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De Nardi L, Natale MF, Messia V, Tomà P, De Benedetti F, Insalaco A. A child with polyarthritis and chronic lung disease: a case report of ataxia-telangiectasia. Ital J Pediatr 2023; 49:111. [PMID: 37667293 PMCID: PMC10478427 DOI: 10.1186/s13052-023-01509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Ataxia-telangiectasia (A-T) is a rare autosomal recessive DNA repair disorder, characterized by progressive cerebellar degeneration, telangiectasia, immunodeficiency, recurrent sinopulmonary infections, radiation sensitivity, premature aging and predisposition to cancer. Although the association with autoimmune and chronic inflammatory conditions such as vitiligo, thrombocytopenia and arthritis has occasionally been reported, an onset with articular involvement at presentation is rare. CASE PRESENTATION We herein report the case of a 7-year-old Caucasian girl who was admitted to the Rheumatology Department with a history of febrile chough and polyarthritis which led initially to the suspicion of an autoinflammatory disease. She had overt polyarthritis with knees deformities and presented with severe pneumonia. A chest Computed Tomography (CT) scan showed bilateral bronchiectasis, parenchymal consolidation and interstitial lung disease; rheumatoid factor and type I interferon signature resulted negative, therefore excluding COatomer Protein subunit Alpha (COPA) syndrome. A diagnosis of sarcoidosis had been suspected based on histological evidence of granulomatous liver inflammation, but ruled out after detecting normal angiotensin converting enzyme and chitotriosidase blood levels. Based on her past medical history characterized by at least six episodes of pneumonia in the previous 4 years, immunological phenotyping was performed. This showed complete IgA and IgE deficiency with defective antigen-specific antibodies to Pneumococcal, Tetanus toxin and Hemophilus Influenzae B vaccines. Additionally, low numbers of B cells and recent thymic emigrants (RTE) were found (CD4Ra 1.4%), along with a low CD4+/CD8 + T cells ratio (< 1). Finally, based on gait disturbances (wobbly wide-based walking), serum alfa-fetoprotein was dosed, which resulted increased at 276 ng/ml (normal value < 7 ng/ml). A diagnosis of Ataxia-Telangiectasia was made, strengthened by the presence of bulbar telangiectasia, and then confirmed by Whole Exome Sequencing (WES). CONCLUSIONS Although rare, A-T should always be ruled out in case of pulmonary bronchiectasis and gait disturbances even in the absence of bulbar or skin telangiectasia. Autoimmune and granulomatous disorders must to be considered as differential diagnosis.
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Affiliation(s)
- Laura De Nardi
- University of Trieste, Piazzale Europa 1, Trieste, 34127, Italy.
| | | | | | - Paolo Tomà
- Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Petley E, Yule A, Alexander S, Ojha S, Whitehouse WP. The natural history of ataxia-telangiectasia (A-T): A systematic review. PLoS One 2022; 17:e0264177. [PMID: 35290391 PMCID: PMC9049793 DOI: 10.1371/journal.pone.0264177] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ataxia-telangiectasia is an autosomal recessive, multi-system, and life-shortening disease caused by mutations in the ataxia-telangiectasia mutated gene. Although widely reported, there are no studies that give a comprehensive picture of this intriguing condition. OBJECTIVES Understand the natural history of ataxia-telangiectasia (A-T), as reported in scientific literature. SEARCH METHODS 107 search terms were identified and divided into 17 searches. Each search was performed in PubMed, Ovid SP (MEDLINE) 1946-present, OVID EMBASE 1980 -present, Web of Science core collection, Elsevier Scopus, and Cochrane Library. SELECTION CRITERIA All human studies that report any aspect of A-T. DATA COLLECTION AND ANALYSIS Search results were de-duplicated, data extracted (including author, publication year, country of origin, study design, population, participant characteristics, and clinical features). Quality of case-control and cohort studies was assessed by the Newcastle-Ottawa tool. Findings are reported descriptively and where possible data collated to report median (interquartile range, range) of outcomes of interest. MAIN RESULTS 1314 cases reported 2134 presenting symptoms. The most common presenting symptom was abnormal gait (1160 cases; 188 studies) followed by recurrent infections in classical ataxia-telangiectasia and movement disorders in variant ataxia-telangiectasia. 687 cases reported 752 causes of death among which malignancy was the most frequently reported cause. Median (IQR, range) age of death (n = 294) was 14 years 0 months (10 years 0 months to 23 years 3 months, 1 year 3 months to 76 years 0 months). CONCLUSIONS This review demonstrates the multi-system involvement in A-T, confirms that neurological symptoms are the most frequent presenting features in classical A-T but variants have diverse manifestations. We found that most individuals with A-T have life limited to teenage or early adulthood. Predominance of case reports, and case series demonstrate the lack of robust evidence to determine the natural history of A-T. We recommend population-based studies to fill this evidence gap.
