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Goulet O, Breton A, Coste ME, Dubern B, Ecochard-Dugelay E, Guimber D, Loras-Duclaux I, Abi Nader E, Marinier E, Peretti N, Lambe C. Pediatric Home Parenteral Nutrition in France: A six years national survey. Clin Nutr 2021; 40:5278-5287. [PMID: 34534896 DOI: 10.1016/j.clnu.2021.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/22/2021] [Revised: 05/31/2021] [Accepted: 08/05/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Home Parenteral Nutrition (HPN) is the cornerstone management for children suffering from chronic intestinal failure (CIF). In France, HPN is organized from a network of 7 certified centers located in University Hospitals spread across the national territory. This study aims to review the data involving children on HPN over a 6-years period in France to outline the global and continuous improvement in care. PATIENTS AND METHODS This cross-sectional study included all children enrolled in any of the 7 French HPN certified centers from January 1st, 2014 to December 31st, 2019. Data was recorded from annual databases provided by each center regarding: age at inclusion, indication and duration of HPN, type of intravenous lipid emulsion (ILE), outcome [PN weaning off, transfer to adult center, death, intestinal transplantation (ITx)], rate of catheter-related bloodstream infections (CRSBIs) for 1000 days of HPN, Taurolidine lock procedure (TLP) use and prevalence of cholestasis defined as conjugated bilirubin ≥20 μmol/l. RESULTS The number of patients increased by 43.6% from 268 in 2014 to 385 in 2019. According to the year of follow up, the indications for HPN were short bowel syndrome (SBS) (42.3-46.6%), congenital enteropathies (CE) (18.5-22.8%), chronic intestinal pseudo-obstruction syndrome (CIPOS) (13.0-16.3%), long segment Hirschsprung's disease (LSHD) (9.7-13.3%), Crohn's disease (CD) (1.6-2.6%) and other non-primary digestive diseases (NPDD) such as immune deficiency, cancer or metabolic disease (4.0-9.2%). The median age at discharge on HPN decreased from 11.7 months in 2014 to 8.3 months in 2019 (p < .001). By December 31st, 2019, 44.8% of children had left the HPN program after a median duration ranging between 39.9 and 66.4 months. Among these patients, 192 (74.2%) were weaned off PN (94.7% SBS), 41 (15.8%) were transferred to adult centers for CIPOS (42%), SBS (31%) or CE (27%), 21 died (8.1%) - mostly in relation to cancer or immune deficiency - and 5 were transplanted (1.9%): 4 underwent combined liver-intestine transplantation for LSHD (n = 2), SBS, CE and one multivisceral Tx for CIPOS. The use of a composite fish-oil based ILE increased from 67.4% in 2014 to 88.3% in 2019 (p < 0.001). CRBSIs dropped from 1.04 CRSBIs per 1000 days HPN in 2014 to 0.61 in 2019 (p < 0.001) while meantime, the percentage of children receiving TLP increased from 29.4% to 63.0% (p < 0.001). The prevalence of cholestasis (conjugated bilirubin ≥ 20 μmol/l) was low and stable between 4.1 and 5.9% of children during the study period. CONCLUSION In France, the number of children enrolled in a HPN program continuously increased over a 6 years period. SBS is the leading cause of CIF requiring HPN. The rate of CRBSIs dropped dramatically as the use of TLP increased. Mortality rate was low and mainly in relation to the underlying disease (cancer, immune deficiency). Cholestasis and intestinal Tx remained very rare.
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Affiliation(s)
- Olivier Goulet
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades University of Paris-UFR Paris Descartes, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Paris, France
| | - Anne Breton
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Purpan University Hospital, Certified Center for Home Parenteral Nutrition, Toulouse, France
| | - Marie-Edith Coste
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, La Timone University Hospital, Certified Center for Home Parenteral Nutrition, Marseille, France
| | - Béatrice Dubern
- Division of Pediatric Nutrition and Gastroenterology, Armand Trousseau University Hospital, Certified Center for Home Parenteral Nutrition, Sorbonne University, Paris, France
| | - Emmanuelle Ecochard-Dugelay
- Division of Pediatric Gastroenterology and Nutrition, Robert Debré University Hospital, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children Paris, France
| | - Dominique Guimber
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Jeanne de Flandre University Hospital, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Lille, France
| | - Irène Loras-Duclaux
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric University Hospital, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Lyon, France
| | - Elie Abi Nader
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades University of Paris-UFR Paris Descartes, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Paris, France
| | - Evelyne Marinier
- Division of Pediatric Gastroenterology and Nutrition, Robert Debré University Hospital, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children Paris, France
| | - Noel Peretti
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric University Hospital, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Lyon, France
| | - Cecile Lambe
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Necker-Enfants Malades University of Paris-UFR Paris Descartes, Certified Center for Home Parenteral Nutrition, Reference Center for Rare Digestive Diseases in Children, Paris, France.
