Pulmonary vascular disease is evident in gene regulation of experimental bronchopulmonary dysplasia

Objective: To examine the gene expression regarding pulmonary vascular disease in experimental bronchopulmonary dysplasia in young mice. Premature delivery puts babies at risk of severe complications. Bronchopulmonary dysplasia (BPD) is a common complication of premature birth leading to lifelong affection of pulmonary function. BPD is recognized as a disease of arrested alveolar development. The disease process is not fully described and no complete cure or prevention is known. The focus of interest in the search for treatment and prevention of BPD has traditionally been at airspace level; however, the pulmonary vasculature is increasingly acknowledged in the pathology of BPD. The aim of the investigation was to study the gene expression in lungs with BPD with regards to pulmonary vascular disease (PVD).Methods: We employed a murine model of hyperoxia-induced BPD and gene expression microarray technique to determine the mRNA expression in lung tissue from young mice. We combined gene expression pathway analysis and analyzed the biological function of multiple single gene transcripts from lung homogenate to study the PVD relevant gene expression.Results: There were n = 117 significantly differentially regulated genes related to PVD through down-regulation of contractile elements, up- and down-regulation of factors involved in vascular tone and tissue-specific genes. Several genes also allowed for pinpointing gene expression differences to the pulmonary vasculature. The gene Nppa coding for a natriuretic peptide, a potent vasodilator, was significantly down-regulated and there was a significant up-regulation of Pde1a (phosphodiesterase 1A), Ptger3 (prostaglandin e receptor 3), and Ptgs1 (prostaglandin-endoperoxide synthase one).Conclusion: The pulmonary vasculature is affected by the arrest of secondary alveolarization as seen by differentially regulated genes involved in vascular tone and pulmonary vasculature suggesting BPD is not purely an airspace disease. Clues to prevention and treatment may lie in the pulmonary vascular system.

Immune System Regulation Affected by a Murine Experimental Model of Bronchopulmonary Dysplasia: Genomic and Epigenetic Findings

BACKGROUND

Bronchopulmonary dysplasia (BPD) is a common cause of abrupted lung development after preterm birth. BPD may lead to increased rehospitalization, more severe and frequent respiratory infections, and life-long reduced lung function. The gene regulation in lungs with BPD is complex, with various genetic and epigenetic factors involved.

OBJECTIVES

The aim of this study was to examine the regulatory relation between gene expression and the epigenome (DNA methylation) relevant for the immune system after hyperoxia followed by a recovery period in air using a mouse model of BPD.

METHODS

Newborn mice pups were subjected to an immediate hyperoxic condition from birth and kept at 85% O2 levels for 14 days followed by a 14-day period in room air. Next, mice lung tissue was used for RNA and DNA extraction with subsequent microarray-based assessment of lung transcriptome and supplementary methylome analysis.

RESULTS

The immune system-related transcriptomeregulation was affected in mouse lungs after hyperoxia. A high proportion of genes relevant in the immune system exhibited significant expression alterations, e.g., B cell-specific genes central to the cytokine-cytokine receptor interaction, the PI3K-AKT, and the B cell receptor signaling pathways. The findings were accompanied by significant DNA hypermethylation observed in the PI3K-AKT pathway and immune system-relevant genes.

CONCLUSIONS

Oxygen damage could be partly responsible for the increased susceptibility and abnormal response to respiratory viruses and infections seen in premature babies with BPD through dysregulated genes.

Comparison of whole genome expression profile between preterm and full-term newborns

OBJECTIVES

Evaluate the time dependent expression of genes in preterm neonates and verify the influence of ontogenic maturation and the environmental factors on the gene expression after birth.

MATERIAL AND METHODS

The study was carried out on 20 full-term newborns and 62 preterm newborns (mean birth weight = 1002 [g] (SD: 247), mean gestational age = 27.2 weeks (SD: 1.9)). Blood samples were drawn from all the study participants at birth and at the 36th week postmenstrual age from the preterm group to assess whole genome expression in umbilical cord blood and in peripheral blood leukocytes, respectively. (SurePrint G3 Human Gene Expression v3, 8x60K Microarrays (Agilent)).

RESULTS

A substantial number of genes was found to be expressed differentially at the time of birth and at 36 PMA in comparison to the term babies with more genes being down-regulated than up-regulated. However, the fold change in the majority of cases was < 2.0. Extremely preterm and very preterm infants were characterized by significantly down-regulated cytokine and chemokine related pathways. The number of down-regulated genes decreased and number of up-regulated genes increased at 36 PMA vs. cord blood. There were no specific gene expression pathway profiles found within the groups of different gestational ages.

CONCLUSIONS

Preterm delivery is associated with a different gene expression profile in comparison to term delivery. The gene expression profile changes with the maturity of a newborn measured by the gestational age.

Mutations in the COL1A1 and COL1A2 genes associated with osteogenesis imperfecta (OI) types I or III

Although over 85% of osteogenesis imperfecta (OI) cases are associated with mutations in the procollagen type I genes (COL1A1 or COL1A2), no hot spots for the mutations were associated with particular clinical phenotypes. Eight patients that were studied here, diagnosed with OI by clinical standards, are from the Polish population with no ethnic background indicated. Previously unpublished mutations were found in six out of those eight patients. Genotypes for polymorphisms (Sp1 - rs1800012 and PvuII - rs412777), linked to bone formation and metabolism were determined. Mutations were found in exons 2, 22, 50 and in introns 13 and 51 of the COL1A1 gene. In COL1A2, one mutation was identified in exon 22. Deletion type mutations in COL1A1 that resulted in OI type I had no effect on collagen type I secretion, nor on its intracellular accumulation. Also, a single base substitution in I13 (c.904-9 G>T) was associated with the OI type I. The OI type III was associated with a single base change in I51 of COL1A1, possibly causing an exon skipping. Also, a missense mutation in COL1A2 changing Gly→Cys in the central part of the triple helical domain of the collagen type I molecule caused OI type III. It affected secretion of the heterotrimeric form of procollagen type I. However, no intracellular accumulation of procollagen chains could be detected. Mutation in COL1A2 affected its incorporation into procollagen type I. The results obtained shall help in genetic counseling of OI patients and provide a rational support for making informed, life important decisions by them and their families.

Identification of deletions in children with congenital hypothyroidism and thyroid dysgenesis with the use of multiplex ligation-dependent probe amplification

INTRODUCTION

Thyroid dysgenesis (TD) is the most common cause of congenital hypothyroidism (CH). Important genetic factors possibly contributing to TD etiologies include mutations of thyroid transcription factors and TSHR-encoding genes.

OBJECTIVE

Our objective was to determine multiplex ligation-dependent probe amplification (MLPA) utility in detecting the copy number changes in patients with CH and TD.

METHODS

The study included 45 children from southeastern Poland selected via already established neonatal screening for CH. Genomic DNA was extracted from peripheral blood samples and used in MLPA analysis. Genetic variations were analyzed within selected fragments of the PAX8, FOXE1, NKX2-1, thyroid stimulating hormone receptor (TSHR), and TPO genes.

RESULTS

Three heterozygous deletion types in probe hybridization regions were identified for the following genes: PAX8 (exon 7), TSHR (exon 2), and FOXE1 (exon 1). Monoallelic deletions were identified in 5/45 TD subjects.

CONCLUSIONS

MLPA is a useful tool for copy number changes detection and might both improve and expand genetic analysis for CH and TD.

MTRNR2L12: A Candidate Blood Marker of Early Alzheimer's Disease-Like Dementia in Adults with Down Syndrome

Morphological abnormalities observed typically in the brains of adults with Down syndrome are identical with those present in patients with Alzheimer's disease. However, only some adults with Down syndrome suffer from early dementia, whereas others remain unaffected. We aimed to identify the genomic background responsible for this observation. We performed cognitive assessment and genome expression analysis of blood mononuclear cells in seniors with Down syndrome. Unaffected elderly patients and younger patients with severe cognitive disability or cognitive deterioration differed significantly with regard to the MTRNR2L12 gene. Our findings suggest the potential value of this gene as a blood marker of early dementia in individuals with Down syndrome.

