1
|
Awchi M, Singh KD, Brenner SB, Burckhardt MA, Hess M, Zeng J, Datta AN, Frey U, Zumsteg U, Szinnai G, Sinues P. Metabolic trajectories of diabetic ketoacidosis onset described by breath analysis. Front Endocrinol (Lausanne) 2024; 15:1360989. [PMID: 38752172 PMCID: PMC11094216 DOI: 10.3389/fendo.2024.1360989] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/02/2024] [Indexed: 05/18/2024] Open
Abstract
Purpose This feasibility study aimed to investigate the use of exhaled breath analysis to capture and quantify relative changes of metabolites during resolution of acute diabetic ketoacidosis under insulin and rehydration therapy. Methods Breath analysis was conducted on 30 patients of which 5 with DKA. They inflated Nalophan bags, and their metabolic content was subsequently interrogated by secondary electrospray ionization high-resolution mass spectrometry (SESI-HRMS). Results SESI-HRMS analysis showed that acetone, pyruvate, and acetoacetate, which are well known to be altered in DKA, were readily detectable in breath of participants with DKA. In addition, a total of 665 mass spectral features were found to significantly correlate with base excess and prompt metabolic trajectories toward an in-control state as they progress toward homeostasis. Conclusion This study provides proof-of-principle for using exhaled breath analysis in a real ICU setting for DKA monitoring. This non-invasive new technology provides new insights and a more comprehensive overview of the effect of insulin and rehydration during DKA treatment.
Collapse
Affiliation(s)
- Mo Awchi
- University Children’s Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Kapil Dev Singh
- University Children’s Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Sara Bachmann Brenner
- University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Marie-Anne Burckhardt
- University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Melanie Hess
- University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Jiafa Zeng
- University Children’s Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Alexandre N. Datta
- University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Urs Frey
- University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Urs Zumsteg
- University Children’s Hospital Basel, Basel, Switzerland
| | - Gabor Szinnai
- University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Pablo Sinues
- University Children’s Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| |
Collapse
|
2
|
Deichmann J, Bachmann S, Burckhardt MA, Pfister M, Szinnai G, Kaltenbach HM. New model of glucose-insulin regulation characterizes effects of physical activity and facilitates personalized treatment evaluation in children and adults with type 1 diabetes. PLoS Comput Biol 2023; 19:e1010289. [PMID: 36791144 PMCID: PMC9974135 DOI: 10.1371/journal.pcbi.1010289] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/28/2023] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
Accurate treatment adjustment to physical activity (PA) remains a challenging problem in type 1 diabetes (T1D) management. Exercise-driven effects on glucose metabolism depend strongly on duration and intensity of the activity, and are highly variable between patients. In-silico evaluation can support the development of improved treatment strategies, and can facilitate personalized treatment optimization. This requires models of the glucose-insulin system that capture relevant exercise-related processes. We developed a model of glucose-insulin regulation that describes changes in glucose metabolism for aerobic moderate- to high-intensity PA of short and prolonged duration. In particular, we incorporated the insulin-independent increase in glucose uptake and production, including glycogen depletion, and the prolonged rise in insulin sensitivity. The model further includes meal absorption and insulin kinetics, allowing simulation of everyday scenarios. The model accurately predicts glucose dynamics for varying PA scenarios in a range of independent validation data sets, and full-day simulations with PA of different timing, duration and intensity agree with clinical observations. We personalized the model on data from a multi-day free-living study of children with T1D by adjusting a small number of model parameters to each child. To assess the use of the personalized models for individual treatment evaluation, we compared subject-specific treatment options for PA management in replay simulations of the recorded data with altered meal, insulin and PA inputs.
Collapse
Affiliation(s)
- Julia Deichmann
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Switzerland
- Life Science Zurich Graduate School, Zurich, Switzerland
| | - Sara Bachmann
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Marie-Anne Burckhardt
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Marc Pfister
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Hans-Michael Kaltenbach
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Switzerland
- * E-mail:
| |
Collapse
|
3
|
Bachmann F, Koch G, Bauer RJ, Steffens B, Szinnai G, Pfister M, Schropp J. Computing optimal drug dosing with OptiDose: implementation in NONMEM. J Pharmacokinet Pharmacodyn 2023; 50:173-188. [PMID: 36707456 DOI: 10.1007/s10928-022-09840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/19/2022] [Indexed: 01/28/2023]
Abstract
Determining a drug dosing recommendation with a PKPD model can be a laborious and complex task. Recently, an optimal dosing algorithm (OptiDose) was developed to compute the optimal doses for any pharmacometrics/PKPD model for a given dosing scenario. In the present work, we reformulate the underlying optimal control problem and elaborate how to solve it with standard commands in the software NONMEM. To demonstrate the potential of the OptiDose implementation in NONMEM, four relevant but substantially different optimal dosing tasks are solved. In addition, the impact of different dosing scenarios as well as the choice of the therapeutic goal on the computed optimal doses are discussed.
Collapse
Affiliation(s)
- Freya Bachmann
- Department of Mathematics and Statistics, University of Konstanz, PO Box 195, 78457, Konstanz, Germany
| | - Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Spitalstrasse 33, 4056, Basel, Switzerland.
| | | | - Britta Steffens
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University of Basel Children's Hospital, Spitalstrasse 33, 4056, Basel, Switzerland.,Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Spitalstrasse 33, 4056, Basel, Switzerland.,Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Johannes Schropp
- Department of Mathematics and Statistics, University of Konstanz, PO Box 195, 78457, Konstanz, Germany
| |
Collapse
|
4
|
Steffens B, Koch G, Gächter P, Claude F, Gotta V, Bachmann F, Schropp J, Janner M, l'Allemand D, Konrad D, Welzel T, Szinnai G, Pfister M. Clinically practical pharmacometrics computer model to evaluate and personalize pharmacotherapy in pediatric rare diseases: application to Graves' disease. Front Med (Lausanne) 2023; 10:1099470. [PMID: 37206476 PMCID: PMC10188966 DOI: 10.3389/fmed.2023.1099470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/14/2023] [Indexed: 05/21/2023] Open
Abstract
Objectives Graves' disease (GD) with onset in childhood or adolescence is a rare disease (ORPHA:525731). Current pharmacotherapeutic approaches use antithyroid drugs, such as carbimazole, as monotherapy or in combination with thyroxine hormone substitutes, such as levothyroxine, as block-and-replace therapy to normalize thyroid function and improve patients' quality of life. However, in the context of fluctuating disease activity, especially during puberty, a considerable proportion of pediatric patients with GD is suffering from thyroid hormone concentrations outside the therapeutic reference ranges. Our main goal was to develop a clinically practical pharmacometrics computer model that characterizes and predicts individual disease activity in children with various severity of GD under pharmacotherapy. Methods Retrospectively collected clinical data from children and adolescents with GD under up to two years of treatment at four different pediatric hospitals in Switzerland were analyzed. Development of the pharmacometrics computer model is based on the non-linear mixed effects approach accounting for inter-individual variability and incorporating individual patient characteristics. Disease severity groups were defined based on free thyroxine (FT4) measurements at diagnosis. Results Data from 44 children with GD (75% female, median age 11 years, 62% receiving monotherapy) were analyzed. FT4 measurements were collected in 13, 15, and 16 pediatric patients with mild, moderate, or severe GD, with a median FT4 at diagnosis of 59.9 pmol/l (IQR 48.4, 76.8), and a total of 494 FT4 measurements during a median follow-up of 1.89 years (IQR 1.69, 1.97). We observed no notable difference between severity groups in terms of patient characteristics, daily carbimazole starting doses, and patient years. The final pharmacometrics computer model was developed based on FT4 measurements and on carbimazole or on carbimazole and levothyroxine doses involving two clinically relevant covariate effects: age at diagnosis and disease severity. Discussion We present a tailored pharmacometrics computer model that is able to describe individual FT4 dynamics under both, carbimazole monotherapy and carbimazole/levothyroxine block-and-replace therapy accounting for inter-individual disease progression and treatment response in children and adolescents with GD. Such clinically practical and predictive computer model has the potential to facilitate and enhance personalized pharmacotherapy in pediatric GD, reducing over- and underdosing and avoiding negative short- and long-term consequences. Prospective randomized validation trials are warranted to further validate and fine-tune computer-supported personalized dosing in pediatric GD and other rare pediatric diseases.
Collapse
Affiliation(s)
- Britta Steffens
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- *Correspondence: Britta Steffens
| | - Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Pascal Gächter
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Fabien Claude
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Freya Bachmann
- Department of Mathematics and Statistics, University of Konstanz, Konstanz, Germany
| | - Johannes Schropp
- Department of Mathematics and Statistics, University of Konstanz, Konstanz, Germany
| | - Marco Janner
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dagmar l'Allemand
- Department of Pediatric Endocrinology and Diabetology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology and Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tatjana Welzel
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| |
Collapse
|
5
|
Otto ME, Burckhardt M, Szinnai G, Pfister M, Gotta V. Semimechanistic modeling of copeptin and aldosterone kinetics and dynamics in response to rehydration treatment for diabetic ketoacidosis in children. CPT Pharmacometrics Syst Pharmacol 2022; 12:207-220. [PMID: 36510706 PMCID: PMC9931437 DOI: 10.1002/psp4.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic ketoacidosis (DKA), a frequent complication of type 1 diabetes (T1D), is characterized by hyperosmolar hypovolemia. The response of water-regulating hormones arginine vasopressin (AVP; antidiuretic hormone) and aldosterone to DKA treatment in children is not well understood, although they may have potential as future diagnostic, prognostic, and/or treatment monitoring markers in diabetic patients. We aimed to characterize the dynamics of the response in copeptin (marker for AVP) and aldosterone secretion to rehydration treatment in pediatric patients with DKA. Data originated from a prospective, observational, multicenter study including 28 pediatric T1D patients treated for DKA (median age, 11.5 years; weight, 35 kg). Serial measurements of hormone levels were obtained during 72 h following rehydration start. Semimechanistic pharmacometric modeling was used to analyze the kinetic/dynamic relationship of copeptin and aldosterone secretion in response to the correction of hyperosmolality and hypovolemia, respectively. Modeling revealed different sensitivities for osmolality-dependent copeptin secretion during the first 72 h of rehydration, possibly explained by an osmotic shift introduced by hypovolemia. Response in aldosterone secretion to the correction of hypovolemia seemed to be delayed, which was well described by an extra upstream turnover compartment, possibly representing chronic upregulation of aldosterone synthase (cytochrome P450 11B2). In conclusion, semimechanistic modeling provided novel physiological insights in hormonal water regulation in pediatric patients during DKA treatment, providing rationale to further evaluate the potential of monitoring copeptin, but not aldosterone due to its delayed response, for future optimization of rehydration treatment to reduce the risk of acute complications such as cerebral edema.
Collapse
Affiliation(s)
- Marije E. Otto
- Pediatric Pharmacology and PharmacometricsUniversity Children's Hospital Basel, University of BaselBaselSwitzerland,Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenThe Netherlands
| | - Marie‐Anne Burckhardt
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital Basel, University of BaselBaselSwitzerland,Department of Clinical ResearchUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital Basel, University of BaselBaselSwitzerland,Department of Clinical ResearchUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Marc Pfister
- Pediatric Pharmacology and PharmacometricsUniversity Children's Hospital Basel, University of BaselBaselSwitzerland,CertaraPrincetonNew JerseyUSA
| | - Verena Gotta
- Pediatric Pharmacology and PharmacometricsUniversity Children's Hospital Basel, University of BaselBaselSwitzerland
| |
Collapse
|
6
|
Nahum U, Refardt J, Chifu I, Fenske WK, Fassnacht M, Szinnai G, Christ-Crain M, Pfister M. Machine learning-based algorithm as an innovative approach for the differentiation between diabetes insipidus and primary polydipsia in clinical practice. Eur J Endocrinol 2022; 187:777-786. [PMID: 36201166 DOI: 10.1530/eje-22-0368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Differentiation between central diabetes insipidus (cDI) and primary polydipsia (PP) remains challenging in clinical practice. Although the hypertonic saline infusion test led to high diagnostic accuracy, it is a laborious test requiring close monitoring of plasma sodium levels. As such, we leverage machine learning (ML) to facilitate differential diagnosis of cDI. DESIGN We analyzed data of 59 patients with cDI and 81 patients with PP from a prospective multicenter study evaluating the hypertonic saline test as new test approach to diagnose cDI. Our primary outcome was the diagnostic accuracy of the ML-based algorithm in differentiating cDI from PP patients. METHODS The data set used included 56 clinical, biochemical, and radiological covariates. We identified a set of five covariates which were crucial for differentiating cDI from PP patients utilizing standard ML methods. We developed ML-based algorithms on the data and validated them with an unseen test data set. RESULTS Urine osmolality, plasma sodium and glucose, known transsphenoidal surgery, or anterior pituitary deficiencies were selected as input parameters for the basic ML-based algorithm. Testing it on an unseen test data set resulted in a high area under the curve (AUC) score of 0.87. A further improvement of the ML-based algorithm was reached with the addition of MRI characteristics and the results of the hypertonic saline infusion test (AUC: 0.93 and 0.98, respectively). CONCLUSION The developed ML-based algorithm facilitated differentiation between cDI and PP patients with high accuracy even if only clinical information and laboratory data were available, thereby possibly avoiding cumbersome clinical tests in the future.
Collapse
Affiliation(s)
- Uri Nahum
- Pediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Julie Refardt
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Irina Chifu
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Wiebke K Fenske
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University Hospital of Bonn, Bonn, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Central Laboratory, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Gabor Szinnai
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics Research Center, University Children's Hospital Basel, University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
7
|
Claude F, Ubertini G, Szinnai G. Endocrine Disorders in Children with Brain Tumors: At Diagnosis, after Surgery, Radiotherapy and Chemotherapy. Children (Basel) 2022; 9:1617. [PMID: 36360345 PMCID: PMC9688119 DOI: 10.3390/children9111617] [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] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Brain tumors are the second most frequent type of all pediatric malignancies. Depending on their localization, patients with brain tumors may present neurological or ophthalmological symptoms, but also weight anomalies and endocrine disorders ranging from growth hormone deficiency, anomalies of puberty, diabetes insipidus to panhypopituitarism. Immediately at diagnosis, all patients with brain tumors require a complete assessment of the hypothalamic-pituitary function in order to address eventual endocrine disorders. Moreover, children and adolescents undergoing brain surgery must receive peri- and postoperative hydrocortisone stress therapy. Post-operative disorders of water homeostasis are frequent, ranging from transient diabetes insipidus, as well as syndrome of inappropriate antidiuretic hormone secretion to persistent diabetes insipidus. Late endocrine disorders may result from surgery near or within the hypothalamic-pituitary region. Pituitary deficits are frequent after radiotherapy, especially growth hormone deficiency. Thyroid nodules or secondary thyroid cancers may arise years after radiotherapy. Gonadal dysfunction is frequent after chemotherapy especially with alkylating agents. CONCLUSION Early detection and treatment of specific endocrine disorders at diagnosis, perioperatively, and during long-term follow-up result in improved general and metabolic health and quality of life.
Collapse
Affiliation(s)
- Fabien Claude
- Department of Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
| | - Graziamaria Ubertini
- Department of Pediatric Endocrinology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Gabor Szinnai
- Department of Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, University of Basel, 4056 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, 4056 Basel, Switzerland
| |
Collapse
|
8
|
Hauser SI, Gregoriano C, Koehler H, Ebrahimi F, Szinnai G, Schuetz P, Mueller B, Kutz A. Trends and outcomes of children, adolescents, and adults hospitalized with inherited metabolic disorders: A population‐based cohort study. JIMD Rep 2022; 63:581-592. [PMID: 36341165 PMCID: PMC9626668 DOI: 10.1002/jmd2.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
Inherited metabolic disorders (IMDs) comprise a heterogeneous class of genetic disorders characterized by impaired biochemical functions in metabolism. However, incidences and outcomes of patients hospitalized with IMDs are largely unknown. We conducted a population‐based cohort study using nationwide in‐hospital claims data in Switzerland from 2012 to 2020. We assessed incidence rates of hospitalizations and hospital‐associated outcomes, stratified in five age groups (0–9, 10–19, 20–39, 40–59, and 60–90 years) and three types of IMDs (peptide, amine and amino acid metabolism disorders [AD], carbohydrate metabolism disorders [CD], fatty acid, and ketone body metabolism disorders [FD]). A total of 7293 hospitalizations with IMD were identified, of which 3638 had AD, 3153 CD, and 502 FD. Incidence rates for hospitalizations per 100 000 person‐years were highest under the age of 10 years across all types of IMDs (8.69 for AD, 5.73 for CD, 3.71 for FD) and decreased thereafter. In patients with AD and CD, hospitalization rates increased again in adults aged 60–90 years (7.28 for AD, 7.25 for CD), while they remained low in patients with FD (0.31). Compared to inpatients without IMD, adult IMD patients had a higher burden of hospital‐associated adverse outcomes including an increased risk of in‐hospital mortality, intensive care unit admission, mechanical ventilation, and longer length of hospital or intensive care unit stay. Incremental risk of 30‐day, 1‐year, and 2‐year hospital readmission was highest among children and adolescents with IMD.
