101
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Acosta-Rivera V, Melendez-Montañez JM, Diaz-Sotomayor F, De Jesús-Rojas W. Surfactant Protein C Deficiency in a Puerto Rican Adolescent With a Rare SFTPC Genetic Variant. Cureus 2021; 13:e17422. [PMID: 34589332 PMCID: PMC8460488 DOI: 10.7759/cureus.17422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
Surfactant protein C (SP-C) is a hydrophobic lipoprotein necessary for lowering alveolar surface tension and lung defense mechanisms. Defects in its function due to genetic mutations in the SFTPC gene have been increasingly identified in patients presenting with childhood interstitial lung disease. SFTPC mutations are inherited in an autosomal dominant pattern with reduced penetration and variable expressivity, although de novo mutations have also been documented. In this article, we present the case of an oxygen-dependent 13-year-old male with interstitial lung disease and severe pulmonary hypertension. Genetic analysis and lung biopsy confirmed the diagnosis of SP-C deficiency with the rare heterozygous mutation IVS4+2. To our knowledge, this is the first documented case of SP-C deficiency in the Puerto Rican population and the second worldwide with the IVS4+2 genetic mutation.
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Affiliation(s)
- Victor Acosta-Rivera
- Department of Internal Medicine, University of Massachusetts Medical School, Massachusetts, USA.,Department of Internal Medicine, Ponce Health Sciences University, Ponce, PRI
| | | | | | - Wilfredo De Jesús-Rojas
- Department of Pediatrics, Ponce Health Sciences University, Ponce, PRI.,Department of Pediatrics, University of Puerto Rico, Medical Sciences Campus, San Juan, PRI
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102
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Pignotti MS, Maiese A, Ugolini S, Iannaccone F, Santoro P, Neri M, Turillazzi E, Paolo MD. Sudden unexpected death in infancy: Severe pulmonary anatomopathological findings in spite of inconsistent clinical features. Med Leg J 2021; 89:173-177. [PMID: 34219536 DOI: 10.1177/00258172211009071] [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] [Indexed: 06/13/2023]
Abstract
Respiratory tract infections play a considerable pathogenetic role in many cases of sudden infant death (SID). Frequently, clinicians encounter difficulties in diagnosing the disease because of its often unspecific clinical and radiological presentation. We report three cases of sudden unexpected death in infancy (SUDI), involving two males and one female admitted to hospital due to mild respiratory distress. In all three cases, complete post-mortem investigations were successful in uncovering interstitial lung disease as the cause of death. These cases highlight the key role of infection-related interstitial lung diseases in the pathogenesis of some currently unexplained SUDI/SIDS and the diagnostic difficulties due to the variable clinical and histological pattern, thereby explaining the importance of performing complete post-mortem investigations whenever an infant dies suddenly and unexpectedly.
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Affiliation(s)
| | - Aniello Maiese
- Section of Legal Medicine, S. Chiara Hospital, University of Pisa, Pisa, Italy
| | | | | | - Paola Santoro
- Section of Legal Medicine, University of Ferrara, Ferrara, Italy
| | - Margherita Neri
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Emanuela Turillazzi
- Section of Legal Medicine, S. Chiara Hospital, University of Pisa, Pisa, Italy
| | - Marco Di Paolo
- Section of Legal Medicine, S. Chiara Hospital, University of Pisa, Pisa, Italy
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103
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Surfactant protein disorders in childhood interstitial lung disease. Eur J Pediatr 2021; 180:2711-2721. [PMID: 33839914 DOI: 10.1007/s00431-021-04066-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/26/2021] [Accepted: 04/04/2021] [Indexed: 10/24/2022]
Abstract
Surfactant, which was first identified in the 1920s, is pivotal to lower the surface tension in alveoli of the lungs and helps to lower the work of breathing and prevents atelectasis. Surfactant proteins, such as surfactant protein B and surfactant protein C, contribute to function and stability of surfactant film. Additionally, adenosine triphosphate binding cassette 3 and thyroid transcription factor-1 are also integral for the normal structure and functioning of pulmonary surfactant. Through the study and improved understanding of surfactant over the decades, there is increasing interest into the study of childhood interstitial lung diseases (chILD) in the context of surfactant protein disorders. Surfactant protein deficiency syndrome (SPDS) is a group of rare diseases within the chILD group that is caused by genetic mutations of SFTPB, SFTPC, ABCA3 and TTF1 genes.Conclusion: This review article seeks to provide an overview of surfactant protein disorders in the context of chILD. What is Known: • Surfactant protein disorders are an extremely rare group of disorders caused by genetic mutations of SFTPB, SPTPC, ABCA3 and TTF1 genes. • Given its rarity, research is only beginning to unmask the pathophysiology, inheritance, spectrum of disease and its manifestations. What is New: • Diagnostic and treatment options continue to be explored and evolve in these conditions. • It is, therefore, imperative that we as paediatricians are abreast with current development in this field.
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104
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陈 慧. [Current Status of and Challenges in Diagnosis and Treatment of Childhood Diffuse Parenchymal Lung Diseases/Childhood Interstitial Lung Diseases]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2021; 52:721-724. [PMID: 34622582 PMCID: PMC10408899 DOI: 10.12182/20210960101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 11/23/2022]
Abstract
The medical field in China has witnessed encouraging progress in specialized theoretical research and clinical practice concerning childhood diffuse parenchymal lung diseases/childhood interstitial lung diseases (chDPLD/chILD) after many years of hard work. However, we have also encountered many tasks and challenges. We must approach the problem with a holistic perspective, and collect, accumulate and analyze, in a uniform way, the data from all over the country. We should try our best to obtain more pathological materials for further analysis of the diagnosis and treatment as well as clinical research. The diagnosis protocol and treatment recommendations should be revised regularly. Moreover, we emphasize the adoption of the clinico-radio-genetic-pathological (C-R-G-P) management model and the multi-disciplinary team (MDT) approach to the diagnosis and treatment of chDPLD/chILD. In this way, we will be able to improve our cognitive understanding and enrich our experience in the prevention and management of chDPLD/chILD further more.
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Affiliation(s)
- 慧中 陈
- 首都儿科研究所附属儿童医院 (北京 100020)Affiliated Children’s Hospital of Capital Institute of Pediatrics, Beijing 100020, China
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105
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Ademhan Tural D, Emiralioglu N, Ozsezen B, Sunman B, Nayir Buyuksahin H, Guzelkas I, Oguz B, Bilginer Y, Orhan D, Yalcin E, Dogru D, Ozcelik U, Ozen S, Kiper N. Clinical spectrum of children with interstitial pneumonia with autoimmune features. Respir Med 2021; 187:106566. [PMID: 34416614 DOI: 10.1016/j.rmed.2021.106566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/08/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Interstitial pneumonia with autoimmune features (IPAF) is a term used to describe adult patients with interstitial lung disease (ILD) who display some clinical or serological features of autoimmune diseases and who do not meet the full criteria for a specific connective tissue disease (CTD). The aim of this study was to define the demographic, clinical, radiologic, serologic and histopathologic features and assess treatment in children with IPAF. METHODS This retrospective cohort study was conducted at a tertiary referral pediatric pulmonology center between January 2010 and August 2020. Children with proven interstitial pneumonia with no known etiologies were evaluated for IPAF according to European Respiratory Society/American Thoracic Society research statement of IPAF. RESULTS Among 132 children with ILD, 17 patients were evaluated in detail for IPAF criteria and six patients were further diagnosed as having IPAF. The incidence of IPAF in our patients with ILD was 4.5%. Four of these patients were female. The median age at the time of ILD diagnosis was 10.5 years. The most common initial symptom was shortness of breath, and the most common physical examination sign was crackles in both lungs. Steroid therapy was given to all patients and four patients received other immunosuppressive agents for steroid sparing. Two of those patients died because of respiratory insufficiency during the follow-up. CONCLUSION Children with interstitial pneumonia and certain clinical, serologic, and/or morphologic features should raise suspicion for the presence of an underlying systemic autoimmune disease. IPAF is also seen in children and should be categorized in chILD classifications.
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Affiliation(s)
- Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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106
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Brennan LC, O’Sullivan A, MacLoughlin R. Cellular Therapy for the Treatment of Paediatric Respiratory Disease. Int J Mol Sci 2021; 22:ijms22168906. [PMID: 34445609 PMCID: PMC8396271 DOI: 10.3390/ijms22168906] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 12/12/2022] Open
Abstract
Respiratory disease is the leading cause of death in children under the age of 5 years old. Currently available treatments for paediatric respiratory diseases including bronchopulmonary dysplasia, asthma, cystic fibrosis and interstitial lung disease may ameliorate symptoms but do not offer a cure. Cellular therapy may offer a potential cure for these diseases, preventing disease progression into adulthood. Induced pluripotent stem cells, mesenchymal stromal cells and their secretome have shown great potential in preclinical models of lung disease, targeting the major pathological features of the disease. Current research and clinical trials are focused on the adult population. For cellular therapies to progress from preclinical studies to use in the clinic, optimal cell type dosage and delivery methods need to be established and confirmed. Direct delivery of these therapies to the lung as aerosols would allow for lower doses with a higher target efficiency whilst avoiding potential effect of systemic delivery. There is a clear need for research to progress into the clinic for the treatment of paediatric respiratory disease. Whilst research in the adult population forms a basis for the paediatric population, varying disease pathology and anatomical differences in paediatric patients means a paediatric-centric approach must be taken.
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Affiliation(s)
- Laura C. Brennan
- College of Medicine, Nursing & Health Sciences, National University of Ireland, H91 TK33 Galway, Ireland;
| | - Andrew O’Sullivan
- Research and Development, Science and Emerging Technologies, Aerogen Limited, Galway Business Park, H91 HE94 Galway, Ireland;
| | - Ronan MacLoughlin
- Research and Development, Science and Emerging Technologies, Aerogen Limited, Galway Business Park, H91 HE94 Galway, Ireland;
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, D02 PN40 Dublin, Ireland
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
- Correspondence:
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107
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Abdelhady SG, Fouda EM, Shaheen MA, Ghazal FA, Mostafa AM, Osman AM, Nicholson AG, Hamza HM. Spectrum of childhood interstitial and diffuse lung diseases at a tertiary hospital in Egypt. ERJ Open Res 2021; 7:00880-2020. [PMID: 34109237 PMCID: PMC8181618 DOI: 10.1183/23120541.00880-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Childhood interstitial and diffuse lung diseases (chILD) encompass a broad spectrum of rare pulmonary disorders. In most developing Middle Eastern countries, chILD is still underdiagnosed. Our objective was to describe and investigate patients diagnosed with chILD in a tertiary university hospital in Egypt. Methods We analysed data of consecutive subjects (aged <18 years) referred for further evaluation at the Children's Hospital, Ain Shams University (Cairo, Egypt). Diagnosis of chILD was made in accordance with the ChILD-EU criteria. The following information was obtained: demographic data, clinical characteristics, chest computed tomography findings, laboratory studies, spirometry, bronchoalveolar lavage and histopathology findings. Results 22 subjects were enrolled over 24 months. Median age at diagnosis was 7 years (range 3.5–14 years). The most common manifestations were dyspnoea (100%), cough (90.9%), clubbing (95.5%) and tachypnoea (90.9%). Systematic evaluation led to the following diagnoses: hypersensitivity pneumonitis (n=3), idiopathic interstitial pneumonias (n=4), chILD related to chronic granulomatous disease (n=3), chILD related to small airways disease (n=3), post-infectious chILD (n=2), Langerhans cell histiocytosis (n=2), idiopathic pulmonary haemosiderosis (n=2), granulomatous lymphocytic interstitial lung disease (n=1), systemic sclerosis (n=1) and familial interstitial lung disease (n=1). Among the subjects who completed the diagnostic evaluation (n=19), treatment was changed in 13 (68.4%) subjects. Conclusion Systematic evaluation and multidisciplinary peer review of chILD patients at our tertiary hospital led to changes in management in 68% of the patients. This study highlights the need for an Egyptian chILD network with genetic testing, as well as the value of collaborating with international groups in improving healthcare for children with chILD. In Egypt, childhood interstitial and diffuse lung diseases (chILD) are still underdiagnosed. Establishment of an Egyptian chILD network with genetic testing is essential to improve healthcare for children diagnosed with chILD.https://bit.ly/385qKsU
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Affiliation(s)
- Salma G Abdelhady
- Dept of Paediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Children's Hospital, Pulmonology Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Eman M Fouda
- Dept of Paediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Children's Hospital, Pulmonology Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Malak A Shaheen
- Dept of Paediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Children's Hospital, Pulmonology Unit, Ain Shams University Hospitals, Cairo, Egypt
| | - Faten A Ghazal
- Dept of Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Pathology Lab, Ain Shams University Hospitals, Cairo, Egypt
| | - Ahmed M Mostafa
- Dept of Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Cardiovascular and Thoracic Academy, Ain Shams University Hospitals, Cairo, Egypt
| | - Ahmed M Osman
- Dept of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Andrew G Nicholson
- Dept of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Heba M Hamza
- Dept of Paediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Children's Hospital, Pulmonology Unit, Ain Shams University Hospitals, Cairo, Egypt
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108
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Schramm D, Freitag N, Nicolai T, Wiemers A, Hinrichs B, Amrhein P, DiDio D, Eich C, Landsleitner B, Eber E, Hammer J. Pediatric Airway Endoscopy: Recommendations of the Society for Pediatric Pneumology. Respiration 2021; 100:1128-1145. [PMID: 34098560 DOI: 10.1159/000517125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
For many decades, pediatric bronchoscopy has been an integral part of the diagnosis and treatment of acute and chronic pulmonary diseases in children. Rapid technical advances have continuously influenced the performance of the procedure. Over the years, the application of pediatric bronchoscopy has considerably expanded to a broad range of indications. In this comprehensive and up-to-date guideline, the Special Interest Group of the Society for Pediatric Pneumology reviewed the most recent literature on pediatric bronchoscopy and reached a consensus on a safe technical performance of the procedure.
