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Linnenkamp U, Greiner G, Fehm T, Adamczewski H, Bizjak G, Borgmeier F, Dortmann O, Ensenauer R, Gräfe V, Hollmann T, Ihle P, Jüngling U, Kaltheuner M, Kerres T, Kuß O, Lange U, Lappe V, Leve V, Meier-Stiegen F, Meyer F, Müller-Bößmann D, Neuenschwander M, Ruckhäberle E, Rupprecht C, Schellhammer S, Schmitz-Losem I, Schneider M, Schumacher L, Tamayo M, Viehmann A, Westerhoff B, Wilm S, Icks A. GestDina – Analysis of the current aftercare situation for gestational diabetes. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- U Linnenkamp
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | - G Greiner
- IVG, Heinrich-Heine-Universität Düsseldorf/DDZ
| | - T Fehm
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | | | - G Bizjak
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | - F Borgmeier
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | | | - R Ensenauer
- Kinderklinik, Universitätsklinikum Düsseldorf
| | - V Gräfe
- Kassenärztliche Vereinigung Nordrhein
| | | | - P Ihle
- pmv Forschungsgruppe, Universität zu Köln
| | | | | | | | | | - U Lange
- Studienbereich Hebammenwissenschaft, HSG Bochum
| | - V Lappe
- pmv Forschungsgruppe, Universität zu Köln
| | - V Leve
- ifam, Heinrich-Heine-Universität Düsseldorf
| | - F Meier-Stiegen
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | | | | | | | - E Ruckhäberle
- Klinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Düsseldorf
| | | | | | | | | | | | - M Tamayo
- Kassenärztliche Vereinigung Nordrhein
| | - A Viehmann
- IVG, Heinrich-Heine-Universität Düsseldorf/DDZ
| | | | - S Wilm
- ifam, Heinrich-Heine-Universität Düsseldorf
| | - A Icks
- IVG, Heinrich-Heine-Universität Düsseldorf/DDZ
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2
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Brei C, Stecher L, Brunner S, Ensenauer R, Heinen F, Wagner PD, Hermsdörfer J, Hauner H. Impact of the n-6:n-3 long-chain PUFA ratio during pregnancy and lactation on offspring neurodevelopment: 5-year follow-up of a randomized controlled trial. Eur J Clin Nutr 2017; 71:1114-1120. [PMID: 28537583 DOI: 10.1038/ejcn.2017.79] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/20/2017] [Accepted: 04/18/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Evidence regarding the effect of n-3 long-chain polyunsaturated fatty acid (LCPUFA) supplementation during pregnancy on offspring's neurodevelopment is not conclusive. SUBJECTS/METHODS In this analysis, the effect of a reduced n-6:n-3 LCPUFA ratio in the diet of pregnant/lactating women (1.2 g n-3 LCPUFA together with an arachidonic acid (AA)-balanced diet between 15th wk of gestation-4 months postpartum vs control diet) on child neurodevelopment at 4 and 5 years of age was assessed. A child development inventory (CDI) questionnaire and a hand movement test measuring mirror movements (MMs) were applied and the association with cord blood LCPUFA concentrations examined. RESULTS CDI questionnaire data, which categorizes children as 'normal', 'borderline' or 'delayed' in different areas of development, showed no significant evidence between study groups at 4 (n=119) and 5 years (n=130) except for the area 'letters' at 5 years of age (P=0.043). Similarly, the results did not strongly support the hypothesis that the intervention has a beneficial effect on MMs (for example, at 5 years: dominant hand, fast: adjusted mean difference, -0.08 (-0.43, 0.26); P=0.631). Children exposed to higher cord blood concentrations of docosahexaenoic acid, eicosapentaenoic acid and AA, as well as a lower ratio of n-6:n-3 fatty acids appeared to show beneficial effects on MMs, but these results were largely not statistically significant. CONCLUSIONS Our results do not show clear benefits or harms of a change in the n-6:n-3 LCPUFA ratio during pregnancy on offspring's neurodevelopment at preschool age. Findings on cord blood LCPUFAs point to a potential influence on offspring development.
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Affiliation(s)
- C Brei
- Else Kröner-Fresenius Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - L Stecher
- Else Kröner-Fresenius Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - S Brunner
- Else Kröner-Fresenius Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - R Ensenauer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Experimental Pediatrics and Metabolism, University Children's Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Research Center, Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - F Heinen
- Department of Pediatric Neurology and Developmental Medicine, Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - P D Wagner
- Department of Sport and Health Sciences, Institute of Human Movement Science, Technische Universität München, Munich, Germany
| | - J Hermsdörfer
- Department of Sport and Health Sciences, Institute of Human Movement Science, Technische Universität München, Munich, Germany
| | - H Hauner
- Else Kröner-Fresenius Center for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,ZIEL - Institute for Food and Health, Nutritional Medicine Unit, Technische Universität München, Freising, Germany
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3
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Berti C, Cetin I, Agostoni C, Desoye G, Devlieger R, Emmett PM, Ensenauer R, Hauner H, Herrera E, Hoesli I, Krauss-Etschmann S, Olsen SF, Schaefer-Graf U, Schiessl B, Symonds ME, Koletzko B. Pregnancy and Infants' Outcome: Nutritional and Metabolic Implications. Crit Rev Food Sci Nutr 2016; 56:82-91. [PMID: 24628089 DOI: 10.1080/10408398.2012.745477] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pregnancy is a complex period of human growth, development, and imprinting. Nutrition and metabolism play a crucial role for the health and well-being of both mother and fetus, as well as for the long-term health of the offspring. Nevertheless, several biological and physiological mechanisms related to nutritive requirements together with their transfer and utilization across the placenta are still poorly understood. In February 2009, the Child Health Foundation invited leading experts of this field to a workshop to critically review and discuss current knowledge, with the aim to highlight priorities for future research. This paper summarizes our main conclusions with regards to maternal preconceptional body mass index, gestational weight gain, placental and fetal requirements in relation to adverse pregnancy and long-term outcomes of the fetus (nutritional programming). We conclude that there is an urgent need to develop further human investigations aimed at better understanding of the basis of biochemical mechanisms and pathophysiological events related to maternal-fetal nutrition and offspring health. An improved knowledge would help to optimize nutritional recommendations for pregnancy.