Impact of Hymenoptera venom allergy and the effects of specific venom immunotherapy on mast cell metabolites in sensitized children

INTRODUCTION AND OBJECTIVE

Mast cells (MC) are effector cells during severe systemic reactions (SR) to Hymenoptera stings. Venom specific immunotherapy (VIT) is the treatment of choice for prevention of SR to stings. Tryptase and prostaglandin D₂ metabolites (PGD₂) are the markers of MC activation. The study design was to 1. compare baseline values of serum tryptase concentration (BST) and PGD₂ metabolites in children with/without venom sensitization, 2. to evaluate an influence of rush VIT on MC markers in treated children.

MATERIALS AND METHODS

Sensitized group: 25 children with SR to Hymenoptera sting.

CONTROL GROUP

19 healthy children. Active treatment: 5-day-rush-VIT. BST was evaluated by ImmunoCAP, PGD₂ metabolites in blood and urine by GC-NICI-MS.

RESULTS

The baseline blood levels of MC markers were significantly higher, while urinary concentration of 9α,11β-PGF₂ was significantly lower in the whole group of venom-sensitized children compared to controls. Severity of SR showed negative correlation with urinary PGD₂ metabolites, while positive with plasma 9α,11β-PGF₂ and BST concentration The highest sensitivity was obtained for plasma 9α,11β-PGF₂ whereas the highest specificity for urinary PGD-M.

CONCLUSIONS

In children with IgE-mediated SR to Hymenoptera stings, elevation of baseline values of PGD₂ metabolites in blood is accompanied by decreased excretion of its urinary metabolites. Assessment of stable PGD₂ metabolites might serve as an independent MC marker to identify allergic children. There is an association between urinary PGD₂ metabolites and severity of the SR to Hymenoptera stings.

Molecular genetics of PKU in Poland and potential impact of mutations on BH4 responsiveness

Tetrahydrobiopterin (BH4) has been recently approved as a treatment of patients with phenylketonuria. However, as a confirmation of BH4-responsiveness, it might require a very expensive trial treatment with BH4 or prolonged BH4-loading procedures. The selection of patients eligible for BH4-therapy by means of genotyping of the PAH gene mutations may be recommended as a complementary approach. A population-wide genotyping study was carried out in 1286 Polish phenyloketonuria-patients. The aim was to estimate the BH4 demand and to cover prospectively the treatment by a National Health Fund. A total of 95 types of mutations were identified. Genetic variants corresponding with probable BH4-responsiveness were found in 28.2% of cases. However, patients with mild or classical phenylketonuria who require continuous treatment accounted for 11.4% of the studied population only. Analysis of the published data shows similar percentage of the "BH4-responsive" variants of a PAH gene in patients from other countries of Eastern Europe. Therefore, it can be concluded, that the proportion of phenylketonuria-patients who could benefit from the use of BH4 reaches approximately 10% in the entire region.

Molecular genetics of PKU in Poland and potential impact of mutations on BH4 responsiveness

Tetrahydrobiopterin (BH4) has been recently approved as a treatment of patients with phenylketonuria. However, as a confirmation of BH4-responsiveness, it might require a very expensive trial treatment with BH4 or prolonged BH4-loading procedures. The selection of patients eligible for BH4-therapy by means of genotyping of the PAH gene mutations may be recommended as a complementary approach. A population-wide genotyping study was carried out in 1286 Polish phenyloketonuria-patients. The aim was to estimate the BH4 demand and to cover prospectively the treatment by a National Health Fund. A total of 95 types of mutations were identified. Genetic variants corresponding with probable BH4-responsiveness were found in 28.2% of cases. However, patients with mild or classical phenylketonuria who require continuous treatment accounted for 11.4% of the studied population only. Analysis of the published data shows similar percentage of the "BH4-responsive" variants of a PAH gene in patients from other countries of Eastern Europe. Therefore, it can be concluded, that the proportion of phenylketonuria-patients who could benefit from the use of BH4 reaches approximately 10% in the entire region.

Transcriptome profiling of the newborn mouse lung after hypoxia and reoxygenation: hyperoxic reoxygenation affects mTOR signaling pathway, DNA repair, and JNK-pathway regulation

BACKGROUND

The use of oxygen in acute treatment of asphyxiated term newborns is associated with increased mortality. It is unclear how hyperoxic reoxygenation after hypoxia affects transcriptional changes in the newborn lung.

METHODS

On postnatal day 7, C57BL/6 mice (n = 62) were randomized to 120-min hypoxia (fraction of inspired oxygen (FiO2) 0.08) or normoxia. The hypoxia group was further randomized to reoxygenation for 30 min with FiO2 0.21, 0.40, 0.60, or 1.00, and the normoxia group to FiO2 0.21 or 1.00. Transcriptome profiling was performed on homogenized lung tissue using the Affymetrix 750k expression array, and validation was carried out by real-time polymerase chain reaction and enzyme-linked immunosorbent assay.

RESULTS

The hypoxia-reoxygenation model induced hypoxia-inducible factor 1 (HIF-1) targets like Vegfc, Adm, and Aqp1. In total, ~70% of the significantly differentially expressed genes were detected in the two high hyperoxic groups (FiO2 0.60 and 1.00). Reoxygenation with 100% oxygen after hypoxia uniquely upregulated Gadd45g, Dusp1, Peg3, and Tgm2. Pathway analysis identified mammalian target of rapamycin (mTOR) signaling pathway, DNA repair, c-jun N-terminal kinase (JNK)-pathway regulation, and cell cycle after hyperoxic reoxygenation was applied.

CONCLUSION

Acute hypoxia induces HIF-1 targets independent of the reoxygenation regime applied. Hyperoxic reoxygenation affects pathways regulating cell growth and survival. DNA-damage-responsive genes are restricted to reoxygenation with 100% oxygen.

Development of children's hymenoptera venom allergy quality of life scale (CHVAQoLS)

Background

Venom allergy is a rare but life-threatening disease and may have a considerable impact on the health-related quality of life (HRQoL) of patients, especially children. This paper presents development of the HRQoL scale for children and adolescents with Hymenoptera venom allergy (HVA).

Methods

The study sample consisted of 71 children, born between 1992 and 2000, who presented with a history of insect sting reaction when referred for consultation in the allergy center of Polish-American Children’s Hospital, Krakow, Poland, during the period from 2000 to 2010. The initial pool of 60 items - divided into 6 domains - was prepared. The items with intercorrelations higher than 0.7 were removed from each domain and then principal component analysis was conducted for each domain separately, to provide a one-dimensional subscale for each domain. Reliability of the subscales was assessed using Cronbach alpha coefficient in terms of Classical Test Theory and with rho coefficient in terms of Item Response Theory. The multidimensionality of the scale was tested using multi-trait scaling.

Results

Three to four items from each domain were subsequently selected to constitute six subscales. Rho coefficients for all the subscales reached 0.8, similar results were achieved with the Cronbach alpha coefficients. Multi-trait method showed that the majority of the items indicated stronger correlations with their own subscales than with other subscales, which proves that our constructed subscales measure different dimensions of HRQoL.

Conclusions

The presented scale comprises high validity and reliability subscales measuring six dimensions of HRQoL related to Hymenoptera venom allergy in children and adolescents. Such information may be useful in everyday clinical practice.

New insight into the pathogenesis of retinopathy of prematurity: assessment of whole-genome expression

BACKGROUND

Retinopathy of prematurity (ROP) is one of the most common preventable causes of blindness and impaired vision among children in developed countries. The aim of the study was to compare whole-genome expression in the first month of life in groups of infants with and without ROP.

