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Prepok FF, Schnabel KK, Sumánszki C, Barta AG, Tislér A, Reismann P. Long-Term Renal Function in Adult Patients with Phenylketonuria. Nephron Clin Pract 2023; 148:195-203. [PMID: 37757776 DOI: 10.1159/000531913] [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: 12/27/2022] [Accepted: 07/04/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION In phenylketonuria (PKU), toxic phenylalanine (Phe) can harm other organs beyond the brain. Furthermore, the lifelong therapy of PKU consists of consumption of increased amounts of amino-acid mixture that provoke hyperfiltration in the glomeruli. Therefore, the adherence to therapy in PKU might influence the long-term kidney function in PKU patients. METHODS Data from 41 adult, early treated PKU patients were analyzed in this 10-year, retrospective, monocentric study. Two subgroups were created according to their therapy adherence: one with long-term blood Phe levels in the therapeutic range (<600 µmol/L), and one with suboptimal blood Phe levels. Renal function and metabolic parameters were collected over 10 years. Kidney function parameters were compared between the two groups and associations between blood Phe levels and kidney function were tested. RESULTS After 10 years, serum creatinine levels (p = 0.369) and estimated glomerular filtration rate (eGFR) (p = 0.723) did not change significantly from baseline in the good therapeutic group. The suboptimal therapeutic group's eGFR decreased in the same period (from 110.4 ± 14 mL/min/1.73 m2 to 94.2 ± 16 mL/min/1.73 m2, p = 0.017). At 10 years, the suboptimal therapeutic group had an increased serum creatinine level (81 ± 14.4 μmol/L vs. 71.5 ± 13 μmol/L, p = 0.038), and a decreased eGFR (94.2 ± 16 mL/min/1.73 m2 vs. 103.3 ± 13 mL/min/1.73 m2p = 0.031) compared to the good adhering group. Significant negative correlation between Phe levels and eGFR (r = -0.41, p = 0.008) was observed. CONCLUSION Long-term suboptimal therapy adherence in PKU patients with high blood Phe levels may lead to deterioration in kidney function.
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Affiliation(s)
| | | | - Csaba Sumánszki
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - András Gellért Barta
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - András Tislér
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Péter Reismann
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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Maissen-Abgottspon S, Muri R, Hochuli M, Reismann P, Barta AG, Alptekin IM, Hermida-Ameijeiras Á, Burlina AP, Burlina AB, Cazzorla C, Carretta J, Trepp R, Everts R. Health-related quality of life in a european sample of adults with early-treated classical PKU. Orphanet J Rare Dis 2023; 18:300. [PMID: 37740225 PMCID: PMC10517574 DOI: 10.1186/s13023-023-02917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Phenylketonuria (PKU) is a rare inborn error of metabolism affecting the catabolism of phenylalanine (Phe). To date, findings regarding health-related quality of life (HRQoL) in adults with early-treated classical PKU are discrepant. Moreover, little is known about metabolic, demographic, and cognitive factors associated with HRQoL. Hence, we aimed to investigate HRQoL and its association with demographic, metabolic, and cognitive characteristics in a large European sample of adults with early-treated classical PKU. RESULTS This cross-sectional study included 124 adults with early-treated classical PKU from Hungary, Italy, Spain, Switzerland, and Turkey. All participants prospectively completed the PKU quality of life questionnaire (PKU-QoL), a questionnaire specifically designed to evaluate the impact of PKU and its treatment on HRQoL in individuals with PKU. In addition, information about Phe levels (concurrent and past year), demographic (age and sex), and cognitive variables (intelligence quotient, IQ) were collected. Most domains revealed little or no impact of PKU on HRQoL and more than three-quarters of the patients rated their health status as good, very good, or excellent. Nevertheless, some areas of concern for patients were identified. Patients were worried about the guilt that they experience if they do not adhere to the dietary protein restriction and they were most concerned about high Phe levels during pregnancy. Further, tiredness was the most affected symptom, and the supplements' taste was considered a main issue for individuals with PKU. The overall impact of PKU on HRQoL was higher in women (U = 1315.5, p = .012) and in adults with a lower IQ (rs = - 0.448, p = .005). The overall impact of dietary protein restriction was higher in adults with higher concurrent Phe levels (rs = 0.272, p = .007) and higher Phe levels during the past year (rs = 0.280, p = .009). CONCLUSION The impact of PKU on most domains assessed in the PKU-QoL was considered to be low. These results likely reflect the successful implementation of the newborn screening resulting in the prevention of severe adverse long-term outcomes. However, a particular clinical focus should be given to patients with lower IQ, higher Phe levels, and women, as these variables were associated with a lower HRQoL.
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Affiliation(s)
- Stephanie Maissen-Abgottspon
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raphaela Muri
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Support Center for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Michel Hochuli
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Péter Reismann
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - András Gellért Barta
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Ismail Mucahit Alptekin
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara University, Ankara, Turkey
| | - Álvaro Hermida-Ameijeiras
- Division of Internal Medicine, European Reference Network for Hereditary Metabolic Disorders (MetabERN), University Clinical Hospital, Santiago de Compostela, Spain
| | | | - Alberto B Burlina
- Division of Inborn Metabolic Diseases, Department of Pediatrics, University Hospital, Padua, Italy
| | - Chiara Cazzorla
- Division of Inborn Metabolic Diseases, Department of Pediatrics, University Hospital, Padua, Italy
| | - Jessica Carretta
- Neurological Unit, St. Bassiano Hospital, Bassano del Grappa, Italy
| | - Roman Trepp
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Regula Everts
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Division of Neuropediatrics, Development and Rehabilitation, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Tőke J, Uhlyarik A, Lohinszky J, Stark J, Huszty G, Micsik T, Borka K, Reismann P, Horányi J, Igaz P, Tóth M. Prognostic factors and mitotane treatment of adrenocortical cancer. Two decades of experience from an institutional case series. Front Endocrinol (Lausanne) 2022; 13:952418. [PMID: 36246926 PMCID: PMC9560769 DOI: 10.3389/fendo.2022.952418] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to characterise the clinicopathological features and prognostic factors of a large cohort of Hungarian patients with adrenocortical cancer diagnosed between 2000-2021. PATIENTS AND METHODS This retrospective study included seventy-four patients (27 men and 47 women) with histologically confirmed adrenocortical cancer in a single tertiary referral endocrine centre. Descriptive statistics were performed, providing summaries of selected clinical and pathological parameters. Clinicopathological factors contributing to overall survival were analysed. RESULTS The median age of patients was 48,5 years (17-84 years) at diagnosis. The majority of cases were diagnosed at ENSAT stage II (39,2%) and stage IV (33,8%). At diagnosis, the median tumour size was 9,0 cm (4,5-20 cm). In 47 patients (71,6%), the tumour was hormonally active. The median overall survival and the 5-year survival rate were 23,5 months (95% CI, 17-30,5 months) and 18,3%, respectively. Primary tumour resection was performed in 68 patients (91,8%); R0 surgical resection was achieved in 30 patients. In univariate Cox regression model, tumours with stages III and IV, high proliferative activity (Ki67-index > 10%), R1-R2 surgical resection state and hormonal activity were associated with poorer survival. Cortisol excess, both isolated and combined with androgen production, was associated with poorer survival. Fifty-five patients were treated with mitotane. The overall survival of patients achieving therapeutic mitotane plasma concentration was significantly better compared to those who never reached it [27.0 (2-175) months vs 18.0 (2-83) months; p<0.05)]. The median age, the distribution of gender, ENSAT stage, resection state and Ki67-index did not differ between these two groups. The time needed to reach the therapeutic range of serum mitotane was 96.5 days (95% CI, 75-133 days). CONCLUSION Our results confirm previous data that disease stage, mitotic activity, the resection state and the mitotane treatment achieving therapeutic concentration are the most critical parameters influencing the prognosis of adrenocortical cancer. Our data suggest that hormonal activity may be more frequent than described previously, and it is a strong and independent prognostic factor of overall survival. To our knowledge, this is the first single-centre study confirming the prognostic importance of achieving therapeutic mitotane concentration.
