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Broussalis E, Grinzinger S, Kunz AB, Killer-Oberpfalzer M, Haschke-Becher E, Hartung HP, Kraus J. Late age onset of amyotrophic lateral sclerosis is often not considered in elderly people. Acta Neurol Scand 2018; 137:329-334. [PMID: 29148035 DOI: 10.1111/ane.12869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease causing an upper and lower motor neuron loss. It is neurology textbook knowledge that the mean age of onset is about 60 years. However, recent investigations show an increasing incidence in older persons. We therefore evaluated whether ALS is potentially not considered in elderly people with ALS symptoms, respectively, not recognized. MATERIALS AND METHODS We included retrospectively all patients with ALS diagnoses after work-up that were admitted to our neurological and geriatric departments from 2007 to 2010 and collected their clinical data. The diagnosis of ALS was based on the El Escorial criteria. Patients were grouped into three categories according to age (<50, between 50 and 70, >70), and differences in clinical and/ or biographical factors were investigated. RESULTS We identified 35 patients (18 men and 17 women) with a median age at onset of 71.5 years (range: 36-87 years). When establishing the diagnosis, 51% were older than 70 years, 40% (14/35) between 50 and 70, and only 9% younger than 50. Only in 46 per cent of patients who were sent to our departments with ALS symptoms ALS was considered by the referring physician. CONCLUSION Late age onset of ALS seems to be more common than formerly assumed and is presumably under-recognized in elderly patients. ALS needs to be considered as a differential diagnosis in older patients. Potential factors accounting for older people being underdiagnosed with ALS relate to frequent presentation with symptoms like dysphagia, frailty or general weakness for other reasons.
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Affiliation(s)
- E. Broussalis
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University and Salzburger Landeskliniken; Salzburg Austria
- Department of Neuroradiology; Christian-Doppler-Klinik; Paracelsus Medical University and Salzburger Landeskliniken; Salzburg Austria
- Research Institute of Neurointervention; Paracelsus Medical University; Salzburg Austria
| | - S. Grinzinger
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University and Salzburger Landeskliniken; Salzburg Austria
| | - A. B. Kunz
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University and Salzburger Landeskliniken; Salzburg Austria
| | - M. Killer-Oberpfalzer
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University and Salzburger Landeskliniken; Salzburg Austria
- Research Institute of Neurointervention; Paracelsus Medical University; Salzburg Austria
| | - E. Haschke-Becher
- Department of Laboratory Medicine; Paracelsus Medical University and Salzburger Landeskliniken; Salzburg Austria
| | - H.-P. Hartung
- Department of Neurology; Heinrich Heine University of Düsseldorf; Medical Faculty; Düsseldorf Germany
| | - J. Kraus
- Research Institute of Neurointervention; Paracelsus Medical University; Salzburg Austria
- Department of Laboratory Medicine; Paracelsus Medical University and Salzburger Landeskliniken; Salzburg Austria
- Department of Neurology; Heinrich Heine University of Düsseldorf; Medical Faculty; Düsseldorf Germany
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Felder T, Ring-Dimitriou S, Auer S, Soyal S, Kedenko L, Rinnerthaler M, Cadamuro J, Haschke-Becher E, Aigner E, Paulweber B, Patsch W. Specific circulating phospholipids, acylcarnitines, amino acids and biogenic amines are aerobic exercise markers. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.639] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cooper P, Bolton K, Mokhachane M, Velaphi S, Mphahlele R, Bomela H, Monaheng L, Roux P, Haschke-Becher E. Growth of infants born to HIV-positive mothers fed a whey-adapted acidified starter formula with prebiotics and nucleotides. South African Journal of Clinical Nutrition 2016. [DOI: 10.1080/16070658.2010.11734287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Harrer A, Pilz G, Wipfler P, Oppermann K, Sellner J, Hitzl W, Haschke-Becher E, Afazel S, Rispens T, van der Kleij D, Trinka E, Kraus J. High interindividual variability in the CD4/CD8 T cell ratio and natalizumab concentration levels in the cerebrospinal fluid of patients with multiple sclerosis. Clin Exp Immunol 2015; 180:383-92. [PMID: 25603898 DOI: 10.1111/cei.12590] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 07/25/2014] [Revised: 12/17/2014] [Accepted: 01/07/2015] [Indexed: 02/04/2023] Open
Abstract
