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Desira M, Gabison E, Jacomet PV, Denis D, Dalmas F, David T, Aziz A. A new treatment changes the game: An innovative management of a child suffering from severe ligneous conjunctivitis with type 1 plasminogen deficiency. Ocul Surf 2023; 30:320-321. [PMID: 37992996 DOI: 10.1016/j.jtos.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Affiliation(s)
- M Desira
- Hôpital Nord, Ophthalmology Department, Aix Marseille Université, France.
| | | | | | - D Denis
- Hôpital Nord, Ophthalmology Department, Aix Marseille Université, France
| | - F Dalmas
- Hôpital Nord, Ophthalmology Department, Aix Marseille Université, France
| | - T David
- Hôpital Nord, Ophthalmology Department, Aix Marseille Université, France
| | - A Aziz
- Hôpital Nord, Ophthalmology Department, Aix Marseille Université, France
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Ahmad AK, Alhamdan FG, Sadiq M. Combined medical and surgical approach in the management of ligneous conjunctivitis in a pediatric patient: A case report. Int J Surg Case Rep 2023; 110:108568. [PMID: 37639967 PMCID: PMC10509789 DOI: 10.1016/j.ijscr.2023.108568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Ligneous conjunctivitis (LC), a rare chronic conjunctivitis linked to plasminogen deficiency, poses challenges in research and management due to its complexity. This case report details the combined medical and surgical approach in managing LC in a 1.5-year-old female with congenital hydrocephalus, plasminogen deficiency, and glaucoma. CASE PRESENTATION The patient's LC required a comprehensive treatment plan involving systemic and topical therapies, surgical intervention, and fresh frozen plasma (FFP) infusions via a central line. DISCUSSION Managing LC necessitates a comprehensive, individualized approach due to its rarity and lack of standardized treatments. Various therapies have shown promise, but their availability, cost, and potential side effects vary. FFP infusions played a crucial role in managing plasminogen deficiency, but the potential complications associated with central lines must be considered. Ongoing clinical trials aim to improve LC treatment, but until results are available, clinicians must rely on existing evidence and clinical judgment. CONCLUSION This case underscores the complexity of managing LC and the significance of adopting an individualized treatment strategy. Regular follow-ups are crucial for flexibility and adaptability in treatment plans to address potential recurrences. Further research is necessary to validate these findings and assess the long-term effectiveness of the combined approach.
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Affiliation(s)
- Abdullah K Ahmad
- Department of Ophthalmology, Abdulrahman Albahar Eye Center, Ibn Sina Hospital, Kuwait.
| | - Faisal G Alhamdan
- Department of Ophthalmology, Abdulrahman Albahar Eye Center, Ibn Sina Hospital, Kuwait
| | - Mohammad Sadiq
- Department of Ophthalmology, Abdulrahman Albahar Eye Center, Ibn Sina Hospital, Kuwait
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Panfili FM, Valente P, Ficari A, Cortellessa F, Vecchio D, Gonfiantini MV, Buonuomo PS, Colafati GS, Agolini E, Bartuli M, Modugno AC, Macchiaiolo M. Long-term follow-up in a pediatric patient with Ligneous Conjunctivitis due to PLG gene mutation in topical plasminogen treatment after successful use of ocular prosthesis for aesthetic rehabilitation: a case report. Ital J Pediatr 2023; 49:101. [PMID: 37612758 PMCID: PMC10463973 DOI: 10.1186/s13052-023-01503-x] [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: 05/03/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Ligneous Conjunctivitis (LC) is the most common clinical manifestation of Type I Plasminogen deficiency (T1PD; OMIM# 217090), and it is characterized by the formation of pseudomembranes (due to deposition of fibrin) on the conjunctivae leading to progressive vision loss. In past times, patients with LC were treated with surgery, topical anti-inflammatory, cytostatic agents, and systemic immunosuppressive drugs with limited results (Blood 108:3021-3026, 2006, Ophthalmology 129:955-957, 2022, Surv Ophthalmol 48:369-388, 2003, Blood 131:1301-1310, 2018). The surgery can also trigger the development of membranes, as observed in patients needing ocular prosthesis (Surv Ophthalmol 48:369-388, 2003). Treatment with topical purified plasminogen is used to prevent pseudomembranes formation (Blood 108:3021-3026, 2006, Ophthalmology 129:955-957, 2022). CASE PRESENTATION We present the case of a sixteen-year-old girl with LC with severe left eye involvement. We reported the clinical conditions of the patient before and after the use of topical plasminogen eye drops and described the treatment schedule allowing the surgical procedure for the pseudomembranes debulking and the subsequent use of ocular prosthesis for aesthetic rehabilitation. CONCLUSIONS The patient showed a progressive response to the topical plasminogen, with a complete absence of pseudomembrane formation at a twelve-year follow-up, despite using an ocular prosthesis.
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Affiliation(s)
- Filippo Maria Panfili
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Pediatric Department, Piazza Di Sant'Onofrio, 4, 00165, Rome, Italy
| | - Paola Valente
- Ophthalmology Department, Bambino Gesù Children's Hospital, IRCCS Pediatric Hospital, Rome, Italy
| | - Andrea Ficari
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabiana Cortellessa
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Pediatric Department, Piazza Di Sant'Onofrio, 4, 00165, Rome, Italy
| | - Davide Vecchio
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Pediatric Department, Piazza Di Sant'Onofrio, 4, 00165, Rome, Italy
| | - Michaela Veronika Gonfiantini
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Pediatric Department, Piazza Di Sant'Onofrio, 4, 00165, Rome, Italy
| | - Paola Sabrina Buonuomo
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Pediatric Department, Piazza Di Sant'Onofrio, 4, 00165, Rome, Italy
| | | | - Emanuele Agolini
- Laboratory of Medical Genetics Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | | | - Marina Macchiaiolo
- Rare Diseases and Medical Genetics Unit, Bambino Gesù Children's Hospital, IRCCS, Pediatric Department, Piazza Di Sant'Onofrio, 4, 00165, Rome, Italy.