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Affiliation(s)
- Judit Tőke
- Department of Internal Medicine and Oncology, European Reference Network on Rare Endocrine Conditions (ENDO-ERN) Health Care Provider (HCP), Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Andrea Uhlyarik
- Department of Internal Medicine and Oncology, European Reference Network on Rare Endocrine Conditions (ENDO-ERN) Health Care Provider (HCP), Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Júlia Lohinszky
- Department of Internal Medicine and Haematology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Júlia Stark
- Department of Internal Medicine and Oncology, European Reference Network on Rare Endocrine Conditions (ENDO-ERN) Health Care Provider (HCP), Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gergely Huszty
- Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Micsik
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Borka
- Department of Pathology, Forensic and Insurance Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Reismann
- Department of Internal Medicine and Oncology, European Reference Network on Rare Endocrine Conditions (ENDO-ERN) Health Care Provider (HCP), Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - János Horányi
- Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Igaz
- Department of Internal Medicine and Oncology, European Reference Network on Rare Endocrine Conditions (ENDO-ERN) Health Care Provider (HCP), Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Endocrinology, European Network for the Study of Adrenal Tumours (ENS@T) Research Center of Excellence, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Magyar Tudományos Akadémia-Semmelweis Egyetem (MTA-SE) Molecular Medicine Research Group, Eötvös Loránd Research Network, Budapest, Hungary
| | - Miklós Tóth
- Department of Internal Medicine and Oncology, European Reference Network on Rare Endocrine Conditions (ENDO-ERN) Health Care Provider (HCP), Faculty of Medicine, Semmelweis University, Budapest, Hungary
- *Correspondence: Miklós Tóth,
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Barta AG, Becsei D, Kiss E, Sumánszki C, Simonová E, Reismann P. The Impact of Phenylketonuria on Body Composition in Adults. Ann Nutr Metab 2021; 78:98-105. [PMID: 34872082 DOI: 10.1159/000520047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients with phenylketonuria (PKU) must follow a lifelong phenylalanine (Phe)-restricted diet with additional amino acid supplementations, and this may put them at risk for nutritional disturbances. However, the body composition and nutritional status of adult patients with PKU has only been partially explored. The current study aims to assess the body composition of adult patients with PKU using multifrequency bioimpedance analysis (MF-BIA) and to reveal potential correlations between therapy adherence and body composition. Additionally, we compared body composition of patients with healthy controls. METHODS Fifty adult patients with early-treated PKU (27 female and 23 male) and 40 healthy, age- and gender-matched controls were included in this single-center, cross-sectional study. MF-BIA was performed on all subjects. Additionally, we determined serum nutritional markers for all patients. In the PKU patient group, correlation analyses were performed between body composition parameters and therapy adherence. We compared body composition of patients with PKU and controls using BIA. RESULTS The proportion of overweight was 56% among all patients with PKU. Female patients with PKU had significantly higher body fat percentage compared with controls. In parallel with higher fat content, we observed lower muscle mass, protein, and mineral content among female patients with PKU compared to controls. Such findings were not observed in male patients. Female patients with PKU had decreased therapy adherence and had significantly lower prealbumin levels compared with males. There was no significant correlation observed between body composition parameters and therapy adherence over the last 10 years in the PKU patient group. CONCLUSION Although female patients had less optimal therapy adherence over the last 10 years compared with male patients, our results suggest that this does not influence body composition fundamentally. Our results suggest that obesity is an important comorbidity in young adult patients with PKU, especially in females. We advocate that nutritional assessments and weight management should be additional objectives of PKU management to provide optimal care.
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Affiliation(s)
- András Gellért Barta
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary,
| | - Dóra Becsei
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Erika Kiss
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Csaba Sumánszki
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Erika Simonová
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Péter Reismann
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
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Tőke J, Jakab Z, Stark J, Huszty G, Reismann P, Tóth M. Complete Remission of Advanced Adrenocortical Cancer Following Mitotane Monotherapy: A Case Report and Literature Review of Predictive Markers. Front Oncol 2021; 11:680853. [PMID: 34046364 PMCID: PMC8144642 DOI: 10.3389/fonc.2021.680853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Mitotane has been used for the treatment of adrenocortical cancer (ACC) for over 50 years. Despite its widespread use both in monotherapy and in combination with chemotherapeutics, our knowledge of its mechanism of action and therapeutic efficacy is scarce. The number of patients with advanced ACC who have achieved complete remission documented by detailed clinical data is below ten. We report a case of a 64-year-old woman with a non-functional ACC. Histological examination showed vascular invasion, Ki67 of 10% and a mitotic count of 3/10 high-power field. Immunohistochemistry revealed p53 positivity. Pathological TNM grade was reported as T2N0M0, ENSAT stage 2. Nine months after the initial diagnosis, re-staging CT revealed multiple peritoneal nodules, lymph node and kidney metastases confirmed by histologic examination. Mitotane monotherapy was started with a maintenance dose between 2.0 and 2.5 grams/day. Partial remission was established at six months. Subsequently, for another 12 months, each of the three-monthly CT scans confirmed complete remission. Nineteen months after the initiation of mitotane, an unexpected sudden death occurred. A detailed autopsy work-up, performed in the full awareness of oncological history, confirmed complete remission. The authors review the molecular biomarkers and clinical features reported as predictors of response to mitotane monotherapy.
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Affiliation(s)
- Judit Tőke
- Department of Internal Medicine and Oncology, ENDO-ERN HCP, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Jakab
- Department of Internal Medicine and Oncology, ENDO-ERN HCP, Semmelweis University, Budapest, Hungary
| | - Júlia Stark
- Department of Internal Medicine and Oncology, ENDO-ERN HCP, Semmelweis University, Budapest, Hungary
| | - Gergely Huszty
- Department for Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Reismann
- Department of Internal Medicine and Oncology, ENDO-ERN HCP, Semmelweis University, Budapest, Hungary
| | - Miklós Tóth
- Department of Internal Medicine and Oncology, ENDO-ERN HCP, Semmelweis University, Budapest, Hungary
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Huszty G, Doros A, Farkas K, Kóbori L, Reismann P, Tőke J, Tóth M, Igaz P. Case Report: Complete Necrosis of a Large Adrenocortical Cancer and Liver Metastases Achieved by Selective Arterial Embolization: A Case Study and Review of Literature. Front Endocrinol (Lausanne) 2021; 12:677187. [PMID: 33995288 PMCID: PMC8121102 DOI: 10.3389/fendo.2021.677187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022] Open
Abstract
There is very limited experience regarding the interventional radiological treatment of adrenocortical cancer (ACC). We present the case of a 57-year-old female patient with a large, potentially unresectable left-sided ACC and two hepatic metastases. Both liver tumors were effectively treated by trans-arterial embolization (TAE), followed by TAE of the bulky primary tumor as a life-saving intervention necessitated by severe intratumoral bleeding. Surgical removal of the primary tumor revealed complete necrosis. The patient is considered tumor free after 3.5 years. To the best of our knowledge, this is the first report to show that even a primary ACC may be completely ablated by selective embolization, and the fourth to prove the curative potential of liver TAE for ACC metastases. This case highlights the potential of selective embolization in ACC treatment.
