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Głuszko P, Sewerynek E, Misiorowski W, Konstantynowicz J, Marcinowska-Suchowierska E, Blicharski T, Jabłoński M, Franek E, Kostka T, Jaworski M, Karczmarewicz E, Kalinka E, Księżopolska-Orłowska K, Więcek A, Lorenc RS. Guidelines for the diagnosis and management of osteoporosis in Poland. Update 2022. Endokrynol Pol 2023; 74:5-15. [PMID: 36847720 DOI: 10.5603/ep.a2023.0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 03/01/2023]
Abstract
Guidelines to provide an update of the previously published Polish recommendations for the management of women and men with osteoporosis have been developed in line with advances in medical knowledge, evidence-based data, and new concepts in diagnostic and therapeutic strategies. A Working Group of experts from the Multidisciplinary Osteoporosis Forum and from the National Institute of Geriatrics, Rheumatology, and Rehabilitation in Warsaw performed a thorough comprehensive review of current relevant publications in the field (including all age groups of people and management of secondary osteoporosis), and they evaluated epidemiological data on osteoporosis in Poland and the existing standards of care and costs. A voting panel of all co-authors assessed and discussed the quality of evidence to formulate 29 specific recommendations and voted independently the strength of each recommendation. This updated practice guidance highlights a new algorithm of the diagnostic and therapeutic procedures for individuals at high and very high fracture risk and presents a spectrum of general management and the use of medication including anabolic therapy. Furthermore, the paper discusses the strategy of primary and secondary fracture prevention, detection of fragility fractures in the population, and points to vital elements for improving management of osteoporosis in Poland.
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Affiliation(s)
- Piotr Głuszko
- Department of Rheumatology, National Institute of Geriatrics, Rheumatology, and Rehabilitation, Warsaw, Poland.
| | - Ewa Sewerynek
- Department of Endocrine Disorders and Bone Metabolism, Medical University of Lodz, Poland
| | | | - Jerzy Konstantynowicz
- Department of Paediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, Medical University of Bialystok, Poland
| | - Ewa Marcinowska-Suchowierska
- Department of Geriatrics and Gerontology, School of Public Health, Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Tomasz Blicharski
- Department of Orthopaedics and Rehabilitation, Medical University of Lublin, Lublin, Poland
| | - Mirosław Jabłoński
- Laboratory of Locomotor Systems Research, Department of Rehabilitation and Physiotherapy, Medical University of Lublin, Poland
| | - Edward Franek
- Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Tomasz Kostka
- Department of Geriatrics Healthy Ageing Research Centre (HARC) Medical University of Lodz, Poland
| | - Maciej Jaworski
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Ewa Kalinka
- Department of Oncology Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland
| | - Krystyna Księżopolska-Orłowska
- Committee for Rehabilitation, Physical Culture and Social Integration of the Polish Academy of Sciences, Krupia Wl., Poland
| | - Andrzej Więcek
- Department of Nephrology, Transplantation, and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Roman S Lorenc
- Multidisciplinary Osteoporosis Forum, Warsaw, Poland, Poland
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Chlebna-Sokół D, Konstantynowicz J, Abramowicz P, Kulik-Rechberger B, Niedziela M, Obuchowicz A, Ziora K, Karalus-Gach J, Golec J, Michałus I, Karczmarewicz E, Halaba ZP. Evidence of a significant vitamin D deficiency among 9-13-year-old Polish children: results of a multicentre study. Eur J Nutr 2018; 58:2029-2036. [PMID: 29936536 PMCID: PMC6647701 DOI: 10.1007/s00394-018-1756-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/20/2018] [Indexed: 10/29/2022]
Abstract
PURPOSE To evaluate the extent to which the population of Polish preadolescents is vitamin D deficient and to assess seasonal variations in vitamin D status. PARTICIPANTS AND METHODS A total of 720 healthy children aged 9-13 years (409 girls, 311 boys) residing in 6 representative geographical locations in Poland were studied. A parental-assisted questionnaire provided data on nutritional habits, vitamin D supplements and sun exposure. Serum concentration of 25-hydroxyvitamin was determined twice, after the winter in March and after the summer in October. RESULTS In March, vitamin D deficiency (25-50 nmol/L) was found in 64%, and severe deficiency (< 25 nmol/L) in 20.2% of children. In October, the deficiency and severe deficiency were still noticed in 25.9 and 0.1% of children, respectively. The mean serum concentration of 25-OHD was 52% higher in October (55.4 ± 14.0 nmol/L) than in March (36.4 ± 13.5 nmol/L), (p < 0.01). In children with 25-OHD < 50 nmol/L in March, their 25-OHD concentration increased by 64% through March to October (32.5 ± 8.2 vs. 53.2 ± 7.9 nmol/L, p < 0.01). An association was found between 25-OHD concentration and regular consumption of vitamin D supplements, cod-liver oil and fish. CONCLUSIONS The majority of preadolescent Polish boys and girls show vitamin D deficiency after the winter period, although a distinct amelioration over summertime is found in this age group. There is a need to implement effective prevention and intervention strategies in the management of vitamin D deficiency among schoolchildren in Poland, with the supplementation throughout the entire year.
