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Hamad Saied M, van Straalen JW, de Roock S, Verduyn Lunel FM, de Wit J, de Rond LGH, Van Nieuwenhove E, Vastert BJ, van Montfrans JM, van Royen-Kerkhof A, de Joode-Smink GCJ, Swart JF, Wulffraat NM, Jansen MHA. Humoral and cellular immunogenicity, effectiveness and safety of COVID-19 mRNA vaccination in patients with pediatric rheumatic diseases: A prospective cohort study. Vaccine 2024; 42:1145-1153. [PMID: 38262809 DOI: 10.1016/j.vaccine.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/02/2024] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To evaluate immunogenicity, effectiveness and safety of COVID-19 vaccination in patients with pediatric autoimmune inflammatory rheumatic disease (pedAIIRD). METHODS A prospective cohort study was performed at the pediatric rheumatology department of the Wilhelmina Children's Hospital in Utrecht, the Netherlands. Vaccination dates, COVID-19 cases and vaccine-related adverse events (AEs) were registered for all pedAIIRD patients during regular clinic visits from March 2021 - August 2022. SARS-CoV-2 IgG antibody levels and T-cell responses were measured from serum samples after vaccination, and clinical and drug therapy data were collected from electronic medical records. Rate of COVID-19 disease was compared between vaccinated and unvaccinated patients in a time-varying Cox regression analysis. RESULTS A total of 157 patients were included in this study and 88 % had juvenile idiopathic arthritis (JIA). One hundred thirty-seven patients were fully vaccinated, of which 47 % used biological agents at the time of vaccination, and 20 patients were unvaccinated. Geometric mean concentrations (GMCs) of post-vaccine antibody levels against SARS-CoV-2 were above the threshold for positivity in patients who did and did not use biological agents at the time of vaccination, although biological users demonstrated significantly lower antibody levels (adjusted GMC ratio: 0.38, 95 % CI: 0.21 - 0.70). T-cell responses were adequate in all but two patients (9 %). The adjusted rate of reported COVID-19 was significantly lower for fully vaccinated patients compared to non-vaccinated patients (HR: 0.53, 95 % CI: 0.29 - 0.97). JIA disease activity scores were not significantly different after vaccination, and no serious AEs were reported. CONCLUSIONS COVID-19 mRNA vaccines were immunogenic (both cellular and humoral), effective and safe in a large cohort of pedAIIRD patients despite their use of immunosuppressive medication.
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Affiliation(s)
- Mohamad Hamad Saied
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Pediatrics, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel.
| | - Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sytze de Roock
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans M Verduyn Lunel
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jelle de Wit
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Lia G H de Rond
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Erika Van Nieuwenhove
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bas J Vastert
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joris M van Montfrans
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annet van Royen-Kerkhof
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerrie C J de Joode-Smink
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc H A Jansen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Erkens RGA, Calis JJA, Verwoerd A, De Roock S, Ter Haar NM, Den Engelsman G, Van der Veken LT, Ernst RF, Van Deutekom HWM, Pickering A, Scholman RC, Jansen MHA, Swart JF, Sinha R, Roth J, Schulert GS, Grom AA, Van Loosdregt J, Vastert SJ. Recombinant Interleukin-1 Receptor Antagonist Is an Effective First-Line Treatment Strategy in New-Onset Systemic Juvenile Idiopathic Arthritis, Irrespective of HLA-DRB1 Background and IL1RN Variants. Arthritis Rheumatol 2024; 76:119-129. [PMID: 37471469 DOI: 10.1002/art.42656] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 03/26/2023] [Revised: 06/07/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Human leukocyte antigen (HLA)-DRB1*15:01 has been recently associated with interstitial lung disease (LD), eosinophilia, and drug reactions in systemic juvenile idiopathic arthritis (sJIA). Additionally, genetic variants in IL1RN have been linked to poor response to anakinra. We sought to reproduce these findings in a prospective cohort study of patients with new-onset sJIA treated with anakinra as first-line therapy. METHODS HLA and IL1RN risk alleles were identified via whole-genome sequencing. Treatment responses and complications were compared between carriers versus noncarriers. RESULTS Seventeen of 65 patients (26%) carried HLA-DRB1*15:01, comparable with the general population, and there was enrichment for HLA-DRB1*11:01, a known risk locus for sJIA. The rates of clinical inactive disease (CID) at 6 months, 1 year, and 2 years were generally high, irrespective of HLA-DRB1 or IL1RN variants, but significantly lower in carriers of an HLA-DRB1*11:01 allele. One patient, an HLA-DRB1*15:01 carrier, developed sJIA-LD. Of the three patients with severe drug reactions to biologics, one carried HLA-DRB1*15:01. The prevalence of eosinophilia did not significantly differ between HLA-DRB1*15:01 carriers and noncarriers at disease onset (6.2% vs 14.9%, P = 0.67) nor after the start of anakinra (35.3% vs 37.5% in the first 2 years of disease). CONCLUSION We observed high rates of CID using anakinra as first-line treatment irrespective of HLA-DRB1 or IL1RN variants. Only one of the 17 HLA-DRB1*15:01 carriers developed sJIA-LD, and of the three patients with drug reactions to biologics, only one carried HLA-DRB1*15:01. Although thorough monitoring for the development of drug hypersensitivity and refractory disease courses in sJIA, including sJIA-LD, remains important, our data support the early start of biologic therapy in patients with new-onset sJIA irrespective of HLA-DRB1 background or IL1RN variants.
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Affiliation(s)
- Remco G A Erkens
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Jorg J A Calis
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Anouk Verwoerd
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Sytze De Roock
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Nienke M Ter Haar
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Gerda Den Engelsman
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Lars T Van der Veken
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Robert F Ernst
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | | | | | - Rianne C Scholman
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Marc H A Jansen
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Joost F Swart
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Rashmi Sinha
- Systemic Juvenile Idiopathic Arthritis Foundation, Cincinnati, Ohio
| | | | - Grant S Schulert
- Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexei A Grom
- Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jorg Van Loosdregt
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
| | - Sebastiaan J Vastert
- University Medical Center Utrecht and University of Utrecht, Utrecht, The Netherlands
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Hamad Saied M, van Straalen JW, de Roock S, de Joode-Smink GCJ, Verduyn Lunel FM, Swart JF, Wulffraat NM, Jansen MHA. Long-term immunoprotection after live attenuated measles-mumps-rubella booster vaccination in children with juvenile idiopathic arthritis. Vaccine 2023; 41:5477-5482. [PMID: 37516575 DOI: 10.1016/j.vaccine.2023.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/08/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Vaccines, especially live attenuated vaccines, in children with JIA pose a great challenge due to both potential lower immunogenicity and safety as a result of immunosuppressive treatment. For many years, in the Netherlands, JIA patients receive a measles-mumps-rubella (MMR) booster vaccine at the age of nine years as part of the national immunization program. OBJECTIVES To study long-term humoral immunoprotection in a large cohort of JIA patients who received the MMR booster vaccine while being treated with immunomodulatory therapies at the Wilhelmina Children's Hospital in Utrecht, the Netherlands. METHODS MMR-specific IgG antibody concentrations in stored serum samples of vaccinated JIA patients were determined with chemiluminescent microparticle immunoassays (CMIA). Samples were analyzed five years after MMR booster vaccination and at last available follow-up visit using both crude and adjusted analyses. Additional clinical data were collected from electronic medical records. RESULTS In total, 236 samples from 182 patients were analyzed, including 67 samples that were available five years post-vaccination, and an additional 169 samples available from last visits with a median duration after vaccination of 6.9 years (IQR: 2.8-8.8). Twenty-eight patients were using biologic disease-modifying antirheumatic drugs (bDMARDS) of whom 96% anti-TNF agents and 4% tocilizumab. Percentages of protective antibody levels against measles after five years were significantly lower for patients who used bDMARD therapy at vaccination compared to patients who did not: 60% versus 86% (P = 0.03). For mumps (80% versus 94%) and rubella (60% versus 83%) this difference did not reach statistical significance (P = 0.11 and P = 0.07, respectively). Antibody levels post-vaccination decreased over time, albeit not significantly different between bDMARD users and non-bDMARD users. CONCLUSION The MMR booster vaccine demonstrated long-term immunogenicity in the majority of children with JIA from a large cohort, although lower percentages of protective measles antibody levels were observed in bDMARD users. Hence, it might be indicated to measure antibody levels at least five years after MMR booster vaccination in the latter group and advice an extra booster accordingly.