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Affiliation(s)
- Dirk Schramm
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology, and Pediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Thomas Nicolai
- University Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Anna Wiemers
- Ruhr University Bochum, St. Josef-Hospital, University Hospital of Pediatrics and Adolescent Medicine, Department of Pediatric Pulmonology, Bochum, Germany
| | - Bernd Hinrichs
- Pediatric Practice Buchholz and Asklepios Medical School Hamburg, Hamburg, Germany
| | - Peter Amrhein
- Department of Pediatric Otorhinolaryngology, Klinikum Stuttgart Katharinenhospital, Olgahospital, Stuttgart, Germany
| | - Diana DiDio
- Department of Pediatric Otorhinolaryngology, Klinikum Stuttgart Katharinenhospital, Olgahospital, Stuttgart, Germany
| | - Christoph Eich
- Department of Anesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hannover, Germany
| | - Bernd Landsleitner
- Department of Anaesthesia and Intensive Care Medicine, Hallerwiese Clinic-Cnopf Children's Hospital, Nuremberg, Germany
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Jürg Hammer
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, University of Basel, Basel, Switzerland
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109
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Leitz DHW, Duerr J, Mulugeta S, Seyhan Agircan A, Zimmermann S, Kawabe H, Dalpke AH, Beers MF, Mall MA. Congenital Deletion of Nedd4-2 in Lung Epithelial Cells Causes Progressive Alveolitis and Pulmonary Fibrosis in Neonatal Mice. Int J Mol Sci 2021; 22:6146. [PMID: 34200296 PMCID: PMC8201155 DOI: 10.3390/ijms22116146] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/31/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
Recent studies found that expression of NEDD4-2 is reduced in lung tissue from patients with idiopathic pulmonary fibrosis (IPF) and that the conditional deletion of Nedd4-2 in lung epithelial cells causes IPF-like disease in adult mice via multiple defects, including dysregulation of the epithelial Na+ channel (ENaC), TGFβ signaling and the biosynthesis of surfactant protein-C proprotein (proSP-C). However, knowledge of the impact of congenital deletion of Nedd4-2 on the lung phenotype remains limited. In this study, we therefore determined the effects of congenital deletion of Nedd4-2 in the lung epithelial cells of neonatal doxycycline-induced triple transgenic Nedd4-2fl/fl/CCSP-rtTA2S-M2/LC1 mice, with a focus on clinical phenotype, survival, lung morphology, inflammation markers in BAL, mucin expression, ENaC function and proSP-C trafficking. We found that the congenital deletion of Nedd4-2 caused a rapidly progressive lung disease in neonatal mice that shares key features with interstitial lung diseases in children (chILD), including hypoxemia, growth failure, sterile pneumonitis, fibrotic lung remodeling and high mortality. The congenital deletion of Nedd4-2 in lung epithelial cells caused increased expression of Muc5b and mucus plugging of distal airways, increased ENaC activity and proSP-C mistrafficking. This model of congenital deletion of Nedd4-2 may support studies of the pathogenesis and preclinical development of therapies for chILD.
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Affiliation(s)
- Dominik H. W. Leitz
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (D.H.W.L.); (M.A.M.)
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany;
- German Center for Lung Research (DZL), Associated Partner Site, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Julia Duerr
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (D.H.W.L.); (M.A.M.)
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany;
- German Center for Lung Research (DZL), Associated Partner Site, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Surafel Mulugeta
- Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk Suite 216, Philadelphia, PA 19104, USA; (S.M.); (M.F.B.)
| | - Ayça Seyhan Agircan
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany;
- German Center for Lung Research (DZL), Associated Partner Site, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Stefan Zimmermann
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Hiroshi Kawabe
- Department of Molecular Neurobiology, Max Planck Institute of Experimental Medicine, Hermann-Rein-Str. 3D, 37075 Goettingen, Germany;
- Laboratory of Molecular Life Science, Department of Gerontology, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation at Kobe, 2-2 Minatojima-Minamimachi Chuo-ku, Kobe 650-0047, Japan
- Division of Pathogenetic Signaling, Department of Biochemistry and Molecular Biology, Kobe University Graduate School of Medicine, 1-5-6 Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan
- Department of Pharmacology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Alexander H. Dalpke
- Institute of Medical Microbiology and Virology, Medical Faculty, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, 01307 Dresden, Germany;
| | - Michael F. Beers
- Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk Suite 216, Philadelphia, PA 19104, USA; (S.M.); (M.F.B.)
| | - Marcus A. Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (D.H.W.L.); (M.A.M.)
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 156, 69120 Heidelberg, Germany;
- German Center for Lung Research (DZL), Associated Partner Site, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Wang B, Cardenas M, Bedoya M, Colin AA, Rossi GA. Upregulation of neuropeptides and obstructive airway disorder in infancy: A review with focus on post-RSV wheezing and NEHI. Pediatr Pulmonol 2021; 56:1297-1306. [PMID: 33524244 DOI: 10.1002/ppul.25292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
Abstract
Obstructive airway disorders, common in infancy and early childhood, include some entities that are recognized to have neuro immune mediators as their underlying pathogenetic mechanisms. The best characterized example amongst post-viral wheezing phenotypes is the disorder that follows respiratory syncytial virus (RSV) infection and leads to intermittent, long-term wheezing. The underlying mechanisms of the airway reactivity related to RSV infection have been extensively studies and are associated with dysregulation of the nonadrenergic-noncholinergic (NANC) system, via upregulation of neurotransmitters, typically Substance P. Neuroendocrine hyperplasia of infancy (NEHI), while a less common entity, is a disorder characterized by more severe and long-term obstructive airway disease. NEHI is pathophysiologically characterized by abundance of neuroendocrine cells in the airways containing the neuroimmune mediator bombesin, the release of which is presumed to be the driver of the persistent small airway obstruction and functional air-trapping. Here we review the NANC and neuroendocrine cells, the neurotransmitter systems and their studied roles in pulmonary diseases with a focus on their role in lung development, and subsequent various pediatric lung diseases. We focus on the juxtaposition of the separate neuroimmune mechanisms underlying the pathogenesis of post-RSV recurrent wheezing and NEHI's persistent small airway obstruction. We finally propose a unifying concept of neuropeptides in obstructive disorders that may encompass these two entities and possibly others.
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Affiliation(s)
- Bin Wang
- Division of Critical Care Medicine, Jackson Memorial Hospital and Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Monica Cardenas
- Division of Pediatric Pulmonology, Jackson Memorial Hospital and Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Mariana Bedoya
- Division of Pediatric Pulmonology, Jackson Memorial Hospital and Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Jackson Memorial Hospital and Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Giovanni A Rossi
- Pulmonary and Allergy Disease Unit, Department of Pediatrics, G. Gaslini University Hospital, Genoa, Italy
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111
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Balinotti JE, Maffey A, Colom A, Roldán O, Díaz W, Medín M, Racimo M, Teper A. Clinical, functional, and computed tomography findings in a cohort of patients with neuroendocrine cell hyperplasia of infancy. Pediatr Pulmonol 2021; 56:1681-1686. [PMID: 33580744 DOI: 10.1002/ppul.25319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/16/2021] [Accepted: 02/09/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Neuroendocrine cell hyperplasia of infancy (NEHI) is one of the most common interstitial lung diseases in children. Both the etiology and pathophysiological mechanisms of the disease are still unknown. Prognosis is usually favorable; however, there are significant morbidities during the early years of life. OBJECTIVE To describe the clinical course, infant pulmonary function tests and computed tomography (CT) findings in a cohort of patients with NEHI in Argentina. METHODS This is a observational multicenter cohort study of children diagnosed with NEHI between 2011 and 2020. RESULTS Twenty patients participated in this study. The median age of onset of symptoms was 3 months and the median age at diagnosis was 6 months. The most common clinical presentation was tachypnea, retractions and hypoxemia. The chest CT findings showed central ground glass opacities and air trapping. Infant pulmonary function tests revealed an obstructive pattern in 75% of the cases (10/12). Most patients (75%) required home oxygen therapy for 17 months (interquartile range 12-25). In 85% of them, tachypnea and hypoxemia spontaneously resolved between the second and third years of life. CONCLUSION In this cohort, the first symptoms appeared during the early months of life. The typical clinical, CT, and functional findings allowed the diagnosis without the need of a lung biopsy. Although most patients required home oxygen therapy, they showed a favorable evolution.
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Affiliation(s)
- Juan E Balinotti
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Alberto Maffey
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Alejandro Colom
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Oscar Roldán
- Division of Pediatric, Sanatorio del Salvador, Córdoba, Argentina
| | - Walter Díaz
- Division of Pediatric, Alexander Fleming Hospital, Mendoza, Argentina
| | - Martín Medín
- Department of Pathology, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Mariano Racimo
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Alejandro Teper
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
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112
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Breuer O, Cohen-Cymberknoh M, Picard E, Bentur L, Bar-Yoseph R, Shoseyov D, Tsabari R, Kerem E, Hevroni A. The Use of Infant Pulmonary Function Tests in the Diagnosis of Neuroendocrine Cell Hyperplasia of Infancy. Chest 2021; 160:1397-1405. [PMID: 34029568 DOI: 10.1016/j.chest.2021.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/15/2021] [Accepted: 05/07/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infant pulmonary function tests (iPFTs) in subjects with neuroendocrine cell hyperplasia of infancy (NEHI) have demonstrated significant expiratory airflow obstruction and air trapping. RESEARCH QUESTION Can indexes from iPFTs be used in the diagnosis of NEHI? STUDY DESIGN AND METHODS This is an observational case-control study evaluating iPFT results from a registry of patients assessed at the Hadassah Hebrew University Medical Center between 2008 and 2018. We used the Kruskal-Wallis H test to compare iPFT results in infants with NEHI with those in two infants in a disease control group (infants evaluated for recurrent wheezing and infants evaluated owing to prematurity) and those in a spirometry control group of infants with normal expiratory airflow. Receiver operating characteristic (ROC) curves were used to assess the diagnostic accuracy of the iPFT indexes. RESULTS We evaluated iPFT data in 481 infants (15, NEHI; 292, wheezing; 128, premature; and 46, control group). Infants with NEHI had significantly increased trapped air volumes (median functional residual capacity measured with baby-body plethysmograph [FRCpleth] was 199% predicted; median ratio of residual volume to total lung capacity was 59% predicted) when compared with results in all evaluated groups of infants (P < .001), including multiple pairwise comparisons. Airflow limitation was demonstrated in infants with NEHI when compared with the infants in the spirometry control group but was similar to that in the two infants in the disease control group. FRCpleth had the best discriminatory ability for NEHI diagnosis, with an FRCpleth ≥ 150% predicted demonstrating a ROC of 0.91 (95% CI, 0.82-1.00), sensitivity of 86.7% (95% CI, 59.5%-98.3%), and specificity of 95.5% (95% CI, 93.2%-97.3%). INTERPRETATION Findings on iPFTs of markedly increased air trapping, out of proportion to the degree of airflow limitation, are characteristic of infants with NEHI. iPFT results demonstrating an FRCpleth ≥ 150% predicted are highly specific for NEHI and may aid in early diagnosis. Further research is required to confirm these findings in a prospective cohort and to understand the pathophysiologic explanation for these findings.