METHODS

Blood samples were drawn from 111 newborns with a mean gestational age of 27.8 wk on the 5th, 14th, and 28th day of life (DOL). The mRNA samples were evaluated for gene expression with the use of human whole-genome microarrays. The infants were divided into two groups: no ROP (n = 61) and ROP (n = 50).

RESULTS

Overall, 794 genes were differentially expressed on the 5th DOL, 1,077 on the 14th DOL, and 3,223 on the 28th DOL. In each of the three time points during the first month of life, more genes were underexpressed than overexpressed in the ROP group. Fold change (FC), which was used in analysis of gene expression data, ranged between 1.0 and 1.5 in the majority of genes differentially expressed.

CONCLUSION

Pathway enrichment analysis revealed that genes in four pathways related to inflammatory response were consistently downregulated due to the following variables: ROP and gestational age.

Coronary artery abnormalities in Kawasaki disease

INTRODUCTION

Kawasaki disease is the number one cause of acquired heart disease among children in developed countries.

AIM

The aim of the study was a retrospective analysis of the factors that may influence the persistence of coronary artery abnormalities in patients with Kawasaki disease.

MATERIALS AND METHODS

Analyzing the medical records of patients hospitalized in the University Children's Hospital of Krakow in the years 2005-2011 we collected the data of 28 patients diagnosed with Kawasaki disease. The group was divided into two subgroups, depending on the duration of the persistence of changes in the coronary arteries - A (n = 17) for up to 6 months, B (n = 11) - for more than 6 months. Both groups were analyzed for the presence of factors that may influence the course of the disease.

RESULTS

There were more boys in group A (11 boys (65%), 6 girls (35%)), whereas in group B the distribution was more uniform (6 boys (55%), 5 girls (45%)). The age of onset in group A was 37.9 months (SD 30.8), in group B 39.5 months (SD 16.7). 17.6% of patients in group A and 36.4% in group B were treated with glucocorticoids.

CONCLUSIONS

In the group of patients in which coronary artery abnormalities disappeared more quickly, male and slightly older children dominated. The only difference observed between the 2 groups related to the frequency of the use of glucocorticoids, they were used more often in children, in whom coronary artery abnormalities persisted longer.

Health-related quality of life in Polish adolescents with Hymenoptera venom allergy treated with venom immunotherapy

INTRODUCTION

Venom allergy, though rare, may seriously influence health-related quality of life (HRQoL). There is a paucity of research on HRQoL of adolescents and young adults with Hymenoptera venom allergy. The aim was to assess the level of HRQoL and to evaluate its independent predictors in Polish adolescents and young adults treated with venom immunotherapy.

MATERIAL AND METHODS

A multicenter cross-sectional study based on the Vespid Allergy Quality of Life Questionnaire (VQLQ) adapted for Polish adolescents was used. The study sample included 87 patients (14-21 years) studied at different stages of venom immunotherapy (VIT). Statistical analysis was done with multivariate linear regression.

RESULTS

Anxiety level was higher in patients with 4(th) grade of Mueller's classification (anaphylactic shock) than in those with 3(rd) grade (B = 0.84, 95% CI = 0.07-1.61, p = 0.03). Caution increased along with an increase of anxiety of adolescents treated with VIT (B = 0.54, 95% CI = 0.39-0.68, p < 0.01). Level of limitations increased with increasing caution of adolescents (B = 0.63, 95% CI = 0.35-0.91, p < 0.01). Discomfort increased along with a rise of caution of patients (B = 0.38, 95% CI = 0.22-0.55, p < 0.01). Similarly, it increased with an increase of their feeling of limitations (B = 0.37, 95% CI = 0.23-0.51, p < 0.01). The level of discomfort in adolescents treated with VIT was lower in those who were treated with conventional protocol in comparison to those treated with rush or ultra-rush ones (B = -0.47, 95% CI = -0.90 - -0.03, p = 0.04).

CONCLUSIONS

Severity of anaphylactic reaction is an independent determinant of anxiety level in adolescents treated with VIT. The VIT protocol affects HRQoL of treated patients.

[Congenital cytomegaly in one twin - a case report]

A report on dichorionic/diamniotic pregnancy in which only one, female, fetus was infected with cytomegalovirus and presented with severe congenital diseases at birth. Infection of the fetus occurred after recurrent maternal infection. The second, male, fetus did not have CMV infection. The cesarean section was performed at the 38th week of gestation. The birth weight of the infected girl was 1680g, the main symptoms, beside dystrophy, concerned the central nervous system: microcephaly, brain atrophy, hydrocephalus, corpus callosum agenesis. She also had Turner syndrome symptoms. The viral load was highest in the urine 81.2 x10^6/ml, in the cerebro-spinal fluid 15.4x10^6/ml and lower in blood 0.38 x10^5/ml. The concentration of specific IgG was 308 U/ml. Specific IgM was not detected. Throughout hospitalization, the infection maintained only one viral genotype gB2. Despite treatment with ganciclovir (10 weeks) and foscarnet (2 weeks), the girl died at the age of 8 months. Novel molecular diagnostic techniques (nested and real time PCR) confirmed the congenital infection and were helpful in the monitoring of the infection and treatment efficacy.

Assessment of the role of copy-number variants in 150 patients with congenital heart defects

BACKGROUND

Congenital heart defects are the most common group of major birth anomalies and one of the leading causes of infant deaths. Mendelian and chromosomal syndromes account for about 20% of congenital heart defects and in some cases are associated with other malformations, intellectual disability, and/or dysmorphic features. The remarkable conservation of genetic pathways regulating heart development in animals suggests that genetic factors can be responsible for a significantly higher percentage of cases.

THE AIM

Assessment of the role of CNVs in the etiology of congenital heart defects using microarray studies.

MATERIAL AND METHODS

Genome-wide array comparative genomic hybridization, targeting genes known to play an important role in heart development or responsible for abnormal cardiac phenotype was used in the study on 150 patients. In addition, we have used multiplex ligation-dependent probe amplification specific for chromosome 22q11.2 region.

RESULTS

We have identified 21 copy-number variants, including 13 known causative recurrent rearrangements (12 deletions 22q11.2 and one deletion 7q11.23), three potentially pathogenic duplications (5q14.2, 15q13.3, and 22q11.2), and five variants likely benign for cardiac anomalies. We suggest that abnormal copy-number of the ARRDC3 and KLF13 genes can be responsible for heart defects.

CONCLUSIONS

Our study demonstrates that array comparative genomic hybridization enables detection of clinically significant chromosomal imbalances in patients with congenital heart defects.

Laboratory markers of mast cell and basophil activation in monitoring rush immunotherapy in bee venom-allergic children

AIM

To evaluate markers of mast cell and basophil activation in children undergoing the initial phase of honeybee venom immunotherapy (VIT).

PATIENTS & METHODS

Five children (four boys and one girl) aged 9.5-18 years with severe systemic bee sting reactions and confirmed IgE-mediated allergy were enrolled. Plasma and urine concentrations of 9α,11β-PGF2 and serum tryptase levels were measured at four time points and peripheral blood basophil count and CD63 expression were measured at three time points in the course of VIT, including 5-day rush initial immunotherapy (cumulative dose of 223 µg of bee venom allergen) and two subsequent maintenance doses of 100 µg.

RESULTS

In the first 40 days of VIT, there was a decrease in mean plasma levels of 9α,11β-PGF2 (from 41.5 to 27.9 pg/ml; p < 0.05), accompanied by an increase in baseline basophil activation (from 2 to 15%; p < 0.05). The median serum tryptase levels increased from 3.45 to 4.40 ng/ml during rush phase and subsequently returned to initial values (statistically not significant). In four patients, the basophil activation test in response to bee venom allergens remained positive throughout the study. The fifth patient was basophil activation test-negative at all three measurements, and a post hoc analysis revealed clinical peculiarities that are discussed in the paper.

