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Dijkstra AM, Evers-van Vliet K, Heiner-Fokkema MR, Bodewes FAJA, Bos DK, Zsiros J, van Aerde KJ, Koop K, van Spronsen FJ, Lubout CMA. A False-Negative Newborn Screen for Tyrosinemia Type 1-Need for Re-Evaluation of Newborn Screening with Succinylacetone. Int J Neonatal Screen 2023; 9:66. [PMID: 38132825 PMCID: PMC10744279 DOI: 10.3390/ijns9040066] [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: 11/01/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Undiagnosed and untreated tyrosinemia type 1 (TT1) individuals carry a significant risk for developing liver fibrosis, cirrhosis and hepatocellular carcinoma (HCC). Elevated succinylacetone (SA) is pathognomonic for TT1 and therefore often used as marker for TT1 newborn screening (NBS). While SA was long considered to be elevated in every TT1 patient, here we present a recent false-negative SA TT1 screen. A nine-year-old boy presented with HCC in a cirrhotic liver. Additional tests for the underlying cause unexpectedly revealed TT1. Nine years prior, the patient was screened for TT1 via SA NBS with a negative result: SA 1.08 µmol/L, NBS cut-off 1.20 µmol/L. To our knowledge, this report is the first to describe a false-negative result from the TT1 NBS using SA. False-negative TT1 NBS results may be caused by milder TT1 variants with lower SA excretion. Such patients are more likely to be missed in NBS programs and can be asymptomatic for years. Based on our case, we advise TT1 to be considered in patients with otherwise unexplained liver pathology, including fibrosis, cirrhosis and HCC, despite a previous negative TT1 NBS status. Moreover, because the NBS SA concentration of this patient fell below the Dutch cut-off value (1.20 µmol/L at that time), as well as below the range of cut-off values used in other countries (1.29-10 µmol/L), it is likely that false-negative screening results for TT1 may also be occurring internationally. This underscores the need to re-evaluate TT1 SA NBS programs.
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Affiliation(s)
- Allysa M. Dijkstra
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (A.M.D.); (K.E.-v.V.); (F.J.v.S.)
| | - Kimber Evers-van Vliet
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (A.M.D.); (K.E.-v.V.); (F.J.v.S.)
| | - M. Rebecca Heiner-Fokkema
- Laboratory of Metabolic Diseases, Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - Frank A. J. A. Bodewes
- Section of Pediatric Gastroeneterology and Hepatology, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - Dennis K. Bos
- Department of Genetics, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands;
| | - József Zsiros
- Princess Máxima Center for Pediatric Oncology, 3584 CX Utrecht, The Netherlands;
| | - Koen J. van Aerde
- Department of Pediatric Infectious Disease and Immunology, Amalia’s Children Hospital, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Klaas Koop
- Section Metabolic Diseases, Department of Pediatrics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Francjan J. van Spronsen
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (A.M.D.); (K.E.-v.V.); (F.J.v.S.)
| | - Charlotte M. A. Lubout
- Section of Metabolic Diseases, Beatrix Children’s Hospital, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (A.M.D.); (K.E.-v.V.); (F.J.v.S.)
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Baarslag MA, Heimovaara JH, Borgers JSW, van Aerde KJ, Koenen HJPM, Smeets RL, Buitelaar PLM, Pluim D, Vos S, Henriet SSV, de Groot JWB, van Grotel M, Rosing H, Beijnen JH, Huitema ADR, Haanen JBAG, Amant F, Gierenz N. Severe Immune-Related Enteritis after In Utero Exposure to Pembrolizumab. N Engl J Med 2023; 389:1790-1796. [PMID: 37937778 DOI: 10.1056/nejmoa2308135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/09/2023]
Abstract
Immune checkpoint blockade has become standard treatment for many types of cancer. Such therapy is indicated most often in patients with advanced or metastatic disease but has been increasingly used as adjuvant therapy in those with early-stage disease. Adverse events include immune-related organ inflammation resembling autoimmune diseases. We describe a case of severe immune-related gastroenterocolitis in a 4-month-old infant who presented with intractable diarrhea and failure to thrive after in utero exposure to pembrolizumab. Known causes of the symptoms were ruled out, and the diagnosis of pembrolizumab-induced immune-related gastroenterocolitis was supported by the results of histopathological assays, immunophenotyping, and analysis of the level of antibodies against programmed cell death protein 1 (PD-1). The infant's condition was successfully treated with prednisolone and infliximab.