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Affiliation(s)
- Oded Breuer
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Elie Picard
- Pediatric Pulmonary Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Lea Bentur
- Pediatric Pulmonary Unit, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Unit, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - David Shoseyov
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Reuven Tsabari
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Eitan Kerem
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Avigdor Hevroni
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Pediatric Pulmonary Unit, Kaplan Medical Center, Rehovot, Israel
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113
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De Rose DU, Auriti C, Lozzi S, Coltella L, Piccioni L, Rossi S, Novelli A, Iannotta R, Pianini T, Picone S, Paolillo P, Savignoni F, Capolupo I, Digilio MC, Cutrera R, Dotta A. Severe herpes virus 6 interstitial pneumonia in an infant with three variants in genes predisposing to lung disease. J Med Virol 2021; 93:5182-5187. [PMID: 33851733 DOI: 10.1002/jmv.27016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/21/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023]
Abstract
Infections due to human herpesvirus 6 (HHV-6) are frequent during early childhood. Usually, they have a favorable clinical course. Conversely, HHV-6 congenital infections occur in about 1% of neonates and may present with more severe clinical pictures. HHV-6 can be found in lung tissues and bronchoalveolar lavage (BAL) samples from patients with pneumonia and in immunocompromised patients can cause mild to severe pneumonia. In neonates, the role of HHV-6 in the genesis of severe pneumonia is poorly defined still now. We describe a healthy infant with a late-onset (15 days of life) severe interstitial pneumonia and heavy HHV-6 genome load, persistently detected in its BAL fluid. The baby underwent high-frequency oscillatory ventilation, hydroxychloroquine, steroids, and ganciclovir for 6 weeks and at 9 months she died. Next-generation sequencing of genes known to cause neonatal respiratory insufficiency revealed the presence of a "probably pathogenetic" heterozygous variant in the autosomal recessive DRC1 gene, a heterozygous variant of unknown significance (VUS) in the autosomal recessive RSPH9 gene, and a heterozygous VUS in the autosomal recessive MUC5B gene. HHV-6 infection should be considered in the differential diagnosis of late-onset severe respiratory distress in neonates and the co-occurrence of genetic predisposing factors or modifiers should be tested by specific molecular techniques. The intensity of HHV-6 genome load in BAL fluid could be an indicator of the response to antiviral therapy.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Simona Lozzi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Luana Coltella
- Microbiology Unit, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Livia Piccioni
- Microbiology Unit, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Sabrina Rossi
- Department of Pathology, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Antonio Novelli
- Medical Genetics Laboratory, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Rossella Iannotta
- Neonatal Intensive Care Unit, "Policlinico Casilino" General Hospital, Rome, Italy
| | - Teresa Pianini
- Neonatal Intensive Care Unit, "Policlinico Casilino" General Hospital, Rome, Italy
| | - Simonetta Picone
- Neonatal Intensive Care Unit, "Policlinico Casilino" General Hospital, Rome, Italy
| | - Piermichele Paolillo
- Neonatal Intensive Care Unit, "Policlinico Casilino" General Hospital, Rome, Italy
| | - Ferdinando Savignoni
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
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114
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Hizal M, Eryilmaz Polat S, Ramasli Gursoy T, Ozsezen B, Ademhan Tural D, Karakaya J, Emiralioglu N, Pekcan S, Tana Aslan A, Yalcin E, Dogru D, Ozcelik U, Kiper N. Risk factors for recurrent pulmonary exacerbation in idiopathic pulmonary hemosiderosis. Pediatr Pulmonol 2021; 56:1060-1068. [PMID: 33247613 DOI: 10.1002/ppul.25189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To evaluate the risk factors of recurrent pulmonary exacerbation and poor prognosis in children with idiopathic pulmonary hemosiderosis (IPH). METHODS In this multicenter study, 54 patients with a diagnosis of IPH were included. Medical records were retrospectively reviewed from three tertiary care hospitals between 1979 and 2019. Also, current information and the long-term progress of patients was determined by contacting the families by telephone. RESULTS A total of 54 children were included. The median age of onset of symptoms was 4.5 years (3 months to 15.8 years). The median time from onset to diagnosis was 0.9 years (0.25 months to 12 years). The mean number of recurrent episodes per child in the recurrence-positive group was 3.55 (1-15). Univariate analysis demonstrated that patients presenting with hypoxia or requiring transfusion at the time of presentation had significantly more recurrence episodes (p = .002). Multivariate analysis showed that the presence of hypoxia at the time of initial presentation was a significant independent predictor of recurrent episodes (p = .027). The median follow-up was 3.3 years (0.75 months to 27 years). There was a significant relationship between the presence of hypoxia, transfusion history, antinuclear antibody positivity, and elevated transaminases at the time of initial evaluation and treatment response. CONCLUSIONS The present study provides substantial information regarding factors that may affect recurrent exacerbations and prognosis in children with IPH. Demonstrating hypoxia as an independent risk factor in recurrence episodes could guide physicians in the planning of treatment strategies.
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Affiliation(s)
- Mina Hizal
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | | | - Beste Ozsezen
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Jale Karakaya
- Department of Biostatistic, Hacettepe University, Ankara, Turkey
| | - Nagehan Emiralioglu
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevgi Pekcan
- Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ayse Tana Aslan
- Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalcin
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Dogru
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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115
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Si X, Steffes LC, Schymick JC, Hazard FK, Tracy MC, Cornfield DN. Three Infants with Pathogenic Variants in the ABCA3 Gene: Presentation, Treatment, and Clinical Course. J Pediatr 2021; 231:278-283.e2. [PMID: 33359301 PMCID: PMC8031471 DOI: 10.1016/j.jpeds.2020.12.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
ABCA3 deficiency is a rare cause of neonatal respiratory failure. Biallelic complete loss of function variants lead to neonatal demise without lung transplantation, but children with partial function variants have variable outcomes. The favorable clinical course of 3 such infants presenting with respiratory distress at birth is described.
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Affiliation(s)
- Xin Si
- Division of Pediatric Pulmonary, Center for Excellence in Pulmonary Biology, Asthma and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford University, Stanford, CA.
| | - Lea C Steffes
- Division of Pediatric Pulmonary, Center for Excellence in Pulmonary Biology, Asthma and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford University, Stanford, CA
| | - Jennifer C Schymick
- Division of Medical Genetics, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford University, Stanford, CA
| | - Florette K Hazard
- Division of Pathology, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford University, Stanford, CA
| | - Michael C Tracy
- Division of Pediatric Pulmonary, Center for Excellence in Pulmonary Biology, Asthma and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford University, Stanford, CA
| | - David N Cornfield
- Division of Pediatric Pulmonary, Center for Excellence in Pulmonary Biology, Asthma and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital at Stanford University, Stanford, CA
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116
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van Moorsel CHM, van der Vis JJ, Grutters JC. Genetic disorders of the surfactant system: focus on adult disease. Eur Respir Rev 2021; 30:30/159/200085. [PMID: 33597124 DOI: 10.1183/16000617.0085-2020] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/30/2020] [Indexed: 12/18/2022] Open
Abstract
Genes involved in the production of pulmonary surfactant are crucial for the development and maintenance of healthy lungs. Germline mutations in surfactant-related genes cause a spectrum of severe monogenic pulmonary diseases in patients of all ages. The majority of affected patients present at a very young age, however, a considerable portion of patients have adult-onset disease. Mutations in surfactant-related genes are present in up to 8% of adult patients with familial interstitial lung disease (ILD) and associate with the development of pulmonary fibrosis and lung cancer.High disease penetrance and variable expressivity underscore the potential value of genetic analysis for diagnostic purposes. However, scarce genotype-phenotype correlations and insufficient knowledge of mutation-specific pathogenic processes hamper the development of mutation-specific treatment options.This article describes the genetic origin of surfactant-related lung disease and presents spectra for gene, age, sex and pulmonary phenotype of adult carriers of germline mutations in surfactant-related genes.
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Affiliation(s)
- Coline H M van Moorsel
- Dept of Pulmonology, St Antonius ILD Center of Excellence, St Antonius Hospital, Nieuwegein, The Netherlands.,Division of Hearts and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joanne J van der Vis
- Dept of Pulmonology, St Antonius ILD Center of Excellence, St Antonius Hospital, Nieuwegein, The Netherlands.,Dept of Clinical Chemistry, St Antonius ILD Center of Excellence, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan C Grutters
- Dept of Pulmonology, St Antonius ILD Center of Excellence, St Antonius Hospital, Nieuwegein, The Netherlands.,Division of Hearts and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
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117
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Shah AS, Black ED, Simon DM, Gambello MJ, Garber KB, Iannucci GJ, Riedesel EL, Kasi AS. Heterogeneous Pulmonary Phenotypes in Filamin A Mutation-Related Lung Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:7-14. [PMID: 33734874 DOI: 10.1089/ped.2020.1280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Interstitial lung disease (ILD) has been recently reported in a few patients with pathogenic variants in the Filamin A (FLNA) gene with variable presentation and prognosis. This study evaluated the respiratory manifestations and clinical features in children with FLNA disease. Methods: We conducted a retrospective review of pediatric patients with variants in FLNA in a tertiary children's hospital. The clinical features, genotype, management, and outcomes were analyzed. Results: We identified 9 patients with variants in FLNA aged 15 months to 24 years, 4 females and 5 males. Six patients had abnormal chest imaging ranging from mild interstitial prominence to atelectasis, interstitial densities, and hyperinflation. Three patients with ILD presented during the neonatal period or early infancy with respiratory distress or respiratory failure requiring supplemental oxygen or assisted ventilation via tracheostomy. We report male twins with the same FLNA variant and lung disease, but different ages and clinical features at presentation eventually culminating in respiratory failure requiring assisted ventilation. All patients had FLNA variants identified by FLNA sequencing, had abnormal echocardiograms, and none of the patients underwent lung biopsy or lung transplantation. The outcomes were variable and could be as severe as chronic respiratory failure. Conclusion: The wide spectrum of respiratory manifestations and abnormal chest imaging in our study highlights the importance of evaluation for lung disease in patients with variants in FLNA. FLNA sequencing in suspected cases with ILD may obviate the need for a lung biopsy, prompt surveillance for progressive lung disease, and evaluation for associated clinical features.
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Affiliation(s)
- Amit S Shah
- Division of Pediatric Pulmonology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Emily D Black
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA
| | - Dawn M Simon
- Division of Pediatric Pulmonology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | | | - Kathryn B Garber
- Department of Human Genetics, Emory University, Atlanta, Georgia, USA.,EGL Genetics, Tucker, Georgia, USA
| | - Glen J Iannucci
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Erica L Riedesel
- Department of Radiology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
| | - Ajay S Kasi
- Division of Pediatric Pulmonology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia, USA
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118
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Willemse BWM, van der Crabben SN, Kerstjens-Frederikse WS, Timens W, van Montfrans JM, Lindemans CA, Boelens JJ, Hennus MP, van Haaften G. New insights in phenotype and treatment of lung disease immuno-deficiency and chromosome breakage syndrome (LICS). Orphanet J Rare Dis 2021; 16:137. [PMID: 33741030 PMCID: PMC7980653 DOI: 10.1186/s13023-021-01770-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
We report five patients with lung disease immuno-deficiency and chromosome breakage syndrome (LICS) but without recurrent infections and severe immunodeficiency. One patient had extended survival to 6.5 years. Hematopoietic stem-cell transplantation failed to cure another patient. Our findings suggest that the immunological abnormalities can be limited and do not fully explain the LICS phenotype.
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Affiliation(s)
- Brigitte W M Willemse
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Saskia N van der Crabben
- Department of Metabolic Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Wim Timens
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joris M van Montfrans
- Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Caroline A Lindemans
- Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Pediatric Blood and Bone Marrow Transplantation, Princess Maxima Center and UMC Utrecht, Utrecht, The Netherlands
| | - Jaap Jan Boelens
- Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.,Stem Cell Transplantation and Cellular Therapies Program, Department Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marije P Hennus
- Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gijs van Haaften
- Department of Genetics (Center for Molecular Medicine, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
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119
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Abstract
PURPOSE OF REVIEW In 2013, the association between T-Box factor 4 (TBX4) variants and pulmonary arterial hypertension (PAH) has first been described. Now - in 2020 - growing evidence is emerging indicating that TBX4 variants associate with a wide spectrum of lung disorders. RECENT FINDINGS TBX4 variants are enriched in both children and adults with PAH. The clinical phenotype associated with a TBX4 variant seems to be milder than that in other PAH-associated gene mutations. Further, TBX4 variants have increasingly been associated with a variety of clinical and histopathological phenotypes, including lethal developmental parenchymal lung diseases such as not only acinar dysplasia in neonates, but also less outspoken parenchymal lung diseases in children and adults. SUMMARY The clinical phenotype of a TBX4 variant has recently been recognised to expand from bone disorders to different types of lung diseases. Recent data suggest that variants of TBX4, a transcription factor known to be an important regulator in embryonic development, are not rare in both children and adults with PAH and/or developmental parenchymal lung diseases.
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120
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Wu M, Sharma PG, Rajderkar DA. Childhood interstitial lung disease: A case-based review of the imaging findings. Ann Thorac Med 2021; 16:64-72. [PMID: 33680127 PMCID: PMC7908900 DOI: 10.4103/atm.atm_384_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/12/2020] [Indexed: 11/04/2022] Open
Abstract
Childhood interstitial lung disease (chILD) consists of a large, heterogeneous group of individually rare disorders. chILD demonstrates major differences in disease etiology, natural history, and management when compared with the adult group. It occurs primarily secondary to an underlying developmental or genetic abnormality affecting the growth and maturity of the pediatric lung. They present with different clinical, radiologic, and pathologic features. In this pictorial review article, we will divide chILD into those more prevalent in infancy and those not specific to infancy. We will use a case based approach to discuss relevant imaging findings including modalities such as radiograph and computed tomography in a wide variety of pathologies.
