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Crouzen JA, Petoukhova AL, Broekman MLD, Fiocco M, Fisscher UJ, Franssen JH, Gadellaa-van Hooijdonk CGM, Kerkhof M, Kiderlen M, Mast ME, van Rij CM, Nandoe Tewarie R, van de Sande MAE, van der Toorn PPG, Vlasman R, Vos MJ, van der Voort van Zyp NCMG, Wiggenraad RGJ, Wiltink LM, Zindler JD. SAFESTEREO: phase II randomized trial to compare stereotactic radiosurgery with fractionated stereotactic radiosurgery for brain metastases. BMC Cancer 2023; 23:273. [PMID: 36964529 PMCID: PMC10039548 DOI: 10.1186/s12885-023-10761-1] [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] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a frequently chosen treatment for patients with brain metastases and the number of long-term survivors is increasing. Brain necrosis (e.g. radionecrosis) is the most important long-term side effect of the treatment. Retrospective studies show a lower risk of radionecrosis and local tumor recurrence after fractionated stereotactic radiosurgery (fSRS, e.g. five fractions) compared with stereotactic radiosurgery in one or three fractions. This is especially true for patients with large brain metastases. As such, the 2022 ASTRO guideline of radiotherapy for brain metastases recommends more research to fSRS to reduce the risk of radionecrosis. This multicenter prospective randomized study aims to determine whether the incidence of adverse local events (either local failure or radionecrosis) can be reduced using fSRS versus SRS in one or three fractions in patients with brain metastases. METHODS Patients are eligible with one or more brain metastases from a solid primary tumor, age of 18 years or older, and a Karnofsky Performance Status ≥ 70. Exclusion criteria include patients with small cell lung cancer, germinoma or lymphoma, leptomeningeal metastases, a contraindication for MRI, prior inclusion in this study, prior surgery for brain metastases, prior radiotherapy for the same brain metastases (in-field re-irradiation). Participants will be randomized between SRS with a dose of 15-24 Gy in 1 or 3 fractions (standard arm) or fSRS 35 Gy in five fractions (experimental arm). The primary endpoint is the incidence of a local adverse event (local tumor failure or radionecrosis identified on MRI scans) at two years after treatment. Secondary endpoints are salvage treatment and the use of corticosteroids, bevacizumab, or antiepileptic drugs, survival, distant brain recurrences, toxicity, and quality of life. DISCUSSION Currently, limiting the risk of adverse events such as radionecrosis is a major challenge in the treatment of brain metastases. fSRS potentially reduces this risk of radionecrosis and local tumor failure. TRIAL REGISTRATION ClincalTrials.gov, trial registration number: NCT05346367 , trial registration date: 26 April 2022.
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Affiliation(s)
- J A Crouzen
- Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - M Fiocco
- Mathematical Institute of Leiden University, Leiden, The Netherlands
| | - U J Fisscher
- Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - M Kerkhof
- Haaglanden Medical Center, The Hague, The Netherlands
| | - M Kiderlen
- Haaglanden Medical Center, The Hague, The Netherlands
| | - M E Mast
- Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | | | | | - R Vlasman
- Radiotherapy Institute Friesland, Leeuwarden, The Netherlands
| | - M J Vos
- Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - L M Wiltink
- Leiden University Medical Center, Leiden, The Netherlands
| | - J D Zindler
- Haaglanden Medical Center, The Hague, The Netherlands.
- Holland Proton Therapy Center, Delft, The Netherlands.
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2
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Kerkhof M, Koekkoek JAF, Vos MJ, van den Bent MJ, Taal W, Postma TJ, Bromberg JEC, Kouwenhoven MCM, Dirven L, Reijneveld JC, Taphoorn MJB. Withdrawal of antiepileptic drugs in patients with low grade and anaplastic glioma after long-term seizure freedom: a prospective observational study. J Neurooncol 2019; 142:463-470. [PMID: 30778733 PMCID: PMC6478626 DOI: 10.1007/s11060-019-03117-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/31/2019] [Indexed: 12/16/2022]
Abstract
Background When glioma patients experience long-term seizure freedom the question arises whether antiepileptic drugs (AEDs) should be continued. As no prospective studies exist on seizure recurrence in glioma patients after AED withdrawal, we evaluated the decision-making process to withdraw AEDs in glioma patients, and seizure outcome after withdrawal. Methods Patients with a histologically confirmed low grade or anaplastic glioma were included. Eligible patients were seizure free ≥ 1 year from the date of last antitumor treatment, or ≥ 2 years since the last seizure when seizures occurred after the end of the last antitumor treatment. Patients and neuro-oncologists made a shared decision on the preferred AED treatment (i.e. AED withdrawal or continuation). Primary outcomes were: (1) outcome of the shared decision-making process and (2) rate of seizure recurrence. Results Eighty-three patients fulfilled all eligibility criteria. However, in 12/83 (14%) patients, the neuro-oncologist had serious objections to AED withdrawal. Therefore, 71/83 (86%) patients were analyzed; In 46/71 (65%) patients it was decided to withdraw AED treatment. In the withdrawal group, 26% (12/46) had seizure recurrence during follow-up. Seven of these 12 patients (58%) had tumor progression, of which three within 3 months after seizure recurrence. In the AED continuation group, 8% (2/25) of patients had seizure recurrence of which one had tumor progression. Conclusion In 65% of patients a shared decision was made to withdraw AEDs, of which 26% had seizure recurrence. AED withdrawal should only be considered in carefully selected patients with a presumed low risk of tumor progression.
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Affiliation(s)
- M Kerkhof
- Department of Neurology, Haaglanden Medical Center, PO Box 2191, 2501 VC, The Hague, The Netherlands.
| | - J A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, PO Box 2191, 2501 VC, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Vos
- Department of Neurology, Haaglanden Medical Center, PO Box 2191, 2501 VC, The Hague, The Netherlands
| | - M J van den Bent
- Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - W Taal
- Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - T J Postma
- Brain Tumor Center Amsterdam at VU University Medical Center, Amsterdam, The Netherlands
| | - J E C Bromberg
- Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M C M Kouwenhoven
- Brain Tumor Center Amsterdam at VU University Medical Center, Amsterdam, The Netherlands
| | - L Dirven
- Department of Neurology, Haaglanden Medical Center, PO Box 2191, 2501 VC, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - J C Reijneveld
- Brain Tumor Center Amsterdam at VU University Medical Center, Amsterdam, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, PO Box 2191, 2501 VC, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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3
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Kerkhof M, Ganeff I, Wiggenraad RGJ, Lycklama À Nijeholt GJ, Hammer S, Taphoorn MJB, Dirven L, Vos MJ. Clinical applicability of and changes in perfusion MR imaging in brain metastases after stereotactic radiotherapy. J Neurooncol 2018; 138:133-139. [PMID: 29392588 PMCID: PMC5928168 DOI: 10.1007/s11060-018-2779-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/25/2018] [Indexed: 12/05/2022]
Abstract
To assess the applicability of perfusion-weighted (PWI) magnetic resonance (MR) imaging in clinical practice, as well as to evaluate the changes in PWI in brain metastases before and after stereotactic radiotherapy (SRT), and to correlate these changes to tumor status on conventional MR imaging. Serial MR images at baseline and at least 3 and 6 months after SRT were retrospectively evaluated. Size of metastases and the relative cerebral blood volume (rCBV), assessed with subjective visual inspection in the contrast enhanced area, were evaluated at each time point. Tumor behavior of metastases was categorized into four groups based on predefined changes on MRI during follow-up, or on histologically confirmed diagnosis; progressive disease (PD), pseudoprogression (PsPD), non-progressive disease (non-PD) and progression unspecified (PU). Twenty-six patients with 42 metastases were included. Fifteen percent (26/168) of all PW images could not be evaluated due to localization near large vessels or the scalp, presence of hemorrhage artefacts, and in 31% (52/168) due to unmeasurable residual metastases. The most common pattern (52%, 13/25 metastases) showed a high rCBV at baseline and low rCBV during follow-up, occurring in metastases with non-PD (23%, 3/13), PsPD (38%, 5/13) and PU (38%, 5/13). Including only metastases with a definite outcome generally showed low rCBV in PsPD or non-PD, and high rCBV in PD. Although non-PD and PsPD may be distinguished from PD after SRT using the PW images, the large proportion of images that could not be assessed due to artefacts and size severely hampers value of PWI in predicting tumor response after SRT.
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Affiliation(s)
- M Kerkhof
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands.
| | - I Ganeff
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands
| | - R G J Wiggenraad
- Department of Radiotherapy, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - S Hammer
- Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - L Dirven
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Vos
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands
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4
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Overwater A, Kessels K, Elias SG, Backes Y, Spanier BWM, Seerden TCJ, Pullens HJM, de Vos Tot Nederveen Cappel WH, van den Blink A, Offerhaus GJA, van Bergeijk J, Kerkhof M, Geesing JMJ, Groen JN, van Lelyveld N, Ter Borg F, Wolfhagen F, Siersema PD, Lacle MM, Moons LMG. Endoscopic resection of high-risk T1 colorectal carcinoma prior to surgical resection has no adverse effect on long-term outcomes. Gut 2018; 67:284-290. [PMID: 27811313 DOI: 10.1136/gutjnl-2015-310961] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [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: 10/25/2015] [Revised: 09/29/2016] [Accepted: 10/09/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE It is difficult to predict the presence of histological risk factors for lymph node metastasis (LNM) before endoscopic treatment of T1 colorectal cancer (CRC). Therefore, endoscopic therapy is propagated to obtain adequate histological staging. We examined whether secondary surgery following endoscopic resection of high-risk T1 CRC does not have a negative effect on patients' outcomes compared with primary surgery. DESIGN Patients with T1 CRC with one or more histological risk factors for LNM (high risk) and treated with primary or secondary surgery between 2000 and 2014 in 13 hospitals were identified in the Netherlands Cancer Registry. Additional data were collected from hospital records, endoscopy, radiology and pathology reports. A propensity score analysis was performed using inverse probability weighting (IPW) to correct for confounding by indication. RESULTS 602 patients were eligible for analysis (263 primary; 339 secondary surgery). Overall, 34 recurrences were observed (5.6%). After adjusting with IPW, no differences were observed between primary and secondary surgery for the presence of LNM (OR 0.97; 95% CI 0.49 to 1.93; p=0.940) and recurrence during follow-up (HR 0.97; 95% CI 0.41 to 2.34; p=0.954). Further adjusting for lymphovascular invasion, depth of invasion and number of retrieved lymph nodes did not alter this outcome. CONCLUSIONS Our data do not support an increased risk of LNM or recurrence after secondary surgery compared with primary surgery. Therefore, an attempt for an en-bloc resection of a possible T1 CRC without evident signs of deep invasion seems justified in order to prevent surgery of low-risk T1 CRC in a significant proportion of patients.
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Affiliation(s)
- A Overwater
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K Kessels
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Gastroenterology & Hepatology, Flevohospital, Almere, The Netherlands
| | - S G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y Backes
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B W M Spanier
- Department of Gastroenterology & Hepatology, Rijnstate, Arnhem, The Netherlands
| | - T C J Seerden
- Department of Gastroenterology & Hepatology, Amphia Hospital, Breda, The Netherlands
| | - H J M Pullens
- Department of Gastroenterology & Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | | | - A van den Blink
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G J A Offerhaus
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J van Bergeijk
- Department of Gastroenterology & Hepatology, Gelderse Vallei, Ede, The Netherlands
| | - M Kerkhof
- Department of Gastroenterology & Hepatology, Groene Hart Hospital, Gouda, The Netherlands
| | - J M J Geesing
- Department of Gastroenterology & Hepatology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - J N Groen
- Department of Gastroenterology & Hepatology, St. Jansdal Harderwijk, Harderwijk, The Netherlands
| | - N van Lelyveld
- Department of Gastroenterology & Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - F Ter Borg
- Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - F Wolfhagen
- Department of Gastroenterology & Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - P D Siersema
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M M Lacle
- Department of Gastroenterology & Hepatology, Isala, Zwolle, The Netherlands
| | - L M G Moons
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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5
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Backes Y, de Vos Tot Nederveen Cappel WH, van Bergeijk J, Ter Borg F, Schwartz MP, Spanier BWM, Geesing JMJ, Kessels K, Kerkhof M, Groen JN, Wolfhagen FHJ, Seerden TCJ, van Lelyveld N, Offerhaus GJA, Siersema PD, Lacle MM, Moons LMG. Risk for Incomplete Resection after Macroscopic Radical Endoscopic Resection of T1 Colorectal Cancer: A Multicenter Cohort Study. Am J Gastroenterol 2017; 112:785-796. [PMID: 28323275 DOI: 10.1038/ajg.2017.58] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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: 10/01/2016] [Accepted: 01/02/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The decision to perform secondary surgery after endoscopic resection of T1 colorectal cancer (CRC) depends on the risk of lymph node metastasis and the risk of incomplete resection. We aimed to examine the incidence and risk factors for incomplete endoscopic resection of T1 CRC after a macroscopic radical endoscopic resection. METHODS Data from patients treated between 2000 and 2014 with macroscopic complete endoscopic resection of T1 CRC were collected from 13 hospitals. Incomplete resection was defined as local recurrence at the polypectomy site during follow-up or malignant tissue in the surgically resected specimen in case secondary surgery was performed. Multivariate regression analysis was performed to analyze factors associated with incomplete resection. RESULTS In total, 877 patients with a median follow-up time of 36.5 months (interquartile range 16.0-68.3) were included, in whom secondary surgery was performed in 358 patients (40.8%). Incomplete resection was observed in 30 patients (3.4%; 95% confidence interval (CI) 2.3-4.6%). Incomplete resection rate was 0.7% (95% CI 0-2.1%) in low-risk T1 CRC vs. 4.4% (95% CI 2.7-6.5%) in high-risk T1 CRC (P=0.04). Overall adverse outcome rate (incomplete resection or metastasis) was 2.1% (95% CI 0-5.0%) in low-risk T1 CRC vs. 11.7% (95% CI 8.8-14.6%) in high-risk T1 CRC (P=0.001). Piecemeal resection (adjusted odds ratio 2.60; 95% CI 1.20-5.61, P=0.02) and non-pedunculated morphology (adjusted odds ratio 2.18; 95% CI 1.01-4.70, P=0.05) were independent risk factors for incomplete resection. Among patients in whom no additional surgery was performed, who developed recurrent cancer, 41.7% (95% CI 20.8-62.5%) died as a result of recurrent cancer. CONCLUSIONS In the absence of histological high-risk factors, a 'wait-and-see' policy with limited follow-up is justified. Piecemeal resection and non-pedunculated morphology are independent risk factors for incomplete endoscopic resection of T1 CRC.
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Affiliation(s)
- Y Backes
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - J van Bergeijk
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - F Ter Borg
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - M P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands
| | - B W M Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - J M J Geesing
- Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands
| | - K Kessels
- Department of Gastroenterology and Hepatology, Flevo Hospital, Almere, The Netherlands
| | - M Kerkhof
- Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands
| | - J N Groen
- Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands
| | - F H J Wolfhagen
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - T C J Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
| | - N van Lelyveld
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - G J A Offerhaus
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M M Lacle
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L M G Moons
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
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6
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Bousquet J, Hellings PW, Agache I, Bedbrook A, Bachert C, Bergmann KC, Bewick M, Bindslev-Jensen C, Bosnic-Anticevitch S, Bucca C, Caimmi DP, Camargos PAM, Canonica GW, Casale T, Chavannes NH, Cruz AA, De Carlo G, Dahl R, Demoly P, Devillier P, Fonseca J, Fokkens WJ, Guldemond NA, Haahtela T, Illario M, Just J, Keil T, Klimek L, Kuna P, Larenas-Linnemann D, Morais-Almeida M, Mullol J, Murray R, Naclerio R, O'Hehir RE, Papadopoulos NG, Pawankar R, Potter P, Ryan D, Samolinski B, Schunemann HJ, Sheikh A, Simons FER, Stellato C, Todo-Bom A, Tomazic PV, Valiulis A, Valovirta E, Ventura MT, Wickman M, Young I, Yorgancioglu A, Zuberbier T, Aberer W, Akdis CA, Akdis M, Annesi-Maesano I, Ankri J, Ansotegui IJ, Anto JM, Arnavielhe S, Asarnoj A, Arshad H, Avolio F, Baiardini I, Barbara C, Barbagallo M, Bateman ED, Beghé B, Bel EH, Bennoor KS, Benson M, Białoszewski AZ, Bieber T, Bjermer L, Blain H, Blasi F, Boner AL, Bonini M, Bonini S, Bosse I, Bouchard J, Boulet LP, Bourret R, Bousquet PJ, Braido F, Briggs AH, Brightling CE, Brozek J, Buhl R, Bunu C, Burte E, Bush A, Caballero-Fonseca F, Calderon MA, Camuzat T, Cardona V, Carreiro-Martins P, Carriazo AM, Carlsen KH, Carr W, Cepeda Sarabia AM, Cesari M, Chatzi L, Chiron R, Chivato T, Chkhartishvili E, Chuchalin AG, Chung KF, Ciprandi G, de Sousa JC, Cox L, Crooks G, Custovic A, Dahlen SE, Darsow U, Dedeu T, Deleanu D, Denburg JA, De Vries G, Didier A, Dinh-Xuan AT, Dokic D, Douagui H, Dray G, Dubakiene R, Durham SR, Du Toit G, Dykewicz MS, Eklund P, El-Gamal Y, Ellers E, Emuzyte R, Farrell J, Fink Wagner A, Fiocchi A, Fletcher M, Forastiere F, Gaga M, Gamkrelidze A, Gemicioğlu B, Gereda JE, van Wick RG, González Diaz S, Grisle I, Grouse L, Gutter Z, Guzmán MA, Hellquist-Dahl B, Heinrich J, Horak F, Hourihane JOB, Humbert M, Hyland M, Iaccarino G, Jares EJ, Jeandel C, Johnston SL, Joos G, Jonquet O, Jung KS, Jutel M, Kaidashev I, Khaitov M, Kalayci O, Kalyoncu AF, Kardas P, Keith PK, Kerkhof M, Kerstjens HAM, Khaltaev N, Kogevinas M, Kolek V, Koppelman GH, Kowalski ML, Kuitunen M, Kull I, Kvedariene V, Lambrecht B, Lau S, Laune D, Le LTT, Lieberman P, Lipworth B, Li J, Lodrup Carlsen KC, Louis R, Lupinek C, MacNee W, Magar Y, Magnan A, Mahboub B, Maier D, Majer I, Malva J, Manning P, De Manuel Keenoy E, Marshall GD, Masjedi MR, Mathieu-Dupas E, Maurer M, Mavale-Manuel S, Melén E, Melo-Gomes E, Meltzer EO, Mercier J, Merk H, Miculinic N, Mihaltan F, Milenkovic B, Millot-Keurinck J, Mohammad Y, Momas I, Mösges R, Muraro A, Namazova-Baranova L, Nadif R, Neffen H, Nekam K, Nieto A, Niggemann B, Nogueira-Silva L, Nogues M, Nyembue TD, Ohta K, Okamoto Y, Okubo K, Olive-Elias M, Ouedraogo S, Paggiaro P, Pali-Schöll I, Palkonen S, Panzner P, Papi A, Park HS, Passalacqua G, Pedersen S, Pereira AM, Pfaar O, Picard R, Pigearias B, Pin I, Plavec D, Pohl W, Popov TA, Portejoie F, Postma D, Poulsen LK, Price D, Rabe KF, Raciborski F, Roberts G, Robalo-Cordeiro C, Rodenas F, Rodriguez-Mañas L, Rolland C, Roman Rodriguez M, Romano A, Rosado-Pinto J, Rosario N, Rottem M, Sanchez-Borges M, Sastre-Dominguez J, Scadding GK, Scichilone N, Schmid-Grendelmeier P, Serrano E, Shields M, Siroux V, Sisul JC, Skrindo I, Smit HA, Solé D, Sooronbaev T, Spranger O, Stelmach R, Sterk PJ, Strandberg T, Sunyer J, Thijs C, Triggiani M, Valenta R, Valero A, van Eerd M, van Ganse E, van Hague M, Vandenplas O, Varona LL, Vellas B, Vezzani G, Vazankari T, Viegi G, Vontetsianos T, Wagenmann M, Walker S, Wang DY, Wahn U, Werfel T, Whalley B, Williams DM, Williams S, Wilson N, Wright J, Yawn BP, Yiallouros PK, Yusuf OM, Zaidi A, Zar HJ, Zernotti ME, Zhang L, Zhong N, Zidarn M. ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle. Clin Transl Allergy 2016; 6:47. [PMID: 28050247 PMCID: PMC5203711 DOI: 10.1186/s13601-016-0137-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/05/2016] [Indexed: 12/13/2022] Open
Abstract
The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.