Collapse
Affiliation(s)
| | - Claudia Gregoriano
- Medical University Department of Medicine Kantonsspital Aarau Aarau Switzerland
| | - Henrik Koehler
- Department of Pediatrics Kantonsspital Aarau Aarau Switzerland
- Department of Clinical Research University Hospital Basel, University of Basel Basel Switzerland
| | - Fahim Ebrahimi
- Division of Gastroenterology, University Center for Gastrointestinal and Liver Diseases St. Clara Hospital and University Hospital Basel Switzerland
| | - Gabor Szinnai
- Department of Clinical Research University Hospital Basel, University of Basel Basel Switzerland
- Department of Pediatric Endocrinology and Diabetology University Children's Hospital Basel Basel Switzerland
| | - Philipp Schuetz
- Medical University Department of Medicine Kantonsspital Aarau Aarau Switzerland
- Department of Clinical Research University Hospital Basel, University of Basel Basel Switzerland
| | - Beat Mueller
- Medical University Department of Medicine Kantonsspital Aarau Aarau Switzerland
- Department of Clinical Research University Hospital Basel, University of Basel Basel Switzerland
| | - Alexander Kutz
- Medical University Department of Medicine Kantonsspital Aarau Aarau Switzerland
| |
Collapse
|
9
|
Bösch F, Landolt MA, Baumgartner MR, Fernandez S, Forny P, Gautschi M, Grünert SC, Häberle J, Horvath C, Karall D, Lampis D, Rohrbach M, Scholl-Bürgi S, Szinnai G, Huemer M. Caregiver burden, and parents' perception of disease severity determine health-related quality of life in paediatric patients with intoxication-type inborn errors of metabolism. Mol Genet Metab Rep 2022; 31:100876. [PMID: 35762020 PMCID: PMC9233158 DOI: 10.1016/j.ymgmr.2022.100876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Living with a non-acute (phenylketonuria) or acute (e.g. urea cycle disorders, organic acidurias) intoxication-type inborn error of metabolism (IT-IEM) can have a substantial impact on health-related quality of life (HrQoL) of paediatric patients and their families. Parents take primary responsibility for treatment monitoring and experience worry and fear about their child's health status. Quantitative evidence on parental psychological factors which may influence the HrQoL of patients with IT-IEM are sparse to non-existent. Methods In this multicenter survey study 50 parents of IT-IEM patients (ages 5–19) assessed the severity of their child's disease, reported on caregiver burden, and proxy-rated their child's HrQoL. Additionally, 35 patient self-reports on HrQoL were obtained (n = 16 female patients, n = 19 male patients). Multiple linear regressions were conducted to examine the predictive power of child age, sex, medical diagnosis type (acute / non-acute), parental perceived disease severity and caregiver burden on patients' HrQoL. Mediation analyses were used to investigate the relation of caregiver burden and parental ratings of disease severity with patients' HrQoL. Results Significant regression models for self-reported [F(5,34) = 10.752, p < .001, R2 adj.. = 0.59] and parent proxy reported HrQoL [F(5,49) = 20.513, p < .001, R2 adj.. = 0.67] emerged. High caregiver burden and perceived disease severity predicted significantly lower patient self- and proxy-reported HrQoL while type of diagnosis (acute versus non-acute) did not. Female sex predicted significantly lower self-reported HrQoL. High caregiver burden was the mediating factor between high perceived severity of the child's disease and lower proxy- by parent rated HrQoL. Conclusion Detecting elevated burden of care and providing support for parents seems crucial to prevent adverse consequences for their children's HrQoL. Intervention studies are needed, to assess which support programs are most efficient. Caregiver burden enforced by high parent-perceived disease severity is a considerable risk factor for low HrQoL in paediatric patients with IT-IEM. The parent perspective was a better estimator for the impact of disease than the mere medical type of diagnosis. Female sex predicted lower self-reported HrQoL
Collapse
|
10
|
Atila C, Gaisl O, Vogt DR, Werlen L, Szinnai G, Christ-Crain M. Glucagon-stimulated copeptin measurements in the differential diagnosis of diabetes insipidus: a double-blind, randomized, placebo-controlled study. Eur J Endocrinol 2022; 187:65-74. [PMID: 35521789 DOI: 10.1530/eje-22-0033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The differential diagnosis of diabetes insipidus is challenging. The most reliable approaches are copeptin measurements after hypertonic saline infusion or arginine, which is a known growth hormone secretagogue but has recently also been shown to stimulate the neurohypophysis. Similar to arginine, glucagon stimulates growth hormone release, but its effect on the neurohypophysis is poorly studied. DESIGN Double-blind, randomized, placebo-controlled trial including 22 healthy participants, 10 patients with central diabetes insipidus, and 10 patients with primary polydipsia at the University Hospital Basel, Switzerland. METHODS Each participant underwent the glucagon test (s.c. injection of 1 mg glucagon) and placebo test. The primary objective was to determine whether glucagon stimulates copeptin and to explore whether the copeptin response differentiates between diabetes insipidus and primary polydipsia. Copeptin levels were measured at baseline, 30, 60, 90, 120, 150, and 180 min after injection. RESULTS In healthy participants, glucagon stimulated copeptin with a median increase of 7.56 (2.38; 28.03) pmol/L, while placebo had no effect (0.10 pmol/L (-0.70; 0.68); P < 0.001). In patients with diabetes insipidus, copeptin showed no relevant increase upon glucagon, with an increase of 0.55 (0.21; 1.65) pmol/L, whereas copeptin was stimulated in patients with primary polydipsia with an increase of 15.70 (5.99; 24.39) pmol/L. Using a copeptin cut-off level of 4.6pmol/L had a sensitivity of 100% (95% CI: 100-100) and a specificity of 90% (95% CI: 70-100) to discriminate between diabetes insipidus and primary polydipsia. CONCLUSION Glucagon stimulates the neurohypophysis, and glucagon-stimulated copeptin has the potential for a safe, novel, and precise test in the differential diagnosis of diabetes insipidus.
Collapse
Affiliation(s)
- Cihan Atila
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Odile Gaisl
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Deborah R Vogt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laura Werlen
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gabor Szinnai
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
11
|
Baumann P, Fuchs A, Gotta V, Ritz N, Baer G, Bonhoeffer JM, Buettcher M, Heininger U, Szinnai G, Bonhoeffer J. The kinetic profiles of copeptin and mid regional proadrenomedullin (MR-proADM) in pediatric lower respiratory tract infections. PLoS One 2022; 17:e0264305. [PMID: 35271609 PMCID: PMC8912143 DOI: 10.1371/journal.pone.0264305] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Kinetics of copeptin and mid regional proadrenomedullin (MR-proADM) during febrile pediatric lower respiratory tract infections (LRTI) are unknown. We aimed to analyze kinetic profiles of copeptin and MR-proADM and the impact of clinical and laboratory factors on those biomarkers. Methods This is a retrospective post-hoc analysis of a randomized controlled trial, evaluating procalcitonin guidance for antibiotic treatment of LRTI (ProPAED-study). In 175 pediatric patients presenting to the emergency department plasma copeptin and MR-proADM concentrations were determined on day 1, 3, and 5. Their association with clinical characteristics and other inflammatory biomarkers were tested by non-linear mixed effect modelling. Results Median copeptin and MR-proADM values were elevated on day 1 and decreased during on day 3 and 5 (-26%; -34%, respectively). The initial concentrations of MR-proADM at inclusion were higher in patients receiving antibiotics intravenously compared to oral administration (difference 0.62 pmol/L, 95%CI 0.44;1.42, p<0.001). Intensive care unit (ICU) admission was associated with a daily increase of MR-proADM (increase/day 1.03 pmol/L, 95%CI 0.43;1.50, p<0.001). Positive blood culture in patients with antibiotic treatment and negative results on nasopharyngeal aspirates, or negative blood culture were associated with a decreasing MR-proADM (decrease/day -0.85 pmol/L, 95%CI -0.45;-1.44), p<0.001). Conclusion Elevated MR-proADM and increases thereof were associated with ICU admission suggesting the potential as a prognostic factor for severe pediatric LRTI. MR-proADM might only bear limited value for decision making on stopping antibiotics due to its slow decrease. Copeptin had no added value in our setting.
Collapse
Affiliation(s)
- Philipp Baumann
- Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children’s Hospital, Basel, Switzerland
- * E-mail:
| | - Aline Fuchs
- Department of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Verena Gotta
- Department of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Nicole Ritz
- Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Gurli Baer
- Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children’s Hospital, Basel, Switzerland
| | - Jessica M. Bonhoeffer
- Department of Paediatrics, University of Basel Children’s Hospital, Basel, Switzerland
| | | | - Ulrich Heininger
- Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children’s Hospital, Basel, Switzerland
| | - Gabor Szinnai
- Department of Paediatric Endocrinology and Diabetology, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan Bonhoeffer
- Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children’s Hospital, Basel, Switzerland
| | | |
Collapse
|
12
|
Glocker V, Bachmann S, Hess M, Szinnai G, Burckhardt MA. Fear of hypoglycemia and quality of life in young people with type 1 diabetes and their parents in the era of sensor glucose monitoring. Front Endocrinol (Lausanne) 2022; 13:958671. [PMID: 35966066 PMCID: PMC9367634 DOI: 10.3389/fendo.2022.958671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION It is crucial to understand psychosocial outcomes in children and adolescents with type 1 diabetes (T1D) and their families to provide optimal family-centered care. Hence, the aim of this study was to explore psychosocial outcomes in young people with T1D and their parents using currently available glucose monitoring devices in a real-life clinic setting. METHODS Children and adolescents aged 2-18 years with T1D for more than 6 months and their parents were recruited into a cross-sectional study to complete the Hypoglycemia Fear Survey (HFS) and the Pediatric Quality of Life Inventory (PedsQL) Generic Score Scales, Diabetes Module and Family Impact Module. Demographics and diabetes-specific parameters were obtained from medicals records. RESULTS Fifty-nine children and adolescents (mean age 15.1 ± 3.0 years) and 49 parents of children (mean age of children 12.5± 3.3 years) of which 44 were child-parent dyads completed the questionnaires. Parents had a higher mean (SD) FOH total and worry subscore than children, total score was 37.9 (14.6) vs. 32.2 (11.9), p = 0.047 and worry subscore was 17.8 (10.4) vs. 12.8 (9.0), p = 0.01. Furthermore, lower parental diabetes-specific QoL score was observed in parents, 78.8 (12.2) vs. 82.7 (10.3), p=0.02. No difference in FOH and QoL between real-time continuous glucose monitoring (rtCGM) and intermittently scanned glucose monitoring (isCGM) users and users of devices with and without alerts was observed. In isCGM users (n=36 completing the child questionnaires, n=33 completing parent questionnaires), higher parental FOH and lower parental diabetes-specific QoL correlated with higher scanning frequency, r = 0.399, p = 0.021, and r = -0.464, p = 0.007 respectively. No significant correlation was documented between scanning frequency and child questionnaire scores. CONCLUSIONS Parents are more likely to perceive higher levels of psychosocial burden related to their child's diabetes than children and adolescents with T1D, especially parents of younger children. This highlights the need for family-based education and treatment resources to support parents in diabetes management in addition to rapidly advancing diabetes technology. In isCGM users, higher parental FOH and lower parent-perceived QoL correlated with a higher scanning frequency, indicating the potential impact of glucose monitoring modality on psychosocial outcomes or vice versa.
Collapse
Affiliation(s)
- Vivien Glocker
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University of Basel, Basel, Switzerland
- Medical School, University of Basel, Basel, Switzerland
| | - Sara Bachmann
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Melanie Hess
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Marie-Anne Burckhardt
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University of Basel, Basel, Switzerland
- *Correspondence: Marie-Anne Burckhardt,
| |
Collapse
|
13
|
Ebrahimi F, Kutz A, Christ ER, Szinnai G. Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study. Front Endocrinol (Lausanne) 2022; 13:940990. [PMID: 36093075 PMCID: PMC9449722 DOI: 10.3389/fendo.2022.940990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Diabetic ketoacidosis (DKA) is a life-threatening complication of both type 1 and type 2 diabetes. We aimed to assess population-based rates, trends and outcomes of patients with DKA. DESIGN AND METHODS This is a nationwide cohort study using hospital discharge claims data from 2010 to 2018 in Switzerland. Incidence rates and in-hospital outcomes of DKA were analyzed throughout lifetime for children (0-9 years), adolescents (10-19 years), and adults (20-29, 30-59, and 60-90 years). Analyses were stratified for type of diabetes mellitus and sex. RESULTS In total, 5,544 hospitalizations with DKA were identified, of whom 3,847 were seen in patients with type 1 diabetes and 1,697 in type 2 diabetes. Incidence rates of DKA among patients with type 1 diabetes were highest during adolescence with 17.67 (girls) and 13.87 (boys) events per 100,000 person-years (incidence rate difference [IRD]: -3.80 [95% CI, -5.59 to -2.02]) and decreased with age in both sexes thereafter. Incidence rates of DKA in patients with type 2 diabetes were low up to an age of 40 years and rose to 5.26 (females) and 6.82 (males) per 100,000 person-years in adults aged 60-90 years. Diabetic ketoacidosis was associated with relevant health-care burden independent of age, sex, or type of diabetes. The population-based incidence rate of DKA increased over time from 7.22 per 100,000 person-years in 2010 to 9.49 per 100,000 person-years in 2018. CONCLUSIONS In type 1 diabetes highest incidence rates of DKA hospitalizations were observed among adolescent females. In comparison, in patients with type 2 diabetes the risk for DKA steadily increased with age with higher rates in adult males. Over the 9 year study period, incidence rates of DKA were increasing irrespective of type of diabetes. DKA was associated with a high burden of disease reflected by high rates of intensive care unit admission, prolonged hospital stay and high mortality rates, especially in elderly.
Collapse
Affiliation(s)
- Fahim Ebrahimi
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Remigius Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
| | - Gabor Szinnai
- Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
- pt?> Pediatric Endocrinology and Diabetology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
14
|
Bachmann S, Auderset A, Burckhardt M, Szinnai G, Hess M, Zumsteg U, Denhaerynck K, Donner B. Autonomic cardiac regulation during spontaneous nocturnal hypoglycemia in children with type 1 diabetes. Pediatr Diabetes 2021; 22:1023-1030. [PMID: 34494709 PMCID: PMC9291884 DOI: 10.1111/pedi.13262] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypoglycemia is the most common complication in insulin treated diabetes. Though mostly mild, it can be fatal in rare cases: It is hypothesized that hypoglycemia related QTc prolongation contributes to cardiac arrhythmia. OBJECTIVE To evaluate influence of nocturnal hypoglycemia on QTc and heart rate variability (HRV) in children with T1D. METHODS Children and adolescents with T1D for at least 6 months participated in an observational study using continuous glucose monitoring (CGM) and Holter electrocardiogram for five consecutive nights. Mean QTc was calculated for episodes of nocturnal hypoglycemia (<3.7 mmol/L) and compared to periods of the same duration preceding hypoglycemia. HRV (RMSSD, low and high frequency power LF and HF) was analyzed for different 15 min intervals: before hypoglycemia, onset of hypoglycemia, before/after nadir, end of hypoglycemia and after hypoglycemia. RESULTS Mean QTc during hypoglycemia was significantly longer compared to euglycemia (412 ± 15 vs. 405 ± 18 ms, p = 0.005). HRV changed significantly: RMSSD (from 88 ± 57 to 73 ± 43 ms) and HF (from 54 ± 17 to 47 ± 17nu) decreased from before hypoglycemia to after nadir, while heart rate (from 69 ± 9 to 72 ± 12 bpm) and LF (from 44 ± 17 to 52 ± 21 nu) increased (p = 0.04). CONCLUSION A QTc lengthening effect of nocturnal hypoglycemia in children with T1D was documented. HRV changes occurred even before detection of nocturnal hypoglycemia by CGM, which may be useful for hypoglycemia prediction.