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Affiliation(s)
- Markus Wu
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Priya Girish Sharma
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
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121
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Legendre M, Butt A, Borie R, Debray MP, Bouvry D, Filhol-Blin E, Desroziers T, Nau V, Copin B, Dastot-Le Moal F, Héry M, Duquesnoy P, Allou N, Bergeron A, Bermudez J, Cazes A, Chene AL, Cottin V, Crestani B, Dalphin JC, Dombret C, Doray B, Dupin C, Giraud V, Gondouin A, Gouya L, Israël-Biet D, Kannengiesser C, Le Borgne A, Leroy S, Longchampt E, Lorillon G, Nunes H, Picard C, Reynaud-Gaubert M, Traclet J, de Vuyst P, Coulomb L'Hermine A, Clement A, Amselem S, Nathan N. Functional assessment and phenotypic heterogeneity of SFTPA1 and SFTPA2 mutations in interstitial lung diseases and lung cancer. Eur Respir J 2020; 56:13993003.02806-2020. [PMID: 32855221 DOI: 10.1183/13993003.02806-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Interstitial lung diseases (ILDs) can be caused by mutations in the SFTPA1 and SFTPA2 genes, which encode the surfactant protein (SP) complex SP-A. Only 11 SFTPA1 or SFTPA2 mutations have so far been reported worldwide, of which five have been functionally assessed. In the framework of ILD molecular diagnosis, we identified 14 independent patients with pathogenic SFTPA1 or SFTPA2 mutations. The present study aimed to functionally assess the 11 different mutations identified and to accurately describe the disease phenotype of the patients and their affected relatives. METHODS The consequences of the 11 SFTPA1 or SFTPA2 mutations were analysed both in vitro, by studying the production and secretion of the corresponding mutated proteins and ex vivo, by analysing SP-A expression in lung tissue samples. The associated disease phenotypes were documented. RESULTS For the 11 identified mutations, protein production was preserved but secretion was abolished. The expression pattern of lung SP-A available in six patients was altered and the family history reported ILD and/or lung adenocarcinoma in 13 out of 14 families (93%). Among the 28 SFTPA1 or SFTPA2 mutation carriers, the mean age at ILD onset was 45 years (range 0.6-65 years) and 48% underwent lung transplantation (mean age 51 years). Seven carriers were asymptomatic. DISCUSSION This study, which expands the molecular and clinical spectrum of SP-A disorders, shows that pathogenic SFTPA1 or SFTPA2 mutations share similar consequences for SP-A secretion in cell models and in lung tissue immunostaining, whereas they are associated with a highly variable phenotypic expression of disease, ranging from severe forms requiring lung transplantation to incomplete penetrance.
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Affiliation(s)
- Marie Legendre
- Sorbonne Université, Inserm Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France.,Dept of Genetics, Armand Trousseau Hospital, Sorbonne University, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.,Both authors contributed equally
| | - Afifaa Butt
- Sorbonne Université, Inserm Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France.,Both authors contributed equally
| | - Raphaël Borie
- Pulmonology Dept A, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Marie-Pierre Debray
- Radiology Dept, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Diane Bouvry
- Pulmonology Dept, EA 2363, Avicenne Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris 13 University, COMUE Sorbonne Paris Cité, Bobigny, France
| | - Emilie Filhol-Blin
- Dept of Genetics, Armand Trousseau Hospital, Sorbonne University, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Tifenn Desroziers
- Sorbonne Université, Inserm Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Valérie Nau
- Dept of Genetics, Armand Trousseau Hospital, Sorbonne University, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Bruno Copin
- Dept of Genetics, Armand Trousseau Hospital, Sorbonne University, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Florence Dastot-Le Moal
- Dept of Genetics, Armand Trousseau Hospital, Sorbonne University, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Mélanie Héry
- Sorbonne Université, Inserm Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Philippe Duquesnoy
- Sorbonne Université, Inserm Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Nathalie Allou
- Pulmonology Dept, Felix Guyon Hospital, Saint Denis de La Reunion, France
| | - Anne Bergeron
- Pulmonology Dept, Saint Louis Hospital, Université de Paris, Paris, France
| | - Julien Bermudez
- Pulmonology Dept and Lung Transplant Team, North Hospital - Assistance Publique Hôpitaux de Marseille (APHM), Marseille - MEPHI, IHU Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Aurélie Cazes
- Pathology Dept, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | | | - Vincent Cottin
- Pulmonology Dept and Coordinating Reference Center for Rare Pulmonary Diseases OrphaLung, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France
| | - Bruno Crestani
- Radiology Dept, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Jean-Charles Dalphin
- Pulmonology Dept, UMR-CNRS Chrono-Environnement 6249, CNRS and CHU, Besançon, France
| | - Christine Dombret
- Radiology Dept, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Bérénice Doray
- Genetic Dept, Felix Guyon Hospital, Saint Denis de La Reunion, France
| | - Clairelyne Dupin
- Pulmonology Dept, Saint Louis Hospital, Université de Paris, Paris, France
| | - Violaine Giraud
- Pulmonology Dept, Ambroise Paré Hospital, Assistance Publique Hôpitaux de Paris (APHP), Boulogne Billancourt, France
| | - Anne Gondouin
- Pulmonology Dept, UMR-CNRS Chrono-Environnement 6249, CNRS and CHU, Besançon, France
| | - Laurent Gouya
- Pulmonology Dept, Saint Louis Hospital, Université de Paris, Paris, France
| | - Dominique Israël-Biet
- Pulmonology Dept, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | - Caroline Kannengiesser
- Genetic Dept, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP), Université de Paris, Paris, France
| | | | - Sylvie Leroy
- Pulmonology Dept, Pasteur Hospital, Nice, France
| | | | - Gwenaël Lorillon
- Pulmonology Dept, Saint Louis Hospital, Université de Paris, Paris, France
| | - Hilario Nunes
- Pulmonology Dept, EA 2363, Avicenne Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris 13 University, COMUE Sorbonne Paris Cité, Bobigny, France
| | | | - Martine Reynaud-Gaubert
- Pulmonology Dept and Lung Transplant Team, North Hospital - Assistance Publique Hôpitaux de Marseille (APHM), Marseille - MEPHI, IHU Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Julie Traclet
- Pulmonology Dept and Coordinating Reference Center for Rare Pulmonary Diseases OrphaLung, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France
| | - Paul de Vuyst
- Pulmonology Dept, Erasme Hospital, Brussels, Belgium
| | | | - Annick Clement
- Sorbonne Université, Inserm Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France.,Pediatric Pulmonology Dept and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, Paris, France
| | - Serge Amselem
- Sorbonne Université, Inserm Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France.,Dept of Genetics, Armand Trousseau Hospital, Sorbonne University, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.,Both authors contributed equally
| | - Nadia Nathan
- Sorbonne Université, Inserm Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France.,Pediatric Pulmonology Dept and Reference Center for Rare Lung Diseases RespiRare, Armand Trousseau Hospital, Paris, France.,Both authors contributed equally
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Abstract
Diffuse interstitial lung disease of infancy (chILD) shows a spectrum of disease substantially different from that of adults. Established classification systems divide chILD into conditions that are more prevalent in infancy and conditions that occur at any age. The classification is based on a multidisciplinary approach including clinical, radiological, genetic, and histological findings. Lung biopsies become necessary if other diagnostic investigations have not identified a precise chILD or if severe or refractory respiratory distress of unknown cause is present. As the majority of pediatric lung biopsies will be received first by pathologists outside of specialist centers this review summarizes relevant clinical and histological findings of chILD.
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123
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Lynn MM, Simon D, Kasi AS. Hypoxaemia and interstitial lung disease in an infant with hypothyroidism and hypotonia. BMJ Case Rep 2020; 13:13/12/e238466. [PMID: 33370995 PMCID: PMC7757479 DOI: 10.1136/bcr-2020-238466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 7-month-old-term male infant presented with cough, tachypnoea, hypoxaemia and post-tussive emesis. Clinical history was significant for respiratory failure and pulmonary hypertension in the neonatal period requiring assisted ventilation, congenital hypothyroidism, mild hypotonia, recurrent respiratory infections, hypoxaemia requiring supplemental oxygen and nasogastric tube feeds. Physical examination showed tachypnoea, coarse bilateral breath sounds and mild hypotonia. Chest radiograph revealed multifocal pulmonary opacities with coarse interstitial markings and right upper lobe atelectasis. Following antibiotic therapy for suspected aspiration pneumonia, chest CT scan was performed and showed multiple areas of pulmonary consolidation and scattered areas of bilateral ground-glass opacities. Genetic studies showed a large deletion of chromosome 14q13.1-14q21.1, encompassing the NK2 homeobox 1 (NKX2-1) gene consistent with a diagnosis of brain-thyroid-lung (BTL) syndrome. Our case highlights the importance of genetic studies to diagnose BTL syndrome in infants with hypothyroidism, hypotonia and lung disease.
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Affiliation(s)
- Melodie M Lynn
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dawn Simon
- Pediatric Pulmonology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ajay S Kasi
- Pediatric Pulmonology, Emory University School of Medicine, Atlanta, Georgia, USA
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124
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Almuntashiri S, Zhu Y, Han Y, Wang X, Somanath PR, Zhang D. Club Cell Secreted Protein CC16: Potential Applications in Prognosis and Therapy for Pulmonary Diseases. J Clin Med 2020; 9:jcm9124039. [PMID: 33327505 PMCID: PMC7764992 DOI: 10.3390/jcm9124039] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 02/06/2023] Open
Abstract
Club cell secretory protein (CC16) is encoded by the SCGB1A1 gene. It is also known as CC10, secretoglobin, or uteroglobin. CC16 is a 16 kDa homodimeric protein secreted primarily by the non-ciliated bronchial epithelial cells, which can be detected in the airways, circulation, sputum, nasal fluid, and urine. The biological activities of CC16 and its pathways have not been completely understood, but many studies suggest that CC16 has anti-inflammatory and anti-oxidative effects. The human CC16 gene is located on chromosome 11, p12-q13, where several regulatory genes of allergy and inflammation exist. Studies reveal that factors such as gender, age, obesity, renal function, diurnal variation, and exercise regulate CC16 levels in circulation. Current findings indicate CC16 not only may reflect the pathogenesis of pulmonary diseases, but also could serve as a potential biomarker in several lung diseases and a promising treatment for chronic obstructive pulmonary disease (COPD). In this review, we summarize our current understanding of CC16 in pulmonary diseases.
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Affiliation(s)
- Sultan Almuntashiri
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA 30912, USA; (S.A.); (Y.Z.); (Y.H.); (P.R.S.)
| | - Yin Zhu
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA 30912, USA; (S.A.); (Y.Z.); (Y.H.); (P.R.S.)
| | - Yohan Han
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA 30912, USA; (S.A.); (Y.Z.); (Y.H.); (P.R.S.)
| | - Xiaoyun Wang
- Center for Vaccines and Immunology, University of Georgia, Athens, GA 30602, USA;
| | - Payaningal R. Somanath
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA 30912, USA; (S.A.); (Y.Z.); (Y.H.); (P.R.S.)
- Department of Medicine, Augusta University, Augusta, GA 30912, USA
| | - Duo Zhang
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, GA 30912, USA; (S.A.); (Y.Z.); (Y.H.); (P.R.S.)
- Correspondence: ; Tel.: +1-706-721-6491; Fax: +1-706-721-3994
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125
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Ferraro VA, Zanconato S, Zamunaro A, Carraro S. Children's Interstitial and Diffuse Lung Diseases (ChILD) in 2020. CHILDREN-BASEL 2020; 7:children7120280. [PMID: 33316882 PMCID: PMC7763071 DOI: 10.3390/children7120280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 11/16/2022]
Abstract
The term children interstitial lung diseases (chILD) refers to a heterogeneous group of rare diseases that diffusely affect the lung. ChILD specific to children younger than 2 years of age include diffuse developmental disorders, growth abnormalities, specific conditions of undefined etiology (neuroendocrine cell hyperplasia of infancy and pulmonary interstitial glycogenosis) and surfactant protein disorders. Clinical manifestations are highly variable, ranging from the absence of relevant symptoms to a severe onset. Most commonly, chILD presents with nonspecific respiratory signs and symptoms, such as dyspnea, polypnea, dry cough, wheezing, recurrent respiratory infections and exercise intolerance. In the diagnostic approach to a child with suspected ILD, chest high resolution computed tomography and genetic tests play a central role. Then, if the diagnosis remains uncertain, laryngotracheal-bronchoscopy and lung biopsy are needed. Pharmacological treatment is mostly empiric and based on anti-inflammatory and immunomodulatory drugs including corticosteroids, hydroxychloroquine and azithromycin. Despite chILD overall rarity, pediatric pulmonologists must be familiar with these diseases in order to carry out a timely diagnosis and patient treatment.
