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Andreassen BU, Aunsholt L, Østergaard E, Ek J, Maroun LL, Jørgensen MH. Microvillus Inclusion Disease Caused by MYO5B: Different Presentation and Phenotypes Despite Same Mutation. JPGN Rep 2023; 4:e309. [PMID: 37200712 PMCID: PMC10187848 DOI: 10.1097/pg9.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/22/2023] [Indexed: 05/20/2023]
Abstract
Microvillus inclusion disease (MVID) is associated with specific variants in the MYO5B gene causing disrupt epithelial cell polarity. MVID may present at birth with intestinal symptoms or with extraintestinal symptoms later in childhood. We present 3 patients, of whom 2 are siblings, with MYO5B variants and different clinical manifestations, ranging from isolated intestinal disease to intestinal disease combined with cholestatic liver disease, predominant cholestatic liver disease clinically similar to low-gamma-glutamyl transferase PFIC, seizures, and fractures. We identified 1 previously unreported MYO5B variant and 2 known pathogenic variants and discuss genotype-phenotype correlations of these variants. We conclude that MVID may present phenotypically different and mimic other severe diseases. We suggest that genetic testing is included early during diagnostic investigations of children with gastrointestinal and cholestatic presentation.
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Affiliation(s)
- Bente Utoft Andreassen
- From the Department for Children and Adolescent, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Lise Aunsholt
- Department of Neonatology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Elsebet Østergaard
- Department of Genetics, Rigshospitalet, Copenhagen University Hospital, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Ek
- Department of Genetics, Rigshospitalet, Copenhagen University Hospital, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lisa Leth Maroun
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Marianne Hørby Jørgensen
- From the Department for Children and Adolescent, Rigshospitalet, Copenhagen University Hospital, Denmark
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Mortensen MS, Hebbelstrup Jensen B, Williams J, Brejnrod AD, O'Brien Andersen L, Röser D, Andreassen BU, Petersen AM, Stensvold CR, Sørensen SJ, Krogfelt KA. Stability and resilience of the intestinal microbiota in children in daycare - a 12 month cohort study. BMC Microbiol 2018; 18:223. [PMID: 30579350 PMCID: PMC6303881 DOI: 10.1186/s12866-018-1367-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We performed a 12-month cohort study of the stability and resilience of the intestinal microbiota of healthy children in daycare in Denmark in relation to diarrheal events and exposure to known risk factors for gastrointestinal health such as travelling and antibiotic use. In addition, we analyzed how gut microbiota recover from such exposures. RESULTS We monitored 32 children in daycare aged 1-6 years. Fecal samples were submitted every second month during a one-year observational period. Information regarding exposures and diarrheal episodes was obtained through questionnaires. Bacterial communities were identified using 16S rRNA gene sequencing. The core microbiota (mean abundance > 95%) dominated the intestinal microbiota, and none of the tested exposures (diarrheal events, travel, antibiotic use) were associated with decreases in the relative abundance of the core microbiota. Samples exhibited lower intra-individual variation than inter-individual variation. Half of all the variation between samples was explained by which child a sample originated from. Age explained 7.6-9.6% of the variation, while traveling, diarrheal events, and antibiotic use explained minor parts of the beta diversity. We found an age-dependent increase of alpha diversity in children aged 1-3 years, and while diarrheal events caused a decrease in alpha diversity, a recovery time of 40-45 days was observed. Among children having had a diarrheal event, we observed a 10x higher relative abundance of Prevotella. After travelling, a higher abundance of two Bacteroides species and 40% less Lachnospiraceae were seen. Antibiotic use did not correlate with changes in the abundance of any bacteria. CONCLUSION We present data showing that Danish children in daycare have stable intestinal microbiota, resilient to the exposures investigated. An early age-dependent increase in the diversity was demonstrated. Diarrheal episodes decreased alpha diversity with an estimated recovery time of 40-45 days.
