1
|
Böckenhauer J, Schild R, Kemper MJ, Henne T, Stein MV, Oh J, Loos S. Volume expansion mitigates Shiga toxin-producing E. coli-hemolytic uremic syndrome in children. Pediatr Nephrol 2024; 39:1901-1907. [PMID: 38240870 PMCID: PMC11026235 DOI: 10.1007/s00467-023-06276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND Shiga toxin-producing E. coli-hemolytic uremic syndrome (STEC-HUS) is associated with high morbidity and relevant mortality. Previous small studies showed that volume expansion could improve the course and outcome of STEC-HUS. The aim of this single-center study was to evaluate the effect of volume expansion on the clinical course and outcome in STEC-HUS. METHODS Data of pediatric patients with STEC-HUS were analyzed retrospectively. Course and outcome of patients treated with volume expansion (VE) from 2019 to 2022 (n = 38) were compared to historical controls (HC) from 2009 to 2018 (n = 111). RESULTS Patients in the VE group had a significant relative median weight gain compared to HC (7.8% (3.4-11.3) vs. 1.2% (- 0.7-3.9), p < 0.0001) 48 h after admission. The need for dialysis was not reduced by VE (VE 21/38 (55.3%) vs. HC 64/111 (57.7%), p = 0.8). However, central nervous system involvement (impairment of consciousness, seizures, focal neurological deficits, and/or visual disturbances) was significantly reduced (VE 6/38 (15.8%) vs. HC 38/111 (34.2%), p = 0.039). None of the patients in the VE group died or developed chronic kidney disease (CKD) stage 5, whereas in the HC group, three patients died and three patients had CKD stage 5 at discharge. CONCLUSIONS This study suggests that volume expansion may be associated with the mitigation of the acute course of STEC-HUS, especially severe neurological involvement and the development of CKD. Prospective trials should lead to standardized protocols for volume expansion in children with STEC-HUS.
Collapse
Affiliation(s)
- Johannes Böckenhauer
- University Medical Center Hamburg-Eppendorf, University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany
| | - Raphael Schild
- University Medical Center Hamburg-Eppendorf, University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany
| | - Markus J Kemper
- Department of Pediatrics, Asklepios Klink Nord, Hamburg, Germany
| | - Thomas Henne
- University Medical Center Hamburg-Eppendorf, University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany
| | - Marie V Stein
- University Medical Center Hamburg-Eppendorf, University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jun Oh
- University Medical Center Hamburg-Eppendorf, University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany
| | - Sebastian Loos
- University Medical Center Hamburg-Eppendorf, University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany.
| |
Collapse
|
2
|
Malakasioti G, Iancu D, Milovanova A, Tsygin A, Horinouchi T, Nagano C, Nozu K, Kamei K, Fujinaga S, Iijima K, Kang HG, Sinha R, Basu B, Morello W, Montini G, Waters A, Boyer O, Yıldırım ZY, Yel S, Dursun İ, McCarthy HJ, Vivarelli M, Prikhodina L, Besouw MTP, Chan EYH, Huang W, Kemper MJ, Loos S, Prestidge C, Wong W, Zlatanova G, Ehren R, Weber LT, Chehade H, Hooman N, Tkaczyk M, Stańczyk M, Miligkos M, Tullus K. Corrigendum to "A multicenter retrospective study of calcineurin inhibitors in nephrotic syndrome secondary to podocyte gene variants." Kidney Int. 2023;103:962-972. Kidney Int 2024; 105:213-214. [PMID: 38182294 DOI: 10.1016/j.kint.2023.10.006] [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: 01/07/2024]
Affiliation(s)
| | - Daniela Iancu
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Alexey Tsygin
- National Medical Research Centre of Children's Health, Moscow, Russia
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - China Nagano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan
| | | | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Aoife Waters
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Olivia Boyer
- Department of Pediatric Nephrology, Hôpital Necker Enfants Malades, AP-HP and Université de Paris, Paris, France
| | - Zeynep Yürük Yıldırım
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Yel
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hugh J McCarthy
- Department of Nephrology, Sydney Children's Hospitals Network & Department of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Bambino Gesù Pediatric Hospital IRCCS, Rome, Italy
| | - Larisa Prikhodina
- Veltishev Research & Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Martine T P Besouw
- Department of Pediatric Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Wenyan Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Markus J Kemper
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Loos
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | | | - William Wong
- Starship Children's Hospital, Auckland, New Zealand
| | - Galia Zlatanova
- Department of Nephrology and Dialysis University Pediatric Hospital "Prof. Ivan Mitev", Department of Pediatrics Medical University, Sofia, Bulgaria
| | - Rasmus Ehren
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hassib Chehade
- Division of Pediatrics and DOHaD Lab, CHUV-UNIL, Lausanne, Switzerland
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Stańczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Michael Miligkos
- Second Department of Pediatrics, University of Athens School of Medicine and P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
Carvajal Abreu K, Loos S, Fischer L, Pape L, Wiech T, Kemper MJ, Tönshoff B, Oh J, Schild R. Case report: Early onset de novo FSGS in a child after kidney transplantation-a successful treatment. Front Pediatr 2023; 11:1280521. [PMID: 37830056 PMCID: PMC10566293 DOI: 10.3389/fped.2023.1280521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Background Early onset de novo focal segmental glomerular sclerosis (FSGS) in the kidney allograft in patients without FSGS in the native kidney is a rare disorder in children. It usually occurs mostly beyond the first year after kidney transplantation and often leads to graft loss. Standardized treatment protocols have not yet been established. Case description We describe a boy with early onset de novo FSGS in the transplanted kidney and non-selective glomerular proteinuria (maximum albumin-to-creatinine ratio of 3.8 g/g; normal range, ≤0.03 g/g creatinine). Manifestation occurred at 30 days posttransplant and was accompanied by a significant graft dysfunction (eGFR 61 ml/min per 1.73 m2). Treatment with 25 sessions of plasmapheresis over 14 weeks and three consecutive days of methylprednisolone pulse therapy (10 mg/kg per day) followed by oral prednisolone as rejection prophylaxis (3.73 mg/m2 per day) led to sustained remission of proteinuria (albumin-to-creatinine ratio of 0.028 g/g) and normalization of graft function (eGFR 92 ml/min per 1.73 m2) after 14 weeks. The follow-up period was 36 months. Conclusions This case underlines the efficacy of immunosuppressive and antibody eliminating therapy in early onset de novo FSGS after kidney transplantation.
Collapse
Affiliation(s)
- Karla Carvajal Abreu
- Department of Pediatric Nephrology, Pediatric Hepatology and Pediatric Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Loos
- Department of Pediatric Nephrology, Pediatric Hepatology and Pediatric Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Pape
- Department of Pediatrics II, University Hospital of Essen, University of Essen-Duisburg, Essen, Germany
| | - Thorsten Wiech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus J. Kemper
- Department of Pediatrics, Asklepios Klinik Nord-Heidberg, Hamburg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Jun Oh
- Department of Pediatric Nephrology, Pediatric Hepatology and Pediatric Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Schild
- Department of Pediatric Nephrology, Pediatric Hepatology and Pediatric Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
4
|
Malakasioti G, Iancu D, Milovanova A, Tsygin A, Horinouchi T, Nagano C, Nozu K, Kamei K, Fujinaga S, Iijima K, Sinha R, Basu B, Morello W, Montini G, Waters A, Boyer O, Yıldırım ZY, Yel S, Dursun İ, McCarthy HJ, Vivarelli M, Prikhodina L, Besouw MTP, Chan EYH, Huang W, Kemper MJ, Loos S, Prestidge C, Wong W, Zlatanova G, Ehren R, Weber LT, Chehade H, Hooman N, Tkaczyk M, Stańczyk M, Miligkos M, Tullus K. A multicenter retrospective study of calcineurin inhibitors in nephrotic syndrome secondary to podocyte gene variants. Kidney Int 2023; 103:962-972. [PMID: 36898413 DOI: 10.1016/j.kint.2023.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 02/04/2023] [Accepted: 02/16/2023] [Indexed: 03/12/2023]
Abstract
While 44-83% of children with steroid-resistant nephrotic syndrome (SRNS) without a proven genetic cause respond to treatment with a calcineurin inhibitor (CNI), current guidelines recommend against the use of immunosuppression in monogenic SRNS. This is despite existing evidence suggesting that remission with CNI treatment is possible and can improve prognosis in some cases of monogenic SRNS. Herein, our retrospective study assessed response frequency, predictors of response and kidney function outcomes among children with monogenic SRNS treated with a CNI for at least three months. Data from 203 cases (age 0-18 years) were collected from 37 pediatric nephrology centers. Variant pathogenicity was reviewed by a geneticist, and 122 patients with a pathogenic and 19 with a possible pathogenic genotype were included in the analysis. After six months of treatment and at last visit, 27.6% and 22.5% of all patients respectively, demonstrated partial or full response. Achievement of at least partial response at six months of treatment conferred a significant reduction in kidney failure risk at last follow-up compared to no response (hazard ratio [95% confidence interval] 0.25, [0.10-0.62]). Moreover, risk of kidney failure was significantly lower when only those with a follow-up longer than two years were considered (hazard ratio 0.35, [0.14-0.91]). Higher serum albumin level at CNI initiation was the only factor related to increased likelihood of significant remission at six months (odds ratio [95% confidence interval] 1.16, [1.08-1.24]). Thus, our findings justify a treatment trial with a CNI also in children with monogenic SRNS.