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126
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Liu L, Liu YJ, Guo T, Luo H. Identification of a Missense Mutation in the Surfactant Protein A2 Gene in a Chinese Family with Interstitial Lung Disease. DNA Cell Biol 2020; 40:126-131. [PMID: 33181027 DOI: 10.1089/dna.2020.6045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Interstitial lung disease (ILD) is a large group of disorders, most of which lead to progressive scarring of lung tissue. The scarring associated with ILD eventually affects your ability to breathe and get enough oxygen into your bloodstream. The typical symptoms of ILD are shortness of breath at rest or aggravated by exertion and dry cough. In this study, we enrolled a family with ILDs from central south region of China. Three patients suffered from repeated cough and shortness of breath. The high resolution computed tomography (HRCT) testing further confirmed the diagnosis of interstitial lung lesions. Whole exome sequencing (WES) and Sanger sequencing were applied to detect the genetic lesion of the family. By employing WES, a novel heterozygous mutation (NM_001098668: c.554C>T/p.A185V) of surfactant protein A2 (SFTPA2) was identified in the affected individuals and absent in the healthy members. Bioinformatics analysis predicted that this mutation is disease-causing mutation and located in an evolutionarily conserved site of SFTPA2 protein. The novel mutation may disrupt the stability of SFTPA2 protein and induce endoplasmic reticulum stress, finally leading to ILD under the influence of microorganisms. Our study not only expands the spectrum of SFTPA2 mutations but also helps the family members to mitigate ILD risk factors. The study also supplements and improves genetic testing strategies and ILD risk estimation methodologies for China.
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Affiliation(s)
- Lv Liu
- Department of Respiratory Medicine, Diagnosis and Treatment Center of Respiratory Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yi-Jie Liu
- Department of Respiratory Medicine, Diagnosis and Treatment Center of Respiratory Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ting Guo
- Department of Respiratory Medicine, Diagnosis and Treatment Center of Respiratory Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hong Luo
- Department of Respiratory Medicine, Diagnosis and Treatment Center of Respiratory Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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127
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Abstract
There is a wide differential diagnosis of early onset respiratory distress especially in term babies, and interstitial lung disease (chILD) is a rare but important consideration in this context. chILD manifesting immediately after birth is usually related to mutations in surfactant protein genes, or conditions related to the Congenital Acinar Dysplasia -Alveolar capillary dysplasia - Congenital Alveolar Dysplasia (CAD-ACD) spectrum. There is currently no specific treatment for these conditions, and management is supportive. Prognosis is very poor in most of these babies if onset is early, with relentless respiratory deterioration unless transplanted. Ideally, the diagnosis is made on genetic analysis, but this may be time-consuming and complex in CAD-ACD spectrum, so lung biopsy may be needed to avoid prolonged and futile treatment being instituted. Milder forms with prolonged survival have been reported. Early onset, less severe chILD is usually related to neuroendocrine cell hyperplasia of infancy (NEHI), pulmonary interstitial glycogenosis (PIG) and less severe disorders of surfactant proteins. PIG and NEHI are not specific entities, but are pulmonary dysmaturity syndromes, and there may be a number of underlying genetic and other cause. If the child is stable and thriving, many will not be subject to lung biopsy, and slow improvement and weaning of supplemental oxygen can be anticipated. Where possible, a precise genetic diagnosis should be made in early onset cHILD allow for genetic counselling. chILD survivors and their families have complex respiratory and other needs, and co-ordinated, multi-disciplinary support in the community is essential.
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Affiliation(s)
- Andrew Bush
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK.
| | | | - Jo Gregory
- Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Andrew Gordon Nicholson
- Royal Brompton and Harefield NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College, UK
| | - Thomas Semple
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Rishi Pabary
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK
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128
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Seidl E, Carlens J, Schwerk N, Wetzke M, Marczak H, Lange J, Krenke K, Mayell SJ, Escribano A, Seidenberg J, Ahrens F, Hebestreit H, Nährlich L, Sismanlar T, Aslan AT, Snijders D, Ullmann N, Kappler M, Griese M. Persistent tachypnea of infancy: Follow up at school age. Pediatr Pulmonol 2020; 55:3119-3125. [PMID: 32761949 DOI: 10.1002/ppul.25004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Persistent tachypnea of infancy (PTI) is a rare pediatric lung disease of unknown origin. The diagnosis can be made by clinical presentation and chest high resolution computed tomography after exclusion of other causes. Clinical courses beyond infancy have rarely been assessed. METHODS Patients included in the Kids Lung Register diagnosed with PTI as infants and now older than 5 years were identified. Initial presentation, extrapulmonary comorbidities, spirometry and clinical outcome were analyzed. RESULTS Thirty-five children older than 5 years with PTI diagnosed as infants were analyzed. At the age of 5 years, 74% of the patients were reported as asymptomatic and did not develope new symptoms during the observational period at school-age (mean, 3.9 years; range, 0.3-6.3). At the age of about 10 years, none of the symptomatic children had abnormal oxygen saturation during sleep or exercise anymore. Lung function tests and breathing frequency were within normal values throughout the entire observational period. CONCLUSIONS PTI is a pulmonary disease that can lead to respiratory insufficiency in infancy. As at school age most of the previously chronically affected children became asymptomatic and did not develop new symptoms. We conclude that the overall clinical course is favorable.
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Affiliation(s)
- Elias Seidl
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, German Center for Lung Research, Munich, Germany
| | - Julia Carlens
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | - Nicolaus Schwerk
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | - Martin Wetzke
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | - Honorata Marczak
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Lange
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Sarah J Mayell
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Amparo Escribano
- Hospital Clínico Universitario, Unidad Neumología Infantil, Universidad de Valencia, Valencia, Spain
| | - Jürgen Seidenberg
- Neonatologie und Intensivmedizin, Klinikum Oldenburg, Oldenburg, Germany
| | | | | | - Lutz Nährlich
- Universities of Giessen and Marburg Lung Center, German Center of Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - Tugba Sismanlar
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayse T Aslan
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Deborah Snijders
- Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Matthias Kappler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, German Center for Lung Research, Munich, Germany
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, German Center for Lung Research, Munich, Germany
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129
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Haarman MG, Kerstjens-Frederikse WS, Vissia-Kazemier TR, Breeman KTN, Timens W, Vos YJ, Roofthooft MTR, Hillege HL, Berger RMF. The Genetic Epidemiology of Pediatric Pulmonary Arterial Hypertension. J Pediatr 2020; 225:65-73.e5. [PMID: 32502478 DOI: 10.1016/j.jpeds.2020.05.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the prevalence of pulmonary arterial hypertension (PAH)-associated gene mutations, and other genetic characteristics in a national cohort of children with PAH from the Dutch National registry and to explore genotype-phenotype associations and outcomes. STUDY DESIGN Children (n = 70) diagnosed with idiopathic PAH, heritable PAH, PAH associated with congenital heart disease with coincidental shunt (PAH-congenital heart disease group 3), PAH after closure of a cardiac shunt (PAH-congenital heart disease group 4), or PAH associated with other noncardiac conditions were enrolled. Targeted next-generation sequencing was performed on PAH-associated genes (BMPR2, ACVRL1, EIF2AK4, CAV1, ENG, KCNK3, SMAD9, and TBX4). Also, children were tested for specific genetic disorders in case of clinical suspicion. Additionally, children were tested for copy number variations. RESULTS Nineteen children (27%) had a PAH-associated gene mutation/variant: BMPR2 n = 7, TBX4 n = 8, ACVRL1 n = 1, KCNK3 n = 1, and EIF2AK4 n = 2. Twelve children (17%) had a genetic disorder with an established association with PAH (including trisomy 21 and cobalamin C deficiency). In another 16 children (23%), genetic disorders without an established association with PAH were identified (including Noonan syndrome, Beals syndrome, and various copy number variations). Survival rates differed between groups and was most favorable in TBX4 variant carriers. CONCLUSIONS Children with PAH show a high prevalence of genetic disorders, not restricted to established PAH-associated genes. Genetic architecture could play a role in risk-stratified care management in pediatric PAH.
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Affiliation(s)
- Meindina G Haarman
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands.
| | | | - Theresia R Vissia-Kazemier
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Karel T N Breeman
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim Timens
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands
| | - Yvonne J Vos
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marc T R Roofthooft
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans L Hillege
- Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands; Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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130
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Huai B, Ding J. Atractylenolide III attenuates bleomycin-induced experimental pulmonary fibrosis and oxidative stress in rat model via Nrf2/NQO1/HO-1 pathway activation. Immunopharmacol Immunotoxicol 2020; 42:436-444. [PMID: 32762376 DOI: 10.1080/08923973.2020.1806871] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bleomycin (BLM) is a chemotherapy drug used to treat cancer, one of which side effects is that it can lead to pulmonary fibrosis (PF). Atractylenoide III (AtrIII), derived from the dried roots of rhizoma atractylodis of compositae, is one of the main active substances of rhizoma atractylodis. It has anti-inflammatory, anti-tumor and other effects. This study aimed to investigate whether AtrIII alleviated BLM-induced PF and oxidative stress in rats through the nuclear factor erythroid-2-related factor 2/NQO1,NAD(P)H:quinine oxidoreductase 1/Heme oxygenase-1 (Nrf2/NQO1/HO-1) pathway. METHODS A BLM-induced pulmonary fibrosis model in SD rats was established. The respiratory dynamics were evaluated by using Wholebody flow-through plethysmography. Lung injury and pulmonary fibrosis were observed by Hematoxylin-eosin (HE) and Masson staining. Apoptosis was assay by Tunel assay. Inflammatory factors were detected with commercial kits. Expression of mRNAs and proteins were detected by RT-qPCR and Western blot, respectively. RESULTS AtrIII (1.2, 2.4 mg/kg) improved the lung injury and lung function in the BLM-induced Sprague-Dawley (SD) rats. AtrIII reduced the apoptosis rate and protein expression of Caspase-3 and Caspase-9. AtrIII (1.2, 2.4 mg/kg) decrease the pulmonary fibrosis damage and protein expression transforming growth factor-β (TGF-β) and α-smooth muscle actin (α-SMA). AtrIII also down-regulated the levels of interleukin 6 (IL-6), inductible nitric oxide synthase (iNOS) and tumor necrosis factor-α (TNF-α), while up-regulated the level of IL-10 in peripheral blood serum. Moreover, AtrIII (1.2, 2.4 mg/kg) increased the activity of superoxide dismutase (SOD) and glutathione (GSH), while decreased the malondialdehyde (MDA) content and lactate dehydrogenase (LDH) activity. AtrIII (1.2, 2.4 mg/kg) increased the levels of Nrf2, NQO1 and HO-1. In addition, AtrIII reversed the effects of Nrf2 interference on pulmonary fibrosis damage, decreased SOD and GSH activity, and increased MDA content. CONCLUSION AtrIII could attenuate the pulmonary fibrosis and reliev oxidative stress through the Nrf2/NQO1/ HO-1 pathway.
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Affiliation(s)
- Bin Huai
- Department of Pharmacy, Jinan Second People's Hospital, Jinan, Shandong, China
| | - Jiyu Ding
- Department of Pharmacy, Jining No.1 People's Hospital, Jining, Shandong, China
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131
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Albinni S, Marx M, Lang IM. Focused Update on Pulmonary Hypertension in Children-Selected Topics of Interest for the Adult Cardiologist. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E420. [PMID: 32825190 PMCID: PMC7559541 DOI: 10.3390/medicina56090420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/16/2022]
Abstract
Pulmonary hypertensive vascular disease (PHVD), and pulmonary hypertension (PH), which is a broader term, are severe conditions associated with high morbidity and mortality at all ages. Treatment guidelines in childhood are widely adopted from adult data and experience, though big differences may exist regarding aetiology, concomitant conditions and presentation. Over the past few years, paediatric aspects have been incorporated into the common guidelines, which currently address both children and adults with pulmonary hypertension (PH). There are multiple facets of PH in the context of cardiac conditions in childhood. Apart from Eisenmenger syndrome (ES), the broad spectrum of congenital heart disease (CHD) comprises PH in failing Fontan physiology, as well as segmental PH. In this review we provide current data and novel aspects on the pathophysiological background and individual management concepts of these conditions. Moreover, we focus on paediatric left heart failure with PH and its challenging issues, including end stage treatment options, such as mechanical support and paediatric transplantation. PH in the context of rare congenital disorders, such as Scimitar Syndrome and sickle cell disease is discussed. Based on current data, we provide an overview on multiple underlying mechanisms of PH involved in these conditions, and different management strategies in children and adulthood. In addition, we summarize the paediatric aspects and the pros and cons of the recently updated definitions of PH. This review provides deeper insights into some challenging conditions of paediatric PH in order to improve current knowledge and care for children and young adults.
