c.1087delC, p.Arg363fster68). Conclusions: According to previous studies, our study further implicates LZTR1 in CBE formation. Exome analysis-derived candidate genes from CE individuals may not represent a frequent indicator for other BEEC phenotypes and warrant molecular analysis before their involvement in disease formation can be assumed.
CRIS-Team Scopus Importer:2023-08-11
Keywords: cloacal exstrophy; exome analysis; exstrophy; molecular inversion probe

Expanding the spectrum of WDR62 mutations : description of new cases - Ruaud, L.; Drunat, S.; Ernault, A.; Capri, Y.; Van Maldergem, L.; Engel, C.; Altuzarra, C.; Bayat, A.; Moortgart, S.; Maystadt, I.; Abramowicz, M.; Zweier, Christiane; et al. (EUROPEAN JOURNAL OF HUMAN GENETICS, 2020)
CRIS-Team WoS Importer:2021-01-22

Expertenempfehlung: Therapie nichtgehfähiger Patienten mit Muskeldystrophie Duchenne - Bernert, Guenther; Hahn, Andreas; Köhler, Cornelia; Meyer, Sascha; Schara, Ulrike; Schlachter, Kurt; Trollmann, Regina; Walter, Maggie C. (Der Nervenarzt, 2020)
Background: Duchenne muscular dystrophy (DMD) is the most frequent genetic neuromuscular disease in childhood with loss of ambulation usually occurring around the age of 9–11 years. Objective, material and methods: Based on current guidelines and clinical trials, neuropediatric and neurological experts developed recommendations for the treatment of nonambulatory DMD patients focusing on drug treatment of adults. This advisory board was sponsored by PTC Therapeutics, the distributers of the substance ataluren. Results and conclusion: Loss of ambulation is heterogeneously defined across clinical trials. Among others, the need of a wheelchair, ambulation without mobility aids or maximum walking distance can be suitable parameters for assessment. Treatment of DMD patients at any stage of the disease is based on supportive and symptomatic measures, which should be continued after loss of ambulation. In addition, disease-modifying drugs are available for the treatment of DMD and glucocorticoids are the usual standard of care treatment even beyond the loss of ambulation. Ataluren, a potentially dystrophin restorative, disease-modifying treatment, has been approved for patients with DMD due to a nonsense mutation (nmDMD), which applies to approximately 13% of DMD patients and is usually combined with steroids. Clinical data from the STRIDE registry demonstrated a delayed disease progression even after loss of ambulation. Currently, no reliable data are available for exon skipping approaches in adult DMD patients. The antioxidant idebenone could be an option in nonambulant adolescent patients not treated with glucocorticoids and without other therapeutic options. A combination treatment of idebenone and glucocorticoids is currently being investigated in a clinical trial. Add-on treatment with idebenone in addition to ataluren may be considered for nonambulant nmDMD patients. Some of the discussed treatment options are still in clinical trials or there are not enough data for older DMD patients; therefore, these expert recommendations correspond to evidence class IV.
CRIS-Team Scopus Importer:2020-11-27
Keywords: Ataluren; Duchenne muscular dystrophy; Exon skipping; Glucocorticoids; Idebenone; Pharmacological therapy

Expertenempfehlung zur Magnetresonanztomographie bei Muskelerkrankungen - Zeng, Rachel; Schlaeger, Sarah; Türk, Matthias; Baum, Thomas; Deschauer, Marcus; Janka, Rolf Matthias; Karampinos, Dimitrios; Kassubek, Jan; Keller-Yamamura, Sarah; Kornblum, Cornelia; Lehmann, Helmar; Lichtenstein, Thorsten; et al. (Der Nervenarzt, 2024)
Background: Magnetic resonance (MRI) imaging of the skeletal muscles (muscle MRI for short) is increasingly being used in clinical routine for diagnosis and longitudinal assessment of muscle disorders. However, cross-centre standards for measurement protocol and radiological assessment are still lacking. Objectives: The aim of this expert recommendation is to present standards for the application and interpretation of muscle MRI in hereditary and inflammatory muscle disorders. Methods: This work was developed in collaboration between neurologists, neuroradiologists, radiologists, neuropaediatricians, neuroscientists and MR physicists from different university hospitals in Germany. The recommendations are based on expert knowledge and a focused literature search. Results: The indications for muscle MRI are explained, including the detection and monitoring of structural tissue changes and oedema in the muscle, as well as the identification of a suitable biopsy site. Recommendations for the examination procedure and selection of appropriate MRI sequences are given. Finally, steps for a structured radiological assessment are presented. Conclusions: The present work provides concrete recommendations for the indication, implementation and interpretation of muscle MRI in muscle disorders. Furthermore, it provides a possible basis for the standardisation of the measurement protocols at all clinical centres in Germany.
CRIS-Team Scopus Importer:2024-05-10
Keywords: Diagnostics; Muscle MRI; Myopathy; Myositis; Semi-quantitative assessment scales

Expertenempfehlung zur Magnetresonanztomographie bei Muskelerkrankungen - Zeng, Rachel; Schlaeger, Sarah; Türk, Matthias; Baum, Thomas; Deschauer, Marcus; Janka, Rolf Matthias; Karampinos, Dimitrios; Kassubek, Jan; Keller-Yamamura, Sarah; Kornblum, Cornelia; Lehmann, Helmar; Lichtenstein, Thorsten; et al. (Die Radiologie, 2024)
BACKGROUND: Magnetic resonance (MRI) imaging of the skeletal muscles (muscle MRI for short) is increasingly being used in clinical routine for diagnosis and longitudinal assessment of muscle disorders. However, cross-centre standards for measurement protocol and radiological assessment are still lacking. OBJECTIVES: The aim of this expert recommendation is to present standards for the application and interpretation of muscle MRI in hereditary and inflammatory muscle disorders. METHODS: This work was developed in collaboration between neurologists, neuroradiologists, radiologists, neuropaediatricians, neuroscientists and MR physicists from different university hospitals in Germany. The recommendations are based on expert knowledge and a focused literature search. RESULTS: The indications for muscle MRI are explained, including the detection and monitoring of structural tissue changes and oedema in the muscle, as well as the identification of a suitable biopsy site. Recommendations for the examination procedure and selection of appropriate MRI sequences are given. Finally, steps for a structured radiological assessment are presented. CONCLUSIONS: The present work provides concrete recommendations for the indication, implementation and interpretation of muscle MRI in muscle disorders. Furthermore, it provides a possible basis for the standardisation of the measurement protocols at all clinical centres in Germany.
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Exploitable metabolic dependencies in MLL-ENL-induced leukemia - Garcia-Cuellar, Maria-Paz; Lawlor, Jennifer; Böttcher, Martin; Mougiakakos, Dimitrios; Metzler, Markus; Slany, Robert (Blood Advances, 2020)
Mixed-lineage leukemia (MLL) fusions are transcriptional activators that induce leukemia, with a dismal prognosis that mandates further elucidation of their transformation mechanism. In this study, knockdown of the direct MLL-ENL target gene polypyrimidine tract binding protein-1 (PTBP1) was rate limiting for cell proliferation and caused a metabolic phenotype associated with reduced glucose consumption and lactate production. This effect was accompanied by a reduction of splice isoform-2 of pyruvate kinase M (PKM2). Because PKM2 restricts glycolytic outflow to provide anabolic intermediates, we tested the consequences of glucose, energy, and Ser/Gly starvation for cell physiology. Administration of deoxyglucose, energetic decoupling with rotenone, and inhibition of Ser biosynthesis by CBR5884 had a significantly stronger influence on self-renewal and survival of transformed cells than on normal controls. In particular, inhibition of Ser synthesis, which branches off glycolysis caused accumulation of reactive oxygen species, DNA damage, and apoptosis, predominantly in leukemic cells. Depletion of exogenous Ser/Gly affected proliferation and self-renewal of murine and human leukemia samples, even though they are classified as nonessential amino acids. Response to Ser/Gly starvation correlated with glucose transport, but did not involve activation of the AMPK energy homeostasis system. Finally, survival times in transplantation experiments were significantly extended by feeding recipients a Ser/Gly-free diet. These results suggest selective starvation as an option for supportive leukemia treatment.
CRIS-Team WoS Importer:2020-09-04

Exploring the complex etiology of oncogenic fusions in childhood cancer - Anderson, Nathaniel D.; De Borja, Richard; Young, Matthew D.; Fuligni, Fabio; Rosic, Andrej; Roberts, Nicola D.; Pillay, Nischalan; Toretsky, Jeffrey A.; Akihiko, Yoshida; Shibata, Tatsuhiro; Metzler, Markus; Somers, Gino; et al. (CANCER RESEARCH, 2019)
CRIS-Team WoS Importer:2019-10-22

Exploring the relationships between composite scores of disease severity, seizure-freedom and quality of life in Dravet syndrome. - Strzelczyk, Adam; Kurlemann, Gerhard; Bast, Thomas; Bettendorf, Ulrich; Kluger, Gerhard; Mayer, Thomas; Neubauer, Bernd A.; Polster, Tilman; von Spiczak, Sarah; Trollmann, Regina; Wolff, Markus; Toward, Toby; et al. (Neurological Research and Practice, 2022)
BACKGROUND: In Dravet syndrome (DS), a rare epileptic and developmental encephalopathy, the effectiveness of a new treatment is predominantly measured in terms of seizure frequency. However, this may not fully capture the impact of a treatment on the broader aspects of the syndrome and patients' health-related quality of life (HRQoL). Using a previously published survey which collected data from DS patients and their carers on the broader manifestations of their syndrome, their HRQoL, and their experience of seizures, this study created composite measures of symptom severity to offer new perspectives on the multifaceted aspects of this rare condition. METHODS: Survey responses on the severity of physical and psychosocial symptoms were combined with independent assessments of disability and care need, to generate three composite symptom scores assessing the manifestations of DS (physical, psychosocial and care requirements). Variation in HRQoL was investigated in multiple regression analyses to assess the strength of association between each of these composite measures and three forms of seizure measures (seizure frequency, days with no seizures and longest interval without seizures), as experienced over a 4- and 12-week period. RESULTS: Composite scores were calculated for a cohort of 75 primarily paediatric patients who were enrolled in the study. Strong associations were found between each of the three composite symptom scores and each of the three seizure measures, with the regression coefficient on symptom score highly significant (p ≤ 0.001) in all nine comparisons. Separate regressions using predictors of HRQoL (Kiddy KINDL and Kid KINDL) as the dependent variable were inconclusive, identifying only behavioural/attention problems and status epilepticus as significant predictors of HRQoL. CONCLUSIONS: These results allow the development of a composite score that may be useful in developing a clinical understanding of the severity of DS for an individual patient and establishing their treatment goals. Where measurement of long-term sequalae of disease is not feasible, such as clinical trials, correlation of the composite score with experience of seizures and seizure-free periods may allow a better contextualisation of the results of short-term assessments. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00011894. Registered 16 March 2017, http://www.drks.de/ DRKS00011894.
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Expression and Regulation of Retinoic Acid Receptor Responders in the Human Placenta - Hübner, Hanna; Rascher, Wolfgang; Strick, Reiner; Kehl, Sven; Heindl, Felix; Wachter, David; Beckmann, Matthias; Fahlbusch, Fabian B.; Rübner, Matthias; Hartner, Andrea (Reproductive Sciences, 2017)
INTRODUCTION: Retinoic acid (RA) signaling through its receptors (RARA, RARB, RARG, and the retinoic X receptor RXRA) is essential for healthy placental and fetal development. An important group of genes regulated by RA are the RA receptor responders (RARRES1, 2, and 3). We set out to analyze their expression and regulation in healthy and pathologically altered placentas of preeclampsia (PE) and intrauterine growth restriction (IUGR) as well as in trophoblast cell lines. METHODS: We performed immunohistochemical staining on placental sections and analyzed gene expression by real-time polymerase chain reaction. Additionally, we performed cell culture experiments and stimulated Swan71 and Jeg-3 cells with different RA derivates and 2'-deoxy-5-azacytidine (AZA) to induce DNA demethylation. RESULTS: RARRES1, 2, and 3 and RARA, RARB, RARG, and RXRA are expressed in the extravillous part of the placenta. RARRES1, RARA, RARG, and RXRA were additionally detected in villous cytotrophoblasts. RARRES gene expression was induced via activation of RARA, RARB, and RARG in trophoblast cells. RARRES1 was overexpressed in villous trophoblasts and the syncytiotrophoblast from PE placentas, but not in IUGR without PE. Promoter methylation was detectable for RARRES1 and RARB based on their sensitivity toward AZA treatment of trophoblast cell lines. DISCUSSION: RARRES1, 2 and 3 are expressed in the functional compartments of the human placenta and can be regulated by RA. We hypothesize that the epigenetic suppression of trophoblast RARRES1 and RARB expression and the upregulation of RARRES1 in PE trophoblast cells suggest an involvement of environmental factors (eg, maternal vitamin A intake) in the pathogenesis of this pregnancy complication.
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Expression of Retinoid Acid Receptor-Responsive Genes in Rodent Models of Placental Pathology - Mocker, Alexander; Schmidt, Marius; Hübner, Hanna; Wachtveitl, Rainer; Cordasic, Nada; Menendez-Castro, Carlos; Hartner, Andrea; Fahlbusch, Fabian (International Journal of Molecular Sciences, 2019)
In humans, retinoic acid receptor responders (RARRES) have been shown to be altered in third trimester placentas complicated by the pathologies preeclampsia (PE) and PE with intrauterine growth restriction (IUGR). Currently, little is known about the role of placental Rarres in rodents. Therefore, we examined the localization and expression of Rarres1 and 2 in placentas obtained from a Wistar rat model of isocaloric maternal protein restriction (E18.5, IUGR-like features) and from an eNOS-knockout mouse model (E15 and E18.5, PE-like features). In both rodent models, Rarres1 and 2 were mainly localized in the placental spongiotrophoblast and giant cells. Their placental expression, as well as the expression of the Rarres2 receptor chemokine-like receptor 1 (CmklR1), was largely unaltered at the examined gestational ages in both animal models. Our results have shown that RARRES1 and 2 may have different expression and roles in human and rodent placentas, thereby underlining immanent limitations of comparative interspecies placentology. Further functional studies are required to elucidate the potential involvement of these proteins in early placentogenesis.
EVALuna2:209516

Expression of the Alpha8 Integrin Chain Facilitates Phagocytosis by Renal Mesangial Cells - Marek, Ines; Becker, Robert; Fahlbusch, Fabian B.; Menendez-Castro, Carlos; Rascher, Wolfgang; Daniel, Christoph; Volkert, Gudrun; Hartner, Andrea (Cellular Physiology and Biochemistry, 2018)
BACKGROUND/AIMS: Healing of mesangioproliferative glomerulonephritis involves degradation of excess extracellular matrix, resolution of hypercellularity by apoptosis and phagocytosis of apoptotic cells. Integrin receptors participate in the regulation of phagocytosis. In mice deficient for alpha8 integrin (Itga8-/-) healing of glomerulonephritis is delayed. As Itga8 is abundant in mesangial cells (MC) which are non-professional phagocytes, we hypothesized that Itga8 facilitates phagocytosis of apoptotic cells and matrix components by MC. METHODS: MC were isolated from wild type (WT) and Itga8-/- mice. Latex beads were coated with matrix components. Apoptosis was induced by cisplatin in macrophages and in DiI-stained MC. After coincubation of latex beads or apoptotic cells with MC, the phagocytosis rate was detected in WT and Itga8-/- MC via fluorescence microscopy and FACS analysis. RESULTS: Itga8-/- MC showed reduced phagocytosis of matrix-coated beads and apoptotic cells compared to WT MC. Reduction of stress fibers was observed in Itga8-/- compared to WT MC. Inhibition of cytoskeletal reorganization by inhibition of Rac1 or ROCK during phagocytosis significantly decreased the rate of phagocytosis by WT MC but not by Itga8-/- MC. CONCLUSION: The expression of Itga8 facilitates phagocytosis in MC, likely mediated by Itga8-cytoskeleton interactions. An impairment of MC phagocytosis might thus contribute to a delayed glomerular regeneration in Itga8-/- mice.
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EZH2 specifically regulates ISL1 during embryonic urinary tract formation - Mingardo, Enrico; Kalanithy, Jeshurun C.; Dworschak, Gabriel; Ishorst, Nina; Yilmaz, Öznur; Lindenberg, Tobias; Hollstein, Ronja; Felger, Tim; Angrand, Pierre-Olivier; Reutter, Heiko M.; Reutter, Heiko Martin; Odermatt, Benjamin (Scientific Reports, 2024)
Isl1 has been described as an embryonic master control gene expressed in the pericloacal mesenchyme. Deletion of Isl1 from the genital mesenchyme in mice leads to an ectopic urethral opening and epispadias-like phenotype. Using genome wide association methods, we identified ISL1 as the key susceptibility gene for classic bladder exstrophy (CBE), comprising epispadias and exstrophy of the urinary bladder. The most significant marker (rs6874700) identified in our recent GWAS meta-analysis achieved a p value of 1.48 × 10- 24 within the ISL1 region. In silico analysis of rs6874700 and all other genome-wide significant markers in Linkage Disequilibrium (LD) with rs6874700 (D' = 1.0; R2 > 0.90) revealed marker rs2303751 (p value 8.12 × 10- 20) as the marker with the highest regulatory effect predicted. Here, we describe a novel 1.2 kb intragenic promoter residing between 6.2 and 7.4 kb downstream of the ISL1 transcription starting site, which is located in the reverse DNA strand and harbors a binding site for EZH2 at the exact region of marker rs2303751. We show, that EZH2 silencing in HEK cells reduces ISL1 expression. We show that ezh2-/- knockout (KO) zebrafish larvae display tissues specificity of ISL1 regulation with reduced expression of Isl1 in the pronephric region of zebrafish larvae. In addition, a shorter and malformed nephric duct is observed in ezh2-/- ko zebrafish Tg(wt1ß:eGFP) reporter lines. Our study shows, that Ezh2 is a key regulator of Isl1 during urinary tract formation and suggests tissue specific ISL1 dysregulation as an underlying mechanism for CBE formation.
CRIS-Team Scopus Importer:2024-10-11
Keywords: Classic bladder exstrophy; EZH2; Gene regulation; HEK293; ISL1; Promoter; Zebrafish

Familial congenital lower urinary tract obstruction (LUTO) suggested by screening for lower urinary tract dysfunction in parents of patients: A descriptive study - Ebach, Fabian; Wagner, Pauline; Stein, Raimund; Dolscheid-Pommerich, Ramona; Reutter, Heiko Martin; Hilger, Alina Christine (Health Science Reports, 2024)
Background: Congenital lower urinary tract obstruction (LUTO) describes a heterogeneous group of congenital malformations. Posterior urethral valves (PUV) represent the most common entity. Familial occurrence has been described, suggestive of underlying genetic factors. LUTO can occur in various degrees of severity. In severe forms, oligohydramnios, pulmonary hypoplasia, and renal damage can occur resulting in high pre- and postnatal mortality. On the contrary, mild forms may become apparent through recurrent urinary tract infections. Such high phenotypic variability has been described even within the same family. Here, we systematically screened parents of affected children for symptoms of LUTO. Methods: The study population consisted of parents of LUTO patients. Fathers over 50 years of age were excluded, to avoid inclusion of male phenocopies due to early prostatic hypertrophy. Uroflowmetry, ultrasonography for residual urine and hydronephrosis, and laboratory examination of standard renal retention parameters were assessed, and a detailed patient history was taken, including the assessment of the International Prostate Symptom Score. Results: Twenty-nine of 42 LUTO families enrolled were found eligible for the present study. Of these, we identified five families in which the father had already been diagnosed with infravesical obstruction (17%). Of the remaining families, nine agreed to participate in our study. Of these nine families, eight families had a child affected with PUV and one family had a child with urethral stenosis. Here, we found two fathers and one mother with symptoms of LUTO suggestive of mild LUTO and one family, in which the unborn male fetal brother of the affected index patient was also diagnosed prenatally with LUTO. Conclusion: Our observations suggest that LUTOs have a higher heritability than previously thought and that first-degree relatives of the affected should be clinically assessed for symptoms of LUTO.
CRIS-Team Scopus Importer:2024-04-05
Keywords: familial LUTO; IPSS; LUTO; obstructive uropathy; postvoid residual volume; PUV; uroflowmetry

Familial homozygot hypobetalipoproteinemia (HHBL): A rare differentialdiagnosis of chronic diarrhea with malabsorption and hepatopathy Familiäre homozygote Hypobetalipoproteinämie (HHBL) Eine seltene Differenzialdiagnose bei chronischer Diarrhö mit Malabsorption und Hepatopathie - Hörning, André; Rieger, Daniel (Pädiatrische Praxis, 2022)
Not only hypercholesterolemia but also reduced cholesterol levels can indicate diseases that must be diagnosed and treated early to prevent progression or secondary organ manifestation. In cases of unclear hepatopathy, especially accompanied by failure to thrive and diarrhea, triglycerides, total cholesterol, and HDL and LDL cholesterol should always be determined. Decreased total cholesterol, LDL cholesterol and triglyceride levels as well as the presence of acanthocytes are indicative of an a- or hypobetalipoproteinemia and should be followed by molecular genetic testing. Differential diagnoses include secondary hypocholesterolemias and, especially in the presence of normal triglycerid levels, chylomicron retention disease. Decisive for the long-term prognosis of these diseases, especially abetalipoproteinemia and the homozygous form of hypobetalipoproteinemia, is the early implementation a fat reduced diet including a substitution of fat-soluble vitamins and essential fatty acids as well as close-meshed multidisciplinary care.
CRIS-Team Scopus Importer:2024-12-16
Keywords: Abetalipoproteinemia; Hypo-triglyceridemia; Hypobetalipoproteinemia; Hypocholesterinemia; lipid metabolism disorder

Fatigue and depression predict health-related quality of life in patients with pediatric-onset multiple sclerosis - Gravesande, Karin Storm Van'S; Blaschek, Astrid; Calabrese, Pasquale; Rostasy, Kevin; Huppke, Peter; Kessler, Josef J.; Kalbe, Elke; Mall, Volker; Kraus,; Dornfeld, E.; Elpers, C.; Lohmann, H.; et al. (Multiple Sclerosis and Related Disorders, 2019)
Background: Fatigue, depression and loss in health-related quality of life (HRQoL) have been reported to occur in a substantial amount of patients with pediatric-onset MS (POMS). This study aims to evaluate depression, fatigue and HRQoL and its relationship in a cohort of patients with POMS and matched healthy controls (HCs).
CRIS-Team WoS Importer:2019-12-27

Feasibility and related outcome of intraluminal pulmonary artery banding - Sandrio, Stany; Purbojo, Ariawan; Arndt, Florian; Toka, Okan; Glöckler, Martin; Dittrich, Sven; Cesnjevar, Robert; Rueffer, Andre (European Journal of Cardio-Thoracic Surgery, 2015)
This retrospective study evaluated the feasibility and related outcome of intraluminal pulmonary artery banding (I-PAB).Thirty-two children underwent I-PAB between July 2006 and April 2014. The median age and weight were 60 days (range: 5 days to 4.2 years) and 3.7 kg (range: 2.6-13.0 kg), respectively. Cardiac diagnoses included single ventricle morphology (n = 11), complex ventricular septal defects (n = 11), balanced atrioventricular septal defects (n = 3), congenitally corrected transposition of the great arteries (n = 2) and aortic arch hypoplasia with ventricular septal defects (n = 5). On cardiopulmonary bypass (CPB), 2 I-PAB modifications with either 1 (n = 24) or 2 ('hour-glass-technique', n = 8) fenestrated pericardial patches were performed.The median fenestration size was 5 mm (range: 4-6.5 mm). In 18 patients I-PAB was a solitary procedure; in 3 of them the decision was made intraoperatively. There was no hospital mortality. The median interval to debanding was 189 days (range: 112 days to 2.6 years). During this period, we observed a significant increase in the pressure gradient over I-PAB (P < 0.01), whereas arterial saturations remained stable. Four patients received balloon dilatation of I-PAB to prolong the palliation period. No patient experienced band occlusion, pulmonary hypertension related to I-PAB, coronary or pulmonary valve impairment. Debanding was performed in 27 patients and one of them required pulmonary patch arterioplasty due to I-PAB-associated pulmonary trunk distortion. Three patients are still awaiting further surgery. There were 2 late deaths prior to, and 3 after debanding, all not related to I-PAB.I-PAB with an exactly defined internal orifice is feasible and effective. Although arterial saturations seem to remain stable, balloon dilatation of I-PAB can be performed safely and efficiently in order to prolong the palliation period. The rate of I-PAB-related complications is low, which might improve the long-term patient outcome. Therefore, despite requiring CPB, I-PAB is our institutional preference for children who require pulmonary artery banding.
EVALuna2:25111

Feasibility and Satisfaction of Young Cancer Survivors Participating in Preventive Interventions. A Subgroup Analysis of the Care for CAYA Program (CFC-P) - Elmers, Simon; Beitzen-Heineke, Antonia; Von Grundherr, Julia; Jensen, Wiebke; Koch, Barbara; Mann, Julia; Salchow, Jannike; Sinn, Marianne; Straub, Lesley-Ann; Wegert, Luisa; Vettorazzi, Elk; Bergelt, Corinna; et al. (ONCOLOGY RESEARCH AND TREATMENT, 2020)
CRIS-Team WoS Importer:2020-03-20

Feasibility of VECOPA, a dose-intensive chemotherapy regimen for children and adolescents with intermediate and advanced stage Hodgkin lymphoma: results of the GPOH-HD-2002/VECOPA pilot trial - Mauz-Koerholz, Christine; Hasenclever, Dirk; Holzendorf, Volker; Bernstaedt, Matthias; Juergens, Heribert; Burdach, Stefan; Eggert, Angelika; Berthold, Frank; Mueller, Hermann L.; Fruehwald, Michael C.; Klingebiel, Thomas; Metzler, Markus; et al. (Leukemia & Lymphoma, 2015)
The GPOH-HD (Gesellschaft für Pädiatrische Onkologie und Hämatologie-Hodgkin Disease) strategy for children and adolescents with intermediate and advanced stage Hodgkin lymphoma is based on two induction cycles of OEPA (vincristine, etoposide, prednisone, doxorubicin) followed by COPP (cyclophosphamide, vincristine, procarbazine, prednisone) or COPDAC (cyclophosphamide, vincristine, prednisone, dacarbazine) consolidation. The feasibility and efficacy of an intensified procarbazine-free consolidation regimen VECOPA (vinblastine, etoposide, cyclophosphamide, vincristine, prednisone, doxorubicin) were investigated. Following two OEPA and one or two VECOPA cycles, involved field radiotherapy was applied. The main endpoint was feasibility. Secondary endpoints were toxicity, proportion of delayed cycles, granulocyte-colony stimulating factor use, and event-free and overall survival. The regimen was well tolerated with mostly hematotoxicity exceeding Common Toxicity Criteria grade 2. In most patients with advanced stage the second VECOPA cycle was delayed despite hematopoietic recovery and absence of serious adverse events. Event-free survival at 36 months was 0.86 (95% confidence interval 0.70-1). The VECOPA regimen is effective and tolerable. However, its time-intensification was not fully exploited within this trial.
EVALuna2:18931

Feasibility, safety and diagnostic impact of endomyocardial biopsies for the diagnosis of myocardial disease in children and adolescents - Mueller, Goetz C.; Michel-Behnke, Ina; Knirsch, Walter; Haas, Nikolaus A.; Abdul-Khaliq, Hashim; Gitter, Roland; Dittrich, Sven; Daehnert, Ingo; Uhlemann, Frank; Schubert, Stephan; Tarusinov, Gleb; Happel, Christoph; et al. (EuroIntervention, 2018)
AIMS: Endomyocardial biopsies (EMBs) are performed infrequently in children owing to significant past complication rates and controversial discussions about the therapeutic value of results. The objective of this study was to investigate the safety and feasibility of EMBs for suspected myocardial disease in relation to their clinical value. METHODS AND RESULTS: We performed a retrospective multicentre review of the Working Group for Interventional Cardiology of the German Society for Paediatric Cardiology. During three consecutive years, 206 EMBs (84 female/mean age 8.95±6.62 years) were performed and analysed at 15 heart centres. In the majority of cases, biopsies were taken from the right ventricle (RV/89.8%; p<0.001). The overall complication rate was 9.7%, whereas major complications occurred in only 0.97% of cases. Risk factors associated with a higher complication rate were biopsy during the first year of life (20.5%) and from the left ventricle (31.1%) (p<0.05). There was no procedure-related mortality. Treatment was changed in 18.0% of cases based on biopsy results. CONCLUSIONS: Today, endomyocardial biopsies in older children with suspected myocardial disease can be performed safely with a low risk of major complications and mortality, whereas the risk of complications if the biopsy is carried out in the first year of life or taken from the left ventricle remains high.
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Fecal calprotectin and platelet count predict histologic disease activity in pediatric ulcerative colitis: results from a projection-predictive feature selection. - Schiller, B.; Wirthgen, E.; Weber, F.; Schiller, S.; Radke, M.; Claßen, Merle; Däbritz, J. (European Journal of Pediatrics, 2024)
Especially for pediatric patients, proxies of mucosal inflammation are needed. The Pediatric Ulcerative Colitis Activity Index (PUCAI) has been established to predict clinical and endoscopic disease activity. However, histologic inflammation might persist. We applied a special variable selection technique to predict histologic healing in pediatric ulcerative colitis (UC) as parsimoniously (but still as precisely) as possible. The retrospective analysis included data from two study cohorts, comprising 91 visits from 59 pediatric patients with UC. A Bayesian ordinal regression model was used in combination with a projection-predictive feature selection (PPFS) to identify a minimal subset of clinical and laboratory parameters sufficient for the prediction of histologic disease activity. Following the PPFS, CEDATA-GPGE patient registry data were analyzed to investigate the relevance of the selected predictors in relation to PUCAI and Physician Global Assessment (PGA) in up to 6697 patient visits. Fecal calprotectin (FC) and platelet count were identified as the minimal subset of predictors sufficient for prediction of histologic disease activity in pediatric UC. FC and platelet count also appeared to be associated with increasing disease activity as measured by PUCAI and PGA in the CEDATA-GPGE registry. Based on the selected model, predictions can be performed with a Shiny web app. Conclusion: Our statistical approach constitutes a reproducible and objective tool to select a minimal subset of the most informative parameters to predict histologic inflammation in pediatric UC. A Shiny app shows how physicians may predict the histologic activity in a user-friendly way using FC and platelet count. To generalize the findings, further prospective studies will be needed. What is Known: • Histologic healing is a major endpoint in the therapy of ulcerative colitis (UC). • The PUCAI score has been established to predict disease activity in pediatric UC but is not suitable for the prediction of histologic healing. What is New: • Our Bayesian ordinal regression model in combination with a projection-predictive feature selection is a reproducible and objective tool to select the minimal subset of clinical and laboratory parameters to predict histologic inflammation in pediatric UC. • Histologic inflammation in pediatric UC can be non-invasively predicted based on the combination of fecal calprotectin levels and platelet count.
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Fehlender Handlungsspielraum und mangelhafte Strukturen. Aufforderung zur Überwindung der Hindernisse für klinische Studien mit Kindern - Rascher, Wolfgang (Monatsschrift Kinderheilkunde, 2020)
CRIS-Team Scopus Importer:2020-11-27

Fetal and Maternal Safety Considerations for In Utero Therapy Clinical Trials: iFeTiS Consensus Statement - Sagar, Rachel; Almeida-Porada, Graça; Blakemore, Karin; Chan, Jerry K.Y.; Choolani, Mahesh; Götherström, Cecilia; Jaulent, Agnes; MacKenzie, Tippi C.; Mattar, Citra; Porada, Christopher D.; Peranteau, William H.; Schneider, Holm; et al. (Molecular Therapy, 2020)
CRIS-Team Scopus Importer:2020-11-06
Keywords: adverse event; clinical trial; fetal; fetal therapy; In utero stem cell transplantation; maternal; safety

Fetal programming of gene expression in growth-restricted rats depends on the cause of low birth weight - Nuesken, Kai-Dietrich; Schneider, Holm; Plank, Christian Georg; Trollmann, Regina; Nuesken, Eva; Rascher, Wolfgang; Doetsch, Joerg (Endocrinology, 2011)
Low birth weight and intrauterine growth restriction (IUGR) can be caused by numerous different conditions. In many experimental settings, however, these different causes are not accounted for. This study aimed at comparing the impact of two frequent causes of IUGR (low utero-placental blood flow vs. malnutrition) on fetal programming of gene expression. We studied offspring of dams treated by uterine artery ligation or sham operation compared with untreated controls and offspring of dams that were fed either a low protein or normal protein diet. After Cesarean section at term, placental and fetal hepatic expression of key "metabolic" and "vasoregulative" genes was investigated by quantitative RT-PCR. Ligation neonates showed IUGR, reduced expression of placental leptin, placental and hepatic IGF-I, hepatic inducible nitric oxide synthase, and increased expression of placental IGF binding protein 1, hepatic IGF-II receptor and erythropoietin (EPO).Low protein offspring also showed IUGR but increased expression of placental leptin; IGF-I; placental and hepatic inducible nitric oxide synthase; hepatic insulin, IGF-I, and IGF-II receptors; and reduced expression of placental IGF binding protein 1, IGF-II, leptin-receptor type A, placental and hepatic leptin receptor type B, and EPO. Expression was independent of sex, birth weight, fetal intrauterine position, and EPO expression. In conclusion, the impact of IUGR on fetal and placental gene expression depends on the cause of low birth weight. Therefore, morbidity after IUGR should be analyzed referring to its pathophysiological cause rather than referring to low birth weight itself. Fetal hypoxia as estimated by hepatic EPO expression does not seem to be a key regulator of transcriptional activity in our models. Copyright © 2011 by The Endocrine Society.
CRIS-Team Scopus Importer:2020-07-01

Fever: physiology, pathophysiology, clinical signs and treatment Fieber: Physiologie, Pathophysiologie, klinische Zeichen und Therapie - Marek, I.; Moritz, Katrin; Rascher, Wolfgang; Neubert, Antje (Monatsschrift Kinderheilkunde, 2021)
Background: Fever is a common leading symptom in children presenting in emergency departments and clinical practices. Parents are often uncertain how to treat the febrile child. Objective: This article presents the current knowledge regarding the physiology and pathophysiology of fever in children and the latest evidence on which the recommendations for pharmacotherapy is based. Material and methods: A structured search and analysis of the literature was performed. Results and discussion: Under physiological conditions the temperature regulation center in the hypothalamus controls a stable core body temperature of 37 °C by balancing heat production and loss. Fever develops when mediators of inflammation override the inhibition of excessive heat production mediated by warmth-sensitive neurons in the hypothalamus. Prior to symptomatic treatment of pediatric fever the clinical cause of the fever has to be found and if necessary a causal treatment has to be initiated. This is especially true for high-risk patients, such as neonates, immunosuppressed individuals and children with foreign bodies, such as catheters. In terms of pharmacotherapy two well-established drugs (paracetamol and ibuprofen) are available for the symptomatic treatment of fever. Monotherapy should be preferred over combined or alternating drug administration. Ibuprofen is slightly superior compared to paracetamol with both drugs showing similar safety profiles. There is insufficient evidence to justify the prophylactic use of antipyretics to prevent febrile seizures.
CRIS-Team Scopus Importer:2021-04-23
Keywords: Child; Evidence-based medicine; Febrile seizure; Pharmacotherapy; Thermoregulation

Fiber rich food suppressed airway inflammation, GATA3 + Th2 cells, and FcεRIα+ eosinophils in asthma. - Schenzel, Alicia; Geiger, Adriana; Nendel, Elvedina; Yang, Zuqin; Krammer, Susanne; Leberle, Anna; Brunst, Ann Kathrin; Trump, Sonja; Mittler, Susanne; Rauh, Manfred; Geppert, Carol-Immanuel; Tausche, Patrick; et al. (Frontiers in Nutrition, 2024)
BACKGROUND: Allergic Asthma is a disease presenting various endotypes and no current therapies act curative but alleviate disease symptoms. Dietary interventions are gaining increasing importance in regulating immune responses. Furthermore, short chain fatty acids (SFCA), as the main products of dietary fiber's fermentation by the gut bacteria, ameliorate the pathogenesis and disease burden of different illnesses including asthma. Nevertheless, the connection and crosstalk between the gut and lung is poorly understood. OBJECTIVE: In this work, the role of high fiber diet on the development of allergic asthma at baseline and after exacerbation of disease induced by respiratory viruses was investigated. METHODS: Hereby, SCFA in serum of asthmatic and non-asthmatic pre-school children before and after airway disease symptoms were analyzed. Moreover, the effect of high fiber diet in vivo in a murine model of house dust mite extract (HDM) induced allergic asthma and in the end in isolated lung and spleen cells infected ex vivo with Rhinovirus was analyzed. RESULTS: In this study, a decrease of the SCFA 3-Hydroxybutyric acid in serum of asthmatic children after symptomatic episodes at convalescent visit as compared to asthmatic and control children at baseline visit was observed. In experimental asthma, in mice fed with high fiber diet, a reduced lung GATA3 + Th2 type mediated inflammation, mucus production and collagen deposition and expression of Fc epsilon receptor Ia (FcεRIa) in eosinophils was observed. By contrast, the CD8+ memory effector T cells were induced in the lungs of asthmatic mice fed with high fiber diet. Then, total lung cells from these asthmatic mice fed with either standard food or with fiber rich food were infected with RV ex vivo. Here, RV1b mRNA was found significantly reduced in the lung cells derived from fiber rich food fed mice as compared to those derived from standard food fed asthmatic mice. Looking for the mechanism, an increase in CD8+ T cells in RV infected spleen cells derived from fiber rich fed asthmatic mice, was observed. CONCLUSION: Convalescent preschool asthmatic children after a symptomatic episode have less serum ß-Hydroxybutyric acid as compared to control and asthmatic children at baseline visit. Fiber rich diet associated with anti-inflammatory effects as well as anti-allergic effects by decreasing Type 2 and IgE mediated immune responses and inducing CD8+ memory effector T cells in a murine model of allergic asthma. Finally, ex vivo infection with Rhinovirus (RV) of total lung cells from asthmatic mice fed with fiber rich food led to a decreased RV load as compared to mice fed with standard food. Moreover, spleen cells derived from asthmatic mice fed with fiber rich food induced CD8+ T cells after ex vivo infection with RV. CLINICAL IMPLICATIONS: Dietary interventions with increased content in natural fibers like pectins would ameliorate asthma exacerbations. Moreover, respiratory infection in asthma downregulated SCFA in the gut contributing to asthma exacerbations.
EVALuna2:568298