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Affiliation(s)
- Emily Petley
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
| | - Alexander Yule
- United Lincolnshire Hospitals NHS Trust, Lincoln, United
Kingdom
| | - Shaun Alexander
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
| | - Shalini Ojha
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
- Children’s Hospital, University Hospitals of Derby and Burton, NHS
Foundation Trust, Derby, United Kingdom
| | - William P. Whitehouse
- School of Medicine, University of Nottingham, Nottingham, United
Kingdom
- Nottingham Children’s Hospital, Nottingham University Hospital NHS Trust,
Nottingham, United Kingdom
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3
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Jończyk-Potoczna K, Potoczny J, Szczawińska-Popłonyk A. Imaging in children with ataxia-telangiectasia-The radiologist's approach. Front Pediatr 2022; 10:988645. [PMID: 36186632 PMCID: PMC9523007 DOI: 10.3389/fped.2022.988645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Ataxia-telangiectasia (A-T) is a syndromic inborn error of immunity (IEI) characterized by genomic instability, defective reparation of the DNA double-strand breaks, and hypersensitivity to ionizing radiation disturbing cellular homeostasis. The role of imaging diagnostics and the conscious choice of safe and advantageous imaging technique, as well as its correct interpretation, are crucial in the diagnostic process and monitoring of children with A-T. This study aimed at defining the role of a radiologist in the early diagnosis of A-T, as well as in detecting and tracking disease complications associated with infections, inflammation, lymphoproliferation, organ-specific immunopathology, and malignancy. Based on our single-center experience, retrospective analysis of investigations using ionizing radiation-free techniques, ultrasound (US), and Magnetic Resonance Imaging (MRI), was performed on regularly followed-up 11 pediatric A-T patients, 6 girls and 5 boys, aged from 2 to 18 years, with the longest period of observation coming to over 13 years. Our attention was especially drawn to the abnormalities that were observed in the US and MRI examinations of the lungs, abdominal cavity, and lymph nodes. The abdominal US showed no abnormalities in organ dimensions or echostructure in 4 out of 11 children studied, yet in the other 7, during follow-up examinations, hepato- and/or splenomegaly, mesenteric, visceral, and paraaortic lymphadenopathy were observable. In 2 patients, focal changes in the liver and spleen were shown, and in one patient progressive abdominal lymphadenopathy corresponded with the diagnosis of non-Hodgkin lymphoma (NHL). The lung US revealed multiple subpleural consolidations and B line artifacts related to the interstitial-alveolar syndrome in 5 patients, accompanied by pleural effusion in one of them. The MRI investigation of the lung enabled the detection of lymphatic nodal masses in the mediastinum, with concomitant airway lesions characteristic of bronchiectasis and focal parenchymal consolidations in one A-T patient with chronic respiratory failure. This patient also manifested organomegaly and granulomatous liver disease in abdominal MRI examination. Our study shows that the use of modern US capabilities and MRI is safe and efficient, thereby serving as a recommended advantageous imaging diagnostic tool in monitoring children with IEI and DNA instability syndromes.
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Affiliation(s)
- Katarzyna Jończyk-Potoczna
- Department of Pediatric Radiology, Institute of Pediatrics, Pozna University of Medical Sciences, Poznań, Poland
| | - Jakub Potoczny
- Department of Radiology, Greater Poland Cancer Center, Poznań, Poland
| | - Aleksandra Szczawińska-Popłonyk
- Department of Pediatric Pneumonology, Allergy and Clinical Immunology, Institute of Pediatrics, Poznań University of Medical Sciences, Poznań, Poland
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Maglione M, Borrelli M, Santamaria F. Comment on "Thoracic Magnetic Resonance Imaging Applications in Children". Eurasian J Med 2021; 53:62-63. [PMID: 33716533 DOI: 10.5152/eurasianjmed.2021.20121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marco Maglione
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Melissa Borrelli
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
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Saunders RA, Michniacki TF, Hames C, Moale HA, Wilke C, Kuo ME, Nguyen J, Hartlerode AJ, Moore BB, Sekiguchi JM. Elevated inflammatory responses and targeted therapeutic intervention in a preclinical mouse model of ataxia-telangiectasia lung disease. Sci Rep 2021; 11:4268. [PMID: 33608602 PMCID: PMC7895952 DOI: 10.1038/s41598-021-83531-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
Ataxia-telangiectasia (A-T) is an autosomal recessive, multisystem disorder characterized by cerebellar degeneration, cancer predisposition, and immune system defects. A major cause of mortality in A-T patients is severe pulmonary disease; however, the underlying causes of the lung complications are poorly understood, and there are currently no curative therapeutic interventions. In this study, we examined the lung phenotypes caused by ATM-deficient immune cells using a mouse model of A-T pulmonary disease. In response to acute lung injury, ATM-deficiency causes decreased survival, reduced blood oxygen saturation, elevated neutrophil recruitment, exaggerated and prolonged inflammatory responses and excessive lung injury compared to controls. We found that ATM null bone marrow adoptively transferred to WT recipients induces similar phenotypes that culminate in impaired lung function. Moreover, we demonstrated that activated ATM-deficient macrophages exhibit significantly elevated production of harmful reactive oxygen and nitrogen species and pro-inflammatory cytokines. These findings indicate that ATM-deficient immune cells play major roles in causing the lung pathologies in A-T. Based on these results, we examined the impact of inhibiting the aberrant inflammatory responses caused by ATM-deficiency with reparixin, a CXCR1/CXCR2 chemokine receptor antagonist. We demonstrated that reparixin treatment reduces neutrophil recruitment, edema and tissue damage in ATM mutant lungs. Thus, our findings indicate that targeted inhibition of CXCR1/CXCR2 attenuates pulmonary phenotypes caused by ATM-deficiency and suggest that this treatment approach represents a viable therapeutic strategy for A-T lung disease.