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Affiliation(s)
- Mohamad Hamad Saied
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Pediatrics, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel.
| | - Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sytze de Roock
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerrie C J de Joode-Smink
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans M Verduyn Lunel
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc H A Jansen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Hamad Saied M, van der Griend L, van Straalen JW, Wulffraat NM, Vastert S, Jansen MHA. The protective effect of COVID-19 vaccines on developing multisystem inflammatory syndrome in children (MIS-C): a systematic literature review and meta-analysis. Pediatr Rheumatol Online J 2023; 21:80. [PMID: 37550719 PMCID: PMC10405572 DOI: 10.1186/s12969-023-00848-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/18/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVE To review whether the current COVID-19 vaccines can prevent the occurrence of multisystem inflammatory syndrome in children (MIS-C) and adolescents. METHODS A systematic literature review and meta-analysis were performed. The data were abstracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Primary outcome was the efficacy of COVID-19 vaccination in preventing MIS-C development. The search was performed in PubMed and Embase. RESULTS The review yielded 13 studies, which were included for critical appraisal and data extraction. The available studies showed a reduced incidence of MIS-C after mRNA COVID-19 vaccination in children aged 12-18 years. Four studies were eligible for meta-analysis and the pooled odds ratio for MIS-C in vaccinated children compared to unvaccinated children was 0.04 (95% confidence interval: 0.03-0.06). Additionally, the risk of MIS-C as an adverse effect of vaccination was much lower compared to the risk of MIS-C post-infection. CONCLUSIONS Our systematic review highlights the current available evidence on the efficacy of COVID-19 vaccination in preventing MIS-C. The published studies so far - mainly conducted during the Delta wave - indicate that (original strain) COVID-19 mRNA vaccines in children are safe and associated with significantly less development of MIS-C. These findings further reinforce the recommendation for COVID-19 vaccination in children, which should be promoted and largely supported.
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Affiliation(s)
- Mohamad Hamad Saied
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. box 85090, Utrecht, 3508 AB, The Netherlands.
- Department of Pediatrics, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel.
| | | | - Joeri W van Straalen
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. box 85090, Utrecht, 3508 AB, The Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. box 85090, Utrecht, 3508 AB, The Netherlands
| | - Sebastiaan Vastert
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. box 85090, Utrecht, 3508 AB, The Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc H A Jansen
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. box 85090, Utrecht, 3508 AB, The Netherlands
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Ohm M, van Straalen JW, de Joode-Smink G, van Montfrans J, Bartels M, van Wildenbeest JG, Lindemans CA, Wennink RA, de Boer JH, Sanders EA, Verduyn-Lunel FM, Berbers GA, Wulffraat NM, Jansen MHA. Meningococcal ACWY conjugate vaccine immunogenicity in adolescents with primary or secondary immune deficiencies, a prospective observational cohort study. Pediatr Rheumatol Online J 2023; 21:73. [PMID: 37475057 PMCID: PMC10360259 DOI: 10.1186/s12969-023-00846-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Immunization with meningococcal ACWY conjugate vaccine induces protective antibodies against invasive meningococcal disease (IMD) caused by serogroups A, C, W and Y. We studied MenACWY-TT vaccine immunogenicity in adolescents with a heterogenous group of primary and secondary immune deficiency including patients with systemic lupus erythematosus, mixed connective tissue disease, vasculitis, uveitis, 22Q11 syndrome, sickle cell disease, and patients who underwent stem cell transplantation for bone marrow failure. FINDINGS We enrolled 69 individuals aged 14-18 years diagnosed with a primary or secondary immune deficiency in a prospective observational cohort study. All patients received a single dose of MenACWY-TT vaccine during the catch-up campaign 2018-19 because of the IMD-W outbreak in the Netherlands. Capsular polysaccharide-specific (PS) IgG concentrations against MenACWY were measured before and 3-6, 12, and 24 months after vaccination. Overall, geometric mean concentrations (GMCs) of MenACWY-PS-specific IgG were lower in patients compared to data from healthy, aged-matched controls (n = 75) reaching significance at 12 months postvaccination for serogroup A and W (adjusted GMC ratios 0.26 [95% CI: 0.15-0.47] and 0.22 [95% CI: 0.10-0.49], respectively). No serious adverse events were reported by study participants. CONCLUSIONS The MenACWY conjugate vaccine was less immunogenic in adolescent patients with primary or secondary immunodeficiency compared to healthy controls, urging the need for further surveillance of these patients and supporting considerations for booster MenACWY conjugate vaccinations in these patient groups.
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Affiliation(s)
- Milou Ohm
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Gerrie de Joode-Smink
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joris van Montfrans
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marije Bartels
- Department of Pediatric Hematology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joanne G van Wildenbeest
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Caroline A Lindemans
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Roos Aw Wennink
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Elisabeth Am Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Frans M Verduyn-Lunel
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Guy Am Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marc H A Jansen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.