Collapse
Affiliation(s)
| | - Daniela Iancu
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Alexey Tsygin
- National Medical Research Centre of Children's Health, Moscow, Russia
| | - Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - China Nagano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan
| | | | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | - Biswanath Basu
- Division of Pediatric Nephrology, Department of Pediatrics, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Aoife Waters
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Olivia Boyer
- Department of Pediatric Nephrology, Hôpital Necker Enfants Malades, AP-HP and Université de Paris, Paris, France
| | - Zeynep Yürük Yıldırım
- Division of Pediatric Nephrology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Yel
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hugh J McCarthy
- Department of Nephrology, Sydney Children's Hospitals Network & Department of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Bambino Gesù Pediatric Hospital IRCCS, Rome, Italy
| | - Larisa Prikhodina
- Veltishev Research & Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Martine T P Besouw
- Department of Pediatric Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Wenyan Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Markus J Kemper
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Loos
- University Children's Hospital, University Medical Center-Hamburg-Eppendorf, Hamburg, Germany
| | | | - William Wong
- Starship Children's Hospital, Auckland, New Zealand
| | - Galia Zlatanova
- Department of Nephrology and Dialysis University Pediatric Hospital "Prof. Ivan Mitev", Department of Pediatrics Medical University, Sofia, Bulgaria
| | - Rasmus Ehren
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hassib Chehade
- Division of Pediatrics and DOHaD Lab, CHUV-UNIL, Lausanne, Switzerland
| | - Nakysa Hooman
- Aliasghar Clinical Research Development Center, Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Stańczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Medical University of Lodz, Lodz, Poland
| | - Michael Miligkos
- Second Department of Pediatrics, University of Athens School of Medicine and P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Loos S, Kemper MJ, Schmaeschke K, Herden U, Fischer L, Hoppe B, Levart TK, Grabhorn E, Schild R, Oh J, Brinkert F. Long-term outcome after combined or sequential liver and kidney transplantation in children with infantile and juvenile primary hyperoxaluria type 1. Front Pediatr 2023; 11:1157215. [PMID: 37009285 PMCID: PMC10064088 DOI: 10.3389/fped.2023.1157215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/28/2023] [Indexed: 04/04/2023] Open
Abstract
Introduction Combined or sequential liver and kidney transplantation (CLKT/SLKT) restores kidney function and corrects the underlying metabolic defect in children with end-stage kidney disease in primary hyperoxaluria type 1 (PH1). However, data on long-term outcome, especially in children with infantile PH1, are rare. Methods All pediatric PH1-patients who underwent CLKT/SLKT at our center were analyzed retrospectively. Results Eighteen patients (infantile PH1 n = 10, juvenile PH1 n = 8) underwent transplantation (CLKT n = 17, SLKT n = 1) at a median age of 5.4 years (1.5-11.8). Patient survival was 94% after a median follow-up of 9.2 years (6.4-11.0). Liver and kidney survival-rates after 1, 10, and 15 years were 90%, 85%, 85%, and 90%, 75%, 75%, respectively. Age at transplantation was significantly lower in infantile than juvenile PH1 (1.6 years (1.4-2.4) vs. 12.8 years (8.4-14.1), P = 0.003). Median follow-up was 11.0 years (6.8-11.6) in patients with infantile PH1 vs. 6.9 years (5.7-9.9) in juvenile PH1 (P = 0.15). At latest follow-up kidney and/or liver graft loss and/or death showed a tendency to a higher rate in patients with infantile vs. juvenile PH1 (3/10 vs. 1/8, P = 0.59). Discussion In conclusion, the overall patient survival and long-term transplant outcome of patients after CLKT/SLKT for PH1 is encouraging. However, results in infantile PH1 tended to be less optimal than in patients with juvenile PH1.
Collapse
Affiliation(s)
- Sebastian Loos
- Department of Pediatric Nephrology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Correspondence: Sebastian Loos
| | - Markus J. Kemper
- Department of Pediatrics, Asklepios Klinik Nord Heidberg, Hamburg, Germany
| | - Kaja Schmaeschke
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Herden
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Hoppe
- German Hyperoxaluria Center, c/o Kindernierenzentrum Bonn, Bonn, Germany
| | | | - Enke Grabhorn
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Schild
- Department of Pediatric Nephrology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Oh
- Department of Pediatric Nephrology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatrics, University Children's Hospital, University Children's Research@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Brinkert
- Department of Pediatric Gastroenterology and Hepatology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
6
|
De Hert M, Loos S, Van Assche K. Euthanasia of a person with a psychiatric disorder does not violate the European Convention on Human Rights ( Mortier v. Belgium (no. 78017/17)). Eur Psychiatry 2022; 65:e80. [DOI: 10.1192/j.eurpsy.2022.2342] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
7
|
Karpman D, Loos S. A link between Krüppel-like factor 4, complement activation, and kidney damage. Kidney Int 2022; 102:14-16. [PMID: 35738827 DOI: 10.1016/j.kint.2022.04.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/19/2022]
Abstract
Krüppel-like factors (KLFs) are transcription factors with important roles in tissue homeostasis. KLF4 possesses antithrombotic and anti-inflammatory properties. In this issue, Estrada et al. show that endothelial KLF4 prevents complement deposition in glomeruli and in its absence the cell-bound complement regulator CD55 was reduced. The study included endothelial-specific KLF4 knockdown mice that mimic thrombotic microangiopathy and thrombotic microangiopathy patient biopsies showing decreased KLF4 and CD55. The results suggest that KLF4 is involved in the regulation of glomerular complement deposition.
Collapse
Affiliation(s)
- Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Sebastian Loos
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
8
|
Tontanahal A, Sperandio V, Kovbasnjuk O, Loos S, Kristoffersson AC, Karpman D, Arvidsson I. IgG Binds Escherichia coli Serine Protease EspP and Protects Mice From E. coli O157:H7 Infection. Front Immunol 2022; 13:807959. [PMID: 35250980 PMCID: PMC8894809 DOI: 10.3389/fimmu.2022.807959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/31/2022] [Indexed: 12/05/2022] Open
Abstract
Shiga toxin-producing Escherichia coli O157:H7 is a virulent strain causing severe gastrointestinal infection, hemolytic uremic syndrome and death. To date there are no specific therapies to reduce progression of disease. Here we investigated the effect of pooled immunoglobulins (IgG) on the course of disease in a mouse model of intragastric E. coli O157:H7 inoculation. Intraperitoneal administration of murine IgG on day 3, or both on day 3 and 6, post-inoculation improved survival and decreased intestinal and renal pathology. When given on both day 3 and 6 post-inoculation IgG treatment also improved kidney function in infected mice. Murine and human commercially available IgG preparations bound to proteins in culture filtrates from E. coli O157:H7. Bound proteins were extracted from membranes and peptide sequences were identified by mass spectrometry. The findings showed that murine and human IgG bound to E. coli extracellular serine protease P (EspP) in the culture filtrate, via the IgG Fc domain. These results were confirmed using purified recombinant EspP and comparing culture filtrates from the wild-type E. coli O157:H7 strain to a deletion mutant lacking espP. Culture filtrates from wild-type E. coli O157:H7 exhibited enzymatic activity, specifically associated with the presence of EspP and demonstrated as pepsin cleavage, which was reduced in the presence of murine and human IgG. EspP is a virulence factor previously shown to promote colonic cell injury and the uptake of Shiga toxin by intestinal cells. The results presented here suggest that IgG binds to EspP, blocks its enzymatic activity, and protects the host from E. coli O157:H7 infection, even when given post-inoculation.
Collapse
Affiliation(s)
- Ashmita Tontanahal
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Vanessa Sperandio
- Departments of Microbiology and Biochemistry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Olga Kovbasnjuk
- Division of Gastroenterology, Department of Internal Medicine, University of New Mexico Health Science Center, Albuquerque, NM, United States
| | - Sebastian Loos
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
- *Correspondence: Diana Karpman,
| | - Ida Arvidsson
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|
9
|
Loos S. Response to Battaglia and Balestracci. Pediatr Nephrol 2022; 37:465. [PMID: 34796392 PMCID: PMC8817009 DOI: 10.1007/s00467-021-05356-6] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Sebastian Loos
- University Medical Center Hamburg-Eppendorf, University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany.
| |
Collapse
|
10
|
Taylan C, Schaaf A, Dorn C, Schmitt CP, Loos S, Kanzelmeyer N, Pape L, Müller D, Weber LT, Thumfart J. Safety of Therapeutic Apheresis in Children and Adolescents. Front Pediatr 2022; 10:850819. [PMID: 35498796 PMCID: PMC9039165 DOI: 10.3389/fped.2022.850819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Therapeutic apheresis (TA) is based on the principles of either removing dissolved pathogenic substances (e.g., antibodies) from the blood plasma or replacing plasma factors. It expands the therapeutic scope for a variety of diseases. Safety analysis in the pediatric field are scant. The aim of this analysis was to analyze specific complications of TA modalities - plasma exchange (PE) and immunoadsorption (IA) - in children and adolescents. METHODS Children and adolescents (n = 298) who had received TA from 2008 to 2018 in five pediatric nephrology centers were analyzed retrospectively. In total, 4.004 treatments (2.287 PE and 1.717 IA) were evaluated. RESULTS Indications for TA were mainly nephrological and neurological diseases. The three main indications were antibody-mediated graft rejection (13.4%), hemolytic uremic syndrome mainly with neurological involvement (12.8%), and AB0-incompatible transplantation (11.7%). Complications developed in 440 of the 4004 sessions (11%), of which one third were non-specific (nausea, headache). IA was better tolerated than PE. Complications were reported in 9.5% (n = 163) of the IA versus 12.1% (277) of the PE sessions (p < 0.001). When considering different types of complications, significantly more non-specific/non-allergic events (p = 0.02) and allergic reactions occurred in PE sessions (p < 0.001). More complications occurred with PE, when using fresh frozen plasma (16.2%; n = 145) in comparison to human albumin (14.5%; n = 115) (p < 0.001). CONCLUSIONS Therapeutic apheresis in childhood and adolescence is a safe treatment procedure. IA showed a lower complication rate than PE. Therefore, IA may be preferably provided if the underlying disease pathomechanisms do not require PE.
Collapse
Affiliation(s)
- Christina Taylan
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Anne Schaaf
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Corina Dorn
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Claus Peter Schmitt
- Pediatric Nephrology, University Hospital for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Sebastian Loos
- University Medical Centre Hamburg-Eppendorf, University Children's Hospital, Hamburg, Germany
| | - Nele Kanzelmeyer
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hanover, Germany
| | - Lars Pape
- Department of Pediatrics II, University Hospital of Essen, Essen, Germany
| | - Dominik Müller
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Julia Thumfart
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
11
|
Schild R, Hopf L, Loos S, Oh J, Levtchenko E. Heterogeneous Recommendations for School Attendance in Children With Chronic Kidney Diseases During the COVID-19 Pandemic in Europe. Front Pediatr 2021; 9:646595. [PMID: 33748050 PMCID: PMC7966519 DOI: 10.3389/fped.2021.646595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/09/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: After worldwide closures due to the COVID-19 pandemic, schools have reopened in most European countries in late 2020. Consequently, for children with chronic diseases the risks of COVID-19 have to be weighed against the long-time risks of missing school. Methods: To evaluate the impact of chronic diseases on school attendance for children in Europe during the COVID-19 pandemic we conducted a survey among members of the European Society for Pediatric Nephrology (ESPN) between September and November 2020. We asked for current forms of schooling, the existence of national guidelines, parental concerns, and the pediatric nephrologists recommendations for school attendance for specific virtual patients with chronic kidney disease (CKD). Results: Recommendations varied widely among pediatric nephrologists. A minority stated that specific recommendations for COVID-19 risk in children with kidney diseases existed in their country from local health authorities (9 of 29 countries; 31%) and/or national pediatric nephrology societies (9 of 29 countries; 31%). Over 90% of physicians have experienced parents keeping their children out of school against medical advice of their health providers and about 50% have experienced their patients being refused by school authorities. Consequently, 25% of all pediatric nephrologists estimated that more than 10% of their patients will not attend school regularly. Conclusion: COVID-19 causes educational deficits in the already vulnerable population of children with CKD. As the evidence for the course of COVID-19 in children with chronic diseases grows, rapidly adapted recommendations from pediatric societies could help reduce uncertainty among doctors, patients, and parents.