Collapse
Affiliation(s)
- Sara Bachmann
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital BaselBaselSwitzerland,Department of Clinical ResearchUniversity of BaselBaselSwitzerland
| | - Anne Auderset
- Pediatric CardiologyUniversity Children's Hospital BaselBaselSwitzerland
| | - Marie‐Anne Burckhardt
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital BaselBaselSwitzerland,Department of Clinical ResearchUniversity of BaselBaselSwitzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital BaselBaselSwitzerland,Department of Clinical ResearchUniversity of BaselBaselSwitzerland
| | - Melanie Hess
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital BaselBaselSwitzerland
| | - Urs Zumsteg
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital BaselBaselSwitzerland
| | - Kris Denhaerynck
- Department of Public HealthInstitute of Nursing Science, University of BaselBaselSwitzerland
| | - Birgit Donner
- Pediatric CardiologyUniversity Children's Hospital BaselBaselSwitzerland
| |
Collapse
|
15
|
Diesch-Furlanetto T, Rovó A, Galimard JE, Szinnai G, Dalissier A, Sedlacek P, Bodova I, Roussou VK, Gibson BE, Poiré X, Fagioli F, Pichler H, Faraci M, Gumy-Pause FG, Dalle JH, Balduzzi A, Bader P, Corbacioglu S. Pregnancy and pregnancy outcomes after hematopoietic stem cell transplantation in childhood: a cross-sectional survey of the EBMT Pediatric Diseases Working Party. Hum Reprod 2021; 36:2871-2882. [PMID: 34529796 DOI: 10.1093/humrep/deab199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What are the characteristics of patients with conceptions transplanted in childhood and adolescence? SUMMARY ANSWER Insemination and conception after hematopoietic stem cell transplantation (HCT) in childhood or adolescence was possible, even after myeloablative conditioning regimes, although some patients required reproductive medicine support. WHAT IS KNOWN ALREADY Preparative regimens of HCT are highly gonadotoxic, which leads to gonadal failure and pubertal development disorders. There are few population-based studies assessing the risk of future infertility in children after HCT. STUDY DESIGN, SIZE, DURATION We conducted a retrospective study to investigate natural or assisted conceptions and their outcomes in patients <18 years old before their first transplantation who received HCT between 1995 and 2016 and were in the European Society for Blood and Marrow Transplantation (EBMT) registry. Adoptions were excluded from the analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Detailed information concerning pregnancy occurrences and outcomes were obtained by a separate questionnaire. Quantitative variables were presented as medians with their interquartile range (IQR) or range, and categorical variables were presented as frequencies and percentages. MAIN RESULTS AND THE ROLE OF CHANCE In total, 62 988 pediatric patients received a first HCT in EBMT centers between 1995 and 2016. Pregnancy was reported in 406 patients in the database. The median age at transplantation was 15.7 (range: 0.7-18) years, and the median age at declared conception was 25.0 (range: 16.3-38.8) years. Details concerning the first pregnancy and pregnancy outcome were obtained from 99 patients (24%) from the returned questionnaires. The median age at delivery or pregnancy interruption of the females was 23.0 (IQR: 20.8-27) years, with a median time after transplant of 10.7 (IQR: 6.6-15.4) years. Compared with the mean age of healthy women at their first child's birth (29 years old), the transplanted women delivered 5 years earlier (mean: 24.3 years). In terms of conception modality, 13/25 (52%) females conditioned with total body irradiation (TBI) and 50/52 (96%) of those conditioned without TBI conceived naturally. All seven male patients who had been conditioned with TBI achieved fatherhood but required assisted fertilization or used their cryopreserved sperm. In the females, 63/70 (90%) of all conceptions resulted in a live birth, 49/63 (84.5%) were at term and 43/46 (93%) had normal birthweight. Cesarean delivery was performed in 9/61 (15%) especially in women who had received a myeloablative regimen. LIMITATIONS, REASONS FOR CAUTION In the EBMT pediatric dataset, the age at last follow-up or death was <17 years for 75% of the patients, therefore a longer follow-up for all patients would be necessary to calculate the cumulative incidence of conception for patients transplanted during childhood and allow all patients to realize their reproductive willingness/potential. WIDER IMPLICATIONS OF THE FINDINGS Reproductive health surveillance and fertility preservation counseling are important in younger transplanted patients. Our results showed that there is a window of opportunity to conceive naturally or with reproductive medicine support. STUDY FUNDING/COMPETING INTEREST(S) Funding was provided by the 'Stiftung für krebskranke Kinder Regio Basiliensis', Basel, Switzerland. All authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- T Diesch-Furlanetto
- Division of Pediatric Oncology/Hematology, University Children's Hospital Basel, UKBB, University of Basel, Basel, Switzerland
| | - A Rovó
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - G Szinnai
- Division of Pediatric Endocrinology/Diabetology, University Children's Hospital Basel, UKBB, University of Basel, Basel, Switzerland
| | | | - P Sedlacek
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - I Bodova
- Pediatric University Teaching Hospital, BMT Unit, II Children's Clinic, Bratislava, Slovakia
| | - V K Roussou
- St. Sophia Children's Hospital, Oncology Center, "MARIANNA V. VARDINOGIANNIS-ELPIDA", BMT Unit, Athens, Greece
| | - B E Gibson
- Department of Hematology, Royal Hospital for Children, Schiehallion Ward (Ward 2A), Glasgow, UK
| | - X Poiré
- Department of Hematology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - F Fagioli
- Onco-Ematologia Pediatrica, Centro Trapianti Cellule Staminali, Ospedale Infantile Regina Margherita, Turin, Italy
| | - H Pichler
- Department of Pediatrics, St. Anna Kinderspital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | - M Faraci
- Dipartimento di Emato-Oncologia Pediatrica, Centro Trapianti Cellule Staminali, Institute G. Gaslini, Genova, Italy
| | - F G Gumy-Pause
- Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - J H Dalle
- Department of Pediatric Hematology, Hôpital Robert Debré, GH APHP-Nord Université de Paris,Paris, France
| | - A Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
| | - P Bader
- Division of Stem-Cell Transplantation and Immunology, Hospital for Children and Adolescents of Frankfurt, Frankfurt, Germany
| | - S Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem-Cell Transplantation, University of Regensburg, Regensburg, Germany
| |
Collapse
|
16
|
Koch G, Steffens B, Leroux S, Gotta V, Schropp J, Gächter P, Bachmann F, Welzel T, Janner M, L'Allemand D, Konrad D, Szinnai G, Pfister M. Modeling of levothyroxine in newborns and infants with congenital hypothyroidism: challenges and opportunities of a rare disease multi-center study. J Pharmacokinet Pharmacodyn 2021; 48:711-723. [PMID: 34117565 PMCID: PMC8405503 DOI: 10.1007/s10928-021-09765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/12/2021] [Indexed: 11/22/2022]
Abstract
Modeling of retrospectively collected multi-center data of a rare disease in pediatrics is challenging because laboratory data can stem from several decades measured with different assays. Here we present a retrospective pharmacometrics (PMX) based data analysis of the rare disease congenital hypothyroidism (CH) in newborns and infants. Our overall aim is to develop a model that can be applied to optimize dosing in this pediatric patient population since suboptimal treatment of CH during the first 2 years of life is associated with a reduced intelligence quotient between 10 and 14 years. The first goal is to describe a retrospectively collected dataset consisting of 61 newborns and infants with CH up to 2 years of age. Overall, 505 measurements of free thyroxine (FT4) and 510 measurements of thyrotropin or thyroid-stimulating hormone were available from patients receiving substitution treatment with levothyroxine (LT4). The second goal is to introduce a scale/location-scale normalization method to merge available FT4 measurements since 34 different postnatal age- and assay-specific laboratory reference ranges were applied. This method takes into account the change of the distribution of FT4 values over time, i.e. a transformation from right-skewed towards normality during LT4 treatment. The third goal is to develop a practical and useful PMX model for LT4 treatment to characterize FT4 measurements, which is applicable within a clinical setting. In summary, a time-dependent normalization method and a practical PMX model are presented. Since there is no on-going or planned development of new pharmacological approaches for CH, PMX based modeling and simulation can be leveraged to personalize dosing with the goal to enhance longer-term neurological outcome in children with the rare disease CH.
Collapse
Affiliation(s)
- Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.
| | - Britta Steffens
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Stephanie Leroux
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Johannes Schropp
- Department of Mathematics and Statistics, University of Konstanz, Konstanz, Germany
| | - Pascal Gächter
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Freya Bachmann
- Department of Mathematics and Statistics, University of Konstanz, Konstanz, Germany
| | - Tatjana Welzel
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Marco Janner
- Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Bern University Hospital , University of Bern, Bern, Switzerland
| | - Dagmar L'Allemand
- Department of Pediatric Endocrinology and Diabetology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology and Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| |
Collapse
|
17
|
van Trotsenburg P, Stoupa A, Léger J, Rohrer T, Peters C, Fugazzola L, Cassio A, Heinrichs C, Beauloye V, Pohlenz J, Rodien P, Coutant R, Szinnai G, Murray P, Bartés B, Luton D, Salerno M, de Sanctis L, Vigone M, Krude H, Persani L, Polak M. Congenital Hypothyroidism: A 2020-2021 Consensus Guidelines Update-An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology. Thyroid 2021; 31:387-419. [PMID: 33272083 PMCID: PMC8001676 DOI: 10.1089/thy.2020.0333] [Citation(s) in RCA: 163] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: An ENDO-European Reference Network (ERN) initiative was launched that was endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology with 22 participants from the ENDO-ERN and the two societies. The aim was to update the practice guidelines for the diagnosis and management of congenital hypothyroidism (CH). A systematic literature search was conducted to identify key articles on neonatal screening, diagnosis, and management of primary and central CH. The evidence-based guidelines were graded with the Grading of Recommendations, Assessment, Development and Evaluation system, describing both the strength of recommendations and the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. Summary: The recommendations include the various neonatal screening approaches for CH as well as the etiology (also genetics), diagnostics, treatment, and prognosis of both primary and central CH. When CH is diagnosed, the expert panel recommends the immediate start of correctly dosed levothyroxine treatment and frequent follow-up including laboratory testing to keep thyroid hormone levels in their target ranges, timely assessment of the need to continue treatment, attention for neurodevelopment and neurosensory functions, and, if necessary, consulting other health professionals, and education of the child and family about CH. Harmonization of diagnostics, treatment, and follow-up will optimize patient outcomes. Lastly, all individuals with CH are entitled to a well-planned transition of care from pediatrics to adult medicine. Conclusions: This consensus guidelines update should be used to further optimize detection, diagnosis, treatment, and follow-up of children with all forms of CH in the light of the most recent evidence. It should be helpful in convincing health authorities of the benefits of neonatal screening for CH. Further epidemiological and experimental studies are needed to understand the increased incidence of this condition.
Collapse
Affiliation(s)
- Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Athanasia Stoupa
- Pediatric Endocrinology, Gynecology and Diabetology Department, Assistance Publique Hôpitaux de Paris (APHP), Hôpital Universitaire Necker Enfants Malades, Paris, France
- Université de Paris, Paris, France
- INSERM U1163, IMAGINE Institute, Paris, France
- INSERM U1016, Cochin Institute, Paris, France
| | - Juliane Léger
- Department of Pediatric Endocrinology and Diabetology, Reference Center for Growth and Development Endocrine Diseases, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1141, Paris, France
| | - Tilman Rohrer
- Department of Pediatric Endocrinology, University Children's Hospital, Saarland University Medical Center, Homburg, Germany
| | - Catherine Peters
- Department of Pediatric Endocrinology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Laura Fugazzola
- Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Cassio
- Department of Pediatric Endocrinology, Unit of Pediatrics, Department of Medical & Surgical Sciences, University of Bologna, Bologna Italy
| | - Claudine Heinrichs
- Pediatric Endocrinology Unit, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Veronique Beauloye
- Unité d'Endocrinologie Pédiatrique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Joachim Pohlenz
- Department of Pediatrics, Johannes Gutenberg University Medical School, Mainz, Germany
| | - Patrice Rodien
- Centre de Référence des Maladies Rares de la Thyroïde et des Récepteurs Hormonaux, Service EDN, CHU d'Angers, Institut MITOVASC, Université d'Angers, Angers, France
| | - Regis Coutant
- Unité d' Endocrinologie Diabetologie Pédiatrique and Centre des Maladies Rares de la Réceptivité Hormonale, CHU-Angers, Angers, France
| | - Gabor Szinnai
- Department of Pediatric Endocrinology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Philip Murray
- European Society for Pediatric Endocrinology
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Beate Bartés
- Thyroid Group, European Patient Advocacy Group Patient Representative (ePAG), Association Vivre sans Thyroide, Léguevin, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, University Hospitals Paris Nord Val de Seine (HUPNVS), Assistance Publique Hôpitaux de Paris (APHP), Bichat Hospital, Paris, France
- Department Risks and Pregnancy (DHU), Université de Paris, Inserm U1141, Paris, France
| | - Mariacarolina Salerno
- Pediatric Endocrine Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Luisa de Sanctis
- Department of Public Health and Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy
| | - Mariacristina Vigone
- Department of Pediatrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Heiko Krude
- Institut für Experimentelle Pädiatrische Endokrinologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luca Persani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology Department, Assistance Publique Hôpitaux de Paris (APHP), Hôpital Universitaire Necker Enfants Malades, Paris, France
- Université de Paris, Paris, France
- INSERM U1163, IMAGINE Institute, Paris, France
- INSERM U1016, Cochin Institute, Paris, France
- Paris Regional Newborn Screening Program, Centre régional de dépistage néonatal, Paris, France
- Centre de Référence Maladies Endocriniennes de la Croissance et du Développement, INSERM U1016, IMAGINE Institute, Paris, France
- ENDO-European Reference Network, Main Thematic Group 8, Paris, France
- Address correspondence to: Michel Polak, MD, PhD, Pediatric Endocrinology Gynecology and Diabetology Department, Hôpital Universitaire Necker Enfants Malades, 149 Rue de Sèvres, Paris 75015, France
| |
Collapse
|
18
|
Bachmann F, Koch G, Pfister M, Szinnai G, Schropp J. OptiDose: Computing the Individualized Optimal Drug Dosing Regimen Using Optimal Control. J Optim Theory Appl 2021; 189:46-65. [PMID: 34720180 PMCID: PMC8550736 DOI: 10.1007/s10957-021-01819-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/22/2021] [Indexed: 05/30/2023]
Abstract
Providing the optimal dosing strategy of a drug for an individual patient is an important task in pharmaceutical sciences and daily clinical application. We developed and validated an optimal dosing algorithm (OptiDose) that computes the optimal individualized dosing regimen for pharmacokinetic-pharmacodynamic models in substantially different scenarios with various routes of administration by solving an optimal control problem. The aim is to compute a control that brings the underlying system as closely as possible to a desired reference function by minimizing a cost functional. In pharmacokinetic-pharmacodynamic modeling, the controls are the administered doses and the reference function can be the disease progression. Drug administration at certain time points provides a finite number of discrete controls, the drug doses, determining the drug concentration and its effect on the disease progression. Consequently, rewriting the cost functional gives a finite-dimensional optimal control problem depending only on the doses. Adjoint techniques allow to compute the gradient of the cost functional efficiently. This admits to solve the optimal control problem with robust algorithms such as quasi-Newton methods from finite-dimensional optimization. OptiDose is applied to three relevant but substantially different pharmacokinetic-pharmacodynamic examples.