Strongly decreased leucocyte counts and a reduced CD4/CD8 T cell ratio in the cerebrospinal fluid (CSF) of natalizumab (NZB)-treated multiple sclerosis (MS) patients may have implications on central nervous (CNS) immune surveillance. With regard to NZB-associated progressive multi-focal leucoencephalopathy, we aimed at delineating a relationship between free NZB, cell-bound NZB, adhesion molecule (AM) expression and the treatment-associated shift in the CSF T cell ratio. Peripheral blood (PB) and CSF T cells from 15 NZB-treated MS patients, and CSF T cells from 10 patients with non-inflammatory neurological diseases and five newly diagnosed MS patients were studied. Intercellular adhesion molecule-1 (ICAM-1), leucocyte function antigen-1 (LFA-1), very late activation antigen-4 (VLA-4), NZB saturation levels, and T cell ratios were analysed by flow cytometry. NZB concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Lower NZB saturation levels (P<0.02) and a higher surface expression of ICAM-1 and LFA-1 (P<0.001) were observed on CSF CD8 T cells. CSF T cell ratios (0.3-2.1) and NZB concentrations (0.01-0.42 µg/ml) showed a pronounced interindividual variance. A correlation between free NZB, cell-bound NZB or AM expression levels and the CSF T cell ratio was not found. Extremely low NZB concentrations and a normalized CSF T cell ratio were observed in one case. The differential NZB saturation and AM expression of CSF CD8 T cells may contribute to their relative enrichment in the CSF. The reduced CSF T cell ratio appeared sensitive to steady-state NZB levels, as normalization occurred quickly. The latter may be important concerning a fast reconstitution of CNS immune surveillance.
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Affiliation(s)
- A Harrer
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - G Pilz
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - P Wipfler
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - K Oppermann
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - J Sellner
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universät München, Germany
| | - W Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, Salzburg, Austria
| | - E Haschke-Becher
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - S Afazel
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - T Rispens
- Department of Immunopathology, Sanquin Research and Academic Medical Centre, Amsterdam, the Netherlands
| | - D van der Kleij
- Laboratory for Monoclonal Therapeutics, Sanquin Diagnostics, Amsterdam, the Netherlands
| | - E Trinka
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria
| | - J Kraus
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, A.ö. Krankenhaus Zell am See, Teaching Hospital of the Paracelsus Medical University Salzburg, Zell am See, Austria
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Ponschab M, Schöchl H, Gabriel C, Süssner S, Cadamuro J, Haschke-Becher E, Gratz J, Zipperle J, Redl H, Schlimp CJ. Haemostatic profile of reconstituted blood in a proposed 1:1:1 ratio of packed red blood cells, platelet concentrate and four different plasma preparations. Anaesthesia 2015; 70:528-36. [DOI: 10.1111/anae.13067] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 12/31/2022]
Affiliation(s)
- M. Ponschab
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; AUVA Research Centre; Vienna Austria
| | - H. Schöchl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; AUVA Research Centre; Vienna Austria
- Department of Anaesthesiology and Intensive Care; AUVA Trauma Centre; Salzburg Austria
| | - C. Gabriel
- Red Cross Blood Transfusion Service for Upper Austria; Linz Austria
| | - S. Süssner
- Red Cross Blood Transfusion Service for Upper Austria; Linz Austria
| | - J. Cadamuro
- Department of Laboratory Medicine; Paracelsus Medical University Salzburg; Salzburg Austria
| | - E. Haschke-Becher
- Department of Laboratory Medicine; Paracelsus Medical University Salzburg; Salzburg Austria
| | - J. Gratz
- Department of Anaesthesia; General Intensive Care and Pain Control; Medical University of Vienna; Vienna Austria
| | - J. Zipperle
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; AUVA Research Centre; Vienna Austria
| | - H. Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; AUVA Research Centre; Vienna Austria
| | - C. J. Schlimp
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; AUVA Research Centre; Vienna Austria
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Wipfler P, Harrer A, Pilz G, Oppermann K, Afazel S, Haschke-Becher E, Sellner J, Trinka E, Kraus J. Natalizumab saturation: biomarker for individual treatment holiday after natalizumab withdrawal? Acta Neurol Scand 2014; 129:e12-5. [PMID: 24032536 DOI: 10.1111/ane.12182] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND More and more patients with multiple sclerosis (MS) switch from natalizumab to fingolimod because of the risk of progressive multifocal leukoencephalopathy. The duration of the treatment holiday is still under debate referring to a possible recurrence of disease activity. AIM OF THE STUDY The aim of this study was to evaluate the prognostic value of natalizumab saturation on T cells for the recurrence of clinical and radiological disease activity. METHODS Cell surface-bound natalizumab saturation (in%) of CD8+ and CD4+ T cells from five patients with MS was determined before initiation of fingolimod by flow cytometry and related to clinical and MRI outcome during a 6-month follow-up. RESULTS In two patients with either clinical or radiological disease activity, the natalizumab saturation on CD8+ and CD4+ T cells was <30%. In contrast, the remaining three patients with absence of disease activity had a median natalizumab saturation of 70% (range 59-79%) on CD4+ and 66% (range 52-68%) on CD8+ T cells. CONCLUSIONS The data of this pilot study indicate that clinical and radiological disease activity is closely linked to natalizumab saturation at the time point of switch. The determination of natalizumab saturation may be an essential tool to monitor cessation of natalizumab treatment.
