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Hornig NC, Ukat M, Schweikert HU, Hiort O, Werner R, Drop SLS, Cools M, Hughes IA, Audi L, Ahmed SF, Demiri J, Rodens P, Worch L, Wehner G, Kulle AE, Dunstheimer D, Müller-Roßberg E, Reinehr T, Hadidi AT, Eckstein AK, van der Horst C, Seif C, Siebert R, Ammerpohl O, Holterhus PM. Identification of an AR Mutation-Negative Class of Androgen Insensitivity by Determining Endogenous AR Activity. J Clin Endocrinol Metab 2016; 101:4468-4477. [PMID: 27583472 PMCID: PMC5095254 DOI: 10.1210/jc.2016-1990] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Only approximately 85% of patients with a clinical diagnosis complete androgen insensitivity syndrome and less than 30% with partial androgen insensitivity syndrome can be explained by inactivating mutations in the androgen receptor (AR) gene. OBJECTIVE The objective of the study was to clarify this discrepancy by in vitro determination of AR transcriptional activity in individuals with disorders of sex development (DSD) and male controls. DESIGN Quantification of DHT-dependent transcriptional induction of the AR target gene apolipoprotein D (APOD) in cultured genital fibroblasts (GFs) (APOD assay) and next-generation sequencing of the complete coding and noncoding AR locus. SETTING The study was conducted at a university hospital endocrine research laboratory. PATIENTS GFs from 169 individuals were studied encompassing control males (n = 68), molecular defined DSD other than androgen insensitivity syndrome (AIS; n = 18), AR mutation-positive AIS (n = 37), and previously undiagnosed DSD including patients with a clinical suspicion of AIS (n = 46). INTERVENTION(S) There were no interventions. MAIN OUTCOME MEASURE(S) DHT-dependent APOD expression in cultured GF and AR mutation status in 169 individuals was measured. RESULTS The APOD assay clearly separated control individuals (healthy males and molecular defined DSD patients other than AIS) from genetically proven AIS (cutoff < 2.3-fold APOD-induction; 100% sensitivity, 93.3% specificity, P < .0001). Of 46 DSD individuals with no AR mutation, 17 (37%) fell below the cutoff, indicating disrupted androgen signaling. CONCLUSIONS AR mutation-positive AIS can be reliably identified by the APOD assay. Its combination with next-generation sequencing of the AR locus uncovered an AR mutation-negative, new class of androgen resistance, which we propose to name AIS type II. Our data support the existence of cellular components outside the AR affecting androgen signaling during sexual differentiation with high clinical relevance.
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Affiliation(s)
- N C Hornig
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - M Ukat
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - H U Schweikert
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - O Hiort
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - R Werner
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - S L S Drop
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - M Cools
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - I A Hughes
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - L Audi
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - S F Ahmed
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - J Demiri
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - P Rodens
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - L Worch
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - G Wehner
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - A E Kulle
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - D Dunstheimer
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - E Müller-Roßberg
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - T Reinehr
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - A T Hadidi
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - A K Eckstein
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - C van der Horst
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - C Seif
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - R Siebert
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - O Ammerpohl
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
| | - P-M Holterhus
- Department of Pediatrics (N.C.H., M.U., J.D., P.R., A.E.K., P.-M.H.), Division of Pediatric Endocrinology and Diabetes, and Institute of Human Genetics (L.W., R.S., O.A.), Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany; Rheinische Friedrich-Wilhelms-Universität Bonn, Department of Medicine III (H.U.S., G.W.), Institute for Biochemistry and Molecular Biology, Nussallee 11, 53115 Bonn, Germany; Department of Pediatrics (O.H., R.W.), Division of Experimental Pediatric Endocrinology, University of Luebeck, 23538 Luebeck, Germany; Department of Pediatrics (S.L.S.D.), Division of Pediatric Endocrinology, Sophia Childreńs Hospital, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; Department of Pediatric Endocrinology (Medical Center), Ghent University Hospital, Ghent University, 9000 Ghent, Belgium; Department of Pediatrics (I.A.H.), University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pediatric Endocrinology Research Unit (L.A.), Vall d'Hebron Institut de Recerca, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red Enfermedades Raras, Instituto de Salud Carlos III, Passeig Vall d'Hebron 119, 08035 Barcelona, Spain; Developmental Endocrinology Research Group (S.F.A.), School of Medicine, University of Glasgow, Yorkhill Glasgow G3 8SJ, United Kingdom; Kinderklinik (D.D.), Klinikum Augsburg, 86156 Augsburg, Germany; Klinikum Esslingen (E.M.-R.), 73730 Esslingen, Germany; Department of Pediatrics (T.R.), Division of Pediatric Endocrinology, Diabetes, and Nutrition, University Witten/Herdecke, 45711 Datteln, Germany; Hypospadiezentrum (A.T.H.), 63500 Seligenstadt, Germany; Gemeinschaftspraxis für Kinderchirurgie (A.K.E.), 24119 Kronshagen, Germany; Urologische Gemeinschaftspraxis (C.v.d.H), and UROLOGIE Zentrum Kiel (C.S.), 24103 Kiel, Germany; and Institute of Human Genetics (R.S.), University of Ulm and University Hospital of Ulm, 89081 Ulm, Germany
