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Holick MF, Shirvani A, Charoenngam N. Fetal Fractures in an Infant with Maternal Ehlers-Danlos Syndrome, CCDC134 Pathogenic Mutation and a Negative Genetic Test for Osteogenesis Imperfecta. CHILDREN-BASEL 2021; 8:children8060512. [PMID: 34204301 PMCID: PMC8235512 DOI: 10.3390/children8060512] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/12/2022]
Abstract
Intrauterine fractures are a rare clinical finding caused by abnormal early-life osteogenesis. In this case report, we reported a male infant with twenty-three intrauterine/fetal fractures resembling osteogenesis imperfecta and tested negative for COL1A1 and COL1A2 mutations. The infant’s mother had Ehlers–Danlos syndrome, hypermobility type. Whole-genome sequencing revealed that there were no pathologic mutations previously documented to be associated with intrauterine fracture. Genetic mutations reported to be associated with fragility fractures were identified. These include the pathogenic homozygous mutation in the CCDC134 gene. Other genetic variants that might be responsible for variable expressivity of the skeletal manifestation include the homozygous variants of the genes CCDC134, COL15A1 and ZFPM1, and the heterozygous variants of the genes MYH3, BCHE, AUTS2. This is the first reported case of in utero fractures, that was confirmed by X-ray after birth, in an infant who had no genetic evidence for osteogenesis imperfecta, had a homozygous pathogenic mutation of an osteogenesis gene and whose mother had Ehlers-Danlos syndrome hypermobility type. Therefore, we have identified a new genetic cause for in utero fractures. If after birth, this infant were found to have these fractures in various stages of healing with a negative genetic test for osteogenesis imperfecta he would have been misdiagnosed as due to nonaccidental trauma.
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Affiliation(s)
- Michael F. Holick
- Section Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (A.S.); (N.C.)
- Correspondence: ; Tel.: +1-617-358-6139
| | - Arash Shirvani
- Section Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (A.S.); (N.C.)
| | - Nipith Charoenngam
- Section Endocrinology, Diabetes, Nutrition and Weight Management, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (A.S.); (N.C.)
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Ogunwale AN, Colon-Emeric CS, Sloane R, Adler RA, Lyles KW, Lee RH. Acetylcholinesterase Inhibitors Are Associated with Reduced Fracture Risk among Older Veterans with Dementia. J Bone Miner Res 2020; 35:440-445. [PMID: 31711264 PMCID: PMC7215241 DOI: 10.1002/jbmr.3916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/16/2019] [Accepted: 11/02/2019] [Indexed: 12/29/2022]
Abstract
Acetylcholinesterase inhibitors (AChEIs) have been noted to increase bone density and quality in mice. Human studies are limited but suggest an association with improved bone healing after hip fracture. We examined the relationship between AChEI use and fracture risk in a national cohort of 360,015 male veterans aged 65 to 99 years with dementia but without prior fracture using Veterans Affairs (VA) hospital, Medicare, and pharmacy records from 2000 to 2010. Diagnosis of dementia, any clinical fracture (excluding facial and digital), comorbidities, and medications were identified using ICD-9 and drug class codes. Cox proportional hazard models considering AChEI use as a time-varying covariate and adjusting for fall and fracture risk factors compared the time-to-fracture in AChEI users versus non-AChEI users. Potential confounders included demographics (age, race, body mass index), comorbidities associated with fracture or falls (diabetes, lung disease, stroke, Parkinson's, seizures, etc.) and medications associated with fracture or falls (bisphosphonates, glucocorticoids, androgen deprivation therapy [ADT], proton pump inhibitors [PPIs], selective serotonin receptor inhibitors [SSRIs], etc.). Competing mortality risk was considered using the methods of Fine and Gray. To account for persistent effects on bone density or quality that might confer protection after stopping the medication, we completed a secondary analysis using the medication possession ratio (MPR) as a continuous variable in logistic regression models and also compared MPR increments of 10% to minimal/no use (MPR 0 to <0.10). Among older veterans with diagnosis of dementia, 20.1% suffered a fracture over an average of 4.6 years of follow-up. Overall, 42.3% of the cohort were prescribed AChEIs during the study period. The hazard of any fracture among AChEI users compared with those on other/no dementia medications was significantly lower in fully adjusted models (hazard ratio [HR] = 0.81; 95% confidence interval [CI] 0.75-0.88). After considering competing mortality risk, fracture risk remained 18% lower in veterans using AChEIs (HR = 0.82; 95% CI 0.76-0.89). © 2019 American Society for Bone and Mineral Research. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Abayomi N Ogunwale