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Affiliation(s)
- Sulaima Albinni
- Paediatric Heart Centre Vienna, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Wien, Austria;
| | - Manfred Marx
- Paediatric Heart Centre Vienna, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Wien, Austria;
| | - Irene M. Lang
- AKH-Vienna, Department of Cardiology, Medical University of Vienna, 1090 Wien, Austria;
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132
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Kang MH, van Lieshout LP, Xu L, Domm JM, Vadivel A, Renesme L, Mühlfeld C, Hurskainen M, Mižíková I, Pei Y, van Vloten JP, Thomas SP, Milazzo C, Cyr-Depauw C, Whitsett JA, Nogee LM, Wootton SK, Thébaud B. A lung tropic AAV vector improves survival in a mouse model of surfactant B deficiency. Nat Commun 2020; 11:3929. [PMID: 32764559 PMCID: PMC7414154 DOI: 10.1038/s41467-020-17577-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 07/04/2020] [Indexed: 12/21/2022] Open
Abstract
Surfactant protein B (SP-B) deficiency is an autosomal recessive disorder that impairs surfactant homeostasis and manifests as lethal respiratory distress. A compelling argument exists for gene therapy to treat this disease, as de novo protein synthesis of SP-B in alveolar type 2 epithelial cells is required for proper surfactant production. Here we report a rationally designed adeno-associated virus (AAV) 6 capsid that demonstrates efficiency in lung epithelial cell transduction based on imaging and flow cytometry analysis. Intratracheal administration of this vector delivering murine or human proSFTPB cDNA into SP-B deficient mice restores surfactant homeostasis, prevents lung injury, and improves lung physiology. Untreated SP-B deficient mice develop fatal respiratory distress within two days. Gene therapy results in an improvement in median survival to greater than 200 days. This vector also transduces human lung tissue, demonstrating its potential for clinical translation against this lethal disease.
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Affiliation(s)
- Martin H Kang
- Sinclair Center for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, K1Y 4E9, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Laura P van Lieshout
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Liqun Xu
- Sinclair Center for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, K1Y 4E9, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Jakob M Domm
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Arul Vadivel
- Sinclair Center for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, K1Y 4E9, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Laurent Renesme
- Sinclair Center for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, K1Y 4E9, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Christian Mühlfeld
- Institute of Functional and Applied Anatomy, Hannover Medical School, 30625, Hannover, Germany
| | - Maria Hurskainen
- Sinclair Center for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, K1Y 4E9, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Ivana Mižíková
- Sinclair Center for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, K1Y 4E9, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Yanlong Pei
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Jacob P van Vloten
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Sylvia P Thomas
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Claudia Milazzo
- Sinclair Center for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, K1Y 4E9, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Chanèle Cyr-Depauw
- Sinclair Center for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, K1Y 4E9, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - Jeffrey A Whitsett
- Divisions of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
| | - Lawrence M Nogee
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Sarah K Wootton
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Bernard Thébaud
- Sinclair Center for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, ON, K1Y 4E9, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, K1N 6N5, Canada.
- Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario (CHEO) and CHEO Research Institute, Ottawa, ON, K1H 8L1, Canada.
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133
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Wu ZQ, Xu J, Zhang AM, Hu X, Huang FR. [Dyspnea and ventilator dependence after birth in a full-term female infant]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:897-902. [PMID: 32800039 PMCID: PMC7441518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 11/13/2023]
Abstract
A female infant, aged 43 days, had shortness of breath, cyanosis, groan, and dyspnea since birth. Physical examination showed cyanosis of lips and three-concave sign, and multiple lung imaging examinations showed diffuse ground-glass opacities in both lungs. The girl was given anti-infective therapy and continuous mechanical ventilation but there were no significant improvements in symptoms. Gene testing confirmed a compound heterozygous mutation, c.1890C>A(p.Tyr630Ter)+c.3208G>A(p.Ala1070Thr), in the ABCA3 gene, with the former from her father and the latter from her mother. Pathological examination of the lungs indicated pulmonary interstitial disease. The girl was diagnosed with infantile diffuse pulmonary interstitial disease caused by mutations in the ABCA3 gene. When full-term neonates experience shortness of breath and dyspnea after birth, pulmonary imaging suggests diffuse ground-glass changes, and conventional treatment is not effective (ventilator-dependent), congenital pulmonary surfactant metabolism defects needs to be considered. Gene testing, which can provide a basis for early intervention, prognostic evaluation, and genetic counseling, should be performed as early as possible.
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Affiliation(s)
- Zi-Qi Wu
- Department of Neonatology, Hunan Provincial People's Hospital/ First Affiliated Hospital of Hunan Normal University, Changsha 410005, China.
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134
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Wu ZQ, Xu J, Zhang AM, Hu X, Huang FR. [Dyspnea and ventilator dependence after birth in a full-term female infant]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:897-902. [PMID: 32800039 PMCID: PMC7441518 DOI: 10.7499/j.issn.1008-8830.2003332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
A female infant, aged 43 days, had shortness of breath, cyanosis, groan, and dyspnea since birth. Physical examination showed cyanosis of lips and three-concave sign, and multiple lung imaging examinations showed diffuse ground-glass opacities in both lungs. The girl was given anti-infective therapy and continuous mechanical ventilation but there were no significant improvements in symptoms. Gene testing confirmed a compound heterozygous mutation, c.1890C>A(p.Tyr630Ter)+c.3208G>A(p.Ala1070Thr), in the ABCA3 gene, with the former from her father and the latter from her mother. Pathological examination of the lungs indicated pulmonary interstitial disease. The girl was diagnosed with infantile diffuse pulmonary interstitial disease caused by mutations in the ABCA3 gene. When full-term neonates experience shortness of breath and dyspnea after birth, pulmonary imaging suggests diffuse ground-glass changes, and conventional treatment is not effective (ventilator-dependent), congenital pulmonary surfactant metabolism defects needs to be considered. Gene testing, which can provide a basis for early intervention, prognostic evaluation, and genetic counseling, should be performed as early as possible.
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Affiliation(s)
- Zi-Qi Wu
- Department of Neonatology, Hunan Provincial People's Hospital/ First Affiliated Hospital of Hunan Normal University, Changsha 410005, China.
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135
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Ring AM, Carlens J, Bush A, Castillo-Corullón S, Fasola S, Gaboli MP, Griese M, Koucky V, La Grutta S, Lombardi E, Proesmans M, Schwerk N, Snijders D, Nielsen KG, Buchvald F. Pulmonary function testing in children's interstitial lung disease. Eur Respir Rev 2020; 29:29/157/200019. [PMID: 32699025 DOI: 10.1183/16000617.0019-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/11/2020] [Indexed: 12/17/2022] Open
Abstract
The use of pulmonary function tests (PFTs) has been widely described in airway diseases like asthma and cystic fibrosis, but for children's interstitial lung disease (chILD), which encompasses a broad spectrum of pathologies, the usefulness of PFTs is still undetermined, despite widespread use in adult interstitial lung disease. A literature review was initiated by the COST/Enter chILD working group aiming to describe published studies, to identify gaps in knowledge and to propose future research goals in regard to spirometry, whole-body plethysmography, infant and pre-school PFTs, measurement of diffusing capacity, multiple breath washout and cardiopulmonary exercise tests in chILD. The search revealed a limited number of papers published in the past three decades, of which the majority were descriptive and did not report pulmonary function as the main outcome.PFTs may be useful in different stages of management of children with suspected or confirmed chILD, but the chILD spectrum is diverse and includes a heterogeneous patient group in all ages. Research studies in well-defined patient cohorts are needed to establish which PFT and outcomes are most relevant for diagnosis, evaluation of disease severity and course, and monitoring individual conditions both for improvement in clinical care and as end-points in future randomised controlled trials.
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Affiliation(s)
- Astrid Madsen Ring
- Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Danish PCD & chILD Centre, CF Centre Copenhagen, Copenhagen, Denmark.,Joint first authors
| | - Julia Carlens
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Medizinische Hochschule Hannover Zentrum fur Kinderheilkunde und Jugendmedizin, Hannover, Germany.,Joint first authors
| | - Andy Bush
- Paediatrics and Paediatric Respiratory Medicine, Imperial College London, London, UK.,Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Silvia Castillo-Corullón
- Unidad de Neumología infantil y Fibrosis quística, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Salvatore Fasola
- Institute of Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - Mirella Piera Gaboli
- Neumologia Infantil y Unidad de Cuidados Intensivos Pediatricos, Hospital Universitario Salamanca, Salamanca, Spain
| | - Matthias Griese
- University Hospital of Munich, Dr. von Hauner Children's Hospital, German Center for Lung Research (DZL), Munich, Germany
| | - Vaclav Koucky
- Dept of Paediatrics, Univerzita Karlova v Praze 2 lekarska fakulta, Prague, Czech Republic
| | - Stefania La Grutta
- Institute of Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Anna Meyer Pediatric University-Hospital, Florence, Italy
| | | | - Nicolaus Schwerk
- Clinic for Paediatric Pneumology, Allergology and Neonatology, Medizinische Hochschule Hannover Zentrum fur Kinderheilkunde und Jugendmedizin, Hannover, Germany
| | | | - Kim Gjerum Nielsen
- Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Danish PCD & chILD Centre, CF Centre Copenhagen, Copenhagen, Denmark.,Joint last authors
| | - Frederik Buchvald
- Paediatric Pulmonary Service, Dept of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Danish PCD & chILD Centre, CF Centre Copenhagen, Copenhagen, Denmark .,Joint last authors
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136
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Ruwisch J, Sehlmeyer K, Roldan N, Garcia-Alvarez B, Perez-Gil J, Weaver TE, Ochs M, Knudsen L, Lopez-Rodriguez E. Air Space Distension Precedes Spontaneous Fibrotic Remodeling and Impaired Cholesterol Metabolism in the Absence of Surfactant Protein C. Am J Respir Cell Mol Biol 2020; 62:466-478. [PMID: 31922895 DOI: 10.1165/rcmb.2019-0358oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Surfactant protein (SP)-C deficiency is found in samples from patients with idiopathic pulmonary fibrosis, especially in familial forms of this disease. We hypothesized that SP-C may contribute to fibrotic remodeling in aging mice and alveolar lipid homeostasis. For this purpose, we analyzed lung function, alveolar dynamics, lung structure, collagen content, and expression of genes related to lipid and cholesterol metabolism of aging SP-C knockout mice. In addition, in vitro experiments with an alveolar macrophage cell line exposed to lipid vesicles with or without cholesterol and/or SP-C were performed. Alveolar dynamics showed progressive alveolar derecruitment with age and impaired oxygen saturation. Lung structure revealed that decreasing volume density of alveolar spaces was accompanied by increasing of the ductal counterparts. Simultaneously, septal wall thickness steadily increased, and fibrotic wounds appeared in lungs from the age of 50 weeks. This remarkable phenotype is unique to the 129Sv strain, which has an increased absorption of cholesterol, linking the accumulation of cholesterol and the absence of SP-C to a fibrotic remodeling process. The findings of this study suggest that overall loss of SP-C results in an age-dependent, complex, heterogeneous phenotype characterized by a combination of overdistended air spaces and fibrotic wounds that resembles combined emphysema and pulmonary fibrosis in patients with idiopathic pulmonary fibrosis. Addition of SP-C to cholesterol-laden lipid vesicles enhanced the expression of cholesterol metabolism and transport genes in an alveolar macrophage cell line, identifying a potential new lipid-protein axis involved in lung remodeling.
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Affiliation(s)
- Jannik Ruwisch
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany.,BREATH (Biomedical Research in Endstage and Obstructive Lung Disease Hannover), Member of the German Center for Lung Research, Hannover, Germany
| | - Kirsten Sehlmeyer
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany.,BREATH (Biomedical Research in Endstage and Obstructive Lung Disease Hannover), Member of the German Center for Lung Research, Hannover, Germany
| | - Nuria Roldan
- Alveolix AG and ARTORG Center, University of Bern, Bern, Switzerland.,Biochemistry and Molecular Biology Department, Faculty of Biology, and Research Institute "Hospital 12 de Octubre," Complutense University Madrid, Madrid, Spain
| | - Begoña Garcia-Alvarez
- Biochemistry and Molecular Biology Department, Faculty of Biology, and Research Institute "Hospital 12 de Octubre," Complutense University Madrid, Madrid, Spain
| | - Jesus Perez-Gil
- Biochemistry and Molecular Biology Department, Faculty of Biology, and Research Institute "Hospital 12 de Octubre," Complutense University Madrid, Madrid, Spain
| | - Timothy E Weaver
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio; and
| | - Matthias Ochs
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany.,BREATH (Biomedical Research in Endstage and Obstructive Lung Disease Hannover), Member of the German Center for Lung Research, Hannover, Germany.,Institute of Vegetative Anatomy, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Lars Knudsen
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany.,BREATH (Biomedical Research in Endstage and Obstructive Lung Disease Hannover), Member of the German Center for Lung Research, Hannover, Germany.,Institute of Vegetative Anatomy, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Elena Lopez-Rodriguez
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany.,BREATH (Biomedical Research in Endstage and Obstructive Lung Disease Hannover), Member of the German Center for Lung Research, Hannover, Germany.,Institute of Vegetative Anatomy, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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137
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Child-Adult Transition in Sarcoidosis: A Series of 52 Patients. J Clin Med 2020; 9:jcm9072097. [PMID: 32635292 PMCID: PMC7408766 DOI: 10.3390/jcm9072097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/16/2020] [Accepted: 06/20/2020] [Indexed: 12/19/2022] Open
Abstract
(1) Background: Pediatric sarcoidosis is a rare and mostly severe disease. Very few pediatric series with a prolonged follow-up are reported. We aimed to evaluate the evolution of pediatric sarcoidosis in adulthood. (2) Material and methods: Patients over 18-years-old with a pediatric-onset sarcoidosis (≤15-year-old) who completed at least a three-year follow-up in French expert centers were included. Clinical information at presentation and outcome in adulthood were studied. (3) Results: A total of 52 patients were included (34 prospectively in childhood and 18 retrospectively in adulthood), with a mean age of 12 (±2.7) at diagnosis. The median duration time of follow-up was 11.5 years (range 3–44.5). Relapses mostly occurred during treatment decrease (84.5%), others within the three years after treatment interruption (9.1%), and rarely when the disease was stable for more than three years (6.4%). Sarcoidosis was severe in 11 (21.2%) in adulthood. Patients received a high corticosteroid cumulative dose (median 17,900 mg) for a median duration of five years (range 0–32), resulting in mostly mild (18; 35.3%) and rarely severe (2; 3.8%) adverse events. (4) Conclusions: Pediatric-onset sarcoidosis needed a long-term treatment in almost half of the patients. Around one fifth of pediatric-onset sarcoidosis patients had severe sarcoidosis consequences in adulthood.