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Affiliation(s)
- Rudel A Saunders
- Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Place, 2063 BSRB, Box 2200, Ann Arbor, MI, 48109, USA
| | - Thomas F Michniacki
- Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Courtney Hames
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Hilary A Moale
- Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Place, 2063 BSRB, Box 2200, Ann Arbor, MI, 48109, USA
| | - Carol Wilke
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Molly E Kuo
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Johnathan Nguyen
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | | | - Bethany B Moore
- Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Place, 2063 BSRB, Box 2200, Ann Arbor, MI, 48109, USA.,Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - JoAnn M Sekiguchi
- Department of Internal Medicine, University of Michigan, 109 Zina Pitcher Place, 2063 BSRB, Box 2200, Ann Arbor, MI, 48109, USA. .,Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.
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Wall LA, Wisner EL, Gipson KS, Sorensen RU. Bronchiectasis in Primary Antibody Deficiencies: A Multidisciplinary Approach. Front Immunol 2020; 11:522. [PMID: 32296433 PMCID: PMC7138103 DOI: 10.3389/fimmu.2020.00522] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/06/2020] [Indexed: 12/18/2022] Open
Abstract
Bronchiectasis, the presence of bronchial wall thickening with airway dilatation, is a particularly challenging complication of primary antibody deficiencies. While susceptibility to infections may be the primary factor leading to the development of bronchiectasis in these patients, the condition may develop in the absence of known infections. Once bronchiectasis is present, the lungs are subject to a progressive cycle involving both infectious and non-infectious factors. If bronchiectasis is not identified or not managed appropriately, the cycle proceeds unchecked and yields advanced and permanent lung damage. Severe symptoms may limit exercise tolerance, require frequent hospitalizations, profoundly impair quality of life (QOL), and lead to early death. This review article focuses on the appropriate identification and management of bronchiectasis in patients with primary antibody deficiencies. The underlying immune deficiency and the bronchiectasis need to be treated from combined immunology and pulmonary perspectives, reflected in this review by experts from both fields. An aggressive multidisciplinary approach may reduce exacerbations and slow the progression of permanent lung damage.
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Affiliation(s)
- Luke A Wall
- Division of Allergy Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States.,Children's Hospital of New Orleans, New Orleans, LA, United States
| | - Elizabeth L Wisner
- Division of Allergy Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States.,Children's Hospital of New Orleans, New Orleans, LA, United States
| | - Kevin S Gipson
- Division of Pulmonology and Sleep Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ricardo U Sorensen
- Division of Allergy Immunology, Department of Pediatrics, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States
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Zhang WJ, Huang YS, Zhu ZM, Luo HL. A case report of unexplained jejunal telangiectasia complicated with bleeding. Int J Surg Case Rep 2020; 67:219-222. [PMID: 32066112 PMCID: PMC7025968 DOI: 10.1016/j.ijscr.2020.01.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 11/10/2022] Open
Abstract
Jejunal telangiectasia with bleeding is relatively rare in clinic. The main clinical manifestation of small intestinal telangiectasia is hematochezia. This disease is prone to recurrent bleeding. There is a lack of specific and effective diagnostic methods in clinical. We gave some experience and suggestions in the process of surgical treatment.