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Affiliation(s)
- Danuta Chlebna-Sokół
- Department of Pediatric Propaedeutics and Metabolic Bone Diseases, Medical University of Lodz, Sporna Street 36/50, 91-738, Łódź, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatric Rheumatology, Immunology, and Metabolic Bone Diseases, Medical University of Bialystok, Waszyngtona Street 17, 15-2742, Białystok, Poland
| | - Paweł Abramowicz
- Department of Pediatric Rheumatology, Immunology, and Metabolic Bone Diseases, Medical University of Bialystok, Waszyngtona Street 17, 15-2742, Białystok, Poland
| | - Beata Kulik-Rechberger
- Departament of Paediatric Propaedeutics, Medical University of Lublin, Gębali Street 6, 20-091, Lublin, Poland
| | - Marek Niedziela
- Department of Pediatric Endocrinology and Rheumatology, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572, Poznań, Poland
| | - Anna Obuchowicz
- Department of Paediatrics, School of Health Sciences in Katowice, Medical University of Silesia, Batorego Street 15, 41-902, Bytom, Poland
| | - Katarzyna Ziora
- Department of Paediatrics, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 3-go Maja Street 13-15, 41-800, Zabrze, Poland
| | - Jolanta Karalus-Gach
- Department of Pediatric Propaedeutics and Metabolic Bone Diseases, Medical University of Lodz, Sporna Street 36/50, 91-738, Łódź, Poland
| | - Joanna Golec
- Department of Pediatric Propaedeutics and Metabolic Bone Diseases, Medical University of Lodz, Sporna Street 36/50, 91-738, Łódź, Poland
| | - Izabela Michałus
- Department of Pediatric Propaedeutics and Metabolic Bone Diseases, Medical University of Lodz, Sporna Street 36/50, 91-738, Łódź, Poland
| | - Elżbieta Karczmarewicz
- Department of Biochemistry and Experimental Medicine, The Children's Memorial Health Institute in Warsaw, Aleja Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Zenon Piotr Halaba
- Department of Medical Simulation, University of Opole, Oleska Street 48, 45-052, Opole, Poland.
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Lorenc R, Głuszko P, Franek E, Jabłoński M, Jaworski M, Kalinka-Warzocha E, Karczmarewicz E, Kostka T, Księżopolska-Orłowska K, Marcinowska-Suchowierska E, Misiorowski W, Więcek A. Zalecenia postępowania diagnostycznego i leczniczego w osteoporozie w Polsce. Aktualizacja 2017. Endokrynol Pol 2017; 68:1-18. [PMID: 29168544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | - Piotr Głuszko
- Klinika Reumatologii, Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji, Warszawa, Poland.