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Affiliation(s)
- Gergely Huszty
- Department of Transplantation and Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- *Correspondence: Gergely Huszty,
| | - Attila Doros
- Department of Transplantation and Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Farkas
- Department of Transplantation and Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - László Kóbori
- Department of Transplantation and Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Reismann
- Department of Endocrinology and Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Internal Medicine and Oncology, European Reference Network for Rare Endocrine Diseases Health Care Provider (ENDO-ERN HCP), Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Judit Tőke
- Department of Endocrinology and Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Internal Medicine and Oncology, European Reference Network for Rare Endocrine Diseases Health Care Provider (ENDO-ERN HCP), Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Miklós Tóth
- Department of Endocrinology and Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Internal Medicine and Oncology, European Reference Network for Rare Endocrine Diseases Health Care Provider (ENDO-ERN HCP), Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Igaz
- Department of Endocrinology and Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Internal Medicine and Oncology, European Reference Network for Rare Endocrine Diseases Health Care Provider (ENDO-ERN HCP), Faculty of Medicine, Semmelweis University, Budapest, Hungary
- MTA-SE Molecular Medicine Research Group, Eotvos Lorand Research Network, Budapest, Hungary
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Doros A, Reismann P, Huszty G, Somogyi D, Mohos G, Szabó T, Tőzsér G, Deák PÁ. Treatment of benign thyroid nodules by radiofrequency thermal ablation. Orv Hetil 2020; 161:1131-1136. [PMID: 32564004 DOI: 10.1556/650.2020.31726] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Benign thyroid nodules are frequent findings in imaging studies, most of the time not requiring any intervention. Treatment is usually started when nodules increase in size, the patient becomes symptomatic or clinically relevant hyperthyroidism develops. Thermoablation is an effective alternative modality. In Hungary, our team has pioneered these interventions using radiofrequency ablation for decreasing the size of the nodules. AIM We are presenting our results showing the effectiveness of this treatment after introducing the role, importance and technique of thermoablation in benign thyroid nodules. METHOD Between June of 2016 and September of 2019, 186 nodules of 140 patients were treated with radiofrequency ablation and had at least 6 months of follow up. The volume and diameter of all the ablated nodules were measured and calculated, then the decreases of these parameters were followed using ultrasonography. The mean follow-up time was 12.5 ± 5.9 months. RESULTS The size measurements at the follow-up ultrasonography examinations showed a decrease in size and vascularity. The mean volume reduction was 44.7 ± 17.6% at one-month post-treatment and 72.9 ± 17.9% at 6 months. There were 3 minor complications. CONCLUSIONS Radiofrequency ablation represents a feasible, effective, well tolerated method for outpatient treatment of benign thyroid nodules. This method is a valuable alternative to surgical treatments in selected cases. Orv Hetil. 2020; 161(27): 1131-1136.
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Affiliation(s)
- Attila Doros
- Általános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika,Semmelweis Egyetem, Budapest, Baross u. 23-25., 1082.,Premier Med Egészségközpont, Budapest
| | - Péter Reismann
- Általános Orvostudományi Kar, II. Belgyógyászati Klinika,Semmelweis Egyetem, Budapest
| | - Gergely Huszty
- Általános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika,Semmelweis Egyetem, Budapest, Baross u. 23-25., 1082
| | - Dóra Somogyi
- Általános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika,Semmelweis Egyetem, Budapest, Baross u. 23-25., 1082
| | - Gábor Mohos
- Általános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika,Semmelweis Egyetem, Budapest, Baross u. 23-25., 1082
| | - Tamás Szabó
- Általános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika,Semmelweis Egyetem, Budapest, Baross u. 23-25., 1082.,Premier Med Egészségközpont, Budapest
| | - Gellért Tőzsér
- Általános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika,Semmelweis Egyetem, Budapest, Baross u. 23-25., 1082.,Premier Med Egészségközpont, Budapest
| | - Pál Ákos Deák
- Általános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika,Semmelweis Egyetem, Budapest, Baross u. 23-25., 1082.,Premier Med Egészségközpont, Budapest
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Barta AG, Sumánszki C, Turgonyi Z, Kiss E, Simon E, Serfőző C, Reismann P. Health Related Quality of Life assessment among early-treated Hungarian adult PKU patients using the PKU-QOL adult questionnaire. Mol Genet Metab Rep 2020; 23:100589. [PMID: 32346514 PMCID: PMC7183227 DOI: 10.1016/j.ymgmr.2020.100589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/27/2022] Open
Abstract
Background: The implementation of neonatal screening and the early initiation of lifelong therapy have helped to prevent severe complications and enabled much more favorable outcomes for early-treated phenylketonuria (ETPKU) patients. However, PKU patients tend to develop subtle cognitive and psychosocial abnormalities and the strict dietary therapy can present financial and social burden. Thus, PKU is expected to affect the quality of life (QoL) of these patients. There is insufficient evidence regarding the relationship between metabolic control and Health-Related QoL (HRQoL). We aimed to assess the effect of short- and long-term therapy on QoL among Hungarian adult PKU patients using the standardized PKU-specific PKU-QoL questionnaire. Methods: We conducted a single-centre, cross-sectional, observational study in Hungary. We included adult PKU patients treated with diet and amino acid supplements only. Patients reported HRQoL using the standardized adult PKU-QoL questionnaire and mean blood Phe concentrations were assessed for three different time periods: the previous 10 years, the previous year and concentration at the time of completing the questionnaire. The correlation between patients’ QoL scores and their Phe levels was assessed. The classical PKU group was further divided into “good” and “suboptimal” adherence groups based on individual mean Phe levels in the examined time period. We evaluated differences in QoL among the two subgroups of classical PKU patients. QoL scores between classical and non-classical patients were also compared. Results: Data from 88 adult patients were analysed (66 had classical PKU). No median PKU-QoL score reached major or severe impact/frequent symptoms in any domain. The highest scores (meaning larger burden) were mostly related to emotional impact of PKU and disease management. When performing correlation analysis between Phe levels and QoL scores by all patients we found weak to fair positive correlation in several domains either short or long term. Patients with classical PKU reported greater financial impact of PKU than patients with less severe PKU. Classical PKU patients with good therapy adherence tended to report better HRQoL scores than patients with suboptimal adherence. Conclusion: We conclude that patients showed good HRQoL using the PKU-specific questionnaire. Our study demonstrates that suboptimal metabolic control is negatively associated with patients' HRQoL.
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Key Words
- AAS, amino acid supplements
- Adult
- ETPKU, early-treated phenylketonuria
- Early treated
- GMP, glycomacropeptide
- HPA, hyperphenylalaninaemia
- HRQoL
- HRQoL, health related quality of life
- Health related quality of life
- IQR, interquartile range
- PKU
- PKU, phenylketonuria
- PKU-QoL, Phenylketonuria Quality of Life questionnaires
- Phe, phenylalanine
- Phenylketonuria
- SD, standard deviation
- Tyr, tyrosine
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Affiliation(s)
- András Gellért Barta
- 2 Department of Internal Medicine, Semmelweis University,Szentkirályi street 46, Budapest 1088, Hungary
| | - Csaba Sumánszki
- 2 Department of Internal Medicine, Semmelweis University,Szentkirályi street 46, Budapest 1088, Hungary
| | - Zsófia Turgonyi
- Faculty of Medicine, Semmelweis University, Üllői út 26, Budapest 1085, Hungary
| | - Erika Kiss
- 1 Department of Pediatrics, Semmelweis University, Bokay J. street 53-54, Budapest 1083, Hungary
| | - Erika Simon
- 1 Department of Pediatrics, Semmelweis University, Bokay J. street 53-54, Budapest 1083, Hungary
| | - Csilla Serfőző
- Department of Ophthalmology, Semmelweis University, Mária street 39, Budapest 1085, Hungary
| | - Péter Reismann
- 2 Department of Internal Medicine, Semmelweis University,Szentkirályi street 46, Budapest 1088, Hungary
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Kender Z, Groener JB, Reismann P, Kopf S. A metformin hatása a vérzsírértékekre, illetve a szív és érrendszeri kockázatra sztatinkezelésben nem részesülő 2-es típusú cukorbetegekben. Orv Hetil 2019; 160:1346-1352. [DOI: 10.1556/650.2019.31547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract: Introduction: Some meta-analyses suggested a positive effect of metformin therapy on lipid parameters, but the potential beneficial effect of metformin on cardiovascular risk in type 2 diabetes is not entirely clear. Aim: We investigated the effect of metformin therapy on lipid parameters and cardiovascular risk in patients with type 2 diabetes. Method: In a cross-sectional, monocentric study, 102 patients with type 2 diabetes without lipid-lowering medication were analysed for lipid profile and cardiovascular risk (United Kingdom Prospective Diabetes Study Risk Calculator) depending on metformin therapy. The patients were divided into two subgroups regarding with (n = 52) or without metformin therapy (n = 50). Results: Patients with metformin therapy had significantly lower total cholesterol and LDL cholesterol levels than patients without metformin (p<0.01 and p<0.05). This effect was independent from glucose control. No intrinsic effect of metformin could be found on systolic blood pressure, HDL cholesterol, triglycerides, and long-term cardiovascular risk using a multivariable risk assessment score. Conclusion: Metformin therapy has beneficial effects on cholesterol levels without improving cardiovascular risk in patients with type 2 diabetes. Orv Hetil. 2019; 160(34): 1346–1352.