CONCLUSIONS

Our preliminary results indicate that plasma levels of 9α,11β-PGF2 decrease while numbers of activated basophils increase during the initial phase of bee venom rush immunotherapy in children.

Congruence of the current practices in Hymenoptera venom allergic patients in Poland with EAACI guidelines

INTRODUCTION

Venom immunotherapy (VIT) practice is the definitive treatment for patients with potentially fatal allergic reactions to Hymenoptera stings. The aim is assesing compliance of VIT practice in Poland with the current European Academy of Allergy and Clinical Immunology (EAACI) guidance.

MATERIAL AND METHODS

A multicentre study was carried out using a structured questionnaire which was sent by post to all VIT practitioners in Poland. Some questionnaire items were altered, in comparison to original version by adding additional answer options or alowing multiple answer option. The response rate was 100%. The obtained results were compared with the published EAACI guidelines.

RESULTS

Twenty-six Polish centres took part in the survey. SSIgE and skin prick tests (SPT) are together used as the first line of investigation, whereas confirmatory intradermal tests (IDT) are applied in half of centres. Only a few centres measure baseline serum tryptase levels. The ultra-rush protocol is preferred. Antihistamine pre-medication is routinely practiced. A target dose equal to 100 µg is used in most centres. A 6-week interval between booster doses is the most frequent. Five years is considered as an optimal VIT duration. Before the VIT completion, SSIgE is evaluated in fifty percent of centres, whereas sting challenge is considered by half of responders.

CONCLUSIONS

There are some differences between current practice in Poland and the EAACI recommendations, indicating areas requiring better compliance. Comparision between Poland and the United Kingdom revealed that health service organization and health care funding may play a major role in the provision of allergy services. This may affect the extent to which international guidance may be applied in individual countries. It is worth considering conducting the same survey in other European countries.

Blood phenylalanine clearance and BH(4)-responsiveness in classic phenylketonuria

Tetrahydrobiopterin (BH(4)) has been shown to decrease blood phenylalanine concentration in selected patients with phenylketonuria who can be identified with use of the BH(4)-loading test. However, the results of the test could be biased due to hydroxylation-independent blood phenylalanine clearance. Considering of this effect is necessary in patients with classic phenylketonuria, particularly in "slow responders," in whom borderline decrease in blood phenylalanine concentration is typically observed as a result of BH(4)-loading.

Plasma levels of leptin and soluble leptin receptor and polymorphisms of leptin gene -18G > A and leptin receptor genes K109R and Q223R, in survivors of childhood acute lymphoblastic leukemia

BACKGROUND

Approximately 20% of children and adolescents in Europe are overweight. Survivors of pediatric acute lymphoblastic leukemia (ALL) are at increased risk of overweight and obesity. The purpose of this study was to assess leptin and leptin soluble receptor levels, as well as polymorphisms of selected genes in survivors of pediatric ALL, and the influence of chemo- and radiotherapy on development of overweight in the context of leptin regulation.

METHODS

Eighty two patients (55% males), of median age 13.2 years (m: 4.8 years; M: 26.2 years) were included in the study. The ALL therapy was conducted according to modified Berlin-Frankfurt-Munster (BFM; n = 69) regimen or New York (n = 13) regimen. In 38% of patients cranial radiotherapy (CRT) was used in median dose of 18.2Gy (m: 14Gy; M: 24Gy). Median age at diagnosis was 4.5 (m: 1 year; M: 16.9 years) and median time from completion of ALL treatment was 3.2 years (m: 0.5 year; M: 4.3 years). Patients with BMI ≥85 percentile were classified as overweight. Correlation of plasma levels of leptin and leptin soluble receptor, and polymorphisms of leptin gene -18G > A, leptin receptor genes K109R and Q223R, and the overweight status were analyzed in relation to gender, intensity of chemotherapy (high intensity vs. standard intensity regimens) and to the use of CRT.

RESULTS

Significant differences of leptin levels in patients treated with and without CRT, both in the entire study group (22.2+/- 3.13 ng/ml vs. 14.9+/-1.6 ng/ml; p < 0.03) and in female patients (29.9+/-4.86 ng/ml vs. 16.9+/-2.44 ng/ml; p = 0.014), were found. Significant increase of leptin levels was also found in overweight patients compared to the non-overweight patients in the entire study group (29.2+/-2.86 ng/ml vs. 12.6+/-1.51 ng/ml; p < 0.0001), female patients (35.4+/-6.48 ng/ml vs. 18.4+/-2.5 ng/ml; p = 0.005), and male patients (25.7+/-2.37 ng/ml vs. 6.9+/-0.95 ng/ml; p < 0.0001). Negative correlation was observed for plasma levels of soluble leptin receptor and overweight status, with significant differences in overweight and non-overweight patients, both in the entire study group (18.2+/-0.75 ng/ml vs. 20.98+/-0.67 ng/ml; p = 0.017) and in male patients (18.2+/-1.03 ng/ml vs. 21.8+/- 1.11 ng/ml; p = 0.038). Significant (p < 0.05) negative correlation was found between leptin and leptin receptor levels in the entire group (correlation coefficient: 0.393) and in both gender subgroups (correlation coefficient in female patients: -0.427; in male patients: -0.396).

CONCLUSIONS

The prevalence of overweight in our cohort was higher than in general European population (31% vs 20%) and increased regardless of the use of CRT. Leptin and leptin receptor levels may be used as useful markers of high risk of becoming overweight in ALL survivors, particularly in females treated with CRT. Polymorphisms of leptin gene -18G > A and leptin receptor genes K109R and Q223R were not associated with overweight status in ALL survivors.

Routine use of CANTAB system for detection of neuropsychological deficits in patients with PKU

Several studies have reported neuropsychological deficits related to hyper phenylalaninemia in patients with phenylketonuria (PKU). As computerized neuropsychological tests seem to be promising in the detection of such abnormalities, we aimed to assess the usefulness of routine use of CANTAB system in PKU clinic. A group of 49 PKU patients aged >16 years were tested by means of computerized CANTAB tests measuring speed of response, response inhibition, sustained attention, and working memory capacity. The scores achieved by study participants were analyzed with respect to their blood phenylalanine concentrations. Proper dietary control was observed in 22 patients, whereas in the remaining 27 persons, blood phenylalanine concentrations exceeded the recommended range. The results of the tests assessing sustained attention, working memory, and inhibitory control achieved by the non-compliant patients were significantly worse in comparison with patients maintaining proper diet. However, the mean scores achieved by treatment-adherent patients were also worse than expected, what could probably be related to problems with early start of treatment during their infancy. Our results confirmed the presence of specific neuropsychological deficits related to hyperphenylalaninemia in adults and adolescents with PKU. In our opinion, routine use of computerized neuropsychological tests should be recommended in PKU clinics.

[Fetal CD34+ cells isolated from maternal blood and cytogenetics array as potential tools in screening, non-invasive prenatal diagnosis--preliminary research]

Current prenatal diagnosis is dependent mainly on invasive methods and it correlates with risk of fetal loss. It is clear that there is necessity to devise new non-invasive prenatal test. During the pregnancy fetal cells pass into the maternal circulation which results in a physiological micro-chimerism. Investigation of this phenomenon creates opportunity to elaborate new tool of prenatal diagnosis. The aim of the study is to evolve novel method of fetal cells isolation from maternal blood, their analyses and assessment of potential cytogenetics arrays application for diagnosis of fetal genetic disorders or obstetric complications. Experimental material contained 22 samples of peripheral blood from pregnant women undergoing an amniocentesis. Our protocol was based on separation and culture of CD34+ hematopoietic cells. To estimate the origin of cells we isolated single colonies and examined hemoglobin genes expression profiles by Real-time PCR assays using specific probes for Hbbeta ang Hbgamma. We demonstrated that Hbbeta/Hbgamma expression ratio was lower in fetal origin cells than in adult ones. We successfully used the native characteristics of fetal CD34+ cells such as strong proliferating potential and hemoglobin expression profile. Expansion of CD34+ cells reduced volume of maternal blood required to run the test.