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Affiliation(s)
- C Berti
- a Unit of Obstetrics & Gynecology, Department of Biomedical and Clinical Sciences, Hospital 'L. Sacco', and Center for Fetal Research Giorgio Pardi , University of Milan , Milan , Italy
| | - I Cetin
- a Unit of Obstetrics & Gynecology, Department of Biomedical and Clinical Sciences, Hospital 'L. Sacco', and Center for Fetal Research Giorgio Pardi , University of Milan , Milan , Italy.,b Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - C Agostoni
- b Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - G Desoye
- c Department of Obstetrics & Gynaecology , Medical University of Graz , Graz , Austria
| | - R Devlieger
- d Department of Obstetrics & Gynaecology , University Hospitals K.U. Leuven , Leuven , Belgium
| | - P M Emmett
- e Centre for Child & Adolescent Health, School of Social & Community Medicine , University of Bristol , Bristol , United Kingdom
| | - R Ensenauer
- f Research Center, Dr. von Hauner Children's Hospital, Klinikum der Ludwig-Maximilians-Universität München , Munich , Germany
| | - H Hauner
- g Else Kroener-Fresenius-Centre for Nutritional Medicine, Klinikum rechts der Isar , Technical University of Munich , Munich , Germany
| | - E Herrera
- h Unit of Biochemistry & Molecular Biology, Universidad San Pablo CEU , Madrid , Spain
| | - I Hoesli
- i Department of Obstetrics and Gynaecology , University Hospital of Basel , Basel , Switzerland
| | - S Krauss-Etschmann
- j Comprehensive Pneumology Center, Ludwig Maximilians University Hospital , Munich , Germany.,k Helmholtz Zentrum München , Munich , Germany
| | - S F Olsen
- l Centre for Fetal Programming, Statens Serum Institut , Copenhagen , Denmark
| | - U Schaefer-Graf
- m Department of Obstetrics & Gynecology , Berlin Center for Diabetes & Pregnancy, St. Joseph Hospital , Berlin , Germany
| | - B Schiessl
- n Fetal Maternal Unit, Department of Obstetrics & Gynecology , University of Munich , Munich , Germany
| | - M E Symonds
- o The Early Life Nutrition Research Unit, Academic Child Health, School of Clinical Sciences, University Hospital of Nottingham , Nottingham , United Kingdom
| | - B Koletzko
- p Dr. von Hauner Children's Hospital , University of Munich Medical Centre , Munich , Germany
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4
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Knabl J, Pestka A, Hüttenbrenner R, Plösch T, Ensenauer R, Welbergen L, Hutter S, Karsten M, Jeschke U. Die Rolle des Kernrezeptor LXR im Spontanabort und im rezidivierenden Abort. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1580642] [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] Open
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5
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Schlune A, vom Dahl S, Häussinger D, Ensenauer R, Mayatepek E. Arginase 1 deficiency: long-term follow-up of the original patients. Z Gastroenterol 2015. [DOI: 10.1055/s-0035-1568028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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6
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Knabl J, Riedel C, Gmach J, Ensenauer R, Brandlhuber L, Schiessl B, Rasmussen K, Kries RV. Eine frühzeitige Entdeckung der exzessiven Gewichtszunahme in der Schwangerschaft ist möglich! Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388142] [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: 10/24/2022] Open
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7
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Krinninger P, Ensenauer R, Ehlers K, Rauh K, Stoll J, Krauss-Etschmann S, Hauner H, Laumen H. Peripheral monocytes of obese women display increased chemokine receptor expression and migration capacity. J Clin Endocrinol Metab 2014; 99:2500-9. [PMID: 24606068 DOI: 10.1210/jc.2013-2611] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The activation of peripheral immune cells and the infiltration of immune cells into adipose tissue in obesity are implicated in the development of type 2 diabetes mellitus. OBJECTIVE The aim of the study was to compare peripheral immune cells from obese and normal-weight women with regard to composition of immune cell subpopulations, surface expression of the chemokine receptors (CCRs) CCR2, CCR3, CCR5, and CXCR3 (chemokine (C-X-C motif) receptor 3) and cell-intrinsic migration capacity. DESIGN This was a case-control study. SETTING The study was conducted at a university clinical study center. PATIENTS Obese females and normal-weight females were included for fluorescence-activated cell sorting analysis and migration assays. MAIN OUTCOME MEASURES Peripheral blood mononuclear cells were prepared from fasting blood samples and used for fluorescence-activated cell sorting analysis and migration assays. RESULTS An increase in the percentages of CD14(+)CD16(+) monocytes was observed in obese subjects compared with controls. The CCR profile of monocytes differed significantly in the obese state; in particular, CCR2 levels were increased. In addition, a higher chemotactic activity of monocytes from obese subjects was observed in a migration assay, which was associated with both insulin resistance and CCR2 expression. CONCLUSION Our results suggest that the enhanced intrinsic migratory capacity of peripheral monocytes in obese women may be due to the increased CCR expression, further supporting a link between peripheral immune cell dysfunction and obesity.
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Affiliation(s)
- P Krinninger
- Else Kroener-Fresenius Center for Nutritional Medicine (P.K., K.E., K.R., J.S., H.H., H.L.), Department of Nutritional Medicine, ZIEL Research Centre for Nutrition and Food Sciences, Clinical Cooperation Group Nutrigenomics and Type 2 Diabetes (K.E., H.H., H.L.), Helmholtz Zentrum München and Technical University München, and Else Kroener-Fresenius-Center for Nutritional Medicine (H.H.), Klinikum Rechts der Isar, Technische Universität München, 85350 Freising-Weihenstephan, Germany; German Center for Diabetes Research, 85764 Neuherberg, Germany; Research Center (R.E.), Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, 80337 München, Germany; Comprehensive Pneumology Center (S.K.-E.), Helmholtz Zentrum München, Ludwig-Maximilians University, and Asklepios Clinic Gauting, 82131 München, Germany
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8
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Knabl J, Riedel C, Gmach J, Ensenauer R, Brandlhuber L, Rasmussen KM, Schiessl B, von Kries R. Prediction of excessive gestational weight gain from week-specific cutoff values: a cohort study. J Perinatol 2014; 34:351-6. [PMID: 24577434 DOI: 10.1038/jp.2014.22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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] [Received: 09/25/2013] [Revised: 12/10/2013] [Accepted: 01/13/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the prognostic validity of the Institute of Medicine/National Research Council (IOM/NRC) week-specific cutoff values for inadequate or excessive total gestational weight gain (GWG) by 4-week intervals. STUDY DESIGN We merged data from two German cohorts (LMU cohort (all maternal-weight categories) and PEACHES cohort (obese women)) to provide information on GWG for 749 women (365 normal weight, 199 overweight and 185 obese). We calculated the prognostic values for suboptimal and excessive GWG according to the IOM/NRC cutoff values. RESULT The positive predictive values for excessive total GWG for those who experienced excessive GWG early in pregnancy was 70.1% (95% confidence interval (CI) 60.5; 78.6) as of week 12/1 to 16/0 in normal-weight women, 89.5% (95% CI 75.2; 97.1) and 95.2 (76.2; 99.9) 95.2% (95% CI 76.2; 99.9) as of week 8/1 to 12/0 for overweight and obese women, respectively. In absence of excessive GWG as of week 12/1 to 16/0, normal-weight women had 77.5% (95% CI 77.1; 83.1) probability of not experiencing excessive total GWG (negative predictive value). In overweight and obese women, the negative predictive value was considerably lower up to week 24/1 to 28/0 (60.0% (95% CI 48.8; 70.5) in week 20/1 to 24/0 and 50.6% (95% CI 39.3; 61.9) in week 24/1 to 28/0). Most women with inadequate GWG in the first and second trimester had adequate total final GWG (positive predictive value for total inadequate GWG <50% up to week 16/1 to 20/0 in all groups). CONCLUSION As women with excessive weight gain can be identified with high confidence if the GWG exceeds the IOM/NRC week-specific cutoff values, interventions may be initiated early in pregnancy.
