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Weiß M, Gutzeit J, Appel KS, Bahmer T, Beutel M, Deckert J, Fricke J, Hanß S, Hettich-Damm N, Heuschmann PU, Horn A, Jauch-Chara K, Kohls M, Krist L, Lorenz-Depiereux B, Otte C, Pape D, Reese JP, Schreiber S, Störk S, Vehreschild JJ, Hein G. Depression and fatigue six months post-COVID-19 disease are associated with overlapping symptom constellations: A prospective, multi-center, population-based cohort study. J Affect Disord 2024; 352:296-305. [PMID: 38360365 DOI: 10.1016/j.jad.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Depression and fatigue are commonly observed sequelae following viral diseases such as COVID-19. Identifying symptom constellations that differentially classify post-COVID depression and fatigue may be helpful to individualize treatment strategies. Here, we investigated whether self-reported post-COVID depression and post-COVID fatigue are associated with the same or different symptom constellations. METHODS To address this question, we used data from COVIDOM, a population-based cohort study conducted as part of the NAPKON-POP platform. Data were collected in three different German regions (Kiel, Berlin, Würzburg). We analyzed data from >2000 individuals at least six months past a PCR-confirmed COVID-19 disease, using elastic net regression and cluster analysis. The regression model was developed in the Kiel data set, and externally validated using data sets from Berlin and Würzburg. RESULTS Our results revealed that post-COVID depression and fatigue are associated with overlapping symptom constellations consisting of difficulties with daily activities, perceived health-related quality of life, chronic exhaustion, unrestful sleep, and impaired concentration. Confirming the overlap in symptom constellations, a follow-up cluster analysis could categorize individuals as scoring high or low on depression and fatigue but could not differentiate between both dimensions. LIMITATIONS The data presented are cross-sectional, consisting primarily of self-reported questionnaire or medical records rather than biometric data. CONCLUSIONS In summary, our results suggest a strong link between post-COVID depression and fatigue, highlighting the need for integrative treatment approaches.
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Affiliation(s)
- Martin Weiß
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany.
| | - Julian Gutzeit
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
| | - Katharina S Appel
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Frankfurt, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Thomas Bahmer
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany; Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm 80, 22927 Großhansdorf, Germany
| | - Manfred Beutel
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Jürgen Deckert
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | - Sabine Hanß
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Nora Hettich-Damm
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, Department of Internal Medicine I, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany; Clinical Trial Center Würzburg (CTC/ZKS), University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Anna Horn
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Kamila Jauch-Chara
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Mirjam Kohls
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany
| | | | - Christian Otte
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
| | - Daniel Pape
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; Institute of Medical Data Science, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Stefan Schreiber
- Department I of Internal Medicine, UKSH Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, Department of Internal Medicine I, University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
| | - Jörg Janne Vehreschild
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Frankfurt, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Grit Hein
- University Hospital Würzburg, Center of Mental Health, Department of Psychiatry, Psychosomatic and Psychotherapy, Margarete-Höppel-Platz 1, 97080 Würzburg, Germany
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2
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Steinbeis F, Thibeault C, Steinbrecher S, Ahlgrimm Y, Haack IA, August D, Balzuweit B, Bellinghausen C, Berger S, Chaplinskaya-Sobol I, Cornely O, Doeblin P, Endres M, Fink C, Finke C, Frank S, Hanß S, Hartung T, Hellmuth JC, Herold S, Heuschmann P, Heyckendorf J, Heyder R, Hippenstiel S, Hoffmann W, Kelle SU, Knape P, Koehler P, Kretzler L, Leistner DM, Lienau J, Lorbeer R, Lorenz-Depiereux B, Lüttke CD, Mai K, Merle U, Meyer-Arndt LA, Miljukov O, Muenchhoff M, Müller-Plathe M, Neuhann J, Neuhauser H, Nieters A, Otte C, Pape D, Pinto RM, Pley C, Pudszuhn A, Reuken P, Rieg S, Ritter P, Rohde G, Rönnefarth M, Ruzicka M, Schaller J, Schmidt A, Schmidt S, Schwachmeyer V, Schwanitz G, Seeger W, Stahl D, Stobäus N, Stubbe HC, Suttorp N, Temmesfeld B, Thun S, Triller P, Trinkmann F, Vadasz I, Valentin H, Vehreschild M, von Kalle C, von Lilienfeld-Toal M, Weber J, Welte T, Wildberg C, Wizimirski R, Zvork S, Sander LE, Vehreschild J, Zoller T, Kurth F, Witzenrath M. Analysis of acute COVID-19 including chronic morbidity: protocol for the deep phenotyping National Pandemic Cohort Network in Germany (NAPKON-HAP). Infection 2024; 52:93-104. [PMID: 37434025 PMCID: PMC10811153 DOI: 10.1007/s15010-023-02057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/29/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) pandemic causes a high burden of acute and long-term morbidity and mortality worldwide despite global efforts in containment, prophylaxis, and therapy. With unprecedented speed, the global scientific community has generated pivotal insights into the pathogen and the host response evoked by the infection. However, deeper characterization of the pathophysiology and pathology remains a high priority to reduce morbidity and mortality of coronavirus disease 2019 (COVID-19). METHODS NAPKON-HAP is a multi-centered prospective observational study with a long-term follow-up phase of up to 36 months post-SARS-CoV-2 infection. It constitutes a central platform for harmonized data and biospecimen for interdisciplinary characterization of acute SARS-CoV-2 infection and long-term outcomes of diverging disease severities of hospitalized patients. RESULTS Primary outcome measures include clinical scores and quality of life assessment captured during hospitalization and at outpatient follow-up visits to assess acute and chronic morbidity. Secondary measures include results of biomolecular and immunological investigations and assessment of organ-specific involvement during and post-COVID-19 infection. NAPKON-HAP constitutes a national platform to provide accessibility and usability of the comprehensive data and biospecimen collection to global research. CONCLUSION NAPKON-HAP establishes a platform with standardized high-resolution data and biospecimen collection of hospitalized COVID-19 patients of different disease severities in Germany. With this study, we will add significant scientific insights and provide high-quality data to aid researchers to investigate COVID-19 pathophysiology, pathology, and chronic morbidity.
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Affiliation(s)
- Fridolin Steinbeis
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Charlotte Thibeault
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Steinbrecher
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Yvonne Ahlgrimm
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ira An Haack
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dietrich August
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Centre-University of Freiburg, Freiburg, Germany
| | - Beate Balzuweit
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carla Bellinghausen
- Department of Respiratory Medicine/Allergology, Medical Clinic 1, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sarah Berger
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Oliver Cornely
- Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Faculty of Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Patrick Doeblin
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Fink
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Finke
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sandra Frank
- Department of Anesthesiology, University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Sabine Hanß
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Tim Hartung
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johannes Christian Hellmuth
- Department of Medicine III, University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Susanne Herold
- Department of Medicine V, Internal Medicine, Infectious Diseases and Infection Control, University Hospital Giessen and Marburg, Giessen, Germany
- German Center for Lung Research (DZL), Institute of Lung Health (ILH), Excellence Cluster Cardiopulmonary Institute (CPI), Justus Liebig-University, Giessen, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
- Clinical Trial Center, Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Jan Heyckendorf
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ralf Heyder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NUM Coordination Office, Berlin, Germany
| | - Stefan Hippenstiel
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine Section Health Care Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Sebastian Ulrich Kelle
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Philipp Knape
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Philipp Koehler
- Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Lucie Kretzler
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - David Manuel Leistner
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Cardiology and Angiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Jasmin Lienau
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Roberto Lorbeer
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Department of Radiology, University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | | | - Knut Mai
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
| | - Uta Merle
- Department of Internal Medicine IVM, University Hospital Heidelberg, Heidelberg, Germany
| | - Lil Antonia Meyer-Arndt
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
| | - Maximilian Muenchhoff
- Max Von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Moritz Müller-Plathe
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Julia Neuhann
- Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Faculty of Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Alexandra Nieters
- Faculty of Medicine, FREEZE-Biobank, Medical Center-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Institute for Immunodeficiency, Medical Center-University of Freiburg, Freiburg, Germany
| | - Christian Otte
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Pape
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rafaela Maria Pinto
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Christina Pley
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NUM Coordination Office, Berlin, Germany
| | - Annett Pudszuhn
- Department of ENT, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp Reuken
- Department of Internal Medicine IV, University Hospital Jena, Jena, Germany
| | - Siegberg Rieg
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Centre-University of Freiburg, Freiburg, Germany
| | - Petra Ritter
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine/Allergology, Medical Clinic 1, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria Rönnefarth
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Ruzicka
- Department of Medicine III, University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jens Schaller
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Anne Schmidt
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sein Schmidt
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Verena Schwachmeyer
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Schwanitz
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Werner Seeger
- German Center for Lung Research (DZL), Institute of Lung Health (ILH), Excellence Cluster Cardiopulmonary Institute (CPI), Justus Liebig-University, Giessen, Germany
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Dana Stahl
- Independent Trusted Third Party, University Medicine Greifswald, Greifswald, Germany
| | - Nicole Stobäus
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hans Christian Stubbe
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Department of Medicine II, University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Bettina Temmesfeld
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sylvia Thun
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Triller
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frederik Trinkmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Heidelberg, Germany
- Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPD-BW), University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Istvan Vadasz
- German Center for Lung Research (DZL), Institute of Lung Health (ILH), Excellence Cluster Cardiopulmonary Institute (CPI), Justus Liebig-University, Giessen, Germany
| | - Heike Valentin
- Independent Trusted Third Party, University Medicine Greifswald, Greifswald, Germany