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Affiliation(s)
- J Bousquet
- Montpellier University Hospital, Montpellier, France ; MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France ; INSERM, U1168, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, 94800 Villejuif, France ; CHRU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - P W Hellings
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
| | - I Agache
- Transylvania University Brasov, Brasov, Romania
| | - A Bedbrook
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - C Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - K C Bergmann
- Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Global Allergy and Asthma European Network (GA²LEN), Berlin, Germany
| | - M Bewick
- iQ4U Consultants Ltd, London, UK
| | - C Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - S Bosnic-Anticevitch
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW Australia
| | - C Bucca
- University Pneumology Unit-AOU Molinette, Hospital City of Health and Science of Torino, Turin, Italy
| | - D P Caimmi
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - P A M Camargos
- Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - G W Canonica
- Asthma and Allergy Clinic, Humanitas University, Rozzano, Milan, Italy
| | - T Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, FL USA
| | - N H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - A A Cruz
- ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil ; GARD Executive Committee, Salvador, Bahia Brazil
| | - G De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - R Dahl
- ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil
| | - P Demoly
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France ; EPAR U707 INSERM, Paris, France ; EPAR UMR-S UPMC, Paris VI, Paris, France
| | - P Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220, Hôpital Foch, Suresnes Université Versailles, Saint-Quentin, France
| | - J Fonseca
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal ; Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal ; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - W J Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - N A Guldemond
- Institute of Health Policy and Management IBMG, Erasmus University, Rotterdam, The Netherlands
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - M Illario
- Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | - J Just
- Allergology Department, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau (APHP), Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, 75013 Paris, France
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - D Larenas-Linnemann
- Clínica de Alergia, Asma y Pediatría, Hospital Médica Sur, Mexico City, Mexico
| | - M Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisbon, Portugal
| | - J Mullol
- ENT Department, Hospital Clinic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, Universitat de Barcelona, Barcelona, Catalonia Spain
| | - R Murray
- MedScript Ltd, Dundalk, County Louth, Ireland
| | - R Naclerio
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medical Center and The Pritzker School of Medicine, The University of Chicago, Chicago, IL USA
| | - R E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC Australia ; Department of Immunology, Monash University, Melbourne, VIC Australia
| | - N G Papadopoulos
- Center for Pediatrics and Child Health, Institute of Human Development, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK ; Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - R Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - P Potter
- Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - D Ryan
- Woodbrook Medical Centre, Loughborough, UK ; Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK
| | - B Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - H J Schunemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - A Sheikh
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, UK
| | - F E R Simons
- Department of Pediatrics and Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - C Stellato
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - A Todo-Bom
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - P V Tomazic
- Department of ENT, Medical University of Graz, Graz, Austria
| | - A Valiulis
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania ; Public Health Institute, Vilnius University, Vilnius, Lithuania ; European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | - E Valovirta
- Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland ; Allergy Clinic, Terveystalo, Turku, Finland
| | - M T Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - M Wickman
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - I Young
- Queen's University, Belfast, Northern Ireland, UK
| | - A Yorgancioglu
- Department of Pulmonology, Celal Bayar University, Manisa, Turkey
| | - T Zuberbier
- Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Global Allergy and Asthma European Network (GA²LEN), Berlin, Germany
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - M Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - I Annesi-Maesano
- EPAR U707 INSERM, Paris, France ; EPAR UMR-S UPMC, Paris VI, Paris, France
| | - J Ankri
- INSERM, U1168, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, 94800 Villejuif, France
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | - J M Anto
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain ; IMIM (Hospital del Mar Research Institute), Barcelona, Spain ; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain ; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - A Asarnoj
- Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden ; Department of Pediatric Pulmonology and Allergy, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - H Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | | | - I Baiardini
- Asthma and Allergy Clinic, Humanitas University, Rozzano, Milan, Italy
| | - C Barbara
- Faculdade de Medicina de Lisboa, Portuguese National Programme for Respiratory Diseases (PNDR), Lisbon, Portugal
| | - M Barbagallo
- Geriatric Unit, Department of Internal Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - E D Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - B Beghé
- Section of Respiratory Disease, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - E H Bel
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - K S Bennoor
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - M Benson
- Centre for Individualized Medicine, Department of Pediatrics, Faculty of Medicine, Linköping University, 58185 Linköping, Sweden
| | - A Z Białoszewski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - T Bieber
- Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - L Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - H Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France ; EA 2991, Euromov, University Montpellier, Montpellier, France
| | - F Blasi
- Department of Pathophysiology and Transplantation, IRCCS Fondazione Ca'Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A L Boner
- Pediatric Department, University of Verona Hospital, Verona, Italy
| | - M Bonini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - S Bonini
- Second University of Naples and Institute of Translational Medicine, Italian National Research Council, Naples, Italy
| | | | | | - L P Boulet
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC Canada
| | - R Bourret
- Montpellier University Hospital, Montpellier, France
| | | | - F Braido
- Asthma and Allergy Clinic, Humanitas University, Rozzano, Milan, Italy
| | - A H Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C E Brightling
- Institute of Lung Health, Respiratory Biomedical Unit, University Hospitals of Leicester NHS Trust, Leicestershire, UK ; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - J Brozek
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - R Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - C Bunu
- University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
| | - E Burte
- INSERM, U1168, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, 94800 Villejuif, France
| | - A Bush
- Royal Brompton Hospital NHS, Imperial College London, London, UK
| | | | - M A Calderon
- Royal Brompton Hospital NHS, Imperial College London, London, UK ; National Heart and Lung Institute, Imperial College London, London, UK
| | - T Camuzat
- Montpellier, Région Languedoc Roussillon France
| | - V Cardona
- S. Allergologia, S. Medicina Interna, Hospital Vall d'Hebron, Barcelona, Spain
| | - P Carreiro-Martins
- CEDOC, Respiratory Research Group, Nova Medical School, Campo dos Martires da Patria, Lisbon, Portugal ; Serviço de Imunoalergologia, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - A M Carriazo
- Regional Ministry of Health of Andalusia, Seville, Spain
| | - K H Carlsen
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway ; University of Oslo, Oslo, Norway
| | - W Carr
- Allergy and Asthma Associates of Southern California, Mission Viejo, CA USA
| | - A M Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia ; SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Cartagena, Colombia
| | - M Cesari
- Gérontopôle de Toulouse, 31059 Toulouse, France
| | - L Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete Greece
| | - R Chiron
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - T Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - E Chkhartishvili
- Chachava Clinic, David Tvildiani Medical University-AIETI Medical School, Grigol Robakidze University, Tbilisi, Georgia
| | - A G Chuchalin
- Pulmonolory Research Institute FMBA, Moscow, Russia ; GARD Executive Committee, Moscow, Russia
| | - K F Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - G Ciprandi
- Medicine Department, IRCCS-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
| | - J Correia de Sousa
- ICVS/3B's-PT Government Associate Laboratory, Life and Health Sciences, Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - L Cox
- Department of Medicine, Nova Southeastern University, Davie, FL USA
| | - G Crooks
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, Scottish Centre for Telehealth and Telecare, NHS 24, Glasgow, UK
| | - A Custovic
- Department of Pediatric, Imperial College London, London, UK
| | - S E Dahlen
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - U Darsow
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany ; ZAUM-Center for Allergy and Environment, Helmholtz Center Munich, Munich, Germany
| | - T Dedeu
- AQuAS, Barcelona, Spain ; EUREGHA, European Regional and Local Health Association, Brussels, Belgium
| | - D Deleanu
- Allergology and Immunology Discipline, "Luliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - J A Denburg
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON Canada
| | | | - A Didier
- Respiratory Diseases Department, Rangueil-Larrey Hospital, Toulouse, France
| | - A T Dinh-Xuan
- Service de Physiologie Respiratoire, Hôpital Cochin, Université Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D Dokic
- University Clinic of Pulmology and Allergy, Medical Faculty, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
| | - H Douagui
- Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algers, Algeria
| | - G Dray
- Ecole des Mines, Alès, France
| | - R Dubakiene
- Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - S R Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - G Du Toit
- Guy's and St Thomas' NHS Trust, Kings College London, London, UK
| | - M S Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - P Eklund
- Computing Science Department, Umeå University, Umeå, Sweden ; Four Computing Oy, Halikko, Finland
| | - Y El-Gamal
- Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
| | - E Ellers
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - R Emuzyte
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania ; Public Health Institute, Vilnius University, Vilnius, Lithuania ; European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | - J Farrell
- Department of Health, Social Services and Public Safety, Belfast, Northern Ireland, UK
| | - A Fink Wagner
- Global Allergy and Asthma Platform GAAPP, Altgasse 8-10, 1130 Vienna, Austria
| | - A Fiocchi
- Division of Allergy, Department of Pediatric Medicine, The Bambino Gesù Children's Research Hospital Holy See, Rome, Italy
| | | | - F Forastiere
- Department of Epidemiology, Regional Health Service Lazio Region, Rome, Italy
| | - M Gaga
- Athens Chest Hospital, Athens, Greece
| | - A Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - B Gemicioğlu
- Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - J E Gereda
- Allergy and Immunology Division, Clinica Ricardo Palma, Lima, Peru
| | - R Gerth van Wick
- Section of Allergology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - S González Diaz
- Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
| | - I Grisle
- Center of Tuberculosis and Lung Diseases, Latvian Association of Allergists, Riga, Latvia
| | - L Grouse
- Faculty of the Department of Neurology, University of Washington School of Medicine, Seattle, WA USA
| | - Z Gutter
- National eHealth Centre, University Hospital Olomouc, Olomouc, Czech Republic
| | - M A Guzmán
- Immunology and Allergy Division Clinical Hospital, University of Chile, Santiago, Chile
| | - B Hellquist-Dahl
- Department of Respiratory Diseases, Odense University Hospital, Odense, Denmark
| | - J Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - F Horak
- Vienna Challenge Chamber, Vienna, Austria
| | - J O' B Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - M Humbert
- Université Paris-Sud, Le Kremlin Bicêtre, France ; Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France ; Inserm UMR_S999, Le Kremlin Bicêtre, France
| | - M Hyland
- School of Psychology, Plymouth University, Plymouth, UK
| | - G Iaccarino
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - E J Jares
- Libra Foundation, Buenos Aires, Argentina
| | - C Jeandel
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France ; Department of Geriatrics, Montpellier University Hospital, Montpellier, France
| | - S L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK ; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - G Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - O Jonquet
- Medical Commission, Montpellier University Hospital, Montpellier, France
| | - K S Jung
- Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do South Korea
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland
| | - I Kaidashev
- Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - M Khaitov
- Laboratory of Molecular Immunology, National Research Center, Institute of Immunology, Federal Medicobiological Agency, Moscow, Russia
| | - O Kalayci
- Pediatric Allergy and Asthma Unit, School of Medicine, Hacettepe University, Ankara, Turkey
| | - A F Kalyoncu
- Immunology and Allergy Division, Department of Chest Diseases, School of Medicine, Hacettepe University, Ankara, Turkey
| | - P Kardas
- First Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | - P K Keith
- Department of Medicine, McMaster University, Health Sciences Centre 3V47, 1280 Main Street West, Hamilton, ON Canada
| | - M Kerkhof
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H A M Kerstjens
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - M Kogevinas
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain ; IMIM (Hospital del Mar Research Institute), Barcelona, Spain ; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain ; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - V Kolek
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Hospital Olomouc, Olomouc, Czech Republic
| | - G H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M L Kowalski
- Department of Immunology, Rheumatology and Allergy and HARC, Medical University of Lodz, Lodz, Poland
| | - M Kuitunen
- Children's Hospital, University of Helsinki, Helsinki, Finland
| | - I Kull
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - V Kvedariene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology, Vilnius University, Vilnius, Lithuania
| | - B Lambrecht
- VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - S Lau
- Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | | | - L T T Le
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - P Lieberman
- Divisions of Allergy and Immunology, Department of Internal Medicine and Pediatrics, University of Tennessee College of Medicine, Germantown, TN USA
| | - B Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
| | - J Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - K C Lodrup Carlsen
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - R Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, Belgium
| | - C Lupinek
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - W MacNee
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Y Magar
- Service de Pneumo-allergologie, Hôpital Saint-Joseph, Paris, France
| | - A Magnan
- Service de Pneumologie, UMR INSERM, UMR1087 and CNR 6291, l'institut du Thorax, University of Nantes, Nantes, France
| | - B Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - D Maier
- Biomax Informatics AG, Munich, Germany
| | - I Majer
- Department of Respiratory Medicine, University of Bratislava, Bratislava, Slovakia
| | - J Malva
- Institute of Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal ; Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - P Manning
- Department of Medicine (RCSI), Bon Secours Hospital, Glasnevin, Dublin, Ireland
| | | | - G D Marshall
- Laboratory of Behavioral Immunology Research, Division of Clinical Immunology and Allergy, The University of Mississippi Medical Center, Jackson, MS USA
| | - M R Masjedi
- Tobacco Control Research Centre, Iranian Anti Tobacco Association, Tehran, Iran
| | | | - M Maurer
- Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Mavale-Manuel
- Department of Paediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - E Melén
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E Melo-Gomes
- Faculdade de Medicina de Lisboa, Portuguese National Programme for Respiratory Diseases (PNDR), Lisbon, Portugal
| | - E O Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, CA USA
| | - J Mercier
- Department of Physiology, CHRU, PhyMedExp, INSERM U1046, CNRS UMR 9214, University Montpellier, Montpellier, France
| | - H Merk
- Hautklinik - Klinik für Dermatologie & Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Germany
| | | | - F Mihaltan