Collapse
Affiliation(s)
- Freya Bachmann
- Department of Mathematics and Statistics, University of Konstanz, Konstanz, Germany
| | - Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Johannes Schropp
- Department of Mathematics and Statistics, University of Konstanz, Konstanz, Germany
| |
Collapse
|
19
|
Deichmann J, Bachmann S, Burckhardt MA, Szinnai G, Kaltenbach HM. Simulation-Based Evaluation of Treatment Adjustment to Exercise in Type 1 Diabetes. Front Endocrinol (Lausanne) 2021; 12:723812. [PMID: 34489869 PMCID: PMC8417413 DOI: 10.3389/fendo.2021.723812] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/26/2021] [Indexed: 01/26/2023] Open
Abstract
Regular exercise is beneficial and recommended for people with type 1 diabetes, but increased glucose demand and changes in insulin sensitivity require treatment adjustments to prevent exercise-induced hypoglycemia. Several different adjustment strategies based on insulin bolus reductions and additional carbohydrate intake have been proposed, but large inter- and intraindividual variability and studies using different exercise duration, intensity, and timing impede a direct comparison of their effects. In this study, we use a mathematical model of the glucoregulatory system and implement published guidelines and strategies in-silico to provide a direct comparison on a single 'typical' person on a standard day with three meals. We augment this day by a broad range of exercise scenarios combining different intensity and duration of the exercise session, and different timing with respect to adjacent meals. We compare the resulting blood glucose trajectories and use summary measures to evaluate the time-in-range and risk scores for hypo- and hyperglycemic events for each simulation scenario, and to determine factors that impede prevention of hypoglycemia events. Our simulations suggest that the considered strategies and guidelines successfully minimize the risk for acute hypoglycemia. At the same time, all adjustments substantially increase the risk of late-onset hypoglycemia compared to no adjustment in many cases. We also find that timing between exercise and meals and additional carbohydrate intake during exercise can lead to non-intuitive behavior due to superposition of meal- and exercise-related glucose dynamics. Increased insulin sensitivity appears as a major driver of non-acute hypoglycemic events. Overall, our results indicate that further treatment adjustment might be required both immediately following exercise and up to several hours later, but that the intricate interplay between different dynamics makes it difficult to provide generic recommendations. However, our simulation scenarios extend substantially beyond the original scope of each model component and proper model validation is warranted before applying our in-silico results in a clinical setting.
Collapse
Affiliation(s)
- Julia Deichmann
- Department of Biosystems Science and Engineering and Swiss Institute of Bioinformatics (SIB), ETH Zurich, Basel, Switzerland
- Life Science Zurich Graduate School, Zurich, Switzerland
| | - Sara Bachmann
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marie-Anne Burckhardt
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Hans-Michael Kaltenbach
- Department of Biosystems Science and Engineering and Swiss Institute of Bioinformatics (SIB), ETH Zurich, Basel, Switzerland
- *Correspondence: Hans-Michael Kaltenbach,
| |
Collapse
|
20
|
Burckhardt MA, Gotta V, Beglinger S, Renggli L, Bachmann S, Hess M, Rentsch K, Pfister M, Koch G, Davis EA, Zumsteg U, Jones TW, Szinnai G. Copeptin Kinetics and Its Relationship to Osmolality During Rehydration for Diabetic Ketoacidosis in Children. J Clin Endocrinol Metab 2020; 105:5896600. [PMID: 32835363 DOI: 10.1210/clinem/dgaa568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Copeptin is a surrogate marker for arginine vasopressin (AVP) release in response to hyperosmolal stimuli such as diabetic ketoacidosis (DKA). OBJECTIVE The objective of this work is to characterize kinetics of copeptin and osmolality, and their dynamic relationship during rehydration and insulin therapy in children with type 1 diabetes (T1D) and DKA. DESIGN AND SETTING A prospective, observational, multicenter study was conducted. PATIENTS AND INTERVENTION Children with T1D admitted for DKA underwent serial serum copeptin and osmolality measurements from start of rehydration at 14 time points during 72 hours. MAIN OUTCOME MEASURES Measurements included temporal course of copeptin and osmolality (kinetics), relationship between both (dynamics), and association between-subject variability (BSV) (coefficient of variation, CV%). RESULTS Twenty-eight children (20 newly diagnosed T1D) aged 1 to 16 years were included. Copeptin decreased from 95 pmol/L (95% CI, 55-136 pmol/L) (CV%, 158%) to 9.7 pmol/L (95% CI, 8.1-11.4 pmol/L) (CV%, 31%) with a 50% recovery time (t1/2) of 7.1 hours (range, 5.1-11.5 hours) (114%). Serum osmolality decreased from 321 mOsm/kg (range, 315-327 mOsm/kg) (4%) to 294 mOsm/kg (range, 292-296 mOsm/kg) (1%) with a t1/2 of 4.3 hours (range, 3.0-5.6 hours) (64%). Copeptin levels doubled with each osmolality increase by 15 mOsm/kg (range, 10-21 mOsm/kg) (59%), from 9.8 pmol/L (range, 7.3-12.3 pmol/L) (48%) to 280 mOsm/kg. Copeptin kinetics differed between newly diagnosed and known T1D patients (P = .001), and less between mild vs moderate-severe DKA (P = .04). CONCLUSIONS First, this study characterized for the first time copeptin kinetics and dynamics in the high hyperosmolar range in children with DKA. Second, it revealed significant differences in copeptin kinetics between newly diagnosed and known T1D patients that may be explained by changes at the osmoreceptor and renal AVP receptor level due to longstanding osmotic diuresis and DKA.
Collapse
Affiliation(s)
- Marie-Anne Burckhardt
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Australia and Perth Children's Hospital, Perth, WA, Australia
| | - Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Svetlana Beglinger
- Pediatric Emergency Department, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Luzia Renggli
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Sara Bachmann
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Melanie Hess
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Elizabeth A Davis
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Australia and Perth Children's Hospital, Perth, WA, Australia
| | - Urs Zumsteg
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Timothy W Jones
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Australia and Perth Children's Hospital, Perth, WA, Australia
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
21
|
Carré A, Gawade S, Dertschnig S, Hafen K, Polak M, Szinnai G. Ex vivo model for elucidating the functional and structural differentiation of the embryonic mouse thyroid. Mol Cell Endocrinol 2020; 510:110834. [PMID: 32360566 DOI: 10.1016/j.mce.2020.110834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
Abstract
Terminal thyroid gland differentiation - the last developmental step needed to enable thyroid hormone (T4) synthesis - involves profound structural and biochemical changes in the thyroid follicular cells (TFCs). We aimed to develop an ex vivo thyroid model of embryonic mouse thyroid that would replicate the in vivo TFC differentiation program. E13.5 thyroid explants were cultured ex vivo in chemically defined medium for 7 days. Immunostaining and qPCR of thyroid explants showed thyroglobulin production onset, follicle formation, and T4 synthesis onset in 1-, 3-, and 5-day-old cultures, respectively. Differentiation was maintained and follicular growth continued throughout the 7-day culture period. Pharmacological approaches to culture inhibition were performed successfully in the ex vivo thyroids. Our robust and well described ex vivo thyroid culture model replicates the sequence of thyroid differentiation to T4 synthesis seen in vivo. This model can be used to test the effects of pharmacological inhibitors on thyroid hormone production.
Collapse
Affiliation(s)
- Aurore Carré
- INSERM U1016, Cochin Institute, Faculté de Médecine, Université de Paris, 75014, Paris, France; IMAGINE Institute Affiliate, 75015, Paris, France
| | - Sanjay Gawade
- Pediatric Immunology,Department of Biomedicine, University of Basel, 4058, Basel; Switzerland
| | - Simone Dertschnig
- Pediatric Immunology,Department of Biomedicine, University of Basel, 4058, Basel; Switzerland
| | - Kathrin Hafen
- Pediatric Immunology,Department of Biomedicine, University of Basel, 4058, Basel; Switzerland
| | - Michel Polak
- INSERM U1016, Cochin Institute, Faculté de Médecine, Université de Paris, 75014, Paris, France; IMAGINE Institute Affiliate, 75015, Paris, France; Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, 75015, Paris, France; Centre de référence des maladies endocriniennes rares de la croissance et du développement, Necker-Enfants Malades University Hospital, Paris, France; Centre régional de dépistage néonatal (CRDN) Ile de France, 75015, Paris, France
| | - Gabor Szinnai
- Pediatric Immunology,Department of Biomedicine, University of Basel, 4058, Basel; Switzerland; Pediatric Endocrinology and Diabetology, University Children's Hospital Basel, University of Basel, 4056, Basel, Switzerland.
| |
Collapse
|
22
|
Leroux S, Marc P, Welzel T, Gächter P, Konrad D, L’Allemand D, Szinnai G, Koch G. MON-081 Mathematical Modeling of Residual Endogenous FT4 Synthesis and Exogenous L-Thyroxine Administration over the First 2 Years of Life in Infants with Congenital Hypothyroidism. J Endocr Soc 2020. [PMCID: PMC7208082 DOI: 10.1210/jendso/bvaa046.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
L-Thyroxine (L-T4) is the treatment of choice of congenital hypothyroidism (CH). Longitudinal measurements of free T4 (FT4) serum concentrations were collected over the first two years of life with oral L-T4 treatment in infants with CH. Purpose of this study was to develop an integrated mathematical model to characterize the kinetics of exogenous L-Thyroxine (L-T4) after multiple dosing in infants with CH, and the dynamics of residual endogenous FT4 synthesis under treatment in the context of severe, moderate and mild disease. A total of 200 FT4 concentrations from 30 patients were available for analysis. At start of treatment, mean (standard deviation [SD]) postnatal age and weight of the population were 11 (8) days and 3.9 (1.3) kg. Mean (SD) pretreatment FT4 concentration was 11.3 (7.4) pmol/L. Measured FT4 concentrations were modelled as sum of residual endogenous FT4 and exogenously administered FT4 (L-T4). The integrated mathematical model consists of an absorption compartment for the exogenous FT4 administration, and a central compartment for measured FT4 with linear elimination. Hence, for residual endogenous and exogenous FT4 the same elimination rate constant was assumed. For the residual endogenous synthesis, different approaches were tested: a constant production and typical time-dependent production functions. FT4 data were analyzed using nonlinear mixed-effects modeling. The integrated mathematical model with a time-dependent non-linear Emax function describing a decreasing residual endogenous FT4 synthesis for increasing time provided the best data fit in terms of Akaike value and various goodness-of-fit plots. This is in line with the expected progressive suppression of the thyroid stimulating hormone by the exogenous FT4, and the subsequent decrease of residual FT4 endogenous synthesis. The developed mathematical model allows simulation of FT4 pharmacokinetic profiles for different disease severities and different dosing regimens.
Collapse
Affiliation(s)
| | - Pfister Marc
- University Children’s Hospital Basel, Basel, Switzerland
| | - Tatjana Welzel
- University Children’s Hospital Basel, Basel, Switzerland
| | - Pascal Gächter
- University Children’s Hospital Basel, Basel, Switzerland
| | - Daniel Konrad
- University Children’s Hospital of Zuerich, Zuerich, Switzerland
| | | | - Gabor Szinnai
- University Children’s Hospital Basel, Basel, Switzerland
| | - Gilbert Koch
- University Children’s Hospital Basel, Basel, Switzerland
| |
Collapse
|
23
|
Leroux S, Pascal G, Gilbert K, Konrad D, l’Allemand D, Welzel T, Pfister M, Szinnai G. MON-102 Serum Concentrations of FT4 and TSH in the First Six Months of L-Thyroxine Treatment in Infants with Congenital Hypothyroidism: Target Attainment Rates Should Be Improved. J Endocr Soc 2020. [PMCID: PMC7207872 DOI: 10.1210/jendso/bvaa046.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Levo-Thyroxine (L-T4) is the medication of choice for treating congenital hypothyroidism (CH). Adequate L-T4 treatment is essential for early neurodevelopment in affected patients. Both under- and overtreatment with L-T4 were associated with long-term adverse neurological outcomes. Based on clinical experience, initial L-T4 dosing does not always result in optimal TSH and FT4 concentrations in all CH patients. The purposes of this study were 1) to quantify FT4 and TSH target attainment rates (TAR) in the first six months of L-T4 treatment in infants with CH, 2) to compare characteristics of patients with FT4 concentrations “OUT of” versus “IN” the target range at first time of monitoring. A multicenter retrospective analysis was conducted in infants born between 1995 and 2018. TSH and FT4 TARs were defined according to the most recent guidelines of the European Society for Paediatric Endocrinology (ESPE), as the percentage of concentrations “in” and “in the upper half” of the corresponding laboratory age-specific reference range for TSH and FT4, respectively. We analyzed a total of 208 TSH and 186 FT4 serum concentrations from 60 patients during the first 6 months of L-T4 treatment. The pretreatment FT4 and TSH serum concentrations (mean±SD) were 8.3±5.7 pmol/L and 338±248 mU/L, respectively. CH severity according to ESPE guidelines was severe, moderate and mild for 32%, 27% and 32% of the patients. Postnatal age (PNA) (mean±SD) at start of treatment was 10±12 days. Starting dose of L-T4 (mean±SD) for severe, moderate and mild CH were 10±4, 10±3, and 7±4 µg/kg/day, respectively. Over the study period, TSH TARs of 63% did not further improve between the first monitoring (mean at 17 days of treatment) and fourth monitoring (mean at 4 months of treatment), while FT4 TARs increased from 22% to 45% paralleled with a decrease of too high FT4 values from 55% to 21%. Comparing patients with FT4 concentrations “OUT of” versus “IN” the target range at first time monitoring (16 versus 18 days after starting treatment; p=0.45), they did not differ in pretreatment FT4 concentrations (p=0.2). In contrast, patients who had FT4 concentrations “OUT of” versus “IN” the target range received first dose of L-T4 at an earlier median PNA (7 versus 16 days; p=0.008), had higher pretreatment mean TSH concentrations (364 versus 181 mU/L; p=0.02) and received a higher mean initial L-T4 dose (10.3 versus 7.1 µg/kg/day; p=0.01). First, our results show that FT4 and TSH target ranges were not reached in all patients in the first six months of treatment. Second, our data suggest that TARs could be improved by individualizing initial L-T4 dosing not only according to pretreatment FT4 but also to pretreatment TSH concentrations. L-T4 dosing optimization is needed in this population.
Collapse
Affiliation(s)
- Stéphanie Leroux
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland
| | - Gächter Pascal
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland
| | - Koch Gilbert
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland
| | - Daniel Konrad
- Pediatric Endocrinology and Diabetology, Children’s Hospital of Zuerich, Zuerich, Switzerland
| | - Dagmar l’Allemand
- Pediatric Endocrinology and Diabetology, Children’s Hospital of Eastern Switzerland, St.Gallen, Switzerland
| | - Tatjana Welzel
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, Basel, Switzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University Children’s Hospital Basel, Basel, Switzerland
| |
Collapse
|
24
|
Stoupa A, Al Hage Chehade G, Chaabane R, Kariyawasam D, Szinnai G, Hanein S, Bole-Feysot C, Fourrage C, Nitschke P, Thalassinos C, Pinto G, Mnif M, Baron S, De Kerdanet M, Reynaud R, Barat P, Hachicha M, Belguith N, Polak M, Carré A. High Diagnostic Yield of Targeted Next-Generation Sequencing in a Cohort of Patients With Congenital Hypothyroidism Due to Dyshormonogenesis. Front Endocrinol (Lausanne) 2020; 11:545339. [PMID: 33692749 PMCID: PMC7937947 DOI: 10.3389/fendo.2020.545339] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To elucidate the molecular cause in a well-characterized cohort of patients with Congenital Hypothyroidism (CH) and Dyshormonogenesis (DH) by using targeted next-generation sequencing (TNGS). STUDY DESIGN We studied 19 well-characterized patients diagnosed with CH and DH by targeted NGS including genes involved in thyroid hormone production. The pathogenicity of novel mutations was assessed based on in silico prediction tool results, functional studies when possible, variant location in important protein domains, and a review of the recent literature. RESULTS TNGS with variant prioritization and detailed assessment identified likely disease-causing mutations in 10 patients (53%). Monogenic defects most often involved TG, followed by DUOXA2, DUOX2, and NIS and were usually homozygous or compound heterozygous. Our review shows the importance of the detailed phenotypic description of patients and accurate analysis of variants to provide a molecular diagnosis. CONCLUSIONS In a clinically well-characterized cohort, TNGS had a diagnostic yield of 53%, in accordance with previous studies using a similar strategy. TG mutations were the most common genetic defect. TNGS identified gene mutations causing DH, thereby providing a rapid and cost-effective genetic diagnosis in patients with CH due to DH.