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Ohm M, van Straalen JW, Zijlstra M, de Joode-Smink G, Jasmijn Sellies A, Swart JF, Vastert SJ, van Montfrans JM, Bartels M, van Royen-Kerkhof A, Wildenbeest JG, Lindemans CA, Wolters V, Wennink RAW, de Boer JH, Knol MJ, Heijstek MW, Sanders EAM, Verduyn-Lunel FM, Berbers GAM, Wulffraat NM, Jansen MHA. Meningococcal ACWY conjugate vaccine immunogenicity and safety in adolescents with juvenile idiopathic arthritis and inflammatory bowel disease: A prospective observational cohort study. Vaccine 2023:S0264-410X(23)00480-2. [PMID: 37198018 DOI: 10.1016/j.vaccine.2023.04.056] [Citation(s) in RCA: 5] [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] [Received: 02/27/2023] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Immunogenicity to meningococcal serogroup ACWY (MenACWY) conjugate vaccine has not been studied in immunocompromised minors with juvenile idiopathic arthritis (JIA) or inflammatory bowel disease (IBD). We determined immunogenicity of a MenACWY-TT vaccine in JIA and IBD patients at adolescent age and compared results to data from aged-matched healthy controls (HCs). METHODS We performed a prospective observational cohort study in JIA and IBD patients (14-18 years old), who received a MenACWY vaccination during a nationwide catch-up campaign (2018-2019) in the Netherlands. Primary aim was to compare MenACWY polysaccharide-specific serum IgG geometric mean concentrations (GMCs) in patients with HCs and secondary between patients with or without anti-TNF therapy. GMCs were determined before and 3-6, 12, and 24 months postvaccination and compared with data from HCs at baseline and 12 months postvaccination. Serum bactericidal antibody (SBA) titers were determined in a subset of patients at 12 months postvaccination. RESULTS We included 226 JIA and IBD patients (66 % and 34 % respectively). GMCs were lower for MenA and MenW (GMC ratio 0·24 [0·17-0·34] and 0·16 [0·10-0·26] respectively, p < 0·01) in patients compared to HCs at 12 months postvaccination. Anti-TNF users had lower MenACWY GMCs postvaccination compared with those without anti-TNF (p < 0·01). The proportion protected (SBA ≥ 8) for MenW was reduced in anti-TNF users (76 % versus 92 % in non-anti-TNF and 100 % in HCs, p < 0.01). CONCLUSION The MenACWY conjugate vaccine was immunogenic in the vast majority of JIA and IBD patients at adolescent age, but seroprotection was lower in patients using anti-TNF agents. Therefore, an extra booster MenACWY vaccination should be considered.
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Affiliation(s)
- Milou Ohm
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marieke Zijlstra
- Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gerrie de Joode-Smink
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anne Jasmijn Sellies
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sebastiaan J Vastert
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joris M van Montfrans
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marije Bartels
- Department of Pediatric Hematology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Annet van Royen-Kerkhof
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joanne G Wildenbeest
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Caroline A Lindemans
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Victorien Wolters
- Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Roos A W Wennink
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marloes W Heijstek
- Department of Rheumatology & Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Elisabeth A M Sanders
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frans M Verduyn-Lunel
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marc H A Jansen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Hamad Saied M, van Straalen JW, de Roock S, de Joode-Smink GCJ, Swart JF, Wulffraat NM, Jansen MHA. Safety of Measles-Mumps-Rubella booster vaccination in patients with juvenile idiopathic arthritis: A long-term follow-up study. Vaccine 2023; 41:2976-2981. [PMID: 37032229 DOI: 10.1016/j.vaccine.2023.03.074] [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: 12/30/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To study short and long-term disease activity and vaccine-related adverse events in a cohort of JIA patients who received the live attenuated measles-mumps-rubella (MMR) booster vaccine while being treated with immunosuppressive and immunomodulatory therapies. METHODS A retrospective study was performed in the UMC Utrecht, clinical and therapeutic data were collected from electronic medical records for two visits before and two visits after the MMR booster vaccine of JIA patients. Drug therapy was collected and adverse events related to the vaccine were requested from the patients during clinical visits or by short phone interviews. Associations between MMR booster vaccination and the active joint count, physician global assessment of disease activity, patient-reported visual analogue scale (VAS) for well-being and clinical Juvenile Arthritis Disease Activity Score (cJADAS) were analyzed using multivariable linear mixed effects analyses. RESULTS A total of 186 JIA patients were included in the study. At the time of vaccination, 51% of the patients used csDMARD and 28% used bDMARD therapy. Overall, adjusted disease activity scores after MMR booster vaccination were not significantly different compared to pre-vaccination. Mild adverse events related to the MMR booster were reported for 7% of the patients. No serious adverse events were reported. CONCLUSION MMR booster vaccination was safe and did not worsen disease activity during long-term follow-up in a large cohort of JIA patients being treated with both csDMARDs and biological DMARDs.
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Affiliation(s)
- Mohamad Hamad Saied
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Pediatrics, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel.
| | - Joeri W van Straalen
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sytze de Roock
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerrie C J de Joode-Smink
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost F Swart
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc H A Jansen
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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8
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Jansen MHA, Rondaan C, Legger GE, Minden K, Uziel Y, Toplak N, Maritsi D, van den Berg L, Berbers GAM, Bruijning P, Egert Y, Normand C, Bijl M, Foster HE, Koné-Paut I, Wouters C, Ravelli A, Elkayam O, Wulffraat NM, Heijstek MW. EULAR/PRES recommendations for vaccination of paediatric patients with autoimmune inflammatory rheumatic diseases: update 2021. Ann Rheum Dis 2023; 82:35-47. [PMID: 35725297 DOI: 10.1136/annrheumdis-2022-222574] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Recent insights supporting the safety of live-attenuated vaccines and novel studies on the immunogenicity of vaccinations in the era of biological disease-modifying antirheumatic drugs in paediatric patients with autoimmune/inflammatory rheumatic diseases (pedAIIRD) necessitated updating the EULAR recommendations. METHODS Recommendations were developed using the EULAR standard operating procedures. Two international expert committees were formed to update the vaccination recommendations for both paediatric and adult patients with AIIRD. After a systematic literature review, separate recommendations were formulated for paediatric and adult patients. For pedAIIRD, six overarching principles and seven recommendations were formulated and provided with the level of evidence, strength of recommendation and Task Force level of agreement. RESULTS In general, the National Immunisation Programmes (NIP) should be followed and assessed yearly by the treating specialist. If possible, vaccinations should be administered prior to immunosuppressive drugs, but necessary treatment should never be postponed. Non-live vaccines can be safely given to immunosuppressed pedAIIRD patients. Mainly, seroprotection is preserved in patients receiving vaccinations on immunosuppression, except for high-dose glucocorticoids and B-cell depleting therapies. Live-attenuated vaccines should be avoided in immunosuppressed patients. However, it is safe to administer the measles-mumps-rubella booster and varicella zoster virus vaccine to immunosuppressed patients under specific conditions. In addition to the NIP, the non-live seasonal influenza vaccination should be strongly considered for immunosuppressed pedAIIRD patients. CONCLUSIONS These recommendations are intended for paediatricians, paediatric rheumatologists, national immunisation agencies, general practitioners, patients and national rheumatology societies to attain safe and effective vaccination and optimal infection prevention in immunocompromised pedAIIRD patients.