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Pludowski P, Jaworski M, Niemirska A, Litwin M, Szalecki M, Karczmarewicz E, Michalkiewicz J. Vitamin D status, body composition and hypertensive target organ damage in primary hypertension. J Steroid Biochem Mol Biol 2014; 144 Pt A:180-4. [PMID: 24189544 DOI: 10.1016/j.jsbmb.2013.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 08/01/2013] [Revised: 10/11/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
Abstract
Overweight/obesity and high blood pressure during growth period are important risk factors of cardiovascular disease later in life. Cardiovascular system, fat and muscles are among target tissues for vitamin D and low 25(OH)D levels are likely to attenuate potential benefits of its action. The study was aimed to evaluate vitamin D status and body composition in children and adolescents with primary hypertension (PH). The study population comprised 78 patients aged 15.4±2.3yrs (9-18yrs; 15 girls) with diagnosed PH. Total 25(OH)D and parathyroid hormone (PTH) were assayed by Cobas e411 machine (Roche Diagnostics). DXA (Prodigy, GE Lunar) was used to assess total body bone mineral content (TBBMC; g), total body bone mineral density (TBBMD; g/cm(2)), lean body mass (LBM; g), % lean body mass (%LBM), fat mass (FM; g), % fat mass (% FM), Android %Fat, Gynoid %Fat and Trunk fat mass (Trunk FM; g). Hypertensive cases (BMI=25.6±4.2kg/m(2)), compared to reference, had slightly increased TBBMD and TBBMC Z-scores (+0.40±0.91 and +0.59±0.96; both p<0.001), and had markedly increased FM and FM/body weight ratio Z-scores of ±1.83±1.63 (p<0.0001) and +1.43±1.05 (p<0.0001). LBM Z-scores were slightly increased as well (+0.34±1.08, p<0.001). In contrast, markedly reduced LBM/body weight ratio Z-scores of -1.47±0.90 (p<0.0001) and disturbed relationship between FM and LBM as assessed by FM/LBM ratio Z-score of +1.53±1.29 (p<0.0001) were noted. The average serum levels of 25(OH)D of 17.8±6.9ng/mL and PTH of 34.8±16.8pg/mL were noted in PH group. 91% PH cases showed 25(OH)D levels lower than 30ng/mL. 71% of PH subjects revealed vitamin D deficiency (25(OH)D<20ng/ml). 10% of PH cases showed 25(OH)D levels lower than 10ng/mL. 25(OH)D levels negatively correlated with PTH showing r=-0.24 (p=0.03). Absolute LBM/body weight ratio values positively correlated with 25(OH)D levels (r=0.31; p=0.01). In contrast, absolute FM/body weight ratio values correlated negatively with 25(OH)D levels (r=-0.32; p<0.01). Moreover, 25(OH)D levels negatively correlated with absolute Trunk FM (r=-0.29; p<0.05), Android %Fat (r=-0.32; p<0.01) and with Gynoid %Fat (r=-0.28; p<0.05). PTH and 25(OH)D concentrations did not differ when severity of hypertension, left ventricular mass and carotid intima-media thickness were controlled for. Concluding, higher muscle mass stores in body weight coincided with higher 25(OH)D levels. Higher fat mass stores coincided with lower 25(OH)D levels in PH group. Whether vitamin D insufficiency/deficiency in PH group should be considered as a cause of disease or epiphenomenon remains unknown. This article is part of a Special Issue entitled '16th Vitamin D Workshop'.
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Affiliation(s)
- Pawel Pludowski
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland.
| | - Maciej Jaworski
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Anna Niemirska
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Mieczyslaw Litwin
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Mieczyslaw Szalecki
- Department of Endocrinology, The Children's Memorial Health Institute, Warsaw, Poland; Department of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Elżbieta Karczmarewicz
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Jacek Michalkiewicz
- Department of Microbiology and Immunology, The Children's Memorial Health Institute, Warsaw, Poland; Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Głuszko P, Lorenc RS, Karczmarewicz E, Misiorowski W, Jaworski M. Polish guidelines for the diagnosis and management of osteoporosis: a review of 2013 update. ACTA ACUST UNITED AC 2014; 124:255-63. [PMID: 24694725 DOI: 10.20452/pamw.2255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To decrease the risk of osteoporotic fractures in Poland, the Multidisciplinary Osteoporotic Forum has set up a joint Working Group including the representatives of the Polish Associations of Orthopedics and Traumatology, Rehabilitation, Gerontology, Rheumatology, Family Medicine, Diabetology, Laboratory Diagnostics, Andropause and Menopause, Endocrinology, Radiology, and the STENKO group as well as experts in the fields of rheumatology, obstetrics, and geriatrics to update the Polish guidelines for the diagnosis and management of osteoporosis in men and postmenopausal women in Poland. The assessment of fracture risk and intervention thresholds was made using the FRAX® calculation tool for Poland. The strength of recommendations was evaluated according to the principles of the Scottish Intercollegiate Guidelines Network and the results have been approved by national consultants. Finally, the Working Group has formulated the updated guidelines and recommended two -step diagnostic and therapeutic procedures. The first stage applies to family physicians or general practitioners and involves the assessment of fracture risk using the FRAX®-BMI to identify patients at high risk of fractures. An osteoporotic fracture remains an absolute indication both for the general practitioner and specialist to implement treatment. At the second stage, the specialist (in an osteoporosis or other specialty clinic) should review the primary or secondary causes of fracture risk, confirm the diagnosis, and introduce an appropriate treatment and monitoring. In patients (men aged >50 years and postmenopausal women) without low-energy fractures, the absolute risk of fractures exceeding 10% should be considered an indication for treatment. The Polish guidelines were compared with other international guidelines in terms of diagnostic measures, pharmacotherapy, as well as calcium and vitamin D supplementation.