Collapse
Affiliation(s)
- Athanasia Stoupa
- INSERM U1016, Cochin Institute, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- IMAGINE Institute affiliate, Paris, France
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Ghada Al Hage Chehade
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Rim Chaabane
- Laboratory of Human Molecular Genetics, Medicine School, University of Sfax, Sfax, Tunisia
| | - Dulanjalee Kariyawasam
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Gabor Szinnai
- Pediatric Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Pediatric Endocrinology, University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Sylvain Hanein
- INSERM U1163, IMAGINE Institute, Translational Genetics, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christine Bole-Feysot
- Genomics Platform, INSERM UMR 1163, Paris Descartes Sorbonne Paris Cite University, Imagine Institute, Paris, France
| | - Cécile Fourrage
- Bioinformatics Platform, Paris Descartes University, IMAGINE Institute, Paris, France
| | - Patrick Nitschke
- Bioinformatics Platform, Paris Descartes University, IMAGINE Institute, Paris, France
| | - Caroline Thalassinos
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Graziella Pinto
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Mouna Mnif
- Endocrinology Department, CHU Hedi Chaker, Sfax, Tunisia
| | - Sabine Baron
- Pediatrics Department, CHU Nantes, Nantes, France
| | | | | | - Pascal Barat
- CHU de Bordeaux, Pediatric Endocrinology, Bordeaux, France
| | | | - Neila Belguith
- Laboratory of Human Molecular Genetics, Medicine School, University of Sfax, Sfax, Tunisia
- Medical Genetics Department, CHU Hedi Chaker, Sfax, Tunisia
| | - Michel Polak
- INSERM U1016, Cochin Institute, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- IMAGINE Institute affiliate, Paris, France
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
- Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Necker-Enfants Malades University Hospital, Paris, France
- Centre Régional de Dépistage Néonatal (CRDN) Ile de France, Paris, France
- *Correspondence: Michel Polak, ; Aurore Carré,
| | - Aurore Carré
- INSERM U1016, Cochin Institute, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- IMAGINE Institute affiliate, Paris, France
- *Correspondence: Michel Polak, ; Aurore Carré,
| |
Collapse
|
25
|
Sasivari Z, Szinnai G, Seebauer B, Konrad D, Lang-Muritano M. Double variants in TSHR and DUOX2 in a patient with hypothyroidism: case report. J Pediatr Endocrinol Metab 2019; 32:1299-1303. [PMID: 31541602 DOI: 10.1515/jpem-2019-0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/27/2019] [Accepted: 08/12/2019] [Indexed: 12/18/2022]
Abstract
Thyroid dyshormonogenesis (TDH) is characterized by the defective synthesis of thyroid hormones. We present a patient with congenital hypothyroidism (CH) who presented in newborn screening with elevated serum thyroid-stimulating hormone (TSH), decreased free thyroxine (fT4) and increased thyroglobulin (Tg) concentrations. Ultrasound scan revealed a properly structured thyroid gland. Treatment with L-thyroxine was initiated. At the age of 2 years, thyroxine replacement was stopped. The patient remained untreated until 6 years of age when TSH levels progressively increased and L-thyroxine treatment was restarted at a dose of 12.5 μg/day. Genetic analysis revealed a double heterozygosity for likely pathogenic variants of dual oxidase 2 (DUOX2) and thyroid stimulating hormone receptor (TSHR). Both genes were earlier shown to be associated with CH. In a literature review, our patient was compared to previously published patients with similar clinical characteristics, and a good genotype-phenotype correlation was identified.
Collapse
Affiliation(s)
- Zerin Sasivari
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Gabor Szinnai
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital, Basel, Switzerland
| | - Britta Seebauer
- Department of Medical Genetics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Konrad
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Mariarosaria Lang-Muritano
- Department of Paediatric Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| |
Collapse
|
26
|
Winzeler B, Cesana-Nigro N, Refardt J, Vogt DR, Imber C, Morin B, Popovic M, Steinmetz M, Sailer CO, Szinnai G, Chifu I, Fassnacht M, Christ-Crain M. Arginine-stimulated copeptin measurements in the differential diagnosis of diabetes insipidus: a prospective diagnostic study. Lancet 2019; 394:587-595. [PMID: 31303316 DOI: 10.1016/s0140-6736(19)31255-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Differential diagnosis of diabetes insipidus is challenging. The most reliable approach is hypertonic saline-stimulated copeptin measurements. However, this test is based on the induction of hypernatraemia and requires close monitoring of plasma sodium concentrations. Arginine-stimulated copeptin measurements might provide an alternative, simple, and safe test. METHODS In this prospective diagnostic study, we recruited a development cohort from University Hospital Basel, Basel, Switzerland, and a validation cohort from five centres in Basel, Aarau, Luzern, Bern, and St Gallen, Switzerland, and the University Hospital Würzburg, Würzburg, Germany. For both cohorts, patients were eligible for inclusion if they were aged 18 years or older, were newly referred with polyuria (>50 mL/kg bodyweight per day) or had a known diagnosis of central diabetes insipidus or primary polydipsia. We also recruited a comparator cohort of healthy controls in parallel to each cohort, comprising adults (aged 18 years and older, with normal drinking habits, and no history of polyuria) and children who underwent arginine stimulation to diagnose growth hormone deficiency (children were only included in the comparator cohort to the development cohort as proof of concept). Patients and healthy controls underwent arginine stimulation with measurement of plasma copeptin at baseline and 30, 45, 60, 90, and 120 min. The primary objective in the development cohort was to determine the diagnostic accuracy of plasma copeptin concentrations to discriminate between diabetes insipidus and primary polydipsia, and in the validation cohort was to confirm those results. Adverse effects of the test were monitored in all participants, with tolerability of the test rated using a visual analogue scale (VAS) that ranged from no (0) to maximum (10) discomfort. This trial is registered with ClinicalTrials.gov, number NCT00757276. FINDINGS Between May 24, 2013, and Jan 11, 2017, 52 patients were enrolled in the development cohort (12 [23%] with complete diabetes insipidus, nine [17%] with partial diabetes insipidus, and 31 [60%] with primary polydipsia) alongside 20 healthy adults and 42 child controls. Between Oct 24, 2017, and June 27, 2018, 46 patients were enrolled in the validation cohort (12 [26%] with complete diabetes insipidus, seven [15%] with partial diabetes insipidus, and 27 [59%] with primary polydipsia) alongside 30 healthy adult controls (two patients in this cohort were excluded from the main analysis because of early vomiting during the test). In the pooled patient and control datasets, median arginine-stimulated copeptin concentrations increased in healthy adult controls (from 5·2 pM [IQR 3·3-10·9] to a maximum of 9·8 pM [6·4-19·6]) and in participants with primary polydipsia (from 3·6 pM [IQR 2·4-5·7] to a maximum of 7·9 pM [5·1-11·8]), but only minimally in those with diabetes insipidus (2·1 pM [IQR 1·9-2·7] to a maximum of 2·5 pM [1·9-3·1]). In the development cohort, a cutoff of 3·5 pM at 60 min provided the highest diagnostic accuracy of 94% (95% CI 84-98). The accuracy of this cutoff in the validation cohort was 86% (95% CI 73-94). By pooling the data from both cohorts, an optimal accuracy of 93% (95% CI 86-97) was reached at a cutoff of 3·8 pM copeptin at 60 min (sensitivity 93%, 95% CI 86-98; specificity 92%, 95% CI 84-100). The test was safe and well tolerated, with median VAS scores of 3·5 (IQR 2-4) in patients with diabetes insipidus, 3 (2-4) in those with primary polydipsia, 1 (1-3) in healthy adults, and 1 (0-5) in healthy children in the pooled participant dataset. INTERPRETATION Arginine-stimulated copeptin measurements are an innovative test for diabetes insipidus with high diagnostic accuracy, and could be a simplified, novel, and safe diagnostic approach to diabetes insipidus in clinical practice. FUNDING Swiss National Science Foundation and University Hospital Basel.
Collapse
Affiliation(s)
- Bettina Winzeler
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland.
| | - Nicole Cesana-Nigro
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Julie Refardt
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Deborah R Vogt
- Clinical Trials Unit, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Cornelia Imber
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Benedict Morin
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Milica Popovic
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Michelle Steinmetz
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Clara O Sailer
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Gabor Szinnai
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland; Department of Paediatric Endocrinology and Diabetology, University Children's Hospital Basel, Basel, Switzerland
| | - Irina Chifu
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Germany; Central Laboratory, University Hospital Würzburg, Germany
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| |
Collapse
|
27
|
Stoupa A, Adam F, Kariyawasam D, Strassel C, Gawade S, Szinnai G, Kauskot A, Lasne D, Janke C, Natarajan K, Schmitt A, Bole-Feysot C, Nitschke P, Léger J, Jabot-Hanin F, Tores F, Michel A, Munnich A, Besmond C, Scharfmann R, Lanza F, Borgel D, Polak M, Carré A. TUBB1 mutations cause thyroid dysgenesis associated with abnormal platelet physiology. EMBO Mol Med 2019; 10:emmm.201809569. [PMID: 30446499 PMCID: PMC6284387 DOI: 10.15252/emmm.201809569] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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] [Indexed: 12/11/2022] Open
Abstract
The genetic causes of congenital hypothyroidism due to thyroid dysgenesis (TD) remain largely unknown. We identified three novel TUBB1 gene mutations that co‐segregated with TD in three distinct families leading to 1.1% of TUBB1 mutations in TD study cohort. TUBB1 (Tubulin, Beta 1 Class VI) encodes for a member of the β‐tubulin protein family. TUBB1 gene is expressed in the developing and adult thyroid in humans and mice. All three TUBB1 mutations lead to non‐functional α/β‐tubulin dimers that cannot be incorporated into microtubules. In mice, Tubb1 knock‐out disrupted microtubule integrity by preventing β1‐tubulin incorporation and impaired thyroid migration and thyroid hormone secretion. In addition, TUBB1 mutations caused the formation of macroplatelets and hyperaggregation of human platelets after stimulation by low doses of agonists. Our data highlight unexpected roles for β1‐tubulin in thyroid development and in platelet physiology. Finally, these findings expand the spectrum of the rare paediatric diseases related to mutations in tubulin‐coding genes and provide new insights into the genetic background and mechanisms involved in congenital hypothyroidism and thyroid dysgenesis.
Collapse
Affiliation(s)
- Athanasia Stoupa
- INSERM U1016, Faculté de Médecine, Cochin Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,IMAGINE Institute Affiliate, Paris, France.,RARE Disorder Center: Centre des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France.,Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Frédéric Adam
- INSERM UMR_S1176, Paris-Sud University, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Dulanjalee Kariyawasam
- RARE Disorder Center: Centre des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France.,Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Catherine Strassel
- INSERM, EFS Grand Est, BPPS UMR-S 1255, FMTS, Université de Strasbourg, Strasbourg, France
| | - Sanjay Gawade
- Department of Biomedicine, Pediatric Immunology, University of Basel, Basel, Switzerland
| | - Gabor Szinnai
- Department of Biomedicine, Pediatric Immunology, University of Basel, Basel, Switzerland.,Pediatric Endocrinology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandre Kauskot
- INSERM UMR_S1176, Paris-Sud University, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Dominique Lasne
- INSERM UMR_S1176, Paris-Sud University, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Necker Children's Hospital, Biological Hematology Service, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carsten Janke
- Institut Curie, CNRS UMR3348, PSL Research University, Orsay, France.,Institut Curie, CNRS UMR3348, Université Paris Sud, Université Paris-Saclay, Orsay, France
| | - Kathiresan Natarajan
- Institut Curie, CNRS UMR3348, PSL Research University, Orsay, France.,Institut Curie, CNRS UMR3348, Université Paris Sud, Université Paris-Saclay, Orsay, France
| | - Alain Schmitt
- INSERM U1016, Faculté de Médecine, Cochin Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christine Bole-Feysot
- Genomic Platform, INSERM UMR 1163, IMAGINE Institute, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Patrick Nitschke
- Bioinformatics Platform, IMAGINE Institute, Paris Descartes University, Paris, France
| | - Juliane Léger
- RARE Disorder Center: Centre des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France.,Pediatric Endocrinology Unit, Hôpital Universitaire Robert Debré, AP-HP, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France.,INSERM UMR 1141, DHU Protect, Paris, France
| | - Fabienne Jabot-Hanin
- Bioinformatics Platform, IMAGINE Institute, Paris Descartes University, Paris, France
| | - Frédéric Tores
- Bioinformatics Platform, IMAGINE Institute, Paris Descartes University, Paris, France
| | - Anita Michel
- INSERM, EFS Grand Est, BPPS UMR-S 1255, FMTS, Université de Strasbourg, Strasbourg, France
| | - Arnold Munnich
- INSERM U1163, IMAGINE Institute, Translational Genetics, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Genetics, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Claude Besmond
- INSERM U1163, IMAGINE Institute, Translational Genetics, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Raphaël Scharfmann
- INSERM U1016, Faculté de Médecine, Cochin Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - François Lanza
- INSERM, EFS Grand Est, BPPS UMR-S 1255, FMTS, Université de Strasbourg, Strasbourg, France
| | - Delphine Borgel
- INSERM UMR_S1176, Paris-Sud University, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,Necker Children's Hospital, Biological Hematology Service, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michel Polak
- INSERM U1016, Faculté de Médecine, Cochin Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,IMAGINE Institute Affiliate, Paris, France.,RARE Disorder Center: Centre des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France.,Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France.,Fédération Parisienne pour le Dépistage et la Prévention des Handicaps de l'Enfant (FPDPHE), Paris, France
| | - Aurore Carré
- INSERM U1016, Faculté de Médecine, Cochin Institute, Université Paris Descartes, Sorbonne Paris Cité, Paris, France .,IMAGINE Institute Affiliate, Paris, France.,RARE Disorder Center: Centre des Maladies Endocriniennes Rares de la Croissance et du Développement, Paris, France
| |
Collapse
|
28
|
Malone SA, Papadakis GE, Messina A, Mimouni NEH, Trova S, Imbernon M, Allet C, Cimino I, Acierno J, Cassatella D, Xu C, Quinton R, Szinnai G, Pigny P, Alonso-Cotchico L, Masgrau L, Maréchal JD, Prevot V, Pitteloud N, Giacobini P. Defective AMH signaling disrupts GnRH neuron development and function and contributes to hypogonadotropic hypogonadism. eLife 2019; 8:47198. [PMID: 31291191 PMCID: PMC6620045 DOI: 10.7554/elife.47198] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/28/2019] [Indexed: 12/27/2022] Open
Abstract
Congenital hypogonadotropic hypogonadism (CHH) is a condition characterized by absent puberty and infertility due to gonadotropin releasing hormone (GnRH) deficiency, which is often associated with anosmia (Kallmann syndrome, KS). We identified loss-of-function heterozygous mutations in anti-Müllerian hormone (AMH) and its receptor, AMHR2, in 3% of CHH probands using whole-exome sequencing. We showed that during embryonic development, AMH is expressed in migratory GnRH neurons in both mouse and human fetuses and unconvered a novel function of AMH as a pro-motility factor for GnRH neurons. Pathohistological analysis of Amhr2-deficient mice showed abnormal development of the peripheral olfactory system and defective embryonic migration of the neuroendocrine GnRH cells to the basal forebrain, which results in reduced fertility in adults. Our findings highlight a novel role for AMH in the development and function of GnRH neurons and indicate that AMH signaling insufficiency contributes to the pathogenesis of CHH in humans.