Fibrillin-1 and alpha8 integrin are co-expressed in the glomerulus and interact to convey adhesion of mesangial cells - Marek, Ines; Volkert, Gudrun; Hilgers, Karl Friedrich; Bieritz, Beate; Rascher, Wolfgang; Reinhardt, Dieter P.; Hartner, Andrea (Cell Adhesion and Migration, 2014)
Fibrillin-1 is a microfibrillar extracellular matrix protein that was described to be a ligand for ?8 integrin. ?8 integrin is a matrix receptor specifically expressed in mesangial and smooth muscle cells of the kidney. In previous studies we detected glomerular expression of fibrillin-1. Moreover, fibrillin-1 promoted adhesion, migration, and proliferation of mesangial cells. We hypothesized that fibrillin-1 and ?8 integrin might interact in the glomerulus, and thus, regulate mesangial cell properties. Our studies showed that fibrillin-1 and ?8 integrin colocalize in the glomerular mesangium. Induction of experimental glomerulonephritis led to an increase of both fibrillin-1 and ?8 integrin expression. In vitro studies revealed that mesangial cells deficient for ?8 integrin adhere weaker to fibrillin-1 and migrate more easily on fibrillin-1 than wild-type mesangial cells. Baseline proliferation on fibrillin-1 is higher in ?8 integrin-deficient mesangial cells, but the induction of proliferation is not different in ?8 integrin-deficient and wild-type mesangial cells. We conclude that fibrillin-1 and ?8 integrin interact, and thus, regulate mesangial cell adhesion and migration. The concomitant induction of both fibrillin-1 and ?8 integrin in a self-limited model of glomerular injury points to a protective role of the interaction of fibrillin-1 with ?8 integrin in the glomerulus resulting in reduced damage of the glomerular tuft as a consequence of firm adhesion of mesangial cells.
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Finding a balance in reduced toxicity hematopoietic stem cell transplantation for thalassemia: role of infused CD3+ cell count and immunosuppression - Meissner, Barbara; Lang, Peter; Bader, Peter; Hoenig, Manfred; Müller, Ingo; Meisel, Roland; Greil, Johann; Sauer, Martin G.; Metzler, Markus; Corbacioglu, Selim; Burkhardt, Birgit; Wölfl, Matthias; et al. (Bone Marrow Transplantation, 2024)
We performed a retrospective analysis on 124 patients with transfusion-dependent thalassemia who were registered in the German pediatric registry for stem cell transplantation. All patients underwent first allogeneic hematopoietic stem cell transplantation (HSCT) between 2011 and 2020 and belonged mainly to Pesaro risk class 1–2. Four-year overall (OS) and thalassemia-free survival (TFS) were 94.5% ± 2.9% and 88.0% ± 3.4% after treosulfan-fludarabine-thiotepa- and 96.9% ± 3.1% (P = 0.763) and 96.9% ± 3.1% (P = 0.155) after busulfan-fludarabine-based conditioning. Mixed chimerism below 75% occurred predominantly in treosulfan-based regimens (27.5% versus 6.2%). OS and TFS did not differ significantly between matched sibling, other matched family and matched unrelated donor (UD) HSCTs (OS: 100.0%, 100.0%, 96.3% ± 3.6%; TFS: 96.5% ± 2.4%, 90.0% ± 9.5%, 88.9% ± 6.0%). However, mismatched UD-HSCTs performed less favorable (OS: 84.7% ± 7.3% (P = 0.029); TFS: 79.9% ± 7.4% (P = 0.082)). We generated a scoring system reflecting the risk to develop mixed chimerism in our cohort. The main risk-reducing factors were a high CD3+ cell count (≥6 × 107/kg) in the graft, busulfan-conditioning, pre-conditioning therapy and low-targeted ciclosporin A trough levels. Acute GvHD grade III-IV in treosulfan-based concepts predominantly occurred in patients with UD and reduced GvHD prophylaxis but not in the context of high CD3+ cell doses. Taken together, this information might be used to develop more risk-adapted HSCT regimens for thalassemia patients.
CRIS-Team Scopus Importer:2024-02-16

First epileptic seizure and epilepsies in adulthood: Abridged version of the S2k guideline of the German Society for Neurology in cooperation with the German Society for Epileptology. English Version - Holtkamp, Martin; May, Theodor W.; Berkenfeld, Ralf; Bien, Christian G.; Coban, Ingrid; Knake, Susanne; Michaelis, Rosa; Rémi, Jan; Seeck, Margitta; Surges, Rainer; Weber, Yvonne; Baum, Petra; et al. (Clinical Epileptology, 2024)
The new S2k guideline “First epileptic seizure and epilepsies in adulthood” provides recommendations on clinically relevant issues in five major topics: management of first epileptic seizures, pharmacotherapy, epilepsy surgery, complementary and supportive treatment, and psychosocial aspects. For the topic management of first epileptic seizures, the guideline provides recommendations on identifying the two major differential diagnoses, syncope and psychogenic non-epileptic seizure. The importance of additional examinations such as EEG, MRI and cerebrospinal fluid for syndromic classification and etiological allocation is discussed. Recommendations on neuropsychological and psychiatric screening tests are also given. The topic pharmacotherapy issues recommendations on antiseizure medication in monotherapy for focal, generalized and unclassified epilepsies; patient groups with special challenges such as the aged, women of childbearing potential and people with intellectual disability are emphasized. Further issues are indications for measuring serum concentrations of antiseizure medication and possible risks of switching manufacturers. In the topic epilepsy surgery, indications for presurgical assessment and the multiple therapeutic approaches, such as resection, laser ablation, and neurostimulation are presented. Recommendations on postoperative management of patients, including rehabilitation and psychosocial counselling, are given. The topic complementary and supportive therapeutic approaches comprises recommendations on the diagnostics and treatment of common psychiatric comorbidities of epilepsy, such as anxiety disorder, depression and psychosis. Another important issue is the management of psychogenic non-epileptic seizures as a neuropsychiatric differential diagnosis or comorbidity of epileptic seizures. Furthermore, recommendations on the potential role of ketogenic diet and on acupuncture, homeopathy and other complementary approaches are made. The recommendations on psychosocial aspects comprise practical issues, such as fitness to drive a car, training and occupation, medical rehabilitation, sport, transition, patients’ self-help, education programs for patients and next of kin, adherence, advise on SUDEP.
CRIS-Team Scopus Importer:2024-08-23
Keywords: Consensus; Epilepsy surgery; Pharmacotherapy; Psychosocial aspects; Recommendations

First experience with Tolvaptan for the treatment of neonates and infants with capillary leak syndrome after cardiac surgery - Kerling, Anne; Toka, Okan; Rueffer, Andre; Mueller, Hanna; Habash, Sheeraz; Weiss, Christel; Dittrich, Sven; Moosmann, Julia (BMC Pediatrics, 2019)
Background: Postoperative fluid management in critically ill neonates and infants with capillary leak syndrome (CLS) and extensive volume overload after cardiac surgery on cardiopulmonary bypass is challenging. CLS is often resistant to conventional diuretic therapy, aggravating the course of weaning from invasive ventilation, increasing length of stay on ICU and morbidity and mortality.
CRIS-Team WoS Importer:2019-02-27

First postnatal lactate blood levels on day 1 and outcome of preterm infants with gestational age <29 weeks - Zipf, Stephanie; Fortmann, Ingmar; Härtel, Christoph; Andres, Oliver; Frieauff, Eric; Paul, Pia; Häfke, Anna; Reutter, Heiko Martin; Morhart, Patrick; Weller, Ursula; Welp, Amrei; Kipke, Henry; et al. (Frontiers in Pediatrics, 2024)
Background: Serum lactate levels are used as biomarkers for perinatal asphyxia, while their value for outcome prediction in preterm infants is uncertain. It was the aim of this observational study to determine the association of the first postnatal serum-lactate levels on day 1 of life and short-term outcome in preterm infants less than 29 gestational weeks. Methods: We analysed data in a population-based cohort of German Neonatal Network (GNN) preterm infants with available first postnatal lactate levels enrolled at 22–28 weeks of gestational age (GA) between 1st of April 2009 and 31st December 2020. We hypothesized that high lactate levels as measured in mmol/L increase the risk of intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) in infants with VLBW regardless of small-for-gestational-age (SGA) status. Hypotheses were evaluated in univariate analyses and multiple logistic regression models. Results: First postnatal lactate levels were available in 2499 infants. The study population had a median GA of 26.7 [IQR 25.2–27.9] weeks and birth weight of 840 g [IQR 665–995]. Infants with short-term complications such as IVH and BPD had higher initial lactate levels than non-affected infants. The positive predictive value of a lactate cut-off of 4 mmol/L was 0.28 for IVH and 0.30 for BPD. After adjustment for known confounding variables, each 1 mmol/L increase of day 1 lactate levels was associated with a modestly increased risk of IVH (OR 1.18; 95% CI 1.03–1.37; p = 0.002) and BPD (OR 1.23; 95% CI 1.06–1.43; p = 0.005) but not with sepsis or mortality. Notably, SGA was associated with lower risk of any grade and severe IVH (OR 0.70; 95% CI 0.54–0.85; p = 0.001). Conclusions: In our observational cohort study higher initial lactate levels were associated with adverse outcome regardless of SGA status. However, the predictive value of lactate cut-off levels such as 4 mmol/L is low.
CRIS-Team Scopus Importer:2024-11-01
Keywords: all-cause mortality; bronchopulmonary dysplasia; extremely preterm infants; intraventricular haemorrhage; lactate levels; small for gestational age

First Presentation of idiopathic Mast Cell Activation Syndrome (MCAS) in a Young Person: Association with Histamine and Salicylate Intolerance as well as an important Differential Diagnosis in gastroenterological Problem Patients - Raithel, Martin; Rechenauer, Tobias; Goetze, Thomas; Siebenlist, Gregor; Rueckel, Aline; Baenkler, Hanns-Wolf; Hartmann, Arndt; Haller, Florian; Hoerning, Andre (INTERNIST, 2019)
CRIS-Team WoS Importer:2019-05-17

First Steps to Evaluate an NLP Tool's Medication Extraction Accuracy from Discharge Letters - Caliskan, Deniz; Zierk, Jakob; Kraska, Detlef; Schulz, Stefan; Daumke, Philipp; Prokosch, Hans-Ulrich; Kapsner, Lorenz (German Medical Data Sciences: Bringing Data to Life, 2021)
INTRODUCTION: The aim of this study is to evaluate the use of a natural language processing (NLP) software to extract medication statements from unstructured medical discharge letters. METHODS: Ten randomly selected discharge letters were extracted from the data warehouse of the University Hospital Erlangen (UHE) and manually annotated to create a gold standard. The AHD NLP tool, provided by MIRACUM's industry partner was used to annotate these discharge letters. Annotations by the NLP tool where then compared to the gold standard on two levels: phrase precision (whether or not the whole medication statement has been identified correctly) and token precision (whether or not the medication name has been identified correctly within correctly discovered medication phrases). RESULTS: The NLP tool detected medication related phrases with an overall F-measure of 0.852. The medication name has been identified correctly with an overall F-measure of 0.936. DISCUSSION: This proof-of-concept study is a first step towards an automated scalable evaluation system for MIRACUM's industry partner's NLP tool by using a gold standard. Medication phrases and names have been correctly identified in most cases by the NLP system. Future effort needs to be put into extending and validating the gold standard.
CRIS-Team Scopus Importer:2021-06-11
Keywords: Data Analysis; Electronic Data Processing; Natural Language Processing; Patient Discharge Summary

First-year predictors of health-related quality of life changes in short-statured children treated with human growth hormone - Quitmann, J.; Bloemeke, J.; Dörr, Helmuth-Günther; Bullinger, M.; Witt, S.; Silva, N. (Journal of Endocrinological Investigation, 2019)
Purpose: Little attention has been directed towards examining the impact of predictors on change in health-related quality of life (HRQOL) within the course of growth hormone (GH) treatment in pediatric short stature. We aimed to assess changes in HRQOL and its sociodemographic, clinical and psychosocial predictors in children and adolescents diagnosed with growth hormone deficiency (GHD), and born short for gestational age (SGA) before and 12-month after start of GH treatment from the parents’ perspective. Results were compared with an untreated group with idiopathic short stature (ISS). In this prospective multicenter study, 152 parents of children/adolescents (aged 4–18 years) provided data on their children’s HRQOL at baseline and at 12-month follow-up. Method: Repeated-measures multivariate analyses of covariance were performed to examine parent-reported HRQOL changes from baseline to 1-year after treatment and hierarchical linear regressions to identify the predictors of HRQOL changes. Results: Results showed that parents of children that were treated with GH report an increase in their children’s HRQOL after 1 year. Changes in HRQOL were mostly explained by psychosocial predictors followed by sociodemographic and clinical variables. Specifically, the diagnosis SGA significantly predicted a greater increase in parent-reported HRQOL. Furthermore, a lower caregiving burden significantly predicted a decrease in parent-reported HRQOL. Conclusion: In conclusion, a substantial percentage of explained variance in HRQOL relates to psychosocial and sociodemographic predictors. However, there appears to be other important factors that are predictors of HRQOL, which need to be determined in large, population-based samples.
CRIS-Team Scopus Importer:2019-08-23
Keywords: Children and adolescents; Growth hormone treatment; HRQOL; Predictors of change; Short stature

Fitter Fontans for future—Impact of physical exercise on cardiopulmonary function in Fontan patients - Weigelt, Annika; Fritsch, Regina; Rottermann, Kathrin; Wällisch, Wolfgang; Moosmann, Julia; Dittrich, Sven; Purbojo, Ariawan; Schöffl, Isabelle (Frontiers in Cardiovascular Medicine, 2022)
Background: In Fontans, exercise tolerance is poorer compared to their healthy peers. Higher (Formula presented.) represents a strong predictor for mortality and morbidity in these patients. Cardiac rehabilitation programs have been shown to improve cardiopulmonary function in Fontans. More habitual physical activity should therefore lead to a better exercise tolerance. Methods: We performed cardiopulmonary exercise testing in 24 Fontan patients who had engaged in physical activity for a minimum of 3 h per week over their lifetime. As a control we performed cardiopulmonary exercise testing in 20 Fontan patients who had undertaken no physical activity or <3 h per week in the past. Results: A total of 44 Fontan patients was included (mean age 18.1 years). The mean parameters measured at peak exercise differed significantly between the active and inactive group (peak oxygen uptake [(Formula presented.)] of 34.0 vs. 25.0 ml/min/kg, peak heart rate (HR) of 169.8/min vs. 139.8/min). Even though the O2pulse and the EF did not differ significantly between both groups, N-Terminal-Pro-B-Type Natriuretic Peptide (NT-pro BNP) was significantly higher in the inactive group. The two groups did not differ with respect to their cardiac function determined by magnetic resonance imaging (MRI). (Formula presented.) was positively correlated with hours of sports performed by Fontans. Conclusions: (Formula presented.) and maximum HR were significantly higher in Fontans who had been physically active compared to those who had been inactive. The values reported in this study were higher than in other studies and reached normal values for (Formula presented.) for most Fontans in the physically active group. The positive correlation between (Formula presented.) and physical activity is an indicator of the importance of incorporating physical exercise programs into the treatment of Fontan patients.
CRIS-Team Scopus Importer:2022-10-07
Keywords: cardiopulmonary exercise testing (CPET); congenital heart disease; habitual exercise; peak oxygen uptake; sports and exercise medicine; TCPC; V̇O

Flight Routes to Germany of Seriously Ill Children and Adolescents From Former Eastern Bloc Countries for Treatment of Renal Failure - Mammadova, Dilbar; Marek, Ines; Galiano, Matthias; Rascher, Wolfgang (Klinische Pädiatrie, 2018)
BACKGROUND: Increased patient mobility and restricted treatment of children with end-stage renal disease forced families from the former Eastern Bloc countries to flee with their children to Germany for adequate medical treatment. METHODS: In a case study, the patients' charts were analysed retrospectively. In structured interviews, parents and patients were asked about their flight routes to Germany, their medical treatment and their integration. RESULTS: From 2003 to 2013, eight children and adolescents with renal failure were treated with dialysis or renal transplantation in Erlangen. Most patients came with the help of human traffickers and a tourist visa. They often told that they had lost their papers in the excitement. One family received new passports from the trafficker with fake names and birth dates. The families had to pay high amounts of money in order to save their child's life. Although dialysis therapy was often difficult because of lower adherence, the overall course was satisfactory. Four patients have been transplanted successfully so far. CONCLUSION: This case study reveals new facets of patient mobility, since leaving home was the only way for the family to ensure their child´s survival. An ethical problems arose, as a chronic dialysis treatment in children seems ethically only justifiable if a kidney transplant is the therapeutic goal. .
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FLOW MEDIATED VASODILATION/VASOCONSTRICTION IN DIFFERENT DISEASE POPULATIONS - Kannenkeril, Dennis; Dienemann, T.; Jung, Susan; Striepe, Kristina; Kopp, C.; Schneider, M.; Ott, Christian; Schmieder, Roland (JOURNAL OF HYPERTENSION, 2019)
CRIS-Team WoS Importer:2019-09-20

Focused screening of a panel of cancer-related genetic polymorphisms reveals new susceptibility loci for pediatric acute lymphoblastic leukemia - Offenmüller, Sonja; Ravindranath, Yadddanapudi; Goyette, Gerard; Kanakapalli, Deepa; Miller, Kathryn S.; Brecht, Ines B.; Zolk, Oliver (Pediatric Blood & Cancer, 2014)
A genetic predisposition to acute lymphoblastic leukemia (ALL) in childhood is well established. Currently known risk loci, however, explain only one third of the estimated total risk related to common genetic variations.We genotyped 1,421 polymorphisms in 407 candidate genes from the SNP500Cancer database (National Cancer Institute) using the Illumina Cancer SNP Panel. We investigated 78 cases (aged 0-19 years at diagnosis, and mixed ethnic background) of childhood B-precursor ALL and compared genotype data with those of 1,417 HapMap controls. To account for the ethnic diversity of the study population, structured association by genetically matching cases and controls using identity-by-state similarity was used. Case-control association analyses were performed using Cochran-Mantel-Haenszel tests, adjusted for the population substructure.Common variations rs6966 (3' UTR of PPP1R13L, chr 19q13.32, P = 4.55 × 10(-9) ) and rs414580 (intron 2 of MSR1, chr 8p22, P = 6.09 × 10(-8) ) were significantly associated with ALL. These SNPs remained significant after adjustment for multiple testing. The SNP rs6966 tags a haplotype block which includes SNPs in PPP1R13L and ERCC2 genes, which are related to DNA repair and cell survival. rs6966 and rs414580 conferred allelic odds ratios of 3.74 (95% confidence interval [CI] 2.31-6.04) and 3.93 (95% CI 2.31-6.69), respectively.These findings reveal two independent novel susceptibility loci for childhood ALL. Pediatr Blood Cancer 2014; 61:1411-1415. © 2014 Wiley Periodicals, Inc.
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Free-Breathing and Single-Breath Hold Compressed Sensing Real-Time MRI of Right Ventricular Function in Children with Congenital Heart Disease. - Treutlein, Christoph; Zeilinger, Martin; Dittrich, Sven; Roth, Jessica; Wetzl, Matthias; Heiß, Rafael; Wuest, Wolfgang; May, Matthias; Uder, Michael; Rompel, Oliver (Diagnostics, 2023)
(1) Purpose: to compare right ventricular (RV) functional parameters in children with surgically repaired congenital heart disease (CHD) using single/double breath hold (BH) and free-breathing (FB) real-time compressed sensing (CS) cine cardiac magnetic resonance (cMRI) with standard retrospective segmented multi breath hold (RMB) cine cMRI. (2) Methods: Twenty patients with CHD underwent BH and FB, as well as RMB cine cMRI, at 3T to obtain a stack of continuous axial images of the RV. Two radiologists independently performed qualitative analysis of the image quality (rated on a 5-point scale; 1 = non-diagnostic to 5 = excellent) and quantitative analysis of the RV volume measurements. (3) Results: The best image quality was provided by RMB (4.5; range 2-5) compared to BH (3.9; range 3-5; p = 0.04) and FB (3.6; range 3-5; p < 0.01). The RV functional parameters were comparable among BH, FB, and RMB with a difference of less than 5%. The scan times for BH (44 ± 38 s, p < 0.01) and FB (24 ± 7 s, p < 0.01) were significantly reduced compared to for RMB (261 ± 68 s). (4) Conclusions: CS-FB and CS-BH real-time cine cMRI in children with CHD provides diagnostic image quality with excellent accuracy for measuring RV function with a significantly reduced scan time compared to RMB.
EVALuna2:539552

Frequency and impact of enteric hyperoxaluria in pediatric short bowel syndrome: a retrospective single centre study - Schaefer, Jan Thomas; Schulz-Heise, Susanne; Rueckel, Aline; Rauh, Manfred; Jüngert, Jörg; Galiano, Matthias; Meier, Norbert; Wölfle, Joachim; Schiffer, Mario; Hörning, André (Frontiers in Pediatrics, 2023)
Objectives: The survival of pediatric patients with short bowel syndrome has improved in recent years. Enteric hyperoxaluria as a pathophysiological consequence has been hardly addressed so far. It can be associated with nephrolithiasis, nephrocalcinosis or even renal insufficiency. We assessed the prevalence of hyperoxaluria and its pathogenic consequences in a retrospective single centre study over the last 12 years. Methods: We conducted an internal database search for all pediatric patients suffering from short bowel syndrome treated from 2010 to 2022 in the department of pediatric gastroenterology as well as the pediatric nephrology and dialysis unit. Out of 56 patients identified, 26 patients were analysed for etiology of short bowel syndrome, renal excretion of oxalate (24/26), remaining short bowel and large intestinal length as well as further clinical parameters such as eGFR, nephrocalcinosis/urinary stone formation or stool frequency. Results: Hyperoxaluria was detected in 14/26 patients (54%). Nephrocalcinosis was present in four patients. Out of these four patients, hyperoxaluria could be proven (21% of all hyperoxaluric patients) in three cases, one hyperoxaluric patient had nephrolithiasis (7%). In one patient hyperoxaluria lead to end stage renal disease. We found that 80% of patients with volvulus developed enteric hyperoxaluria. None of the investigated factors had an effect on oxalate excretion. Conclusion: Enteric hyperoxaluria is a relevant pathophysiological finding in patients with short bowel syndrome occurring in about 50% of our cohort with multiple pathogenic complications. Regular screening for hyperoxaluria may be implemented in medical care for patients with short bowel syndrome. If necessary, prophylaxis, e.g., dietary advice or metaphylaxis should be initiated.
CRIS-Team Scopus Importer:2023-08-11
Keywords: enteric hyperoxaluria; hyperoxaluria; intestinal failure; kidney stone; nephrolithiasis; pediatric; short bowel syndrome

Frequency and Predictive Factors of Hypoglycemia in Patients Treated With rhIGF-1: Data From the Eu-IGFD Registry. - Bang, Peter; Polak, Michel; Bossowski, Artur; Maghnie, Mohamad; Argente, Jesús; Ramon-Krauel, Marta; Sert, Caroline; Perrot, Valerie; Mazain, Sarah; Wölfle, Joachim (Journal of Clinical Endocrinology and Metabolism, 2023)
CONTEXT: The European Increlex® Growth Forum Database (Eu-IGFD) is an ongoing surveillance registry (NCT00903110) established to collect long-term safety and effectiveness data on the use of recombinant human insulin-like growth factor-1 (rhIGF-1, mecasermin, Increlex) for the treatment of children/adolescents with severe primary insulin-like growth factor-1 deficiency (SPIGFD). OBJECTIVE: This analysis of Eu-IGFD data aimed to identify the frequency and predictive factors for hypoglycemia adverse events (AEs) in children treated with rhIGF-1. METHODS: Data were collected from December 2008 to May 2021. Logistic regression was performed to identify predictive risk factors for treatment-induced hypoglycemia AEs. Odds ratios (ORs) are presented with 95% CIs for each factor. RESULTS: In total, 306 patients were enrolled in the registry; 84.6% were diagnosed with SPIGFD. Patients who experienced ≥ 1 hypoglycemia AE (n = 80) compared with those with no hypoglycemia AEs (n = 224) had a lower mean age at treatment start (8.7 years vs 9.8 years), a more frequent diagnosis of Laron syndrome (27.5% vs 10.3%), and a history of hypoglycemia (18.8% vs 4.5%). Prior history of hypoglycemia (OR 0.25; 95% CI: [0.11; 0.61]; P = .002) and Laron syndrome diagnosis (OR 0.36; 95% CI: [0.18; 0.72]; P = .004) predicted future hypoglycemia AEs. Total hypoglycemia AEs per patient per treatment year was 0.11 and total serious hypoglycemia AEs per patient per treatment year was 0.01. CONCLUSION: Hypoglycemia occurs more frequently in patients with prior history of hypoglycemia and/or Laron syndrome compared with patients without these risk factors, and these patients should be carefully monitored for this AE throughout treatment.
EVALuna2:548565

Frequency of B-cell subsets in infliximab-treated paediatric IBD patients - Schnell, Alexander; Schwarz, B.; Wahlbuhl-Becker, Mandy; Allabauer, I.; Rechenauer, Tobias; Siebenlist, G.; Kaspar, S.; Ehrsam, C.; Rueckel, A.; Rascher, Wolfgang; Hoerning, A. (JOURNAL OF CROHNS & COLITIS, 2019)
CRIS-Team WoS Importer:2019-03-20

Frequency of Ketoacidosis at Diagnosis of Pediatric Type 1 Diabetes Associated With Socioeconomic Deprivation and Urbanization: Results From the German Multicenter DPV Registry - Auzanneau, Marie; Rosenbauer, Joachim; Warncke, Katharina; Maier, Werner; Kamrath, Clemens; Hofmann, Thomas; Wurm, Michael; Hammersen, Johanna; Schröder, Carmen; Hake, Kathrin; Holl, Reinhard W. (Diabetes Care, 2022)
OBJECTIVE: To investigate whether socioeconomic deprivation and urbanization are associated with the frequency of diabetic ketoacidosis (DKA) at diagnosis of pediatric type 1 diabetes. RESEARCH DESIGN AND METHODS: Children and adolescents aged ≤18 years, living in Germany, with newly diagnosed type 1 diabetes documented between 2016 and 2019 in the Diabetes Prospective Follow-up Registry (DPV; Diabetes-Patienten-Verlaufsdokumentation), were assigned to a quintile of regional socioeconomic deprivation (German Index of Socioeconomic Deprivation) and to a degree of urbanization (Eurostat) by using their residence postal code. With multiple logistic regression models, we investigated whether the frequency of DKA at diagnosis was associated with socioeconomic deprivation or urbanization and whether associations differed by age-group, sex, or migration status. RESULTS: In 10,598 children and adolescents with newly diagnosed type 1 diabetes, the frequency of DKA was lowest in the least deprived regions (Q1: 20.6% [95% CI 19.0-22.4], and increased with growing socioeconomic deprivation to 26.9% [25.0-28.8] in the most deprived regions [Q5]; P for trend <0.001). In rural areas, the frequency of DKA at diagnosis was significantly higher than in towns and suburbs (intermediate areas) or in cities (27.6% [95% CI 26.0-29.3] vs. 22.7% [21.4-24.0], P < 0.001, or vs. 24.3% [22.9-25.7], P = 0.007, respectively). The results did not significantly differ by age-group, sex, or migration background or after additional adjustment for socioeconomic deprivation or urbanization. CONCLUSIONS: This study provides evidence that prevention of DKA at diagnosis by means of awareness campaigns and screening for presymptomatic type 1 diabetes should particularly target socioeconomically disadvantaged regions and rural areas.
CRIS-Team Scopus Importer:2022-08-12

Frequent and sex-biased deletion of SLX4IP by illegitimate V(D)J-mediated recombination in childhood acute lymphoblastic leukemia - Meissner, Barbara; Bartram, Thies; Eckert, Cornelia; Trka, Jan; Panzer-Grümayer, Renate; Hermanova, Ivana; Ellinghaus, Eva; Franke, Andre; Möricke, Anja; Schrauder, Andre; Teigler-Schlegel, Andrea; Dörge, Petra; et al. (Human Molecular Genetics, 2014)
Acute lymphoblastic leukemia (ALL) accounts for 25% of pediatric malignancies. Of interest, the incidence of ALL is observed 20% higher in males relative to females. The mechanism behind the phenomenon of sex-specific differences is presently not understood. Employing genome-wide genetic aberration screening in 19 ALL samples, one of the most recurrent lesions identified was monoallelic deletion of the 5' region of SLX4IP. We characterized this deletion by conventional molecular genetic techniques and analyzed its interrelationships with biological and clinical characteristics using specimens and data from 993 pediatric patients enrolled into trial AIEOP-BFM ALL 2000. Deletion of SLX4IP was detected in 30% of patients. Breakpoints within SLX4IP were defined to recurrent positions and revealed junctions with typical characteristics of illegitimate V(D)J-mediated recombination. In initial and validation analyses, SLX4IP deletions were significantly associated with male gender and ETV6/RUNX1-rearranged ALL (both overall P < 0.0001). For mechanistic validation, a second recurrent deletion affecting TAL1 and caused by the same molecular mechanism was analyzed in 1149 T-cell ALL patients. Validating a differential role by sex of illegitimate V(D)J-mediated recombination at the TAL1 locus, 128 out of 1149 T-cell ALL samples bore a deletion and males were significantly more often affected (P = 0.002). The repeatedly detected association of SLX4IP deletion with male sex and the extension of the sex bias to deletion of the TAL1 locus suggest that differential illegitimate V(D)J-mediated recombination events at specific loci may contribute to the consistent observation of higher incidence rates of childhood ALL in boys compared with girls.
EVALuna2:18859

From initiation to eradication: The lifespan of an MLL-rearranged therapy-related paediatric AML - Krumbholz, Manuela; Bradtke, J.; Stachel, D.; Peters, O.; Hero, B.; Holter, Wolfgang; Slany, Robert; Metzler, Markus (Bone Marrow Transplantation, 2015)

Front-line imatinib treatment in children and adolescents with chronic myeloid leukemia: results from a phase III trial - Suttorp, Meinolf; Schulze, Philipp; Glauche, Ingmar; Goehring, Gudrun; Von Neuhoff, Nils; Metzler, Markus; Sedlacek, Petr; De Bont, Eveline S. J. M.; Balduzzi, Adriana; Lausen, Birgitte; Aleinikova, Olga; Sufliarska, Sabina; et al. (Leukemia, 2018)
A total of 156 patients (age range 1.3-18.0 years, median 13.2 years; 91 (58.3%) male) with newly diagnosed CML (N = 146 chronic phase (CML-CP), N = 3 accelerated phase (CML-AP), N = 7 blastic phase (CML-BP)) received imatinib up-front (300, 400, 500 mg/m2, respectively) within a prospective phase III trial. Therapy response, progression-free survival, causes of treatment failure, and side effects were analyzed in 148 children and adolescents with complete data. Event-free survival rate by 18 months for patients in CML-CP (median follow-up time 25 months, range: 1-120) was 97% (95% CI, 94.2-99.9%). According to the 2006 ELN-criteria complete hematologic response by month 3, complete cytogenetic response (CCyR) by month 12, and major molecular response (MMR) by month 18 were achieved in 98, 63, and 59% of the patients, respectively. By month 36, 86% of the patients achieved CCyR and 74% achieved MMR. Thirty-eight patients (27%) experienced imatinib failure because of unsatisfactory response or intolerance (N = 9). In all, 28/148 patients (19%) underwent stem cell transplantation (SCT). In the SCT sub-cohort 2/23 patients diagnosed in CML-CP, 0/1 in CML-AP, and 2/4 in CML-BP, respectively, died of relapse (N = 3) or SCT-related complications (N = 2). This large pediatric trial extends and confirms data from smaller series that first-line imatinib in children is highly effective.
EVALuna2:35826

Frosted branch angiitis : Clinical findings and Spectralis OCT follow-up - Bergua, A.; Galiano, M.; Hohberger, B.; Rudolph, Michael (Ophthalmologe, 2016)
Frosted branch angiitis is a special form of retinal vasculitis, which has only rarely been reported in the literature. Although the majority of cases of frosted branch angiitis are idiopathic, a systematic clinical work-up should be done in order to exclude other causes, such as infectious and autoimmune diseases. The aim of this study was to correlate the clinical findings with the images obtained during follow-up by spectral domain optical coherence tomography (OCT).
EVALuna2:21248

Functional and clinical analysis of five EDA variants associated with ectodermal dysplasia but with a hard-to-predict significance - Goekdere, Sare; Schneider, Holm; Hehr, Ute; Willen, Laure; Schneider, Pascal; Maier-Wohlfart, Sigrun (Frontiers in Genetics, 2022)
Deficiency of ectodysplasin A1 (EDA1) due to variants of the gene EDA causes X-linked hypohidrotic ectodermal dysplasia (XLHED), a rare genetic condition characterized by abnormal development of ectodermal structures. XLHED is defined by the triad of hypotrichosis, hypo- or anhidrosis, and hypo- or anodontia. Anhidrosis may lead to life-threatening hyperthermia. A definite genetic diagnosis is, thus, important for the patients' management and amenability to a novel prenatal treatment option. Here, we describe five familial EDA variants segregating with the disease in three families, for which different prediction tools yielded discordant results with respect to their significance. Functional properties in vitro and levels of circulating serum EDA were compared with phenotypic data on skin, hair, eyes, teeth, and sweat glands. EDA1-Gly176Val, although associated with relevant hypohidrosis, still bound to the EDA receptor (EDAR). Subjects with EDA1-Pro389LeufsX27, -Ter392GlnfsX30, -Ser125Cys, and an EDA1 splice variant (c.924+7A > G) showed complete absence of pilocarpine-induced sweating. EDA1-Pro389LeufsX27 was incapable of binding to EDAR and undetectable in serum. EDA1-Ter392GlnfsX30, produced in much lower amounts than wild-type EDA1, could still bind to EDAR, and so did EDA1-Ser125Cys that was, however, undetectable in serum. The EDA splice variant c.924+7A > G resulted experimentally in a mix of wild-type EDA1 and EDA molecules truncated in the middle of the receptor-binding domain, with reduced EDA serum concentration. Thus, in vitro assays reflected the clinical phenotype in two of these difficult cases, but underestimated it in three others. Absence of circulating EDA seems to predict the full-blown phenotype of XLHED, while residual EDA levels may also be found in anhidrotic patients. This indicates that unborn subjects carrying variants of uncertain significance could benefit from an upcoming prenatal medical treatment even if circulating EDA levels or tests in vitro suggest residual EDA1 activity.
CRIS-Team WoS Importer:2022-08-12

Functional characterization of a novel CFTR mutation P67S identified in a patient with atypical cystic fibrosis - Kraus, Cornelia; Reis, André; Naehrlich, Lutz; Dötsch, Jörg; Korbmacher, Christoph; Rauh, Robert (Cellular Physiology and Biochemistry, 2007)
Cystic fibrosis (CF) is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. CFTR serves as a cAMP-stimulated chloride channel in a wide range of epithelial tissues and its dysfunction is a hallmark of CF. Over 1400 mutations in the CFTR gene are known, but functional data exist only for a minority of the mutant channels. The aim of the present study was to functionally characterize a novel CFTR mutation identified in a patient with atypical CF. Full length sequencing of the patient's CFTR gene revealed a homozygous C to T transition at nucleotide position 331 (CCT>TCT), which results in a P67S amino acid substitution. Mutant and wild-type CFTR were heterologously expressed in Xenopus laevis oocytes. CFTR whole-cell currents were studied using the two-electrode voltage-clamp technique. Channel surface expression was assessed by a chemiluminescence assay. Expression of P67S-CFTR resulted in functional CFTR chloride channels. However, the CFTR chloride conductance observed in oocytes expressing the mutant channel averaged only 24% of that in oocytes expressing wild-type CFTR. Similarly, surface expression of the mutant channel was reduced. In contrast, the mutation did not alter the anion selectivity of the channel, and Western blot analysis indicated a similar protein expression level of mutant and wild-type CFTR. Our findings indicate that the P67S mutation reduces CFTR chloride channel function by reducing channel surface expression. The mild disease phenotype of the patient indicates that the residual function of the mutant channel is sufficient to prevent the development of severe CF symptoms. Copyright © 2007 S. Karger AG.
UnivIS-Import:2015-04-14:Pub.2007.med.IPK.LPVP.functi
Keywords: CFTR; Chloride channel; Cystic fibrosis; Electrophysiology; P67S mutation; Pancreatic insufficiency; Surface expression; Xenopus laevis oocytes