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4
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Treatment of ligneous conjunctivitis with plasminogen eyedrops. Ophthalmology 2022; 129:955-957. [PMID: 35346720 DOI: 10.1016/j.ophtha.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
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Mérigot C, Viard C, Pechmeja J, Eyvrard F, Sorli SC. [Pharmaceutical supply of human plasminogen replacement therapy for the treatment of ligneous conjunctivitis: Logistics for a university hospital]. J Fr Ophtalmol 2021; 44:1008-1020. [PMID: 34049718 DOI: 10.1016/j.jfo.2020.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
In order to treat a pediatric patient with ligneous conjunctivitis secondary to congenital plasminogen deficiency, a supply of topically administered replacement human plasminogen has been required. In the absence of market approval, this blood-derived drug is managed by a temporary authorisation for nominative use, allowing monthly hospital dispensations. To ensure regulatory compliance and proper use of the drug, it took two years of interactions between various hospital departments and the laboratory to define the pharmaceutical supply chain in our hospital and allow the patient to receive treatment. The main difficulties lie in respecting the cold chain of this drug stored frozen in the bottles not ready for use. Transportation from the laboratory to the patient's home via the hospital pharmacy is carried out in calibrated conditions, ensuring a temperature below -20°C for 72h. Reception and dispensing steps were combined into a single pharmaceutical service in order to optimise transport time while ensuring the safety and traceability of the drug lots. Each month, a date is scheduled between the hospital pharmacy, the laboratory and the family to ensure that delivery and dispensing take place on the same day. Appropriate use and handling are explained to the family. However, two issues remain to be addressed by the manufacturer to facilitate future use of human plasminogen: the thermostability problem, which does not allow stays away from home longer than three days, and self-administration by the child, which is unlikely to be feasible due to handling difficulties.
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Affiliation(s)
- C Mérigot
- Service pharmacie essais cliniques-autorisation temporaire d'utilisation- rétrocessions, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - C Viard
- Service pharmaceutique référent de la pédiatrie, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - J Pechmeja
- Service ophtalmologie, hôpital Pierre-Paul-Riquet, centre hospitalier universitaire de Toulouse, place du Docteur-Baylac, 31059 Toulouse, France
| | - F Eyvrard
- Service pharmacie essais cliniques-autorisation temporaire d'utilisation- rétrocessions, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - S C Sorli
- Service pharmacie essais cliniques-autorisation temporaire d'utilisation- rétrocessions, hôpital Paule-de-Viguier, centre hospitalier universitaire de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France.
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6
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Yurttaser Ocak S, Bas E. Treatment of ligneous conjunctivitis with fresh frozen plasm in twin babies. J AAPOS 2021; 25:50-52. [PMID: 33348042 DOI: 10.1016/j.jaapos.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/16/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Abstract
Ligneous conjunctivitis is a rare form of chronic conjunctivitis. Mostly seen in childhood, it is characterized by the formation of fibrin-rich pseudomembranes in the tarsal conjunctiva. Plasminogen deficiency plays an important role in its etiology. There is no standart treatment protocol for managing this challenging condition, which can, with corneal involvement, lead to blindness. We present twin babies with ligneous conjunctivitis managed with fresh frozen plasma, topical heparin, and topical cyclosporine, without surgical excision of membranes.
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Affiliation(s)
- Serap Yurttaser Ocak
- Department of Ophtalmology, University of Health Sciences, Okmeydanı Education and Research and Hospital, Istanbul, Turkey.
| | - Emine Bas
- Department of Ophtalmology, University of Health Sciences, Okmeydanı Education and Research and Hospital, Istanbul, Turkey
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Shapiro AD, Menegatti M, Palla R, Boscarino M, Roberson C, Lanzi P, Bowen J, Nakar C, Janson IA, Peyvandi F. An international registry of patients with plasminogen deficiency (HISTORY). Haematologica 2020; 105:554-561. [PMID: 32001536 PMCID: PMC7049368 DOI: 10.3324/haematol.2019.241158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/20/2020] [Indexed: 12/20/2022] Open
Abstract
Plasminogen deficiency is an ultra-rare multisystem disorder characterized by the development of fibrin-rich pseudomembranes on mucous membranes. Ligneous conjunctivitis, which can result in vision impairment or loss, is the most frequent symptom reported. Affected systems may also include the respiratory tract, oropharynx, female reproductive tract, gingiva, middle ear, renal collecting system, skin and central nervous system. Untreated, plasminogen deficiency may result in significant reduction in quality of life and morbidity with potential life-threatening complications. Non-specific therapies are inadequate and plasminogen concentrates are not commercially available. The current understanding of plasminogen deficiency and management of disease symptoms and its progression are based on case reports/series and two small clinical trials. To date there has never been a comprehensive, international study to examine the natural history or optimal therapeutic intervention; knowledge gaps include identification of contributing factors and triggers of disease manifestations, inability to predict disease course, and insufficient real-world data for use of therapeutics. We have created an international, observational study (HISTORY) in a large cohort of persons with plasminogen deficiency and first-degree family members to address these gaps and to advance knowledge and care. HISTORY will build upon the established relationship between the Indiana Hemophilia and Thrombosis Center and the Fondazione Angelo Bianchi Bonomi, IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan and will utilize a modified version of the Prospective Rare Bleeding Disorders Database (PRO-RBDD). A biorepository containing samples from subjects with plasminogen deficiency will be established. This article describes the rationale behind the study and efforts towards its goals.
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Affiliation(s)
- Amy D Shapiro
- Indiana Hemophilia & Thrombosis Center, Indianapolis, IN, USA
| | - Marzia Menegatti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Roberta Palla
- Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Marco Boscarino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | | | | | | | - Charles Nakar
- Indiana Hemophilia & Thrombosis Center, Indianapolis, IN, USA
| | - Isaac A Janson
- Indiana Hemophilia & Thrombosis Center, Indianapolis, IN, USA
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy.,Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
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8
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Watts P, Agha SH, Mameesh M, Conor P, Ganesh A, Al-Mujaini A, Jewsbury H, Pathare A, Al-Rawas A. Fresh frozen plasma (Octaplas) and topical heparin in the management of ligneous conjunctivitis. J AAPOS 2019; 23:42-45.e1. [PMID: 30165199 DOI: 10.1016/j.jaapos.2018.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 04/07/2018] [Accepted: 05/16/2018] [Indexed: 11/18/2022]
Abstract
Ligneous conjunctivitis is a rare form of chronic recurrent membranous conjunctivitis with reduced plasminogen activity. It is characterized by the formation of characteristic firm ("woody") membranes on the tarsal conjunctiva. Similar lesions may occur on other mucous membranes. When treated with local excision, ligneous conjunctivitis is invariably associated with recurrences. Various therapeutic modalities, including topical heparin, cyclosporine, fresh frozen plasma (FFP), plasminogen, and amniotic membrane transplantation have been reported to reduce postoperative recurrences. We present 2 cases of recurrent ligneous conjunctivitis in children successfully managed with surgical excision under cover of FFP transfusion, amniotic membrane grafting, and combined with concomitant postoperative administration of topical heparin, steroids.