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Affiliation(s)
- Marc H A Jansen
- Department of Paediatric Immunology & Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands .,RITA, European Reference Networks, Brussels, Belgium
| | - Christien Rondaan
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, The Netherlands
| | - Geertje E Legger
- RITA, European Reference Networks, Brussels, Belgium.,Department of Paediatric Rheumatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Kirsten Minden
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Yosef Uziel
- Paediatric Rheumatology Unit, Department of Paediatrics, Meir Medical Center, Kfar Saba, Israel
| | - Natasa Toplak
- RITA, European Reference Networks, Brussels, Belgium.,Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, Ljubljana, Slovenia
| | - Despoina Maritsi
- Infectious Diseases, Immunology and Rheumatology Unit, Department of Paediatrics, Kyriakou Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lotte van den Berg
- Dutch JIA Patient and Parent Organisation (JVN), Member of ENCA, Amsterdam, The Netherlands
| | - Guy A M Berbers
- Centre for Infectious Disease Control Netherlands, Laboratory for Infectious Diseases and Screening, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Patricia Bruijning
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yona Egert
- European Network Childhood Arthritis (ENCA) Patient Organisation, Judea and Samaria Area, Israel
| | - Christophe Normand
- MCI Secretariat, European Network for Children with Arthritis (ENCA), Geneva, Switzerland
| | - Marc Bijl
- Department of Internal Medicine and Rheumatology, Martini Hospital Groningen, Groningen, The Netherlands
| | - Helen E Foster
- Population and Health Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Isabelle Koné-Paut
- Department of Paediatric Rheumatology and CEREMAIA, Hôpital Bicêtre, AP HP, Université Paris Saclay, Paris, France
| | - Carine Wouters
- Division of Paediatric Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Angelo Ravelli
- RITA, European Reference Networks, Brussels, Belgium.,Department of Rheumatology, Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center and the Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicolaas M Wulffraat
- Department of Paediatric Immunology & Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,RITA, European Reference Networks, Brussels, Belgium
| | - Marloes W Heijstek
- RITA, European Reference Networks, Brussels, Belgium.,Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Veldkamp SR, Jansen MHA, Swart JF, Lindemans CA. Case Report: Lessons Learned From Subsequent Autologous and Allogeneic Hematopoietic Stem Cell Transplantations in a Pediatric Patient With Relapsing Polychondritis. Front Immunol 2022; 13:812927. [PMID: 35359992 PMCID: PMC8960202 DOI: 10.3389/fimmu.2022.812927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/10/2021] [Accepted: 02/17/2022] [Indexed: 12/29/2022] Open
Abstract
Background Autologous hematopoietic stem cell transplantation (autoHSCT) is increasingly being recognized as a treatment option for severe refractory autoimmune diseases (AD). However, efficacy is hampered by high relapse rates. In contrast, allogeneic HSCT (alloHSCT) has high potential to cure AD, but is associated with significant morbidity and mortality, and data in AD are limited. Experience with autoHSCT in relapsing polychondritis, a rare episodic inflammatory disorder characterized by destruction of cartilage, is scarce and alloHSCT has not been described before. Case Presentation Here, we present a case of a 9-year-old girl who was diagnosed with relapsing polychondritis, with severe airway involvement requiring a tracheostomy. The disease proved to be steroid-dependent and refractory to a wide array of disease-modifying anti-rheumatic drugs and biologicals. After an autoHSCT procedure, the disease became inactive for a short period of time, until the patient experienced a relapse after 31 days, accompanied by repopulation of effector/memory CD8+ T cells. Because of persistent inflammation and serious steroid toxicity, including severe osteoporosis, growth restriction, and excessive weight gain, the patient was offered an alloHSCT. She experienced transient antibody-mediated immune events post-alloHSCT, which subsided after rituximab. She ultimately developed a balanced immune reconstitution and is currently still in long-term disease remission, 8 years after alloHSCT. Conclusion This case adds to the few existing reports on autoHSCT in relapsing polychondritis and gives new insights in its pathogenesis, with a possible role for CD8+ T cells. Moreover, it is the first report of successful alloHSCT as a treatment for children with this severe autoimmune disease.
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Affiliation(s)
- Saskia R Veldkamp
- Center for Translational Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc H A Jansen
- Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joost F Swart
- Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Caroline A Lindemans
- Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Blood and Bone Marrow Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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10
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Bizjak M, Heshin-Bekenstein M, Jansen MHA, Ziv A, Angevare S, Uziel Y, Wulffraat NM, Toplak N. Vaccinology in pediatric rheumatology: Past, present and future. Front Pediatr 2022; 10:1098332. [PMID: 36704144 PMCID: PMC9872015 DOI: 10.3389/fped.2022.1098332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
With the introduction of biological disease-modifying antirheumatic drugs (bDMARDs), the treatment of pediatric patients with autoimmune/inflammatory rheumatic diseases (pedAIIRD) has advanced from the "Stone Age" to modern times, resulting in much better clinical outcomes. However, everything comes with a price, and use of new bDMARDs has resulted in an increased risk of infections. Therefore, preventing infections in pedAIIRD patients is one of the top priorities. The most effective preventive measure against infection is vaccination. The first study on humoral immunity after vaccination in pediatric rheumatology was published in 1974 and on safety in 1993. For many years, data about safety and immunogenicity in pedAIIRD patients were available only for non-live vaccines and the first studies on live-attenuated vaccines in pedAIIRD patients treated with immunosuppressive therapy were available only after 2007. Even today the data are limited, especially for children treated with bDMARDs. Vaccinations with non-live vaccines are nowadays recommended, although their long-term immunogenicity and efficacy in pedAIIRD patients are still under investigation. Vaccinations with live-attenuated vaccines are not universally recommended in immunosuppressed patients. However, measles-mumps-rubella booster and varicella zoster virus vaccination can be considered under specific conditions. Additional research is needed to provide more evidence on safety and immunogenicity, especially regarding live-attenuated vaccines in immunosuppressed patients with pedAIIRD. Due to the limited number of these patients, well-designed, prospective, international studies are needed. Further challenges were presented by the COVID-19 pandemic. This mini review article reviews past and present data and discusses the future of vaccinology in pediatric rheumatology.
