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Ashton JJ, Satsangi J, Uhlig HH. Intestinal inflammation and extraintestinal disease: understanding dynamic risk. Gastroenterology 2024:S0016-5085(24)00418-9. [PMID: 38604541 DOI: 10.1053/j.gastro.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Affiliation(s)
- James J Ashton
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK; Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Jack Satsangi
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Holm H Uhlig
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK; Biomedical Research Centre, University of Oxford, Oxford, UK; Department of Paediatrics, University of Oxford, Oxford, UK
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Seaby EG, Leggatt G, Cheng G, Thomas NS, Ashton JJ, Stafford I, Baralle D, Rehm HL, O'Donnell-Luria A, Ennis S. A gene pathogenicity tool "GenePy" identifies missed biallelic diagnoses in the 100,000 Genomes Project. Genet Med 2024; 26:101073. [PMID: 38245859 DOI: 10.1016/j.gim.2024.101073] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
PURPOSE The 100,000 Genomes Project diagnosed a quarter of affected participants, but 26% of diagnoses were not on the applied gene panel(s); with many being de novo variants. Assessing biallelic variants without a gene panel is more challenging. METHODS We sought to identify missed biallelic diagnoses using GenePy, which incorporates allele frequency, zygosity, and a user-defined deleterious metric, generating an aggregate GenePy score per gene, per participant. We calculated GenePy scores for 2862 recessive disease genes in 78,216 100,000 Genomes Project participants. For each gene, we ranked participant GenePy scores and scrutinized affected participants without a diagnosis, whose scores ranked among the top 5 for each gene. In cases which participant phenotypes overlapped with the disease gene of interest, we extracted rare variants and applied phase, ClinVar, and ACMG classification. RESULTS 3184 affected individuals without a molecular diagnosis had a top-5-ranked GenePy score and 682 of 3184 (21%) had phenotypes overlapping with a top-ranking gene. In 122 of 669 (18%) phenotype-matched cases (excluding 13 withdrawn participants), we identified a putative missed diagnosis (2.2% of all undiagnosed participants). A further 334 of 669 (50%) cases have a possible missed diagnosis but require functional validation. CONCLUSION Applying GenePy at scale has identified 456 potential diagnoses, demonstrating the value of novel diagnostic strategies.
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Affiliation(s)
- Eleanor G Seaby
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, United Kingdom; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA; Paediatric Infectious Diseases, Imperial College London, London, United Kingdom.
| | - Gary Leggatt
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, United Kingdom
| | - Guo Cheng
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, United Kingdom
| | - N Simon Thomas
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, United Kingdom; Wessex Regional Genomics Laboratory, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - James J Ashton
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, United Kingdom
| | | | - Diana Baralle
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, United Kingdom
| | - Heidi L Rehm
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - Anne O'Donnell-Luria
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA
| | - Sarah Ennis
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, United Kingdom
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Green Z, Ashton JJ, Rodrigues A, Spray C, Howarth L, Mallikarjuna A, Chanchlani N, Hart J, Bakewell C, Lee KY, Wahid A, Beattie RM. Sustained Increase in Pediatric Inflammatory Bowel Disease Incidence Across the South West United Kingdom Over the Last 10 Years. Inflamm Bowel Dis 2024:izad302. [PMID: 38372691 DOI: 10.1093/ibd/izad302] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Pediatric inflammatory bowel disease (pIBD) incidence has increased over the last 25 years. We aim to report contemporaneous trends across the South West United Kingdom. METHODS Data were provided from centers covering the South West United Kingdom (Bristol, Oxford, Cardiff, Exeter, and Southampton), with a total area at-risk population (<18 years of age) of 2 947 534. Cases were retrieved from 2013 to 2022. Incident rates were reported per 100 000 at-risk population, with temporal trends analyzed through correlation. Subgroup analysis was undertaken for age groups (0-6, 6-11, and 12-17 years of age), sex, and disease subtype. Choropleth maps were created for local districts. RESULTS In total, 2497 pIBD cases were diagnosed between 2013 and 2022, with a mean age of 12.6 years (38.7% female). Diagnosis numbers increased from 187 to 376, with corresponding incidence rates of 6.0 per 100 000 population per year (2013) to 12.4 per 100 000 population per year (2022) (b = 0.918, P < .01). Female rates increased from 5.1 per 100 000 population per year in 2013 to 11.0 per 100 000 population per year in 2022 (b = 0.865, P = .01). Male rates increased from 5.7 per 100 000 population per year to 14.4 per 100 000 population per year (b = 0.832, P = .03). Crohn's disease incidence increased from 3.1 per 100 000 population per year to 6.3 per 100 000 population per year (b = 0.897, P < .01). Ulcerative colitis increased from 2.3 per 100 000 population per year to 4.3 per 100 000 population per year (b = 0.813, P = .04). Inflammatory bowel disease unclassified also increased, from 0.6 per 100 000 population per year to 1.8 per 100 000 population per year (b = 0.851, P = .02). Statistically significant increases were seen in those ≥12 to 17 years of age, from 11.2 per 100 000 population per year to 24.6 per 100 000 population per year (b = 0.912, P < .01), and the 7- to 11-year-old age group, with incidence rising from 4.4 per 100 000 population per year to 7.6 per 100 000 population per year (b = 0.878, P = .01). There was no statistically significant increase in very early onset inflammatory bowel disease (≤6 years of age) (b = 0.417, P = .231). CONCLUSIONS We demonstrate significant increases in pIBD incidence across a large geographical area including multiple referral centers. Increasing incidence has implications for service provision for services managing pIBD.
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Affiliation(s)
- Zachary Green
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, United Kingdom
- Department of Paediatric Gastroenterology, Noah's Ark Children's Hospital for Wales, Cardiff, United Kingdom
| | - James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, United Kingdom
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, United Kingdom
| | - Astor Rodrigues
- Department of Paediatric Gastroenterology, Oxford University Hospitals, Oxford, United Kingdom
| | - Christine Spray
- Department of Paediatric Gastroenterology, Bristol Children's Hospital, Bristol, United Kingdom
| | - Lucy Howarth
- Department of Paediatric Gastroenterology, Oxford University Hospitals, Oxford, United Kingdom
| | - Akshatha Mallikarjuna
- Department of Paediatric Gastroenterology, Bristol Children's Hospital, Bristol, United Kingdom
| | - Neil Chanchlani
- Department of Paediatrics, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - James Hart
- Department of Paediatrics, Royal Devon University Healthcare NHS Foundation Trust, Exeter, United Kingdom
| | - Christopher Bakewell
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, United Kingdom
| | - Kwang Yang Lee
- Department of Paediatric Gastroenterology, Bristol Children's Hospital, Bristol, United Kingdom
| | - Amar Wahid
- Department of Paediatric Gastroenterology, Noah's Ark Children's Hospital for Wales, Cardiff, United Kingdom
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, United Kingdom
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4
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Klomberg RCW, van der Wal HC, Aardoom MA, Kemos P, Rizopoulos D, Ruemmele FM, Charrout M, Escher JC, Croft NM, de Ridder L, Milovanovich ID, Ashton JJ, Henderson P, Ledder O, de Meij TGJ, Hansen R, Hummel TZ, Arai K, Rodrigues A, Cameron F, Koletzko S, Muhammed R, Nedelkopoulou N. Improved clinical outcomes with early anti-tumour necrosis factor alpha therapy in children with newly diagnosed Crohn's disease: real world data from the international prospective PIBD-SETQuality inception cohort study. J Crohns Colitis 2023:jjad197. [PMID: 38011797 DOI: 10.1093/ecco-jcc/jjad197] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND & AIMS Treatment guidelines for paediatric Crohn's disease (CD) suggest early use of anti-tumour necrosis factor alpha (anti-TNF) in high-risk individuals. The aim is to evaluate the effect of early anti-TNF in a real-world cohort. METHODS Children with newly-diagnosed CD were prospectively recruited at 28 participating sites of the international observational PIBD-SETQuality study. Outcomes were compared at 3 months, 1 and 2 years between patients receiving early anti-TNF (<90 days after diagnosis) and those not receiving early anti-TNF. Outcomes included sustained steroid-free remission (SSFR) without treatment intensification (specified as SSFR*) and sustained steroid-free mild/inactive disease without treatment intensification (specified as SSFMI*). Penalised logistic regression model-based standardisation was applied to estimate the relative risks (RR) of early therapy on outcomes. RRs were estimated for high-risk and low-risk patients based on presence of predictors of poor outcome (POPOs) and disease activity at diagnosis. RESULTS In total, 331 children (median age 13.9 years [IQR 12.2 - 15.3]) were enrolled, with 135 (41%) receiving early anti-TNF. At 1 year, patients on early anti-TNF had higher rates of SSFR* (30% vs. 14%, p<0.001) and SSFMI* (69% vs. 33%, p<0.001), with RRs of 2.95 (95%CI 1.63-5.36) and 4.67 (95%CI 2.46-8.87) respectively. At 1 year, the RRs for SSFMI* were higher, and statistically significant in high-risk patients, i.e. those with moderate/severe disease compared to mild/inactive disease at diagnosis (5.50 [95%CI 2.51-12.05]) vs. 2.91 [95%CI 0.92-9.11]), and those with any POPO compared to no POPO (5.05 [95%CI 2.45-10.43] vs. 3.41 [95%CI 0.54-21.7]). CONCLUSION In this cohort of children with newly-diagnosed CD, early anti-TNF demonstrated superior effectiveness in high-risk patients.
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Affiliation(s)
- Renz C W Klomberg
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hella C van der Wal
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Martine A Aardoom
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Polychronis Kemos
- Pediatric Gastroenterology, Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Dimitris Rizopoulos
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Frank M Ruemmele
- Department of Pediatric Gastroenterology, Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France
| | - Mohammed Charrout
- Delft Bioinformatics Lab, Delft University of Technology, Delft, the Netherlands
| | - J C Escher
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nicholas M Croft
- Pediatric Gastroenterology, Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Lissy de Ridder
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ivan D Milovanovich
- Department of Gastroenterology, Hepatology, and Endoscopy, University Children's Hospital, Belgrade, Serbia
| | - James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, United Kingdom, Human Genetics and Genomic Medicine, University of Southampton, Southampton, United Kingdom
| | - Paul Henderson
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Oren Ledder
- Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tim G J de Meij
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - Richard Hansen
- Clinical Reader in Child Health, Department of Child Health, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland, Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, Scotland
| | - Thalia Z Hummel
- Department of Paediatric Gastroenterology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Astor Rodrigues
- Department of Paediatric Gastroenterology, Oxford Children's Hospital, Oxford, United Kingdom
| | - Fiona Cameron
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany, Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
| | - Rafeeq Muhammed
- Department of Paediatric Gastroenterology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Natalia Nedelkopoulou
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom
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Stafford IS, Ashton JJ, Mossotto E, Cheng G, Mark Beattie R, Ennis S. Supervised Machine Learning Classifies Inflammatory Bowel Disease Patients by Subtype Using Whole Exome Sequencing Data. J Crohns Colitis 2023; 17:1672-1680. [PMID: 37205778 PMCID: PMC10637043 DOI: 10.1093/ecco-jcc/jjad084] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND Inflammatory bowel disease [IBD] is a chronic inflammatory disorder with two main subtypes: Crohn's disease [CD] and ulcerative colitis [UC]. Prompt subtype diagnosis enables the correct treatment to be administered. Using genomic data, we aimed to assess machine learning [ML] to classify patients according to IBD subtype. METHODS Whole exome sequencing [WES] from paediatric/adult IBD patients was processed using an in-house bioinformatics pipeline. These data were condensed into the per-gene, per-individual genomic burden score, GenePy. Data were split into training and testing datasets [80/20]. Feature selection with a linear support vector classifier, and hyperparameter tuning with Bayesian Optimisation, were performed [training data]. The supervised ML method random forest was utilised to classify patients as CD or UC, using three panels: 1] all available genes; 2] autoimmune genes; 3] 'IBD' genes. ML results were assessed using area under the receiver operating characteristics curve [AUROC], sensitivity, and specificity on the testing dataset. RESULTS A total of 906 patients were included in analysis [600 CD, 306 UC]. Training data included 488 patients, balanced according to the minority class of UC. The autoimmune gene panel generated the best performing ML model [AUROC = 0.68], outperforming an IBD gene panel [AUROC = 0.61]. NOD2 was the top gene for discriminating CD and UC, regardless of the gene panel used. Lack of variation in genes with high GenePy scores in CD patients was the best classifier of a diagnosis of UC. DISCUSSION We demonstrate promising classification of patients by subtype using random forest and WES data. Focusing on specific subgroups of patients, with larger datasets, may result in better classification.