Functional null mutations in the gonosomal homologue gene TBL1Y are associated with non-syndromic coarctation of the aorta - Tagariello, Andreas; Breuer, C.; Birkner, Y.; Schmidt, Stefan; Koch, Anna Maria; Cesnjevar, Robert; Rueffer, A.; Dittrich, Sven; Schneider, H.; Winterpacht, Andreas; Sticht, Heinrich; Doetsch, J.; et al. (Current Molecular Medicine, 2012)
In patients with congenital heart defects, chromosomal anomalies are 100 times more frequent than in control subjects. Coarctation of the aorta can be detected in 15-20% of patients with Ullrich-Turner syndrome. By extensively reviewing literature involving breakpoint analysis of gonosomal deletions in Ullrich- Turner syndrome patients with and without coarctation of the aorta, we identified several gonosomal homolgous gene pairs of interest. Four of these homologous gene pairs were investigated by standard DNA sequencing in a cohort of 83 patients with non-syndromic coarctation of the aorta. Subsequently stability of mutant RNA and protein was analyzed to verify functional relevance of detected mutations. We identified two unreported missense mutations in Exon 8 (p.D69H) and 9 (p.R176W) of TBL1Y. Bioinformatic analysis and 3D modelling predicted that both mutations lead to TBL1Y loss of function. In RT-PCR and Western blot analyses of HEK293 cells transfected with a vector carrying the full-length TBL1Y (wild-type and mutant), we documented the predicted protein instability by showing protein decay for both mutant proteins. TBL1Y is similar to its gonosomal homologue, TBL1X, and its autosomal homologue, TBLR1, on chromosome 3. Both genes are part of co-repressor machineries and required for transcriptional activation by transcription factors that involve CtBP1/2, which contributes to Notch signaling. Several studies have shown that Notch signalling is important for proper development of the left ventricular outflow tract. Our findings suggest that TBL1Y is involved in the genesis of non-syndromic coarctation of the aorta.
EVALuna2:9136

Further delineation of SLC9A3-related congenital sodium diarrhea - Bogdanic, Ema; Mueller, Thomas; Heinz-Erian, Peter; Garczarczyk-Asim, Dorota; Janecke, Andreas R.; Rueckel, Aline (Molecular Genetics and Genomic Medicine, 2022)
Background: Congenital sodium diarrhea (CSD) is a rare enteropathy displaying both broad variability in clinical severity and genetic locus and allelic heterogeneity. Eleven CSD patients were reported so far with SLC9A3 variants that impair the function of the encoded intestinal sodium-proton exchanger 3 (NHE3). Methods: We report a 4-year-old patient, born prematurely in the 35th week of gestation, with antenatal polyhydramnios and dilated intestinal loops, and with diarrhea of congenital onset, 2–6 times a day, and with polydipsia. She thrived age-appropriately under a normal family diet. Serum sodium levels were repeatedly normal but urinary sodium excretion was low. Exome sequencing revealed compound heterozygous variants in SLC9A3 as the likely cause of the congenital diarrhea. Results: While exome sequencing did not reveal pathogenic or likely pathogenic variants in other genes that cause syndromic or non-syndromic forms of congenital and intractable diarrheas, we identified novel compound heterozygous variants in SLC9A3, a complex allele with two missense changes, NP_004165.2:p.[Ser331Leu;Val449Ile] and in-trans the missense variant p.(Phe451Ser). Conclusion: The clinical phenotype here appears to localize to the milder end of the known CSD spectrum, and the identified variants suggest that this is the twelfth patient reported to date with CSD due to mutations in SLC9A3.
CRIS-Team Scopus Importer:2022-07-08
Keywords: compound heterozygous; CSD; NHE3; parenteral nutrition; SLC9A3; urinary sodium

Further Evidence of Neuroprotective Effects of Recombinant Human Erythropoietin and Growth Hormone in Hypoxic Brain Injury in Neonatal Mice - Klepper, Simon; Jung, Susan; Dittmann, Lara; Geppert, Carol-Immanuel; Hartmann, Arndt; Beier, Nicole; Trollmann, Regina (International Journal of Molecular Sciences, 2022)
Experimental in vivo data have recently shown complementary neuroprotective actions of rhEPO and growth hormone (rhGH) in a neonatal murine model of hypoxic brain injury. Here, we hypothesized that rhGH and rhEPO mediate stabilization of the blood-brain barrier (BBB) and regenerative vascular effects in hypoxic injury to the developing brain. Using an established model of neonatal hypoxia, neonatal mice (P7) were treated i.p. with rhGH (4000 mu g/kg) or rhEPO (5000 IU/kg) 0/12/24 h after hypoxic exposure. After a regeneration period of 48 h or 7 d, cerebral mRNA expression of Vegf-A, its receptors and co-receptors, and selected tight junction proteins were determined using qRT-PCR and ELISA. Vessel structures were assessed by Pecam-1 and occludin (Ocln) IHC. While Vegf-A expression increased significantly with rhGH treatment (p < 0.01), expression of the Vegfr and TEK receptor tyrosine kinase (Tie-2) system remained unchanged. RhEPO increased Vegf-A (p < 0.05) and Angpt-2 (p < 0.05) expression. While hypoxia reduced the mean vessel area in the parietal cortex compared to controls (p < 0.05), rhGH and rhEPO prevented this reduction after 48 h of regeneration. Hypoxia significantly reduced the Ocln(+) fraction of cortical vascular endothelial cells. Ocln signal intensity increased in the cortex in response to rhGH (p < 0.05) and in the cortex and hippocampus in response to rhEPO (p < 0.05). Our data indicate that rhGH and rhEPO have protective effects on hypoxia-induced BBB disruption and regenerative vascular effects during the post-hypoxic period in the developing brain.
CRIS-Team WoS Importer:2022-08-26

General Anesthesia in the First 36 Months of Life. - Schüttler, Christina; Münster, Tino; Gall, Christine; Trollmann, Regina; Schüttler, Jürgen (Deutsches Ärzteblatt international, 2021)
BACKGROUND: Experimental data have shown that the developing brain is especially vulnerable to exogenous noxious substances. The potential effects of anesthetic drugs on brain growth and development are a matter of concern. Clinical studies of children who underwent general anesthesia in their earliest years can make a major contribution to our understanding of the effects of anesthetic drugs on infants and toddlers (i.e., children under age 5). METHODS: Children born at term during the years 2007-2011 who were exposed to general anesthesia before their third birthday were included in the study. Data on general anesthesia were retrospectively evaluated, and the overall intelligence quotient (IQ) was determined prospectively as the primary target parameter. Children who had not been exposed to general anesthesia were recruited as a control group. The non-inferiority threshold was set at a difference of 5 IQ points out of a consideration of clinical relevance. RESULTS: 430 complete data sets were available from exposed children and 67 from members of the control group. The exposed group achieved a mean IQ score of 108.2, with a 95% confidence interval of [107; 109.4]; the corresponding values in the control group were 113 [110; 116.1]. Both groups achieved a mean score that was higher than the expected 100 points. After adjustment for age, socioeconomic status, and sex, the difference between the two groups was 2.9 points [0.2; 5.6], indicating a significantly better outcome in the control group than in the exposed group. The non-inferiority threshold of 5 IQ points was within the confidence interval; thus, non-inferiority was not demonstrated. CONCLUSION: The fact that both groups achieved a higher IQ score than the expected 100 points may be attributable, at least in part, to the restriction of the study to children born at term. The results indicate that general anesthesia in early childhood is not associated with markedly reduced intelligence in later years, although noninferiority could not be demonstrated.
EVALuna2:491351

Generation and characterization of function-blocking anti-ectodysplasin A (EDA) monoclonal antibodies that induce ectodermal dysplasia - Kowalczyk-Quintas, Christine; Willen, Laure; Anh Thu Dang,; Sarrasin, Heidi; Tardivel, Aubry; Hermes, Katharina; Schneider, Holm; Gaide, Olivier; Donze, Olivier; Kirby, Neil; Headon, Denis J.; Schneider, Pascal (Journal of Biological Chemistry, 2014)
Development of ectodermal appendages, such as hair, teeth, sweat glands, sebaceous glands, and mammary glands, requires the action of the TNF family ligand ectodysplasin A (EDA). Mutations of the X-linked EDA gene cause reduction or absence of many ectodermal appendages and have been identified as a cause of ectodermal dysplasia in humans, mice, dogs, and cattle. We have generated blocking antibodies, raised in Eda-deficient mice, against the conserved, receptor-binding domain of EDA. These antibodies recognize epitopes overlapping the receptor-binding site and prevent EDA from binding and activating EDAR at close to stoichiometric ratios in in vitro binding and activity assays. The antibodies block EDA1 and EDA2 of both mammalian and avian origin and, in vivo, suppress the ability of recombinant Fc-EDA1 to rescue ectodermal dysplasia in Eda-deficient Tabby mice. Moreover, administration of EDA blocking antibodies to pregnant wild type mice induced in developing wild type fetuses a marked and permanent ectodermal dysplasia. These function-blocking anti-EDA antibodies with wide cross-species reactivity will enable study of the developmental and postdevelopmental roles of EDA in a variety of organisms and open the route to therapeutic intervention in conditions in which EDA may be implicated.
EVALuna2:18884

Gene replacement therapy with onasemnogene abeparvovec in children with spinal muscular atrophy aged 24 months or younger and bodyweight up to 15 kg: an observational cohort study - Weiß, Claudia; Ziegler, Andreas; Becker, Lena Luise; Johannsen, Jessika; Brennenstuhl, Heiko; Schreiber, Gudrun; Flotats-Bastardas, Marina; Stoltenburg, Corinna; Hartmann, Hans; Illsinger, Sabine; Denecke, Jonas; Pechmann, Astrid; et al. (The Lancet Child & Adolescent Health, 2022)
Background: Given the novelty of gene replacement therapy with onasemnogene abeparvovec in spinal muscular atrophy, efficacy and safety data are limited, especially for children older than 24 months, those weighing more than 8·5 kg, and those who have received nusinersen. We aimed to provide real-world data on motor function and safety after gene replacement therapy in different patient subgroups. Methods: We did a protocol-based, multicentre prospective observational study between Sept 21, 2019, and April 20, 2021, in 18 paediatric neuromuscular centres in Germany and Austria. All children with spinal muscular atrophy types 1 and 2 receiving onasemnogene abeparvovec were included in our cohort, and there were no specific exclusion criteria. Motor function was assessed at the time of gene replacement therapy and 6 months afterwards, using the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) and Hammersmith Functional Motor Scale-Expanded (HFMSE) scores. Additionally, in children pretreated with nusinersen, motor function was assessed before and after treatment switch. Off-target adverse events were analysed with a focus on liver function, thrombocytopaenia, and potential cardiotoxicity. Findings: 76 children (58 pretreated with nusinersen and 18 who were nusinersen naive) with spinal muscular atrophy were treated with onasemnogene abeparvovec at a mean age of 16·8 months (range 0·8–59·0, IQR 9–23) and a mean weight of 9·1 kg (range 4·0–15·0, IQR 7·4–10·6). In 60 patients with available data, 49 had a significant improvement on the CHOP-INTEND score (≥4 points) and HFMSE score (≥3 points). Mean CHOP INTEND scores increased significantly in the 6 months after therapy in children younger than 8 months (n=16; mean change 13·8 [SD 8·5]; p<0·0001) and children aged between 8 and 24 months (n=34; 7·7 [SD 5·2]; p<0·0001), but not in children older than 24 months (n=6; 2·5 [SD 5·2]; p=1·00). In the 45 children pretreated with nusinersen and had available data, CHOP INTEND score increased by 8·8 points (p=0·0003) at 6 months after gene replacement therapy. No acute complications occurred during infusion of onasemnogene abeparvovec, but 56 (74%) patients had treatment-related side-effects. Serious adverse events occurred in eight (11%) children. Liver enzyme elevation significantly increased with age and weight at treatment. Six (8%) patients developed acute liver dysfunction. Other adverse events included pyrexia (n=47 [62%]), vomiting or loss of appetite (41 [54%]), and thrombocytopenia (n=59 [78%]). Prednisolone treatment was significantly prolonged with a mean duration of 15·7 weeks (IQR 9–19), mainly due to liver enzyme elevation. Cardiac adverse events were rare; only two patients had abnormal echocardiogram and echocardiography findings. Interpretation: This study provides class IV evidence that children with spinal muscular atrophy aged 24 months or younger and patients pretreated with nusinersen significantly benefit from gene replacement therapy, but adverse events can be severe and need to be closely monitored. Funding: None. Translation: For the German translation of the abstract see Supplementary Materials section.
CRIS-Team Scopus Importer:2021-12-24

Generic formulations of imatinib for treatment of Philadelphia chromosome-positive leukemia in pediatric patients - Suttorp, Meinolf; Metzler, Markus; Shimada, Hiroyuki; Bansal, Deepak; Gunes, Adalet Meral; Kalwak, Krzysztof; Sedlacek, Petr; Baruchel, Andre; Biondi, Andrea; Hijiya, Nobuko; Schultz, Kirk R.; Schrappe, Martin; et al. (Pediatric Blood & Cancer, 2018)
Since the patent for imatinib has expired, the role of generic imatinib (GI) in the management of Philadelphia chromosome-positive (Ph+) leukemia in pediatric patients has had ongoing discussion. Some studies in adults demonstrated that equivalent doses of GI and branded imatinib (BI) result in comparable plasma concentrations and clinical efficacy. However, other studies found that GI users are more likely to stop imatinib, with intolerance and decreased persistence as the main causes. Economic factors also heavily influence GI selection. This article aims to review the present knowledge to support further discussion on the role of GI in the management of pediatric Ph+ leukemia.
EVALuna2:35822

Genetic Counseling for Birth Defects - Reutter, Heiko Martin (European Journal of Pediatric Surgery, 2021)
CRIS-Team WoS Importer:2021-12-31

Genetic Counseling for Bladder Exstrophy-Epispadias Complex - Reutter, Heiko Martin; Holmdahl, Gundela (European Journal of Pediatric Surgery, 2021)
Bladder exstrophy-epispadias complex (BEEC) represents the severe end of the uro-rectal malformation spectrum and has profound impact on continence, sexual, and renal function. Treatment of BEEC is primarily surgical, and the main goals are safe closure of the abdominal wall, urinary continence while preserving renal function, and adequate cosmetic and functional genital reconstruction. Psychosocial and psychosexual outcomes and adequate health-related quality of life depend on long-term multidisciplinary care. The overall outcome is now considered very positive and affected individuals usually lead self-determined and independent lives with the desire to start their own families later in life. Certainty about the risk of recurrence and the provision of information about the current state of knowledge about the identified genetic causes with high penetrance will have an impact on family planning for healthy parents with an affected child and for affected individuals themselves. This review addresses this information and presents the current state of knowledge.
CRIS-Team WoS Importer:2021-12-31

Genetic modifiers of fetal hemoglobin affect the course of sickle cell disease in patients treated with hydroxyurea - Allard, Pierre; Alhaj, Nareen; Lobitz, Stephan; Cario, Holger; Jarisch, Andreas; Grosse, Regine; Oevermann, Lena; Hakimeh, Dani; Tagliaferri, Laura; Kohne, Elisabeth; Kopp-Schneider, Annette; Kulozik, Andreas E.; et al. (Haematologica, 2022)
The course of sickle cell disease (SCD) is modified by polymorphisms boosting fetal hemoglobin (HbF) synthesis. However, it has remained an open question how these polymorphisms affect patients who are treated with the HbF-inducing drug hydroxyurea/hydroxycarbamide. The German SCD registry offers the opportunity to answer this question, because >90% of patients are treated according to national guidelines recommending the use of hydroxyurea in all patients above 2 years of age. We analyzed the modifying effect of HbF-related genetic polymorphisms in 417 patients with homozygous SCD >2 years old who received hydroxyurea. HbF levels were correlated with higher total hemoglobin levels, lower rates of hemolysis, a lower frequency of painful crises and of red blood cell transfusions. The minor alleles of the polymorphisms in the γ-globin promoter (rs7482144), BCL11A (rs1427407) and HMIP (rs66650371) were strongly associated with increased HbF levels. However, these associations did not translate into lower frequencies of vaso-occlusive events which did not differ between patients either carrying or not carrying the HMIP and BCL11A polymorphisms. Patients on hydroxyurea carrying the γ-globin promoter polymorphism demonstrated substantially higher hemoglobin levels (P<10-4) but also higher frequencies of painful crises and hospitalizations (P<0.01) when compared to patients without this polymorphism. Taken together, these data indicate that the γ-globin, HMIP and BCL11A polymorphisms correlate with increased HbF in SCD patients on hydroxyurea. While HbF is negatively correlated with the frequency of painful crises and hospitalizations, this was not observed for the presence of known HbF-boosting alleles.
CRIS-Team Scopus Importer:2022-07-15

Genetic screening confirms heterozygous mutations in ACAN as a major cause of idiopathic short stature - Hauer, Nadine; Sticht, Heinrich; Boppudi, Sangamitra; Büttner, Christian; Kraus, Cornelia; Trautmann, Udo; Zenker, Martin; Zweier, Christiane; Wiesener, Antje; Abou Jamra, Rami; Wieczorek, Dagmar; Kelkel, Jaqueline; et al. (Scientific Reports, 2017)
Short stature is a common pediatric disorder affecting 3% of the population. However, the clinical variability and genetic heterogeneity prevents the identification of the underlying cause in about 80% of the patients. Recently, heterozygous mutations in the ACAN gene coding for the proteoglycan aggrecan, a main component of the cartilage matrix, were associated with idiopathic short stature. To ascertain the prevalence of ACAN mutations and broaden the phenotypic spectrum in patients with idiopathic short stature we performed sequence analyses in 428 families. We identified heterozygous nonsense mutations in four and potentially disease-causing missense variants in two families (1.4%). These patients presented with a mean of -3.2 SDS and some suggestive clinical characteristics. The results suggest heterozygous mutations in ACAN as a common cause of isolated as well as inherited idiopathic short stature.
EVALuna2:9379

GENETICS IN ENDOCRINOLOGY: Gain and loss of function mutations of the calcium-sensing receptor and associated proteins: current treatment concepts - Mayr, Bernhard; Schnabel, Dirk; Dörr, Helmuth-Günther; Schöfl, Christof (European Journal of Endocrinology, 2016)
The calcium-sensing receptor (CASR) is the main calcium sensor in the maintenance of calcium metabolism. Mutations of the CASR, the G protein alpha 11 (GNA11) and the adaptor-related protein complex 2 sigma 1 subunit (AP2S1) genes can shift the set point for calcium sensing causing hyper- or hypo-calcemic disorders. Therapeutic concepts for these rare diseases range from general therapies of hyper- and hypo-calcemic conditions to more pathophysiology oriented approaches such as parathyroid hormone (PTH) substitution and allosteric CASR modulators. Cinacalcet is a calcimimetic that enhances receptor function and has gained approval for the treatment of hyperparathyroidism. Calcilytics in turn attenuate CASR activity and are currently under investigation for the treatment of various diseases. We conducted a literature search for reports about treatment of patients harboring inactivating or activating CASR, GNA11 or AP2S1 mutants and about in vitro effects of allosteric CASR modulators on mutated CASR. The therapeutic concepts for patients with familial hypocalciuric hypercalcemia (FHH), neonatal hyperparathyroidism (NHPT), neonatal severe hyperparathyroidism (NSHPT) and autosomal dominant hypocalcemia (ADH) are reviewed. FHH is usually benign, but symptomatic patients benefit from cinacalcet. In NSHPT patients pamidronate effectively lowers serum calcium, but most patients require parathyroidectomy. In some patients cinacalcet can obviate the need for surgery, particularly in heterozygous NHPT. Symptomatic ADH patients respond to vitamin D and calcium supplementation but this may increase calciuria and renal complications. PTH treatment can reduce relative hypercalciuria. None of the currently available therapies for ADH, however, prevent tissue calcifications and complications, which may become possible with calcilytics that correct the underlying pathophysiologic defect.
EVALuna2:2068

Genetic testing and surveillance in infantile myofibromatosis: a report from the SIOPE Host Genome Working Group - Hettmer, Simone; Dachy, Guillaume; Seitz, Guido; Agaimy, Abbas; Duncan, Catriona; Jongmans, Marjolijn; Hirsch, Steffen; Kventsel, Iris; Kordes, Uwe; De Krijger, Ronald R.; Metzler, Markus; Michaeli, Orli; et al. (Familial Cancer, 2020)
Infantile myofibromatosis (IM), which is typically diagnosed in young children, comprises a wide clinical spectrum ranging from inconspicuous solitary soft tissue nodules to multiple disseminated tumors resulting in life-threatening complications. Familial IM follows an autosomal dominant mode of inheritance and is linked to PDGFRB germline variants. Somatic PDGFRB variants were also detected in solitary and multifocal IM lesions. PDGFRB variants associated with IM constitutively activate PDGFRB kinase activity in the absence of its ligand. Germline variants have lower activating capabilities than somatic variants and, thus, require a second cis-acting hit for full receptor activation. Typically, these mutant receptors remain sensitive to tyrosine kinase inhibitors such as imatinib. The SIOPE Host Genome Working Group, consisting of pediatric oncologists, clinical geneticists and scientists, met in January 2020 to discuss recommendations for genetic testing and surveillance for patients who are diagnosed with IM or have a family history of IM/PDGFRB germline variants. This report provides a brief review of the clinical manifestations and genetics of IM and summarizes our interdisciplinary recommendations.
CRIS-Team Scopus Importer:2020-09-18
Keywords: Genetic counseling; Infantile myofibromatosis; PDGFRB variants; Surveillance

Genetic variants associated with methotrexate-induced mucositis in cancer treatment: A systematic review and meta-analysis - Maagdenberg, Hedy; Oosterom, Natanja; Zanen, Jolanda; Gemmati, Donato; Windsor, Rachael E.; Heil, Sandra G.; Esperón, Patricia; Jabeen, Shakila; Ruiz-Argüelles, Guillermo J.; Zolk, Oliver; Hörning, Susanne; Sleurs, Charlotte; et al. (Critical Reviews in Oncology Hematology, 2021)
Methotrexate (MTX), an important chemotherapeutic agent, is often accompanied with mucositis. The occurrence and severity are unpredictable and show large interindividual variability. In this study, we review and meta-analyze previously studied genetic variants in relation to MTX-induced mucositis. We conducted a systematic search in Medline and Embase. We included genetic association studies of MTX-induced mucositis in cancer patients. A meta-analysis was conducted for single nucleotide polymorphisms (SNPs) for which at least two studies found a statistically significant association. A total of 34 SNPs were associated with mucositis in at least one study of the 57 included studies. Two of the seven SNPs included in our meta-analysis were statistically significantly associated with mucositis: MTHFR c.677C > T (recessive, grade ≥3 vs grade 0–2, OR 2.53, 95 %CI [1.48–4.32], False Discovery Rate[FDR]-corrected p-value 0.011) and MTRR c.66A > G (overdominant, grade ≥1 vs grade 0, OR 2.08, 95 %CI [1.16–3.73], FDR-corrected p-value 0.042).
CRIS-Team Scopus Importer:2021-05-21
Keywords: Adult; Cancer; Gastrointestinal toxicity; Methotrexate; Mucositis; Pediatric; Pharmacogenomics

Genome-wide association study identifies multiple new loci associated with Ewing sarcoma susceptibility - Machiela, Mitchell J.; Gruenewald, Thomas G. P.; Surdez, Didier; Reynaud, Stephanie; Mirabeau, Olivier; Karlins, Eric; Rubio, Rebeca Alba; Zaidi, Sakina; Grossetete-Lalami, Sandrine; Ballet, Stelly; Lapouble, Eve; Laurence, Valerie; et al. (CANCER RESEARCH, 2018)
CRIS-Team WoS Importer:2019-06-04

Genome-wide association study identifies multiple new loci associated with Ewing sarcoma susceptibility - Machiela, Mitchell J.; Grunewald, Thomas G. P.; Surdez, Didier; Reynaud, Stephanie; Mirabeau, Olivier; Karlins, Eric; Rubio, Rebeca Alba; Zaidi, Sakina; Grossetete-Lalami, Sandrine; Ballet, Stelly; Lapouble, Eve; Laurence, Valerie; et al. (Nature Communications, 2018)
Ewing sarcoma (EWS) is a pediatric cancer characterized by the EWSR1-FLI1 fusion. We performed a genome-wide association study of 733 EWS cases and 1346 unaffected individuals of European ancestry. Our study replicates previously reported susceptibility loci at 1p36.22, 10q21.3 and 15q15.1, and identifies new loci at 6p25.1, 20p11.22 and 20p11.23. Effect estimates exhibit odds ratios in excess of 1.7, which is high for cancer GWAS, and striking in light of the rarity of EWS cases in familial cancer syndromes. Expression quantitative trait locus (eQTL) analyses identify candidate genes at 6p25.1 (RREB1) and 20p11.23 (KIZ). The 20p11.22 locus is near NKX2-2, a highly overexpressed gene in EWS. Interestingly, most loci reside near GGAA repeat sequences and may disrupt binding of the EWSR1-FLI1 fusion protein. The high locus to case discovery ratio from 733 EWS cases suggests a genetic architecture in which moderate risk SNPs constitute a significant fraction of risk.
EVALuna2:35825

GENOME-WIDE ASSOCIATION STUDY IN PATIENTS WITH ANATOMICAL OBSTRUCTIONS OF THE LOWER URINARY TRACT - Van Der Zanden, Loes F. M.; Maj, Carlo; Borisov, Oleg; Van Rooij, Iris A. L. M.; Quaedackers, Josine S. L. T.; Steffens, Martijn; Schierbaum, Luca; Schneider, Sophia; Waffenschmidt, Lea; Kiemeney, Lambert A. L. M.; De Wall, Liesbeth; Heilmann, Stefanie; et al. (PEDIATRIC NEPHROLOGY, 2022)
CRIS-Team WoS Importer:2022-09-30

Genome-wide association study in patients with posterior urethral valves - van der Zanden, Loes F.M.; Maj, Carlo; Borisov, Oleg; van Rooij, Iris A.L.M.; Quaedackers, Josine S.L.T.; Steffens, Martijn; Schierbaum, Luca; Schneider, Sophia; Waffenschmidt, Lea; Kiemeney, Lambertus A.L.M.; de Wall, Liesbeth L.L.; Heilmann, Stefanie; et al. (Frontiers in Pediatrics, 2022)
Congenital lower urinary tract obstructions (LUTO) are most often caused by posterior urethral valves (PUV), a male limited anatomical obstruction of the urethra affecting 1 in 4,000 male live births. Little is known about the genetic background of PUV. Here, we report the largest genome-wide association study (GWAS) for PUV in 4 cohorts of patients and controls. The final meta-analysis included 756 patients and 4,823 ethnicity matched controls and comprised 5,754,208 variants that were genotyped or imputed and passed quality control in all 4 cohorts. No genome-wide significant locus was identified, but 33 variants showed suggestive significance (P < 1 × 10−5). When considering only loci with multiple variants residing within < 10 kB of each other showing suggestive significance and with the same effect direction in all 4 cohorts, 3 loci comprising a total of 9 variants remained. These loci resided on chromosomes 13, 16, and 20. The present GWAS and meta-analysis is the largest genetic study on PUV performed to date. The fact that no genome-wide significant locus was identified, can be explained by lack of power or may indicate that common variants do not play a major role in the etiology of PUV. Nevertheless, future studies are warranted to replicate and validate the 3 loci that yielded suggestive associations.
CRIS-Team Scopus Importer:2022-10-28
Keywords: BMP7; genome wide association study; lower urinary tract obstruction; obstructive uropathy; PCDH9; posterior urethral valves; SALL1

Genome-wide identification of disease-causing copy number variations in 450 individuals with anorectal malformations - Fabian, Julia; Dworschak, Gabriel C.; Waffenschmidt, Lea; Schierbaum, Luca; Bendixen, Charlotte; Heilmann-Heimbach, Stefanie; Sivalingam, Sugirthan; Buness, Andreas; Schwarzer, Nicole; Boemers, Thomas M.; Schmiedeke, Eberhard; Neser, Jorg; et al. (European Journal of Human Genetics, 2022)
Anorectal malformations (ARM) represent a spectrum of rare malformations originating from a perturbated development of the embryonic hindgut. Approximately 60% occur as a part of a defined genetic syndrome or within the spectrum of additional congenital anomalies. Rare copy number variations (CNVs) have been associated with both syndromic and non-syndromic forms. The present study represents the largest study to date to explore the contribution of CNVs to the expression of ARMs. SNP-array-based molecular karyotyping was applied in 450 individuals with ARM and 4392 healthy controls. CNVs were identified from raw intensity data using PennCNV. Overlapping CNVs between cases and controls were discarded. Remaining CNVs were filtered using a stringent filter algorithm of nine filter steps. Prioritized CNVs were confirmed using qPCR. Filtering prioritized and qPCR confirmed four microscopic chromosomal anomalies and nine submicroscopic CNVs comprising seven microdeletions (del2p13.2, del4p16.2, del7q31.33, del9p24.1, del16q12.1, del18q32, del22q11.21) and two microduplications (dup2p13.2, dup17q12) in 14 individuals (12 singletons and one affected sib-pair). Within these CNVs, based on their embryonic expression data and function, we suggest FOXK2, LPP, and SALL3 as putative candidate genes. Overall, our CNV analysis identified putative microscopic and submicroscopic chromosomal rearrangements in 3% of cases. Functional characterization and re-sequencing of suggested candidate genes is warranted.
CRIS-Team Scopus Importer:2022-11-18

Genome-Wide Survey for Microdeletions or -Duplications in 155 Patients with Lower Urinary Tract Obstructions (LUTO) - Schierbaum, Luca M.; Schneider, Sophia; Herms, Stefan; Sivalingam, Sugirthan; Fabian, Julia; Reutter, Heiko Martin; Weber, Stefanie; Merz, Waltraut M.; Tkaczyk, Marcin; Miklaszewska, Monika; Sikora, Przemyslaw; Szmigielska, Agnieszka; et al. (Genes, 2021)
Lower urinary tract obstruction (LUTO) is, in most cases, caused by anatomical blockage of the bladder outlet. The most common form are posterior urethral valves (PUVs), a male-limited phenotype. Here, we surveyed the genome of 155 LUTO patients to identify disease-causing CNVs. Raw intensity data were collected for CNVs detected in LUTO patients and 4.392 healthy controls using CNVPartition, QuantiSNP and PennCNV. Overlapping CNVs between patients and controls were discarded. Additional filtering implicated CNV frequency in the database of genomic variants, gene content and final visual inspection detecting 37 ultra-rare CNVs. After, prioritization qPCR analysis confirmed 3 microduplications, all detected in PUV patients. One microduplication (5q23.2) occurred de novo in the two remaining microduplications found on chromosome 1p36.21 and 10q23.31. Parental DNA was not available for segregation analysis. All three duplications comprised 11 coding genes: four human specific lncRNA and one microRNA. Three coding genes (FBLIM1, SLC16A12, SNCAIP) and the microRNA MIR107 have previously been shown to be expressed in the developing urinary tract of mouse embryos. We propose that duplications, rare or de novo, contribute to PUV formation, a male-limited phenotype.
CRIS-Team WoS Importer:2021-10-08

Genomic EWSR1 Fusion Sequence as Highly Sensitive and Dynamic Plasma Tumor Marker in Ewing Sarcoma - Krumbholz, Manuela; Hellberg, Julia; Steif, Benedikt; Bäuerle, Tobias; Gillmann, Clarissa; Fritscher, Torsten; Agaimy, Abbas; Frey, Benjamin; Juengert, Joerg; Wardelmann, Eva; Hartmann, Wolfgang; Juergens, Heribert; et al. (Clinical Cancer Research, 2016)
The application of the tumor-specific genomic fusion sequence as noninvasive biomarker for therapy monitoring in Ewing sarcoma (EwS) has been evaluated.EwS xenograft mouse models were used to explore detectability in small plasma volumes and correlation of genomic EWSR1-FLI1 copy numbers with tumor burden. Furthermore, 234 blood samples from 20 EwS patients were analyzed before and during multimodal treatment. EWSR1 fusion sequence levels in patients' plasma were quantified using droplet digital PCR and compared with tumor volumes calculated from MRI or CT imaging studies.Kinetics of EWSR1 fusion sequence copy numbers in the plasma are correlated with changes of the tumor volume in patients with localized and metastatic disease. The majority of patients showed a fast reduction of cell-free tumor DNA (ctDNA) during initial chemotherapy. Recurrence of increasing ctDNA levels signalized relapse development.Genomic fusion sequences represent promising noninvasive biomarkers for improved therapy monitoring in EwS. Until now, response assessment is largely based on MRI and CT imaging, implying restrictions on closely repeated performance and limitations on the differentiation between vital tumor and reactive stromal tissue. Particularly in patients with prognostic unfavorable disseminated disease, ctDNA is a valuable addition for the assessment of therapy response. Clin Cancer Res; 22(17); 4356-65. ©2016 AACR.
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Genotype, Clinical Course, and Therapeutic Decision Making in 76 Infants with Severe Generalized Junctional Epidermolysis Bullosa - Hammersen, Johanna; Has, Cristina; Naumann-Bartsch, Nora; Stachel, Daniel; Kiritsi, Dimitra; Söder, Stephan; Tardieu, Mathilde; Metzler, Markus; Bruckner-Tuderman, Leena; Schneider, Holm (Journal of Investigative Dermatology, 2016)
Severe generalized junctional epidermolysis bullosa, a lethal hereditary blistering disorder, is usually treated by palliative care. Allogeneic stem cell transplantation (SCT) has been proposed as a therapeutic approach, yet without clinical evidence. Decision making was evaluated retrospectively in 76 patients with severe generalized junctional epidermolysis bullosa born in the years 2000-2015. The diagnosis was based on the absence of laminin-332 in skin biopsies. With an incidence of 1 of 150,000, severe generalized junctional epidermolysis bullosa occurred more often than published previously. Eleven as yet unreported mutations in the laminin-332 genes were detected. Although patients homozygous for the LAMB3 mutation c.1903C>T lived longer than the others, life expectancy was greatly diminished (10.8 vs. 4.6 months). Most patients failed to thrive. In two patients with initially normal weight gain, the decision for SCT from haploidentical bone marrow or peripheral blood was made. Despite transiently increasing skin erosions, the clinical status of both subjects stabilized for several weeks after SCT, but finally deteriorated. Graft cells, but no laminin-332, were detected in skin biopsies. The patients died 96 and 129 days after SCT, respectively, one of them after receiving additional skin grafts. Treatment of severe generalized junctional epidermolysis bullosa by SCT is a last-ditch attempt still lacking proof of efficacy.
EVALuna2:6828

Genotype-phenotype correlation in boys with X-linked hypohidrotic ectodermal dysplasia - Burger, Kristin; Schneider, Anne-Theres; Wohlfart, Sigrun; Kiesewetter, Franklin; Huttner, Kenneth; Johnson, Ramsey; Schneider, Holm (American Journal of Medical Genetics Part A, 2014)
X-linked hypohidrotic ectodermal dysplasia (XLHED), the most frequent form of ectodermal dysplasia, is a genetic disorder of ectoderm development characterized by malformation of multiple ectodermal structures such as skin, hair, sweat and sebaceous glands, and teeth. The disease is caused by a broad spectrum of mutations in the gene EDA. Although XLHED symptoms show inter-familial and intra-familial variability, genotype-phenotype correlation has been demonstrated with respect to sweat gland function. In this study, we investigated to which extent the EDA genotype correlates with the severity of XLHED-related skin and hair signs. Nineteen male children with XLHED (age range 3-14 years) and seven controls (aged 6-14 years) were examined by confocal microscopy of the skin, quantification of pilocarpine-induced sweating, semi-quantitative evaluation of full facial photographs with respect to XLHED-related skin issues, and phototrichogram analysis. All eight boys with known hypomorphic EDA mutations were able to produce at least some sweat and showed less severe cutaneous signs of XLHED than the anhidrotic XLHED patients (e.g., perioral and periorbital eczema or hyperpigmentation, regional hyperkeratosis, characteristic wrinkles under the eyes). As expected, individuals with XLHED had significantly less and thinner hair than healthy controls. However, there were also significant differences in hair number, diameter, and other hair characteristics between the group with hypomorphic EDA mutations and the anhidrotic patients. In summary, this study indicated a remarkable genotype-phenotype correlation of skin and hair findings in prepubescent males with XLHED.
EVALuna2:18885

Genotype/phenotype correlations in 538 congenital adrenal hyperplasia patients from Germany and Austria: discordances in milder genotypes and in screened versus prescreening patients - Riedl, Stefan; Roehl, Friedrich-Wilhelm; Bonfig, Walter; Braemswig, Juergen; Richter-Unruh, Annette; Fricke-Otto, Susanne; Bettendorf, Markus; Riepe, Felix; Kriegshaeuser, Gernot; Schoenau, Eckhard; Even, Gertrud; Hauffa, Berthold; et al. (Endocrine Connections, 2019)
Congenital adrenal hyperplasia (CAH) due to CYP21A2 gene mutations is associated with a variety of clinical phenotypes (salt wasting, SW; simple virilizing, SV; nonclassical, NC) depending on residual 21-hydroxylase activity. Phenotypes and genotypes correlate well in 80-90% of cases. We set out to test the predictive value of CAH phenotype assignment based on genotype classification in a large multicenter cohort. A retrospective evaluation of genetic data from 538 CAH patients (195 screened) collected from 28 tertiary centers as part of a German quality control program was performed. Genotypes were classified according to residual 21-hydroxylase activity (null, A, B, C) and assigned clinical phenotypes correlated with predicted phenotypes, including analysis of Prader stages. Ultimately, concordance of genotypes with clinical phenotypes was compared in patients diagnosed before or after the introduction of nationwide CAH-newborn screening. Severe genotypes (null and A) correlated well with the expected phenotype (SW in 97 and 91%, respectively), whereas less severe genotypes (B and C) correlated poorly (SV in 45% and NC in 57%, respectively). This was underlined by a high degree of virilization in girls with C genotypes (Prader stage >1 in 28%). SW was diagnosed in 90% of screening-positive babies with classical CAH compared with 74% of prescreening patients. In our CAH series, assigned phenotypes were more severe than expected in milder genotypes and in screened vs prescreening patients. Diagnostic discrimination between phenotypes based on genotypes may prove overcome due to the overlap in their clinical presentations.
CRIS-Team WoS Importer:2019-03-20