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Léonard M, Caldari D, Mas E, Lambe C, Compte A, Ley D, Peretti N, Borderon C, Marinier E, Coste ME, Lamireau T, Rubio A, Turquet A, Dubern B, Dabadie A, Gautry J, Kyheng M, Guimber D, Gottrand F. Experience of using a semi-elemental formula for home enteral nutrition in children: a french multicenter study. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.2088] [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: 11/25/2022]
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Vély F, Barlogis V, Marinier E, Coste ME, Dubern B, Dugelay E, Lemale J, Martinez-Vinson C, Peretti N, Perry A, Bourgeois P, Badens C, Goulet O, Hugot JP, Farnarier C, Fabre A. Combined Immunodeficiency in Patients With Trichohepatoenteric Syndrome. Front Immunol 2018; 9:1036. [PMID: 29868001 PMCID: PMC5958188 DOI: 10.3389/fimmu.2018.01036] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 12/01/2017] [Accepted: 04/25/2018] [Indexed: 11/13/2022] Open
Abstract
The syndromic diarrhea/trichohepatoenteric syndrome (SD/THE) is a rare and multi-system genetic disorder caused by mutation in SKIV2L or in TTC37, two genes encoding subunits of the putative human SKI complex involved in RNA degradation. The main features are intractable diarrhea of infancy, hair abnormalities, facial dysmorphism, and intrauterine growth restriction. Immunologically this syndrome is associated with a hypogammaglobulinemia leading to an immunoglobulin supplementation. Our immune evaluation of a large French cohort of SD/THE patient revealed several immunological defects. First, switched memory B lymphocytes count is very low. Second, IFN-γ production by T and NK cells is impaired and associated with a reduced degranulation of NK cells. Third, T cell proliferation was abnormal in 3/6 TTC37-mutated patients. These three patients present with severe EBV infection and a transient hemophagocytosis which may be related to these immunological defects. Moreover, an immunological screening of patients with clinical features of SD/THE could facilitate both diagnosis and therapeutic management of these patients.
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Affiliation(s)
- Frédéric Vély
- Aix Marseille Univ, CNRS, INSERM, CIML, Marseille, France.,APHM, Hôpital de la Timone, Service d'Immunologie, Marseille-Immunopôle, Marseille, France
| | - Vincent Barlogis
- APHM, Hôpital de la Timone, Service d'Hématologie et Oncologie Pédiatrique, Marseille, France
| | - Evelyne Marinier
- APHP Robert Debré, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Paris, France
| | - Marie-Edith Coste
- APHM, Hôpital de la Timone Enfant, Service de Pédiatrie Multidisciplinaire, Marseille, France
| | - Béatrice Dubern
- Nutrition et Gastroentérologie Pédiatriques, Hôpital Armand-Trousseau, UMR-S U1166 Nutriomics, UPMC, Sorbonne University, Paris, France
| | - Emmanuelle Dugelay
- APHP Robert Debré, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Paris, France
| | - Julie Lemale
- Nutrition et Gastroentérologie Pédiatriques, Hôpital Armand-Trousseau, UMR-S U1166 Nutriomics, UPMC, Sorbonne University, Paris, France
| | - Christine Martinez-Vinson
- APHP Robert Debré, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Paris, France
| | - Noël Peretti
- Department of Pediatric Nutrition, University Pediatric Hospital of Lyon, Hospices Civils de Lyon HCL, INSERM U1060, CarMeN Laboratory, University Claude Bernard Univ Lyon-1, Lyon, France
| | - Ariane Perry
- APHP, Hôpitaux Universitaires Paris Sud, Hôpital Antoine Béclère, Centre de référence des maladies héréditaires du métabolisme hépatique, Clamart, France
| | - Patrice Bourgeois
- APHM, Hôpital de la Timone Enfant, Service de biologie moléculaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Catherine Badens
- APHM, Hôpital de la Timone Enfant, Service de biologie moléculaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Olivier Goulet
- APHP, Necker-Enfants Malades Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Paris-Descartes University, Intestinal Failure Rehabilitation Center, National Reference Centre for Rare Digestive Diseases, Paris, France
| | - Jean-Pierre Hugot
- APHP, Hôpital Robert Debré, Paris, France.,UMR 1149, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Labex Inflamex, Université Paris-Diderot Sorbonne Paris-Cité, Paris, France
| | - Catherine Farnarier
- APHM, Hôpital de la Timone, Service d'Immunologie, Marseille-Immunopôle, Marseille, France
| | - Alexandre Fabre
- APHM, Hôpital de la Timone Enfant, Service de Pédiatrie Multidisciplinaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
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Billiauws L, Armengol Debeir L, Poullenot F, Chambrier C, Cury N, Ceccaldi PF, Latour Beaudet E, Corcos O, Marinier E, Goulet O, Lerebours E, Joly F. Pregnancy is possible on long-term home parenteral nutrition in patients with chronic intestinal failure: Results of a long term retrospective observational study. Clin Nutr 2017; 36:1165-1169. [DOI: 10.1016/j.clnu.2016.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