Collapse
Affiliation(s)
- Raphael Schild
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Luke Hopf
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Sebastian Loos
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Jun Oh
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Elena Levtchenko
- Department of Pediatric Nephrology and Organ Transplantation, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
12
|
Loos S, Oh J, van de Loo L, Kemper MJ, Blohm M, Schild R. Hemoconcentration and predictors in Shiga toxin-producing E. coli-hemolytic uremic syndrome (STEC-HUS). Pediatr Nephrol 2021; 36:3777-3783. [PMID: 34046736 PMCID: PMC8497454 DOI: 10.1007/s00467-021-05108-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/18/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hemoconcentration has been identified as a risk factor for a complicated course in Shiga toxin-producing E. coli-hemolytic uremic syndrome (STEC-HUS). This single-center study assesses hemoconcentration and predictors at presentation in STEC-HUS treated from 2009-2017. METHODS Data of 107 pediatric patients with STEC-HUS were analyzed retrospectively. Patients with mild HUS (mHUS, definition: max. serum creatinine < 1.5 mg/dL and no major neurological symptoms) were compared to patients with severe HUS (sHUS, definition: max. serum creatinine ≥ 1.5 mg/dL ± major neurological symptoms). Additionally, predictors of complicated HUS (dialysis ± major neurological symptoms) were analyzed. RESULTS Sixteen of one hundred seven (15%) patients had mHUS. Admission of patients with sHUS occurred median 2 days earlier after the onset of symptoms than in patients with mHUS. On admission, patients with subsequent sHUS had significantly higher median hemoglobin (9.5 g/dL (3.6-15.7) vs. 8.5 g/dL (4.2-11.5), p = 0.016) than patients with mHUS. The product of hemoglobin (g/dL) and LDH (U/L) (cutoff value 13,302, sensitivity 78.0%, specificity of 87.5%) was a predictor of severe vs. mild HUS. Creatinine (AUC 0.86, 95% CI 0.79-0.93) and the previously published score hemoglobin (g/dL) + 2 × creatinine (mg/dL) showed a good prediction for development of complicated HUS (AUC 0.87, 95% CI 0.80-0.93). CONCLUSIONS At presentation, patients with subsequent severe STEC-HUS had a higher degree of hemoconcentration. This underlines that fluid loss or reduced fluid intake/administration may be a risk factor for severe HUS. The good predictive value of the score hemoglobin (g/dL) + 2 × creatinine (mg/dL) for complicated HUS could be validated in our cohort. A higher resolution version of the Graphical abstract is available as Supplementary Information.
Collapse
Affiliation(s)
- Sebastian Loos
- University Medical Center Hamburg-Eppendorf, University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Jun Oh
- University Medical Center Hamburg-Eppendorf, University Children’s Hospital, Martinistrasse 52, 20246 Hamburg, Germany ,University Children’s Research@Kinder-UKE, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura van de Loo
- University Medical Center Hamburg-Eppendorf, University Children’s Hospital, Martinistrasse 52, 20246 Hamburg, Germany
| | - Markus J. Kemper
- Department of Pediatrics, Asklepios Klink Nord, Hamburg, Germany
| | - Martin Blohm
- University Medical Center Hamburg-Eppendorf, University Children’s Hospital, Martinistrasse 52, 20246 Hamburg, Germany
| | - Raphael Schild
- University Medical Center Hamburg-Eppendorf, University Children’s Hospital, Martinistrasse 52, 20246 Hamburg, Germany
| |
Collapse
|
13
|
Loos S, Tutus D, Kilian R, Goldbeck L. Do caregivers' perspectives matter? Working alliances and treatment outcomes in trauma-focused cognitive behavioural therapy with children and adolescents. Eur J Psychotraumatol 2020; 11:1753939. [PMID: 32537097 PMCID: PMC7269039 DOI: 10.1080/20008198.2020.1753939] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 03/07/2020] [Accepted: 03/29/2020] [Indexed: 11/02/2022] Open
Abstract
Background: Caregivers play a key role in the success of trauma-focused cognitive behavioural therapy (TF-CBT). Yet, the effect of their alliance on treatment outcomes besides the other parties in treatment has hardly been studied. Objective: This study examined the working alliance (WA) of therapists, patients and caregivers in TF-CBT and its contribution on treatment outcome over time. Methods: N = 76 children and adolescents (mean age = 12.66 years, range 7-17, M/F ratio: .43) participated in the TF-CBT arm of a randomized controlled trial. The WA was assessed with the Working Alliance Inventory Short Version (WAI-S) at two measurement points, while symptom level of posttraumatic stress symptoms (PTSS) was assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Paired sample t-tests, intraclass correlations (ICC), and mixed-effects regression models for longitudinal data were performed. Results: The alliance rating was high across all informants, with caregivers achieving the highest rating. The average level of cross-informant agreement on the alliance was low between therapists and caregivers (ICC = .26) and moderate between therapists and patients (ICC =.65). A significant contribution of an alliance improvement to the reduction of PTSS over time was found in each of the two tested models: therapists with patients model (b = .682) and therapists with caregivers model (b = .807). However, these effects were not detected with all four perspectives in one comprehensive model. Conclusion: In summary, the potential of caregivers' views should receive more attention in the therapeutic process of trauma-focused therapy.
Collapse
Affiliation(s)
- S Loos
- Department of Psychiatry and Psychotherapy II, University Clinic Ulm, Ulm, Germany.,Department of Child and Adolescent Psychiatry/Psychotherapy, University Clinic Ulm, Ulm, Germany
| | - D Tutus
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Clinic Ulm, Ulm, Germany
| | - R Kilian
- Department of Psychiatry and Psychotherapy II, University Clinic Ulm, Ulm, Germany
| | - L Goldbeck
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Clinic Ulm, Ulm, Germany
| |
Collapse
|
14
|
Johansson KE, Ståhl AL, Arvidsson I, Loos S, Tontanahal A, Rebetz J, Chromek M, Kristoffersson AC, Johannes L, Karpman D. Shiga toxin signals via ATP and its effect is blocked by purinergic receptor antagonism. Sci Rep 2019; 9:14362. [PMID: 31591425 PMCID: PMC6779916 DOI: 10.1038/s41598-019-50692-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/17/2019] [Indexed: 12/26/2022] Open
Abstract
Shiga toxin (Stx) is the main virulence factor of enterohemorrhagic Escherichia coli (EHEC), that cause gastrointestinal infection leading to hemolytic uremic syndrome. The aim of this study was to investigate if Stx signals via ATP and if blockade of purinergic receptors could be protective. Stx induced ATP release from HeLa cells and in a mouse model. Toxin induced rapid calcium influx into HeLa cells, as well as platelets, and a P2X1 receptor antagonist, NF449, abolished this effect. Likewise, the P2X antagonist suramin blocked calcium influx in Hela cells. NF449 did not affect toxin intracellular retrograde transport, however, cells pre-treated with NF449 exhibited significantly higher viability after exposure to Stx for 24 hours, compared to untreated cells. NF449 protected HeLa cells from protein synthesis inhibition and from Stx-induced apoptosis, assayed by caspase 3/7 activity. The latter effect was confirmed by P2X1 receptor silencing. Stx induced the release of toxin-positive HeLa cell- and platelet-derived microvesicles, detected by flow cytometry, an effect significantly reduced by NF449 or suramin. Suramin decreased microvesicle levels in mice injected with Stx or inoculated with Stx-producing EHEC. Taken together, we describe a novel mechanism of Stx-mediated cellular injury associated with ATP signaling and inhibited by P2X receptor blockade.
Collapse
Affiliation(s)
- Karl E Johansson
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anne-Lie Ståhl
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ida Arvidsson
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Sebastian Loos
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ashmita Tontanahal
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Johan Rebetz
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Milan Chromek
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Ludger Johannes
- Institut Curie, U1143 INSERM, UMR3666 CNRS, Cellular and Chemical Biology unit, Paris, France
| | - Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden.
| |
Collapse
|
15
|
Loos S, Aulbert W, Hoppe B, Ahlenstiel-Grunow T, Kranz B, Wahl C, Staude H, Humberg A, Benz K, Krause M, Pohl M, Liebau MC, Schild R, Lemke J, Beringer O, Müller D, Härtel C, Wigger M, Vester U, Konrad M, Haffner D, Pape L, Oh J, Kemper MJ. Intermediate Follow-up of Pediatric Patients With Hemolytic Uremic Syndrome During the 2011 Outbreak Caused by E. coli O104:H4. Clin Infect Dis 2018; 64:1637-1643. [PMID: 28329394 DOI: 10.1093/cid/cix218] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background. In 2011 Escherichia coli O104:H4 caused an outbreak with >800 cases of hemolytic uremic syndrome (HUS) in Germany, including 90 children. Data on the intermediate outcome in children after HUS due to E. coli O104:H4 have been lacking. Methods. Follow-up data were gathered retrospectively from the medical records of patients who had been included in the German Pediatric HUS Registry during the 2011 outbreak. Results. Seventy-two of the 89 (81%) patients were included after a median follow-up of 3.0 (0.9-4.7) years. Hypertension and proteinuria were present in 19% and 28% of these patients, respectively. Of 4 patients with chronic kidney disease (CKD) > stage 2 at short-term follow-up, 1 had a normalized estimated glomerular filtration rate, and 3 (4%) had persistent CKD > stage 2. In 1 of these patients, CKD improved from stage 4 to 3; 1 who had CKD stage 5 at presentation received kidney transplantation; and 1 patient required further hemodialysis during follow-up. One patient (1.4%) still had major neurological symptoms at the latest follow-up. Dialysis during the acute phase (P = .01), dialysis duration (P = .01), and the duration of oligo-/anuria (P = .005) were associated with the development of renal sequelae. Patients treated with eculizumab (n = 11) and/or plasmapheresis (n = 13) during the acute phase of HUS had comparable outcomes. Conclusions. The overall outcome of pediatric patients after HUS due to E. coli O104:H4 was equivalent to previous reports on HUS due to other types of Shiga toxin-producing E. coli (STEC). Regular follow-up visits in patients are recommended after STEC-HUS.