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Affiliation(s)
- P. Wipfler
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University; Salzburg Austria
| | - A. Harrer
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University; Salzburg Austria
| | - G. Pilz
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University; Salzburg Austria
| | - K. Oppermann
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University; Salzburg Austria
| | - S. Afazel
- Central Laboratory; Christian-Doppler-Klinik; Paracelsus Medical University; Salzburg Austria
| | - E. Haschke-Becher
- Central Laboratory; Christian-Doppler-Klinik; Paracelsus Medical University; Salzburg Austria
| | - J. Sellner
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University; Salzburg Austria
- Department of Neurology; Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | - E. Trinka
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University; Salzburg Austria
| | - J. Kraus
- Department of Neurology; Christian-Doppler-Klinik; Paracelsus Medical University; Salzburg Austria
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Sellner J, Koczi W, Harrer A, Oppermann K, Obregon-Castrillo E, Pilz G, Wipfler P, Afazel S, Haschke-Becher E, Trinka E, Kraus J. Glatiramer acetate attenuates the pro-migratory profile of adhesion molecules on various immune cell subsets in multiple sclerosis. Clin Exp Immunol 2013; 173:381-9. [PMID: 23611040 DOI: 10.1111/cei.12125] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2013] [Indexed: 01/01/2023] Open
Abstract
An altered expression pattern of adhesion molecules (AM) on the surface of immune cells is a premise for their extravasation into the central nervous system (CNS) and the formation of acute brain lesions in multiple sclerosis (MS). We evaluated the impact of glatiramer acetate (GA) on cell-bound and soluble AM in the peripheral blood of patients with relapsing-remitting MS (RRMS). Fifteen patients treated de novo with GA were studied on four occasions over a period of 12 months. Surface levels of intracellular cell adhesion molecule (ICAM)-1, ICAM-3, lymphocyte function-associated antigen (LFA)-1 and very late activation antigen (VLA)-4 were assessed in T cells (CD3(+) CD8(+) , CD3(+) CD4(+) ), B cells, natural killer (NK) cells, natural killer T cells (NK T) and monocytes by five-colour flow cytometry. Soluble E-selectin, ICAM-1, ICAM-3, platelet endothelial cell adhesion molecule (PECAM)-1, P-selectin and vascular cell adhesion molecule (VCAM)-1 were determined with a fluorescent bead-based immunoassay. The pro-migratory pattern in RRMS was verified by comparison with healthy controls and was characterized by up-regulation of LFA-1 (CD3(+) CD4(+) T cells, B cells), VLA-4 (CD3(+) CD8(+) T cells, NK cells), ICAM-1 (B cells) and ICAM-3 (NK cells). Effects of GA treatment were most pronounced after 6 months and included attenuated levels of LFA-1 (CD3(+) CD4(+) ) and VLA-4 (CD3(+) CD4(+) , CD3(+) CD8(+) , NK, NK T, monocytes). Further effects included lowering of ICAM-1 and ICAM-3 levels in almost all immune cell subsets. Soluble AM levels in RRMS did not differ from healthy controls and remained unaltered after GA treatment. The deregulated pro-migratory expression profile of cell-bound AM is altered by GA treatment. While this alteration may contribute to the beneficial action of the drug, the protracted development and unselective changes indicate more secondary immune regulatory phenomena related to these effects.