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Janecke AR, Heinz-Erian P, Yin J, Petersen BS, Franke A, Lechner S, Fuchs I, Melancon S, Uhlig HH, Travis S, Marinier E, Perisic V, Ristic N, Gerner P, Booth IW, Wedenoja S, Baumgartner N, Vodopiutz J, Frechette-Duval MC, De Lafollie J, Persad R, Warner N, Tse CM, Sud K, Zachos NC, Sarker R, Zhu X, Muise AM, Zimmer KP, Witt H, Zoller H, Donowitz M, Müller T. Reduced sodium/proton exchanger NHE3 activity causes congenital sodium diarrhea. Hum Mol Genet 2015; 24:6614-23. [PMID: 26358773 DOI: 10.1093/hmg/ddv367] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/03/2015] [Indexed: 02/06/2023] Open
Abstract
Congenital sodium diarrhea (CSD) refers to an intractable diarrhea of intrauterine onset with high fecal sodium loss. CSD is clinically and genetically heterogeneous. Syndromic CSD is caused by SPINT2 mutations. While we recently described four cases of the non-syndromic form of CSD that were caused by dominant activating mutations in intestinal receptor guanylate cyclase C (GC-C), the genetic cause for the majority of CSD is still unknown. Therefore, we aimed to determine the genetic cause for non-GC-C non-syndromic CSD in 18 patients from 16 unrelated families applying whole-exome sequencing and/or chromosomal microarray analyses and/or direct Sanger sequencing. SLC9A3 missense, splicing and truncation mutations, including an instance of uniparental disomy, and whole-gene deletion were identified in nine patients from eight families with CSD. Two of these nine patients developed inflammatory bowel disease (IBD) at 4 and 16 years of age. SLC9A3 encodes Na(+)/H(+) antiporter 3 (NHE3), which is the major intestinal brush-border Na(+)/H(+) exchanger. All mutations were in the NHE3 N-terminal transport domain, and all missense mutations were in the putative membrane-spanning domains. Identified SLC9A3 missense mutations were functionally characterized in plasma membrane NHE null fibroblasts. SLC9A3 missense mutations compromised NHE3 activity by reducing basal surface expression and/or loss of basal transport function of NHE3 molecules, whereas acute regulation was normal. This study identifies recessive mutations in NHE3, a downstream target of GC-C, as a cause of CSD and implies primary basal NHE3 malfunction as a predisposition for IBD in a subset of patients.
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Affiliation(s)
| | | | - Jianyi Yin
- Department of Medicine, Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Britt-Sabina Petersen
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel 24105, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel 24105, Germany
| | | | | | - Serge Melancon
- Department of Medical Genetics, McGill University Health Centre, Montreal, Canada H3H 1P3
| | - Holm H Uhlig
- Translational Gastroenterology Unit, Nuffield Department of Medicine, and Children's Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Nuffield Department of Medicine, and Children's Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Evelyne Marinier
- Service des maladies digestives et respiratoires de l'enfant, Centre de référence des maladies digestives rares, Hôpital R Debré, Paris 75935, France
| | - Vojislav Perisic
- Department of Hepatology and GI Endoscopy, University Children's Hospital, Belgrade 11000, Serbia
| | - Nina Ristic
- Department of Hepatology and GI Endoscopy, University Children's Hospital, Belgrade 11000, Serbia
| | - Patrick Gerner
- Zentrum für Kinder-und Jugendmedizin, Universitätsklinikum, Freiburg 79106, Germany
| | - Ian W Booth
- Paediatrics and Child Health, University of Birmingham, Birmingham B4 6NH, UK
| | - Satu Wedenoja
- Department of Medical Genetics, University of Helsinki, Helsinki 00014, Finland
| | - Nadja Baumgartner
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - Julia Vodopiutz
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Wien 1090, Austria
| | | | - Jan De Lafollie
- Abteilung Allgemeine Pädiatrie & Neonatologie, Zentrum für Kinderheilkunde und Jugendmedizin, Justus-Liebig-Universität, Gießen 35392, Germany
| | - Rabindranath Persad
- Stollery Children's Hospital, University of Alberta, Edmonton, Canada T6G 2B7
| | - Neil Warner
- SickKids Inflammatory Bowel Disease Center and Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada M5G 1X8
| | - C Ming Tse
- Department of Medicine, Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Karan Sud
- Department of Medicine, Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Nicholas C Zachos
- Department of Medicine, Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Rafiquel Sarker
- Department of Medicine, Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Xinjun Zhu
- Department of Medicine, Albany Medical Center, Albany, NY 12208, USA
| | - Aleixo M Muise
- SickKids Inflammatory Bowel Disease Center and Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada M5G 1X8, Department of Biochemistry, Department of IMS, Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of Toronto, Toronto, ON, Canada M5G 1X8 and
| | - Klaus-Peter Zimmer
- Abteilung Allgemeine Pädiatrie & Neonatologie, Zentrum für Kinderheilkunde und Jugendmedizin, Justus-Liebig-Universität, Gießen 35392, Germany
| | - Heiko Witt
- Pädiatrische Ernährungsmedizin, Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Technische Universität München, Freising-Weihenstephan 85350, Germany