Collapse
Affiliation(s)
- Sebastian Loos
- University Children's Hospital, University Medical Center Hamburg-Eppendorf
| | - Wiebke Aulbert
- University Children's Hospital, University Medical Center Hamburg-Eppendorf
| | - Bernd Hoppe
- Department of Pediatric Nephrology, University Children's Hospital Bonn
| | | | - Birgitta Kranz
- Department of General Pediatrics, Pediatric Nephrology, University Children's Hospital Muenster
| | | | - Hagen Staude
- Department of Pediatrics, University Hospital Rostock
| | - Alexander Humberg
- Department of Pediatrics, University Hospital Schleswig-Holstein, Lu¨beck
| | - Kerstin Benz
- Department of Pediatrics, University Hospital Erlangen
| | - Martin Krause
- Department of Pediatrics, University Hospital Schleswig-Holstein, Kiel
| | - Martin Pohl
- Department of Pediatrics, University Hospital Freiburg
| | - Max C Liebau
- Department of Pediatrics, Department II of Internal Medicine, Center for Molecular Medicine, Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD), and Systems Biology of Ageing Cologne (Sybacol), University of Cologne
| | - Raphael Schild
- University Children's Hospital, University Medical Center Hamburg-Eppendorf
| | - Johanna Lemke
- University Children's Hospital, University Medical Center Hamburg-Eppendorf
| | | | | | - Christoph Härtel
- Department of Pediatrics, University Hospital Schleswig-Holstein, Lu¨beck
| | | | - Udo Vester
- Department of Pediatrics, University Hospital Essen
| | - Martin Konrad
- Department of General Pediatrics, Pediatric Nephrology, University Children's Hospital Muenster
| | - Dieter Haffner
- Departement of Pediatric Nephrology, Medical School Hannover
| | - Lars Pape
- Departement of Pediatric Nephrology, Medical School Hannover
| | - Jun Oh
- University Children's Hospital, University Medical Center Hamburg-Eppendorf
| | - Markus J Kemper
- University Children's Hospital, University Medical Center Hamburg-Eppendorf
- Department of Pediatrics, AK Hamburg Nord, Asklepios Medical School, Germany
| |
Collapse
|
16
|
Kobbe R, Schild R, Christner M, Oh J, Loos S, Kemper MJ. Case report - atypical hemolytic uremic syndrome triggered by influenza B. BMC Nephrol 2017; 18:96. [PMID: 28320387 PMCID: PMC5358041 DOI: 10.1186/s12882-017-0512-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/15/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Influenza A infections have been described to cause secondary hemolytic uremic syndrome and to trigger atypical hemolytic uremic syndrome (aHUS) in individuals with an underlying genetic complement dysregulation. To date, influenza B has not been reported to trigger aHUS. CASE PRESENTATION A 6-month-old boy presented with hemolytic uremic syndrome triggered by influenza B infection. Initially the child recovered spontaneously. When he relapsed Eculizumab treatment was initiated, resulting in complete and sustained remission. A pathogenic mutation in membrane cofactor protein (MCP) was detected. CONCLUSION Influenza B is a trigger for aHUS and might be underreported as such. Influenza vaccination may protect patients at risk.
Collapse
Affiliation(s)
- Robin Kobbe
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany.
| | - Raphael Schild
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany
| | - Martin Christner
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany
| | - Jun Oh
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany
| | - Sebastian Loos
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany
| | - Markus J Kemper
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany
| |
Collapse
|
17
|
Abstract
Haemolytic uraemic syndrome (HUS) is defined by the simultaneous occurrence of nonimmune haemolytic anaemia, thrombocytopenia and acute renal failure. This leads to the pathological lesion termed thrombotic microangiopathy, which mainly affects the kidney, as well as other organs. HUS is associated with endothelial cell injury and platelet activation, although the underlying cause may differ. Most cases of HUS are associated with gastrointestinal infection with Shiga toxin-producing enterohaemorrhagic Escherichia coli (EHEC) strains. Atypical HUS (aHUS) is associated with complement dysregulation due to mutations or autoantibodies. In this review, we will describe the causes of HUS. In addition, we will review the clinical, pathological, haematological and biochemical features, epidemiology and pathogenetic mechanisms as well as the biochemical, microbiological, immunological and genetic investigations leading to diagnosis. Understanding the underlying mechanisms of the different subtypes of HUS enables tailoring of appropriate treatment and management. To date, there is no specific treatment for EHEC-associated HUS but patients benefit from supportive care, whereas patients with aHUS are effectively treated with anti-C5 antibody to prevent recurrences, both before and after renal transplantation.
Collapse
Affiliation(s)
- Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Sebastian Loos
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ramesh Tati
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ida Arvidsson
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| |
Collapse
|
18
|
Arvidsson I, Rebetz J, Loos S, Herthelius M, Kristoffersson AC, Englund E, Chromek M, Karpman D. Early Terminal Complement Blockade and C6 Deficiency Are Protective in EnterohemorrhagicEscherichia coli–Infected Mice. J I 2016; 197:1276-86. [DOI: 10.4049/jimmunol.1502377] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 06/15/2016] [Indexed: 02/05/2023]
|
19
|
Beneke J, Sartison A, Kielstein JT, Haller H, Nitschke M, Kunzendorf U, Loos S, Kemper MJ, Stahl RAK, Menne J. Clinical and Laboratory Consequences of Platelet Transfusion in Shiga Toxin-Mediated Hemolytic Uremic Syndrome. Transfus Med Rev 2016; 31:51-55. [PMID: 27468945 DOI: 10.1016/j.tmrv.2016.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 06/02/2016] [Accepted: 06/10/2016] [Indexed: 11/25/2022]
Abstract
Recent studies suggest that platelet transfusions are harmful in patients with thrombotic thrombocytopenic purpura, an entity of thrombotic microangiopathies. As the typical or Shiga toxin-producing Escherichia coli-induced hemolytic uremic syndrome (STEC-HUS) is also classified as thrombotic microangiopathy, we complement these data with an analysis of 250 patients from the German O104:H4 STEC-HUS outbreak. The effect of platelet transfusion in 44 patients who received platelet transfusions vs 206 control patients was investigated. Criteria for both groups were severe thrombocytopenia less than 50/nL, severe hemolysis with administration of packed red blood cells, and a complicated clinical course with admission to intensive care units. Readouts were clinical complications and changes in routine clinical chemistry and whole blood count. Chemistry values at admission and demographic parameters were comparable. Platelet transfusions were administered in 44 cases a median of 7 (interquartile range, 6-9) days after diarrhea onset. After platelet transfusion, we observed a transient and slight increase in inflammation parameters. No significant difference in major complications such as seizures, or requirement for ventilation or renal replacement therapy could be observed. Thrombotic events such as thrombosis or embolism were comparably rare in both groups (2.3% in platelet transfused vs 4.4% in controls, P=not significant). The mortality was not significantly different (0% vs 2.6%, P=not significant) in our study cohort, but overall in the outbreak, 6 of 711 STEC-HUS patients in Germany died of a procedural-related bleeding complications. In conclusion, platelet transfusions seem comparably safe in adult STEC-HUS patients, considering both the possible necessity for invasive procedures and potential risk for severe bleeding.
Collapse
Affiliation(s)
- Jan Beneke
- Department of Nephrology and Hypertension, Hanover Medical School, Hanover, Germany.
| | - Aleksej Sartison
- Department of Nephrology and Hypertension, Hanover Medical School, Hanover, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension, Hanover Medical School, Hanover, Germany
| | - Hermann Haller
- Department of Nephrology and Hypertension, Hanover Medical School, Hanover, Germany
| | | | | | - Sebastian Loos
- University Children's Hospital, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus J Kemper
- University Children's Hospital, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf A K Stahl
- 3rd Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Menne
- Department of Nephrology and Hypertension, Hanover Medical School, Hanover, Germany
| | | |
Collapse
|
20
|
Reisig V, Kuhn J, Loos S, Nennstiel-Ratzel U, Wildner M, Caselmann WH. [Primary Prevention And Health Promotion in Bavaria: Taking Stock]. Gesundheitswesen 2016; 79:238-246. [PMID: 27315233 DOI: 10.1055/s-0042-108585] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Health promotion and prevention are key elements of Bavarian health policy and are currently being re-oriented along the framework of the "Bavarian Prevention Plan". In this context, a stock taking of prevention and health promotion in Bavaria was conducted with the aim to contribute to the continued strategic and quality-orientated development of this field. Methods: The investigation was restricted to activities of primary prevention and health promotion with a focus on the action areas of the Bavarian Prevention Plan. The prevention actors, not projects, were the smallest units that were surveyed. During the 3-month field phase in 2014/2015, 595 prevention players were contacted and asked to complete an online questionnaire on their activities and target groups as well as quality and structural aspects. In addition, 9 expert interviews were conducted in an urban and a rural area in order to explore the field of small commercial and civic prevention actors. Results: 135 prevention players took part in the survey (return rate 23%). The most commonly cited themes of activities are health literacy (62% of players) and mental health (58%). The target groups are often broadly defined, gender specific measures and those for socially disadvantaged groups are comparatively rare. Provision of health-related information is the most commonly used approach (58-69% of players depending on the action area), least used are community work approaches (9-12%). 77% of the respondents state to use models of best practice and 55% scientific results in the development of measures; 43% conduct outcome evaluations and 80% take part in committee work and networks. The latter are mainly used to exchange information (90% of actors), 55 and 54% state to use them for joint planning and delivery of interventions, respectively. Conclusions: The most important prevention players took part in the survey. Methodologically it proved difficult to achieve a meaningful depiction of central aspects of the prevention scene via a quantitative survey approach. There is a lack of well-tried instruments and approaches for such cross-agency surveys. Nevertheless, the study allows trend statements on the spectrum, structure and quality of prevention in Bavaria. Thus, a starting line for the implementation of the Bavarian Prevention Plan as well as the basis of prevention reporting as intended by the new national prevention law could be established.