| | - Maria Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christof von Kalle
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marie von Lilienfeld-Toal
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Jena, Germany
| | - Joachim Weber
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Welte
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Wildberg
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Wizimirski
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Saskia Zvork
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Leif Erik Sander
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Janne Vehreschild
- Medical Department 2, Hematology/Oncology and Infectious Diseases, University Hospital of Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Department I for Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Thomas Zoller
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Florian Kurth
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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3
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Shi Y, Strobl R, Apfelbacher C, Bahmer T, Geisler R, Heuschmann P, Horn A, Hoven H, Keil T, Krawczak M, Krist L, Lemhöfer C, Lieb W, Lorenz-Depiereux B, Mikolajczyk R, Montellano FA, Reese JP, Schreiber S, Skoetz N, Störk S, Vehreschild JJ, Witzenrath M, Grill E. Persistent symptoms and risk factors predicting prolonged time to symptom-free after SARS‑CoV‑2 infection: an analysis of the baseline examination of the German COVIDOM/NAPKON-POP cohort. Infection 2023; 51:1679-1694. [PMID: 37231313 PMCID: PMC10212223 DOI: 10.1007/s15010-023-02043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE We aimed to assess symptoms in patients after SARS-CoV-2 infection and to identify factors predicting prolonged time to symptom-free. METHODS COVIDOM/NAPKON-POP is a population-based prospective cohort of adults whose first on-site visits were scheduled ≥ 6 months after a positive SARS-CoV-2 PCR test. Retrospective data including self-reported symptoms and time to symptom-free were collected during the survey before a site visit. In the survival analyses, being symptom-free served as the event and time to be symptom-free as the time variable. Data were visualized with Kaplan-Meier curves, differences were tested with log-rank tests. A stratified Cox proportional hazard model was used to estimate adjusted hazard ratios (aHRs) of predictors, with aHR < 1 indicating a longer time to symptom-free. RESULTS Of 1175 symptomatic participants included in the present analysis, 636 (54.1%) reported persistent symptoms after 280 days (SD 68) post infection. 25% of participants were free from symptoms after 18 days [quartiles: 14, 21]. Factors associated with prolonged time to symptom-free were age 49-59 years compared to < 49 years (aHR 0.70, 95% CI 0.56-0.87), female sex (aHR 0.78, 95% CI 0.65-0.93), lower educational level (aHR 0.77, 95% CI 0.64-0.93), living with a partner (aHR 0.81, 95% CI 0.66-0.99), low resilience (aHR 0.65, 95% CI 0.47-0.90), steroid treatment (aHR 0.22, 95% CI 0.05-0.90) and no medication (aHR 0.74, 95% CI 0.62-0.89) during acute infection. CONCLUSION In the studied population, COVID-19 symptoms had resolved in one-quarter of participants within 18 days, and in 34.5% within 28 days. Over half of the participants reported COVID-19-related symptoms 9 months after infection. Symptom persistence was predominantly determined by participant's characteristics that are difficult to modify.
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Affiliation(s)
- Yanyan Shi
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel (UKSH Kiel), Kiel, Germany
| | - Ramsia Geisler
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt Am Main, Germany
| | - Peter Heuschmann
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Anna Horn
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
| | - Hanno Hoven
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Keil
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Lemhöfer
- Institute of Physical and Rehabilitation Medicine, University Hospital Jena, Jena, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bettina Lorenz-Depiereux
- Research Unit Molecular Epidemiology, Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- German Centre for Mental Health, Site Jena-Magdeburg-Halle, Halle, Germany
| | - Felipe A Montellano
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Jens Peter Reese
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University, Würzburg, Würzburg, Germany
| | - Stefan Schreiber
- Internal Medicine Department I, University Hospital Schleswig-Holstein Campus Kiel (UKSH Kiel), Kiel, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Jörg Janne Vehreschild
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt Am Main, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn‑Cologne, Cologne, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Giessen, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Marchioninistr. 15, 81377, Munich, Germany.
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany.
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4
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Tilch K, Hopff SM, Appel K, Kraus M, Lorenz-Depiereux B, Pilgram L, Anton G, Berger S, Geisler R, Haas K, Illig T, Krefting D, Lorbeer R, Mitrov L, Muenchhoff M, Nauck M, Pley C, Reese JP, Rieg S, Scherer M, Stecher M, Stellbrink C, Valentin H, Winter C, Witzenrath M, Vehreschild JJ. Ethical and coordinative challenges in setting up a national cohort study during the COVID-19 pandemic in Germany. BMC Med Ethics 2023; 24:84. [PMID: 37848886 PMCID: PMC10583323 DOI: 10.1186/s12910-023-00959-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
With the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), global researchers were confronted with major challenges. The German National Pandemic Cohort Network (NAPKON) was launched in fall 2020 to effectively leverage resources and bundle research activities in the fight against the coronavirus disease 2019 (COVID-19) pandemic. We analyzed the setup phase of NAPKON as an example for multicenter studies in Germany, highlighting challenges and optimization potential in connecting 59 university and nonuniversity study sites. We examined the ethics application process of 121 ethics submissions considering durations, annotations, and outcomes. Study site activation and recruitment processes were investigated and related to the incidence of SARS-CoV-2 infections. For all initial ethics applications, the median time to a positive ethics vote was less than two weeks and 30 of these study sites (65%) joined NAPKON within less than three weeks each. Electronic instead of postal ethics submission (9.5 days (Q1: 5.75, Q3: 17) vs. 14 days (Q1: 11, Q3: 26), p value = 0.01) and adoption of the primary ethics vote significantly accelerated the ethics application process. Each study center enrolled a median of 37 patients during the 14-month observation period, with large differences depending on the health sector. We found a positive correlation between recruitment performance and COVID-19 incidence as well as hospitalization incidence. Our analysis highlighted the challenges and opportunities of the federated system in Germany. Digital ethics application tools, adoption of a primary ethics vote and standardized formal requirements lead to harmonized and thus faster study initiation processes during a pandemic.
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Affiliation(s)
- Katharina Tilch
- Faculty of Medicine, Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf, University of Cologne, University Hospital Cologne, Cologne, Germany.
| | - Sina M Hopff
- Faculty of Medicine, Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Katharina Appel
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Monika Kraus
- Helmholtz Center Munich, Institute of Epidemiology, Research Unit Molecular Epidemiology, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Bettina Lorenz-Depiereux
- Helmholtz Center Munich, Institute of Epidemiology, Research Unit Molecular Epidemiology, Munich, Germany
| | - Lisa Pilgram
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gabi Anton
- Helmholtz Center Munich, Institute of Epidemiology, Research Unit Molecular Epidemiology, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Sarah Berger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Berlin, Germany
| | - Ramsia Geisler
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kirsten Haas
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Julius Maximilian University of Würzburg, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science (ImDS), Josef-Schneider Straße 2, 97080, Würzburg, Germany
| | - Thomas Illig
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Dagmar Krefting
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Roberto Lorbeer
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
- Deutsches Herzzentrum der Charité, Medical Heart Center of Charité and German Heart Institute Berlin, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany
- Department of Radiology, University Hospital LMU Munich, Munich, Germany
| | - Lazar Mitrov
- Faculty of Medicine, Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Maximilian Muenchhoff
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Max Von Pettenkofer Institute & GeneCenter, Virology, Faculty of Medicine, Ludwig-Maximilians University, Munich, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christina Pley
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Berlin, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Julius Maximilian University of Würzburg, Würzburg, Germany
- University Hospital Würzburg, Institute for Medical Data Science (ImDS), Josef-Schneider Straße 2, 97080, Würzburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Margarete Scherer
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Melanie Stecher
- Faculty of Medicine, Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf, University of Cologne, University Hospital Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
| | - Christoph Stellbrink
- Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Klinikum Bielefeld, Academic Department of Cardiology and Internal Intensive Care Medicine, Bielefeld, Germany
| | - Heike Valentin
- Trusted Third Party of the University Medicine Greifswald, Ellernholzstr. 1-2, 17475, Greifswald, Germany
| | - Christof Winter
- School of Medicine, Institute of Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Munich, Germany
- TranslaTUM, Center for Translational Cancer Research, Technical University of Munich, Munich, Germany
| | - Martin Witzenrath
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Berlin, Germany
- German Center for Lung Research (DZL), Berlin, Germany
| | - J Janne Vehreschild
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
- German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
- Department I for Internal Medicine, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
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5
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Yusuf KO, Chaplinskaya-Sobol I, Schoneberg A, Hanss S, Valentin H, Lorenz-Depiereux B, Hansch S, Fiedler K, Scherer M, Sikdar S, Miljukov O, Reese JP, Wagner P, Bröhl I, Geisler R, Vehreschild JJ, Blaschke S, Bellinghausen C, Milovanovic M, Krefting D. Impact of Clinical Study Implementation on Data Quality Assessments - Using Contradictions within Interdependent Health Data Items as a Pilot Indicator. Stud Health Technol Inform 2023; 307:152-158. [PMID: 37697849 DOI: 10.3233/shti230707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Contradiction is a relevant data quality indicator to evaluate the plausibility of interdependent health data items. However, while contradiction assessment is achieved using domain-established contradictory dependencies, recent studies have shown the necessity for additional requirements to reach conclusive contradiction findings. For example, the oral or rectal methods used in measuring the body temperature will influence the thresholds of fever definition. The availability of this required information as explicit data items must be guaranteed during study design. In this work, we investigate the impact of activities related to study database implementation on contradiction assessment from two perspectives including: 1) additionally required metadata and 2) implementation of checks within electronic case report forms to prevent contradictory data entries. METHODS Relevant information (timestamps, measurement methods, units, and interdependency rules) required for contradiction checks are identified. Scores are assigned to these parameters and two different studies are evaluated based on the fulfillment of the requirements by two selected interdependent data item sets. RESULTS None of the studies have fulfilled all requirements. While timestamps and measurement units are found, missing information about measurement methods may impede conclusive contradiction assessment. Implemented checks are only found if data are directly entered. DISCUSSION Conclusive contradiction assessment typically requires metadata in the context of captured data items. Consideration during study design and implementation of data capture systems may support better data quality in studies and could be further adopted in primary health information systems to enhance clinical anamnestic documentation.