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Affiliation(s)
- J Knabl
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - C Riedel
- Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - J Gmach
- 1] Department of Obstetrics and Gynecology, Ludwig-Maximilians-Universität München, Munich, Germany [2] Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität München, Munich, Germany [3] Research Center, Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany [4] Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - R Ensenauer
- Research Center, Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - L Brandlhuber
- Research Center, Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - K M Rasmussen
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - B Schiessl
- Department of Obstetrics and Gynecology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - R von Kries
- 1] Department of Obstetrics and Gynecology, Ludwig-Maximilians-Universität München, Munich, Germany [2] Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
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9
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Dahlhoff M, Pfister S, Blutke A, Rozman J, Klingenspor M, Deutsch MJ, Rathkolb B, Fink B, Gimpfl M, Hrabě de Angelis M, Roscher AA, Wolf E, Ensenauer R. Peri-conceptional obesogenic exposure induces sex-specific programming of disease susceptibilities in adult mouse offspring. Biochim Biophys Acta 2014. [PMID: 24275555 DOI: 10.1016/j.bbadis.2013.ll.021] [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] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Vulnerability of the fetus upon maternal obesity can potentially occur during all developmental phases. We aimed at elaborating longer-term health outcomes of fetal overnutrition during the earliest stages of development. We utilized Naval Medical Research Institute (NMRI) mice to induce pre-conceptional and gestational obesity and followed offspring outcomes in the absence of any postnatal obesogenic influences. Male adult offspring developed overweight, insulin resistance, hyperleptinemia, hyperuricemia and hepatic steatosis; all these features were not observed in females. Instead, they showed impaired fasting glucose and a reduced fat mass and adipocyte size. Influences of the interaction of maternal diet∗sex concerned offspring genes involved in fatty liver disease, lipid droplet size regulation and fat mass expansion. These data suggest that a peri-conceptional obesogenic exposure is sufficient to shape offspring gene expression patterns and health outcomes in a sex- and organ-specific manner, indicating varying developmental vulnerabilities between sexes towards metabolic disease in response to maternal overnutrition.
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Key Words
- ANOVA
- ATP citrate lyase
- AUC
- Acaca
- Acetyl-Coenzyme A carboxylase 1
- Acly
- Actb
- Analysis of variance
- Area under the curve
- B cell leukemia/lymphoma 2
- BW
- Bax
- Bcl2
- Bcl2-associated X protein
- Berardinelli–Seip congenital lipodystrophy 2 (also known as seipin)
- Beta-actin
- Body weight
- Bscl2
- CD
- CET
- CT
- Carbon dioxide production
- Carnitine palmitoyltransferase 1
- Cd36
- Cd36 antigen
- Cell death-inducing DNA fragmentation factor, alpha subunit-like effector A
- Central European Time
- Cidea
- Computed tomography
- Control diet
- Cpt1
- Day post coitum
- EEC
- European Economic Commission
- Exposure to maternal control diet
- Exposure to maternal high-fat, high-calorie diet
- FA
- Fabp4
- Fasn
- Fatty acid
- Fatty acid binding protein 4
- Fatty acid synthase
- GR
- GTT
- Glucocorticoid receptor
- Glucose tolerance test
- H&E
- HFD
- HMW
- HOMA-IR
- HP
- Hairy and enhancer of split 1
- Heat production
- Hematoxylin–eosin
- Hes1
- High-fat, high-calorie diet
- High-molecular-weight
- Homeostatic model assessment of insulin resistance
- Lep
- Leptin
- MD
- MDA
- MRI
- Magnetic resonance imaging
- Maintenance diet
- Malic enzyme 1
- Malondialdehyde
- Me1
- Mesoderm-specific transcript/imprinted paternally expressed gene 1 (also known as Peg1)
- Mest
- N
- NAFLD
- NEFA
- NMRI
- NRL
- Naval Medical Research Institute
- Nitrogen
- Non-alcoholic fatty liver disease
- Non-esterified fatty acid
- Nose–rump-length
- Nr1h3
- Nr3c1
- Nuclear receptor subfamily 1, group H, member 3 (also known as Lxra, liver X receptor alpha)
- Nuclear receptor subfamily 3, group C, member 1 (also known as Gr, glucocorticoid receptor)
- Obesity
- Offspring
- Oxygen consumption
- PFA
- Paraformaldehyde
- Patatin-like phospholipase domain-containing protein 2 (also known as Atgl, adipose triglyceride lipase)
- Peptidylprolyl isomerase A
- Peri-conceptional
- Perilipin 2
- Peroxisome proliferator activated receptor alpha
- Peroxisome proliferator activated receptor gamma
- Plin2
- Pnpla2
- Ppara
- Pparg
- Ppia
- Pregnancy
- Programming
- RER
- ROI
- Region of interest
- Respiratory exchange ratio
- S.e.m.