Collapse
Affiliation(s)
- V Reisig
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
| | - J Kuhn
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
| | - S Loos
- IGES Institut GmbH, Berlin
| | - U Nennstiel-Ratzel
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
| | - M Wildner
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Oberschleißheim
| | - W H Caselmann
- Bayerisches Staatsministerium für Gesundheit und Pflege, München
| |
Collapse
|
21
|
Reisig V, Kuhn J, Täger S, Ochmann R, Loos S, Nennstiel-Ratzel U, Wildner M, Caselmann W. Präventionserhebung 2015 Bayern. Der ÖGD vor Ort – ein Akteur unter vielen? Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1578900] [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: 10/22/2022]
|
22
|
Karpman D, Ståhl AL, Arvidsson I, Johansson K, Loos S, Tati R, Békássy Z, Kristoffersson AC, Mossberg M, Kahn R. Complement Interactions with Blood Cells, Endothelial Cells and Microvesicles in Thrombotic and Inflammatory Conditions. Adv Exp Med Biol 2015; 865:19-42. [PMID: 26306441 DOI: 10.1007/978-3-319-18603-0_2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The complement system is activated in the vasculature during thrombotic and inflammatory conditions. Activation may be associated with chronic inflammation on the endothelial surface leading to complement deposition. Complement mutations allow uninhibited complement activation to occur on platelets, neutrophils, monocytes, and aggregates thereof, as well as on red blood cells and endothelial cells. Furthermore, complement activation on the cells leads to the shedding of cell derived-microvesicles that may express complement and tissue factor thus promoting inflammation and thrombosis. Complement deposition on red blood cells triggers hemolysis and the release of red blood cell-derived microvesicles that are prothrombotic. Microvesicles are small membrane vesicles ranging from 0.1 to 1 μm, shed by cells during activation, injury and/or apoptosis that express components of the parent cell. Microvesicles are released during inflammatory and vascular conditions. The repertoire of inflammatory markers on endothelial cell-derived microvesicles shed during inflammation is large and includes complement. These circulating microvesicles may reflect the ongoing inflammatory process but may also contribute to its propagation. This overview will describe complement activation on blood and endothelial cells and the release of microvesicles from these cells during hemolytic uremic syndrome, thrombotic thrombocytopenic purpura and vasculitis, clinical conditions associated with enhanced thrombosis and inflammation.
Collapse
Affiliation(s)
- Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
He X, Quiñones B, Loo MT, Loos S, Scavia G, Brigotti M, Levtchenko E, Monnens L. Serum Shiga toxin 2 values in patients during acute phase of diarrhoea-associated haemolytic uraemic syndrome. Acta Paediatr 2015; 104:e564-8. [PMID: 26361237 DOI: 10.1111/apa.13211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/23/2015] [Accepted: 09/08/2015] [Indexed: 12/25/2022]
Abstract
AIM Shiga toxins are delivered via systemic circulation and are considered to be the cause of diarrhoea-associated haemolytic uraemic syndrome (HUS), as they injure endothelial cells, particularly in the glomeruli. This study measured Shiga toxin 2 (Stx2) in the serum of children affected in by HUS due to Stx2 producing Escherichia coli. METHODS The concentration of free Stx2 was measured in the serum of 16 children, collected immediately after admission to the clinic in the acute phase of HUS, using a sandwich enzyme-linked immunosorbent assay. The family members of two children were also investigated, with the relative toxicity of Stx2 assessed by a Vero cell-based fluorescent assay. RESULTS Stx2 was found in the serum of eight of the 16 children who were investigated. It was also detected in four of the six family members not showing symptomatic HUS, with an extremely high level in two. CONCLUSION An absent or rather low concentration of Stx2 was found in the serum of children admitted to the clinic with diarrhoea-associated HUS. The high concentration of Stx2 in family members without HUS, but mostly with watery diarrhoea and raised functional activity, was in line with the concept of early injury by Stx2.
Collapse
Affiliation(s)
- Xiaohua He
- US Department of Agriculture; ARS; WRRC; Foodborne Toxin Detection and Prevention Unit; Albany NY USA
| | - Beatriz Quiñones
- US Department of Agriculture; ARS; WRRC; Produce Safety and Microbiology Unit; Albany NY USA
| | - Maroeska Te Loo
- Department of Pediatrics; Radboud University Nijmegen Medical Center; Nijmegen The Netherlands
| | - Sebastian Loos
- Division of Pediatric Nephrology; Department of Pediatrics; University Medical Center; Hamburg Germany
| | - Gaia Scavia
- EU Reference Laboratory for E. coli; Instituto Superiore di Sanita; Rome Italy
| | - Maurizio Brigotti
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale; Sede di Patologia Generale; Universita di Bologna; Bologna Italy
| | - Elena Levtchenko
- Department of Pediatric Nephrology and Growth and Regeneration; University Hospitals Leuven; Leuven Belgium
| | - Leo Monnens
- Department of Physiology; Radboud University; Nijmegen Medical Center; Nijmegen The Netherlands
| |
Collapse
|
24
|
Reisig V, Taeger S, Loos S, Kuhn J, Nennstiel-Ratzel U, Wildner M, Caselmann W. (Un)Fassbar (un)erfassbar? – Eine Untersuchung der Präventionslandschaft in Bayern. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563013] [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: 10/23/2022]
|
25
|
Ståhl AL, Arvidsson I, Johansson KE, Chromek M, Rebetz J, Loos S, Kristoffersson AC, Békássy ZD, Mörgelin M, Karpman D. A novel mechanism of bacterial toxin transfer within host blood cell-derived microvesicles. PLoS Pathog 2015; 11:e1004619. [PMID: 25719452 PMCID: PMC4342247 DOI: 10.1371/journal.ppat.1004619] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 12/10/2014] [Indexed: 12/25/2022] Open
Abstract
Shiga toxin (Stx) is the main virulence factor of enterohemorrhagic Escherichia coli, which are non-invasive strains that can lead to hemolytic uremic syndrome (HUS), associated with renal failure and death. Although bacteremia does not occur, bacterial virulence factors gain access to the circulation and are thereafter presumed to cause target organ damage. Stx was previously shown to circulate bound to blood cells but the mechanism by which it would potentially transfer to target organ cells has not been elucidated. Here we show that blood cell-derived microvesicles, shed during HUS, contain Stx and are found within patient renal cortical cells. The finding was reproduced in mice infected with Stx-producing Escherichia coli exhibiting Stx-containing blood cell-derived microvesicles in the circulation that reached the kidney where they were transferred into glomerular and peritubular capillary endothelial cells and further through their basement membranes followed by podocytes and tubular epithelial cells, respectively. In vitro studies demonstrated that blood cell-derived microvesicles containing Stx undergo endocytosis in glomerular endothelial cells leading to cell death secondary to inhibited protein synthesis. This study demonstrates a novel virulence mechanism whereby bacterial toxin is transferred within host blood cell-derived microvesicles in which it may evade the host immune system.
Collapse
Affiliation(s)
- Anne-lie Ståhl
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ida Arvidsson
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Karl E. Johansson
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Milan Chromek
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Johan Rebetz
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Sebastian Loos
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Zivile D. Békássy
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Matthias Mörgelin
- Division of Infection Medicine, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
- * E-mail:
| |
Collapse
|
26
|
Bauer A, Loos S, Wehrmann C, Horstmann D, Donnerstag F, Lemke J, Hillebrand G, Löbel U, Pape L, Haffner D, Bindt C, Ahlenstiel T, Melk A, Lehnhardt A, Kemper MJ, Oh J, Hartmann H. Neurological involvement in children with E. coli O104:H4-induced hemolytic uremic syndrome. Pediatr Nephrol 2014; 29:1607-15. [PMID: 24664191 DOI: 10.1007/s00467-014-2803-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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] [Received: 01/02/2014] [Revised: 02/27/2014] [Accepted: 02/28/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to analyze the neurological involvement and outcome in pediatric patients with hemolytic uremic syndrome (HUS) during the 2011 epidemic caused by Escherichia coli O104:H4. METHODS Clinical data and data from magnetic resonance imaging (MRI) scans and electroencephalography (EEG) during the acute phase of the disease and during follow-up at 3 and 6 months were analyzed in 50 patients. Twenty-five of these patients underwent neuropsychological testing (WISC IV) during follow-up. RESULTS Neurological involvement (stupor or coma, seizures, visual disturbances, paresis, myocloni) was initially observed in 14/50 (28%) patients. One patient died. EEG abnormalities were more frequent in patients with neurological involvement than in those without (12/14 vs. 13/25, respectively). Cranial MRI scans were analyzed in nine patients with neurological involvement, of whom five showed abnormal findings. At the 3- and 6-month follow-ups, EEG abnormalities were found in 14/40 (35%) and 7/36 (19%) patients, respectively, whereas 28/42 (67%) and 17/39 (44%) patients, respectively, complained about on-going reduced performance. Neuropsychological testing showed a slightly lower global intelligence quotient in patients with neurological involvement versus those without (113.4 ± 2.8 vs. 119.4 ± 1.8, respectively). CONCLUSIONS Neurological involvement was frequent in our cohort. Accordingly, the incidence of pathological EEG findings was high, even in patients without clinical signs of neurological involvement. Nevertheless, major neurological sequelae were rare, and neuropsychological outcome was favorable after 6 months.
Collapse
Affiliation(s)
- Angela Bauer
- Department of Pediatrics, University Medical Center Hamburg, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
van Husen M, Lehnhardt A, Fischer AK, Brinkert F, Loos S, Oh J, Kemper MJ. Fibroblast growth factor 23 and calcium phosphate homeostasis after pediatric renal transplantation. Pediatr Transplant 2012; 16:443-50. [PMID: 22554017 DOI: 10.1111/j.1399-3046.2012.01702.x] [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: 01/20/2023]
Abstract
FGF23 is a circulating factor regulating TPR and is increased in CKD. After RT, it seems to induce phosphorus wasting in adults. Data on FGF23 after PRT are scarce. Parameters of bone metabolism including calcium, phosphate, 25-(OH) vitamin D, 1,25-(OH)(2) vitamin D, alkaline phosphatase, PTH, and FGF23 were analyzed in 57 children after PRT and 11 controls. Median time after PRT was 25.9 (range 2-135) months. eGFR after PRT ranged from 15 to 175 mL/min/1.73 qm. Mean (±s.e.) FGF23 and PTH levels were significantly elevated compared with controls (146 ± 30 vs. 43 ± 3 ng/L, p = 0.001 and 182 ± 42 vs. 74 ± 18 ng/L, p = 0.004, respectively). Highest FGF23 levels were found in children with an eGFR below 60 mL/min*1.73 sqm (280 ± 69 vs. 62 ± 5 ng/L, p = 0.001), but significantly elevated values were already present in CKD2T. In a multivariate analysis, eGFR, PTH, calcium, and phosphate were significantly associated with FGF23. In a subgroup of 17 patients (29.8%) with persistent hypophosphatemia, phosphate levels were significantly associated with FGF23 and not with PTH. FGF23 is increased in children after PRT, especially in patients with chronic allograft dysfunction, and seems to be a more sensitive marker of dysregulated calcium phosphate homeostasis than PTH.