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Affiliation(s)
- Patrick Watts
- Departments of Ophthalmology, University Hospital Wales, Cardiff, United Kingdom
| | - Shahab H Agha
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Maha Mameesh
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman; Department of Ophthalmology, Alexandria University, Egypt
| | - Phillip Conor
- Department of Paediatric Haematology, University Hospital Wales, Cardiff, United Kingdom
| | - Anuradha Ganesh
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman.
| | - Abdullah Al-Mujaini
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hugh Jewsbury
- Departments of Ophthalmology, University Hospital Wales, Cardiff, United Kingdom
| | - Anil Pathare
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
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9
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Varu DM, Rhee MK, Akpek EK, Amescua G, Farid M, Garcia-Ferrer FJ, Lin A, Musch DC, Mah FS, Dunn SP. Conjunctivitis Preferred Practice Pattern®. Ophthalmology 2019; 126:P94-P169. [DOI: 10.1016/j.ophtha.2018.10.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023] Open
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10
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Shamim MM, Weissman HM, Al-Mohtaseb ZN. Treatment of Ligneous Conjunctivitis Using Topical Plasminogen Therapy in an 8-Week-Old Female Infant. J Pediatr Ophthalmol Strabismus 2018; 55:e30-e32. [PMID: 30180242 DOI: 10.3928/01913913-20180806-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/25/2018] [Indexed: 11/20/2022]
Abstract
An 8-week-old female infant presented with bilateral eyelid swelling and conjunctival membranes. She was diagnosed as having ligneous conjunctivitis. The membranes were excised but recurred despite topical cyclosporine, heparin, fresh frozen plasma, and systemic fresh frozen plasma transfusions. Topical plasminogen prevented membrane recurrence and intravenous plasminogen therapy treated systemic manifestations of the disease. [J Pediatr Ophthalmol Strabismus. 2018;55:e30-e32.].
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Raimann R, Moya R, Anguita R, Kobus R, Pérez M, Gonzalez P. Clinical, histopathological, and genetic aspects in one case of ligneous conjunctivitis. Ophthalmic Genet 2018; 39:642-644. [DOI: 10.1080/13816810.2018.1502791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Rolf Raimann
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
- Departamento de Oftalmología, Centro de la visión, Clínica las Condes, Santiago, Chile
| | - Rene Moya
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
- Departamento de Oftalmología, Centro de la visión, Clínica las Condes, Santiago, Chile
| | - Rodrigo Anguita
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
| | - Rudolf Kobus
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
| | - Marcela Pérez
- Hospital Del Salvador, Universidad de Chile, Santiago, Chile
- Departamento de Oftalmología, Centro de la visión, Clínica las Condes, Santiago, Chile
| | - Patricio Gonzalez
- Instituto de Ciencias Biomédicas (ICBM), Universidad de Chile, Santiago, Chile
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O'Leary L, Specht A, Isaza N, Kallberg M, Barrie K, Cottrell D, Plummer C. Amniotic membrane transplantation for ligneous conjunctivitis in a doberman. Vet Ophthalmol 2018; 21:652-660. [DOI: 10.1111/vop.12559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Louise O'Leary
- Department of Small Animal Clinical Sciences; University of Florida; Gainesville FL USA
| | - Andrew Specht
- Department of Small Animal Clinical Sciences; University of Florida; Gainesville FL USA
| | - Natalie Isaza
- Department of Small Animal Clinical Sciences; University of Florida; Gainesville FL USA
| | | | - Kathleen Barrie
- Department of Small Animal Clinical Sciences; University of Florida; Gainesville FL USA
| | | | - Caryn Plummer
- Department of Small Animal Clinical Sciences; University of Florida; Gainesville FL USA
- Department of Large Animal Clinical Sciences; University of Florida; Gainesville FL USA
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13
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Topical Plasminogen as Adjunctive Treatment in Recurrent Ligneous Conjunctivitis. Ophthalmic Plast Reconstr Surg 2017; 33:e37-e39. [DOI: 10.1097/iop.0000000000000694] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Flick MJ, Bugge TH. Plasminogen-receptor KT : plasminogen activation and beyond. J Thromb Haemost 2017; 15:150-154. [PMID: 27740735 PMCID: PMC5280338 DOI: 10.1111/jth.13541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 12/15/2022]
Abstract
The cell surface orchestrates plasminogen activation through the concomitant binding of plasminogen and plasminogen activators to specific receptors. In this issue, Miles and colleagues describe their detailed phenotypic characterization of mice deficient in Plg-RKT, a key plasminogen receptor expressed in numerous tissues, but highly expressed by proinflammatory macrophages. The analysis provides critical and surprising new insights into the biology of this receptor.
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Affiliation(s)
- Matthew J. Flick
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Thomas H. Bugge
- Proteases and Tissue Remodeling Section, Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
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Conforti FM, Di Felice G, Bernaschi P, Bartuli A, Bianco G, Simonetti A, Buzzonetti L, Valente P, Corsetti T. Novel plasminogen and hyaluronate sodium eye drop formulation for a patient with ligneous conjunctivitis. Am J Health Syst Pharm 2016; 73:556-61. [PMID: 27045067 DOI: 10.2146/ajhp150395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The development, analysis, and first clinical use of a novel eye drop formulation of plasminogen and hyaluronate sodium for the treatment of a patient with ligneous conjunctivitis (LC) are described. SUMMARY LC is a chronic inflammatory disorder of the eye that can in rare cases lead to corneal involvement and subsequent blindness. Topically administered plasminogen is an effective treatment for LC; however, the lack of a specific and validated formulation of plasminogen for topical treatment can constitute a gap in the quality of care. A novel formulation of plasminogen and hyaluronate sodium for the treatment of LC was developed by combining commercially available products. Through a series of tests, including microbiological, viscosity, and pH analyses, the novel eye drop formulation was demonstrated to have constant activity (3.3 IU/mL or greater), to be microbiologically stable (i.e., sterile), and to be safe enough for daily administration. The first clinical application of the novel eye drop formulation was in the case of a nine-year-old girl with LC affecting both eyes. Initially, the girl's parents administered two drops every three hours to the left eye each day while the girl was awake. On examination after 30 days of daily use of the eye drop formulation, the patient was found to have a clear cornea and no membrane development on the conjunctiva; the formulation was subsequently administered in both eyes, with positive results. CONCLUSION A new formulation of plasminogen plus hyaluronate sodium was developed, tested, and used successfully in a girl with LC.