Genotype-phenotype correlations in children and adolescents with nonclassical congenital adrenal hyperplasia due to 21-hydroxylase deficiency. - Dörr, Helmuth-Günther; Schulze, Nadja; Bettendorf, Markus; Binder, Gerhard; Bonfig, Walter; Denzer, Christian; Dunstheimer, Desirée; Salzgeber, Kirsten; Schmidt, Heinrich; Schwab, Karl-Otfried; Voss, Egbert; Wabitsch, Martin; et al. (Molecular and Cellular Pediatrics, 2020)
BACKGROUND: Nonclassical congenital adrenal hyperplasia due to 21-hydroxylase deficiency is caused by mutations in the active 21-hydroxylase gene (CYP21A2). The clinical symptoms can vary greatly. To date, no systematic studies have been undertaken in Germany. AIMS: Description of the phenotype, evaluation of the diagnostics and genotype-phenotype correlation PATIENTS AND METHODOLOGY: Retrospective analysis of the data of 134 patients (age range 0.1-18.6 years) in a multicentre study covering 10 paediatric endocrinology centres in Bavaria and Baden-Württemberg. The data was gathered on site from the medical records. Two hundred and thirty-three alleles with a mutation of the CYP21A2 gene were identified in 126 patients. A genotype-phenotype correlation of the mutation findings was undertaken (C1, severe/mild; C2, mild/mild). Individuals with a heterozygous mutation of the CYP21A2 were also included (C3). The data was collected with the approval of the ethics committee of the University Hospital of Erlangen during the period of 2014 and 2015. RESULTS (MW ± SD): One hundred and seventeen out of 134 patients (115 f, 29 m) were symptomatic. The chronological age (CA) at diagnosis was 7.1 ± 4.4 years. The most frequent symptom (73.5%) was premature pubarche. The height-SDS on diagnosis was 0.8 ± 1.3 and the BMI-SDS was 0.8 ± 1.2. Bone age (BA) was ascertained in 82.9% of the symptomatic patients. The difference between BA and CA was 1.9 ± 1.4 years. Basal 17OHP concentrations were 14.5 ± 19.1 ng/ml (18 patients < 2 ng/ml). In total, 58.1% mild and 34.7% severe mutations were found. The most common mutation was p.Val281Leu (39.1%); 65.8% of the patients could be allocated to group C1. No phenotypical differences were found between the 3 mutation groups. The 17OHP levels (basal and after ACTH) in the standard ACTH stimulation test were highest in group C1 and also significantly higher in group C2 as in C3, the ACTH-stimulated cortisol levels (ng/ml) were significantly lower in groups C1 (192.1 ± 62.5) and C2 (218 ± 50) than in C3 (297.3 ± 98.7). CONCLUSION: Most of the patients have symptoms of mild androgenisation. Male patients are underdiagnosed. Diagnostics are not standardised. Differences between the types of mutations are found in the hormone concentrations but not in phenotype. We speculate that further, as yet not clearly defined, factors are responsible for the development of the respective phenotypes.
EVALuna2:385044

Genotyping circulating tumor DNA of pediatric Hodgkin lymphoma - Desch, Ann Kathrin; Hartung, Kristin; Botzen, Ante; Brobeil, Alexander; Rummel, Mathias; Kurch, Lars; Georgi, Thomas; Jox, Theresa; Bielack, Stefan; Burdach, Stefan; Classen, Carl Friedrich; Claviez, Alexander; et al. (Leukemia, 2019)
We used hybrid capture-targeted next-generation sequencing of circulating cell-free DNA (ccfDNA) of pediatric Hodgkin lymphoma (PHL) patients to determine pathogenic mechanisms and assess the clinical utility of this method. Hodgkin-Reed/Sternberg (HRS) cell-derived single nucleotide variants, insertions/deletions, translocations and VH-DH-JH rearrangements were detected in pretherapy ccfDNA of 72 of 96 patients. Number of variants per patient ranged from 1 to 21 with allele frequencies from 0.6 to 42%. Nine translocation breakpoints were detected. Genes involved in JAK/STAT, NFkB and PI3K signaling and antigen presentation were most frequently affected. SOCS1 variants, mainly deletions, were found in most circulating tumor (ct) DNAs, and seven of the nine translocation breakpoints involved SOCS1. Analysis of VH-DH-JH rearrangements revealed an origin of PHL HRS cells from partially selected germinal center B cells. Amounts of pretherapy ctDNA were correlated with metabolic tumor volumes. Furthermore, in all ccfDNA samples of 43 patients with early response assessment quantitative qPET < 3, indicative of a favorable clinical course, ctDNA was not detectable. In contrast, in five of six patients with qPET > 3, indicative of an unfavorable clinical course, ctDNA remained detectable. ccfDNA analysis of PHL is thus a suitable approach to determine pathogenic mechanisms and monitor therapy response.
CRIS-Team Scopus Importer:2019-08-27

Genotyp-Phänotyp-Korrelation bei Zwillingsmädchen mit nichtklassischem adrenogenitalem Syndrom und 21-Hydroxylase-Defekt - Dörr, Helmuth-Günther; Oppelt, Patricia (Gynakologische Endokrinologie, 2020)
CRIS-Team Scopus Importer:2020-03-06

Genotyp-Phänotyp-Korrelationen bei Kindern und Jugendlichen mit nichtklassischem adrenogenitalen Syndrom mit 21-Hydroxylase-Defekt - Dörr, Helmuth-Günther; Schulze, Nadja; Bettendorf, M.; Binder, G.; Bonfig, W.; Denzer, C.; Dunstheimer, D.; Salzgeber, K.; Schmidt, H.; Schwab, K. O.; Voss, E.; Wabitsch, M.; et al. (Monatsschrift Kinderheilkunde, 2020)
Background: Nonclassical congenital adrenal hyperplasia due to 21-hydroxylase deficiency (NCCAH) is caused by mutations in the active 21-hydroxylase gene (CYP21A2). The clinical symptoms can vary greatly. To date, no systematic studies have been undertaken in Germany. Objective: Description of the phenotype, evaluation of the diagnostics, genotype-phenotype correlation. Patients and methodology: Retrospective analysis of the data of 134 patients (age range 0.1–18.6 years) in a multicenter study covering 10 pediatric endocrinology centers in Bavaria and Baden-Württemberg. The data were collected on site from the medical records. In 126 patients 233 alleles with a mutation of the CYP21A2 gene were identified. A genotype-phenotype correlation of the mutation findings was undertaken (C1: severe/mild, C2: mild/mild). Individuals with a heterozygote mutation (C3) were also included in the analysis. The data were collected with the approval of the ethics committee of the University Hospital of Erlangen during the time period of 2014 and 2015. Results (MW ± SD): Out of 134 patients (115 female, 29 male) 117 were symptomatic. The chronological age (CA) at diagnosis was 7.1 ± 4.4 years. The most frequent symptom (73.5%) was premature pubarche. The height-standard deviation score (SDS) on diagnosis was 0.8 ± 1.3 and the body mass index (BMI)-SDS was 0.8 ± 1.2. Bone age (BA) was ascertained in 82.9% of the symptomatic patients. The difference between BA and CA was 1.9 ± 1.4 years. Basal 17-hydroxyprogesterone (17-OHP) concentrations were 14.5 ± 19.1 ng/ml (18 patients <2 ng/ml). In total 58.1% mild and 34.7% severe mutations were found. The most common mutation (39.1%) was p.Val281Leu and 65.8% of the patients could be allocated to group C1. No phenotypical differences were found between the three mutation groups. The 17-OHP levels (basal and after ACTH) in the ACTH test were highest in group C1 and also significantly higher in group C2 than in group C3. The ACTH-stimulated cortisol levels (ng/ml) were significantly lower in groups C1 (192.1 ± 62.5) and C2 (218 ± 50) than in C3 (297.3 ± 98.7). Conclusion: Most of the patients had symptoms of mild androgenization. Male patients were underdiagnosed. The diagnostics were not standardized. Differences between the types of mutations were found in the hormone concentrations but not in the phenotype. We speculate that further, as yet not clearly defined, factors are responsible for the development of the respective phenotypes.
CRIS-Team Scopus Importer:2020-07-24
Keywords: 17-OHP; ACTH stimulation test; Androgenisation; CYP21A2 gene mutations; Premature pubarche

German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease: Report 2020-Comprehensive Data from 6 Years of Experience - Beckmann, Andreas; Dittrich, Sven; Arenz, C.; Krogmann, O. N.; Horke, A.; Tengler, A.; Meyer, R.; Bauer, U. M. M.; Hofbeck, Michael (Thoracic and Cardiovascular Surgeon, 2021)
Background a Based on a quality assurance initiative of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) and the German Society for Pediatric Cardiology and Congenital Heart Defects (DGPK), a voluntary registry was founded for assessment of treatment and outcomes of patients with congenital heart disease in Germany. This evaluation by the German Registry for cardiac operations and interventions in patients with congenital heart disease reports the data and the outcome over a 6-year period in patients undergoing invasive treatment. Methods a This real-world database collects clinical characteristics, in-hospital complications, and medium-term outcome of patients who underwent cardiac surgical and interventional procedures within the prospective, all-comers registry. Patients were followed-up for up to 90 days. Results a In the period from 2013 to 2018, a total of 35,730 patients, 39,875 cases, respectively 46,700 procedures were included at up to 31 German institutions. The cases could be subcategorized according to the treatment intention into 21,027 (52.7%) isolated operations, 17,259 (43.3%) isolated interventions, and 1,589 (4.0%) with multiple procedures. Of these, 4,708 (11.8%) were performed in neonates, 10,047 (25.2%) in infants, 19,351 (48.5%) in children of 1 to 18 years, and 5,769 (14.5%) in adults. Also, 15,845 (33.9%) cases could be allocated to so-called index procedures which underwent a more detailed evaluation to enable meaningful comparability. The mean unadjusted in-hospital mortality of all cases in our registry ranged from 0.3% in patients with isolated interventions and 2.0% in patients with surgical procedures up to 9.1% in patients undergoing multiple procedures. Conclusion a This annually updated registry of both scientific societies represents voluntary public reporting by accumulating actual information for surgical and interventional procedures in patients with congenital heart disease (CHD) in Germany. It describes advancements in cardiac medicine and is a basis for internal and external quality assurance for all participating institutions. In addition, the registry demonstrates that in Germany, both interventional and surgical procedures for treatment of CHD are offered with high medical quality.
CRIS-Team Scopus Importer:2021-03-19
Keywords: congenital heart disease; congenital heart surgery; multicenter registry; outcomes; pediatric cardiology

German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease: Report 2021 and 9 Years' Longitudinal Observations on Fallot and Coarctation Patients - Dittrich, Sven; Arenz, Claudia; Krogmann, Otto; Tengler, Anja; Meyer, Renate; Bauer, Ulrike; Hofbeck, Michael; Beckmann, Andreas; Horke, Alexander (Thoracic and Cardiovascular Surgeon, 2022)
BACKGROUND: The annual report of the German Quality Assurance of Congenital Heart Disease displays a broad overview on outcome of interventional and surgical treatment with respect to patient's age and risk categorization. Particular features of the German all-comers registry are the inclusion of all interventional and surgical procedures, the possibility to record repeated treatments with distinct individual patient assignment, and to record various procedures within one case. METHODS: International Pediatric and Congenital Cardiac Code terminology for diagnoses and procedures as well as classified adverse events, also recording of demographic data, key procedural performance indicators, and key quality indicators (mortality, adverse event rates). Surgical and interventional adverse events were classified according to the Society of Thoracic Surgeons and to the Congenital Heart Disease Adjustment for Risk Method of the congenital cardiac catheterization project on outcomes. Annual analysis of all cases and additional long-term evaluation of patients after repair of Fallot and primary treatment of native coarctation of the aorta were performed. RESULTS: In 2020, 5,532 patients with 6,051 cases (hospital stays) with 6,986 procedures were treated in 23 German institutions. Cases dispense on 618 newborns (10.2%), 1,532 infants (25.3%), 3,077 children (50.9%), and 824 adults (13.6%). Freedom from adverse events was 94.5% in 2,795 interventional cases, 67.9% in 2,887 surgical cases, and 42.9% in 336 cases with multiple procedures (without considering the 33 hybrid interventions). In-hospital mortality was 0.5% in interventional, 1.6% in surgical, and 5.7% in cases with multiple treatments. Long-term observation of 1,632 patient after repair of Fallot depicts the impact of previous palliation in 18% of the patients on the rate of 20.8% redo cases. Differentiated analysis of 1,864 patients with native coarctation picture clear differences of patient, age, and procedure selection and outcome. The overall redo procedure rate in this patient population is high with 30.8%. CONCLUSION: Improvement in quality of care requires detailed analysis of risks, performance indicators, and outcomes. The high necessity of redo procedures in patients with complex congenital heart disease underlines the imperative need of long-term observations.
CRIS-Team Scopus Importer:2022-10-14

Germline variants in HEY2 functional domains lead to congenital heart defects and thoracic aortic aneurysms - van Walree, Eva S.; Dombrowsky, Gregor; Jansen, Iris E.; Mirkov, Maša Umićević; Zwart, Rob; Ilgun, Aho; Guo, Dongchuan; Clur, Sally Ann B.; Amin, Ahmed S.; Savage, Jeanne E.; van der Wal, Allard C.; Waisfisz, Quinten; et al. (Genetics in Medicine, 2020)
Purpose: In this study we aimed to establish the genetic cause of a myriad of cardiovascular defects prevalent in individuals from a genetically isolated population, who were found to share a common ancestor in 1728. Methods: Trio genome sequencing was carried out in an index patient with critical congenital heart disease (CHD); family members had either exome or Sanger sequencing. To confirm enrichment, we performed a gene-based association test and meta-analysis in two independent validation cohorts: one with 2685 CHD cases versus 4370. These controls were also ancestry-matched (same as FTAA controls), and the other with 326 cases with familial thoracic aortic aneurysms (FTAA) and dissections versus 570 ancestry-matched controls. Functional consequences of identified variants were evaluated using expression studies. Results: We identified a loss-of-function variant in the Notch target transcription factor-encoding gene HEY2. The homozygous state (n = 3) causes life-threatening congenital heart defects, while 80% of heterozygous carriers (n = 20) had cardiovascular defects, mainly CHD and FTAA of the ascending aorta. We confirm enrichment of rare risk variants in HEY2 functional domains after meta-analysis (MetaSKAT p = 0.018). Furthermore, we show that several identified variants lead to dysregulation of repression by HEY2. Conclusion: A homozygous germline loss-of-function variant in HEY2 leads to critical CHD. The majority of heterozygotes show a myriad of cardiovascular defects.
CRIS-Team Scopus Importer:2020-08-28
Keywords: cardiovascular defects; congenital heart defect; HEY2; thoracic aortic aneurysm

Germline variants in transcription factor HEY2 functional domains lead to congenital heart defects and thoracic aortic aneurysms - Van Walree, E. S.; Dombrowsky, G.; Jansen, I. E.; Mirkov, M. Umicevic; Zwart, R.; Ilgun, A.; Guo, D.; Clur, S. B.; Amin, A. S.; Savage, J. E.; Van Der Wal, A. C.; Waisfisz, Q.; et al. (EUROPEAN JOURNAL OF HUMAN GENETICS, 2020)
CRIS-Team WoS Importer:2021-01-22

Gesundheit, Empathie und Ökonomie Kostbare Werte in der Medizin - Frewer, Andreas; Rascher, Wolfgang; Bruns, Florian (Königshausen & Neumann, 2011)

Glucose-Restricted Diet Regulates the Tumor Immune Microenvironment and Prevents Tumor Growth in Lung Adenocarcinoma - Gähler, Alexander; Trufa, Denis; Chiriac, Mircea-Teodor; Tausche, Patrick; Hohenberger, Katja; Brunst, Ann-Kathrin; Rauh, Manfred; Geppert, Carol-Immanuel; Rieker, Ralf; Krammer, Susanne; Leberle, Anna; Neurath, Markus; et al. (Frontiers in Oncology, 2022)
BackgroundLung cancer is the second common cancer type in western countries and has a high mortality. During the development and progression of the tumor, the nutrients in its environment play a central role. The tumor cells depend crucially on glucose metabolism and uptake. Tumor cell metabolism is dominated by the Warburg effect, where tumor cells produce large amounts of lactate from pyruvate under aerobic conditions. We thus reasoned that, reducing carbohydrates in the diet might support anti-tumoral effects of current immunotherapy and additionally target tumor immune escape. ObjectivesThe link between reducing carbohydrates to improve current immunotherapy is not clear. We thus aimed at analyzing the effects of different glucose levels on the tumor development, progression and the anti-tumoral immune response. MethodsWe correlated the clinical parameters of our LUAD cohort with different metabolic markers. Additionally, we performed cell culture experiments with A549 tumor cell line under different glucose levels. Lastly, we investigated the effect of low and high carbohydrate diet in an experimental murine model of lung cancer on the tumor progression and different immune subsets. ResultsHere we found a positive correlation between the body mass index (BMI), blood glucose levels, reduced overall survival (OS) and the expression of Insulin-like growth factor-1 receptor (IGF1R) in the lung tumoral region of patients with lung adenocarcinoma (LUAD). Furthermore, increasing extracellular glucose induced IGF1R expression in A549 LUAD cells. Functional studies in a murine model of LUAD demonstrated that, glucose restricted diet resulted in decreased tumor load in vivo. This finding was associated with increased presence of lung infiltrating cytotoxic CD8+ T effector memory (TEM), tissue resident memory T (TRM) and natural killer cells as well as reduced IGFR mRNA expression, suggesting that glucose restriction regulates lung immunity in the tumor microenvironment. ConclusionsThese results indicate that, glucose restricted diet improves lung immune responses of the host and suppresses tumor growth in experimental lung adenocarcinoma. As glucose levels in LUAD patients were negatively correlated to postoperative survival rates, glucose-restricted diet emerges as therapeutic avenue for patients with LUAD.
CRIS-Team WoS Importer:2022-05-27

Goal-directed-perfusion in neonatal aortic arch surgery - Cesnjevar, Robert; Purbojo, Ariawan; Münch, Frank; Juengert, Joerg; Rueffer, Andre (Translational Pediatrics, 2016)
Reduction of mortality and morbidity in congenital cardiac surgery has always been and remains a major target for the complete team involved. As operative techniques are more and more standardized and refined, surgical risk and associated complication rates have constantly been reduced to an acceptable level but are both still present. Aortic arch surgery in neonates seems to be of particular interest, because perfusion techniques differ widely among institutions and an ideal form of a so called "total body perfusion (TBP)" is somewhat difficult to achieve. Thus concepts of deep hypothermic circulatory arrest (DHCA), regional cerebral perfusion (RCP/with cardioplegic cardiac arrest or on the perfused beating heart) and TBP exist in parallel and all carry an individual risk for organ damage related to perfusion management, chosen core temperature and time on bypass. Patient safety relies more and more on adequate end organ perfusion on cardiopulmonary bypass, especially sensitive organs like the brain, heart, kidney, liver and the gut, whereby on adequate tissue protection, temperature management and oxygen delivery should be visualized and monitored.
EVALuna2:34094

Graves’ disease in children with Down syndrome - Cebeci, Ayse Nurcan; Schempp, Vera; Förtsch, Katharina; Gohlke, Bettina; Marx, Martin; Dörr, Helmuth-Günther; Wölfle, Joachim (Endocrine Connections, 2024)
While subclinical or overt hypothyroidism are common in Down syndrome (DS); Graves’ disease (GD) is rare (ranges 0.6–3%). We aimed to evaluate the clinical features, course, and treatment of GD in children with DS and compare them with those without DS. Among 161 children with GD, 13 (8 female, 5 male) had DS (8%). Data were collected retrospectively from patients’ medical records. The mean age at diagnosis was 10.6 ± 4.5 years, with a female-to-male ratio 1.6:1. The main symptoms were weight loss (n = 6), increased irritability (n = 3), and increased sweating (n = 3). None had orbitopathy. Seven of 11 patients with a thyroid ultrasound at diagnosis had a goitre. On admission, all had thyroid-stimulating hormone (TSH) <0.01 mU/L (normal range (NR): 0.51–4.30), free triiodothyronine, free thyroxine (mean ± s.d.), and thyrotrophin receptor antibodies (median, range) were 22.2 ± 10.2 pmol/L (NR: 3.5–8.1), 50.2 ± 18.7 pmol/L (NR 12.6–20.9), and 17.0 (2.89–159.0) U/L (NR <1), respectively. Patients were treated either with methimazole (n = 10) or carbimazole (n = 3), a dose of 0.54 ± 0.36 mg/kg/day. The treatment was ‘block and replace’ in ten patients and ‘dose titration’ in three patients, with a mean duration of 43.4 ± 11.0 months. Of 13 patients, four are still receiving primary treatment, three are in remission, one patient had two medically treated recurrences, three underwent surgery without complications, and two patients were lost to follow-up. Our data show that the clinical course of GD in patients with DS was similar to those without DS and suggest that a prolonged medical therapy should be the preferred option.
CRIS-Team Scopus Importer:2024-06-28
Keywords: anti-thyroid drug medication; autoimmune thyroiditis; Down syndrome; Graves’ disease; hyperthyroidism

Größenwachstum und Knochengesundheit bei Erkrankungen der Wachstumsfuge und des Knochens: Möglichkeiten und Grenzen einer GH-Therapie - Wölfle, Joachim; Bettendorf, M.; Bechtold-Dalla Pozza, S.; Binder, G.; Grasemann, C.; Reinehr, T.; Semler, O.; Dörr, Helmuth-Günther (Monatsschrift Kinderheilkunde, 2020)
Background: Genetic, paracrine and endocrine factors influence longitudinal growth in the area of the epiphyseal plates and bone mineralization. Objective: The aim was to review the spontaneous longitudinal growth and bone health in patients with rare bone diseases. Can growth hormone (GH) treatment improve growth and bone health in these diseases? Material and methods: Findings of an expert workshop including literature search on bone health in bone disorders associated with stunted growth and the treatment options. Results: Most patients with osteogenesis imperfecta are of short stature. Additional administration of GH has no influence on adult height and is currently not used. Pseudohypoparathyroidism (PHP) patients with insufficient longitudinal growth and confirmed GH deficiency can be treated with GH and can benefit from the treatment. Children with X‑linked hereditary hypophosphatemic rickets show progressive disproportionate short stature under the current treatment with phosphate and calcitriol. Randomized GH treatment studies resulted in a temporary improvement in body height but not in a significant improvement of adult height. The use of GH is approved for treatment of SHOX-deficient children and is comparably effective as in girls with Turner’s syndrome (TS). Observational studies also suggest that GH treatment can lower the risk of bone fractures, known to be increased in TS. Inflammation, reduced physical activity and malnutrition can result in impaired growth with loss of muscle and bone mass in patients with juvenile idiopathic arthritis (JIA). Studies could demonstrate a positive impact of GH on longitudinal growth, density and geometry of bones and on bone metabolism as well as on muscular mass; however, GH treatment is not approved for patients with JIA. Conclusion: Regarding the various bone diseases mentioned above, all growth disorders have to be considered individually. Apart from longitudinal growth GH can have a positive impact on metabolism, bone mineral content and bone density depending on the indications. The only approved indications for GH treatment are GH deficiency in PHP and children born small for gestational age (SGA) and TS/SHOX deficiency. Apart from increased growth, improvements in bone health in children and adolescents should be discussed as an outcome measure for GH treatment.
CRIS-Team Scopus Importer:2020-10-02
Keywords: Bone; Bone health; Growth; Growth hormone (GH); Growth plate

Growth of hypoplastic mitral valves in hypoplastic left heart complex and similar constellations after anatomical left superior vena cava correction - Cesnjevar, Robert; Harig, Frank; Dietz, Moritz; Alkassar, Muhannad; Waellisch, Wolfgang; Rueffer, André; Dittrich, Sven; Purbojo, Ariawan (European Journal of Cardio-Thoracic Surgery, 2021)
OBJECTIVES: Left superior vena cava (LSVC)-related obstruction of mitral inflow is a rare finding in patients with complex cardiac anomalies like hypoplastic left heart complex. We report our experience by establishing a left superior to right superior caval vein continuity (innominate vein creation by direct LSVC-right superior vena cava end-to-side-anastomosis), and coronary sinus unroofing if indicated for LSVC-related mitral inflow obstruction. METHODS: Nineteen patients (median age: 1.0 ± 0.3 years; range: 7 days-4.8 years) underwent anatomical correction of LSVC without the use of foreign material in conjunction with repair or palliation of congenital anomalies in a single centre between April 2015 and November 2019. Indications for the procedure were LSVC-related obstruction of left ventricular inflow due to a dilated coronary sinus. Additional procedures included mitral (n = 7) or atrioventricular (n = 3) valve surgery, right ventricular to pulmonary artery conduit (n = 3), first stage palliation (n = 3) or biventricular repair (n = 5) of hypoplastic left heart complex. Three patients needed secondary mitral valve replacement (n = 3). RESULTS: All LSVC or coronary sinus-related obstructions were effectively relieved. No patient died early, 2 patients died late after the procedure. One patient needed stenting of the superior vena cava below the unobstructed cephalad vein anastomosis at the former right superior vena cava-cannulation-site. Follow-up was complete and demonstrated an 89.5% survival after 2.5 ± 0.4 years. Innominate vein patency was 100% documented by echocardiography (n = 19), cardiac catheterization (n = 6) or both. Mean mitral valve z-scores before the operation were -1.7 ± 0.2 (range -3.8 to 0.3) and increased to 0.7 ± 0.2 (range -0.7 to 1.9) after LSVC repair. CONCLUSIONS: Anatomical correction by surgical creation of an innominate vein is an effective method to relieve LSVC-related obstructions and promotes mitral valvar growth. Mitral ring sizes were at least normalized after surgery at the time of discharge. Further prospective follow-up studies to evaluate the growth potential of left-sided heart structures by reporting cardiac z-scores are needed to evaluate the true impact of coronary sinus unroofing.
CRIS-Team Scopus Importer:2021-01-29
Keywords: Congenital heart disease; Hypoplastic left heart complex; Left superior vena cava; Mitral valve growth; Mitral valve z-score

Guided Multispectral Optoacoustic Tomography for 3D Imaging of the Murine Colon - Knieling, Ferdinand; Brown, Emma L.; Eckstein, Markus; Thoma, Oana-Maria; Wachter, Felix; Mandelbaum, Henriette; Ludwig, Petra; Claßen, Merle; Oraiopoulou, Mariam Eleni; Rother, Ulrich; Neurath, Markus; Wölfle, Joachim; et al. (Advanced Science, 2025)
Multispectral optoacoustic tomography is a promising medical imaging modality that combines light and sound to provide molecular imaging information at depths of several centimeters, based on the optical absorption of endogenous chromophores, such as hemoglobin. Assessment of inflammatory bowel disease has emerged as a promising clinical application of optoacoustic tomography. In this context, preclinical studies in animal models are essential to identify novel disease-specific imaging biomarkers and understand findings from emerging clinical pilot studies, however to-date, these studies have been limited by the precise identification of the bowel wall. Herein, a transrectal-absorber guide is applied, serving as a high-contrast landmark for 3D optoacoustic tomography of the colon. This study shows that guided multispectral optoacoustic tomography is able to measure changes in blood oxygenation status over the course of acute, chemically-induced colitis in mice and correlates with standard disease activity scores. This novel approach depicts intestinal hemoglobin composition non-invasively during murine inflammation. These results underscore the potential for optoacoustic imaging in translational inflammatory bowel disease research.
CRIS-Team Scopus Importer:2025-01-31
Keywords: dextran sodium sulfate induced colitis; inflammatory bowel disease; multispectral optoacoustic tomography; murine acute colitis; optoacoustic imaging; photoacoustic imaging

Guideline Adherence and Registry Recruitment of Congenital Primary Hypothyroidism: Data from the German Registry for Congenital Hypothyroidism (HypoDok) - Thomann, Julia; Tittel, Sascha R.; Voss, Egbert; Oeverink, Rudolf; Palm, Katja; Fricke-Otto, Susanne; Kapelari, Klaus; Holl, Reinhard W.; Wölfle, Joachim; Bettendorf, Markus (International Journal of Neonatal Screening, 2021)
Neonatal screening for congenital primary hypothyroidism (CH) is mandatory in Germany but medical care thereafter remains inconsistent. Therefore, the registry HypoDok of the German Society of Pediatric Endocrinology and Diabetology (DGKED) was analyzed to evaluate the implementation of evidence-based guidelines and to assess the number of included patients. Inclusion criteria were (i) date of birth between 10/2001 and 05/2020 and (ii) increased thyroid-stimulating hormone (TSH) at screening and/or confirmation. The cohort was divided into before (A) and after (B) guideline publication in 02/2011, to assess the guideline's influence on medical care. A total of 659 patients were analyzed as group A (n = 327) and group B (n = 332) representing 17.5% and 10.3% of CH patients identified in the German and Austrian neonatal screening program during the respective time period. Treatment start and thyroxine doses were similar in both groups and consistent with recommendations. Regular follow-ups were documented. In the first three years of life, less than half of the patients underwent audiometry; developmental assessment was performed in 49.3% (A) and 24.8% (B) (p < 0.01). Documentation of CH patient care by pediatric endocrinologists seemed to be established, however, it reflected only a minority of the affected patients. Therefore, comprehensive documentation as an important instrument of quality assurance and evidence-based medicine should be legally enforced and officially funded in order to record, comprehend, and optimize care and outcome in patients with rare diseases such as CH.
CRIS-Team WoS Importer:2021-04-16

Gut Pathobiont–Derived Outer Membrane Vesicles Drive Liver Inflammation and Fibrosis in Primary Sclerosing Cholangitis–Associated Inflammatory Bowel Disease - Dorner, Heidrun; Stolzer, Iris; Mattner, Jochen; Kaminski, Sophie; Leistl, Sofia; Edrich, Lisa-Maria; Schwendner, Raphael; Hobauer, Julia; Sebald, Adrian Thomas Erwin; Leikam, Stefanie; Gonzalez Acera, Miguel; Düll, Miriam; et al. (Gastroenterology, 2024)
Background & Aims: Primary sclerosing cholangitis (PSC), often associated with inflammatory bowel disease (IBD), presents a multifactorial etiology involving genetic, immunologic, and environmental factors. Gut dysbiosis and bacterial translocation have been implicated in PSC-IBD, yet the precise mechanisms underlying their pathogenesis remain elusive. Here, we describe the role of gut pathobionts in promoting liver inflammation and fibrosis due to the release of bacterial outer membrane vesicles (OMVs). Methods: Preclinical mouse models in addition to ductal organoids were used to acquire mechanistic data. A proof-of-concept study including serum and liver biopsies of a patient cohort of PSC (n = 22), PSC-IBD (n = 45), and control individuals (n = 27) was performed to detect OMVs in the systemic circulation and liver. Results: In both preclinical model systems and in patients with PSC-IBD, the translocation of OMVs to the liver correlated with enhanced bacterial sensing and accumulation of the NLRP3 inflammasome. Using ductal organoids, we were able to precisely attribute the pro-inflammatory and pro-fibrogenic properties of OMVs to signaling pathways dependent on Toll-like receptor 4 and NLRP3–gasdermin-D. The immunostimulatory potential of OMVs could be confirmed in macrophages and hepatic stellate cells. Furthermore, when we administered gut pathobiont–derived OMVs to Mdr2–/– mice, we observed a significant enhancement in liver inflammation and fibrosis. In a translational approach, we substantiated the presence of OMVs in the systemic circulation and hepatic regions of severe fibrosis using a PSC-IBD patient cohort. Conclusions: This study demonstrates the contribution of gut pathobionts in releasing OMVs that traverse the mucosal barrier and, thus, promote liver inflammation and fibrosis in PSC-IBD. OMVs might represent a critical new environmental factor that interacts with other disease factors to cause inflammation and thus define potential new targets for fibrosis therapy.
CRIS-Team Scopus Importer:2024-09-27
Keywords: Bacterial Extracellular Vesicle; Hepatic Inflammation; Inflammasome; PSC-IBD

Haematological characteristics and spontaneous haematological recovery in Pearson syndrome - Yoshimi, Ayami; Gruenert, Sarah C.; Cario, Holger; Fisch, Aron; Gross-Wieltsch, Ute; Timmermann, Kirsten; Kontny, Udo; Lobitz, Stephan; Odenthal, Helen S.; Schmid, Irene; Uetz, Barbara; Hoell, Tanja; et al. (British Journal of Haematology, 2021)
CRIS-Team Scopus Importer:2021-04-23
Keywords: hematological recovery; mitochondrial disease; Pearson syndrome; single large-scale mitochondrial DNA deletion

Handlungsempfehlung nach der AWMF-S1-Leitlinie Fieberkrämpfe im Kindesalter - Trollmann, Regina (Monatsschrift Kinderheilkunde, 2024)
CRIS-Team Scopus Importer:2024-10-04

Health Problems and Quality of Life of Young Cancer Survivors in the Comprehensive Care for CAYA Program - Elmers, Simon; Beitzen-Heineke, Antonia; Von Grundherr, Julia; Jensen, Wiebke; Koch, Barbara; Mann, Julia; Salchow, Jannike; Sinn, Marianne; Straub, Lesley-Ann; Wegert, Luisa; Vettorazzi, Eik; Bergelt, Corinna; et al. (ONCOLOGY RESEARCH AND TREATMENT, 2020)
CRIS-Team WoS Importer:2020-03-20

Health-related quality of life in children and adolescents with tuberous sclerosis complex and their caregivers: A multicentre cohort study from Germany - Willems, Laurent M.; Schubert-Bast, Susanne; Grau, Janina; Hertzberg, Christoph; Kurlemann, Gerhard; Wiemer-Kruel, Adelheid; Bast, Thomas; Bertsche, Astrid; Bettendorf, Ulrich; Fiedler, Barbara; Hahn, Andreas; Hartmann, Hans; et al. (European Journal of Paediatric Neurology, 2021)
Objective: This study aimed to measure health-related quality of life (HRQOL) in children and adolescents with tuberous sclerosis complex (TSC) and quality of life (QOL) and depressive symptoms among caregivers. Methods: Adequate metrics were used to assess HRQOL in children and adolescents with TSC (4–18 years, KINDLR) as well as QOL (EQ-5D) and symptoms of depression (BDI-II) among caregivers. Predictors for reduced HRQOL and depressive symptoms were identified by variance analysis, ordinal regression, and bivariate correlation. Results: The mean HRQOL score was 67.9 ± 12.7, and significantly lower values were associated with increasing age, attending special needs education, TSC-associated psychiatric symptoms, and drug-related adverse events. The mean QOL of caregivers was 85.4 ± 15.7, and caregiver's sex, TSC mutation locus, familial TSC clustering, special needs education, degree of disability, care dependency, presence of TSC-associated psychiatric symptoms, and TSC severity were significant predictors of lower QOL. Depressive symptoms were identified in 45.7% of caregivers, associated with female sex of the caregiver, familial TSC clustering, special needs education, and presence of TSC-associated psychiatric symptoms of the child. Multivariate regression analysis revealed adolescence and drug-related adverse events as significant predictors for lower HRQOL in TSC children, and TSC2 variants predicted lower QOL and depressive symptoms in caregivers. Conclusion: Compared with other chronic diseases, such as headache, diabetes or obesity, children with TSC have significantly lower HRQOL, which further decreases during adolescence. A decreased HRQOL of patients correlates with a lower QOL and increased symptoms of depression of their caregivers. These results may improve the comprehensive therapy and care of children and adolescents with TSC and their families and caregivers. Trial registration: DRKS, DRKS00016045. Registered 01 March 2019, http://www.drks.de/DRKS00016045.
CRIS-Team Scopus Importer:2021-10-29
Keywords: Angiomyolipoma; Depression; Epilepsy; Seizure; TSC

Hemoglobin A1c patterns of youth with type 1 diabetes 10 years post diagnosis from 3 continents - Sherr, Jennifer L.; Schwandt, Anke; Phelan, Helen; Clements, Mark A.; Holl, Reinhard W.; Benitez-Aguirre, Paul Z.; Miller, Kellee M.; Wölfle, Joachim; Dover, Thomas; Maahs, David M.; Fröhlich-Reiterer, Elke; Craig, Maria E. (Pediatrics, 2021)
Objectives: Distinct hemoglobin A1c (HbA1c) trajectories during puberty are identified in youth with established type 1 diabetes (T1D). We used data from 3 international registries to evaluate whether distinct HbA1c trajectories occur from T1D onset. Methods: Participants were <18 years old at diagnosis with at least 1 HbA1c measured within 12 months post diagnosis, along with ≥3 duration-year-aggregated HbA1c values over 10 years of follow-up. Participants from the Australasian Diabetes Data Network (n = 7292), the German-Austrian-Luxembourgian-Swiss diabetes prospective follow-up initiative (Diabetes Patienten Verlaufsdokumentation) (n = 39 226) and the US-based Type 1 Diabetes Exchange Clinic Registry (n = 3704) were included. With group-based trajectory modeling, we identified unique HbA1c patterns from the onset of T1D. Results: Five distinct trajectories occurred in all 3 registries, with similar patterns of proportions by group. More than 50% had stable HbA1c categorized as being either low stable or intermediate stable. Conversely, ∼15% in each registry were characterized by stable HbA1c >8.0% (high stable), and ∼11% had values that began at or near the target but then increased (target increase). Only ∼5% of youth were above the target from diagnosis, with an increasing HbA1c trajectory over time (high increase). This group differed from others, with higher rates of minority status and an older age at diagnosis across all 3 registries (P ≤ .001). Conclusions: Similar postdiagnostic HbA1c patterns were observed across 3 international registries. Identifying the youth at the greatest risk for deterioration in HbA1c over time may allow clinicians to intervene early, and more aggressively, to avert increasing HbA1c.
CRIS-Team Scopus Importer:2021-09-10

