1
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Lone AH, Tang J, Pignalosa A, Hsu HH, Abdul-Sater AA, Sweeney G. A novel blood-based bioassay to monitor adiponectin signaling. Int Immunopharmacol 2024; 132:111890. [PMID: 38547772 DOI: 10.1016/j.intimp.2024.111890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 05/01/2024]
Abstract
The diverse beneficial effects of adiponectin-receptor signaling, including its impact on the regulation of inflammatory processes in vivo, have resulted in development of adiponectin receptor agonists as a treatment for metabolic disorders. However, there are no established non-invasive bioassays for detection of adiponectin target engagement in humans or animal models. Here, we designed an assay using small amounts of blood to assess adiponectin action. Specifically, we tested effects of the small 10-amino acid peptide adiponectin receptor agonist, ALY688, in a sublethal LPS endotoxemia model in mice. LPS-induced pro-inflammatory cytokine levels in serum were significantly reduced in mice treated with ALY688, assessed via multiplex ELISA in flow cytometry. Furthermore, ALY688 alone significantly induced TGF-β release in serum 1 h after treatment and was elevated for up to 24 h. Additionally, using a flow-cytometry panel for detection of changes in circulating immune cell phenotypes, we observed a significant increase in absolute T cell counts in mice after ALY688 treatment. To assess changes in intracellular signaling effectors downstream of adiponectin, phospho-flow cytometry was conducted. There was a significant increase in phosphorylation of AMPK and p38-MAPK in mice after ALY688 treatment. We then used human donor immune cells (PBMCs) treated with ALY688 ex vivo and observed elevation of AMPK and p38-MAPK phosphorylation from baseline in response to ALY688. Together, these results indicate we can detect adiponectin action on immune cells in vivo by assessing adiponectin signaling pathway for AMPK and p38-MAPK, as well as pro-inflammatory cytokine levels. This new approach provides a blood-based bioassay for screening adiponectin action.
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Affiliation(s)
| | - Jialing Tang
- Department of Biology, York University, Toronto, ON, Canada
| | | | - Henry H Hsu
- Allysta Pharmaceuticals Inc., Bellevue, WA, USA
| | - Ali A Abdul-Sater
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| | - Gary Sweeney
- Department of Biology, York University, Toronto, ON, Canada.
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2
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Yoshida T, Delaney A. Impact of Childhood Cancer on Growth. J Clin Endocrinol Metab 2024; 109:e892-e900. [PMID: 37539847 DOI: 10.1210/clinem/dgad457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/02/2023] [Indexed: 08/05/2023]
Abstract
Along with improvements in cancer treatment over time, the number of childhood cancer survivors has been growing. Survivors are at risk for serious medical complications, and growth impairment is among the most common. There are multiple factors that may cause impaired growth among survivors. In this article, we review the impact of cancer on growth in children and adolescents. We first provide an overview of growth disturbance among childhood cancer patients and survivors due to nonhormonal causes, including a recent understanding of the effect of targeted cancer therapies (eg, tyrosine kinase inhibitors and immune checkpoint inhibitors) on growth. Then we describe the hormonal causes of growth impairment among survivors, focusing on growth hormone deficiency, including the prevalence, risk factors, and treatment. Lastly, we briefly summarize overgrowth and tall stature in childhood cancer. It is critical to assess the linear growth of children and adolescents, especially in cancer survivors who are at risk for growth disturbance, since growth is an important measure of their health.
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Affiliation(s)
- Tomoko Yoshida
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Angela Delaney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
- Division of Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
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3
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Zhao Y, Mäkitie O, Laakso S, Fedosova V, Sävendahl L, Zaman F. A novel link between chronic inflammation and humanin regulation in children. Front Endocrinol (Lausanne) 2024; 14:1142310. [PMID: 38322155 PMCID: PMC10844658 DOI: 10.3389/fendo.2023.1142310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024] Open
Abstract
Objective Children with inflammatory bowel disease (IBD) often suffer from poor bone growth and impaired bone health. Humanin is a cytoprotective factor expressed in bone and other tissues and we hypothesized that humanin levels are suppressed in conditions of chronic inflammation. To address this, humanin levels were analyzed in serum samples from IBD patients and in ex vivo cultured human growth plate tissue specimens exposed to IBD serum or TNF alone. Methods Humanin levels were measured by ELISA in serum from 40 children with IBD and 40 age-matched healthy controls. Growth plate specimens obtained from children undergoing epiphysiodesis surgery were cultured ex vivo for 48 hours while being exposed to IBD serum or TNF alone. The growth plate samples were then processed for immunohistochemistry staining for humanin, PCNA, SOX9 and TRAF2 expression. Dose-response effect of TNF was studied in the human chondrocytic cell line HCS-2/8. Ex vivo cultured fetal rat metatarsal bones were used to investigate the therapeutic effect of humanin. Results Serum humanin levels were significantly decreased in children with IBD compared to healthy controls. When human growth plate specimens were cultured with IBD serum, humanin expression was significantly suppressed in the growth plate cartilage. When cultured with TNF alone, the expression of humanin, PCNA, SOX9, and TRAF2 were all significantly decreased in the growth plate cartilage. Interestingly, treatment with the humanin analog HNG prevented TNF-induced bone growth impairment in cultured metatarsal bones. Conclusion Our data showing suppressed serum humanin levels in IBD children with poor bone health provides the first evidence for a potential link between chronic inflammation and humanin regulation. Such a link is further supported by the novel finding that serum from IBD patients suppressed humanin expression in ex vivo cultured human growth plates.
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Affiliation(s)
- Yunhan Zhao
- Department of Women’s and Children’s Health, Karolinska Institutet and Pediatric Endocrinology Unit, Karolinska University Hospital, Solna, Sweden
| | - Outi Mäkitie
- Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Saila Laakso
- Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Vera Fedosova
- Department of Women’s and Children’s Health, Karolinska Institutet and Pediatric Endocrinology Unit, Karolinska University Hospital, Solna, Sweden
| | - Lars Sävendahl
- Department of Women’s and Children’s Health, Karolinska Institutet and Pediatric Endocrinology Unit, Karolinska University Hospital, Solna, Sweden
| | - Farasat Zaman
- Department of Women’s and Children’s Health, Karolinska Institutet and Pediatric Endocrinology Unit, Karolinska University Hospital, Solna, Sweden
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4
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Ahn MB, Yoo IH. Risk Factors of Low Bone Mineral Density in Newly Diagnosed Pediatric Inflammatory Bowel Disease. Nutrients 2023; 15:5048. [PMID: 38140307 PMCID: PMC10746078 DOI: 10.3390/nu15245048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/22/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract with an increasing worldwide incidence. IBD is frequently diagnosed during childhood in the adolescent period of ongoing growth and development, and it can affect patients' linear growth, puberty, nutrition, and bone health. Therefore, its treatment and monitoring are critical to prevent secondary outcomes. However, few studies have highlighted the association between pediatric IBD and skeletal outcomes in Asian populations. We aimed to identify the prevalence and risk factors for low bone mineral density (BMD) in Korean children and adolescents with newly diagnosed IBD. Patients aged 10-18 years diagnosed with either Crohn's disease (CD) or ulcerative colitis (UC) who underwent lumbar spine bone mineral density (LSBMD) and femoral bone mineral density (FBMD) analyses via dual-energy X-ray absorptiometry at the time of IBD diagnosis were included. Low BMD was considered when the age- and sex-matched BMD Z-score was <-1.0. The LSBMD and FBMD Z-scores were correlated with clinical parameters, including general characteristics, anthropometry, and IBD-associated laboratory markers. Regression analyses were performed to identify the risk factors for low BMD. Although the general characteristics between CD (n = 42) and UC (n = 9) groups did not differ, the mean Z-scores of LSBMD and FBMD of the 51 subjects were -0.11 ± 1.24 and -0.58 ± 1.38, respectively. Furthermore, 7.8% and 18% of the study subjects had LSBMD and FBMD Z-scores < -2.0, whereas more than 50% had scores of 0--1.0. Among the clinical factors, body mass index (BMI) Z-score, duration of clinical manifestations, and serum alanine aminotransferase and selenium levels were associated with LSBMD Z-scores in the final multivariate regression analyses. Odds ratios of BMI < -2.0 standard deviation for low LSBMD and FBMD Z-scores were 31.97 and 41.45, respectively. A BMI Z-score < -0.93 was determined as the best cut-off for predicting low BMD. In newly diagnosed pediatric IBD, a substantial number of children are likely to have low BMD in prior to initial treatment while lower BMI, longer duration of clinical manifestation, and higher selenium concentration could affect initial BMD status. Routine bone health surveillance from initial IBD diagnosis throughout the treatment's completion is recommended for preventing the early development of secondary osteoporosis.
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Affiliation(s)
| | - In Hyuk Yoo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
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Bhatti G, Villalon A, Li R, Elammari M, Price A, Steele L, Garcia JM, Marcelli M, Jorge R. Hormonal changes in veterans with Gulf War Illness. Life Sci 2023; 328:121908. [PMID: 37406768 DOI: 10.1016/j.lfs.2023.121908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
AIMS Gulf War Illness (GWI) is a multi-system condition of complex etiology and pathophysiology without specific treatment. There is an overlap between the symptoms of GWI and endocrinopathies. This study aimed to identify hormonal alterations in 1990-91 Gulf War (GW) veterans and the relationship between GWI and hormonal dysregulation. MAIN METHODS Data from 81 GW veterans (54 with GWI and 27 controls without GWI) was analyzed in a cross-sectional, case-control observational study. Participants completed multiple questionnaires, neuropsychiatric assessments, and a comprehensive set of hormone assays including a glucagon stimulation test (GST) for adult growth hormone deficiency (AGHD) and a high-dose adrenocorticotropic hormone (ACTH) stimulation test for adrenal insufficiency. KEY FINDINGS The GWI group had lower quality of life and greater severity of all symptoms compared to controls. Pain intensity and pain-related interference with general activity were also higher in the GWI group. AGHD was observed in 18 of 51 veterans with GWI (35.3 %) and 2 of 26 veterans without GWI (7.7 %) (p = 0.012 for interaction). Veterans with GWI also exhibited reduced insulin-like growth factor 1 (IGF-1) levels and IGF-1 Z-scores compared to controls. One participant with GWI met the criteria for adrenal insufficiency. No significant changes were observed in other hormonal axes. SIGNIFICANCE The frequency of AGHD was significantly higher in veterans with GWI compared to controls. Recombinant human growth hormone replacement therapy (GHRT) may become a breakthrough therapeutic option for this subgroup. A large clinical trial is needed to evaluate the efficacy of GHRT in patients with GWI and AGHD.
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Affiliation(s)
- Gursimrat Bhatti
- Michael E. DeBakey VA Medical Center, Seattle, WA, USA; Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA
| | - Audri Villalon
- Michael E. DeBakey VA Medical Center, Seattle, WA, USA; Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA
| | - Ruosha Li
- UT Health Science Center School of Public Health, Seattle, WA, USA
| | - Mohamed Elammari
- Michael E. DeBakey VA Medical Center, Seattle, WA, USA; Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA
| | - Alexandra Price
- Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA
| | - Lea Steele
- Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA
| | - Jose M Garcia
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, and Gerontology and Geriatric Medicine-Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Ricardo Jorge
- Michael E. DeBakey VA Medical Center, Seattle, WA, USA; Beth K and Stuart C Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Seattle, WA, USA.