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Affiliation(s)
- Zoltán Kender
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg Heidelberg, Im Neuenheimer Feld 410, 69120 Germany
- German Center for Diabetes Research (DZD) Munich-Neuherberg, Germany
- Rácz Károly Doktori Iskola, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Jan Benedikt Groener
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg Heidelberg, Im Neuenheimer Feld 410, 69120 Germany
- German Center for Diabetes Research (DZD) Munich-Neuherberg, Germany
| | - Péter Reismann
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Stefan Kopf
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg Heidelberg, Im Neuenheimer Feld 410, 69120 Germany
- German Center for Diabetes Research (DZD) Munich-Neuherberg, Germany
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Kövesdi A, Tóth M, Butz H, Szücs N, Sármán B, Pusztai P, Tőke J, Reismann P, Fáklya M, Tóth G, Somogyi A, Borka K, Erdei A, Nagy EV, Deák V, Valkusz Z, Igaz P, Patócs A, Grolmusz VK. True MEN1 or phenocopy? Evidence for geno-phenotypic correlations in MEN1 syndrome. Endocrine 2019; 65:451-459. [PMID: 31044390 PMCID: PMC6656790 DOI: 10.1007/s12020-019-01932-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/09/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Multiple endocrine neoplasia type 1 is a rare tumor syndrome caused by germline mutations of MEN1 gene. Phenotype varies widely, and no definitive correlation with the genotype has been observed. Mutation-negative patients with MEN1-associated tumors represent phenocopies. By comparing mutation-positive and mutation-negative patients, we aimed to identify phenotype features predictive for a positive genetic test and to evaluate the role of MEN1 mutations in phenotype modulation. METHODS Mutation screeening of MEN1 gene by Sanger sequencing and assessment of clinical data of 189 consecutively enrolled probands and relatives were performed at our national and European Reference Center. Multiple ligation probe amplification analysis of MEN1 gene and Sanger sequencing of CDKN1B were carried out in clinically suspicious but MEN1-negative cases. RESULTS Twenty-seven probands and twenty family members carried MEN1 mutations. Five mutations have not been described earlier. Pronouncedly high number of phenocopies (>70%) was observed. Clinical suspicion of MEN1 syndrome emerged at significantly earlier age in MEN1-positive compared to MEN1-negative probands. Gastroenteropancreatic neuroendocrine tumors developed significantly earlier and more frequently in carriers compared to non-carriers. Probands with high-impact (frameshift, nonsense, large deletions) mutations, predicted to affect menin function significantly, developed GEP-NETs more frequently compared to low-impact (inframe and missense) mutation carriers. CONCLUSIONS MEN1 phenocopy is common and represents a significant confounder for the genetic testing. GEP-NET under 30 years best predicted a MEN1 mutation. The present study thus confirmed a previous proposal and suggested that GEP-NET under 30 years should be considered as a part of the indication criteria for MEN1 mutational analysis.
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Affiliation(s)
- Annamária Kövesdi
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
- "Lendület" Hereditary Endocrine Tumors Research Group, Hungarian Academy of Sciences - Semmelweis University, Budapest, Hungary
| | - Miklós Tóth
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Henriett Butz
- "Lendület" Hereditary Endocrine Tumors Research Group, Hungarian Academy of Sciences - Semmelweis University, Budapest, Hungary
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Nikolette Szücs
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Beatrix Sármán
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Pusztai
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Judit Tőke
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Reismann
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Géza Tóth
- Markhot Ferenc Hospital, Eger, Hungary
| | - Anikó Somogyi
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Borka
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Annamária Erdei
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Endre V Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | | | - Péter Igaz
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
- MTA-SE Molecular Medicine Research Group, Hungarian Academy of Sciences - Semmelweis University, Budapest, Hungary
| | - Attila Patócs
- "Lendület" Hereditary Endocrine Tumors Research Group, Hungarian Academy of Sciences - Semmelweis University, Budapest, Hungary.
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
| | - Vince Kornél Grolmusz
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
- "Lendület" Hereditary Endocrine Tumors Research Group, Hungarian Academy of Sciences - Semmelweis University, Budapest, Hungary
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Bartus A, Palasti F, Juhasz E, Kiss E, Simonova E, Sumanszki C, Reismann P. The influence of blood phenylalanine levels on neurocognitive function in adult PKU patients. Metab Brain Dis 2018; 33:1609-1615. [PMID: 29948654 DOI: 10.1007/s11011-018-0267-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
Abstract
It is well known that hyperphenylalaninemia caused by phenylketonuria (PKU) negatively influences cognitive performance. Several tests have been used to study these functions. Until now, no universal, optimal tool has been developed for detecting PKU-caused brain dysfunctions. Using computerized neuropsychological tests during daily routine would be helpful for screening subclinical brain deficits in adult PKU patients. In a monocentric, cross-sectional study, adult patients with PKU (n = 46; median age = 29.5 years; female/male ratio = 21/25) were tested with the computerized Cambridge Cognition (CANTAB) test measuring neurocognitive functions. Patients were divided into two groups: The "on diet" group included patients whose blood Phe-level was under 600 μmol/l (n = 20), and the "loose diet" group included patients whose blood Phe-level was above 600 μmol/l (n = 26) at the examination time. The results of the PKU-affected individuals were compared with a healthy control group (n = 31; median age = 25 years; female/male ratio = 11/20). Compared with the control group, PKU patients had significantly worse test results in memory, problem-solving skills, and strategy. However, there were no significant differences in response speed or initial thinking time. There was no correlation between the blood Phe-level, tyrosine (Tyr)-level or Phe/Tyr ratio and the different cognitive test results. There were no significant differences in test results between the two PKU subgroups. Several cognitive functions measured by CANTAB are negatively influenced by hyperphenylalaninemia in adult PKU patients. However, response speed and initial thinking time were not impaired as seriously as other functions. Patients with lower Phe-levels failed to achieve better test results than patients whose Phe-levels were notably elevated.
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Affiliation(s)
- A Bartus
- 2nd Department of Internal Medicine, Semmelweis University, Szentkirályi Street 46, Budapest, H-1088, Hungary
| | - F Palasti
- 2nd Department of Internal Medicine, Semmelweis University, Szentkirályi Street 46, Budapest, H-1088, Hungary
| | - E Juhasz
- 2nd Department of Internal Medicine, Semmelweis University, Szentkirályi Street 46, Budapest, H-1088, Hungary
| | - E Kiss
- 1st Department of Pediatrics, Semmelweis University, Bókay János u. 53-54, Budapest, H-1083, Hungary
| | - E Simonova
- 1st Department of Pediatrics, Semmelweis University, Bókay János u. 53-54, Budapest, H-1083, Hungary
| | - Cs Sumanszki
- 2nd Department of Internal Medicine, Semmelweis University, Szentkirályi Street 46, Budapest, H-1088, Hungary
| | - P Reismann
- 2nd Department of Internal Medicine, Semmelweis University, Szentkirályi Street 46, Budapest, H-1088, Hungary.