| | - Heinz Zoller
- Department of Internal Medicine, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - Mark Donowitz
- Department of Medicine, Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Marinier E, Liebert F, Doit C. P083: Comparaison de la Fréquence des septicémies sur CVC en NPAD en pédiatrie sous verrous de taurolidine, serum salé ou héparine. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70726-5] [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: 11/28/2022]
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Fabre A, Breton A, Coste ME, Colomb V, Dubern B, Lachaux A, Lemale J, Mancini J, Marinier E, Martinez-Vinson C, Peretti N, Perry A, Roquelaure B, Venaille A, Sarles J, Goulet O, Badens C. Syndromic (phenotypic) diarrhoea of infancy/tricho-hepato-enteric syndrome. Arch Dis Child 2014; 99:35-8. [PMID: 24108068 DOI: 10.1136/archdischild-2013-304016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 12/17/2022]
Abstract
OBJECTIVES Syndromic diarrhoea/tricho-hepato-enteric syndrome (SD/THE) is a rare congenital syndrome. The main features are intractable diarrhoea of infancy, hair abnormalities, facial dysmorphism, intrauterine growth restriction and immune system abnormalities. It has been linked to abnormalities in two components of the putative human ski complex: SKIV2L and TTC37. The long-term outcome of this syndrome is still unknown. We aim to describe the long-term outcome, in the French cohort of patients born since 1992. DESIGN Review of the clinical and biological features of the 15 patients with SD/THE, followed in France and born between 1992 and 2010. RESULTS All patients presented typical SD/THE syndrome features, of intractable diarrhoea in infancy requiring parenteral nutrition, a facial dysmorphism with hair abnormalities, and immunological disorders. Half of them also had liver and skin abnormalities. Five children died, among which 3 died due to infections. Probabilities of survival according to the Kaplan-Meier method were 93.3%, 86.7%, 74.3 and 61.9%, respectively at 1 year, 5 years, 10 years and 15 years of age. 3/15 were weaned from parenteral nutrition (PN) with likelihood of weaning being 10% at 5 years and 40% at 10 years. At birth 80% were small for gestational age and the short stature persisted in 60%. Haemophagocytic syndrome was noted in 60% and mild mental retardation was present in 60%. CONCLUSIONS SD/THE is a rare disease with high morbidity and mortality. Management should be focused on nutrition and immunological defects.
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Affiliation(s)
- Alexandre Fabre
- Service de Pédiatrie Multidisciplinaire, Hôpital d'enfants de la Timone, , Marseille, France
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Salomon J, Goulet O, Canioni D, Brousse N, Lemale J, Tounian P, Coulomb A, Marinier E, Hugot JP, Ruemmele F, Dufier JL, Roche O, Bodemer C, Colomb V, Talbotec C, Lacaille F, Campeotto F, Cerf-Bensussan N, Janecke AR, Mueller T, Koletzko S, Bonnefont JP, Lyonnet S, Munnich A, Poirier F, Smahi A. Genetic characterization of congenital tufting enteropathy: epcam associated phenotype and involvement of SPINT2 in the syndromic form. Hum Genet 2013; 133:299-310. [PMID: 24142340 DOI: 10.1007/s00439-013-1380-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 10/06/2013] [Indexed: 02/08/2023]
Abstract
Congenital tufting enteropathy (CTE) is a rare and severe enteropathy recently ascribed to mutations in the epcam gene. Here we establish SPINT2, previously ascribed to congenital sodium diarrhea, as a second gene associated with CTE and report molecular and immunohistochemistry data in 57 CTE patients. Inclusion criteria were early onset diarrhea and intestinal insufficiency with the typical histological CTE abnormalities. The clinical phenotype was registered, the entire coding regions of epcam and SPINT2 sequenced, and immunostaining of EpCAM and SPINT2 performed on intestinal biopsies. An epcam mutation was involved in 41 patients (73 %) who mainly displayed isolated digestive symptoms. Mutations severely affected gene expression since the EpCAM signal on intestinal tissues was either undetectable or low and irregular. Twelve other patients (21 %) carried mutations in SPINT2, and were phenotypically characterized by systematic association with keratitis (p < 10(-4)) and, for half of them, with choanal atresia (p < 10(-4)). Dependency on parenteral nutrition (PN) was comparable in patients with epcam or SPINT2 mutations, but the frequent epcam mutation c.556-14A>G (abnormal splicing) was significantly associated with a better outcome (p = 0.032) with milder PN dependency to weaning in some cases. Finally, four patients (7 %) with isolated digestive symptoms had no detectable epcam or SPINT2 mutation. Two candidate genes, Elf3 and Claudin7, were excluded from this population. Our study allows us to separate CTE patients into at least three genetic classes, each with specific phenotypes. The genetics approach raises the question of the distinction between two congenital enteropathies. Our findings should help improve the diagnosis of CTE, guide toward strategies of long-term PN management, and limit indications for intestinal transplantation to life-threatening PN complications.