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6
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Rahimpour S, Jabbari H, Yousofi H, Fathi A, Mahmoodi S, Jafarian MJ, Shomali N, Shotorbani SS. Regulatory effect of sericin protein in inflammatory pathways; A comprehensive review. Pathol Res Pract 2023; 243:154369. [PMID: 36812737 DOI: 10.1016/j.prp.2023.154369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
Sericin protein is a type of protein derived from silk cocoons. Sericin hydrogen bonds cause adhesion to the silk cocoon. This substance contains a large amount of serine amino acids in its structure. At first, the medicinal properties of this substance were unknown, but today many properties have been discovered for this substance. The unique properties of this substance have made it widely used in the pharmaceutical and cosmetic industries. The applications of Sericin in pharmacy are as follows. Sericin is used to repair wounds by producing collagen. Other uses for the drug include anti-diabetic, anti-cholesterol, metabolic modulator, anti-tumor, heart protection, antioxidant, antibacterial, wound healing, cell proliferation, UV protection, freezing, and skin moisturizing. The physicochemical properties of Sericin have attracted the attention of pharmacists and their widespread use in the production of drugs and treatment of diseases. One of the critical and unique properties of Sericin is its anti-inflammatory property. In this article, this property of Sericin is discussed in detail, and according to the experiments performed by pharmacists, this substance has shown a significant effect in eliminating inflammation. This study aimed to evaluate the impact of Sericin protein in relieving inflammation.
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Affiliation(s)
- Sina Rahimpour
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Jabbari
- Department of Chemistry, Payame Noor University, P.O. Box 19395-4697, Tehran, Iran
| | - Hajar Yousofi
- Faculty of paramedical science, Islamic Azad University Tehran Medical Branch, Tehran, Iran
| | - Arian Fathi
- School of Pharmacy, Shiraz university of medical science, Shiraz, Iran
| | - Shiva Mahmoodi
- School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Navid Shomali
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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7
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Liang X, Xie Y, Liu X, Xu H, Ren H, Tang S, Liu Q, Huang M, Shao X, Li C, Zhou Y, Geng M, Xie Z, Liu H. Discovery of Novel Imidazo[4,5- c]quinoline Derivatives to Treat Inflammatory Bowel Disease (IBD) by Inhibiting Multiple Proinflammatory Signaling Pathways and Restoring Intestinal Homeostasis. J Med Chem 2022; 65:11949-11969. [PMID: 36053746 DOI: 10.1021/acs.jmedchem.2c00390] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As a complex pathogenesis driven by immune inflammatory factors and intestinal microbiota, the treatment of inflammatory bowel disease (IBD) may rely on the comprehensive regulation of these important pathogenic factors to reach a favorable therapeutic effect. In the current study, we discovered a series of imidazo[4,5-c]quinoline derivatives that potently and simultaneously inhibited two primary proinflammatory signaling pathways JAK/STAT and NF-κB. Especially, lead compound 8l showed potent inhibitory activities against interferon-stimulated genes (IC50: 3.3 nM) and NF-κB pathways (IC50: 150.7 nM) and decreased the release of various proinflammatory factors at the nanomolar level, including IL-6, IL-8, IL-1β, TNF-α, IL-12, and IFN-γ. In vivo, 8l produced a strong anti-inflammatory activity in both dextran sulfate sodium (DSS)- and 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced acute enteritis models and restored the structural composition of gut microbiota. Collectively, this study provided valuable lead compounds for the treatment of IBD and revealed the great anti-inflammatory potential of the simultaneous suppression of JAK/STAT and NF-κB signals.
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Affiliation(s)
- Xuewu Liang
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Yongle Xie
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Xuyi Liu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Hui Xu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Hairu Ren
- School of Pharmaceutical Science and Technology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou310024, China
| | - Shuai Tang
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Qi Liu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Min Huang
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Xueqing Shao
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Chunpu Li
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Yu Zhou
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Meiyu Geng
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Zuoquan Xie
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China
| | - Hong Liu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, 555 Zu Chong Zhi Road, Shanghai201203, China.,University of Chinese Academy of Sciences, Beijing100049, China.,School of Pharmaceutical Science and Technology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou310024, China
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8
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Hulst JM, Huysentruyt K, Gerasimidis K, Shamir R, Koletzko B, Chourdakis M, Fewtrell M, Joosten KF. A Practical Approach to Identifying Pediatric Disease-Associated Undernutrition: A Position Statement from the ESPGHAN Special Interest Group on Clinical Malnutrition. J Pediatr Gastroenterol Nutr 2022; 74:693-705. [PMID: 35258497 DOI: 10.1097/mpg.0000000000003437] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
ABSTRACT Disease-associated undernutrition (DAU) is still common in hospitalized children and is generally accepted to be associated with adverse effects on disease outcomes; hence making proper identification and assessment essential in the management of the sick child. There are however several barriers to routine screening, assessment, and treatment of sick children with poor nutritional status or DAU, including limited resources, lack of nutritional awareness, and lack of agreed nutrition policies. We recommend all pediatric facilities to 1) implement procedures for identification of children with (risk of) DAU, including nutritional screening, criteria for further assessment to establish diagnosis of DAU, and follow-up, 2) assess weight and height in all children asa minimum, and 3) have the opportunity for children at risk to be assessed by a hospital dietitian. An updated descriptive definition of pediatric DAU is proposed as "Undernutrition is a condition resulting from imbalanced nutrition or abnormal utilization of nutrients which causes clinically meaningful adverse effects on tissue function and/or body size/composition with subsequent impact on health outcomes." To facilitate comparison of undernutrition data, it is advised that in addition to commonly used criteria for undernutrition such as z score < -2 for weight-for-age, weight-for-length, or body mass index <-2, an unintentional decline of >1inthese z scores over time should be considered as an indicator requiring further assessment to establish DAU diagnosis. Since the etiology of DAU is multifactorial, clinical evaluation and anthropometry should ideally be complemented by measurements of body composition, assessment of nutritional intake, requirements, and losses, and considering disease specific factors.
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Affiliation(s)
- Jessie M Hulst
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario
- the Department of Pediatrics & Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Koen Huysentruyt
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario
- the Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Konstantinos Gerasimidis
- the Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Raanan Shamir
- the Institute of Gastroenterology, Nutrition and Liver diseases, Schneider Children's Medical Center, Petah Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Berthold Koletzko
- the LMU - Ludwig-Maximilians-Universitat Munich, Div. Metabolic and Nutritional Medicine, Department Paediatrics, Dr von Hauner Children's Hospital, LMU University Hospitals, Munich, Germany
| | - Michail Chourdakis
- the School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mary Fewtrell
- the UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Koen F Joosten
- the Department of Pediatrics and Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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9
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Gordon IO, Abushamma S, Kurowski JA, Holubar SD, Kou L, Lyu R, Rieder F. Paediatric Ulcerative Colitis Is a Fibrotic Disease and Is Linked with Chronicity of Inflammation. J Crohns Colitis 2021; 16:804-821. [PMID: 34849664 PMCID: PMC9228908 DOI: 10.1093/ecco-jcc/jjab216] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/20/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Intestinal fibrosis has recently been characterised in adult ulcerative colitis and may affect motility, diarrhoea, and the symptom of urgency. We aimed to charactersze the presence of fibrosis in paediatric patients with ulcerative colitis, and its link to severity and chronicity of mucosal inflammation, as well as clinical factors of severity. METHODS We performed a single-centre cross-sectional study in children ages 1-18 years with ulcerative colitis, undergoing colectomy or proctocolectomy. Tissue cross-sections were derived from proximal, mid, and distal colon and rectum, and inflammation and fibrosis were graded based on previously developed scores. Clinical data were collected prospectively. RESULTS From 62 patients, 205 intestinal sections were evaluated. Median age at diagnosis was 13 years, 100% had extensive colitis, and all resections were done for refractory disease. The presence, chronicity, and degree of inflammation were linked with the presence of fibrosis. Thickness of the muscularis mucosa was also linked with presence and chronicity of inflammation. The overall submucosal fibrosis burden was associated with prior anti-tumour necrosis factor use. CONCLUSIONS Paediatric patients with ulcerative colitis exhibit colorectal submucosal fibrosis and muscularis mucosa thickening, which correlate with the presence, chronicity, and degree of mucosal inflammation. Fibrosis should be recognised as a complication of paediatric ulcerative colitis, and ulcerative colitis should be considered a progressive disease.
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Affiliation(s)
- Ilyssa O Gordon
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Suha Abushamma
- Department of Gastroenterology, Washington University School of Medicine, Barnes Jewish Hospital, St Louis, MO,USA
| | - Jacob A Kurowski
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Stefan D Holubar
- Department of Colorectal Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lei Kou
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ruishen Lyu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Florian Rieder
- Corresponding author: Florian Rieder, MD, Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, 9500 Euclid Avenue – A3, Cleveland, OH, 44195, USA. Tel.: +1 [216] 445 4916; fax: +1 [216] 636 0104;
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10
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Steell L, Gray SR, Russell RK, MacDonald J, Seenan JP, Wong SC, Gaya DR. Pathogenesis of Musculoskeletal Deficits in Children and Adults with Inflammatory Bowel Disease. Nutrients 2021; 13:nu13082899. [PMID: 34445056 PMCID: PMC8398806 DOI: 10.3390/nu13082899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022] Open
Abstract
Musculoskeletal deficits are among the most commonly reported extra-intestinal manifestations and complications of inflammatory bowel disease (IBD), especially in those with Crohn’s disease. The adverse effects of IBD on bone and muscle are multifactorial, including the direct effects of underlying inflammatory disease processes, nutritional deficits, and therapeutic effects. These factors also indirectly impact bone and muscle by interfering with regulatory pathways. Resultantly, individuals with IBD are at increased risk of osteoporosis and sarcopenia and associated musculoskeletal morbidity. In paediatric IBD, these factors may contribute to suboptimal bone and muscle accrual. This review evaluates the main pathogenic factors associated with musculoskeletal deficits in children and adults with IBD and summarises the current literature and understanding of the musculoskeletal phenotype in these patients.