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138
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Lee E, Lee SY, Hong SJ. The past, present, and future of humidifier disinfectant-associated interstitial lung diseases in children. Clin Exp Pediatr 2020; 63:251-258. [PMID: 32024320 PMCID: PMC7374007 DOI: 10.3345/cep.2019.01326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
Exposure to environmental factors can cause interstitial lung diseases (ILDs); however, such types of ILDs are rare. From 2007 to 2011, an ILD epidemic occurred in South Korea owing to inhalational exposure to toxic chemicals in humidifier disinfectants (HDs). HD-associated ILDs (HD-ILDs) are characterized by rapidly progressing respiratory failure with pulmonary fibrosis and a high mortality rate of 43.8%-58.0%. Although 18.1%-31.1% of the general population used HDs, only a small proportion of HD users were diagnosed with HD-ILDs. This finding suggests that investigation of the pathophysiologies underlying HD-ILDs is needed in addition to the identification of susceptibility to HD-ILDs. Further, there have been several concerns regarding the diverse health effects of exposure to toxic chemicals in HDs, including those that have not been identified, and long-term prognoses in terms of pulmonary function and residual pulmonary lesions observed on follow-up chest images. In this review, we summarize the clinical features, pathologic findings, and changes in radiologic findings over time in patients with HD-ILDs and the results of previous experimental research on the mechanisms underlying the effects of toxic chemicals in HDs. Studies are currently underway to identify the pathophysiologies of HD-ILDs and possible health effects of exposure to HDs along with the development of targeted therapeutic strategies. The experience of identification of HD-ILDs has encouraged stricter control of safe chemicals in everyday life.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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139
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Vece TJ, Wambach JA, Hagood JS. Childhood rare lung disease in the 21st century: "-omics" technology advances accelerating discovery. Pediatr Pulmonol 2020; 55:1828-1837. [PMID: 32533908 PMCID: PMC8711209 DOI: 10.1002/ppul.24809] [Citation(s) in RCA: 6] [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: 01/17/2020] [Accepted: 04/28/2020] [Indexed: 01/14/2023]
Abstract
Childhood rare lung diseases comprise a large number of heterogeneous respiratory disorders that are individually rare but are collectively associated with substantial morbidity, mortality, and healthcare resource utilization. Although the genetic mechanisms for several of these disorders have been elucidated, the pathogenesis mechanisms for others remain poorly understood and treatment options remain limited. Childhood rare lung diseases are enriched for genetic etiologies; identification of the disease mechanisms underlying these rare disorders can inform the biology of normal human lung development and has implications for the treatment of more common respiratory diseases in children and adults. Advances in "-omics" technology, such as genomic sequencing, clinical phenotyping, biomarker discovery, genome editing, in vitro and model organism disease modeling, single-cell analyses, cellular imaging, and high-throughput drug screening have enabled significant progress for diagnosis and treatment of rare childhood lung diseases. The most striking example of this progress has been realized for patients with cystic fibrosis for whom effective, personalized therapies based on CFTR genotype are now available. In this chapter, we focus on recent technology advances in childhood rare lung diseases, acknowledge persistent challenges, and identify promising new technologies that will impact not only biological discovery, but also improve diagnosis, therapies, and survival for children with these rare disorders.
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Affiliation(s)
- Timothy J. Vece
- Division of Pediatric Pulmonology, Program for Rare and Interstitial Lung Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer A. Wambach
- Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - James S. Hagood
- Division of Pediatric Pulmonology, Program for Rare and Interstitial Lung Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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140
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Nathan N, Berdah L, Delestrain C, Sileo C, Clement A. Interstitial lung diseases in children. Presse Med 2020; 49:103909. [PMID: 32563946 DOI: 10.1016/j.lpm.2019.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/11/2019] [Indexed: 01/16/2023] Open
Abstract
Interstitial lung disease (ILD) in children (chILD) is a heterogeneous group of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality. The pathogenesis of the various chILD is complex and the diseases share common features of inflammatory and fibrotic changes of the lung parenchyma that impair gas exchanges. The etiologies of chILD are numerous. In this review, we chose to classify them as ILD related to exposure/environment insults, ILD related to systemic and immunological diseases, ILD related to primary lung parenchyma dysfunctions and ILD specific to infancy. A growing part of the etiologic spectrum of chILD is being attributed to molecular defects. Currently, the main genetic mutations associated with chILD are identified in the surfactant genes SFTPA1, SFTPA2, SFTPB, SFTPC, ABCA3 and NKX2-1. Other genetic contributors include mutations in MARS, CSF2RA and CSF2RB in pulmonary alveolar proteinosis, and mutations in TMEM173 and COPA in specific auto-inflammatory forms of chILD. However, only few genotype-phenotype correlations could be identified so far. Herein, information is provided about the clinical presentation and the diagnosis approach of chILD. Despite improvements in patient management, the therapeutic strategies are still relying mostly on corticosteroids although specific therapies are emerging. Larger longitudinal cohorts of patients are being gathered through ongoing international collaborations to improve disease knowledge and targeted therapies. Thus, it is expected that children with ILD will be able to reach the adulthood transition in a better condition.
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Affiliation(s)
- Nadia Nathan
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France; Sorbonne université and Inserm UMRS933, 75012 Paris, France
| | - Laura Berdah
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France; Sorbonne université and Inserm UMRS933, 75012 Paris, France
| | - Céline Delestrain
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France
| | - Chiara Sileo
- Radiology department, AP-HP, Trousseau hospital, 75012 Paris, France
| | - Annick Clement
- Pediatric pulmonology department, Trousseau hospital, reference center for rare lung diseases RespiRare, Assistance publique-Hôpitaux de Paris (AP-HP), , 75012 Paris, France; Sorbonne université and Inserm UMRS933, 75012 Paris, France.
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141
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Gower WA, Hagood JS. To Bx, or not to Bx, that is the question. Pediatr Pulmonol 2020; 55:1303-1304. [PMID: 32364314 DOI: 10.1002/ppul.24797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/12/2022]
Affiliation(s)
- William A Gower
- Division of Pediatric Pulmonology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - James S Hagood
- Division of Pediatric Pulmonology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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142
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Douros K, Everard ML. Time to Say Goodbye to Bronchiolitis, Viral Wheeze, Reactive Airways Disease, Wheeze Bronchitis and All That. Front Pediatr 2020; 8:218. [PMID: 32432064 PMCID: PMC7214804 DOI: 10.3389/fped.2020.00218] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022] Open
Abstract
The diagnosis and management of infants and children with a significant viral lower respiratory tract illness remains the subject of much debate and little progress. Over the decades various terms for such illnesses have been in and fallen out of fashion or have evolved to mean different things to different clinicians. Terms such as "bronchiolitis," "reactive airways disease," "viral wheeze," and many more are used to describe the same condition and the same term is frequently used to describe illnesses caused by completely different dominant pathologies. This lack of clarity is due, in large part, to a failure to understand the basic underlying inflammatory and associated processes and, in part, due to the lack of a simple test to identify a condition such as asthma. Moreover, there is a lack of insight into the fact that the same pathology can produce different clinical signs at different ages. The consequence is that terminology and fashions in treatment have tended to go around in circles. As was noted almost 60 years ago, amongst pre-school children with a viral LRTI and airways obstruction there are those with a "viral bronchitis" and those with asthma. In the former group, a neutrophil dominated inflammation response is responsible for the airways' obstruction whilst amongst asthmatics much of the obstruction is attributable to bronchoconstriction. The airways obstruction in the former group is predominantly caused by airways secretions and to some extent mucosal oedema (a "snotty lung"). These patients benefit from good supportive care including supplemental oxygen if required (though those with a pre-existing bacterial bronchitis will also benefit from antibiotics). For those with a viral exacerbation of asthma, characterized by bronchoconstriction combined with impaired b-agonist responsiveness, standard management of an exacerbation of asthma (including the use of steroids to re-establish bronchodilator responsiveness) represents optimal treatment. The difficulty is identifying which group a particular patient falls into. A proposed simplified approach to the nomenclature used to categorize virus associated LRTIs is presented based on an understanding of the underlying pathological processes and how these contribute to the physical signs.
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Affiliation(s)
- Konstantinos Douros
- Third Department of Paediatrics, Attikon Hospital, University of Athens School of Medicine, Athens, Greece
| | - Mark L. Everard
- Division of Paediatrics and Child Health, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
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143
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Gros M, Aissat A, Perez‐Martin S, Abou Taam R, Funalot B, Fanen P, Epaud R, Becdelievre A. Interstitial lung disease reveals 48,XXYY syndrome in a child. Acta Paediatr 2020; 109:1060-1061. [PMID: 31721284 DOI: 10.1111/apa.15090] [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]
Affiliation(s)
- Marion Gros
- Service de Pédiatrie Centre Intercommunal de Créteil Créteil France
| | - Abdel Aissat
- Laboratoire de Génétique Hôpital Henri Mondor AP‐HP Créteil France
- Inserm U955 Equipe 5 Créteil France
- DHU Ageing Thorax Vessel Blood Créteil France
- Faculté de Médecine Université Paris‐Est Créteil Créteil France
| | | | - Rola Abou Taam
- Service de pneumologie pédiatrique AP‐HP Hôpital Necker Enfants‐Malades Paris France
| | - Benoit Funalot
- Laboratoire de Génétique Hôpital Henri Mondor AP‐HP Créteil France
- Faculté de Médecine Université Paris‐Est Créteil Créteil France
| | - Pascale Fanen
- Laboratoire de Génétique Hôpital Henri Mondor AP‐HP Créteil France
- Inserm U955 Equipe 5 Créteil France
- DHU Ageing Thorax Vessel Blood Créteil France
- Faculté de Médecine Université Paris‐Est Créteil Créteil France
- Centre des Maladies Respiratoires Rare Respirare® Créteil France
| | - Ralph Epaud
- Service de Pédiatrie Centre Intercommunal de Créteil Créteil France
- Inserm U955 Equipe 5 Créteil France
- DHU Ageing Thorax Vessel Blood Créteil France
- Faculté de Médecine Université Paris‐Est Créteil Créteil France
- Centre des Maladies Respiratoires Rare Respirare® Créteil France
| | - Alix Becdelievre
- Laboratoire de Génétique Hôpital Henri Mondor AP‐HP Créteil France
- Inserm U955 Equipe 5 Créteil France
- DHU Ageing Thorax Vessel Blood Créteil France
- Centre des Maladies Respiratoires Rare Respirare® Créteil France
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144
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Verma N, Altmayer S, Hochhegger B, Barros MC, Rajderkar D, Mohammed TL. ChILD: A Pictorial Review of Pulmonary Imaging Findings in Childhood Interstitial Lung Diseases. Curr Probl Diagn Radiol 2020; 50:95-103. [PMID: 32317133 DOI: 10.1067/j.cpradiol.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/18/2020] [Indexed: 11/22/2022]
Abstract
Childhood interstitial lung disease (chILD) is a group of lung disorders characterized by lung remodeling leading to abnormal gas exchange. ChILD is classified differently from adult interstitial lung disease and encompasses 2 broad categories: "disorders more prevalent in infancy" (<2 years) and "disorders not specific to infancy" (>2 years). High-resolution computed tomography can play an important role in the evaluation of chILD by narrowing the differential diagnosis and preventing unnecessary invasive procedures if typical imaging patterns are recognized. Thus, the pediatric radiologist should consider chILD in children with respiratory distress and identify the imaging patterns to suggest the diagnosis.
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Affiliation(s)
- Nupur Verma
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Stephan Altmayer
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno Hochhegger
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Dhanashree Rajderkar
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Tan-Lucien Mohammed
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL.