- Scd2
- Secreted frizzled-related sequence protein 5
- Sex-specificity
- Sfrp5
- Srebf1
- Standard error of the mean
- Stearoyl-Coenzyme A desaturase 2
- Sterol regulatory element binding transcription factor 1
- TBARS
- Thiobarbituric acid-reactive substances
- Ube2d2
- Ubiquitin-conjugating enzyme E2D 2
- VCO(2)
- VO(2)
- dpc
- mat-CD
- mat-HFD
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Affiliation(s)
- M Dahlhoff
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universität München, Feodor-Lynen-Strasse 25, 81377 Munich, Germany.
| | - S Pfister
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
| | - A Blutke
- Institute of Veterinary Pathology at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Veterinärstrasse 13, 80539 Munich, Germany.
| | - J Rozman
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764 München-Neuherberg, Germany; Molecular Nutritional Medicine, Else-Kröner Fresenius Center, Technische Universität München, Gregor-Mendel-Strasse 2, 85350 Freising-Weihenstephan, Germany.
| | - M Klingenspor
- Molecular Nutritional Medicine, Else-Kröner Fresenius Center, Technische Universität München, Gregor-Mendel-Strasse 2, 85350 Freising-Weihenstephan, Germany.
| | - M J Deutsch
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
| | - B Rathkolb
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universität München, Feodor-Lynen-Strasse 25, 81377 Munich, Germany; German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764 München-Neuherberg, Germany.
| | - B Fink
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
| | - M Gimpfl
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
| | - M Hrabě de Angelis
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764 München-Neuherberg, Germany; Lehrstuhl für Experimentelle Genetik, Wissenschaftszentrum Weihenstephan, Technische Universität München, Alte Akademie 8, 85354 Freising, Germany; Member of German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, 85764 München-Neuherberg, Germany.
| | - A A Roscher
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
| | - E Wolf
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universität München, Feodor-Lynen-Strasse 25, 81377 Munich, Germany.
| | - R Ensenauer
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
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10
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Nehring I, Chmitorz A, Reulen H, von Kries R, Ensenauer R. Gestational diabetes predicts the risk of childhood overweight and abdominal circumference independent of maternal obesity. Diabet Med 2013; 30:1449-56. [PMID: 23869909 DOI: 10.1111/dme.12286] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [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] [Accepted: 07/17/2013] [Indexed: 12/12/2022]
Abstract
AIM Gestational diabetes mellitus is believed to be a risk factor for childhood overweight/obesity. We aimed to assess whether this association is either a reflection or independent of confounding by maternal BMI. METHODS Data from 7355 mother-child dyads of the German Perinatal Prevention of Obesity cohort with full anthropometric information on mothers and children, gestational diabetes and confounding factors were obtained at school entry health examination. We calculated crude and adjusted logistic regression models for the association of gestational diabetes and childhood overweight/obesity and abdominal adiposity defined by age- and sex-specific percentiles for BMI and waist circumference. RESULTS Among all children (mean age 5.8 years), 8.1% were overweight, 2.6% were obese and 15.5% had abdominal adiposity. The prevalence of overweight (obesity) was 21% (8.2%) in children of mothers with gestational diabetes and 10.4% (2.4%) in children of healthy mothers. Analyses with adjustment for maternal BMI and other potential confounders yielded an odds ratio of 1.81 (95% CI 1.23-2.65) and 2.80 (95% CI 1.58-4.99) for the impact of gestational diabetes on childhood overweight and obesity, respectively. Similar results were obtained for the risk of childhood abdominal adiposity (odds ratio 1.64, 95% CI 1.16-2.33) by maternal gestational diabetes. CONCLUSIONS The postulated increased risk of overweight and abdominal adiposity in offspring of mothers with gestational diabetes cannot be explained by maternal BMI alone and may be stronger for childhood obesity than for overweight.
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Affiliation(s)
- I Nehring
- Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Germany
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11
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Dahlhoff M, Pfister S, Blutke A, Rozman J, Klingenspor M, Deutsch MJ, Rathkolb B, Fink B, Gimpfl M, Hrabě de Angelis M, Roscher AA, Wolf E, Ensenauer R. Peri-conceptional obesogenic exposure induces sex-specific programming of disease susceptibilities in adult mouse offspring. Biochim Biophys Acta Mol Basis Dis 2013; 1842:304-17. [PMID: 24275555 DOI: 10.1016/j.bbadis.2013.11.021] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/20/2013] [Accepted: 11/19/2013] [Indexed: 12/23/2022]
Abstract
Vulnerability of the fetus upon maternal obesity can potentially occur during all developmental phases. We aimed at elaborating longer-term health outcomes of fetal overnutrition during the earliest stages of development. We utilized Naval Medical Research Institute (NMRI) mice to induce pre-conceptional and gestational obesity and followed offspring outcomes in the absence of any postnatal obesogenic influences. Male adult offspring developed overweight, insulin resistance, hyperleptinemia, hyperuricemia and hepatic steatosis; all these features were not observed in females. Instead, they showed impaired fasting glucose and a reduced fat mass and adipocyte size. Influences of the interaction of maternal diet∗sex concerned offspring genes involved in fatty liver disease, lipid droplet size regulation and fat mass expansion. These data suggest that a peri-conceptional obesogenic exposure is sufficient to shape offspring gene expression patterns and health outcomes in a sex- and organ-specific manner, indicating varying developmental vulnerabilities between sexes towards metabolic disease in response to maternal overnutrition.