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Affiliation(s)
- Lewis Steell
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK; (L.S.); (S.R.G.)
| | - Stuart R. Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK; (L.S.); (S.R.G.)
| | - Richard K. Russell
- Department of Paediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh EH16 4TJ, UK;
| | - Jonathan MacDonald
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; (J.M.); (J.P.S.)
| | - John Paul Seenan
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK; (J.M.); (J.P.S.)
| | - Sze Choong Wong
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow G51 4TF, UK;
| | - Daniel R. Gaya
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
- Correspondence:
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Chronic inflammation and the growth hormone/insulin-like growth factor-1 axis. Cent Eur J Immunol 2021; 45:469-475. [PMID: 33613096 PMCID: PMC7882400 DOI: 10.5114/ceji.2020.103422] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/06/2020] [Indexed: 12/18/2022] Open
Abstract
Interactions between growth hormone (GH), insulin-like growth factor-1 (IGF-1), and the immune system are complex, bidirectional, but not fully explained. Current reviews based on numerous studies have indicated that chronic inflammation could suppress the GH/IGF-1 axis via several mechanisms such as relative GH and/or IGF-1 insufficiency, peripheral resistance to GH and/or IGF-1 resulting from down-regulation of GH and IGF-1 receptors, disruption in the GH/IGF-1 signalling pathways, dysregulation of IGF binding proteins (IGFBPs), reduced IGF bioavailability, and modified gene regulation due to changes in the microRNA system. It is well-known that relationships between the immune system and the GH/IGF-1 axis are mutual and GH as well as IGF-1 could modulate inflammatory response and the activity of systemic inflammation. Available data indicate that the GH/IGF-1 axis exerts both pro-inflammatory and anti-inflammatory effects. Pro-inflammatory cytokines such as interleukin-6 (IL-6), tumour necrosis factor-a (TNF-α), and interleukin-1b (IL-b) are some of the most significant factors, besides malnutrition, chronic stress, and prolonged use of glucocorticoids, which impair the activity of the GH/IGF-1 axis, and consequently lead to growth retardation in children suffering from childhood-onset chronic inflammatory diseases. In this review, we discuss the mechanisms underlying the impact of chronic inflammation on the GH/IGF-1 axis and growth processes during childhood and adolescence, based on a number of experimental and human studies.
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Amaro F, Chiarelli F. Growth and Puberty in Children with Inflammatory Bowel Diseases. Biomedicines 2020; 8:biomedicines8110458. [PMID: 33138015 PMCID: PMC7692295 DOI: 10.3390/biomedicines8110458] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022] Open
Abstract
Inflammatory bowel diseases (IBD) are gastrointestinal tract pathologies of unknown etiology; they have an alternating trend, with active and silent phases. IBD are classified in two main forms: ulcerative colitis (UC) and Crohn’s disease (CD). Both have chronic and recurrent course, gastrointestinal symptoms, and extraintestinal manifestations. The altered immune response role seems to be important both in UC and CD. In the majority of cases, CD begins with abdominal pain, diarrhea, decrease in appetite, and weight loss; there can be also perianal fistulas, rhagades, and perianal recurrent abscesses. In addition, retarded growth and delayed puberty can precede the development of the disease or can even be predominant at onset. Growth retardation is found in 40% of IBD patients, but the underlying mechanism of this and other extra-intestinal manifestations are partially known: the main hypotheses are represented by malnutrition and inflammatory response during the active phase of the disease. The increased level of pro-inflammatory cytokines can influence growth, but also the onset of puberty and its progression. In addition, it could be essential to clarify the role and the possible effects of all the currently used treatments concerning growth failure and delayed puberty.
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El Mouzan M, Alahmadi N, ALSaleeem KA, Assiri A, AlSaleem B, Al Sarkhy A. Prevalence of nutritional disorders in Saudi children with inflammatory bowel disease based on the national growth reference. Arab J Gastroenterol 2020; 21:179-182. [PMID: 32798189 DOI: 10.1016/j.ajg.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/28/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIM The prevalence of nutritional disorders in Saudi children with inflammatory bowel diseases (IBDs) has been reported using the World Health Organization (WHO) reference. Our aim was to provide more accurate definition of the prevalence of nutritional impairment in Saudi children with IBDs based on the national growth reference and to demonstrate the effect of using a reference from other populations on the prevalence rates. PATIENTS AND METHODS Weight, height, and body mass index data, from the multicenter study of IBDs in Saudi children and adolescents, were plotted on the new Saudi national growth reference. Statistical analyses included frequency calculations and z-test for proportions to investigate the significance of the difference in prevalence. A p-value of < 0.05 was considered significant. RESULTS Among a total of 374 patients, 119 (32%) had ulcerative colitis (UC) and 255 (68%) had Crohn's disease (CD). Compared with the WHO reference, the Saudi national reference produced a significantly lower prevalence of thinness in patients with UC (24% vs. 8%, p = 0.001), CD (35% vs. 20%, p = 0.002), and of short stature in patients with CD (28% vs. 11%, p < 0.001). The difference in the prevalence of overweight was not significant. CONCLUSIONS We provide more accurate prevalence estimate of nutritional disorders in Saudi children with IBDs based on national reference. The use of the WHO reference overestimated the prevalence of thinness and short stature in Saudi children. Prevalence estimates based on references from other populations should be interpreted with caution.
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Affiliation(s)
- Mohammad El Mouzan
- Department of Paediatrics, Gastroenterology Unit, Head Paediatric IBD Research Group, King Saud University, Riyadh, Saudi Arabia.
| | - Najat Alahmadi
- Maternity & Children Hospital, Ministry of Health. Almadina Almonawarh, Saudi Arabia
| | - Khalid A ALSaleeem
- Department of Paediatrics, Head Section of Paediatric Gastroenterology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
| | - Asaad Assiri
- Department of Paediatrics and Prince Abdullah Bin Khalid Coeliac Disease Research Chair, King Saud University. Riyadh, Saudi Arabia
| | - Badr AlSaleem
- Division of Gastroenterology, The Children Hospital, King Fahad Medical City, Pediatric Intestinal Failure and Parenteral Nutrition Program, Riyadh, Saudi Arabia.
| | - Ahmed Al Sarkhy
- Department of Paediatrics, Gastroenterology Unit, Head Paediatric IBD Research Group, King Saud University, Riyadh, Saudi Arabia
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Mechanisms by which sialylated milk oligosaccharides impact bone biology in a gnotobiotic mouse model of infant undernutrition. Proc Natl Acad Sci U S A 2019; 116:11988-11996. [PMID: 31138692 PMCID: PMC6575181 DOI: 10.1073/pnas.1821770116] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Identifying components of breast milk that influence postnatal development though their effects on the gut microbiota and immune system could provide new therapeutic approaches for childhood undernutrition, including heretofore treatment-refractory linear growth faltering (stunting). Plasma biomarkers of osteoclast-mediated bone resorption and osteoblast-driven bone formation in stunted Bangladeshi children provided evidence for elevated osteoclastic activity. Gnotobiotic mice, colonized with a stunted infant’s gut microbiota, exhibited decreased bone resorption when consuming diets supplemented with a purified bovine oligosaccharide mixture dominated by sialylated structures found in human breast milk. Supplementation decreased osteoclastogenesis while sparing osteoblast activity; the microbiota, intestinal cell populations, and immune mediators contribute to these responses. The influence of milk oligosaccharides on the gut microbiota–bone axis has diagnostic and therapeutic implications. Undernutrition in children is a pressing global health problem, manifested in part by impaired linear growth (stunting). Current nutritional interventions have been largely ineffective in overcoming stunting, emphasizing the need to obtain better understanding of its underlying causes. Treating Bangladeshi children with severe acute malnutrition with therapeutic foods reduced plasma levels of a biomarker of osteoclastic activity without affecting biomarkers of osteoblastic activity or improving their severe stunting. To characterize interactions among the gut microbiota, human milk oligosaccharides (HMOs), and osteoclast and osteoblast biology, young germ-free mice were colonized with cultured bacterial strains from a 6-mo-old stunted infant and fed a diet mimicking that consumed by the donor population. Adding purified bovine sialylated milk oligosaccharides (S-BMO) with structures similar to those in human milk to this diet increased femoral trabecular bone volume and cortical thickness, reduced osteoclasts and their bone marrow progenitors, and altered regulators of osteoclastogenesis and mediators of Th2 responses. Comparisons of germ-free and colonized mice revealed S-BMO-dependent and microbiota-dependent increases in cecal levels of succinate, increased numbers of small intestinal tuft cells, and evidence for activation of a succinate-induced tuft cell signaling pathway linked to Th2 immune responses. A prominent fucosylated HMO, 2′-fucosyllactose, failed to elicit these changes in bone biology, highlighting the structural specificity of the S-BMO effects. These results underscore the need to further characterize the balance between, and determinants of, osteoclastic and osteoblastic activity in stunted infants/children, and suggest that certain milk oligosaccharides may have therapeutic utility in this setting.
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Procianoy RS. Events that have an impact on growth. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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Procianoy RS. Events that have an impact on growth. J Pediatr (Rio J) 2019; 95 Suppl 1:1. [PMID: 30593789 DOI: 10.1016/j.jped.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Renato Soibelmann Procianoy
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Serviço de Neonatologia, Porto Alegre, RS, Brazil; Editor-in-chief of the Jornal de Pediatria, Porto Alegre, RS, Brazil.
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Ferreira PVDALS, Cavalcanti ADS, Silva GAPD. Linear growth and bone metabolism in pediatric patients with inflammatory bowel disease. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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18
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Ferreira PVDALS, Cavalcanti ADS, Silva GAPD. Linear growth and bone metabolism in pediatric patients with inflammatory bowel disease. J Pediatr (Rio J) 2019; 95 Suppl 1:59-65. [PMID: 30562479 DOI: 10.1016/j.jped.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To review the pathophysiology and evaluation methods of linear growth and bone mineral density in children and adolescents diagnosed with inflammatory bowel disease. SOURCE OF DATA Narrative review carried out in the PubMed and Scopus databases through an active search of the terms: inflammatory bowel disease, growth, failure to thrive, bone health, bone mineral density, and children and adolescents, related to the last ten years, searching in the title, abstract, or keyword fields. SYNTHESIS OF FINDINGS Inflammatory bowel diseases of childhood onset may present as part of the clinical picture of delayed linear growth in addition to low bone mineral density. The presence of a chronic inflammatory process with elevated serum levels of inflammatory cytokines negatively interferes with the growth rate and bone metabolism regulation, in addition to increasing energy expenditure, compromising nutrient absorption, and favoring intestinal protein losses. Another important factor is the chronic use of glucocorticoids, which decreases the secretion of growth hormone and the gonadotrophin pulses, causing pubertal and growth spurt delay. In addition to these effects, they inhibit the replication of osteoblastic lineage cells and stimulate osteoclastogenesis. CONCLUSION Insufficient growth and low bone mineral density in pediatric patients with inflammatory bowel disease are complex problems that result from multiple factors including chronic inflammation, malnutrition, decreased physical activity, late puberty, genetic susceptibility, and immunosuppressive therapies, such as glucocorticoids.
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Affiliation(s)
- Paloma Velez de Andrade Lima Simões Ferreira
- Universidade Federal de Pernambuco (UFPE), Programa de Pós-graduação em Saúde da Criança e do Adolescente (PPGSCA), Recife, PE, Brazil; Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil
| | | | - Giselia Alves Pontes da Silva
- Universidade Federal de Pernambuco (UFPE), Programa de Pós-graduação em Saúde da Criança e do Adolescente (PPGSCA), Recife, PE, Brazil; Universidade Federal de Pernambuco (UFPE), Departamento Materno-Infantil, Recife, PE, Brazil.