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Affiliation(s)
- Martin Steen Mortensen
- Department of Biology, Section of Microbiology, Copenhagen University, Copenhagen, Denmark
| | - Betina Hebbelstrup Jensen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, DK2300, Copenhagen S, Artillerivej 5, Denmark.,Department of Internal Medicine, Amager Hospital, Copenhagen, Denmark
| | - Jeanne Williams
- Department of Biology, Section of Microbiology, Copenhagen University, Copenhagen, Denmark
| | - Asker Daniel Brejnrod
- Department of Biology, Section of Microbiology, Copenhagen University, Copenhagen, Denmark
| | - Lee O'Brien Andersen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, DK2300, Copenhagen S, Artillerivej 5, Denmark
| | - Dennis Röser
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, DK2300, Copenhagen S, Artillerivej 5, Denmark.,Department of Pediatrics, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Andreas Munk Petersen
- Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen, Denmark.,Department of Gastroenterology, Hvidovre Hospital, Copenhagen, Denmark
| | - Christen Rune Stensvold
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, DK2300, Copenhagen S, Artillerivej 5, Denmark
| | | | - Karen Angeliki Krogfelt
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, DK2300, Copenhagen S, Artillerivej 5, Denmark.
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Lauritzen D, Andreassen BU, Heegaard NHH, Klinge LG, Walsted AM, Neland M, Nielsen RG, Wittenhagen P. Pediatric Inflammatory Bowel Diseases: Should We Be Looking for Kidney Abnormalities? Inflamm Bowel Dis 2018; 24:2599-2605. [PMID: 29718370 DOI: 10.1093/ibd/izy166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Kidney disease has been reported in adults with inflammatory bowel disease (IBD) and is regarded an extraintestinal manifestation or more rarely a side effect of the medical treatment. METHODS In this cross-sectional study we describe the extent of kidney pathology in a cohort of 56 children with IBD. Blood and urine samples were analyzed for markers of kidney disease and ultrasonography was performed to evaluate pole-to-pole kidney length. RESULTS We found that 25% of the patients had either previously reported kidney disease or ultrasonographic signs of chronic kidney disease. The median kidney size compared with normal children was significantly reduced. In a multivariate linear mixed model, small kidneys significantly correlated with the use of infliximab, whereas the use of enteral nutritional therapy was associated with larger kidneys. CONCLUSION Children with IBD are at risk of chronic kidney disease, and the risk seems to be increased with the severity of the disease.
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Affiliation(s)
- Didde Lauritzen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Bente Utoft Andreassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Niels Henrik H Heegaard
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark.,Department of Autoimmunology & Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | | | | | - Mette Neland
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Per Wittenhagen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
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Kristensen KHS, Rytter MJH, Sørensen ACK, Christensen VB, Namusoke H, Skov M, Andreassen BU, Friis H. [Oedematous malnutrition can also be seen in Danish children]. Ugeskr Laeger 2016; 178:V03160185. [PMID: 27697120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We describe two children with oedematous malnutrition; one admitted to a nutrition unit in Uganda and another to a paediatric department in Denmark. Both children received nutritional therapy and recovered. Although oedematous malnutrition is rarely seen in industrialized countries, the condition has been associated with chronic diseases. It is a life-threatening condition, and the pathogenesis remains unknown. Specialized nutrition products have been developed for low-resource clinics in developing countries, however, no specific protocols or products are available for physicians in Denmark.
