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Stinca S, Barnes TW, Vogel P, Meyers W, Schulte-Pelkum J, Filchtinski D, Steller L, Hauser T, Manni S, Gardiner DF, Popik S, Roth NJ, Schuetz P. Modelling the concentration of anti-SARS-CoV-2 immunoglobulin G in intravenous immunoglobulin product batches. PLoS One 2021; 16:e0259731. [PMID: 34843493 PMCID: PMC8629175 DOI: 10.1371/journal.pone.0259731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Plasma-derived intravenous immunoglobulin (IVIg) products contain a dynamic spectrum of immunoglobulin (Ig) G reactivities reflective of the donor population from which they are derived. We sought to model the concentration of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG which could be expected in future plasma pool and final-product batches of CSL Behring’s immunoglobulin product Privigen. Study design and methods Data was extracted from accessible databases, including the incidence of coronavirus disease 2019 and SARS-CoV-2 vaccination status, antibody titre in convalescent and vaccinated groups and antibody half-life. Together, these parameters were used to create an integrated mathematical model that could be used to predict anti-SARS-CoV-2 antibody levels in future IVIg preparations. Results We predict that anti-SARS-CoV-2 IgG concentration will peak in batches produced in mid-October 2021, containing levels in the vicinity of 190-fold that of the mean convalescent (unvaccinated) plasma concentration. An elevated concentration (approximately 35-fold convalescent plasma) is anticipated to be retained in batches produced well into 2022. Measurement of several Privigen batches using the Phadia™ EliA™ SARS-CoV-2-Sp1 IgG binding assay confirmed the early phase of this model. Conclusion The work presented in this paper may have important implications for physicians and patients who use Privigen for indicated diseases.
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Affiliation(s)
- Sara Stinca
- Department of Bioanalytical Sciences, Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Thomas W. Barnes
- Department of Bioanalytical Sciences, Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Peter Vogel
- Global Digital Core, Plasma Product Development, Research & Development, CSL Behring Innovation GmbH, Marburg, Germany
| | - Wilfried Meyers
- Global Digital Core, Plasma Product Development, Research & Development, CSL Behring Innovation GmbH, Marburg, Germany
| | | | - Daniel Filchtinski
- Assay Design, Thermo Fisher Scientific ImmunoDiagnostics Phadia GmbH, Freiburg, Germany
| | - Laura Steller
- Assay Design, Thermo Fisher Scientific ImmunoDiagnostics Phadia GmbH, Freiburg, Germany
| | - Thomas Hauser
- Department of Bioanalytical Sciences, Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Sandro Manni
- Department of Bioanalytical Sciences, Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - David F. Gardiner
- Immunology, CSL Behring, King of Prussia, Pennsylvania, United States of America
| | - Sharon Popik
- Immunology, CSL Behring, King of Prussia, Pennsylvania, United States of America
| | - Nathan J. Roth
- Department of Bioanalytical Sciences, Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Patrick Schuetz
- Department of Bioanalytical Sciences, Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
- * E-mail:
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Gowachirapant S, Jaiswal N, Melse-Boonstra A, Galetti V, Stinca S, Mackenzie I, Thomas S, Thomas T, Winichagoon P, Srinivasan K, Zimmermann MB. Effect of iodine supplementation in pregnant women on child neurodevelopment: a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol 2017; 5:853-863. [PMID: 29030199 DOI: 10.1016/s2213-8587(17)30332-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [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: 05/06/2017] [Revised: 07/20/2017] [Accepted: 07/26/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Iodine deficiency during pregnancy might be associated with reduced intelligence quotient (IQ) score in offspring. We assessed the effect of iodine supplementation in mildly iodine-deficient pregnant women on neurodevelopment of their offspring in areas where schoolchildren were iodine sufficient. METHODS In this randomised, placebo-controlled trial, pregnant women in Bangalore, India, and Bangkok, Thailand, were randomly assigned (1:1) to receive 200 μg iodine orally once a day or placebo until delivery. Randomisation was done with a computer-generated sequence and stratified by site. Co-primary outcomes were verbal and performance IQ scores on the Wechsler Preschool and Primary Scale of Intelligence Third Edition (WPPSI-III) and the global executive composite score from the Behaviour Rating Inventory of Executive Function-Preschool Version (BRIEF-P) in the children at age 5-6 years. The trial was double-blinded; some unmasking took place at age 2 years for an interim analysis, but participants and nearly all investigators remained masked to group assignment until age 5-6 years. Analysis was by intention to treat using mixed-effects models. This trial is registered with ClinicalTrials.gov, number NCT00791466. FINDINGS Between Nov 18, 2008, and March 12, 2011, 832 women entered the trial at a mean gestational age of 10·7 weeks (SD 2·7); median urinary iodine concentration was 131 μg/L (IQR 81-213). Mean compliance with supplementation was 87%, assessed by monthly tablet counts. 