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Hu R, Zou H, Wang Z, Cao B, Peng Q, Jing X, Wang Y, Shao Y, Pei Z, Zhang X, Xue B, Wang L, Zhao S, Zhou Y, Kong X. Nutritional Interventions Improved Rumen Functions and Promoted Compensatory Growth of Growth-Retarded Yaks as Revealed by Integrated Transcripts and Microbiome Analyses. Front Microbiol 2019; 10:318. [PMID: 30846981 PMCID: PMC6393393 DOI: 10.3389/fmicb.2019.00318] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 02/06/2019] [Indexed: 12/11/2022] Open
Abstract
Growth retardation reduces the incomes of livestock farming. However, effective nutritional interventions to promote compensatory growth and the mechanisms involving digestive tract microbiomes and transcripts have yet to be elucidated. In this study, Qinghai plateau yaks, which frequently suffer from growth retardation due to malnutrition, were used as an experimental model. Young growth-retarded yaks were pastured (GRP), fed basal ration (GRB), fed basal ration addition cysteamine hydrochloride (CSH; GRBC) or active dry yeast (ADY; GRBY). Another group of growth normal yak was pastured as a positive control (GNP). After 60-day nutritional interventions, the results showed that the average daily gain (ADG) of GRB was similar to the level of GNP, and the growth rates of GRBC and GRBY were significantly higher than the level of GNP (P < 0.05). Basal rations addition of CSH or ADY either improved the serum biochemical indexes, decreased serum LPS concentration, facilitated ruminal epithelium development and volatile fatty acids (VFA) fermentation of growth-retarded yaks. Comparative transcriptome in rumen epithelium between growth-retarded and normal yaks identified the differentially expressed genes mainly enriched in immune system, digestive system, extracellular matrix and cell adhesion pathways. CSH addition and ADY addition in basal rations upregulated ruminal VFA absorption (SLC26A3, PAT1, MCT1) and cell junction (CLDN1, CDH1, OCLN) gene expression, and downregulated complement system (C2, C7) gene expression in the growth-retarded yaks. 16S rDNA results showed that CSH addition and ADY addition in basal rations increased the rumen beneficial bacterial populations (Prevotella_1, Butyrivibrio_2, Fibrobacter) of growth-retarded yaks. The correlation analysis identified that ruminal VFAs and beneficial bacteria abundance were significantly positively correlated with cell junction and VFA absorption gene expressions and negatively correlated with complement system gene expressions on the ruminal epithelium. Therefore, CSH addition and ADY addition in basal rations promoted rumen health and body growth of growth-retarded yaks, of which basal ration addition of ADY had the optimal growth-promoting effects. These results suggested that improving nutrition and probiotics addition is a more effective method to improve growth retardation caused by gastrointestinal function deficiencies.
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Affiliation(s)
- Rui Hu
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Huawei Zou
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Zhisheng Wang
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Binghai Cao
- State Key Laboratory of Animal Nutrition, College of Animal Science and Technology, China Agricultural University, Beijing, China
| | - Quanhui Peng
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Xiaoping Jing
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Yixin Wang
- Institute of Animal Genetics and Breeding, College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, China
| | - Yaqun Shao
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Zhaoxi Pei
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Xiangfei Zhang
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Bai Xue
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Lizhi Wang
- Key Laboratory of Low Carbon Culture and Safety Production in Cattle in Sichuan, Animal Nutrition Institute, Sichuan Agricultural University, Chengdu, China
| | - Suonan Zhao
- Animal Husbandry and Veterinary Institute, Haibei, China
| | - Yuqing Zhou
- Animal Husbandry and Veterinary Institute, Haibei, China
| | - Xiangying Kong
- Animal Husbandry and Veterinary Institute, Haibei, China
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20
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Bapayeva G, Poddighe D, Terzic S, Zhumadilova A, Kulbayeva S, Terzic M. Organochlorine pesticides exposure in female adolescents: potential impact on sexual hormones and interleukin-1 levels. Immunol Res 2018; 66:756-760. [PMID: 30519792 DOI: 10.1007/s12026-018-9049-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The objective of this study was to assess the potential impact of organochlorine pesticides (OCPs) on IL-1 axis in exposed female adolescents through an observational cross-sectional study. The study was conducted in Sary-Agach District (OCPs exposed girls) and Sairam District (OCPs unexposed controls), South Kazakhstan. The study included 524 female adolescents aged 10-17 years (OCPs exposed, n = 253; OCPs unexposed, n = 271). The main outcome was assessment of OCPs blood levels (correlating to pubertal development and sexual hormonal status) and IL-1 levels. The delayed sexual development and the hormonal profile in OCPs exposed female adolescents correlated to the blood levels of OCPs. Interestingly, serum IL-1α and IL-1β in girls living in contaminated areas correlated to OCPs blood levels as well. Both OCPs and IL-1 blood levels in exposed female adolescents resulted to be increased, but further research is required to establish if that might represent an additional factor contributing to puberty disorders and/or reproductive health issues.
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Affiliation(s)
- Gauri Bapayeva
- Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, 32 Turan Avenue, Astana, 010000, Kazakhstan
| | - Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, 5/1 Kerey and Zhanibek Khans str., Astana, 010000, Kazakhstan.
| | - Sanja Terzic
- Department of Medicine, Nazarbayev University School of Medicine, 5/1 Kerey and Zhanibek Khans str., Astana, 010000, Kazakhstan
| | - Akmaral Zhumadilova
- Department of Hygiene and Epidemiology, South Kazakhstan Medical Academy, Al-Farabi Square, 1, Shimkent, 160019, Kazakhstan
| | - Saltanat Kulbayeva
- Department of Obstetrics and Gynecology, South Kazakhstan Medical Academy, Al-Farabi Square, 1, Shimkent, 160019, Kazakhstan
| | - Milan Terzic
- Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, 32 Turan Avenue, Astana, 010000, Kazakhstan.,Department of Medicine, Nazarbayev University School of Medicine, 5/1 Kerey and Zhanibek Khans str., Astana, 010000, Kazakhstan
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Capriati T, Bizzarri C, Dilillo A, Nobili V, Oliva S, Diamanti A. Growth failure in Crohn's disease children: may the first treatment have a role? Expert Rev Clin Immunol 2018; 15:97-104. [PMID: 30403894 DOI: 10.1080/1744666x.2019.1543590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Growth failure in children is a frequent feature of childhood-onset Crohn's disease (CD), and stunting can persist into adulthood. Growth is an important outcome by which to judge the effectiveness of therapies in children; currently available studies in CD children have focused on the short-term impact of treatments on growth, and there are limited data regarding the long-term effects of treatments upon growth. Areas covered: We designed the present article to review whether the first treatment performed in newly diagnosed CD children may have a role on the future growth course. We conducted a systematic literature search to identify relevant studies published on the PubMed database from January 2002 up to now. We found only six surveys that documented mid-term growth course in newly diagnosed CD patients. Expert commentary: In the last years there have been relevant advances in the clinical management of CD children; however, there is a lack of knowledge about the best strategy to reverse growth failure. Children treated with enteral nutrition have appropriate height and weight gain but do not reverse the growth course. Further surveys are required to better explore not only clinical outcomes but also long-term growth course following each therapeutic strategy.
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Affiliation(s)
- Teresa Capriati
- a Artificial Nutrition Unit , "Bambino Gesù" Children Hospital , Rome , Italy
| | - Carla Bizzarri
- b Endocrinology Unit , "Bambino Gesù" Children Hospital , Rome , Italy
| | - Anna Dilillo
- a Artificial Nutrition Unit , "Bambino Gesù" Children Hospital , Rome , Italy
| | - Valerio Nobili
- c Hepatology- Gastroenterology and Nutrition Unit , "Bambino Gesù" Children Hospital , Rome , Italy
| | - Salvatore Oliva
- d Department of Pediatrics and Childhood Neuropsychiatry , Sapienza University of Rome , Rome , Italy
| | - Antonella Diamanti
- a Artificial Nutrition Unit , "Bambino Gesù" Children Hospital , Rome , Italy
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Szalecki M, Malinowska A, Prokop-Piotrkowska M, Janas R. Interactions between the growth hormone and cytokines - A review. Adv Med Sci 2018; 63:285-289. [PMID: 29579637 DOI: 10.1016/j.advms.2018.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 12/16/2017] [Accepted: 03/02/2018] [Indexed: 01/09/2023]
Abstract
Numerous reports on the interactions between the immune and endocrine systems, especially growth hormone axis, can be found in the literature. Growth hormone acts mainly indirectly through insulin-like growth factor-1, which stimulates the growth and development processes, metabolism of lipids, proteins, and carbohydrates, and it also has a modulating effect on the cells of the immune system. Several studies have been conducted on the influence of growth hormone therapy on the immunological parameters in children and adults with and without growth hormone deficiency. However, there have been no definite results and some of them have been even contradictory. Some studies have suggested that administration of growth hormone increases the production of tumor necrosis factor and certain pro- and anti-inflammatory cytokines; whereas other studies have demonstrated the lack of correlation between growth hormone and interleukins. The aim of this paper was to evaluate the available literature on the interaction between growth hormone and TNF-α, pro-inflammatory (IL-1β, IL-2, IL-6) and anti-inflammatory (IL-4, IL-10) interleukins.
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Affiliation(s)
- Mieczysław Szalecki
- Department of Endocrinology and Diabetology, The Children's Memorial Health Institute, Warsaw, Poland; Department of Medicine and Health Sciences, University of Jan Kochanowski (UJK), Kielce, Poland
| | - Anna Malinowska
- Department of Endocrinology and Diabetology, The Children's Memorial Health Institute, Warsaw, Poland.
| | - Monika Prokop-Piotrkowska
- Department of Endocrinology and Diabetology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Roman Janas
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
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The pre-treatment characteristics and evaluation of the effects of recombinant human growth hormone therapy in children with growth hormone deficiency and celiac disease or inflammatory bowel disease. Cent Eur J Immunol 2018; 43:69-75. [PMID: 29736148 PMCID: PMC5927175 DOI: 10.5114/ceji.2018.74875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022] Open
Abstract
The aim of the study was to investigate the coincidence of growth hormone deficiency (GHD) and celiac disease (CD) or inflammatory bowel disease (IBD) in patients referred for short stature, and to evaluate the baseline anthropometric parameters and the effectiveness of recombinant human growth hormone (rhGH) therapy in the first year in those patients (GHD+CD/IBD subgroup) in comparison to patients with GHD without CD or IBD (GHD-CD/IBD subgroup). Material and methods The study was retrospective and included 2196 short patients (height SDS [Standard Deviation Score] ≤ –1.2). 1454 patients had height SDS ≤ –2. Twenty-nine patients suffered from CD or IBD. GHD was confirmed in 419 patients with height SDS ≤ –2. The coexistence of GHD and CD or IBD was found in seven patients (GHD+CD/IBD subgroup). Results At baseline the GHD-CD/IBD subgroup did not differ significantly in chronological age, height SDS, height velocity (HV) before rhGH therapy, body weight SDS, and body mass index SDS from the GHD+CD/IBD subgroup. The improvement in height SDS within the first year of rhGH therapy was higher in the GHD+CD/IBD subgroup than in the GHD-CD/IBD subgroup and the difference was statistically significant (p<0.05). HV in the first year of rhGH therapy was also significantly higher in the GHD+CD/IBD subgroup than in the GHD-CD/IBD subgroup (p < 0.05). Conclusions In patients with chronic inflammatory disorders of the gastrointestinal tract, especially celiac disease, coexisting with GHD, rhGH therapy could be effective and should be administered together with therapy of primary gastrointestinal disease.