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Abstract
Starting from 1975 phenylketonuria is part of the newborn screening program in Hungary. Since then a generation, treated with special diet and medical foods right after neonatal diagnosis has reached adulthood. Thanks to early treatment initiation, children with phenylketonuria are able to lead life to the full. Consequently, phenylketonuria is no longer considered a pediatric disease. Follow up of adult patients with phenylketonuria is performed in internal medicine centers specialized in metabolic diseases. The outcome of the lifelong special treatment, and the particularities of phenylketonuria in adulthood are yet to be determined. The aim of our review is to present recent findings in phenylketonuria focusing mainly on the adult care. After long time the first international guidelines appeared, new therapies were put in use, and these current developments are expected to be implemented in daily practice in the near future. New challenges must be met such as maternal phenylketonuria, long term effects of dietotherapy and the sequelae of untreated phenylketonuria in adulthood. Orv Hetil. 2017; 158(46): 1857-1863.
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Affiliation(s)
- Csaba Sumánszki
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Szentkirályi u. 46., 1084
| | - András Gellért Barta
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Szentkirályi u. 46., 1084
| | - Péter Reismann
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Szentkirályi u. 46., 1084
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Affiliation(s)
- Péter Reismann
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Szentkirályi u. 46., 1084
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Abstract
Classical galactosemia is an inherited disorder of the carbohydrate metabolism, most often caused by the deficient activity of the enzyme galactose-1-phosphate-uridyltransferase. Classical galactosemia presents in the neonatal period with life threatening illness after galactose is introduced in the diet. Symptoms and signs include poor feeding, vomiting, and diarrhea, weight loss, jaundice, hypotension, cataracts, hepatosplenomegaly, hepatocellular insufficiency, and encephalopathy. Since 1975 the testing for galactosemia is part of the neonatal screening program in Hungary. Affected newborns are recognized in the first days of their life, and special diet is introduced immediately. The therapy of galactosemia is the lactose-free and galactose-poor diet for life. As a result of the nationwide newborn screening and the lifelong medical therapy, early treatment with galactosemia can achieve a normal life without serious complications. Orv Hetil. 2017; 158(47): 1864-1867.
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Affiliation(s)
- Erika Kiss
- I. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Bókay J. u. 53.,1083
| | - Lídia Balogh
- I. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Bókay J. u. 53.,1083
| | - Péter Reismann
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
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Abstract
INTRODUCTION Patients with phenylketonuria have lower bone mineral density compared to healthy people, however, the ethiology of these alterations is not clear. Hungarian data were missing in this topic. AIM The main aim of our study was to survey the correlation between metabolic control and change of bone mineral density in early treated Hungarian adult patients with phenylketonuria. METHOD In this monocentric study bone mineral density of 59 adult PKU patients have been repeatedly measured in a 4-year interval using dual-energy X-ray absorptiometry. Two subgroups have been established based on average blood phenylalanine levels. The correlation between the change in bone mineral density and average phenylalanine, tyrosine concentrations have been determined while initial bone mineral density and change have also been examined in the subgroups. RESULTS Mean phenylalanine concentration was 614 (182-1222) micromol/L, whereas mean tyrosine concentration was 49 (24-99) micromol/L and the calculated ratio was 16 (4,5-35). Three patients have had severely decreased bone mineral density in either localisation while 22 have had mild decrease. Low bone mineral density compared to cronological age has been found by 9 patient. The mean change was +0.0380 (-0.1550-0.7800) g/cm2 in femur, and +0.0120 (-0.57300-0.3130) g/cm2 in the lumbar spine. There was a correlation in the change in Z-score neither with mean phenylalanine nor with tyrosine concentration. CONCLUSIONS Bone mineral density was not changed and hardly influenced by the metabolic control in early-treated young adult phenylketonuria patients in a few years interval. Orv Hetil. 2017; 158(47): 1868-1872.
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Affiliation(s)
- András Gellért Barta
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Szentkirályi u. 46., 1088
| | - Csaba Sumánszki
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Szentkirályi u. 46., 1088
| | - Péter Reismann
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Szentkirályi u. 46., 1088
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Abstract
Abstract: Williams syndrome is a rare genetic disorder, that occurs equally in all ethnic groups and both sexes. The diagnosis might be missed during childhood in mild cases. However, establishing the diagnosis is important, not only to find the cause of intellectual disability but to look for cardiovascular, endocrine, psychiatry, urology and other conditions, which can occur at any age in the patients’ lifetime. This case report presents the story of 47-year-old woman, who was admitted with haematemesis. During her stay on the ward, in the light of the distinctive facial features, mental retardation, and social behaviour patterns, the possibility of Williams syndrome emerged. Later, the diagnosis was confirmed by genetic analysis. This female is the oldest living patient with Williams syndrome in Hungary. Orv Hetil. 2017; 158(47): 1883–1888.
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Affiliation(s)
| | - György Fekete
- II. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Irén Haltrich
- II. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Miklós Tóth
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Szentkirályi u. 46., 1088
| | - Péter Reismann
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Szentkirályi u. 46., 1088
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Grolmusz VK, Ács OD, Feldman-Kovács K, Szappanos Á, Stenczer B, Fekete T, Szendei G, Reismann P, Rácz K, Patócs A. Genetic variants of the HSD11B1 gene promoter may be protective against polycystic ovary syndrome. Mol Biol Rep 2014; 41:5961-9. [DOI: 10.1007/s11033-014-3473-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 06/14/2014] [Indexed: 01/08/2023]
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Kender Z, Fleming T, Kopf S, Torzsa P, Grolmusz V, Herzig S, Schleicher E, Rácz K, Reismann P, Nawroth P. Effect of Metformin on Methylglyoxal Metabolism in Patients with Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2014; 122:316-9. [DOI: 10.1055/s-0034-1371818] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Z. Kender
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - T. Fleming
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - S. Kopf
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - P. Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - V. Grolmusz
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - S. Herzig
- Joint Research Division, Molecular Metabolic Control, German Cancer Research Center DKFZ, Network Aging Research, ZMBH, Heidelberg, Germany
| | - E. Schleicher
- Division of Clinical Chemistry/Central Laboratory, Department of Internal Medicine, University of Tubingen, Tubingen, Germany
| | - K. Rácz
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - P. Reismann
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - P. Nawroth
- Department of Internal Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
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Groener JB, Reismann P, Fleming T, Kalscheuer H, Lehnhoff D, Hamann A, Roser P, Bierhaus A, Nawroth PP, Rudofsky G. C332C genotype of glyoxalase 1 and its association with late diabetic complications. Exp Clin Endocrinol Diabetes 2013; 121:436-9. [PMID: 23775136 DOI: 10.1055/s-0033-1345124] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS/INTRODUCTION Glyoxalase 1 catalyses the detoxification of methylglyoxal, a major precursor of advanced glycation end products associated with aging, neurodegenerative diseases, and microvascular complications of diabetes. Here, we examine a possible association of a single nucleotide polymorphism of glyoxalase 1 gene (Glo1 A332C, rs4746 or rs2736654) with the prevalence of microvascular diabetic complications in patients with type 1 and type 2 diabetes. MATERIALS AND METHODS Genotyping was performed in 209 patients with type 1 and 524 patients with type 2 diabetes using polymerase chain reaction and subsequent cleavage by restriction endonuclease Bsa I. RESULTS Frequencies of the glyoxalase 1 genotypes were different with respect to diabetes type with a significantly higher prevalence of A332A-genotype in type 1 diabetes (35.9% vs. 27.3%; p=0.03). In type 1 diabetes, there was no correlation of any genotype with diabetic retinopathy, nephropathy or neuropathy. In contrast, type 2 diabetic patients homozygous for the C332C allele showed a significantly increased prevalence of diabetic neuropathy (p=0.03; OR=1.49 [95%-CI: 1.04; 2.11]), while no association with diabetic nephropathy or retinopathy was found. However, the significance of this association was lost after correction for multiple testing. CONCLUSIONS Our data suggest a possible association of C332C-genotype of the glyoxalase 1 gene with diabetic neuropathy in type 2 diabetes, supporting the hypothesis that methylglyoxal might be an important mediator of diabetic neuropathy in type 2 diabetes.