Collapse
Affiliation(s)
- Michael van Husen
- Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
28
|
Lehnhardt A, Dunst F, van Husen M, Loos S, Oh J, Eiermann T, Koch M, Kemper MJ. Elevated serum levels of B-cell activating factor in pediatric renal transplant patients. Pediatr Nephrol 2012; 27:1389-95. [PMID: 22453734 DOI: 10.1007/s00467-012-2142-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 02/09/2012] [Accepted: 02/10/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND B-cells are increasingly recognized as important players in alloimmunity. B cell-activating factor (BAFF) and its receptor BAFF-R are essential for B-cell differentiation and survival. Data on BAFF levels in pediatric renal transplant (RT) patients are scarce. OBJECTIVE It is known from adult data that elevated BAFF levels correlate with an unfavorable outcome in bone marrow and kidney recipients. To analyze this hypothesis in pediatric renal transplant patients we performed a cross-sectional analysis of serum BAFF levels, lymphocyte surface BAFF-R expression, and clinical variables in a cohort of 43 pediatric renal transplant patients. METHODS We studied serum BAFF, CD19+ B-, and FoxP3+ regulatory T-cells (Tregs) and BAFF-R expression in 43 children 2.9 (0.1-12.4) years after RT on maintenance immunosuppression. Twenty-two healthy children and 19 children with chronic kidney disease stage 5 (CKD5) served as controls. RESULTS BAFF levels were significantly higher in RT patients than in healthy children (1,435±574 vs 894±189 pg/mL; p<0.0001) whereas numbers of B-cells and Tregs were significantly lower. BAFF-R expression on B-cells was decreased after RT (531±334 vs 707±257 MFI; p<0.005), BAFF inversely correlated with BAFF-R (r=-0.5022, p<0.006), but not with B-cell count. BAFF was elevated in CKD5 patients (1,276±294 pg/mL). In RT patients BAFF was significantly higher in those with eGFR <60 ml/min/1.73m(2) (1,553±447 vs 1,234±323 pg/mL; p=0.02). BAFF levels and BAFF-R expression did not correlate with HLA antibody status, time after transplantation, age or gender of the patients. CONCLUSION Serum BAFF concentrations were significantly elevated in pediatric RT patients. They correlated with decreased BAFF-R expression on CD19+ B-cells and impaired allograft function. Our findings of a dysregulated BAFF/BAFF-R axis may be of clinical relevance after renal transplantation and therefore underline the importance of further research into BAFF-dependent mechanisms.
Collapse
Affiliation(s)
- Anja Lehnhardt
- University Medical Center Hamburg-Eppendorf, Pediatric Nephrology, Martinistrasse 52, 20246 Hamburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Loos S, Ahlenstiel T, Kranz B, Staude H, Pape L, Härtel C, Vester U, Buchtala L, Benz K, Hoppe B, Beringer O, Krause M, Müller D, Pohl M, Lemke J, Hillebrand G, Kreuzer M, König J, Wigger M, Konrad M, Haffner D, Oh J, Kemper MJ. An outbreak of Shiga toxin-producing Escherichia coli O104:H4 hemolytic uremic syndrome in Germany: presentation and short-term outcome in children. Clin Infect Dis 2012; 55:753-9. [PMID: 22670043 DOI: 10.1093/cid/cis531] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In May and June 2011 the largest known outbreak of hemolytic uremic syndrome (HUS) occurred in northern Germany. Because, quite unusually, a large number of adults was affected and the causative Escherichia coli strain, serotype O104:H4, showed an atypical virulence factor pattern, it was speculated that this outbreak was associated with an aggressive course and an unfavorable prognosis also in children. METHODS Retrospective analysis of medical records of 90 children and comparison to previous outbreak and sporadic case series. RESULTS Median age was unusually high (11.5 years) compared with that in historical series. Only 1 patient (1.1%) died in the acute phase. Most patients (67/90 [74%]) received supportive care only. Renal replacement therapy was required in 64 of 90 (71%) of the children. Neurological complications, mainly seizures and altered mental stage, were present in 23 of 90 (26%) patients. Ten patients received plasmapheresis, 6 eculizumab, and 7 a combination of both. After a median follow-up of 4 months, renal function normalized in 85 of 90 (94%) patients, whereas 3 patients had chronic kidney disease stage 3 or 4, and 1 patient (1.1%) still requires dialysis. Complete neurological recovery occurred in 18 of 23 patients. Mild to moderate and major residual neurological changes were present in 3 patients and 1 patient, respectively, although all patients were still improving. CONCLUSIONS E. coli O104:H4 caused the largest HUS outbreak in children reported in detail to date and most patients received supportive treatment only. Initial morbidity, as well as short-term outcome, due to this pathogen, is comparable to previous pediatric series of Shiga toxin-producing E. coli HUS.
Collapse
|
30
|
Klein J, Lacroix C, Caubet C, Siwy J, Muller F, Bascands JL, Decramer S, Schanstra J, Camilla R, Camilla R, Loiacono E, Peruzzi L, Gallo R, Donadio ME, Vergano L, Campolo F, Morando L, Amore A, Coppo R, Dossier C, Leclerc AL, Lapidus N, Rousseau A, Charbit M, Sarda H, Madhi F, Carrat F, Deschenes G, Harambat J, Dallocchio A, Guigonis V, Ichay L, Bessenay L, Broux F, Garnier A, Morin D, Llanas B, Saint-Marcoux F, Decramer S, Van Stralen K, Verrina E, Belingheri M, Dusek J, Dudley J, Grenda R, Rubik J, Rudaitis S, Rudin C, Schaefer F, Jager K, Loos S, Kemper MJ. Paediatric nephrology. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
Rohde H, Qin J, Cui Y, Li D, Loman NJ, Hentschke M, Chen W, Pu F, Peng Y, Li J, Xi F, Li S, Li Y, Zhang Z, Yang X, Zhao M, Wang P, Guan Y, Cen Z, Zhao X, Christner M, Kobbe R, Loos S, Oh J, Yang L, Danchin A, Gao GF, Song Y, Li Y, Yang H, Wang J, Xu J, Pallen MJ, Wang J, Aepfelbacher M, Yang R. Open-source genomic analysis of Shiga-toxin-producing E. coli O104:H4. N Engl J Med 2011; 365:718-24. [PMID: 21793736 DOI: 10.1056/nejmoa1107643] [Citation(s) in RCA: 307] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
An outbreak caused by Shiga-toxin–producing Escherichia coli O104:H4 occurred in Germany in May and June of 2011, with more than 3000 persons infected. Here, we report a cluster of cases associated with a single family and describe an open-source genomic analysis of an isolate from one member of the family. This analysis involved the use of rapid, bench-top DNA sequencing technology, open-source data release, and prompt crowd-sourced analyses. In less than a week, these studies revealed that the outbreak strain belonged to an enteroaggregative E. coli lineage that had acquired genes for Shiga toxin 2 and for antibiotic resistance.
Collapse
Affiliation(s)
- Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Nielsen S, Frank C, Fruth A, Spode A, Prager R, Graff A, Plenge-Bönig A, Loos S, Lütgehetmann M, Kemper MJ, Müller-Wiefel DE, Werber D. Desperately Seeking Diarrhoea: Outbreak of Haemolytic Uraemic Syndrome Caused by Emerging Sorbitol-Fermenting Shiga Toxin-Producing Escherichia coli O157:H-, Germany, 2009. Zoonoses Public Health 2011; 58:567-72. [DOI: 10.1111/j.1863-2378.2011.01405.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
33
|
Siemann H, Müller B, Stein E, Esselmann H, Loos S, Ennen J, Lehnert H, Hallschmid M, Wiltfang J. Comparative study of the effects of intranasal insulin on memory deficits in type 2 diabetes and early Alzheimer's dementia concept and study scope. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)72207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IntroductionRecent data support the view that the neurodegeneration underlying sporadic Alzheimer's Disease (AD) is in part related to brain insulin deficiency and brain insulin resistance. There is a higher incidence of AD in patients with diabetes mellitus type II (T2D) and both diseases show a decline in memory function. In a preceding trial intranasal insulin improved memory function in healthy volunteers so that an increase of central-nervous insulin concentration may improve cognitive function in both amnestic patient groups.AimsWe want to analyse the effects of intranasal insulin on patients with early Alzheimers's disease (eAD) and patients with T2D in the state of amnestic mild cognitive impairment (aMCI).MethodsRecruitment of 30 patients with eAD, 30 patients with T2D in aMCI state and 30 age-matched healthy controls. All patients undergo a run-in period of 2 weeks with 4 × daily administration of placebo. It follows a double blinded trial with daily intranasal administration of 4 × 40 I.U. insulin vs. placebo for 8 weeks and another 8 weeks of follow-up. At 4 defined time points memory function is assessed by word lists comprising 30 items of emotional, nutritional and neutral content which have to be memorized and are recalled after one week. To assess structural changes of the brain, a quantitative analysis for hippocampal N-acetyl-aspartate, choline and creatine is performed by 3 Tesla magnetic resonance spectroscopy.Results: Since the study has not finished yet, we present experiences from the initiation and the beginning phase.
Collapse
|
34
|
Clausen G, Borchelt M, Janssen C, Loos S, Mull L, Pfaff H. [Patient satisfaction and geriatric care - an empirical study]. Z Gerontol Geriatr 2007; 39:48-56. [PMID: 16502227 DOI: 10.1007/s00391-006-0300-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2004] [Accepted: 03/11/2005] [Indexed: 10/25/2022]
Abstract
Patients' satisfaction has become a central concept in quality assurance. Despite progress in research in this area is still a lack of data for geriatric patients. Referring to the consumer model, satisfaction can be described as a difference between expectations and assessed performance. The aim of this study is to analyze satisfaction among geriatric patients in an in-patient setting. A personal interview was performed 1-2 days before discharge. Patients suffering for dementia or with problems to communicate were excluded. 124 of 268 geriatric patients who were discharged in 2003 were included (inclusion rate 46.3%). 119 were willing to participate (response rate 96.0%). Respondents were between 61 and 96 years old, 39% were male and 42% had serious functional limitations at time of admission. Multiple linear regression analysis revealed three significant predictors of a combined index of satisfaction and expectations: a) quality of hotel services; b) experience of neglect; c) provision of medical information and skills. In summary, standardized personal questionnaires can provide valid and reliable data of geriatric patients. Satisfaction of elderly patients is negatively affected by neglect and positively influenced by provision of medical information and a good hotel services.