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Promising Biomarkers of Environmental Enteric Dysfunction: A Prospective Cohort study in Pakistani Children. Sci Rep 2018; 8:2966. [PMID: 29445110 PMCID: PMC5813024 DOI: 10.1038/s41598-018-21319-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/22/2018] [Indexed: 12/13/2022] Open
Abstract
Environmental Enteric Dysfunction (EED), a syndrome characterized by chronic gut inflammation, contributes towards stunting and poor response to enteric vaccines in children in developing countries. In this study, we evaluated major putative biomarkers of EED using growth faltering as its clinical proxy. Newborns (n = 380) were enrolled and followed till 18 months with monthly anthropometry. Biomarkers associated with gut and systemic inflammation were assessed at 6 and 9 months. Linear mixed effects model was used to determine the associations of these biomarkers with growth faltering between birth and 18 months. Fecal myeloperoxidase (neutrophil activation marker) at 6 months [β = −0.207, p = 0.005], and serum GLP 2 (enterocyte proliferation marker) at 6 and 9 months [6M: β = −0.271, p = 0.035; 9M: β = −0.267, p = 0.045] were associated with decreasing LAZ score. Ferritin at 6 and 9 months was associated with decreasing LAZ score [6M: β = −0.882, p < 0.0001; 9M: β = −0.714, p < 0.0001] and so was CRP [β = −0.451, p = 0.039] and AGP [β = −0.443, p = 0.012] at 9 months. Both gut specific and systemic biomarkers correlated negatively with IGF-1, but only weakly correlated, if at all with each other. We therefore conclude that EED may be contributing directly towards growth faltering, and this pathway is not entirely through the pathway of systemic inflammation.
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Sigall-Boneh R, Levine A, Lomer M, Wierdsma N, Allan P, Fiorino G, Gatti S, Jonkers D, Kierkus J, Katsanos KH, Melgar S, Yuksel ES, Whelan K, Wine E, Gerasimidis K. Research Gaps in Diet and Nutrition in Inflammatory Bowel Disease. A Topical Review by D-ECCO Working Group [Dietitians of ECCO]. J Crohns Colitis 2017; 11:1407-1419. [PMID: 28961811 DOI: 10.1093/ecco-jcc/jjx109] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/04/2017] [Indexed: 02/06/2023]
Abstract
Although the current doctrine of IBD pathogenesis proposes an interaction between environmental factors and gut microbiota in genetically susceptible individuals, dietary exposures have attracted recent interest and are, at least in part, likely to explain the rapid rise in disease incidence and prevalence. The D-ECCO working group along with other ECCO experts with expertise in nutrition, microbiology, physiology, and medicine reviewed the evidence investigating the role of diet and nutritional therapy in the onset, perpetuation, and management of IBD. A narrative topical review is presented where evidence pertinent to the topic is summarised collectively under three main thematic domains: i] the role of diet as an environmental factor in IBD aetiology; ii] the role of diet as induction and maintenance therapy in IBD; and iii] assessment of nutritional status and supportive nutritional therapy in IBD. A summary of research gaps for each of these thematic domains is proposed, which is anticipated to be agenda-setting for future research in the area of diet and nutrition in IBD.
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Affiliation(s)
- Rotem Sigall-Boneh
- PIBD Research Center, Pediatric Gastroenterology and Nutrition Unit, Edith Wolfson Medical Center, Israel
| | - Arie Levine
- Paediatric Gastroenterology & Nutrition Unit, Wolfson Medical Center, Tel Aviv University, Israel
| | - Miranda Lomer
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust and King's College London, UK
| | - Nicolette Wierdsma
- Department of Nutrition and Dietetics, VU University Medical Centre, The Netherlands
| | - Philip Allan
- Department of Translational Gastroenterology, John Radcliffe Hospital, UK
| | - Gionata Fiorino
- Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Italy
| | - Simona Gatti
- Department of Paediatrics, Polytechnic University of Marche, Italy
| | - Daisy Jonkers
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, The Netherlands
| | - Jaroslaw Kierkus
- Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, Children's Memorial Health Institute, Poland
| | - Konstantinos H Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Greece
| | - Silvia Melgar
- APC Microbiome Institute, University College Cork, Ireland
| | - Elif Saritas Yuksel
- Department of Gastroenterology, Izmir Katip Celebi University Ataturk Teaching and Research Hospital, Turkey
| | - Kevin Whelan
- King's College London, Division of Diabetes and Nutritional Sciences, UK
| | - Eytan Wine
- Division of Paediatric Gastroenterology and Nutrition, Departments of Paediatrics and Physiology, University of Alberta, Canada
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Liu X, Huang D, Guo P, Wu Q, Dai M, Cheng G, Hao H, Xie S, Yuan Z, Wang X. PKA/CREB and NF-κB pathway regulates AKNA transcription: A novel insight into T-2 toxin-induced inflammation and GH deficiency in GH3 cells. Toxicology 2017; 392:81-95. [DOI: 10.1016/j.tox.2017.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/14/2017] [Accepted: 10/22/2017] [Indexed: 12/22/2022]
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Disease Status and Pubertal Stage Predict Improved Growth in Antitumor Necrosis Factor Therapy for Pediatric Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2017; 64:47-55. [PMID: 27657882 DOI: 10.1097/mpg.0000000000001379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Growth failure is well-recognized in pediatric inflammatory bowel disease (PIBD; <18 years). We aimed to examine whether antitumor necrosis factor (TNF) therapy improves growth in a PIBD population-based cohort. METHODS A retrospective review of all Scottish children receiving anti-TNF (infliximab [IFX] and adalimumab [ADA]) from 2000 to 2012 was performed; height was collected at 12 months before anti-TNF (T-12), start (T0), and 12 (T+12) months after anti-TNF. RESULTS Ninety-three of 201 treated with IFX and 28 of 49 with ADA had satisfactory growth data; 66 had full pubertal data. Univariate analysis demonstrated early pubertal stages (Tanner 1-3 n = 44 vs T4-5 n = 22), disease remission, disease duration ≥2 years, and duration of IFX ≥12 months were associated with improved linear growth for IFX; for ADA only improvement was seen in Tanner 1-3. For IFX, Tanner 1-3 median Δ standard deviation scores for height (Ht SDS) -0.3 (-0.7, 0.2) at T0 changed to 0.04 (-0.5, 0.7) at T+12 (P < 0.001) versus -0.01 (-0.5, 0.9) at T0 in T4-5 changed to -0.01 (-0.4, 0.2) at T+12 (P > 0.05). For IFX disease duration ≥2 year, median Δ Ht SDS was -0.13 (-0.6, 0.3) at T0 then 0.07 (-0.3, 0.6) at T+12 (P < 0.001). Remission improved Δ Ht SDS (median Δ Ht SDS -0.14 [-0.6, 0.3] at T0 to 0.17 [-0.2, 0.7] at T+12 [P < 0.001]). Multiple regression analysis demonstrated corticosteroid usage at T0 predicted improved Δ Ht SDS at T+12 for IFX and ADA. CONCLUSIONS Anti-TNF therapy is more likely to be associated with growth improvement when used at earlier stages of puberty with remission a key growth-promoting strategy in pediatric Crohn disease.
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Abstract
OBJECTIVES The respective role of disease activity and steroid therapy in growth impairment in paediatric-onset Crohn disease (CD) is still debated. Our aim was to investigate whether the growth pattern of children with CD was correlated with the inflammatory status during the disease course, regardless the cumulative duration of steroid therapy. METHODS One hundred and seven patients with a diagnosis of CD <17 years, followed during ≥2 years and for whom ≥2 height measures were available during follow-up, were identified between 1998 and 2010. Height, C-reactive protein (CRP), orosomucoid, and steroid therapy duration were collected at each visit. The relationship between the evolution of growth velocity and inflammatory status during follow-up was investigated using a linear mixed model with random coefficients. RESULTS Median age at diagnosis was 11.7 years (Q1-Q3: 9.8-13.5). Mean height for age (H/A) z score was 0.14 ± 1.29 at diagnosis and 0.05 ± 1.23 among the 75 patients who had reached their final height at maximal follow-up (median: 4.9 years; Q1-Q3: 3.8-6.4). Growth failure (H/A z score <-2) was present in 7 (8%) patients at diagnosis and 5 (5%) at maximal follow-up. Growth velocity was negatively correlated with the evolution of CRP (P < 0.0001) and orosomucoid (P < 0.0001) during follow-up. After adjustment for the cumulative duration of steroid therapy, these 2 correlations remained significant (CRP: P = 0.0008; orosomucoid: P < 0.0001). CONCLUSIONS Children with CD with uncontrolled inflammatory status have a lower growth velocity. The inflammatory status should be kept as close to normal as possible in paediatric-onset patients with CD to optimize their growth pattern.
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Wong SC, Dobie R, Altowati MA, Werther GA, Farquharson C, Ahmed SF. Growth and the Growth Hormone-Insulin Like Growth Factor 1 Axis in Children With Chronic Inflammation: Current Evidence, Gaps in Knowledge, and Future Directions. Endocr Rev 2016; 37:62-110. [PMID: 26720129 DOI: 10.1210/er.2015-1026] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Growth failure is frequently encountered in children with chronic inflammatory conditions like juvenile idiopathic arthritis, inflammatory bowel disease, and cystic fibrosis. Delayed puberty and attenuated pubertal growth spurt are often seen during adolescence. The underlying inflammatory state mediated by proinflammatory cytokines, prolonged use of glucocorticoid, and suboptimal nutrition contribute to growth failure and pubertal abnormalities. These factors can impair growth by their effects on the GH-IGF axis and also directly at the level of the growth plate via alterations in chondrogenesis and local growth factor signaling. Recent studies on the impact of cytokines and glucocorticoid on the growth plate further advanced our understanding of growth failure in chronic disease and provided a biological rationale of growth promotion. Targeting cytokines using biological therapy may lead to improvement of growth in some of these children, but approximately one-third continue to grow slowly. There is increasing evidence that the use of relatively high-dose recombinant human GH may lead to partial catch-up growth in chronic inflammatory conditions, although long-term follow-up data are currently limited. In this review, we comprehensively review the growth abnormalities in children with juvenile idiopathic arthritis, inflammatory bowel disease, and cystic fibrosis, systemic abnormalities of the GH-IGF axis, and growth plate perturbations. We also systematically reviewed all the current published studies of recombinant human GH in these conditions and discussed the role of recombinant human IGF-1.