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Affiliation(s)
- Khalid O Yusuf
- Department of Medical Informatics, University Medical Center Göttingen, Germany
| | | | - Anne Schoneberg
- Department of Medical Informatics, University Medical Center Göttingen, Germany
| | - Sabine Hanss
- Department of Medical Informatics, University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany
| | - Heike Valentin
- Trusted Third Party of the University Medicine Greifswald, Germany
| | | | - Stefan Hansch
- Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Germany
| | - Karin Fiedler
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Margarete Scherer
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Shimita Sikdar
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Olga Miljukov
- University of Würzburg, Institute for Clinical Epidemiology and Biometry
| | - Jens-Peter Reese
- University of Würzburg, Institute for Clinical Epidemiology and Biometry
| | - Patricia Wagner
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Isabel Bröhl
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Ramsia Geisler
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jörg J Vehreschild
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Sabine Blaschke
- Emergency Department, University Medical Center Goettingen, Germany
| | - Carla Bellinghausen
- Goethe University Frankfurt, University Hospital Frankfurt, Medical Clinic I, Department of Respiratory Medicine / Allergology
| | - Milena Milovanovic
- Malteser Krankenhaus St. Franziskus Hospital, Medical Clinic I, Flensburg, Germany
| | - Dagmar Krefting
- Department of Medical Informatics, University Medical Center Göttingen, Germany
- Campus Institute Data Science, Georg-August-University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Germany
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6
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Krefting D, Anton G, Chaplinskaya-Sobol I, Hanss S, Hoffmann W, Hopff SM, Kraus M, Lorbeer R, Lorenz-Depiereux B, Illig T, Schäfer C, Schaller J, Stahl D, Valentin H, Heuschmann P, Vehreschild J. The Importance of Being FAIR and FAST - The Clinical Epidemiology and Study Platform of the German Network University Medicine (NUKLEUS). Stud Health Technol Inform 2023; 302:93-97. [PMID: 37203616 DOI: 10.3233/shti230071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The COVID-19 pandemic has urged the need to set up, conduct and analyze high-quality epidemiological studies within a very short time-scale to provide timely evidence on influential factors on the pandemic, e.g. COVID-19 severity and disease course. The comprehensive research infrastructure developed to run the German National Pandemic Cohort Network within the Network University Medicine is now maintained within a generic clinical epidemiology and study platform NUKLEUS. It is operated and subsequently extended to allow efficient joint planning, execution and evaluation of clinical and clinical-epidemiological studies. We aim to provide high-quality biomedical data and biospecimens and make its results widely available to the scientific community by implementing findability, accessibility, interoperability and reusability - i.e. following the FAIR guiding principles. Thus, NUKLEUS might serve as role model for FAIR and fast implementation of clinical epidemiological studies within the setting of University Medical Centers and beyond.
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Affiliation(s)
- Dagmar Krefting
- Dpt. of Medical Informatics, University Medical Center Göttingen, German Center for Cardiovascular Research (DZHK) partner site Göttingen, Germany
- Campus Institute Data Science (CIDAS), Georg-August-University Göttingen, Germany
| | - Gabi Anton
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Irina Chaplinskaya-Sobol
- Dpt. of Medical Informatics, University Medical Center Göttingen, German Center for Cardiovascular Research (DZHK) partner site Göttingen, Germany
| | - Sabine Hanss
- Dpt. of Medical Informatics, University Medical Center Göttingen, German Center for Cardiovascular Research (DZHK) partner site Göttingen, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Sina M Hopff
- Faculty of Medicine, University of Cologne, Department I of Internal Medicine, University Hospital Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Monika Kraus
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Roberto Lorbeer
- Medical Heart Center and Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Bettina Lorenz-Depiereux
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Thomas Illig
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Christian Schäfer
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Jens Schaller
- Medical Heart Center and Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Dana Stahl
- Independent Trusted Third Party of the University Medicine Greifswald, Germany
| | - Heike Valentin
- Independent Trusted Third Party of the University Medicine Greifswald, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg; Clinical Trial Center, University Hospital Würzburg, Germany
| | - Janne Vehreschild
- Faculty of Medicine, University of Cologne, Department I of Internal Medicine, University Hospital Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Department II for Internal Medicine, Hematology/Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany
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7
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Günthner R, Knipping L, Jeruschke S, Satanoskij R, Lorenz-Depiereux B, Hemmer C, Braunisch MC, Riedhammer KM, Ćomić J, Tönshoff B, Tasic V, Abazi-Emini N, Nushi-Stavileci V, Buiting K, Gjorgjievski N, Momirovska A, Patzer L, Kirschstein M, Gross O, Lungu A, Weber S, Renders L, Heemann U, Meitinger T, Büscher AK, Hoefele J. Renal X-inactivation in female individuals with X-linked Alport syndrome primarily determined by age. Front Med (Lausanne) 2022; 9:953643. [PMID: 36341250 PMCID: PMC9630586 DOI: 10.3389/fmed.2022.953643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/21/2022] [Indexed: 08/29/2023] Open
Abstract
X-linked Alport syndrome (AS) caused by hemizygous disease-causing variants in COL4A5 primarily affects males. Females with a heterozygous state show a diverse phenotypic spectrum ranging from microscopic hematuria to end-stage kidney disease (ESKD) and extrarenal manifestations. In other X-linked diseases, skewed X-inactivation leads to preferential silencing of one X-chromosome and thus can determine the phenotype in females. We aimed to show a correlation between X-inactivation in blood and urine-derived renal cells and clinical phenotype of females with a heterozygous disease-causing variant in COL4A5 compared to healthy controls. A total of 56 females with a heterozygous disease-causing COL4A5 variant and a mean age of 31.6 ± 18.3 SD years were included in this study. A total of 94% had hematuria, 62% proteinuria >200 mg/day, yet only 7% had decreased eGFR. Using human androgen receptor assay X-inactivation was examined in blood cells of all 56 individuals, in urine-derived cells of 27 of these individuals and in all healthy controls. X-inactivation did not correlate with age of first manifestation, proteinuria or eGFR neither in blood, nor in urine. The degree of X-inactivation showed a moderate association with age, especially in urine-derived cells of the patient cohort (rho = 0.403, p = 0.037). Determination of X-inactivation allelity revealed a shift of X-inactivation toward the COL4A5 variant bearing allele. This is the first study examining X-inactivation of urine-derived cells from female individuals with AS. A correlation between phenotype and X-inactivation could not be observed suspecting other genetic modifiers shaping the phenotype in female individuals with AS. The association of X-inactivation with age in urine-derived cells suggests an escape-mechanism inactivating the COL4A5 variant carrying allele in female individuals with AS.