- National Institute of Pneumology M. Nasta, Bucharest, Romania
| | - B Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia ; Serbian Association for Asthma and COPD, Belgrade, Serbia
| | - J Millot-Keurinck
- Caisse d'assurance retraite et de la santé au travail du Languedoc-Roussillon (CARSAT-LR), Montpellier, France
| | - Y Mohammad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria
| | - I Momas
- Department of Public Health and Health Products, EA 4064, Paris Descartes University-Sorbonne Paris Cité, Paris, France ; Paris Municipal Department of Social Action, Childhood, and Health, Paris, France
| | - R Mösges
- Institute of Medical Statistics, Informatics and Epidemiology, Medical Faculty, University of Cologne, Cologne, Germany
| | - A Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - L Namazova-Baranova
- Scientific Centre of Children's Health Under the Russian Academy of Medical Sciences, Moscow, Russia
| | - R Nadif
- INSERM, U1168, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, 94800 Villejuif, France
| | - H Neffen
- Hospital de Niños Orlando Alassia, Santa Fe, Argentina
| | - K Nekam
- Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
| | - A Nieto
- Neumología y Alergología Infantil, Hospital La Fe, Valencia, Spain
| | - B Niggemann
- Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - L Nogueira-Silva
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal ; Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal ; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal ; Department of Internal Medicine, Centro Hospitalar Sao Joao, Porto, Portugal
| | - M Nogues
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France ; Caisse d'assurance retraite et de la santé au travail du Languedoc-Roussillon (CARSAT-LR), Montpellier, France
| | - T D Nyembue
- ENT Department, University Hospital of Kinshasa, Kinshasa, Congo
| | - K Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
| | - Y Okamoto
- Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - K Okubo
- Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - M Olive-Elias
- Montpellier University Hospital, Montpellier, France ; Institute of Health Policy and Management IBMG, Erasmus University, Rotterdam, The Netherlands ; Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - S Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - P Paggiaro
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - I Pali-Schöll
- Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine, Medical University, Vienna, Austria
| | - S Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - P Panzner
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - A Papi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - H S Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - G Passalacqua
- Asthma and Allergy Clinic, Humanitas University, Rozzano, Milan, Italy
| | - S Pedersen
- University of Southern Denmark, Kolding, Denmark
| | - A M Pereira
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal ; Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal ; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal ; Allergy Unit, CUF-Porto Hospital and Institute, Porto, Portugal
| | - O Pfaar
- Center for Rhinology and Allergology, Wiesbaden, Germany ; Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - R Picard
- Conseil Général de l'Economie, Ministère de l'Economie, de l'Industrie et du Numérique, Paris, France
| | - B Pigearias
- Société de Pneumologie de Langue Française, Espace francophone de Pneumologie, Paris, France
| | - I Pin
- Département de pédiatrie, CHU de Grenoble, Grenoble, France
| | - D Plavec
- Children's Hospital Srebrnjak, Zagreb, Croatia ; School of Medicine, University J.J. Strossmayer, Osijek, Croatia
| | - W Pohl
- Karl Landsteiner Institute for Clinical and Experimental Pneumology, Hietzing Hospital, Vienna, Austria
| | - T A Popov
- Clinic of Allergy and Asthma, Medical University Sofia, Sofia, Bulgaria
| | - F Portejoie
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - D Postma
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L K Poulsen
- Laboratory of Medical Allergology, Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark
| | - D Price
- Academic Centre of Primary Care, University of Aberdeen, Aberdeen, Scotland, UK ; Research in Real-Life, Cambridge, UK
| | - K F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany ; Department of Medicine, Christian Albrechts University, Airway Research Center North, German Center for Lung Research (DZL), Kiel, Germany
| | - F Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - G Roberts
- NHS Foundation Trust, University Hospitals of Southampton, Southampton, UK
| | - C Robalo-Cordeiro
- Centre of Pneumology, Coimbra University Hospital, Coimbra, Portugal
| | - F Rodenas
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | | | - C Rolland
- Association Asthme et Allergie, Paris, France
| | - M Roman Rodriguez
- Primary Care Respiratory Research Unit, Institutode Investigación Sanitaria de Palma IdisPa, Palma de Mallorca, Spain
| | - A Romano
- Allergy Unit, Complesso Integrato Columbus, Rome, Italy
| | - J Rosado-Pinto
- Serviço de Imunoalergologia, Hospital da Luz, Lisbon, Portugal
| | - N Rosario
- Hospital de Clinicas, University of Parana, Curitiba, Brazil
| | - M Rottem
- Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - M Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico-Docente La Trinidad and Clínica El Avila, Caracas, Venezuela
| | | | - G K Scadding
- The Royal National TNE Hospital, University College London, London, UK
| | | | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - E Serrano
- Otolaryngology and Head and Neck Surgery, CHU Rangueil-Larrey, Toulouse, France
| | - M Shields
- Child Health, Queen's University, Belfast, Northern Ireland, UK ; Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
| | - V Siroux
- INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France
| | - J C Sisul
- Sociedad Paraguaya de Alergia Asma e Inmunologıa, Asunción, Paraguay
| | - I Skrindo
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - H A Smit
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - D Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - T Sooronbaev
- Kyrgyzstan National Centre of Cardiology and Internal Medicine, Euro-Asian Respiratory Society, Bishkek, Kyrgyzstan
| | - O Spranger
- Global Allergy and Asthma Platform GAAPP, Altgasse 8-10, 1130 Vienna, Austria
| | - R Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - P J Sterk
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - T Strandberg
- European Union Geriatric Medicine Society (EUGMS), Helsinki, Finland
| | - J Sunyer
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain ; IMIM (Hospital del Mar Research Institute), Barcelona, Spain ; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain ; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - C Thijs
- Department of Epidemiology, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - M Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - A Valero
- Pneumology and Allergy Department, Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | | | - E van Ganse
- PELyon, Lyon, France ; HESPER 7425, Health Services and Performance Resarch, Université Claude Bernard Lyon, Villeurbanne, France
| | - M van Hague
- Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden ; Department of Pediatric Pulmonology and Allergy, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden ; University Hospital, Stockholm, Sweden
| | - O Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - L L Varona
- Philippines Society of Allergy, Asthma and Immunology, Manila, Philippines
| | - B Vellas
- Gérontopôle de Toulouse, 31059 Toulouse, France
| | - G Vezzani
- Pulmonary Unit, Department of Cardiology, Thoracic and Vascular Medicine, Arcispedale S. Maria Nuova/IRCCS, Research Hospital, Reggio Emilia, Italy ; Regional Agency for Health and Social Care, Reggio Emilia, Italy
| | - T Vazankari
- Finnish Lung Association (FILHA), Helsinki, Finland
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy ; CNR Institute of Biomedicine and Molecular Immunology "A. Monroy", Palermo, Italy
| | | | - M Wagenmann
- Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - S Walker
- Asthma UK, Mansell Street, London, UK
| | - D Y Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - U Wahn
- Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - T Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - B Whalley
- School of Psychology, Plymouth University, Plymouth, UK
| | - D M Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC USA
| | | | - N Wilson
- Northern Health Alliance, Newcastle, UK
| | - J Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - B P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN USA
| | | | - O M Yusuf
- The Allergy and Asthma Institute, Lahore, Pakistan
| | - A Zaidi
- Social Sciences, University of Southampton, Southampton, UK
| | - H J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa ; MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - M E Zernotti
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - L Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Beijing, China ; Beijing Institute of Otolaryngology, Beijing, China
| | - N Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - M Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
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7
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Nieuwenhuis MA, Siedlinski M, van den Berge M, Granell R, Li X, Niens M, van der Vlies P, Altmüller J, Nürnberg P, Kerkhof M, van Schayck OC, Riemersma RA, van der Molen T, de Monchy JG, Bossé Y, Sandford A, Bruijnzeel-Koomen CA, Gerth van Wijk R, ten Hacken NH, Timens W, Boezen HM, Henderson J, Kabesch M, Vonk JM, Postma DS, Koppelman GH. Combining genomewide association study and lung eQTL analysis provides evidence for novel genes associated with asthma. Allergy 2016; 71:1712-1720. [PMID: 27439200 DOI: 10.1111/all.12990] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Genomewide association studies (GWASs) of asthma have identified single-nucleotide polymorphisms (SNPs) that modestly increase the risk for asthma. This could be due to phenotypic heterogeneity of asthma. Bronchial hyperresponsiveness (BHR) is a phenotypic hallmark of asthma. We aim to identify susceptibility genes for asthma combined with BHR and analyse the presence of cis-eQTLs among replicated SNPs. Secondly, we compare the genetic association of SNPs previously associated with (doctor's diagnosed) asthma to our GWAS of asthma with BHR. METHODS A GWAS was performed in 920 asthmatics with BHR and 980 controls. Top SNPs of our GWAS were analysed in four replication cohorts, and lung cis-eQTL analysis was performed on replicated SNPs. We investigated association of SNPs previously associated with asthma in our data. RESULTS A total of 368 SNPs were followed up for replication. Six SNPs in genes encoding ABI3BP, NAF1, MICA and the 17q21 locus replicated in one or more cohorts, with one locus (17q21) achieving genomewide significance after meta-analysis. Five of 6 replicated SNPs regulated 35 gene transcripts in whole lung. Eight of 20 asthma-associated SNPs from previous GWAS were significantly associated with asthma and BHR. Three SNPs, in IL-33 and GSDMB, showed larger effect sizes in our data compared to published literature. CONCLUSIONS Combining GWAS with subsequent lung eQTL analysis revealed disease-associated SNPs regulating lung mRNA expression levels of potential new asthma genes. Adding BHR to the asthma definition does not lead to an overall larger genetic effect size than analysing (doctor's diagnosed) asthma.
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8
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Bousquet J, Anto JM, Akdis M, Auffray C, Keil T, Momas I, Postma D, Valenta R, Wickman M, Cambon‐Thomsen A, Haahtela T, Lambrecht BN, Lodrup Carlsen KC, Koppelman GH, Sunyer J, Zuberbier T, Annesi‐Maesano I, Arno A, Bindslev‐Jensen C, De Carlo G, Forastiere F, Heinrich J, Kowalski ML, Maier D, Melén E, Palkonen S, Smit HA, Standl M, Wright J, Asarnoj A, Benet M, Ballardini N, Garcia‐Aymerich J, Gehring U, Guerra S, Hohman C, Kull I, Lupinek C, Pinart M, Skrindo I, Westman M, Smagghe D, Akdis C, Albang R, Anastasova V, Anderson N, Bachert C, Ballereau S, Ballester F, Basagana X, Bedbrook A, Bergstrom A, Berg A, Brunekreef B, Burte E, Carlsen KH, Chatzi L, Coquet JM, Curin M, Demoly P, Eller E, Fantini MP, Gerhard B, Hammad H, Hertzen L, Hovland V, Jacquemin B, Just J, Keller T, Kerkhof M, Kiss R, Kogevinas M, Koletzko S, Lau S, Lehmann I, Lemonnier N, McEachan R, Mäkelä M, Mestres J, Minina E, Mowinckel P, Nadif R, Nawijn M, Oddie S, Pellet J, Pin I, Porta D, Rancière F, Rial‐Sebbag A, Saeys Y, Schuijs MJ, Siroux V, Tischer CG, Torrent M, Varraso R, De Vocht J, Wenger K, Wieser S, Xu C. Paving the way of systems biology and precision medicine in allergic diseases: the MeDALL success story: Mechanisms of the Development of ALLergy; EU FP7-CP-IP; Project No: 261357; 2010-2015. Allergy 2016; 71:1513-1525. [PMID: 26970340 PMCID: PMC5248602 DOI: 10.1111/all.12880] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 01/06/2023]
Abstract
MeDALL (Mechanisms of the Development of ALLergy; EU FP7-CP-IP; Project No: 261357; 2010-2015) has proposed an innovative approach to develop early indicators for the prediction, diagnosis, prevention and targets for therapy. MeDALL has linked epidemiological, clinical and basic research using a stepwise, large-scale and integrative approach: MeDALL data of precisely phenotyped children followed in 14 birth cohorts spread across Europe were combined with systems biology (omics, IgE measurement using microarrays) and environmental data. Multimorbidity in the same child is more common than expected by chance alone, suggesting that these diseases share causal mechanisms irrespective of IgE sensitization. IgE sensitization should be considered differently in monosensitized and polysensitized individuals. Allergic multimorbidities and IgE polysensitization are often associated with the persistence or severity of allergic diseases. Environmental exposures are relevant for the development of allergy-related diseases. To complement the population-based studies in children, MeDALL included mechanistic experimental animal studies and in vitro studies in humans. The integration of multimorbidities and polysensitization has resulted in a new classification framework of allergic diseases that could help to improve the understanding of genetic and epigenetic mechanisms of allergy as well as to better manage allergic diseases. Ethics and gender were considered. MeDALL has deployed translational activities within the EU agenda.
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Affiliation(s)
- J. Bousquet
- University Hospital Montpellier France
- MACVIA‐LR Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc‐Roussillon European Innovation Partnership on Active and Healthy Ageing Reference Site France
- INSERM VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches UVSQ Université Versailles St‐Quentin‐en‐Yvelines Paris France
| | - J. M. Anto
- Centre for Research in Environmental Epidemiology (CREAL) ISGLoBAL Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
| | - M. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - C. Auffray
- European Institute for Systems Biology and Medicine CNRS‐ENS‐UCBL Université de Lyon Lyon France
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics Charité–Universitätsmedizin Berlin Berlin Germany
- Institute for Clinical Epidemiology and Biometry University of Wuerzburg Wuerzburg Germany
| | - I. Momas
- Department of Public Health and Health Products Paris Descartes University‐Sorbonne Paris Cité Paris France
- Paris Municipal Department of Social Action, Childhood, and Health Paris France
| | - D.S. Postma
- Department of Pulmonary Medicine and Tuberculosis GRIAC Research Institute University Medical Center Groningen University of Groningen Groningen the Netherlands
| | - R. Valenta
- Division of Immunopathology Department of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - M. Wickman
- Sachs’ Children and Youth Hospital, Södersjukhuset Stockholm and Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - A. Cambon‐Thomsen
- UMR Inserm U1027 and Université de Toulouse III Paul Sabatier Toulouse France
| | - T. Haahtela
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
| | - B. N. Lambrecht
- VIB Inflammation Research Center Ghent University Ghent Belgium
| | - K. C. Lodrup Carlsen
- Department of Paediatrics Faculty of Medicine Institute of Clinical Medicine Oslo University Hospital University of Oslo Oslo Norway
| | - G. H. Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology Beatrix Children's Hospital GRIAC Research Institute University Medical Center Groningen University of Groningen Groningen the Netherlands
| | - J. Sunyer
- Centre for Research in Environmental Epidemiology (CREAL) ISGLoBAL Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
| | - T. Zuberbier
- Secretary General of the Global Allergy and Asthma European Network (GALEN) Allergy‐Centre‐Charité at the Department of Dermatology Charité–Universitätsmedizin Berlin Berlin Germany
| | | | - A. Arno
- Onmedic Networks Barcelona Spain
| | - C. Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Denmark
| | - G. De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - F. Forastiere
- Department of Epidemiology Regional Health Service Lazio Region Rome Italy
| | - J. Heinrich
- Institute of Epidemiology I German Research Centre for Environmental Health Helmholtz Zentrum München Neuherberg Germany
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy Medical University of Lodz Lodz Poland
| | - D. Maier
- Biomax Informatics AG Munich Germany
| | - E. Melén
- Department of Pulmonary Medicine and Tuberculosis GRIAC Research Institute University Medical Center Groningen University of Groningen Groningen the Netherlands
- Stockholm County Council Centre for Occupational and Environmental Medicine Stockholm Sweden
| | - S. Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - H. A. Smit
- Julius Center of Health Sciences and Primary Care University Medical Center Utrecht University of Utrecht Utrecht the Netherlands
| | - M. Standl
- Institute of Epidemiology I German Research Centre for Environmental Health Helmholtz Zentrum München Neuherberg Germany
| | - J. Wright
- Bradford Institute for Health Research Bradford Royal Infirmary Bradford UK