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Affiliation(s)
- Masa Bizjak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Merav Heshin-Bekenstein
- Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marc H A Jansen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Amit Ziv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
| | - Saskya Angevare
- European Network for Children with Arthritis, Geneva, Switzerland.,KAISZ, Amsterdam, Netherlands
| | - Yosef Uziel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
| | - Nicolaas M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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11
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Lerkvaleekul B, Veldkamp SR, van der Wal MM, Schatorjé EJH, Kamphuis SSM, van den Berg JM, Muller PCEH, Armbrust W, Vastert SJ, Wienke J, Jansen MHA, van Royen-Kerkhof A, van Wijk F. Siglec-1 expression on monocytes is associated with the interferon signature in juvenile dermatomyositis and can predict treatment response. Rheumatology (Oxford) 2021; 61:2144-2155. [PMID: 34387304 PMCID: PMC9071568 DOI: 10.1093/rheumatology/keab601] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 02/22/2021] [Revised: 07/20/2021] [Indexed: 12/01/2022] Open
Abstract
Objective JDM is a rare chronic immune-mediated inflammatory disease with a predominant role for type I IFN responses. We aimed to determine the potential of Siglec-1 expression on monocytes as a novel IFN-inducible biomarker for disease activity monitoring and prediction of treatment response in patients with JDM. Methods Siglec-1 was measured by flow cytometry on circulating monocytes of 21 newly diagnosed JDM patients before start of treatment and, for 10 of these, also during follow-up. The expression levels of five type I IFN-stimulated genes, MX1, IFI44, IFI44L, LY6E and IFIT3, were measured by RT-qPCR to determine the IFN signature and calculate an IFN score. IFN-inducible plasma proteins CXCL10 and galectin-9 were measured by multiplex immunoassay. Results Siglec-1 and IFN score were increased in JDM patients compared with controls and correlated with clinical disease activity. Stratification of patients by Siglec-1 expression at diagnosis identified those with high Siglec-1 expression as having a higher risk of requiring treatment intensification within the first 3 months after diagnosis (55% vs 0% of patients, P = 0.01). Siglec-1 expression strongly correlated with plasma levels of previously validated biomarkers CXCL10 (rs = 0.81, P < 0.0001) and galectin-9 (rs = 0.83, P < 0.0001), and was superior to the IFN score in predicting treatment response (area under the curve 0.87 vs 0.53, P = 0.01). Conclusion Siglec-1 on monocytes is a novel IFN-inducible biomarker in JDM that correlates with clinical disease activity and identifies patients at risk for a suboptimal treatment response. Further studies are required to validate these findings and their clinical potential.
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Affiliation(s)
- Butsabong Lerkvaleekul
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saskia R Veldkamp
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maria M van der Wal
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ellen J H Schatorjé
- Department of Paediatrics, Paediatric Rheumatology, Amalia Children's Hospital, Radboud University Medical Centre Nijmegen, Nijmegen, the Netherlands
| | - Sylvia S M Kamphuis
- Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - J Merlijn van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Petra C E Hissink Muller
- Department of Paediatric Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wineke Armbrust
- Department of Pediatric Rheumatology and Immunology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sebastiaan J Vastert
- Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Judith Wienke
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc H A Jansen
- Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annet van Royen-Kerkhof
- Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Ter Haar NM, Jansen MHA, Frenkel JF, Vastert SJ. How autoinflammation may turn into autoimmune inflammation: Insights from monogenetic and complex IL-1 mediated auto-inflammatory diseases. Clin Immunol 2020; 219:108538. [PMID: 32681980 DOI: 10.1016/j.clim.2020.108538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 06/14/2020] [Accepted: 07/08/2020] [Indexed: 12/12/2022]
Abstract
IL-1 mediated auto-inflammatory diseases are characterised by episodes of unexplained fever, generalized and localized inflammation. The characteristic symptoms predominantly result from exaggerated activation of innate immune pathways. However, in some patients with typical IL-1 mediated diseases, chronic disease manifestations develop in the absence of acute inflammation, suggesting the involvement of adaptive immune pathways. We discuss clinical observations as well as novel insights in how chronic activation of innate immune pathways can lead to auto-immune disease features in patients with auto-inflammatory diseases and how we need to better understand these sequelae in order to improve treatment strategies.
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Affiliation(s)
- N M Ter Haar
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Center for Translational Immunology (CTI), University Medical Center Utrecht, Utrecht, the Netherlands
| | - M H A Jansen
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J F Frenkel
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S J Vastert
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Center for Translational Immunology (CTI), University Medical Center Utrecht, Utrecht, the Netherlands.
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13
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Veldhuijzen van Zanten SEM, El-Khouly FE, Jansen MHA, Bakker DP, Sanchez Aliaga E, Haasbeek CJA, Wolf NI, Zwaan CM, Vandertop WP, van Vuurden DG, Kaspers GJL. Correction to: A phase I/II study of gemcitabine during radiotherapy in children with newly diagnosed diffuse intrinsic pontine glioma. J Neurooncol 2017; 136:219-220. [PMID: 29063425 DOI: 10.1007/s11060-017-2636-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Table 2 of the original publication, there were errors in the baseline scores for the PedsQL TM 3.0 Cancer Module questionnaire, so a corrected version of Table 2 is shown in this erratum. In the subcategories of the PedsQL TM 3.0 Cancer Module questionnaire, nausea and fear of procedure did not score significantly lower after treatment compared to baseline. So, based on the corrected data in Table 2, there was no significant decrease in the total score of the cancer questionnaire, and this statement in the previous manuscript was incorrect.
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Affiliation(s)
| | - Fatma E El-Khouly
- Department of Pediatric Oncology ‑ Hematology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Pharmacology & Pharmacy, VU University Medical Center, Amsterdam, The Netherlands
| | - Marc H A Jansen
- Department of Pediatric Oncology ‑ Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Dewi P Bakker
- Department of Child Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther Sanchez Aliaga
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis J A Haasbeek
- Department of Radiotherapy, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole I Wolf
- Department of Child Neurology, VU University Medical Center, Amsterdam, The Netherlands.,Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - C Michel Zwaan
- Department of Pediatric Oncology ‑ Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - W Peter Vandertop
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Dannis G van Vuurden
- Department of Pediatric Oncology ‑ Hematology, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Pediatrics, Division of Oncology ‑ Hematology, VU University Medical Center, De Boelelaan 1117, Room 9D36, 1081 HV, Amsterdam, The Netherlands.
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology ‑ Hematology, VU University Medical Center, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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14
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Veldhuijzen van Zanten SEM, El-Khouly FE, Jansen MHA, Bakker DP, Sanchez Aliaga E, Haasbeek CJA, Wolf NI, Zwaan CM, Vandertop WP, van Vuurden DG, Kaspers GJL. A phase I/II study of gemcitabine during radiotherapy in children with newly diagnosed diffuse intrinsic pontine glioma. J Neurooncol 2017; 135:307-315. [PMID: 28748343 PMCID: PMC5663796 DOI: 10.1007/s11060-017-2575-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/16/2017] [Indexed: 01/17/2023]
Abstract
The purpose of this phase I/II, open-label, single-arm trial is to investigate the safety, tolerability, maximum tolerated dose and preliminary efficacy of the potential radiosensitizer gemcitabine, administered concomitantly to radiotherapy, in children with newly diagnosed diffuse intrinsic pontine glioma (DIPG). Six doses of weekly gemcitabine were administered intravenously, concomitantly to 6 weeks of hyperfractionated radiotherapy. Successive cohorts received increasing doses of 140, 175 and 200 mg/m2 gemcitabine, respectively, following a 3 + 3 dose-escalation schedule without expansion cohort. Dose-limiting toxicities (DLT) were monitored during treatment period. Clinical response was assessed using predefined case report forms and radiological response was assessed using the modified RANO criteria. Quality of life (QoL) was assessed using PedsQL questionnaires. Between June 2012 and December 2016, nine patients were enrolled. Treatment was well tolerated, and no DLTs were observed up to the maximum dose of 200 mg/m2. All patients experienced reduction of tumor-related symptoms. QoL tended to improve during treatment. PFS and MOS were 4.8 months (95% CI 4.0–5.7) and 8.7 months (95% CI 7.0–10.4). Classifying patients according to the recently developed DIPG survival prediction model, intermediate risk patients (n = 4), showed a PFS and MOS of 6.4 and 12.4 months, respectively, versus a PFS and MOS of 4.5 and 8.1 months, respectively, in high risk patient (n = 5). Gemcitabine up to 200 mg/m2/once weekly, added to radiotherapy, is safe and well tolerated in children with newly diagnosed DIPG. PFS and MOS were not significantly different from literature.