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Affiliation(s)
- J B Groener
- Department of Medicine, Division of Endocrinology and Clinical Chemistry, University of Heidelberg, 69120 Heidelberg, Germany. - heidelberg.de
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Grolmusz VK, Stenczer B, Fekete T, Szendei G, Patócs A, Rácz K, Reismann P. Lack of association between C385A functional polymorphism of the fatty acid amide hydrolase gene and polycystic ovary syndrome. Exp Clin Endocrinol Diabetes 2013; 121:338-42. [PMID: 23616186 DOI: 10.1055/s-0033-1337941] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The endocannabinoid system contributes to the regulation of appetite, food intake and energy balance. Fatty acid amide hydrolase is responsible for degradating anandamide, a key messenger of the endocannabinoid system. C385A is a common, functionally active genetic polymorphism of the gene encoding fatty acid amide hydrolase and has been associated with overweight and obesity. Our aim was to establish whether single nucleotide polymorphism C385A has an association with polycystic ovary syndrome or its clinical features.A monocentric pilot study was performed on 63 patients with polycystic ovary syndrome and 67 healthy control subjects. Anthropometric parameters and laboratory data were acquired from subjects. The alleles of the polymorphism were detected using polymerase chain reaction and subsequent cleavage by Eco130I (StyI) restriction endonuclease verified by direct DNA sequencing.No difference was found in minor allele frequency between patient and control groups. Those patients, carrying the C385A polymorphism were associated with higher free thyroxine hormone levels. In the control group, carriers of the polymorphism had significantly lower insulin levels.Our data indicate that the C385A polymorphism of the fatty acid amide hydrolase gene is not a genetic susceptibility factor for the development of polycystic ovary syndrome. However, the polymorphism might have a role in influencing the synthesis or metabolism of different hormones including thyroxin and insulin.
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Affiliation(s)
- V K Grolmusz
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
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Groener JB, Reismann P, Fleming T, Kalscheuer H, Lehnhoff D, Hamann A, Bierhaus A, Nawroth PP, Rudofsky G. C332C Genotyp der Glyoxalase 1 und seine Assoziation mit diabetischen Spätschäden. DIABETOL STOFFWECHS 2013. [DOI: 10.1055/s-0033-1341728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kender Z, Torzsa P, Grolmusz K. V, Patócs A, Lichthammer A, Veresné Bálint M, Rácz K, Reismann P. The role of methylglyoxal metabolism in type-2 diabetes and its complications. Orv Hetil 2012; 153:574-85. [DOI: 10.1556/oh.2012.29348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Transient or chronic hyperglycaemia increases the formation of intracellular reactive oxygen species and aldehydes. The accumulation of reactive aldehydes is implicated in the development of diabetic complications. Methylglyoxal, a glucose dependent α-dicarbonyl might be the most important reactive aldehyde in diabetes and its complications. Diabetes was the first disease in which evidence emerged for the increased formation of methylglyoxal in the cells and in the serum. Methylglyoxal has a toxic effect on insulin secretion from pancreatic beta-cells, and on modifications of proteins and nucleic acids. Moreover, methylglyoxal is one of the major precursors of advanced glycation end-products. The glyoxalase enzyme system that exists in all mammalian cells is catalyzing the detoxification of methylglyoxal. This review summarizes the methylglyoxal metabolism in normoglycaemic and hyperglycamic conditions and the role of methylglyoxal in the development of late diabetic microvascular complications. Orv. Hetil., 2012, 153, 574–585.
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Affiliation(s)
- Zoltán Kender
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Péter Torzsa
- Semmelweis Egyetem, Általános Orvostudományi Kar Családorvosi Tanszék Budapest
| | | | - Attila Patócs
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
- Magyar Tudományos Akadémia–Semmelweis Egyetem Molekuláris Medicina Kutatócsoport Budapest
| | - Adrienn Lichthammer
- Semmelweis Egyetem, Általános Orvostudományi Kar Dietetikai és Táplálkozástudományi Tanszék Budapest
| | - Márta Veresné Bálint
- Semmelweis Egyetem, Általános Orvostudományi Kar Dietetikai és Táplálkozástudományi Tanszék Budapest
| | - Károly Rácz
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
- Magyar Tudományos Akadémia–Semmelweis Egyetem Molekuláris Medicina Kutatócsoport Budapest
| | - Péter Reismann
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
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Abstract
UNLABELLED Toll-like receptor 4, a central mediator of the innate immune response has been shown to play an important role not only in the defense mechanism against microorganism, but also other non-infectious inflammatory diseases such as atherosclerosis. The Asp299Gly and Thr399Ile, which are common co-segregation polymorphisms of the Toll-like receptor 4 gene have been shown to be associated with increased susceptibility for Gram-negative infections, but with a lower risk of carotid atherosclerosis and a reduced level of certain proinflammatory cytokines. AIM The role of these polymorphisms in diabetes mellitus with its late microvascular complications, in ischemic stroke, and in chronic periodontitis was investigated in three independent studies. METHODS In all studies the alleles of both polymorphisms were detected by polymerase chain reaction and subsequent cleavage by restriction endonucleases followed by gel electrophoresis. RESULTS In patients with type 2 diabetes, heterozygote carriers of the Asp299Gly and Thr399Ile polymorphisms of the Toll-like receptor 4 gene had a significantly reduced prevalence of peripheral neuropathy, while there was no association with any other diabetic microvascular complication, or with cerebral ischemia or with chronic periodontitis. CONCLUSIONS Toll-like receptor 4 gene polymorphisms are not enough sensitive genetic markers for risk stratification either in diabetes mellitus or in cerebral ischemia or in chronic periodontitis.
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Affiliation(s)
- Péter Reismann
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi utca 46. 1088.
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Rudofsky G, Tsioga M, Reismann P, Leowardi C, Kopf S, Grafe IA, Nawroth PP, Isermann B. Transient hyperthyroidism after surgery for secondary hyperparathyroidism: a common problem. Eur J Med Res 2011; 16:375-80. [PMID: 21813380 PMCID: PMC3351989 DOI: 10.1186/2047-783x-16-8-375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative hyperthyroidism occurs in approximately one third of patients following parathyroidectomy due to primary hyperparathyroidism (PHP), but has only rarely been described in secondary hyperparathyroidism (SHP). The frequency, course, and laboratory markers of postoperative hyperthyroidism in SHP remain unknown. Our purpose was to evaluate the frequency and the clinical course of postoperative hypcrthyroidism following surgery of SHP and to determine the diagnostic value of thyroglobulin in this setting. Material and Methods A total of 40 patients undergoing parathyroidectomy because of SHP were included in this study. Thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fl4), and thyroglobulin (Tg) were determined one day before and on day 1, 3, 5, 10, and 40 after surgery. At each of these visits patients were clinically evaluated for signs or symptoms of hyperthyroidism. Results Biochemical evidence of hyperthyroidism was evident in 77% of patients postoperatively despite of preoperatively normal serum levels. TSH dropped from 1.18 ± 0.06mU/L to 0.15 ± 0.07mU/L (p = 0.0015). Free triiodothyronine (fT3) and fT4 levels increased from 2.86 ± 0.02ng/L and 10.32 ± 0.13ng/L, respectively, to their maximum of 4.83 ± 0.17ng/L and 19.35 ± 0.58ng/L, respectively. Thyroglobulin levels rose from 3.8 ± 0.8ng/mL to 111.8 ± 45.3ng/mL (p < 0.001). At day 40 all thyroid related laboratory values were within normal range. Correlation analysis of postoperative values revealed significant correlations for lowest TSH (r = -0.32; p = 0.038), and highest fT3 (r = 0.55; p < 0.001) and fT4 levels (r = 0.67; p < 0.001) with Tg. Conclusion Transient hyperthyroidism is frequent after parathyroidectomy for SHP with Tg being a suitable marker. Awareness of this self-limiting disorder is important to avoid inappropriate and potentially harmful treatment.