313 children (iodine group, n=159; placebo group, n=154) were analysed for verbal and performance IQ with WPPSI-III and 315 (iodine group, n=159; placebo group, n=156) for overall executive function with BRIEF-P. Mean WPPSI-III scores for verbal IQ were 89·5 (SD 9·8) in the iodine group and 90·2 (9·8) in the placebo group (difference -0·7, 95% CI -2·9 to 1·5; p=0·77), and for performance IQ were 97·5 (12·5) in the iodine group and 99·1 (13·4) in the placebo group (difference -1·6, -4·5 to 1·3; p=0·44). The mean BRIEF-P global executive composite score was 90·6 (26·2) in the iodine group and 91·5 (27·0) in the placebo group (difference -0·9, -6·8 to 5·0; p=0·74). The frequency of adverse events did not differ between groups during gestation or at delivery: 24 women in the iodine group and 28 in the placebo group reported adverse events (iodine group: abortion, n=20; blighted ovum, and n=2; intrauterine death, n=2; placebo group: abortion, n=22; blighted ovum, n=1; intrauterine death, n=2; early neonatal death, n=1; and neonatal death, n=2). INTERPRETATION Daily iodine supplementation in mildly iodine-deficient pregnant women had no effect on child neurodevelopment at age 5-6 years. FUNDING Swiss National Science Foundation, Nestlé Foundation, Wageningen University and Research, and ETH Zurich.
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Affiliation(s)
- Sueppong Gowachirapant
- Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand; Division of Human Nutrition, Wageningen University and Research, Wageningen, Netherlands
| | - Nidhi Jaiswal
- Division of Human Nutrition, Wageningen University and Research, Wageningen, Netherlands; St John's Research Institute, Bangalore, India
| | - Alida Melse-Boonstra
- Division of Human Nutrition, Wageningen University and Research, Wageningen, Netherlands
| | - Valeria Galetti
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Sara Stinca
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Ian Mackenzie
- Hearing Impairment Research Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | | | - Michael B Zimmermann
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland.
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Brindle E, Lillis L, Barney R, Hess SY, Wessells KR, Ouédraogo CT, Stinca S, Kalnoky M, Peck R, Tyler A, Lyman C, Boyle DS. Simultaneous assessment of iodine, iron, vitamin A, malarial antigenemia, and inflammation status biomarkers via a multiplex immunoassay method on a population of pregnant women from Niger. PLoS One 2017; 12:e0185868. [PMID: 28982133 PMCID: PMC5628875 DOI: 10.1371/journal.pone.0185868] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022] Open
Abstract
Deficiencies of vitamin A, iron, and iodine are major public health concerns in many low- and middle-income countries, but information on their status in populations is often lacking due to high costs and logistical challenges associated with assessing micronutrient status. Accurate, user-friendly, and low-cost analytical tools are needed to allow large-scale population surveys on micronutrient status. We present the expansion of a 7-plex protein microarray tool for the simultaneous measurement of up to seven biomarkers with relevance to the assessment of the key micronutrients iron, iodine, and vitamin A, and inflammation and malaria biomarkers: α-1-acid glycoprotein, C-reactive protein, ferritin, retinol binding protein 4, soluble transferrin receptor, thyroglobulin, and histidine-rich protein II. Assay performance was assessed using international reference standards and then verified by comparing the multiplexed and conventional immunoassay results on a training panel of plasma samples collected from US adults. These data were used to assign nominal concentrations to the calibrators of the assay to further improve performance which was then assessed by interrogating plasma samples from a cohort of pregnant women from Niger. The correlation between assays for each biomarker measured from this cohort was typically good, with the exception of thyroglobulin, and the sensitivity ranged from 74% to 93%, and specificity from 81% to 98%. The 7-Plex micronutrient assay has the potential for use as an affordable tool for population surveillance of vitamin A, iron, and iodine deficiencies as well as falciparum malarial parasitemia infectivity and inflammation. The assay is easy-to-use, requires minimal sample volume, and is scalable, rapid, and accurate—needing only a low-cost reader and basic equipment present in most reference laboratory settings and so may be employed by low and middle income countries for micronutrient surveillance to inform on status in key populations. Micronutrient deficiencies including iron, iodine, and vitamin A affect a significant portion of the world’s population. Efforts to assess the prevalence of these deficiencies in vulnerable populations are challenging, partly due to measurement tools that are inadequate for assessing multiple micronutrients in large-scale population surveys. We have developed a 7-plex immunoassay for the simultaneous measurement of seven biomarkers relevant to assessing iodine, iron, and vitamin A status, inflammation and Plasmodium falciparum parasitemia by measuring levels of thyroglobulin, ferritin, soluble transferrin receptor, retinol binding protein 4, α-1-acid glycoprotein, C-reactive protein, and histidine-rich protein II. This 7-plex immunoassay technique has potential as a rapid and effective tool for use in large-scale surveys and assessments of nutrition intervention programs in low- and middle-income countries.