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Affiliation(s)
- S C Wong
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - R Dobie
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - M A Altowati
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - G A Werther
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - C Farquharson
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - S F Ahmed
- Developmental Endocrinology Research Group (S.C.W., M.A.A., S.F.A.), University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, United Kingdom; Division of Developmental Biology (R.D., C.F.), Roslin Institute, University of Edinburgh, Midlothian EH25 9RG, United Kingdom; and Hormone Research (G.A.W.), Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
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El Mouzan MI, Al Mofarreh MA, Saadah OI, Al-Hussaini AA, Al-Saleem KA, Al Mehaidib AI. Impact of pediatric inflammatory bowel disease on linear growth: Data from a national cohort study in Saudi Arabia. Saudi J Gastroenterol 2016; 22:106-8. [PMID: 26997215 PMCID: PMC4817292 DOI: 10.4103/1319-3767.178524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/AIM Linear growth impairment (LGI) is one of the most important features peculiar to children with inflammatory bowel disease (IBD). The aim of this report is to define the impact of IBD on the linear growth of children in the Kingdom of Saudi Arabia (KSA). SETTING AND DESIGN Multicenter retrospective study. PATIENTS AND METHODS Data from a cohort of newly- diagnosed children with IBD from 2003 to 2012 were analyzed retrospectively. The diagnosis of IBD was confirmed in accordance with the published criteria. Length/height for age was measured at diagnosis. The World Health Organization (WHO) reference was used and LGI was defined by length/height for age <-2 standard deviation. Chi-square test was used to test the significance of estimates and a P < 0.05 was considered significant. RESULTS There were 374 children from 0.33 to 16 years of age, including 119 ulcerative colitis (UC) (32%), and 255 Crohn's disease (CD) (68%) patients. The prevalence of LGI was 26%, 28%, and 21% in IBD, CD, and UC, respectively. In children below 10 years, LGI was significantly more common in CD (P = 0.010), while in UC children, it was more common in older children (P = 0.011). CONCLUSION This study demonstrates a prevalence of LGI consistent with that reported in the literature, but higher in CD children with early onset (<10 years) and in older children with UC, underscoring the importance of monitoring growth in children with IBD in the Saudi population. Prospective studies are needed to define the impact of IBD on growth velocity, puberty, and final adult stature.
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Affiliation(s)
- Mohammad I. El Mouzan
- Department of Pediatrics, Head, Pediatric Inflammatory Bowel Disease Research Group, Member of Prince Abdullah Bin Khalid Celiac Disease Research Chair, King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Prof. Mohammad I. El Mouzan, Department of Pediatrics, Gastroenterology Division, PO Box 2925, Riyadh - 11461, Kingdom of Saudi Arabia. E-mail:
| | | | - Omar I. Saadah
- Department of Pediatrics, Faculty of Medicine and Inflammatory Bowel Disease Research Group, King Abdul Aziz University, Riyadh, Saudi Arabia
| | - Abdulrahman A. Al-Hussaini
- The Children's Hospital, Division of Gastroenterology, Hepatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid A. Al-Saleem
- Department of Pediatrics, Section of gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ali I. Al Mehaidib
- Department of Pediatrics, Section of gastroenterology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Hubbard LD. Long-term outcomes in adults with recessive dystrophic epidermolysis bullosa fed by a gastrostomy tubein situ. Int J Dermatol 2015; 55:181-6. [DOI: 10.1111/ijd.12876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 09/15/2014] [Accepted: 09/25/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Lynne D. Hubbard
- Department of Nutrition and Dietetics; St Thomas' Hospital; London UK
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Abstract
Nutrition is one of the most important factors affecting pubertal development. Puberty entails a progressive nonlinear process starting from prepubescent to full sexual maturity through the interaction and cooperation of biological, physical, and psychological changes. Consuming an adequate and balanced healthy diet during all phases of growth (infancy, childhood and puberty) appears necessary both for proper growth and normal pubertal development. Girls begin puberty at an earlier age compared to past decades. Excessive eating of many processed, high-fat foods, may be the cause of this phenomenon. Overweight or obese children are more likely to enter puberty early. Some evidence suggests that obesity can accelerate the onset of puberty in girls and may delay the onset of puberty in boys. Moreover, the progression of puberty is affected by nutrition. On the other hand, puberty triggers a growth spurt, which increases nutritional needs including macro and micronutrients. Increased caloric, protein, iron, calcium, zinc and folate needs have to be provided during this critical period of rapid growth. Severe primary or secondary malnutrition also can delay the onset and progression of puberty. The higher incidence of anorexia nervosa and bulimia in adolescents imposes a nutritional risk on pubertal development. Moreover, many environmental endocrine disruptors (EDs) have been identified that can significantly impair the normal course of puberty. This mini-review sums up some important findings in this important complex that link nutrition and pubertal development.
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Affiliation(s)
- Ashraf Soliman
- Department of Pediatrics, University of Alexandria Children's Hospital, Alexandria, Egypt
| | - Vincenzo De Sanctis
- Department of Pediatric and Adolescent Outpatients Clinic, Quisisana Hospital, Ferrara, Italy
| | - Rania Elalaily
- Department of Primary Health Care, AbuNakhla Hospital, Doha, Qatar
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Abstract
Crohn's disease in childhood causes linear growth retardation, which has a substantial effect on management of this disease. By contrast, growth is rarely a problem in children presenting with ulcerative colitis. Depending on how growth failure is defined, approximately one-third of children with Crohn's disease have growth retardation at diagnosis. Although corticosteroids can suppress growth, decreased height at diagnosis demonstrates that this finding is a consequence of the disease and not merely an adverse effect of treatment. Both inflammation and undernutrition contribute to decreased height velocity. Increased cytokine production acts both on the hepatic expression of insulin-like growth factor 1 (IGF-1) and at chondrocytes of the growth plates of long bones. Growth hormone insensitivity caused by deranged immune function is a major mechanism in growth retardation. Resolution of inflammation is the cornerstone of treatment, but current studies on growth hormone and IGF-1 might yield therapies for those children whose inflammation is refractory to treatment.
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Affiliation(s)
- Ian R Sanderson
- Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. 4 Newark Street, London E1 2AT, UK
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Zhang C, Tian Y, Yan F, Kang X, Han R, Sun G, Zhang H. Modulation of growth and immunity by dietary supplementation with resveratrol in young chickens receiving conventional vaccinations. Am J Vet Res 2014; 75:752-9. [DOI: 10.2460/ajvr.75.8.752] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Laakso S, Valta H, Verkasalo M, Toiviainen-Salo S, Mäkitie O. Compromised peak bone mass in patients with inflammatory bowel disease--a prospective study. J Pediatr 2014; 164:1436-43.e1. [PMID: 24650398 DOI: 10.1016/j.jpeds.2014.01.073] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 12/17/2013] [Accepted: 01/29/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate peak bone mass attainment in children and adolescents with inflammatory bowel disease and to identify risk factors for suboptimal bone mass attainment. STUDY DESIGN We conducted a prospective follow-up study of 47 children and adolescents (24 males) with ulcerative colitis (n = 30) or Crohn's disease (n = 17). They were assessed for lumbar spine areal bone mineral density (aBMD) and for height-adjusted whole body less head bone mineral content (BMC); the values were corrected for bone age. RESULTS Altogether, 73% of the patients had completed pubertal development after the median follow-up time of over 5 years. Despite clinical inactivity of the disease in 70% of the patients at the follow-up visit, BMD or BMC Z-scores improved in none of the measurement sites. Lumbar spine aBMD Z-scores (mean difference [95% CI], -0.47 [-0.92 to -0.03]; P = .04) and whole body less head BMC height- and bone age-adjusted Z-scores (-0.52 [-1.01 to -0.02]; P = .04) decreased in patients who were pubertal at baseline and completed their pubertal development during the follow-up. Postpubertal patients had lower aBMD and BMC Z-scores in comparison with prepubertal and pubertal patients. Low lumbar spine aBMD (Z-score < -1.0) was associated with completed pubertal development, underweight, and greater lifetime cumulative weight-adjusted prednisolone dose. Vertebral fractures were detected in 3 patients (6%). One-fourth of the patients had insufficient serum 25-hydroxyvitamin D concentrations (<50 nmol/L). CONCLUSIONS The longitudinal follow-up over the pubertal years shows that inflammatory bowel disease poses a significant threat for bone health. The suboptimal peak bone mass attainment may have life-long consequences.
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Affiliation(s)
- Saila Laakso
- Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland.
| | - Helena Valta
- Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Matti Verkasalo
- Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Sanna Toiviainen-Salo
- Helsinki Medical Imaging Center, Department of Pediatric Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Outi Mäkitie
- Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Potential role of IGF-1 z score to predict permanent linear growth impairment in children with IBD. J Pediatr Gastroenterol Nutr 2014; 58:472-6. [PMID: 24663033 DOI: 10.1097/mpg.0000000000000234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
In this pilot study, we analyzed serum insulin-like growth factor 1 (IGF-1)- and IGF-binding protein-3-for-age z scores from 54 inflammatory bowel disease children with no, temporary, or permanent growth impairment. Although our findings did not reach statistical significance, patients with permanent linear growth impairment had lower IGF-1-for-age z scores (-1.76 [-2.25 to -0.43]) compared with those with no or temporary growth impairment (-0.84 [-1.49 to -0.3]) and -1.16 [-1.59 to -1.51], respectively). IGF-binding protein-3 levels were similar across the 3 groups. In the absence of significant inflammation and malnutrition, lower IGF-1-for-age z scores may help distinguish patients likely to have permanent growth impairment from those whose growth impairment is likely to be temporary.
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Abstract
Inflammatory bowel disease, particularly Crohn's disease (CD), can potentially cause growth failure during childhood as well as a reduction in final adult height. The underlying mechanism is multifactorial and includes poor nutrition, chronic inflammation, and the prolonged use of steroids. Despite major advances in the treatment of CD, current cohorts of children continue to display a deficit in linear growth and may qualify for growth-promoting hormonal therapy. However, currently there is limited evidence to support the use of endocrine therapy directed primarily at improving growth. This review is aimed at summarising the current evidence for growth impairment in inflammatory bowel disease and discusses the rationale for using growth promoting therapy.
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Soo J, Malik BA, Turner JM, Persad R, Wine E, Siminoski K, Huynh HQ. Use of exclusive enteral nutrition is just as effective as corticosteroids in newly diagnosed pediatric Crohn's disease. Dig Dis Sci 2013; 58:3584-91. [PMID: 24026403 DOI: 10.1007/s10620-013-2855-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/20/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND The efficacy of exclusive enteral nutrition (EEN) in induction of remission in pediatric Crohn's disease (CD) is reported to be equivalent to that of corticosteroids (CS). AIMS Our objective was to compare the efficacy of EEN and CS in inducing remission in pediatric onset CD and the effects of the treatment on nutritional status and bone mineral density (BMD). METHODS Medical charts were retrospectively studied for patients diagnosed with CD between 2000 and 2010 at the Stollery children's hospital in Edmonton, Alberta. Anthropometric and dual-energy X-ray absorptiometry (DXA) data were collected to assess effects of therapy; clinical remission, relapse, and severity were defined on the basis of the pediatric Crohn's disease activity index. RESULTS To induce remission at first presentation, 36 patients (mean age 12.9 years) received EEN and 69 (mean age 11.2 years) received CS. Remission (88.9% in the EEN group versus 91.3% in the CS group (p=0.73) at 3 months) and relapse (40.6 vs. 28.6%, respectively (p=0.12) over 12 months) were similar in both treatment groups. Thirty-four patients had paired DXA scans at the time of diagnosis and one year later: 16 given EEN and 18 given CS. Change in BMD spine z-scores based on bone age adjusted for height and chronological age was greater for EEN patients but not statistically significant (Δz-score 0.30 vs. 0.03, p=0.28). CONCLUSIONS EEN has similar efficacy to corticosteroids; however, EEN may lead to better BMD accrual. EEN should be preferred to corticosteroids as first-line therapy for induction of remission in pediatric CD.