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Affiliation(s)
- Imogen S Stafford
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research, University Hospital Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - James J Ashton
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Enrico Mossotto
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Guo Cheng
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research, University Hospital Southampton, Southampton, UK
| | - Robert Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
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Green Z, Beattie RM, Ashton JJ. Recent developments in the assessment and management of inflammatory bowel disease in childhood: a narrative review. Transl Pediatr 2023; 12:1853-1874. [PMID: 37969128 PMCID: PMC10644027 DOI: 10.21037/tp-23-210] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/15/2023] [Indexed: 11/17/2023] Open
Abstract
Background and Objective The landscape of paediatric inflammatory bowel disease (pIBD) continues to evolve in an era of increasing incidence. There have been rapid developments in understanding, as we begin to perceive IBD as a spectrum of conditions, alongside advancements in monitoring and treatment. The objective of this article was to provide an overview of recent advances and challenges in the management of pIBD, with a focus on sustainable healthcare, personalised therapy, genomics, new drugs and avenues for future optimisation. Methods We present a narrative review that synthesises and summarises recent research (2017-2022) related to pIBD. We undertook a structured search of the literature (PubMed and Medline) and additional articles were identified through manual searches of reference lists. Evidence tables were compiled for disease outcomes. Key Content and Findings In this review we outline current practice, integrating clinical guidelines and contemporary research. We discuss initial investigations (including suggested threshold for paediatric faecal calprotectin), specialist investigations for disease monitoring [with reference to video capsule endoscopy (VCE) and therapeutic drug levels] and outline new and established treatment options. Biomarkers and genomic testing are examined as important tools for individualising care and identifying potential therapeutic targets, including for top-down therapy. Despite these advances, significant challenges remain, including the need for further research to understand the mechanisms of disease and the translation of these advances into real-world improvements in practice. Conclusions Recent advances in understanding of the pathogenesis of pIBD, alongside genomic and pharmacological developments have added more tools to the armamentarium for the treatment of these conditions and highlighted ongoing areas of research need.
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Affiliation(s)
- Zachary Green
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
- Department of Paediatric Gastroenterology, Noah’s Ark Children’s Hospital for Wales, Cardiff, UK
| | - Robert Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - James J. Ashton
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
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Marino LV, Paulson S, Ashton JJ, Weeks C, Young A, Pappachan JVP, Swann JR, Johnson MJ, Beattie RM. A scoping review: urinary markers of metabolic maturation in infants with CHD and the relationship to growth. Cardiol Young 2023; 33:1879-1888. [PMID: 36325968 DOI: 10.1017/s1047951122003262] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Growth failure in infants born with CHD is a persistent problem, even in those provided with adequate nutrition. OBJECTIVE To summarise the published data describing the change in urinary metabolites during metabolic maturation in infants with CHD and identify pathways amenable to therapeutic intervention. DESIGN Scoping review. ELIGIBILITY CRITERIA Studies using qualitative or quantitative methods to describe urinary metabolites pre- and post-cardiac surgery and the relationship with growth in infants with CHD. SOURCES OF EVIDENCE NICE Healthcare Databases website was used as a tool for multiple searches. RESULTS 347 records were identified, of which 37 were duplicates. Following the removal of duplicate records, 310 record abstracts and titles were screened for inclusion. The full texts of eight articles were reviewed for eligibility, of which only two related to infants with CHD. The studies included in the scoping review described urinary metabolites in 42 infants. A content analysis identified two overarching themes of metabolic variation predictive of neurodevelopmental abnormalities associated with anaerobic metabolism and metabolic signature associated with the impact on gut microbiota, inflammation, energy, and lipid digestion. CONCLUSION The results of this scoping review suggest that there are considerable gaps in our knowledge relating to metabolic maturation of infants with CHD, especially with respect to growth. Surgery is a key early life feature for CHD infants and has an impact on the developing biochemical phenotype with implications for metabolic pathways involved in immunomodulation, energy, gut microbial, and lipid metabolism. These early life fingerprints may predict those individuals at risk for neurodevelopmental abnormalities.
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Affiliation(s)
- Luise V Marino
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust; Faculty of Health Science, University of Southampton, Southampton, UK
| | - Simone Paulson
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton, UK
| | - James J Ashton
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; Faculty of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Charlotte Weeks
- Paediatric Intensive Care Unit, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aneurin Young
- Department of Neonatal Medicine, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust and NIHR Southampton Biomedical Research Centre, UK
| | - John V P Pappachan
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; Faculty of Medicine, University of Southampton, Southampton, UK
| | - John R Swann
- Biomolecular Medicine, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark J Johnson
- Neonatal Medicine, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust; Faculty of Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust; Faculty of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
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Marino LV, Fandinga C, Barratt J, Brady I, Denton SA, Fitzgerald K, Mills T, Palframan K, Phillips S, Rees L, Scanlan N, Ashton JJ, Beattie RM. Pedi-R-MAPP | the development, testing, validation, and refinement of a digital nutrition awareness tool. Clin Nutr 2023; 42:1701-1710. [PMID: 37531806 DOI: 10.1016/j.clnu.2023.07.018] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND & AIMS The Remote Malnutrition Application (R-MAPP) was developed during the COVID-19 pandemic to provide support for health care professionals (HCPs) working in the community to complete remote nutritional assessments and provide practical guidance for nutritional care. R-MAPP was adapted into Pediatric Remote Malnutrition Application (Pedi-R-MAPP) using a modified Delphi consensus, with the goal of providing a structured approach to completing a nutrition focused assessment as part of a technology enabled care service (TECS) consultation. The aim of this study was to develop and validate a digital version of Pedi-R-MAPP using the IDEAS framework (Integrate, Design, Assess and Share). METHODS A ten-step process was completed using the IDEAS framework. This involved the four concept processes; Stage-1, Integrate (Step 1-3) identify the problem, specify the goal, and use an evidence-based approach. Stage-2, (Step 4-7) design iteratively and rapidly with user feedback. Stage 3, (Step 8-9) Assess rigorously, and Stage 4 (Step 9-10) publish and launch of the tool. RESULTS Stage 1:Evidence-based development, Pedi-R-MAPP was developed using Delphi consensus methodology. Stage 2:Iteration & design, HCPs (n = 22) from UK, Europe, South Africa, and North America were involved four workshops to further develop a paper prototype of the tool and complete small-scale testing of a beta version of the tool which resulted in eight iterations. Stage 3:Assess rigorously, Small scale retrospective testing of the tool on children with congenital heart disease (n = 80) was completed by a single researcher, with iterative changes made to improve agreement with summary advice. Large scale testing amongst (n = 745) children in different settings was completed by specialist paediatric dietitians (n = 15) advice who recorded agreement with the summary advice compared with their own clinical assessment. Paediatric dietitians were in overall agreement with the summary advice in the tool 86% (n = 640), compared to their own clinical practice. The main reasons for disagreement were i) frequency of planned review 57.1% (n = 60/105), ii) need for ongoing dietetic review due to chronic condition 20.0% (n = 21/105), iii) disagreement with recommendation for discharge 16.2% (n = 17/105) and iv) concerns with faltering growth and/or need for condition specific growth charts 6.7% (7/105). Iterative changes were made to the algorithm, leading to an improvement in agreement of the summary advice on re-evaluation to 98% (p=<0.0001). CONCLUSION A digital version of the Pedi-R-MAPP nutrition awareness tool was developed using the IDEAS framework. The summary advice provided by the tool achieved a high level of agreement when compared to paediatric dietetic assessment, by providing a structured approach to completing a remote nutrition focused assessment, along with identifying the frequency of follow-up or an in-person assessment.
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Affiliation(s)
- L V Marino
- Paediatric Intensive Care Unit, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Health Science, University of Southampton, Southampton, UK.
| | - C Fandinga
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Barratt
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - I Brady
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S A Denton
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Fitzgerald
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - T Mills
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Palframan
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Phillips
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - L Rees
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N Scanlan
- Department of Dietetics/ Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J J Ashton
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Medicine, University of Southampton, Southampton, UK
| | - R M Beattie
- Paediatric Gastroenterology, Southampton Children's Hospital, NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust, Faculty of Medicine, University of Southampton, Southampton, UK
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9
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Ashton JJ, Gurung A, Davis C, Seaby EG, Coelho T, Batra A, Afzal NA, Ennis S, Beattie RM. The Pediatric Crohn Disease Morbidity Index (PCD-MI): Development of a Tool to Assess Long-Term Disease Burden Using a Data-Driven Approach. J Pediatr Gastroenterol Nutr 2023; 77:70-78. [PMID: 37079872 PMCID: PMC10259218 DOI: 10.1097/mpg.0000000000003793] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND/OBJECTIVE Heterogeneity and chronicity of Crohn disease (CD) make prediction of outcomes difficult. To date, no longitudinal measure can quantify burden over a patient's disease course, preventing assessment and integration into predictive modeling. Here, we aimed to demonstrate the feasibility of constructing a data driven, longitudinal disease burden score. METHODS Literature was reviewed for tools used in assessment of CD activity. Themes were identified to construct a pediatric CD morbidity index (PCD-MI). Scores were assigned to variables. Data were extracted automatically from the electronic patient records at Southampton Children's Hospital, diagnosed from 2012 to 2019 (inclusive). PCD-MI scores were calculated, adjusted for duration of follow up and assessed for variation (ANOVA) and distribution (Kolmogorov-Smirnov). RESULTS Nineteen clinical/biological features across five themes were included in the PCD-MI including blood/fecal/radiological/endoscopic results, medication usage, surgery, growth parameters, and extraintestinal manifestations. Maximal score was 100 after accounting for follow-up duration. PCD-MI was assessed in 66 patients, mean age 12.5 years. Following quality filtering, 9528 blood/fecal test results and 1309 growth measures were included. Mean PCD-MI score was 14.95 (range 2.2-32.5); data were normally distributed ( P = 0.2) with 25% of patients having a PCD-MI < 10. There was no difference in the mean PCD-MI when split by year of diagnosis, F -statistic 1.625, P = 0.147. CONCLUSIONS PCD-MI is a calculatable measure for a cohort of patients diagnosed over an 8-year period, integrating a wide-range of data with potential to determine high or low disease burden. Future iterations of the PCD-MI require refinement of included features, optimized scores, and validation on external cohorts.