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Affiliation(s)
| | - Fatma E El-Khouly
- Department of Pediatric Oncology - Hematology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Pharmacology & Pharmacy, VU University Medical Center, Amsterdam, The Netherlands
| | - Marc H A Jansen
- Department of Pediatric Oncology - Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Dewi P Bakker
- Department of Child Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther Sanchez Aliaga
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis J A Haasbeek
- Department of Radiotherapy, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole I Wolf
- Department of Child Neurology, VU University Medical Center, Amsterdam, The Netherlands.,Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - C Michel Zwaan
- Department of Pediatric Oncology - Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - W Peter Vandertop
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Dannis G van Vuurden
- Department of Pediatric Oncology - Hematology, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Pediatrics, Division of Oncology - Hematology, VU University Medical Center, De Boelelaan 1117, Room 9D36, 1081 HV, Amsterdam, The Netherlands.
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology - Hematology, VU University Medical Center, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Jansen MHA, Lagerweij T, Sewing ACP, Vugts DJ, van Vuurden DG, Molthoff CFM, Caretti V, Veringa SJE, Petersen N, Carcaboso AM, Noske DP, Vandertop WP, Wesseling P, van Dongen GAMS, Kaspers GJL, Hulleman E. Bevacizumab Targeting Diffuse Intrinsic Pontine Glioma: Results of 89Zr-Bevacizumab PET Imaging in Brain Tumor Models. Mol Cancer Ther 2016; 15:2166-74. [PMID: 27325687 DOI: 10.1158/1535-7163.mct-15-0558] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 05/26/2016] [Indexed: 11/16/2022]
Abstract
The role of the VEGF inhibitor bevacizumab in the treatment of diffuse intrinsic pontine glioma (DIPG) is unclear. We aim to study the biodistribution and uptake of zirconium-89 ((89)Zr)-labeled bevacizumab in DIPG mouse models. Human E98-FM, U251-FM glioma cells, and HSJD-DIPG-007-FLUC primary DIPG cells were injected into the subcutis, pons, or striatum of nude mice. Tumor growth was monitored by bioluminescence imaging (BLI) and visualized by MRI. Seventy-two to 96 hours after (89)Zr-bevacizumab injections, mice were imaged by positron emission tomography (PET), and biodistribution was analyzed ex vivo High VEGF expression in human DIPG was confirmed in a publically available mRNA database, but no significant (89)Zr-bevacizumab uptake could be detected in xenografts located in the pons and striatum at an early or late stage of the disease. E98-FM, and to a lesser extent the U251-FM and HSJD-DIPG-007 subcutaneous tumors, showed high accumulation of (89)Zr-bevacizumab. VEGF expression could not be demonstrated in the intracranial tumors by in situ hybridization (ISH) but was clearly present in the perinecrotic regions of subcutaneous E98-FM tumors. The poor uptake of (89)Zr-bevacizumab in xenografts located in the brain suggests that VEGF targeting with bevacizumab has limited efficacy for diffuse infiltrative parts of glial brain tumors in mice. Translating these results to the clinic would imply that treatment with bevacizumab in patients with DIPG is only justified after targeting of VEGF has been demonstrated by (89)Zr-bevacizumab immuno-PET. We aim to confirm this observation in a clinical PET study with patients with DIPG. Mol Cancer Ther; 15(9); 2166-74. ©2016 AACR.
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Affiliation(s)
- Marc H A Jansen
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands
| | - Tonny Lagerweij
- Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands. Department of Neurosurgery VU University Medical Center and Academic Medical Center, Amsterdam, the Netherlands
| | - A Charlotte P Sewing
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands. Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands
| | - Danielle J Vugts
- Department of Radiology & Nuclear Medicine VU University Medical Center, Amsterdam, the Netherlands
| | - Dannis G van Vuurden
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands. Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands
| | - Carla F M Molthoff
- Department of Radiology & Nuclear Medicine VU University Medical Center, Amsterdam, the Netherlands
| | - Viola Caretti
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands. Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands. Departments of Neurology, Pediatrics and Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Susanna J E Veringa
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands. Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands
| | - Naomi Petersen
- Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands
| | - Angel M Carcaboso
- Preclinical Therapeutics and Drug Delivery Research Program, Department of Oncology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - David P Noske
- Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands. Department of Neurosurgery VU University Medical Center and Academic Medical Center, Amsterdam, the Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery VU University Medical Center and Academic Medical Center, Amsterdam, the Netherlands
| | - Pieter Wesseling
- Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands. Department of Pathology VU University Medical Center. Amsterdam, the Netherlands. Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guus A M S van Dongen
- Department of Radiology & Nuclear Medicine VU University Medical Center, Amsterdam, the Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands
| | - Esther Hulleman
- Department of Pediatrics, Pediatric Hematology and Oncology, Cancer Center, Amsterdam, the Netherlands. Neuro-oncology Research Group Cancer Center, Amsterdam, the Netherlands.
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16
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Veldhuijzen van Zanten SEM, van Meerwijk CLLI, Jansen MHA, Twisk JWR, Anderson AK, Coombes L, Breen M, Hargrave OJ, Hemsley J, Craig F, Cruz O, Kaspers GJL, van Vuurden DG, Hargrave DR. Palliative and end-of-life care for children with diffuse intrinsic pontine glioma: results from a London cohort study and international survey. Neuro Oncol 2015; 18:582-8. [PMID: 26459800 DOI: 10.1093/neuonc/nov250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 07/12/2015] [Accepted: 09/04/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND More than 90% of patients with diffuse intrinsic pontine glioma (DIPG) will die within 2 years of diagnosis. Patients deteriorate rapidly during the disease course, which severely impairs their quality of life. To date, no specific research on this clinically important subject has been conducted. This study aimed to compile an inventory of symptoms experienced, interventions applied, and current service provision in end-of-life care for DIPG. METHODS We performed a retrospective cohort study of children with DIPG, aged 0-18 years, who received treatment under the care of 2 London hospitals. Symptoms, interventions, and services applied during the 12 weeks before death were analyzed. In addition, we conducted a global questionnaire-study among health care professionals. RESULTS In more than 78% of DIPG patients, problems concerning mobility, swallowing, communication, consciousness, and breathing arose during end-stage disease. Supportive drugs were widely prescribed. The use of medical aids was only documented in <15% of patients. Palliative and end-of-life care was mostly based on the health care professional's experience; only 21% of the questionnaire respondents reported to have a disease-specific palliative care guideline available. CONCLUSIONS This research assessed the current state of palliative and end-of-life care for children with DIPG. Our results show the variability and complexity of symptoms at end-stage disease and the current lack of disease-specific guidelines for this vulnerable group of patients. This first descriptive paper is intended to act as a solid basis for developing an international clinical trial and subsequent guideline to support high-quality palliative and end-of-life care.