- Department of Medicine, Duke University, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Cathleen S Colon-Emeric
- Department of Medicine, Duke University, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Richard Sloane
- Department of Medicine, Duke University, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Robert A Adler
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA.,Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kenneth W Lyles
- Department of Medicine, Duke University, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Richard H Lee
- Department of Medicine, Duke University, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA
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Meriç P, Buduneli N, Kanmaz B, Gürlek Ö, Çömlekoğlu E, Calvert G, Lappin DF, Nile C. Cholinergic signalling mechanisms and early implant healing phases in healthy versus generalized aggressive periodontitis patients: A prospective, case-control study. J Clin Periodontol 2019; 46:1155-1163. [PMID: 31444906 DOI: 10.1111/jcpe.13185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/27/2019] [Accepted: 08/21/2019] [Indexed: 12/27/2022]
Abstract
AIMS Periodontal diseases negatively affect implant osseointegration. Perturbations in non-neuronal cholinergic signalling mechanisms are associated with periodontitis; however, their role in generalized aggressive periodontitis (GAgP) is unknown. The aim of this prospective case-control study was to determine the relationship between non-neuronal cholinergic signalling mechanisms, secreted Ly-6/uPAR-related protein-1 (SLURP-1), interleukin-17 (IL-17) family cytokines and healing of dental implants in health and GAgP. MATERIAL AND METHODS Thirteen GAgP patients and seven periodontally healthy individuals (PH) were recruited. Peri-implant crevicular fluid (PICF) was obtained at baseline and 1 month post-placement. Acetylcholine (ACh) levels and cholinesterase activity were determined biochemically. SLURP-1, IL-17A and IL-17E levels were determined by ELISA. Marginal bone loss (MBL) at 1 and 6 months post-placement was determined radiographically. RESULTS The concentration of ACh, cholinesterase activity and IL-17A levels was elevated in PICF of patients with GAgP compared to PH individuals at baseline and 1 month post-placement. The concentration of ACh and cholinesterase activity levels in PICF correlated with levels of IL-17A and MBL around implants 1 month post-placement in patients with GAgP. CONCLUSIONS Non-neuronal cholinergic mechanisms may play a role in the aetiopathogenesis of GAgP and may directly or indirectly, through modulation of IL-17A, influence early implant osseointegration and potential long-term implant survival.
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Affiliation(s)
- Pınar Meriç
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Nurcan Buduneli
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Burcu Kanmaz
- Department of Periodontology, Faculty of Dentistry, İzmir Demokrasi University, İzmir, Turkey
| | - Önder Gürlek
- Department of Periodontology, School of Dentistry, Ege University, İzmir, Turkey
| | - Erhan Çömlekoğlu
- Department of Prosthodontics, School of Dentistry, Ege University, İzmir, Turkey
| | - Gareth Calvert
- Oral Sciences Research Group, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - David F Lappin
- Oral Sciences Research Group, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Christopher Nile
- Oral Sciences Research Group, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Grando SA, Kawashima K, Kirkpatrick CJ, Kummer W, Wessler I. Recent progress in revealing the biological and medical significance of the non-neuronal cholinergic system. Int Immunopharmacol 2015; 29:1-7. [PMID: 26362206 DOI: 10.1016/j.intimp.2015.08.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
Abstract
This special issue of International Immunopharmacology is the proceedings of the Fourth International Symposium on Non-neuronal Acetylcholine that was held on August 28-30, 2014 at the Justus Liebig University of Giessen in Germany. It contains original contributions of meeting participants covering the significant progress in understanding of the biological and medical significance of the non-neuronal cholinergic system extending from exciting insights into molecular mechanisms regulating this system via miRNAs over the discovery of novel cholinergic cellular signaling circuitries to clinical implications in cancer, wound healing, immunity and inflammation, cardiovascular, respiratory and other diseases.