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145
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Urbankowska E, Urbankowski T, Drobczyński Ł, Griese M, Lange J, Brzewski M, Kulus M, Krenke K. Lung ultrasound-a new diagnostic modality in persistent tachypnea of infancy. Pediatr Pulmonol 2020; 55:1028-1036. [PMID: 31978279 DOI: 10.1002/ppul.24654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 01/06/2020] [Indexed: 01/14/2023]
Abstract
Lung ultrasound (LUS) has been increasingly used in diagnosing and monitoring of various pulmonary diseases in children. The aim of the current study was to evaluate its usefulness in children with persistent tachypnea of infancy (PTI). This was a controlled, prospective, cross-sectional study that included children with PTI and healthy subjects. In patients with PTI, LUS was performed at baseline and then after 6 and 12 months of follow-up. Baseline results of LUS were compared to (a) baseline high-resolution computed tomography (HRCT) images, (b) LUS examinations in control group, and (c) follow-up LUS examinations. Twenty children with PTI were enrolled. B-lines were found in all children with PTI and in 11 (55%) control subjects (P < .001). The total number of B-lines, the maximal number of B lines in any intercostal space, the distance between B-lines, and pleural thickness were significantly increased in children with PTI compared to controls. An irregularity of the pleural line was found in all patients with PTI and in none of the healthy children. There were no significant changes in LUS findings in patients with PTI during the study period. The comparison of HRCT indices and LUS findings revealed significant correlations between the mean lung attenuation, skewness, kurtosis and fraction of interstitial pulmonary involvement, and the number of B-lines as well as the pleural line thickness. LUS seems to be a promising diagnostic tool in children with PTI. Its inclusion in the diagnostic work-up may enable to reduce the number of costly, hazardous, and ionizing radiation-based imaging procedures.
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Affiliation(s)
- Emilia Urbankowska
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Urbankowski
- Department of Internal Medicine, Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Drobczyński
- Pediatric Radiology Department, Jan Polikarp Brudziński Pediatric Hospital, Warsaw, Poland
| | - Matthias Griese
- Department of Pediatric Pneumology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians University, German Centre for Lung Research (DZL), Munich, Germany
| | - Joanna Lange
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Michał Brzewski
- Department of Pediatric Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kulus
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
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146
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Prenzel F, Harfst J, Schwerk N, Ahrens F, Rietschel E, Schmitt-Grohé S, Rubak SML, Poplawska K, Baden W, Vogel M, Hollizeck S, Ley-Zaporozhan J, Brasch F, Reu S, Griese M. Lymphocytic interstitial pneumonia and follicular bronchiolitis in children: A registry-based case series. Pediatr Pulmonol 2020; 55:909-917. [PMID: 32040879 DOI: 10.1002/ppul.24680] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/26/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Pediatric lymphocytic interstitial pneumonia (LIP) and follicular bronchiolitis (FB) are poorly characterized lymphoproliferative disorders. We present and quantify demographics, radiological and histopathologic patterns, treatments and their responses, and outcomes in non-HIV-infected children with LIP and FB. METHODS This structured registry-based study included a retrospective chart review, blinded analysis of imaging studies and lung biopsies, genetic testing, and evaluation of treatments and outcomes. RESULTS Of the 13 patients (eight females) studied, eight had FB, four had combined LIP/FB, and one had isolated LIP; diagnoses were highly concordant between the pathologists. Most patients became symptomatic during the first 2 years of life, with a mean lag time to diagnosis of 4 years. The most common symptoms were coughing and respiratory infections (11 out of 13 each), dyspnea (10 out of 13), and wheezing (eight out of 13). Autoantibodies were found in eight out of 13 patients. In three patients, disease-causing mutations in the COPA gene were identified. CT revealed hilar lymphadenopathy (five out of 12), ground-glass opacity (eight out of 12), consolidation (five out of 12), and cysts (four out of 13). Systemic steroids as intravenous pulses (11 out of 13) or oral intake (10 out of 13) were the main treatments and showed high response rates of 100% and 90%, respectively. Within the mean observation period of 68 months, all children had chronic courses, eight out of 13 had severe diseases, two died, and one worsened. CONCLUSIONS Children with LIP/FB have chronic diseases that occurred in early childhood and were commonly associated with immune dysregulation as well as high morbidity and mortality. Early diagnosis and treatment may be crucial to improve the outcome.
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Affiliation(s)
- Freerk Prenzel
- Department of Pediatrics, Center for Pediatric Research Leipzig (CPL), University of Leipzig Medical Center, Leipzig, Germany
| | - Jacqueline Harfst
- Hauner Children's Hospital and KUBUS Research Center, University of Munich, Munich, Germany
| | - Nicolaus Schwerk
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | | | - Ernst Rietschel
- University Children's Hospital, University of Cologne, Cologne, Germany
| | | | - Sune M L Rubak
- Danish Center of Pediatric Pulmonology and Allergology, University Hospital of Aarhus, Aarhus, Denmark
| | | | - Winfried Baden
- University Children's Hospital Tübingen, Tübingen, Germany
| | - Mandy Vogel
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Sebastian Hollizeck
- Hauner Children's Hospital and KUBUS Research Center, University of Munich, Munich, Germany
| | | | - Frank Brasch
- Department of Pathology, Academic Teaching Hospital Bielefeld, Bielefeld, Germany
| | - Simone Reu
- Department of Pathology, University of Munich, Munich, Germany
| | - Matthias Griese
- Hauner Children's Hospital and KUBUS Research Center, University of Munich, Munich, Germany
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147
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Hafezi N, Heimberger MA, Lewellen KA, Maatman T, Montgomery GS, Markel TA. Lung biopsy in children's interstitial and diffuse lung disease: Does it alter management? Pediatr Pulmonol 2020; 55:1050-1060. [PMID: 32040887 DOI: 10.1002/ppul.24683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/27/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Pediatric patients with acute life-threatening consequences of interstitial and diffuse lung disease are often treated with empiric systemic corticosteroids, immune modulators, and/or broad antibiotic therapy. Histological evaluation of lung tissue represents the final necessary step in diagnosis-however, a definitive diagnosis may still remain elusive and medical therapies may not be changed following biopsy. We hypothesized that lung biopsy from pediatric patients with children's interstitial and diffuse lung disease (chILD) without a defined lesion on computed tomography (CT) imaging would guide diagnosis, but not substantially alter clinical management. METHODS After IRB approval, patients who underwent a lung biopsy at a single large children's hospital between 2013 and 2018 were retrospectively reviewed. Patients without a defined lesion were included. Demographics, length of stay, oxygen-requirements, steroid, unique number of immune modulators, and antibiotics prebiopsy and postbiopsy were reviewed. Nonparametric data were compared by the Mann Whitney U and Kruskal Wallace tests and expressed as median with interquartile range. Decision tree alterations were analyzed by t test. P < .05 was significant. RESULTS Sixty-four patients underwent lung biopsy during the period. Nineteen (30%) did not have a defined lesion on CT scan, and were included. A significant difference was seen between prebiopsy, 2 weeks, and 2 months postbiopsy prednisone dosing (P = .03), while the number of unique immune modulators, antibiotics, type of oxygen support and FiO2 were not significantly different before or after obtaining biopsy results. Pathology results provided additional information in 12 of 19 (63%) patients which resulted in management changes. CONCLUSIONS Lung biopsy in chILD may guide clinical management, especially influencing the management of steroid dosing. Although on aggregate the number of antibiotics, immune modulators, mode of oxygen support and FiO2 did not differ significantly before and after biopsy, the pathologic evaluation provided diagnostic information that led to a variety of changes in therapeutic management in greater than half of the population.
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Affiliation(s)
- Niloufar Hafezi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark A Heimberger
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kyle A Lewellen
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gregory S Montgomery
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Troy A Markel
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
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148
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Abstract
Home oxygen therapy is increasingly prescribed for various conditions in the neonatal period, particularly for infants with bronchopulmonary dysplasia. Due to limited evidence on indication, minimal target oxygen saturation, monitoring, application and discontinuation of home oxygen therapy clinical practice varies widely throughout the world. International guidelines provide recommendations mostly on the basis of nonsystematic clinical observations. Most relevant points for the clinical management of home oxygen therapy include a minimal target oxygen saturation of equal to or greater than 93%, the provision of a home monitoring of oxygen saturation ideally with a memory function, and the conduct of continuous overnight oximetry or polysomnography during weaning from supplemental oxygen. This review summarizes relevant literature as well as existing guidelines and recommendations on home oxygen therapy to aid clinicians in the management of these patients and identifies areas for future research.
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Affiliation(s)
- Sabine Pirr
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Germany.
| | - Corinna Peter
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Germany.
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149
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Vincent M, Karolak JA, Deutsch G, Gambin T, Popek E, Isidor B, Szafranski P, Le Caignec C, Stankiewicz P. Clinical, Histopathological, and Molecular Diagnostics in Lethal Lung Developmental Disorders. Am J Respir Crit Care Med 2020; 200:1093-1101. [PMID: 31189067 DOI: 10.1164/rccm.201903-0495tr] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lethal lung developmental disorders are a rare but important group of pediatric diffuse lung diseases presenting with neonatal respiratory failure. On the basis of histopathological appearance at lung biopsy or autopsy, they have been termed: alveolar capillary dysplasia with misalignment of the pulmonary veins, acinar dysplasia, congenital alveolar dysplasia, and other unspecified primary pulmonary hypoplasias. However, the histopathological continuum in these lethal developmental disorders has made accurate diagnosis challenging, which has implications for recurrence risk. Over the past decade, genetic studies in infants with alveolar capillary dysplasia with misalignment of the pulmonary veins have revealed the causative role of the dosage-sensitive FOXF1 gene and its noncoding regulatory variants in the distant lung-specific enhancer at chromosome 16q24.1. In contrast, the molecular bases of acinar dysplasia and congenital alveolar dysplasia have remained poorly understood. Most recently, disruption of the TBX4-FGF10-FGFR2 epithelial-mesenchymal signaling pathway has been reported in patients with these lethal pulmonary dysplasias. Application of next-generation sequencing techniques, including exome sequencing and whole-genome sequencing, has demonstrated their complex compound inheritance. These data indicate that noncoding regulatory elements play a critical role in lung development in humans. We propose that for more precise lethal lung developmental disorder diagnosis, a diagnostic pathway including whole-genome sequencing should be implemented.
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Affiliation(s)
- Marie Vincent
- Service de Genetique Medicale, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Université de Nantes, L'institut du Thorax, Nantes, France
| | - Justyna A Karolak
- Department of Molecular and Human Genetics and.,Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Gail Deutsch
- Department of Pathology, Seattle Children's Hospital, Seattle, Washington
| | - Tomasz Gambin
- Department of Molecular and Human Genetics and.,Department of Medical Genetics, Institute of Mother and Child, Warsaw, Poland; and.,Institute of Computer Science, Warsaw University of Technology, Warsaw, Poland
| | - Edwina Popek
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Bertrand Isidor
- Service de Genetique Medicale, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Université de Nantes, L'institut du Thorax, Nantes, France
| | | | - Cedric Le Caignec
- Service de Genetique Medicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
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150
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Deterding RR, DeBoer EM, Cidon MJ, Robinson TE, Warburton D, Deutsch GH, Young LR. Approaching Clinical Trials in Childhood Interstitial Lung Disease and Pediatric Pulmonary Fibrosis. Am J Respir Crit Care Med 2020; 200:1219-1227. [PMID: 31322415 DOI: 10.1164/rccm.201903-0544ci] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Childhood interstitial lung disease (chILD) comprises a spectrum of rare diffuse lung disorders. chILD is heterogeneous in origin, with different disease manifestations occurring in the context of ongoing lung development. The large number of disorders in chILD, in combination with the rarity of each diagnosis, has hampered scientific and clinical progress within the field. Epidemiologic and natural history data are limited. The prognosis varies depending on the etiology, with some forms progressing to lung transplant or death. There are limited treatment options for patients with chILD. Although U.S. Food and Drug Administration-approved treatments are now available for adult patients with idiopathic pulmonary fibrosis, no clinical trials have been conducted in a pediatric population using agents designed to treat lung fibrosis. This review will focus on progressive chILD disorders and on the urgent need for meaningful objective outcome measures to define, detect, and monitor fibrosis in children.
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Affiliation(s)
- Robin R Deterding
- Section of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado Denver, Denver, Colorado.,The Children's Hospital Colorado, Aurora, Colorado
| | - Emily M DeBoer
- Section of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado Denver, Denver, Colorado.,The Children's Hospital Colorado, Aurora, Colorado
| | - Michal J Cidon
- Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Terry E Robinson
- Pulmonary Division, Center for Excellence in Pulmonary Biology, Lucile Packard Children's Hospital at Stanford, Palo Alto, California
| | - David Warburton
- Children's Hospital Los Angeles, Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Gail H Deutsch
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington.,Seattle Children's Hospital, Seattle, Washington; and
| | - Lisa R Young
- Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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