Introduction Small intestinal telangiectasia is a clinically rare disease, which is mainly characterized by gastrointestinal bleeding. There is a lack of specific and effective diagnostic methods in clinical practice due to its unknown etiology and difficult localization, it is often difficult to find the location of the lesion even through observation, touch, endoscope or intestinal incision. Case presentation A 39-year-old female patient, who had black stool twice without obvious inducement 3 days ago, and came to our hospital for treatment and was hospitalized with gastrointestinal bleeding. the main manifestation of this patient was repeated black stool, sometimes dark red. Initially, we considered other diseases of the digestive tract (gastric ulcers, duodenal ulcers and intestinal tumors). However, no abnormalities were found by CT, gastroscopy and enteroscopy. Later, we considered that there was a greater possibility of intestinal vascular disease, and then blood clots was found in the upper and middle segment of the jejunum through capsule endoscopy, but no bleeding site was found. Therefore, we decided to open the abdomen for further intraoperative enteroscopy exploration, finally found the bleeding point, and then stopped the bleeding by suture. Later, through further follow-up, no rebleeding was found in the patient. Conclusion Jejunal telangiectasia with bleeding is a very rare intestinal vascular disease, which is difficult to identify and diagnose clinically. Therefore, the possibility of this disease should be considered in patients with negative results through some examinations such as gastroscopy, enteroscopy, gastrointestinal barium meal radiography, etc. In order to treat in time and prevent bleeding
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8
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Bush A, Floto RA. Pathophysiology, causes and genetics of paediatric and adult bronchiectasis. Respirology 2019; 24:1053-1062. [PMID: 30801930 DOI: 10.1111/resp.13509] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
Bronchiectasis has historically been considered to be irreversible dilatation of the airways, but with modern imaging techniques it has been proposed that 'irreversible' be dropped from the definition. The upper limit of normal for the ratio of airway to arterial development increases with age, and a developmental perspective is essential. Bronchiectasis (and persistent bacterial bronchitis, PBB) is a descriptive term and not a diagnosis, and should be the start not the end of the patient's diagnostic journey. PBB, characterized by airway infection and neutrophilic inflammation but without significant airway dilatation may be a precursor of bronchiectasis, and there are many commonalities in the microbiology and the pathology, which are reviewed in this article. A high index of suspicion is essential, and a history of chronic wet or productive cough for more than 4-8 weeks should prompt investigation. There are numerous underlying causes of bronchiectasis, although in many cases no cause is found. Causes include post-infectious, especially after tuberculosis, adenoviral or pertussis infection; aspiration syndromes; defects in host defence, which may solely affect the airways (cystic fibrosis, not considered in this review, and primary ciliary dyskinesia); and primary ciliary dyskinesia or be systemic, such as common variable immunodeficiency; genetic syndromes; and anatomical defects such as intraluminal airway obstruction (e.g. foreign body), intramural obstruction (e.g. complete cartilage rings) and external airway compression (e.g. by tuberculous lymph nodes). Identification of the underlying cause is important, because some of these conditions have specific treatments and others genetic implications for the family.
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Affiliation(s)
- Andrew Bush
- Department of Paediatrics, Imperial College, London, UK.,Department of Paediatric Respirology, National Heart and Lung Institute, London, UK.,Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - R Andres Floto
- Department of Respiratory Biology, University of Cambridge, Cambridge, UK.,Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK
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9
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Duecker R, Baer P, Eickmeier O, Strecker M, Kurz J, Schaible A, Henrich D, Zielen S, Schubert R. Oxidative stress-driven pulmonary inflammation and fibrosis in a mouse model of human ataxia-telangiectasia. Redox Biol 2017; 14:645-655. [PMID: 29172151 PMCID: PMC5975220 DOI: 10.1016/j.redox.2017.11.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/13/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022] Open
Abstract
Lung failure is responsible for significant morbidity and is a frequent cause of death in ataxia-telangiectasia (A-T). Disturbance in the redox balance of alveolar epithelial cells must be considered as a causal factor for respiratory disease in A-T. To investigate bronchoalveolar sensitivity to reactive oxygen species (ROS) and ROS-induced DNA damage, we used bleomycin (BLM) to induce experimental inflammation and fibrotic changes in the Atm-deficient mouse model. BLM or saline was administered by oropharyngeal instillation into the lung of Atm-deficient mice and wild-type mice. Mice underwent pulmonary function testing at days 0, 9, and 28, and bronchoalveolar lavage (BAL) was analysed for cell distribution and cytokines. Lung tissue was analysed by histochemistry. BLM administration resulted in a tremendous increase in lung inflammation and fibrotic changes in the lung tissue of Atm-deficient mice and was accompanied by irreversible deterioration of lung function. ATM (ataxia telangiectasia mutated) deficiency resulted in reduced cell viability, a delay in the resolution of γH2AX expression and a significant increase in intracellular ROS in pulmonary epithelial cells after BLM treatment. This was confirmed in the human epithelial cell line A549 treated with the ATM-kinase inhibitor KU55933. Our results demonstrate high bronchoalveolar sensitivity to ROS and ROS-induced DNA damage in the Atm-deficient mouse model and support the hypothesis that ATM plays a pivotal role in the control of oxidative stress-driven lung inflammation and fibrosis.
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Affiliation(s)
- Ruth Duecker
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany.
| | - Patrick Baer
- Division of Nephrology, Department of Internal Medicine III, Goethe-University, Frankfurt/Main, Germany
| | - Olaf Eickmeier
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany
| | - Maja Strecker
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany
| | - Jennifer Kurz
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany
| | - Alexander Schaible
- Department of Trauma, Hand & Reconstructive Surgery, Goethe-University, Frankfurt/Main, Germany
| | - Dirk Henrich
- Department of Trauma, Hand & Reconstructive Surgery, Goethe-University, Frankfurt/Main, Germany
| | - Stefan Zielen
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany
| | - Ralf Schubert
- Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt/Main, Germany
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van Os NJH, Haaxma CA, van der Flier M, Merkus PJFM, van Deuren M, de Groot IJM, Loeffen J, van de Warrenburg BPC, Willemsen MAAP. Ataxia-telangiectasia: recommendations for multidisciplinary treatment. Dev Med Child Neurol 2017; 59:680-689. [PMID: 28318010 DOI: 10.1111/dmcn.13424] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 12/29/2022]
Abstract
Ataxia-telangiectasia is a rare, neurodegenerative, and multisystem disease, characterized by cerebellar ataxia, oculocutaneous telangiectasia, immunodeficiency, progressive respiratory failure, and an increased risk of malignancies. It demands specialized care tailored to the individual patient's needs. Besides the classic ataxia-telangiectasia phenotype, a variant phenotype exists with partly overlapping but some distinctive disease characteristics. This guideline summarizes frequently encountered medical problems in the disease course of patients with classic and variant ataxia-telangiectasia, in the domains of neurology, immunology and infectious diseases, pulmonology, anaesthetic and perioperative risk, oncology, endocrinology, and nutrition. Furthermore, it provides a practical guide with evidence- and expert-based recommendations for the follow-up and treatment of all these different clinical topics.