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Affiliation(s)
- J Sellner
- Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
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Wipfler P, Harrer A, Pilz G, Oppermann K, Haschke-Becher E, Afazel S, Sellner J, Trinka E, Kraus J. Natalizumab saturation: Biomarker for individual treatment holiday after natalizumab withdrawal? J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1383] [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: 11/26/2022]
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9
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Broussalis E, Hutterer M, Oppermann K, Wipfler P, Pilz G, Harrer A, Haschke-Becher E, Golaszewski S, Schönauer U, Weis S, Killer-Oberpfalzer M, Mc Coy M, Trinka E, Kraus J. Isolated leptomeningeal infiltration of a primary CNS B-cell lymphoma diagnosed by flow cytometry and confirmed by necropsy. Acta Neurol Scand 2012; 126:e11-6. [PMID: 22211863 DOI: 10.1111/j.1600-0404.2011.01630.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND The diagnosis of the isolated leptomeningeal involvement of a primary central nervous system B-cell lymphoma without parenchyma lesions may be difficult. Patients with leptomeningeal meningeosis lymphomatosa can present with various neurologic deficits. AIMS OF THE STUDY To demonstrate the impact of cerebrospinal fluid (CSF) flow cytometry in the diagnosis of an isolated leptomeningeal manifestation of B-cell lymphoma by presenting an interesting case report. METHODS Flow cytometric analysis of B-cell monoclonality of the CSF was performed as complementary diagnostic procedure in addition to CSF cytology. Final diagnosis was confirmed by necropsy. RESULTS We suspected isolated leptomeningeal manifestation of B-cell lymphoma with palsy of the VI and VII cranial nerves in a 79-year-old male, because of mononuclear pleocytosis in CSF. Interestingly, the decisive diagnostic hint was given by implementation of flow cytometry of the CSF. Diagnosis was confirmed by postmortem autopsy. CONCLUSION Our case shows that flow cytometry of the CSF in addition to conventional CSF cytology has the potential to accelerate diagnosis of lymphomeningeal infiltration of B-cell lymphoma.
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Affiliation(s)
- E. Broussalis
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Department of Neurology; Paracelsus Medical University; Salzburg; Austria
| | - M. Hutterer
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Department of Neurology; Paracelsus Medical University; Salzburg; Austria
| | - K. Oppermann
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Department of Neurology; Paracelsus Medical University; Salzburg; Austria
| | - P. Wipfler
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Department of Neurology; Paracelsus Medical University; Salzburg; Austria
| | - G. Pilz
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Department of Neurology; Paracelsus Medical University; Salzburg; Austria
| | - A. Harrer
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Department of Neurology; Paracelsus Medical University; Salzburg; Austria
| | - E. Haschke-Becher
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Central Laboratory; Paracelsus Medical University; Salzburg; Austria
| | - S. Golaszewski
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Central Laboratory; Paracelsus Medical University; Salzburg; Austria
| | - U. Schönauer
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Central Laboratory; Paracelsus Medical University; Salzburg; Austria
| | - S. Weis
- Institute of Pathology and Neuropathology; Wagner-JaureggHospital; Linz; Austria
| | - M. Killer-Oberpfalzer
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Department of Neurology; Paracelsus Medical University; Salzburg; Austria
| | - M. Mc Coy
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Department of Radiology; Paracelsus Medical University; Salzburg; Austria
| | - E. Trinka
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Department of Neurology; Paracelsus Medical University; Salzburg; Austria
| | - J. Kraus
- SalzburgerLandeskliniken; Christian-Doppler-Klinik; Department of Neurology; Paracelsus Medical University; Salzburg; Austria
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Kraus J, Zaunrieth R, Obregon-Castrillo E, Oppermann K, Pilz G, Wipfler P, Afazel S, Haschke-Becher E, Golaszewski S, Hitzl W, Trinka E, Harrer A. Serum Levels of Soluble Adhesion Molecules Remain Stable during Short- and Long-Term Interferon-beta-1b Treatment (P02.144). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.144] [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: 11/15/2022] Open
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Kraus J, Oppermann K, Pilz G, Wipfler P, Afazel S, Haschke-Becher E, Trinka E, Harrer A. Natalizumab Treatment Effects Sustained Decrease in Serum Levels of Fibronectin and Soluble Adhesion Molecules sVCAM-1 and sICAM-3 (P02.114). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.114] [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: 11/15/2022] Open