[Do infants treated in the neonatal intensive care unit need multi-stage, universal hearing screening testing?]

INTRODUCTION

The universal hearing screening program has special value for neonatal intensive care unit (NICU) patients because of the multiple risk factors of hearing loss they are subjected to.

AIM

To summarize the results of hearing tests on consecutive stages of the screening program and to evaluate the value of hearing loss factors.

MATERIALS AND METHODS

The group included 851 infants born between 1.10.2006 - 31.12.2009 and treated in the NICU of the University Children's Hospital in Cracow, Poland. Infants with abnormal screening test results (TEOAE) and/or with hearing loss risk factors, or absent from the first stage of the test were qualified for the next stage hearing diagnostics (TEOAE+ABR). Multivariate logistic regression was used in order to evaluate hearing loss risk factors.

RESULTS

679 (80%) newborns were screened by the first stage hearing test. 579 (68%) were tested on the second level diagnostics. 60 patients are still under control. 11/519 (2.1%) had hearing impairment (sensorineual or mixed). 10 had bilateral and 1 had unilateral hearing impairment. The family history was negative for congenital hypoacusis. 1st minute Apgar score < 4 points, congenital TORCH infections and craniofacial anomalies were independent risk factors of hearing loss, however it was not possible to predict more than 2/11 patients with hearing loss based on these factors. Patients with abnormal result of the first stage test had lower birth weight and gestation age than that with normal result. The sensitivity of the first TEOAE test was 82%, specificity 70%, PPV 6.2%, NPV 99%.

CONCLUSION

Hearing impairment was rarely a complication of treatment in the NICU, although it was 10 times more frequent in comparison to the whole newborn population. Because the sensitivity, specificity and PPV of first hearing test is not satisfactory, next stage diagnostics in the audiology department are strongly recommended.

[Use of computerized neuropsychological tests and of nuclear magnetic resonance spectroscopy in clinical assessment of adult patients with phenylketonuria]

Phenylketonuria is the most common inborn error of metabolism. Adult patients often discontinue dietary treatment and can subsequently develop serious brain dysfunction. Some of them, however, do not present any symptoms, despite long-term exposition to high blood phenylalanine concentration. As the extent of brain toxicity of hyperphenylalaninemia is not clear in adults, new diagnostic methods are needed to assess brain effects of hyperphenylalaninemia. The aim of the study was to evaluate the usefulness of magnetic resonance spectroscopy and of computerized neuropsychological tests for measurement of brain phenylalanine concentration and for early detection of hyperphenylalaninemia-related brain dysfunction. Assessment of sustained attention, working memory and inhibitive control was performed in a group of 50 adults with phenylketonuria by means of computerized CANTAB system. Additionally, in 40 patients, measurement of brain phenylalanine signal was done by means of magnetic resonance spectroscopy. The results were correlated with plasma phenylalanine concentrations. Worsening of neuropsychological efficiency as well as increase of brain phenylalanine concentration correlated with high levels of plasma phenylalanine. Interestingly, in two cases, despite high plasma phenylalanine concentration, low brain phenylalanine concentration was observed accompanied by good results of neuropsychological tests. This finding suggests presence of mechanisms limiting brain toxicity of hyperphenylalaninemia in some patients. It should be stressed, however, that such situation can be expected rarely, and is probably restricted to cases with moderate hyperphenylalaninemia. Combination of computerized neu- ropsychological tests and of magnetic resonance spectroscopy is a useful diagnostic method which could allow for careful individualization of dietary recommendations in selected patients with phenylketonuria.

[The use of microarrays for gene expression analysis in premature children--new strategy of searching for genetic basis of late complications of prematurity--preliminary research]

Progress achieved in the development of medical care for children born prematurely has resulted in increased survival of the smallest and most immature infants. At the same time increased incidence of the late complications of prematurity such as bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) has become a growing problem. The aim of the study was to identify groups of genes potentially involved in the development of long-term complications of prematurity, by conducting genome wide microarray expression analysis. The prospective cohort study was conducted, 52 premature babies were included. At the 5th, 14th and 28th day of life samples of the peripheral blood were taken from the study participants. Subsequently, total RNA was extracted and microarray experiment, with the use of GeneChip Human Gene 1.0 ST Array (Affymetrix), was performed. The analysis of the results was carried out in the separate cohorts of prematures. Within 52 infants 2 groups were distinguished--children without BPD (n = 25) and children with BPD (n = 27). Significant difference in the expression of 251 genes was observed. Additionally, a group of 20 participants of the study, in whom ROP was diagnosed, was compared with the group of the remaining 32 children without proven retinopathy. The analysis revealed a significant difference in the expression between the analyzed groups with regard to 752 genes. Further study is needed to verify the obtained results. The impact of the over- and underexpressed genes should be studied, as well as detailed analysis of the metabolic pathways should be performed.

Serum tryptase level is a better predictor of systemic side effects than prostaglandin D2 metabolites during venom immunotherapy in children

OBJECTIVES

We performed a prospective study to analyze mast cell mediators as predictors of systemic adverse reactions during rush venom-specific immunotherapy (VIT) in children.

PATIENTS AND METHODS

Nineteen children aged 5-17 years received VIT with Venomenhal (HALAllergy). We analyzed serum tryptase (CAP, Phadia), plasma prostaglandin (PG) D2 metabolites (9alpha, 11beta-PGF2), and urine PGD2 metabolites (9alpha, 11beta-PGF2, tetranor-PGD-M) using gas chromatography mass spectrometry before and after the rush protocol.

RESULTS

Three boys with high baseline serum tryptase values (>7.76 g/L) (P < .001) and low 9alpha, 11beta-PGF2 concentrations developed grade III systemic adverse reactions during VIT. Baseline serum tryptase was lowest in children who had a Mueller grade II reaction (1.93 [0.36]) before VIT and highest in children with a Mueller grade III reaction (6.31 [4.80]) (P = .029). Repeated measures analysis of variance confirmed that, in children who developed systemic adverse reactions during VIT, serum tryptase was higher both before and after desensitization and increased significantly following the procedure. Analysis of PGD2 metabolites in the prediction of systemic adverse reactions during VIT was inadequate (sensitivity 67% and specificity 0.53%), whilst prediction based on serum tryptase was accurate.

CONCLUSIONS

In children with severe systemic adverse reactions to Hymenoptera sting, the evaluation of baseline tryptase levels should be a standard procedure. Children with Apis mellifera venom allergy and baseline tryptase levels higher than 7.75 g/L are at risk of anaphylaxis during buildup. Lower baseline values of plasma and urinary PGD2 metabolite concentration in patients with systemic adverse reaction during VIT suggest that prostaglandin catabolism is altered.

[Primary ciliary dyskinesia in highlights of consensus statement. Presentation of pediatric cases]

Cilia are evolutionarily conserved structures that play a role in diverse cell types. Motile cilia are involved in the most prominent ciliopathy called primary ciliary dyskinesia (PCD), which combines oto-sino-pulmonary symptoms (impaired mucociliary clearance that is important innate defense mechanism), male infertility and in nearly 50% cases situs inversus. Disease is usually inherited as autosomal recessive disorder, concerning mainly outer and/or inner dynein arms of cilia. Diagnosis of PCD requires the presence of characteristic clinical phenotype and confirmation the diagnosis by either identification of specific defect in electron microscopy or other evidence of abnormal ciliary function. The diagnosis of PCD may be delayed, missed or made incorrectly. The first ERS consensus statement which formulates recommendations regarding diagnostic as well as therapeutic approaches to children with PCD, is a very helpful tool in the management of this patients. We present our own experience with three children with PCD diagnosed in our Department.

CONCLUSION

in children with clinical symptoms suggesting PCD, even with negative screening tests, the estimation of specific cilia defect in electron microscopy is indicated.