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Affiliation(s)
| | - Giovina Di Felice
- Laboratory Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Paola Bernaschi
- Laboratory Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Andrea Bartuli
- Pediatrics Medicine Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Giuseppe Bianco
- Healthcare Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Alessandra Simonetti
- University-Hospital Pediatric Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Luca Buzzonetti
- Department of Surgery, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Paola Valente
- Department of Surgery, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy
| | - Tiziana Corsetti
- Healthcare Department, Research Institute, Bambino Gesú Children's Hospital, Rome, Italy.
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Motley MP, Madsen DH, Jürgensen HJ, Spencer DE, Szabo R, Holmbeck K, Flick MJ, Lawrence DA, Castellino FJ, Weigert R, Bugge TH. A CCR2 macrophage endocytic pathway mediates extravascular fibrin clearance in vivo. Blood 2016; 127:1085-96. [PMID: 26647393 PMCID: PMC4778161 DOI: 10.1182/blood-2015-05-644260] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 11/30/2015] [Indexed: 12/20/2022] Open
Abstract
Extravascular fibrin deposition accompanies many human diseases and causes chronic inflammation and organ damage, unless removed in a timely manner. Here, we used intravital microscopy to investigate how fibrin is removed from extravascular space. Fibrin placed into the dermis of mice underwent cellular endocytosis and lysosomal targeting, revealing a novel intracellular pathway for extravascular fibrin degradation. A C-C chemokine receptor type 2 (CCR2)-positive macrophage subpopulation constituted the majority of fibrin-uptaking cells. Consequently, cellular fibrin uptake was diminished by elimination of CCR2-expressing cells. The CCR2-positive macrophage subtype was different from collagen-internalizing M2-like macrophages. Cellular fibrin uptake was strictly dependent on plasminogen and plasminogen activator. Surprisingly, however, fibrin endocytosis was unimpeded by the absence of the fibrin(ogen) receptors, αMβ2 and ICAM-1, the myeloid cell integrin-binding site on fibrin or the endocytic collagen receptor, the mannose receptor. The study identifies a novel fibrin endocytic pathway engaged in extravascular fibrin clearance and shows that interstitial fibrin and collagen are cleared by different subsets of macrophages employing distinct molecular pathways.
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Affiliation(s)
- Michael P Motley
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Daniel H Madsen
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD; Center for Cancer Immune Therapy, Department of Haematology, Herlev University Hospital, Herlev, Denmark; Finsen Laboratory, Biotech Research and Innovation Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik J Jürgensen
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD; Finsen Laboratory, Biotech Research and Innovation Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - David E Spencer
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Roman Szabo
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Kenn Holmbeck
- Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Matthew J Flick
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Daniel A Lawrence
- Division of Cardiovascular Medicine, Internal Medicine, University of Michigan Medical School, Ann Arbor, MI; and
| | - Francis J Castellino
- W. M. Keck Center for Transgene Research and Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN
| | - Roberto Weigert
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
| | - Thomas H Bugge
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD
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Beyond hemostasis: the challenge of treating plasminogen deficiency. A report of three cases. J Thromb Thrombolysis 2015; 41:544-7. [DOI: 10.1007/s11239-015-1225-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tu Y, Gonzalez-Gronow M, Kolomeyer AM, Cohen A, Pruzon J, Milman T, Chu DS. Adult-Onset Ligneous Conjunctivitis with Detection of a Novel Plasminogen Gene Mutation and Anti-Plasminogen IgA Antibody: A Clinicopathologic Study and Review of Literature. Semin Ophthalmol 2015; 31:526-31. [DOI: 10.3109/08820538.2015.1005319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Baiula M, Spampinato S. Phase II drugs under investigation for allergic conjunctivitis. Expert Opin Investig Drugs 2014; 23:1671-86. [DOI: 10.1517/13543784.2014.944640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nye M, Rudner S, Bielory L. Emerging therapies in allergic conjunctivitis and dry eye syndrome. Expert Opin Pharmacother 2013; 14:1449-65. [DOI: 10.1517/14656566.2013.802773] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Pignataro G, Vinciguerra A, Cuomo O, Sirabella R, Di Renzo GF, Scorziello A. Conjunctival instillation of plasminogen eliminates ocular lesion in B6.129P2-Plg(tm1Jld) transgenic mice, a model of ligneous conjunctivitis. Pharmacol Res 2013; 74:45-8. [PMID: 23684723 DOI: 10.1016/j.phrs.2013.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022]
Abstract
Ligneous conjunctivitis is a severe and rare chronic "idiopathic membraneous" conjunctivitis, characterized by the formation of pseudomembranes mostly on the palpebral surfaces that progressively replace the normal mucosa. Evidence has been provided that ligneous conjunctivitis is caused by a severe systemic plasminogen deficiency with decreased plasminogen antigen and decreased plasminogen functional activities. Objective of the present study is to verify the hypothesis that a topical eye application of plasminogen is able to ameliorate the consequences of this disease. Here we report the results of pre-clinical studies performed to investigate the therapeutic effectiveness of an eye-drop plasminogen preparation in B6.129P2-Plg(tm1Jld) transgenic mice, a model of ligneous conjunctivitis. The entity of protection mediated by plasminogen was evaluated by measuring the extent of the eye lesion by means of a computerized system and dedicated software. The results of the present study clearly showed that the administration for six times a day of plasminogen eye-drop solution in the lesioned eye of animals knock-out for plasminogen gene and developing ligneous conjunctivitis caused a dose and time related reduction of the extent of the ocular lesion. These findings may pave the road for the pharmacological treatment of the ocular lesion associated to the ligneous conjunctivitis that at the present is surgically treated by removing the pseudomembranes generated on the eye.