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Karczmarewicz E, Czekuć-Kryśkiewicz E, Płudowski P. Effect of vitamin D status on pharmacological treatment efficiency: Impact on cost-effective management in medicine. Dermatoendocrinol 2013; 5:1-6. [PMID: 24494037 PMCID: PMC3897577 DOI: 10.4161/derm.25531] [Citation(s) in RCA: 9] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 05/25/2013] [Accepted: 06/19/2013] [Indexed: 01/28/2023]
Abstract
At least 80% of the whole Polish population, including prepubertal children and adolescents, adults and seniors, are vitamin D deficient, defined as 25(OH)D < 50 nmol/L. 83% of Polish newborns start their lives at the state of vitamin D deficiency because 78% of their mothers are also deficient. It was observed that treating patient vitamin D deficiency to vitamin D status serum 25(OH)D) 75-100 nmol/L increased effectiveness of therapies in infectious diseases (chronic hepatitis C, tuberculosis), osteoporosis, multiple sclerosis, epilepsy, Chronic Kidney Diseases and atopic dermatitis. . For these reasons doctors should take special attension to vitamin D status in patients suffering for these diseases properly implementing recent vitamin D recommendation.
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Affiliation(s)
- Elżbieta Karczmarewicz
- Department of Biochemistry and Experimental Medicine; The Children's Memorial Health Institute; Warsaw, Poland
| | - Edyta Czekuć-Kryśkiewicz
- Department of Biochemistry and Experimental Medicine; The Children's Memorial Health Institute; Warsaw, Poland
| | - Paweł Płudowski
- Department of Biochemistry and Experimental Medicine; The Children's Memorial Health Institute; Warsaw, Poland
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7
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Grenda R, Karczmarewicz E, Rubik J, Matusik H, Płudowski P, Kiliszek M, Piskorski J. Bone mineral disease in children after renal transplantation in steroid-free and steroid-treated patients--a prospective study. Pediatr Transplant 2011; 15:205-13. [PMID: 21199211 DOI: 10.1111/j.1399-3046.2010.01448.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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
UNLABELLED Bone disease may persist after transplantation. Different approaches aiming to ameliorate this problem have been investigated. The aim of the study was to compare the long-term effect of three medical interventions: (i) two prophylactic oral doses of 50 mg ibandronate; (ii) daily oral dose of 0.25 μg of 1α-OHD3 (both of these regimens in patients receiving steroids), and (iii) steroid minimization immunosuppressive protocol in patients with no other specific prophylaxis. PATIENTS A total of 37 children, at a mean age of 13.33±3.49 yr, dialyzed for 15.93±16.7 months before transplantation, were divided into three groups, depending on medical intervention. Bone mineral content and density (BMC, BMD, DXA), serum markers of bone resorption and formation (CTX, P1NP), calcium, phosphate, 25OHD3/1.25 (OH)2D3 and PTH concentration were evaluated during two yr of follow-up. The mean values of BMD in the whole population and among the three subgroups remained within the age- and gender-matched normal range during follow-up. PATIENTS from groups II (alphacalcidiol) and III (steroid minimization) showed a significant decrease in BMD Z-scores over time, and this effect was determined with increasing age using multivariate analysis. PATIENTS receiving two doses of ibandronate maintained unchanged Z-scores for BMD and BMC over time.
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Affiliation(s)
- Ryszard Grenda
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children's Memorial Health Institute, Warsaw, Poland.