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Affiliation(s)
- Sophie E M Veldhuijzen van Zanten
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Charlotte L L I van Meerwijk
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Marc H A Jansen
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Jos W R Twisk
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Anna-Karenia Anderson
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Lucy Coombes
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Maggie Breen
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Olivia J Hargrave
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - June Hemsley
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Finella Craig
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Ofelia Cruz
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Gertjan J L Kaspers
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Dannis G van Vuurden
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
| | - Darren R Hargrave
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center Amsterdam, Netherlands (S.E.M.V.v.Z., C.L.L.I.v.M., M.H.A.J., G.J.L.K., D.G.v.V.); Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Netherlands (J.W.R.T.); Paediatrics Unit, Royal Marsden NHS Foundation Trust, Sutton, UK (A.-K.A., L.C., M.B.); Department of Oncology, Great Ormond Street Hospital, London, UK (O.J.H., J.H., F.C., D.R.H.); Department of Pediatric Oncology, Hospital Sant Joan de Déu, Barcelona, Spain (O.C.)
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Veldhuijzen van Zanten SEM, Jansen MHA, Sanchez Aliaga E, van Vuurden DG, Vandertop WP, Kaspers GJL. A twenty-year review of diagnosing and treating children with diffuse intrinsic pontine glioma in The Netherlands. Expert Rev Anticancer Ther 2014; 15:157-64. [PMID: 25435089 DOI: 10.1586/14737140.2015.974563] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Children with diffuse intrinsic pontine glioma (DIPG) face a dismal prognosis, with a median overall survival of 9 months. Our aims are to determine the incidence of DIPG in the Netherlands and to identify points for improvement in clinical research, a prerequisite for increasing the chance to find a cure. METHODS We performed a population-based retrospective cohort study by evaluating all children diagnosed with DIPG in the Netherlands between 1990 and 2010. RESULTS The incidence of DIPG in the Netherlands corresponds with international literature. Between 1990 and 2010, a large heterogeneity of treatment schedules was applied and only a minority of patients was included in clinical trials. DISCUSSION Given the rarity of DIPG, we emphasize the need for (inter-)national trials to facilitate the identification of potentially effective therapeutics in the future. This can be supported by the recent development of a European DIPG registry enabling international study collaborations.
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Affiliation(s)
- Sophie E M Veldhuijzen van Zanten
- Department of Pediatrics, Division of Oncology/Hematology, VU University Medical Center, De Boelelaan 1118, Room KTC4.027, 1081 HZ Amsterdam, The Netherlands
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18
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Sewing ACP, Caretti V, Lagerweij T, Schellen P, Jansen MHA, van Vuurden DG, Idema S, Molthoff CFM, Vandertop WP, Kaspers GJL, Noske DP, Hulleman E. Convection enhanced delivery of carmustine to the murine brainstem: a feasibility study. J Neurosci Methods 2014; 238:88-94. [PMID: 25263805 DOI: 10.1016/j.jneumeth.2014.09.020] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Systemic delivery of therapeutic agents remains ineffective against diffuse intrinsic pontine glioma (DIPG), possibly due to an intact blood-brain-barrier (BBB) and to dose-limiting toxicity of systemic chemotherapeutic agents. Convection-enhanced delivery (CED) into the brainstem may provide an effective local delivery alternative for DIPG patients. NEW METHOD The aim of this study is to develop a method to perform CED into the murine brainstem and to test this method using the chemotherapeutic agent carmustine (BiCNU). To this end, a newly designed murine CED catheter was tested in vitro and in vivo. After determination of safety and distribution, mice bearing VUMC-DIPG-3 and E98FM-DIPG brainstem tumors were treated with carmustine dissolved in DW 5% or carmustine dissolved in 10% ethanol. RESULTS Our results show that CED into the murine brainstem is feasible and well tolerated by mice with and without brainstem tumors. CED of carmustine dissolved in 5% DW increased median survival of mice with VUMC-DIPG-3 and E98FM-DIPG tumors with 35% and 25% respectively. Dissolving carmustine in 10% ethanol further improved survival to 45% in mice with E98FM-DIPG tumors. COMPARISON WITH EXISTING METHODS Since genetically engineered and primary DIPG models are currently only available in mice, murine CED studies have clear advantages over CED studies in other animals. CONCLUSION CED in the murine brainstem can be performed safely, is well tolerated and can be used to study efficacy of chemotherapeutic agents orthotopically. These results set the foundation for more CED studies in murine DIPG models.
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Affiliation(s)
- A Charlotte P Sewing
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Viola Caretti
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Tonny Lagerweij
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Pepijn Schellen
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Marc H A Jansen
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Dannis G van Vuurden
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Sander Idema
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Carla F M Molthoff
- Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - David P Noske
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther Hulleman
- Department of Pediatric Oncology, VU University Medical Center, Amsterdam, The Netherlands; Neuro-oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands.
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Caretti V, Sewing ACP, Lagerweij T, Schellen P, Bugiani M, Jansen MHA, van Vuurden DG, Navis AC, Horsman I, Vandertop WP, Noske DP, Wesseling P, Kaspers GJL, Nazarian J, Vogel H, Hulleman E, Monje M, Wurdinger T. Human pontine glioma cells can induce murine tumors. Acta Neuropathol 2014; 127:897-909. [PMID: 24777482 DOI: 10.1007/s00401-014-1272-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [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] [Received: 11/07/2012] [Revised: 03/07/2014] [Accepted: 03/20/2014] [Indexed: 01/12/2023]
Abstract
Diffuse intrinsic pontine glioma (DIPG), with a median survival of only 9 months, is the leading cause of pediatric brain cancer mortality. Dearth of tumor tissue for research has limited progress in this disease until recently. New experimental models for DIPG research are now emerging. To develop preclinical models of DIPG, two different methods were adopted: cells obtained at autopsy (1) were directly xenografted orthotopically into the pons of immunodeficient mice without an intervening cell culture step or (2) were first cultured in vitro and, upon successful expansion, injected in vivo. Both strategies resulted in pontine tumors histopathologically similar to the original human DIPG tumors. However, following the direct transplantation method all tumors proved to be composed of murine and not of human cells. This is in contrast to the indirect method that included initial in vitro culture and resulted in xenografts comprising human cells. Of note, direct injection of cells obtained postmortem from the pons and frontal lobe of human brains not affected by cancer did not give rise to neoplasms. The murine pontine tumors exhibited an immunophenotype similar to human DIPG, but were also positive for microglia/macrophage markers, such as CD45, CD68 and CD11b. Serial orthotopic injection of these murine cells results in lethal tumors in recipient mice. Direct injection of human DIPG cells in vivo can give rise to malignant murine tumors. This represents an important caveat for xenotransplantation models of DIPG. In contrast, an initial in vitro culture step can allow establishment of human orthotopic xenografts. The mechanism underlying this phenomenon observed with direct xenotransplantation remains an open question.