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Affiliation(s)
- James J. Ashton
- From the Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- the Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Abhilasha Gurung
- the Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Cai Davis
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Eleanor G. Seaby
- From the Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Tracy Coelho
- the Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Akshay Batra
- the Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Nadeem A. Afzal
- the Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Sarah Ennis
- From the Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - R. Mark Beattie
- the Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
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10
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Seaby EG, Leggatt G, Cheng G, Thomas NS, Ashton JJ, Stafford I, Baralle D, Rehm HL, O'Donnell-Luria A, Ennis S. A gene pathogenicity tool 'GenePy' identifies missed biallelic diagnoses in the 100,000 Genomes Project. medRxiv 2023:2023.03.21.23287545. [PMID: 37034701 PMCID: PMC10081430 DOI: 10.1101/2023.03.21.23287545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The 100,000 Genomes Project (100KGP) diagnosed a quarter of recruited affected participants, but 26% of diagnoses were in genes not on the chosen gene panel(s); with many being de novo variants of high impact. However, assessing biallelic variants without a gene panel is challenging, due to the number of variants requiring scrutiny. We sought to identify potential missed biallelic diagnoses independent of the gene panel applied using GenePy - a whole gene pathogenicity metric. GenePy scores all variants called in a given individual, incorporating allele frequency, zygosity, and a user-defined deleterious metric (CADD v1.6 applied herein). GenePy then combines all variant scores for individual genes, generating an aggregate score per gene, per participant. We calculated GenePy scores for 2862 recessive disease genes in 78,216 individuals in 100KGP. For each gene, we ranked participant GenePy scores for that gene, and scrutinised affected individuals without a diagnosis whose scores ranked amongst the top-5 for each gene. We assessed these participants' phenotypes for overlap with the disease gene associated phenotype for which they were highly ranked. Where phenotypes overlapped, we extracted rare variants in the gene of interest and applied phase, ClinVar and ACMG classification looking for putative causal biallelic variants. 3184 affected individuals without a molecular diagnosis had a top-5 ranked GenePy gene score and 682/3184 (21%) had phenotypes overlapping with one of the top-ranking genes. After removing 13 withdrawn participants, in 122/669 (18%) of the phenotype-matched cases, we identified a putative missed diagnosis in a top-ranked gene supported by phasing, ClinVar and ACMG classification. A further 334/669 (50%) of cases have a possible missed diagnosis but require functional validation. Applying GenePy at scale has identified potential diagnoses for 456/3183 (14%) of undiagnosed participants who had a top-5 ranked GenePy score in a recessive disease gene, whilst adding only 1.2 additional variants (per individual) for assessment.
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Affiliation(s)
- Eleanor G Seaby
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, SO16 6YD, UK
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA
- Paediatric Infectious Diseases, Imperial College London, London, W2 1NY, UK
| | - Gary Leggatt
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, SO16 6YD, UK
| | - Guo Cheng
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, SO16 6YD, UK
| | - N Simon Thomas
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, SO16 6YD, UK
- Wessex Regional Genomics Laboratory, Salisbury NHS Foundation Trust, Salisbury, SP2 8BJ, UK
| | - James J Ashton
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, SO16 6YD, UK
| | | | - Diana Baralle
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, SO16 6YD, UK
| | - Heidi L Rehm
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anne O'Donnell-Luria
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA
| | - Sarah Ennis
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, Southampton, Hampshire, SO16 6YD, UK
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11
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Ashton JJ, Brooks-Warburton J, Allen PB, Tham TC, Hoque S, Kennedy NA, Dhar A, Sebastian S. The importance of high-quality 'big data' in the application of artificial intelligence in inflammatory bowel disease. Frontline Gastroenterol 2022; 14:258-262. [PMID: 37056322 PMCID: PMC10086732 DOI: 10.1136/flgastro-2022-102342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Johanne Brooks-Warburton
- Department of Clinical Pharmacology and Biological Sciences, University of Hertfordshire, Hatfield, UK
- Gastroenterology Department, Lister Hospital, Stevenage, UK
| | - Patrick B Allen
- Department of Gastroenterology, Ulster Hospital, Dundonald, Belfast, UK
| | - Tony C Tham
- Department of Gastroenterology, Ulster Hospital, Dundonald, Belfast, UK
| | - Sami Hoque
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- IBD Pharmacogenetics, University of Exeter, Exeter, UK
| | - Anjan Dhar
- Department of Gastroenterology, County Durham & Darlington NHS Foundation Trust, Darlington, Co. Durham, UK
- Teesside University, Middlesbrough, UK
| | - Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Hull York Medical School, Hull, UK
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12
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Ashton JJ, Cheng G, Stafford IS, Kellermann M, Seaby EG, Cummings JRF, Coelho TAF, Batra A, Afzal NA, Beattie RM, Ennis S. Prediction of Crohn's Disease Stricturing Phenotype Using a NOD2-derived Genomic Biomarker. Inflamm Bowel Dis 2022; 29:511-521. [PMID: 36161322 PMCID: PMC10069659 DOI: 10.1093/ibd/izac205] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Crohn's disease (CD) is highly heterogenous and may be complicated by stricturing behavior. Personalized prediction of stricturing will inform management. We aimed to create a stricturing risk stratification model using genomic/clinical data. METHODS Exome sequencing was performed on CD patients, and phenotype data retrieved. Biallelic variants in NOD2 were identified. NOD2 was converted into a per-patient deleteriousness metric ("GenePy"). Using training data, patients were stratified into risk groups for fibrotic stricturing using NOD2. Findings were validated in a testing data set. Models were modified to include disease location at diagnosis. Cox proportional hazards assessed performance. RESULTS Six hundred forty-five patients were included (373 children and 272 adults); 48 patients fulfilled criteria for monogenic NOD2-related disease (7.4%), 24 of whom had strictures. NOD2 GenePy scores stratified patients in training data into 2 risk groups. Within testing data, 30 of 161 patients (18.6%) were classified as high-risk based on the NOD2 biomarker, with stricturing in 17 of 30 (56.7%). In the low-risk group, 28 of 131 (21.4%) had stricturing behavior. Cox proportional hazards using the NOD2 risk groups demonstrated a hazard ratio (HR) of 2.092 (P = 2.4 × 10-5), between risk groups. Limiting analysis to patients diagnosed aged < 18-years improved performance (HR-3.164, P = 1 × 10-6). Models were modified to include disease location, such as terminal ileal (TI) disease or not. Inclusion of NOD2 risk groups added significant additional utility to prediction models. High-risk group pediatric patients presenting with TI disease had a HR of 4.89 (P = 2.3 × 10-5) compared with the low-risk group patients without TI disease. CONCLUSIONS A NOD2 genomic biomarker predicts stricturing risk, with prognostic power improved in pediatric-onset CD. Implementation into a clinical setting can help personalize management.
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Affiliation(s)
- James J Ashton
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.,Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Guo Cheng
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Imogen S Stafford
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.,Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Melina Kellermann
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Eleanor G Seaby
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - J R Fraser Cummings
- Department of Gastroenterology, University Hospital Southampton, Southampton, UK
| | - Tracy A F Coelho
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Akshay Batra
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Nadeem A Afzal
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
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13
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Marino LV, Paulson S, Ashton JJ, Weeks C, Young A, Pappachan JV, Swann J, Johnson MJ, Beattie RM. A Scoping Review: Urinary Markers of Metabolic Maturation in Preterm Infants and Future Interventions to Improve Growth. Nutrients 2022; 14:nu14193957. [PMID: 36235609 PMCID: PMC9571892 DOI: 10.3390/nu14193957] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Growth failure in infants born preterm is a significant issue, increasing the risk of poorer neurodevelopmental outcomes and metabolic syndrome later in life. During the first 1000 days of life biological systems mature rapidly involving developmental programming, cellular senescence, and metabolic maturation, regulating normal growth and development. However, little is known about metabolic maturation in infants born preterm and the relationship with growth. Objective: To examine the available evidence on urinary markers of metabolic maturation and their relationship with growth in infants born preterm. Eligibility criteria: Studies including in this scoping review using qualitative or quantitative methods to describe urinary markers of metabolic maturation and the relationship with growth in infants born preterm. Results: After a screening process 15 titles were included in this review, from 1998–2021 drawing from China (n = 1), Italy (n = 3), Germany (n = 3), Greece (n = 1), Japan (n = 2), Norway (n = 1), Portugal (n = 1), Spain (n = 2) and USA (n = 1). The included studies examined urinary metabolites in 1131 infants. A content analysis identified 4 overarching themes relating to; (i) metabolic maturation relative to gestational age, (ii) metabolic signature and changes in urinary metabolites over time, (iii) nutrition and (iv) growth. Conclusion: The results of this scoping review suggest there are considerable gaps in our knowledge relating to factors associated with metabolic instability, what constitutes normal maturation of preterm infants, and how the development of reference phenome age z scores for metabolites of interest could improve nutritional and growth outcomes.
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Affiliation(s)
- Luise V. Marino
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Faculty of Health Science, University of Southampton, Southampton SO17 1BJ, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Correspondence: ; Tel.: +44-(0)-23-8079-6000
| | - Simone Paulson
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
| | - James J. Ashton
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Paediatric Gastroenterology, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Charlotte Weeks
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
| | - Aneurin Young
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton SO17 1BJ, UK
- Department of Neonatal Medicine, Southampton Children’s Hospital, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
| | - John V. Pappachan
- Paediatric Intensive Care Unit, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Jonathan Swann
- Biomolecular Medicine, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Mark J. Johnson
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Department of Neonatal Medicine, Southampton Children’s Hospital, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Robert Mark Beattie
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation, Southampton S016 6YD, UK
- Paediatric Gastroenterology, Southampton Children’s Hospital, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton S016 6YD, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton SO17 1BJ, UK
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14
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Abstract
Studies of Crohn's disease consistently implicate NOD2 as the most important gene in disease pathogenesis since first being identified in 2001. Since this point, genome-wide association, next-generation sequencing, and functional analyses have all confirmed a key role for NOD2, but despite this, NOD2 also has significant unresolved complexity. More recent studies have reinvigorated an early hypothesis that NOD2 may be a single-gene cause of disease, and the distinct ileal stricturing phenotype seen with NOD2-related disease presents an opportunity for personalised diagnosis, disease prediction and targeted therapy. The genomics of NOD2 has much that remains unknown, including the role of rare variation, phasing of variants across the haplotype block and the role of variation in the NOD2-regulatory regions. Here, we discuss the evidence and the unmet needs of NOD2-research, based on recently published evidence, and suggest methods that may meet these requirements.