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Skowrońska‑Jóźwiak E, Płudowski P, Karczmarewicz E, Lorenc RS, Lewiński A. Effect of sex, age, and anthropometric parameters on the size and shape of vertebrae in densitometric morphometry. Results of the EPOLOS study. Pol Arch Intern Med 2010. [DOI: 10.20452/pamw.923] [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: 11/23/2022]
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Piekutowska-Abramczuk D, Magner M, Popowska E, Pronicki M, Karczmarewicz E, Sykut-Cegielska J, Kmiec T, Jurkiewicz E, Szymanska-Debinska T, Bielecka L, Krajewska-Walasek M, Vesela K, Zeman J, Pronicka E. SURF1 missense mutations promote a mild Leigh phenotype. Clin Genet 2009; 76:195-204. [PMID: 19780766 DOI: 10.1111/j.1399-0004.2009.01195.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
UNLABELLED SURF1 gene mutations are the most common cause of Leigh syndrome (LS), a rare progressive neurodegenerative disorder of infancy, characterized by symmetric necrotizing lesions and hypervascularity in the brainstem and basal ganglia, leading to death before the age of 4 years. Most of the reported mutations create premature termination codons, whereas missense mutations are rare. The aim of the study was to characterize the natural history of LS patients carrying at least one missense mutation in the SURF1 gene. Nineteen such patients (8 own cases and 11 reported in the literature) were compared with a reference group of 20 own c.845_846delCT homozygous patients, and with other LS(SURF-) cases described in the literature. Disease onset in the studied group was delayed. Acute failure to thrive and hyperventilation episodes were rare, respiratory failure did not appear before the age of 4 years. Dystonia, motor regression and eye movement dissociation developed slowly. The number of patients who survived 7 years of life totaled 9 out of 15 (60%) in the 'missense group' and 1 out of 26 (4%) patients with mutations leading to truncated proteins. IN CONCLUSION (i) The presence of a missense mutation in the SURF1 gene may correlate with a milder course and longer survival of Leigh patients, (ii) normal magnetic resonance imaging (MRI) findings, normal blood lactate value, and only mild decrease of cytochrome c oxidase (COX) activity are not sufficient reasons to forego SURF1 mutation analysis in differential diagnosis.
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Pronicki M, Matyja E, Piekutowska-Abramczuk D, Szymanska-Debinska T, Karkucinska-Wieckowska A, Karczmarewicz E, Grajkowska W, Kmiec T, Popowska E, Sykut-Cegielska J. Light and electron microscopy characteristics of the muscle of patients with SURF1 gene mutations associated with Leigh disease. J Clin Pathol 2007; 61:460-6. [PMID: 17908801 PMCID: PMC2571978 DOI: 10.1136/jcp.2007.051060] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS Leigh syndrome (LS) is characterised by almost identical brain changes despite considerable causal heterogeneity. SURF1 gene mutations are among the most frequent causes of LS. Although deficiency of cytochrome c oxidase (COX) is a typical feature of the muscle in SURF1-deficient LS, other abnormalities have been rarely described. The aim of the present work is to assess the skeletal muscle morphology coexisting with SURF1 mutations from our own research and in the literature. METHODS Muscle samples from 21 patients who fulfilled the criteria of LS and SURF1 mutations (14 homozygotes and 7 heterozygotes of c.841delCT) were examined by light and electron microscopy. RESULTS Diffuse decreased activity or total deficit of COX was revealed histochemically in all examined muscles. No ragged red fibres (RRFs) were seen. Lipid accumulation and fibre size variability were found in 14 and 9 specimens, respectively. Ultrastructural assessment showed several mitochondrial abnormalities, lipid deposits, myofibrillar disorganisation and other minor changes. In five cases no ultrastructural changes were found. Apart from slight correlation between lipid accumulation shown by histochemical and ultrastructural techniques, no other correlations were revealed between parameters investigated, especially between severity of morphological changes and the patient's age at the biopsy. CONCLUSION Histological and histochemical features of muscle of genetically homogenous SURF1-deficient LS were reproducible in detection of COX deficit. Minor muscle changes were not commonly present. Also, ultrastructural abnormalities were not a consistent feature. It should be emphasised that SURF1-deficient muscle assessed in the light and electron microscopy panel may be interpreted as normal if COX staining is not employed.
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Affiliation(s)
- M Pronicki
- Department of Pathology, The Children's Memorial Health Institute, Warsaw, Poland.