Collapse
Affiliation(s)
- Samuel Andrew Malone
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Georgios E Papadakis
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Andrea Messina
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Nour El Houda Mimouni
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Sara Trova
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Monica Imbernon
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Cecile Allet
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Irene Cimino
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France
| | - James Acierno
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Daniele Cassatella
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Cheng Xu
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Richard Quinton
- Institute of Genetic Medicine, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, United Kingdom
| | - Gabor Szinnai
- Pediatric Endocrinology and Diabetology, University of Basel Children's Hospital, Basel, Switzerland
| | - Pascal Pigny
- CHU Lille, Laboratoire de Biochimie et Hormonologie, Centre de Biologie Pathologie, Lille, France
| | - Lur Alonso-Cotchico
- Departament de Química, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Laura Masgrau
- Departament de Química, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | | | - Vincent Prevot
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| | - Nelly Pitteloud
- Faculty of Biology and Medicine, Service of Endocrinology, Diabetology and Metabolism, University Hospital, Lausanne, Switzerland
| | - Paolo Giacobini
- Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172, Lille, France.,University of Lille, FHU 1, 000 Days for Health, Lille, France
| |
Collapse
|
29
|
Dufort G, Larrivée-Vanier S, Eugène D, De Deken X, Seebauer B, Heinimann K, Lévesque S, Gravel S, Szinnai G, Van Vliet G, Deladoëy J. Wide Spectrum of DUOX2 Deficiency: From Life-Threatening Compressive Goiter in Infancy to Lifelong Euthyroidism. Thyroid 2019; 29:1018-1022. [PMID: 31030636 DOI: 10.1089/thy.2018.0461] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Six patients are described with bi-allelic DUOX2 variants and widely variable phenotypes. Patient 1 is an infant with a compressive hypothyroid goiter causing respiratory distress, which was promptly alleviated by levothyroxine (LT4). He was a compound heterozygote for DUOX2 variants, including a novel deletion of 540 base pairs. Patients 2 and 3 are siblings with the same compound heterozygous mutations of DUOX2, yet one had overt hypothyroidism at 14 months and the other lifelong euthyroidism. Patient 4 is a compound heterozygote individual and has mild persistent congenital hypothyroidism; his sister (patient 5) only had a borderline thyrotropin elevation at newborn screening, consistent with homozygous DUOX2 variants with a mild impact on enzyme activity. Their euthyroid mother (patient 6) is a compound heterozygote for the same DUOX2 mutations as her son. Targeted exome sequencing did not reveal any relevant modifiers. It is concluded that (i) prompt LT4 replacement in infants with respiratory distress due to a hypothyroid goiter makes surgery unnecessary; and (ii) the clinical expression of DUOX2 deficiency varies widely between individuals and over time, justifying periodic reevaluation of the need for LT4 replacement.
Collapse
Affiliation(s)
- Gabrielle Dufort
- 1Endocrinology Service and Research Center of the Sainte-Justine Hospital and Department of Pediatrics, Université de Montreal, Montreal, Quebec, Canada
| | - Stéphanie Larrivée-Vanier
- 1Endocrinology Service and Research Center of the Sainte-Justine Hospital and Department of Pediatrics, Université de Montreal, Montreal, Quebec, Canada
| | - Dardye Eugène
- 2Centre Hospitalier de l'Université Laval, Department of Pediatrics, Université Laval, Quebec, Canada
| | - Xavier De Deken
- 3Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Britta Seebauer
- 4Institute for Medical Genetics and Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Karl Heinimann
- 4Institute for Medical Genetics and Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sébastien Lévesque
- 5Molecular Genetics Laboratory, Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Serge Gravel
- 5Molecular Genetics Laboratory, Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Gabor Szinnai
- 6Department of Pediatric Endocrinology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Guy Van Vliet
- 1Endocrinology Service and Research Center of the Sainte-Justine Hospital and Department of Pediatrics, Université de Montreal, Montreal, Quebec, Canada
| | - Johnny Deladoëy
- 1Endocrinology Service and Research Center of the Sainte-Justine Hospital and Department of Pediatrics, Université de Montreal, Montreal, Quebec, Canada
| |
Collapse
|
30
|
Jackson CB, Huemer M, Bolognini R, Martin F, Szinnai G, Donner BC, Richter U, Battersby BJ, Nuoffer JM, Suomalainen A, Schaller A. A variant in MRPS14 (uS14m) causes perinatal hypertrophic cardiomyopathy with neonatal lactic acidosis, growth retardation, dysmorphic features and neurological involvement. Hum Mol Genet 2019; 28:639-649. [PMID: 30358850 DOI: 10.1093/hmg/ddy374] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
Dysfunction of mitochondrial translation is an increasingly important molecular cause of human disease, but structural defects of mitochondrial ribosomal subunits are rare. We used next-generation sequencing to identify a homozygous variant in the mitochondrial small ribosomal protein 14 (MRPS14, uS14m) in a patient manifesting with perinatal hypertrophic cardiomyopathy, growth retardation, muscle hypotonia, elevated lactate, dysmorphy and mental retardation. In skeletal muscle and fibroblasts from the patient, there was biochemical deficiency in complex IV of the respiratory chain. In fibroblasts, mitochondrial translation was impaired, and ectopic expression of a wild-type MRPS14 cDNA functionally complemented this defect. Surprisingly, the mutant uS14m was stable and did not affect assembly of the small ribosomal subunit. Instead, structural modeling of the uS14m mutation predicted a disruption to the ribosomal mRNA channel.Collectively, our data demonstrate pathogenic mutations in MRPS14 can manifest as a perinatal-onset mitochondrial hypertrophic cardiomyopathy with a novel molecular pathogenic mechanism that impairs the function of mitochondrial ribosomes during translation elongation or mitochondrial mRNA recruitment rather than assembly.
Collapse
Affiliation(s)
- Christopher B Jackson
- Research Programs Unit, Molecular Neurology, Biomedicum Helsinki, University of Helsinki, Helsinki FIN, Finland
| | - Martina Huemer
- Division of Metabolism and Children's Research Center, University Children's Hospital Zürich, Zürich CH, Switzerland.,University Children's Hospital Basel, University of Basel, Switzerland
| | - Ramona Bolognini
- Division of Human Genetics, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern CH, Switzerland
| | - Franck Martin
- CNRS, Architecture et Réactivité de l'ARN, Université de Strasbourg, UPR 9002, Strasbourg F, France
| | - Gabor Szinnai
- University Children's Hospital Basel, University of Basel, Switzerland.,Division of Pediatric Endocrinology, University Children's Hospital Basel, Basel CH, Switzerland
| | - Birgit C Donner
- Division of Cardiology, University of Basel, Basel CH, Switzerland
| | - Uwe Richter
- Institute of Biotechnology, University of Helsinki, Helsinki, FIN, Finland
| | | | - Jean-Marc Nuoffer
- Institute of Clinical Chemistry, University of Bern, Inselspital, Bern CH, Switzerland.,Division of Endocrinology Diabetology and Metabolism, University Children's Hospital, University of Bern, Bern CH, Switzerland
| | - Anu Suomalainen
- Research Programs Unit, Molecular Neurology, Biomedicum Helsinki, University of Helsinki, Helsinki FIN, Finland.,Neuroscience Center, University of Helsinki, Helsinki FIN, Finland
| | - André Schaller
- Division of Human Genetics, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern CH, Switzerland
| |
Collapse
|
31
|
Abstract
Perioperative derangements of fluid and electrolyte homeostasis are rare complications in healthy children. Nonetheless, early diagnosis and treatment are mandatory to avoid a potentially life-threatening situation. However, the variety of underlying pathologies may prove to make accurate diagnosis challenging. This case report presents the management of an unexpected occurrence of a perioperative partial diabetes insipidus with massive fluid loss. Diagnostic and therapeutic procedures are discussed in the context of laboratory findings, and an overview of the existing literature is given. Finally, we emphasize that a multidisciplinary approach is most appropriate for diagnosis, accurate treatment, and follow-up of the patient.
Collapse
Affiliation(s)
| | | | - Gabor Szinnai
- Pediatric Endocrinology, University Children's Hospital Basel, Basel, Switzerland
| | | | - Jens Moll
- From the Departments of Anesthesiology
| |
Collapse
|
32
|
Tacke U, Guzman R, Prüfer F, Papachristofilou A, Szinnai G, Wondrusch C, Gutzwiller J, Heinzelmann M, Möschlin K, Diesch T, Scheinemann K. QOL-27. THE PEDIATRIC BRAIN AND SPINE TUMOR CENTER AT THE UNIVERSITY CHILDREN’S HOSPITAL IN BASEL, SWITZERLAND. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Uta Tacke
- University Children’s Hospital Basel, Basel, Switzerl
| | - Raphael Guzman
- University Children’s Hospital Basel, Basel, Switzerl
- University Hospital Basel, Basel, Switzerl
| | | | | | - Gabor Szinnai
- University Children’s Hospital Basel, Basel, Switzerl
| | | | | | | | | | - Tamara Diesch
- University Children’s Hospital Basel, Basel, Switzerl
| | | |
Collapse
|
33
|
Cassatella D, Howard SR, Acierno JS, Xu C, Papadakis GE, Santoni FA, Dwyer AA, Santini S, Sykiotis GP, Chambion C, Meylan J, Marino L, Favre L, Li J, Liu X, Zhang J, Bouloux PM, Geyter CD, Paepe AD, Dhillo WS, Ferrara JM, Hauschild M, Lang-Muritano M, Lemke JR, Flück C, Nemeth A, Phan-Hug F, Pignatelli D, Popovic V, Pekic S, Quinton R, Szinnai G, l'Allemand D, Konrad D, Sharif S, Iyidir ÖT, Stevenson BJ, Yang H, Dunkel L, Pitteloud N. Congenital hypogonadotropic hypogonadism and constitutional delay of growth and puberty have distinct genetic architectures. Eur J Endocrinol 2018; 178:377-388. [PMID: 29419413 PMCID: PMC5863472 DOI: 10.1530/eje-17-0568] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/01/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Congenital hypogonadotropic hypogonadism (CHH) and constitutional delay of growth and puberty (CDGP) represent rare and common forms of GnRH deficiency, respectively. Both CDGP and CHH present with delayed puberty, and the distinction between these two entities during early adolescence is challenging. More than 30 genes have been implicated in CHH, while the genetic basis of CDGP is poorly understood. DESIGN We characterized and compared the genetic architectures of CHH and CDGP, to test the hypothesis of a shared genetic basis between these disorders. METHODS Exome sequencing data were used to identify rare variants in known genes in CHH (n = 116), CDGP (n = 72) and control cohorts (n = 36 874 ExAC and n = 405 CoLaus). RESULTS Mutations in at least one CHH gene were found in 51% of CHH probands, which is significantly higher than in CDGP (7%, P = 7.6 × 10-11) or controls (18%, P = 5.5 × 10-12). Similarly, oligogenicity (defined as mutations in more than one gene) was common in CHH patients (15%) relative to CDGP (1.4%, P = 0.002) and controls (2%, P = 6.4 × 10-7). CONCLUSIONS Our data suggest that CDGP and CHH have distinct genetic profiles, and this finding may facilitate the differential diagnosis in patients presenting with delayed puberty.
Collapse
Affiliation(s)
- Daniele Cassatella
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and MedicineUniversity of Lausanne, Lausanne, Switzerland
| | - Sasha R Howard
- Centre for EndocrinologyWilliam Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - James S Acierno
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and MedicineUniversity of Lausanne, Lausanne, Switzerland
| | - Cheng Xu
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and MedicineUniversity of Lausanne, Lausanne, Switzerland
| | - Georgios E Papadakis
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Federico A Santoni
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrew A Dwyer
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and MedicineUniversity of Lausanne, Lausanne, Switzerland
| | - Sara Santini
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerasimos P Sykiotis
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Caroline Chambion
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Jenny Meylan
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Laura Marino
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Lucie Favre
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Jiankang Li
- BGI-ShenzhenShenzhen, China
- Shenzhen Key Laboratory of NeurogenomicsBGI-Shenzhen, Shenzhen, China
| | | | - Jianguo Zhang
- BGI-ShenzhenShenzhen, China
- Shenzhen Key Laboratory of NeurogenomicsBGI-Shenzhen, Shenzhen, China
| | - Pierre-Marc Bouloux
- Centre for Neuroendocrinology (Royal Free Campus)University College London, London, UK
| | - Christian De Geyter
- University Hospital BaselClinic of Gynecological Endocrinology and Reproductive Medicine, Basel, Switzerland
| | - Anne De Paepe
- Center for Medical GeneticsGhent University Hospital, Ghent, Belgium
| | - Waljit S Dhillo
- Section of Investigative MedicineImperial College London, Hammersmith Hospital, London, UK
| | | | - Michael Hauschild
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Mariarosaria Lang-Muritano
- Division of Pediatric Endocrinology and Diabetology and Children's Research CentreUniversity Children's Hospital, Zurich, Switzerland
| | - Johannes R Lemke
- Institute of Human GeneticsUniversity of Leipzig Hospitals and Clinics, Leipzig, Germany
| | - Christa Flück
- Pediatric Endocrinology and DiabetologyDepartment of Clinical Research, University Children's Hospital Bern, Bern, Switzerland
| | | | - Franziska Phan-Hug
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Duarte Pignatelli
- Serviço de EndocrinologiaDiabetes e Metabolismo, Hospital de São João e Faculdade de Medicina do Porto, Porto, Portugal
| | - Vera Popovic
- School of MedicineUniversity of Belgrade, Belgrade, Serbia
| | - Sandra Pekic
- School of MedicineUniversity of Belgrade, Belgrade, Serbia
- Clinic for EndocrinologyDiabetes and Diseases of Metabolism, University Clinical Center, Belgrade, Serbia
| | - Richard Quinton
- Department of EndocrinologyInstitute for Human Genetics, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
| | - Gabor Szinnai
- University of Basel Chidren's HospitalBasel, Switzerland
| | - Dagmar l'Allemand
- Department of EndocrinologyChildren's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology and Children's Research CentreUniversity Children's Hospital, Zurich, Switzerland
| | - Saba Sharif
- Clinical Genetics UnitBirmingham Women's Hospital, Birmingham, UK
| | - Özlem Turhan Iyidir
- Department of Endocrinology and MetabolismGazi University Faculty of Medicine, Ankara, Turkey
| | | | - Huanming Yang
- BGI-ShenzhenShenzhen, China
- James D. Watson Institute of Genome SciencesHangzhou, China
| | - Leo Dunkel
- Centre for EndocrinologyWilliam Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nelly Pitteloud
- Service of EndocrinologyDiabetology and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and MedicineUniversity of Lausanne, Lausanne, Switzerland
| |
Collapse
|
34
|
Fuchs A, Gotta V, Decker ML, Szinnai G, Baumann P, Bonhoeffer J, Ritz N. Cytokine kinetic profiles in children with acute lower respiratory tract infection: a post hoc descriptive analysis from a randomized control trial. Clin Microbiol Infect 2018; 24:1341.e1-1341.e7. [PMID: 29555393 DOI: 10.1016/j.cmi.2018.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Standard inflammatory markers and chest radiography lack the ability to discriminate bacterial from non-bacterial lower respiratory tract infection (LRTI). Cytokine profiles may serve as biomarkers for LRTI, but their applicability to identify aetiology, severity of disease and need for antibiotic prescription in children remains poorly defined. Objectives were to determine the cytokine kinetic profiles over 5 days in paediatric patients with LRTI, to investigate the relationship between cytokine patterns, and clinical and laboratory variables. METHODS We included patients aged 1 month to 18 years, with febrile LRTI and three consecutive cytokines measurements on days 1, 3 and 5 of a randomized controlled trial (ProPAED study). We evaluated differences in cytokine concentrations between days and associations with clinical and laboratory variables. RESULTS A total of 181 patients (median age 4.1 years) were included; 72/181 (40%) received antibiotics. Serum concentrations of interferon (IFN)-γ, interleukin (IL)-1ra, IL-6, IL-10, IFN-γ-inducible protein (IP)-10 and tumor necrosis factor-α were elevated on day 1 and decreased subsequently, with the greatest decline between day 1 and 3 (by -8 to >-94%). Procalcitonin (PCT) and C-reactive protein (CRP) values showed a protracted decrease with the most prominent reduction in concentrations between days 3 and 5. Significantly elevated IL-6 concentrations were associated with hospital admission, antibiotic treatment, and prolonged antibiotic treatment. Bacteraemic LRTI patients had higher concentrations of IL-1ra (p <0.0055) and IL-6 (p <0.0055) on day 1. CONCLUSIONS We observed an earlier decrease of elevated cytokines compared to PCT or CRP. Both pro- and anti-inflammatory cytokines may serve as markers for severity of LRTI.