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Affiliation(s)
- James J Ashton
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.,Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Eleanor G Seaby
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
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15
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Ashton JJ, Barakat FM, Barnes C, Coelho TAF, Batra A, Afzal NA, Beattie RM. Incidence and Prevalence of Paediatric Inflammatory Bowel Disease Continues to Increase in the South of England. J Pediatr Gastroenterol Nutr 2022; 75:e20-e24. [PMID: 35666860 DOI: 10.1097/mpg.0000000000003511] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/12/2022]
Abstract
OBJECTIVE The incidence of paediatric inflammatory bowel disease (IBD) has been increasing over 25 years; however, contemporary trends are not established and the impact of COVID-19 on case rates is unclear. METHODS Data from Southampton Children's hospital prospective IBD database were retrieved for 2002-2021. Incidence rates were calculated based on referral area populations and temporal trends analysed. Disease prevalence for those aged <18 years was calculated for 2017-2021. Monoclonal prescriptions were reported. RESULTS In total, 1150 patients were included (mean age at diagnosis 12.63 years, 40.5% female). An estimated 704 patients had Crohn's disease (61.2%), 385 had ulcerative colitis (33.5%), and 61 had IBD unclassified (5.3%). Overall IBD incidence increased, β = 0.843, P = 3 × 10 -6 , driven by Crohn's disease, β = 0.732, P = 0.00024 and ulcerative colitis, β = 0.816, P = 0.000011. There was no change in IBDU incidence, β = 0.230, P = 0.33. From 2002-2021, 51 patients were diagnosed <6 years of age, 160 patients aged 6 to <10 years and 939 patients aged 10 to <18 years of age. Increased incidence was observed in patients aged 10 to <18 years of age (β = 0.888, P = 1.8 × 10 -7 ). There was no significant change in incidence of IBD in <6 years (β = 0.124, P = 0.57), or 6 to <10 years (β = 0.146, P = 0.54). IBD prevalence increased by an average of 1.71%/year from 2017 to 2021, β = 0.979, P = 0.004. The number of new monoclonal prescriptions increased from 6 in 2007 to 111 in 2021. CONCLUSIONS IBD incidence continues to increase in Southern England. Compounding prevalence and increased monoclonal usage has implications for service provision.
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Affiliation(s)
- James J Ashton
- *Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Farah M Barakat
- the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Claire Barnes
- the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Tracy A F Coelho
- the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Akshay Batra
- the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Nadeem A Afzal
- the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - R Mark Beattie
- the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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16
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Ashton JJ, Boukas K, Stafford IS, Cheng G, Haggarty R, Coelho TAF, Batra A, Afzal NA, Williams AP, Polak ME, Beattie RM, Ennis S. Deleterious Genetic Variation Across the NOD Signaling Pathway Is Associated With Reduced NFKB Signaling Transcription and Upregulation of Alternative Inflammatory Transcripts in Pediatric Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:912-922. [PMID: 34978330 PMCID: PMC9165556 DOI: 10.1093/ibd/izab318] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory bowel disease may arise with inadequate immune response to intestinal bacteria. NOD2 is an established gene in Crohn's disease pathogenesis, with deleterious variation associated with reduced NFKB signaling. We hypothesized that deleterious variation across the NOD2 signaling pathway impacts on transcription. METHODS Treatment-naïve pediatric inflammatory bowel disease patients had ileal biopsies for targeted autoimmune RNA-sequencing and blood for whole exome sequencing collected at diagnostic endoscopy. Utilizing GenePy, a per-individual, per-gene score, genes within the NOD signaling pathway were assigned a quantitative score representing total variant burden. Where multiple genes formed complexes, GenePy scores were summed to create a "complex" score. Normalized transcript expression of 95 genes within this pathway was retrieved. Regression analysis was performed to determine the impact of genomic variation on gene transcription. RESULTS Thirty-nine patients were included. Limited clustering of patients based on NOD signaling transcripts was related to underlying genomic variation. Patients harboring deleterious variation in NOD2 had reduced NOD2 (β = -0.702, P = 4.3 × 10-5) and increased NFKBIA (β = 0.486, P = .001), reflecting reduced NFKB signal activation. Deleterious variation in the NOD2-RIPK2 complex was associated with increased NLRP3 (β = 0.8, P = 3.1475 × 10-8) and TXN (β = -0.417, P = 8.4 × 10-5) transcription, components of the NLRP3 inflammasome. Deleterious variation in the TAK1-TAB complex resulted in reduced MAPK14 transcription (β = -0.677, P = 1.7 × 10-5), a key signal transduction protein in the NOD2 signaling cascade and increased IFNA1 (β = 0.479, P = .001), indicating reduced transcription of NFKB activators and alternative interferon transcription in these patients. CONCLUSIONS Data integration identified perturbation of NOD2 signaling transcription correlated with genomic variation. A hypoimmune NFKB signaling transcription response was observed. Alternative inflammatory pathways were activated and may represent therapeutic targets in specific patients.
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Affiliation(s)
- James J Ashton
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, United Kingdom
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, United Kingdom
| | - Konstantinos Boukas
- Wessex Investigational Sciences Hub laboratory (WISH lab), University of Southampton, Faculty of Medicine, Southampton, United Kingdom
| | - Imogen S Stafford
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, United Kingdom
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdomand
| | - Guo Cheng
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdomand
| | - Rachel Haggarty
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdomand
| | - Tracy A F Coelho
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, United Kingdom
| | - Akshay Batra
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, United Kingdom
| | - Nadeem A Afzal
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, United Kingdom
| | - Anthony P Williams
- Wessex Investigational Sciences Hub laboratory (WISH lab), University of Southampton, Faculty of Medicine, Southampton, United Kingdom
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Marta E Polak
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
- Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, United Kingdom
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, United Kingdom
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17
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Ashton JJ, Ennis S, Beattie RM. Infliximab at diagnosis: moving towards personalisation in paediatric inflammatory bowel disease. Gut 2022; 71:2-3. [PMID: 33722861 DOI: 10.1136/gutjnl-2021-324214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 12/08/2022]
Affiliation(s)
- James J Ashton
- Paediatric Gastroenterology, University Hospital Southampton, Southampton, Hampshire, UK.,Human Genetics and Genomics, University of Southampton, Southampton, UK
| | - Sarah Ennis
- Human Genetics and Genomics, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Paediatric Gastroenterology, University Hospital Southampton, Southampton, Hampshire, UK
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18
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital.,Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital
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19
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Ashton JJ, Narula P, Kiparissi F, Spray C, Wilson DC, Tayler R, Howarth L, Torrente F, Deb P, Cameron FL, Muhammed R, Paul T, Epstein J, Lawson M, Maginnis J, Zamvar V, Fagbemi A, Devadason D, Bhavsar HS, Kammermeier J, Beattie RM. Transition Services for Paediatric Inflammatory Bowel Disease: A Multicentre Study of Practice in the United Kingdom. J Pediatr Gastroenterol Nutr 2021; 73:251-258. [PMID: 33853108 DOI: 10.1097/mpg.0000000000003148] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Patients with paediatric inflammatory bowel disease (IBD) constitute one of the largest cohorts requiring transition from paediatric to adult services. Standardised transition care improves short and long-term patient outcomes. This study aimed to detail the current state of transition services for IBD in the United Kingdom (UK). METHODS We performed a nationwide study to ascertain current practice, facilities and resources for children and young people with IBD. Specialist paediatric IBD centres were invited to contribute data on: timing of transition/transfer of care; transition resources available including clinics, staff and patient information; planning for future improvement. RESULTS Twenty of 21 (95%) of invited centres responded. Over 90% of centres began the transition process below 16 years of age and all had completed transfer to adult care at 18 years of age. The proportion of patients in the transition process at individual centres varied from 10% to 50%.Joint clinics were held in every centre, with a mean of 12.9 clinics per year. Adult and paediatric gastroenterologists attended at all sites. Availability of additional team members was patchy across the UK, with dietetic, psychological and surgical attendance available in <50% centres. A structured transition tool was used in 75% of centres. Sexual health, contraception and pregnancy were discussed by <60% of teams. CONCLUSIONS This study provides real-world clinical data on UK-wide transition services. These data can be used to develop a national strategy to complement current transition guidelines, focused on standardising services whilst allowing for local implementation.
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital
- Human Genetics and Genomic Medicine, University of Southampton, Southampton
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield
| | - Fevronia Kiparissi
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital, London
| | - Christine Spray
- Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol
| | - David C Wilson
- Department of Paediatric Gastroenterology, The Royal Hospital for Sick Children, Edinburgh
| | - Rachel Tayler
- Department of Paediatric Gastroenterology, Royal Hospital for Children Glasgow, Glasgow
| | - Lucy Howarth
- Department of Paediatric Gastroenterology, Oxford University Hospitals, Oxford
| | - Franco Torrente
- Department of Paediatric Gastroenterology, Addenbrooke's Hospital, Cambridge
| | - Protima Deb
- Department of Paediatric Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London
| | - Fiona L Cameron
- Department of Paediatric Gastroenterology, Alderhey Children's Hospital NHS Foundation Trust, West Derby, Liverpool
| | - Rafeeq Muhammed
- Department of Paediatric Gastroenterology, Birmingham Children's Hospital, Birmingham
| | - Thankam Paul
- Department of Paediatric Gastroenterology, St. Georges University Hospital NHS Foundation Trust
| | - Jenny Epstein
- Department of Paediatric Gastroenterology, Chelsea and Westminster Hospital, London
| | - Maureen Lawson
- Department of Paediatric Gastroenterology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle
| | - Janis Maginnis
- Department of Paediatric Gastroenterology, University Hospitals of North Staffordshire NHS Trust, Stoke-On-Trent
| | - Veena Zamvar
- Department of Paediatric Gastroenterology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Andrew Fagbemi
- Department of Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, UK
| | - David Devadason
- Department of Paediatric Gastroenterology, Nottingham Children's Hospital, Queens Medical Centre, Nottingham
| | - Hemant S Bhavsar
- Department of Paediatric Gastroenterology, University Hospitals of Leicester NHS Trust, Leicester
| | - Jochen Kammermeier
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, UK
| | - Robert M Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital
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20
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Ashton JJ, Peiris D, Green Z, Johnson MJ, Marino LV, Griffiths M, Beattie RM. Routine abdominal magnetic resonance imaging can determine psoas muscle area in paediatric Crohn's disease and correlates with bioelectrical impedance spectroscopy measures of lean mass. Clin Nutr ESPEN 2021; 42:233-238. [PMID: 33745585 DOI: 10.1016/j.clnesp.2021.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Paediatric Crohn's disease (CD) has been associated with undernutrition. Accurate and accessible measures of body composition would provide data to personalise nutritional therapy. We assessed feasibility of MRI-derived measures of psoas cross-sectional area (PCSA) in paediatric CD and correlated with anthropometric and bioelectrical impedance spectroscopy (BIS) measures. METHODS MRI small bowel/pelvis images of patients with CD, aged <18 years, were retrieved. Patients with concurrent anthropometric and BIS measurements were eligible for inclusion. The PCSA at L3 was calculated by two assessors and combined. To assess reproducibility of measures we calculated the coefficient of variation (CoV). Age, height-Z-scores, weight-Z-scores and BIS measures were correlated with PCSA. Using normal paediatric data from CT-scans we derived psoas area Z-scores for our cohort. RESULTS 10 patients were included. Mean age at MRI scan was 14.6 years (11.7-16.3). PCSA was calculated for all MRI scans. There was high reproducibility between measurers, mean CoV 0.099. There was a significant positive correlation between PCSA and BIA-derived fat free mass, Pearson correlation coefficient (PCC) 0.831, p = 0.003. Correlation coefficients for PCSA and Height-for-age Z-score, weight-for-age -Z-score and age were PCC 0.343- p = 0.33, PCC = 0.222- p = 0.54, and PCC 0.6034- p = 0.065, respectively. The mean PCSA Z-score was -1.81, with 70% of the patients having a Z-score < -2.0. CONCLUSIONS These data demonstrate the feasibility of deriving measures of body composition from routine MRI imagine. There was significant positive correlation between PCSA and BIS-derived lean mass. Further studies are required to confirm applicability of normal ranges prior to routine clinical implementation.