[Genotyping and minimal residual disease study in children with acute myeloid leukemia: preliminary results]

The aim of the paper is to present the initial results of molecular examination which was started in 2006 for children with acute myeloid leukemia. Better knowledge of biology of this disease, can result in establishing of new risk factors what allows more precise patient stratification to different therapeutic groups. Study was obtained patients until to 18 years of age treated according to AML-BFM 2004 INTERIM protocol in 14 centers of the Polish Pediatric Leukemia/Lymphoma Study Group. Mononuclear cells were collected from bone marrow on time points established according to the AML-BFM 2004 INTERIM protocol. Collected cells were isolated on Ficoll gradient, and RNA and DNA were isolated using TRIZOL reagent. To synthesize cDNA an amount of 1 mg of total RNA was used. To perform quantitative RT-PCR and RQ-PCR reactions 4 fusion gene transcripts (AML1-ETO, CBFb-MYH11, PML-RARA /subtype bcrl and bcr3/) were used according to the protocol established by Europe Against Cancer Program. An expression of WT1 gene was tested additionally. An analysis of ABL control gene was used to normalize of achieved results. Determination of duplication of FLT3 gene in DNA sample was performed with starters complementary to JM region. Genotyping was performed in 75 patients with acute myeloid leukemia so far. AML1-ETO fusion gene transcript was found in 14 patients (19%). PML-RARA (subtype bcr3) and CBFB-MYH11 gene transcripts were detected in 3 (4%) and 3 (4%) patients, respectively. Duplication of FLT3 gene was found in 4 (5.3%) cases. Between 67 tested children over expression of WT1 was present in 51 patients (76%). Analysis of MRD level in subsequent time points showed systematic decrease of number of fusion gene transcript copies and gene WT1 expression. To establish the rate of molecular marker presence in AML in children and the influence of the presence of MRD on the treatment results as well, the study has to be conducted on a larger group of patients with longer follow-up.

[Health-related quality of life in children with Hymenoptera venom allergy treated with VIT and quality of life of their parents]

Hymenoptera venom allergy, although rare in children, by its potential fatalities, leads to many psychosocial consequences, influencing quality of life of children and their parents. Aim of this paper is the estimation of health-related quality of life of venom allergic children treated with specific immunotherapy, and their parents. Assessment of factors influencing health-related quality of life levels was also performed.

MATERIAL AND METHODS

Sample under study consisted of 73 children: mean age 10.6, SD 2, 4, treated because of Hymenoptera venom allergy in 5 clinical allergy centers in Poland. Data was collected using VQLQ questionnaire adapted for children and their parents. Determinants of quality of life were assessed with multivariate linear and logistic regression models. Analysis were done with SPSS 15 for Windows package.

RESULTS

Girls reported higher level of anxiety than boys (B = 0.47; 95% CI = (0.01; 0.94)). Level of caution in children increased along with increase of their anxiety against re-sting (B = 0.49; 95% CI = (0.27; 0.71)). Level of anxiety of children who were under treatment from 6 months to 2 years was lower than level of anxiety of parents of children treated shorter than 6 months (B = -1.21; 95% CI = (-2.16; -0.25)). The lowest level of caution was reported by parents of children aged 10 year or less (B = -0.86; 95% CI = (-1.67; -0.05)), while the highest was reported by parents of children aged 11 years (B = 0.86; 95% CI = (0.20; 1.53)) in comparison to parents of children aged 12 years or more. Parents' caution increased along with increase of their anxiety (B = 0.61; 95% CI = (0.40; 0.83)). Higher level of limitations was imposed by parents of children treated with rush or ultra rush method, in comparison to parents of children treated with conventional method (B = 1.27; 95% CI = (0.21; 2.33)). Levels of quality of life in children and their parents were strongly dependent in the same dimensions.

CONCLUSIONS

1. Levels of quality of life in particular dimension in children is related to level of the same dimension in parents. 2. Age of children influenced level of caution of their parents. 3. Treatment duration influenced level of anxiety of parents. 4. Safety feeling acquired by parents at the beginning of treatment improves their quality of life in all dimensions.

Pituitary enlargement in patients with PROP1 gene inactivating mutation represents cystic hyperplasia of the intermediate pituitary lobe. Histopathology and over 10 years follow-up of two patients

Patients with a PROP1 inactivating mutation present combined pituitary hormone deficiency (CPHD) and pituitary maldevelopment. A retrospective analysis of 31 CPHD patients with a PROP1 mutation revealed two individuals, aged 18 and 4.5 years, who had undergone subtotal surgery to remove pituitary tumors, 16.8 x 12 mm and 9 x 10 x 12 mm in size. Histological reassessment of tissue samples revealed epithelial cells, partially oxyphilic, forming gland-like microcystic structures, most of them filled with eosinophilic colloid. These structures were directly linked with fragments of the posterior lobe. Neither atypia nor any traces of proliferation activity (Ki-67 LI=0%) were noted. Immunohistochemistry showed the presence of all hormonal phenotypes of cells. These findings corresponded to the intermediate lobe of the pituitary gland. For this type of pathology we propose the term 'cystic hyperplasia of the intermediate pituitary lobe' and suggest PROP1 gene assessment in patients with CPHD in order to avoid unnecessary neurosurgical interventions.

Additional genetic risk factor for death in children with acute lymphoblastic leukemia: a common polymorphism of the MTHFR gene

BACKGROUND

The presence of metabolically important genetic polymorphisms may affect treatment efficacy in patients with malignancies. The objective of this prospective multicenter study was to evaluate the role of selected polymorphisms of genes associated with metabolism of chemotherapeutic drugs as prognostic markers in children with acute lymphoblastic leukemia.

PROCEDURE

Genotyping for the presence of 7 genetic variants in 403 patients and analysis of death cases were performed.

RESULTS

Thirty-one children died before reaching remission maintenance phase. Genetic analysis revealed in this group increased frequency of homozygosity for c.677C>T polymorphism of the MTHFR gene (26% vs. 8% in the survivors; OR 4.09; 95% CI 1.67-10; adjusted for multiple testing P = 0.028).

CONCLUSION

Our data suggest that modification of anti-leukemic treatment should be considered in patients homozygous for c.677C>T polymorphism.

[Health status at the age of 5-7 years of preterm infants with and without bronchopulmonary dysplasia]

BACKGROUND AND AIM

Bronchopulmonary dysplasia (BPD) is one of the most common late complications of prematurity. The study aimed to evaluate: 1) somatic development, 2) psychomotor development, 3) parental opinion of health status of the child and 4) prevalence of bronchial hyperreactivity among 5-7 years old children with history of BPD.

METHODS

Case-control study included 56 newborns born < or =32 weeks of gestation with mean birthweight (SD) 1057+/-218g. BPD was defined as at least 28 days of oxygen therapy and oxygen or positive pressure support at 36 weeks postmenstrual age. The control group consisted of newborns matched by sex, birthweight (+/-100g), gestational age (+/-1 weeks) and year of hospitalization. Somatic and psychomotor developments were prospectively evaluated up to age of 5-7 years. Parents were asked to complete two questionnaires: one assessing normal daily activity of the child and the standardized questionnaire used by International Study of Asthma and Allergies In Childhood (ISAAC). Peak expiratory flow rates (PEFR) before and after the inhalation of betamimetic were evaluated.