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Affiliation(s)
- Roman Günthner
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Lea Knipping
- Pediatric Nephrology, University Hospital Essen, Essen, Germany
| | | | - Robin Satanoskij
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | | | - Clara Hemmer
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Matthias C. Braunisch
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Korbinian M. Riedhammer
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Jasmina Ćomić
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Velibor Tasic
- University Children’s Hospital, Medical Faculty of Skopje, Skopje, North Macedonia
| | - Nora Abazi-Emini
- University Children’s Hospital, Medical Faculty of Skopje, Skopje, North Macedonia
| | | | - Karin Buiting
- Institute for Human Genetics, University Hospital Essen, Essen, Germany
| | - Nikola Gjorgjievski
- University Hospital of Nephrology, Faculty of Medicine, University “Ss Cyril and Methodius,” Skopje, North Macedonia
| | | | - Ludwig Patzer
- Department of Pediatrics, Children’s Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | | | - Oliver Gross
- Clinic for Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Adrian Lungu
- Fundeni Clinical Institute, Pediatric Nephrology Department, Bucharest, Romania
| | - Stefanie Weber
- Department of Pediatrics II, University Children’s Hospital, Philipps-University Marburg, Marburg, Germany
| | - Lutz Renders
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Anja K. Büscher
- Pediatric Nephrology, University Hospital Essen, Essen, Germany
| | - Julia Hoefele
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
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8
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Schons M, Pilgram L, Reese JP, Stecher M, Anton G, Appel KS, Bahmer T, Bartschke A, Bellinghausen C, Bernemann I, Brechtel M, Brinkmann F, Brünn C, Dhillon C, Fiessler C, Geisler R, Hamelmann E, Hansch S, Hanses F, Hanß S, Herold S, Heyder R, Hofmann AL, Hopff SM, Horn A, Jakob C, Jiru-Hillmann S, Keil T, Khodamoradi Y, Kohls M, Kraus M, Krefting D, Kunze S, Kurth F, Lieb W, Lippert LJ, Lorbeer R, Lorenz-Depiereux B, Maetzler C, Miljukov O, Nauck M, Pape D, Püntmann V, Reinke L, Römmele C, Rudolph S, Sass J, Schäfer C, Schaller J, Schattschneider M, Scheer C, Scherer M, Schmidt S, Schmidt J, Seibel K, Stahl D, Steinbeis F, Störk S, Tauchert M, Tebbe JJ, Thibeault C, Toepfner N, Ungethüm K, Vadasz I, Valentin H, Wiedmann S, Zoller T, Nagel E, Krawczak M, von Kalle C, Illig T, Schreiber S, Witzenrath M, Heuschmann P, Vehreschild JJ. The German National Pandemic Cohort Network (NAPKON): rationale, study design and baseline characteristics. Eur J Epidemiol 2022; 37:849-870. [PMID: 35904671 PMCID: PMC9336157 DOI: 10.1007/s10654-022-00896-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
Abstract
The German government initiated the Network University Medicine (NUM) in early 2020 to improve national research activities on the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. To this end, 36 German Academic Medical Centers started to collaborate on 13 projects, with the largest being the National Pandemic Cohort Network (NAPKON). The NAPKON’s goal is creating the most comprehensive Coronavirus Disease 2019 (COVID-19) cohort in Germany. Within NAPKON, adult and pediatric patients are observed in three complementary cohort platforms (Cross-Sectoral, High-Resolution and Population-Based) from the initial infection until up to three years of follow-up. Study procedures comprise comprehensive clinical and imaging diagnostics, quality-of-life assessment, patient-reported outcomes and biosampling. The three cohort platforms build on four infrastructure core units (Interaction, Biosampling, Epidemiology, and Integration) and collaborations with NUM projects. Key components of the data capture, regulatory, and data privacy are based on the German Centre for Cardiovascular Research. By April 01, 2022, 34 university and 40 non-university hospitals have enrolled 5298 patients with local data quality reviews performed on 4727 (89%). 47% were female, the median age was 52 (IQR 36–62-) and 50 pediatric cases were included. 44% of patients were hospitalized, 15% admitted to an intensive care unit, and 12% of patients deceased while enrolled. 8845 visits with biosampling in 4349 patients were conducted by April 03, 2022. In this overview article, we summarize NAPKON’s design, relevant milestones including first study population characteristics, and outline the potential of NAPKON for German and international research activities. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04768998.https://clinicaltrials.gov/ct2/show/NCT04747366.https://clinicaltrials.gov/ct2/show/NCT04679584
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Affiliation(s)
- Maximilian Schons
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pilgram
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Jens-Peter Reese
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
| | - Gabriele Anton
- Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Katharina S. Appel
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Alexander Bartschke
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Carla Bellinghausen
- Department of Respiratory Medicine and Allergology, Medical Clinic 1, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Inga Bernemann
- Hannover Medical School, Hannover Unified Biobank, Hannover, Germany
| | - Markus Brechtel
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Folke Brinkmann
- Department of Paediatric Pneumology, Allergy and CF- Centre, University Children’s Hospital, Ruhr- University Bochum, Bochum, Germany
| | - Clara Brünn
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christine Dhillon
- COVID-19 Task Force, University Hospital Augsburg, Augsburg, Germany
| | - Cornelia Fiessler
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Ramsia Geisler
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Eckard Hamelmann
- Department of Pediatrics, Children’s Center Bethel, University Hospital East Westphalia, University Bielefeld, Bielefeld, Germany
| | - Stefan Hansch
- Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
| | - Frank Hanses
- Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Sabine Hanß
- University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
| | - Susanne Herold
- Department of Internal Medicine V, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany
- Department of Internal Medicine, German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University Giessen, Giessen, Germany
- Institute for Lung Health (ILH), Giessen, Germany
| | - Ralf Heyder
- NUM Coordination Office, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Anna-Lena Hofmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Sina Marie Hopff
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Horn
- Insitute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Carolin Jakob
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Steffi Jiru-Hillmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Thomas Keil
- Insitute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - Yascha Khodamoradi
- Department of Infectious Diseases, Medical Clinic 2, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Mirjam Kohls
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Monika Kraus
- Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Dagmar Krefting
- University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
| | - Sonja Kunze
- Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
| | - Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, and Department of Medicine I, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Lena Johanna Lippert
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Roberto Lorbeer
- Department of Radiology, University Hospital, LMU, Munich, Germany
- Medical Heart Center of Charité and German Heart Institute Berlin, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany
| | - Bettina Lorenz-Depiereux
- Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich, Germany
| | - Corina Maetzler
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Daniel Pape
- Department I of Internal Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Valentina Püntmann
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Lennart Reinke
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Römmele
- COVID-19 Task Force, University Hospital Augsburg, Augsburg, Germany
| | - Stefanie Rudolph
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Joint Charité and BIH Clinical Study Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Julian Sass
- Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Schäfer
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK e.V. (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Jens Schaller
- Medical Heart Center of Charité and German Heart Institute Berlin, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt – Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Mario Schattschneider
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christian Scheer
- Department of Anesthesiology and Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Margarete Scherer
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Sein Schmidt
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Clinical Study Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Julia Schmidt
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Kristina Seibel
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dana Stahl
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
- University Medicine Greifswald, Greifswald, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Maike Tauchert
- Institute of Epidemiology, Helmholtz Center Munich, Munich, Germany
| | - Johannes Josef Tebbe
- Department of Gastroenterology and Infectious Disease, University Medical Center East Westphalia-Lippe, Klinikum Lippe, Detmold, Germany
| | - Charlotte Thibeault
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Nicole Toepfner
- Department of Pediatrics, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | - Kathrin Ungethüm
- Insitute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Istvan Vadasz
- Institute for Lung Health (ILH), Giessen, Germany
- Department of Internal Medicine, University Hospital Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
- Universities of Giessen and Marburg Lung Center (UGMLC), German Center for Lung Research (DZL), Frankfurt, Germany
| | - Heike Valentin
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
- University Medicine Greifswald, Greifswald, Germany
| | - Silke Wiedmann
- NUM Coordination Office, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Zoller
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Eike Nagel
- German Center for Cardiovascular Diseases (DZHK), Berlin, Germany
- Institute for Experimental and Translational Cardiovascular Imaging, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christof von Kalle
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin Institute of Health (BIH) at Charité – Universitätsmedizin Berlin, Joint Charité and BIH Clinical Study Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Illig
- Hannover Medical School, Hannover Unified Biobank, Hannover, Germany
| | - Stefan Schreiber
- Department of Internal Medicine I, University Hospital Schleswig Holstein, Kiel University, Kiel, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- German Center for Lung Research (DZL), Frankfurt, Germany
| | - Peter Heuschmann
- Insitute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt,, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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9
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Dayal D, Gupta S, Kumar R, Srinivasan R, Lorenz-Depiereux B, Strom TM. A novel homozygous variant in exon 10 of the GALNT3 gene causing hyperphosphatemic familial tumoral calcinosis in a family from North India. Intractable Rare Dis Res 2021; 10:55-57. [PMID: 33614378 PMCID: PMC7882081 DOI: 10.5582/irdr.2020.03084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hyperphosphatemic familial tumoral calcinosis (HFTC) is an extremely rare autosomal recessive disorder caused by variants in the GALNT3 (N-acetylgalactosaminyltransferase 3), FGF23 (Fibroblast Growth Factor-23) and αKL (α-Klotho) genes, which results in progressive calcification of soft tissues. We describe the case of a 9-year-old girl who presented with recurrent hard nodular swellings on her feet and knees which intermittently discharged chalky white material. Her younger brother also had a similar condition. Both siblings showed hyperphosphatemia, but the parentsbiochemical parameters were normal. The histological features of the material aspirated from a skin lesion were consistent with tumoral calcinosis. Sanger sequencing identified a novel homozygous non-synonymous sequence variant in exon 10 of the GALNT3 gene (NM_004482.3:c.[1681T>A];[1681T>A], NP_004473.2:p. [Cys561Ser];[Cys561Ser] in the proband and her affected brother. The parents were heterozygous carriers for the same sequence variant. In conclusion, we report a new variant in the GALNT3 gene that caused HFTC in a North Indian family.
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Affiliation(s)
- Devi Dayal
- Endocrinology and Diabetes Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Address correspondence to:Devi Dayal, Endocrinology and Diabetes Unit, Department of Pediatrics, 3108, Level III, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India. E-mail:
| | - Shruti Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kumar
- Endocrinology and Diabetes Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Tim M Strom
- Institute of Human Genetics, Technische Universität München, Munich, Germany
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10
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Krenn M, Wagner M, Hotzy C, Graf E, Weber S, Brunet T, Lorenz-Depiereux B, Kasprian G, Aull-Watschinger S, Pataraia E, Stogmann E, Zimprich A, Strom TM, Meitinger T, Zimprich F. Diagnostic exome sequencing in non-acquired focal epilepsies highlights a major role of GATOR1 complex genes. J Med Genet 2020; 57:624-633. [PMID: 32086284 DOI: 10.1136/jmedgenet-2019-106658] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The genetic architecture of non-acquired focal epilepsies (NAFEs) becomes increasingly unravelled using genome-wide sequencing datasets. However, it remains to be determined how this emerging knowledge can be translated into a diagnostic setting. To bridge this gap, we assessed the diagnostic outcomes of exome sequencing (ES) in NAFE. METHODS 112 deeply phenotyped patients with NAFE were included in the study. Diagnostic ES was performed, followed by a screen to detect variants of uncertain significance (VUSs) in 15 well-established focal epilepsy genes. Explorative gene prioritisation was used to identify possible novel candidate aetiologies with so far limited evidence for NAFE. RESULTS ES identified pathogenic or likely pathogenic (ie, diagnostic) variants in 13/112 patients (12%) in the genes DEPDC5, NPRL3, GABRG2, SCN1A, PCDH19 and STX1B. Two pathogenic variants were microdeletions involving NPRL3 and PCDH19. Nine of the 13 diagnostic variants (69%) were found in genes of the GATOR1 complex, a potentially druggable target involved in the mammalian target of rapamycin (mTOR) signalling pathway. In addition, 17 VUSs in focal epilepsy genes and 6 rare variants in candidate genes (MTOR, KCNA2, RBFOX1 and SCN3A) were detected. Five patients with reported variants had double hits in different genes, suggesting a possible (oligogenic) role of multiple rare variants. CONCLUSION This study underscores the molecular heterogeneity of NAFE with GATOR1 complex genes representing the by far most relevant genetic aetiology known to date. Although the diagnostic yield is lower compared with severe early-onset epilepsies, the high rate of VUSs and candidate variants suggests a further increase in future years.
