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Jørgensen OJ, Steineger JE, Hillarp A, Pareli Wåland E, Holme PA, Heimdal K, Dheyauldeen S. Elevated FVIII levels in hereditary hemorrhagic telangiectasia: Implications for clinical management. Laryngoscope Investig Otolaryngol 2024; 9:e1196. [PMID: 38362186 PMCID: PMC10866586 DOI: 10.1002/lio2.1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/10/2023] [Accepted: 11/26/2023] [Indexed: 02/17/2024] Open
Abstract
Objectives The objective of this study was twofold: to determine the prevalence of arterial and venous thromboembolic events in the Norwegian Hereditary Hemorrhagic Telangiectasia (HHT) population, and to explore potential factors linked to such events, with particular emphasis on FVIII. Methods Patients with an HHT diagnosis attending the Otorhinolaryngology Department at Oslo University Hospital-Rikshospitalet were included consecutively between April 2021 and November 2022. We recorded the participants' medical history with an emphasis on thromboembolic events. Measurements of blood constituents, including FVIII, FIX, vWF, hemoglobin, iron, ferritin, and CRP were performed. Results One hundred and thirty-four patients were included in the study. The total prevalence of thromboembolic events among the participants was 23.1%. FVIII levels were high (>150 IU/dL) in the majority of HHT patients (n = 84) (68.3%) and were significantly associated with thromboembolic events (p < .001), as was age. Of the patients with high FVIII levels, 28 (33%) had experienced a thromboembolic event. Furthermore, FVIII levels were measured consecutively in 51 patients and were found to fluctuate above or below 150 IU/dL in 25% of these cases. Conclusion Thromboembolic events are highly prevalent in the Norwegian HHT population and are significantly associated with FVIII levels. FVIII levels can fluctuate, and measurements should be repeated in HHT patients to assess the risk of thromboembolic events. Level of Evidence 4.
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Affiliation(s)
- Ole Jakob Jørgensen
- Department of Otorhinolaryngology & Head and Neck SurgeryOslo University Hospital, Medical Faculty, University of OsloOsloNorway
| | - Johan Edvard Steineger
- Department of Otorhinolaryngology & Head and Neck SurgeryOslo University Hospital, Medical Faculty, University of OsloOsloNorway
| | - Andreas Hillarp
- Department of Translational MedicineLund UniversityLundSweden
- Department of Medical Biochemistry, Section for Haemostasis and ThrombosisOslo University HospitalOsloNorway
| | - Erik Pareli Wåland
- Department of Medical Biochemistry, Section for Haemostasis and ThrombosisOslo University HospitalOsloNorway
| | - Pål André Holme
- Department of HematologyOslo University Hospital, Institute of Clinical Medicine, Faculty of Medicine, University of OsloOsloNorway
| | - Ketil Heimdal
- Department of Medical GeneticsOslo University HospitalOsloNorway
| | - Sinan Dheyauldeen
- Department of Otorhinolaryngology & Head and Neck SurgeryOslo University Hospital, Medical Faculty, University of OsloOsloNorway
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Chen YL, Jiang HY, Li DP, Lin J, Chen Y, Xu LL, Gao H. Multi-organ hereditary hemorrhagic telangiectasia: A case report. World J Clin Cases 2023; 11:6831-6840. [PMID: 37901025 PMCID: PMC10600850 DOI: 10.12998/wjcc.v11.i28.6831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Type 2 hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disease and is associated with ALK1 gene mutations. Type 2 HHT patients primarily suffer from recurrent bleeding. There is currently no promising treatment. CASE SUMMARY A 5-year-old Chinese patient (III23) was admitted to Zhongshan Hospital for recurrent melena occurring over 2 mo. She had been experiencing epistaxis for years and had been diagnosed with idiopathic pulmonary hypertension 4 mo before presentation. Abdominal computed tomography examination showed hepatic arteriovenous malformation. Gene testing revealed a c.1121G>A mutation on the ALK1 gene. According to the international diagnostic criteria, this patient was diagnosed with HHT. In addition, 8 more family members exhibited HHT symptoms to varying degrees. Gene testing in 5 family members (2 with HHT symptoms and 3 without HHT symptoms) revealed the ALK1 c.1121G>A mutation in the 2 family members with HHT symptoms. This missense mutation results in the substitution of arginine for glutamine at amino acid position 374 (R374Q) in the conserved functional kinase domain of ALK1. Biological studies revealed that this mutation decreased the kinase activity of ALK1 and impeded the phosphorylation of its substrate Smad1. Moreover, the R374Q mutant downregulated the protein level of collagen-1, a fibrogenic factor, indicating abnormal fiber generation during vascular formation. CONCLUSION The R374Q mutant of ALK1 and its subsequent influence on fiber generation highly indicated its pathogenic role in this family with type 2 HHT. Detection of this gene mutation will facilitate early diagnosis of suspected type 2 HHT patients, and mechanistic studies will provide insights for future therapy.