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Key Words
- ANOVA
- ATP citrate lyase
- AUC
- Acaca
- Acetyl-Coenzyme A carboxylase 1
- Acly
- Actb
- Analysis of variance
- Area under the curve
- B cell leukemia/lymphoma 2
- BW
- Bax
- Bcl2
- Bcl2-associated X protein
- Berardinelli–Seip congenital lipodystrophy 2 (also known as seipin)
- Beta-actin
- Body weight
- Bscl2
- CD
- CET
- CT
- Carbon dioxide production
- Carnitine palmitoyltransferase 1
- Cd36
- Cd36 antigen
- Cell death-inducing DNA fragmentation factor, alpha subunit-like effector A
- Central European Time
- Cidea
- Computed tomography
- Control diet
- Cpt1
- Day post coitum
- EEC
- European Economic Commission
- Exposure to maternal control diet
- Exposure to maternal high-fat, high-calorie diet
- FA
- Fabp4
- Fasn
- Fatty acid
- Fatty acid binding protein 4
- Fatty acid synthase
- GR
- GTT
- Glucocorticoid receptor
- Glucose tolerance test
- H&E
- HFD
- HMW
- HOMA-IR
- HP
- Hairy and enhancer of split 1
- Heat production
- Hematoxylin–eosin
- Hes1
- High-fat, high-calorie diet
- High-molecular-weight
- Homeostatic model assessment of insulin resistance
- Lep
- Leptin
- MD
- MDA
- MRI
- Magnetic resonance imaging
- Maintenance diet
- Malic enzyme 1
- Malondialdehyde
- Me1
- Mesoderm-specific transcript/imprinted paternally expressed gene 1 (also known as Peg1)
- Mest
- N
- NAFLD
- NEFA
- NMRI
- NRL
- Naval Medical Research Institute
- Nitrogen
- Non-alcoholic fatty liver disease
- Non-esterified fatty acid
- Nose–rump-length
- Nr1h3
- Nr3c1
- Nuclear receptor subfamily 1, group H, member 3 (also known as Lxra, liver X receptor alpha)
- Nuclear receptor subfamily 3, group C, member 1 (also known as Gr, glucocorticoid receptor)
- Obesity
- Offspring
- Oxygen consumption
- PFA
- Paraformaldehyde
- Patatin-like phospholipase domain-containing protein 2 (also known as Atgl, adipose triglyceride lipase)
- Peptidylprolyl isomerase A
- Peri-conceptional
- Perilipin 2
- Peroxisome proliferator activated receptor alpha
- Peroxisome proliferator activated receptor gamma
- Plin2
- Pnpla2
- Ppara
- Pparg
- Ppia
- Pregnancy
- Programming
- RER
- ROI
- Region of interest
- Respiratory exchange ratio
- S.e.m.
- Scd2
- Secreted frizzled-related sequence protein 5
- Sex-specificity
- Sfrp5
- Srebf1
- Standard error of the mean
- Stearoyl-Coenzyme A desaturase 2
- Sterol regulatory element binding transcription factor 1
- TBARS
- Thiobarbituric acid-reactive substances
- Ube2d2
- Ubiquitin-conjugating enzyme E2D 2
- VCO(2)
- VO(2)
- dpc
- mat-CD
- mat-HFD
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Affiliation(s)
- M Dahlhoff
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universität München, Feodor-Lynen-Strasse 25, 81377 Munich, Germany.
| | - S Pfister
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
| | - A Blutke
- Institute of Veterinary Pathology at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität München, Veterinärstrasse 13, 80539 Munich, Germany.
| | - J Rozman
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764 München-Neuherberg, Germany; Molecular Nutritional Medicine, Else-Kröner Fresenius Center, Technische Universität München, Gregor-Mendel-Strasse 2, 85350 Freising-Weihenstephan, Germany.
| | - M Klingenspor
- Molecular Nutritional Medicine, Else-Kröner Fresenius Center, Technische Universität München, Gregor-Mendel-Strasse 2, 85350 Freising-Weihenstephan, Germany.
| | - M J Deutsch
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
| | - B Rathkolb
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universität München, Feodor-Lynen-Strasse 25, 81377 Munich, Germany; German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764 München-Neuherberg, Germany.
| | - B Fink
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
| | - M Gimpfl
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
| | - M Hrabě de Angelis
- German Mouse Clinic, Institute of Experimental Genetics, Helmholtz Zentrum München, Ingolstädter Landstrasse 1, 85764 München-Neuherberg, Germany; Lehrstuhl für Experimentelle Genetik, Wissenschaftszentrum Weihenstephan, Technische Universität München, Alte Akademie 8, 85354 Freising, Germany; Member of German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, 85764 München-Neuherberg, Germany.
| | - A A Roscher
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
| | - E Wolf
- Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians-Universität München, Feodor-Lynen-Strasse 25, 81377 Munich, Germany.
| | - R Ensenauer
- Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany.
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Freudenberg F, Bufler P, Ensenauer R, Lohse P, Koletzko S. Cholesteryl Ester Storage Disease: an Easily Missed Diagnosis in Oligosymptomatic Children. Z Gastroenterol 2013; 51:1184-7. [DOI: 10.1055/s-0033-1350463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- F. Freudenberg
- Dr. von Hauner Childrens Hospital, Ludwig-Maximilians University Munich, Germany
| | - P. Bufler
- Dr. von Hauner Childrens Hospital, Ludwig-Maximilians University Munich, Germany
| | - R. Ensenauer
- Dr. von Hauner Childrens Hospital, Ludwig-Maximilians University Munich, Germany
| | - P. Lohse
- Department of Clinical Chemistry − Großhadern, Ludwig-Maximilians University Munich, Germany
| | - S. Koletzko
- Dr. von Hauner Childrens Hospital, Ludwig-Maximilians University Munich, Germany
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13
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Fudickar A, Smigaj K, Ensenauer R, Fischer G, Dütschke P, Steinfath M, Bein B. Effect of propofol and sevoflurane on acid-base balance during pediatric heart catheterization. Minerva Anestesiol 2013; 79:626-633. [PMID: 23511362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Propofol is routinely used for anesthesia during pediatric heart catheterization. Propofol infusion syndrome (PRIS) is a rare, but often fatal complication mainly defined as bradycardia with progress to asystolia during propofol infusion. Metabolic acidosis is regarded as an early warning sign of PRIS. In this study the effect of propofol and sevoflurane on serum base excess, pH and lactate have been examined during pediatric heart catheterization. METHODS In this prospective randomised study 42 children have been anesthetised for pediatric heart catheterization with propofol (N.=22) or sevoflurane (N.=20) with ethic committee approval. Base excess, pH and lactate were measured by blood gas analysis at the beginning, during and at the end of the procedure. Changes relative to baseline were analysed by paired t-Test with correction for multiple testing. The study was powered to detect a difference of 1.5 mmol.L-1 for base excess and lactate. RESULTS Base excess (-2.59 [2.33] vs. -4.48 [2.88], P=0.0004, mean [standard deviation]) and pH (7.39 [0.05] vs. 7.36 [0.06], P=0.0008,) changed significantly in in the propofol group but not in the sevoflurane group. The number of patients with base excess < 5.0 increased in the propofol group only from 2 to 10 (P=0.016). Lactate decreased in both groups (1.1 [0.3] vs. 0.9 [0.2], P=0.003 for sevoflurane and 1.0 [0.3] vs. 0.8 [0.3], P=0.0004 for propofol). CONCLUSION Propofol but not sevoflurane had an effect on base excess and pH during pediatric heart catheterization.