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Affiliation(s)
- Nienke J H van Os
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Charlotte A Haaxma
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel van der Flier
- Department of Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter J F M Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital and Canisius Wilhelmina Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel van Deuren
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Loeffen
- Department of Pediatric Oncology and Hematology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Bart P C van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michèl A A P Willemsen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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Maglione M, Montella S, Mollica C, Carnovale V, Iacotucci P, De Gregorio F, Tosco A, Cervasio M, Raia V, Santamaria F. Lung structure and function similarities between primary ciliary dyskinesia and mild cystic fibrosis: a pilot study. Ital J Pediatr 2017; 43:34. [PMID: 28403885 PMCID: PMC5389053 DOI: 10.1186/s13052-017-0351-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/27/2017] [Indexed: 11/14/2022] Open
Abstract
Background Primary ciliary dyskinesia (PCD) and cystic fibrosis (CF) are increasingly compared. There are no chest magnetic resonance imaging (MRI) comparative studies of PCD and CF. We assessed clinical, functional, microbiological and MRI findings in PCD and mild CF patients in order to evaluate different expression of lung disease. Methods Twenty PCD (15.1 years) and 20 CF subjects with mild respiratory impairment (16 years, 70% with pancreatic insufficiency) underwent MRI, spirometry, and sputum cultures when clinically stable. MRI was scored using the modified Helbich system. Results PCD was diagnosed later than CF (9.9 versus 0.6 years, p = 0.03), despite earlier symptoms (0.1 versus 0.6 years, p = 0.02). In the year preceding the study, patients from both groups underwent two systemic antibiotic courses (p = 0.48). MRI total scores were 11.6 ± 0.7 and 9.1 ± 1 in PCD and CF, respectively. FEV1 and FVC Z-scores were −1.75 (range, −4.6–0.7) and −0.6 (−3.9–1.8) in PCD, and −0.9 (range, −5.4–2.3) and −0.3 (−3.4–2.5) in CF, respectively. No difference was found between lung function or structure, despite a higher MRI subscore of collapse/consolidation in PCD versus CF (1.6 ± 0.1 and 0.6 ± 0.2, p < 0.001). These findings were confirmed after data-control for diagnostic delay. Pseudomonas aeruginosa and Staphylococcus aureus were more frequent in CF than in PCD (p = 0.05 and p = 0.003, respectively). Conclusions MRI is a valuable radiation-free tool for comparative PCD and CF lung disease assessment. Patients with PCD may exhibit similar MRI and lung function changes as CF subjects with mild pulmonary disease. Delay in PCD diagnosis is unlikely the only determinant of similarities. Electronic supplementary material The online version of this article (doi:10.1186/s13052-017-0351-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marco Maglione
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Silvia Montella
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Carmine Mollica
- Biostructure and Bioimaging Institute, National Research Council, Naples, Italy
| | - Vincenzo Carnovale
- Department of Translational Medical Sciences, Adult Cystic Fibrosis Center, Federico II University, Naples, Italy
| | - Paola Iacotucci
- Department of Translational Medical Sciences, Adult Cystic Fibrosis Center, Federico II University, Naples, Italy
| | - Fabiola De Gregorio
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Antonella Tosco
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Mariarosaria Cervasio
- Department of Advanced Biomedical Sciences, Anatomo-Pathology Unit, Federico II University, Naples, Italy
| | - Valeria Raia
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy.
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Montella S, Corcione A, Santamaria F. Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience. Int J Mol Sci 2017; 18:ijms18020296. [PMID: 28146079 PMCID: PMC5343832 DOI: 10.3390/ijms18020296] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 12/26/2022] Open
Abstract
Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%–9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician.