| | - A. Asarnoj
- Clinical Immunology and Allergy Unit Department of Medicine Solna Karolinska Institutet Stockholm Sweden
- Astrid Lindgren Children's Hospital Department of Pediatric Pulmonology and Allergy Karolinska University Hospital Stockholm Sweden
| | - M. Benet
- Centre for Research in Environmental Epidemiology (CREAL) ISGLoBAL Barcelona Spain
| | - N. Ballardini
- Sachs’ Children and Youth Hospital, Södersjukhuset Stockholm and Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
- St John's Institute of Dermatology King's College London London UK
| | - J. Garcia‐Aymerich
- Centre for Research in Environmental Epidemiology (CREAL) ISGLoBAL Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
| | - U. Gehring
- Institute for Risk Assessment Sciences Utrecht University Utrecht the Netherlands
| | - S. Guerra
- Centre for Research in Environmental Epidemiology (CREAL) ISGLoBAL Barcelona Spain
| | - C. Hohman
- Institute of Social Medicine, Epidemiology and Health Economics Charité–Universitätsmedizin Berlin Germany
| | - I. Kull
- Sachs’ Children and Youth Hospital, Södersjukhuset Stockholm and Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
- Department of Clinical Science and Education, Södersjukhuset Karolinska InstitutetStockholm Sweden
| | - C. Lupinek
- Division of Immunopathology Department of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - M. Pinart
- Centre for Research in Environmental Epidemiology (CREAL) ISGLoBAL Barcelona Spain
| | - I. Skrindo
- Department of Paediatrics Faculty of Medicine Institute of Clinical Medicine Oslo University Hospital University of Oslo Oslo Norway
| | - M. Westman
- Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | | | - C. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - R. Albang
- Biomax Informatics AG Munich Germany
| | - V. Anastasova
- UMR Inserm U1027 and Université de Toulouse III Paul Sabatier Toulouse France
| | - N. Anderson
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - C. Bachert
- ENT Department Ghent University Hospital Gent Belgium
| | - S. Ballereau
- European Institute for Systems Biology and Medicine CNRS‐ENS‐UCBL Université de Lyon Lyon France
| | - F. Ballester
- Environment and Health Area Centre for Public Health Research (CSISP) CIBERESP Department of Nursing University of Valencia Valencia Spain
| | - X. Basagana
- Centre for Research in Environmental Epidemiology (CREAL) ISGLoBAL Barcelona Spain
| | - A. Bedbrook
- MACVIA‐LR Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc‐Roussillon European Innovation Partnership on Active and Healthy Ageing Reference Site France
| | - A. Bergstrom
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - A. Berg
- Research Institute Department of Pediatrics Marien‐Hospital Wesel Germany
| | - B. Brunekreef
- Julius Center of Health Sciences and Primary Care University Medical Center Utrecht University of Utrecht Utrecht the Netherlands
| | - E. Burte
- INSERM VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches UVSQ Université Versailles St‐Quentin‐en‐Yvelines Paris France
| | - K. H. Carlsen
- Department of Paediatrics Oslo University Hospital University of Oslo Oslo Norway
| | - L. Chatzi
- Department of Social Medicine Faculty of Medicine University of Crete Heraklion Crete Greece
| | - J. M. Coquet
- VIB Inflammation Research Center Ghent University Ghent Belgium
| | - M. Curin
- Division of Immunopathology Department of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - P. Demoly
- Department of Respiratory Diseases Montpellier University Hospital France
| | - E. Eller
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Denmark
| | - M. P. Fantini
- Department of Medicine and Public Health Alma Mater Studiorum–University of Bologna Bologna Italy
| | | | - H. Hammad
- VIB Inflammation Research Center Ghent University Ghent Belgium
| | - L. Hertzen
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
| | - V. Hovland
- Department of Paediatrics Oslo University Hospital University of Oslo Oslo Norway
| | - B. Jacquemin
- Centre for Research in Environmental Epidemiology (CREAL) ISGLoBAL Barcelona Spain
| | - J. Just
- Allergology Department Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand‐Trousseau (APHP) Sorbonne Universités Institut Pierre Louis d'Epidémiologie et de Santé Publique Paris France
| | - T. Keller
- Institute of Social Medicine, Epidemiology and Health Economics Charité–Universitätsmedizin Berlin Germany
| | - M. Kerkhof
- Department of Pulmonary Medicine and Tuberculosis GRIAC Research Institute University Medical Center Groningen University of Groningen Groningen the Netherlands
| | - R. Kiss
- Division of Immunopathology Department of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - M. Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL) ISGLoBAL Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
| | - S. Koletzko
- Division of Paediatric Gastroenterology and Hepatology Ludwig Maximilians University of Munich Munich Germany
| | - S. Lau
- Department for Pediatric Pneumology and Immunology Charité Medical University Berlin Germany
| | - I. Lehmann
- Department of Environmental Immunology/Core Facility Studies Helmholtz Centre for Environmental Research, UFZ Leipzig Germany
| | - N. Lemonnier
- European Institute for Systems Biology and Medicine CNRS‐ENS‐UCBL Université de Lyon Lyon France
| | - R. McEachan
- Bradford Institute for Health Research Bradford Royal Infirmary Bradford UK
| | - M. Mäkelä
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
| | - J. Mestres
- Chemotargets SL and Chemogenomics Laboratory GRIB Unit IMIM‐Hospital del Mar and University Pompeu Fabra Barcelona Catalonia Spain
| | - E. Minina
- Biomax Informatics AG Munich Germany
| | - P. Mowinckel
- Department of Paediatrics Oslo University Hospital University of Oslo Oslo Norway
| | - R. Nadif
- INSERM VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches UVSQ Université Versailles St‐Quentin‐en‐Yvelines Paris France
| | - M. Nawijn
- Department of Pediatric Pulmonology and Pediatric Allergology Beatrix Children's Hospital GRIAC Research Institute University Medical Center Groningen University of Groningen Groningen the Netherlands
| | - S. Oddie
- Bradford Institute for Health Research Bradford Royal Infirmary Bradford UK
| | - J. Pellet
- European Institute for Systems Biology and Medicine CNRS‐ENS‐UCBL Université de Lyon Lyon France
| | - I. Pin
- Département de Pédiatrie CHU de Grenoble Grenoble Cedex 9 France
| | - D. Porta
- Department of Epidemiology Regional Health Service Lazio Region Rome Italy
| | - F. Rancière
- Department of Public Health and Health Products Paris Descartes University‐Sorbonne Paris Cité Paris France
| | - A. Rial‐Sebbag
- UMR Inserm U1027 and Université de Toulouse III Paul Sabatier Toulouse France
| | - Y. Saeys
- VIB Inflammation Research Center Ghent University Ghent Belgium
| | - M. J. Schuijs
- VIB Inflammation Research Center Ghent University Ghent Belgium
| | | | - C. G. Tischer
- Institute of Epidemiology I German Research Centre for Environmental Health Helmholtz Zentrum München Neuherberg Germany
| | - M. Torrent
- Centre for Research in Environmental Epidemiology (CREAL) ISGLoBAL Barcelona Spain
- ib‐salut Area de Salut de Menorca Spain
| | - R. Varraso
- INSERM VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches UVSQ Université Versailles St‐Quentin‐en‐Yvelines Paris France
| | - J. De Vocht
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - K. Wenger
- Biomax Informatics AG Munich Germany
| | - S. Wieser
- Division of Immunopathology Department of Pathophysiology and Allergy Research Center for Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
| | - C. Xu
- Department of Pulmonary Medicine and Tuberculosis GRIAC Research Institute University Medical Center Groningen University of Groningen Groningen the Netherlands
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Kerkhof M, Ganeff I, Wiggenraad RG, Lycklama à Nijeholt GJ, Hammer S, Taphoorn MJ, Dirven L, Vos MJ. P13.16 Changes in perfusion MR imaging in brain metastases after stereotactic radiotherapy. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.260] [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: 11/14/2022] Open
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Kerkhof M, Koekkoek JA, Vos MJ, van den Bent MJ, Taal W, Postma TJ, Bromberg JE, Dirven L, Reijneveld JC, Taphoorn MJ. P09.06 Withdrawal of antiepileptic drugs in glioma patients after long-term seizure freedom. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Kerkhof M, Hagenbeek RE, van der Kallen BFW, Lycklama À Nijeholt GJ, Dirven L, Taphoorn MJB, Vos MJ. Interobserver variability in the radiological assessment of magnetic resonance imaging (MRI) including perfusion MRI in glioblastoma multiforme. Eur J Neurol 2016; 23:1528-33. [PMID: 27424939 DOI: 10.1111/ene.13070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 10/21/2015] [Accepted: 05/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Conventional magnetic resonance imaging (MRI) has limited value for differentiation of true tumor progression and pseudoprogression in treated glioblastoma multiforme (GBM). Perfusion weighted imaging (PWI) may be helpful in the differentiation of these two phenomena. Here interobserver variability in routine radiological evaluation of GBM patients is assessed using MRI, including PWI. METHODS Three experienced neuroradiologists evaluated MR scans of 28 GBM patients during temozolomide chemoradiotherapy at three time points: preoperative (MR1) and postoperative (MR2) MR scan and the follow-up MR scan after three cycles of adjuvant temozolomide (MR3). Tumor size was measured both on T1 post-contrast and T2 weighted images according to the Response Assessment in Neuro-Oncology criteria. PW images of MR3 were evaluated by visual inspection of relative cerebral blood volume (rCBV) color maps and by quantitative rCBV measurements of enhancing areas with highest rCBV. Image interpretability of PW images was also scored. Finally, the neuroradiologists gave a conclusion on tumor status, based on the interpretation of both T1 and T2 weighted images (MR1, MR2 and MR3) in combination with PWI (MR3). RESULTS Interobserver agreement on visual interpretation of rCBV maps was good (κ = 0.63) but poor on quantitative rCBV measurements and on interpretability of perfusion images (intraclass correlation coefficient 0.37 and κ = 0.23, respectively). Interobserver agreement on the overall conclusion of tumor status was moderate (κ = 0.48). CONCLUSIONS Interobserver agreement on the visual interpretation of PWI color maps was good. However, overall interpretation of MR scans (using both conventional and PW images) showed considerable interobserver variability. Therefore, caution should be applied when interpreting MRI results during chemoradiation therapy.
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Affiliation(s)
- M Kerkhof
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
| | - R E Hagenbeek
- Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands
| | | | | | - L Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Vos
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
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12
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Backes Y, Moons LMG, van Bergeijk JD, Berk L, Ter Borg F, Ter Borg PCJ, Elias SG, Geesing JMJ, Groen JN, Hadithi M, Hardwick JCH, Kerkhof M, Mangen MJJ, Straathof JWA, Schröder R, Schwartz MP, Spanier BWM, de Vos Tot Nederveen Cappel WH, Wolfhagen FHJ, Koch AD. Endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) for resection of large distal non-pedunculated colorectal adenomas (MATILDA-trial): rationale and design of a multicenter randomized clinical trial. BMC Gastroenterol 2016; 16:56. [PMID: 27229709 PMCID: PMC4882830 DOI: 10.1186/s12876-016-0468-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 04/13/2016] [Accepted: 05/14/2016] [Indexed: 02/08/2023] Open
Abstract
Background Endoscopic mucosal resection (EMR) is currently the most used technique for resection of large distal colorectal polyps. However, in large lesions EMR can often only be performed in a piecemeal fashion resulting in relatively low radical (R0)-resection rates and high recurrence rates. Endoscopic submucosal dissection (ESD) is a newer procedure that is more difficult resulting in a longer procedural time, but is promising due to the high en-bloc resection rates and the very low recurrence rates. We aim to evaluate the (cost-)effectiveness of ESD against EMR on both short (i.e. 6 months) and long-term (i.e. 36 months). We hypothesize that in the short-run ESD is more time consuming resulting in higher healthcare costs, but is (cost-) effective on the long-term due to lower patients burden, a higher number of R0-resections and lower recurrence rates with less need for repeated procedures. Methods This is a multicenter randomized clinical trial in patients with a non-pedunculated polyp larger than 20 mm in the rectum, sigmoid, or descending colon suspected to be an adenoma by means of endoscopic assessment. Primary endpoint is recurrence rate at follow-up colonoscopy at 6 months. Secondary endpoints are R0-resection rate, perceived burden and quality of life, healthcare resources utilization and costs, surgical referral rate, complication rate and recurrence rate at 36 months. Quality-adjusted-life-year (QALY) will be estimated taking an area under the curve approach and using EQ-5D-indexes. Healthcare costs will be calculated by multiplying used healthcare services with unit prices. The cost-effectiveness of ESD against EMR will be expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per recurrence free patient and as ICER showing additional costs per QALY. Discussion If this trial confirms ESD to be favorable on the long-term, the burden of extra colonoscopies and repeated procedures can be prevented for future patients. Trial registration NCT02657044 (Clinicaltrials.gov), registered January 8, 2016.
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Affiliation(s)
- Y Backes
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3508, GA, Utrecht, Netherlands
| | - L M G Moons
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3508, GA, Utrecht, Netherlands.
| | - J D van Bergeijk
- Department of Gastroenterology & Hepatology, Gelderse Vallei, Ede, Netherlands
| | - L Berk
- Department of Gastroenterology & Hepatology, Sint Franciscus, Rotterdam, Netherlands
| | - F Ter Borg
- Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, Netherlands
| | - P C J Ter Borg
- Department of Gastroenterology & Hepatology, Ikazia, Rotterdam, Netherlands
| | - S G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - J M J Geesing
- Department of Gastroenterology & Hepatology, Diakonessenhuis, Utrecht, Netherlands
| | - J N Groen
- Department of Gastroenterology & Hepatology, Sint Jansdal, Harderwijk, Netherlands
| | - M Hadithi
- Department of Gastroenterology & Hepatology, Maasstad hospital, Rotterdam, Netherlands
| | - J C H Hardwick
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - M Kerkhof
- Department of Gastroenterology & Hepatology, Groene Hart Hospital, Gouda, Netherlands
| | - M J J Mangen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - J W A Straathof
- Department of Gastroenterology & Hepatology, Máxima Medical Center, Eindhoven, Netherlands
| | - R Schröder
- Department of Gastroenterology & Hepatology, Gelre Hospital, Apeldoorn, Netherlands
| | - M P Schwartz
- Department of Gastroenterology & Hepatology, Meander Medical Center, Amersfoort, Netherlands
| | - B W M Spanier
- Department of Gastroenterology & Hepatology, Rijnstate hospital, Arnhem, Netherlands
| | | | - F H J Wolfhagen
- Department of Gastroenterology & Hepatology, Albert Schweitzer, Dordrecht, Netherlands
| | - A D Koch
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
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13
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Bousquet J, Anto JM, Wickman M, Keil T, Valenta R, Haahtela T, Lodrup Carlsen K, van Hage M, Akdis C, Bachert C, Akdis M, Auffray C, Annesi-Maesano I, Bindslev-Jensen C, Cambon-Thomsen A, Carlsen KH, Chatzi L, Forastiere F, Garcia-Aymerich J, Gehrig U, Guerra S, Heinrich J, Koppelman GH, Kowalski ML, Lambrecht B, Lupinek C, Maier D, Melén E, Momas I, Palkonen S, Pinart M, Postma D, Siroux V, Smit HA, Sunyer J, Wright J, Zuberbier T, Arshad SH, Nadif R, Thijs C, Andersson N, Asarnoj A, Ballardini N, Ballereau S, Bedbrook A, Benet M, Bergstrom A, Brunekreef B, Burte E, Calderon M, De Carlo G, Demoly P, Eller E, Fantini MP, Hammad H, Hohman C, Just J, Kerkhof M, Kogevinas M, Kull I, Lau S, Lemonnier N, Mommers M, Nawijn M, Neubauer A, Oddie S, Pellet J, Pin I, Porta D, Saes Y, Skrindo I, Tischer CG, Torrent M, von Hertzen L. Are allergic multimorbidities and IgE polysensitization associated with the persistence or re-occurrence of foetal type 2 signalling? The MeDALL hypothesis. Allergy 2015; 70:1062-78. [PMID: 25913421 DOI: 10.1111/all.12637] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 12/22/2022]
Abstract
Allergic diseases [asthma, rhinitis and atopic dermatitis (AD)] are complex. They are associated with allergen-specific IgE and nonallergic mechanisms that may coexist in the same patient. In addition, these diseases tend to cluster and patients present concomitant or consecutive diseases (multimorbidity). IgE sensitization should be considered as a quantitative trait. Important clinical and immunological differences exist between mono- and polysensitized subjects. Multimorbidities of allergic diseases share common causal mechanisms that are only partly IgE-mediated. Persistence of allergic diseases over time is associated with multimorbidity and/or IgE polysensitization. The importance of the family history of allergy may decrease with age. This review puts forward the hypothesis that allergic multimorbidities and IgE polysensitization are associated and related to the persistence or re-occurrence of foetal type 2 signalling. Asthma, rhinitis and AD are manifestations of a common systemic immune imbalance (mesodermal origin) with specific patterns of remodelling (ectodermal or endodermal origin). This study proposes a new classification of IgE-mediated allergic diseases that allows the definition of novel phenotypes to (i) better understand genetic and epigenetic mechanisms, (ii) better stratify allergic preschool children for prognosis and (iii) propose novel strategies of treatment and prevention.