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK; Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Dilane Peiris
- Department of Paediatric Radiology, Southampton Children's Hospital, Southampton, UK
| | - Zachary Green
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Mark J Johnson
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK; National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Luise V Marino
- Department of Dietetics/SLT, University Hospital Southampton Foundation NHS Trust, Southampton, UK
| | - Mark Griffiths
- Department of Paediatric Radiology, Southampton Children's Hospital, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.
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21
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Marino LV, Ashton JJ, Beattie RM. The impact of national lockdown on nutritional status of children with inflammatory bowel disease. J Hum Nutr Diet 2021; 34:656-659. [PMID: 33560555 DOI: 10.1111/jhn.12862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had wide-reaching primary and secondary health implications. The UK government implemented a national lockdown to slow the rate of infection at the end of March 2020, lasting until early summer 2020. The results from a UK nationwide survey suggest the majority of inflammatory bowel disease patients were followed up using technology-enabled care services (TECS) during this time. We therefore aimed to explore the impact of the pandemic on nutritional status of children with inflammatory bowel disease, focusing on the effect of national lockdown from March to early summer 2020. METHODS A retrospective study was conducted. All patients with a diagnosis of inflammatory bowel disease, aged <18 years, and under the care of Southampton Children's Hospital were eligible for inclusion. Those patients who attended an outpatient appointment during time period 1 (November 2019 to February 2020), and following the period of national lockdown, time period 2 (July to November 2020), were included in the analysis. RESULTS In total, 116 patients had paired measures. Using the World Health Organization criteria of nutritional status, 19% (n = 22/116) were mildly malnourished with a body mass index Z score (BMIZ) < -1. In this group, the mean BMIZ was -1.3 ± 0.9 at time point 1 versus -1.9 ± 0.9 at time point 2 (p = 0.03). The mean BMIZ score of those children who were overweight at time point 1 was 1.2 ± 1.2 versus 1.6 ± 1.4 at time point 2 (p = 0.2) During the period of lockdown, 27% of malnourished children (n = 6/22), 2% of normally nourished children (BMIZ > -1 to < 1) (n = 1/51) (p ≤ 0.0001) and none of the overweight children (BMIZ > 1) (n = 0/43) children (p ≤ 0.0001) had a TECS nutrition review. CONCLUSIONS Dietetic reviews were severely restricted during the first national lockdown. Patients with low BMIZ prior to lockdown became more malnourished. During the ongoing pandemic, it is important to identify those children with nutrition risk, focusing support on this group of children.
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Affiliation(s)
- Luise V Marino
- Department of Dietetics and Speech & Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Nutrition & Dietetics, Faculty of Health and Well Being, University of Winchester, Winchester, UK.,NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - James J Ashton
- NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Paediatric Gastroenterology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, Southampton University, Southampton, UK
| | - Robert Mark Beattie
- NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Paediatric Gastroenterology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, Southampton University, Southampton, UK
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22
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Ashton JJ, Green Z, Young A, Borca F, Coelho T, Batra A, Afzal NA, Ennis S, Johnson MJ, Beattie RM. Growth failure is rare in a contemporary cohort of paediatric inflammatory bowel disease patients. Acta Paediatr 2021; 110:326-334. [PMID: 32485032 DOI: 10.1111/apa.15383] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
AIM We assessed growth in a paediatric inflammatory bowel disease (PIBD) cohort. METHODS Paediatric inflammatory bowel disease patients were eligible if they were diagnosed at Southampton Children's Hospital from 2011 to 2018. Weight and height standard deviation scores (SDS) were retrieved. Mean SDS values, SDS change and anti-TNF status were analysed at diagnosis and during follow-up. RESULTS Four hundred and ninety patients were included, 313 with Crohn's disease (CD). CD patients presented with mean height SDS -0.13, -0.1 at 1-year, -0.11 at 2-years and -0.03 at 5 years, reflecting preserved linear growth. There was no significant height-SDS change from diagnosis to 5-year follow-up, +0.12, 95%-CI: 0.48 to -0.24. Mean weight-SDS at diagnosis was -0.39, driven by CD patients (-0.65). Mean weight-SDS approached 0 after 1 year and remained at the 50th centile throughout follow-up. Growth in ulcerative colitis was maintained. In multivariable regression males had worse height growth from diagnosis to transition (P = .036). Anti-TNF treatment (P = .013) and surgical resection (P = .005) were also associated with poorer linear growth. Patients treated with anti-TNF therapy had lower height-SDS compared to those never treated with anti-TNF at 1 year (-0.2 vs -0.01, P = .22), 2-years (-0.27 vs -0.01, P = .07) and 5 years (-0.21 vs 0.25, P = .051). CONCLUSION Height was generally maintained in Crohn's disease, and impaired linear growth was rare in this cohort.
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Affiliation(s)
- James J. Ashton
- Department of Paediatric Gastroenterology Southampton Children's Hospital Southampton UK
- Department of Human Genetics and Genomic Medicine University of Southampton Southampton UK
| | - Zachary Green
- Department of Paediatric Gastroenterology Southampton Children's Hospital Southampton UK
| | - Aneurin Young
- NIHR Southampton Biomedical Research Centre University Hospital Southampton Southampton UK
- Department of Neonatal Medicine, Southampton Children's Hospital University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Florina Borca
- NIHR Southampton Biomedical Research Centre University Hospital Southampton Southampton UK
| | - Tracy Coelho
- Department of Paediatric Gastroenterology Southampton Children's Hospital Southampton UK
| | - Akshay Batra
- Department of Paediatric Gastroenterology Southampton Children's Hospital Southampton UK
| | - Nadeem A. Afzal
- Department of Paediatric Gastroenterology Southampton Children's Hospital Southampton UK
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine University of Southampton Southampton UK
| | - Mark J. Johnson
- NIHR Southampton Biomedical Research Centre University Hospital Southampton Southampton UK
- Department of Neonatal Medicine, Southampton Children's Hospital University Hospital Southampton NHS Foundation Trust Southampton UK
| | - R. Mark Beattie
- Department of Paediatric Gastroenterology Southampton Children's Hospital Southampton UK
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23
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Ashton JJ, Boukas K, Davies J, Stafford IS, Vallejo AF, Haggarty R, Coelho TAF, Batra A, Afzal NA, Vadgama B, Williams AP, Beattie RM, Polak ME, Ennis S. Ileal Transcriptomic Analysis in Paediatric Crohn's Disease Reveals IL17- and NOD-signalling Expression Signatures in Treatment-naïve Patients and Identifies Epithelial Cells Driving Differentially Expressed Genes. J Crohns Colitis 2020; 15:774-786. [PMID: 33232439 PMCID: PMC8095388 DOI: 10.1093/ecco-jcc/jjaa236] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease [CD] arises through host-environment interaction. Abnormal gene expression results from disturbed pathway activation or response to bacteria. We aimed to determine activated pathways and driving cell types in paediatric CD. METHODS We employed contemporary targeted autoimmune RNA sequencing, in parallel to single-cell sequencing, to ileal tissue derived from paediatric CD and controls. Weighted gene co-expression network analysis [WGCNA] was performed and differentially expressed genes [DEGs] were determined. We integrated clinical data to determine co-expression modules associated with outcomes. RESULTS In all, 27 treatment-naive CD [TN-CD], 26 established CD patients and 17 controls were included. WGCNA revealed a 31-gene signature characterising TN-CD patients, but not established CD, nor controls. The CSF3R gene is a hub within this module and is key in neutrophil expansion and differentiation. Antimicrobial genes, including S100A12 and the calprotectin subunit S100A9, were significantly upregulated in TN CD compared with controls [p = 2.61 x 10-15 and p = 9.13 x 10-14, respectively] and established CD [both p = 0.0055]. Gene-enrichment analysis confirmed upregulation of the IL17-, NOD- and Oncostatin-M-signalling pathways in TN-CD patients, identified in both WGCNA and DEG analyses. An upregulated gene signature was enriched for transcripts promoting Th17-cell differentiation and correlated with prolonged time to relapse [correlation-coefficient-0.36, p = 0.07]. Single-cell sequencing of TN-CD patients identified specialised epithelial cells driving differential expression of S100A9. Cell groups, determined by single-cell gene expression, demonstrated enrichment of IL17-signalling in monocytes and epithelial cells. CONCLUSIONS Ileal tissue from treatment-naïve paediatric patients is significantly upregulated for genes driving IL17-, NOD- and Oncostatin-M-signalling. This signal is driven by a distinct subset of epithelial cells expressing antimicrobial gene transcripts.
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Affiliation(s)
- James J Ashton
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK,Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Konstantinos Boukas
- Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK
| | - James Davies
- Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Imogen S Stafford
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK,Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Andres F Vallejo
- Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rachel Haggarty
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Tracy A F Coelho
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Akshay Batra
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Nadeem A Afzal
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Bhumita Vadgama
- Department of Paediatric Histopathology, Southampton Children’s Hospital, Southampton, UK
| | - Anthony P Williams
- Wessex Investigational Sciences Hub, University of Southampton Faculty of Medicine, Southampton General Hospital, Southampton, UK,Institute for Life Sciences, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children’s Hospital, Southampton, UK
| | - Marta E Polak
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK,Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK,Corresponding author: Professor Sarah Ennis, PhD, Human Genetics and Genomic Medicine, University of Southampton, Duthie Building [Mailpoint 808], Southampton General Hospital, Southampton SO16 6YD, UK. Tel.: +44 [0]23 8079 8614;
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24
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Affiliation(s)
- R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Ian D Penman
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
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25
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Ashton JJ, Batra A, Coelho TAF, Afzal NA, Beattie RM. Challenges in chronic paediatric disease during the COVID-19 pandemic: diagnosis and management of inflammatory bowel disease in children. Arch Dis Child 2020; 105:706. [PMID: 32381515 DOI: 10.1136/archdischild-2020-319482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2020] [Indexed: 11/03/2022]
Affiliation(s)
- James J Ashton
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.,Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Akshay Batra
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Tracy A F Coelho
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Nadeem A Afzal
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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26
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton SO16 6YD, UK
- Department of Human Genetics and Genomics, University of Southampton, Southampton, UK
| | - Rebecca Smith
- Department of Gastroenterology, University Hospital Southampton, Southampton, UK
| | - Trevor Smith
- Department of Gastroenterology, University Hospital Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton SO16 6YD, UK
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27
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Affiliation(s)
- R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK,Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Ian D Penman
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK
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28
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Ashton JJ, Beattie RM. Can risk stratification help reduce negative appendicectomy rates? Lancet Child Adolesc Health 2020; 4:252-253. [PMID: 32078807 DOI: 10.1016/s2352-4642(20)30042-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 12/20/2022]
Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton SO16 6YD, UK; Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton SO16 6YD, UK.