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MESH Headings
- Humans
- Infant
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Enteritis/chemically induced
- Enteritis/diagnosis
- Enteritis/drug therapy
- Enteritis/immunology
- Neoplasms/drug therapy
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Immune Checkpoint Inhibitors/administration & dosage
- Immune Checkpoint Inhibitors/adverse effects
- Immune Checkpoint Inhibitors/therapeutic use
- Failure to Thrive/chemically induced
- Failure to Thrive/immunology
- Diarrhea, Infantile/chemically induced
- Diarrhea, Infantile/immunology
- Gastroenteritis/chemically induced
- Gastroenteritis/diagnosis
- Gastroenteritis/drug therapy
- Gastroenteritis/immunology
- Enterocolitis/chemically induced
- Enterocolitis/diagnosis
- Enterocolitis/drug therapy
- Enterocolitis/immunology
- Programmed Cell Death 1 Receptor/immunology
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Affiliation(s)
- Manuel A Baarslag
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Joosje H Heimovaara
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Jessica S W Borgers
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Koen J van Aerde
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Hans J P M Koenen
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Ruben L Smeets
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Pauline L M Buitelaar
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Dick Pluim
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Shoko Vos
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Stefanie S V Henriet
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Jan Willem B de Groot
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Martine van Grotel
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Hilde Rosing
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Jos H Beijnen
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Alwin D R Huitema
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - John B A G Haanen
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Frédéric Amant
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
| | - Nicole Gierenz
- From the Departments of Pediatrics (M.A.B.), Pediatric Infectious Diseases and Immunology (K.J.A., S.S.V.H.), Pathology (S.V.), and Pediatric Gastroenterology and Hepatology (N.G.), Amalia Children's Hospital, and the Department of Laboratory Medicine, Laboratory Medical Immunology (H.J.P.M.K., R.L.S.), and the Radboudumc Laboratory for Diagnostics (R.L.S.), Radboud University Medical Center, Nijmegen, the Departments of Gynecologic Oncology (J.H.H., F.A.), Medical Oncology (J.S.W.B., J.B.A.G.H.), Pharmacy and Pharmacology (P.L.M.B., H.R., J.H.B., A.D.R.H.), and Pharmacology (D.P.), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Department of Medical Oncology, Isala Hospital, Zwolle (J.W.B.G.), the Departments of Pediatric Oncology (M.G.) and Pharmacology (A.D.R.H.), Princess Máxima Center for Pediatric Oncology, and the Departments of Pharmaceutical Sciences (J.H.B.) and Clinical Pharmacy (A.D.R.H.), University Medical Center Utrecht, Utrecht University, Utrecht - all in the Netherlands; and the Department of Oncology, Katholieke Universiteit Leuven (J.H.H., F.A.), and the Division of Gynecologic Oncology, Universitair Ziekenhuis Leuven (F.A.) - both in Leuven, Belgium
