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Broekhuis A, Koenen SV, Broeren MAC, Krabbe JG, Pop VJM. High first trimester ferritin levels differ according to parity and are independently related to preterm birth: A prospective cohort study. Acta Obstet Gynecol Scand 2024. [PMID: 38650165 DOI: 10.1111/aogs.14830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION A considerable amount of neonatal morbidity and mortality worldwide is caused by preterm birth. To date, the underlying etiology of preterm birth has not been fully clarified. Previous studies demonstrate that inflammation is one of the pathological factors that might cause preterm birth, and that there is a difference between primiparous and multiparous women in immune response to pregnancy. The objective of this prospective cohort study was to investigate the role of two inflammatory markers, ferritin and C-reactive protein (CRP) and preterm birth, in first trimester women, stratified for parity. In addition, a possible association between high ferritin and CRP, and a possible association between high ferritin and CRP and preterm birth were assessed. MATERIAL AND METHODS A total of 2044 healthy, low-risk pregnant women from primary obstetric care in the Netherlands participated in this study. Their ferritin and CRP levels were evaluated at 12 weeks' gestation. Levels above the parity specific 95th percentile were defined as high. The main outcome of this study was to assess the presence of a possible association between parity specific high ferritin and CRP, and preterm birth. The secondary outcomes were the ferritin and CRP levels of women, stratified for parity, and the possible association between high ferritin and CRP levels. Logistic regression analysis was performed with preterm birth as a dependent variable and parity specific high ferritin and CRP as an independent variable, adjusting for age and history of preterm birth. RESULTS Ferritin levels decreased with increasing parity. Ferritin and CRP levels at 12 weeks' gestation were significantly higher in women with preterm birth. In primiparous women, high ferritin levels (OR: 2.5, CI: 1.14-5.38) and high CRP levels (OR: 5.0, CI: 2.61-9.94) were independently associated with preterm birth. In multiparous women, high ferritin levels (OR: 6.0, CI: 2.28-16.67) were independently associated with preterm birth while high CRP levels were not. CONCLUSIONS First trimester parity specific ferritin and CRP levels could play a part in predictive models for preterm birth, and further research for their additive role in preterm birth is needed.
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Affiliation(s)
- Annabel Broekhuis
- Department of Obstetrics and Gynecology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Steven V Koenen
- Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Maarten A C Broeren
- Department of Clinical Chemistry, Máxima Medical Center, Veldhoven, The Netherlands
| | - Johannes G Krabbe
- Department of Clinical Chemistry and Laboratory Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Zhang Y, Mustieles V, Korevaar T, Martin L, Sun Y, Bibi Z, Torres N, Coburn-Sanderson A, First O, Souter I, Petrozza JC, Broeren MAC, Botelho JC, Calafat AM, Wang YX, Messerlian C. Association between per- and polyfluoroalkyl substances exposure and thyroid function biomarkers among females attending a fertility clinic. Environ Pollut 2024; 346:123513. [PMID: 38350534 PMCID: PMC10950513 DOI: 10.1016/j.envpol.2024.123513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 02/15/2024]
Abstract
Per- and polyfluoroalkyl substances (PFAS) exposure was associated with changes in thyroid function in pregnant mothers and the general population. Limited such evidence exists in other susceptible populations such as females with fertility problems. This cross-sectional study included 287 females seeking medically assisted reproduction at a fertility clinic in Massachusetts, United States, between 2005 and 2019. Six long-alkyl chain PFAS, thyroid hormones, and autoimmune antibodies were quantified in baseline serum samples. We used generalized linear models and quantile g-computation to evaluate associations of individual PFAS and their total mixture with thyroid biomarkers. Most females were White individuals (82.7%), had graduate degrees (57.8%), and nearly half had unexplained subfertility (45.9%). Serum concentrations of all examined PFAS and their mixture were significantly associated with 2.6%-5.6% lower total triiodothyronine (TT3) concentrations. Serum concentrations of perfluorononanoate (PFNA), perfluorodecanoate (PFDA), and perfluoroundecanoate (PFUnDA), and of the total mixture were associated with higher ratios of free thyroxine (FT4) to free triiodothyronine (FT3). No associations were found for PFAS and TSH or autoimmune antibodies. Our findings support the thyroid-disrupting effect of long alkyl-chain PFAS among a vulnerable population of subfertile females.