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Affiliation(s)
- Ying-Ling Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong-Yue Jiang
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dong-Ping Li
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Yun Chen
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Li-Li Xu
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong Gao
- Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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3
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Iwasa T, Urasaki A, Kakihana Y, Nagata-Akaho N, Harada Y, Takeda S, Kawamura T, Shiraishi I, Kurosaki K, Morisaki H, Yamada O, Nakagawa O. Computational and Experimental Analyses for Pathogenicity Prediction of ACVRL1 Missense Variants in Hereditary Hemorrhagic Telangiectasia. J Clin Med 2023; 12:5002. [PMID: 37568404 PMCID: PMC10419700 DOI: 10.3390/jcm12155002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is a vascular disease caused by the defects of ALK1/ACVRL1 receptor signaling. In this study, we evaluated 25 recently identified ACVRL1 missense variants using multiple computational pathogenicity classifiers and experimentally characterized their signal transduction capacity. Three extracellular residue variants showed no detectable cell surface expression and impairment of bone morphogenetic protein 9 (BMP9) responsiveness of SMAD-dependent transcription in luciferase assays. Four variants with amino acid replacement in the motifs essential for the intracellular kinase function lost SMAD-dependent signaling. Most of other variations in the kinase domain also caused marked downregulation of signaling; however, two variants behaved as the wild-type ACVRL1 did, while computational classifiers predicted their functional abnormalities. Three-dimensional structure prediction using the ColabFold program supported the significance of the L45 loop and NANDOR domain of ACVRL1 for its association with SMAD1 and BMPR2, respectively, and the variations in these motifs resulted in the reduction of SMAD signaling. On the other hand, two of the GS domain variants maintained high signal transduction capacity, which did not accord with their computational pathogenicity prediction. These results affirm the requirement of a combinatory approach using computational and experimental analyses to accurately predict the pathogenicity of ACVRL1 missense variants in the HHT patients.
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Affiliation(s)
- Toru Iwasa
- Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan; (T.I.)
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Akihiro Urasaki
- Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan; (T.I.)
| | - Yuki Kakihana
- Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan; (T.I.)
| | - Nami Nagata-Akaho
- Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan; (T.I.)
| | - Yukihiro Harada
- Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan; (T.I.)
- Laboratory of Stem Cell and Regenerative Medicine, Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, 1-1-1 Noji-Higashi, Kusatsu, Shiga 525-8577, Japan
| | - Soichi Takeda
- Department of Advanced Medical Technologies, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Teruhisa Kawamura
- Laboratory of Stem Cell and Regenerative Medicine, Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, 1-1-1 Noji-Higashi, Kusatsu, Shiga 525-8577, Japan
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Hiroko Morisaki
- Department of Medical Genetics, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo 183-0003, Japan
| | - Osamu Yamada
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Osamu Nakagawa
- Department of Molecular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan; (T.I.)