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Affiliation(s)
- Julie Salomon
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Descartes, Sorbonne Paris Cité, 149 rue de Sèvres, 75015, Paris, France,
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Liebert F, Poisson C, Colomb V, Marinier E. Amélioration d’un programme en nutrition parentérale à domicile. Arch Pediatr 2013. [DOI: 10.1016/j.arcped.2013.02.053] [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: 11/25/2022]
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d’Autume C, Musher-Eizenman D, Marinier E, Viarme F, Frelut ML, Isnard P. Conduites alimentaires et symptômes émotionnels dans l’obésité infantile : étude exploratoire transversale à partir d’autoquestionnaires chez 63 enfants et adolescents. Arch Pediatr 2012; 19:803-10. [PMID: 22795779 DOI: 10.1016/j.arcped.2012.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 02/04/2012] [Accepted: 05/23/2012] [Indexed: 11/28/2022]
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Osman N, Perrinet M, Marinier E, Brion F, Storme T. P130 La nutrition parentérale « à la carte » en pédiatrie : une vraie nécessité. NUTR CLIN METAB 2011. [DOI: 10.1016/s0985-0562(11)70197-2] [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: 11/30/2022]
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Peretti N, Loras-Duclaux I, Kassai B, Restier-Miron L, Guimber D, Gottrand F, Coopman S, Michaud L, Marinier E, Yantren H, Michalski MC, Aubert F, Mercier C, Pelosse M, Lopez M, Chatelain P, Lachaux A. Growth hormone to improve short bowel syndrome intestinal autonomy: a pediatric randomized open-label clinical trial. JPEN J Parenter Enteral Nutr 2011; 35:723-31. [PMID: 21975668 DOI: 10.1177/0148607111415531] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The ability of growth hormone (GH) to promote the weaning-off of parenteral nutrition (PN) in short bowel syndrome (SBS) is unclear. No randomized controlled study is available in children. This study was undertaken to determine if GH could enhance the weaning off of PN in PN-dependent children with SBS. METHODS A prospective randomized open-label multicenter study was performed in 14 patients (mean age, 9 ± 1.4 years) with SBS (average small bowel length, 33 cm) and long-term PN dependency (8 years) on an unrestricted diet. A standardized PN decrease with and without GH (0.14 mg/kg/d) was conducted. The patients were randomized to either a GH group (4 months of GH) or a control (CTR) group (4 months without GH, followed by 4 months with GH). Blood tests and a nutrition assessment of enteral and parenteral intakes were performed. Groups were compared with the Wilcoxon test. RESULTS Treatment with GH did not improve the weaning off of PN (decrease in PN caloric intake of 32.5% ± 9.6% in the GH group vs 35.2% ± 8.7% in the CTR group, nonsignificant). In the CTR group, GH treatment induced an additional but not statistically significant decrease of 8.8% ± 12.4% in daily calories. Parenteral needs returned to near basal rates 6 months after GH discontinuation (GH: 77.6% ± 10.6% vs CTR: 73.2% ± 7.4%). Weight decreased slightly in both groups. No biological parameters varied significantly. CONCLUSIONS GH did not improve the weaning off of PN in PN-dependent children with SBS.
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Affiliation(s)
- Noel Peretti
- Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France.
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Beltrand J, Colomb V, Marinier E, Daubrosse C, Alison M, Burcelin R, Cani PD, Chevenne D, Marchal CL. Lower insulin secretory response to glucose induced by artificial nutrition in children: prolonged and total parenteral nutrition. Pediatr Res 2007; 62:624-9. [PMID: 17805200 DOI: 10.1203/pdr.0b013e3181559d5c] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Long-term parenteral nutrition (TPN) in children is associated with sustained hyperinsulinemia due to a high nutriment infusion flow 12 h/24 h, with plausible lipotoxicity secondary to repeated lipid infusions and with changes in incretin hormone release. The aim of this study was to test whether long-term TPN can lead to an alteration in beta-cell function. Thirteen children (age 9.5 +/- 3.9 y) on total TPN without obvious alternation in glucose tolerance were included. beta-Cell function was quantified with an intravenous glucose tolerance test (IVGTT) and a graded glucose infusion. First phase insulin release (FPIR) was low in five patients. The same demonstrated a lower insulin release under graded glucose infusion, although plasma glucose reached values as high as 15 mM. These data emphasize that metabolic conditions induced by TPN can lead to lower insulin secretory response to glucose. Patients who remain dependent on TPN are at risk of developing glucose tolerance disorders.