RESULTS

No significant difference in somatic development was found between the study group and the control group. Normal psychomotor development was diagnosed in 11 (39%) children with BPD and in 13(46%) children without BPD. Mild or moderate impairment was diagnosed in 12 (43%) cases and 13 (36%) controls, and severe impairment in 5 (18%) and 2 (7%) children. At the age of 5-7 years children with BPD presented lower IQ as compared to children without BPD (94+/-25 vs. 103+/-16, p= 0.2). Parents of children with BPD more often declared that their child's development is impaired (39% vs. 11%, OR: 4.96; 95%CI: 1.2-20). Wheezing in past history was noted in 18 cases (64%) and only in 10 (35%) children without BPD (OR: 3.24; 95% CI: 1.09-9.67). Mean PEFR did not differ significantly between the studied groups (80.5+/-16.3% vs 84.5+/-15.4%; p=0.4). Moreover, changes of PEFR after a dose of betamimetic were similar in both groups (21% vs. 19%, p=0.7).

CONCLUSION

The intellectual development of children with BPD at the age of 5-7 is worse than in the control group, especially as declared by their parents. Episodes of wheezing in infancy occurred more frequently in the group of children with BPD. However, bronchial hyperreactivity at the age of 5-7 is not significantly more frequent.

[Genotyping and treatment modification in patients with phenylketonuria: an introduction to pharmacogenomics]

INTRODUCTION

Phenylketonuria is the most common inborn error of metabolism. The disease is caused by mutations of the phenylalanine hydroxylase gene, decreasing or completely abolishing the activity of the encoded enzyme. Treatment consists in maintaining low blood phenylalanine concentration. Untreated patients develop mental retardation. Use of tetrahydrobiopterin is a new, alternative treatment method, effective in some phenylketonuria-patients. Because the dietary treatment becomes less restrictive in such patients, quality of life rises in them substantially. Phenylketonuria-causing mutations strictly determine susceptibility to tetrahydrobiopterin in a given patient.

AIM

The aim of the study was to select candidates for tetrahydrobiopterin treatment basing on analysis of detected mutations of the phenylalanine hydroxylase gene.

METHODS

Phenylketonuria-patients from Krakow region were genotyped by means of PCR, DHPLC and sequencing.

RESULTS

95% of mutations of the phenylalanine hydroxylase gene were identified in a group of 238 phenylketonuria-patients followed up in Krakow region. A genotype excluding treatment with tetrahydrobiopterin was find in >53% of patients. In 23% of patients genotypes were found which were typical for milder forms of the disease (far less restrictive dietary treatment needed in comparison with patients with classical phenylketonuria). Approximately half of the remaining patients could probably benefit from use of dietary treatment with additional tetrahydrobiopterin supplementation.

[Respiratory syncytial virus prophylaxis among preterm infants--four seasons' experience]

BACKGROUND

Respiratory syncitial virus (RSV) is the main reason of hospitalizations due to respiratory tract infection in children within the first year of life. The course of infection is more severe in children from a risk group, which includes children who were born preterm, these with bronchopulmonary dysplasia (BPD), children with heart defects significantly influencing their hemodynamics, and immunocompromised children. Palivizumab is a humanized monoclonal antibody class IgG-1 used to prevent RSV infection.

AIM

To assess the results of treatment and to evaluate factors influencing the efficacy of RSV infection prophylaxis in preterm newborns.

METHODS

The study included 55 preterm newborns (mean birth weight-970g, mean gestational age-27 weeks), who were given a dose of palmivizumab of 15mg per kg body weight every four weeks in autumn and winter from season 2004/ 2005 to season 2007/2008.

RESULTS

Ten children (18%) required hospitalization between the doses and within 28 days after the last dose of palmivizumab. Among these, 2 children (3.6%) were hospitalized because of very severe RSV infection. Eight children (16%) were hospitalized due to respiratory tract infection within 12 months after completing the prophylaxis; none of them was infected with RSV. The episodes of respiratory tract infection between the doses and within 28 days after the last dose occurred in 19 children (31%), and in 26 patients included in the follow-up (51%) within 12 months after completing the prophylaxis. The effect of treatment was most beneficial in preterm neonates with extremely low birth weight and in children who did not require respiratory medications at the moment of discharge from the neonatal unit.

CONCLUSION

RSV infection prophylaxis is of most benefit in children born with extremely low birth weight. In this group of children the prophylaxis should be considered both for children suffering from BPD and in children free of this disease.

[The maternal phenylketonuria syndrom--still current problem]

Phenylketonuria (OMIM 261600) is a congenital genetically conditioned error of metabolism phenylalanine to tyrosine. Being untreated or insufficiently treated phenylketonuria (PKU) sometimes leads to irreversible damage of mielin. Similarly, high phenylalanine concentration in the blood of pregnant woman with PKU exert the teratogenic effect on growing and developing foetus (in the majority of cases being the carrier of PKU), which leads to appearance of maternal phenylketonuria syndrom (MPKU syndrom). The features of MPKU syndrome consist: low weight at birth, the congenital heart defects, digestive tract defects, osseous arrangements, microcephaly, handicap of intellectual development. Spontaneous miscarriages at pregnant women with PKU are more often.

THE AIM OF WORK

the evaluation of influence hyperphenylalaninemia of pregnant woman with PKU on her foetus, depending on the metabolic control in the pre- and postconception period.

MATERIAL AND METHOD

under the care of Outpatient Metabolic Clinic of University Children's Hospital in Cracow remain 430 patients aged from 0 to 56 years with hyperphenylalaninemia. In the register of Outpatient Metabolic Clinic there are the data about 50 pregnancies of 21 women with hyperphylalaninemia (from mild hyperphenylalaninemia to classic PKU). Only 10 pregnancies were planned - the low-phenylalanine diet was obligatory introduced 3 months before conception and was applied throughout the whole period of pregnancy in order to maintain the levels of phenylalanine in the range of 2 to 6 mg/dl. One pregnancy finished with spontaneous miscarriage, the other 9- the birth of healthy offspring. By contrast, out of 40 unplanned pregnancies 8 ended in spontaneous miscarriage, and of the remaining 32 unplanned pregnancies 33 children were born: 24 (75%) newborns with the maternal PKU features, 1 child died during thel-st year of life, 3 have the lack of any data, and only 5 (15.6%) children were born clinically healthy (1 twin birth). Among the children with maternal PKU syndrome: microcephaly was diagnosed in 17 cases, congenital heart defect and microcephaly in 6 children, and microcephaly and the anal atresia in 1 child. Among the children, born from unplanned pregnancies, there are two (twins), whose mother from the 6 week of gestation had returned to applying diet (average phe levels 6.37 mg/dl); two children of mothers who were conducting the therapeutic implemented since 18-th and 32-th weeks of gestation (average phe 7.5 mg/dl) (there is the lack of detailed data about these children, because the women are never reported to our Outpatient Clinic), and one child, whose mother raised and began the therapy from 12-th week of gestation (average phe levels 10.37 mg/dl), who presents the features of ADHD syndrome.

CONCLUSIONS

1. All pregnancies of women with hyperphenylalaninemia should be planned to avoid the complications in the form of maternal PKU syndrom. 2. It is essential to educate the women with PKU and their families about the problems concerning maternal PKU. 3. It is also necessary to inform pediatricians, family physicians and gynaecologists-obstetricians about the features of maternal PKU syndrom.

[Prevalence and risk factors of bronchopulmonary dysplasia among extremely low birth weight newborns of regional birth cohort of south-east Poland]

BACKGROUND

Advances in intensive health care within the last 30 years have resulted in increased survival of most immature neonates. The results of epidemiological studies indicate, however, that late complications of prematurity, including bronchopulmonary dysplasia (BPD), have become more frequent since the late 1990s. The identification of risk factors predisposing to severe BPD might help in developing treatment methods directed at the group of children with high risk of developing the disease.

AIM

Analysis of prevalence and risk factors of bronchopulmonary dysplasia among extremely low birth weight newborns of regional birth cohort of south-east Poland.

METHODS

The study included newborns of birth weight < or = 1000g born in south-east district of Poland within one calendar year. The data assessed were: the need of oxygen therapy of at least 28 days' duration and the need of oxygen therapy at 36 weeks of postmenstrual age (PMA).