HIBCH deficiency in a patient with phenotypic characteristics of mitochondrial disorders - Reuter, Miriam; Sass, Joern Oliver; Leis, Thomas; Koehler, Julia; Mayr, Johannes A.; Feichtinger, Rene G.; Rauh, Manfred; Schanze, Ina; Baehr, Luzy; Trollmann, Regina; Uebe, Steffen; Ekici, Arif Bülent; et al. (American Journal of Medical Genetics Part A, 2014)
HIBCH (3-hydroxyisobutyryl-CoA hydrolase) deficiency (MIM #250620) is a rare autosomal recessive inborn error of metabolism, leading to a block in the catabolic pathway of the amino acid valine and presumably to accumulation of toxic valine metabolites in mitochondria. Only three families with HIBCH deficiency and biallelic HIBCH mutations have been described. We report on a further patient, first child of healthy consanguineous parents, with severe developmental delay, seizures, hyperintensities of the basal ganglia on magnetic resonance imaging (MRI), progressive brain atrophy, optic nerve atrophy, repeatedly elevated blood lactate, and respiratory chain complexes I, I + III and cytochrome c oxidase deficiencies with borderline depletion of mitochondrial DNA in muscle tissue. Laboratory findings in blood and skeletal muscle were inconsistent and did not allow a definite diagnosis, but supported the hypothesis of mitochondrial dysfunction. Homozygosity mapping and whole-exome sequencing revealed a homozygous one-base pair insertion in HIBCH. Deficiency of enzyme activity was confirmed in cultured fibroblasts. Although relatively unspecific, the clinical features were similar to those of the previously reported cases. Given the clinical variability and large number of differential diagnoses, the prevalence of HIBCH deficiency is probably underestimated. Next-generation sequencing approaches are an effective tool for identifying the underlying genetic basis in patients suspected of mitochondrial disorders. © 2014 Wiley Periodicals, Inc.
EVALuna2:9220

High-Dose Treosulfan and Melphalan as Consolidation Therapy Versus Standard Therapy for High-Risk (Metastatic) Ewing Sarcoma - Koch, Raphael; Gelderblom, Hans; Haveman, Lianne; Brichard, Benedicte; Jürgens, Heribert; Cyprova, Sona; Van Den Berg, Henk; Hassenpflug, Wolf; Raciborska, Anna; Ek, Torben; Baumhoer, Daniel; Egerer, Gerlinde; et al. (Journal of Clinical Oncology, 2022)
PURPOSEEwing 2008R3 was conducted in 12 countries and evaluated the effect of treosulfan and melphalan high-dose chemotherapy (TreoMel-HDT) followed by reinfusion of autologous hematopoietic stem cells on event-free survival (EFS) and overall survival in high-risk Ewing sarcoma (EWS).METHODSPhase III, open-label, prospective, multicenter, randomized controlled clinical trial. Eligible patients had disseminated EWS with metastases to bone and/or other sites, excluding patients with only pulmonary metastases. Patients received six cycles of vincristine, ifosfamide, doxorubicin, and etoposide induction and eight cycles of vincristine, actinomycin D, and cyclophosphamide consolidation therapy. Patients were randomly assigned to receive additional TreoMel-HDT or no further treatment (control). The random assignment was stratified by number of bone metastases (1, 2-5, and > 5). The one-sided adaptive-inverse-normal-4-stage-design was changed after the first interim analysis via Müller-Schäfer method.RESULTSBetween 2009 and 2018, 109 patients were randomly assigned, and 55 received TreoMel-HDT. With a median follow-up of 3.3 years, there was no significant difference in EFS between TreoMel-HDT and control in the adaptive design (hazard ratio [HR] 0.85; 95% CI, 0.55 to 1.32, intention-to-treat). Three-year EFS was 20.9% (95% CI, 11.5 to 37.9) in TreoMel-HDT and 19.2% (95% CI, 10.8 to 34.4) in control patients. The results were similar in the per-protocol collective. Males treated with TreoMel-HDT had better EFS compared with controls: median 1.0 years (95% CI, 0.8 to 2.2) versus 0.6 years (95% CI, 0.5 to 0.9); P =.035; HR 0.52 (0.28 to 0.97). Patients age < 14 years benefited from TreoMel-HDT with a 3-years EFS of 39.3% (95% CI, 20.4 to 75.8%) versus 9% (95% CI, 2.4 to 34); P =.016; HR 0.40 (0.19 to 0.87). These effects were similar in the per-protocol collective. This observation is supported by comparable results from the nonrandomized trial EE99R3.CONCLUSIONIn patients with very high-risk EWS, additional TreoMel-HDT was of no benefit for the entire cohort of patients. TreoMel-HDT may be of benefit for children age < 14 years.
CRIS-Team Scopus Importer:2022-06-10

High molecular diagnostic yields and novel phenotypic expansions involving syndromic anorectal malformations - Reutter, Heiko Martin (European Journal of Human Genetics, 2023)
CRIS-Team Scopus Importer:2023-01-13

High Platelet Counts, Thrombosis, Bleeding Signs, and Acquired Von Willebrand Syndrome at Diagnosis of Pediatric Chronic Myeloid Leukemia - Suttorp, Meinolf; Knoefler, Ralf; Deutsch, Helene; Paul, Franziska; Tiebel, Oliver; Metzler, Markus; Millot, Frederic (BLOOD, 2019)
CRIS-Team WoS Importer:2021-10-18

High-resolution label-free mapping of murine kidney vasculature by raster-scanning optoacoustic mesoscopy: an ex vivo study - Goebel, Colin A.; Brown, Emma; Fahlbusch, Fabian; Wagner, Alexandra; Buehler, Adrian; Raupach, Thomas; Hohmann, Martin; Späth, Moritz; Burton, Neal; Wölfle, Joachim; Schmidt, Michael; Hartner, Andrea; et al. (Molecular and Cellular Pediatrics, 2022)
Background: Chronic kidney disease (CKD) is a global burden affecting both children and adults. Novel imaging modalities hold great promise to visualize and quantify structural, functional, and molecular organ damage. The aim of the study was to visualize and quantify murine renal vasculature using label-free raster scanning optoacoustic mesoscopy (RSOM) in explanted organs from mice with renal injury. Material and methods: For the experiments, freshly bisected kidneys of alpha 8 integrin knock-out (KO) and wildtype mice (WT) were used. A total of n=7 female (n=4 KO, n=3 WT) and n=6 male animals (n=2 KO, n=4 WT) aged 6 weeks were examined with RSOM optoacoustic imaging systems (RSOM Explorer P50 at SWL 532nm and/or ms-P50 imaging system at 532 nm, 555 nm, 579 nm, and 606 nm). Images were reconstructed using a dedicated software, analyzed for size and vascular area and compared to standard histologic sections. Results: RSOM enabled mapping of murine kidney size and vascular area, revealing differences between kidney sizes of male (m) and female (f) mice (merged frequencies (MF) f vs. m: 52.42±6.24 mm2 vs. 69.18±15.96 mm2, p=0.0156) and absolute vascular area (MF f vs. m: 35.67±4.22 mm2 vs. 49.07±13.48 mm2, p=0.0036). Without respect to sex, the absolute kidney area was found to be smaller in knock-out (KO) than in wildtype (WT) mice (WT vs. KO: MF: p=0.0255) and showed a similar trend for the relative vessel area (WT vs. KO: MF p=0.0031). Also the absolute vessel areas of KO compared to WT were found significantly different (MF p=0.0089). A significant decrease in absolute vessel area was found in KO compared to WT male mice (MF WT vs. KO: 54.37±9.35 mm2 vs. 34.93±13.82 mm2, p=0.0232). In addition, multispectral RSOM allowed visualization of oxygenated and deoxygenated parenchymal regions by spectral unmixing. Conclusion: This study demonstrates the capability of RSOM for label-free visualization of differences in vascular morphology in ex vivo murine renal tissue at high resolution. Due to its scalability optoacoustic imaging provides an emerging modality with potential for further preclinical and clinical imaging applications.
CRIS-Team Scopus Importer:2022-07-15
Keywords: Chronic kidney disease; Ex vivo kidney imaging; msRSOM; Optoacoustic; Photoacoustic; Raster scanning optoacoustic mesoscopy; RSOM

High-resolution pediatric reference intervals for 15 biochemical analytes described using fractional polynomials - Zierk, Jakob; Baum, Hannsjörg; Bertram, Alexander; Boeker, Martin; Buchwald, Armin; Cario, Holger; Christoph, Jürgen; Frühwald, Michael C.; Groß, Hans Jürgen; Groening, Arndt; Gscheidmeier, Thomas; Hoff, Torsten; et al. (Clinical Chemistry and Laboratory Medicine, 2021)
Assessment of children's laboratory test results requires consideration of the extensive changes that occur during physiological development and result in pronounced sex- and age-specific dynamics in many biochemical analytes. Pediatric reference intervals have to account for these dynamics, but ethical and practical challenges limit the availability of appropriate pediatric reference intervals that cover children from birth to adulthood. We have therefore initiated the multi-center data-driven PEDREF project (Next-Generation Pediatric Reference Intervals) to create pediatric reference intervals using data from laboratory information systems. We analyzed laboratory test results from 638,683 patients (217,883-982,548 samples per analyte, a median of 603,745 test results per analyte, and 10,298,067 test results in total) performed during patient care in 13 German centers. Test results from children with repeat measurements were discarded, and we estimated the distribution of physiological test results using a validated statistical approach (kosmic). We report continuous pediatric reference intervals and percentile charts for alanine transaminase, aspartate transaminase, lactate dehydrogenase, alkaline phosphatase, γ-glutamyl-transferase, total protein, albumin, creatinine, urea, sodium, potassium, calcium, chloride, anorganic phosphate, and magnesium. Reference intervals are provided as tables and fractional polynomial functions (i.e., mathematical equations) that can be integrated into laboratory information systems. Additionally, Z-scores and percentiles enable the normalization of test results by age and sex to facilitate their interpretation across age groups. The provided reference intervals and percentile charts enable precise assessment of laboratory test results in children from birth to adulthood. Our findings highlight the pronounced dynamics in many biochemical analytes in neonates, which require particular consideration in reference intervals to support clinical decision making most effectively.
CRIS-Team Scopus Importer:2021-03-05
Keywords: continuous reference intervals; data mining; indirect reference intervals; pediatric reference intervals; percentile charts

High salt intake reprioritizes osmolyte and energy metabolism for body fluid conservation - Kitada, Kento; Daub, Steffen; Zhang, Yahua; Klein, Janet D.; Nakano, Daisuke; Pedchenko, Tetyana; Lantier, Louise; Larocque, Lauren M.; Marton, Adriana; Neubert, Patrick; Schröder, Agnes; Rakova, Natalia; et al. (Journal of Clinical Investigation, 2017)
Natriuretic regulation of extracellular fluid volume homeostasis includes suppression of the renin-angiotensin-aldosterone system, pressure natriuresis, and reduced renal nerve activity, actions that concomitantly increase urinary Na+ excretion and lead to increased urine volume. The resulting natriuresis-driven diuretic water loss is assumed to control the extracellular volume. Here, we have demonstrated that urine concentration, and therefore regulation of water conservation, is an important control system for urine formation and extracellular volume homeostasis in mice and humans across various levels of salt intake. We observed that the renal concentration mechanism couples natriuresis with correspondent renal water reabsorption, limits natriuretic osmotic diuresis, and results in concurrent extracellular volume conservation and concentration of salt excreted into urine. This water-conserving mechanism of dietary salt excretion relies on urea transporter-driven urea recycling by the kidneys and on urea production by liver and skeletal muscle. The energy-intense nature of hepatic and extrahepatic urea osmolyte production for renal water conservation requires reprioritization of energy and substrate metabolism in liver and skeletal muscle, resulting in hepatic ketogenesis and glucocorticoid-driven muscle catabolism, which are prevented by increasing food intake. This natriuretic-ureotelic, water-conserving principle relies on metabolism-driven extracellular volume control and is regulated by concerted liver, muscle, and renal actions.
EVALuna2:34241

High sensitivity and clonal stability of the genomic fusion as single marker for response monitoring in ETV6-RUNX1-positive acute lymphoblastic leukemia - Hoffmann, Jana; Krumbholz, Manuela; Gutiérrez, Helia Pimentel; Fillies, Marion; Szymansky, Annabell; Bleckmann, Kirsten; zur Stadt, Udo; Köhler, Rolf; Kuiper, Roland P.; Horstmann, Martin; von Stackelberg, Arend; Eckert, Cornelia; et al. (Pediatric Blood & Cancer, 2019)
Background: Assessment of minimal residual disease (MRD) is an integral component for response monitoring and treatment stratification in acute lymphoblastic leukemia (ALL). We aimed to evaluate the genomic ETV6-RUNX1 fusion sites as a single marker for MRD quantification. Procedure: In a representative, uniformly treated cohort of pediatric relapsed ALL patients (n = 52), ETV6-RUNX1 fusion sites were compared to the current gold standard, immunoglobulin/T-cell receptor (Ig/TCR) gene rearrangements. Results: Primer/probe sets designed to ETV6-RUNX1 fusions achieved significantly more frequent a sensitivity and a quantitative range of at least 10 –4 compared to the gold standard with 100% and 73% versus 76% and 47%, respectively. The breakpoint sequence was identical at diagnosis and relapse in all tested cases. There was a high degree of concordance between quantitative MRD results assessed using ETV6-RUNX1 and the highest Ig/TCR marker (Spearman's 0.899, P <.01) with differences >½ log-step in only 6% of patients. A high proportion of ETV6-RUNX1-positive ALL relapses (40%) in our cohort showed a poor response to induction treatment at relapse, and therefore had an indication for hematopoietic stem cell transplantation, demonstrating the need of accurate identification of this subgroup. Conclusions: ETV6-RUNX1 fusion sites are highly sensitive and reliable MRD markers. Our data confirm that they are unaffected by clonal evolution and selection during front-line and second-line chemotherapy in contrast to Ig/TCR rearrangements, which require several markers per patient to compensate for the observed loss of target clones. In future studies, the genomic ETV6-RUNX1 fusion can be used as single MRD marker.
CRIS-Team Scopus Importer:2019-05-17
Keywords: acute lymphoblastic leukemia; fusion gene; genomic breakpoint; minimal residual disease; response monitoring

High Sodium Diet - Role in Renal Sympathodepression - Rodionova, Kristina; Ditting, Tilmann; Fahrmeier, Franziska; Ott, Christian; Schmieder, Roland; Schiffer, Mario; Amann, Kerstin Ute; Veelken, Roland (FASEB JOURNAL, 2020)
CRIS-Team WoS Importer:2020-10-16

Histone deacetylases inhibition by SAHA/Vorinostat normalizes the glioma microenvironment via xCT equilibration - Wolf, Ines; Fan, Zheng; Rauh, Manfred; Seufert, Sebastian; Hore, Nirjhar; Buchfelder, Michael; Savaskan, Nic E.; Eyupoglu, Ilker Y. (Scientific Reports, 2014)
Malignant gliomas are characterized by neurodegenerative actions leading to the destruction of surrounding brain parenchyma. The disturbance in glutamate homeostasis caused by increased expression of the glutamate transporter xCT plays a key role in glioma progression. We demonstrate that the HDAC-inhibitor SAHA specifically inhibits the xCT-transporter expression. Thereby, tumor cell stress is engendered, marked by increase in ROS. Moreover, SAHA dependent xCT-reduction correlates with the inhibition of ATF4-expression, a factor known to foster xCT expression. Since xCT/system Xc- is pivotal for the brain tumor microenvironment, normalization of this system is a key in the management of malignant gliomas. To date, the problem lay in the inability to specifically target xCT due to the ubiquitous expression of the xCT-transporter–i.e. in non-cancerously transformed cells too–as well as its essential role in physiological CNS processes. Here, we show xCT-transporter equilibration through SAHA is specific for malignant brain tumors whereas SAHA does not affect the physiological xCT levels in healthy brain parenchyma. Our data indicate that SAHA operates on gliomas specifically via normalizing xCT expression which in consequence leads to reduced extracellular glutamate levels. This in turn causes a marked reduction in neuronal cell death and normalized tumor microenvironment.
EVALuna2:18895

Histopathological proof of the pathogenicity of a rare GFAP mutation in a patient with flaccid paraparesis - Brackmann, Florian; Coras, Roland; Rössler, Karl; Kraus, Cornelia; Rompel, Oliver; Trollmann, Regina (Brain & Development, 2017)
Infantile Alexander disease is a rare progressive leukodystrophy caused by autosomal dominant mutations in the (GFAP) gene typically presenting with psychomotor retardation, progressive macrocephaly and refractory epilepsy. Neuroradiological hallmarks are extensive white matter lesions with frontal preponderance as well as signal intensity changes of basal ganglia and medulla oblongata with variable contrast enhancement. Here, we report an atypical manifestation in a 21-month-old boy presenting with flaccid paraparesis and areflexia. Cognitive, visual as well as fine motor skills and muscular strength of the upper extremities were appropriate for age. Weight and height as well as head circumference were within normal range. Clinical or electroencephalographic signs of seizures were absent. Cranial MRI demonstrated bifrontal cystic tumorous lesions with partial contrast rims, as well as space-occupying focal lesions of the caudate nuclei. Spinal MRI revealed swelling of the lumbar and cervical spinal cord. CSF and blood chemistry showed normal results. Histopathology of a subcortical lesion showed large amounts of Rosenthal fibers and protein droplets characteristic of Alexander disease. Sequencing detected a heterozygous mutation of the GFAP gene (c.205G > A; p.(Glu69Lys)) that has been reported before as probably pathogenetic in another case of lower spinal involvement. This well documented case draws attention to atypical spinal manifestations of Alexander disease and gives histopathological proof of the pathogenetic role of a rare GFAP mutation with marked spinal involvement.
EVALuna2:9396

HIV-1 fusion is blocked through binding of GB Virus C E2D peptides to the HIV-1 gp41 disulfide loop - Eißmann, Kristin; Müller, Sebastian; Sticht, Heinrich; Jung, Susan; Zou, Peng; Jiang, Shibo; Gross, Andrea; Eichler, Jutta; Fleckenstein, Bernhard; Reil, Heide (PLoS ONE, 2013)
A strategy for antiviral drug discovery is the elucidation and imitation of viral interference mechanisms. HIV-1 patients benefit from a coinfection with GB Virus C (GBV-C), since HIV-positive individuals with long-term GBV-C viraemia show better survival rates than HIV-1 patients without persisting GBV-C. A direct influence of GBV-C on HIV-1 replication has been shown in coinfection experiments. GBV-C is a human non-pathogenic member of the flaviviridae family that can replicate in T and B cells. Therefore, GBV-C shares partly the same ecological niche with HIV-1. In earlier work we have demonstrated that recombinant glycoprotein E2 of GBV-C and peptides derived from the E2 N-terminus interfere with HIV entry. In this study we investigated the underlying mechanism. Performing a virus-cell fusion assay and temperature-arrested HIV-infection kinetics, we provide evidence that the HIV-inhibitory E2 peptides interfere with late HIV-1 entry steps after the engagement of gp120 with CD4 receptor and coreceptor. Binding and competition experiments revealed that the N-terminal E2 peptides bind to the disulfide loop region of HIV-1 transmembrane protein gp41. In conjunction with computational analyses, we identified sequence similarities between the N-termini of GBV-C E2 and the HIV-1 glycoprotein gp120. This similarity appears to enable the GBV-C E2 N-terminus to interact with the HIV-1 gp41 disulfide loop, a crucial domain involved in the gp120-gp41 interface. Furthermore, the results of the present study provide initial proof of concept that peptides targeted to the gp41 disulfide loop are able to inhibit HIV fusion and should inspire the development of this new class of HIV-1 entry inhibitors.
EVALuna2:8190

Hodgkin lymphoma: hypodense lesions in mediastinal masses - Damek, Adrian; Kurch, Lars; Franke, Friedrich Christian; Attarbaschi, Andishe; Beishuizen, Auke; Cepelova, Michaela; Ceppi, Francesco; Daw, Stephen; Dieckmann, Karin; Fernández-Teijeiro, Ana; Feuchtinger, Tobias; Flerlage, Jamie E.; et al. (Scientific Reports, 2024)
Hypodense volumes (HDV) in mediastinal masses can be visualized in a computed tomography scan in Hodgkin lymphoma. We analyzed staging CT scans of 1178 patients with mediastinal involvement from the EuroNet-PHL-C1 trial and explored correlations of HDV with patient characteristics, mediastinal tumor volume and progression-free survival. HDV occurred in 350 of 1178 patients (29.7%), typically in larger mediastinal volumes. There were different patterns in appearance with single lesions found in 243 patients (69.4%), multiple lesions in 107 patients (30.6%). Well delineated lesions were found in 248 cases (70.1%), diffuse lesions were seen in 102 cases (29.1%). Clinically, B symptoms occurred more often in patients with HDV (47.7% compared to 35.0% without HDV (p = 0.039)) and patients with HDV tended to be in higher risk groups. Inadequate overall early-18F-FDG-PET-response was strongly correlated with the occurrence of hypodense lesions (p < 0.001). Patients with total HDV > 40 ml (n = 80) had a 5 year PFS of 79.6% compared to 89.7% (p = 0.01) in patients with HDV < 40 ml or no HDV. This difference in PFS is not caused by treatment group alone. HDV is a common phenomenon in HL with mediastinal involvement.
CRIS-Team Scopus Importer:2024-07-05
Keywords: Hodgkin lymphoma; Hypodense lesion; Thymic cyst; Tomography; X-ray computed

Hoffnung und Verantwortung Herausforderungen für die Medizin - Frewer, Andreas; Rascher, Wolfgang; Bruns, Florian (Königshausen & Neumann, 2010)

Hologene 5: A Phase II/III Clinical Trial of Combined Cell and Gene Therapy of Junctional Epidermolysis Bullosa - De Rosa, Laura; Enzo, Elena; Zardi, Giulia; Bodemer, Christine; Magnoni, Cristina; Schneider, Holm; De Luca, Michele (Frontiers in Genetics, 2021)
Epidermolysis bullosa (EB) is a group of devastating genetic diseases characterized by skin and mucosal fragility and formation of blisters, which develop either spontaneously or in response to minor mechanical trauma. There is no definitive therapy for any form of EB. Intermediate junctional EB (JEB) caused by mutations in the gene LAMB3 has been the first genetic skin disease successfully tackled by ex vivo gene therapy. Here, we present a multicenter, open-label, uncontrolled phase II/III study that aims at confirming the efficacy of Hologene 5, a graft consisting of cultured transgenic keratinocytes and epidermal stem cells and meant to combine cell and gene therapy for the treatment of LAMB3-related JEB. Autologous clonogenic keratinocytes will be isolated from patients’ skin biopsies, genetically corrected with a gamma-retroviral vector (γRV) carrying the full-length human LAMB3 cDNA and plated onto a fibrin support (144cm2). The transgenic epidermis will be transplanted onto surgically prepared selected skin areas of at least six JEB patients (four pediatric and two adults). Evaluation of clinical efficacy will include, as primary endpoint, a combination of clinical parameters, such as percentage of re-epithelialization, cellular, molecular, and functional parameters, mechanical stress tests, and patient-reported outcome (PRO), up to 12months after transplantation. Safety and further efficacy endpoints will also be assessed during the clinical trial and for additional 15years in an interventional non-pharmacological follow-up study. If successful, this clinical trial would provide a therapeutic option for skin lesions of JEB patients with LAMB3 mutations and pave the way to a combined cell and gene therapy platform tackling other forms of EB and different genodermatoses. Clinical Trial Registration: EudraCT Number: 2018-000261-36.
CRIS-Team Scopus Importer:2021-10-01
Keywords: cell and gene therapy; clinical trial; epidermal stem cell; epidermolysis bullosa; genodermatoses; skin

Homozygous Biallelic KRT5 Mutations in Epidermolysis Bullosa Simplex, Including a Complete Human Keratin 5 "Knock-Out", in Families with Extensive Consanguinity - Vahidnezhad, H.; Youssefian, L.; Daneshpazhooh, M.; Mahmoudi, H.; Kariminejad, A.; Fischer, J.; Christiansen, J.; Schneider, Holm; Guy, A.; Liu, L.; Mcgrath, J. A.; Has, C.; et al. (JOURNAL OF INVESTIGATIVE DERMATOLOGY, 2019)
CRIS-Team WoS Importer:2019-09-27

Homozygous familial hypercholesterolemia with severe involvement of the aortic valve—A sibling-controlled case study on the efficacy of lipoprotein apheresis - Galiano, Matthias; Hammersen, Johanna; Sauerstein, Katja; Blessing, Holger; Rümmele, Petra; Purbojo, Ariawan; Schöber, Martin; Moosmann, Julia; Raffelsbauer, Gunter; Heibges, Andreas; Klingel, Reinhard (Journal of Clinical Apheresis, 2020)
Background: Homozygous familial hypercholesterolemia (hoFH) can cause severe atherosclerotic cardiovascular disease (ASCVD) in early infancy. Diagnosis and initiation of effective lipid-lowering therapy (LLT) are recommended as early as possible to prevent ASCVD-related morbidity and mortality. Methods: The clinical courses of a pair of siblings with an identical hoFH genotype, who exhibited major similarities of their clinical phenotype were analyzed in a case-control fashion including the family. Results: The older sibling was diagnosed with hoFH at the age of 4. Untreated LDL-cholesterol (LDL-C) was 17 mmol/L (660 mg/dL). LLT including lipoprotein apheresis (LA) was initiated and has been successful for 8 years now. A reduction of estimated cholesterol burden by 74% was achieved by LA and combined drug therapy including statins and ezetimibe. The efficacy of escalation of drug therapy was limited because the underlying LDL receptor (LDLR) mutation in the family resulted in substantially reduced receptor function. Treatment with proprotein convertase subtilisin-kexin type 9 (PCSK9)-antibodies failed. His younger brother died at the age of 2 years shortly after the hoFH diagnosis of the elder sibling. Postmortem examination revealed advanced aortic root atheroma and aortic valve stenosis. In the older sibling, aortic valve stenosis and insufficiency were treated at the age of 9 years with mechanical aortic valve replacement. Conclusions: LLT including LA should be initiated as early as possible following the diagnosis of hoFH with very high LDL-C levels. With the same genotype, the phenotype of hoFH can exhibit similar patterns but outcome is substantially related to treatment.
CRIS-Team Scopus Importer:2020-03-27
Keywords: aortic valve stenosis; children; familial hypercholesterolemia; LDL-cholesterol; lipoprotein apheresis; prevention

Horn of plenty: Value of the international registry for pediatric chronic myeloid leukemia - Suttorp, Meinolf; Metzler, Markus; Millot, Frederic (World Journal of Clinical Oncology, 2020)
Chronic myeloid leukemia (CML) in minors is a rare disease which can be effectively treated by tyrosine kinase inhibitors (TKIs) since the year 2000. A majority of pediatricians will encounter one or two CML patients in the course of their careers and will typically have to rely on written information along with their own intuition to provide care. Knowledge of response to TKIs and of age-specific side effects has an impact on the design of pediatric CML trials in many ways aiming to contribute toward greater predictability of clinical improvements. Information from a registry on a rare disease like CML offers the enormous benefit of enabling treating physicians to interact and share their collective experience. The International Registry on Pediatric CML (IR-PCML) was founded at Poitiers/France almost 10 years ago. Since then, the number of collaboration centers and in parallel of registered patients continuously increased (> 550 patients as of December 2019). Ideally, from a given treatment center in a country data are transferred to a national coordinator who interacts with the IR-PCML. In the sense of quality assurance, the registry can offer dissemination of knowledge on state-of-the-art diagnostics (including reference appraisal), optimal treatment approaches, and follow-up procedures within a network that is exerting its strength via participation. With continuous growth during the recent years, very rare subgroups of patients could be identified (e.g., CML diagnosed at age < 3 years, children presenting with specific problems at diagnosis or during course of treatment) which had not been described before. Publications coming from the IR-PCML disseminated this useful information derived from patients who robustly participate and share information about their disease, among themselves and with their caregivers and clinicians. Patient input driving the collection of data on this rare leukemia is the basis for the considerable success of bringing new therapeutics into clinical use.
CRIS-Team WoS Importer:2020-08-28

How does empagliflozin improve arterial stiffness in patients with type 2 diabetes mellitus? - Bosch, A.; Ott, Christian; Jung, Susan; Striepe, Kristina; Karg, M. V.; Kannenkeril, Dennis; Dienemann, T.; Schmieder, Roland (EUROPEAN HEART JOURNAL, 2018)
CRIS-Team WoS Importer:2019-03-15

How does empagliflozin improve arterial stiffness in patients with type 2 diabetes mellitus? Sub analysis of a clinical trial - Bosch, Agnes; Ott, Christian; Jung, Susan; Striepe, Kristina; Karg, Marina V.; Kannenkeril, Dennis; Dienemann, Thomas; Schmieder, Roland (Cardiovascular Diabetology, 2019)
BackgroundEmpagliflozin has been shown to reduce cardiovascular mortality, but the underlying pathogenetic mechanisms are poorly understood. It was previously demonstrated that empagliflozin improved arterial stiffness.MethodsOur analysis comprising 58 patients with type 2 diabetes mellitus identifies factors triggering the improvement of arterial stiffness. All patients participated in an investigator-initiated, prospective, double-blind, randomized, placebo-controlled, interventional clinical trial (http://www.ClinicalTrials.gov: NCT02471963, registered 15th June 2015, retrospectively registered) and received either 6-weeks treatment with 25mg empagliflozin orally once daily or placebo (crossover). Central systolic pressure and central pulse pressure were recorded by the SphygmoCor System (AtCor Medical). Now, we investigated the impact of parameters of glucose metabolism, volume status, sympathetic activation, lipids, uric acid, blood pressure and inflammation on vascular parameters of arterial stiffness using multivariate regression analysis.ResultsAs previously reported, therapy with empagliflozin improved arterial stiffness as indicated by reduced central systolic blood pressure (113.612.1 vs 118.612.9mmHg, p<0.001), central pulse pressure (39.1 +/- 10.2 vs 41.9 +/- 10.7mmHg, p=0.027) forward (27.1 +/- 5.69 vs 28.7 +/- 6.23mmHg, p=0.031) as well as reflected wave amplitude (18.9 +/- 5.98 vs 20.3 +/- 5.97mmHg, p=0.045) compared to placebo. The multivariate regression analysis included age, sex and change between empagliflozin and placebo therapy of the following parameters: HbA1c, copeptin, hematocrit, heart rate, LDL-cholesterol, uric acid, systolic 24-h ambulatory blood pressure and high sensitive CRP (hsCRP). Besides the influence of age (beta=-0.259, p=0.054), sex (beta=0.292, p=0.040) and change in systolic 24-h ambulatory blood pressure (beta=0.364, p=0.019), the change of hsCRP (beta=0.305, p=0.033) emerged as a significant determinant of the empagliflozin induced reduction in arterial stiffness (placebo corrected). When replacing HbA1c with fasting plasma glucose in the multivariate regression analysis, a similar effect of the change in hsCRP (beta=0.347, p=0.017) on arterial stiffness parameters was found.Conclusion Besides age and sex, change in systolic 24-h ambulatory blood pressure and change in hsCRP were determinants of the empagliflozin induced improvement of vascular parameters of arterial stiffness, whereas parameters of change in glucose metabolism and volume status had no significant influence. Our analysis suggests that empagliflozin exerts, at least to some extent, its beneficial vascular effects via anti-inflammatory mechanisms.
CRIS-Team WoS Importer:2019-04-18

How often do SmPCs Contain Contraindications and Special Warnings that are Specific for the Paediatric Population - Wimmer, Stefan; Rascher, Wolfgang; Neubert, Antje (Klinische Pädiatrie, 2019)
BACKGROUND: 3.2-3.8% of all medicine prescriptions for minor outpatients are off-label only because of the patients' age group. The younger, the more patients are affected by this issue. Only one fifth of the most commonly used medicines for newborns are licensed for this age group. The aim of this study is to analyse all German SmPCs whether they contain contraindications and warnings that specifically concern paediatric patients. METHODS: All available SmPCs were processed to search the sections Contraindications and Special warnings and precautions for information on paediatric age groups. Results were evaluated for differences between age groups, ATC classification and routes of application. RESULTS: 13547 SmPCs (22863 medicinal products) were evaluated. For 3603 (15.8%) medicinal products the SmPC contained contraindications for at least one paediatric age group. For 9687 (42.4%) medicinal products contraindications or warnings were found, including 2833 (12.4%) where all patients below 18 years were affected. Preterms were particularly affected (n=9581, 41.9%) as well as the ATC therapeutic subgroups contrast media (89.0%), cough and cold preparations (86.2%) and Corticosteroids (topical 88.2%, systemic 86.6%). Concerning liquids for oral use the proportion was higher than average (58.2%). CONCLUSION: It can be assumed that for most medicinal products the contraindications for paediatrics result from a lack of data and age specific formulations rather than from pharmacokinetic or -dynamic differences in paediatric patients. The EU Paediatric Regulation did not significantly stimulate the conduction of paediatric studies in off-patent medicines to this day.
EVALuna2:206642

How to administer near-infrared spectroscopy in critically ill neonates, infants, and children - Bruns, Nora; Moosmann, Julia; Münch, Frank; Dohna-Schwake, Christian; Wölfle, Joachim; Cesnjevar, Robert; Dittrich, Sven; Felderhoff-Müser, Ursula; Müller, Hanna (Journal of Visualized Experiments, 2020)
Near infrared spectroscopy (NIRS) calculates regional tissue oxygenation (rSO2) using the different absorption spectra of oxygenated and deoxygenated hemoglobin molecules. A probe placed on the skin emits light that is absorbed, scattered, and reflected by the underlying tissue. Detectors in the probe sense the amount of reflected light: this reflects the organ-specific ratio of oxygen supply and consumption-independent of pulsatile flow. Modern devices enable the simultaneous monitoring at different body sites. A rise or dip in the rSO2 curve visualizes changes in oxygen supply or demand before vital signs indicate them. The evolution of rSO2 values in relation to the starting point is more important for interpretation than are absolute values. A routine clinical application of NIRS is the surveillance of somatic and cerebral oxygenation during and after cardiac surgery. It is also administered in preterm infants at risk for necrotizing enterocolitis, newborns with hypoxic ischemic encephalopathy and a potential risk of impaired tissue oxygenation. In the future, NIRS could be increasingly used in multimodal neuromonitoring, or applied to monitor patients with other conditions (e.g., after resuscitation or traumatic brain injury).
CRIS-Team Scopus Importer:2020-09-18

HRV-based Monitoring of Neonatal Seizures with Machine Learning - Lu, Hui; Kusnik, Stefan; Mammadova, Dilbar; Trollmann, Regina; Koelpin, Alexander (2024 46th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), 2024)
With the rapid development of machine learning (ML) in biomedical signal processing, ML-based neonatal seizure detection using heart rate variability (HRV) parameters extracted from the electrocardiogram (ECG) has gained increasing interest. In this paper, we present a benchmarking of various ML classifiers for HRV-based neonatal seizure monitoring. We extract the HRV parameter in time-domain, frequency-domain, and nonlinear-domain from segments with duration ranging from 30 to 180 s and perform the feature selection with minimum redundancy and maximum relevance (mRmR). In the next step, we evaluate the performance using nested cross-validation on a dataset collected from 16 preterm and term newborns with neonatal seizures with a total duration of over 35 hours. The best-performing classifier was the support vector machine (SVM) with a linear kernel using HRV parameters from the 180 s segment, achieving an area under the operator characteristic operating curve (AUC) score of 0.627, 89.7% sensitivity, 34.6% specificity, and 92.3% good detection rate.
CRIS-Team Scopus Importer:2025-02-04
Keywords: ECG; HRV; machine learning; nested cross-validation; newborns; seizure monitoring