Collapse
Affiliation(s)
- A Fuchs
- Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - V Gotta
- Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - M-L Decker
- Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - G Szinnai
- Paediatric Endocrinology and Diabetology, University of Basel Children's Hospital, Basel, Switzerland
| | - P Baumann
- Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - J Bonhoeffer
- Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - N Ritz
- Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland; Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
| |
Collapse
|
35
|
Gotta V, Baumann P, Ritz N, Fuchs A, Baer G, Bonhoeffer JM, Heininger U, Szinnai G, Bonhoeffer J. Drivers of antibiotic prescribing in children and adolescents with febrile lower respiratory tract infections. PLoS One 2017; 12:e0185197. [PMID: 28957358 PMCID: PMC5619731 DOI: 10.1371/journal.pone.0185197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 04/11/2017] [Accepted: 09/05/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Knowledge of key drivers for antibiotic prescribing in pediatric lower respiratory tract infection (LRTI) could support rational antibiotic use. Thus, we aimed to determine the impact of clinical and laboratory factors on antibiotic prescribing in children and adolescents with febrile LRTI. METHODS Pediatric patients from the standard care control group of a randomized controlled trial (ProPAED) investigating procalcitonin guided antibiotic treatment in febrile LRTI were included in a multivariate logistic regression analysis to evaluate the impact of laboratory and clinical factors on antibiotic prescribing. RESULTS The standard care control group of the ProPAED study comprised 165 LRTI patients (median age: 2.7 years, range: 0.1-16), out of which 88 (55%) received antibiotic treatment. Factors significantly associated with antibiotic prescribing in patients with complete clinical and laboratory documentation (n = 158) were C-reactive protein (OR 5.8 for a 10-fold increase, 95%CI 2.2-14.9), white blood count beyond age-dependent reference range (OR 3.9, 95%CI 1.4-11.4), body temperature (OR 1.7 for an increase by 1°C, 95%CI 1.02-2.68), and pleuritic pain (OR 2.8, 95%CI 1.1-7.6). Dyspnea (OR 0.3, 95%CI 0.1-0.7) and wheezing (OR 0.3, 95%CI 0.13-0.95) were inversely associated with antibiotic prescribing. CONCLUSION Laboratory markers were strong drivers of antibiotic prescribing in children with febrile lower respiratory tract infections, in spite of their known poor prediction of antibiotic need. Building on current guidelines for antibiotic treatment in children with febrile LRTI, a reliable decision algorithm for safe antibiotic withholding considering the laboratory and clinical factors evaluated in this study has the potential to further reduce antibiotic prescribing.
Collapse
Affiliation(s)
- Verena Gotta
- Department of Pediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Philipp Baumann
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, Basel, Switzerland
- * E-mail:
| | - Nicole Ritz
- Department of Pediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, Basel, Switzerland
| | - Aline Fuchs
- Department of Pediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
| | - Gurli Baer
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, Basel, Switzerland
| | | | - Ulrich Heininger
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, Basel, Switzerland
| | - Gabor Szinnai
- Department of Pediatric Endocrinology and Diabetology, University of Basel Children’s Hospital, Basel, Switzerland
| | - Jan Bonhoeffer
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, Basel, Switzerland
| | | |
Collapse
|
36
|
Baumann P, Baer G, Bonhoeffer J, Fuchs A, Gotta V, Heininger U, Ritz N, Szinnai G, Bonhoeffer J. Procalcitonin for Diagnostics and Treatment Decisions in Pediatric Lower Respiratory Tract Infections. Front Pediatr 2017; 5:183. [PMID: 28894729 PMCID: PMC5581362 DOI: 10.3389/fped.2017.00183] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/11/2017] [Indexed: 12/12/2022] Open
Abstract
Mortality and morbidity remain high in pediatric lower respiratory tract infections (LRTIs) despite progress in research and implementation of global diagnostic and treatment strategies in the last decade. Still, 120 million annual episodes of pneumonia affect children younger than 5 years each year leading to 1.3 million fatalities with the major burden of disease carried by low- and middle-income countries (95%). The definition of pneumonia is still challenging. Traditional diagnostic measures (i.e., chest radiographs, C-reactive protein) are unable to distinguish viral and from bacterial etiology. As a result, common antibiotic overuse contributes to growing antibiotic resistance. We present an overview of current evidence from observational and randomized controlled trials on a procalcitonin (PCT)-based diagnosis of pediatric LRTIs and discuss the need for an adequate PCT threshold for antibiotic treatment decision-making.
Collapse
Affiliation(s)
- Philipp Baumann
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Gurli Baer
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | | | - Aline Fuchs
- Department of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Verena Gotta
- Department of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Ulrich Heininger
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Nicole Ritz
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland.,Department of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Gabor Szinnai
- Department of Pediatric Endocrinology and Diabetology, University of Basel Children's Hospital, Basel, Switzerland
| | - Jan Bonhoeffer
- Department of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| |
Collapse
|
37
|
Gawade S, Mayer C, Hafen K, Barthlott T, Krenger W, Szinnai G. Cell Growth Dynamics in Embryonic and Adult Mouse Thyroid Revealed by a Novel Approach to Detect Thyroid Gland Subpopulations. Thyroid 2016; 26:591-9. [PMID: 26854713 DOI: 10.1089/thy.2015.0523] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The thyroid is composed of endocrine epithelial cells, blood vessels, and mesenchyme. However, no data exist thus far on absolute cell numbers, relative distribution, and proliferation of the different cell populations in the developing and mature thyroid. The aim of this study was therefore to establish a flow cytometry protocol that allows detection and quantification of discrete cell populations in embryonic and adult murine thyroid tissues. METHODS Cell-type anti-mouse specific antibodies were used for erythroid cells (Ter119), hematopoietic cells (CD45), epithelial cells (EpCam/CD326, E-cadherin/CD324), thyroid follicular cells and C-cells (Nkx2-1), endothelial cells (Pecam/CD31, Icam-1/CD54), and fibroblasts (PDGFRa/CD140a). Proliferating cells were detected after labeling with 5-bromo-2'-deoxyuridine (BrdU). For flow cytometry analyses, micro-dissected embryonic (E) and adult thyroids were pooled (E13.5, n = 25; E15.5, n = 15; E17.5, n = 15; adult, n = 4) in one sample. RESULTS The absolute parenchymal cell numbers per mouse thyroid (M ± SD), excluding the large number of CD45(+) and Ter119(+) cells, increased from 7425 ± 1338 at E13.5 to 271,561 ± 22,325 in adult tissues. As expected, Nkx2-1(+) cells represented the largest cell population in adult tissues (61.2 ± 1.1%). Surprisingly, at all three embryonic stages analyzed, thyroid follicular cells and C-cells accounted only for a small percentage of the total thyroid cell mass (between 4.7 ± 0.4% and 9.4 ± 1.6%). In contrast, the largest cell population at all three embryonic stages was identified as PDGFRa/CD140a(+) fibroblasts (61.4 ± 0.4% to 77.3 ± 1.1%). However, these cells represented the smallest population in adult tissues (5.2 ± 0.8%). Pecam/CD31(+) endothelial cells increased from E13.5 to E15.5 from 3.7 ± 0.8% to 8.5 ± 3.0%, then remained stable at E17.5 and adult tissues. Proliferation rates were sizable during the entire organogenesis but differed between cell populations, with distinct proliferative peaks at E13.5 in epithelial cells (32.7 ± 0.6% BrdU(+) cells), and at E15.5 in endothelial cells (22.4 ± 2.4% BrdU(+) cells). Fibroblasts showed a constant proliferation rate in embryonic tissues. In adult tissues, BrdU(+) cells were between 0.1% and 0.4% in all cell types. CONCLUSIONS Using a novel flow cytometry-based method, a previously unobserved highly dynamic growth pattern of thyroid cell populations during embryogenesis was uncovered. This approach will provide a useful new tool for cell function analyses in murine thyroid disease models.
Collapse
Affiliation(s)
- Sanjay Gawade
- 1 Pediatric Immunology, Department of Biomedicine, University of Basel , Basel, Switzerland
| | - Carlos Mayer
- 1 Pediatric Immunology, Department of Biomedicine, University of Basel , Basel, Switzerland
| | - Katrin Hafen
- 1 Pediatric Immunology, Department of Biomedicine, University of Basel , Basel, Switzerland
| | - Thomas Barthlott
- 1 Pediatric Immunology, Department of Biomedicine, University of Basel , Basel, Switzerland
| | - Werner Krenger
- 1 Pediatric Immunology, Department of Biomedicine, University of Basel , Basel, Switzerland
| | - Gabor Szinnai
- 1 Pediatric Immunology, Department of Biomedicine, University of Basel , Basel, Switzerland
- 2 Pediatric Endocrinology, University Children's Hospital Basel, University of Basel , Basel, Switzerland
| |
Collapse
|
38
|
Affiliation(s)
- Michel Polak
- Service d'Endocrinologie Gynécologie Diabétologie Pédiatriques, Hôpital Universitaire Necker Enfants Malades, Université Paris Descartes, INSERM U1016, affilié IMAGINE, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Paris, France
| | | |
Collapse
|
39
|
Cerqueira TLO, Carré A, Chevrier L, Szinnai G, Tron E, Léger J, Cabrol S, Queinnec C, De Roux N, Castanet M, Polak M, Ramos HE. Functional characterization of the novel sequence variant p.S304R in the hinge region of TSHR in a congenital hypothyroidism patients and analogy with other formerly known mutations of this gene portion. J Pediatr Endocrinol Metab 2015; 28:777-84. [PMID: 25153578 DOI: 10.1515/jpem-2014-0194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/14/2014] [Indexed: 11/15/2022]
Abstract
CONTEXT Thyroid dysgenesis may be associated with loss-of-function mutations in the thyrotropin receptor (TSHR) gene. OBJECTIVES The aim of this study was to characterize a novel TSHR gene variant found in one patient harboring congenital hypothyroidism (CH) from a cohort of patients with various types of thyroid defects. MATERIALS AND METHODS This cross-sectional cohort study involved 118 patients with CH and their family members, including 45 with familial and 73 with sporadic diseases. The thyroid gland was normal in 23 patients, 25 patients had hypoplasia, 25 hemithyroid agenesis, 21 had athyreosis, and 21 had ectopy. Genomic DNA was extracted, and 10 exons of the TSHR gene were amplified and sequenced. Mutations in other candidate genes were investigated. Ortholog alignment was performed, and TSHR functional assays were evaluated. RESULTS We identified one previously unknown missense variation in the hinge region (HinR) of the TSHR gene (p.S304R) in one patient with thyroid hypoplasia. This variant is conserved in our ortholog alignment. However, the p.S304R TSHR variant presented a normal glycosylation pattern and signal transduction activity in functional analysis. CONCLUSION We report the ocurrence of a novel nonsynonymous substitution in the HinR of the large N-terminal extracellular domain of the TSHR gene in a patient with thyroid hypoplasia. In contrast with four others in whom TSHR mutations of the hinge portion were previously identified, the p.S304R TSHR variation neither affected TSH binding nor cAMP pathway activation. This TSHR gene variant was documented in a CH patient, but the current data do not support its role in the clinical phenotype.
Collapse
|
40
|
Burckhardt MA, Schifferli A, Krieg AH, Baumhoer D, Szinnai G, Rudin C. Tumor-associated FGF-23-induced hypophosphatemic rickets in children: a case report and review of the literature. Pediatr Nephrol 2015; 30:179-82. [PMID: 25326108 DOI: 10.1007/s00467-014-2979-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 05/10/2014] [Revised: 09/24/2014] [Accepted: 09/29/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tumor-associated fibroblast growth factor 23 (FGF-23)-induced hypophosphatemic rickets is a rare but known pediatric entity first described in 1959. It results from local production of phosphatonins by benign and malignant mesenchymal tumors. CASE-DIAGNOSIS/TREATMENT We report an 8-year-old boy with tumor-associated hypophosphatemic rickets due to paraneoplastic FGF-23 secretion from a benign mesenchymal pelvic-bone tumor. Excessive FGF-23 production was visualized by immunohistochemistry in the resected tumor. Phosphate wasting stopped immediately after tumor resection. We reviewed 26 reports of pediatric patients with tumor-induced hypophosphatemic rickets; paraneoplastic FGF-23 secretion was documented in only three of them. All tumors developed inside bone, were benign in 21/26 cases, and were localized in femur/tibia (13/26), radius/ulna/humerus (7/26), pelvis (4/26), rib (1/26), and craniofacial (1/26) bones. Mean interval between onset of signs and/or symptoms and diagnosis was 34 months. CONCLUSIONS In patients with hypophosphatemic rickets acquired beyond infancy, radiologic investigations for bone tumors need to be performed rapidly. In contrast to biochemical screening for increased circulating FGF-23 levels, immunohistochemical confirmation of FGF-23 production in resected tumor tissue can be regarded as being well established.
Collapse
|
41
|
Ramos HE, Carré A, Chevrier L, Szinnai G, Tron E, Cerqueira TLO, Léger J, Cabrol S, Puel O, Queinnec C, De Roux N, Guillot L, Castanet M, Polak M. Extreme phenotypic variability of thyroid dysgenesis in six new cases of congenital hypothyroidism due to PAX8 gene loss-of-function mutations. Eur J Endocrinol 2014; 171:499-507. [PMID: 25214233 DOI: 10.1530/eje-13-1006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
CONTEXT Within the last two decades, heterozygous loss-of-function PAX8 mutations have been reported in patients with a wide degree of thyroid gland dysfunction and growth despite the presence of identical mutations. OBJECTIVES To search for PAX8 mutations in a cohort of patients with congenital hypothyroidism (CH) and various types of thyroid gland defects. DESIGN A cross-sectional study was conducted in a cohort of patients. SETTING The French neonatal screening program was used for recruiting patients. PATIENTS A total of 118 patients with CH, including 45 with familial and 73 with sporadic diseases, were included in this study. The thyroid gland was normal in 23 patients had hypoplasia, 25 had hemithyroid agenesis, 21 had athyreosis, and 21 had ectopy. RESULTS We found four different PAX8 mutations (p.R31C, p.R31H, p.R108X, and p.I47T) in ten patients (six patients with CH and four family members), two with sporadic and eight with familial diseases. Imaging studies performed in the index cases showed ectopic thyroid gland (n=2), hypoplasia (n=2), eutopic lobar asymmetry (n=1), and eutopic gland compatible with dyshormonogenesis (n=1). The previously reported p.R31C and the novel p.I47T PAX8 mutations are devoid of activity. CONCLUSION Four different PAX8 mutations were detected in six index patients with CH (ten total subjects). The p.R31C, p.R31H, and p.R108X mutations have been reported. The novel p.I47T PAX8 mutation presented loss of function leading to CH. Thyroid ectopy was observed in two cases of PAX8 (p.R31H) mutation, a finding that has not been reported previously. We observed a high inter-individual and intra-familial variability of the phenotype in PAX8 mutations, underlining that population genetic studies for CH should include patients with various clinical presentations.