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Affiliation(s)
- Yu Zhang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Vicente Mustieles
- Instituto de Investigación Biosanitaria Ibs GRANADA, Spain. University of Granada, Center for Biomedical Research (CIBM), Spain. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - T.I.M. Korevaar
- Department of Internal Medicine and Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3015 GE Rotterdam, The Netherlands
| | - Leah Martin
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yang Sun
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zainab Bibi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicole Torres
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ayanna Coburn-Sanderson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Olivia First
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Irene Souter
- Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital Fertility Center, Boston, MA, USA
| | - John C. Petrozza
- Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital Fertility Center, Boston, MA, USA
| | - Maarten A. C. Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Julianne C. Botelho
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Antonia M. Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yi-Xin Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital Fertility Center, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Osinga JAJ, Liu Y, Männistö T, Vafeiadi M, Tao FB, Vaidya B, Vrijkotte TGM, Mosso L, Bassols J, López-Bermejo A, Boucai L, Aminorroaya A, Feldt-Rasmussen U, Hisada A, Yoshinaga J, Broeren MAC, Itoh S, Kishi R, Ashoor G, Chen L, Veltri F, Lu X, Taylor PN, Brown SJ, Chatzi L, Popova PV, Grineva EN, Ghafoor F, Pirzada A, Kianpour M, Oken E, Suvanto E, Hattersley A, Rebagliato M, Riaño-Galán I, Irizar A, Vrijheid M, Delgado-Saborit JM, Fernández-Somoano A, Santa-Marina L, Boelaert K, Brenta G, Dhillon-Smith R, Dosiou C, Eaton JL, Guan H, Lee SY, Maraka S, Morris-Wiseman LF, Nguyen CT, Shan Z, Guxens M, Pop VJM, Walsh JP, Nicolaides KH, D'Alton ME, Visser WE, Carty DM, Delles C, Nelson SM, Alexander EK, Chaker L, Palomaki GE, Peeters RP, Bliddal S, Huang K, Poppe KG, Pearce EN, Derakhshan A, Korevaar TIM. Risk Factors for Thyroid Dysfunction in Pregnancy: An Individual Participant Data Meta-Analysis. Thyroid 2024. [PMID: 38546971 DOI: 10.1089/thy.2023.0646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background: International guidelines recommend targeted screening to identify gestational thyroid dysfunction. However, currently used risk factors have questionable discriminative ability. We quantified the risk for thyroid function test abnormalities for a subset of risk factors currently used in international guidelines. Methods: We included prospective cohort studies with data on gestational maternal thyroid function and potential risk factors (maternal age, body mass index [BMI], parity, smoking status, pregnancy through in vitro fertilization, twin pregnancy, gestational age, maternal education, and thyroid peroxidase antibody [TPOAb] or thyroglobulin antibody [TgAb] positivity). Exclusion criteria were pre-existing thyroid disease and use of thyroid interfering medication. We analyzed individual participant data using mixed-effects regression models. Primary outcomes were overt and subclinical hypothyroidism and a treatment indication (defined as overt hypothyroidism, subclinical hypothyroidism with thyrotropin >10 mU/L, or subclinical hypothyroidism with TPOAb positivity). Results: The study population comprised 65,559 participants in 25 cohorts. The screening rate in cohorts using risk factors currently recommended (age >30 years, parity ≥2, BMI ≥40) was 58%, with a detection rate for overt and subclinical hypothyroidism of 59%. The absolute risk for overt or subclinical hypothyroidism varied <2% over the full range of age and BMI and for any parity. Receiver operating characteristic curves, fitted using maternal age, BMI, smoking status, parity, and gestational age at blood sampling as explanatory variables, yielded areas under the curve ranging from 0.58 to 0.63 for the primary outcomes. TPOAbs/TgAbs positivity was associated with overt hypothyroidism (approximate risk for antibody negativity 0.1%, isolated TgAb positivity 2.4%, isolated TPOAb positivity 3.8%, combined antibody positivity 7.0%; p < 0.001), subclinical hypothyroidism (risk for antibody negativity 2.2%, isolated TgAb positivity 8.1%, isolated TPOAb positivity 14.2%, combined antibody positivity 20.0%; p < 0.001) and a treatment indication (risk for antibody negativity 0.2%, isolated TgAb positivity 2.2%, isolated TPOAb positivity 3.0%, and combined antibody positivity 5.1%; p < 0.001). Twin pregnancy was associated with a higher risk of overt hyperthyroidism (5.6% vs. 0.7%; p < 0.001). Conclusions: The risk factors assessed in this study had poor predictive ability for detecting thyroid function test abnormalities, questioning their clinical usability for targeted screening. As expected, TPOAb positivity (used as a benchmark) was a relevant risk factor for (subclinical) hypothyroidism. These results provide insights into different risk factors for gestational thyroid dysfunction.