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29
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Ashton JJ, Borca F, Mossotto E, Phan HTT, Ennis S, Beattie RM. Analysis and Hierarchical Clustering of Blood Results Before Diagnosis in Pediatric Inflammatory Bowel Disease. Inflamm Bowel Dis 2020; 26:469-475. [PMID: 30561629 DOI: 10.1093/ibd/izy369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/09/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pediatric inflammatory bowel disease (PIBD) is associated with a diagnostic delay. Blood tests are a routine part of the work-up in children with chronic abdominal symptoms (pain, diarrhea). Normal blood tests cannot exclude PIBD. We analyzed blood results at diagnosis over a 5-year period. METHODS Patients diagnosed from 2013 to 2017 were identified from the Southampton-PIBD database. Results were obtained up to 100 days before diagnostic endoscopy. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin, hemoglobin, platelets, packed cell volume (PCV), white cell count (WCC), and alanine transferase (ALT) were analyzed. Hierarchical clustering was applied to normalized results. RESULTS Two hundred fifty-six patients were included (Crohn's disease [CD], 151; ulcerative colitis [UC], 95; IBD-unclassified, 10; median age, 13.48 years; 36.7% female). Hierarchical clustering of patients revealed novel groupings enriched for CD and UC, characterized by specific patterns of results. In PIBD, 9% presented with all normal blood tests, 21.9% with normal CRP and ESR. Abnormal results were seen in all tests (ESR, 56.4% of patients; CRP, 53.4%; albumin, 28%; hemoglobin, 61.9%; platelets, 55.6%; PCV, 64.6%; WCC, 22.7%; and ALT, 7.2%). Normal inflammatory markers were more common in UC compared with CD (UC, 34%; CD, 15.8%; P = 0.0035). UC (14.4% normal) presented with all normal results more frequently than CD (CD, 5.3%; P = 0.02). CRP, ESR, and platelets were significantly higher in CD compared with UC. Albumin and hemoglobin were significantly lower. CONCLUSIONS Most cases of PIBD present with >1 abnormal blood result, although 1/11 patients presents with normal blood tests and 1/5 present with normal inflammatory markers. Hierarchical clustering offers the potential to produce novel groupings to inform disease categorization and best management.
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Florina Borca
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Enrico Mossotto
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Hang T T Phan
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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30
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Ashton JJ, Mossotto E, Stafford IS, Haggarty R, Coelho TA, Batra A, Afzal NA, Mort M, Bunyan D, Beattie RM, Ennis S. Genetic Sequencing of Pediatric Patients Identifies Mutations in Monogenic Inflammatory Bowel Disease Genes that Translate to Distinct Clinical Phenotypes. Clin Transl Gastroenterol 2020; 11:e00129. [PMID: 32463623 PMCID: PMC7145023 DOI: 10.14309/ctg.0000000000000129] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/03/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Monogenic inflammatory bowel disease (IBD) comprises rare Mendelian causes of gut inflammation, often presenting in infants with severe and atypical disease. This study aimed to identify clinically relevant variants within 68 monogenic IBD genes in an unselected pediatric IBD cohort. METHODS Whole exome sequencing was performed on patients with pediatric-onset disease. Variants fulfilling the American College of Medical Genetics criteria as "pathogenic" or "likely pathogenic" were assessed against phenotype at diagnosis and follow-up. Individual patient variants were assessed and processed to generate a per-gene, per-individual, deleteriousness score. RESULTS Four hundred one patients were included, and the median age of disease-onset was 11.92 years. In total, 11.5% of patients harbored a monogenic variant. TRIM22-related disease was implicated in 5 patients. A pathogenic mutation in the Wiskott-Aldrich syndrome (WAS) gene was confirmed in 2 male children with severe pancolonic inflammation and primary sclerosing cholangitis. In total, 7.3% of patients with Crohn's disease had apparent autosomal recessive, monogenic NOD2-related disease. Compared with non-NOD2 Crohn's disease, these patients had a marked stricturing phenotype (odds ratio 11.52, significant after correction for disease location) and had undergone significantly more intestinal resections (odds ratio 10.75). Variants in ADA, FERMT1, and LRBA did not meet the criteria for monogenic disease in any patients; however, case-control analysis of mutation burden significantly implicated these genes in disease etiology. DISCUSSION Routine whole exome sequencing in pediatric patients with IBD results in a precise molecular diagnosis for a subset of patients with IBD, providing the opportunity to personalize therapy. NOD2 status informs risk of stricturing disease requiring surgery, allowing clinicians to direct prognosis and intervention.
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Affiliation(s)
- James J. Ashton
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK;
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK;
| | - Enrico Mossotto
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK;
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK;
| | - Imogen S. Stafford
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK;
| | - Rachel Haggarty
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK;
| | - Tracy A.F. Coelho
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK;
| | - Akshay Batra
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK;
| | - Nadeem A. Afzal
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK;
| | - Matthew Mort
- Human Genetic Mutation Database, Cardiff University, Cardiff, UK
| | - David Bunyan
- Wessex Regional Genetics Laboratory, Salisbury NHS Foundation Trust, Salisbury, UK.
| | - Robert Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK;
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK;
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Maclean A, Ashton JJ, Garrick V, Beattie RM, Hansen R. Impact of COVID-19 on the diagnosis, assessment and management of children with inflammatory bowel disease in the UK: implications for practice. BMJ Paediatr Open 2020; 4:e000786. [PMID: 34192173 PMCID: PMC7549416 DOI: 10.1136/bmjpo-2020-000786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/07/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022] Open
Abstract
The assessment and management of patients with known, or suspected, paediatric inflammatory bowel disease (PIBD) has been hugely impacted by the COVID-19 pandemic. Although current evidence of the impact of COVID-19 infection in children with PIBD has provided a degree of reassurance, there continues to be the potential for significant secondary harm caused by the changes to normal working practices and reorganisation of services. Disruption to the normal running of diagnostic and assessment procedures, such as endoscopy, has resulted in the potential for secondary harm to patients including delayed diagnosis and delay in treatment. Difficult management decisions have been made in order to minimise COVID-19 risk for this patient group while avoiding harm. Initiating and continuing immunosuppressive and biological therapies in the absence of normal surveillance and diagnostic procedures have posed many challenges. Despite this, changes to working practices, including virtual clinic appointments, home faecal calprotectin testing kits and continued intensive support from clinical nurse specialists and other members of the multidisciplinary team, have resulted in patients still receiving a high standard of care, with those who require face-to-face intervention being highlighted. These changes have the potential to revolutionise the way in which patients receive routine care in the future, with the inclusion of telemedicine increasingly attractive for stable patients. There is also the need to use lessons learnt from this pandemic to plan for a possible second wave, or future pandemics as well as implementing some permanent changes to normal working practices. In this review, we describe the diagnosis, management and direct impact of COVID-19 in paediatric patients with IBD. We summarise the guidance and describe the implemented changes, evolving evidence and the implications of this virus on paediatric patients with IBD and working practices.
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Affiliation(s)
- Abbie Maclean
- School of Medicine, Dentistry and Nursing, University of Glasgow College of Medical, Veterinary and Life Sciences, Glasgow, UK
| | - James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Vikki Garrick
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Richard Hansen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, UK
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Abstract
Introduction: Long-term, sustained, remission is the ultimate goal of contemporary inflammatory bowel disease (IBD) therapy. Avoiding complications, surgery and malignancy, alongside minimizing the side effects of medications are vital. However, the reality of treatment involves patients losing response to therapy, or developing complications requiring cessation of medication. The reasons underlying this are numerous and include medication and host-related influences. Underpinning the response to medication, long-term outcomes and loss of response are individual etiological factors including the molecular cause of disease and individual pharmacogenomic influences.Areas covered: In this review, we discuss the long-term outcome of IBD, with a focus on pediatric-onset illness and discuss the factors leading to loss of treatment response whilst briefly considering the future of personalized therapy as a strategy to improve long-term outcomes.Expert opinion: Research findings are now moving toward clinical translation, including application of novel medications targeting new pathways. The integration of biological and multiomic data to predict disease outcome will provide personalized therapeutic management.
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Zachary Green
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Vinod Kolimarala
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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33
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,Department of Human Genetics and Genomics, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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Ashton JJ, Beattie RM. Treatment of Active Crohn's Disease With an Ordinary Food-Based Diet That Replicates Exclusive Enteral Nutrition. Gastroenterology 2019; 157:1160-1161. [PMID: 31228437 DOI: 10.1053/j.gastro.2019.01.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/07/2019] [Indexed: 12/02/2022]
Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital and Department of Human Genetics and Genomics, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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35
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Ashton JJ, Latham K, Beattie RM, Ennis S. Review article: the genetics of the human leucocyte antigen region in inflammatory bowel disease. Aliment Pharmacol Ther 2019; 50:885-900. [PMID: 31518029 DOI: 10.1111/apt.15485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/03/2019] [Revised: 07/05/2019] [Accepted: 08/10/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The human leucocyte antigen (HLA) complex, located at chromosome 6p21.3 is a highly polymorphic region containing the classical class I and II HLA genes. The region is highly associated with inflammatory bowel disease (IBD), largely through genome-wide association studies (GWAS). AIMS To review the role of HLA in immune function, summarise data on risk/protective HLA genotypes for IBD, discuss the role of HLA in IBD pathogenesis, treatment and examine limitations that might be addressed by future research. METHODS An organised search strategy was used to collate articles describing HLA genes in IBD, including Crohn's disease and ulcerative colitis. RESULTS All classical HLA genes with variation (including HLA-A, B, C, DRB1, DQA1, DQB1, DPA1 and DPB1) harbour IBD-associated genotypes. The most implicated gene is HLA-DRB1, with HLA-DRB1*03:01 the most associated risk allele in both Crohn's disease and ulcerative colitis. Elucidating precise disease associations is challenging due to high linkage disequilibrium between HLA genotypes. The mechanisms by which risk alleles cause disease are multifactorial, with the best evidence indicating structural and electrostatic alteration impacting antigen binding and downstream signalling. Adverse medication events have been associated with HLA genotypes including with thiopurines (pancreatitis) and anti-TNF agents (antibody formation). CONCLUSIONS The HLA complex is associated with multiple risk/protective alleles for IBD. Future research utilising long-read technology, ascertainment of zygosity and integration in disease modelling will improve the functional understanding and clinical translation of genetic findings.