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Affiliation(s)
- Jason Soo
- Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, Edmonton, AB, T6G 2J3, Canada
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Deboer MD, Steinman J, Li Y. Partial normalization of pubertal timing in female mice with DSS colitis treated with anti-TNF-α antibody. J Gastroenterol 2012; 47:647-54. [PMID: 22322660 PMCID: PMC3378759 DOI: 10.1007/s00535-012-0542-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 12/26/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) and resultant colitis occurring prior to puberty are frequently associated with delayed puberty and losses of growth and bone mineralization. Some of this delay may be due to colonic inflammation and associated systemic inflammation. To date no treatments for IBD have been shown to normalize the timing of puberty. Our objective in this study was to determine whether there is a normalization of the timing of puberty during treatment of colitis using monoclonal antibodies (abs) to tumor necrosis factor (TNF)-α. METHODS We induced colitis in 23-day-old C57Bl6 female mice using 3% dextran sodium sulfate (DSS) for 7 days, followed by removal of DSS for an additional 3 days, resulting in 10 days of worsening colitis. DSS-treated mice received either TNF-α ab or Control ab on days 4 and 8 of colitis, while non-colitic Control mice received injections of TNF-α ab (Control + TNF-α ab). All groups were followed for the timing of vaginal opening until day of life 33, when they were euthanized for serum and colon collection. RESULTS The DSS + TNF-α ab group had lower levels of systemic interleukin (IL)-6 and a partial normalization of the timing of vaginal opening compared to the DSS + Control ab group. There were no differences in weight gain, growth, or colon histological inflammatory scores between the DSS + TNFα ab and DSS + Control ab groups over the course of the experiment. CONCLUSIONS We conclude that anti-TNF-α ab treatment causes a partial normalization of pubertal timing coincident with decreased systemic inflammation in DSS colitis. These data may have implications regarding growth and bone mineralization outcomes in pediatric IBD.
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Affiliation(s)
- Mark Daniel Deboer
- Division of Pediatric Endocrinology, University of Virginia, Charlottesville, VA 22908, USA.
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Haynes L, Mellerio JE, Martinez AE. Gastrostomy tube feeding in children with epidermolysis bullosa: consideration of key issues. Pediatr Dermatol 2012; 29:277-84. [PMID: 22288644 DOI: 10.1111/j.1525-1470.2011.01612.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Complications of severe forms of epidermolysis bullosa (EB) almost invariably lead to chronic malnutrition, jeopardizing immune status, growth, iron status, bone health, wound healing, and quality of life. Although gastrostomy tube (G-tube) feeding has successfully addressed the difficulties of providing nutrition and medications in some children attending our center, others have developed problems such as abdominal distension, poor feed tolerance, and leakage of gastric contents with persistent localized skin ulceration, posing enormous challenges to skin management and nutritional maintenance. Suspicions that G-tube placement and feeding cause or exacerbate these problems has led to a decline in placements at our center over the last 10 years. We therefore recognized that it should not be rejected without due consideration of why some patients seem more prone to complications than others. Thus, information on selected issues and outcomes of G-tube placement was obtained from records of 66 patients undergoing surgery between 1989 and 2008. The complex interrelationships of the sequelae of severe EB, changes in practice over 20 years and lack of data for patients treated early in the series make it impossible to draw firm conclusions at this stage, however, our scrutiny provides valuable information on which to base debate and future studies. It also offers well as useful insights for fellow professionals involved in nutrition support in children with severe EB.
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Affiliation(s)
- Lesley Haynes
- Department of Dietetics, Hospital for Children, NHS Trust, London, UK.
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Malik S, Ahmed SF, Wilson ML, Shah N, Loganathan S, Naik S, Bourke B, Thomas A, Akobeng AK, Fagbemi A, Wilson DC, Russell RK. The effects of anti-TNF-α treatment with adalimumab on growth in children with Crohn's disease (CD). J Crohns Colitis 2012; 6:337-44. [PMID: 22405171 DOI: 10.1016/j.crohns.2011.09.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 09/15/2011] [Accepted: 09/15/2011] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Adalimumab is used to treat children with Crohn's disease (CD), but the effects of adalimumab on growth in CD have not been studied. AIM To study growth and disease activity over 12 months (6 months prior to (T-6), baseline (T0) and for 6 months following (T+6) adalimumab). SUBJECTS AND METHODS Growth and treatment details of 36 children (M: 22) who started adalimumab at a median (10th, 90th) age of 14.7 years (11.3, 16.8) were reviewed. RESULTS Of 36 cases, 28 (78%) went into remission. Overall 42% of children showed catch up growth, which was more likely in: (i) those who achieved remission (median change in height SDS (ΔHtSDS) increased from -0.2 (-0.9, 1.0) at T0 to 0.2 (-0.6, 1.6) at T+6, (p=0.007)), (ii) in those who were on immunosuppression ΔHtSDS increased from -0.2 (-0.9, 1.0) at T0 to 0.1 (-0.8, 1.3) at T+6, (p=0.03) and (iii) in those whose indication for using adalimumab therapy was an allergic reaction to infliximab, median ΔHtSDS increased significantly from -0.3 (-0.9, 1.0) at T0 to 0.3 (-0.5, 1.6) at T+6, (p=0.02). Median ΔHtSDS also increased from -0.4 (-0.8, 0.7) at T0 to 0.0 (-0.6, 1.6) at T+6, (p=0.04) in 15 children who were on prednisolone therapy when starting adalimumab. CONCLUSION Clinical response to adalimumab therapy is associated with an improvement in linear growth in a proportion of children with CD. Improved growth is more likely in patients entering remission and on immunosuppression but is not solely due to a steroid sparing effect.
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Affiliation(s)
- S Malik
- Bone & Endocrine Research Group Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
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Trauernicht AK, Steiner SJ. Serum antibodies and anthropometric data at diagnosis in pediatric Crohn's disease. Dig Dis Sci 2012; 57:1020-5. [PMID: 22075854 DOI: 10.1007/s10620-011-1954-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 10/20/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Serum antibodies, including ASCA, anti-OmpC, and ANCA, correlate with disease location and predict disease phenotype in inflammatory bowel disease. AIM The objective of this study was to determine relationships between serum antibody status and anthropometric data for children with newly diagnosed Crohn's disease. METHODS A retrospective review was conducted on children diagnosed with Crohn's disease at our institution from 2003 to 2008. Patients who had ASCA IgA, ASCA IgG, anti-OmpC, and pANCA antibodies, and anthropometric data measured before diagnosis and therapy were included. Z-scores for height and weight were compared among groups according to the presence of specific antibodies. Spearman's rank correlation was used to assess association between antibodies and growth data. RESULTS One hundred and two patients, mean age 11.9 years, met the inclusion criteria. Patients with the presence of any of the four antibodies had lower mean height and weight z-scores than patients without any antibodies present. When individual antibodies were studied, patients with positive ASCA titers had lower mean weight and height z-scores than patients without any antibodies present. Spearman's rank correlation coefficient demonstrated a significant association between increasing ASCA titers and lower weight z-scores, but not lower height z-scores. CONCLUSIONS Pediatric patients with newly diagnosed Crohn's disease and the presence of ASCA antibodies have lower mean height and weight z-scores. This study provides evidence that specific subsets of children with Crohn's disease may be at greater risk of growth impairment.
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Affiliation(s)
- Anna K Trauernicht
- Division of Pediatric Gastroenterology/Hepatology/Nutrition, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive/ROC 4210, Indianapolis, IN 46202-5225, USA
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Levine J, Lai J, Edelman M, Schuval SJ. Conservative long-term treatment of children with eosinophilic esophagitis. Ann Allergy Asthma Immunol 2012; 108:363-6. [PMID: 22541409 DOI: 10.1016/j.anai.2012.02.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/17/2012] [Accepted: 02/27/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND Current treatments of eosinophilic esophagitis (EoE), including restrictive diets or glucocorticoids, provide only transient improvement. Proton pump inhibitor (PPI) use in EoE does not lead to histologic improvement; however, the long-term use of PPI on symptoms and prevention of complications has not been evaluated. OBJECTIVE To evaluate the use of PPI as maintenance therapy in children with EoE. METHODS Eosinophilic esophagitis was diagnosed based on initial endoscopic biopsies and persistent eosinophilic inflammation despite PPI therapy. Inclusion criteria included diagnosis of EoE and PPI use as primary maintenance treatment. Patients were excluded if they were treated with dietary or glucocorticoid therapy. Histologic evidence of inflammation as well as degree of subepithelial fibrosis at presentation was compared with most recent biopsies while receiving PPI therapy. RESULTS Thirty-eight patients (30 males and 8 females; average age 6.7 ± 5.4 years) fulfilled inclusion criteria. Duration of follow-up was 3.0 ± 2.4 years. At presentation, vomiting was significantly more frequent in the younger patients, whereas dysphagia occurred more frequently in the older patients. At follow-up, 26 patients were asymptomatic, and the remaining 12 patients' symptoms were significantly improved. No complications of stricture or food impaction were seen. Significant eosinophilic inflammation persisted in 28 patients. No difference in degree of subepithelial fibrosis at diagnosis compared with most recent biopsies. The z-scores of the treated EoE patients significantly improved. CONCLUSION Patients with EoE treated with PPIs show an improvement in symptoms and z-scores despite persistent eosinophilic inflammation. PPI treatment may be useful maintenance therapy in children with EoE.
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Affiliation(s)
- Jeremiah Levine
- Division of Pediatric Gastroenterology and Nutrition, Cohen Children's Medical Center, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA.
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Use of ghrelin as a treatment for inflammatory bowel disease: mechanistic considerations. INTERNATIONAL JOURNAL OF PEPTIDES 2011; 2011:189242. [PMID: 21845198 PMCID: PMC3154487 DOI: 10.1155/2011/189242] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 06/21/2011] [Indexed: 12/24/2022]
Abstract
Inflammatory bowel diseases (IBD)-and in particular Crohn's disease-are immune-mediated processes that result in denuded intestinal mucosa and can produce decreased appetite, weight loss, and systemic inflammation. Current treatments include anti-inflammatory medications, immunomodulators, and feeding interventions. Ghrelin is an endogenous orexigenic hormone that directly stimulates growth hormone release, increases gut motility, and has cardiovascular and anti-inflammatory properties. Although ghrelin levels are elevated in active IBD, administration of ghrelin in most (but not all) animal models of colitis has produced improvements in disease activity and systemic inflammation. The mechanism for these effects is not known but may relate to decreased inflammation, increased motility, increased appetite, and increased colonic blood flow. Human trials have not been performed, however, and more research is clearly needed.