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Pilz G, Harrer A, Oppermann K, Wipfler P, Golaszewski S, Afazel S, Haschke-Becher E, Trinka E, Kraus J. Molecular evidence of transient therapeutic effectiveness of natalizumab despite high-titre neutralizing antibodies. Mult Scler 2011; 18:506-9. [DOI: 10.1177/1352458511423650] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Natalizumab is a humanized monoclonal antibody directed against the alpha-4 integrin subunit of very late activation antigen-4 (VLA-4). Natalizumab neutralizing antibodies (NAB) have been found to significantly reduce beneficial effects of natalizumab treatment in multiple sclerosis. We investigated interactions of NAB with natalizumab by serial measurements of alpha-4 integrin levels on peripheral blood mononuclear cells using flow cytometry. In addition, serum concentrations of soluble vascular cell adhesion molecule-1 (sVCAM-1), the endothelial ligand of VLA-4, and serum NAB were serially determined. Natalizumab infusion led to a transient reduction in alpha-4 integrin levels on immune cells and serum sVCAM-1 levels along with serum negativity of NAB lasting for a few days post-infusion. Apparently, the high-dose effect of freshly infused natalizumab resulted in a transient neutralization of NAB possibly involving a transient therapeutic effectiveness.
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Affiliation(s)
- G Pilz
- Paracelsus Medical University, Salzburger Landeskliniken; Christian-Doppler-Klinik, Department of Neurology, Salzburg, Austria
| | - A Harrer
- Paracelsus Medical University, Salzburger Landeskliniken; Christian-Doppler-Klinik, Department of Neurology, Salzburg, Austria
| | - K Oppermann
- Paracelsus Medical University, Salzburger Landeskliniken; Christian-Doppler-Klinik, Department of Neurology, Salzburg, Austria
| | - P Wipfler
- Paracelsus Medical University, Salzburger Landeskliniken; Christian-Doppler-Klinik, Department of Neurology, Salzburg, Austria
| | - S Golaszewski
- Paracelsus Medical University, Salzburger Landeskliniken; Christian-Doppler-Klinik, Department of Neurology, Salzburg, Austria
| | - S Afazel
- Paracelsus Medical University, Salzburger Landeskliniken; Christian-Doppler-Klinik, Department of Neurology, Salzburg, Austria
| | - E Haschke-Becher
- Paracelsus Medical University, Salzburger Landeskliniken; Christian-Doppler-Klinik, Department of Neurology, Salzburg, Austria
| | - E Trinka
- Paracelsus Medical University, Salzburger Landeskliniken; Christian-Doppler-Klinik, Department of Neurology, Salzburg, Austria
| | - J Kraus
- Paracelsus Medical University, Salzburger Landeskliniken; Christian-Doppler-Klinik, Department of Neurology, Salzburg, Austria
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Kohlmann A, Klein HU, Weissmann S, Bresolin S, Chaplin T, Cuppens H, Haschke-Becher E, Garicochea B, Grossmann V, Hanczaruk B, Hebestreit K, Gabriel C, Iacobucci I, Jansen JH, te Kronnie G, van de Locht L, Martinelli G, McGowan K, Schweiger MR, Timmermann B, Vandenberghe P, Young BD, Dugas M, Haferlach T. The Interlaboratory RObustness of Next-generation sequencing (IRON) study: a deep sequencing investigation of TET2, CBL and KRAS mutations by an international consortium involving 10 laboratories. Leukemia 2011; 25:1840-8. [PMID: 21681191 DOI: 10.1038/leu.2011.155] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Massively parallel pyrosequencing allows sensitive deep sequencing to detect molecular aberrations. Thus far, data are limited on the technical performance in a clinical diagnostic setting. Here, we investigated as an international consortium the robustness, precision and reproducibility of amplicon next-generation deep sequencing across 10 laboratories in eight countries. In a cohort of 18 chronic myelomonocytic leukemia patients, mutational analyses were performed on TET2, a frequently mutated gene in myeloproliferative neoplasms. Additionally, hotspot regions of CBL and KRAS were investigated. The study was executed using GS FLX sequencing instruments and the small volume 454 Life Sciences Titanium emulsion PCR setup. We report a high concordance in mutation detection across all laboratories, including a robust detection of novel variants, which were undetected by standard Sanger sequencing. The sensitivity to detect low-level variants present with as low as 1-2% frequency, compared with the 20% threshold for Sanger-based sequencing is increased. Together with the output of high-quality long reads and fast run time, we demonstrate the utility of deep sequencing in clinical applications. In conclusion, this multicenter analysis demonstrated that amplicon-based deep sequencing is technically feasible, achieves high concordance across multiple laboratories and allows a broad and in-depth molecular characterization of cancer specimens with high diagnostic sensitivity.