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Maccari ME, Wolkewitz M, Schwab C, Lorenzini T, Leiding JW, Aladjdi N, Abolhassani H, Abou-Chahla W, Aiuti A, Azarnoush S, Baris S, Barlogis V, Barzaghi F, Baumann U, Bloomfield M, Bohynikova N, Bodet D, Boutboul D, Bucciol G, Buckland MS, Burns SO, Cancrini C, Cathébras P, Cavazzana M, Cheminant M, Chinello M, Ciznar P, Coulter TI, D'Aveni M, Ekwall O, Eric Z, Eren E, Fasth A, Frange P, Fournier B, Garcia-Prat M, Gardembas M, Geier C, Ghosh S, Goda V, Hammarström L, Hauck F, Heeg M, Heropolitanska-Pliszka E, Hilfanova A, Jolles S, Karakoc-Aydiner E, Kindle GR, Kiykim A, Klemann C, Koletsi P, Koltan S, Kondratenko I, Körholz J, Krüger R, Jeziorski E, Levy R, Le Guenno G, Lefevre G, Lougaris V, Marzollo A, Mahlaoui N, Malphettes M, Meinhardt A, Merlin E, Meyts I, Milota T, Moreira F, Moshous D, Mukhina A, Neth O, Neubert J, Neven B, Nieters A, Nove-Josserand R, Oksenhendler E, Ozen A, Olbrich P, Perlat A, Pac M, Schmid JP, Pacillo L, Parra-Martinez A, Paschenko O, Pellier I, Sefer AP, Plebani A, Plantaz D, Prader S, Raffray L, Ritterbusch H, Riviere JG, Rivalta B, Rusch S, Sakovich I, Savic S, Scheible R, Schleinitz N, Schuetz C, Schulz A, Sediva A, Semeraro M, Sharapova SO, Shcherbina A, Slatter MA, Sogkas G, Soler-Palacin P, Speckmann C, Stephan JL, Suarez F, Tommasini A, Trück J, Uhlmann A, van Aerde KJ, van Montfrans J, von Bernuth H, Warnatz K, Williams T, Worth AJJ, Ip W, Picard C, Catherinot E, Nademi Z, Grimbacher B, Forbes Satter LR, Kracker S, Chandra A, Condliffe AM, Ehl S. Activated phosphoinositide 3-kinase δ syndrome: Update from the ESID Registry and comparison with other autoimmune-lymphoproliferative inborn errors of immunity. J Allergy Clin Immunol 2023; 152:984-996.e10. [PMID: 37390899 DOI: 10.1016/j.jaci.2023.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 04/08/2023] [Revised: 05/30/2023] [Accepted: 06/08/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Activated phosphoinositide-3-kinase δ syndrome (APDS) is an inborn error of immunity (IEI) with infection susceptibility and immune dysregulation, clinically overlapping with other conditions. Management depends on disease evolution, but predictors of severe disease are lacking. OBJECTIVES This study sought to report the extended spectrum of disease manifestations in APDS1 versus APDS2; compare these to CTLA4 deficiency, NFKB1 deficiency, and STAT3 gain-of-function (GOF) disease; and identify predictors of severity in APDS. METHODS Data was collected from the ESID (European Society for Immunodeficiencies)-APDS registry and was compared with published cohorts of the other IEIs. RESULTS The analysis of 170 patients with APDS outlines high penetrance and early onset of APDS compared to the other IEIs. The large clinical heterogeneity even in individuals with the same PIK3CD variant E1021K illustrates how poorly the genotype predicts the disease phenotype and course. The high clinical overlap between APDS and the other investigated IEIs suggests relevant pathophysiological convergence of the affected pathways. Preferentially affected organ systems indicate specific pathophysiology: bronchiectasis is typical of APDS1; interstitial lung disease and enteropathy are more common in STAT3 GOF and CTLA4 deficiency. Endocrinopathies are most frequent in STAT3 GOF, but growth impairment is also common, particularly in APDS2. Early clinical presentation is a risk factor for severe disease in APDS. CONCLUSIONS APDS illustrates how a single genetic variant can result in a diverse autoimmune-lymphoproliferative phenotype. Overlap with other IEIs is substantial. Some specific features distinguish APDS1 from APDS2. Early onset is a risk factor for severe disease course calling for specific treatment studies in younger patients.