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Affiliation(s)
- J. Bousquet
- University Hospital; Montpellier France
- MACVIA-LR; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon; European Innovation Partnership on Active and Healthy Ageing Reference Site; Paris France
- INSERM; VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, U1168; Paris France
- UVSQ; UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; Versailles France
| | - J. M. Anto
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Barcelona Spain
- Department of Experimental and Health Sciences; University of Pompeu Fabra (UPF); Barcelona Spain
| | - M. Wickman
- Sachs’ Children's Hospital; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - T. Keil
- Institute of Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
- Institute for Clinical Epidemiology and Biometry; University of Wuerzburg; Wuerzburg Germany
| | - R. Valenta
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - T. Haahtela
- Skin and Allergy Hospital; Helsinki University Hospital; Helsinki Finland
| | - K. Lodrup Carlsen
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - M. van Hage
- Clinical Immunology and Allergy Unit; Department of Medicine Solna; Karolinska Institutet and University Hospital; Stockholm Sweden
| | - C. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
| | - C. Bachert
- ENT Department; Ghent University Hospital; Gent Belgium
| | - M. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
| | - C. Auffray
- European Institute for Systems Biology and Medicine; Lyon France
| | - I. Annesi-Maesano
- EPAR U707 INSERM; Paris France
- EPAR UMR-S UPMC; Paris VI; Paris France
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
| | - A. Cambon-Thomsen
- UMR Inserm U1027; Université de Toulouse III Paul Sabatier; Toulouse France
| | - K. H. Carlsen
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
- University of Oslo; Oslo Norway
| | - L. Chatzi
- Department of Social Medicine; Faculty of Medicine; University of Crete; Heraklion Crete Greece
| | - F. Forastiere
- Department of Epidemiology; Regional Health Service Lazio Region; Rome Italy
| | - J. Garcia-Aymerich
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Barcelona Spain
- Department of Experimental and Health Sciences; University of Pompeu Fabra (UPF); Barcelona Spain
| | - U. Gehrig
- Julius Center of Health Sciences and Primary Care; University Medical Center Utrecht; University of Utrecht; Utrecht the Netherlands
| | - S. Guerra
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
| | - J. Heinrich
- Institute of Epidemiology; German Research Centre for Environmental Health; Helmholtz Zentrum München; Neuherberg Germany
| | - G. H. Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology; GRIAC Research Institute; University Medical Center Groningen; Beatrix Children's Hospital; University of Groningen; Groningen the Netherlands
| | - M. L. Kowalski
- Department of Immunology, Rheumatology and Allergy; Medical University of Lodz; Lodz Poland
| | - B. Lambrecht
- VIB Inflammation Research Center; Ghent University; Ghent Belgium
| | - C. Lupinek
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | | | - E. Melén
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - I. Momas
- Department of Public Health and Biostatistics, EA 4064; Paris Descartes University; Paris France
- Paris Municipal Department of Social Action, Childhood, and Health; Paris France
| | - S. Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients' Associations; Brussels Belgium
| | - M. Pinart
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
| | - D. Postma
- Department of Respiratory Medicine; GRIAC Research Institute; University Medical Center Groningen; Beatrix Children's Hospital; University of Groningen; Groningen the Netherlands
| | | | - H. A. Smit
- Julius Center of Health Sciences and Primary Care; University Medical Center Utrecht; University of Utrecht; Utrecht the Netherlands
| | - J. Sunyer
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Barcelona Spain
- Department of Experimental and Health Sciences; University of Pompeu Fabra (UPF); Barcelona Spain
| | - J. Wright
- Bradford Institute for Health Research; Bradford Royal Infirmary; Bradford UK
| | - T. Zuberbier
- Allergy-Centre-Charité at the Department of Dermatology; Charité - Universitätsmedizin Berlin; Berlin Germany
- Secretary General of the Global Allergy and Asthma European Network (GA2LEN); Berlin Germany
| | - S. H. Arshad
- David Hide Asthma and Allergy Research Centre; Isle of Wight UK
| | - R. Nadif
- INSERM; VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, U1168; Paris France
- UVSQ; UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; Versailles France
| | - C. Thijs
- Department of Epidemiology; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - N. Andersson
- Sachs’ Children's Hospital; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - A. Asarnoj
- Sachs’ Children's Hospital; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - N. Ballardini
- Sachs’ Children's Hospital; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - S. Ballereau
- European Institute for Systems Biology and Medicine; Lyon France
| | - A. Bedbrook
- MACVIA-LR; Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon; European Innovation Partnership on Active and Healthy Ageing Reference Site; Paris France
| | - M. Benet
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
| | - A. Bergstrom
- Sachs’ Children's Hospital; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - B. Brunekreef
- Julius Center of Health Sciences and Primary Care; University Medical Center Utrecht; University of Utrecht; Utrecht the Netherlands
| | - E. Burte
- INSERM; VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, U1168; Paris France
- UVSQ; UMR-S 1168; Université Versailles St-Quentin-en-Yvelines; Versailles France
| | - M. Calderon
- National Heart and Lung Institute; Imperial College London; Royal Brompton Hospital NHS; London UK
| | - G. De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients' Associations; Brussels Belgium
| | - P. Demoly
- Department of Respiratory Diseases; Montpellier University Hospital; Montpellier France
| | - E. Eller
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
| | - M. P. Fantini
- Department of Medicine and Public Health; Alma Mater Studiorum - University of Bologna; Bologna Italy
| | - H. Hammad
- VIB Inflammation Research Center; Ghent University; Ghent Belgium
| | - C. Hohman
- Institute of Social Medicine, Epidemiology and Health Economics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - J. Just
- Allergology Department; Centre de l'Asthme et des Allergies; Hôpital d'Enfants Armand-Trousseau (APHP); Paris France
- Institut Pierre Louis d'Epidémiologie et de Santé Publique; Equipe EPAR; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136; Paris France
| | - M. Kerkhof
- Department of Respiratory Medicine; GRIAC Research Institute; University Medical Center Groningen; Beatrix Children's Hospital; University of Groningen; Groningen the Netherlands
| | - M. Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); Barcelona Spain
- Department of Experimental and Health Sciences; University of Pompeu Fabra (UPF); Barcelona Spain
| | - I. Kull
- Sachs’ Children's Hospital; Stockholm Sweden
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - S. Lau
- Department for Pediatric Pneumology and Immunology; Charité Medical University; Berlin Germany
| | - N. Lemonnier
- European Institute for Systems Biology and Medicine; Lyon France
| | - M. Mommers
- Department of Epidemiology; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - M. Nawijn
- Department of Pediatric Pulmonology and Pediatric Allergology; GRIAC Research Institute; University Medical Center Groningen; Beatrix Children's Hospital; University of Groningen; Groningen the Netherlands
| | | | - S. Oddie
- Bradford Institute for Health Research; Bradford Royal Infirmary; Bradford UK
| | - J. Pellet
- European Institute for Systems Biology and Medicine; Lyon France
| | - I. Pin
- Département de pédiatrie; CHU de Grenoble; Grenoble Cedex 9 France
| | - D. Porta
- Department of Epidemiology; Regional Health Service Lazio Region; Rome Italy
| | - Y. Saes
- VIB Inflammation Research Center; Ghent University; Ghent Belgium
| | - I. Skrindo
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - C. G. Tischer
- Institute of Epidemiology; German Research Centre for Environmental Health; Helmholtz Zentrum München; Neuherberg Germany
| | - M. Torrent
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Area de Salut de Menorca, ib-salut; Illes Balears Spain
| | - L. von Hertzen
- Skin and Allergy Hospital; Helsinki University Hospital; Helsinki Finland
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Garcia-Aymerich J, Benet M, Saeys Y, Pinart M, Basagaña X, Smit HA, Siroux V, Just J, Momas I, Rancière F, Keil T, Hohmann C, Lau S, Wahn U, Heinrich J, Tischer CG, Fantini MP, Lenzi J, Porta D, Koppelman GH, Postma DS, Berdel D, Koletzko S, Kerkhof M, Gehring U, Wickman M, Melén E, Hallberg J, Bindslev-Jensen C, Eller E, Kull I, Lødrup Carlsen KC, Carlsen KH, Lambrecht BN, Kogevinas M, Sunyer J, Kauffmann F, Bousquet J, Antó JM. Phenotyping asthma, rhinitis and eczema in MeDALL population-based birth cohorts: an allergic comorbidity cluster. Allergy 2015; 70:973-84. [PMID: 25932997 DOI: 10.1111/all.12640] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Asthma, rhinitis and eczema often co-occur in children, but their interrelationships at the population level have been poorly addressed. We assessed co-occurrence of childhood asthma, rhinitis and eczema using unsupervised statistical techniques. METHODS We included 17 209 children at 4 years and 14 585 at 8 years from seven European population-based birth cohorts (MeDALL project). At each age period, children were grouped, using partitioning cluster analysis, according to the distribution of 23 variables covering symptoms 'ever' and 'in the last 12 months', doctor diagnosis, age of onset and treatments of asthma, rhinitis and eczema; immunoglobulin E sensitization; weight; and height. We tested the sensitivity of our estimates to subject and variable selections, and to different statistical approaches, including latent class analysis and self-organizing maps. RESULTS Two groups were identified as the optimal way to cluster the data at both age periods and in all sensitivity analyses. The first (reference) group at 4 and 8 years (including 70% and 79% of children, respectively) was characterized by a low prevalence of symptoms and sensitization, whereas the second (symptomatic) group exhibited more frequent symptoms and sensitization. Ninety-nine percentage of children with comorbidities (co-occurrence of asthma, rhinitis and/or eczema) were included in the symptomatic group at both ages. The children's characteristics in both groups were consistent in all sensitivity analyses. CONCLUSION At 4 and 8 years, at the population level, asthma, rhinitis and eczema can be classified together as an allergic comorbidity cluster. Future research including time-repeated assessments and biological data will help understanding the interrelationships between these diseases.
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Kerkhof M, Vos M, Taphoorn M. P16.18 * INTEROBSERVER VARIABILITY IN THE RADIOLOGICAL ASSESSMENT OF PERFUSION MR IMAGING IN GLIOBLASTOMA MULTIFORME. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.314] [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: 11/14/2022] Open
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16
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Caudri D, Savenije OEM, Smit HA, Postma DS, Koppelman GH, Wijga AH, Kerkhof M, Gehring U, Hoekstra MO, Brunekreef B, de Jongste JC. Perinatal risk factors for wheezing phenotypes in the first 8 years of life. Clin Exp Allergy 2014; 43:1395-405. [PMID: 24261948 DOI: 10.1111/cea.12173] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 05/24/2013] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND A novel data-driven approach was used to identify wheezing phenotypes in pre-schoolchildren aged 0-8 years, in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort. Five phenotypes were identified: never/infrequent wheeze, transient early wheeze, intermediate onset wheeze, persistent wheeze and late onset wheeze. It is unknown which perinatal risk factors drive development of these phenotypes. OBJECTIVE The objective of the study was to assess associations of perinatal factors with wheezing phenotypes and to identify possible targets for prevention. METHODS In the PIAMA study (n = 3963), perinatal factors were collected at 3 months, and wheezing was assessed annually until the age of 8 years. Associations between perinatal risk factors and the five wheezing phenotypes were assessed using weighted multinomial logistic regression models. Odds ratios were adjusted for confounding variables and calculated with 'never/infrequent wheeze' as reference category. RESULTS Complete data were available for 2728 children. Risk factors for transient early wheeze (n = 455) were male gender, maternal and paternal allergy, low maternal age, high maternal body mass index, short pregnancy duration, smoking during pregnancy, presence of older siblings and day-care attendance. Risk factors for persistent wheeze (n = 83) were male gender, maternal and paternal allergy, and not receiving breastfeeding for at least 12 weeks. Intermediate onset wheeze (n = 98) was associated with a lower birth weight and late onset wheeze (n = 45) with maternal allergy. CONCLUSION AND CLINICAL RELEVANCE We identified different risk factors for specific childhood wheezing phenotypes. Some of these are modifiable, such as maternal age and body mass index, smoking, day-care attendance and breastfeeding, and may be important targets for prevention programmes.
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Affiliation(s)
- D Caudri
- Department of Pediatrics/Respiratory Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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Kreiner-Møller E, Chawes BLK, Vissing NH, Koppelman GH, Postma DS, Madsen JS, Olsen DA, Baty F, Vonk JM, Kerkhof M, Sleiman P, Hakonarsson H, Mortensen LJ, Poorisrisak P, Bisgaard H, Bønnelykke K. VEGFA variants are associated with pre-school lung function, but not neonatal lung function. Clin Exp Allergy 2014; 43:1236-45. [PMID: 24152156 DOI: 10.1111/cea.12188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/10/2013] [Accepted: 07/14/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) is implicated in airway remodelling and asthma development. We studied VEGFA gene variants and plasma levels and the development of lung function, bronchial hyperresponsiveness and asthma in childhood. METHODS We analysed 13 SNPs in the VEGFA gene in 411 children from the COPSAC2000 high-risk birth cohort. Asthma was diagnosed prospectively, and lung function measurements were obtained at birth and 6 years of age. Plasma VEGF levels were measured at 18 months of age. We used a Bonferroni adjusted significance level. Findings were replicated in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort at age 8. RESULTS At age six, three SNPs from the same linkage block were associated with FEV1 (rs699947, P = 1.31E-05), independent of asthma, and there were suggestive associations between FEV1/FVC ratio and rs833052 and maximal mid-expiratory flow and rs6900017. Replication in the PIAMA cohort showed borderline association between FEV1 and rs699947 and significant meta-analysis result. SNPs upstream and nearby rs699947 were nominally associated with VEGF plasma levels. VEGF levels were not associated with asthmatic symptoms or lung function measures. CONCLUSIONS AND CLINICAL RELEVANCE VEGF gene variants are associated with lung function at school age, but not at birth, suggesting a role of VEGF in post-natal lung function development.
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Affiliation(s)
- E Kreiner-Møller
- COPSAC: Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital, Gentofte, Denmark; The Danish Pediatric Asthma Center, Copenhagen University Hospital, Gentofte, Denmark
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Fuertes E, MacIntyre E, Melén E, Heinrich J, Kerkhof M, Pershagen G, Gehring U, Kozyrskyj A, Chan-Yeung M, Brauer M, Carlsten C. Traffic-related air pollution as a risk factor for the development of childhood allergic diseases: the “Traffic, Asthma and Genetics” project. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.227] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Fuertes
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Institute Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
| | - E MacIntyre
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Institute Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
| | - E Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - J Heinrich
- Institute Epidemiology I, Helmholtz Zentrum München, German Research Centre for Environmental Health, Munich, Germany
| | - M Kerkhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, GRIAC Institute, Groningen, The Netherlands
| | - G Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - U Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - A Kozyrskyj
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children’s Health Research Institute, Edmonton, Canada
- School of Public Health, University of Alberta, Edmonton, Canada
| | - M Chan-Yeung
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - M Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - C Carlsten
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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19
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Affiliation(s)
- M Kerkhof
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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20
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Libbers L, Flokstra - de Blok BMJ, Vlieg - Boerstra BJ, van der Heide S, van der Meulen GN, Kukler J, Kerkhof M, Dubois AEJ. No matrix effect in double-blind, placebo-controlled egg challenges in egg allergic children. Clin Exp Allergy 2013; 43:1067-70. [DOI: 10.1111/cea.12164] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 05/22/2013] [Accepted: 05/23/2013] [Indexed: 11/29/2022]
Affiliation(s)
- L. Libbers
- Department of Paediatric Pulmonology and Paediatric Allergy; University of Groningen; University Medical Center Groningen; Groningen; The Netherlands
| | | | - B. J. Vlieg - Boerstra
- Emma Children's Hospital; Pediatric Respiratory Medicine and Allergy; Academic Medical Center; University of Amsterdam; Amsterdam; The Netherlands
| | | | - G. N. van der Meulen
- Department of Paediatric Pulmonology and Paediatric Allergy; University of Groningen; University Medical Center Groningen; Groningen; The Netherlands
| | - J. Kukler
- Department of Paediatric Pulmonology and Paediatric Allergy; University of Groningen; University Medical Center Groningen; Groningen; The Netherlands
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21
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Tischer CG, Gref A, Standl M, Bauer M, Bergström A, Brauer M, Carlsten C, Gehring U, Granell R, Henderson J, Kerkhof M, MacNutt M, Melén E, Wickman M, Heinrich J. Glutathione-S-transferase P1, early exposure to mould in relation to respiratory and allergic health outcomes in children from six birth cohorts. A meta-analysis. Allergy 2013; 68:339-46. [PMID: 23330922 DOI: 10.1111/all.12093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are conflicting study results regarding the association of exposure to visible mould and fungal components in house dust with respiratory and allergic diseases in children. It has been suggested that functional polymorphisms of the GSTP1 gene may influence the risk for allergic disorders through an impaired defence against oxidant injury. METHODS We examined in six birth cohorts of over 14 000 children whether the association between early exposure to reported mould at home in relation to respiratory and allergic diseases is modified by a single nucleotide polymorphism of the GSTP1 gene. RESULTS We observed a positive association of mould exposure with nasal symptoms (2-10 year) aOR: 1.19 (1.02-11.38). Further, there was a borderline significant increased risk of rhinoconjunctivitis (6-8 year) in children homozygous for the minor allele Val/Val, aOR: 1.25 (0.98-1.60). In stratified analyses, subjects homozygous for the minor allele and exposed to mould at home were at increased risk for early wheezing aOR: 1.34 (1.03-1.75), whereas the major allele may confer susceptibility for later nasal outcomes, (6-8 year) aOR: 1.20 (1.00-1.45) and (2-10 year) aOR: 1.30 (1.04-1.61), respectively. For none of the health outcomes studied, we found gene by environment interactions. CONCLUSION A genetic influence of the GSTP1 gene cannot be ruled out, but the magnitude of the effect is a matter of further research. In conclusion, the interplay between gene and environments is complex and remains subject of further study.
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Affiliation(s)
- C. G. Tischer
- Helmholtz Centre Munich; German Research Centre for Environmental Health; Institute of Epidemiology I; Neuherberg; Germany
| | - A. Gref
- Institute of Environmental Medicine; Centre for Allergy Research; Karolinska Institutet; Stockholm; Sweden
| | - M. Standl
- Helmholtz Centre Munich; German Research Centre for Environmental Health; Institute of Epidemiology I; Neuherberg; Germany
| | - M. Bauer
- Department of Environmental Immunology; UFZ - Helmholtz Centre for Environmental Research; Leipzig; Germany
| | - A. Bergström
- Institute of Environmental Medicine; Centre for Allergy Research; Karolinska Institutet; Stockholm; Sweden
| | - M. Brauer
- School of Population and Public Health & Department of Medicine - Atmospheric Science Programme; Faculty of Medicine; University of British Columbia; Vancouver; BC; Canada
| | - C. Carlsten
- Respiratory Medicine Division; University of British Columbia; Vancouver; BC; Canada
| | - U. Gehring
- Institute for Risk Assessment Sciences; Utrecht University; Utrecht; the Netherlands
| | - R. Granell
- School of Social and Community Medicine; University of Bristol; Bristol; UK
| | - J. Henderson
- School of Social and Community Medicine; University of Bristol; Bristol; UK
| | - M. Kerkhof
- Department of Epidemiology; University Medical Centre Groningen; University of Groningen; Groningen; the Netherlands
| | - M. MacNutt
- Respiratory Medicine Division; University of British Columbia; Vancouver; BC; Canada
| | - E. Melén
- Institute of Environmental Medicine; Centre for Allergy Research; Karolinska Institutet; Stockholm; Sweden
| | - M. Wickman
- Institute of Environmental Medicine; Centre for Allergy Research; Karolinska Institutet; Stockholm; Sweden
| | - J. Heinrich
- Helmholtz Centre Munich; German Research Centre for Environmental Health; Institute of Epidemiology I; Neuherberg; Germany
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van der Valk RJP, Caudri D, Savenije O, Koppelman GH, Smit HA, Wijga AH, Postma DS, Kerkhof M, Brunekreef B, de Jongste JC. Childhood wheezing phenotypes and FeNO in atopic children at age 8. Clin Exp Allergy 2013; 42:1329-36. [PMID: 22925319 DOI: 10.1111/j.1365-2222.2012.04010.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fractional exhaled Nitric Oxide (FeNO) is a surrogate biomarker of the degree of eosinophilic airway inflammation. Using longitudinal latent class analysis, five wheezing phenotypes have been identified, characterized by different ages of onset and prognosis. OBJECTIVES To assess FeNO measured at 4 and 8 years in children with different phenotypes of wheeze and atopy. METHODS Children participated in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study, a prospective birth cohort in the Netherlands. Respiratory health was assessed yearly by questionnaires until the age of 8 years; these data were used to identify five wheezing phenotypes. Associations between FeNO and wheezing phenotypes were investigated using weighted linear regression. RESULTS Data on wheezing phenotypes and FeNO at 4 and 8 years were available in 588 and 973 children respectively. Compared with the phenotype of never and transient wheeze, FeNO at 4 years was higher in intermediate onset and persistent wheeze. FeNO at 8 years of age differed significantly between all phenotypes, with highest FeNO values for persistent, intermediate onset, and late onset wheeze. Rise in FeNO from 4 to 8 years in intermediate and late onset wheezers was significantly higher compared to FeNO rise in never and transient wheezers. Stratified analyses showed that the increase in FeNO in persistent, intermediate, and late onset wheeze was only present in children with allergic sensitization at 8 years. CONCLUSIONS AND CLINICAL RELEVANCE The FeNO measured at 8 years was associated with specific wheezing phenotypes, only among atopic children.