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Affiliation(s)
- Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States of America
| | | | | | - Sonja Y. Hess
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
| | - K. Ryan Wessells
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
| | - Césaire T. Ouédraogo
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
- Helen Keller International, Niamey, Niger
| | - Sara Stinca
- Laboratory of Human Nutrition, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | - Roger Peck
- PATH, Seattle, WA, United States of America
| | - Abby Tyler
- Quansys Biosciences, Logan, Utah, United States of America
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Stinca S, Andersson M, Herter-Aeberli I, Chabaa L, Cherkaoui M, El Ansari N, Aboussad A, Weibel S, Zimmermann MB. Moderate-to-Severe Iodine Deficiency in the "First 1000 Days" Causes More Thyroid Hypofunction in Infants Than in Pregnant or Lactating Women. J Nutr 2017; 147:589-595. [PMID: 28202636 DOI: 10.3945/jn.116.244665] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/16/2016] [Accepted: 01/12/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Iodine deficiency early in the life cycle-the "first 1000 days"-can cause hypothyroidism and irreversibly impair neuromotor development. However, the relative vulnerability among women and infants during this critical period is unclear, making it difficult for country-based programs with limited resources to prioritize their iodine interventions.Objective: Our aim was to determine the prevalence of thyroid hypofunction in women and infants living in an area of moderate-to-severe iodine deficiency.Methods: In a cross-sectional survey in Morocco, we measured urinary iodine concentrations (UICs) and concentrations of thyroid-stimulating hormone (TSH) and total or free thyroxine (TT4 or fT4, respectively) in women of reproductive age (n = 156), pregnant women (n = 245), and lactating women (n = 239) and their young infants (n = 239). We calculated daily iodine intakes and measured iodine concentrations in breast milk and household salt. We compared the incidence of hypothyroidism between the 3 groups of women and with the infants.Results: Women of reproductive age, pregnant women, and lactating women had median (IQR) UICs of 41 (29-63), 32 (17-58), and 35 (19-62) μg/L; and estimated iodine intakes were ∼60%, 22%, and 26% of Recommended Nutrient Intakes (RNIs). The infants' median UIC was 73 (28-157) μg/L, which was greater than for all 3 groups of women (P < 0.001), and their dietary intakes were 27% of the RNI. The prevalence of hypothyroidism was not significantly different between the 4 groups, whereas the prevalence of hypothyroxinemia was higher in infants (40%) than in the 3 groups of women (11-14%) (P < 0.001). The median breast-milk iodine concentration was 42 (26-81) μg/L. Only 6% of salt samples were adequately iodized to a concentration of ≥15 ppm; 54% were inadequately iodized and 40% contained no measurable iodine.Conclusions: In an area of moderate-to-severe iodine deficiency, the prevalence of thyroid hypofunction is ∼4-fold higher in young infants compared with the 3 groups of women, suggesting that, in the "first 1000 days," infants are more vulnerable than their mothers and that programs should prioritize iodine prophylaxis for this group.