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Affiliation(s)
- Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
| | - Adele Corcione
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
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Rothblum-Oviatt C, Wright J, Lefton-Greif MA, McGrath-Morrow SA, Crawford TO, Lederman HM. Ataxia telangiectasia: a review. Orphanet J Rare Dis 2016; 11:159. [PMID: 27884168 PMCID: PMC5123280 DOI: 10.1186/s13023-016-0543-7] [Citation(s) in RCA: 348] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 11/16/2016] [Indexed: 12/15/2022] Open
Abstract
DEFINITION OF THE DISEASE Ataxia telangiectasia (A-T) is an autosomal recessive disorder primarily characterized by cerebellar degeneration, telangiectasia, immunodeficiency, cancer susceptibility and radiation sensitivity. A-T is often referred to as a genome instability or DNA damage response syndrome. EPIDEMIOLOGY The world-wide prevalence of A-T is estimated to be between 1 in 40,000 and 1 in 100,000 live births. CLINICAL DESCRIPTION A-T is a complex disorder with substantial variability in the severity of features between affected individuals, and at different ages. Neurological symptoms most often first appear in early childhood when children begin to sit or walk. They have immunological abnormalities including immunoglobulin and antibody deficiencies and lymphopenia. People with A-T have an increased predisposition for cancers, particularly of lymphoid origin. Pulmonary disease and problems with feeding, swallowing and nutrition are common, and there also may be dermatological and endocrine manifestations. ETIOLOGY A-T is caused by mutations in the ATM (Ataxia Telangiectasia, Mutated) gene which encodes a protein of the same name. The primary role of the ATM protein is coordination of cellular signaling pathways in response to DNA double strand breaks, oxidative stress and other genotoxic stress. DIAGNOSIS The diagnosis of A-T is usually suspected by the combination of neurologic clinical features (ataxia, abnormal control of eye movement, and postural instability) with one or more of the following which may vary in their appearance: telangiectasia, frequent sinopulmonary infections and specific laboratory abnormalities (e.g. IgA deficiency, lymphopenia especially affecting T lymphocytes and increased alpha-fetoprotein levels). Because certain neurological features may arise later, a diagnosis of A-T should be carefully considered for any ataxic child with an otherwise elusive diagnosis. A diagnosis of A-T can be confirmed by the finding of an absence or deficiency of the ATM protein or its kinase activity in cultured cell lines, and/or identification of the pathological mutations in the ATM gene. DIFFERENTIAL DIAGNOSIS There are several other neurologic and rare disorders that physicians must consider when diagnosing A-T and that can be confused with A-T. Differentiation of these various disorders is often possible with clinical features and selected laboratory tests, including gene sequencing. ANTENATAL DIAGNOSIS Antenatal diagnosis can be performed if the pathological ATM mutations in that family have been identified in an affected child. In the absence of identifying mutations, antenatal diagnosis can be made by haplotype analysis if an unambiguous diagnosis of the affected child has been made through clinical and laboratory findings and/or ATM protein analysis. GENETIC COUNSELING Genetic counseling can help family members of a patient with A-T understand when genetic testing for A-T is feasible, and how the test results should be interpreted. MANAGEMENT AND PROGNOSIS Treatment of the neurologic problems associated with A-T is symptomatic and supportive, as there are no treatments known to slow or stop the neurodegeneration. However, other manifestations of A-T, e.g. immunodeficiency, pulmonary disease, failure to thrive and diabetes can be treated effectively.
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Affiliation(s)
| | - Jennifer Wright
- The Ataxia Telangiectasia Clinical Center, Johns Hopkins Medical Institutions, Baltimore, Maryland USA
| | - Maureen A. Lefton-Greif
- The Ataxia Telangiectasia Clinical Center, Departments of Pediatrics and Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland USA
| | - Sharon A. McGrath-Morrow
- The Ataxia Telangiectasia Clinical Center, Departments of Pediatrics and Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland USA
| | - Thomas O. Crawford
- The Ataxia Telangiectasia Clinical Center, Departments of Pediatrics and Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland USA
| | - Howard M. Lederman
- The Ataxia Telangiectasia Clinical Center, Departments of Pediatrics, Medicine and Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland USA
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14
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Ammendola RM, Barchetti G, Ceravolo I, Fiorelli A, Carbone I. Diagnosis of pneumothorax without exposure to ionising radiation. Thorax 2016; 71:1068-1069. [PMID: 27388484 DOI: 10.1136/thoraxjnl-2016-208667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 06/07/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Rosa Maria Ammendola
- Department of Radiological Sciences, Pathology and Oncology, Sapienza University of Rome, Rome, Italy
| | - Giovanni Barchetti
- Department of Radiological Sciences, Pathology and Oncology, Sapienza University of Rome, Rome, Italy
| | - Isabella Ceravolo
- Department of Radiological Sciences, Pathology and Oncology, Sapienza University of Rome, Rome, Italy
| | - Andrea Fiorelli
- Department of Radiological Sciences, Pathology and Oncology, Sapienza University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological Sciences, Pathology and Oncology, Sapienza University of Rome, Rome, Italy
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15
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Arslan S, Poyraz N, Ucar R, Yesildag M, Yesildag A, Caliskaner AZ. Magnetic Resonance Imaging May Be a Valuable Radiation-Free Technique for Lung Pathologies in Patients with Primary Immunodeficiency. J Clin Immunol 2015; 36:66-72. [PMID: 26707785 DOI: 10.1007/s10875-015-0227-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 12/14/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE In some primary immunodeficiency (PID) patients, especially in the subgroup with common variable immunodeficiency (CVID), radiosensitivity is a concern and avoidance of repeated radiation exposure has been recommended. To investigate the use of lung Magnetic resonance imaging (MRI) instead of Computed Tomography (CT) for the diagnosis and follow-up of various lesions in the lung parenchyma and airways, especially in PID patients in whom x-ray exposure should be limited. METHODS The study enrolled 23 patients with PID who underwent thorax CT within the last 3 months and/or who will undergo initial radiological assessment. Lung MRI was performed in all patients to compare the pulmonary findings with CT images. RESULTS MRI performance was weaker at detecting bronchiectasis extension, and a low concordance was found between MRI and CT in the assessment of the number of bronchial generations. CT better identified peripheral airway abnormalities, while CT and MRI gave similar results for detecting the presence and extension of consolidation, bullae, mucus plugging, bronchial wall thickening, bronchiectasis severity and nodules. CONCLUSIONS Despite the low spatial resolution, higher cost, and low availability, we suggest MRI as a possible radiation-free alternative to CT in selected patients with PID.