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Affiliation(s)
- A Fudickar
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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14
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Grünert SC, Müllerleile S, de Silva L, Barth M, Walter M, Walter K, Meissner T, Lindner M, Ensenauer R, Santer R, Bodamer OA, Baumgartner MR, Brunner-Krainz M, Karall D, Haase C, Knerr I, Marquardt T, Hennermann JB, Steinfeld R, Beblo S, Koch HG, Konstantopoulou V, Scholl-Bürgi S, van Teeffelen-Heithoff A, Suormala T, Sperl W, Kraus JP, Superti-Furga A, Schwab KO, Sass JO. Propionic acidemia: neonatal versus selective metabolic screening. J Inherit Metab Dis 2012; 35:41-9. [PMID: 22134541 DOI: 10.1007/s10545-011-9419-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [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] [Received: 03/23/2011] [Revised: 10/08/2011] [Accepted: 10/17/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Whereas propionic acidemia (PA) is a target disease of newborn screening (NBS) in many countries, it is not in others. Data on the benefit of NBS for PA are sparse. STUDY DESIGN Twenty PA patients diagnosed through NBS were compared to 35 patients diagnosed by selective metabolic screening (SMS) prompted by clinical findings, family history, or routine laboratory test results. Clinical and biochemical data of patients from 16 metabolic centers in Germany, Austria, and Switzerland were evaluated retrospectively. Additionally, assessment of the intelligent quotient (IQ) was performed. In a second step, the number of PA patients who have died within the past 20 years was estimated based on information provided by the participating metabolic centers. RESULTS Patients diagnosed through NBS had neither a milder clinical course regarding the number of metabolic crises nor a better neurological outcome. Among NBS patients, 63% were already symptomatic at the time of diagnosis, and <10% of all patients remained asymptomatic. Among all PA patients, 76% were found to be at least mildly mentally retarded, with an IQ <69. IQ was negatively correlated with the number of metabolic decompensations, but not simply with the patients' age. Physical development was also impaired in the majority of patients. Mortality rates tended to be lower in NBS patients compared with patients diagnosed by SMS. CONCLUSION Early diagnosis of PA through NBS seems to be associated with a lower mortality rate. However, no significant benefit could be shown for surviving patients with regard to their clinical course, including the number of metabolic crises, physical and neurocognitive development, and long-term complications.
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Affiliation(s)
- S C Grünert
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Freiburg, Germany
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15
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Kraus JP, Spector E, Venezia S, Estes P, Chiang PW, Creadon-Swindell G, Müllerleile S, de Silva L, Barth M, Walter M, Walter K, Meissner T, Lindner M, Ensenauer R, Santer R, Bodamer OA, Baumgartner MR, Brunner-Krainz M, Karall D, Haase C, Knerr I, Marquardt T, Hennermann JB, Steinfeld R, Beblo S, Koch HG, Konstantopoulou V, Scholl-Bürgi S, van Teeffelen-Heithoff A, Suormala T, Ugarte M, Sperl W, Superti-Furga A, Schwab KO, Grünert SC, Sass JO. Mutation analysis in 54 propionic acidemia patients. J Inherit Metab Dis 2012; 35:51-63. [PMID: 22033733 DOI: 10.1007/s10545-011-9399-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [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] [Received: 03/23/2011] [Revised: 07/20/2011] [Accepted: 09/15/2011] [Indexed: 10/15/2022]
Abstract
Deficiency of propionyl CoA carboxylase (PCC), a dodecamer of alpha and beta subunits, causes inherited propionic acidemia. We have studied, at the molecular level, PCC in 54 patients from 48 families comprised of 96 independent alleles. These patients of various ethnic backgrounds came from research centers and hospitals in Germany, Austria and Switzerland. The thorough clinical characterization of these patients was described in the accompanying paper (Grünert et al. 2012). In all 54 patients, many of whom originated from consanguineous families, the entire PCCB gene was examined by genomic DNA sequencing and in 39 individuals the PCCA gene was also studied. In three patients we found mutations in both PCC genes. In addition, in many patients RT-PCR analysis of lymphoblast RNA, lymphoblast enzyme assays, and expression of new mutations in E.coli were carried out. Eight new and eight previously detected mutations were identified in the PCCA gene while 15 new and 13 previously detected mutations were found in the PCCB gene. One missense mutation, p.V288I in the PCCB gene, when expressed in E.coli, yielded 134% of control activity and was consequently classified as a polymorphism in the coding region. Numerous new intronic polymorphisms in both PCC genes were identified. This study adds a considerable amount of new molecular data to the studies of this disease.
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Affiliation(s)
- J P Kraus
- Department of Pediatrics, Colorado Intellectual and Developmental Disabilities Research Center (IDDRC), University of Colorado Denver, Anschutz Medical Campus, Aurora, CO 80045, USA.
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16
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Abstract
Magnetic force combined with magnetic nanoparticles recently has shown potential for enhancing nucleic acid delivery. Achieving effective siRNA delivery into primary cultured cells is challenging. We compared the utility of magnetofection with lipofection procedures for siRNA delivery to primary and immortalized mammalian fibroblasts. Transfection efficiency and cell viability were analyzed by flow cytometry and effects of gene knockdown were quantified by real-time PCR. Lipofectamine 2000 and magnetofection achieved high transfection efficiencies comparable to similar gene silencing effects of about 80%; the cytotoxic effect of magnetofection, however, was significantly less. Magnetofection is a reliable and gentle alternative method with low cytotoxicity for siRNA delivery into difficult to transfect cells such as mammalian fibroblasts. These features are especially advantageous for functional end point analyses of gene silencing, e.g., on the metabolite level.