Humans with inherited MyD88 and IRAK-4 deficiencies are predisposed to hypoxemic COVID-19 pneumonia - Garcia-Garcia, Ana; De Diego, Rebeca Perez; Flores, Carlos; Rinchai, Darawan; Sole-Violan, Jordi; Deya-Martinez, Angela; Garcia-Solis, Blanca; Lorenzo-Salazar, Jose M.; Hernandez-Brito, Elisa; Lanz, Anna-Lisa; Moens, Leen; Bucciol, Giorgia; et al. (Journal of Experimental Medicine, 2023)
X-linked recessive deficiency of TLR7, a MyD88- and IRAK-4-dependent endosomal ssRNA sensor, impairs SARS-CoV-2 recognition and type I IFN production in plasmacytoid dendritic cells (pDCs), thereby underlying hypoxemic COVID-19 pneumonia with high penetrance. We report 22 unvaccinated patients with autosomal recessive MyD88 or IRAK-4 deficiency infected with SARS-CoV-2 (mean age: 10.9 yr; 2 mo to 24 yr), originating from 17 kindreds from eight countries on three continents. 16 patients were hospitalized: six with moderate, four with severe, and six with critical pneumonia, one of whom died. The risk of hypoxemic pneumonia increased with age. The risk of invasive mechanical ventilation was also much greater than in age-matched controls from the general population (OR: 74.7, 95% CI: 26.8-207.8, P < 0.001). The patients' susceptibility to SARS-CoV-2 can be attributed to impaired TLR7-dependent type I IFN production by pDCs, which do not sense SARS-CoV-2 correctly. Patients with inherited MyD88 or IRAK-4 deficiency were long thought to be selectively vulnerable to pyogenic bacteria, but also have a high risk of hypoxemic COVID-19 pneumonia.
CRIS-Team WoS Importer:2023-04-21

Human ultrarare genetic disorders of sulfur metabolism demonstrate redundancies in H2S homeostasis - Kožich, Viktor; Schwahn, Bernd C.; Sokolová, Jitka; Křížková, Michaela; Ditroi, Tamas; Krijt, Jakub; Khalil, Youssef; Křížek, Tomáš; Vaculíková-Fantlová, Tereza; Stibůrková, Blanka; Mills, Philippa; Clayton, Peter; et al. (Redox Biology, 2022)
Regulation of H2S homeostasis in humans is poorly understood. Therefore, we assessed the importance of individual enzymes in synthesis and catabolism of H2S by studying patients with respective genetic defects. We analyzed sulfur compounds (including bioavailable sulfide) in 37 untreated or insufficiently treated patients with seven ultrarare enzyme deficiencies and compared them to 63 controls. Surprisingly, we observed that patients with severe deficiency in cystathionine β-synthase (CBS) or cystathionine γ-lyase (CSE) - the enzymes primarily responsible for H2S synthesis - exhibited increased and normal levels of bioavailable sulfide, respectively. However, an approximately 21-fold increase of urinary homolanthionine in CBS deficiency strongly suggests that lacking CBS activity is compensated for by an increase in CSE-dependent H2S synthesis from accumulating homocysteine, which suggests a control of H2S homeostasis in vivo. In deficiency of sulfide:quinone oxidoreductase - the first enzyme in mitochondrial H2S oxidation - we found normal H2S concentrations in a symptomatic patient and his asymptomatic sibling, and elevated levels in an asymptomatic sibling, challenging the requirement for this enzyme in catabolizing H2S under physiological conditions. Patients with ethylmalonic encephalopathy and sulfite oxidase/molybdenum cofactor deficiencies exhibited massive accumulation of thiosulfate and sulfite with formation of large amounts of S-sulfocysteine and S-sulfohomocysteine, increased renal losses of sulfur compounds and concomitant strong reduction in plasma total cysteine. Our results demonstrate the value of a comprehensive assessment of sulfur compounds in severe disorders of homocysteine/cysteine metabolism and provide evidence for redundancy and compensatory mechanisms in the maintenance of H2S homeostasis.
CRIS-Team Scopus Importer:2022-11-04
Keywords: Cystathionine β-synthase; Cystathionine γ-lyase; Molybdenum cofactor; Persulfide dioxygenase; Sulfide:quinone oxidoreductase; Sulfite oxidase

Hybrid reflected-ultrasound computed tomography versus B-mode-ultrasound for muscle scoring in spinal muscular atrophy - Danko, Vera; Jüngert, Jörg M.; Schüssler, Stephanie; Bühler, Adrian; Klett, Daniel; Federle, Anna; Roos, Andreas; Lochmüller, Hanns; Neurath, Markus; Wölfle, Joachim; Trollmann, Regina; Waldner, Maximilian; et al. (Journal of Neuroimaging, 2023)
Background and Purpose: Novel light- and sound-based technologies like multispectral optoacoustic tomography (MSOT) with co-registered reflected-ultrasound computed tomography (RUCT) could add additional value to conventional ultrasound (US) for disease phenotyping in pediatric spinal muscular atrophy (SMA). The aim of this study was to investigate the quality of RUCT compared to US for qualitative and quantitative assessment of imaging neuromuscular disorders. Methods: Subanalyzing the MSOT SMA study, 288 RUCT and 276 US images from 10 SMA patients (mean age 9.0 ± 3.7) and 10 gender- and age-matched healthy volunteers (HV; mean age 8.7 ± 4.3) were analyzed for quantitative (grayscale levels [GSLs]) and qualitative (echogenicity, distribution pattern, Heckmatt scale, and muscle texture) muscle changes. RUCT and US measures were further correlated with clinical standard motor outcomes. Results: Quantitative agreement using GSLs revealed significantly higher GSLs in muscles of SMA patients compared to healthy muscles in both techniques (US mean GSL [SD] SMA vs. HV: 110.70 [27.8] vs. 68.85 [19.2], p <.0001; RUCT mean GSL [SD] SMA vs. HV: 91.81 [21.8] vs. 59.86 [8.2], p <.0001) with good correlation with motor outcome tests, respectively. Qualitative agreement between methods for muscle composition was excellent for differentiation of pathological versus healthy muscles, echogenicity, and distribution pattern, moderate for Heckmatt scale, and poor for muscle texture. Conclusions: The data suggest that RUCT may allow the assessment of basic qualitative and quantitative measures for muscular diseases with comparable results to conventional US.
CRIS-Team Scopus Importer:2023-01-20
Keywords: neuromuscular disorders; optoacoustics; photoacoustics; spinal muscular atrophy; ultrasound

Hybrid ultrasound and single wavelength optoacoustic imaging reveals muscle degeneration in peripheral artery disease - Träger, Anna P.; Günther, Josefine; Raming, Roman; Paulus, Lars-Philip; Lang, Werner; Meyer, Alexander; Kempf, Julius; Caranovic, Milenko; Li, Yi; Wagner, Alexandra; Tan, Lina; Danko, Vera; et al. (Photoacoustics, 2024)
Peripheral arterial disease (PAD) leads to chronic vascular occlusion and results in end organ damage in critically perfused limbs. There are currently no clinical methods available to determine the muscular damage induced by chronic mal-perfusion. This monocentric prospective cross-sectional study investigated n = 193 adults, healthy to severe PAD, in order to quantify the degree of calf muscle degeneration caused by PAD using a non-invasive hybrid ultrasound and single wavelength optoacoustic imaging (US/SWL-OAI) approach. While US provides morphologic information, SWL-OAI visualizes the absorption of pulsed laser light and the resulting sound waves from molecules undergoing thermoelastic expansion. US/SWL-OAI was compared to multispectral data, clinical disease severity, angiographic findings, phantom experiments, and histological examinations from calf muscle biopsies. We were able to show that synergistic use of US/SWL-OAI is most likely to map clinical degeneration of the muscle and progressive PAD.
CRIS-Team Scopus Importer:2023-12-15
Keywords: Muscle degeneration; Muscle imaging; Optoacoustics; Peripheral artery disease; Photoacoustics

Hydrocortisone dosing in children with classic congenital adrenal hyperplasia: Results of the german/austrian registry - Hoyer-Kuhn, Heike; Huebner, Angela; Richter-Unruh, Anette; Bettendorf, Markus; Rohrer, Tilman; Kapelari, Klaus; Riedl, Stefan; Mohnike, Klaus; Dörr, Helmuth-Günther; Roehl, Friedrich Wilhelm; Fink, Katharina; Holl, Reinhard W.; et al. (Endocrine Connections, 2021)
Objective: Treatment of classic congenital adrenal hyperplasia (CAH) is necessary to compensate for glucocorticoid/mineralocorticoid deficiencies and to suppress androgen excess. Hydrocortisone (HC) is preferred in growing children with classic CAH but recommendations regarding dosage/administration are inconsistent. The aim of this study was to evaluate HC dosing in children with CAH in relation to chronological age, sex, and phenotype based on a multicenter CAH registry. Design: The CAH registry was initiated in 1997 by the AQUAPE in Germany. On December 31st 2018, data from 1571 patients were included. Methods: A custom-made electronic health record software is used at the participating centers. Pseudonymized data are transferred for central analysis. Parameters were selected based on current guidelines. Descriptive analyses and linear regression models were implemented with SAS 9.4. Results: We identified 1288 patients on exclusive treatment with hydrocortisone three times daily (604 boys; median age 7.2 years; 817 salt-wasting phenotype, 471 simple-virilizing phenotype). The mean (lower-upper quartiles) daily HC dose (mg/m² body surface area) was 19.4 (18.9–19.8) for patients <3 months (n = 329), 15.0 (14.6–15.3) for age ≥3–12 months (n = 463), 14.0 (13.7–14.3) for age 1–5.9 years (n = 745), 14.2 (14.0–14.5) for age 6 years to puberty entry (n = 669), and 14.9 (14.6–15.2) during puberty to 18 years (n = 801). Fludrocortisone was administered in 74.1% of patients with a median daily dosage of 88.8 µg. Conclusion: Our analyses showed that still a high proportion of children are treated with HC doses higher than recommended. This evaluation provides comprehensive information on nationwide hydrocortisone substitution dosages in children with CAH underlining the benefit of systematic data within a registry to assess daily practice.
CRIS-Team Scopus Importer:2021-06-11
Keywords: CYP21A2; fludrocortisone; glucocorticoids; treatment

Hyperactive mTOR pathway promotes lymphoproliferation and abnormal differentiation in autoimmune lymphoproliferative syndrome - Voelkl, Simon; Rensing-Ehl, Anne; Allgäuer, Andrea; Schreiner, Elisabeth; Lorenz, Myriam Ricarda; Rohr, Jan; Klemann, Christian; Fuchs, Ilka; Schuster, Volker; Von Bueren, Andre O.; Naumann-Bartsch, Nora; Gambineri, Eleonora; et al. (Blood, 2016)
Autoimmune lymphoproliferative syndrome (ALPS) is a human disorder characterized by defective Fas signaling, resulting in chronic benign lymphoproliferation and accumulation of TCR??(+) CD4(-) CD8(-) double-negative T (DNT) cells. Although their phenotype resembles that of terminally differentiated or exhausted T cells, lack of KLRG1, high eomesodermin, and marginal T-bet expression point instead to a long-lived memory state with potent proliferative capacity. Here we show that despite their terminally differentiated phenotype, human ALPS DNT cells exhibit substantial mitotic activity in vivo. Notably, hyperproliferation of ALPS DNT cells is associated with increased basal and activation-induced phosphorylation of serine-threonine kinases Akt and mechanistic target of rapamycin (mTOR). The mTOR inhibitor rapamycin abrogated survival and proliferation of ALPS DNT cells, but not of CD4(+) or CD8(+) T cells in vitro. In vivo, mTOR inhibition reduced proliferation and abnormal differentiation by DNT cells. Importantly, increased mitotic activity and hyperactive mTOR signaling was also observed in recently defined CD4(+) or CD8(+) precursor DNT cells, and mTOR inhibition specifically reduced these cells in vivo, indicating abnormal programming of Fas-deficient T cells before the DNT stage. Thus, our results identify the mTOR pathway as a major regulator of lymphoproliferation and aberrant differentiation in ALPS.
EVALuna2:25746

Hypermethylation and loss of retinoic acid receptor responder 1 expression in human choriocarcinoma - Hübner, Hanna; Strick, Reiner; Wachter, David Lukas; Kehl, Sven; Strissel, Pamela; Schneider-Stock, Regine; Rascher, Wolfgang; Horn, L. C.; Beckmann, Matthias; Rübner, Matthias; Fahlbusch, F. B.; Hartner, Andrea (Journal of Experimental & Clinical Cancer Research, 2017)
BACKGROUND: Human placental development resembles tumorigenesis, due to the invasive and fusogenic potential of trophoblasts. However, these features are tightly controlled in trophoblasts. Disturbance of this spatial and temporal regulation is thought to contribute to the rare formation of choriocarcinomas. Promoter hypermethylation and loss of the tumor suppressor Retinoic acid receptor responder 1 (RARRES1) were shown to contribute to cancer progression. Our study investigated the epigenetic and transcriptional regulation of RARRES1 in healthy human placenta in comparison to choriocarcinoma cell lines and cases. METHODS: Three choriocarcinoma cell lines (Jeg-3, JAR and BeWo) were treated with three different retinoic acid derivates (Am580, Tazarotene and all-trans retinoic acid) and 5-aza-2'-deoxycytidine. We analyzed RARRES1 promoter methylation by pyrosequencing and performed realtime-PCR quantification to determine RARRES1 expression in placental tissue and trophoblastic cell lines. Additionally, RARRES1 was stained in healthy placentas and in biopsies of choriocarcinoma cases (n = 10) as well as the first trimester trophoblast cell line Swan71 by immunofluorescence and immunohistochemistry. RESULTS: In the choriocarcinoma cell lines, RARRES1 expression could not be induced by sole retinoic acid treatment. Stimulation with 5-aza-2'-deoxycytidine significantly induced RARRES1 expression, which then could be further increased with Am580, Tazarotene and all-trans retinoic acid. In comparison to healthy placenta, choriocarcinoma cell lines showed a hypermethylation of the RARRES1 promoter, which correlated with a reduced RARRES1 expression. In concordance, RARRES1 protein expression was lost in choriocarcinoma tissue. Additionally, in the trophoblastic cell line Swan71, we found a significant induction of RARRES1 expression with increased cell density, during mitosis and in syncytial knots. CONCLUSIONS: Our findings showed that RARRES1 expression is absent in choriocarcinoma due to promoter methylation. Based on our analysis, we hypothesize that RARRES1 might exert tumor suppressive functions in multiple cellular processes (e.g. cell cycle regulation, adhesion, invasion and apoptosis).
EVALuna2:33950

Hypohidrotic Ectodermal Dysplasia: Breastfeeding Complications Due to Impaired Breast Development - Wahlbuhl-Becker, Mandy; Faschingbauer, Florian; Beckmann, Matthias; Schneider, Holm (Geburtshilfe und Frauenheilkunde, 2017)
Background X-linked hypohidrotic ectodermal dysplasia (XLHED), the most common form of ectodermal dysplasia, is caused by mutations in the gene EDA. While only affected men develop the full-blown clinical picture, females who are heterozygous for an EDA mutation often also show symptoms such as hypodontia, hypotrichosis and hypohidrosis. These women may also suffer from malformations of the mammary gland which represent not just a cosmetic problem but can limit their breastfeeding capability. This paper summarizes the findings of the first systematic study on the impact of hypohidrotic ectodermal dysplasia on breastfeeding. Patients Thirty-eight adult female members of the German-Swiss-Austrian ectodermal dysplasia patient support group participated in a structured interview; most of them also agreed to a photodocumentation of their mammary region. Thirty-one women carried mutations in EDA (Group A) and seven were affected by other forms of hypohidrotic ectodermal dysplasia (Group B). Results 39 % of the women of Group A reported that their breasts were of different size or entirely absent on one side. In Group B, 86 % of the women reported differently sized or even absent breasts; two of these women lacked both breasts entirely. Most women described their nipples as exceptionally flat. 10 % of the women of Group A had more than two nipples. The high percentage of deviations from the norm was confirmed in the photodocumentation. Both groups had few or no sebaceous glands of Montgomery in the areolar region. Around 80 % of interviewed women had children and had attempted to breastfeed their first child. 67 % of the mothers in Group A had had difficulty in breastfeeding their infants and generally attributed this difficulty to their flat nipples. All of the mothers in Group B reported difficulties in breastfeeding; 60 % had not been able to breastfeed their first child. Conclusion Mothers with hypohidrotic ectodermal dysplasia very often have difficulty in breastfeeding because of their impaired breast development. This causal relationship needs to be taken into account in lactation counseling.
EVALuna2:34219

Hypothalamic-Pituitary Axis Dysfunction after Whole Brain Radiotherapy - A Cohort Study - Gebauer, Judith; Mehta, Preena; Fahlbusch, Fabian; Schmid, Sebastian M.; Rades, Dirk; Janssen, Stefan (Anticancer Research, 2020)
BACKGROUND/AIM: Hypothalamic-pituitary (HT-P) dysfunction is one of the most common endocrine late effects following cranial radiotherapy. However, there are currently no specific data describing this complication in adult-onset cancer patients after whole brain radiotherapy (WBRT). The present cohort study aims to establish the prevalence of HT-P axis dysfunction in this group of patients. PATIENTS AND METHODS: Twenty-six cancer patients previously treated with WBRT (median follow-up=20.5 months) received standardized endocrine check-up focusing on HT-P function. RESULTS: In 50% of the patients, impaired hypothalamic-pituitary function was detected during follow-up. While functional loss of a single hormonal axis was evident in 34.6% of patients, 7.7% showed an impairment of multiple endocrine axes, and one patient developed adrenocorticotropic hormone deficiency. Hypothalamic-pituitary dysfunction did not directly correlate with the applied WBRT total doses. CONCLUSION: In our cohort, hypothalamic-pituitary dysfunction appeared to be common after WBRT and was diagnosed as early as 6 months following radiation. This finding highlights the need for routine endocrine follow-up even in patients with limited life expectancy.
CRIS-Team Scopus Importer:2020-10-16
Keywords: cancer survivor; endocrine late effects; hypothalamic-pituitary dysfunction; Whole brain radiotherapy

Hypoxia in A Patient with Anti-p200 Pemphigoid under Combined Dapsone and Pantoprazole Treatment - Lang, Sebastian; Saenger, Philipp Wilhelm; Kocina, Sandra; Von Loeffelholz, Christian (Biomedicines, 2022)
A 70-year-old male patient was admitted to our dermatology outpatient clinic with newly developed personality changes and signs of hypoxemia. His anti-p200 Pemphigoid was treated with Dapsone for a few weeks. Due to generalized tonic-clonic seizure with a subsequent Glasgow Coma Scale of 5 points and a peripheral oxygen saturation not exceeding 88% under conditions of high-flow nasal cannula, he was intubated by the emergency team and transferred to the intensive care unit. Comprehensive tests were performed, but Dapsone-induced methemoglobinemia remained the exclusive explanation for the observed scenario, although arterial MetHb analysis showed a peak value of only 6%. The patient recovered shortly after repeated infusions of Methylene blue and Ascorbate, and cessation of Dapsone. We provide an overview of the pathophysiology, diagnostic procedures, and possible explanations for this case of Dapsone-induced methaemoglobinaemia. In conclusion, our case report provides evidence that even mild chronic methemglobinemia can induce severe clinical symptoms.
CRIS-Team Scopus Importer:2022-11-25
Keywords: CYP2C19; CYP2C9; G6PD-deficiency; hemolysis; NAFLD; proton pump inhibitors; sepsis

Hypoxia inducible factor stabilization improves defective ischemia-induced angiogenesis in a rodent model of chronic kidney disease - Schellinger, Isabel Nahal; Cordasic, Nada; Panesar, Julian; Buchholz, Björn; Jacobi, Johannes; Hartner, Andrea; Klanke, Bernd; Jakubiczka-Smorag, Joanna; Burzlaff, Nicolai; Heinze, Eva; Warnecke, Christina; Raaz, Uwe; et al. (Kidney International, 2017)
Chronic kidney disease (CKD) is associated with increased risk and worse prognosis of cardiovascular disease, including peripheral artery disease. An impaired angiogenic response to ischemia may contribute to poor outcomes of peripheral artery disease in patients with CKD. Hypoxia inducible factors (HIF) are master regulators of angiogenesis and therefore represent a promising target for therapeutic intervention. To test this we induced hind-limb ischemia in rats with CKD caused by 5/6 nephrectomy and administered two different treatments known to stabilize HIF protein in vivo: carbon monoxide and a pharmacological inhibitor of prolyl hydroxylation 2-(1-chloro-4- hydroxyisoquinoline-3-carboxamido) acetate (ICA). Expression levels of pro-angiogenic HIF target genes (Vegf, Vegf-r1, Vegf-r2, Ho-1) were measured by qRT-PCR. Capillary density was measured by CD31 immunofluorescence staining and HIF expression was evaluated by immunohistochemistry. Capillary density in ischemic skeletal muscle was significantly lower in CKD animals compared to sham controls. Rats with CKD showed significantly lower expression of HIF and all measured pro-angiogenic HIF target genes, including VEGF. Both HIF stabilizing treatments rescued HIF target gene expression in animals with CKD and led to significantly higher ischemia-induced capillary sprouting compared to untreated controls. ICA was effective regardless of whether it was administered before or after induction of ischemia and led to a HIF expression in skeletal muscle. Thus, impaired ischemia-induced angiogenesis in rats with CKD can be improved by HIF stabilization, even if started after onset of ischemia.
EVALuna2:3925
Keywords: cardiovascular disease; chronic kidney disease; hypoxia

Hypoxia Potentiates LPS-Mediated Cytotoxicity of BV2 Microglial Cells In Vitro by Synergistic Effects on Glial Cytokine and Nitric Oxide System - Frey, Daniel; Jung, Susan; Brackmann, Florian; Richter-Kraus, Mandy; Trollmann, Regina (Neuropediatrics, 2015)
Microglial activation due to a variety of stimuli induces secretion of neurotoxic substances including inflammatory cytokines and nitric oxide (NO). Clinical studies indicate a cross-link between inflammatory and hypoxia-regulated pathways suggesting that bacterial infections markedly sensitize the immature brain to hypoxic injury.The impact of inflammation and hypoxia on interleukin (IL)-1?, IL-6, tumor necrosis factor ? (TNF-?), and NO secretion and microglia-induced cytotoxicity was investigated exposing BV2 cells to lipopolysaccharides (LPS) and hypoxia (1% O2). Cytotoxicity, NO, and cytokine release was quantified by MTS and Griess assays and by enzyme-linked immunosorbent assays, respectively.LPS exposure of BV2 cells induced a significant, persistent production of NO, IL-1?, IL-6, and TNF-?. Even after LPS removal, ongoing NO and cytokine secretion was observed. Hypoxia mediated exclusively a significant, short-term IL-1? increase, but enhanced LPS-induced cytokine and NO secretion significantly. In addition, LPS-induced supernatants exhibited a stronger cytotoxic effect in glial and neuronal cells than LPS exposition (p < 0.001). Hypoxia potentiated LPS-induced cytotoxicity.Present data prove that LPS-induced soluble factors rather than LPS exposure mediate microglial toxicity under conditions of hypoxia in vitro. Apart from potential protective effects of the hypoxia-inducible transcription factor (HIF)-1? system, activation of proinflammatory pathways may markedly sensitize microglial cells to promote hypoxia-induced injuries of the developing brain.
EVALuna2:18925

Idiopathic Mast Cell Activation Syndrome With Associated Salicylate Intolerance - Rechenauer, Tobias; Raithel, Martin; Goetze, Thomas; Siebenlist, Gregor; Rueckel, Aline; Baenkler, Hanns-Wolf; Hartmann, Arndt; Haller, Florian; Hoerning, Andre (Frontiers in Pediatrics, 2018)
Idiopathic mast cell activation syndrome can be a rare cause for chronic abdominal pain in children. It remains a diagnosis by exclusion that can be particularly challenging due to the vast variety of possible clinical manifestations. We present a 13-year-old boy who suffered from a multitude of unspecific complaints over a long period of time. In this case, an assessment of mast cell-derived metabolites and immunohistochemical analysis of bioptic specimen was worthwhile. After ruling out, primary (oncologic) and secondary causes for mast cell activation, pharmacologic treatment adapted to the patient's salicylate intolerance resulted in a major relief of symptoms.
EVALuna2:34101

IFN-α/IFN-λ responses to respiratory viruses in paediatric asthma - Bergauer, Annika; Sopel, Nina; Kross, Bettina; Vuorinen, Tytti; Xepapadaki, Paraskevi; Weiss, Scott T.; Blau, Ashley; Sharma, Himanshu; Kraus, Cornelia; Springel, Rebekka; Rauh, Manfred; Mittler, Susanne; et al. (European Respiratory Journal, 2016)
We analysed the influence of rhinovirus (RV) in nasopharyngeal fluid (NPF) on type I and III interferon (IFN) responses (e.g. IFN-? and IFN -: ?) and their signal transduction, at baseline and during disease exacerbation, in cohorts of pre-school children with and without asthma.At the time of recruitment into the Europe-wide study PreDicta, and during symptoms, NPF was collected and the local RV colonisation was analysed. Peripheral blood mononuclear cells (PBMCs) were challenged in vitro with RV or not. RNA was analysed by quantitative real-time PCR and gene arrays. Serum was analysed with ELISA for IFNs and C-reactive protein.We found that PBMCs from asthmatic children infected in vitro with the RV1b serotype upregulated MYD88, IRF1, STAT1 and STAT2 mRNA, whereas MYD88, IRF1, STAT1 and IRF9 were predominantly induced in control children. Moreover, during symptomatic visits because of disease exacerbation associated with RV detection in NPF, IFN-? production was found increased, while IFN-? secretion was already induced by RV in asthmatic children at baseline.During asthma exacerbations associated with RV, asthmatic children can induce IFN-? secretion, indicating a hyperactive immune response to repeated respiratory virus infection.
EVALuna2:9365

IFN-α/IFN-λ responses to respiratory viruses in paediatric asthma - Bergauer, Annika; Sopel, Nina; Kross, Bettina; Vuorinen, Tytti; Xepapadaki, Paraskevi; Weiss, Scott T.; Blau, Ashley; Sharma, Himanshu; Kraus, Cornelia; Springel, Rebekka; Rauh, Manfred; Mittler, Susanne; et al. (European Respiratory Journal, 2017)
EVALuna:34061

IGF-I in cord blood is predictive of final height in monozygotic twins with intra-twin birth weight differences - Kasner, Charlotte; Schulte, Sandra; Schreiner, Felix; Fimmers, Rolf; Stoffel-Wagner, Birgit; Bartmann, Peter; Wölfle, Joachim; Gohlke, Bettina (Clinical Endocrinology, 2020)
Objective: Adverse prenatal conditions can exert a long-lasting impact on growth up to final height (FH). Due to different prenatal nutrient availability, monozygotic twin pairs with discordant birth weight (bw) provide an excellent model to examine the impact of genes and environment and to analyse the predictive value of bw, birth length (bl) and cord blood (cb) concentration of IGF-I on FH. Patients and Methods: Twenty eight monozygotic twin pairs with intra-twin bw-/bl-differences were studied at birth and longitudinally until FH. Intra-twin bw difference >1 SDS was defined “discordant” (n = 10 pairs). IGF-I was analysed in cord blood in all twins. Intra-twin differences (∆) in bw, bl and cord blood IGF-I were correlated with ∆FH. Results: Throughout growth and up until FH intra-twin length/height differences remained for all but two (26/28) twins and for all (10/10) discordant twins. In the discordant group, a highly significant intra-twin difference for FH-SDS was found with a mean intra-twin Δheight- SDS of 1.23 (range, 0.29-2.34). This corresponds to a mean Δintra-twin difference at FH of 7.9 cm (3.1 inch; range, 2-15 cm [0.79-5.9 inch]). Correlation coefficients were calculated to identify factors predicting FH: ∆bw (r =.678; P =.0005), ∆bl (r =.333; P =.0002) and ∆IGF-I in cb (r =.418; P =.0023). Interaction terms showed that IGF-I is an additional factor to the auxological data, leading to an improvement of the ∆FH modelling. Conclusion: Prenatal environment leading to bw-/bl- and cbIGF-I differences in monozygotic twins had a long-lasting impact on growth until FH. Both, anthropometric data at birth and cbIGF-I are predictive of FH.
CRIS-Team Scopus Importer:2020-06-19
Keywords: birth length; birth weight; final height; foetal programming; growth; IGF-I

IL-33/ST2 immune responses to respiratory bacteria in pediatric asthma - Hentschke, Isabell; Graser, Anna; Melichar, Volker O.; Kiefer, Alexander; Zimmermann, Theodor; Kross, Bettina; Haag, Patricia; Xepapadaki, Paraskevi; Papadopoulos, Nikolaos G.; Bogdan, Christian; Finotto, Susetta (Scientific Reports, 2017)
Here we investigated the relationship between local bacterial colonization and anti-bacterial immune responses in pre-school asthmatic and control children within the EU-wide study PreDicta. In this cohort of pre-school asthmatic children, nasopharyngeal colonization with Gram-negative bacteria such as Haemophilus influenzae and Moraxella catarrhalis was found to be associated with the highest interferon beta (IFN?) and IL-33 levels in the nasal pharyngeal fluids (NPF). IL33R-ST2 was found induced in the blood of asthmatic children with additional Gram + bacteria in the nasopharynx (Gr+/-). Furthermore, asthmatic children had more episodes of infection that required antibiotic therapy than the control group. Treatment with antibiotics associated with reduced ST2 in blood cells of both asthmatic and control children and reduced IL-33 levels in the airways of asthmatic children. In the absence of Staphylococcus (S.) aureus in NPF, antibiotic therapy associated with decreased IL-33 levels in the NPF and lower ST2 values in the blood of control children but not of asthmatic children. These data suggest that, in asthmatic children, Gram- bacteria, which persist after antibiotic therapy, contributes to IL-33 locally and associated with Gr + bacteria colonization in the airways, inhibited IFN-? and in the absence of Staphylococcus (S.) aureus, induced ST2 bearing cells in their blood.
EVALuna2:7728

IL-6 activated integrated BATF/IRF4 functions in lymphocytes are T-bet-independent and reversed by subcutaneous immunotherapy - Mousset, Stephanie; Koch, Sonja; Mousset, Stephanie; Graser, Anna; Reppert, Sarah; Uebel, Caroline; Reinhardt, Cornelia; Zimmermann, Theodor; Rieker, Ralf; Lehr, Hans A.; Finotto, Susetta (Scientific Reports, 2013)
IL-6 plays a central role in supporting pathological TH2 and TH17 cell development and inhibiting the protective T regulatory cells in allergic asthma. TH17 cells have been demonstrated to regulate allergic asthma in general and T-bet-deficiency-induced asthma in particular. Here we found an inverse correlation between T-bet and Il-6 mRNA expression in asthmatic children. Moreover, experimental subcutaneous immunotherapy (SIT) in T-bet((-/-)) mice inhibited IL-6, IL-21R and lung TH17 cells in a setting of asthma. Finally, local delivery of an anti-IL-6R antibody in T-bet((-/-)) mice resulted in the resolution of this allergic trait. Noteworthy, BATF, crucial for the immunoglobulin-class-switch and TH2,TH17 development, was found down-regulated in the lungs of T-bet((-/-)) mice after SIT and after treatment with anti-IL-6R antibody, indicating a critical role of IL-6 in controlling BATF/IRF4 integrated functions in TH2, TH17 cells and B cells also in a T-bet independent fashion in allergic asthma.

ILCOR 2022: notfallpharmakologische Implikationen - Dormann, Harald; Ittner, Karl Peter; Neubert, Antje; Böttiger, Bernd W. (Notarzt, 2023)
CRIS-Team Scopus Importer:2023-06-23

Imatinib treatment and longitudinal growth in pediatric patients with chronic myeloid leukemia: influence of demographic, pharmacological, and genetic factors in the German CML-PAED cohort - Stiehler, Sophie; Sembill, Stephanie; Schleicher, Oliver; Marx, Martin; Rauh, Manfred; Krumbholz, Manuela; Karow, Axel; Suttorp, Meinolf; Wölfle, Joachim; Maj, Carlo; Metzler, Markus (Haematologica, 2024)
In children and adolescents, impaired growth due to tyrosine kinase inhibitor therapy remains an insufficiently studied adverse effect. This study examines demographic, pharmacological, and genetic factors associated with impaired longitudinal growth in a uniform pediatric cohort treated with imatinib. We analyzed 94 pediatric patients with chronic myeloid leukemia (CML) diagnosed in the chronic phase and treated with imatinib for >12 months who participated in the Germany-wide CML-PAEDII study between February 2006 and February 2021 (clinicaltrials gov. Identifier: NCT00445822). During imatinib treatment, significant height reduction occurred, with medians of -0.35 standard deviation score (SDS) at 12 months and -0.76 SDS at 24 months. Cumulative height SDS change (Δ height SDS) showed a more pronounced effect in prepubertal patients during the first year but were similar between prepubertal and pubertal subgroups by the second year (-0.55 vs. -0.50). From months 12 to 18 on imatinib, only 18% patients achieved individually longitudinal growth adequate to the growth standard (Δ height SDS ≥0). When patients were divided into two subgroups based on median Δ height SDS (classifier Δ height SDS > or ≤-0.37) after 1 year on imatinib therapy, cohort 1 (Δ height SDS ≤-0.37) showed younger age at diagnosis, a higher proportion of prepubertal children, but also better treatment response and higher imatinib serum levels. Exploring the association of growth parameters with pharmacokinetically relevant single nucleotide polymorphisms, known for affecting imatinib response, showed no correlation. This retrospective study provides new insights into imatinib-related growth impairment. We emphasize the importance of optimizing treatment strategies for pediatric patients to realize their maximum growth potential.
CRIS-Team Scopus Importer:2024-08-16

Immediate and Sustained Effect of Neonatal Teaching in a Perinatal Setting in Urban Laos - Hoehn, Thomas; Genet, Petra; Balan, Percy; Schramm, Dirk; Verde, Pablo Emilio; Phengsavanh, Alongkone (American Journal of Perinatology, 2020)
OBJECTIVE: This study aimed to quantify knowledge on neonatal topics among obstetricians and pediatricians participating in a perinatal teaching program aimed at reducing neonatal mortality in Laos. STUDY DESIGN: Obstetricians and pediatricians from Vientiane and the surrounding areas participated in a 1-week teaching program in obstetric and neonatal topics and responded to pre- and posttests questionnaires to quantify their knowledge. RESULTS: Although questions were predominantly related to neonatal topics, obstetricians performed significantly better than pediatricians during the pretest. Both groups increased their knowledge significantly as quantified by the results of the posttest. CONCLUSION: The teaching program was effective in improving knowledge on perinatal mortality related topics of the participants. These results may be related to the fact that most of the obstetricians had participated in a structured teaching program previously, whereas the pediatricians did not. We thus speculate that there is a sustained effect of even a 1-week teaching program in neonatology even several years after the initial teaching.
CRIS-Team Scopus Importer:2020-03-17

Immunoregulatory role of NFAT-interacting protein (NIP) 45 in adaptive and innate immune responses in allergic asthma - Koch, Sonja; Maeding, N.; Karwot, R.; Mirzakhani, H.; Springel, R.; Mittler, S.; Zimmermann, Theodor; Melichar, V. O.; Knipfer, Lisa; Wirtz, Stefan; Weiss, S. T. (2017)
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Impact of a computerized physician order entry system on medication safety in pediatrics-The AVOID study - Wimmer, Stefan; Toni, Irmgard; Botzenhardt, Sebastian; Trollmann, Regina; Rascher, Wolfgang; Neubert, Antje (Pharmacology Research and Perspectives, 2023)
BACKGROUND: One of the most critical steps in the medication process on pediatric wards is the medical prescription. This study aims to investigate the impact of a computerized physician order entry (CPOE) system on Adverse Drug Events (ADEs) and potentially harmful ADEs (pot ADEs) in comparison with paper-based documentation in a general pediatric ward at a German University hospital. METHODS: A prospective pre-post study was conducted. All patients aged 17 years or younger were observed during the study periods (5 months pre- and postimplementation). Issues Regarding Medication (IRM) were identified by intensive chart review. Events were assessed regarding causality (WHO), severity (WHO; Dean & Barber for MEs), and preventability (Shumock) and classified into (pot) ADEs, (pot) Medication errors (ME), Adverse drug Reactions (ADR), and Other incidents (OI) accordingly. RESULTS: Total of 333 patients with medication were included in the paper-based prescribing cohort (phase I) and 320 patients with medication in the electronic prescribing cohort (phase II). In each cohort, patients received a median number of four different drugs (IQR 5 and IQR 4). A total of 3966 IRM was observed. During the hospitalization, 2.7% (n = 9) patients in phase I and 2.8% (n = 9) in phase II experienced an ADE. Potentially harmful MEs were less often observed in the cohort with electronic prescribing (n = 228 vs. n = 562). The mean number per patient significantly decreased from 1.69 to 0.71 (p < .01). CONCLUSION: The implementation of a CPOE system resulted in a reduction of issues regarding medication, particularly MEs with the potential to harm patients decreased significantly.
CRIS-Team Scopus Importer:2023-06-02
Keywords: adverse drug event; adverse drug reaction; computerized physician order entry; electronic prescribing; medication error; medication safety; pediatrics