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Affiliation(s)
- James J Ashton
- Human Genetics and Genomic Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Katy Latham
- Anthony Nolan Research Institute, University College London, London, UK
| | - Robert Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Sarah Ennis
- Human Genetics and Genomic Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
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Andrews ET, Ashton JJ, Pearson F, Beattie RM, Johnson MJ. Handheld 3D scanning as a minimally invasive measuring technique for neonatal anthropometry. Clin Nutr ESPEN 2019; 33:279-282. [PMID: 31451267 DOI: 10.1016/j.clnesp.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/28/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Measurement of length and head circumference (HC) in addition to weight is vital in assessing the nutritional status of preterm infants. Current anthropometry represents an interruption to preterm infants, and may not be possible in unstable infants. Handheld 3D scanning has the potential to perform bedside anthropometry (length and HC) in a less invasive manner. We aimed to evaluate the feasibility and performance of 3D scanning as a 'non-touch' measuring technique for routine anthropometry. METHODS Preterm infants born before 30 weeks gestation were recruited from a single neonatal unit. HC and length were measured both manually and by a handheld 3D scanner at recruitment and weekly until discharge. The two methods were compared using the Bland-Altman method and linear regression. RESULTS Seventeen infants had manual and 3D-scan measurements (67 HC, 87 length). The mean difference (95%CI) between manual and 3D-scan measures, as a percentage of the manual value, was 2.87% (2.27-3.47%) for HC and 3.10% (2.65-3.54%) for length. Correlation between manual and 3D measures was high; HC r = 0.957 and length 0.963. Bland-Altman plots showed reasonable agreement between the two methods, and there was a high correlation between scanner and manual measurements. CONCLUSIONS These data show a high correlation between measurements gathered from 3D scan images and standard anthropometry. However, 3D measures are not yet precise enough for routine clinical use. Refinement of technique/technology may translate into practical monitoring the growth of preterm infants with minimal handling and without interruption to developmental care.
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Affiliation(s)
- Edward T Andrews
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, UK
| | - James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, UK; Human Genetics and Genomic Medicine, University of Southampton, UK
| | - Freya Pearson
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, UK; National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Mark J Johnson
- Department of Neonatal Medicine, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, UK; National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
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Ashton JJ, Beattie RM. Screen time in children and adolescents: is there evidence to guide parents and policy? The Lancet Child & Adolescent Health 2019; 3:292-294. [DOI: 10.1016/s2352-4642(19)30062-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 11/29/2022]
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton SO16 6YD, UK; Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton SO16 6YD, UK.
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39
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Affiliation(s)
- Matthew Kurien
- Academic Unit of Gastroenterology, Departments of Infection and Immunity and Cardiovascular Science, University of Sheffield Medical School, Sheffield, UK
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield
| | - David S Sanders
- Academic Unit of Gastroenterology, Departments of Infection and Immunity and Cardiovascular Science, University of Sheffield Medical School, Sheffield, UK
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield
| | - James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, UK
- Department of Human Genetics and Genomic Medicine, University of Southampton
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, UK
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40
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Ashton JJ, Borca F, Mossotto E, Coelho T, Batra A, Afzal NA, Phan HTT, Stanton M, Ennis S, Beattie RM. Increased prevalence of anti-TNF therapy in paediatric inflammatory bowel disease is associated with a decline in surgical resections during childhood. Aliment Pharmacol Ther 2019; 49:398-407. [PMID: 30628109 DOI: 10.1111/apt.15094] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 09/17/2018] [Revised: 10/15/2018] [Accepted: 11/21/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anti-tumour necrosis factor-α (anti-TNF) therapy use has risen in paediatric-onset inflammatory bowel disease (PIBD). Whether this has translated into preventing/delaying childhood surgery is uncertain. The Wessex PIBD cohort was analysed for trends in anti-TNF-therapy and surgery. AIM To assess patients diagnosed with PIBD within Wessex from 1997 to 2017. The prevalence of anti-TNF-therapy and yearly surgery rates (resection and perianal) during childhood (<18 years) were analysed (Pearson's correlation, multivariate regression, Fisher's exact). RESULTS Eight-hundred-and-twenty-five children were included (498 Crohn's disease, 272 ulcerative colitis, 55 IBD-unclassified), mean age at diagnosis 13.6 years (1.6-17.6), 39.6% female. The prevalence of anti-TNF-treated patients increased from 5.1% to 27.1% (2007-2017), P = 0.0001. Surgical resection-rate fell (7.1%-1.5%, P = 0.001), driven by a decrease in Crohn's disease resections (8.9%-2.3%, P = 0.001). Perianal surgery and ulcerative colitis resection-rates were unchanged. Time from diagnosis to resection increased (1.6-2.8 years, P = 0.028) but mean age at resection was unchanged. Patients undergoing resections during childhood were diagnosed at a younger age in the most recent 5 years (2007-2011 = 13.1 years, 2013-2017 = 11.9 years, P = 0.014). Resection-rate in anti-TNF-therapy treated (16.1%) or untreated (12.2%) was no different (P = 0.25). Patients started on anti-TNF-therapy <3 years post-diagnosis (11.6%) vs later (28.6%) had a reduction in resections, P = 0.047. Anti-TNF-therapy prevalence was the only significant predictor of resection-rate using multivariate regression (P = 0.011). CONCLUSIONS The prevalence of anti-TNF-therapy increased significantly, alongside a decrease in surgical resection-rate. Patients diagnosed at younger ages still underwent surgery during childhood. Anti-TNF-therapy may reduce the need for surgical intervention in childhood, thereby influencing the natural history of PIBD.
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Florina Borca
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Enrico Mossotto
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Tracy Coelho
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Akshay Batra
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Nadeem A Afzal
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Hang T T Phan
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Michael Stanton
- Department of Paediatric Surgery, Southampton Children's Hospital, Southampton, UK
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Robert Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
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Abstract
Up to 25% of inflammatory bowel disease (IBD) presents during childhood, often with severe and extensive disease, leading to significant morbidity including delayed growth and nutritional impairment. The classical approach to management has centred on differentiation into Crohn's disease (CD) or ulcerative colitis (UC), with subsequent treatment based on symptoms, results and complications. However, IBD is a heterogeneous condition with substantial variation in phenotype, disease course and outcome, so whilst effective treatment exists one size does not fit all. The ability to predict disease course at diagnosis, alongside tailoring medications based on response gives the potential for a more 'personalised approach'. The move to a pre-emptive strategy to prevent IBD-related complications, whilst simultaneously minimising side effects and long-term toxicity from therapy, particularly in those with relatively indolent disease, has the potential to revolutionise care. In very early-onset IBD, personalised approaches to diagnosis and management have become the standard of treatment enabling clinicians to significantly alter the outcomes of the few children with monogenic disease. However, the promise of discoveries in genomics, microbiome and transcriptomics in paediatric IBD has not yet translated to clinical application for the vast majority of patients. Despite this, the opportunity presents itself to apply data gathered at diagnosis and follow-up to predict which patients are likely to progress to complicated disease, which will respond well and which will require additional therapy. Using complex mathematics and innovative, cutting-edge machine learning (ML) techniques gives the potential to use this data to develop personalised clinical care algorithms to treat patients more effectively, reduce toxicity and improve outcome. In this review, we will consider current management of paediatric IBD, discuss how precision medicine is making inroads into clinical practice already, examine the contemporary studies applying data to stratify patients and explore how future management may be revolutionised by personalisation with clinical, genomic and other multi-omic data.
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.,Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - Enrico Mossotto
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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Gavin J, Marino LV, Ashton JJ, Beattie RM. Patient, parent and professional perception of the use of maintenance enteral nutrition in Paediatric Crohn's Disease. Acta Paediatr 2018; 107:2199-2206. [PMID: 30192409 DOI: 10.1111/apa.14571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/08/2018] [Revised: 06/29/2018] [Accepted: 09/05/2018] [Indexed: 12/30/2022]
Abstract
AIM Maintenance enteral nutrition (MEN) is routinely used in Paediatric Crohn's Disease (CD) to prolong remission although there is limited evidence for efficacy and a lack of formal guidelines. This study surveyed patients', parents' and professional experience with MEN. METHODS Two questionnaires were developed to survey the experience of MEN; (i) Patients/Parents (children >10 years of age aimed to complete independently) and (ii) Dietitians. Questionnaires were sent to families prescribed MEN after exclusive enteral nutrition (EEN) between 2015-17 (n = 77) and dietitians working in paediatric regional centres in UK (n = 23). RESULTS Response rate to the questionnaires was 53% patients, 62% parents and 83% dietitians. Patients/parents reported medical/dietetic advice to be the primary factor affecting compliance, 30% patients reported side effects. Fifty-six per cent of patients/58% parents stated a preference for dietary advice rather than MEN. Dietetic responses indicated 79% used MEN after EEN as standard procedure and 79% did not have exit criteria for MEN. Sixty-eight per cent perceived the taste was the primary factor affecting patient compliance. CONCLUSION Patients' perception of the usefulness of MEN differs to professionals. This study highlights the extensive practice of MEN after EEN in clinical remission, which may not be nutritionally indicated. Patient preference is for dietary advice rather than MEN.
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Affiliation(s)
- J Gavin
- Department of Dietetics/SLT; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - L V Marino
- Department of Dietetics/SLT; University Hospital Southampton Foundation NHS Trust; Southampton UK
- Department of Human Genetics and Genomic Medicine; University of Southampton; Southampton UK
| | - J J Ashton
- Department of Human Genetics and Genomic Medicine; University of Southampton; Southampton UK
- Department of Paediatric Gastroenterology; Southampton Children's Hospital University Hospitals Southampton; Southampton UK
| | - R M Beattie
- Department of Paediatric Gastroenterology; Southampton Children's Hospital University Hospitals Southampton; Southampton UK
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Ashton JJ, Beattie RM. Gastro-oesphageal reflux in infants: what are we treating? Lancet Child Adolesc Health 2018; 2:475-476. [PMID: 30169314 DOI: 10.1016/s2352-4642(18)30178-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 11/27/2022]
Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton SO16 6YD, UK; Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton SO16 6YD, UK.
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44
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Ashton JJ, Gavin J, Beattie RM. Exclusive enteral nutrition in Crohn's disease: Evidence and practicalities. Clin Nutr 2018; 38:80-89. [PMID: 29398336 DOI: 10.1016/j.clnu.2018.01.020] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/08/2017] [Accepted: 01/11/2018] [Indexed: 12/19/2022]
Abstract
Exclusive enteral nutrition (EEN) is the first line therapy for paediatric Crohn's disease, providing a complete nutritional feed whilst simultaneously inducing remission in up to 80% of cases. The effect of EEN on systemic/local intestinal immune function and subsequent inflammation (including barrier permeability, direct anti-inflammatory effects and cytokine signalling pathways), alongside changes in the microbiome (specific species and broad taxonomic shifts, functional changes) are becoming clearer, however the exact mechanism for induction of remission in Crohn's disease remains uncertain. The evidence of efficacy in paediatric Crohn's disease is strong, with selected adult populations also benefiting from EEN. However despite recommendations from all major societies (ECCO, ESPGHAN, NASPGHAN and ESPEN) first-line use of EEN is varied and Europe/Australasia/Canada show significantly more routine use than other parts of North America. Growth and nutritional status are significantly improved with EEN compared to corticosteroids but long-term outcomes are sparse. This review discusses the evidence underlying the use of EEN, highlighting the mechanisms thought to underlie how EEN induces remission in Crohn's disease, when and how to use EEN, including practical issues in both paediatric and adult practice (formulation, compliance, volumes and administration), and summarises the ongoing research priorities.