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Affiliation(s)
- R J P van der Valk
- Department of Pediatrics, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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Bousquet J, Anto JM, Demoly P, Schünemann HJ, Togias A, Akdis M, Auffray C, Bachert C, Bieber T, Bousquet PJ, Carlsen KH, Casale TB, Cruz AA, Keil T, Lodrup Carlsen KC, Maurer M, Ohta K, Papadopoulos NG, Roman Rodriguez M, Samolinski B, Agache I, Andrianarisoa A, Ang CS, Annesi-Maesano I, Ballester F, Baena-Cagnani CE, Basagaña X, Bateman ED, Bel EH, Bedbrook A, Beghé B, Beji M, Ben Kheder A, Benet M, Bennoor KS, Bergmann KC, Berrissoul F, Bindslev Jensen C, Bleecker ER, Bonini S, Boner AL, Boulet LP, Brightling CE, Brozek JL, Bush A, Busse WW, Camargos PAM, Canonica GW, Carr W, Cesario A, Chen YZ, Chiriac AM, Costa DJ, Cox L, Custovic A, Dahl R, Darsow U, Didi T, Dolen WK, Douagui H, Dubakiene R, El-Meziane A, Fonseca JA, Fokkens WJ, Fthenou E, Gamkrelidze A, Garcia-Aymerich J, Gerth van Wijk R, Gimeno-Santos E, Guerra S, Haahtela T, Haddad H, Hellings PW, Hellquist-Dahl B, Hohmann C, Howarth P, Hourihane JO, Humbert M, Jacquemin B, Just J, Kalayci O, Kaliner MA, Kauffmann F, Kerkhof M, Khayat G, Koffi N'Goran B, Kogevinas M, Koppelman GH, Kowalski ML, Kull I, Kuna P, Larenas D, Lavi I, Le LT, Lieberman P, Lipworth B, Mahboub B, Makela MJ, Martin F, Martinez FD, Marshall GD, Mazon A, Melen E, Meltzer EO, Mihaltan F, Mohammad Y, Mohammadi A, Momas I, Morais-Almeida M, Mullol J, Muraro A, Naclerio R, Nafti S, Namazova-Baranova L, Nawijn MC, Nyembue TD, Oddie S, O'Hehir RE, Okamoto Y, Orru MP, Ozdemir C, Ouedraogo GS, Palkonen S, Panzner P, Passalacqua G, Pawankar R, Pigearias B, Pin I, Pinart M, Pison C, Popov TA, Porta D, Postma DS, Price D, Rabe KF, Ratomaharo J, Reitamo S, Rezagui D, Ring J, Roberts R, Roca J, Rogala B, Romano A, Rosado-Pinto J, Ryan D, Sanchez-Borges M, Scadding GK, Sheikh A, Simons FER, Siroux V, Schmid-Grendelmeier PD, Smit HA, Sooronbaev T, Stein RT, Sterk PJ, Sunyer J, Terreehorst I, Toskala E, Tremblay Y, Valenta R, Valeyre D, Vandenplas O, van Weel C, Vassilaki M, Varraso R, Viegi G, Wang DY, Wickman M, Williams D, Wöhrl S, Wright J, Yorgancioglu A, Yusuf OM, Zar HJ, Zernotti ME, Zidarn M, Zhong N, Zuberbier T. Severe chronic allergic (and related) diseases: a uniform approach--a MeDALL--GA2LEN--ARIA position paper. Int Arch Allergy Immunol 2012; 158:216-31. [PMID: 22382913 DOI: 10.1159/000332924] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.
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Affiliation(s)
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- Centre Hospitalier Universitaire Montpellier, Montpellier Cedex 05, France.
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Valk RJP, Duijts L, Kerkhof M, Willemsen SP, Hofman A, Moll HA, Smit HA, Brunekreef B, Postma DS, Jaddoe VWV, Koppelman GH, Jongste JC. Interaction of a 17q12 variant with both fetal and infant smoke exposure in the development of childhood asthma-like symptoms. Allergy 2012; 67:767-74. [PMID: 22469062 DOI: 10.1111/j.1398-9995.2012.02819.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Gene variants on chromosome 17q12-21 are associated with an increased risk of childhood-onset asthma, a risk known to be modified by environmental tobacco smoke (ETS). OBJECTIVES To assess whether the association of rs2305480 on chromosome 17q12 in the GSDML gene with asthma-like symptoms in the first 4 years of life is modified by smoke exposure during fetal and early postnatal life. METHODS We used data from two independent prospective cohort studies from fetal life onwards in the Netherlands. We genotyped rs2305480 and assessed maternal smoking during pregnancy and ETS exposure at the age of 2. Asthma-like symptoms, defined as any reported wheezing, shortness of breath or dry nocturnal cough, were reported by parents when the children were 1, 2, 3, and 4 years. Analyses were based on a total group of 4461 Caucasian children. RESULTS The G risk-allele of rs2305480 was associated with asthma-like symptoms [overall odds ratio 1.17 (1.11, 1.24), 2.66E-9]. The effect of rs2305480 on asthma-like symptoms was stronger among children who were exposed to smoke during fetal life (P-interaction = 0.04). Smoke exposure in early postnatal life was also associated with an increased effect of the 17q12 single nucleotide polymorphism (SNP) on asthma-like symptoms (P-interaction = 5.06E-4). These associations were consistent in both cohorts. CONCLUSION A 17q12 variant, rs2305480, was associated with asthma-like symptoms in preschool children, and this association was modified by smoke exposure already during fetal life, and in infancy. Further investigation regarding SNPs in linkage disequilibrium with rs2305480 in relation to pathophysiological pathways is needed.
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Affiliation(s)
| | | | - M. Kerkhof
- Department of Epidemiology; University Medical Center Groningen; GRIAC research Institute; University of Groningen; Groningen; the Netherlands
| | - S. P. Willemsen
- Department of Biostatistics; Erasmus University Medical Center; Rotterdam; the Netherlands
| | | | - H. A. Moll
- Department of Pediatrics; Erasmus University Medical Center; Rotterdam; the Netherlands
| | | | | | - D. S. Postma
- Department of Pulmonary Medicine and Tuberculosis; University Medical Center Groningen; GRIAC Research Institute; University of Groningen; Groningen; the Netherlands
| | | | - G. H. Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology; Beatrix Children's Hospital; University Medical Center Groningen; GRIAC Research Institute; University of Groningen; Groningen; the Netherlands
| | - J. C. Jongste
- Department of Pediatrics; Erasmus University Medical Center; Rotterdam; the Netherlands
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Gehring U, de Jongste JC, Kerkhof M, Oldewening M, Postma D, van Strien RT, Wijga AH, Willers SM, Wolse A, Gerritsen J, Smit HA, Brunekreef B. The 8-year follow-up of the PIAMA intervention study assessing the effect of mite-impermeable mattress covers. Allergy 2012; 67:248-56. [PMID: 22023655 DOI: 10.1111/j.1398-9995.2011.02739.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exposure to high levels of house dust mite (HDM) allergens is associated with the development of allergic sensitization to HDM, a risk factor for the development of asthma, rhinitis, and allergic dermatitis. We studied the effect of an early intervention with mite-impermeable mattress covers on HDM allergen levels and the development of asthma and mite allergy throughout the first 8 years of life. METHODS High-risk children (allergic mother) were prenatally recruited and randomly allocated to two groups receiving mite allergen-impermeable (n = 416) and placebo mattress covers (n = 394) or no intervention (n = 472). Asthma and allergies were assessed yearly by questionnaire. Specific immunoglobulin E and bronchial hyper-responsiveness were measured at the age of 8 years. Mattress dust samples collected at different time points were analyzed for HDM allergens. RESULTS At the age of 8 years, levels of HDM allergen Der f1 but not Der p1 were lower in the active than the placebo mattress cover group. In repeated measures analyses, we found a temporary decreased risk of asthma symptoms at the age of 2 years in the intervention group compared to the placebo group and a temporary association between higher HDM allergen exposure at the age of 3 months and more asthma symptoms. CONCLUSION Early intervention with mite-impermeable mattress covers is successful in reducing exposure to Der f1; it only temporarily reduces the risk of asthma symptoms and does not reduce the risk of hay fever, eczema, and allergic sensitization.
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Affiliation(s)
- U Gehring
- Institute for Risk Assessment Sciences, Utrecht University, The Netherlands.
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26
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van Oeffelen AAM, Bekkers MBM, Smit HA, Kerkhof M, Koppelman GH, Haveman-Nies A, van der A DL, Jansen EHJM, Wijga AH. Serum micronutrient concentrations and childhood asthma: the PIAMA birth cohort study. Pediatr Allergy Immunol 2011; 22:784-93. [PMID: 21929603 DOI: 10.1111/j.1399-3038.2011.01190.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research suggests an influence of micronutrients on childhood asthma. So far, evidence mainly originates from cross-sectional studies using nutrient intake data, which is not an accurate measure of nutrient status. This study aimed to investigate the cross-sectional and prospective associations between serum concentrations of magnesium, vitamin D, selenium, and zinc and prevalence of (severe) asthma, atopy, and bronchial hyperresponsiveness (BHR) in childhood. METHODS In the Prevention and Incidence of Asthma and Mite Allergy birth cohort study, serum nutrient concentrations were available for a 4-yr-old subgroup (n = 372) and for a different 8-yr-old subgroup (n = 328). Yearly questionnaires inquired about asthma prevalence until 8 yr of age. Allergic sensitization was measured at 4 and 8 yr of age; BHR was measured at 8 yr of age. Data were analyzed with logistic regression and generalized estimating equations models. RESULTS There was a consistent (non-significant) inverse association between serum magnesium concentrations and asthma prevalence. Serum vitamin D concentrations measured at age 4 were inversely associated with asthma at ages 4-8 [e.g., cross-sectional association between vitamin D tertile 3 vs. 1 and severe asthma: odds ratio (OR): 0.49, 95% confidence interval (CI): 0.25-0.95], whereas vitamin D measured at age 8 was positively associated with asthma at age 8 (e.g., cross-sectional association between vitamin D tertile 3 vs. 1 and severe asthma: OR: 2.14, 95% CI: 0.67-6.82). CONCLUSIONS Our study contributes to the evidence that children with higher serum magnesium concentrations are less likely to have asthma. The associations between serum vitamin D concentrations and asthma were age-dependent.
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Affiliation(s)
- A A M van Oeffelen
- Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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27
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Zhou X, Kerkhof M, Span L, Friedrich A, Arends J. Algorithm for empirical glycopeptide treatment in patients with hematologic malignancies and enterococcus faecium blood stream infection. BMC Proc 2011. [PMCID: PMC3239782 DOI: 10.1186/1753-6561-5-s6-p49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Brandsma CA, Kerstjens HAM, Geerlings M, Kerkhof M, Hylkema MN, Postma DS, Timens W. The search for autoantibodies against elastin, collagen and decorin in COPD. Eur Respir J 2011; 37:1289-92. [PMID: 21532021 DOI: 10.1183/09031936.00116710] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bekkers MBM, Brunekreef B, de Jongste JC, Kerkhof M, Smit HA, Postma DS, Gehring U, Wijga AH. Childhood overweight and asthma symptoms, the role of pro-inflammatory proteins. Clin Exp Allergy 2011; 42:95-103. [PMID: 21801245 DOI: 10.1111/j.1365-2222.2011.03824.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systemic inflammation is suggested as a mechanism by which overweight might induce asthma. However, few studies have linked childhood overweight, inflammation and asthma. OBJECTIVE To study the association between body mass index (BMI), asthma symptoms and pro-inflammatory proteins. METHODS High-sensitivity C-reactive protein (hs-CRP), complement factor 3 (C3) and 4 (C4) concentrations, and body weight and height were available for 359 4-year-old children participating in the Prevention and Incidence of Asthma and Mite Allergy birth cohort study. Data on asthma symptoms were obtained by yearly questionnaires. Logistic regression and generalized estimating equations were used to analyse the cross-sectional and prospective associations between BMI, asthma symptoms and pro-inflammatory proteins. RESULTS BMI was associated with asthma symptoms {odds ratio [OR] 1.43 [95% confidence interval (CI): 1.08-1.88] per BMI standard deviation scores [SDS]}. The inclusion of hs-CRP, C3 and C4 in the statistical models did not change this association. C3 was cross-sectionally associated with frequent asthma symptoms [OR per interquartile range of C3: 1.97 (95% CI: 1.20-3.24)] and prospectively with asthma symptoms [OR: 1.48 (95%CI: 1.04-2.09)], independent of BMI SDS. CONCLUSIONS AND CLINICAL RELEVANCE We showed no evidence for a role of hs-CRP, C3 and C4 in the association between BMI and asthma symptoms. C3 concentrations were associated with (frequent) asthma symptoms, independent of BMI.
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Affiliation(s)
- M B M Bekkers
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
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Sikkema M, Looman CWN, Steyerberg EW, Kerkhof M, Kastelein F, van Dekken H, van Vuuren AJ, Bode WA, van der Valk H, Ouwendijk RJT, Giard R, Lesterhuis W, Heinhuis R, Klinkenberg EC, Meijer GA, ter Borg F, Arends JW, Kolkman JJ, van Baarlen J, de Vries RA, Mulder AH, van Tilburg AJP, Offerhaus GJA, ten Kate FJW, Kusters JG, Kuipers EJ, Siersema PD. Predictors for neoplastic progression in patients with Barrett's Esophagus: a prospective cohort study. Am J Gastroenterol 2011; 106:1231-8. [PMID: 21577245 DOI: 10.1038/ajg.2011.153] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patients with Barrett's esophagus (BE) have an increased risk of developing esophageal adenocarcinoma (EAC). As the absolute risk remains low, there is a need for predictors of neoplastic progression to tailor more individualized surveillance programs. The aim of this study was to identify such predictors of progression to high-grade dysplasia (HGD) and EAC in patients with BE after 4 years of surveillance and to develop a prediction model based on these factors. METHODS We included 713 patients with BE (≥ 2 cm) with no dysplasia (ND) or low-grade dysplasia (LGD) in a multicenter, prospective cohort study. Data on age, gender, body mass index (BMI), reflux symptoms, tobacco and alcohol use, medication use, upper gastrointestinal (GI) endoscopy findings, and histology were prospectively collected. As part of this study, patients with ND underwent surveillance every 2 years, whereas those with LGD were followed on a yearly basis. Log linear regression analysis was performed to identify risk factors associated with the development of HGD or EAC during surveillance. RESULTS After 4 years of follow-up, 26/713 (3.4%) patients developed HGD or EAC, with the remaining 687 patients remaining stable with ND or LGD. Multivariable analysis showed that a known duration of BE of ≥ 10 years (risk ratio (RR) 3.2; 95% confidence interval (CI) 1.3-7.8), length of BE (RR 1.11 per cm increase in length; 95% CI 1.01-1.2), esophagitis (RR 3.5; 95% CI 1.3-9.5), and LGD (RR 9.7; 95% CI 4.4-21.5) were significant predictors of progression to HGD or EAC. In a prediction model, we found that the annual risk of developing HGD or EAC in BE varied between 0.3% and up to 40%. Patients with ND and no other risk factors had the lowest risk of developing HGD or EAC (<1%), whereas those with LGD and at least one other risk factor had the highest risk of neoplastic progression (18-40%). CONCLUSIONS In patients with BE, the risk of developing HGD or EAC is predominantly determined by the presence of LGD, a known duration of BE of ≥10 years, longer length of BE, and presence of esophagitis. One or combinations of these risk factors are able to identify patients with a low or high risk of neoplastic progression and could therefore be used to individualize surveillance intervals in BE.
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Affiliation(s)
- M Sikkema
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Bousquet J, Anto J, Auffray C, Akdis M, Cambon-Thomsen A, Keil T, Haahtela T, Lambrecht BN, Postma DS, Sunyer J, Valenta R, Akdis CA, Annesi-Maesano I, Arno A, Bachert C, Ballester F, Basagana X, Baumgartner U, Bindslev-Jensen C, Brunekreef B, Carlsen KH, Chatzi L, Crameri R, Eveno E, Forastiere F, Garcia-Aymerich J, Guerra S, Hammad H, Heinrich J, Hirsch D, Jacquemin B, Kauffmann F, Kerkhof M, Kogevinas M, Koppelman GH, Kowalski ML, Lau S, Lodrup-Carlsen KC, Lopez-Botet M, Lotvall J, Lupinek C, Maier D, Makela MJ, Martinez FD, Mestres J, Momas I, Nawijn MC, Neubauer A, Oddie S, Palkonen S, Pin I, Pison C, Rancé F, Reitamo S, Rial-Sebbag E, Salapatas M, Siroux V, Smagghe D, Torrent M, Toskala E, van Cauwenberge P, van Oosterhout AJM, Varraso R, von Hertzen L, Wickman M, Wijmenga C, Worm M, Wright J, Zuberbier T. MeDALL (Mechanisms of the Development of ALLergy): an integrated approach from phenotypes to systems medicine. Allergy 2011; 66:596-604. [PMID: 21261657 DOI: 10.1111/j.1398-9995.2010.02534.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The origin of the epidemic of IgE-associated (allergic) diseases is unclear. MeDALL (Mechanisms of the Development of ALLergy), an FP7 European Union project (No. 264357), aims to generate novel knowledge on the mechanisms of initiation of allergy and to propose early diagnosis, prevention, and targets for therapy. A novel phenotype definition and an integrative translational approach are needed to understand how a network of molecular and environmental factors can lead to complex allergic diseases. A novel, stepwise, large-scale, and integrative approach will be led by a network of complementary experts in allergy, epidemiology, allergen biochemistry, immunology, molecular biology, epigenetics, functional genomics, bioinformatics, computational and systems biology. The following steps are proposed: (i) Identification of 'classical' and 'novel' phenotypes in existing birth cohorts; (ii) Building discovery of the relevant mechanisms in IgE-associated allergic diseases in existing longitudinal birth cohorts and Karelian children; (iii) Validation and redefinition of classical and novel phenotypes of IgE-associated allergic diseases; and (iv) Translational integration of systems biology outcomes into health care, including societal aspects. MeDALL will lead to: (i) A better understanding of allergic phenotypes, thus expanding current knowledge of the genomic and environmental determinants of allergic diseases in an integrative way; (ii) Novel diagnostic tools for the early diagnosis of allergy, targets for the development of novel treatment modalities, and prevention of allergic diseases; (iii) Improving the health of European citizens as well as increasing the competitiveness and boosting the innovative capacity of Europe, while addressing global health issues and ethical issues.