Impact of age on safety of Busulfan-Melphalan followed by autologous hematopoietic stem-cell transplantation versus standard chemotherapy in the patients of the EURO-E.W.I.N.G. 99 and Ewing 2008 clinical trials - Choderlos de Laclos, Xavier; Risbourg, Séverine; Marec-Bérard, Perrine; Cécile Le Deley, Marie; Tabone, Marie Dominique; Bertucci, François; Gaspar, Nathalie; Gandemer, Virginie; Brennan, Bernadette; Strauss, Sandra; McCabe, Martin G.; Windsor, Rachael; et al. (European Journal of Cancer, 2024)
Introduction: Ewing sarcoma (ES), is a rare cancer affecting children, adolescents and adults. After VIDE (vincristine-ifosfamide-doxorobucin-etoposide) induction chemotherapy, Busulfan-Melphalan (BuMel) high-dose chemotherapy followed by autologous hematopoietic stem cells transplantation improved outcomes in unfavourable localized ES, but with more toxicities than conventional chemotherapy (VAI: Vincristine-dactinomycin-Ifosfamide). We evaluated whether the risk of acute toxicity associated with BuMel compared to VAI varied according to age in patients recruited in the R2Loc and R2Pulm randomised trials of the Euro-E.W.I.N.G.99 and Ewing-2008 trials. Methods: We included patients with a localized high-risk disease, or pulmonary or pleural metastasis. We analysed the risk of severe toxicity according to randomised treatment group (VAI versus BuMel) and age group (<12 years, 12–17 years, 18–24 years, ≥25 years). We evaluated the heterogeneity of treatment effects by age group using interaction terms in logistic multivariable models. Results: The analysis included 243 patients treated with VAI and 205 with BuMel. Overall, BuMel was associated with a higher risk of severe acute toxicity than VAI particularly haematological, gastrointestinal, liver, sinusoidal occlusive syndrome, and infections. Severe haematological toxicity and lower general condition were significantly more frequent in younger patients, whatever treatment. We did not observe any significant heterogeneity in terms of the excess risk of severe toxicities associated with BuMel compared to VAI according to age group. Conclusion: The excess of acute toxicity associated with BuMel compared to VAI does not vary significantly with age, suggesting the feasibility of BuMel across all age groups.
CRIS-Team Scopus Importer:2024-07-26
Keywords: Autologous hematopoietic stem cells transplantation; Ewing sarcoma (ES); High dose chemotherapy; Safety

IMPACT OF BLOOD PRESSURE AND AGEING ON RETINAL NEURODEGENERATION ASSESSED BY SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY - Jung, Susan; Bosch, Agnes; Kohler, N.; Ott, Christian; Kannenkeril, Dennis; Dienemann, T.; Harazny, J. M.; Michelson, Georg; Schmieder, Roland (JOURNAL OF HYPERTENSION, 2019)
CRIS-Team WoS Importer:2019-09-20

Impact of COVID-19 infection on lung function and nutritional status amongst individuals with cystic fibrosis: A global cohort study - Semenchuk, Julie; Naito, Yumi; Charman, Susan C.; Carr, Siobhán B.; Cheng, Stephanie Y.; Marshall, Bruce C.; Faro, Albert; Elbert, Alexander; Gutierrez, Hector H.; Goss, Christopher H.; Karadag, Bulent; Burgel, Pierre Régis; et al. (Journal of Cystic Fibrosis, 2024)
Background: Factors associated with severe COVID-19 infection have been identified; however, the impact of infection on longer-term outcomes is unclear. The objective of this study was to examine the impact of COVID-19 infection on the trajectory of lung function and nutritional status in people with cystic fibrosis (pwCF). Methods: This is a retrospective global cohort study of pwCF who had confirmed COVID-19 infection diagnosed between January 1, 2020 and December 31, 2021. Forced expiratory volume in one second percent predicted (ppFEV1) and body mass index (BMI) twelve months prior to and following a diagnosis of COVID-19 were recorded. Change in mean ppFEV1 and BMI were compared using a t-test. A linear mixed-effects model was used to estimate change over time and to compare the rate of change before and after infection. Results: A total of 6,500 cases of COVID-19 in pwCF from 33 countries were included for analysis. The mean difference in ppFEV1 pre- and post-infection was 1.4 %, (95 % CI 1.1, 1.7). In those not on modulators, the difference in rate of change pre- and post-infection was 1.34 %, (95 % CI -0.88, 3.56) per year (p = 0.24) and -0.74 % (-1.89, 0.41) per year (p = 0.21) for those on elexacaftor/tezacaftor/ivacaftor. No clinically significant change was noted in BMI or BMI percentile before and after COVID-19 infection. Conclusions: No clinically meaningful impact on lung function and BMI trajectory in the year following infection with COVID-19 was identified. This work highlights the ability of the global CF community to unify and address critical issues facing pwCF.
CRIS-Team Scopus Importer:2024-09-20
Keywords: Coronavirus; COVID-19; Cystic fibrosis

Impact of Newborn Screening on Adult Height in Patients With Congenital Adrenal Hyperplasia (CAH) - Hoyer-Kuhn, Heike; Eckert, Alexander J.; Binder, Gerhard; Bonfig, Walter; Dübbers, Angelika; Riedl, Stefan; Wölfle, Joachim; Dörr, Helmuth-Günther; Holl, Reinhard W. (Journal of Clinical Endocrinology and Metabolism, 2023)
CONTEXT: Treatment of children with classical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is challenging. Linear growth and adult height are compromised according to recent publications. However, most of these data were obtained in the era before CAH newborn screening. DESIGN: Body height of patients with classical CAH diagnosed before and after the establishment of newborn screening were analyzed retrospectively. PATIENTS AND METHODS: We identified 600 patients with classical CAH (227 male) with data on near-adult height (NAH), target height (TH), and information on newborn screening from the electronic German CAH registry (German Society for Paediatric Endocrinology and Diabetology). Newborn screening was performed in 101 (16.8%) patients. All patients received hydrocortisone with or without fludrocortisone.To assess the effects of newborn screening, a linear regression model adjusted/stratified for sex and phenotype was used (SAS 9.4). RESULTS: TH corrected NAH (mean; 95% confidence interval) was closer to 0 in patients with CAH and newborn screening [-0.25 standard deviation score (SDS); -0.44 to -0.06] than in patients without newborn screening (-0.44 SDS; -0.52 to -0.36) (P = .069). Screening had no effect on NAH in female patients. In male patients, NAH was significantly better (P = .033) with screening than without screening. After stratifying for CAH phenotype, screening did not affect the NAH of patients with salt-wasting CAH. Patients with simple-virilizing CAH had a significantly better cNAH (P = .034) with screening (0.15 SDS; -0.28-0.59) than without screening (-0.35 SDS; -0.52 to -0.18). CONCLUSIONS: Our data suggest that newborn screening might be associated with improved NAH in male CAH patients and in patients with simple-virilizing CAH.
CRIS-Team Scopus Importer:2023-11-03
Keywords: congenital adrenal hyperplasia; CYP21A2; near adult height; newborn screening

Impact of premature birth on cardiopulmonary function in later life - Weigelt, Annika; Bleck, Steffen; Hübner, Matthias; Rottermann, Kathrin; Wällisch, Wolfgang; Morhart, Patrick; Abu-Tair, Tariq; Dittrich, Sven; Schöffl, Isabelle (European Journal of Pediatrics, 2023)
Pulmonary function is reduced in children after preterm birth. The variety of subgroups ranges from early to late preterm births. Limitations in pulmonary function can be observed even after late preterm birth without signs of bronchopulmonary dysplasia and/or history of mechanical ventilation. Whether this reduction in lung function is reflected in the cardiopulmonary capacity of these children is unclear. This study aims to investigate the impact of moderate to late premature birth on cardiopulmonary function. Cardiopulmonary exercise testing on a treadmill was performed by 33 former preterm infants between 8 and 10 years of age who were born between 32 + 0 and 36 + 6 weeks of gestation and compared with a control group of 19 children born in term of comparable age and sex. The former preterm children achieved comparable results to the term-born controls with respect to most of the cardiopulmonary exercise parameters (V˙O2peak43.9±6.6mlkgminminvs.41.9±8.8mlkg/min) . The only differences were in a slightly higher oxygen uptake efficiency slope (OUESof1.6±0.4vs1.4±0.4) and higher peak minute ventilation V˙Epeakof55.2±11.3ml/minvs.49.1ml±8.8/min) in the group of children born preterm. With respect to heart rate recovery (-35.3±13.8bpmvs.-37.2bpm±14.0after1min) and breathing efficiency (V˙E/V˙CO2of35.9±4.1vs34.0±4.6) , there were no significant differences. Conclusion: Children born preterm did not show limitations in cardiopulmonary function in comparison with matched controls. What is Known: • Preterm birth is associated with reduced pulmonary function in later life, this is also true for former late preterms. • As a consequence of being born premature, the lungs have not finished their important embryological development. Cardiopulmonary fitness is an important parameter for overall mortality and morbidity in children and adults and a good pulmonary function is therefore paramount. What is New: • Children born prematurely were comparable to an age- and sex-matched control group with regards to almost all cardiopulmonary exercise variables. • A significantly higher OUES, a surrogate parameter for VO 2 peak was found for the group of former preterm children, most likely reflecting on more physical exercise in this group. Importantly, there were no signs of impaired cardiopulmonary function in the group of former preterm children.
CRIS-Team Scopus Importer:2023-05-19
Keywords: Cardiopulmonary exercise testing; Habitual exercise; Premature birth; Sports

Impact of regional SARS-CoV-2 proceedings on changes in diagnoses of pediatric malignancies in Bavaria during the COVID-19 pandemic - Reger, Mira; Manz, Kirsi; Kaeuferle, Theresa; Coffey, Ramona; Wotschofsky, Zofia; von Luettichau, Irene; Schlegel, Paul Gerhardt; Frühwald, Michael C.; Corbacioglu, Selim; Metzler, Markus; Feuchtinger, Tobias (Pediatric Hematology and Oncology, 2024)
The COVID-19 pandemic affected daily life significantly and had massive consequences for healthcare systems with tremendous regional differences. This retrospective study aimed to investigate whether the pandemic and resulting societal changes impacted the diagnosis of pediatric malignancies in a distinct region. Pediatric cancer cases in Bavaria (2016–2021) and SARS-CoV-2 proceedings during the peak phase of the pandemic (2020–2021) were retrospectively analyzed. All new diagnoses of pediatric malignancies reported from cancer centers in Bavaria were included. Clinical data from pre-pandemic years was compared to diagnoses made during the pandemic. Official SARS-CoV-2 reports were received from the Bavarian Health and Food Safety Authority and data on regional pandemic measures were obtained from the Healthcare Data Platform. With this design, a comprehensive analysis of the pandemic proceedings was performed. We found significantly decreased incidence-rate ratios for pediatric cancer diagnosis during the early spring peak of SARS-CoV-2 as it was observed in May during the pandemic, followed by non-significantly increased metastatic cancer diagnosis two months later. Additionally, the time-to-diagnosis of pediatric malignancies was significantly prolonged during the pandemic, and outpatient contacts were significantly reduced, although the availability of consultations remained the same. From our findings, we may hypothesize that there have been effects on pediatric cancer diagnosis during the COVID-19 pandemic at vulnerable times. Interpretation of changes remains speculative with potential causes from behavior patterns, such as hesitation, concerns, and potential societal changes during phases of public restrictions, rather than overwhelmed medical capacities. Nevertheless, specific awareness is needed to protect this patient population during potential future pandemics.
CRIS-Team Scopus Importer:2024-09-13
Keywords: Incidence; pandemic; pediatric malignancies; SARS-CoV-2; time-to-diagnosis

IMPAIRED GENE-EXPRESSION AND EPIGENETIC REGULATION OF RETINOIC ACID RECEPTOR RESPONDER 1 IN PREECLAMPSIA AND CHORIOCARCINOMA - Hübner, Hanna; Fahlbusch, Fabian B.; Strissel, Pamela; Strick, Reiner; Wachter, David; Beckmann, Matthias; Rübner, Matthias (2016)
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Impaired myocardial performance in a normotensive rat model of intrauterine growth restriction - Menendez-Castro, Carlos; Toka, Okan; Fahlbusch, Fabian; Cordasic, Nada; Wachtveitl, Rainer; Hilgers, Karl Friedrich; Rascher, Wolfgang; Hartner, Andrea (Pediatric Research, 2014)
Intrauterine growth restriction (IUGR) is an important risk factor for cardiovascular disease. Previous studies revealed altered myocardial matrix composition after IUGR. We hypothesized that IUGR is accompanied by compromised myocardial performance independently from arterial hypertension.IUGR was induced in Wistar rats by maternal protein restriction, and hearts of male offspring were studied using echocardiography, immunohistochemistry, real-time PCR, and western blot analysis.At day 70 of life, in the absence of arterial hypertension (mean arterial blood pressure: 101.3 ± 7.1 mmHg in IUGR vs. 105.3 ± 4.6 mmHg in controls, not significant (NS)), echocardiography showed a reduced contractility (ejection fraction: 65.4 ± 1.8% in IUGR vs. 82.2 ± 1.5% in controls, P < 0.001) of a more distensible myocardium in IUGR rats. Altered expression patterns of myosin chains and titin isoforms and increased expression levels of atrial natriuretic peptide, Na/K-ATPase, and ?-adrenergic receptor 1 were detected. A higher number of cardiac fibroblasts and vascular cross-sections were observed in IUGR rats, accompanied by elevated expression of hypoxia inducible factor 1 target genes, such as vascular endothelial growth factor and its receptors.We observed a blood pressure-independent impairment of myocardial function after IUGR, which possibly favors cardiovascular disease later in life. Some IUGR-induced myocardial changes (e.g., sarcomeric components) may partly explain the compromised cardiac performance, whereas others (e.g., elevated vascular supply) reflect compensatory mechanisms.
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Impaired Neovascularization and Reduced Capillary Supply in the Malignant vs. Non-malignant Course of Experimental Renovascular Hypertension - Jagusch, Lisa Gudrun; Cordasic, Nada; Amann, Kerstin Ute; Veelken, Roland; Jacobi, Johannes; Hilgers, Karl Friedrich; Hartner, Andrea (Frontiers in Physiology, 2016)
Malignant hypertension develops in some cases of hypertension but not in others. We hypothesized that an impaired neovascularization and a reduced capillary supply characterizes the malignant course of experimental hypertension. Two-kidney, one-clip renovascular hypertension was induced in rats; controls (sham) were sham operated. To distinguish malignant hypertension from non-malignant hypertension, we considered two factors: weight loss, and the number of typical vascular lesions (onion skin lesions and fibrinoid necroses) per kidney section of the nonclipped kidney. Animals in the upper half for both criteria were defined as malignant hypertensives. After 5 weeks, mean arterial blood pressure was elevated to the same degree in malignant hypertension and non-malignant hypertension whereas plasma renin and aldosterone were significantly higher in malignant hypertensives. The expression of plasminogen activator inhibitor-1 was elevated (up to 14-fold) in non-malignant but significantly more increased (up to 36-fold) in malignant hypertensive rats, compared to sham. As a bioassay for neovascularization, the area of granulation tissue ingrowth in polyvinyl discs (implanted subcutaneously) was reduced in malignant hypertension compared to non-malignant hypertension and sham, while there was no difference between non-malignant hypertension and sham. The number of renal and left ventricular capillaries was significantly lower in malignant hypertension compared to non-malignant hypertension, as was the number of proliferating endothelial cells. We conclude that an impaired neovascularization and capillarization occurs in malignant renovascular hypertension but not in the non-malignant course of the disease despite comparable blood pressure levels. This might contribute to the unique vascular lesions and progressive target organ damage observed in malignant hypertension.
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Important aspects of medication safety in pediatric emergencies Wichtige Aspekte zur Medikamentensicherheit bei Kindernotfällen - Kaufmann, Jost; Neubert, Antje; Hoffmann, Florian; Jung, Philipp (Monatsschrift Kinderheilkunde, 2021)
Medication errors represent a threat to patients of all ages. Errors occur more frequently with children than with adults because age group-specific features must be considered, an individual calculation of the dose is necessary and the emergency team cannot be familiar with the dose to be administered. Especially in emergency situations, it is necessary to administer drugs with the high potential for life-threatening complications within a short period of time. Even the wrong placing of a comma when calculating a dose of epinephrine leads to a life-threatening tenfold error. Preclinically, it is often impossible to provide specialized pediatric teams. This CME article analyses the process of drug administration with the typical pitfalls, presents successful interventions and the recommendations of the S2k guidelines on medication safety in pediatric emergencies coordinated by the Association of the Scientific Medical Societies in Germany (AWMF).
CRIS-Team Scopus Importer:2021-10-22
Keywords: Medication errors; Off-label use; Patient safety; Safety management; Weight estimation

Improved upper limb function in non-ambulant children with SMA type 2 and 3 during nusinersen treatment: a prospective 3-years SMArtCARE registry study - Pechmann, Astrid; Behrens, Max; Dörnbrack, Katharina; Tassoni, Adrian; Wenzel, Franziska; Stein, Sabine; Vogt, Sibylle; Zöller, Daniela; Bernert, Günther; Hagenacker, Tim; Schara-Schmidt, Ulrike; Walter, Maggie C.; et al. (Orphanet Journal of Rare Diseases, 2022)
Background: The development and approval of disease modifying treatments have dramatically changed disease progression in patients with spinal muscular atrophy (SMA). Nusinersen was approved in Europe in 2017 for the treatment of SMA patients irrespective of age and disease severity. Most data on therapeutic efficacy are available for the infantile-onset SMA. For patients with SMA type 2 and type 3, there is still a lack of sufficient evidence and long-term experience for nusinersen treatment. Here, we report data from the SMArtCARE registry of non-ambulant children with SMA type 2 and typen 3 under nusinersen treatment with a follow-up period of up to 38 months. Methods: SMArtCARE is a disease-specific registry with data on patients with SMA irrespective of age, treatment regime or disease severity. Data are collected during routine patient visits as real-world outcome data. This analysis included all non-ambulant patients with SMA type 2 or 3 below 18 years of age before initiation of treatment. Primary outcomes were changes in motor function evaluated with the Hammersmith Functional Motor Scale Expanded (HFMSE) and the Revised Upper Limb Module (RULM). Results: Data from 256 non-ambulant, pediatric patients with SMA were included in the data analysis. Improvements in motor function were more prominent in upper limb: 32.4% of patients experienced clinically meaningful improvements in RULM and 24.6% in HFMSE. 8.6% of patients gained a new motor milestone, whereas no motor milestones were lost. Only 4.3% of patients showed a clinically meaningful worsening in HFMSE and 1.2% in RULM score. Conclusion: Our results demonstrate clinically meaningful improvements or stabilization of disease progression in non-ambulant, pediatric patients with SMA under nusinersen treatment. Changes were most evident in upper limb function and were observed continuously over the follow-up period. Our data confirm clinical trial data, while providing longer follow-up, an increased number of treated patients, and a wider range of age and disease severity.
CRIS-Team Scopus Importer:2022-11-04
Keywords: Later-onset; Nusinersen; Sitter; SMArtCARE; Spinal muscular atrophy

Improvements in Walking Distance during Nusinersen Treatment - A Prospective 3-year SMArtCARE Registry Study - Pechmann, Astrid; Behrens, Max; Dörnbrack, Katharina; Tassoni, Adrian; Wenzel, Franziska; Stein, Sabine; Vogt, Sibylle; Zöller, Daniela; Bernert, Günther; Hagenacker, Tim; Schara-Schmidt, Ulrike; Walter, Maggie C.; et al. (Journal of Neuromuscular Diseases, 2023)
BACKGROUND AND OBJECTIVES: Disease progression in patients with spinal muscular atrophy (SMA) has changed dramatically within the past years due to the approval of three different disease-modifying treatments. Nusinersen was the first drug to be approved for the treatment of SMA patients. Clinical trials provided data from infants with SMA type 1 and children with SMA type 2, but there is still insufficient evidence and only scarcely reported long-term experience for nusinersen treatment in ambulant patients. Here, we report data from the SMArtCARE registry of ambulant patients under nusinersen treatment with a follow-up period of up to 38 months. METHODS: SMArtCARE is a disease-specific registry in Germany, Austria and Switzerland. Data are collected as real-world data during routine patient visits. Our analysis included all patients under treatment with nusinersen able to walk independently before start of treatment with focus on changes in motor function. RESULTS: Data from 231 ambulant patients were included in the analysis. During the observation period, 31 pediatric walkers (27.2%) and 31 adult walkers (26.5%) experienced a clinically meaningful improvement of≥30 m in the 6-Minute-Walk-Test. In contrast, only five adult walkers (7.7%) showed a decline in walking distance≥30 m, and two pediatric walkers (1.8%) lost the ability to walk unassisted under treatment with nusinersen. HFMSE and RULM scores improved in pediatric and remained stable in adult patients. CONCLUSION: Our data demonstrate a positive effect of nusinersen treatment in most ambulant pediatric and adult SMA patients. We not only observed a stabilization of disease progression or lack of deterioration, but clinically meaningful improvements in walking distance.
CRIS-Team Scopus Importer:2023-01-20
Keywords: ambulant; nusinersen; SMArtCARE; Spinal muscular atrophy; walker

Improving the Safety of Drug Therapy through a Hospital-Internal Reporting System - Analysis of Reports over 15 Years from a Children's Hospital - Toni, Irmgard; Neubert, Antje; Rascher, Wolfgang (Klinische Pädiatrie, 2020)
BackgroundPatient safety is a major challenge and has high priority in the inpatient care. Notably, drug therapy is considered critical after surgery. The medication process is particularly difficult and problematic in newborns and children. Method In a retrospective analysis, hospital-internal spontaneous reports on Drug-related Problems (DRP) from a children's hospital were analysed, which were reported between 2000 and 2014. Results229 spontaneous reports on DRP were considered for analysis. 72.5% of these were due to a Medication Error. Nearly half of the DRP occurred during drug dispensing (44.5%), followed by problems during administration (38.0%) and prescribing (11.4%). 61.4% of Medication Errors were dispensing errors (esp. confusion of patients, wrong dose). Almost all Other Incidents happened during drug administration (mainly extravasations). 40.6% of DRP reports were associated with clinically relevant patient harm and occurred particularly during drug administration. ConclusionThese results show that drug therapy in paediatrics is a complex and hazardous process. The system of hospital-internal spontaneous reports has led to regular training and raising awareness of the employees for critical situations. In addition, it fosters a safety culture to report mistakes. Spontaneous reporting is suitable for increasing the safety of drug therapy in paediatrics.
CRIS-Team WoS Importer:2020-09-11

Incidence of SCID in Germany from 2014 to 2015 an ESPED* Survey on Behalf of the API*** Erhebungseinheit für Seltene Pädiatrische Erkrankungen in Deutschland (German Paediatric Surveillance Unit) ** Arbeitsgemeinschaft Pädiatrische Immunologie - Shai, Sonu; Perez-Becker, Ruy; Andres, Oliver; Bakhtiar, Shahrzad; Bauman, Ulrich; von Bernuth, Horst; Classen, Carl Friedrich; Dückers, Gregor; El-Helou, Sabine M.; Gangfuß, Andrea; Ghosh, Sujal; Grimbacher, Bodo; et al. (Journal of Clinical Immunology, 2020)
Purpose: Severe combined immunodeficiencies (SCID) are a heterogeneous group of fatal genetic disorders, in which the immune response is severely impaired. SCID can be cured if diagnosed early. We aim to determine the incidence of clinically defined SCID cases, acquire data of reported cases and evaluate their possible prediction by newborn screening, before introduction of a general screening program in Germany. Methods: The German Surveillance Unit for rare Paediatric Diseases (ESPED) prospectively queried the number of incident SCID cases in all German paediatric hospitals in 2014 and 2015. Inclusion criteria were (1) opportunistic or severe infections or clinical features associated with SCID (failure to thrive, lacking thymus or lymphatic tissue, dysregulation of the immune system, graft versus host reaction caused by maternal T cells), (2) dysfunctional T cell immunity or proof of maternal T cells and (3) exclusion of a secondary immunodeficiency such as human immunodeficiency virus (HIV) infection. In a capture-recapture analysis, cases were matched with cases reported to the European Society for Immunodeficiencies (ESID). Results: Fifty-eight patients were initially reported to ESPED, 24 reports could be confirmed as SCID, 21 patients were less than 1 year old at time of diagnosis. One SCID case was reported to ESID only. The estimated incidence of SCID in Germany is 1.6/100,000 (1:62,500) per year in children less than 1 year of age. Most patients reported were symptomatic and mortality in regard to reported outcome was high (29% (6/22)). The majority of incident SCID cases were considered to be probably detectable by newborn screening. Conclusions: SCID is a rare disease with significant mortality. Newborn screening may give the opportunity to improve the prognosis in a significant number of children with SCID.
CRIS-Team Scopus Importer:2020-06-02
Keywords: SCID surveillance newborn screening paediatric incidence

Incidence of Secondary Malignancies After TBI/VP16 Conditioning for Childhood All - Results of the Prospective ALL-SCT-BFM-2003 Trial - Eichinger, Anna; Glogova, Evgenia; Beier, Rita; Guengoer, Tayfun; Stachel, Daniel; Stachel, Daniel; Lang, Peter; Sauer, Martin; Strahm, Brigitte; Schulz, Ansgar; Gruhn, Bernd; Wawer, Angela; et al. (BONE MARROW TRANSPLANTATION, 2020)
CRIS-Team WoS Importer:2021-01-22

Incidence of subsequent malignancies after total body irradiation-based allogeneic HSCT in children with ALL - long-term follow-up from the prospective ALL-SCT 2003 trial - Eichinger, Anna; Poetschger, Ulrike; Glogova, Evgenia; Bader, Peter; Basu, Oliver; Beier, Rita; Burkhardt, Birgit; Classen, Carl-Friedrich; Claviez, Alexander; Corbacioglu, Selim; Deubzer, Hedwig E.; Greil, Johann; et al. (Leukemia, 2022)
Total body irradiation (TBI)-based conditioning is associated with superior leukemia-free survival in children with ALL undergoing HSCT. However, the risk for subsequent malignant neoplasms (SMN) remains a significant concern. We analyzed 705 pediatric patients enrolled in the prospective ALL-SCT-BFM-2003 trial and its subsequent registry. Patients >2 years received conditioning with TBI 12 Gy/etoposide (n = 558) and children <= 2 years of age or with contraindications for TBI received busulfan/cyclophosphamide/etoposide (n = 110). The 5- and 10-year cumulative incidence of SMN was 0.02 +/- 0.01 and 0.13 +/- 0.03, respectively. In total, 39 SMN (34 solid tumors, 5 MDS/AML) were diagnosed in 33 patients at a median of 5.8 years (1.7-13.4), exclusively in the TBI group. Of 33 affected patients, 21 (64%) are alive at a median follow-up of 5.1 years (0-9.9) after diagnosis of their first SMN. In univariate analysis, neither age at HSCT, donor type, acute GVHD, chronic GVHD, nor CMV constituted a significant risk factor for SMN. The only significant risk factor was TBI versus non-TBI based conditioning. This analysis confirms and quantifies the increased risk of SMN in children with ALL after conditioning with TBI. Future strategies to avoid TBI will need careful tailoring within prospective, controlled studies to prevent unfavorable outcomes.
CRIS-Team WoS Importer:2022-09-23

Increased expression of nuclear factor of activated T cells 1 drives IL-9-mediated allergic asthma - Koch, Sonja; Graser, Anna; Mirzakhani, Hooman; Zimmermann, Theodor; Melichar, Volker O.; Woelfel, Marco; Croteau-Chonka, Damien C.; Raby, Benjamin A.; Weiss, Scott T.; Finotto, Susetta (Journal of Allergy and Clinical Immunology, 2016)
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Increased Rat Placental Fatty Acid, but Decreased Amino Acid and Glucose Transporters Potentially Modify Intrauterine Programming - Nuesken, Eva; Gellhaus, Alexandra; Kuehnel, Elisabeth; Swoboda, Isabelle; Wohlfarth, Maria; Vohlen, Christina; Schneider, Holm; Doetsch, Joerg; Nuesken, Kai-Dietrich (Journal of Cellular Biochemistry, 2016)
Regulation of placental nutrient transport significantly affects fetal development and may modify intrauterine growth restriction (IUGR) and fetal programming. We hypothesized that placental nutrient transporters are differentially affected both by utero-placental insufficiency and prenatal surgical stress. Pregnant rats underwent bilateral uterine artery and vein ligation (LIG), sham operation (SOP) or no operation (controls, C) on gestational day E19. Placentas were obtained by caesarean section 4 h (LIG, n=20 placentas; SOP, n=24; C, n=12), 24 h (LIG, n=28; SOP, n=20; C, n=12) and 72 h (LIG, n=20; SOP, n=20; C, n=24) after surgery. Gene and protein expression of placental nutrient transporters for fatty acids (h-FABP, CD36), amino acids (SNAT1, SNAT2) and glucose (GLUT-1, Connexin 26) were examined by qRT-PCR, western blot and immunohistochemistry. Interestingly, the mean protein expression of h-FABP was doubled in placentas of LIG and SOP animals 4, 24 (SOP significant) and 72 h (SOP significant) after surgery. CD36 protein was significantly increased in LIG after 72 h. SNAT1 and SNAT2 protein and gene expressions were significantly reduced in LIG and SOP after 24 h. Further significantly reduced proteins were GLUT-1 in LIG (4 h, 72 h) and SOP (24 h), and Connexin 26 in LIG (72 h). In conclusion, placental nutrient transporters are differentially affected both by reduced blood flow and stress, probably modifying the already disturbed intrauterine milieu and contributing to IUGR and fetal programming. Increased fatty acid transport capacity may affect energy metabolism and could be a compensatory reaction with positive effects on brain development. J. Cell. Biochem. 117: 1594-1603, 2016. © 2015 Wiley Periodicals, Inc.
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Increased risk of chronic fatigue and hair loss following COVID-19 in individuals with hypohidrotic ectodermal dysplasia - Hennig, Verena; Schuh, Wolfgang; Neubert, Antje; Mielenz, Dirk; Jäck, Hans-Martin; Schneider, Holm (Orphanet Journal of Rare Diseases, 2021)
Background: Hypohidrotic ectodermal dysplasia (HED) is a group of genodermatoses in which deficient ectodysplasin A signalling leads to maldevelopment of skin appendages, various eccrine glands, and teeth. Individuals with HED often have disrupted epithelial barriers and, therefore, were suspected to be more susceptible to coronavirus infection. Methods: 56 households with at least one member who had coronavirus disease of 2019 (COVID-19) were enrolled in a longitudinal study to compare the course of illness, immune responses, and long-term consequences of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection in HED patients (n = 15, age 9–52 years) and control subjects of the same age group (n = 149). Results: In 14 HED patients, mild or moderate typical COVID-19 symptoms were observed that lasted for 4–45 days. Fever during the first days sometimes required external cooling measures. The course of COVID-19 was similar to that in control subjects if patients developed antibodies blocking the SARS-CoV-2 spike protein. Five out of six HED patients with completely abrogated ectodysplasin A signalling (83%) suffered from chronic, in two cases very severe fatigue following COVID-19, while only 25% of HED patients with residual activity of this pathway and 21% of control subjects recovering from COVID-19 experienced postinfectious fatigue. Hair loss after COVID-19 was also more frequent among HED patients (64%) than in the control group (13%). Conclusions: HED appears to be associated with an increased risk of long-term consequences of a SARS-CoV-2 infection. Preventive vaccination against COVID-19 should be recommended for individuals affected by this rare genetic disorder.
CRIS-Team Scopus Importer:2021-09-17
Keywords: Chronic fatigue; COVID-19; Hair loss; Hypohidrotic ectodermal dysplasia; SARS-CoV-2

Increased salt consumption induces body water conservation and decreases fluid intake - Rakova, Natalia; Kitada, Kento; Lerchl, Kathrin; Dahlmann, Anke; Birukov, Anna; Daub, Steffen; Kopp, Christoph; Pedchenko, Tetyana; Zhang, Yahua; Beck, Luis; Johannes, Bernd; Marton, Adriana; et al. (Journal of Clinical Investigation, 2017)
BACKGROUND: The idea that increasing salt intake increases drinking and urine volume is widely accepted. We tested the hypothesis that an increase in salt intake of 6 g/d would change fluid balance in men living under ultra-long-term controlled conditions. METHODS: Over the course of 2 separate space flight simulation studies of 105 and 205 days' duration, we exposed 10 healthy men to 3 salt intake levels (12, 9, or 6 g/d). All other nutrients were maintained constant. We studied the effect of salt-driven changes in mineralocorticoid and glucocorticoid urinary excretion on day-to-day osmolyte and water balance. RESULTS: A 6-g/d increase in salt intake increased urine osmolyte excretion, but reduced free-water clearance, indicating endogenous free water accrual by urine concentration. The resulting endogenous water surplus reduced fluid intake at the 12-g/d salt intake level. Across all 3 levels of salt intake, half-weekly and weekly rhythmical mineralocorticoid release promoted free water reabsorption via the renal concentration mechanism. Mineralocorticoid-coupled increases in free water reabsorption were counterbalanced by rhythmical glucocorticoid release, with excretion of endogenous osmolyte and water surplus by relative urine dilution. A 6-g/d increase in salt intake decreased the level of rhythmical mineralocorticoid release and elevated rhythmical glucocorticoid release. The projected effect of salt-driven hormone rhythm modulation corresponded well with the measured decrease in water intake and an increase in urine volume with surplus osmolyte excretion. CONCLUSION: Humans regulate osmolyte and water balance by rhythmical mineralocorticoid and glucocorticoid release, endogenous accrual of surplus body water, and precise surplus excretion. FUNDING: Federal Ministry for Economics and Technology/DLR; the Interdisciplinary Centre for Clinical Research; the NIH; the American Heart Association (AHA); the Renal Research Institute; and the TOYOBO Biotechnology Foundation. Food products were donated by APETITO, Coppenrath und Wiese, ENERVIT, HIPP, Katadyn, Kellogg, Molda, and Unilever.
EVALuna2:34240

Increase of liver stiffness and altered bile acid metabolism after triple CFTR modulator initiation in children and young adults with cystic fibrosis - Schnell, Alexander; Jüngert, Jörg M.; Klett, Daniel; Hober, Hannah; Kaiser, Natalie; Ruppel, Renate; Geppert, Annika; Tremel, Christina; Sobel, Julia; Plattner, Erika; Schmitt-Grohe, Sabina; Zirlik, Sabine; et al. (Liver International, 2023)
Background: Novel cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies (elexacaftor/tezacaftor/ivacaftor—ETI) promise clinically significant and sustained improvements for patients with cystic fibrosis (CF). In this study, we investigated the impact of ETI therapy on liver stiffness and bile acid metabolism in a cohort of children and young adults with CF. Methods: A prospective observational study (NCT05576324) was conducted from September 2020 to November 2021 enrolling CF patients naive to ETI. Standard laboratory chemistry, sweat test, lung function, share wave velocity (SWV) derived by acoustic radiation force impulse imaging (ARFI) and serum bile acid profiles were assessed before and 6 months after induction of ETI therapy. Results: A total of 20 patients (10 aged <20 years) completed the study. While lung function and BMI improved after ETI therapy, ARFI SWV increased in CF patients <20 years of age (from 1.27 to 1.43 m/s, p = 0.023). Bile acid (BA) profiles revealed a decrease in unconjugated (5.75 vs 1.46, p = 0.007) and increase in glycine-conjugated derivatives (GCDCA) (4.79 vs 6.64 p = 0.016). There was a positive correlation between ARFI SWV values and GCDCA (r = 0.80, p < 0.0001). Glycine-conjugated BA provided high diagnostic accuracy to predict increased ARFI measurements (AUC 0.90) and clinical (Colombo) CFLD grading (AUC 0.97). Conclusions: ARFI SWV and bile acid profiles provide evidence for early increase in liver stiffness and altered bile acid metabolism in young CF patients after initiation of ETI and may serve as synergistic measures for detection of hepatic complications during ETI therapy.
CRIS-Team Scopus Importer:2023-03-17
Keywords: ARFI; bile acids; CFLD; cystic fibrosis

Indirect determination of hematology reference intervals in adult patients on Beckman Coulter UniCell DxH 800 and Abbott CELL-DYN Sapphire devices - Zierk, Jakob; Arzideh, Farhad; Haeckel, Rainer; Rauh, Manfred; Metzler, Markus; Ganslandt, Thomas; Krause, Stefan (Clinical Chemistry and Laboratory Medicine, 2018)
Background Conventional establishment of reference intervals for hematological analytes is challenging due to the need to recruit healthy persons. Indirect methods address this by deriving reference intervals from clinical laboratory databases which contain large datasets of both physiological and pathological test results. Methods We used the "Reference Limit Estimator" (RLE) to establish reference intervals for common hematology analytes in adults aged 18-60 years. One hundred and ninety-five samples from 44,519 patients, measured on two different devices in a tertiary care center were analyzed. We examined the influence of patient cohorts with an increasing proportion of abnormal test results, compared sample selection strategies, explored inter-device differences, and analyzed the stability of reference intervals in simulated datasets with varying overlap of pathological and physiological test results. Results Reference intervals for hemoglobin, hematocrit, red cell count and platelet count remained stable, even if large numbers of pathological samples were included. Reference intervals for red cell indices, red cell distribution width and leukocyte count were sufficiently stable, if patient cohorts with the highest fraction of pathological samples were excluded. In simulated datasets, estimated reference limits shifted, if the pathological dataset contributed more than 15%-20% of total samples and approximated the physiological distribution. Advanced sample selection techniques did not improve the algorithm's performance. Inter-device differences were small except for red cell distribution width. Conclusions The RLE is well-suited to create reference intervals from clinical laboratory databases even in the challenging setting of a adult tertiary care center. The procedure can be used as a complement for reference interval determination where conventional approaches are limited.
EVALuna2:34837

Indirect determination of serum creatinine reference intervals in a Pakistani pediatric population using big data analytics - Ahmed, Sibtain; Zierk, Jakob; Siddiqui, Imran; Khan, Aysha Habib (World Journal of Clinical Pediatrics, 2021)
BACKGROUND The indirect methods of reference intervals (RI) establishment based on data mining are utilized to overcome the ethical, practical challenges and the cost associated with the conventional direct approach. AIM To generate RIs for serum creatinine in children and adolescents using an indirect statistical tool. METHODS Data mining of the laboratory information system was performed for serum creatinine analyzed from birth to 17 years for both genders. The timeline was set at six years from January 2013 to December 2018. Microsoft Excel 2010 and an indirect algorithm developed by the German Society of Clinical Chemistry and Laboratory Medicine’s Working Group on Guide Limits were used for the data analysis. RESULTS Data were extracted from 96104 samples and after excluding multiple samples for the same individual, we calculated RIs for 21920 males and 14846 females, with stratification into six discrete age groups. CONCLUSION Serum creatinine dynamics varied significantly across gender and age groups.
CRIS-Team Scopus Importer:2021-08-06
Keywords: Creatinine; Data mining; Indirect; Pakistan; Pediatric; Reference intervals