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Affiliation(s)
- R Ensenauer
- Children's Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
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17
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Mercimek-Mahmutoglu S, Stoeckler-Ipsiroglu S, Adami A, Appleton R, Araújo HC, Duran M, Ensenauer R, Fernandez-Alvarez E, Garcia P, Grolik C, Item CB, Leuzzi V, Marquardt I, Mühl A, Saelke-Kellermann RA, Salomons GS, Schulze A, Surtees R, van der Knaap MS, Vasconcelos R, Verhoeven NM, Vilarinho L, Wilichowski E, Jakobs C. GAMT deficiency: Features, treatment, and outcome in an inborn error of creatine synthesis. Neurology 2006; 67:480-4. [PMID: 16855203 DOI: 10.1212/01.wnl.0000234852.43688.bf] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Guanidinoactetate methyltransferase (GAMT) deficiency is an autosomal recessive disorder of creatine synthesis. The authors analyzed clinical, biochemical, and molecular findings in 27 patients. METHODS The authors collected data from questionnaires and literature reports. A score including degree of intellectual disability, epileptic seizures, and movement disorder was developed and used to classify clinical phenotype as severe, moderate, or mild. Score and biochemical data were assessed before and during treatment with oral creatine substitution alone or with additional dietary arginine restriction and ornithine supplementation. RESULTS Intellectual disability, epileptic seizures, guanidinoacetate accumulation in body fluids, and deficiency of brain creatine were common in all 27 patients. Twelve patients had severe, 12 patients had moderate, and three patients had mild clinical phenotype. Twenty-one of 27 (78%) patients had severe intellectual disability (estimated IQ 20 to 34). There was no obvious correlation between severity of the clinical phenotype, guanidinoacetate accumulation in body fluids, and GAMT mutations. Treatment resulted in almost normalized cerebral creatine levels, reduced guanidinoacetate accumulation, and in improvement of epilepsy and movement disorder, whereas the degree of intellectual disability remained unchanged. CONCLUSION Guanidinoactetate methyltransferase deficiency should be considered in patients with unexplained intellectual disability, and urinary guanidinoacetate should be determined as an initial diagnostic approach.
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Affiliation(s)
- S Mercimek-Mahmutoglu
- Division of Biochemical Diseases, British Columbia Children's Hospital, Vancouver, Canada
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18
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Ensenauer R, Thiel T, Schwab KO, Tacke U, Stöckler-Ipsiroglu S, Schulze A, Hennig J, Lehnert W. Guanidinoacetate methyltransferase deficiency: differences of creatine uptake in human brain and muscle. Mol Genet Metab 2004; 82:208-13. [PMID: 15234333 DOI: 10.1016/j.ymgme.2004.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Revised: 04/08/2004] [Accepted: 04/08/2004] [Indexed: 11/20/2022]
Abstract
Deficiency of guanidinoacetate methyltransferase (GAMT), the first described creatine biosynthesis defect, leads to depletion of creatine and phosphocreatine, and accumulation of guanidinoacetate in brain. This results in epilepsy, mental retardation, and extrapyramidal movement disorders. Investigation of skeletal muscle by proton and phosphorus magnetic resonance spectroscopy before therapy demonstrated the presence of considerable amounts of creatine and phosphocreatine, and accumulation of phosphorylated guanidinoacetate in a 7-year-old boy diagnosed with GAMT deficiency, suggesting separate mechanisms for creatine uptake and synthesis in brain and skeletal muscle. The combination of creatine supplementation and a guanidinoacetate-lowering therapeutic approach resulted in improvement of clinical symptoms and metabolite concentrations in brain, muscle, and body fluids.
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Affiliation(s)
- R Ensenauer
- Metabolic Unit, University Children's Hospital, Freiburg, Germany.
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Babovic-Vuksanovic D, Jenkins SC, Ensenauer R, Newman DC, Jalal SM. Subtelomeric deletion of 18p in an adult with paranoid schizophrenia and mental retardation. ACTA ACUST UNITED AC 2003; 124A:318-22. [PMID: 14708108 DOI: 10.1002/ajmg.a.20391] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Chromosome anomalies are responsible for a significant proportion of patients with mental retardation, and congenital anomalies. Development of new molecular cytogenetic techniques has provided a powerful tool for detection of patients with subtle chromosome abnormalities. Particularly, investigation of the gene-rich subtelomeric regions has generated interest regarding the implications and prevalence of cryptic chromosomal rearrangements. Here we describe an adult with a submicroscopic deletion of 18pter, detected by subtelomeric FISH probe. The patient is a 42-year-old man with a history of developmental delay, moderate mental retardation, and symptoms of paranoid schizophrenia since adolescence. His physical examination is remarkable for only a few dysmorphic findings typically seen in 18p- syndrome (round face, hypertelorism, down-slanted palpebral fissures, temporal narrowing, small hands and feet). He lacks significant short stature, skin changes, and associated anomalies involving internal organs. All known patients with deletions of the short arm of chromosome 18 have either loss of large parts of 18p or of the entire p-arm, or have complex chromosomal rearrangement involving other chromosomes. To our knowledge, this is the first description of a cryptic subtelomeric deletion of 18p and the first case of such a chromosomal anomaly in a patient with schizophrenia. Small subtelomeric chromosomal deletions would be missed by standard G-banded karyotyping. Therefore, FISH analysis using subtelomeric probes should be considered for diagnostic evaluation of patients with psychiatric symptoms and mental retardation in whom the karyotype is normal.
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Grafakou O, Hol FA, Otfried Schwab K, Siers MH, ter Laak H, Trijbels F, Ensenauer R, Boelen C, Smeitink J. Exercise intolerance, muscle pain and lactic acidaemia associated with a 7497G>A mutation in the tRNASer(UCN) gene. J Inherit Metab Dis 2003; 26:593-600. [PMID: 14605505 DOI: 10.1023/a:1025960300710] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [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: 11/12/2022]
Abstract
A 13-year-old girl with non-familial exercise intolerance, muscle pain and lactic acidaemia underwent a muscle biopsy for suspected mitochondrial disease. Muscle morphology showed 25% ragged-red fibres and 80% COX-negative staining. Enzymatic activities of mitochondrially co-encoded respiratory chain enzymes (complexes I, III, and IV) were decreased in muscle but normal in cultured skin fibroblasts. mtDNA analysis revealed the presence of the 7497G>A mutation in the tRNASer(UCN) gene, homoplasmic in skeletal muscle and 90% in leukocytes. Analysis of the mother's mtDNA showed 10% heteroplasmy in blood. It may be concluded that the 7497G>A mutation is associated with a muscle-only disease presentation for which high levels of mutated mtDNA are required. Exercise intolerance and muscle pain in otherwise normal children warrants further mitochondrial evaluation.
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Affiliation(s)
- O Grafakou
- Department of Pediatrics, Nijmegen Center for Mitochondrial Disorders, University Medical Center Nijmegen, The Netherlands
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21
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Gempel K, von Praun C, Baumkötter J, Lehnert W, Ensenauer R, Gerbitz KD, Bauer MF. "Adult" form of muscular carnitine palmitoyltransferase II deficiency: manifestation in a 2-year-old child. Eur J Pediatr 2001; 160:548-51. [PMID: 11585077 DOI: 10.1007/s004310100802] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 10/27/2022]
Abstract
UNLABELLED We describe a 6-year-old girl admitted with acute muscular weakness and pain which made her unable to walk. Her parents reported a 4-year history of similar episodes which occurred once or twice a year and always resolved spontaneously. Laboratory investigations showed elevated serum creatine kinase which peaked at day 2 of the attack with 18,600 U/l. Carnitine palmitoyltransferase-II deficiency was suspected based on the determination of serum acylcarnitines by tandem mass spectrometry which showed a characteristic elevation of long-chain C16 and C18:1 acylcarnitines. The diagnosis was confirmed by impaired in-vitro palmitate oxidation in blood and the detection of a homozygous substitution S113L in the carnitine palmitoyltransferase-II gene. CONCLUSION Carnitine palmitoyltransferase-II deficiency should be included in the differential diagnosis of isolated muscular weakness even when manifesting in early childhood.