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Sbalchiero A, Abu Hweij Y, Mazza T, Buscarini E, Scotti C, Pagella F, Manfredi G, Matti E, Spinozzi G, Olivieri C. Hereditary hemorrhagic telangiectasia: First demonstration of a founder effect in Italy; the ACVRL1 c.289_294del variant originated in the country of Bergamo 200 years ago. Mol Genet Genomic Med 2022; 10:e1972. [PMID: 35620871 PMCID: PMC9356557 DOI: 10.1002/mgg3.1972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 11/11/2022] Open
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder, affecting 1:5000 individuals worldwide. All the genes associated to the disease (ENG, ACVRL1, SMAD4, GDF2) belong to the TGF‐β/BMPs signaling pathway. We found 19 HHT unrelated families, coming from a Northern Italy region and sharing the ACVRL1 in‐frame deletion c.289_294del (p.H97_N98). Methods To test the hypothesis of a founder effect, we analyzed 88 subjects from 19 families (66 variant carriers, showing clinical signs of HHT, and 22 non‐carriers, unaffected) using eight microsatellite markers within 3.7 Mb around the ACVRL1 locus. After the haplotype reconstruction, age estimation of the variant was carried out. Results We observed a common disease haplotype in 16/19 families, while three families showed evidence of recombination around the ACVRL1 locus. The subsequent age estimation analyses suggested that the mutation occurred about 8 generations ago, corresponding to about 200 years ago. We also present novel in silico and modeling data supporting the variant pathogenicity: the deletion alters the protein stability and removes the unique extracellular glycosylation site. Conclusion We have demonstrated, for the first time, a “founder effect” for a HHT pathogenic variant in Italy.
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Affiliation(s)
- Anna Sbalchiero
- General Biology and Medical Genetics Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Yasmin Abu Hweij
- General Biology and Medical Genetics Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Tommaso Mazza
- Laboratory of Bioinformatics, Fondazione IRCCS Casa Sollievo della Sofferenza-Mendel, San Giovanni Rotondo (FG), Italy
| | - Elisabetta Buscarini
- UOC of Gastroenterology-Reference Centre for HHT, ASST Ospedale Maggiore di Crema, Crema (CR), Italy
| | - Claudia Scotti
- Immunology and General Pathology Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Fabio Pagella
- UOC of Otorhinolaryngology, Department of Surgical Sciences, University of Pavia, Pavia, Italy.,UOC of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Guido Manfredi
- UOC of Gastroenterology-Reference Centre for HHT, ASST Ospedale Maggiore di Crema, Crema (CR), Italy
| | - Elina Matti
- UOC of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Spinozzi
- UOC of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carla Olivieri
- General Biology and Medical Genetics Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Major T, Bereczky Z, Gindele R, Balogh G, Rácz B, Bora L, Kézsmárki Z, Brúgós B, Pfliegler G. Current Status of Clinical and Genetic Screening of Hereditary Hemorrhagic Telangiectasia Families in Hungary. J Clin Med 2021; 10:jcm10173774. [PMID: 34501220 PMCID: PMC8432115 DOI: 10.3390/jcm10173774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/15/2021] [Accepted: 08/20/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Tamás Major
- Division of Otorhinolaryngology and Head & Neck Surgery, Kenézy Gyula Campus, University of Debrecen Medical Center, University of Debrecen, H-4031 Debrecen, Hungary;
- Correspondence: (T.M.); (Z.B.); Tel.: +36-52-511777 (ext. 1756) (T.M.); +36-52-431956 (Z.B.); Fax: +36-52-511755 (T.M.); +36-52-340011 (Z.B.)
| | - Zsuzsanna Bereczky
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (R.G.); (G.B.)