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11
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Pawłowska J, Matusik H, Socha P, Ismail H, Ryzko J, Karczmarewicz E, Jankowska I, Teisseyre M, Lorenc R. Beneficial effect of liver transplantation on bone mineral density in small infants with cholestasis. Transplant Proc 2004; 36:1479-80. [PMID: 15251362 DOI: 10.1016/j.transproceed.2004.04.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/16/2022]
Abstract
Reports of bone mineral density in children after liver transplantation are few. Eleven cholestatic children were analyzed before and 6 months after liver transplantation. No changes in serum levels of calcium, alkaline phosphates, or 25OHD were observed before versus after LTx. The serum levels of phosphorus and 1-25(OH)2D3 as well as total bone mass density and Cole index were significantly increased after liver transplantation.
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Affiliation(s)
- J Pawłowska
- Children's Memorial Health Institute, Warsaw, Poland
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12
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Pronicka E, Piekutowska-Abramczuk DH, Popowska E, Pronicki M, Karczmarewicz E, Sykut-Cegielskâ Y, Taybert J. Compulsory hyperventilation and hypocapnia of patients with Leigh syndrome associated with SURF1 gene mutations as a cause of low serum bicarbonates. J Inherit Metab Dis 2001; 24:707-14. [PMID: 11804207 DOI: 10.1023/a:1012937204315] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 12/30/2022]
Abstract
Experimental data show that elevation of intracellular pH leads to severe lesions of brain cells. Acidification of intracellular fluid by accumulation of lactate may compensate the effect of respiratory alkalosis. Increased serum pH, and low PCO2, associated with hyperlactataemia (sometimes incorrectly called 'acidosis') have been reported in children with Leigh syndrome (LS). The aim of the study was to determine whether respiratory alkalosis is characteristic of patients with LS due to SURF1 mutations. All venous blood gas data (88 samples) of 18 spontaneously breathing LS patients with recently established SURF1 mutations, hospitalized during 1986-2000, were retrospectively reviewed. The data of an affected boy who survived on a respirator for more than 3 months (79 daily samples) were analysed separately. In spontaneously breathing patients, the data indicated that the patients had compensated or partially compensated respiratory alkalosis (pH 7.388+/-0.060, Pco2 29.2+/-5.7 mmHg, HCO3- 17.4+/-3.0 mmol/L, BE -6.7+/-3.2 mmol/L). Bicarbonate excretion was detected in urine of two examined LS cases in spite of decreased serum HCO3-. In the affected child maintained on a respirator, simple manipulation of the inspired CO2 tension to establish a normal pressure of 35-45 mmHg automatically caused an increase of serum HCO3- concentration to a normal value of 26.3+/-2.9 mmol/L (and BE to +2.2+/-3.1 mmol/L), in spite of cytochrome oxidase (COX) deficiency due to a confirmed SURF1 mutation. We suggest that respiratory alkalosis (hypocapnia) of Leigh syndrome patients with SURF1 mutations results from compulsory hyperventilation and speculate that hypocapnia may contribute to Leigh-like brain damage in the SURF1-deficient patients as well as in other patients presenting with Leigh-like syndrome. The supposition that accumulation of lactate may protect the brain of LS patients from alkalosis-related damage requires further study. Avoidance of any factors stimulating hyperventilation of LS patients and caution when attempting to correct low plasma bicarbonate are suggested.
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Affiliation(s)
- E Pronicka
- Department of Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland.
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Wasniewska M, Karczmarewicz E, Pronicki M, Piekutowska-Abramczuk D, Zablocki K, Popowska E, Pronicka E, Duszyński J. Abnormal calcium homeostasis in fibroblasts from patients with Leigh disease. Biochem Biophys Res Commun 2001; 283:687-93. [PMID: 11341780 DOI: 10.1006/bbrc.2001.4834] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/22/2022]
Abstract
Recently, we reported that in various cell lines under conditions of deenergization of the mitochondrial membrane, the release of Ca(2+) from the endoplasmic reticulum (ER) does not produce the expected activation of store-operated calcium channels (SOCs) in the plasma membrane. In the present work, we examined the activation of SOCs in fibroblasts derived from three patients with Leigh disease (LS). We identified mutations in the SURF-1 gene in all these cells. Consequently, cytochrome oxidase (COX) deficiency was found in all these (LS(COX)) cell lines and, thus, the main mitochondrial mechanism of generation of the electrochemical proton gradient on the mitochondrial membrane was naturally depressed. We demonstrated that, in untreated LS(COX) fibroblasts, the rate of Ca(2+)-inflow through SOCs was low compared to the fibroblasts from healthy individuals even after thapsigargin-induced maximal release of Ca(2+) from the ER. Moreover, the pretreatment of LS(COX) fibroblasts with a protonophore did not modify this rate. Thus, in LS(COX) fibroblasts, the activation of SOCs was naturally impaired. Our findings suggest that altered calcium metabolism, apart from severe energy production failure, may also contribute to developing pathological conditions in patients with COX-deficient Leigh disease related to SURF-1 gene mutation.