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Affiliation(s)
- Maria Elena Maccari
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte Schwab
- Department of Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tiziana Lorenzini
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Nathalie Aladjdi
- Pediatric Haemato-Immunology, Clinical Investigation Center (CIC) 1401, Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d'Investigation Clinique Pluridisciplinaire (CICP), Bordeaux University Hospital and Centre de Reference National des Cytopenies Auto-immunoes de l'Enfant (CEREVANCE), Bordeaux, France
| | - Hassan Abolhassani
- Division of Clinical Immunology, Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Wadih Abou-Chahla
- Department of Pediatric Hematology, Jeanne de Flandre Hospital, Centre Hospitalier Universitaire (CHU), Lille, France
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (Sr-Tiget), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Saba Azarnoush
- Pediatric Hematology and Immunology Unit, Robert Debré Hospital, Paris, France
| | - Safa Baris
- Pediatric Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey; Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
| | - Vincent Barlogis
- Pediatric Hematology, Immunology and Oncology, Aix-Marseille Université, Marseille, France
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy (Sr-Tiget), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
| | - Ulrich Baumann
- Pediatric Pulmonology, Allergy, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Marketa Bloomfield
- Department of Immunology, Motol University Hospital, Prague, Czech Republic; Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nadezda Bohynikova
- Department of Immunology, Children's Memorial Health Institute, Warsaw, Poland
| | - Damien Bodet
- Department of Pediatric Hematology and Oncology, University Hospital of Caen, Caen, France
| | - David Boutboul
- Clinical Immunology Department, Hôpital Saint-Louis, Paris, France
| | - Giorgia Bucciol
- Departments of Pediatrics, University Hospitals Leuven, Leuven, Belgium; Microbiology, Immunology, and Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Matthew S Buckland
- Barts Health National Health Service Trust, London, United Kingdom; Molecular and Cellular Immunology Section, Immunity and Inflammation Department, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, London, United Kingdom; Department of Immunology, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Caterina Cancrini
- Department of System Medicine, Pediatric Chair, University of Tor Vergata, Rome, Italy; Research and Clinical Unit of Primary Immunodeficiencies, IRCCS Bambin Gesù Children Hospital, Rome, Italy
| | | | - Marina Cavazzana
- Imagine Institute, INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France; Biotherapy Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France; Biotherapy Clinical Investigation Center Groupe Hospitalier Centre, AP-HP, INSERM, Paris, France
| | - Morgane Cheminant
- Imagine Institute, INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France; Service d'Hématologie Adulte, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France
| | - Matteo Chinello
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Peter Ciznar
- Pediatric Department, Comenius University Medical Faculty, Bratislava, Slovakia
| | - Tanya I Coulter
- Belfast Health and Social Care Trust, Ireland, United Kingdom
| | - Maud D'Aveni
- Department of Hematology, Nancy University Hospital, Université de Lorraine, Nancy, France; UMR 7365, Centre National de la Recherche Scientifique, Ingénierie Moléculaire et Physiopathologie Articulaire, Université de Lorraine, Nancy, France
| | - Olov Ekwall
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Zelimir Eric
- University Clinical Centre of the Republic of Srpska, Republic of Srpska, Bosnia and Herzegovina
| | - Efrem Eren
- University Hospital Southampton, Southampton, United Kingdom
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medicine, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Pierre Frange
- Unité de Recherche Propre 7328, Fédération pour l'Étude et évaluation des Thérapeutiques intra-UtérineS (FETUS), Institut Imagine, Université Paris Cité, Paris, France; Laboratory of Clinical Microbiology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France
| | - Benjamin Fournier
- Pediatric Immunology-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France
| | - Marina Garcia-Prat
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Christoph Geier
- Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sujal Ghosh
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University-University Hospital Düsseldorf, Düsseldorf, Germany
| | - Vera Goda
- Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Lennart Hammarström
- Division of Clinical Immunology, Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Fabian Hauck
- Division of Pediatric Immunology and Rheumatology, Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maximilian Heeg
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Anna Hilfanova
- Department of Pediatrics, Immunology, Infectious and Rare Diseases, European Medical School, International European University, Kyiv, Ukraine
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
| | - Elif Karakoc-Aydiner
- Pediatric Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey; Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey; Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Gerhard R Kindle