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Affiliation(s)
- Sara Stinca
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland;
| | - Maria Andersson
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Isabelle Herter-Aeberli
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Laila Chabaa
- Mohammed VI University Hospital, Marrakesh, Morocco; and.,Medical and Pharmaceutical Faculty, University Cady Ayyad, Marrakesh, Morocco
| | | | - Nawal El Ansari
- Mohammed VI University Hospital, Marrakesh, Morocco; and.,Medical and Pharmaceutical Faculty, University Cady Ayyad, Marrakesh, Morocco
| | - Abdelmounaim Aboussad
- Mohammed VI University Hospital, Marrakesh, Morocco; and.,Medical and Pharmaceutical Faculty, University Cady Ayyad, Marrakesh, Morocco
| | - Sandra Weibel
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland;
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Stinca S, Andersson M, Weibel S, Herter-Aeberli I, Fingerhut R, Gowachirapant S, Hess SY, Jaiswal N, Jukic T, Kusic Z, Mabapa NS, Nepal AK, San Luis TOL, Zhen JQ, Zimmermann MB. Dried Blood Spot Thyroglobulin as a Biomarker of Iodine Status in Pregnant Women. J Clin Endocrinol Metab 2017; 102:23-32. [PMID: 27732337 DOI: 10.1210/jc.2016-2829] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 07/28/2016] [Accepted: 10/06/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT Thyroglobulin (Tg) could be a sensitive biomarker of iodine nutrition in pregnant women (PW). A dried blood spot (DBS) assay would simplify collection and transport in field studies. OBJECTIVES Our aims were to (1) establish and test a reference range for DBS-Tg in PW; (2) determine whether co-measurement of Tg antibodies (Abs) is necessary to define population iodine status. DESIGN, SETTING, AND PARTICIPANTS Standardized cross-sectional studies of 3870 PW from 11 countries. For the DBS-Tg reference range, we included TgAb-negative PW (n = 599) from 3 countries with sufficient iodine intake. MAIN OUTCOME MEASURES We measured the urinary iodine concentration and DBS thyroid-stimulating hormone, total thyroxin, Tg, and TgAb. RESULTS In the reference population, the median DBS-Tg was 9.2 μg/L (95% confidence interval, 8.7 to 9.8 μg/L) and was not significantly different among trimesters. The reference range was 0.3 to 43.5 μg/L. Over a range of iodine intake, the Tg concentrations were U-shaped. Within countries, the median DBS-Tg and the presence of elevated DBS-Tg did not differ significantly between all PW and PW who were TgAb-negative. CONCLUSIONS A median DBS-Tg of ∼10 μg/L with <3% of values ≥44 μg/L indicated population iodine sufficiency. Concurrent measurement of TgAb did not appear necessary to assess the population iodine status.
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Affiliation(s)
- Sara Stinca
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich 8092, Switzerland
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich 8092, Switzerland
| | - Sandra Weibel
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich 8092, Switzerland
| | - Isabelle Herter-Aeberli
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich 8092, Switzerland
| | - Ralph Fingerhut
- Swiss Newborn Screening Laboratory, Children's Research Center (CRC), University Children's Hospital of Zurich, Zurich 8032, Switzerland
| | | | - Sonja Y Hess
- Department of Nutrition, University of California, Davis, Davis, California 95616
| | - Nidhi Jaiswal
- St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore 560034, India
| | - Tomislav Jukic
- Department of Oncology and Nuclear Medicine, University of Zagreb School of Medicine, Sisters of Charity University Hospital Centre, Zagreb 10,000, Croatia
| | - Zvonko Kusic
- Department of Oncology and Nuclear Medicine, University of Zagreb School of Medicine, Sisters of Charity University Hospital Centre, Zagreb 10,000, Croatia
| | | | - Ashwini Kumar Nepal
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Ghopa, Dharan 56700, Nepal
| | | | - Jia Qing Zhen
- Shanxi Institute for Endemic Disease Prevention and Treatment, LinFen 041000, China
| | - Michael Bruce Zimmermann
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, ETH Zurich, Zurich 8092, Switzerland
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Stinca S, Andersson M, Erhardt J, Zimmermann MB. Development and Validation of a New Low-Cost Enzyme-Linked Immunoassay for Serum and Dried Blood Spot Thyroglobulin. Thyroid 2015; 25:1297-305. [PMID: 26528830 DOI: 10.1089/thy.2015.0428] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 11/12/2022]
Abstract