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Affiliation(s)
- James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK; Human Genetics and Genomic Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Joan Gavin
- Department of Paediatric Dietetics, Southampton Children's Hospital, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK.
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Gavin J, Ashton JJ, Heather N, Marino LV, Beattie RM. Nutritional support in paediatric Crohn's disease: outcome at 12 months. Acta Paediatr 2018; 107:156-162. [PMID: 28901585 DOI: 10.1111/apa.14075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 04/04/2017] [Revised: 08/10/2017] [Accepted: 09/08/2017] [Indexed: 12/22/2022]
Abstract
AIM Paediatric Crohn's disease (CD) is associated with growth delay and poor nutritional status. Maintenance enteral nutrition (MEN) supplementation is a potential adjunct to improve growth/prolong remission. METHODS Newly diagnosed CD patients were identified. Anthropometry, treatments and outcomes were collected for 12 months following diagnosis. Data are presented as medians. RESULTS A total of 102 patients were identified (age = 13 years, 76% male), 58 (57%) completed exclusive enteral nutrition (EEN) as induction therapy, and 77 (75%) entered clinical remission. Following induction, 58 (57%) of all patients continued MEN and 44 (43%) consumed normal diet (ND). BMI Z-score increased (diagnosis-12 months) for EEN (-1.41 to -0.21 (p = <0.0001)) and steroid groups (-0.97 to -0.11 (p = 0.001)). BMI Z-score increased (post induction - 12 months) for MEN (-0.62 to -0.44 (p = 0.04)) but not ND (-0.33 to -0.4 (p = 0.79)). Height Z-score did not increase for any treatment group over 12 months. MEN and ND group relapse rates were similar at six months, MEN = 21/58 (36%); ND = 21/44 (48%) (p = 0.24) and 12 months, MEN = 24/58 (41%); ND = 13/44 (30%) (p = 0.22). Fewer patients treated with EEN then MEN relapsed less than six months, 14 of 43 (33%), compared to patients treated with steroids then ND 16/29 (55%) (p = 0.09). CONCLUSION BMI Z-score increased but height Z-score remained unchanged over 12 months for the MEN group. Use of MEN was not associated with prolonged time to relapse. Prospective studies are required to examine the utility of MEN.
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Affiliation(s)
- J Gavin
- Department of Dietetics; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - JJ Ashton
- Department of Paediatric Gastroenterology; Southampton Children's Hospital; University Hospitals Southampton; Southampton UK
- Department of Human Genetics and Genomic Medicine; University of Southampton; Southampton UK
| | - N Heather
- Department of Dietetics; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - LV Marino
- Department of Dietetics; University Hospital Southampton Foundation NHS Trust; Southampton UK
| | - RM Beattie
- Department of Paediatric Gastroenterology; Southampton Children's Hospital; University Hospitals Southampton; Southampton UK
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46
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Ashton JJ, Beattie RM. Improving remission rates in newly diagnosed paediatric ulcerative colitis. Lancet Gastroenterol Hepatol 2017; 2:838-839. [DOI: 10.1016/s2468-1253(17)30289-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 12/20/2022]
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47
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Ashton JJ, Ennis S, Beattie RM. Early-onset paediatric inflammatory bowel disease. The Lancet Child & Adolescent Health 2017; 1:147-158. [DOI: 10.1016/s2352-4642(17)30017-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/08/2017] [Accepted: 06/14/2017] [Indexed: 12/27/2022]
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Ashton JJ, Johnson MJ, Pond J, Crowley P, Dimitrov BD, Pearson F, Beattie RM. Assessing the growth of preterm infants using detailed anthropometry. Acta Paediatr 2017; 106:889-896. [PMID: 28240375 DOI: 10.1111/apa.13804] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 11/30/2016] [Revised: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
Abstract
AIM Preterm infants display altered body composition compared to term infants, and weight gain is a crude indicator body composition. Childhood mid-upper arm circumference (MUAC) is a measure of nutritional status. This study investigates MUAC and mid-thigh circumference (MTC) to monitor growth in preterm infants. METHODS Preterm infants (<30-week gestation) were recruited. MUAC, MTC, weight, length and head circumference (HC) were measured at recruitment and weekly intervals until discharge. Descriptive, correlation and regression analyses were used. RESULTS Ninety-three infants were recruited. Median measurement duration was eight weeks (1-19). Median gestational age was 27 weeks (23-29). Analysis by curve estimation displayed a mean increase of 2.58 mm/week (left MUAC) (p ≤ 0.0001), 2.56 mm/week (right MUAC) (p ≤ 0.0001), 4.16 mm/week (left MTC) (p ≤ 0.0001), 4.20 mm/week (right MTC) (p ≤ 0.0001). Coefficients of determination (R2 ) were calculated using a growth regression model for MUAC and MTC (0.866-0.917); measures were comparable to growth modelling of weight (0.913), length (0.945) and HC (0.928). High concordance between left and right MUAC and MTC generated a Pearson's correlation coefficient of 0.999 (MUAC) (p ≤ 0.001) and 0.994 (MTC) (p ≤ 0.001). CONCLUSION Data demonstrate the potential utility of MUAC and MTC as additional measures of growth in preterm infants that are reproducible over time. There is potential to gain insights to improve lean-mass accretion in preterm infants.
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Affiliation(s)
- James J. Ashton
- Department of Paediatric Gastroenterology and Nutrition; Southampton Children's Hospital; Southampton UK
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Mark J. Johnson
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - Jenny Pond
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - Philippa Crowley
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - Borislav D. Dimitrov
- Primary Care and Population Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | - Freya Pearson
- Department of Neonatal Medicine; Princess Anne Hospital; Southampton UK
| | - R. Mark Beattie
- Department of Paediatric Gastroenterology and Nutrition; Southampton Children's Hospital; Southampton UK
- NIHR Southampton Biomedical Research Centre; University of Southampton Faculty of Medicine and University Hospital Southampton NHS Foundation Trust; Southampton UK
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Ashton JJ, Colquhoun CM, Cleary DW, Coelho T, Haggarty R, Mulder I, Batra A, Afzal NA, Beattie RM, Scott KP, Ennis S. 16S sequencing and functional analysis of the fecal microbiome during treatment of newly diagnosed pediatric inflammatory bowel disease. Medicine (Baltimore) 2017; 96:e7347. [PMID: 28658154 PMCID: PMC5500076 DOI: 10.1097/md.0000000000007347] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The human microbiome is of considerable interest to pediatric inflammatory bowel disease (PIBD) researchers with 1 potential mechanism for disease development being aberrant immune handling of the intestinal bacteria. This study analyses the fecal microbiome through treatment in newly diagnosed PIBD patients and compares to cohabiting siblings where possible. Patients were recruited on clinical suspicion of PIBD before diagnosis. Treatment-naïve fecal samples were collected, with further samples at 2 and 6 weeks into treatment. Samples underwent 16S ribosomal ribonucleic acid (RNA) gene sequencing and short-chain fatty acids (SCFAs) analysis, results were analyzed using quantitative-insights-into-microbial-ecology. Six PIBD patients were included in the cohort: 4 Crohn disease (CD), 1 ulcerative colitis (UC), 1 inflammatory bowel disease (IBD) unclassified, and median age 12.6 (range 10-15.1 years); 3 patients had an unaffected healthy sibling recruited. Microbial diversity (observed species/Chao1/Shannon diversity) was reduced in treatment-naïve patients compared to siblings and patients in remission. Principal coordinate analysis using Bray-Curtis dissimilarity and UniFrac revealed microbial shifts in CD over the treatment course. In treatment-naïve PIBD, there was reduction in functional ability for amino acid metabolism and carbohydrate handling compared to controls (P = .038) and patients in remission (P = .027). Metabolic function returned to normal after remission was achieved. SCFA revealed consistent detection of lactate in treatment-naïve samples. This study adds in-depth 16S rRNA sequencing analysis on a small longitudinal cohort to the literature and includes sibling controls and patients with UC/IBD unclassified. It highlights the initial dysbiosis, reduced diversity, altered functional potential, and subsequent shifts in bacteria from diagnosis over time to remission.
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Affiliation(s)
- James J. Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton
| | | | - David W. Cleary
- Academic Unit of Clinical and Experimental Sciences, University of Southampton, Southampton
| | - Tracy Coelho
- Department of Paediatric Gastroenterology, Southampton Children's Hospital
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton
| | - Rachel Haggarty
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton
| | - Imke Mulder
- Gut Health Division, Rowett Institute, University of Aberdeen, Aberdeen
- 4D Pharma PLC, Aberdeen, UK
| | - Akshay Batra
- Department of Paediatric Gastroenterology, Southampton Children's Hospital
| | - Nadeem A. Afzal
- Department of Paediatric Gastroenterology, Southampton Children's Hospital
| | - R. Mark Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital
| | - Karen P. Scott
- Gut Health Division, Rowett Institute, University of Aberdeen, Aberdeen
| | - Sarah Ennis
- Department of Human Genetics and Genomic Medicine, University of Southampton, Southampton
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Mossotto E, Ashton JJ, Coelho T, Beattie RM, MacArthur BD, Ennis S. Classification of Paediatric Inflammatory Bowel Disease using Machine Learning. Sci Rep 2017; 7:2427. [PMID: 28546534 PMCID: PMC5445076 DOI: 10.1038/s41598-017-02606-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/12/2017] [Indexed: 02/07/2023] Open
Abstract
Paediatric inflammatory bowel disease (PIBD), comprising Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU) is a complex and multifactorial condition with increasing incidence. An accurate diagnosis of PIBD is necessary for a prompt and effective treatment. This study utilises machine learning (ML) to classify disease using endoscopic and histological data for 287 children diagnosed with PIBD. Data were used to develop, train, test and validate a ML model to classify disease subtype. Unsupervised models revealed overlap of CD/UC with broad clustering but no clear subtype delineation, whereas hierarchical clustering identified four novel subgroups characterised by differing colonic involvement. Three supervised ML models were developed utilising endoscopic data only, histological only and combined endoscopic/histological data yielding classification accuracy of 71.0%, 76.9% and 82.7% respectively. The optimal combined model was tested on a statistically independent cohort of 48 PIBD patients from the same clinic, accurately classifying 83.3% of patients. This study employs mathematical modelling of endoscopic and histological data to aid diagnostic accuracy. While unsupervised modelling categorises patients into four subgroups, supervised approaches confirm the need of both endoscopic and histological evidence for an accurate diagnosis. Overall, this paper provides a blueprint for ML use with clinical data.
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Affiliation(s)
- E Mossotto
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - J J Ashton
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - T Coelho
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - R M Beattie
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - B D MacArthur
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - S Ennis
- Human Genetics and Genomic Medicine, University of Southampton, Southampton, UK.
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