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Affiliation(s)
- Sergei A Grando
- Department of Dermatology, University of California, Irvine, CA 92697, USA
| | - Koichiro Kawashima
- Department of Molecular Pharmacology, Kitasato University School of Pharmacy, Tokyo 108-8641, Japan
| | - Charles J Kirkpatrick
- Institute of Pathology, University Medical Center, Johannes Gutenberg-University, Mainz D-55101, Germany
| | - Wolfgang Kummer
- Institute for Anatomy and Cell Biology, Justus-Liebig-University, Giessen D-35385, Germany
| | - Ignaz Wessler
- Institute of Pathology, University Medical Center, Johannes Gutenberg-University, Mainz D-55101, Germany
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Kauschke V, Kneffel M, Floel W, Hartmann S, Kampschulte M, Dürselen L, Ignatius A, Schnettler R, Heiss C, Lips KS. Bone status of acetylcholinesterase-knockout mice. Int Immunopharmacol 2015; 29:222-30. [PMID: 26250336 DOI: 10.1016/j.intimp.2015.07.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 12/19/2022]
Abstract
Acetylcholinesterase (AChE) hydrolyzes acetylcholine (ACh) to acetate and choline and thereby terminates nerve impulse transmission. ACh is also expressed in bone tissue and enhances here proliferation and differentiation of osteoblasts, which makes it interesting to investigate effects of AChE deficiency on bone. To our knowledge, this is the first study that analyzed bone of heterozygous acetylcholinesterase-knockout (AChE-KO) mice. Tibia, femur, thoracic and lumbar vertebrae of 16-week-old female heterozygous AChE-KO mice and their corresponding wildtypes (WT) were analyzed using real-time RT-PCR, dual-energy X-ray absorptiometry, biomechanics, micro-computed tomography, histology and histomorphometry. Our data revealed that heterozygous AChE-KO did not cause negative effects upon bone parameters analyzed. In contrast, the number of osteoclasts per perimeter was significantly reduced in lumbar vertebrae. In addition, we found a significant decrease in trabecular perimeter of lumbar vertebrae and cortical area fraction (Ct.Ar/Tt.Ar) in the mid-diaphysis of femurs of AChE-KO mice compared to their WT. Therefore, presumably a local homozygous knockout of AChE or AChE-inhibitor administration might be beneficial for bone formation due to ACh accumulation. However, many other bone parameters analyzed did not differ statistically significantly between AChE-KO and WT mice. That might be reasoned by the compensating effect of butyrylcholinesterase (BChE).
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Affiliation(s)
- Vivien Kauschke
- Laboratory of Experimental Trauma Surgery, Justus-Liebig-University Giessen, Schubertstr. 81, 35392 Giessen, Germany.
| | - Mathias Kneffel
- Laboratory of Experimental Trauma Surgery, Justus-Liebig-University Giessen, Schubertstr. 81, 35392 Giessen, Germany
| | - Wolfgang Floel
- Laboratory of Experimental Trauma Surgery, Justus-Liebig-University Giessen, Schubertstr. 81, 35392 Giessen, Germany
| | - Sonja Hartmann
- Laboratory of Experimental Trauma Surgery, Justus-Liebig-University Giessen, Schubertstr. 81, 35392 Giessen, Germany
| | - Marian Kampschulte
- Department of Radiology, University Hospital of Giessen-Marburg, Klinikstr. 33, 35392 Giessen, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Medical Faculty, Helmholtzstr. 14, 89081 Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Medical Faculty, Helmholtzstr. 14, 89081 Ulm, Germany
| | - Reinhard Schnettler
- Laboratory of Experimental Trauma Surgery, Justus-Liebig-University Giessen, Schubertstr. 81, 35392 Giessen, Germany; Department of Trauma Surgery, University Hospital of Giessen-Marburg, Rudolph-Buchheimstr. 7, 35392 Giessen, Germany
| | - Christian Heiss
- Laboratory of Experimental Trauma Surgery, Justus-Liebig-University Giessen, Schubertstr. 81, 35392 Giessen, Germany; Department of Trauma Surgery, University Hospital of Giessen-Marburg, Rudolph-Buchheimstr. 7, 35392 Giessen, Germany
| | - Katrin Susanne Lips
- Laboratory of Experimental Trauma Surgery, Justus-Liebig-University Giessen, Schubertstr. 81, 35392 Giessen, Germany
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