BACKGROUND Thyroglobulin (Tg), a biomarker of iodine nutrition, can be measured on dried blood spots (DBS), which simplifies collection and transport in surveys. The World Health Organization recommends DBS-Tg for monitoring iodine status in children. It could also be a useful iodine biomarker during pregnancy. However, the Tg antibody (Ab) used in earlier DBS-Tg assays is no longer commercially available. The aims of the present study were: (i) to develop a new low-cost serum and DBS-Tg sandwich enzyme-linked immunosorbent assay for assessment of Tg in population studies; (ii) to check the stability of DBS-Tg during long-term storage; and (iii) to assess within-subject variability in DBS-Tg. METHODS Serum and DBS samples were measured from healthy pregnant women (n = 424) with the new assays, as well as the Immulite 2000 (Siemens), including TgAb positive (n = 150) and TgAb negative (n = 274) women. DBS-Tg stability was tested over 15 weeks of storage at -20 °C. Within-subject variability was evaluated over four weeks in four healthy adults. RESULTS Intra-assay and interassay variability was 4.4-7.3% and 10.1-12.9% for the new serum Tg assay, and 7.6-12.3% and 7.6-16.5% for the DBS-Tg assay. Correlation between the two serum methods was high (r = 0.68, p < 0.01). Assay performance in all women and those TgAb negative was comparable. Correlation between the new serum Tg assay and the DBS-Tg assay was high (r = 0.78, p < 0.01), and agreement expressed as a function of the average Tg concentration for the two methods (X) was 0.59X -4.59 μg/L. DBS-Tg was stable for 15 weeks stored at -20 °C. Within-subject variability in DBS-Tg was 21.1%. Reagents and antibodies costs for the new serum and DBS assays are ∼ US$1. CONCLUSIONS These new low-cost serum and DBS-Tg assays perform well over a wide range of Tg concentrations, and the field-friendly DBS assay may be particularly useful in population studies of iodine nutrition.
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Affiliation(s)
- Sara Stinca
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
| | - Maria Andersson
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
| | - Jürgen Erhardt
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food Nutrition and Health, Swiss Federal Institute of Technology (ETH) , Zurich, Switzerland
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Herter-Aeberli I, Cherkaoui M, El Ansari N, Rohner R, Stinca S, Chabaa L, von Eckardstein A, Aboussad A, Zimmermann MB. Iodine Supplementation Decreases Hypercholesterolemia in Iodine-Deficient, Overweight Women: A Randomized Controlled Trial. J Nutr 2015; 145:2067-75. [PMID: 26203098 DOI: 10.3945/jn.115.213439] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/30/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In iodine deficiency, thyrotropin (TSH) may increase to stimulate thyroidal iodine uptake. In iodine-sufficient populations, higher TSH predicts higher total cholesterol. Whether higher TSH caused by iodine deficiency affects serum lipids is uncertain. OBJECTIVE Our aim was to determine if iodine repletion decreases serum TSH and improves the lipid profile. METHODS In this randomized controlled intervention, iodine-deficient, overweight or obese Moroccan women (n = 163) received 200 μg oral iodine or a placebo daily for 6 mo. Main outcomes were serum TSH and plasma total and LDL cholesterol. Secondary outcomes included thyroid hormones and measures of lipid and glucose metabolism and urinary iodine concentration (UIC). Data were compared by using mixed-model analysis. RESULTS In the intervention group, median UIC increased from 38 (95% CI: 34, 45) μg/L to 77 (95% CI: 59, 89) μg/L (P < 0.001). After 6 mo of intervention, TSH was 33% lower in the treatment group than in the placebo group (P = 0.024). The triiodothyronine (T3) to thyroxine (T4) ratio and thyroglobulin decreased with treatment [-15% (P = 0.002) and -32% (P < 0.001), respectively], whereas T4 concentrations were higher in the treatment group (P < 0.001). Total cholesterol in subjects with elevated baseline cholesterol (>5 mmol/L) was reduced by 11% after the intervention (P = 0.034). At 6 mo, only 21.5% of treated women remained hypercholesterolemic (total cholesterol >5 mmol/L) vs. 34.8% of controls (baseline: 44.2% in the intervention and 36.8% in the control group; P = 0.015). The reduction in the prevalence of elevated LDL cholesterol (>3 mmol/L) in the intervention group (50.6% to 35.4% compared with 47.4% to 44.9% in the control group) was not significant (P-interaction = 0.23). CONCLUSIONS Our findings suggest that moderate to severe iodine deficiency in overweight women elevates serum TSH and produces a more atherogenic lipid profile and that iodine supplementation in this group reduces the prevalence of hypercholesterolemia. Thus, iodine prophylaxis may reduce cardiovascular disease risk in overweight adults. This trial was registered at clinicaltrials.gov as NCT01985204.