- Correspondence: (T.M.); (Z.B.); Tel.: +36-52-511777 (ext. 1756) (T.M.); +36-52-431956 (Z.B.); Fax: +36-52-511755 (T.M.); +36-52-340011 (Z.B.)
| | - Réka Gindele
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (R.G.); (G.B.)
| | - Gábor Balogh
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (R.G.); (G.B.)
| | - Benedek Rácz
- Division of Otorhinolaryngology and Head & Neck Surgery, Kenézy Gyula Campus, University of Debrecen Medical Center, University of Debrecen, H-4031 Debrecen, Hungary;
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (R.G.); (G.B.)
| | - László Bora
- Department of Radiology, Szent Lázár County Hospital, H-3100 Salgótarján, Hungary;
| | - Zsolt Kézsmárki
- Division of Radiology, Kenézy Gyula Campus, University of Debrecen Medical Center, University of Debrecen, H-4031 Debrecen, Hungary;
| | - Boglárka Brúgós
- Division of Rare Diseases, Department of Internal Medicine Block B, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (B.B.); (G.P.)
| | - György Pfliegler
- Division of Rare Diseases, Department of Internal Medicine Block B, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (B.B.); (G.P.)
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6
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Major T, Gindele R, Balogh G, Bárdossy P, Bereczky Z. Founder Effects in Hereditary Hemorrhagic Telangiectasia. J Clin Med 2021; 10:jcm10081682. [PMID: 33919892 PMCID: PMC8070971 DOI: 10.3390/jcm10081682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/26/2022] Open
Abstract
A founder effect can result from the establishment of a new population by individuals from a larger population or bottleneck events. Certain alleles may be found at much higher frequencies because of genetic drift immediately after the founder event. We provide a systematic literature review of the sporadically reported founder effects in hereditary hemorrhagic telangiectasia (HHT). All publications from the ACVRL1, ENG and SMAD4 Mutation Databases and publications searched for terms “hereditary hemorrhagic telangiectasia” and “founder” in PubMed and Scopus, respectively, were extracted. Following duplicate removal, 141 publications were searched for the terms “founder” and “founding” and the etymon “ancest”. Finally, 67 publications between 1992 and 2020 were reviewed. Founder effects were graded upon shared area of ancestry/residence, shared core haplotypes, genealogy and prevalence. Twenty-six ACVRL1 and 12 ENG variants with a potential founder effect were identified. The bigger the cluster of families with a founder mutation, the more remarkable is its influence to the populational ACVRL1/ENG ratio, affecting HHT phenotype. Being aware of founder effects might simplify the diagnosis of HHT by establishing local genetic algorithms. Families sharing a common core haplotype might serve as a basis to study potential second-hits in the etiology of HHT.
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Affiliation(s)
- Tamás Major
- Division of Otorhinolaryngology and Head & Neck Surgery, Kenézy Gyula Campus, University of Debrecen Medical Center, H-4031 Debrecen, Hungary
- Correspondence: (T.M.); (Z.B.); Tel.: +36-52-511777/1756 (T.M.); +36-52-431956 (Z.B.); Fax: +36-52-511755 (T.M.); +36-52-340011 (Z.B.)
| | - Réka Gindele
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (R.G.); (G.B.)
| | - Gábor Balogh
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (R.G.); (G.B.)
| | - Péter Bárdossy
- Hungarian Heraldry and Genealogical Society, H-1014 Budapest, Hungary;
| | - Zsuzsanna Bereczky
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (R.G.); (G.B.)
- Correspondence: (T.M.); (Z.B.); Tel.: +36-52-511777/1756 (T.M.); +36-52-431956 (Z.B.); Fax: +36-52-511755 (T.M.); +36-52-340011 (Z.B.)