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Lucas-Herald A, Bertelloni S, Juul A, Bryce J, Jiang J, Rodie M, Sinnott R, Boroujerdi M, Lindhardt Johansen M, Hiort O, Holterhus PM, Cools M, Guaragna-Filho G, Guerra-Junior G, Weintrob N, Hannema S, Drop S, Guran T, Darendeliler F, Nordenstrom A, Hughes IA, Acerini C, Tadokoro-Cuccaro R, Ahmed SF. The Long-Term Outcome of Boys With Partial Androgen Insensitivity Syndrome and a Mutation in the Androgen Receptor Gene. J Clin Endocrinol Metab 2016; 101:3959-3967. [PMID: 27403927 PMCID: PMC5095251 DOI: 10.1210/jc.2016-1372] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND In boys with suspected partial androgen insensitivity syndrome (PAIS), systematic evidence that supports the long-term prognostic value of identifying a mutation in the androgen receptor gene (AR) is lacking. OBJECTIVE To assess the clinical characteristics and long-term outcomes in young men with suspected PAIS in relation to the results of AR analysis. METHODS Through the International Disorders of Sex Development Registry, clinical information was gathered on young men suspected of having PAIS (n = 52) who presented before the age of 16 years and had genetic analysis of AR. RESULTS The median ages at presentation and at the time of the study were 1 month (range, 1 day to 16 years) and 22 years (range, 16 to 52 years), respectively. Of the cohort, 29 men (56%) had 20 different AR mutations reported. At diagnosis, the median external masculinization scores were 7 and 6 in cases with and without AR mutation, respectively (P = .9), and median current external masculinization scores were 9 and 10, respectively (P = .28). Thirty-five men (67%) required at least one surgical procedure, and those with a mutation were more likely to require multiple surgeries for hypospadias (P = .004). All cases with an AR mutation had gynecomastia, compared to 9% of those without an AR mutation. Of the six men who had a mastectomy, five (83%) had an AR mutation. CONCLUSIONS Boys with genetically confirmed PAIS are likely to have a poorer clinical outcome than those with XY DSD, with normal T synthesis, and without an identifiable AR mutation. Routine genetic analysis of AR to confirm PAIS informs long-term prognosis and management.
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MESH Headings
- Adolescent
- Adult
- Aging
- Androgen-Insensitivity Syndrome/diagnosis
- Androgen-Insensitivity Syndrome/genetics
- Androgen-Insensitivity Syndrome/physiopathology
- Child
- Child, Preschool
- Cohort Studies
- Disease Progression
- Disorder of Sex Development, 46,XY/diagnosis
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/physiopathology
- Gynecomastia/etiology
- Gynecomastia/surgery
- Humans
- Hypospadias/etiology
- Hypospadias/surgery
- Infant
- Infant, Newborn
- International Agencies
- Male
- Mastectomy
- Middle Aged
- Mutation
- Prognosis
- Puberty, Delayed
- Receptors, Androgen/genetics
- Receptors, Androgen/metabolism
- Registries
- Retrospective Studies
- Severity of Illness Index
- Young Adult
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Affiliation(s)
- A Lucas-Herald
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S Bertelloni
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - A Juul
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - J Bryce
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - J Jiang
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Rodie
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - R Sinnott
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Boroujerdi
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Lindhardt Johansen
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - O Hiort
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - P M Holterhus
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - M Cools
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - G Guaragna-Filho
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - G Guerra-Junior
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - N Weintrob
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S Hannema
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S Drop
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - T Guran
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - F Darendeliler
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - A Nordenstrom
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - I A Hughes
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - C Acerini
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - R Tadokoro-Cuccaro
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
| | - S F Ahmed
- University of Glasgow (A.L.-H., J.B., J.J., M.R., R.S., M.B., S.F.A.), Glasgow G51 4TF, United Kingdom; University Hospital Pisa (S.B.), 56125 Pisa, Italy; Copenhagen University Hospital (A.J., M.L.J.), 2100 Copenhagen, Denmark; University of Luebeck (O.H.), 23562 Luebeck, Germany; Christian-Albrechts-University of Kiel and University Hospital of Schleswig-Holstein (P.M.H.), 24105 Kiel, Germany; University Hospital Ghent and Ghent University (M.C.), B-9000 Ghent, Belgium; State University of Campinas (UNICAMP) (G.G.-F., G.G.-J.), Campinas 13083-970, Brazil; Dana Dwek Children's Hospital (N.W.), Tel Aviv University, Tel Aviv 64239, Israel; Leids Universitair Medisch Centrum (S.H.), 2333 ZA Leiden, The Netherlands; Sophia Children's Hospital (S.H.), Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; Marmara University (T.G.), 34722 Istanbul, Turkey; Istanbul University (F.D.), 34452 Istanbul, Turkey; Karolinska Institutet (A.N.), SE-171 77 Stockholm, Sweden; and University of Cambridge (I.A.H., C.A., R.T.-C.), Cambridge CB2 1TN, United Kingdom
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