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Gerasimidis K, McGrogan P, Edwards CA. The aetiology and impact of malnutrition in paediatric inflammatory bowel disease. J Hum Nutr Diet 2011; 24:313-26. [PMID: 21564345 DOI: 10.1111/j.1365-277x.2011.01171.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Disease-associated undernutrition of all types is very common in paediatric inflammatory bowel disease (IBD). Recent weight loss remains one of the triad of clinical manifestations and a cornerstone for the diagnosis of Crohn's disease (CD), although significantly fewer patients now present as being underweight. Recent evidence suggests that the introduction of medical treatment will quickly restore body weight, although this does not reflect concomitant changes in body composition. CD children present with features of nutritional cachexia with normal fat stores but depleted lean mass. Poor bone health, delayed puberty and growth failure are additional features that further complicate clinical management. Suboptimal nutritional intake is a main determinant of undernutrition, although activation of the immune system and secretion of pro-inflammatory cytokines exert additional independent effects. Biochemically low concentrations of plasma micronutrients are commonly reported in IBD patients, although their interpretation is difficult in the presence of an acute phase response and other indices of body stores adequacy are needed. Anaemia is a common extraintestinal manifestation of the IBD child. Iron-deficient anaemia is the predominant type, with anaemia of chronic disease second. Decreased dietary intake, as a result of decreased appetite and food aversion, is the major cause of undernutrition in paediatric IBD. Altered energy and nutrient requirements, malabsorption and increased gastrointestinal losses are additional factors, although their contribution to undernutrition in paediatric CD needs to be studied further.
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Affiliation(s)
- K Gerasimidis
- Human Nutrition Section, Developmental Medicine, University of Glasgow, Royal Hospital for Sick Children, UK.
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Wong SC, Kumar P, Galloway PJ, Blair JC, Didi M, Dalzell AM, Hassan K, McGrogan P, Ahmed SF. A preliminary trial of the effect of recombinant human growth hormone on short-term linear growth and glucose homeostasis in children with Crohn's disease. Clin Endocrinol (Oxf) 2011; 74:599-607. [PMID: 21470283 DOI: 10.1111/j.1365-2265.2011.03977.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is unclear whether recombinant human growth hormone (rhGH) improves linear growth in children with Crohn's disease (CD). AIMS To investigate the effects of rhGH on height velocity (HV) and glucose homeostasis over a 6-month period. DESIGN AND SETTING Randomized controlled trial in two tertiary children's hospitals in 22 children with inflammatory bowel disease amongst whom 21 had CD. Duration of disease from diagnosis and number of acute relapses requiring either exclusive enteral nutrition or therapeutic dose of oral prednisolone were similar in the treatment and control groups. INTERVENTION Either rhGH (0·067 mg/kg per day) as daily subcutaneous injections (rhGH group; n, 11) or no rhGH, (Ctrl; n, 11) for 6 months. MAIN OUTCOME MEASURE Percentage change in HV after 6 months in the two groups. Auxology, puberty, skeletal age, disease factors, treatment and glucose homeostasis were also assessed. RESULTS Median HV increased from 4·5 (range, 0·6, 8·9) at baseline to 10·8 (6·1, 15·0) cm/year at 6 month (P = 0·003) in the rhGH group, whereas in the Ctrl group, it was 3·8 (1·4, 6·7) and 3·5 cm/year (2·0, 9·6), respectively (P = 0·58). Median percentage increase in HV after 6 months in the rhGH group was 140% (16·7, 916·7) compared with 17·4% (-42·1%, 97·7%) in the Ctrl group (P < 0·001). There were no significant differences in disease activity and proinflammatory cytokines at baseline and 6 months in both groups and change in bone age for chronological age was also similar in the two groups. In the rhGH group, fasting insulin increased from 4·0 (2·0, 11·0) to 7·0 mU/l (2·0, 16·0) (P = 0·02), whereas in the Ctrl group, it was 3·0 (1·2, 12·7) and 3·8 mU/l (2·1, 7·0) (P = 0·72), respectively. CONCLUSIONS Although this pilot trial shows that rhGH can improve short-term linear growth in children with CD, the clinical efficacy of this therapy needs to be further studied in longer-term studies of growth, glucose homeostasis and disease status.
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Affiliation(s)
- S C Wong
- Developmental Endocrinology Research Group, Royal Hospital for Sick Children, Glasgow, UK
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Abstract
Objective: To assess the characteristics and course of childhood-onset Crohn’s disease among Hungarian patients. Methods: Records of 81 patients admitted between 1984 and 2006 and treated at least for one year until the 18th year of age were reviewed. Results: There was a 62% male dominance and a rate of 12.5% of familial cases. The diagnostic lag was 11.36 (1–96) months. The mean age was 13.6 years (4–17), the activity index was 37.88 (5–80) at diagnosis and the initial frequencies were as follows: ileal affection 87%, stricturing and penetrating forms 27%, perianal manifestation 26%, giant cells or granuloma formation 47%, malnutrition 23,5%, growth failure 11%. Steroid therapy and azathioprin treatment were given in 84% and 62% of the patients, respectively. Biologic treatment was not possible during the study period. 31% of the patients underwent surgery (abdominal surgery 20%, perianal surgery 11%). When patients reached the 18th year of age the mean activity index decreased to 6.63 (0–35), the rate of malnutrition to 9.9% and that of growth failure to 2.5%. All these changes were statistically significant. Conclusions: Characteristics of childhood-onset Crohn’s disease in Hungary are similar to those obtained in other European countries. The prolonged diagnostic lag, the high initial activity index, the granuloma formation and the stricturing/penetrating behavior may predict subsequent complications and need for surgery, and, therefore, justify intense initial therapy. The early introduction of immunomodulatory therapy affects favorably the course of illness. Orv. Hetil., 2011, 152, 546–554.
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Affiliation(s)
- Judit B. Kovács
- Fővárosi Önkormányzat Heim Pál Gyermekkórháza Gasztroenterológiai és Nefrológiai Osztály Budapest Üllői út 86. 1089
| | - Anikó Nagy
- Fővárosi Önkormányzat Heim Pál Gyermekkórháza Gasztroenterológiai és Nefrológiai Osztály Budapest Üllői út 86. 1089
| | - András Szabó
- Fővárosi Önkormányzat Heim Pál Gyermekkórháza Gasztroenterológiai és Nefrológiai Osztály Budapest Üllői út 86. 1089
| | - Margit Lőrincz
- Fővárosi Önkormányzat Heim Pál Gyermekkórháza Gasztroenterológiai és Nefrológiai Osztály Budapest Üllői út 86. 1089
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Deboer MD, Li Y. Puberty is delayed in male mice with dextran sodium sulfate colitis out of proportion to changes in food intake, body weight, and serum levels of leptin. Pediatr Res 2011; 69:34-9. [PMID: 20940665 PMCID: PMC3039692 DOI: 10.1203/pdr.0b013e3181ffee6c] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In boys, inflammatory bowel disease often results in delayed puberty associated with decreased bone mineral density and decreased linear growth. Our goal was to investigate whether pubertal timing and levels of leptin differed between prepubertal male mice with colitis and food-restricted (FR) mice maintained at a similar weight. We induced colitis in 32-d-old male mice using dextran sodium sulfate (DSS), resulting in 10 d of worsening colitis. We followed up these mice for separation of the prepuce from the glans penis as a marker of pubertal progression. Compared with free-feeding control mice, DSS and FR mice had significantly lower weight on d 7-10 of treatment. DSS mice had later puberty than control and FR mice. DSS mice also had smaller testes, lower FSH levels, increased systemic cytokines, and increased colonic inflammation by histology. Leptin levels were similar between DSS and FR mice, whereas both had decreases in leptin compared with controls. We conclude that DSS colitis causes delayed puberty in sexually immature male mice beyond what is seen among FR mice of similar weight, food intake, and leptin levels. These experiments provide support for the hypothesis that pubertal delay in colitis is influenced by factors beyond poor weight gain alone.
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Affiliation(s)
- Mark D Deboer
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22908, USA.
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Improvement in growth of children with Crohn disease following anti-TNF-α therapy can be independent of pubertal progress and glucocorticoid reduction. J Pediatr Gastroenterol Nutr 2011; 52:31-7. [PMID: 21150651 DOI: 10.1097/mpg.0b013e3181edd797] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Treatment with antitumour necrosis factor-α therapy such as infliximab may improve growth in children with Crohn disease (CD), but the extent of improvement in growth and its relation to pubertal progress and glucocorticoid (GC) therapy are unclear. This is a retrospective study of growth, puberty, and disease activity during the 6 months before starting infliximab (T - 6), at baseline (T0), and for the following 6 months (T + 6) and 12 months (T + 12) in children with CD. PATIENTS AND METHODS The growth and treatment details of 28 children (male, 17) who were given infliximab at a median (10th, 90th) age of 13.1 years (10.0, 15.7) were reviewed. Data on disease markers (C-reactive protein, erythrocyte sedimentation rate, and albumin), total alkaline phosphatase, and a physician's global assessment were also collected. Results are expressed as median (10th, 90th). RESULTS Of the 28 cases, 21 (75%) demonstrated a clinical response to infliximab treatment. Overall, height velocity (HV) increased from 3.6 cm/y (0.4-7.8) at T0 to 5.5 cm/y (2.1-9.2) at T + 6 (P = 0.003). In infliximab responders, HV increased from 2 cm/y (0.3-7.1) to 6.4 cm/y (2.3-9.1) (P = 0.004) and in the nonresponders, HV remained static at 4.3 cm/y (2.5-8.6) at T0 and 3.0 cm/y (2.0-11.3) (P = 0.701) at T + 6. HV also increased in the subgroup of 13 children who had remained prepubertal from 4.5 cm/y (0.4-8) to 5.5 cm/y (3.3-8.4) (P = 0.050). In the subgroup of 11 children who had a reduction (n = 2) or cessation in GC (n = 9), HV increased from 1.8 cm/y (0.3-8.3) at T0 to 5.6 cm/y (2.2-9.2) at T + 6 (P = 0.14), whereas those children who did not receive GC during the 12 months had an increase from 3.7 cm/y (0.6-6.5) to 6.4 cm/y (2.9-9.0) (P < 0.05). HV at T0 and T + 6 showed a significant association with the average alkaline phosphatase during the prior 6 months (r = 0.39, P < 0.05). HV did not show any association with individual markers of disease activity. CONCLUSIONS Clinical response to infliximab therapy is associated with an improvement in linear growth in the short term in children with CD. This increase in height may not be simply due to progress in pubertal status or reduction in GC dose.
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Malik S, Ahmed SF. Biologic therapy and its effect on skeletal development in children with chronic inflammation. Expert Rev Endocrinol Metab 2010; 5:733-740. [PMID: 30764025 DOI: 10.1586/eem.10.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic inflammatory conditions in children such as juvenile idiopathic arthritis, inflammatory bowel disease, cystic fibrosis and systemic lupus erythematosus can cause reduced linear growth, final height and bone mass. There are many mechanisms leading to these skeletal alterations but inflammation itself is considered to play an important role. Biologic therapy is being used increasingly for the treatment of chronic inflammatory conditions and may also be effective in improving growth and skeletal development. The main aim of this article is to summarize the effects of inflammation on growth and skeletal development and evaluate the effects of biologic therapy on growth and skeletal development in children with chronic inflammatory conditions.
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Affiliation(s)
- Salma Malik
- a Bone & Endocrine Research Group, Division of Developmental Medicine, University of Glasgow, Royal Hospital for Sick Children, Yorkhill, Glasgow, G3 8SJ, UK
| | - S Faisal Ahmed
- a Bone & Endocrine Research Group, Division of Developmental Medicine, University of Glasgow, Royal Hospital for Sick Children, Yorkhill, Glasgow, G3 8SJ, UK
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