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Hebbelstrup Jensen B, Röser D, Andreassen BU, Olsen KEP, Nielsen HV, Roldgaard BB, Schjørring S, Mirsepasi-Lauridsen HC, Jørgensen SL, Mortensen EM, Petersen AM, Krogfelt KA. Childhood diarrhoea in Danish day care centres could be associated with infant colic, low birthweight and antibiotics. Acta Paediatr 2016; 105:90-5. [PMID: 26355526 DOI: 10.1111/apa.13209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/13/2015] [Accepted: 09/07/2015] [Indexed: 12/11/2022]
Abstract
AIM Diarrhoea is very common in children attending day care centres. The aim of this study was to examine certain predisposing risk factors for an association with diarrhoea, including foreign travel, treatment with antibiotics, having household pets, infant colic, bottle feeding, using a pacifier and low birthweight. METHODS A dynamic one-year follow-up cohort study comprising 179 children from 36 day care centres was conducted from September 2009 to July 2013 in Copenhagen, Denmark. Questionnaires were sent to the children's parents or legal guardians every two months for a year, requesting information on gastrointestinal symptoms and exposure. A logistic regression was performed to identify the odds ratios of different risk factors for diarrhoea. RESULTS The odds ratios for diarrhoea were 1.97 (0.93-4.20) for children with a history of infant colic, 1.91 (0.90-4.04) for low birthweight children and 1.45 (0.74-2.82) for children who had used antibiotics. Having a pet in the household had a possible protective effect towards diarrhoeal events, with an odds ratio of 0.47 (0.20-1.09). CONCLUSION A history of infant colic, low birthweight, and to a lesser extent antibiotic use, possibly increased the risk of diarrhoea in Danish children in day care centres.
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Affiliation(s)
| | - Dennis Röser
- Department of Microbiology and Infection Control; Statens Serum Institut; Copenhagen Denmark
- Department of Paediatrics; Hvidovre University Hospital; Copenhagen Denmark
| | | | - Katharina E. P. Olsen
- Department of Microbiology and Infection Control; Statens Serum Institut; Copenhagen Denmark
| | - Henrik Vedel Nielsen
- Department of Microbiology and Infection Control; Statens Serum Institut; Copenhagen Denmark
| | - Bent Bjørn Roldgaard
- Department of Microbiology and Infection Control; Statens Serum Institut; Copenhagen Denmark
| | - Susanne Schjørring
- Department of Microbiology and Infection Control; Statens Serum Institut; Copenhagen Denmark
| | | | - Steffen L. Jørgensen
- Department of Microbiology and Infection Control; Statens Serum Institut; Copenhagen Denmark
| | - Esben Munk Mortensen
- Department of Microbiology and Infection Control; Statens Serum Institut; Copenhagen Denmark
| | - Andreas Munk Petersen
- Department of Microbiology and Infection Control; Statens Serum Institut; Copenhagen Denmark
- Department of Gastroenterology; Hvidovre University Hospital; Copenhagen Denmark
- Department of Clinical Microbiology; Hvidovre University Hospital; Copenhagen Denmark
| | - Karen Angeliki Krogfelt
- Department of Microbiology and Infection Control; Statens Serum Institut; Copenhagen Denmark
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Andreassen BU, Paerregaard A, Michaelsen KF, Andersen J, Heilmann CJ, Müller K. Nutrition, anthropometry, gastrointestinal dysfunction, and circulating levels of tumour necrosis factor alpha receptor I and interleukin-1 receptor antagonist in children during stem cell transplantation. Pediatr Transplant 2009; 13:182-7. [PMID: 18482213 DOI: 10.1111/j.1399-3046.2008.00975.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To evaluate anthropometry, nutrition and gastrointestinal dysfunction, and to characterize the relation between these parameters and the inflammatory activity evaluated by plasma levels of soluble tumour necrosis factor alpha receptor I (sTNFRI) and interleukin-1 receptor antagonist (IL-1Ra) levels during stem cell transplantation (SCT) in children. Clinical assessments and blood sampling were performed on days -3, 0, +7, +15 and +31 in eight children undergoing SCT. Energy intake, anthropometry, gastrointestinal dysfunction (WHO toxicity score) and sTNFRI and IL-1Ra were evaluated. The energy intake was below recommended levels. There was a loss of lean body mass (arm muscle area)(median, 2031 mm(2) (day -3) vs 1477 mm(2) (day 31); p = 0.04), and of fat mass (arm fat area) (791 mm(2) (day -3) vs 648 mm(2) (day +31); p = 0.04). sTNFRI was elevated throughout the course of transplantation, and peaked after the day of graft infusion (day 0). sTNFRI levels at day 0 predicted changes in weight SDS (r = 0.65; p = 0.05), triceps skinfold SDS (r = 0.85; p = 0.007) and gastrointestinal dysfunction (r = 0.88; p = 0.004). Likewise, IL-1Ra levels at day 0 correlated with the gastrointestinal dysfunction (r = 0.83; p = 0.01) and with the change in weight SDS (r = 0.77; p = 0.03). This study suggests that pretransplant levels of inflammatory markers are associated with posttransplant symptoms of gastrointestinal dysfunction and loss of both fat and lean body mass. Future studies should address if the use of conditioning regimens with limited proinflammatory cytokine inducing activity, anti-inflammatory agents, or more optimised nutritional support can reduce the burden of such posttransplant complications.