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Centre for Biobanking FREEZE, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ayca Kiykim
- Pediatric Allergy and Immunology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Christian Klemann
- Departments of Human Genetics, Hannover Medical School, Hannover, Germany; Department of Pediatric Immunology, Rheumatology, & Infectiology, Hospital for Children and Adolescents, Leipzig University, Leipzig, Germany
| | - Patra Koletsi
- Department of Pediatrics, Penteli Children's Hospital, Athens, Greece
| | - Sylwia Koltan
- Department of Paediatric Haematology and Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Irina Kondratenko
- Russian Clinical Childrens Hospital, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Julia Körholz
- Department of Pediatrics, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden, Dresden, Germany
| | - Renate Krüger
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin Institute of Health, Berlin, Germany
| | - Eric Jeziorski
- General Pediatrics, CHU Montpellier, Montpellier, France; Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, Montpellier, France
| | - Romain Levy
- Pediatric Immunology-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, Hôpital d'Estaing, Clermont-Ferrand, France
| | - Guillaume Lefevre
- CHU Lille, Institut d'Immunologie and University of Lille, Lille, France; Inserm U995, LIRIC-Lille Inflammation Research International Center, Lille, France
| | - Vassilios Lougaris
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Marzollo
- Pediatric Hematology, Oncology, and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy
| | - Nizar Mahlaoui
- Pediatric Immunology-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France; Necker Enfants Malades University Hospital, AP-HP, French National Reference Center for Primary Immune Deficiencies (CEREDIH), Paris Université Cité, Paris, France
| | | | - Andrea Meinhardt
- Center for Pediatrics and Adolescent Medicine, Department of Pediatric Hematology and Oncology, Medical Center, University Hospital Giessen, Giessen, Germany
| | - Etienne Merlin
- Department of Pediatrics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Isabelle Meyts
- Departments of Pediatrics, University Hospitals Leuven, Leuven, Belgium; Microbiology, Immunology, and Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Tomas Milota
- Department of Immunology, Motol University Hospital, Prague, Czech Republic; Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fernando Moreira
- Department of Immunology, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Despina Moshous
- Laboratories of Dynamique du Génome et Système Immunitaire, Institut Imagine, Université Paris Cité, Paris, France; Pediatric Immunology-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France; Necker Enfants Malades University Hospital, AP-HP, French National Reference Center for Primary Immune Deficiencies (CEREDIH), Paris Université Cité, Paris, France
| | - Anna Mukhina
- Department of Immunology, Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Consejo Superior de Investigaciones Cientificas, Red de Investigación Translacional en Infectología Pediátrica, Seville, Spain
| | - Jennifer Neubert
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University-University Hospital Düsseldorf, Düsseldorf, Germany
| | - Benedicte Neven
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, Université Paris Cité, Paris, France; Pediatric Immunology-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France
| | - Alexandra Nieters
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Centre for Biobanking FREEZE, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | - Ahmet Ozen
- Pediatric Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey; Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey; Isil Berat Barlan Center for Translational Medicine, Istanbul, Turkey
| | - Peter Olbrich
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Consejo Superior de Investigaciones Cientificas, Red de Investigación Translacional en Infectología Pediátrica, Seville, Spain
| | | | - Malgorzata Pac
- Department of Immunology, Children's Memorial Health Institute, Warsaw, Poland
| | - Jana Pachlopnik Schmid
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, Zurich, Switzerland
| | - Lucia Pacillo
- Department of System Medicine, Pediatric Chair, University of Tor Vergata, Rome, Italy; Research and Clinical Unit of Primary Immunodeficiencies, IRCCS Bambin Gesù Children Hospital, Rome, Italy
| | - Alba Parra-Martinez
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Olga Paschenko
- Russian Clinical Childrens Hospital, Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Asena Pinar Sefer
- Pediatric Allergy and Immunology, Faculty of Medicine, Marmara University, Istanbul, Turkey; Istanbul Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Istanbul, Turkey
| | - Alessandro Plebani
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Dominique Plantaz
- Unit of Pediatric Immuno Hemato and Oncology, University Hospital Centre of Grenoble, Grenoble, France
| | - Seraina Prader
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, Zurich, Switzerland
| | - Loic Raffray
- Internal Medicine Department, Felix Guyon University Hospital, Saint Denis, La Réunion, France; Mixed Research Unit (UMR) "Infectious Processes in Tropical Island Environments", La Réunion, France
| | - Henrike Ritterbusch
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jacques G Riviere