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Affiliation(s)
- Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Matias Wagner
- Institute of Human Genetics, Technical University Munich, Munich, Bayern, Germany.,Institute of Neurogenomics, Helmholtz Center Munich, Neuherberg, Bayern, Germany
| | - Christoph Hotzy
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Graf
- Institute of Human Genetics, Helmholtz Center Munich, Neuherberg, Bayern, Germany
| | - Sandrina Weber
- Institute of Human Genetics, Helmholtz Center Munich, Neuherberg, Bayern, Germany
| | - Theresa Brunet
- Institute of Human Genetics, Technical University Munich, Munich, Bayern, Germany
| | | | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | - Tim M Strom
- Institute of Human Genetics, Technical University Munich, Munich, Bayern, Germany.,Institute of Human Genetics, Helmholtz Center Munich, Neuherberg, Bayern, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Technical University Munich, Munich, Bayern, Germany.,Institute of Human Genetics, Helmholtz Center Munich, Neuherberg, Bayern, Germany
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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11
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Wagner M, Berutti R, Lorenz-Depiereux B, Graf E, Eckstein G, Mayr JA, Meitinger T, Ahting U, Prokisch H, Strom TM, Wortmann SB. Mitochondrial DNA mutation analysis from exome sequencing-A more holistic approach in diagnostics of suspected mitochondrial disease. J Inherit Metab Dis 2019; 42:909-917. [PMID: 31059585 DOI: 10.1002/jimd.12109] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 12/19/2022]
Abstract
Diagnostics for suspected mitochondrial disease (MD) can be challenging and necessitate invasive procedures like muscle biopsy. This is due to the extremely broad genetic and phenotypic spectrum, disease genes on both nuclear and mitochondrial DNA (mtDNA), and the tissue specificity of mtDNA variants. Exome sequencing (ES) has revolutionized the diagnostics for MD. However, the nuclear and mtDNA are investigated with separate tests, increasing costs and duration of diagnostics. The full potential of ES is often not exploited as the additional analysis of "off-target reads" deriving from the mtDNA can be used to analyze both genomes. We performed mtDNA analysis by ES of 2111 cases in a clinical setting. We further assessed the recall rate and precision as well as the estimation of heteroplasmy by ES data by comparison with targeted mtDNA next generation sequencing in 49 cases. ES identified known pathogenic mtDNA point mutations in 38 individuals, increasing the diagnostic yield by nearly 2%. Analysis of mtDNA variants by ES had a high recall rate (96.2 ± 5.6%) and an excellent precision (99.5 ± 2.2%) when compared to the gold standard of targeted mtDNA next generation sequencing. ES estimated heteroplasmy levels with an average difference of 6.6 ± 3.8%, sufficient for clinical decision making. Taken together, the mtDNA analysis from ES is of sufficient quality for clinical diagnostics. We therefore propose ES, investigating both nuclear and mtDNA, as first line test in individuals with suspected MD. One should be aware, that a negative result does not exclude MD and necessitates further test (in additional tissues).
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Affiliation(s)
- Matias Wagner
- Institute of Human Genetics, Technical University München, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Riccardo Berutti
- Institute of Human Genetics, Technical University München, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | | | - Elisabeth Graf
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gertrud Eckstein
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Johannes A Mayr
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Thomas Meitinger
- Institute of Human Genetics, Technical University München, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Uwe Ahting
- Institute of Human Genetics, Technical University München, Munich, Germany
| | - Holger Prokisch
- Institute of Human Genetics, Technical University München, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Tim M Strom
- Institute of Human Genetics, Technical University München, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Saskia B Wortmann
- Institute of Human Genetics, Technical University München, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
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12
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Diener S, Schorpp K, Strom TM, Hadian K, Lorenz-Depiereux B. Development of A Cell-Based Assay to Identify Small Molecule Inhibitors of FGF23 Signaling. Assay Drug Dev Technol 2015; 13:476-87. [DOI: 10.1089/adt.2015.653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Susanne Diener
- German Research Center for Environmental Health, Institute of Human Genetics, HelmholtzZentrum München, Neuherberg, Bavaria, Germany
| | - Kenji Schorpp
- Assay Development and Screening Platform, German Research Center for Environmental Health, Institute of Molecular Toxicology and Pharmacology, HelmholtzZentrum München, Neuherberg, Bavaria, Germany
| | - Tim-Matthias Strom
- German Research Center for Environmental Health, Institute of Human Genetics, HelmholtzZentrum München, Neuherberg, Bavaria, Germany
- Institute of Human Genetics, Klinikum rechts der Isar der Technischen Universität München, Munich, Bavaria, Germany
| | - Kamyar Hadian
- Assay Development and Screening Platform, German Research Center for Environmental Health, Institute of Molecular Toxicology and Pharmacology, HelmholtzZentrum München, Neuherberg, Bavaria, Germany
| | - Bettina Lorenz-Depiereux
- German Research Center for Environmental Health, Institute of Human Genetics, HelmholtzZentrum München, Neuherberg, Bavaria, Germany
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13
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Steichen-Gersdorf E, Lorenz-Depiereux B, Strom TM, Shaw NJ. Early onset hearing loss in autosomal recessive hypophosphatemic rickets caused by loss of function mutation in ENPP1. J Pediatr Endocrinol Metab 2015; 28:967-70. [PMID: 25741938 DOI: 10.1515/jpem-2014-0531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 02/04/2015] [Indexed: 11/15/2022]
Abstract
Autosomal recessive hypophosphatemic rickets 2 (ARHR2) is a rare form of renal tubular phosphate wasting disorder. Loss of function mutations of the ecto-nucleotide pyrophosphatase/pyrophosphodiesterase 1 gene (ENPP1) causes a wide spectrum of phenotypes, ranging from lethal generalized arterial calcification of infancy to hypophosphatemic rickets with hypertension. Hearing loss was not previously thought to be one of the features of the disease entities and was merely regarded as a complication rather than a part of the disease. We report two children who presented in mid to late childhood with progressive varus deformity of their legs due to hypophosphatemic rickets caused by mutations in the ENPP1 gene. Both children had evidence of progressive hearing loss requiring the use of hearing aids. This report of two unrelated infants with compound heterozygous mutations in ENPP1 and previously published cases confirms that mild to moderate hearing loss is frequently associated with ARHR2. Early onset conductive hearing loss may further distinguish the autosomal recessive ENPP1 related type from other types of hypophosphatemia.
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Pekkarinen T, Lorenz-Depiereux B, Lohman M, Mäkitie O. Unusually severe hypophosphatemic rickets caused by a novel and complex re-arrangement of thePHEXgene. Am J Med Genet A 2014; 164A:2931-7. [DOI: 10.1002/ajmg.a.36721] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/09/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Tuula Pekkarinen
- Division of Endocrinology; Department of Medicine; Helsinki University Central Hospital; Vantaa Finland
| | | | - Martina Lohman
- HUS Medical Imaging Center; Helsinki University Hospital; Helsinki Finland
| | - Outi Mäkitie
- Pediatric Endocrinology and Metabolic Bone Diseases; Children's Hospital; Helsinki University Central Hospital and University of Helsinki; Helsinki Finland
- Folkhälsan Institute of Genetics; Helsinki Finland
- Department of Molecular Medicine and Surgery; Karolinska Institutet; and Department of Clinical Genetics; Karolinska University Hospital; Stockholm Sweden
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Sabrautzki S, Rubio-Aliaga I, Hans W, Fuchs H, Rathkolb B, Calzada-Wack J, Cohrs CM, Klaften M, Seedorf H, Eck S, Benet-Pagès A, Favor J, Esposito I, Strom TM, Wolf E, Lorenz-Depiereux B, Hrabĕ de Angelis M. Erratum to: New mouse models for metabolic bone diseases generated by genome-wide ENU mutagenesis. Mamm Genome 2014. [PMCID: PMC4714016 DOI: 10.1007/s00335-014-9534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sabrautzki S, Janas E, Lorenz-Depiereux B, Calzada-Wack J, Aguilar-Pimentel JA, Rathkolb B, Adler T, Cohrs C, Hans W, Diener S, Fuchs H, Gailus-Durner V, Busch DH, Höfler H, Ollert M, Strom TM, Wolf E, Neff F, Hrabě de Angelis M. An ENU mutagenesis-derived mouse model with a dominant Jak1 mutation resembling phenotypes of systemic autoimmune disease. Am J Pathol 2013; 183:352-68. [PMID: 23791841 DOI: 10.1016/j.ajpath.2013.04.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 04/10/2013] [Accepted: 04/12/2013] [Indexed: 01/12/2023]
Abstract
Within the Munich, Germany, N-ethyl-N-nitrosourea mouse mutagenesis program, we isolated a dominant Jak1 mouse model resembling phenotypic characteristics related to autoimmune disease. Chromosomal sequencing revealed a new Jak1 (p.Ser645Pro) point mutation at the conserved serine of the pseudokinase domain, corresponding to a somatic human mutation (p.Ser646Phe) inducing a constitutive activation of the Janus kinase (JAK)/STAT pathway. Morphologically, all Jak1(S645P+/-) mice showed a progressive structural deterioration of ears starting at the age of 4 months, with mononuclear cell infiltration into the dermis. Female mutant mice, in particular, developed severe skin lesions in the neck from 7 months of age. The IHC analysis of these lesions showed an activation of Stat3 downstream to Jak1(S645P) and elevated tissue levels of IL-6. Histopathological analysis of liver revealed a nodular regenerative hyperplasia. In the spleen, the number of Russell bodies was doubled, correlating with significant increased levels of all immunoglobulin isotypes and anti-DNA antibodies in serum. Older mutant mice developed thrombocytopenia and altered microcytic red blood cell counts. Jak1(S645P+/-) mice showed phenotypes related to impaired bone metabolism as increased carboxy-terminal collagen cross-link-1 levels and alkaline phosphatase activities in plasma, hypophosphatemia, and strongly decreased bone morphometric values. Taken together, Jak1(S645P+/-) mice showed an increased activation of the IL-6-JAK-STAT pathway leading to a systemic lupus erythematosus-like phenotype and offering a new valuable tool to study the role of the JAK/STAT pathway in disease development.