Collapse
Affiliation(s)
- H E Ramos
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Fede
| | - A Carré
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Fede
| | - L Chevrier
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France
| | - G Szinnai
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France
| | - E Tron
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Fede
| | - T L O Cerqueira
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Fede
| | - J Léger
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France
| | - S Cabrol
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France
| | - O Puel
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France
| | - C Queinnec
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France
| | - N De Roux
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France
| | - L Guillot
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France
| | - M Castanet
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Fede
| | - M Polak
- INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilINSERM U676Paris Diderot University, Robert Debré Hospital, Paris, FrancePediatric EndocrinologyUniversity Children's Hospital Basel, University Basel, Basel, SwitzerlandPediatric Endocrine UnitHôpital Armand Trousseau, AP-HP, Paris, FrancePediatrics DepartmentCHU, Bordeaux, FrancePediatrics DepartmentCH de Cornouailles-Hopital Laennec, Quimper, FranceSaint-Antoine Research CenterINSERM UMRS 938, Saint-Antonie Hospital, Université Pierre-et-Marie-Curie, Paris, France andPediatrics DepartmentCH Charles Nicolle, University Hospital of Rouen, Rouen, France INSERM U1016Université Paris Descartes, Sorbonne Paris Cité, Paris, FrancePediatric EndocrineGynecology and Diabetes Unit, Centre des Maladies Endocriniennes Rares de la Croissance, Hôpital Necker Enfants-Malades, AP-HP, Paris, FranceIMAGINE InstituteParis, FranceLaboratório de Estudo da Tireoide (LET)Departamento de Biorregulação, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Bahia, BrazilCurso de Pós-Graduação em Biotecnologia em Saúde e Medicina InvestigativaCentro de Pesquisa Gonçalo Moniz - FIOCRUZ/BA, Salvador, Bahia, BrazilCurso de Pós-Graduação em Processos Interativos de Órgãos e SistemasInstituto de Ciências da Saúde, Universidade Fede
| |
Collapse
|
42
|
Burckhardt MA, Wellmann M, Fouzas S, Lapaire O, Burkhardt T, Benzing J, Bührer C, Szinnai G, Wellmann S. Sexual disparity of copeptin in healthy newborn infants. J Clin Endocrinol Metab 2014; 99:E1750-3. [PMID: 25004250 DOI: 10.1210/jc.2014-2244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Arginine vasopressin (AVP) regulates water balance and blood pressure and plays a role in social behavioral processes. Healthy adult men as compared with women have higher blood levels of AVP and its C-terminal precursor peptide, copeptin. OBJECTIVE The objective of the study was to investigate whether sexual disparity of copeptin is present at birth. METHODS In 241 prospectively enrolled healthy newborn infants, 131 boys and 110 girls, plasma copeptin concentrations were measured at birth and on day 3 of life. RESULTS Multivariable linear regression analysis revealed stressful delivery (regression coefficient β = .569, P <0.001), acidosis (β = -.347, P < .001), and male gender (β = .132, P < .01) as independent determinants of copeptin at birth. In infants born without stress, that is by primary cesarean section (n = 81), male gender was the sole variable associated with copeptin (β = .286, P < .05), copeptin concentrations being higher in boys [median 5.5 pmol/L (interquartile range 4.4-10.2)] than in girls [4.8 pmol/L (interquartile range 3.6-5.8), P < .05]. At day 3 of life, copeptin was determined independently by postnatal physiological dehydration (β = .485; P < .001) and birth weight (β = .279; P < .01). CONCLUSION Sexual disparity of copeptin is already present at birth, indicating increased activation of the AVP system in newborn boys as compared with girls.
Collapse
Affiliation(s)
- Marie-Anne Burckhardt
- Departments of Pediatric Endocrinology (M.-A.B., G.S.) and Neonatology (S.F., J.B., S.W.), University Children's Hospital Basel, CH-4056 Basel, Switzerland; Division of Obstetrics and Gynecology (M.W., O.L.), University Hospital Basel, CH-4031 Basel, Switzerland; Neonatal Intensive Care Unit (S.F.), University Hospital of Patras, 26500 Patras, Greece; Department of Obstetrics (T.B.), University Hospital Zurich, Zurich 8091, Switzerland; Zurich Center for Integrative Human Physiology (T.B., S.W.), University of Zurich, CH-8032 Zurich, Switzerland; Department of Neonatology (C.B.), Charité University Medical Center, D-10117 Berlin, Germany; and Department of Neonatology (S.W.), University Hospital Zurich, CH-8091 Zurich, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Wellmann S, Benzing J, Fleischlin S, Morgenthaler N, Fouzas S, Bührer CA, Szinnai G, Burkhardt T, Lapaire O. Cardiovascular biomarkers in preeclampsia at triage. Fetal Diagn Ther 2014; 36:202-7. [PMID: 24853905 DOI: 10.1159/000361016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 02/28/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To investigate the ability of cardiovascular plasma biomarkers to identify imminent preeclampsia (PE) among pregnant women at triage. MATERIAL AND METHODS C-terminal pro-arginine vasopressin (copeptin), C-terminal pro-endothelin-1 (CT-proET-1), mid-regional pro-adrenomedullin (MR-proADM), and mid-regional pro-atrial natriuretic peptide (MR-proANP) were prospectively measured in pregnant women presenting at the obstetrical triage units of the University Hospitals of Basel and Zurich, Switzerland. Logistic regression and receiver operating characteristics (ROC) analysis was used to assess and quantify the predictive ability of cardiovascular biomarkers. RESULTS Of the 147 included women, 27 (18.4%) were diagnosed at admission with PE. All biomarker levels were significantly higher in participants with PE as compared to controls. However, only MR-proANP, MR-proADM and CT-proET-1 were significant and independent predictors of PE, after taking into account the effect of various clinical confounders. The area under the ROC curve (AUC) was 0.62 (95% confidence interval 0.50-0.73) for copeptin, 0.64 (0.52-0.76) for MR-proADM, 0.71 (0.61-0.82) for CT-proET-1, and 0.83 (0.73-0.92) for MR-proANP. The combination of MR-proANP and MR-proADM resulted in the highest diagnostic performance (AUC 0.88; 0.79-0.96). DISCUSSION Assessment of the cardiovascular plasma biomarkers MR-proANP and MR-proADM holds promise to support diagnosis of PE at triage.
Collapse
Affiliation(s)
- Sven Wellmann
- University Children's Hospital Basel (UKBB), Basel, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Fenske WK, Christ-Crain M, Hörning A, Simet J, Szinnai G, Fassnacht M, Rutishauser J, Bichet DG, Störk S, Allolio B. A copeptin-based classification of the osmoregulatory defects in the syndrome of inappropriate antidiuresis. J Am Soc Nephrol 2014; 25:2376-83. [PMID: 24722436 DOI: 10.1681/asn.2013080895] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hyponatremia, the most frequent electrolyte disorder, is caused predominantly by the syndrome of inappropriate antidiuresis (SIAD). A comprehensive characterization of SIAD subtypes, defined by type of osmotic dysregulation, is lacking, but may aid in predicting therapeutic success. Here, we analyzed serial measurements of serum osmolality and serum sodium, plasma arginine vasopressin (AVP), and plasma copeptin concentrations from 50 patients with hyponatremia who underwent hypertonic saline infusion. A close correlation between copeptin concentrations and serum osmolality existed in 68 healthy controls, with a mean osmotic threshold±SD of 282±4 mOsM/kg H2O. Furthermore, saline-induced changes in copeptin concentrations correlated with changes in AVP concentrations in controls and patients. With use of copeptin concentration as a surrogate measure of AVP concentration, patients with SIAD could be grouped according to osmoregulatory defect: Ten percent of patients had grossly elevated copeptin concentrations independent of serum osmolality (type A); 14% had copeptin concentrations that increased linearly with rising serum osmolality but had abnormally low osmotic thresholds (type B); 44% had normal copeptin concentrations independent of osmolality (type C), and 12% had suppressed copeptin concentrations independent of osmolality (type D). A novel SIAD subtype discovered in 20% of patients was characterized by a linear decrease in copeptin concentrations with increasing serum osmolality (type E or "barostat reset"). In conclusion, a partial or complete loss of AVP osmoregulation occurs in patients with SIAD. Although the mechanisms underlying osmoregulatory defects in individual patients are presumably diverse, we hypothesize that treatment responses and patient outcomes will vary according to SIAD subtype.
Collapse
Affiliation(s)
- Wiebke Kristin Fenske
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany; Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
| | | | - Anna Hörning
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany
| | - Jessica Simet
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany
| | - Gabor Szinnai
- Pediatric Endocrinology, University Children's Hospital Basel, University Basel, Basel, Switzerland
| | - Martin Fassnacht
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany; Department of Internal Medicine IV, Ludwig-Maximilians-Universität, Munich, Germany
| | - Jonas Rutishauser
- University Clinic for Internal Medicine, Kantonsspital Baselland-Bruderholz, Bruderholz, Switzerland; and
| | - Daniel G Bichet
- Department of Physiology and Medicine, Hôpital du Sacré-Coeur, Université de Montréal, Montréal, Canada
| | - Stefan Störk
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Bruno Allolio
- Department of Internal Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany;
| |
Collapse
|
45
|
Fenske W, Christ Crain M, Hörning A, Simet J, Szinnai G, Fassnacht M, Rutishauser J, Bichet D, Störk S, Allolio B. The syndrome of inappropriate antidiuresis: a copeptin-based classification and identification of a novel subtype. Exp Clin Endocrinol Diabetes 2014. [DOI: 10.1055/s-0034-1372009] [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: 10/25/2022]
|
46
|
Abstract
The most frequent cause of congenital hypothyroidism is thyroid dysgenesis. Thyroid dysgenesis summarizes a spectrum of developmental abnormalities of the embryonic thyroid ranging from complete absence of the thyroid gland (athyreosis), to a normally located but too small thyroid (hypoplasia), or an abnormally located thyroid gland (ectopy). Although considered a sporadic disease, distinct genetic forms of isolated or syndromic thyroid dysgenesis have been described in recent years. However, genetics of thyroid dysgenesis (TD) are mostly not following simple Mendelian patterns, and beside monogenic, multigenic and epigenetic mechanisms need to be considered. The review will highlight the molecular mechanisms of thyroid organogenesis, clinical and genetic features of the different monogenetic forms of thyroid dysgenesis, the aspects relevant for diagnosis and counseling of affected families and current research strategies to get more insight into the non-Medelian mechanisms of normal and abnormal thyroid development.
Collapse
Affiliation(s)
- Gabor Szinnai
- Division of Paediatric Endocrinology and Diabetology, University Children's Hospital Basel UKBB, Spitalstrasse 33, CH-4031 Basel, Switzerland; Department of Biomedicine, University Basel, Spitalstrasse 33, CH-4031 Basel, Switzerland.
| |
Collapse
|
47
|
Abstract
Congenital hypothyroidism (CH) is a state of insufficient thyroid hormone supply to the organism, starting in utero. Two forms of permanent primary or thyroidal CH are known. Thyroid dysgenesis (TD) describes a spectrum of defects of thyroid organogenesis. Five monogenetic forms due to mutations in TSHR, PAX8, NKX2-1, FOXE1 and NKX2-5 have been identified so far. Thyroid dyshormonogenesis comprises defects at every step of thyroid hormone synthesis. Mutations in 7 genes are well described causing iodine transport defect (SLC5A5), iodine organification defect (TPO, DUOX2, DUOXA2, SLC26A4), thyroglobulin (TG) synthesis or transport defect or iodotyrosine deiodinase (IYD/DEHAL1) deficiency. The new consensus guidelines for CH recommend genetic counseling for each family with an affected child. Mode of inheritance, recurrence rate and possible associated malformations in the context of syndromic forms should be outlined. Molecular genetic studies should be preceded by a detailed phenotypic description of the patient's thyroid disease and a detailed family history. This review summarizes clinical, biochemical and radiological phenotypes and molecular aspects of the known genetic forms of TD and thyroid dyshormonogenesis relevant for genetic counseling and molecular studies.
Collapse
Affiliation(s)
- Gabor Szinnai
- Pediatric Endocrinology, University Children's Hospital Basel, and Department of Biomedicine, University of Basel, Basel, Switzerland
| |
Collapse
|
48
|
Abstract
Resistance to thyroid hormone (RTH) or thyroid hormone action defect (THAD) is the most frequent form of syndromes of reduced sensitivity to thyroid hormone. It is characterized by variable tissue hyposensitivity to thyroid hormone. RTHβ (formerly only RTH) is caused by mutations in the thyroid hormone receptor β gene (THRB). The clinical phenotype reflects the dysbalance between resistance of tissues predominantly expressing the thyroid hormone receptor β-isoforms 1 and 2 and the overstimulation of tissues mainly expressing the thyroid hormone receptor α-isoform to thyroid hormones. The hallmark of RTHβ is goiter, sinus tachycardia, attention deficit hyperactivity disorder in the context of increased levels of triiodothyronine/free thyroxine and nonsuppressed thyroid-stimulating hormone. Only recently have mutations in the thyroid hormone receptor α gene (THRA) been identified causing a new form of RTH, RTHα. The few patients described so far suffered from mental retardation of variable degree, short stature with decreased subischial leg length, chronic constipation and bradycardia. This review provides an overview of clinical, biochemical and genetic aspects of RTHα and RTHβ relevant for diagnosis, treatment and counseling of affected patients and families.
Collapse
Affiliation(s)
- Kazumichi Onigata
- Postgraduate Clinical Practice Center and Department of Pediatrics, Shimane Faculty of Medicine, Izumo, Japan
| | | |
Collapse
|
49
|
Szinnai G, Léger J, Bauer AJ, Pearce EN, Ramos HE, Canalli MH, Onigata K, Elisei R, Radetti G, Polak M, Van Vliet G, Deladoëy J. Clinical case seminar in pediatric thyroid disease. Endocr Dev 2014; 26:214-44. [PMID: 25231455 DOI: 10.1159/000363166] [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] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Pediatric thyroid diseases cover a large spectrum of congenital and acquired forms, ranging from congenital primary or central hypothyroidism, autoimmune thyroid disease, iodine deficiency, rare genetic defects of thyroid hormone action, metabolism and cell membrane transport to benign nodules and malignant tumors. The previous 15 papers of the textbook Paediatric Thyroidology gave a systematic overview of the current knowledge and guidelines on all these diseases. In this final paper, the authors collected a series of patient histories from their clinics illustrating frequently encountered clinical problems and providing key learning points and references to each case. Although not fully comprehensive, it aims at providing relevant clinical knowledge on thyroid diseases of the neonate, the child, and the adolescent.
Collapse
Affiliation(s)
- G Szinnai
- Pediatric Endocrinology, University Children's Hospital Basel, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Wuttke A, Dixit KC, Szinnai G, Werth SC, Haagen U, Christ-Crain M, Morgenthaler N, Brabant G. Copeptin as a marker for arginine-vasopressin/antidiuretic hormone secretion in the diagnosis of paraneoplastic syndrome of inappropriate ADH secretion. Endocrine 2013; 44:744-9. [PMID: 23479045 DOI: 10.1007/s12020-013-9919-9] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/03/2013] [Indexed: 10/27/2022]
Abstract
Direct measurement of arginine-vasopressin/antidiuretic hormone (AVP/ADH) concentrations is not included in the standard diagnostic procedures for paraneoplastic syndrome of inappropriate ADH secretion (SIADH). Here, we evaluate the potential of copeptin measurement as a surrogate marker of AVP/ADH secretion for the direct diagnosis of suspected SIADH in cancer patients. Forty-six unselected cancer patients with serum sodium concentrations permanently below 135 mmol/L were included in this study. We compared standard diagnostic criteria for SIADH to the measurement of plasma copeptin in relation to osmolality. Normative data for comparison were constructed from 24 healthy controls studied under basal conditions, experimental dehydration, and hypotonic hypervolemia as well as from 222 hospital patients with no suspicion of an altered ADH regulation. Log transformation of copeptin revealed a linear relationship to plasma osmolality in the controls (R = 0.495, p < 0.001). Compared to these normative data, copeptin levels in most cancer patients were inappropriately high for plasma osmolality and were not significantly correlated. These results, suggestive for paraneoplastic SIADH, could be confirmed by conventional diagnostic procedures for SIADH. Current strategies to diagnose SIADH are difficult to perform under outpatients conditions. Our approach allows screening from a single plasma sample for true paraneoplastic ADH oversecretion and thus rapid selection for a specific therapy with an AVP receptor antagonist.
Collapse
Affiliation(s)
- A Wuttke
- Experimental and Clinical Endocrinology Med. Clinic I, University of Luebeck, Ratzeburger Allee 160D, 23538, Luebeck, Germany,
| | | | | | | | | | | | | | | |
Collapse
|