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Beatrice Rivalta
- Department of System Medicine, Pediatric Chair, University of Tor Vergata, Rome, Italy; Research and Clinical Unit of Primary Immunodeficiencies, IRCCS Bambin Gesù Children Hospital, Rome, Italy
| | - Stephan Rusch
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Inga Sakovich
- Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology, Minsk, Belarus
| | - Sinisa Savic
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom; Department of Clinical Immunology and Allergy, St James's University Hospital, Leeds, United Kingdom
| | - Raphael Scheible
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute for AI and Informatics in Medicine, University Hospital Rechts der Isar, Technical University Munich, Munich, Germany
| | - Nicolas Schleinitz
- Département de Médecine Interne, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - Catharina Schuetz
- Department of Pediatrics, Universitätsklinikum Carl-Gustav-Carus, Technische Universität Dresden, Dresden, Germany
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Anna Sediva
- Department of Immunology, Motol University Hospital, Prague, Czech Republic; Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michaela Semeraro
- Clinical Investigation Center (CIC) 1419, Necker-Enfants Malades Hospital, AP-HP, Groupe Hospitalier Paris Centre, Paris, France; EA7323 Pediatric and Perinatal Drug Evaluation and Pharmacology Research Unit, Université Paris Cité, Paris, France
| | - Svetlana O Sharapova
- Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology, Minsk, Belarus
| | - Anna Shcherbina
- Department of Immunology, Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Mary A Slatter
- Great North Children' s Hospital, Newcastle upon Tyne, United Kingdom; Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Georgios Sogkas
- Rheumatology and Immunology, Hannover Medical School, Hannover, Germany; Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carsten Speckmann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jean-Louis Stephan
- Department of Pediatrics, North Hospital, University Hospital of Saint Etienne, Saint-Etienne, France; University Jean Monnet, Saint-Etienne, France
| | - Felipe Suarez
- Imagine Institute, INSERM U1163, Institut Imagine, Université Paris Cité, Paris, France; Service d'Hématologie Adulte, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France
| | - Alberto Tommasini
- Department of Medical Sciences, University of Trieste, Trieste, Italy; Institute for Maternal and Child Health, IRCCS Burlo Garofalo, Trieste, Italy
| | - Johannes Trück
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, Zurich, Switzerland
| | - Annette Uhlmann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Koen J van Aerde
- Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands
| | - Joris van Montfrans
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Horst von Bernuth
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Berlin Institute of Health, Berlin, Germany
| | - Klaus Warnatz
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Immunology, University Hospital Zurich, Zurich, Switzerland
| | - Tony Williams
- University Hospital Southampton, Southampton, United Kingdom
| | - Austen J J Worth
- Great Ormond Street Hospital for Children, University College London, London, United Kingdom
| | - Winnie Ip
- Great Ormond Street Institute of Child Health, London, United Kingdom; Great Ormond Street Hospital for Children, University College London, London, United Kingdom
| | - Capucine Picard
- Lymphocyte Activation and Susceptibility to EBV Infection, Institut Imagine, Université Paris Cité, Paris, France; Pediatric Immunology-Hematology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France; Study Center for Primary Immunodeficiencies, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) Centre, Paris, France; Necker Enfants Malades University Hospital, AP-HP, French National Reference Center for Primary Immune Deficiencies (CEREDIH), Paris Université Cité, Paris, France
| | | | - Zohreh Nademi
- Great North Children' s Hospital, Newcastle upon Tyne, United Kingdom; Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bodo Grimbacher
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF-German Center for Infection Research, Satellite Center Freiburg, Freiburg, Germany; CIBSS-Centre for Integrative Biological Signalling Studies, Albert-Ludwigs University, Freiburg, Germany; Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, Hannover, Germany
| | - Lisa R Forbes Satter
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex; William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston, Tex
| | - Sven Kracker
- Human Lymphohematopoiesis, INSERM Unité Mixte de Recherche (UMR) 1163, Institut Imagine, Université Paris Cité, Paris, France; Université Paris Cité, Paris, France
| | - Anita Chandra
- Department of Clinical Immunology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom; Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Alison M Condliffe
- Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, United Kingdom
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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4
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Oegema S, Henriet SSV, van Aerde KJ, Bredius RGM, Berghuis D. First Successful Allogeneic Hematopoietic Stem Cell Transplantation for MKL1 Deficiency. J Clin Immunol 2022; 42:1608-1610. [PMID: 35857180 DOI: 10.1007/s10875-022-01336-z] [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] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/17/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Sanne Oegema