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Affiliation(s)
- G Pignataro
- Division Pharmacology, Department of Neuroscience, School of Medicine, "Federico II" University of Naples, Via Pansini, 5, 80131 Naples, Italy
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Ku JY, Lichtinger A, Yeung SN, Kim P, Cserti-Gazdewich C, Slomovic AR. Topical fresh frozen plasma and heparin treatment of ligneous conjunctivitis in a Canadian hospital setting. Can J Ophthalmol 2012; 47:e27-8. [DOI: 10.1016/j.jcjo.2012.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Sivolella S, De Biagi M, Sartori MT, Berengo M, Bressan E. Destructive membranous periodontal disease (ligneous gingivitis): a literature review. J Periodontol 2011; 83:465-76. [PMID: 21859319 DOI: 10.1902/jop.2011.110261] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Destructive membranous periodontal disease, or ligneous gingivitis, is a rare condition involving nodular gingival enlargement with ulceration and periodontal tissue destruction. This review gives a brief account of the cases reported in the literature. An effort is also made to define the periodontal disease caused by plasminogen deficiency with a view to its potential inclusion in the classification of periodontal diseases. METHODS A MEDLINE/PubMed and manual search was conducted to find papers describing ≥1 case of ligneous disease involving the oral mucosa. RESULTS We identified 23 articles reporting 35 cases. For each patient, we analyzed various characteristics, including age, sex, age of onset, oral symptoms, histologic features, plasminogen levels (functional activity, plasma antigen), genetic features, treatment, and results of treatment during the reported follow-up. CONCLUSIONS Ligneous gingivitis is a rare periodontal disorder closely associated with ligneous conjunctivitis and plasminogen deficiency. Its diagnosis may be supported by the finding of genetic mutations responsible for the condition. Research is focusing on the future development of an effective therapy capable of arresting the destructive evolution of the disease. Additional studies, investigating features such as probing depth and attachment loss, are needed for the appropriate classification of this periodontal disease.
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Affiliation(s)
- Stefano Sivolella
- Department of Oral Surgery, University of Padova, Institute of Clinical Dentistry, Padova, Italy.
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25
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Sulniute R, Lindh T, Wilczynska M, Li J, Ny T. Plasmin is essential in preventing periodontitis in mice. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 179:819-28. [PMID: 21704601 PMCID: PMC3157224 DOI: 10.1016/j.ajpath.2011.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 04/03/2011] [Accepted: 05/02/2011] [Indexed: 12/18/2022]
Abstract
Periodontitis involves bacterial infection, inflammation of the periodontium, degradation of gum tissue, and alveolar bone resorption, which eventually leads to loss of teeth. To study the role of the broad-spectrum protease plasmin in periodontitis, we examined the oral health of plasminogen (Plg)-deficient mice. In wild-type mice, the periodontium was unaffected at all time points studied; in Plg-deficient mice, periodontitis progressed rapidly, within 20 weeks. Morphological study results of Plg-deficient mice revealed detachment of gingival tissue, resorption of the cementum layer, formation of necrotic tissue, and severe alveolar bone degradation. IHC staining showed massive infiltration of neutrophils in the periodontal tissues. Interestingly, doubly deficient mice, lacking both tissue- and urokinase-type plasminogen activators, developed periodontal disease similar to that in Plg-deficient mice; however, mice lacking only tissue- or urokinase-type plasminogen activator remained healthy. Supplementation by injection of Plg-deficient mice with human plasminogen for 10 days led to necrotic tissue absorption, inflammation subsidence, and full regeneration of gum tissues. Notably, there was also partial regrowth of degraded alveolar bone. Taken together, our results show that plasminogen is essential for the maintenance of a healthy periodontium and plays an important role in combating the spontaneous development of chronic periodontitis. Moreover, reversal to healthy status after supplementation of Plg-deficient mice with plasminogen suggests the possibility of using plasminogen for therapy of periodontal diseases.
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Affiliation(s)
- Rima Sulniute
- Department of Medical Biochemistry and Biophysics, Umeå University, Umeå, Sweden
| | - Tomas Lindh
- Department of Medical Biochemistry and Biophysics, Umeå University, Umeå, Sweden
- Department of Odontology/Prosthetic Dentistry, Umeå University, Umeå, Sweden
| | | | - Jinan Li
- Department of Medical Biochemistry and Biophysics, Umeå University, Umeå, Sweden
| | - Tor Ny
- Department of Medical Biochemistry and Biophysics, Umeå University, Umeå, Sweden
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26
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Utine CA, Stern M, Akpek EK. Clinical review: topical ophthalmic use of cyclosporin A. Ocul Immunol Inflamm 2011; 18:352-61. [PMID: 20735287 DOI: 10.3109/09273948.2010.498657] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cyclosporine A (CsA) is an immunomodulatory agent that primarily inhibits the proliferation and action of T cells. Systemic CsA has been used successfully in solid organ transplantation and noninfectious uveitis. Topical CsA with various formulations has been used in the field of ocular surface diseases since early 1980s. An ophthalmic emulsion 0.05% (Restasis, Allergan, Irvine, CA), was approved by the United States Food and Drug Administration in 2003 to treat dry eye syndrome. This article aims to evaluate the peer-reviewed published scientific literature and to define well-established uses of CsA eyedrops in the field of ocular surface diseases.
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Affiliation(s)
- Canan Asli Utine
- The Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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27
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Neff KD, Holland EJ, Schwartz GS. Ligneous Conjunctivitis. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Induction of bilateral ligneous conjunctivitis with the use of a prosthetic eye. Int Ophthalmol 2010; 31:25-8. [DOI: 10.1007/s10792-010-9381-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 05/18/2010] [Indexed: 11/26/2022]
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Selective abrogation of the uPA-uPAR interaction in vivo reveals a novel role in suppression of fibrin-associated inflammation. Blood 2010; 116:1593-603. [PMID: 20466854 DOI: 10.1182/blood-2010-03-276642] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The urokinase plasminogen activator receptor (uPAR) has emerged as a potential regulator of cell adhesion, cell migration, proliferation, differentiation, and cell survival in multiple physiologic and pathologic contexts. The urokinase plasminogen activator (uPA) was the first identified ligand for uPAR, but elucidation of the specific functions of the uPA-uPAR interaction in vivo has been difficult because uPA has important physiologic functions that are independent of binding to uPAR and because uPAR engages multiple ligands. Here, we developed a new mouse strain (Plau(GFDhu/GFDhu)) in which the interaction between endogenous uPA and uPAR is selectively abrogated, whereas other functions of both the protease and its receptor are retained. Specifically, we introduced 4 amino acid substitutions into the growth factor domain (GFD) of uPA that abrogate uPAR binding while preserving the overall structure of the domain. Analysis of Plau(GFDhu/GFDhu) mice revealed an unanticipated role of the uPA-uPAR interaction in suppressing inflammation secondary to fibrin deposition. In contrast, leukocyte recruitment and tissue regeneration were unaffected by the loss of uPA binding to uPAR. This study identifies a principal in vivo role of the uPA-uPAR interaction in cell-associated fibrinolysis critical for suppression of fibrin accumulation and fibrin-associated inflammation and provides a valuable model for further exploration of this multifunctional receptor.