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Affiliation(s)
- M Wasniewska
- Department of Cellular Biochemistry, Nencki Institute of Experimental Biology, 3 Pasteur Street, Warsaw, 02 093, Poland
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Czarnowska E, Kurzelewski M, Beresewicz A, Karczmarewicz E. The role of endogenous nitric oxide in inhibition of ischemia/reperfusion-induced cardiomyocyte apoptosis. Folia Histochem Cytobiol 2001; 39:179-80. [PMID: 11374814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
The effect of nitric oxide (NO) synthase inhibition on apoptosis of cardiomyocytes during ischemia/reperfusion was investigated. Isolated perfused guinea-pig hearts were subjected to 35 min ischemia (I) followed by 30 min reperfusion (IR) in the presence or absence of NO synthase inhibitors, L-NAME or L-NMMA or a superoxide scavenger, SOD. Apoptosis was assessed by immunohistochemistry (TUNEL assay, Bax protein staining), by spectrophotometric measurement of cytochrome oxidase activity (COX), and by ultrastructural analysis. Inhibition of NOS significantly increased apoptosis with activation of Bax protein and decrease of COX. SOD infusion had a protective effect on these apoptotic markers. The results suggest that endogenous NO synthesis during I/R protects the heart against apoptotic cell death.
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Affiliation(s)
- E Czarnowska
- Department of Pathology, The Children's Memorial Health Institute, Warsaw, Poland.
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Piekutowska-Abramczuk D, Popowska E, Pronicka E, Karczmarewicz E, Pronicki M, Kmieć T, Krajewska-Walasek M. SURF1 gene mutations in Polish patients with COX-deficient Leigh syndrome. J Appl Genet 2001; 42:103-8. [PMID: 14564068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
One of the most frequent forms of Leigh syndrome (LS), a severe neurodegenerative, genetically heterogenous disease, is associated with cytochrome c oxidase (COX) deficiency. No mutations in any of the 13 polypeptide subunits of human COX have been detected in LS patients. Recently, SURF1, a positional candidate gene for LS has been identified on chromosome 9q34. We present the identification of SURF1 mutations in a randomly chosen group of Polish patients with a classical form of LS. Sequence analysis revealed the presence of a novel 704T-->C transition (Met235Thr), and two recurrent dinucleotide deletions (758delCA, 845delCT), as well as one novel polymorphic 573C-->G transversion (Thr191Thr). 845delCT was identified in 66% of all our patients in homozygous or heterozygous form. Our study confirms the recent observations that SURF1 is consistently involved in disorders of the mitochondrial respiratory chain in patients with typical Leigh syndrome.
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Czarnowska E, Wierzchoń T, Maranda-Niedbała A, Karczmarewicz E. Improvement of titanium alloy for biomedical applications by nitriding and carbonitriding processes under glow discharge conditions. J Mater Sci Mater Med 2000; 11:73-81. [PMID: 15348050 DOI: 10.1023/a:1008980631780] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Although titanium alloys are used in medicine, they present low wear resistance. In this paper we present the results of studies on surface layers produced by nitriding at three different temperatures, and by carbonitriding under glow discharge conditions in order to improve wear resistance, hardness, and to modulate microstructure and chemical composition of surface layers. A cell culture model using human fibroblasts was chosen to study the effect of such treatments on the cytocompatibility of these materials. The results showed that nitrided and carbonitrided surface layers were cytocompatible. Modulation of surface microstructure by temperature in the nitriding process and chemical composition of surface layers by carbonitriding led to differences in cellular behaviour. Cell proliferation appeared to be slightly reduced from the 6th day of culture on nitrided surfaces produced at 730 degrees C and 1000 degrees C, however after 12 days of culture, the best growth was on surface layers produced at 850 degrees C. The best viability was observed on the carbonitrided layer. The orientation and shape of the cells corresponded to surface topography. Nitriding and carbonitriding under glow discharge conditions may constitute interesting techniques allowing the formation of surface layers on parts with sophisticated shapes. They may also permit modulating surface topography in a way improving the features of titanium alloys for various applications in medicine.