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Gottrand F, Staszewski P, Colomb V, Loras-Duclaux I, Guimber D, Marinier E, Breton A, Magnificat S. Satisfaction in different life domains in children receiving home parenteral nutrition and their families. J Pediatr 2005; 146:793-7. [PMID: 15973321 DOI: 10.1016/j.jpeds.2005.01.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [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: 10/25/2022]
Abstract
OBJECTIVE To assess the quality-of-life (QOL) of children receiving home parenteral nutrition (HPN). STUDY DESIGN A national multicenter study of 72 patients (median age 4 years) presenting with a digestive disease requiring HPN, and 90 siblings, 67 fathers, and 69 mothers of these children. Median duration of HPN was 2 years (3 months-18 years). QOL was measured using validated, nondisease-specific questionnaires appropriate to the children's ages. RESULTS The QOL scores were high in patients of all ages and were not significantly different from scores in a reference population of healthy children and adolescents. Lower QOL scores were recorded in the domains related to hospital, health, doctors, medications, and obligations. The QOL was not affected in siblings but was significantly impaired in parents, especially in mothers, who showed a lower level of satisfaction than did fathers for items related to work, inner life, and freedom. Presence of an ileostomy was the only factor that influenced QOL, especially of adolescents. CONCLUSIONS QOL of HPN-dependent children and siblings is not different from that of healthy children, suggesting that these children actively use effective coping strategies. In contrast, the QOL of parents of HPN-dependent children is low.
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Affiliation(s)
- Frédéric Gottrand
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Jeanne de Flandre University Hospital, Lille, France.
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Béghin L, Michaud L, Hankard R, Guimber D, Marinier E, Hugot JP, Cézard JP, Turck D, Gottrand F. Total energy expenditure and physical activity in children treated with home parenteral nutrition. Pediatr Res 2003; 53:684-90. [PMID: 12612198 DOI: 10.1203/01.pdr.0000057208.05549.3b] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [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: 11/06/2022]
Abstract
Determining total energy expenditure (TEE) and its components in children treated with home parenteral nutrition (CHPN) under free-living conditions is an important consideration in the assessment of energy requirements and the maintenance of health. The aim of this study was to assess TEE and physical activity in CHPN. Eleven CHPN (three girls and eight boys; median age, 6.0 y; range, 4.5-15.0 y) were compared with 11 healthy children (three girls and eight boys; median age, 6.0 y, range, 4.5-14.0 y) after pairing for sex, age, and weight. Underlying diseases included chronic intractable diarrhea (n = 5), short bowel syndrome (n = 3), and intestinal dysmotility (n = 3). None of these children had inflammatory disease or recent infection when studied. Fat-free mass (FFM), measured by body impedance analysis, fat mass (FM), measured by skinfold thickness, and energy intake were similar between the two groups, suggesting that CHPN had normal body composition and energy intake. Resting energy expenditure (REE), measured by indirect calorimetry, and TEE, assessed by a technique using 24-h heart-rate monitoring calibrated against indirect calorimetry and physical activity using a triaxial accelerometer, were simultaneously recorded and were also similar in the two groups. Sleeping energy expenditure (SEE), expressed per kilogram of FFM, was significantly greater in the CHPN group (median, 0.15; range, 0.10-0.23 kJ/min/kg FFM versus median, 0.12; range, 0.09-0.21 kJ/min/kg FFM for controls; p < 0.05, Wilcoxon rank test). These findings were explained by the high correlation between the energy flow infused by parenteral nutrition and sleeping energy expenditure (p < 0.05, Spearman test) and also-diet induced thermogenesis (p < 0.05 Spearman test). These results suggest that the energy requirements of children on long-term home parenteral nutrition programs do not differ from controls and that cyclic parenteral nutrition does not interfere with physical activity.
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Affiliation(s)
- Laurent Béghin
- Unité de Gastroentérologie, Hépatologie et Nutrition, Clinique de Pédiatrie, Hôpital Jeanne de Flandre, 2, Avenue Oscar Lambret, F-59037 Lille Cedex, France;
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Leroy-Willig A, Willig TN, Henry-Feugeas MC, Frouin V, Marinier E, Boulier A, Barzic F, Schouman-Claeys E, Syrota A. Body composition determined with MR in patients with Duchenne muscular dystrophy, spinal muscular atrophy, and normal subjects. Magn Reson Imaging 1997; 15:737-44. [PMID: 9309604 DOI: 10.1016/s0730-725x(97)00046-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Magnetic resonance imaging was used to determine total fat mass of patients with neuromuscular disorders, accounting for intramuscular fat. Nineteen boys aged 9 to 12 (eight with Duchenne muscular dystrophy, three with type II spinal muscular atrophy and eight control subjects) underwent whole-body magnetic resonance imaging examination and anthropometric measurements. Whole-body fat mass was deduced from automated analysis of images normalized by a reference signal. Intramuscular and subcutaneous fat masses were deduced from manual analysis of twelve reference slices. Affected children significantly differed from control subjects for higher total fat mass, mostly related to intramuscular fat mass. Shorter protocols validated from whole-body data were shown to be more accurate than fat mass estimation derived from anthropometric measurements.
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Affiliation(s)
- A Leroy-Willig
- Association Française contre les Myopathies, Evry, France.