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7
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Zhao Y, Zhang Y, Wang X, Zhang L. Variant analysis in Chinese families with hereditary hemorrhagic telangiectasia. Mol Genet Genomic Med 2019; 7:e893. [PMID: 31400083 PMCID: PMC6732279 DOI: 10.1002/mgg3.893] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022] Open
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) is a vascular dysplasia disorder characterized by epistaxis, mucocutaneous telangiectasias and arteriovenous malformations in internal organs. Recurrent epistaxis is the primary complaint in 90%‐96% of HHT patients and the other symptoms come with age. The aim of this study was to analyze HHT‐associated gene variant spectrum in Chinese HHT patients and to assess whether genetic testing could contribute to the early diagnosis. Methodology/Principal Thirty one HHT families including 62 individuals were recruited. Variants in the coding regions of four genes involved in HHT were amplified and analyzed using Sanger sequencing and multiplex ligation‐dependent probe amplification (MLPA). Results Twenty unique variants, including 8 novel variants were found in 24 of the 31 (77.4%) kindred. Diagnosis is confirmed for 7 possible individuals from 6 kindred. Thirteen ACVRL1 variants were detected from 17 isolated HHT families. Variants in ACVRL1 from 8/17 (47.1%) families were located in exon8. Seven ENG variants were found in 7 unrelated families throughout the coding region. Conclusion We conclude that ACVRL1 gene variant is 2.4 times more prevalent than that in ENG in Chinese individuals with HHT, and exon8 of the ACVRL1 gene may be a hotspot region. Genetic testing could contribute to early diagnosis for HHT.
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Affiliation(s)
- Yali Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yuan Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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8
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Steineger J, Geirdal AØ, Osnes T, Heimdal KR, Dheyauldeen S. Intranasal bevacizumab injections improve quality of life in HHT patients. Laryngoscope 2019; 130:E284-E288. [DOI: 10.1002/lary.28179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/15/2019] [Accepted: 06/19/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Johan Steineger
- Division of Head and Neck and Reconstructive Surgery, Department of Otorhinolaryngology, Head and Neck SurgeryOslo University Hospital Rikshospitalet Oslo Norway
- Institute of Clinical MedicineUniversity of Oslo Norway
| | | | - Terje Osnes
- Division of Head and Neck and Reconstructive Surgery, Department of Otorhinolaryngology, Head and Neck SurgeryOslo University Hospital Rikshospitalet Oslo Norway
- Institute of Clinical MedicineUniversity of Oslo Norway
| | | | - Sinan Dheyauldeen
- Division of Head and Neck and Reconstructive Surgery, Department of Otorhinolaryngology, Head and Neck SurgeryOslo University Hospital Rikshospitalet Oslo Norway
- Institute of Clinical MedicineUniversity of Oslo Norway
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9
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Major T, Gindele R, Szabó Z, Kis Z, Bora L, Jóni N, Bárdossy P, Rácz T, Bereczky Z. The Stratified Population Screening of Hereditary Hemorrhagic Telangiectasia. Pathol Oncol Res 2019; 26:2783-2788. [PMID: 30685840 DOI: 10.1007/s12253-019-00602-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant multisystemic vascular disease with a wordwide prevalence of 1:5000-1:10000. We introduce our algorithm for the stratified population screening of HHT. Probands are selected from the consecutive hospital database review for HHT (I7800) and recurrent epistaxis (R0400) and the review of patient records referred by family practicioners. A proportion of probands might be de novo diagnosed with HHT in the 10-year study period. The checkup of probands consists of physical examination, arteriovenous malformation exploration and and genetic testing (ACVRL1 and ENG sequence analysis). The family screening of HHT consists of physical examination and screening for the family-specific mutation of each at-risk individual, and furthermore, arteriovenous malformation exploration in individuals with suspected/definite HHT and/or carrying the mutation. Twenty-five definite HHT patients were explored: 7 of them by the I7800 review, 1 by the R0400 review, 3 were de novo diagnosed, and the remaining 14 were explored by the systematic family screening. Considering the 20 patients alive at the end of the study period and the unavailable 5 potential HHT patients and 12 at-risk family members, the HHT prevalence is estimated to be 1:6090-1:11267 in our study area, implying our algorithm's effectivity in the stratified population screening of HHT.