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Affiliation(s)
- Isabelle Herter-Aeberli
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland;
| | | | - Nawal El Ansari
- Medical and Pharmaceutical Faculty, University Cady Ayyad, Marrakesh, Morocco; Mohammed VI University Hospital, Marrakesh, Morocco
| | - Riccarda Rohner
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| | - Sara Stinca
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland
| | - Laila Chabaa
- Mohammed VI University Hospital, Marrakesh, Morocco
| | | | - Abdelmounaim Aboussad
- Medical and Pharmaceutical Faculty, University Cady Ayyad, Marrakesh, Morocco; Mohammed VI University Hospital, Marrakesh, Morocco
| | - Michael B Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland; Iodine Global Network, Zurich, Switzerland
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Granfors M, Andersson M, Stinca S, Åkerud H, Skalkidou A, Sundström Poromaa I, Wikström AK, Filipsson Nyström H. Iodine deficiency in a study population of pregnant women in Sweden. Acta Obstet Gynecol Scand 2015; 94:1168-74. [DOI: 10.1111/aogs.12713] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/09/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Michaela Granfors
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Maria Andersson
- Human Nutrition Laboratory; Department of Health Sciences and Technology; Swiss Federal Institute of Technology (ETH) Zurich; Zurich Switzerland
- The Iodine Global Network (IGN); Zurich Switzerland
| | - Sara Stinca
- Human Nutrition Laboratory; Department of Health Sciences and Technology; Swiss Federal Institute of Technology (ETH) Zurich; Zurich Switzerland
| | - Helena Åkerud
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | | | - Anna-Karin Wikström
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - Helena Filipsson Nyström
- Department of Endocrinology; Sahlgrenska University Hospital; Göteborg Sweden
- Sahlgrenska Academy at University of Gothenburg; Göteborg Sweden
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Bouhouch RR, Bouhouch S, Cherkaoui M, Aboussad A, Stinca S, Haldimann M, Andersson M, Zimmermann MB. Direct iodine supplementation of infants versus supplementation of their breastfeeding mothers: a double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol 2014; 2:197-209. [PMID: 24622750 DOI: 10.1016/s2213-8587(13)70155-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Iodine deficiency in infants can damage the developing brain and increase mortality. Present recommendations state that oral iodised oil should be given to breastfeeding mothers to correct iodine deficiency in infancy when iodised salt is not available, and that direct supplementation should be given to infants who are not being breastfed or receiving iodine-fortified complimentary foods. However, there is little evidence for these recommendations. We aimed to assess the safety and efficacy of direct versus indirect supplementation of the infant. METHODS We did this double blind, randomised, placebo-controlled trial in Morocco. Healthy breastfeeding mothers and their term newborn babies (aged ≤8 weeks) were block randomised by clinic day to receive either: one dose of 400 mg iodine to the mother and placebo to the infant (indirect infant supplementation), or one dose of about 100 mg iodine to the infant and placebo to the mother (direct infant supplementation). Randomisation was masked to participants and investigators. Coprimary outcomes were: maternal and infant urinary iodine concentrations, breastmilk iodine concentration, maternal and infant thyroid-stimulating hormone (TSH) concentrations, maternal and infant thyroxine (T4) concentrations, and infant growth. These outcomes were measured at baseline, and when infants were aged about 3 months, 6 months, and 9 months, and the two groups were compared using mixed effects models. This study is registered with ClinicalTrials.gov, number NCT01126125. FINDINGS We recruited 241 mother-infant pairs between Feb 25, and Aug 10, 2010, and completed data collection by Aug 6, 2011. At baseline, median urinary iodine concentration was 35 μg/L (IQR 29-40) in mothers and 73 μg/L (29-237) in infants, suggesting iodine deficiency. During the study, maternal urinary iodine concentration (p=0.011), breastmilk iodine concentration (p<0.0001), and infant urinary iodine concentration (p=0.042) were higher in the indirect infant supplementation group than in the direct supplementation group. Maternal TSH (p=0.276) and T4 (p=0.074) concentrations did not differ between the groups over the course of the study, nor did infant TSH (p=0.597) and T4 (p=0.184) concentrations, but the number of infants with thyroid hypofunction was lower (p=0.023) in the indirect supplementation group than the direct supplementation group. The infant groups did not differ in anthropomorphic measures, except that length-for-age Z score was slightly greater in the direct infant supplementation group (p=0.032). At 3 months and 6 months of age, median infant urinary iodine concentration in the indirect infant supplementation group was sufficient (>100 μg/L), whereas infant urinary iodine concentration was sufficient only at 6 months in the direct supplementation group. There were no serious adverse events in either group. INTERPRETATION In regions of moderate-to-severe iodine deficiency without effective salt iodisation, lactating women who receive one dose of 400 mg iodine as oral iodised oil soon after delivery can provide adequate iodine to their infants through breastmilk for at least 6 months, enabling the infants to achieve euthyroidism. Direct supplementation is less effective in improving infant iodine status. FUNDING ETH Zurich, Switzerland; the Medicor Foundation, Vaduz, Lichtenstein.