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Affiliation(s)
- Sibylle Sabrautzki
- Institute of Experimental Genetics and the German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
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Horn D, Kapeller J, Rivera-Brugués N, Moog U, Lorenz-Depiereux B, Eck S, Hempel M, Wagenstaller J, Gawthrope A, Monaco AP, Bonin M, Riess O, Wohlleber E, Illig T, Bezzina CR, Franke A, Spranger S, Villavicencio-Lorini P, Seifert W, Rosenfeld J, Klopocki E, Rappold GA, Strom TM. Identification of FOXP1 deletions in three unrelated patients with mental retardation and significant speech and language deficits. Hum Mutat 2010; 31:E1851-60. [PMID: 20848658 PMCID: PMC3049153 DOI: 10.1002/humu.21362] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mental retardation affects 2-3% of the population and shows a high heritability.Neurodevelopmental disorders that include pronounced impairment in language and speech skills occur less frequently. For most cases, the molecular basis of mental retardation with or without speech and language disorder is unknown due to the heterogeneity of underlying genetic factors.We have used molecular karyotyping on 1523 patients with mental retardation to detect copy number variations (CNVs) including deletions or duplications. These studies revealed three heterozygous overlapping deletions solely affecting the forkhead box P1 (FOXP1) gene. All three patients had moderate mental retardation and significant language and speech deficits. Since our results are consistent with a de novo occurrence of these deletions, we considered them as causal although we detected a single large deletion including FOXP1 and additional genes in 4104 ancestrally matched controls. These findings are of interest with regard to the structural and functional relationship between FOXP1 and FOXP2. Mutations in FOXP2 have been previously related to monogenic cases of developmental verbal dyspraxia. Both FOXP1 and FOXP2 are expressed in songbird and human brain regions that are important for the developmental processes that culminate in speech and language.
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Affiliation(s)
- Denise Horn
- Institute of Medical Genetics, Charité, University Medicine of Berlin, Berlin, Germany
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Lorenz-Depiereux B, Schnabel D, Tiosano D, Häusler G, Strom TM. Loss-of-function ENPP1 mutations cause both generalized arterial calcification of infancy and autosomal-recessive hypophosphatemic rickets. Am J Hum Genet 2010; 86:267-72. [PMID: 20137773 PMCID: PMC2820166 DOI: 10.1016/j.ajhg.2010.01.006] [Citation(s) in RCA: 248] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/04/2010] [Accepted: 01/08/2010] [Indexed: 01/08/2023] Open
Abstract
The analysis of rare genetic disorders affecting phosphate homeostasis led to the identification of several proteins that are essential for the renal regulation of phosphate homeostasis; for example, fibroblast growth factor 23 (FGF23), which inhibits renal phosphate reabsorption and 1,25-dihydroxyvitamin D synthesis. Here, we report presumable loss-of-function mutations in the ENPP1 gene (ectonucleotide pyrophosphatase/phosphodiesterase) in members of four families affected with hypophosphatemic rickets. We provide evidence for the conclusion that ENPP1 is the fourth gene-in addition to PHEX, FGF23, and DMP1-that, if mutated, causes hypophosphatemic rickets resulting from elevated FGF23 levels. Surprisingly, ENPP1 loss-of-function mutations have previously been described in generalized arterial calcification of infancy, suggesting an as yet elusive mechanism that balances arterial calcification with bone mineralization.
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Affiliation(s)
- Bettina Lorenz-Depiereux
- Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Dirk Schnabel
- Department of Pediatric Endocrinology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Dov Tiosano
- Pediatric Endocrinology, Meyer Children's Hospital, Rambam Medical Center, 31096 Haifa, Israel
- Faculty of Medicine, Technion-Israel Institute of Technology, 31096 Haifa, Israel
| | - Gabriele Häusler
- Department of Pediatrics, Medizinische Universität Wien, 1090 Vienna, Austria
| | - Tim M. Strom
- Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
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Barthlen W, Blankenstein O, Mau H, Koch M, Höhne C, Mohnike W, Eberhard T, Fuechtner F, Lorenz-Depiereux B, Mohnike K. Evaluation of [18F]fluoro-L-DOPA positron emission tomography-computed tomography for surgery in focal congenital hyperinsulinism. J Clin Endocrinol Metab 2008; 93:869-75. [PMID: 18073294 DOI: 10.1210/jc.2007-2036] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In congenital hyperinsulinism (CHI), the identification and precise localization of a focal lesion is essential for successful surgery. OBJECTIVE Our objective was to evaluate the predictive value and accuracy of integrated [18F]fluoro-L-DOPA ([18F]FDOPA) positron emission tomography (PET)-computed tomography (CT) for the surgical therapy of CHI. DESIGN This was an observational study. SETTING The study was performed in the Department of Pediatric Surgery at a university hospital. PATIENTS From February 2005 to September 2007, 10 children with the clinical signs of CHI and an increased radiotracer uptake in a circumscribed area of the pancreas in the [18F]FDOPA PET-CT were evaluated. INTERVENTIONS Guided by the [18F]FDOPA PET-CT report, all children underwent partial pancreatic resection, in two cases twice. MAIN OUTCOME MEASURES Correlation of the anatomical findings at surgery with the report of the [18F]FDOPA PET-CT, and the results of surgery and clinical outcome were determined. RESULTS In nine children the intraoperative situation corresponded exactly to the description of the [18F]FDOPA PET-CT. A limited resection of the pancreas was curative in eight cases at the first surgery, in one case at the second intervention. We observed no diabetes mellitus or exocrine insufficiency in the follow up so far. In one child, hypoglycemia persisted even after two partial resections of the pancreatic head. Histological analysis finally revealed an atypical intermediate form of CHI. CONCLUSIONS The integrated [18F]FDOPA PET-CT is accurate to localize the lesion in focal CHI and is a valuable tool to guide the surgeon in limited pancreatic resection.
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Affiliation(s)
- Winfried Barthlen
- Clinic for Pediatric Surgery, Institute for Pathology, Charité University Medicine Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Mittelallee 8, D-13353 Berlin, Germany.
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Wollweber A, Däublin G, Lorenz-Depiereux B, Strom TM, Blankenstein O, Raile K. Erfolgreiche Glibenclamidtherapie eines jungen Säuglings mit einer Mutation im KCNJ11-Gen. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Däublin G, Lorenz-Depiereux B, Strom TM, Blankenstein O, Raile K. Early glibenclamide treatment in a clinical newborn with KCNJ11 gene mutation. Diabetes Care 2007; 30:e104. [PMID: 17901525 DOI: 10.2337/dc07-1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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22
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Wagenstaller J, Spranger S, Lorenz-Depiereux B, Kazmierczak B, Nathrath M, Wahl D, Heye B, Glaser D, Liebscher V, Meitinger T, Strom TM. Copy-number variations measured by single-nucleotide-polymorphism oligonucleotide arrays in patients with mental retardation. Am J Hum Genet 2007; 81:768-79. [PMID: 17847001 PMCID: PMC2227926 DOI: 10.1086/521274] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 06/26/2007] [Indexed: 12/31/2022] Open
Abstract
Whole-genome analysis using high-density single-nucleotide-polymorphism oligonucleotide arrays allows identification of microdeletions, microduplications, and uniparental disomies. We studied 67 children with unexplained mental retardation with normal karyotypes, as assessed by G-banded chromosome analyses. Their DNAs were analyzed with Affymetrix 100K arrays. We detected 11 copy-number variations that most likely are causative of mental retardation, because they either arose de novo (9 cases) and/or overlapped with known microdeletions (2 cases). The eight deletions and three duplications varied in size from 200 kb to 7.5 Mb. Of the 11 copy-number variations, 5 were flanked by low-copy repeats. Two of those, on chromosomes 15q25.2 and Xp22.31, have not been described before and have a high probability of being causative of new deletion and duplication syndromes, respectively. In one patient, we found a deletion affecting only a single gene, MBD5, which codes for the methyl-CpG-binding domain protein 5. In addition to the 67 children, we investigated 4 mentally retarded children with apparent balanced translocations and detected four deletions at breakpoint regions ranging in size from 1.1 to 14 Mb.