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Affiliation(s)
- K Gempel
- Institute for Clinical Chemistry, Molecular Diagnostics and Mitochondrial Genetics, Academic Hospital Schwabing, Munich, Germany.
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22
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Ensenauer R, Müller CB, Schwab KO, Gibson KM, Brandis M, Lehnert W. 3-Methylglutaconyl-CoA hydratase deficiency: a new patient with speech retardation as the leading sign. J Inherit Metab Dis 2000; 23:341-4. [PMID: 10896289 DOI: 10.1023/a:1005670911799] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R Ensenauer
- University Children's Hospital Freiburg, Germany
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23
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Abstract
In children with short-bowel syndrome and the need for long-term parenteral nutrition, hepatic dysfunction is a multifactorial phenomenon that has not been completely understood. Alterations in gut motility lead to intraluminal stasis which is thought to be a major etiologic factor for bacterial overgrowth and subsequent cholestasis, especially when the ileocecal valve is absent. We report on two infants with short-bowel syndrome caused by gastroschisis and intestinal atresia. The intestinal lengths after resection were 18 and 55 cm. Long-term parenteral nutrition (PN) was obligatory due to intestinal shortness in the first patient and dilatation of the preatretic bowel segment with ineffective peristalsis in the second patient. Despite multiple trials of enteral nutrition and medical therapy for gut decontamination and stimulation of bowel motility, hepatopathy developed in both patients in a similar period of time and to about the same degree. At the age of 4 and 6 weeks, respectively, increasing bilirubin values were measured. Deterioration of liver function and thrombocytopenia at the age of 3 to 4 months led to the diagnosis of acute cytomegalovirus (CMV) infection. Treatment with ganciclovir followed. Both patients died of acute liver failure at the age of 7 and 9 months, respectively. Additional hepatic injury secondary to CMV infection might have contributed to the rapid deterioration of liver disease. Screening for further hepatotoxic factors, especially infectious etiologies, is therefore recommended in children with short-bowel syndrome. Liver transplantation should be considered early in cases of progressive hepatic dysfunction.
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Ensenauer R, Püttmann M, Quintel M, Kattermann R, Aufenanger J. Comparison of serum phospholipase A2, polymorphonuclear granulocyte elastase, C-reactive protein and serum amyloid A with the APACHE II score in the prognosis of multiple injured patients. Clin Investig 1994; 72:843-9. [PMID: 7894209 DOI: 10.1007/bf00190738] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This prospective study of 35 multitraumatized intensive care unit patients requiring mechanical ventilation examined the relative utility of four biochemical parameters with a physiological scoring system for predicting lethal outcome. Levels of serum phospholipase A2 (PLA2), serum amyloid A (SAA), polymorphonuclear granulocyte elastase (PMN elastase), and C-reactive protein (CRP) were determined at short intervals during the patient's hospitalization. The first specimen was obtained at the time of admission, and subsequent specimens were drawn at 8 h intervals for the first 48 h and then twice daily until death or convalescence. Calculations of the APACHE II score used the most deranged variables during the first 24 h of admission to assess patient outcome. Additional calculations of the APACHE II score at the time of each blood draw served as an indicator of patient status. The results indicate that during the first 24 h after admission none of the four examined biochemical parameters gives reliable information about the outcome. The APACHE II score provided the earliest indicator of patient outcome (83% sensitivity, 65% specificity). PMN elastase provided useful information first at 32 h (83% sensitivity, 45% specificity) and better at 132 h (86% sensitivity, 86% specificity). CRP was of intermediate use in predicting outcome initially at 72 h (83% sensitivity, 50% specificity) and later at 132 h (86% sensitivity, 93% specificity). PLA2 and SAA were not useful as early indicators of lethal outcome.
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Affiliation(s)
- R Ensenauer
- Institut für Klinische Chemie, Klinikum Mannheim, Universität Heidelberg, Mannheim, Germany
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25
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Aufenanger J, Zimmer W, Püttmann M, Ensenauer R. Determination of the catalytic activity of phospholipase A2: E. coli-based assay compared to a photometric micelle assay. Eur J Clin Chem Clin Biochem 1993; 31:777-85. [PMID: 7508272 DOI: 10.1515/cclm.1993.31.11.777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Phospholipase A2 activity in human sera was determined of the basis of the E. coli assay and compared to a photometric micelle assay. The E. coli assay is based on the hydrolysis of phospholipids from [1-14C]oleic acid-labelled E. coli biomembranes. In the photometric assay the phospholipase A2 acts on mixed phospholipid micelles. The amount of fatty acid produced is quantitated in a subsequent photometric assay by coupling in the reaction to the coenzyme A metabolism. The E. coli membranes are essentially resistant to other lipases in human sera, i.e. lipoprotein lipases, hepatic triacylglycerolipase or pancreatic lipase and thus a very specific substrate for the phospholipase A2 of human serum. The photometric assay, though, is susceptible to other lipases in human serum. The ratio of [1-14C]oleic acid to released total fatty acids served as the basis for the calculation of the true enzymatic activity. The assay closely correlated with the photometric assay based on mixed micelles in the higher ranges of phospholipase A2 activity, but not in the normal range. The sensitivity is higher by at least two powers of 10. The human serum phospholipase A2 strongly preferred E. coli membranes as substrate to the mixed micelles containing phosphatidylcholine/phosphatidylethanolamine. In conclusion, the modified phospholipase A2 assay based on E. coli membranes is a sensitive, specific, reliable, and convenient method for the measurement of phospholipase A2 activity in human sera. The photometric assay suffers from low sensitivity but has the advantage of practicability in a normal routine laboratory, including the amenability to automation.
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Affiliation(s)
- J Aufenanger
- Institut für Klinische Chemie, Klinikum Mannheim, Fakultät für Klinische Medizin der Universität Heidelberg, Germany
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