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Affiliation(s)
- A Kohlmann
- Department of Molecular Genetics, MLL Munich Leukemia Laboratory, Munich, Germany.
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Wipfler P, Oppermann K, Pilz G, Afazel S, Haschke-Becher E, Harrer A, Huemer M, Kunz A, Golaszewski S, Staffen W, Ladurner G, Kraus J. Adhesion molecules are promising candidates to establish surrogate markers for natalizumab treatment. Mult Scler 2010; 17:16-23. [PMID: 20937631 DOI: 10.1177/1352458510383075] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Natalizumab is the first monoclonal antibody therapy approved for multiple sclerosis (MS). Its therapeutic mechanism is the blockade of the α4-integrin subunit of the adhesion molecule (AM) very late activation antigen-4 (VLA-4), which leads to an inhibition of immune cell extravasation into the central nervous system (CNS). METHODS We investigated changes in the expression levels of unblocked α4-integrin and further AM (intercellular adhesion molecule-1, -2, -3 (cICAM-1, -2, -3), leukocyte function associated antigen-1 (LFA-1)) on peripheral blood mononuclear cells (PBMC) determined by flow cytometry from 25 patients with MS before the first natalizumab infusion and before the fourth infusion. In 15 MS patients AM expression was evaluated every 3 months over 1 year. RESULTS We found a significant decrease (p < 0.0001) of unblocked α4-integrin cell surface expression on all investigated PBMC subsets (T cells -61.7%, B cells -69.1%, monocytes/macrophages -46.4%) in the blood of MS patients after 3 months of natalizumab treatment. Moreover, a continuous decrease (p < 0.05) of unblocked α4-integrin expression levels was seen after 3, 6, 9, and 12 months. As a secondary effect, expression levels of the other investigated AM were differentially affected. CONCLUSIONS Results show a sustained decrease of unblocked α4-integrin expression not only in all patients but also in all investigated PBMC subsets. This probably results in a continuously decreasing transmigration of PBMC into the CNS and may explain the improved clinical efficacy in the second treatment year and also the increasing risk of progressive multifocal leukoencephalopathy during long-term natalizumab therapy. We conclude that AM expression profiles are promising candidates for the development of a biomarker system to determine both natalizumab treatment response and patients at risk for opportunistic CNS infections.
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Affiliation(s)
- P Wipfler
- Paracelsus Medical University, Christian-Doppler-Klinik, University Hospital of Neurology, Salzburg, Austria.