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Affiliation(s)
- Viola Caretti
- Departments of Neurology, Neurosurgery and Pediatrics, Stanford University School of Medicine, Stanford, USA,
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Jansen MHA, Kloet RW, van Vuurden DG, Veldhuijzen van Zanten SE, Witte BI, Goldman S, Vandertop WP, Comans EF, Hoekstra OS, Boellaard R, Kaspers GJJ. 18 F-FDG PET standard uptake values of the normal pons in children: establishing a reference value for diffuse intrinsic pontine glioma. EJNMMI Res 2014; 4:8. [PMID: 24472395 PMCID: PMC3910228 DOI: 10.1186/2191-219x-4-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET) scanning with [18 F]fluorodeoxyglucose (18 F-FDG) is a useful diagnostic and prediction tool in brain tumors, but its value in childhood diffuse intrinsic pontine glioma (DIPG) is still unclear. For interpretation of 18 F-FDG PET results in DIPG, uptake values of the normal pons of children of increasing ages are mandatory. The aim of this study was to determine 18 F-FDG standard uptake value ratios (SUVr) of the normal pons and to compare these to those of DIPG. METHODS We studied 36 subjects with a normal, non-affected pons (aged 5 to 23 years) and 6 patients with DIPG (aged 4 to 17 years) who underwent 18 F-FDG PET scanning. Magnetic resonance imaging (MRI) was co-registered to define the regions of interest. SUVr and SUVrmax for the pons/cerebellum (SUVrp/c) and the pons/occipital lobe (SUVrp/o) were calculated. Independent-samples t tests and Mann-Whitney U tests were used to compare the mean SUVr and Pearson's test for correlations. RESULTS For the normal pons, mean SUVrp/c and SUVrp/o were 0.65 (±0.054) and 0.51 (±0.056), respectively. No significant correlations were found between the SUVr of the normal pons and sex, age, nor pontine volume. A modest but statistically significant correlation was found between SUVr and post-injection time acquisition timing. For DIPG, mean SUVrp/c and SUVrp/o were 0.74 (±0.20) and 0.65 (±0.30), respectively, while mean SUVrp(max)/c and SUVrp(max)/o were 1.95 (±0.48) and 1.81 (±0.20), respectively. CONCLUSION The SUVr of the unaffected pons are strikingly constant between children, irrespective of sex and age, and can therefore be well used as a reference value for 18 F-FDG PET studies in DIPG.
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Affiliation(s)
- Marc H A Jansen
- Division of Oncology and Hematology, Department of Pediatrics, VU University Medical Center, De Boelelaan 1118, Amsterdam 1007 MB, the Netherlands.
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Caretti V, Jansen MHA, van Vuurden DG, Lagerweij T, Bugiani M, Horsman I, Wessels H, van der Valk P, Cloos J, Noske DP, Vandertop WP, Wesseling P, Wurdinger T, Hulleman E, Kaspers GJL. Implementation of a multi-institutional diffuse intrinsic pontine glioma autopsy protocol and characterization of a primary cell culture. Neuropathol Appl Neurobiol 2013; 39:426-36. [PMID: 22845849 DOI: 10.1111/j.1365-2990.2012.01294.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS Diffuse intrinsic pontine glioma (DIPG) is a fatal paediatric malignancy. Tumour resection is not possible without serious morbidity and biopsies are rarely performed. The resulting lack of primary DIPG material has made preclinical research practically impossible and has hindered the development of new therapies for this disease. The aim of the current study was to address the lack of primary DIPG material and preclinical models by developing a multi-institutional autopsy protocol. METHODS An autopsy protocol was implemented in the Netherlands to obtain tumour material within a brief post mortem interval. A team of neuropathologists and researchers was available at any time to perform the autopsy and process the material harvested. Whole brain autopsy was performed and primary DIPG material and healthy tissue were collected from all affected brain areas. Finally, the study included systematic evaluation by parents. RESULTS Five autopsies were performed. The mean time interval between death and time of autopsy was 3 h (range 2-4). All tumours were graded as glioblastoma. None of the parents regretted their choice to participate, and they all derived comfort in donating tissue of their child in the hope to help future DIPG patients. In addition, we developed and characterized one of the first DIPG cell cultures from post mortem material. CONCLUSION Here we show that obtaining post mortem DIPG tumour tissue for research purposes is feasible with short delay, and that the autopsy procedure is satisfying for participating parents and can be suitable for the development of preclinical DIPG models.
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Affiliation(s)
- V Caretti
- Department of Pediatric Oncology, VU University Medical Center, 1081 HZ Amsterdam, The Netherlands
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Veringa SJE, Biesmans D, van Vuurden DG, Jansen MHA, Wedekind LE, Horsman I, Wesseling P, Vandertop WP, Noske DP, Kaspers GJL, Hulleman E. In vitro drug response and efflux transporters associated with drug resistance in pediatric high grade glioma and diffuse intrinsic pontine glioma. PLoS One 2013; 8:e61512. [PMID: 23637844 PMCID: PMC3639279 DOI: 10.1371/journal.pone.0061512] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 03/09/2013] [Indexed: 12/04/2022] Open
Abstract
Pediatric high-grade gliomas (pHGG), including diffuse intrinsic pontine gliomas (DIPG), are the leading cause of cancer-related death in children. While it is clear that surgery (if possible), and radiotherapy are beneficial for treatment, the role of chemotherapy for these tumors is still unclear. Therefore, we performed an in vitro drug screen on primary glioma cells, including three DIPG cultures, to determine drug sensitivity of these tumours, without the possible confounding effect of insufficient drug delivery. This screen revealed a high in vitro cytotoxicity for melphalan, doxorubicine, mitoxantrone, and BCNU, and for the novel, targeted agents vandetanib and bortezomib in pHGG and DIPG cells. We subsequently determined the expression of the drug efflux transporters P-gp, BCRP1, and MRP1 in glioma cultures and their corresponding tumor tissues. Results indicate the presence of P-gp, MRP1 and BCRP1 in the tumor vasculature, and expression of MRP1 in the glioma cells themselves. Our results show that pediatric glioma and DIPG tumors per se are not resistant to chemotherapy. Treatment failure observed in clinical trials, may rather be contributed to the presence of drug efflux transporters that constitute a first line of drug resistance located at the blood-brain barrier or other resistance mechanism. As such, we suggest that alternative ways of drug delivery may offer new possibilities for the treatment of pediatric high-grade glioma patients, and DIPG in particular.
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Affiliation(s)
- Susanna J. E. Veringa
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Dennis Biesmans
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Dannis G. van Vuurden
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
| | - Marc H. A. Jansen
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Laurine E. Wedekind
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Ilona Horsman
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Pieter Wesseling
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - David P. Noske
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurosurgery, VU University Medical Center, Amsterdam, The Netherlands
| | - GertJan J. L. Kaspers
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Esther Hulleman
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neuro-Oncology Research Group, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
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