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Affiliation(s)
- Amanda Richards
- Casey Eye Institute, Oregon Health and Science University, Portland, Ore, USA
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31
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Abstract
The coagulation and fibrinolytic pathways regulate hemostasis and thrombosis, and an imbalance in these pathways may result in pathologic hemophilia or thrombosis. The plasminogen system is the primary proteolytic pathway for fibrinolysis, but also has important proteolytic functions in cell migration, extracellular matrix degradation, metalloproteinase activation, and hormone processing. Several studies have demonstrated plasmin cleavage and inactivation of several coagulation factors, suggesting plasmin may be not only be the primary fibrinolytic enzyme, but may have anticoagulant properties as well. The objective of this review is to examine both in vitro and in vivo evidence for plasmin inactivation of coagulation, and to consider whether plasmin may act as a physiological regulator of coagulation. While several studies have demonstrated strong evidence for plasmin cleavage and inactivation of coagulation factors FV, FVIII, FIX, and FX in vitro, in vivo evidence is lacking for a physiologic role for plasmin as an anticoagulant. However, inactivation of coagulation factors by plasmin may be useful as a localized anticoagulant therapy or as a combined thrombolytic and anticoagulant therapy.
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Affiliation(s)
- Jane Hoover-Plow
- Joseph J Jacobs Center for Thrombosis and Vascular Biology, Department of Cardiovascular Medicine, Lerner Research Institute Cleveland Clinic, Cleveland, Ohio 44195, USA.
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32
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Abstract
Plasminogen deficiency has emerged as a well-recognized disorder in which reduced levels of plasminogen lead to the development of pseudo membranes on mucosal surfaces, with subsequent end-organ damage of the affected tissue. Ligneous conjunctivitis is the most recognizable, well-documented, and common presentation of the clinical syndromes associated with plasminogen deficiency, although numerous other organs have been reported to be affected. Interestingly, while plasminogen deficiency was initially believed to be related to development of venous thromboembolic disease, more recent data suggest that decreased plasminogen levels may not, in and of themselves, increase the risk of thrombosis. Two types of plasminogen deficiency have been described in the literature. Type I represents a quantitative deficiency and type II a qualitative deficiency. It appears that hypoplasminogenaemia (type I deficiency) is the type most associated with pseudomembrane disease. A variety of genetic mutations has been identified recently and is reported to lead to these disorders. These defects have been identified in diverse populations, with no specific ethnic predilection. However, this disorder may have increased prevalence in areas and communities where consanguinity is more common. Despite the fact that the characteristic lesions are now better recognized and plasminogen levels are accurately and easily measured, adequate treatment of the clinical manifestations of this disorder is lacking. For ligneous conjunctivitis, a plasminogen concentrate formulated into an ophthalmologic preparation has been found to be an effective local therapy. Unfortunately, no plasminogen concentrate is currently available commercially for either systemic or local therapy.
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Affiliation(s)
- R Mehta
- Department of Clinical Medicine, Section of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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33
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El-Darouti M, Zayed AA, El-Kamah GY, Mostafa MI. Ligneous conjunctivitis with oral mucous membrane involvement and decreased plasminogen level. Pediatr Dermatol 2009; 26:448-51. [PMID: 19689523 DOI: 10.1111/j.1525-1470.2009.00951.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ligneous conjunctivitis (MIM 217090) is a rare autosomal recessive hereditary disorder. We report a case with both ligneous conjunctivitis and ligneous periodontitis in association with plasminogen type I deficiency. Diagnosis was based on the clinical and histological findings and most importantly, decreased serum level of plasminogen type I.
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Torres MD, Leiva M, Tabar MD, Naranjo C, Pastor J, Peña T. Ligneous conjunctivitis in a plasminogen-deficient dog: clinical management and 2-year follow-up. Vet Ophthalmol 2009; 12:248-53. [DOI: 10.1111/j.1463-5224.2009.00700.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Pseudomembranous disease (ligneous inflammation) of the female genital tract, peritoneum, gingiva, and paranasal sinuses associated with plasminogen deficiency. Ann Diagn Pathol 2009; 13:132-9. [DOI: 10.1016/j.anndiagpath.2008.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Systemic and Topical Fresh-Frozen Plasma Treatment in a Newborn With Ligneous Conjunctivitis. Cornea 2008; 27:501-3. [DOI: 10.1097/ico.0b013e318162a8e0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McLean NSJ, Ward DA, Hendrix DVH, Donnell RL, Ilha MRS. Ligneous conjunctivitis secondary to a congenital plasminogen deficiency in a dog. J Am Vet Med Assoc 2008; 232:715-21. [DOI: 10.2460/javma.232.5.715] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Plasminogen (plg) deficiency has been classified as (i) hypoplasminogenemia or 'true' type I plg deficiency, and (ii) dysplasminogenemia, also called type II plg deficiency. Both forms, severe hypoplasminogenemia and dysplasminogenemia, are not causally linked to venous thrombosis. Dysplasminogenemia does not lead to a specific clinical manifestation and probably represents only a polymorphic variation in the general population, mainly in Asian countries. Severe hypoplasminogenemia is associated with compromised extracellular fibrin clearance during wound healing, leading to pseudomembraneous (ligneous) lesions on affected mucous membranes (eye, middle ear, mouth, pharynx, duodenum, upper and lower respiratory tract and female genital tract). Ligneous conjunctivitis is by far the most common clinical manifestation. More than 12% of patients with severe hypoplasminogenemia exhibit congenital occlusive hydrocephalus. In milder cases of ligneous conjunctivitis, topical application of plg-containing eye drops, fresh frozen plasma, heparin, corticosteroids or certain immunosuppressive agents (such as azathioprine) may be more or less effective. Oral treatment with sex hormones was successful in two female patients with ligneous conjunctivitis. In severe cases with possibly life-threatening multi-organ involvement, true therapeutic options are not available at present. The plg-knockout mouse is a useful tool to study the many different properties of plg in a variety of settings, such as wound healing, tissue repair and tissue remodeling, virulence and invasiveness of certain bacteria in the human host, tumor growth and dissemination, as well as arteriosclerosis.