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Munck A, Marinier E, Pérennec V, Béréziat G, Le Brun A, Dutot G, Driss F, Melin C, Cézard J, Navarro J. Comparison of fatty acid status in TPN-dependent children receiving two lipid emulsions with different essential fatty acid (EFA) content. Clin Nutr 1993. [DOI: 10.1016/0261-5614(93)90229-w] [Citation(s) in RCA: 2] [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: 11/27/2022]
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Breton I, Marinier E, Dutot G, Bereziat G, Pescio M, Melin C. Influence of varying the essential fatty acid (EFA) intake on fatty acids metabolism during TPN. Clin Nutr 1991. [DOI: 10.1016/0261-5614(91)90167-b] [Citation(s) in RCA: 3] [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: 10/26/2022]
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Marinier E, Gorski AM, de Courcy GP, Criqui C, Bunodiere M, Christides JP, Causse MB, Brion F, Ricour C, Navarro J. Blood levels of water-soluble vitamins in pediatric patients on total parenteral nutrition using a multiple vitamin preparation. JPEN J Parenter Enteral Nutr 1989; 13:176-84. [PMID: 2496249 DOI: 10.1177/0148607189013002176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 01/01/2023]
Abstract
Although guidelines for the parenteral use of vitamin preparations in pediatric patients have been published, there are very limited data on the efficiency of these preparations and on the exact needs of infants and children on total parenteral nutrition (TPN). We report here an open, prospective, study of the blood levels of water-soluble vitamins in infants and children on TPN before and during supplementation with a new water-soluble multivitamin formula containing per vial unit: B1, 3 mg; B2, 3.6 mg; B6, 4 mg; niacin, 40 mg; pantothenate, 15 mg; ascorbate, 100 mg; biotin, 60 micrograms; folic acid, 400 micrograms; B12, 5 micrograms. Thirteen children, 9 months to 15 yr old, on home TPN for 1.5 months to 7 yr, and 17 hospitalized infants and children, 1 week to 15 yr old, receiving TPN were studied for 2 weeks to 4 months. Daily doses were given according to age: 1/2 vial if less than 18 months; 1 vial if greater than 18 months and less than 10 years; 1.5 vials if greater than 10 years. Assays for B1, B2, biotin, niacin, plasma and red blood cell (RBC) folates were performed by microbiologic methods, B12 was measured by radioimmunoassay. During the study, B1 levels were consistently above the upper limit of the normal range, B2 and B12 remained in the normal range although there was a slight decrease in B12 values. Almost half of the patients had initially low levels of biotin, niacin, and folates. Biotin, after a significant sharp rise during the first month of supplementation returned to normal range. Niacin levels were initially low in infants and rose toward normal values during treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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Marinier E, Lincoln BC, Garneau M, David F, Brunengraber H. Contribution of the shunt pathway of mevalonate metabolism to the regulation of cholesterol synthesis in rat liver. J Biol Chem 1987; 262:16936-40. [PMID: 3680279] [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: 01/06/2023] Open
Abstract
The modulation of the shunt pathway of mevalonate metabolism (Edmond, J., and Popják, G. (1974) J. Biol. Chem. 249, 66-71) has been studied in livers from fed, starved, and diabetic rats perfused with a physiological concentration (300 nM) of [5-14C] + [5-3H]mevalonate. Shunt activity was measured by (i) production of 14CO2 (corrected for loss of label by exchange reactions) and (ii) production of 3H2O. Contribution of exogenous mevalonate to total mevalonate production (0.06-0.11%) was assessed in parallel experiments by the incorporation of 3H2O into sterols. Inhibition of non-saponifiable lipid synthesis by starvation and diabetes is not associated with an inhibition of mevalonate production but with a major increase in shunting (7-34%) of sterol-bound mevalonate. The shunt pathway of mevalonate metabolism appears to participate in the regulation of cholesterol synthesis.
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Affiliation(s)
- E Marinier
- Department of Nutrition, University of Montreal, PQ, Canada
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Marinier E, Lincoln BC, Garneau M, David F, Brunengraber H. Contribution of the shunt pathway of mevalonate metabolism to the regulation of cholesterol synthesis in rat liver. J Biol Chem 1987. [DOI: 10.1016/s0021-9258(18)45473-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lambert-Zechovsky N, Bingen E, Cezard JP, Mashako L, Marinier E, Navarro J. [Effects of loperamide on the fecal flora in children in severe diarrheas]. Pathol Biol (Paris) 1987; 35:656-60. [PMID: 3112712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Loperamide has been recently indicated in the management of infants with severe protracted diarrhea. The purpose of this study was to determine the effect of loperamide on fecal flora in severe protracted diarrheas. 19 children aged 1 to 36 months, with severe protracted diarrhea were studied: 14 received loperamide (0.5 mg/kg/d) and 5 were without loperamide treatment. Criteria analysed were: clinical tolerance (vomiting and abdominal distention); efficacy (number of stools, transit time and Na+/K+ in stools) and effect on fecal flora, with differential qualitative and quantitative analysis method (complete identification and counts of aerobic and strict anaerobic bacteria in fresh fecal samples before and 4 to 8 days after the beginning of loperamide). Parenteral and/or oral alimentation remain constant during the study. Results show a rapid (24 h) efficacy in 9/14. Although important changes in specific fecal flora counts was noticed for streptococcus D and Proteus as compared to five controls, no bacterial overgrowth appeared or was increased during loperamide treatment.