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Affiliation(s)
- Janine Wagenstaller
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany
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Lorenz-Depiereux B, Bastepe M, Benet-Pagès A, Amyere M, Wagenstaller J, Müller-Barth U, Badenhoop K, Kaiser SM, Rittmaster RS, Shlossberg AH, Olivares JL, Loris C, Ramos FJ, Glorieux F, Vikkula M, Jüppner H, Strom TM. DMP1 mutations in autosomal recessive hypophosphatemia implicate a bone matrix protein in the regulation of phosphate homeostasis. Nat Genet 2006; 38:1248-50. [PMID: 17033625 PMCID: PMC5942547 DOI: 10.1038/ng1868] [Citation(s) in RCA: 359] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 08/03/2006] [Indexed: 12/14/2022]
Abstract
Hypophosphatemia is a genetically heterogeneous disease. Here, we mapped an autosomal recessive form (designated ARHP) to chromosome 4q21 and identified homozygous mutations in DMP1 (dentin matrix protein 1), which encodes a non-collagenous bone matrix protein expressed in osteoblasts and osteocytes. Intact plasma levels of the phosphaturic protein FGF23 were clearly elevated in two of four affected individuals, providing a possible explanation for the phosphaturia and inappropriately normal 1,25(OH)2D levels and suggesting that DMP1 may regulate FGF23 expression.
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Affiliation(s)
- Bettina Lorenz-Depiereux
- Institute of Human Genetics, GSF National Research Center for Environment and Health, 85764 Munich-Neuherberg, Germany
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Rjosk D, Lorenz-Depiereux B, Janni W, Friese K. Klinik und molekulargenetische Untersuchungen bei XY-Gonadendysgenesie (Swyer-Syndrom). Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Kato K, Jeanneau C, Tarp MA, Benet-Pagès A, Lorenz-Depiereux B, Bennett EP, Mandel U, Strom TM, Clausen H. Polypeptide GalNAc-transferase T3 and familial tumoral calcinosis. Secretion of fibroblast growth factor 23 requires O-glycosylation. J Biol Chem 2006; 281:18370-7. [PMID: 16638743 DOI: 10.1074/jbc.m602469200] [Citation(s) in RCA: 305] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Mutations in the gene encoding the glycosyltransferase polypeptide GalNAc-T3, which is involved in initiation of O-glycosylation, were recently identified as a cause of the rare autosomal recessive metabolic disorder familial tumoral calcinosis (OMIM 211900). Familial tumoral calcinosis is associated with hyperphosphatemia and massive ectopic calcifications. Here, we demonstrate that the secretion of the phosphaturic factor fibroblast growth factor 23 (FGF23) requires O-glycosylation, and that GalNAc-T3 selectively directs O-glycosylation in a subtilisin-like proprotein convertase recognition sequence motif, which blocks processing of FGF23. The study suggests a novel posttranslational regulatory model of FGF23 involving competing O-glycosylation and protease processing to produce intact FGF23.
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Affiliation(s)
- Kentaro Kato
- Department of Medical Biochemistry and Genetics, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark
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Lorenz-Depiereux B, Benet-Pages A, Eckstein G, Tenenbaum-Rakover Y, Wagenstaller J, Tiosano D, Gershoni-Baruch R, Albers N, Lichtner P, Schnabel D, Hochberg Z, Strom TM. Hereditary hypophosphatemic rickets with hypercalciuria is caused by mutations in the sodium-phosphate cotransporter gene SLC34A3. Am J Hum Genet 2006; 78:193-201. [PMID: 16358215 PMCID: PMC1380229 DOI: 10.1086/499410] [Citation(s) in RCA: 232] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Accepted: 10/10/2005] [Indexed: 01/08/2023] Open
Abstract
Hypophosphatemia due to isolated renal phosphate wasting results from a heterogeneous group of disorders. Hereditary hypophosphatemic rickets with hypercalciuria (HHRH) is an autosomal recessive form that is characterized by reduced renal phosphate reabsorption, hypophosphatemia, and rickets. It can be distinguished from other forms of hypophosphatemia by increased serum levels of 1,25-dihydroxyvitamin D resulting in hypercalciuria. Using SNP array genotyping, we mapped the disease locus in two consanguineous families to the end of the long arm of chromosome 9. The candidate region contained a sodium-phosphate cotransporter gene, SLC34A3, which has been shown to be expressed in proximal tubulus cells. Sequencing of this gene revealed disease-associated mutations in five families, including two frameshift and one splice-site mutation. Loss of function of the SLC34A3 protein presumably results in a primary renal tubular defect and is compatible with the HHRH phenotype. We also show that the phosphaturic factor FGF23 (fibroblast growth factor 23), which is increased in X-linked hypophosphatemic rickets and carries activating mutations in autosomal dominant hypophosphatemic rickets, is at normal or low-normal serum levels in the patients with HHRH, further supporting a primary renal defect. Identification of the gene mutated in a further form of hypophosphatemia adds to the understanding of phosphate homeostasis and may help to elucidate the interaction of the proteins involved in this pathway.
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Affiliation(s)
- Bettina Lorenz-Depiereux
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Anna Benet-Pages
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Gertrud Eckstein
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Yardena Tenenbaum-Rakover
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Janine Wagenstaller
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Dov Tiosano
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Ruth Gershoni-Baruch
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Norbert Albers
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Peter Lichtner
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Dirk Schnabel
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Ze’ev Hochberg
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
| | - Tim M. Strom
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Munich-Neuherberg, Germany; Pediatric Endocrine Unit, Ha’ Emek Medical Center, Afula, Israel; Meyer Children’s Hospital and Technion–Israel Institute of Technology, Haifa, Israel; Children’s Hospital, Osnabrück, Germany; Department for Pediatric Endocrinology, Charité, Berlin; and Institute of Human Genetics, Klinikum rechts der Isar, Technical University, Munich
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Dichgans M, Freilinger T, Eckstein G, Babini E, Lorenz-Depiereux B, Biskup S, Ferrari MD, Herzog J, van den Maagdenberg AMJM, Pusch M, Strom TM. Mutation in the neuronal voltage-gated sodium channel SCN1A in familial hemiplegic migraine. Lancet 2005; 366:371-7. [PMID: 16054936 DOI: 10.1016/s0140-6736(05)66786-4] [Citation(s) in RCA: 548] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Familial hemiplegic migraine is an autosomal dominant severe subtype of migraine with aura characterised by some degree of hemiparesis during the attacks. So far, mutations in two genes regulating ion translocation-CACNA1A and ATP1A2-have been identified in pedigrees with this disease. METHODS To identify additional genes for familial hemiplegic migraine, we did a genome-wide linkage analysis of two disease pedigrees without mutations in CACNA1A and ATP1A2. Ion channel genes in the candidate interval were analysed for mutations, and the functional consequences of the recorded sequence alteration were determined. FINDINGS We identified a novel locus for familial hemiplegic migraine on chromosome 2q24. Sequencing of candidate genes in this region revealed a heterozygous missense mutation (Gln1489Lys) in the neuronal voltage-gated sodium channel gene SCN1A, mutations of which have been associated with epilepsy. This same mutation was present in three families with familial hemiplegic migraine. It results in a charge-altering aminoacid exchange in the so-called hinged-lid domain of the protein, which is critical for fast inactivation of the channel. Whole-cell recordings in transiently transfected tsA201 cells expressing the highly homologous SCN5A sodium channel showed that the mutation induces a two-fold to four-fold accelerated recovery from fast inactivation without altering any of the other channel parameters investigated. INTERPRETATION Dysfunction of the neuronal sodium channel SCN1A can cause familial hemiplegic migraine. Our findings have implications for the understanding of migraine aura. Moreover, our study reinforces the molecular links between migraine and epilepsy, two common paroxysmal disorders.
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Affiliation(s)
- Martin Dichgans
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-Universität, 81377 München, Germany.
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Benet-Pagès A, Orlik P, Strom TM, Lorenz-Depiereux B. An FGF23 missense mutation causes familial tumoral calcinosis with hyperphosphatemia. Hum Mol Genet 2005; 14:385-90. [PMID: 15590700 DOI: 10.1093/hmg/ddi034] [Citation(s) in RCA: 407] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Familial tumoral calcinosis (FTC) is an autosomal recessive disorder characterized by ectopic calcifications and elevated serum phosphate levels. Recently, mutations in the GALNT3 gene have been described to cause FTC. The FTC phenotype is regarded as the metabolic mirror image of hypophosphatemic conditions, where causal mutations are known in genes FGF23 or PHEX. We investigated an individual with FTC who was negative for GALNT3 mutations. Sequencing revealed a homozygous missense mutation in the FGF23 gene (p.S71G) at an amino acid position which is conserved from fish to man. Wild-type FGF23 is secreted as intact protein and processed N-terminal and C-terminal fragments. Expression of the mutated protein in HEK293 cells showed that only the C-terminal fragment is secreted, whereas the intact protein is retained in the Golgi complex. In addition, determination of circulating FGF23 in the affected individual showed a marked increase in the C-terminal fragment. These results suggest that the FGF23 function is decreased by absent or extremely reduced secretion of intact FGF23. We conclude that FGF23 mutations in hypophosphatemic rickets and FTC have opposite effects on phosphate homeostasis.