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Affiliation(s)
- V Schuster
- Hospital for Children and Adolescents, Medical Faculty of Leipzig University, Liebigstrasse 20a, Leipzig, Germany.
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Kurtulus I, Gokbuget A, Efeoglu A, Cintan S, Tefs K, Schuster V, Scully C. Hypoplasminogenemia with ligneous periodontitis: a failed local therapeutic approach. J Periodontol 2007; 78:1164-75. [PMID: 17539733 DOI: 10.1902/jop.2007.060422] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Hypoplasminogenemia is a rare condition that is associated with ligneous conjunctivitis, a form of chronic conjunctivitis characterized by firm, fibrin-rich, pseudomembranous lesions on the tarsal conjunctivae and oral lesions. Pseudomembranes may develop on the gingivae, and there may be periodontal involvement. METHODS Several therapeutic approaches have been developed to treat such patients, but they have had limited effect. We used gingivectomies, topical heparin, and corticosteroids to treat periodontal lesions in an 18-year-old girl. RESULTS This approach had no benefit. CONCLUSION The question remains about how best to manage patients with hypoplasminogenemia.
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Affiliation(s)
- Idil Kurtulus
- Department of Periodontology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey.
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41
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Rodríguez-Ares MT, Abdulkader I, Blanco A, Touriño-Peralba R, Ruiz-Ponte C, Vega A, Cameselle-Teijeiro J. Ligneous conjunctivitis: a clinicopathological, immunohistochemical, and genetic study including the treatment of two sisters with multiorgan involvement. Virchows Arch 2007; 451:815-21. [PMID: 17701212 DOI: 10.1007/s00428-007-0481-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 07/07/2007] [Accepted: 07/18/2007] [Indexed: 10/23/2022]
Abstract
Ligneous conjunctivitis (LC) is a rare disease characterized by wood-like pseudomembranes developing on the ocular and extraocular mucosae secondary to plasminogen (PLG) deficiency. In this paper, we report two cases of LC in two sisters of 57 and 62 years of age that presented with recurrent, bilateral pseudomembranes on conjunctiva and a history of consanguinity and deafness. Pseudomembranes showed superficial and/or subepithelial deposits of eosinophilic amorphous hyaline, amyloid-like material with a variable proportion of granulation tissue, and inflammatory cells. The eosinophilic deposits were negative for Congo red stain, immunoreactive for fibrinogen, and consistently negative for amyloid A component, transthyretin, beta(2)-microglobulin, albumin, fibronectin, collagen type IV, vimentin, and cytokeratins. Among inflammatory cells, a percentage of positivity of roughly 60% for lymphocytes T (CD3+) and 40% for lymphocytes B (CD8+), with a relation of cytotoxic/helper (CD8/4) T cells of 3:2, was found. In one case, nasal polyps and recurrent gastric peptic ulcer were also characterized by the same subepithelial hyaline deposits. A novel homozygous point mutation c.1856 C>T was found in exon 15 of the PLG gene in both patients. Amniotic membrane transplantation was done in one case with promising results.
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Affiliation(s)
- M Teresa Rodríguez-Ares
- Anterior Segment Unit, Department of Ophthalmology, Hospital de Conxo-Complexo Hospitalario Universitario de Santiago, Galicia, Spain
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McCullough K, Nguyen H, Stechschulte D, Tawfik O. Ligneous conjunctivitis: a case report with multiorgan involvement. Histopathology 2007; 50:511-3. [PMID: 17448029 DOI: 10.1111/j.1365-2559.2007.02585.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pierro VSS, Vazquez-Sullca R, Vieira ASB, Takiya CM, Carakushansky G, Feres-Filho EJ. Ligneous Periodontitis and Ehlers-Danlos Syndrome. J Periodontol 2006; 77:123-8. [PMID: 16579713 DOI: 10.1902/jop.2006.77.1.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Generalized membranous gingival enlargement due to an accumulation of fibrin deposits associated with severe alveolar bone loss (ligneous periodontitis) is a rare condition, and plasminogen deficiency seems to play a central role in its pathogenesis. However, this condition has not been described in association with syndromes. This article reports a case of ligneous periodontitis in a boy with the classic type of Ehlers-Danlos syndrome (EDS). METHODS A 12-year-old white male presented with generalized gingival overgrowth and severe alveolar bone loss. A physical examination revealed clinical signs of EDS (velvety skin with mild hyperextensibility, marked hypermobility of the limb joints, atrophic scars on his knees, and easy bruising), which is associated with a positive family history for joint hypermobility. A biopsy of gingival tissues was submitted for routine histology, hematoxylin and eosin (H&E), and direct immunofluorescence (antifibrinogen). An evaluation of plasminogen activity was also performed. RESULTS Histopathology revealed chronic periodontitis with fibrinoid material deposition, and direct immunofluorescence proved to be positive for fibrin. Functional plasminogen was reduced. A conclusive diagnosis of ligneous periodontitis due to plasminogen deficiency associated with the classic type of EDS was rendered. CONCLUSIONS Ehlers-Danlos syndrome can be associated with ligneous periodontitis. In the present case, the histologic examination represented an important tool in the differential diagnosis, because it ruled out EDS type VIII as the associated systemic factor to periodontal breakdown.
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Affiliation(s)
- Viviane S S Pierro
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Tatlipinar S, Akpek EK. Topical ciclosporin in the treatment of ocular surface disorders. Br J Ophthalmol 2005; 89:1363-7. [PMID: 16170133 PMCID: PMC1772855 DOI: 10.1136/bjo.2005.070888] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2005] [Indexed: 11/04/2022]
Abstract
Mounting evidence suggests that inflammation is the key factor in the pathogenesis of various ocular surface diseases, with a complex interplay of genetic, environmental, and psychosocial factors. Management of these conditions is often challenging. Topical corticosteroids, with their associated side effects, are the mainstay of current treatments for patients with vision threatening disease. Ciclosporin A is an immunomodulator that specifically inhibits T lymphocyte proliferation. Recently, a topical ciclosporin preparation was approved by the US Food and Drug Administration and became available for use in ophthalmology. Given the increasing use of ciclosporin eye drops, the goal of this article is to provide the reader with an overview of the well established uses of ciclosporin and to help refine the questions that should be addressed by future investigations.