Collapse
Affiliation(s)
- G Clausen
- Geriatrisches Zentrum Hagenhof im Klinikum Hannover, Rohdehof 3, 30853, Langenhagen, Germany
| | | | | | | | | | | |
Collapse
|
35
|
Ragaert P, Devlieghere F, Loos S, Dewulf J, Van Langenhove H, Foubert I, Vanrolleghem PA, Debevere J. Role of yeast proliferation in the quality degradation of strawberries during refrigerated storage. Int J Food Microbiol 2006; 108:42-50. [PMID: 16387380 DOI: 10.1016/j.ijfoodmicro.2005.10.017] [Citation(s) in RCA: 19] [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] [Received: 10/01/2004] [Revised: 06/15/2005] [Accepted: 10/12/2005] [Indexed: 11/18/2022]
Abstract
Quality changes of strawberries during storage can be caused both by microbiological and physiological processes. There is little known about the possible contribution of microbiological processes to the quality degradation of strawberries. In this study, quality of strawberries during storage was evaluated by analytical and sensorial analyses. It was the aim to investigate the influence of microbiological activity on the changes of different quality factors of strawberries during storage. During storage at 7 degrees C, quality was mainly determined by the odor and by visual defects. Regarding the odor, highly microbiologically contaminated late-season strawberries packaged in air at 7 degrees C became sensorially unacceptable due to the presence of high amounts of ethyl acetate. This could be attributed to the yeast proliferation: at yeast concentrations above 5.0 log cfu/g, an increase in ethanol was detected in the headspace of the strawberries. It was shown that ethanol was converted to ethyl acetate by strawberries resulting in an unacceptable odor. In an experiment with low microbiologically contaminated early-season strawberries, not reaching the above mentioned yeast counts, less ethyl acetate was detected which resulted in strawberries that were sensorially acceptable during the whole storage period (12 days). Strawberries packaged in modified atmosphere conditions showed a different quality pattern due to the effect of decreased O2-concentrations on both microbiological and physiological processes. This paper demonstrates that also microbiological processes on strawberries should be considered as they could play an important role in the sensorial quality when interacting with physiological processes.
Collapse
Affiliation(s)
- P Ragaert
- Department of Food Safety and Food Quality, Laboratory of Food Microbiology and Food Preservation, Ghent University, Coupure Links 653, B-9000 Ghent, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Ragaert P, Devlieghere F, Loos S, Dewulf J, Van Langenhove H, Debevere J. Metabolite production of yeasts on a strawberry-agar during storage at 7°C in air and low oxygen atmosphere. Food Microbiol 2006; 23:154-61. [PMID: 16942999 DOI: 10.1016/j.fm.2005.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Revised: 02/21/2005] [Accepted: 02/21/2005] [Indexed: 11/23/2022]
Abstract
Changes of different quality factors of strawberries have been described until now from a physiological point of view. Possible effects on quality caused by yeast proliferation have not been described. To elucidate the metabolic activity of yeasts (i.e. Debaryomyces melissophilus, Rhodotorula glutinis, Cryptococcus laurentii), isolated from strawberries, they were inoculated on a simulation medium of strawberries (strawberry-agar). Their activity was measured by analysing and correlating microbiological counts, metabolite concentration in the headspace as well as in the medium, and sugar consumption. The isolated yeasts from strawberries could grow on the strawberry-agar, both under air conditions and modified atmosphere (MA) conditions. The maximum count for the yeasts reached 7.5-8.5 log cfu cm(-2) (air conditions) and 5.6-6.4 log cfu cm(-2) (MA conditions). Production or consumption of a number of compounds could be detected when microbial counts reached levels between 4.7 log cfu cm(-2) and 8.5 log cfu cm(-2) depending on species and atmospheric conditions. A range of volatile organic compounds, produced by the yeasts, was detected: acetone, ethyl acetate, ethanol, isopropyl acetate, ethyl butyrate, 1-propanol, 2-methyl-1-propanol, 1-butanol, 2-methyl-1-butanol, 3-methyl-1-butanol, 1-hexanol and hexyl acetate. These compounds are able to influence the sensory properties of strawberries. A simultaneous decrease in sugar concentrations (sucrose, glucose, fructose) was observed. When ethanol reached high concentrations, ethyl acetate and ethyl butyrate were produced. This production can be attributed to a detoxification of ethanol by yeasts. The fermentative metabolism of yeasts during aerobic conditions could be explained by the Crabtree effect. As the detected volatile organic compounds produced by yeasts are also found in fresh strawberries, it can be concluded that these compounds are produced both by microbiological and physiological processes.
Collapse
Affiliation(s)
- P Ragaert
- Department of Food Safety and Food Quality, Laboratory of Food Microbiology and Food Preservation, Ghent University, Coupure links 653, B-9000 Ghent, Belgium
| | | | | | | | | | | |
Collapse
|
37
|
Clausen G, Borchelt M, Janßen C, Loos S, Mull L, Pfaff H. Patientenzufriedenheit in der Geriatrie. Eine empirische Untersuchung. Gesundheitswesen 2005. [DOI: 10.1055/s-2005-920697] [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: 10/28/2022]
|
38
|
Thiele A, Bang R, Gütschow M, Rossol M, Loos S, Eger K, Tiegs G, Hauschildt S. Cytokine modulation and suppression of liver injury by a novel analogue of thalidomide. Eur J Pharmacol 2002; 453:325-34. [PMID: 12398921 DOI: 10.1016/s0014-2999(02)02423-8] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Thalidomide has been shown to reduce the production of tumor necrosis factor-alpha (TNF-alpha), a cytokine with deleterious pathophysiologic effects in various diseases. In search of thalidomide analogues with improved TNF-alpha inhibiting properties, 5-ethyl-1-phenyl-5-(3,4,5,6-tetrafluorophthalimido)barbituric acid (TFBA) was found to be superior to thalidomide. Besides TNF-alpha, TFBA also suppressed interleukin-6 and interleukin-10 production of isolated monocytes. The possibility that TFBA exerts its action by increasing levels of cAMP via inhibition of phosphodiesterase-4 activity was excluded. TFBA had no influence on T cell proliferation; neither did it inhibit TNF-alpha production in peripheral blood mononuclear cells stimulated by anti-CD3 monoclonal antibody. When applied to mice treated with D-galactosamine and lipopolysaccharide, TFBA prevented a rise in serum TNF-alpha, had no effect on interleukin-6 levels and led to an increase in interleukin-10 production. The changes in cytokine production observed in vitro and in vivo were reflected by similar changes in the mRNA expression. Moreover, TFBA significantly reduced liver transaminase levels in D-galactosamine/lipopolysaccharide-treated mice and thus efficiently protected the animals from liver injury. Thus, according to its properties, TFBA has the potential of modulating an immune response by acting as an anti-inflammatory agent.
Collapse
Affiliation(s)
- Andrea Thiele
- Department of Immunobiology, Institute of Zoology, University of Leipzig, Talstrasse 33, D-04103, Leipzig, Germany
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Paddenberg R, Loos S, Schöneberger HJ, Wulf S, Müller A, Iwig M, Mannherz HG. Serum withdrawal induces a redistribution of intracellular gelsolin towards F-actin in NIH 3T3 fibroblasts preceding apoptotic cell death. Eur J Cell Biol 2001; 80:366-78. [PMID: 11432727 DOI: 10.1078/0171-9335-00166] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The intracellular distribution of gelsolin in NIH 3T3 cells was examined by immunostaining using affinity-purified polyclonal gelsolin antibodies before and after induction of apoptosis by serum withdrawal. Serum deprivation induced detachment of an increasing number of NIH 3T3 cells, but also apoptosis in attached cells as verified morphologically by chromatin condensation, nuclear fragmentation and labelling of their periphery by FITC-annexin V. Ongoing apoptosis was also demonstrated by activation of caspase-3 activity and chromatin cleavage into high-molecular-mass fragments, although no internucleosomal chromatin degradation (DNA-ladder formation) was detected. When cells were maintained in the presence of 10% foetal calf serum, gelsolin immunoreactivity was evenly distributed in the cytoplasm. No obvious co-localisation of gelsolin and the actin-containing stress fibres was detected under these conditions. At day one after serum withdrawal, a redistribution of gelsolin to actin filaments was detected within a few attached cells by double fluorescence staining. The number of cells exhibiting this redistribution increased at days two to four. In addition, the stress fibres increased in thickness and their length was continuously reduced. At day four, many cells contained shortened stress fibres, which had lost their longitudinal orientation. Additionally, the cytoplasm of a number of attached cells was highly condensed around their nuclei and a homogenous distribution of both gelsolin and actin was detected in the remaining cytoplasmic rim. Up to day two, these effects were reversible after re-addition of serum to attached cells. A similar redistribution of gelsolin immunore-activity was observed after induction of apoptosis by cycloheximide, but not after initiation of necrosis by hydrogen peroxide. In NIH 3T3 cells no alteration in the expression of gelsolin at the level of protein (Western blot) or specific mRNA (Northern blot) was observed after serum withdrawal. Using Western blotting, no proteolysis of gelsolin was detected up to day 4, although caspase-3 activity was found to have increased fivefold after serum withdrawal. These results suggested that in these cells F-actin severing might occur in the absence or advance of gelsolin cleavage by caspases. Intact gelsolin on its own may be sufficient for the dissolution of the microfilaments, since micro-injection of gelsolin into primary bovine lens cells led to a transient disappearance of the stress fibres and to a reduction of their attachment area to the substratum. In NIH 3T3 cells similar effects of micro-injected gelsolin were only observed at day one after serum withdrawal.