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Affiliation(s)
- Tamás Major
- Department of Otolaryngology and Head and Neck Surgery, B-A-Z County Central Hospital and University Teaching Hospital, Szentpéteri kapu 72-76, Miskolc, H-3526, Hungary. .,Borsod-Abaúj-Zemplén Megyei Központi Kórház és Egyetemi Oktatókórház Fül-Orr-Gége és Fej-Nyak Sebészeti Osztály, Szentpéteri kapu 72-76, Miskolc, 3526, Hungary.
| | - Réka Gindele
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Zsuzsanna Szabó
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
| | - Zsuzsanna Kis
- Department of Radiology, Ferenc Markhot County Hospital, Széchenyi u. 27-29, Eger, H-3300, Hungary
| | - László Bora
- Department of Radiology, Szent Lázár County Hospital, Füleki út 54-56, Salgótarján, H-3100, Hungary
| | - Natália Jóni
- Department of Internal Medicine, Ferenc Markhot County Hospital, Széchenyi u. 27-29, Eger, H-3300, Hungary
| | - Péter Bárdossy
- Hungarian Heraldry and Genealogical Society, Bécsi Kapu tér 2-4, Budapest, H-1014, Hungary
| | - Tamás Rácz
- Department of Otorhinolaryngology, Ferenc Markhot County Hospital, Széchenyi u. 27-29, Eger, H-3300, Hungary
| | - Zsuzsanna Bereczky
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4032, Hungary
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10
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Ruiz-Llorente L, Gallardo-Vara E, Rossi E, Smadja DM, Botella LM, Bernabeu C. Endoglin and alk1 as therapeutic targets for hereditary hemorrhagic telangiectasia. Expert Opin Ther Targets 2017; 21:933-947. [PMID: 28796572 DOI: 10.1080/14728222.2017.1365839] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Hereditary Haemorrhagic Telangiectasia (HHT) is as an autosomal dominant trait characterized by frequent nose bleeds, mucocutaneous telangiectases, arteriovenous malformations (AVMs) of the lung, liver and brain, and gastrointestinal bleedings due to telangiectases. HHT is originated by mutations in genes whose encoded proteins are involved in the transforming growth factor β (TGF-β) family signalling of vascular endothelial cells. In spite of the great advances in the diagnosis as well as in the molecular, cellular and animal models of HHT, the current treatments remain just at the palliative level. Areas covered: Pathogenic mutations in genes coding for the TGF-β receptors endoglin (ENG) (HHT1) or the activin receptor-like kinase-1 (ACVRL1 or ALK1) (HHT2), are responsible for more than 80% of patients with HHT. Therefore, ENG and ALK1 are the main potential therapeutic targets for HHT and the focus of this review. The current status of the preclinical and clinical studies, including the anti-angiogenic strategy, have been addressed. Expert opinion: Endoglin and ALK1 are attractive therapeutic targets in HHT. Because haploinsufficiency is the pathogenic mechanism in HHT, several therapeutic approaches able to enhance protein expression and/or function of endoglin and ALK1 are keys to find novel and efficient treatments for the disease.
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Affiliation(s)
- Lidia Ruiz-Llorente
- a Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas (CSIC), and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) , Madrid , Spain
| | - Eunate Gallardo-Vara
- a Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas (CSIC), and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) , Madrid , Spain
| | - Elisa Rossi
- b Faculté de Pharmacie , Paris Descartes University, Sorbonne Paris Cité and Inserm UMR-S1140 , Paris , France
| | - David M Smadja
- b Faculté de Pharmacie , Paris Descartes University, Sorbonne Paris Cité and Inserm UMR-S1140 , Paris , France
| | - Luisa M Botella
- a Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas (CSIC), and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) , Madrid , Spain
| | - Carmelo Bernabeu
- a Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas (CSIC), and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) , Madrid , Spain
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11
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Major T, Gindele R, Szabó Z, Alef T, Thiele B, Bora L, Kis Z, Bárdossy P, Rácz T, Havacs I, Bereczky Z. Evidence for the founder effect of a novel ACVRL1 splice-site mutation in Hungarian hereditary hemorrhagic telangiectasia families. Clin Genet 2016; 90:466-467. [PMID: 27291782 DOI: 10.1111/cge.12806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- T Major
- Department of Otorhinolaryngology, Markhot Ferenc Hospital, Eger, Hungary.