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Affiliation(s)
- Sevket Arslan
- Faculty of Medicine, Department of Internal Medicine, Division of Allergy and Immunology Diseases, Necmettin Erbakan University Meram, Konya, Turkey.
| | - Necdet Poyraz
- Faculty of Medicine, Department of Radiology, Necmettin Erbakan University Meram, Konya, Turkey
| | - Ramazan Ucar
- Faculty of Medicine, Department of Internal Medicine, Division of Allergy and Immunology Diseases, Necmettin Erbakan University Meram, Konya, Turkey
| | - Mihrican Yesildag
- Department of Chest Diseases, Konya Training and Research Hospital, Meram, Konya, Turkey
| | - Ahmet Yesildag
- Faculty of Medicine, Department of Radiology, Necmettin Erbakan University Meram, Konya, Turkey
| | - Ahmet Zafer Caliskaner
- Faculty of Medicine, Department of Internal Medicine, Division of Allergy and Immunology Diseases, Necmettin Erbakan University Meram, Konya, Turkey
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Bhatt JM, Bush A, van Gerven M, Nissenkorn A, Renke M, Yarlett L, Taylor M, Tonia T, Warris A, Zielen S, Zinna S, Merkus PJFM. ERS statement on the multidisciplinary respiratory management of ataxia telangiectasia. Eur Respir Rev 2015; 24:565-81. [PMID: 26621971 PMCID: PMC9487625 DOI: 10.1183/16000617.0066-2015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/08/2015] [Indexed: 11/05/2022] Open
Abstract
Ataxia telangiectasia (A-T) is a rare, progressive, multisystem disease that has a large number of complex and diverse manifestations which vary with age. Patients with A-T die prematurely with the leading causes of death being respiratory diseases and cancer. Respiratory manifestations include immune dysfunction leading to recurrent upper and lower respiratory infections; aspiration resulting from dysfunctional swallowing due to neurodegenerative deficits; inefficient cough; and interstitial lung disease/pulmonary fibrosis. Malnutrition is a significant comorbidity. The increased radiosensitivity and increased risk of cancer should be borne in mind when requesting radiological investigations. Aggressive proactive monitoring and treatment of these various aspects of lung disease under multidisciplinary expertise in the experience of national multidisciplinary clinics internationally forms the basis of this statement on the management of lung disease in A-T. Neurological management is outwith the scope of this document.
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Affiliation(s)
- Jayesh M Bhatt
- Nottingham Children's Hospital, UK Paediatric National Clinic, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Bush
- Imperial College and Royal Brompton Hospital, London, UK
| | - Marjo van Gerven
- Dept of Paediatrics, Division of Respiratory Medicine, Amalia Children's Hospital Radboud, University Medical Centre, Nijmegen, The Netherlands
| | - Andreea Nissenkorn
- Rare Diseases Service and Pediatric Neurology Unit, Edmond and Lilly Safra Pediatric Hospital, Sheba Medical Center, Tel HaShomer, Israel Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Renke
- Dept of Allergology, Pneumology and Cystic Fibrosis, Children's Hospital, Goethe-University Theodor-Stern Kai, Frankfurt/Main, Germany
| | | | - Malcolm Taylor
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Adilia Warris
- Institute of Medical Sciences, University of Aberdeen and the Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Stefan Zielen
- Dept of Allergology, Pneumology and Cystic Fibrosis, Children's Hospital, Goethe-University Theodor-Stern Kai, Frankfurt/Main, Germany
| | - Shairbanu Zinna
- Nottingham Children's Hospital, UK Paediatric National Clinic, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter J F M Merkus
- Dept of Paediatrics, Division of Respiratory Medicine, Amalia Children's Hospital Radboud, University Medical Centre, Nijmegen, The Netherlands
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Bhatt JM, Bush A, van Gerven M, Nissenkorn A, Renke M, Yarlett L, Taylor M, Tonia T, Warris A, Zielen S, Zinna S, Merkus PJFM. Ataxia telangiectasia: why should the ERS care? Eur Respir J 2015; 46:1557-60. [PMID: 26621885 DOI: 10.1183/13993003.01456-2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jayesh M Bhatt
- Nottingham Children's Hospital, UK Paediatric National Clinic, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Bush
- Imperial College and Royal Brompton Hospital, London, UK
| | - Marjo van Gerven
- Dept of Paediatrics, Division of Respiratory Medicine, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Andreea Nissenkorn
- Rare Diseases Service and Pediatric Neurology Unit, Edmond and Lilly Safra Pediatric Hospital, Sheba Medical Center, Tel Ha Shomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Renke
- Dept of Allergology, Pneumology and Cystic Fibrosis, Children's Hospital, Goethe-University Theodor-Stern Kai, Frankfurt/Main, Germany