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Affiliation(s)
- J Bousquet
- University Hospital, Department of Respiratory Diseases, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Vlieg-Boerstra BJ, van de Weg WE, van der Heide S, Kerkhof M, Arens P, Heijerman-Peppelman G, Dubois AEJ. Identification of low allergenic apple cultivars using skin prick tests and oral food challenges. Allergy 2011; 66:491-8. [PMID: 21058957 DOI: 10.1111/j.1398-9995.2010.02499.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND As oral allergy syndrome (OAS) symptoms to apple are frequent, we aimed to identify low allergenic apple cultivars and to validate the prick-to-prick skin prick test (SPT) as a suitable screening method. METHODS Sixty-eight apple cultivars were tested by SPTs in 33 Dutch adults with OAS, before and during the birch pollen season in 2006 and 2007, respectively. Three cultivars yielding the largest number of negative SPTs (Elise, Santana and Pink Lady®) and one reference cultivar (Golden Delicious) were subsequently tested by single-blind oral food challenges (SBFC) just after picking in fall 2007 (fresh) and in spring 2008 (stored), outside the birch pollen season and preceded by SPTs. In spring, Santana was replaced by Modi®. RESULTS In fresh apples, OAS symptoms of Elise, as measured by cumulative scores on a Visual Analogue Scale VASt, were significantly lower than those of Santana, Pink Lady and Golden Delicious (P = 0.021; 0.040 and 0.005, respectively). VASt scores of Santana were significantly lower than those of Golden Delicious (P = 0.049). In stored apples, VASt scores of Elise were significantly lower than that of Golden Delicious (P = 0.038). VASt scores of fresh apples did not differ significantly from stored apples, except in Golden Delicious (spring < fall: P = 0.021). The SPTs did not predict the severity of OAS. CONCLUSION SPTs are not useful to assess the allergenicity of apple cultivars. By using SBFC, Elise and Santana were identified as low allergenic apple cultivars in patient with OAS. Our data on the effect of storage are inconclusive.
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Affiliation(s)
- B J Vlieg-Boerstra
- University Medical Centre Groningen, Department of General Practice, University of Groningen, Groningen, The Netherlands.
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Reijmerink NE, Kerkhof M, Bottema RWB, Gerritsen J, Stelma FF, Thijs C, van Schayck CP, Smit HA, Brunekreef B, Postma DS, Koppelman GH. Toll-like receptors and microbial exposure: gene-gene and gene-environment interaction in the development of atopy. Eur Respir J 2011; 38:833-40. [PMID: 21349911 DOI: 10.1183/09031936.00099210] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Environmental and genetic factors contribute to atopy development. High microbial exposure may confer a protective effect on atopy. Toll-like receptors (TLRs) bind microbial products and are important in activating the immune system. To assess whether interactions between microbial exposures and genes encoding TLRs (and related genes) result in atopy, genes, environmental factors and gene-environment interactions of 66 single-nucleotide polymorphisms (SNPs) of 12 genes (TLR 1-6, 9 and 10, CD14, MD2, lipopolysaccharide-binding protein (LBP) and Dectin-1), and six proxy parameters of microbial exposure (sibship size, pets (three different parameters), day-care and intrauterine and childhood tobacco smoke exposure) were analysed for association with atopic phenotypes in 3,062 Dutch children (the Allergenic study). The presence of two or more older siblings increased the risk of developing high total immunoglobulin (Ig)E levels at different ages. This risk increased further in children aged 1-2 yrs carrying the minor allele of TLR6 SNP rs1039559. Furthermore, novel two- and three-factor gene-gene and gene-environment interactions were found (e.g. between sibship size, day-care and LBP SNP rs2232596). Larger sibship size is associated with increased total IgE levels. Furthermore, complex two- and three-factor interactions exist between genes and the environment. The TLRs and related genes interact with proxy parameters of high microbial exposure in atopy development.
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Affiliation(s)
- N E Reijmerink
- Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
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Willers SM, Wijga AH, Brunekreef B, Scholtens S, Postma DS, Kerkhof M, de Jongste JC, Smit HA. Childhood diet and asthma and atopy at 8 years of age: the PIAMA birth cohort study. Eur Respir J 2010; 37:1060-7. [PMID: 21109553 DOI: 10.1183/09031936.00106109] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diet may affect the development of asthma. We investigated whether asthma or atopy outcomes at 8 yrs of age were associated with long-term dietary exposure, and whether associations were different for consumption at early or later age. The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort enrolled 4,146 participants at baseline, who were followed up to 8 yrs of age. Dietary intakes of interest were fruit, vegetables, brown/wholemeal bread, fish, milk, butter and margarine. Associations between food intake at early (2-3 yrs) and later (7-8 yrs) age, and long-term intake, asthma and atopy at 8 yrs of age were calculated by logistic regression. Complete longitudinal dietary data for at least one of the food groups were available for 2,870 children. Fruit consumption at early age was associated with reduced asthma symptoms (OR per 1 consumption day per week increase 0.93, 95% CI 0.85-1.00). Long-term fruit intake was inversely associated with asthma symptoms (OR 0.90, 95% CI 0.82-0.99) and sensitisation to inhaled allergens (OR 0.90, 95% CI 0.82-0.99). We found no consistent associations between diet and outcomes for other foods. This study indicates no consistent effects of increased early or late consumption, or long-term intake of certain foods on asthma and atopy in 8-yr-olds, with a possible exception for fruit.
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Affiliation(s)
- S M Willers
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Bonarius HPJ, Brandsma CA, Kerstjens HAM, Koerts JA, Kerkhof M, Nizankowska-Mogilnicka E, Roozendaal C, Postma DS, Timens W. Antinuclear autoantibodies are more prevalent in COPD in association with low body mass index but not with smoking history. Thorax 2010; 66:101-7. [PMID: 21047865 DOI: 10.1136/thx.2009.134171] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with a higher prevalence of antinuclear autoantibodies (ANAs). However, a significant subgroup of patients is ANA negative. It remains to be determined which patient groups carry autoantibodies. METHODS The association of smoking behaviour, disease status, gender, age and body mass index (BMI) with the presence of autoantibodies in the serum was determined in 124 patients with COPD and 108 non-COPD control subjects. In addition, the role of B cells in autoantibody generation in COPD was investigated by sequencing the antibody repertoire of B cells in the lungs of patients with COPD and of ex-smoking and never-smoking control subjects. RESULTS Patients with COPD had a significantly higher risk of being serum positive for ANAs (OR 3.12, 95% CI 1.68 to 5.76, p<0.001). ANAs were not significantly associated with age, smoking status, gender or pack-years of smoking. Within the COPD population, subjects with BMI <22 kg/m2 had a significantly higher risk of ANAs (OR 4.93, 95% CI 1.50 to 16.50, p=0.009) than those with normal or high BMI. The antibody repertoire of B cells in the lungs of patients with COPD had a high frequency of positively charged CDR3 residues, a feature which is associated with self-reactive antibodies. CONCLUSION The results show that COPD is a heterogeneous disease with respect to the prevalence of ANAs. ANAs are primarily associated with the presence of COPD and with low BMI, but not with smoking and forced expiratory volume in 1 s.
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Affiliation(s)
- H P J Bonarius
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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36
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Lubbers DD, Kuijpers D, Bodewes R, Kappert P, Kerkhof M, van Ooijen PMA, Oudkerk M. Inter-observer variability of visual analysis of "stress"-only adenosine first-pass myocardial perfusion imaging in relation to clinical experience and reading criteria. Int J Cardiovasc Imaging 2010; 27:557-62. [PMID: 20882414 PMCID: PMC3101342 DOI: 10.1007/s10554-010-9703-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 09/10/2010] [Indexed: 12/04/2022]
Abstract
To assess the inter-observer agreement of adenosine “stress”-only visual analysis of perfusion MR images in relation to experience and reading criteria. 106 adenosine perfusion MR examinations out of 350, 46 consecutive positive examinations and 60 randomly selected negative examinations were visually analysed by three individual readers (two residents and a technician) with different levels of experience. Readings (blinded for any information) were compared with the reading of an expert radiologist. After a month the examinations were presented again (randomly) without knowledge regarding the first readings. This time readings were performed with the systematical use of reading criteria. Agreement with the expert reading was good for the most experienced resident (k = 0.88). Kappa was 0.48 for the least experienced, and 0.57 for the technician. After the second systematical reading inter-observer agreement increased to 0.9, 0.68 and 0.77 respectively. Overall kappa increased from 0.59 to 0.71. The use of reading criteria significantly improved the performance of the least experienced reader (P = 0.01). Visual analysis of adenosine “stress”-only first-pass perfusion MR images has moderate to very good agreement. Performance is experience related, but the systematic use of reading criteria significantly increased performance for the least experienced observer.
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Affiliation(s)
- D D Lubbers
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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37
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Tischer C, Gehring U, Chen CM, Kerkhof M, Koppelman G, Sausenthaler S, Herbarth O, Schaaf B, Lehmann I, Krämer U, Berdel D, von Berg A, Bauer CP, Koletzko S, Wichmann HE, Brunekreef B, Heinrich J. Respiratory health in children, and indoor exposure to (1,3)-β-D-glucan, EPS mould components and endotoxin. Eur Respir J 2010; 37:1050-9. [PMID: 20817706 DOI: 10.1183/09031936.00091210] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
For a long time, exposure to mould and dampness-derived microbial components was considered a risk factor for the development of respiratory diseases and symptoms. Some recent studies suggested that early childhood exposure to mould components, such as (1,3)-β-D-glucan and extracellular polysaccharides (EPSs), may protect children from developing allergy. We investigated the association of exposure to (1,3)-β-D-glucan, EPS and endotoxin with asthma and allergies in 6-yr-old children. This investigation was the follow-up to a nested case-control study among three European birth cohorts. Children from two ongoing birth cohort studies performed in Germany (n = 358) and one in the Netherlands (n = 338) were selected. Levels of (1,3)-β-D-glucan, EPS and endotoxin were measured in settled house dust sampled from children's mattresses and living-room floors when the children were, on average, 5 yrs of age. At the age of 6 yrs, health outcome information was available for 678 children. In the two German subsets, domestic EPS and endotoxin exposure from children's mattresses were significantly negatively associated with physician-diagnosed asthma (OR per interquartile range increase 0.60 (95% CI 0.39-0.92) and 0.55 (95% CI 0.31-0.97), respectively). In addition, EPS exposure was inversely related to physician-diagnosed allergic rhinitis (OR 0.50, 95% CI 0.31-0.81). For the Dutch population, no associations were observed between exposure to microbial agents and respiratory health outcomes. We found inverse associations between domestic exposure to EPS and endotoxin from children's mattresses, and doctor-diagnosed asthma and rhinitis in German, but not in Dutch, school children. The reasons for the differences between countries are not clear.
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Affiliation(s)
- C Tischer
- Institute of EpidemiologyHelmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany.
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Kerkhof M, Postma DS, Brunekreef B, Reijmerink NE, Wijga AH, de Jongste JC, Gehring U, Koppelman GH. Toll-like receptor 2 and 4 genes influence susceptibility to adverse effects of traffic-related air pollution on childhood asthma. Thorax 2010; 65:690-7. [PMID: 20685742 DOI: 10.1136/thx.2009.119636] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Epidemiological studies have reported adverse effects of ambient air pollution on the prevalence of asthma. Laboratory studies have suggested that innate immune responses are involved. OBJECTIVE A study was undertaken to determine whether the Toll-like receptor 2 and 4 genes (TLR2 and TLR4) influence the susceptibility to adverse effects of traffic-related air pollution with respect to the prevalence of childhood asthma. METHODS Haplotype tagging single nucleotide polymorphisms (SNPs) in the TLR2 (n=4) and TLR4 genes (n=9) were genotyped in 916 children from the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort. Exposure to particulate matter (PM(2.5)), soot and nitrogen dioxide (NO(2)) at the birth address was estimated by land use regression models. Interactions between levels of pollutants and SNPs in relation to annual questionnaire reports of asthma diagnosis and symptoms from birth up to 8 years of age were analysed longitudinally by generalised estimating equations. RESULTS Two TLR2 SNPs and four TLR4 SNPs significantly modified the effect of air pollution on the prevalence of doctor-diagnosed asthma from birth up to 8 years of age. The risk of having doctor-diagnosed asthma increased with increasing PM(2.5) levels in children with at least one copy of the TLR2 rs4696480 A allele (OR 2.0 (95% CI 1.2 to 3.1) for an interquartile range increase in exposure). Similar observations were present with the following TLR4 genotypes: rs2770150 TC (OR 2.0 (95% CI 1.1 to 3.6)), rs10759931 GG (OR 2.6 (95% CI 1.4 to 4.9)), rs6478317 GG (OR 2.2 (95% CI 1.2 to 4.3)), rs10759932 CT or CC (OR 2.9 (95% CI 1.2 to 6.9)) and rs1927911 TT (OR 4.4 (95% CI 1.7 to 11.7)). CONCLUSIONS Variant alleles of TLR2 and TLR4 genes influence the susceptibility to adverse effects of traffic-related air pollution on childhood asthma.
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Affiliation(s)
- M Kerkhof
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands.
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39
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Bottema RWB, Kerkhof M, Reijmerink NE, Koppelman GH, Thijs C, Stelma FF, Smit HA, Brunekreef B, van Schayck CP, Postma DS. X-chromosome Forkhead Box P3 polymorphisms associate with atopy in girls in three Dutch birth cohorts. Allergy 2010; 65:865-74. [PMID: 20028375 DOI: 10.1111/j.1398-9995.2009.02291.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Forkhead Box P3 (FOXP3) gene, located on the X-chromosome, encodes a transcription factor that directs T cells toward a regulatory phenotype. Regulatory T cells may suppress development of atopy. We evaluated whether single-nucleotide polymorphisms (SNPs) of FOXP3 are associated with atopy development in childhood. METHODS Seven SNPs in FOXP3 were genotyped in 3062 children (51% boys) participating in the Allergenic study, which consists of three Dutch birth cohorts (PIAMA, PREVASC and KOALA). Association of FOXP3 SNPs with total serum IgE and sensitisation (presence of specific serum IgE to egg, milk, and indoor, i.e. house-dust mite, cat, and/or dog allergens) was investigated at ages 1, 2, 4, and 8. Analysis of variance and logistic regression were performed, stratified for gender. RESULTS Our most consistent finding was observed for sensitisation to egg and indoor allergens. In girls, five FOXP3 SNPs (rs5906761, rs2294021, rs2294019, rs6609857 and rs3761548) were significantly associated with sensitisation to egg at ages 1 and 2 and with sensitisation to indoor allergens at age 2 (P < 0.05), but not at 4 and 8, a finding that was observed across the three cohorts. Rs5906761 and rs2294021 were associated with remission of sensitisation to food allergens in boys, as tested in the PIAMA cohort. CONCLUSION This is the first study showing across three cohorts that X-chromosomal FOXP3 genotypes may contribute to development of sensitisation against egg and indoor allergens in girls in early childhood. In addition, an association with remission of sensitisation to food allergens existed in boys only.
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Affiliation(s)
- R W B Bottema
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Reijmerink NE, Bottema RWB, Kerkhof M, Gerritsen J, Stelma FF, Thijs C, van Schayck CP, Smit HA, Brunekreef B, Koppelman GH, Postma DS. TLR-related pathway analysis: novel gene-gene interactions in the development of asthma and atopy. Allergy 2010; 65:199-207. [PMID: 19968634 DOI: 10.1111/j.1398-9995.2009.02111.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The toll-like receptor (TLR)-related pathway is important in host defence and may be crucial in the development of asthma and atopy. Numerous studies have shown associations of TLR-related pathway genes with asthma and atopy phenotypes. So far it has not been investigated whether gene-gene interactions in this pathway contribute to atopy and asthma development. METHODS One hundred and sixty-nine haplotype tagging single nucleotide polymorphisms (SNPs) of 29 genes (i.e. membrane and intracellular receptors, TLR4 or lipopolysaccharide-binding/facilitating proteins, adaptors, interleukin-1 receptor associated kinases, kinases, chaperone molecules, transcription factors and inhibitors) were analysed for single- and multilocus associations with atopy [total and specific immunglobulin E (IgE) at 1-2 and 6-8 years] and asthma (6-8 years). A total of 3062 Dutch children from the birth cohorts PIAMA, PREVASC and KOALA (Allergenic study) were investigated. Chi-squared test, logistic regression and the data mining approach multifactor dimensionality reduction method (MDR) were used in analysis. RESULTS Several genes in the TLR-related pathway were associated with atopy and/or asthma [e.g. IL1RL1, BPI, NOD1, NOD2 and MAP3K7IP1]. Multiple, single associations were found with the phenotypes under study. MDR analysis showed novel, significant gene-gene interactions in association with atopy and asthma phenotypes (e.g. IL1RL1 and TLR4 with sIgE to indoor allergens and IRAK1, NOD1 and MAP3K7IP1 with asthma). Interestingly, gene-gene interactions were identified with SNPs that did not have an effect on their own. CONCLUSION Our unbiased approach provided suggestive evidence for interaction between several TLR-related pathway genes important in atopy and/or asthma development and pointed to novel genes.
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Affiliation(s)
- N E Reijmerink
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, the Netherlands
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Schuttelaar MLA, Kerkhof M, Jonkman MF, Koppelman GH, Brunekreef B, de Jongste JC, Wijga A, McLean WHI, Postma DS. Filaggrin mutations in the onset of eczema, sensitization, asthma, hay fever and the interaction with cat exposure. Allergy 2009; 64:1758-65. [PMID: 19839980 DOI: 10.1111/j.1398-9995.2009.02080.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Filaggrin gene (FLG) mutations contribute to the development of eczema and asthma, but their contribution to sensitization and hay fever remains unclear. METHODS FLG mutations R501X, 2282del4 and R2447X were genotyped in the Prevention and Incidence of Asthma and Mite Allergy birth cohort (n = 934) to evaluate longitudinally, for up to 8 years, their association with eczema, sensitization, asthma, hay fever and their interaction with cat exposure. RESULTS The combined FLG mutations were significantly associated with eczema at all ages when occurring in the first year of life (OR = 2.0; 95% CI: 1.4-2.8). Combined FLG mutations were associated with both atopic and nonatopic eczema, as well as asthma (OR = 3.7; 95% CI: 1.8-7.5). When the FLG 2282del4 mutation was analysed separately, it was significantly associated with the development of eczema during the first year, having eczema up to 8 years and sensitization at the age of 8 years, which was enhanced by early-life cat exposure (ORs being 8.2; 95% CI: 2.6-25.9, 6.0; 95% CI: 3.2-11.3 and 5.4; 95% CI: 1.2-23.6 respectively). FLG 2282del4 was significantly associated with hay fever from the age 5 years onwards (OR = 3.9; 95% CI: 1.5-10.5). CONCLUSIONS FLG mutations are associated both with atopic and nonatopic eczema starting in the first year of life. FLG mutations combined with eczema in the first year of life are associated with a later development of asthma and hay fever, a clear example of the atopic march. We confirm that cat exposure enhances the effect of a FLG mutation on the development of eczema and sensitization.