| | - R Gindele
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Z Szabó
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - T Alef
- Medical Diagnostic Laboratory, Institute of Immunology and Genetics, Kaiserslautern, Germany
| | - B Thiele
- Medical Diagnostic Laboratory, Institute of Immunology and Genetics, Kaiserslautern, Germany
| | - L Bora
- Department of Radiology, Markhot Ferenc Hospital, Eger, Hungary
| | - Z Kis
- Department of Radiology, Markhot Ferenc Hospital, Eger, Hungary
| | - P Bárdossy
- Hungarian Heraldic and Genealogical Society, Budapest, Hungary
| | - T Rácz
- Department of Otorhinolaryngology, Markhot Ferenc Hospital, Eger, Hungary
| | - I Havacs
- Department of Otorhinolaryngology, Markhot Ferenc Hospital, Eger, Hungary
| | - Z Bereczky
- Division of Clinical Laboratory Science, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
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12
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Kuhajda I, Milosevic M, Ilincic D, Kuhajda D, Pekovic S, Tsirgogianni K, Tsavlis D, Tsakiridis K, Sakkas A, Kantzeli A, Zarogoulidis K, Zarogoulidis P, Zissimopoulos A, Durić D. Pulmonary arteriovenous malformation-etiology, clinical four case presentations and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:171. [PMID: 26261842 DOI: 10.3978/j.issn.2305-5839.2015.06.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 06/17/2015] [Indexed: 11/14/2022]
Abstract
Pulmonary arteriovenous malformation (PAVM) is a rare clinical condition with abnormal direct communication between the branches of pulmonary artery and vein. It may occur as an isolated anomaly or in association with hereditary hemorrhagic telangiectasia (HHT). Although these vascular pulmonary pathologies are quite uncommon, they are the important part of the differential diagnosis of common pulmonary problems such as hypoxemia and pulmonary nodules. The diagnosis of PAVM in patients remains a diagnostic challenge to the emergency physician. The most common clinical signs of PAVM are recurrent episodes of epistaxis and hemoptysis, so surgical resection is deemed the best curative option to avoid further episodes and recurrence of hemoptysis. Quite often the diagnosis is established after pathohistological examinations. We report a case of a female patient with a massive recurrent hemoptysis and without pathologic radiological findings which would suggest to PAVM and who was successfully treated with lobectomy.
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Affiliation(s)
- Ivan Kuhajda
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Misel Milosevic
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dejan Ilincic
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Danijela Kuhajda
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Sandra Pekovic
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Katerina Tsirgogianni
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Drosos Tsavlis
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kosmas Tsakiridis
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Antonios Sakkas
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Angeliki Kantzeli
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Zarogoulidis
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paul Zarogoulidis
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Zissimopoulos
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dejan Durić
- 1 Clinic for Thoracic Surgery, 2 Center for respiratory rehabilitation, 3 Clinic of urgent pulmology, Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia; 4 Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Cardiothoracic Surgery Department, "Saint Luke" Private Hospital, Thessaloniki, Panorama, Greece ; 6 Department of Internal Medicine, "Evangelisches Krankenhaus", Mülheim, Germany ; 7 Department of Internal Medicine, "Helios Klinikum", Wuppertal, Germany ; 8 Department of Nuclear Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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