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Affiliation(s)
- Gottfried Rudofsky
- Division of Endocrinology and Clinical Chemistry, Department of Medicine, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
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Abstract
Both diabetes mellitus and thyroid disorders are common diseases. According to epidemiologic studies the prevalence of specific thyroid disorders in diabetic subjects is two times higher. Risk factors are age, female gender and autoimmune diabetes mellitus. However, thyroid disorders are diagnosed only half of the cases in diabetic population. The review briefly summarizes the association of autoimmune diabetes mellitus and thyreoiditis, the risk of thyroid disorders in type 1 diabetic pregnant women. Furthermore, the influence of obesity in the risk on thyroid cancer and the effect of glucagon-like peptide 1 analogue on thyroid medullary C-cells are discussed. Orv. Hetil., 2011, 152, 516–519.
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Affiliation(s)
- Péter Reismann
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Anikó Somogyi
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
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Reismann P, Kender Z, Dabasi G, Sréter L, Rácz K, Igaz P. Somatostatin receptor endoradiotherapy of neuroendocrine tumors: experience in Hungarian patients. Orv Hetil 2011; 152:392-7. [DOI: 10.1556/oh.2011.29057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Beside conventional therapies for the treatment of neuroendocrine tumors, a new therapeutical approach, peptide receptor radionuclide therapy has been developed recently. There are two important features which make this therapy feasible: somatostatin receptors are strongly over-expressed in most neuroendocrine tumors resulting in a high tumor-to-background ratio and internalization of the somatostatin-receptor complex in neuroendocrine cells. Due to these features, neuroendocrine tumors can be treated with radiolabelled somatostatin analogues. For peptide receptor radionuclide therapy, somatostatin analogues are conjugated to a chelator that can bind a radionuclide. The most frequently used radionuclides for neuroendocrine tumor treatment are the β-emitter Yttrium-90 (90Y) and the β+γ emitter Lutetium-177 (177Lu). Candidates for somatostatin receptor endoradiotherapy are patients with progressive, metastatic, somatostatin-receptor positive neuroendocrine tumors. Many patients have been successively treated with this approach: according to international results major remission can be achieved in 25% of the cases. Although this therapy is still unavailable in Hungary, Hungarian patients can be treated with somatostatin receptor endoradiotherapy with financial support from the National Health Fund in a co-operation with the University of Basel since 2005. During the past 5 years, 51 Hungarian patients have been treated with this therapy. This review briefly summarizes the theoretical background, indications, effectiveness and side effects of somatostatin receptor endoradiotherapy and the authors present the first data obtained from Hungarian patients. Orv. Hetil., 2011, 152, 392–397.
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Affiliation(s)
- Péter Reismann
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Zoltán Kender
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Gabriella Dabasi
- Semmelweis Egyetem, Általános Orvostudományi Kar Transzplantációs és Sebészeti Klinika Budapest
| | - Lídia Sréter
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Károly Rácz
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
| | - Péter Igaz
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088
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Abstract
The most frequent liver disorder in metabolic syndrome is the nonalcoholic fatty liver disease. Its pathogenesis is a complex, multifactorial process, characterized by insulin resistance and involvement of the endocrine system. Hypothyroidism may lead to nonalcoholic steatohepatitis via hyperlipidemia and obesity. Adult patients with growth hormone deficiency have a metabolic syndrome-like phenotype with obesity and many characteristic metabolic alterations. The chronic activation of the hypothalamic-pituitary-adrenal axis results in metabolic syndrome as well. Cushing's syndrome has also features of metabolic syndrome. Mild elevation of transaminase activities is commonly seen in patients with adrenal failure. Non-alcoholic steatosis is twice as common in postmenopusal as in premenopausal women and hormonal replacement therapy decreases the risk of steatosis. Insulin resistance, diabetes mellitus type 2, sleeping apnoe syndrome, cardiovascular disorders and non-alcoholic fatty liver disease are more frequent in polycystic ovary syndrome. Hypoandrogenism in males and hyperandrogenism in females may lead to fatty liver via obesity and insulin resistance. Adipokines (leptin, acylation stimulating protein, adiponectin) have a potential role in the pathogenesis of nonalcoholic fatty liver. The alterations of endocrine system must be considered in the background of cryptogenic liver diseases. The endocrine perspective may help the therapeutic approaches in the future.
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Rudofsky G, Schlotterer A, Reismann P, Engel J, Grafe IA, Tafel J, Morcos M, Humpert PM, Nawroth P, Bierhaus A, Hamann A. The -174G>C IL-6 gene promoter polymorphism and diabetic microvascular complications. Horm Metab Res 2009; 41:308-13. [PMID: 19140096 DOI: 10.1055/s-0028-1119373] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study examined a possible association of the G>C polymorphism at nucleotide -174 in the promoter region of the interleukin-6 (IL-6) gene (rs1800795) with the prevalence of diabetic complications in 235 patients with type 1 and 498 patients with type 2 diabetes. Genotyping was performed using polymerase chain reaction (PCR) and subsequent cleavage by Nla III restriction endonuclease. Analyzing all diabetic patients together demonstrated that 301 patients (41.1%) carried the GG genotype, 114 (15.6%) the CC genotype, and 318 (43.3%) were heterozygous for the GC genotype. However, there was no correlation of any of the genotypes with the prevalence of diabetic nephropathy or diabetic neuropathy, but subjects with the CC genotype had a significantly higher prevalence of diabetic retinopathy compared to patients with the GC and GG genotype (p=0.016). This association was mainly lost when a logistic regression model was adjusted for diabetes duration (p=0.07). Consistently, a weak but not significant association of the polymorphism with diabetic retinopathy was observed when type 1 and type 2 diabetic patients were analyzed separately (patients with type 1 diabetes: p=0.12; patients with type 2 diabetes: p=0.09). Analogically, no association of the polymorphism was found for diabetic nephropathy or diabetic neuropathy in these groups. In conclusion these data suggest no major influence of the -174G>C variant in the promoter region of the IL-6 gene on the development of microvascular complications in patients with diabetes.
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Affiliation(s)
- G Rudofsky
- Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany.
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Reismann P, Rácz K, Tulassay Z. [Polymorphisms of the Toll-like receptor 4 gene and their potential role in infectious diseases and chronic inflammatory disorders]. Orv Hetil 2008; 149:1791-9. [PMID: 18805765 DOI: 10.1556/oh.2008.28452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Toll-like receptor 4 is a key mediator of the innate immune response. Besides its main ligand, the Gram-negative bacterial lipopolysaccharides, other molecules such as heat-shock protein 60, oxidized low density lipoprotein and fibronectin can also bind to the receptor. Activation of the Toll-like receptor induces the production of proinflammatory cytokines. There is increasing evidence showing that the Toll-like receptor 4 plays a role not only in the immune reaction against infectious agents but also in chronic non-infectious inflammatory diseases, such as atherosclerosis, diabetes mellitus and inflammatory bowel disease. This review briefly summarizes recent knowledge on the Toll-like receptor 4, its common co-segregation polymorphisms and the impact of these polymorphisms on various human diseases.