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Affiliation(s)
- M L A Schuttelaar
- Departments of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Scholtens S, Wijga AH, Brunekreef B, Kerkhof M, Hoekstra MO, Gerritsen J, Aalberse R, de Jongste JC, Smit HA. Breast feeding, parental allergy and asthma in children followed for 8 years. The PIAMA birth cohort study. Thorax 2009; 64:604-9. [PMID: 19561280 DOI: 10.1136/thx.2007.094938] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND It is unclear how the association between breast feeding and asthma develops with age of the child and how this association over time is influenced by maternal or paternal allergy. These factors--the age of the child and maternal or paternal allergy--might partly explain the conflicting results observed in cross-sectional studies. METHODS The study population consisted of 3115 Dutch children born in 1996/1997 who participated in the PIAMA (Prevention and Incidence of Asthma and Mite Allergy) birth cohort study. Data on breast feeding and asthma (based on wheeze, dyspnoea and prescription of inhaled steroids) were collected by yearly questionnaires. At 8 years, specific immunoglobulin E (IgE) to airborne allergens and bronchial responsiveness were measured. Data were analysed by logistic regression and generalised estimating equations (GEEs), and stratified by maternal and paternal allergic status. RESULTS 35% (n = 1081) of the children were breast fed for >16 weeks. At 8 years of age, 12.6% (n = 392) had asthma. Breast feeding (>16 weeks vs no breast feeding) was significantly associated with a lower asthma prevalence from 3 to 8 years of age, in children of both non-allergic and allergic mothers. The inverse association between breast feeding and sensitisation to airborne allergens at 8 years was non-significant. Breast feeding was not associated with bronchial hyper-responsiveness. No interaction between breast feeding and gender, maternal allergy or paternal allergy was observed in any of the associations. CONCLUSIONS Breast feeding is associated with a lower asthma risk in children until 8 years of age without evidence of attenuation and regardless of the family history of allergy.
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Affiliation(s)
- S Scholtens
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
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Kerkhof M, Wijga AH, Brunekreef B, Smit HA, de Jongste JC, Aalberse RC, Hoekstra MO, Gerritsen J, Postma DS. Effects of pets on asthma development up to 8 years of age: the PIAMA study. Allergy 2009; 64:1202-8. [PMID: 19245426 DOI: 10.1111/j.1398-9995.2009.02016.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recall bias may provide discrepant relationships of pet exposure with sensitization and asthma development. We studied prospectively effects of pets at home on development of sensitization, asthma and respiratory symptoms from birth up to age 8 years. METHODS Event history analysis was performed on annually registered data of 2951 children, participating in the PIAMA birth cohort study. RESULTS Children with a cat or dog at home at 3 months of age had a significantly lower prevalence of sensitization to inhalant allergens at age 8, but not of asthma. A cat decreased the risk of house dust mite sensitization at age 8 [odds ratio (OR) = 0.68, 95% confidence interval (CI) 0.49-0.95], a dog of pollen sensitization (OR = 0.49, 95% CI: 0.29-0.83). A cat or dog at home did not significantly affect asthma incidence in each subsequent year. From 2 years of age onwards, the incidence of wheeze (OR = 1.52, 95% CI: 1.12-2.05) and a dry cough at night (OR = 1.28, 95% CI: 1.05-1.57) was higher in children with a dog, whereas removal of a dog increased the risk of developing asthma symptoms. Comparing analyses using prospectively and retrospectively collected data on diagnosed asthma showed important recall bias. CONCLUSIONS Our prospective study shows a protective effect of early presence of pets at home on sensitization to inhalant allergens, but no prevention of asthma development. Furthermore, children with pets had more frequent transient or intermittent asthma symptoms. Parental report of asthma by recall may provide spurious results of these associations.
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Affiliation(s)
- M Kerkhof
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, Groningen 9700 RB, The Netherlands
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Pinelli E, Willers SM, Hoek D, Smit HA, Kortbeek LM, Hoekstra M, de Jongste J, van Knapen F, Postma D, Kerkhof M, Aalberse R, van der Giessen JWB, Brunekreef B. Prevalence of antibodies against Ascaris suum and its association with allergic manifestations in 4-year-old children in The Netherlands: the PIAMA birth cohort study. Eur J Clin Microbiol Infect Dis 2009; 28:1327-34. [PMID: 19644714 DOI: 10.1007/s10096-009-0785-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 07/11/2009] [Indexed: 11/28/2022]
Abstract
The association between helminth infections and childhood atopic diseases remains controversial. The majority of studies have been carried out in tropical areas, whereas less information is available from western countries with low intensity of helminth infections. In the Netherlands, the infection of pigs with Ascaris suum is very common, particularly on pig farms with outdoor facilities. This helminth can also infect humans, causing visceral larva migrans. This study aims at determining the prevalence of antibodies against A. suum and its association with allergic symptoms and sensitisation in a population of 4-year-old children living in The Netherlands. Blood samples from 629 children from the prospective birth cohort Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study were examined for Ascaris antibodies. Data on allergic symptoms and sensitisation were collected using questionnaires and radioallergosorbent tests (RAST). A total of 45 out of 629 (7%) were found to be Ascaris-seropositive. In addition, a positive association between Ascaris seropositivity and wheeze in the last year, doctor-diagnosed asthma and food and aero-allergen sensitisation was found. These results support the hypothesis that low-level or transient infection with helminths enhances allergic reactivity.
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Affiliation(s)
- E Pinelli
- Department of Parasitology and Mycology, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, Centre for Infectious Disease Control Netherlands, National Institute of Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
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Bottema RWB, Postma DS, Reijmerink NE, Thijs C, Stelma FF, Smit HA, van Schayck CP, Brunekreef B, Koppelman GH, Kerkhof M. Interaction of T-cell and antigen presenting cell co-stimulatory genes in childhood IgE. Eur Respir J 2009; 35:54-63. [PMID: 19574333 DOI: 10.1183/09031936.00018909] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It is likely that multiple genes contribute to immunoglobulin (Ig)E production. Co-stimulatory molecules are crucial for the cross-talk between antigen presenting cells and T-lymphocytes which drives the IgE response. We evaluated gene-gene interactions of haplotype tagging polymorphisms in a pathway of 24 co-stimulatory genes in relation to serum IgE levels. We assessed this at ages 1-2 yrs and 6-8 yrs in 3,062 Dutch children from a pooled data set of three birth cohorts: PIAMA (Prevention and Incidence Asthma and Mite Allergy), PREVASC (Prevention of Asthma in Children) and KOALA (Child, parents and health: lifestyle and genetic constitution). Single- and multi-locus associations with serum IgE levels (3rd versus 1st tertile) were evaluated by Chi-squared tests and the multifactor dimensionality reduction (MDR) method in the following co-stimulatory genes: VTCN1, TNFRSF4, TNFRSF18, TNFRSF14, TNFSF18, TNFSF4, CD28, CTLA4, ICOS, PDCD1, BTLA, CD80, CD86, HLA-G, CD274, PDCD1LG2, CD276, LILRA4, LILRB1, LILRB2, LILRB4, CD40, ICOSLG, and CD40LG. We found multiple statistically significant single-locus ((S)) and multi-locus ((M)) associations for the genes VTCN1(SM), TNFSF18(SM), TNFSF4(S), CD28(S), CTLA4(M), ICOS(S), BTLA(M), CD80(M), CD86(SM), CD274(SM), PDCD1LG2(M), LILRA4(SM), LILRB4(M), and CD40(SM) with serum IgE. Two-locus interactions of CD86 with VTCN1 and CD274 with LILRA4 were confirmed by logistic regression. In conclusion, serum IgE levels are regulated by multiple gene-gene interaction effects in the co-stimulatory pathway. We suggest using research strategies that model multiple gene-gene interactions in genetic studies.
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Affiliation(s)
- R W B Bottema
- Dept of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Reijmerink NE, Kerkhof M, Koppelman GH, Gerritsen J, de Jongste JC, Smit HA, Brunekreef B, Postma DS. Smoke exposure interacts with ADAM33 polymorphisms in the development of lung function and hyperresponsiveness. Allergy 2009; 64:898-904. [PMID: 19236319 DOI: 10.1111/j.1398-9995.2009.01939.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION ADAM33 is the first identified asthma gene by positional cloning, especially asthma combined with bronchial hyperresponsiveness (BHR). Moreover, ADAM33 is associated with early-life lung function and decline of forced expiratory volume in 1 s (FEV(1)) in the general population. In utero and postnatal cigarette smoke exposure (CSE) are associated with reduced lung function, and development of BHR and asthma. We hypothesized that this may occur via interaction with ADAM33. AIM To replicate the role of ADAM33 in childhood lung function and development of BHR and asthma. Furthermore, we investigated gene-environment interaction of ADAM33 with in utero and postnatal CSE in the Dutch PIAMA cohort. METHODS Six ADAM33 single-nucleotide polymorphisms (SNPs) were genotyped. Rint was measured at age 4 and 8 years, FEV(1) and BHR at age 8 years; asthma was based on questionnaire data at age 8. RESULTS In the total cohort, the rs511898 A, rs528557 C, and rs2280090 A alleles increased the risk to develop asthma (+BHR). There existed interaction between in utero but not postnatal CSE and the rs528557 and rs3918396 SNPs with respect to development of BHR, the rs3918396 SNP with Rint at age 8 and the rs528557 SNP with FEV(1)% predicted. CONCLUSIONS We confirm associations between ADAM33 and the development of asthma (+BHR). This is the first study suggesting that interaction of in utero CSE with ADAM33 results in reduced lung function and the development of BHR, which needs further confirmation.
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Affiliation(s)
- N E Reijmerink
- Department of Pulmonology, University medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ruskamp JM, Hoekstra MO, Postma DS, Kerkhof M, Bottema RW, Koppelman GH, Rovers MM, Wijga AH, de Jongste JC, Brunekreef B, Sanders EAM. Exploring the role of polymorphisms in ficolin genes in respiratory tract infections in children. Clin Exp Immunol 2009; 155:433-40. [PMID: 19220833 PMCID: PMC2669519 DOI: 10.1111/j.1365-2249.2008.03844.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [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] [Accepted: 11/07/2008] [Indexed: 11/30/2022] Open
Abstract
Ficolins are pattern-recognition molecules that appear to be relevant for innate immune defence against infections. The ficolin genes in Caucasians are polymorphic and genetic variations may have functional consequences, both in relation to function and concentration. Low levels of Ficolin-2 have been suggested to associate with recurrent respiratory tract infections (RTI), whereas data on Ficolin-3 are still very limited. We investigated the association between variation in genes encoding Ficolin-2 (FCN2) and Ficolin-3 (FCN3) and frequency of RTI during the first 4 years of life. The study population consisted of 900 children from a large, population-based birth cohort of Dutch children, followed prospectively from birth to 4 years of age. The number of RTI was assessed by annual parental questionnaires. Nine single nucleotide polymorphisms in FCN2 and two in FCN3, all based on functionality or haplotype-tagging characteristics, were determined and haplotypes constructed. We found that single nucleotide polymorphisms in FCN2 and FCN3 were not associated with increased risk of RTI during the first 4 years of life. No difference existed between haplotype-frequencies of FCN2 and FCN3 in children grouped according to the reported number of RTI. In conclusion, at a population level, genetic variation in ficolin genes FCN2 and FCN3 do not seem to contribute to the risk of RTI in Caucasian children.
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Affiliation(s)
- J M Ruskamp
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Jansen H, Wijga AH, Smit HA, Scholtens S, Kerkhof M, Koppelman GH, de Jongste JC, Stolk RP. HbA(1c) levels in non-diabetic Dutch children aged 8-9 years: the PIAMA birth cohort study. Diabet Med 2009; 26:122-7. [PMID: 19236613 DOI: 10.1111/j.1464-5491.2008.02641.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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: 11/25/2022]
Abstract
AIM Glycated haemoglobin (HbA(1c)) is considered the best index of glycaemic control in established diabetes. It may also be useful in the diagnosis of diabetes and as a screening tool. Little is known about the distribution of HbA(1c) in healthy children and its predictors. The aim of this study is to describe the distribution of HbA(1c) in non-diabetic Dutch children aged 8-9 years and to investigate potential associations of HbA(1c) in this group. METHODS HbA(1c) was measured in 788 non-diabetic children aged 8-9 years participating in the PIAMA birth cohort study. Data on parents and children were collected prospectively by questionnaires. Weight, height and waist and hip circumference of the children were measured when blood samples were taken. RESULTS Mean (SD) HbA(1c) was 4.9 +/- 0.33%, range 3.5-6.0%. HbA(1c) was significantly higher in boys (4.9 +/- 0.31 vs. 4.9 +/- 0.33%) and in children of mothers with gestational diabetes (5.0 +/- 0.37 vs. 4.9 +/- 0.32%). We found a significant inverse association between HbA(1c) and haemoglobin (regression coefficient: -0.169 (95% CI -0.221 to -0.118), P < 0.001). HbA(1c) was not significantly associated with age, body mass index, waist circumference, parental diabetes or maternal body mass index. CONCLUSIONS We found no significant relation between known risk factors for Type 2 diabetes and HbA(1c) at age 8-9 years. Moreover, there was a significant inverse association between haemoglobin and HbA(1c). These results suggest that HbA(1c) may not only reflect the preceding blood glucose levels, but seems to be determined by other factors as well.
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Affiliation(s)
- H Jansen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Bottema RWB, Reijmerink NE, Kerkhof M, Koppelman GH, Stelma FF, Gerritsen J, Thijs C, Brunekreef B, van Schayck CP, Postma DS. Interleukin 13, CD14, pet and tobacco smoke influence atopy in three Dutch cohorts: the allergenic study. Eur Respir J 2008; 32:593-602. [PMID: 18417506 DOI: 10.1183/09031936.00162407] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Studying gene-environment interactions may elucidate the complex origins of atopic diseases but requires large study populations. Pooling data from several cohort studies may help but may also obscure findings. Gene-environment interactions in atopy development were studied and the benefits of pooling data were evaluated. Haplotype-tagging polymorphisms in the genes interleukin (IL)13 and CD14 were genotyped in 3,062 children from the following birth cohorts: the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study; the Prevention of Asthma in Children (PREVASC) study; and the Child, Parent, Health, Focus on Lifestyle and Predisposition (KOALA) study, and tested for association with total and specific immunoglobulin (Ig)E and interaction with tobacco smoke and pet exposure at ages 1, 2, 4 and 8 yrs by analysis of variance, Chi-squared tests and regression analyses. At all ages, in IL13, minor alleles of rs1295685 and rs20541 were significantly associated with elevated IgE levels in pooled analyses. In CD14, the rs2569190-TT and rs2569191-CC genotypes associated with lower IgE and decreased risk of sensitisation at 4 and 8 yrs in children exposed to pets, with an opposite effect in nonexposed children. Findings for IL13 and CD14 were comparable in separate cohorts. The present study indicates that atopy is importantly influenced by interleukin 13 at age 1-8 yrs and by CD14 in interaction with pet exposure at ages 4 and 8 yrs. Additionally, pooled data improved effect estimates and genetic effects could be detected in interaction with important environmental factors.
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Affiliation(s)
- R W B Bottema
- Dept of Pulmonology, University Medical Center Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands
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Kerkhof M, Steyerberg EW, Kusters JG, Kuipers EJ, Siersema PD. Predicting presence of intestinal metaplasia and dysplasia in columnar-lined esophagus: a multivariate analysis. Endoscopy 2007; 39:772-8. [PMID: 17703384 DOI: 10.1055/s-2007-966737] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS In patients with presumed Barrett esophagus we evaluated clinical risk factors that could predict the presence of intestinal metaplasia and dysplasia in biopsies of columnar-lined esophagus (CLE), independently of histological results. PATIENTS AND METHODS In 908 patients with CLE of length > or = 2 cm, data on age, sex, reflux symptoms, tobacco and alcohol use, medication use, and upper gastrointestinal endoscopy findings were prospectively collected. Multivariate logistic regression analysis was performed, and a model for predicting the histological results was developed. RESULTS In 127/908 patients, biopsies of CLE did not contain intestinal metaplasia. Of the 781 patients with intestinal metaplasia, 663 patients (85%) had no dysplasia, and 118 (15%) had low grade dysplasia (LGD). The most important predictors for the presence of intestinal metaplasia were length of CLE, size of hiatal hernia, and male sex, while among those with intestinal metaplasia, age and male sex were most important for the presence of LGD. Multivariate combinations of these predictors yielded reliable models, which were able to discriminate intestinal metaplasia well from no intestinal metaplasia (area under receiver operating characteristic [ROC] curve 0.82), but only reasonably discriminated LGD from no dysplasia (area under ROC 0.65). CONCLUSIONS A simple model based on clinical findings can be used to predict the presence of intestinal metaplasia in biopsies from CLE. In contrast, predicting the presence of LGD versus no dysplasia in intestinal metaplasia is more difficult. Predictions from these models may aid decision making on whether a patient with CLE should have surveillance, in view of the known sampling error at endoscopy and interobserver variability at histology.
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Affiliation(s)
- M Kerkhof
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
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