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Cézard JP, Bingen E, Lambert-Zechovsky N, Marchand M, Marinier E, Navarro J. [Effect of loperamide on fecal flora of children with severe prolonged diarrhea]. Arch Fr Pediatr 1987; 44:109-14. [PMID: 3579464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Loperamide has recently been proposed in the management of infants with severe protracted diarrhea. The purpose of this study was to determine the effect of loperamide (0.5 mg/kg/d) on fecal flora in 19 cases of severe protracted diarrhea. Criteria analysed were: clinical tolerance (vomiting and abdominal distension) and efficacy (number of stools, transit time and Na/k in stools); complete identification and counts of aerobic and strict anaerobic bacteria in fresh stools before and 4 to 8 days after the beginning of loperamide. Parental and/or oral alimentation remained unchanged during the entire study. Clinical resolution of diarrhea was rapid (less than 24 h) in 9 of 14 patients. In 2 cases ileus was observed and resolved when loperamide was discontinued. Although important changes in specific fecal flora counts was noticed for streptococcus D and proteus as compared to 5 controls, no bacterial overgrowth appeared or was worsened during loperamide treatment.
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Therond P, Marchand M, Marinier E, Biou D, Demelier JF, Navarro J. Influence d'une supplémentation en vitamine E sur le sélénium au cours d'une nutrition parentérale exclusive chez l'enfant. NUTR CLIN METAB 1987. [DOI: 10.1016/s0985-0562(87)80027-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Marinier E, Barrois V, Larouze B, London WT, Cofer A, Diakhate L, Blumberg BS. Lack of perinatal transmission of hepatitis B virus infection in Senegal, West Africa. J Pediatr 1985; 106:843-9. [PMID: 3998929 DOI: 10.1016/s0022-3476(85)80371-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Between 1977 and 1980, 1442 pregnant women in Thies, Senegal, were tested for serologic markers of hepatitis B virus (HBV) infection. Of these, 9.8% were HBsAg(+), 59.9% were anti-HBs(+), and 15.6% had anti-HBc alone. Of 116 HBsAg(+) pregnant women, only 19.8% were HBeAg(+), a much lower proportion of infectious carriers than seen in Asian populations. Cord blood from 1353 babies was HBsAg(-), implying that the babies were not infected prior to birth. Four hundred sixty-two babies, including 88 born to HBsAg(+) mothers, were observed for 2 weeks to 38 months after birth. In contrast to observations in Asia, none of the babies became HBsAg(+) before 5 months of age, and only three of the 16 born to HBeAg(+) mothers became HBsAg(+) within the first year of life; all three developed chronic infections (i.e., HBsAg(+) for greater than or equal to 6 months. In the second year of life, six of 34 babies born to HBsAg(+), HBeAg(-)/anti-HBe(-) mothers became infected with HBV, and four of the six developed chronic infections. During the first 3 years of life, infections occurred at a higher rate in infants born to HBsAg(+) (17%) than to HBsAg(-) (4%) women. The latter group of infants included 4.0% of those born to anti-HBs(+) mothers, 4.6% born to anti-HBcAg(+), and 3.2% born to uninfected women. These observations indicate that HBV infections in Senegal usually do not occur perinatally, but do occur at high incidence later in infancy and childhood. Such infections can be prevented by the use of hepatitis B vaccine alone; administration of hepatitis B immune globulin should not be needed.
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Weinstock SB, Kopito RR, Endemann G, Tomera JF, Marinier E, Murray DM, Brunengraber H. The shunt pathway of mevalonate metabolism in the isolated perfused rat liver. J Biol Chem 1984; 259:8939-44. [PMID: 6430893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The shunt pathway of mevalonate metabolism (Edmond, J., and Popják, G. (1974) J. Biol. Chem. 249, 66-71) has been studied in isolated livers from fed rats perfused with physiological concentrations of variously labeled [14C]mevalonates. The measured rates of 14CO2 production were converted to rates of mitochondrial acetyl-CoA production from mevalonate by methods which take into account underestimations of metabolic rates derived from 14CO2 production. Our data confirm that the shunt pathway leads to mitochondrial acetyl-CoA. The apparent negligible rate of mevalonate shunting in liver, previously reported by others, stems from the very low contribution (congruent to 0.1%) of plasma mevalonate to total mevalonate metabolism in the liver. This contribution was assessed from the relative incorporations of 3H2O and [5-14C]mevalonate into sterols. In livers from fed rats, the shunt diverts about 5% of the production of mevalonate. The total rate of mevalonate shunting in the liver is about 200 times greater than in two kidneys. The liver is therefore the main site of mevalonate shunting in the rat.
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Weinstock SB, Kopito RR, Endemann G, Tomera JF, Marinier E, Murray DM, Brunengraber H. The shunt pathway of mevalonate metabolism in the isolated perfused rat liver. J Biol Chem 1984. [DOI: 10.1016/s0021-9258(17)47246-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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