Collapse
Affiliation(s)
- R Paddenberg
- Department of Anatomy and Cell Biology, Ruhr-University, Bochum/Germany
| | | | | | | | | | | | | |
Collapse
|
40
|
Loos S, Plate A, Dapp U, Lüttje D, Meier-Baumgartner HP, Oster P, Vogel W, Steinhagen-Thiessen E. [Geriatric care in Germany--results of an empirical study]. Z Gerontol Geriatr 2001; 34:61-73. [PMID: 11310231 DOI: 10.1007/s003910170095] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In Germany, the situation of geriatric medicine has improved significantly over the past few years. Until now, though, there was little information available on the structure of the clinical geriatric departments. Since this information is vital to assess whether these departments can provide high-quality services, the German Federal Association of Clinical Geriatric Departments conducted a survey among its members. The goal was to gain deeper insight into the structure of the geriatric acute hospitals and rehabilitation units. METHODS In 1999, member institutions were mailed a standardized questionnaire and all institutions (100%) returned the questionnaire to the association's central office. To increase data quality, data were screened and reports were generated for each institution. These reports were returned to the institutions which were asked to verify them. RESULTS This article shows that in 1998 acute geriatric hospitals (n = 89), rehabilitation units (n = 52), acute day clinics (n = 45) and rehabilitation day clinics (n = 26) had--on average--60/60/15.3/14 beds/places and 828.15/677.3/164.2/125.9 patients. Occupancy rates averaged out at 88.7%/84.3%/86.4%/63.7% and daily hospital rates at DM 401.4/322.4/293.8/243.2. Basically, all geriatric institutions included in this survey had a multi-professional geriatric team. Patient-to-staff ratios for psychologists, social workers, ergo-, physio- and speech therapists were better in day clinics than in in-patient clinics and better in rehabilitation units than in acute hospitals. Geriatric institutions mainly focused on the treatment of neurological deficits. Most patients were admitted from other hospitals and discharged to their private residence. CONCLUSIONS The results of this survey indicate that especially the acute hospitals are often not sufficiently staffed. Moreover, further efforts are necessary to clarify the indications for and modalities of geriatric day clinic treatment and rehabilitation. The data also show that a categorical distinction between geriatric acute hospitals and rehabilitation units is not possible. However, further data collection and more detailed analyses are needed.
Collapse
Affiliation(s)
- S Loos
- Forschungsgruppe Geriatrie an der Charité Berlin am Ev. Geriatriezentrum Berlin (EGZB) Reinickendorfer Str. 61 13347 Berlin
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Welle GJ, Clark M, Loos S, Pauls D, Warden D, Sheffield M, Parsells C. Stereotactic breast biopsy: recumbent biopsy using add-on upright equipment. AJR Am J Roentgenol 2000; 175:59-63. [PMID: 10882246 DOI: 10.2214/ajr.175.1.1750059] [Citation(s) in RCA: 26] [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: 11/18/2022]
Abstract
OBJECTIVE The purpose of the study was to show that stereotactic breast biopsy can be performed effectively and accurately using add-on stereotactic equipment when it is performed with the patient in a decubitus or recumbent position. MATERIALS AND METHODS We retrospectively reviewed the results of 225 stereotactic core breast biopsies performed during a 42-month period. The biopsies were performed using a reclining mammography chair and add-on stereotactic equipment. Procedures were performed with the patient in the right or left lateral decubitus position or upright. Patients with benign biopsy results were followed up mammographically at 6 months initially, then yearly. RESULTS Of the 225 lesions biopsied stereotactically, 205 lesions (91%) were biopsied with the patient in the decubitus (right or left) position and 20 (9%) biopsied with the patient upright. Pathology results were classified as abnormal in 45 lesions (20%) and normal in 180 lesions (80%). All but one of the abnormal lesions were followed up with surgical excision. One hundred thirty-four of the 180 benign lesions have been followed up with at least one 6-month mammogram (follow-up range, 6-40 months), and none of the lesions has been subsequently proven malignant. CONCLUSION Stereotactic core biopsy can be performed effectively and accurately using standard add-on equipment when it is performed with the patient in the decubitus position. This approach obviates the use of dedicated prone stereotactic equipment.
Collapse
|
42
|
Aigner T, Loos S, Müller S, Sandell LJ, Unni KK, Kirchner T. Cell differentiation and matrix gene expression in mesenchymal chondrosarcomas. Am J Pathol 2000; 156:1327-35. [PMID: 10751358 PMCID: PMC1876868 DOI: 10.1016/s0002-9440(10)65003-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mesenchymal chondrosarcomas are small-cell malignancies named as chondrosarcomas due to the focal appearance of cartilage islands. In this study, the use of in situ detection techniques on a large series of mesenchymal chondrosarcoma specimens allowed the identification of tumor-cell differentiation pathways in these neoplasms. We were able to trace all steps of chondrogenesis within mesenchymal chondrosarcoma by using characteristic marker genes of chondrocytic development. Starting from undifferentiated cells, which were negative for vimentin and any other mesenchymal marker, a substantial portion of the cellular (undifferentiated) tumor areas showed a chondroprogenitor phenotype with an onset of expression of vimentin and collagen type IIA. Cells in the chondroid areas showed the full expression panel of mature chondrocytes including type X collagen indicating focal hypertrophic differentiation of the neoplastic chondrocytes. Finally, evidence was found for transdifferentiation of the neoplastic chondrocytes to osteoblast-like cells in areas of neoplastic bone formation. These results establish mesenchymal chondrosarcoma as the very neoplasm of differentiating premesenchymal chondroprogenitor cells. The potential of neoplastic bone formation in mesenchymal chondrosarcoma introduces a new concept of neoplastic (chondrocytic) osteogenesis in musculoskeletal malignant neoplasms, which qualifies the old dogma that neoplastic bone/osteoid formation automatically implies the diagnosis of osteosarcoma.
Collapse
Affiliation(s)
- T Aigner
- Institute of Pathology, the University of Erlangen-Nürnberg, Erlangen, Germany.
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
Chondroblastoma is defined as a 'benign tumour, characterized by highly cellular and relatively undifferentiated tissue composed of rounded or polygonal chondroblast-like cells' and the 'presence of cartilaginous intercellular matrix' (WHO). An extensive analysis of the extracellular matrix composition and gene expression pattern of a large series of chondroblastoma cases shows, however, that type II collagen, which is the main component of any cartilage matrix, is not expressed by the neoplastic cells of this tumour entity and is not deposited into the extracellular tumour matrix. Instead, osteoid and fibrous matrix is formed, with its typical biochemical composition. The multifocal expression of aggrecan proteoglycan in most chondroblastomas explains the bluish, pseudo-chondroid appearance of some of the matrix-rich areas of chondroblastomas. This study did not show chondroid matrix formation or chondroblastic cell differentiation in chondroblastomas, suggesting that chondroblastoma should be classified as a specific bone-forming, rather than cartilage-forming neoplasm.
Collapse
Affiliation(s)
- T Aigner
- Institute of Pathology, University of Erlangen-Nürnberg, Krankenhausstrasse 8-10, D-91054 Erlangen, Germany.
| | | | | | | | | | | | | |
Collapse
|
44
|
Loos S. [A drink for fat cells]. MMW Fortschr Med 1999; 141:14. [PMID: 10912135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
|
45
|
Abstract
Gross cystic disease fluid protein 15 (GCDFP-15) is a major protein component of benign breast gross cysts. It is also found in approximately 50% of all breast cancer specimens. Androgen receptor (AR) mediated regulation of GCDFP-15 expression was investigated in the AR-positive human mammary cancer cell lines MFM-223 and ZR-75-1. Proliferation of MFM-223 and ZR-75-1 cells is inhibited by androgens. Ten nM 5alpha-dihydrotestosterone stimulated the expression of GCDFP-15 mRNA in MFM-223 (ca. 3-fold) and ZR-75-1 cancer cells (ca. 30-fold) as well as the secretion of GCDFP-15 into the culture medium. Competition experiments with DHT and the antiandrogens hydroxyflutamide and casodex confirmed the involvement of the AR in the regulation of GCDFP-15. Both antiandrogens inhibited GCDFP-15 mRNA expression even in the absence of DHT. AR mRNA was down-regulated in MFM-223 and ZR-75-1 cells (80 and 20% of the control, respectively) during incubation with DHT. Our data demonstrate the effective inhibition of GCDFP-15 expression by pure antiandrogens.
Collapse
Affiliation(s)
- S Loos
- Department of Obstetrics and Gynecology, Philipps-University, D-35037 Marburg, Germany
| | | | | |
Collapse
|
46
|
Hackenberg R, Loos S, Nia AH, Kunzmann R, Schulz KD. Expression of placental protein 14 by the new endometrial cancer cell line MFE-280 in vitro and by endometrial carcinomas in vivo. Anticancer Res 1998; 18:1153-8. [PMID: 9615781] [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: 02/07/2023]
Abstract
MFE-280 endometrial cancer cells express PP14 (placental protein 14) in vitro. PP14 is normally found in the secretory endometrium and in placental tissue. MFE-280 cells, which are tumorigenic in nude mice, were derived from a recurrent, poorly differentiated endometrial carcinoma. The cells were initially grown in suspension culture and later transferred to monolayer cultures. Karyotyping revealed near-diploidy with a complex heterogeneous aberration pattern. MFE-280 cells were positive for the cytokeratins 7, 8, 18 and 19 as well as for vimentin. The expression of PP14 in MFE-280 cells was demonstrated by immunochemistry and reverse transcriptase--polymerase chain reaction. PP14-mRNA was also detected in one out of five endometrial cancer specimen. In tumor tissue the expression of PP14 was not dependent on progestins.
Collapse
Affiliation(s)
- R Hackenberg
- Zentrum für Frauenheilkunde und Geburtshilfe, Philipps-Universität, Marburg, Germany
| | | | | | | | | |
Collapse
|
47
|
Abstract
The hepatic clearance rate and secretion rate mainly determine peripheral plasma concentrations of regulatory peptides released from the gastrointestinal tract. In the present study hepatic extraction of peptide YY (PYY) during a single passage was investigated in the in situ perfused rat liver excluding modulating actions of circulating hormones. During perfusion of low amounts of PYY (50, 100, 500 pmol l-1), peptide concentrations in the portal vein (5.1 +/- 4.6, 98.1 +/- 2.6, 558 +/- 13.6 pmol l-1) and in the hepatic vein (50.2 +/- 1.4, 88.6 +/- 2.2, 503 +/- 18.1 pmol l-1 was only 22.1%. PYY had no influence on hepatic glucose and lactate production, portal flow as well as bile flow and bile acid secretion at these concentrations. PYY seems to traverse the liver almost intact and reaches the target organs without any significant hepatic extraction. Concomitant studies on metabolic and excretory functions of the liver showed no effect of PYY.
Collapse
Affiliation(s)
- K Beckh
- Department of Internal Medicine, Philipps-University, Marburg, Germany
| | | | | | | | | |
Collapse
|
48
|
Binder K, Keresztesi K, Loos S. [Report on the Caries Symposium at Vienna]. Osterr Z Stomatol 1973; 70:193-9. [PMID: 4145371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
49
|
Loos S, Mikkelsen C. New laws bring new approaches. Method for the evaluation of therapeutic abortion candidates meets the requirements of California state law and the needs of patients, while conserving the time of the medical staff. Hospitals 1972; 46:76-9. [PMID: 5055360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
50
|
Loos S. [Disorders in mastication due to old age]. Dtsch Zahnarztl Z 1970; 25:184-7. [PMID: 5264933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|