| | | | - Malcolm Taylor
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Adilia Warris
- Institute of Medical Sciences, University of Aberdeen and the Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Stefan Zielen
- Dept of Allergology, Pneumology and Cystic Fibrosis, Children's Hospital, Goethe-University Theodor-Stern Kai, Frankfurt/Main, Germany
| | - Shairbanu Zinna
- Nottingham Children's Hospital, UK Paediatric National Clinic, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter J F M Merkus
- Dept of Paediatrics, Division of Respiratory Medicine, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
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Milito C, Pulvirenti F, Serra G, Valente M, Pesce AM, Granata G, Catalano C, Fraioli F, Quinti I. Lung magnetic resonance imaging with diffusion weighted imaging provides regional structural as well as functional information without radiation exposure in primary antibody deficiencies. J Clin Immunol 2015; 35:491-500. [PMID: 26067227 PMCID: PMC4502290 DOI: 10.1007/s10875-015-0172-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/25/2015] [Indexed: 12/26/2022]
Abstract
Purpose Primary antibody deficiency patients suffer from infectious and non-infectious pulmonary complications leading over time to chronic lung disease. The complexity of this pulmonary involvement poses significant challenge in differential diagnosis in patients with long life disease and increased radio sensitivity. We planned to verify the utility of chest Magnetic Resolution Imaging with Diffusion-Weighted Imaging as a radiation free technique. Methods Prospective evaluation of 18 patients with Common Variable Immunodeficiency and X-linked Agammaglobulinemia. On the same day, patients underwent Magnetic Resonance Imaging with Diffusion Weighted Imaging sequences, High Resolution Computerized Tomography and Pulmonary Function Tests, including diffusing capacity factor for carbon monoxide. Images were scored using a modified version of the Bhalla scoring system. Results Magnetic Resonance Imaging was non-inferior to High Resolution Computerized Tomography in the capacity to identify bronchial and parenchymal abnormalities. HRCT had a higher capacity to identify peripheral airways abnormalities, defined as an involvement of bronchial generation up to the fifth and distal (scores 2–3). Bronchial scores negatively related to pulmonary function tests. One third of consolidations and nodules had Diffusion Weighted Imaging restrictions associated with systemic granulomatous disease and systemic lymphadenopathy. Lung Magnetic Resolution Imaging detected an improvement of bronchial and parenchymal abnormalities, in recently diagnosed patients soon after starting Ig replacement. Conclusions Magnetic Resonance Imaging with Diffusion Weighted Imaging was a reliable technique to detect lung alterations in patients with Primary Antibody Deficiencies. Electronic supplementary material The online version of this article (doi:10.1007/s10875-015-0172-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Viale dell'Università 37, Rome, Italy
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Eickmeier O, Kim SY, Herrmann E, Döring C, Duecker R, Voss S, Wehner S, Hölscher C, Pietzner J, Zielen S, Schubert R. Altered mucosal immune response after acute lung injury in a murine model of Ataxia Telangiectasia. BMC Pulm Med 2014; 14:93. [PMID: 24884546 PMCID: PMC4050222 DOI: 10.1186/1471-2466-14-93] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 05/20/2014] [Indexed: 11/11/2022] Open
Abstract
Background Ataxia telangiectasia (A-T) is a rare but devastating and progressive disorder characterized by cerebellar dysfunction, lymphoreticular malignancies and recurrent sinopulmonary infections. In A-T, disease of the respiratory system causes significant morbidity and is a frequent cause of death. Methods We used a self-limited murine model of hydrochloric acid-induced acute lung injury (ALI) to determine the inflammatory answer due to mucosal injury in Atm (A-T mutated)- deficient mice (Atm-/-). Results ATM deficiency increased peak lung inflammation as demonstrated by bronchoalveolar lavage fluid (BALF) neutrophils and lymphocytes and increased levels of BALF pro-inflammatory cytokines (e.g. IL-6, TNF). Furthermore, bronchial epithelial damage after ALI was increased in Atm-/- mice. ATM deficiency increased airway resistance and tissue compliance before ALI was performed. Conclusions Together, these findings indicate that ATM plays a key role in inflammatory response after airway mucosal injury.
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Affiliation(s)
- Olaf Eickmeier
- Pediatric Pulmonology, Allergy and Cystic Fibrosis, Johann Wolfgang Goethe- University, Theodor-Stern-Kai 7, Frankfurt D-60590, Germany.
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