Induction and coexpression of latent transforming growth factor β-binding protein-1 and fibrillin-1 in experimental glomerulonephritis - Porst, Markus; Daniel, Christoph; Plank, Christian; Schocklmann, Harald O.; Reinhardt, Dieter P.; Hartner, Andrea (Nephron Experimental Nephrology, 2006)
Background: Latent transforming growth factor-β-binding protein 1 (LTBP-1) and fibrillin-1 were shown to colocalize and interact in the extracellular matrix of the skin and vasculature. This interaction may regulate transforming growth factor-β (TGF-β) activity. TGF-β is an important progression factor for glomerular diseases. We hypothesized that LTBP-1 and fibrillin-1 are coexpressed in the glomerulus and upregulated during glomerulonephritis. Methods: Acute anti-Thy1.1 glomerulonephritis was induced with a single intravenous injection (1 mg/kg body weight) of a monoclonal anti-Thy1.1 antibody in rats. Real-time RT-PCR and immunohistochemical analyses for LTBP-1 and fibrillin-1 were performed. Results: Induction of glomerular LTBP-1 mRNA was detected on day 2 of disease, while mRNA for fibrillin-1 was already upregulated 1 day after induction of disease. Both LTBP-1 and fibrillin-1 showed a mesangial distribution. An expansion of the LTBP-1 and fibrillin-1-positive mesangial area was seen on day 6 of disease, when transient matrix accumulation was most prominent. On day 12 of disease, glomerular LTBP-1 and fibrillin-1 immunoreactivities had returned to control levels. In serial sections, some colocalization of LTBP-1 and fibrillin-1 was detected in control as well as in nephritic glomeruli. Conclusion: Mesangial expression of LTBP-1 and fibrillin-1 is induced early in experimental nephritis and LTBP-1 and fibrillin-1 are partially colocalized in the nephritic glomerulus. An interaction of these molecules could stabilize latent TGF-β complexes and thus attenuate the activation of TGF-β during this self-limited glomerular disease. Copyright © 2006 S. Karger AG.
Created from Fastlane, Scopus look-up
Keywords: Anti-Thy1.1 nephritis; Extracellular matrix; Glomerulus; Mesangial cells; Microfibrillar proteins; Transforming growth factor-β

INFANTS AND NEWBORNS WITH ATYPICAL TERATOID/RHABDOID TUMORS (ATRT) AND EXTRACRANIAL MALIGNANT RHABDOID TUMORS: A UNIQUE AND CHALLENGING POPULATION - Nemes, Karolina; Johann, Pascal D.; Steinbuegl, Mona; Gruhle, Miriam; Bens, Susanne; Kachanov, Denis; Teleshova, Margarita; Peter, Hauser; Simon, Thorsten; Tippelt, Stephan; Eberl, Wolfgang; Chada, Martin; et al. (NEURO-ONCOLOGY, 2022)
CRIS-Team WoS Importer:2022-09-02

Infants and Newborns with Atypical Teratoid Rhabdoid Tumors (ATRT) and Extracranial Malignant Rhabdoid Tumors (eMRT) in the EU-RHAB Registry: A Unique and Challenging Population - Nemes, Karolina; Johann, Pascal D.; Steinbügl, Mona; Gruhle, Miriam; Bens, Susanne; Kachanov, Denis; Teleshova, Margarita; Hauser, Peter; Simon, Thorsten; Tippelt, Stephan; Eberl, Wolfgang; Chada, Martin; et al. (Cancers, 2022)
Introduction: Malignant rhabdoid tumors (MRT) predominantly affect infants and young children. Patients below six months of age represent a particularly therapeutically challenging group. Toxicity to developing organ sites limits intensity of treatment. Information on prognostic factors, genetics, toxicity of treatment and long-term outcomes is sparse. Methods: Clinical, genetic, and treatment data of 100 patients (aged below 6 months at diagnosis) from 13 European countries were analyzed (2005–2020). Tumors and matching blood samples were examined for SMARCB1 mutations using FISH, MLPA and Sanger sequencing. DNA methylation subgroups (ATRT-TYR, ATRT-SHH, and ATRT-MYC) were determined using 450 k/850 k-profiling. Results: A total of 45 patients presented with ATRT, 29 with extracranial, extrarenal (eMRT) and 9 with renal rhabdoid tumors (RTK). Seventeen patients demonstrated synchronous tumors (SYN). Metastases (M+) were present in 27% (26/97) at diagnosis. A germline mutation (GLM) was detected in 55% (47/86). DNA methylation subgrouping was available in 50% (31 / 62) with ATRT or SYN; for eMRT, methylation-based subgrouping was not performed. The 5-year overall (OS) and event free survival (EFS) rates were 23.5 ± 4.6% and 19 ± 4.1%, respectively. Male sex (11 ± 5% vs. 35.8 ± 7.4%), M+ stage (6.1 ± 5.4% vs. 36.2 ± 7.4%), presence of SYN (7.1 ± 6.9% vs. 26.6 ± 5.3%) and GLM (7.7 ± 4.2% vs. 45.7 ± 8.6%) were significant prognostic factors for 5-year OS. Molecular subgrouping and survival analyses confirm a previously described survival advantage for ATRT-TYR. In an adjusted multivariate model, clinical factors that favorably influence the prognosis were female sex, localized stage, absence of a GLM and maintenance therapy. Conclusions: In this cohort of homogenously treated infants with MRT, significant predictors of outcome were sex, M-stage, GLM and maintenance therapy. We confirm the need to stratify which patient groups benefit from multimodal treatment, and which need novel therapeutic strategies. Biomarker-driven tailored trials may be a key option.
CRIS-Team Scopus Importer:2022-05-13
Keywords: atypical teratoid rhabdoid tumors; EU-RHAB registry; extracranial malignant rhabdoid tumor; germline mutation; RTPS1; RTPS2; SMARCB1

Infliximab therapy of relapsing tracheal stenosis in a pediatric patient with granulomatosis with polyangiitis: a case report - Schnell, Alexander; Ruppel, Renate; Tremel, Christina; Galiano, Matthias; Meßbacher, Maria-Elena; Krickau, Tobias (Journal of Medical Case Reports, 2022)
Background: Granulomatosis with polyangiitis is a granulomatous, necrotizing small-vessel vasculitis affecting both children and adults. However, subglottic tracheal stenosis appears more frequently in the pediatric cohort. To date, granulomatosis with polyangiitis is often treated with steroids, cyclophosphamide, azathioprine, or rituximab, but tumor-necrosis-factor-α-antagonistic drugs are increasingly gaining significance in treatment of refractory cases. Case presentation: We report the case of a 15-year-old Caucasian male diagnosed with proteinase-3-positive granulomatosis with polyangiitis with acute shortness of breath. X-ray and magnet resonance imaging showed extensive subglottic narrowing. Forced expiratory volume in 1 s was reduced to 50% of age norm, with massively increased effective airway resistance. The patient initially responded very well to high-dose steroids and maintenance therapy with azathioprine. He was subsequently treated with four doses of rituximab, and levels of proteinase 3 antibodies normalized. After 6 months of clinical remission, the patient presented again with acute respiratory symptoms. Again, he was treated with high-dose steroids, but showed poor clinical response this time. Therefore, we decided to commence a tumor-necrosis-factor-α-antagonistic treatment with infliximab, under which our patient achieved clinical remission and normalization of lung function parameters. Conclusions: The use of tumor-necrosis-factor-α-antagonistic agents might be a promising alternative for the treatment of refractory tracheal stenosis in pediatric patients with granulomatosis with polyangiitis.
CRIS-Team Scopus Importer:2022-04-15
Keywords: Children; Granulomatosis with polyangiitis; TNF-α inhibitor; Tracheal stenosis

Influence of factor XIII activity on post-operative transfusion in congenital cardiac surgery-A retrospective analysis - Fahlbusch, Fabian B.; Heinlein, Thomas; Rauh, Manfred; Dittrich, Sven; Cesnjevar, Robert; Moosmann, Julia; Nadal, Jennifer; Schmid, Matthias; Münch, Frank; Schroth, Michael; Rascher, Wolfgang; Topf, Hans-Georg (PLoS ONE, 2018)
OBJECTIVES: Coagulation factor XIII (FXIII) plays a key role in fibrin clot stabilization-an essential process for wound healing following cardiothoracic surgery. However, FXIII deficiency as a risk for post-operative bleeding in pediatric cardiac surgery involving cardiopulmonary bypass (CPB) for congenital heart disease (CHD) is controversially discussed. Thus, as primary outcome measures, we analyzed the association of pre-operative FXIII activity and post-operative chest tube drainage (CTD) loss with transfusion requirements post-operatively. Secondary outcomes included the influence of cyanosis and sex on transfusion. METHODS: Our retrospective analysis (2009-2010) encompassed a single center series of 76 cardio-surgical cases with CPB (0-17 years, mean age 5.61 years) that were post-operatively admitted to our pediatric intensive care unit (PICU). The observational period was 48 hours after cardiac surgery. Blood cell counts and coagulation status, including FXIII activity were routinely performed pre- and post-operatively. The administered amount of blood products and volume expanders was recorded electronically, along with the amount of CTD loss. Uni- and multivariate logistic regression analysis was performed to calculate the associations (odds ratios) of variables with post-operative transfusion needs. RESULTS: FXIII activities remained stable following CPB surgery. There was no association of pre- and post-operative FXIII activities and transfusion of blood products or volume expanders in the first 48 hours after surgery. Similarly, FXIII showed no association with CTD loss. Cyanosis and female sex were associated with transfusion rates. CONCLUSIONS: Although essentially involved in wound healing and clotting after surgery, FXIII activity does not serve as a valid predictor of post-operative transfusion need.
EVALuna2:35481

Influence of labor on direct and indirect determinants of placental 11beta-hydroxysteroid dehydrogenase activity - Hübner, Hanna; Heussner, Kirsten; Rübner, Matthias; Schmid, Matthias; Nadal, Jennifer; Wölfle, Joachim; Hartner, Andrea; Menendez-Castro, Carlos; Rauh, Manfred; Beckmann, Matthias; Kehl, Sven; Fahlbusch, Fabian (Archives of Gynecology and Obstetrics, 2020)
Purpose: Labor is a complex process involving multiple para-, auto- and endocrine cascades. The interaction of cortisol, corticotropin-releasing hormone (CRH) and progesterone is essential. The action of cortisol on the human feto-placental unit is regulated by 11beta-hydroxysteroid dehydrogenase type 2 (11β-HSD2/HSD11B2) that converts cortisol into inactive cortisone. The majority of studies on the assessment of placental 11β-HSD2 function determined indirect activity parameters. It remains elusive if indirect measurements correlate with enzymatic function and if these parameters are affected by potential confounders (e.g., mode of delivery). Thus, we compared determinants of indirect 11β-HSD2 tissue activity with its direct enzymatic turnover rate in placental samples from spontaneous births and cesarean (C)-sections. Methods: Using LC–MS/MS, we determined CRH, cortisol, cortisone, progesterone and 17-hydroxy(OH)-progesterone in human term placentas (spontaneous birth vs. C-section, n = 5 each) and measured the enzymatic glucocorticoid conversion rates in placental microsomes. Expression of HSD11B1, 2 and CRH was determined via qRT-PCR in the same samples. Results: Cortisol–cortisone ratio correlated with direct microsomal enzymatic turnover. While this observation seemed independent of sampling site, a strong influence of mode of delivery on tissue steroids was observed. The mRNA expression of HSD11B2 correlated with indirect and direct cortisol turnover rates in C-section placentas only. In contrast to C-sections, CRH, cortisol and cortisone levels were significantly increased in placental samples following spontaneous birth. Conclusion: Labor involves a series of complex hormonal processes including activation of placental CRH and glucocorticoid metabolism. This has to be taken into account when selecting human cohorts for comparative analysis of placental steroids.
CRIS-Team Scopus Importer:2020-09-11
Keywords: 11beta-hydroxysteroid dehydrogenase; CRH; LC–MS/MS; Mode of delivery; Placenta

Influence of Low Protein Diet-Induced Fetal Growth Restriction on the Neuroplacental Corticosterone Axis in the Rat - Schmidt, Marius; Rauh, Manfred; Schmid, Matthias C.; Hübner, Hanna; Rübner, Matthias; Wachtveitl, Rainer; Cordasic, Nada; Rascher, Wolfgang; Menendez-Castro, Carlos; Hartner, Andrea; Fahlbusch, Fabian B. (Frontiers in Endocrinology, 2019)
Objectives: Placental steroid metabolism is linked to the fetal hypothalamus-pituitary-adrenal axis. Intrauterine growth restriction (IUGR) might alter this cross-talk and lead to maternal stress, in turn contributing to the pathogenesis of anxiety-related disorders of the offspring, which might be mediated by fetal overexposure to, or a reduced local enzymatic protection against maternal glucocorticoids. So far, direct evidence of altered levels of circulating/local glucocorticoids is scarce. Liquid chromatography tandem-mass spectrometry (LC-MS/MS) allows quantitative endocrine assessment of blood and tissue. Using a rat model of maternal protein restriction (low protein [LP] vs. normal protein [NP]) to induce IUGR, we analyzed fetal and maternal steroid levels via LC-MS/MS along with the local expression of 11beta-hydroxysteroid- dehydrogenase (Hsd11b).
CRIS-Team WoS Importer:2019-03-20

Influence of passive mechanical properties in healthy and infarcted rat myocardium on the cardiac cycle - Martonová, Denisa; Alkassar, Muhannad; Seufert, Julia; Holz, David; Duong, Minh Tuan; Reischl, Barbara; Friedrich, Oliver; Leyendecker, Sigrid (Proc. Appl. Math. Mech. (PAMM), 2021)

Influence of PCO2 Control on Clinical and Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants - Thome, Ulrich H.; Dreyhaupt, Jens; Genzel-Boroviczeny, Orsolya; Bohnhorst, Bettina; Schmid, Manuel; Fuchs, Hans; Rohde, Oliver; Avenarius, Stefan; Topf, Hans-Georg; Zimmermann, Andrea; Faas, Dirk; Timme, Katharina; et al. (Neonatology, 2018)
BACKGROUND: Levels or fluctuations in the partial pressure of CO2 (PCO2) may affect outcomes for extremely low birth weight infants. OBJECTIVES: In an exploratory analysis of a randomized trial, we hypothesized that the PCO2 values achieved could be related to significant outcomes. METHODS: On each treatment day, infants were divided into 4 groups: relative hypocapnia, normocapnia, hypercapnia, or fluctuating PCO2. Ultimate assignment to a group for the purpose of this analysis was made according to the group in which an infant spent the most days. Statistical analyses were performed with analysis of variance (ANOVA), the Kruskal-Wallis test, the χ2 test, and the Fisher exact test as well as by multiple logistic regression. RESULTS: Of the 359 infants, 57 were classified as hypocapnic, 230 as normocapnic, 70 as hypercapnic, and 2 as fluctuating PCO2. Hypercapnic infants had a higher average product of mean airway pressure and fraction of inspired oxygen (MAP × FiO2). For this group, mortality was higher, as was the likelihood of having moderate/severe bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and poorer neurodevelopment. Multiple logistic regression analyses showed an increased risk for BPD or death associated with birth weight (p < 0.001) and MAP × FiO2 (p < 0.01). The incidence of adverse neurodevelopment was associated with birth weight (p < 0.001) and intraventricular hemorrhage (IVH; p < 0.01). CONCLUSIONS: Birth weight and respiratory morbidity, as measured by MAP × FiO2, were the most predictive of death or BPD and NEC, whereas poor neurodevelopmental outcome was associated with low birth weight and IVH. Univariate models also identified PCO2. Thus, hypercapnia seems to reflect greater disease severity, a likely contributor to differences in outcomes.
EVALuna2:35728

Influence of prenatal environment and genetic background on glucocorticoid steroid metabolism in monozygotic twins with intra-twin birthweightdifferences - Schulte, Sandra; Schreiner, Felix; Plamper, Michaela; Kasner, Charlotte; Gruenewald, Mathias; Bartmann, Peter Bartmann; Fimmers, Rolf; Hartmann, Michaela F.; Wudy, Stefan A.; Wölfle, Joachim; Gohlke, Bettina (HORMONE RESEARCH IN PAEDIATRICS, 2022)
CRIS-Team WoS Importer:2022-10-07

Influence of Prenatal Environment on Androgen Steroid Metabolism In Monozygotic Twins With Birthweight Differences - Schulte, Sandra; Schreiner, Felix; Plamper, Michaela; Kasner, Charlotte; Gruenewald, Mathias; Bartmann, Peter; Fimmers, Rolf; Hartmann, Michaela F.; Wudy, Stefan A.; Stoffel-Wagner, Birgit; Wölfle, Joachim; Gohlke, Bettina (Journal of Clinical Endocrinology and Metabolism, 2020)
OBJECTIVE: Although low birthweight (bw) and unfavorable intrauterine conditions have been associated with metabolic sequelae in later life, little is known about their impact on steroid metabolism. We studied genetically identical twins with intra-twin bw-differences from birth to adolescence to analyze the long-term impact of bw on steroid metabolism. METHODS: 68 monozygotic twin pairs with a bw-difference of <1 standard deviation score (SDS; concordant; n = 41) and ≥1 SDS (discordant; n = 27) were recruited. At 14.9 years (mean age), morning urine samples were collected and analyzed with gas chromatography-mass-spectrometry. RESULTS: No significant differences were detected in the concordant group. In contrast, in the smaller twins of the discordant group, we found significantly higher concentrations not only of the dehydroepiandrosterone sulfate (DHEAS) metabolite 16α-OH-DHEA (P = 0.001, 656.11 vs 465.82 µg/g creatinine) but also of cumulative dehydroepiandrosterone and downstream metabolites (P = 0.001, 1650.22 vs 1131.92 µg/g creatinine). Relative adrenal (P = 0.002, 0.25 vs 0.18) and overall androgen production (P = 0.001, 0.79 vs 0.65) were significantly higher in the formerly smaller discordant twins. All twin pairs exhibited significant intra-twin correlations for all individual steroid metabolites, sums of metabolites, indicators of androgen production, and enzyme activities. Multiple regression analyses of the smaller twins showed that individual steroid concentrations of the larger co-twin were the strongest influencing factor among nearly all parameters analyzed. CONCLUSION: In monozygotic twin pairs with greater intra-twin bw-differences (≥1 SDS), we found that bw had a long-lasting impact on steroid metabolism, with significant differences regarding DHEAS metabolites and relative androgen production. However, most parameters showed significant intra-twin correlations, suggesting a consistent interrelationship between prenatal environment, genetic background, and steroid metabolism.
CRIS-Team Scopus Importer:2020-09-04
Keywords: androgens; androgen production; fetal programming; low birthweight; steroid hormones; twin-to-twin transfusion syndrome

Influence of the autotaxin-lysophosphatidic acid axis on cellular function and cytokine expression in different breast cancer cell lines - Hauck, Theresa; Kadam, Sheetal; Heinz, Katharina; Garcia Peraza, Maria; Schmid, Rafael; Kremer, Andreas; Wolf, Katharina; Bauer, Alina; Horch, Raymund E.; Arkudas, Andreas; Kengelbach-Weigand, Annika (Scientific Reports, 2022)
Previous studies provide high evidence that autotaxin (ATX)-lysophosphatidic acid (LPA) signaling through LPA receptors (LPAR) plays an important role in breast cancer initiation, progression, and invasion. However, its specific role in different breast cancer cell lines remains to be fully elucidated to offer improvements in targeted therapies. Within this study, we analyzed in vitro the effect of LPA 18:1 and the LPAR1, LPAR3 (and LPAR2) inhibitor Ki16425 on cellular functions of different human breast cancer cell lines (MDA-MB-231, MDA-MB-468, MCF-7, BT-474, SKBR-3) and the human breast epithelial cell line MCF-10A, as well as Interleukin 8 (IL-8), Interleukin 6 (IL-6) and tumor necrosis factor (TNF)-alpha cytokine secretion after LPA-incubation. ATX-LPA signaling showed a dose-dependent stimulatory effect especially on cellular functions of triple-negative and luminal A breast cancer cell lines. Ki16425 inhibited the LPA-induced stimulation of triple-negative breast cancer and luminal A cell lines in variable intensity depending on the functional assay, indicating the interplay of different LPAR in those assays. IL-8, IL-6 and TNF-alpha secretion was induced by LPA in MDA-MB-468 cells. This study provides further evidence about the role of the ATX-LPA axis in different breast cancer cell lines and might contribute to identify subtypes suitable for a future targeted therapy of the ATX-LPA axis.
CRIS-Team Scopus Importer:2022-04-15
Keywords: Cancer; Medical research; Molecular medicine

Influence of Timing of Antenatal Corticosteroid Administration on Morbidity of Preterm Neonates - Morhart, Patrick; Gärtner, Janis; Weiss, Christel; Stumpfe, Florian; Dammer, Ulf; Faschingbauer, Florian; Fahlbusch, Fabian; Beckmann, Matthias; Kehl, Sven (In Vivo, 2022)
Background/Aim: We investigated the impact of the timing of antenatal corticosteroid (ACS) administration on the clinical outcome of preterm infants. Patients and Methods: Two hundred and fifty-five preterm infants between 28+0 and 34+0 weeks of gestation were retrospectively assigned to one of two groups: In the first group, ACS was given within 7 days before birth; the second group, did not receive ACS during that period. The primary outcome parameter was respiratory failure (defined by need for continuous positive airway pressure or mechanical ventilation) due to grade 1-4 respiratory distress syndrome (RDS). Secondary outcomes included the rates of intraventricular hemorrhage (IVH), periventricular leukomalacia, and necrotizing enterocolitis. Results: The rate of RDS was significantly higher in the no ACS group (40% vs. 62%, p=0.0009), especially of the more severe grades 24 (n=37 vs. n=48, p=0.0121). In addition, IVH (1% vs. 9%, p=0.0041) and neonatal infections (72% vs. 89%, p=0.0025) were significantly increased. Univariable and multivariable regression analyses showed a lower likelihood of RDS in the ACS group [odds ratio (OR)=0.295] in infants born closer to term (OR=0.907) and following preterm onset of labor (OR=0.495). Similarly, we observed a lower probability of IVH in the ACS group (OR=0.098), with a higher probability of occurrence of IVH in pre-eclampsia/HELLP syndrome (hemolysis, elevated liver enzyme levels, low platelet count) (OR=7.914). Conclusion: ACS treatment within the last 7 days before birth significantly reduced the risk of RDS and IVH in preterm. These data emphasize that the timing of ACS administration determines its success.
CRIS-Team WoS Importer:2022-07-15

Influence of Turkish origin on hematology reference intervals in the German population - Mayr, Franz Xaver; Bertram, Alexander; Cario, Holger; Frühwald, Michael C.; Groß, Hans Jürgen; Groening, Arndt; Grützner, Stefanie; Gscheidmeier, Thomas; Hoffmann, Reinhard; Krebs, Alexander; Ruf, Hans Georg; Torge, Antje; et al. (Scientific Reports, 2021)
Reference intervals for laboratory test results have to be appropriate for the population in which they are used to be clinically useful. While sex and age are established partitioning criteria, patients’ origin also influences laboratory test results, but is not commonly considered when creating or applying reference intervals. In the German population, stratification for ethnicity is rarely performed, and no ethnicity-specific hematology reference intervals have been reported yet. In this retrospective study, we investigated whether specific reference intervals are warranted for the numerically largest group of non-German descent, individuals originating from Turkey. To this end, we analyzed 1,314,754 test results from 167,294 patients from six German centers. Using a name-based algorithm, 1.9% of patients were identified as originating from Turkey, in line with census data and the algorithm’s sensitivity. Reference intervals and their confidence intervals were calculated using an indirect data mining approach, and Turkish and non-Turkish reference limits overlapped completely or partially in nearly all analytes, regardless of age and sex, and only 5/144 (3.5%) subgroups’ reference limits showed no overlap. We therefore conclude that the current practice of using common reference intervals is appropriate and allows correct clinical decision-making in patients originating from Turkey.
CRIS-Team Scopus Importer:2021-11-05

Inhibition of activator protein 1 signaling abrogates transforming growth factor β-mediated activation of fibroblasts and prevents experimental fibrosis - Avouac, Jerome; Palumbo, Katrin; Tomcik, Michal; Zerr, Pawel; Dees, Clara; Horn, Angelika; Maurer, Britta; Akhmetshina, Alfiya; Beyer, Christian; Sadowski, Anika; Schneider, Holm; Shiozawa, Shunichi; et al. (Arthritis and Rheumatism, 2012)
Objective To investigate whether c-Jun and c-Fos contribute to the pathologic activation of fibroblasts in systemic sclerosis (SSc) and to evaluate the antifibrotic potential of selective activator protein 1 (AP-1) inhibition. Methods Expression of c-Jun and c-Fos was determined by real-time polymerase chain reaction (PCR) and immunohistochemical analysis. Fibroblasts were stimulated with transforming growth factor β (TGFβ) and incubated with T-5224, a small-molecule inhibitor of AP-1, or were transfected with small interfering RNA (siRNA) duplexes against c-Jun and c-Fos. Collagen synthesis was quantified by real-time PCR and hydroxyproline assay. Differentiation of resting fibroblasts into myofibroblasts was assessed by staining for α-smooth muscle actin and stress fibers. The antifibrotic potential of T-5224 was evaluated in mouse models of dermal fibrosis induced by bleomycin or by adenoviral overexpression of a constitutively active TGFβ receptor type I. Results Up-regulation of c-Jun and c-Fos was detected in mouse models of SSc and in the skin and dermal fibroblasts of patients with SSc. Stimulation of healthy fibroblasts with TGFβ induced the expression of c-Jun and c-Fos. Treatment with T-5224 or nucleofection with siRNA directed against c-Jun and c-Fos abrogated the profibrotic effects of TGFβ. T-5224 decreased the release of collagen selectively in SSc fibroblasts. T-5224 was well tolerated and prevented dermal fibrosis induced by bleomycin or by adenoviral activation of TGFβ signaling. Conclusion AP-1 is up-regulated in a TGFβ-dependent manner in SSc. The selective AP-1 inhibitor T-5224 reduced collagen synthesis selectively in SSc fibroblasts and efficiently prevented the development of experimental dermal fibrosis. Thus, AP-1 might be a promising new molecular target for the treatment of SSc. Copyright © 2012 by the American College of Rheumatology.
CRIS-Team Scopus Importer:2020-07-01

Inhibition of sumoylation prevents experimental fibrosis - Khodzhigorova, Aisa; Distler, Alfiya; Lang, Veronika; Dees, Clara; Schneider, Holm; Beyer, Christian; Gelse, Kolja; Distler, Oliver; Schett, Georg; Distler, Jörg (Annals of the Rheumatic Diseases, 2012)
Objectives: Fibrosis is a predominant cause of death in systemic sclerosis (SSc). First epigenetic modifications have recently been shown to contribute to activation of SSc fibroblasts. Here, we investigated inhibition of sumoylation as a novel antifibrotic approach. Methods: Sumoylation was inhibited by siRNA-mediated knockdown of the Small Ubiquitin-like MOdifiers (SUMO) E2-conjugating enzyme Ubc9, which is essential for sumoylation. The effects of knockdown of Ubc9 were analysed in bleomycin-induced dermal fibrosis, and in the model of fibrosis induced by overexpression of a constitutively active TGF-beta receptor type I (TBR). SUMO-1 and phosphorylated Smad3 were detected by immunohistochemistry. Results: Increased staining for SUMO-1 was detected in patients with SSc and in experimental fibrosis. Inhibition of sumoylation exerted potent antifibrotic effects and prevented dermal thickening, myofibroblast differentiation and accumulation of collagen induced by bleomycin, or by overexpression of constitutively active TBR. Moreover, knockdown of Ubc9 reduced the accumulation of phosphorylated Smad3 in experimental fibrosis indicating that inhibition of sumoylation may normalise canonical TGF-β signalling in vivo. Conclusions: We demonstrate that inhibition of sumoylation reduces canonical TGF-β signalling and prevents experimental fibrosis in different preclinical models. These data provide first evidence that targeting of aberrant sumoylation may be a novel therapeutic approach for fibrotic diseases.
CRIS-Team Scopus Importer:2020-07-01

Inhibition of tgf-β signaling and decreased apoptosis in iugr-associated lung disease in rats - Alcazar, Miguel Angel Alejandre; Morty, Rory E.; Lendzian, Lisa; Vohlen, Christina; Oestreicher, Iris; Plank, Christian Georg; Schneider, Holm; Doetsch, Joerg (PLoS ONE, 2011)
Intrauterine growth restriction is associated with impaired lung function in adulthood. It is unknown whether such impairment of lung function is linked to the transforming growth factor (TGF)-β system in the lung. Therefore, we investigated the effects of IUGR on lung function, expression of extracellular matrix (ECM) components and TGF-β signaling in rats. IUGR was induced in rats by isocaloric protein restriction during gestation. Lung function was assessed with direct plethysmography at postnatal day (P) 70. Pulmonary activity of the TGF-β system was determined at P1 and P70. TGF-β signaling was blocked in vitro using adenovirus-delivered Smad7. At P70, respiratory airway compliance was significantly impaired after IUGR. These changes were accompanied by decreased expression of TGF-β1 at P1 and P70 and a consistently dampened phosphorylation of Smad2 and Smad3. Furthermore, the mRNA expression levels of inhibitors of TGF-β signaling (Smad7 and Smurf2) were reduced, and the expression of TGF-β-regulated ECM components (e.g. collagen I) was decreased in the lungs of IUGR animals at P1; whereas elastin and tenascin N expression was significantly upregulated. In vitro inhibition of TGF-β signaling in NIH/3T3, MLE 12 and endothelial cells by adenovirus-delivered Smad7 demonstrated a direct effect on the expression of ECM components. Taken together, these data demonstrate a significant impact of IUGR on lung development and function and suggest that attenuated TGF-β signaling may contribute to the pathological processes of IUGR-associated lung disease. © 2011 Alejandre Alcázar et al.
CRIS-Team Scopus Importer:2020-07-01

Initial experience with cinematic rendering for the visualization of extracardiac anatomy in complex congenital heart defects - Röschl, Florian; Purbojo, Ariawan; Rüffer, André; Cesnjevar, Robert; Dittrich, Sven; Glöckler, Martin (Interactive Cardiovascular and Thoracic Surgery, 2019)
OBJECTIVES: Detailed anatomical information is essential for planning of surgical therapy in patients with congenital heart disease. We wanted to determine whether cinematic rendering, the novel 3-dimensional visualization technique, could help paediatric cardiac surgeons achieve better preoperative visualization of the extracardiac anatomy in patients with complex congenital heart defects. Therefore, cinematic rendering was compared to the traditional volume rendering technique by means of a questionnaire with predefined criteria. METHODS: Picture sets from 20 infant patients (mean age = 17 days) were generated from computed tomography data with both the cinematic rendering and the volume rendering techniques. These were presented side by side in a digital high-resolution portfolio without labelling them. Three experienced paediatric cardiac surgeons were provided with these portfolios and a questionnaire. They were asked to evaluate the images individually in predefined categories on a 4-point Likert scale from 1 = 'fully acceptable' to 4 = 'unacceptable'. RESULTS: Cinematic rendering scored significantly better values on the Likert scale in 7 of 9 categories, namely 'spatial impression in general', 'depth perception', 'delineation of the atrial appendages/pulmonary veins/peripheral pulmonary arteries', 'assessability of the anterior interventricular sulcus' and 'assessability of the aortic arch branches'. CONCLUSIONS: Cinematic rendering is a valuable software tool, and our data suggest that it provides significantly better visualization than volume rendering. The surgeons appraised improved depth perception and delineation of structures adjacent to the heart as the most significant advantages.
CRIS-Team Scopus Importer:2019-06-18
Keywords: Cinematic rendering; Computed tomography; Congenital heart disease; Three-dimensional

Inosine Released from Dying or Dead Cells Stimulates Cell Proliferation via Adenosine Receptors - Chen, Jin; Chaurio, Ricardo A.; Maueröder, Christian; Derer, Anja; Rauh, Manfred; Kost, Andriy; Liu, Yi; Mo, Xianming; Hueber, Axel; Bilyy, Rostyslav; Herrmann, Martin; Zhao, Yi; et al. (Frontiers in Immunology, 2017)
Many antitumor therapies induce apoptotic cell death in order to cause tumor regression. Paradoxically, apoptotic cells are also known to promote wound healing, cell proliferation, and tumor cell repopulation in multicellular organisms. We aimed to characterize the nature of the regenerative signals concentrated in the micromilieu of dead and dying cells.Cultures of viable melanoma B16F10 cells, mouse fibroblasts, and primary human fibroblast-like synoviocytes (FLS) in the presence of dead and dying cells, their supernatants (SNs), or purified agonists and antagonists were used to evaluate the stimulation of proliferation. Viable cell quantification was performed by either flow cytometry of harvested cells or by crystal violet staining of adherent cells. High-performance liquid chromatography and liquid chromatography coupled with mass spectrometry of cell SNs were deployed to identify the nature of growth-promoting factors. Coimplantation of living cells in the presence of SNs collected from dead and dying cells and specific agonists was used to evaluate tumor growth in vivo.The stimulation of proliferation of few surviving cells by bystander dead cells was confirmed for melanoma cells, mouse fibroblasts, and primary FLS. We found that small soluble molecules present in the protein-free fraction of SNs of dead and dying cells were responsible for the promotion of proliferation. The nucleoside inosine released by dead and dying cells acting via adenosine receptors was identified as putative inducer of proliferation of surviving tumor cells after irradiation and heat treatment.Inosine released by dead and dying cells mediates tumor cell proliferation via purinergic receptors. Therapeutic strategies surmounting this pathway may help to reduce the rate of recurrence after radio- and chemotherapy.
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In Reply - Rascher, Wolfgang (Deutsches Ärzteblatt international, 2016)
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Insights into the infiltrative behavior of adamantinomatous craniopharyngioma in a new xenotransplant mouse model - Stache, Christina; Hoelsken, Annett; Schlaffer, Sven-Martin; Heß, Andreas; Metzler, Markus; Frey, Benjamin; Fahlbusch, Rudolf; Flitsch, Joerg; Buchfelder, Michael; Buslei, Rolf (Brain Pathology, 2015)
Adamantinomatous craniopharyngiomas (adaCP) cause hypothalamic pituitary dysfunction. Elucidation of pathomechanisms underlying tumor progression is essential for the development of targeted chemotherapeutic treatment options. In order to study the mechanisms of tumor outgrowth, we implanted human primary adaCP tissue from three different surgical specimens stereotactically into the brain of immunodeficient mice (n = 20). Three months after tumor inoculation, magnetic resonance imaging and histology confirmed tumor engraftment in all 20 mice (100%) that obtained tissue transplants. The lesions invaded adjoining brain tissue with micro finger-shaped protrusions. Immunohistochemical comparison of the primary tumor and xenotransplants revealed a similar amount of proliferation (Mib-1) and cytokeratin expression pattern (KL-1). Whole tumor reconstruction using serial sections confirmed whirl-like cell clusters with nuclear ?-catenin accumulations at the tumor brain border. These whirls were surrounded by a belt of Claudin-1 expressing cells, showed an activated epidermal growth factor receptor (EGFR) and distinct CD133 as well as p21(WAF1/Cip1) positivity, indicating a tumor stem cell phenotype. Consistent with our previous in vitro studies, intracranial xenotransplants of adaCP confirmed cells with nuclear ?-catenin and activated EGFR being the driving force of tumor outgrowth. This model provides the possibility to study in vivo tumor cell migration and to test novel treatment regimens targeting this tumor stem cell niche.
EVALuna2:7210

Integrative analysis of genomic variants reveals new associations of candidate haploinsufficient genes with congenital heart disease - Audain, Enrique; Wilsdon, Anna; Breckpot, Jeroen; Izarzugaza, Jose M.G.; Fitzgerald, Tomas W.; Kahlert, Anne Karin; Sifrim, Alejandro; Wünnemann, Florian; Perez-Riverol, Yasset; Abdul-Khaliq, Hashim; Bak, Mads; Bassett, Anne S.; et al. (PLoS Genetics, 2021)
Numerous genetic studies have established a role for rare genomic variants in Congenital Heart Disease (CHD) at the copy number variation (CNV) and de novo variant (DNV) level. To identify novel haploinsufficient CHD disease genes, we performed an integrative analysis of CNVs and DNVs identified in probands with CHD including cases with sporadic thoracic aortic aneurysm. We assembled CNV data from 7,958 cases and 14,082 controls and performed a gene-wise analysis of the burden of rare genomic deletions in cases versus controls. In addition, we performed variation rate testing for DNVs identified in 2,489 parentoffspring trios. Our analysis revealed 21 genes which were significantly affected by rare CNVs and/or DNVs in probands. Fourteen of these genes have previously been associated with CHD while the remaining genes (FEZ1, MYO16, ARID1B, NALCN, WAC, KDM5B and WHSC1) have only been associated in small cases series or show new associations with CHD. In addition, a systems level analysis revealed affected protein-protein interaction networks involved in Notch signaling pathway, heart morphogenesis, DNA repair and cilia/centrosome function. Taken together, this approach highlights the importance of re-analyzing existing datasets to strengthen disease association and identify novel disease genes and pathways. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
CRIS-Team Scopus Importer:2021-08-13