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Pediatric Immunology and Stem Cell Transplantation, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Stefanie S V Henriet
- Department of Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen J van Aerde
- Department of Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robbert G M Bredius
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Pediatric Immunology and Stem Cell Transplantation, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Dagmar Berghuis
- Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Pediatric Immunology and Stem Cell Transplantation, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
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5
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Leow TYS, Bekkers S, Janssen AM, Pegge SAH, Kunst HPM, Waterval JJ, Jansen TTG, Henriet SSV, van Aerde KJ, van Ingen J, Hol MKS. Quality of life in children receiving treatment for Mycobacterium abscessus otomastoiditis. Clin Otolaryngol 2022; 47:529-535. [PMID: 35340110 PMCID: PMC9314591 DOI: 10.1111/coa.13931] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/31/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Theresa Y S Leow
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stijn Bekkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arno M Janssen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sjoert A H Pegge
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Henricus P M Kunst
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.,Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen, The Netherlands
| | - Jerome J Waterval
- Dutch Academic Alliance Skull Base Pathology, Radboud University Medical Center, Maastricht University Medical Center+, Nijmegen, The Netherlands
| | - Thijs T G Jansen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefanie S V Henriet
- Department of Pediatric Infectious Disease and Immunology, Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen J van Aerde
- Department of Pediatric Infectious Disease and Immunology, Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jakko van Ingen
- Radboudumc Center for Infectious Diseases, Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Myrthe K S Hol
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands.,Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, Netherlands
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6
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van Aerde KJ, Jansen R, Merkus PJ, van der Flier M. Breath Test: Clinical Application of Breath Analysis in Lower Respiratory Tract Infection Diagnosis. Pediatr Infect Dis J 2021; 40:e434-e436. [PMID: 34591801 DOI: 10.1097/inf.0000000000003310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Koen J van Aerde
- From the Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences
- Radboud Center for Infectious Diseases
| | - Robin Jansen
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences
| | - Peter J Merkus
- Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen
| | - Michiel van der Flier
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences
- Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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van Aerde KJ, de Haan L, van Leur M, Gerrits GP, Schers H, Moll HA, Hagedoorn NN, Herberg JA, Levin M, Rivero-Calle I, de Jonge MI, de Groot R, van der Flier M. Respiratory Tract Infection Management and Antibiotic Prescription in Children: A Unique Study Comparing Three Levels of Healthcare in The Netherlands. Pediatr Infect Dis J 2021; 40:e100-e105. [PMID: 33395212 DOI: 10.1097/inf.0000000000003019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Respiratory tract infections (RTIs) are common in children with febrile illness visiting the general practitioner (GP) or emergency department. We studied the management of children with fever and RTI at 3 different levels of healthcare in The Netherlands, focusing on antibiotic prescription. METHODS This prospective observational study is part of the Management and Outcome of Febrile children in Europe study. Data were used from face-to-face patient contacts of children with febrile illness in three healthcare settings in Nijmegen, The Netherlands during 2017. These settings were primary (GP), secondary (general hospital) and tertiary care (university hospital). RESULTS Of 892 cases with RTI without complex comorbidities, overall antibiotic prescription rates were 29% with no differences between the 3 levels of healthcare, leading to an absolute number of 5031 prescriptions per 100,000 children per year in primary care compared with 146 in secondary and tertiary care combined. The prescription rate in otitis media was similar in all levels: 60%. In cases with lower RTI who received nebulizations prescription rates varied between 19% and 55%. CONCLUSIONS Antibiotic prescription rates for RTIs in children were comparable between the 3 levels of healthcare, thus leading to a majority of antibiotics being prescribed in primary care. Relatively high prescription rates for all foci of RTIs were found, which was not in agreement with the national guidelines. Antibiotic stewardship needs improvement at all 3 levels of healthcare. Guidelines to prescribe small spectrum antibiotics for RTIs need to be better implemented in hospital care settings.