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Affiliation(s)
- E Czarnowska
- The Children's Memorial Health Institute, Pathology Department, Warsaw, Poland
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Matyaszczyk M, Karczmarewicz E, Czarnowska E, Reynolds RD, Lorenc RS. Vitamin B-6 deficiency alters rat enterocyte calcium homeostasis but not duodenal transport. J Nutr 1993; 123:204-15. [PMID: 8429369 DOI: 10.1093/jn/123.2.204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Isolated enterocytes were used as differential transporting cells to examine calcium homeostasis in control and vitamin B-6-deficient rats. Kinetic analysis of calcium fluxes, as well as biochemical determinations, indicated that enterocytes from control animals had high concentrations of cytosol ionized calcium (318.5 +/- 22.4 nmol/L) and a large pool of exchangeable calcium (2.72 nmol/mg protein, or 86% of total cell calcium). Vitamin B-6 deficiency resulted in a 44% reduction in total cellular calcium (1.71 +/- 0.24 vs. 3.07 +/- 0.29 nmol/mg protein), a 69% reduction in total exchangeable calcium (0.85 vs. 2.72 nmol/mg protein) and a 56% reduction in cytosol ionized calcium concentration (141.4 +/- 13.5 vs. 318.5 +/- 22.4 nmol/L). Calcium fluxes between all cellular compartments were markedly diminished as a result of vitamin B-6 deficiency. However, vitamin B-6 deficiency did not affect the basic morphological or functional features of the enterocytes, such as cell viability, cell volume, membrane permeability and protein content. Moreover, intestinal calcium transport in vivo was not affected during vitamin B-6 deficiency, perhaps due to the greater paracellular ion movement compensating for the lower transcellular transport.
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Affiliation(s)
- M Matyaszczyk
- Department of Biochemistry and Experimental Medicine, Child's Health Centre, Warsaw-Miedzylesie, Poland
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Karczmarewicz E, Matyaszczyk M, Vorbrodt Z, Lorenc R. Activation of liver cytosol phosphoenolpyruvate carboxykinase by Ca2+ through intracellular redistribution of Mn2+. Eur J Biochem 1985; 151:561-5. [PMID: 4029148 DOI: 10.1111/j.1432-1033.1985.tb09140.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Calcium has no known direct effect on phosphoenolpyruvate carboxykinase from rat liver cytosol. However, addition of calcium salts to liver postnuclear supernatant led to an increase in assayable enzyme activity in cytosols. This indicates that mitochondria and microsomes present in postnuclear supernatant can participate in observed enzyme activation. The stimulation of phosphoenolpyruvate carboxykinase was prevented by the manganese complexion 1-(2-pyridylazo)-2-naphthol, was not additive with activation by MnCl2 and was inhibited by La3+, Sr2+ and ruthenium red. These data indicate that manganese and mitochondrial or microsomal calcium carriers participate in the mechanism of indirect calcium effect. Measuring of manganese content in cytosols directly, by atomic absorption spectrometry, has provided evidence that there is a pool of manganese associated with mitochondrial and microsomal fraction of rat liver that can be mobilized to the cytosol by calcium ions. The direct addition of this pool of manganese to the cytosol caused the stimulation of phosphoenolpyruvate carboxykinase activity to the same levels as did calcium ions in the postnuclear supernatant. It is postulated that calcium can effect enzyme activity indirectly by releasing manganese from specific cellular compartments into the cytosol.
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Karczmarewicz E. [Diseases of senility]. Pieleg Polozna 1970; 1:4-6. [PMID: 5201167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Karczmarewicz E. [Geriatric patient]. Pieleg Polozna 1969; 12:6. [PMID: 5199015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Karczmarewicz E. [The geriatric community]. Pieleg Polozna 1969; 11:8 passim. [PMID: 5199008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Karczmarewicz E. [The problem of old age]. Pieleg Polozna 1969; 10:15 passim. [PMID: 5198996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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