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Affiliation(s)
- Péter Reismann
- Semmelweis Egyetem, Altalános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u. 46. 1088.
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Abstract
Lysosomal storage disorders are caused either by deficiencies or decreased activity of enzymes localised in lysosomal vesicles or transport failure of these enzymes or their substrates. Accumulation of macromolecules destroy cell function presenting in clinical symptoms. Up to date, there are about 40 different lysosomal storage disorders according to the accumulated macromolecules. Till the last decades supportive therapy was the only option by these disorders. Enhanced researches in the last decades have presented some breakthrough results in the field of storage disease therapy. The review briefly introduces the lysosomal storage disorders, summarizes the actual therapy possibilities, as enzyme replacement therapy, substrate deprivation therapy, bone marrow transplantation. Finally, the review outlines future therapeutic potentials, like stem-cell and gene therapy.
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Affiliation(s)
- Péter Reismann
- Semmelweis Egyetem, Altalános Orvostudományi Kar, II. Belgyógyászati Klinika, Budapest MTA-SE Molekuláris Medicina Kutatócsoport, Budapest.
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Rudofsky G, Reismann P, Djuric Z, Humpert PM, Isermann B, Hamann A, Morcos M, Nawroth PP, Bierhaus A. Vergleichende Untersuchungen zum Einfluss von hochdosierter Statintherapie und Statin-Ezetimib-Kombinationstherapie auf Entzündungsparameter bei Typ-2-Diabetes. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rudofsky G, Reismann P, Grafe IA, Konrade I, Djuric Z, Tafel J, Buchbinder S, Zorn M, Humpert PM, Hamann A, Morcos M, Nawroth PP, Bierhaus A. Improved vascular function upon pioglitazone treatment in type 2 diabetes is not associated with changes in mononuclear NF-kappaB binding activity. Horm Metab Res 2007; 39:665-71. [PMID: 17846974 DOI: 10.1055/s-2007-985395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Thiazolidinediones such as pioglitazone have been shown to exert anti-inflammatory effects independent of their insulin sensitizing effects by reducing activation of the proinflammatory transcription factor NF-kappaB in animal models of experimental diabetes. Furthermore, short-term pioglitazone treatment ameliorates endothelial dysfunction in conduit arteries of patients with type 2 diabetes. Since inflammation is supposed to impair flow-mediated vasodilatation, we studied the effects of an 8-week pioglitazone intervention on endothelial function and mononuclear NF-kappaB activation in patients with type 2 diabetes. Twenty patients were included in a randomized, double-blind, placebo-controlled study receiving 30 mg pioglitazone or placebo, respectively. Flow-mediated endothelium dependent vasodilatation (FMD) of the brachial artery, NF-kappaB binding activity in peripheral blood mononuclear cells [pBMC, determined by electrophoretic mobility shift assay (EMSA)] and interleukin-6 (IL-6)-transcription rates (determined by real-time PCR) were measured at study entry and after eight weeks of intervention. Pioglitazone treatment resulted in a significant improvement of FMD (4.3%+/-3.3; p=0.003), while no effect was seen under placebo medication (2.0%+/-2.7; p=0.71). The correction of FMD was neither paralleled by a pioglitazone-dependent reduction in mononuclear NF-kappaB binding activity (DeltaNF-kappaB activity: pioglitazone: 9.2%+/-6.7, p=0.24; placebo: 5.7%+/-19.6; p=0.82) nor in NF-kappaB dependent gene transcription as determined for IL-6 (DeltaIL-6 pioglitazone: +1.8%+/-12.0, p=0.93; placebo: -0.2%+/-9.7; p=0.92). These data demonstrate for the first time that pioglitazone treatment improves endothelial dysfunction in patients with type 2 diabetes without affecting NF-kappaB binding activity and NF-kappaB dependent proinflammatory gene expression in pBMC.
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Affiliation(s)
- G Rudofsky
- Department Medicine I and Clinical Chemistry, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, Germany
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Rudofsky G, Schlotterer A, Tafel J, Reismann P, Humpert PM, Morcos M, Bierhaus A, Nawroth PP, Hamann A. Der M55V Polymorphismus im SUMO4-Gen ist mit einem vermindertem Risiko für Retinopathie bei Typ-1-Diabetes assoziiert. DIABETOL STOFFWECHS 2006. [DOI: 10.1055/s-2006-943845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rudofsky G, Schlimme M, Schlotterer A, von Eynatten M, Reismann P, Tafel J, Grafe I, Morcos M, Nawroth P, Bierhaus A, Hamann A. No association of the 94T/G polymorphism in the adiponectin gene with diabetic complications. Diabetes Obes Metab 2005; 7:455-9. [PMID: 15955133 DOI: 10.1111/j.1463-1326.2004.00454.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM This study examined a possible association of the T/G polymorphism at nucleotide 94 in the adiponectin gene with the prevalence of diabetic complications. METHODS The study was performed in 696 patients with type 1 diabetes and type 2 diabetes. Genotyping was performed by means of polymerase chain reaction and subsequent cleavage by using SmaI restriction endonuclease. RESULTS The 94G/G genotype was significantly more prevalent in patients with type 2 diabetes (2.2%) than in type 1 diabetics (0.0%) (p = 0.02), whereas no differences were found for frequencies of the 94T/T and the 94G/T genotypes, respectively. In patients with type 1 diabetes, 45 of 239 patients were heterozygous for the 94T/G polymorphism (carrier rate (CR): 18.8%; allele frequency (AF): 0.094). In type 2 diabetics, 71 of 457 patients were heterozygous and 10 patients were homozygous for the 94G/G genotype (CR: 17.7%; AF: 0.10). No association with diabetic nephropathy, diabetic neuropathy or diabetic retinopathy was found for either genotype in patients with type 1 and type 2 diabetes. CONCLUSIONS The 94T/G polymorphism in the adiponectin gene is not associated with diabetic complications. The significance of a higher prevalence of the G allele in type 2, compared to type 1 diabetes remains to be clarified.
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Affiliation(s)
- G Rudofsky
- Division of Endocrinology and Metabolism, Department of Medicine, University of Heidelberg, Heidelberg, Germany
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Rudofsky G, Reismann P, Schiekofer S, Petrov D, von Eynatten M, Humpert PM, Isermann B, Müller-Hoff C, Thai TP, Lichtenstein S, Bärtsch U, Hamann A, Nawroth P, Bierhaus A. Reduction of postprandial hyperglycemia in patients with type 2 diabetes reduces NF-kappaB activation in PBMCs. Horm Metab Res 2004; 36:630-8. [PMID: 15486815 DOI: 10.1055/s-2004-825904] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS Short-lasting hyperglycemia results in activation of the transcription factor NF-kappaB in peripheral blood mononuclear cells. We therefore studied whether the postprandial increase in glucose is sufficient to induce mononuclear NF-kappaB activation and whether blunting postprandial hyperglycemia with the alpha-glucosidase inhibitor acarbose reduces NF-kappaB activation. METHODS 20 patients with type 2 diabetes were included in a double-blind randomized trial receiving 100 mg acarbose or placebo three times a day over a period of eight weeks. Peripheral blood mononuclear cells were isolated before and 120 minutes after a standardized breakfast. NF-kappaB binding activity was estimated by electrophoretic mobility shift assay and NF-kappaB-p65; translocation was determined by Western blot. RESULTS Eight weeks of treatment with acarbose significantly reduced postprandial hyperglycemia (p = 0.004 when compared to placebo), postprandial mononuclear NF-kappaB-binding activity (p = 0.045) and nuclear translocation of NF-kappaB-p65 (p = 0.02). CONCLUSION Reduction of postprandial glucose peak levels by acarbose reduces postprandial mononuclear NF-kappaB activation.
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Affiliation(s)
- G Rudofsky
- Department of Medicine I, University of Heidelberg, Germany
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