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Affiliation(s)
| | - Sabir Bouhouch
- Laboratory of Human Ecology, Faculty of Sciences Semlalia, University Cadi Ayyad Marrakesh, Morocco
| | - Mohamed Cherkaoui
- Laboratory of Human Ecology, Faculty of Sciences Semlalia, University Cadi Ayyad Marrakesh, Morocco
| | - Abdelmounaim Aboussad
- Mohammed VI University Hospital, Marrakesh, Morocco; Medical Faculty, University Cadi Ayyad, Marrakesh, Morocco
| | - Sara Stinca
- Laboratory of Human Nutrition, ETH Zurich, Zurich, Switzerland
| | - Max Haldimann
- Consumer Protection Directorate, Federal Office of Public Health, Bern, Switzerland
| | - Maria Andersson
- Laboratory of Human Nutrition, ETH Zurich, Zurich, Switzerland; The International Council for the Control of Iodine Deficiency Disorders Global Network, Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, ETH Zurich, Zurich, Switzerland; The International Council for the Control of Iodine Deficiency Disorders Global Network, Zurich, Switzerland.
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Bouhouch RR, Bouhouch S, Stinca S, Cherkaoui M, Aboussad A, Andersson M, Zimmermann M. Infant iodine supplementation and motor and cognitive development: a randomized controlled trial. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.346.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Sara Stinca
- Laboratory of Human NutritionETHZurichSwitzerland
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Payne AN, Chassard C, Zimmermann M, Müller P, Stinca S, Lacroix C. The metabolic activity of gut microbiota in obese children is increased compared with normal-weight children and exhibits more exhaustive substrate utilization. Nutr Diabetes 2011; 1:e12. [PMID: 23154580 PMCID: PMC3302137 DOI: 10.1038/nutd.2011.8] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [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: 12/11/2022] Open
Abstract
Objective: The gut microbiota contribute otherwise impossible metabolic functions to the human host. Shifts in the relative proportions of gut microbial communities in adults have been correlated with intestinal disease and have been associated with obesity. The aim of this study was to elucidate differences in gut microbial compositions and metabolite concentrations of obese versus normal-weight children. Materials and methods: Fecal samples were obtained from obese (n=15; mean body mass index (BMI) s.d. score=1.95) and normal-weight (n=15; BMI s.d. score=−0.14) Swiss children aged 8–14 years. Composition and diversity of gut microbiota were analyzed by qPCR and temperature gradient gel electrophoresis (TGGE). Results: No significant quantitative differences in gut microbiota communities of obese and normal-weight children were identified. Microbial community profiling by TGGE revealed a high degree of both intra- and intergroup variation. Intergroup comparison of TGGE profiles failed to identify any distinct populations exclusive to either obese or normal-weight children. High-pressure liquid chromatography analysis identified significantly higher (P<0.05) concentrations of short-chain fatty acids (SCFA) butyrate and propionate in obese versus normal-weight children. Significantly lower concentrations of intermediate metabolites were detected in obese children, suggesting exhaustive substrate utilization by obese gut microbiota. Conclusions: Our results indicate that a dysbiosis may be involved in the etiology of childhood obesity. In turn, aberrant and overactive metabolic activity within the intestine could dictate survival or loss of individual microbial communities, leading to the altered population ratios previously identified in adult obesity.
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Affiliation(s)
- A N Payne
- Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland
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