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Affiliation(s)
- S Tatlipinar
- The Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD 21287-9238, USA
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45
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46
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Tabbara KF. Prevention of ligneous conjunctivitis by topical and subconjunctival fresh frozen plasma. Am J Ophthalmol 2004; 138:299-300. [PMID: 15289146 DOI: 10.1016/j.ajo.2004.02.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE To present a case of ligneous conjunctivitis where the recurrence of membranous conjunctivitis was prevented by subconjunctival and topical instillation of fresh frozen plasma. DESIGN Interventional case report. METHODS A case of ligneous conjunctivitis with multiple recurrences since the age of 3 years developed recurrent membranous conjunctivitis after transconjunctival levator recession. Blood plasminogen activity was determined. The membrane was excised, and the membrane reappeared 4 days later. The patient was treated with excision of the membrane and subconjunctival injection of fresh frozen plasma and topical fresh frozen plasma. Plasminogen activity of the fresh frozen plasma was normal. RESULTS Plasminogen blood functional activity was 52% (normal is 80%-120%). The patient had complete remission with no recurrences of membranous conjunctivitis after topical and subconjunctival fresh frozen plasma. CONCLUSIONS Prophylactic use of topical and subconjunctival fresh frozen plasma may help in the prevention of membranes in susceptible patients with plasminogen deficiency.
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Affiliation(s)
- Khalid F Tabbara
- The Eye Center and The Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia.
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Heidemann DG, Williams GA, Hartzer M, Ohanian A, Citron ME. Treatment of Ligneous Conjunctivitis with Topical Plasmin and Topical Plasminogen. Cornea 2003; 22:760-2. [PMID: 14576528 DOI: 10.1097/00003226-200311000-00009] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe treatment of a child with recalcitrant ligneous conjunctivitis secondary to a systemic plasminogen deficiency. DESIGN Interventional case report. METHODS A seven-year-old boy developed severe unilateral membranous conjunctivitis recalcitrant to surgical debridement and treatment with topical prednisone, topical cyclosporine, and oral prednisone. Systemic evaluation revealed a severe plasminogen deficiency. RESULTS Treatment with surgical debridement and topical plasmin was ineffective and resulted in prompt recurrence of dense conjunctival membranes. Treatment with topical plasminogen resulted in dramatic improvement and complete resolution of the membranes. CONCLUSIONS Ligneous conjunctivitis is secondary to a systemic plasminogen deficiency. Treatment with topical plasminogen resulted in prompt resolution of the membranes. Treatment with topical plasmin was ineffective.
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Affiliation(s)
- David G Heidemann
- Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan, USA.
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Abstract
Ligneous conjunctivitis (McKusick 217090) is a rare form of chronic conjunctivitis characterized by the development of firm fibrin-rich, woody-like pseudomembraneous lesions mainly on the tarsal conjunctivae. Less frequently, similar lesions may occur on other mucous membranes of the body indicating that these manifestations are part of a systemic disease. Histopathological findings from affected humans and (plasminogen-deficient) mice indicate that wound healing, mainly of injured mucosal tissue, is impaired due to markedly decreased (plasmin-mediated) extracellular fibrinolysis. Pseudomembraneous lesions of the eyes and other mucosal tissue mainly contain clotted fibrin(ogen). Actually, systemic plasminogen deficiency has been linked to ligneous conjunctivitis in humans and mice. In one case, ligneous conjunctivitis has been induced by antifibrinolytic treatment with tranexamic acid. Further rare associated disorders of ligneous conjunctivitis are congenital occlusive hydrocephalus and juvenile colloid milium. This review outlines the historical background, clinical characteristics of ligneous conjunctivitis and its associated complications, histological abnormalities of pseudomembraneous lesions, inheritance, hemostasiologic and molecular genetic findings in affected patients, current treatment approaches, and the plasminogen-deficient mouse as an animal model.
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Affiliation(s)
- Volker Schuster
- Department of Pediatrics, Leipzig University Medical School, Leipzig, Germany
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Çiftçi E, Ince E, Akar N, Dogru Ü, Tefs K, Schuster V. Ligneous conjunctivitis, hydrocephalus, hydrocele, and pulmonary involvement in a child with homozygous type I plasminogen deficiency. Eur J Pediatr 2003; 162:462-465. [PMID: 12719968 DOI: 10.1007/s00431-003-1205-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2002] [Accepted: 02/18/2003] [Indexed: 11/25/2022]
Abstract
UNLABELLED Ligneous conjunctivitis is a rare and unusual form of chronic pseudomembranous conjunctivitis which usually starts in early infancy. Plasminogen deficiency has recently been associated with ligneous conjunctivitis. The disease may be associated with pseudomembranous lesions of other mucous membranes in the mouth, nasopharynx, trachea, and female genital tract and also with congenital hydrocephalus. In this report, a 1-month-old Turkish boy who had pseudomembranous conjunctivitis, occlusive hydrocephalus, and hydrocele is presented. After surgery for ventriculo-peritoneal shunt establishment, he developed inspiratory stridor, respiratory distress, and pulmonary atelectasis. Tracheal pseudomembranes were also demonstrated by bronchoscopy. Plasminogen antigen level and plasminogen activity were very low. Genomic DNA from the patient was screened for mutations in the plasminogen gene and a homozygous L650fsX652 mutation (deletion of 2081C) was detected. Both of his parents were heterozygous for this mutation. He died due to respiratory failure during follow-up. CONCLUSION Ligneous conjunctivitis related to type I plasminogen deficiency is relatively common in the Turkish population, however, mutations are heterogeneous and a common founder is unlikely.
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Affiliation(s)
- Ergin Çiftçi
- Department of Paediatric Infectious Diseases, University of Ankara Medical School, 06100, Dikimevi Ankara, Turkey.
| | - Erdal Ince
- Department of Paediatric Infectious Diseases, University of Ankara Medical School, 06100, Dikimevi Ankara, Turkey
| | - Nejat Akar
- Department of Paediatric Infectious Diseases, University of Ankara Medical School, 06100, Dikimevi Ankara, Turkey
| | - Ülker Dogru
- Department of Paediatric Infectious Diseases, University of Ankara Medical School, 06100, Dikimevi Ankara, Turkey
| | - Katrin Tefs
- Department of Paediatrics, University of Leipzig, Leipzig, Germany
| | - Volker Schuster
- Department of Paediatrics, University of Leipzig, Leipzig, Germany
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