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Affiliation(s)
- Koen J van Aerde
- From the Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences
- Radboud Center for Infectious Diseases, Radboud University Medical Center
| | - Liza de Haan
- Department of Pediatrics, Canisius Wilhelmina Hospital
| | | | | | - Henk Schers
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, FaME-Net, Nijmegen
| | - Henriette A Moll
- Department of General Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nienke N Hagedoorn
- Department of General Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jethro A Herberg
- Section of Pediatrics, Imperial College
- Pediatric Emergency Department, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Levin
- Section of Pediatrics, Imperial College
- Pediatric Emergency Department, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Irene Rivero-Calle
- Genetics, Vaccines, Infections and Pediatrics Research group (GENVIP), Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Marien I de Jonge
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences
- Radboud Center for Infectious Diseases, Radboud University Medical Center
| | - Ronald de Groot
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences
- Radboud Center for Infectious Diseases, Radboud University Medical Center
| | - Michiel van der Flier
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Institute for Molecular Life Sciences
- Genetics, Vaccines, Infections and Pediatrics Research group (GENVIP), Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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8
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van de Kant KDG, Klaassen EMM, van Aerde KJ, Damoiseaux J, Bruggeman CA, Stelma FF, Stobberingh EE, Muris JWM, Jöbsis Q, van Schayck OCP, Dompeling E. Erratum: Impact of bacterial colonization on exhaled inflammatory markers in wheezing preschool children. J Breath Res 2012. [DOI: 10.1088/1752-7163/6/4/049601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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van de Kant KDG, Klaassen EMM, van Aerde KJ, Damoiseaux J, Bruggeman CA, Stelma FF, Stobberingh EE, Muris JWM, Jöbsis Q, van Schayck OCP, Dompeling E. Impact of bacterial colonization on exhaled inflammatory markers in wheezing preschool children. J Breath Res 2012; 6:046001. [PMID: 22990010 DOI: 10.1088/1752-7155/6/4/046001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Wheeze is a common symptom in preschool children. The role of bacteria, regulatory T (T(reg)) cells and their association with airway inflammation in preschool wheeze is largely unknown. We evaluated inflammatory markers in exhaled breath condensate (EBC), bacterial colonization and circulating T(reg) cells in preschool children with and without recurrent wheeze. We recruited 252 children (aged two to four years) with (N = 202) and without (N = 50) recurrent wheeze. EBC was collected using an efficient closed glass condenser. Inflammatory markers in EBC (Interleukin(IL)-2, IL-4, IL-8, IL-10, IL-13) were assessed using multiplex immunoassay. Nasal and throat swabs were analysed for presence of Streptococcus pneumoniae, Haemophilus (para)influenzae and Staphylococcus aureus. Proportions of T(reg) cells (CD4(+)CD25(high)CD127(-)) were quantified by flow cytometry. Recurrent wheezing children had elevated EBC levels of IL-2, IL-4, IL-10 and IL-13 compared to non-wheezers (odds ratio (95% confidence interval): 1.67 (1.23-2.27): 1.58 (1.15-2.18): 1.47 (1.14-1.90): 1.55 (1.16-2.06), p <0.05, respectively). Bacteria were frequently present in children with and without wheeze, with no difference in prevalence (16-52% versus 16-50%, respectively). Moreover, the proportion of T(reg) cells did not differ between both groups. Wheezing children with bacterial colonization did not significantly differ in exhaled levels of inflammatory markers or proportion of T(reg) cells compared to wheezing children without colonization. The analysis of EBC might serve as a helpful non-invasive tool to early assess airway inflammation in wheezing children. The various elevated exhaled inflammatory markers indicate increased airway inflammation in wheezing preschool children. In the presence of wheeze, we found no evidence for bacterial induced airway inflammation.
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Affiliation(s)
- Kim D G van de Kant
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC), PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
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