RESULTS

During the study period 109 newborns with birth weight < or = 1000g) were hospitalized in three third-level departments of neonatology in south-east Poland. The final assessment for BPD included 56 children (51%), whose mean birth weight was 839g (SD: 128) and mean gestational age was 27.3 weeks (SD: 2.2). Thirty-nine children (70%) required oxygen therapy for at least 28 days, and 27 children (48%) required oxygen therapy at 36 weeks of PMA. Gestational age of the newborn, the need of respiratory support at birth, and the need of surgical treatment of PDA were found to be independent risk factors of oxygen therapy lasting for at least 28 days. Only the need of respiratory support at 7 days of life and the need for surgical treatment of PDA were found to be independent risk factors of oxygen therapy at the 36 weeks of PMA.

CONCLUSION

The analysis of several risk factors of BPD in children with birth weight < or =1000g revealed that the need for respiratory support at seven days of life is a major risk factor of developing chronic respiratory disease. The risk of BPD may be significantly reduced by adequate care aimed at shortening the time of conventional respiratory support and at limiting the persistence of ductus arteriosus.

Ovarian hyperstimulation syndrome in newborns--a case presentation and literature review

Preterm ovarian hyperstimulation syndrome (POHS) is a rare condition in which immaturity of the gonadal axis is accepted as the cause. Based on our case and 8 cases from the literature, we made an attempt to specify the mechanisms underlying the syndrome and its pathognomonic signs. All POHS newborns were born between 24 and 31 weeks postconception age (WPCA) and developed vulvar, hypogastric and upper leg swelling, and ovarian follicular cyst/cysts (10-40 mm in diameter) with mildly or considerably elevated E(2) concentrations (80-5,300 pmol/l) between 35 and 39 WPCA. The GnRH test, performed in 5 cases, confirmed gonadal axis activation. In our case the observed normalization of elevated gonadotropin values by 43 WPCA, accompanied by a simultaneously increasing E(2) value (approximately 800 pmol/l), could correspond with the maturation of the gonadal steroid-dependent negative-feedback mechanism. The continuously increasing E(2) levels after this period (maximum 1,300 pmol/l) suggest its autonomous secretion. In all the cases, including 3 neonates treated with medroxyprogesterone and surgery, the swelling resolved by 6 months.

CONCLUSIONS

A pathognomonic sign of POHS is swelling which develops around 37 +/- 3 WPCA, and the syndrome is only infrequently diagnosed when the swelling is profound. The direct etiologic factor here is not E(2). POHS does not require therapy as long as there is no danger of cyst torsion.

Two novel COL1A1 mutations in patients with osteogenesis imperfecta (OI) affect the stability of the collagen type I triple-helix

Osteogenesis imperfecta (OI) is a bone dysplasia caused by mutations in the COL1A1 and COL1A2 genes. Although the condition has been intensely studied for over 25 years and recently over 800 novel mutations have been published, the relation between the location of mutations and clinical manifestation is poorly understood. Here we report missense mutations in COL1A1 of several OI patients. Two novel mutations were found in the D1 period. One caused a substitution of glycine 200 by valine at the N-terminus of D1 in OI type I/IV, lowering collagen stability by 50% at 34 degrees C. The other one was a substitution of valine 349 by phenylalanine at the C-terminus of D1 in OI type I, lowering collagen stability at 37.5 degrees C. Two other mutations, reported before, changed amino residues in D4. One was a lethal substitution changing glycine 866 to serine in genetically identical twins with OI type II. That mutated amino acid was near the border of D3 and D4. The second mutation changed glycine 1040 to serine located at the border of D4 and D0.4, in a proband manifesting OI type III, and lowered collagen stability at 39 degrees C (2 degrees C lower than normal). Our results confirm the hypothesis on a critical role of the D1 and D4 regions in stabilization of the collagen triple-helix. The defect in D1 seemed to produce a milder clinical type of OI, whereas the defect in the C-terminal end of collagen type caused the more severe or lethal types of OI.

[Wheezing in very low birth weight infants: sequence of early neonatal lung injury or increased susceptibility for allergic reactions? Follow-up study up to age of 5-7 years]

BACKGROUND

Prevalence of wheezing during infancy and pre-school age among very low birth weight (VLBW) infants is high. There is too little data to determine exactly the cause of wheezing in this group of children--it may result from early neonatal lung injury or increased susceptibility for allergic reactions.

AIM

Analysis of wheezing episodes up to 5-7 years of age in a group of VLBW infants and recognition of risk factors.

METHODS

A sample of 104 children aged 5-7 years with birth weight < or = 1500g was prospectively evaluated. The standardized ISAAC (International Study of Asthma and Allergies in Childhood) protocol was used to evaluate the number and quality of wheezing episodes. Total IgE level, specific IgE, lymphocyte Th1/Th2 ratio and skin prick tests (SPT) were performed. Children were divided into 3 groups: without wheezing, with episodes of wheezing in the history (more than 12 months previously), and with persistent episodes of wheezing.

RESULTS

Episodes of wheezing were diagnosed in 52 (50%) cases: 27% of children showed signs of wheezing during 12 previous months and 23% of children reported wheezing only in their past history. Children with persistent wheezing presented more frequently than other groups: positive family history for atopy, allergic rhinitis, and positive allergic laboratory markers. Children with wheezing only during early infancy had bronchopulmonary dysplasia and more severe respiratory distress syndrome after birth.

CONCLUSION

Prevalence of wheezing during infancy and preschool age among VLBW infants is high. Chronic and recurrent episodes of wheezing are more directly related to atopy than derive from neonatal problems.

[Difficulties in diagnosing febrile states in 21-month-old patient: case report]

A 21-month-old girl was admitted to our Department of Pediatrics to diagnose febrile states lasting for previous two weeks, anemia and increased erythrocyte sedimentation rate (ESR - erythrocyte sedimentation rate). The physical examination revealed the paleness of skin and oral mucosa, silent systolic murmur and hypotrophic constitution. The laboratory tests confirmed anemia and showed increased ESR and moderately increased C Reactive Protein (CRP - C Reactive Protein). The blood culture, the urine culture, the stool culture, the tests of the stool in direction of parasites and the serologic tests carried out in direction of infection caused by Toxoplasma ghondi, Mycoplasma pneumoniae, HAV, HCV, CMV, EBV and Parvovirus B19 were all negative. The chest X-ray picture and ultrasonographic examination of abdomen showed no abnormality. The consulting hematologist carried the bone marrow biopsy out--the bone marrow was poorly cellular. The urinary level of catecholamines and plasma level of neuron-specific enolase (NSE) were greatly increased. The computer tomography scan of head, neck, thorax and abdomen did not confirmed the presence of the tumor. Nevertheless the bone scintigraphy demonstrated the presence of foci of abnormally increased activity in left femur and the right hip-bone--pathognomonic of metastatic disease. During the hospitalization we did not observe the fever, but only the deepening anemia, weakness, irritability, limping and the presence of spectacle-shaped hematomas. The blood parameters temporarily were normal after blood transfusion. The patient was transmitted to the Department of Children's Oncology and Hematology. The trepanobiopsy of the bone marrow showed the presence of metastases of neuroblastoma. The magnetic resonance imaging (MRI) was made, but it did not revealed the presence of the primary tumor. The patient underwent a course of chemotherapy.

LAT1 gene variants--potential factors influencing the clinical course of phenylketonuria

The LAT1 amino acid exchanger is responsible for phenylalanine transport across the blood-brain barrier. As phenylalanine excess in the brain leads to mental retardation in untreated patients with phenylketonuria, mutations of the LAT1 gene can be responsible for milder clinical manifestations (lower brain toxicity of hyperphenylalaninaemia) observed in some patients. The aim of this study was to screen for LAT1 gene mutations in phenylketonuric patients. Within the coding sequence of the gene, three polymorphism and one new mutation (G41D) were detected. The protein sequence change due to the mutation described could influence the clinical course of phenylketonuria.