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Kraus J, Wipfler P, Pilz G, Oppermann K, Sulzer C, Afazel S, Haschke-Becher E, Huemer M, Staffen W, Ladurner G. Langfristiger Effekt von Natalizumab auf das Profil von zellgebundenen Adhäsionsmolekülen unter einer Therapie der Multiplen Sklerose. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238767] [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]
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Oppermann K, Pilz G, Wipfler P, Sulzer C, Afazel S, Haschke-Becher E, Kunz A, Golaszewski S, Ladurner G, Kraus J. Effect of natalizumab treatment on soluble adhesion molecules. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238768] [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]
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Pilz G, Wipfler P, Oppermann K, Sulzer C, Kunz A, Golaszewski S, Afazel S, Haschke-Becher E, Ladurner G, Kraus J. Adhesion molecule expression indicates a therapeutical effect of natatizumab despite the presence of neutralizing antibodies. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238769] [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]
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Kraus J, Wipfler P, Pilz G, Afazel S, Haschke-Becher E, Huemer M, Jakab M, Ritter M, Ladurner G. Einfluss einer Therapie der Multiplen Sklerose mit Natalizumab auf die Expression von zellgebundenen Adhäsionsmolekülen. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086838] [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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Niggemann B, von Berg A, Bollrath C, Berdel D, Schauer U, Rieger C, Haschke-Becher E, Wahn U. Safety and efficacy of a new extensively hydrolyzed formula for infants with cow's milk protein allergy. Pediatr Allergy Immunol 2008; 19:348-54. [PMID: 18167160 DOI: 10.1111/j.1399-3038.2007.00653.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cow's milk protein allergy (CMPA) is best treated by complete elimination of cow's milk from the diet. For infants with CMPA who cannot be breast-fed, formulas based on extensively hydrolyzed proteins or on amino acids are the preferred substitutes for cow's milk-based formulas. In this study, we compared the tolerance and growth of infants with CMPA who were fed a new extensively hydrolyzed formula containing lactose (eHF) with those who were fed an amino acid formula (AAF). This was a prospective, multi-center, randomized, reference-controlled study. Seventy-seven infants <12 months old with suspected CMPA were enrolled. In 66 of these, CMPA was confirmed by oral challenge in a double-blind, placebo-controlled food challenge (DBPCFC) or by a medical history of severe allergic reaction to cow's milk and a positive skin prick test. These infants were then tested for their reaction to eHF and AAF in a DBPCFC. All infants tolerated both formulas and were randomized to receive either eHF (n = 34) or AAF (n = 32) for 180 days. Growth (weight, length, and head circumference) and tolerance [skin, gastro-intestinal, and respiratory tract symptoms of allergy] were evaluated after 30, 60, 90, and 180 days. There were no significant differences between the two groups in any of the growth measurements. Length and head circumference were similar to Euro-growth standards, but weight was slightly lower. Gastro-intestinal and respiratory tract symptoms of allergy were also similar in the two groups. However, whereas SCORAD scores for atopic dermatitis remained constant throughout the study in infants-fed eHF, there was a slight decrease in those fed AAF. Infants-fed eHF had significantly fewer incidents of vomiting than infants-fed AAF and a significantly higher frequency of soft stools. The new eHF is safe and well tolerated in infants diagnosed with CMPA.
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Affiliation(s)
- B Niggemann
- Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité, Berlin, Germany.
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20
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Haschke-Becher E, Baumgartner M, Bachmann C. Assay of D-lactate in urine of infants and children with reference values taking into account data below detection limit. Clin Chim Acta 2000; 298:99-109. [PMID: 10876007 DOI: 10.1016/s0009-8981(00)00272-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [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: 10/18/2022]
Abstract
Accumulation of D-lactic acid produced by intestinal bacteria such as streptococci and lactobacilli has been extensively studied in ruminants [1-4]. In humans an increased production of D-lactate by intestinal bacteria under pathological conditions such as the short bowel syndrome can cause metabolic acidosis [5-8]. Since the lactate assays routinely used only measure L-lactate we developed a sensitive method of D-lactate quantification and established reference values in spot urines of infants and children (0 to 4 years of age). The enzymatic method with fluorimetric quantification of NADH is linear up to 2 mmol/l. It has a detection limit of 3.4 micromol/l. Among structurally related organic acids an interference was found only for L-lactate and DL-2-hydroxybutyrate at concentrations which are way beyond their physiological excretion. One hundred and sixty five spot urines of healthy Swiss (S), Austrian (A), German (G) and Chilean (CHI) infants aged from 0 to 4 years were analyzed. The distribution of the data is close to a lognormal one. Values below the detection limit were simulated and age groups were formed. In all populations D-lactate excretion was found highest during the first year of life; it declines with age during infancy and remains stable from 2.5 to 4 years of age. We show that D-lactate is excreted physiologically by healthy infants and children below 4 years of age and present reference values for D-lactate excretion which show some differences between the populations tested.
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Affiliation(s)
- E Haschke-Becher
- Laboratoire Central de Chimie Clinique, Centre Hospitalier Universitaire Vaudois, Bugnon 46, CH-1011, Lausanne, Switzerland.
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