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Affiliation(s)
- Anna Benet-Pagès
- Institute of Human Genetics, GSF National Research Center for Environment and Health, Ingolstädter Landstr. 1, 85764 Munich-Neuherberg, Germany
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Lorenz-Depiereux B, Guido VE, Johnson KR, Zheng QY, Gagnon LH, Bauschatz JD, Davisson MT, Washburn LL, Donahue LR, Strom TM, Eicher EM. New intragenic deletions in the Phex gene clarify X-linked hypophosphatemia-related abnormalities in mice. Mamm Genome 2004; 15:151-61. [PMID: 15029877 PMCID: PMC2859190 DOI: 10.1007/s00335-003-2310-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
X-linked hypophosphatemic rickets (XLH) in humans is caused by mutation in the PHEX gene. Previously, three mutations in the mouse Phex gene have been reported: Phex(Hyp), Gy, and Phex(Ska1). Here we report analysis of two new spontaneous mutation in the mouse Phex gene, Phex(Hyp-2J) and Phex(Hyp-Duk). Phex(Hyp-2J) and Phex(Hyp-Duk) involve intragenic deletions of at least 7.3 kb containing exon 15, and 30 kb containing exons 13 and 14, respectively. Both mutations cause similar phenotypes in males, including shortened hind legs and tail, a shortened square trunk, hypophosphatemia, hypocalcemia, and rachitic bone disease. In addition, mice carrying the Phex(Hyp-Duk) mutation exhibit background-dependent variable expression of deafness, circling behavior, and cranial dysmorphology, demonstrating the influence of modifying genes on Phex-related phenotypes. Cochlear cross-sections from Phex(Hyp-2J)/Y and Phex(Hyp-Duk)/Y males reveal a thickening of the temporal bones surrounding the cochlea with the presence of a precipitate in the scala tympani. Evidence of the degeneration of the organ of Corti and spiral ganglion also are present in the hearing-impaired Phex(Hyp-Duk)/Y mice, but not in the normal-hearing Phex(Hyp-2J)/Y mice. Analysis of the phenotypes noted in Phex(Hyp-Duk)/Y and Phex(Hyp-2J)/Y males, together with those noted in Phex(Ska1)/Y and Phex(Hyp)/Y males, now allow XLH-related phenotypes to be separated from non-XLH-related phenotypes, such as those noted in Gy/Y males. Also, identification of the genetic modifiers of hearing and craniofacial dysmorphology in Phex(Hyp-Duk)/Y mice could provide insight into the phenotypic variation of XLH in humans.
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Benet-Pagès A, Lorenz-Depiereux B, Zischka H, White KE, Econs MJ, Strom TM. FGF23 is processed by proprotein convertases but not by PHEX. Bone 2004; 35:455-62. [PMID: 15268897 DOI: 10.1016/j.bone.2004.04.002] [Citation(s) in RCA: 213] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Revised: 03/23/2004] [Accepted: 04/01/2004] [Indexed: 11/26/2022]
Abstract
X-linked hypophosphatemia (XLH) and autosomal dominant hypophosphatemic rickets (ADHR) are characterized by renal phosphate wasting, rickets, and osteomalacia. ADHR is caused by gain of function mutations in the fibroblast growth factor 23 gene (FGF23). During secretion, FGF23 is processed at the C-terminus between amino acids 179 and 180. The cleavage site is mutated in ADHR, preventing processing of FGF23. Here, we show that FGF23 is likely to be cleaved by subtilisin-like proprotein convertases (SPC) as cleavage can be inhibited by a specific SPC inhibitor in HEK293 cells. SPCs, which are widely expressed, were demonstrated to be also present in HEK293 cells as well as in osteoblasts. XLH is caused by loss of function mutations in the putative endopeptidase PHEX. It was tempting to speculate that FGF23 is a substrate of PHEX, but studies have been inconclusive so far. Here, we used a secreted form of PHEX (secPHEX) and tagged and untagged FGF23 constructs for co-incubation experiments. These experiments provided evidence against cleavage of intact FGF23(25-251) as well as of N-terminal (FGF23(25-179)) and C-terminal (FGF23(180-251)) fragments by the endopeptidase PHEX.
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Affiliation(s)
- Anna Benet-Pagès
- Institute of Human Genetics, GSF National Research Center, 85764 München-Neuherberg, Germany
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Freilinger T, Eckstein G, Herzog J, Lorenz-Depiereux B, Huber S, Strom T, Dichgans M. Kartierung eines dritten Genlocus für familiäre hemiplegische Migräne. Akt Neurol 2004. [DOI: 10.1055/s-2004-833361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Grabowski M, Zimprich A, Lorenz-Depiereux B, Kalscheuer V, Asmus F, Gasser T, Meitinger T, Strom TM. The epsilon-sarcoglycan gene (SGCE), mutated in myoclonus-dystonia syndrome, is maternally imprinted. Eur J Hum Genet 2003; 11:138-44. [PMID: 12634861 DOI: 10.1038/sj.ejhg.5200938] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2002] [Revised: 11/11/2002] [Accepted: 11/14/2002] [Indexed: 11/08/2022] Open
Abstract
Myoclonus-dystonia syndrome (MDS) is a non-degenerative neurological disorder that has been described to be inherited in an autosomal dominant mode with incomplete penetrance. MDS is caused by loss of function mutations in the epsilon-sarcoglycan gene. Reinvestigation of MDS pedigrees provided evidence for a maternal imprinting mechanism. As differential methylated regions (DMRs) are a characteristic feature of imprinted genes, we studied the methylation pattern of CpG dinucleotides within the CpG island containing the promoter region and the first exon of the SGCE gene by bisulphite genomic sequencing. Our findings revealed that in peripheral blood leukocytes the maternal allele is methylated, while the paternal allele is unmethylated. We also showed that most likely the maternal allele is completely methylated in brain tissue. Furthermore, CpG dinucleotides in maternal and paternal uniparental disomy 7 (UPD7) lymphoblastoid cell lines show a corresponding parent-of-origin specific methylation pattern. The effect of differential methylation on the expression of the SGCE gene was tested in UPD7 cell lines with only a weak RT-PCR signal observed in matUPD7 and a strong signal in patUPD7. These results provide strong evidence for a maternal imprinting of the SGCE gene. The inheritance pattern in MDS families is in agreement with such an imprinting mechanism with the exception of a few cases. We investigated one affected female that inherited the mutated allele from her mother. Surprisingly, we found the paternal wild type allele expressed whereas the mutated maternal allele was not detectable in peripheral blood cDNA.
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Affiliation(s)
- Monika Grabowski
- Institute of Human Genetics, GSF National Research Center, D-85764 München-Neuherberg, Germany
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Abstract
BACKGROUND The gene for the renal phosphate wasting disorder autosomal-dominant hypophosphatemic rickets (ADHR) is FGF23, which encodes a secreted protein related to the fibroblast growth factors (FGFs). We previously detected missense mutations R176Q, R179W, and R179Q in FGF23 from ADHR kindreds. The mutations replace R residues within a subtilisin-like proprotein convertase (SPC) cleavage site 176RHTR-179 (RXXR motif). The goal of these studies was to determine if the ADHR mutations lead to protease resistance of FGF-23. METHODS The ADHR mutations were introduced into human FGF-23 cDNA clones with or without an N-terminal FLAG tag by site-directed mutagenesis and were transiently transfected into HEK293 cells. Protein expression was determined by Western analyses. RESULTS Antibodies directed toward the C-terminal portion of FGF-23 revealed that the native FGF-23 protein resolved as 32 kD and 12 kD species in HEK293 conditioned media; however, the three mutated proteins were detected only as the 32 kD band. An N-terminal FLAG-tagged native FGF-23 resolved as two bands of 36 kD and 26 kD when detected with a FLAG antibody, whereas the R176Q mutant resolved primarily as the 36 kD protein species. Cleavage of FGF-23 was not enhanced by extracellular incubation of FGF-23 with HEK293 cells. Native and mutant FGF-23s bound heparin. CONCLUSIONS FGF-23 proteins containing the ADHR mutations are secreted, and produce polypeptides less sensitive to protease cleavage than wild-type FGF-23. Therefore, the ADHR mutations may protect FGF-23 from proteolysis, thereby potentially elevating circulating concentrations of FGF-23 and leading to phosphate wasting in ADHR patients.
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Affiliation(s)
- K E White
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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White KE, Jonsson KB, Carn G, Hampson G, Spector TD, Mannstadt M, Lorenz-Depiereux B, Miyauchi A, Yang IM, Ljunggren O, Meitinger T, Strom TM, Jüppner H, Econs MJ. The autosomal dominant hypophosphatemic rickets (ADHR) gene is a secreted polypeptide overexpressed by tumors that cause phosphate wasting. J Clin Endocrinol Metab 2001; 86:497-500. [PMID: 11157998 DOI: 10.1210/jcem.86.2.7408] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The gene mutated in autosomal dominant hypophosphatemic rickets (ADHR), a phosphate wasting disorder, has been identified as FGF-23, a protein that shares sequence homology with fibroblast growth factors (FGFs). Patients with ADHR display many of the clinical and laboratory characteristics that are observed in patients with oncogenic hypophosphatemic osteomalacia (OHO), a disorder thought to arise by the secretion of a phosphate wasting factor from different mesenchymal tumors. In the present studies, we therefore investigated whether FGF-23 is a secreted factor and whether it is abundantly expressed in OHO tumors. After transient transfection of OK-E, COS-7, and HEK293 cells with the plasmid encoding full-length FGF-23, all three cell lines efficiently secreted two protein species into the medium that were approximately 32 and 12 kDa upon SDS-PAGE and subsequent Western blot analysis using an affinity-purified polyclonal antibody to FGF-23. Furthermore, Northern blot analysis using total RNA from five different OHO tumors revealed extremely high levels of FGF-23 mRNA, and Western blot analysis of extracts from a sixth tumor detected the 32 kDa FGF-23 protein species. In summary, FGF-23, the gene mutated in ADHR, is a secreted protein and its mRNA is abundantly expressed by several different OHO tumors. Our findings indicate that FGF-23 may be a candidate phosphate wasting factor, previously designated "phosphatonin".
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Affiliation(s)
- K E White
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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