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Affiliation(s)
- B U Andreassen
- Paediatric Clinics, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
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Andreassen BU, Paerregaard A, Schmiegelow K, Rechnitzer C, Heilman C, Hartmann B, Holst JJ, Michaelsen KF. Glucagon-like peptide-2 (GLP-2) response to enteral intake in children during anti-cancer treatment. J Pediatr Gastroenterol Nutr 2005; 40:48-53. [PMID: 15625426 DOI: 10.1097/00005176-200501000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Intestinal dysfunction is frequent in cancer and during anti-cancer treatment. Glucagon-like peptide-2 (GLP-2) is secreted in a nutrition-dependent manner from the intestinal enteroendocrine L-cells. It accelerates crypt cell proliferation and nutrient absorption, inhibits enterocyte apoptosis and decreases mucosal permeability. Lack of GLP-2 may increase the risk of malabsorption and intestinal bacterial translocation. The aim of this study is to evaluate meal stimulated secretion of GLP-2 in children with cancer undergoing anti-cancer treatment. METHODS Plasma-GLP-2 analysis after an overnight fast and 1 hour after intake of a mixed test meal. Data on gastrointestinal toxicity, blood neutrophile counts and food records were included in the analysis. RESULTS Forty-four meal stimulation tests were performed in 25 children (median age, 6.0 years; range, 2.5-19) during anti-cancer treatment. Median GI toxicity score was 5 (range, 0-15), and mean energy intake was 62.4% of recommended values. P-GLP-2 values increased from mean (SD) 38 (18) to 63 (51) pmol/l (P < 0.0001). Twelve of the meal stimulation tests (28%) resulted in a p-GLP-2 increase >2 fold, which is assumed to be the lower limit of normal values. The increase was strongly dependent on the energy intake (r = 0.62, P < 0.0001), while toxicity score and neutrophile count had no significant influence (multiple regression). CONCLUSION In children treated with anti-cancer therapy, GLP-2 secretion seems to be normal if the enteral energy intake is sufficient. Insufficient GLP-2 secretion could influence the gastrointestinal problems seen in the children with a low enteral energy intake.
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Affiliation(s)
- B U Andreassen
- Paediatric Nutrition Unit, Rigshospitalet, Coppenhagen, Denmark.
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Andreassen BU, Andersen K, Ebbesen F. [Necrotizing enterocolitis. Occurrence in Western Denmark]. Ugeskr Laeger 1995; 157:3326-30. [PMID: 7631441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We reviewed the clinical presentation, subsequent course and outcome of 45 newborn infants with neuotizing enterocolitis (NEC) seen on eight neonatal intensive care units during a 10 year period (01.01.82-31.12.91). The average incidence of NEC was found to be 1.2 (0.3-3.8) per 10,000 liveborn infants with a tendency to increase during the period. Eighteen percent had a birth weight of less than 1,000 g. Thirty-six percent had a birthweight between 1,000 and 1,500 g. Twenty-nine percent had a birthweight between 1,500 and 2,500 g. The last group made up of 16% had birth weights above 2,500 g. The mortality was determined by the severity of the disease, being 0% for infants within Bell's stage I, 25% in Bell's stage II and 71% in Bell's stage III. Sixty-nine percent of the infants were diagnosed in stage III, probably because of low attention to NEC in its early stages. The prognosis of surviving infants was good with no gastrointestinal symptoms when evaluated four to five years later.
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