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Affiliation(s)
- Joris A J Osinga
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yindi Liu
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tuija Männistö
- Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui, China
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, United Kingdom
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lorena Mosso
- Departments of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, Girona, Spain
| | - Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, New York, USA
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Aya Hisada
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ghalia Ashoor
- Harris Birthright Research Center for Fetal Medicine, King's College Hospital, London, United Kingdom
| | - Liangmiao Chen
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Flora Veltri
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Xuemian Lu
- Department of Endocrinology and Rui'an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Polina V Popova
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Elena N Grineva
- Department of Endocrinology, First Medical University, Saint Petersburg, Russia
| | - Farkhanda Ghafoor
- Department of Research and Innovation, Shalamar Institute of Health Sciences, Lahore, Pakistan
| | | | - Maryam Kianpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Andrew Hattersley
- Department of Molecular Medicine, University of Exeter Medical School, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom
| | - Marisa Rebagliato
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Predepartamental Unit of Medicine, Jaume I University, Castelló, Spain
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Isolina Riaño-Galán
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
- IUOPA-Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
- Servicio de Pediatría, Endocrinología Pediátrica, HUCA, Oviedo, Asturias, Spain
| | - Amaia Irizar
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain
- Department of Preventive Medicine and Public Health, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Martine Vrijheid
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Juana Maria Delgado-Saborit
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain
- Department of Medicine, Faculty of Health Sciences, Universitat Jaume I, Castellón de la Plana, Spain
| | - Ana Fernández-Somoano
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
- IUOPA-Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
| | - Loreto Santa-Marina
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, San Sebastian, Spain
- Department of Health of the Basque Government, Subdirectorate of Public Health of Gipuzkoa, San Sebastian, Spain
| | - Kristien Boelaert
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Gabriela Brenta
- Department of Internal Medicine, Unidad Asistencial Dr. César Milstein, Buenos Aires, Argentina
| | - Rima Dhillon-Smith
- Tommys National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Chrysoula Dosiou
- Division of Endocrinology, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer L Eaton
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, and Women and Infants Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Haixia Guan
- The First Hospital of China Medical University, Shenyang, China
| | - Sun Y Lee
- Section of Endocrinology, Diabetes, and Nutrition, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Endocrine Section, Medicine Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Lilah F Morris-Wiseman
- Division of Endocrine Surgery, Johns Hopkins Department of Surgery, Baltimore, Maryland, USA
| | - Caroline T Nguyen
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Zhongyan Shan
- Department of Endocrinology and Metabolism, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| | - Mònica Guxens
- Spanish Consortium for Research on Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Kypros H Nicolaides
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine King's College London, London, United Kingdom
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York, USA
| | - W Edward Visser
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - David M Carty
- Department of Diabetes, Endocrinology and Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Scott M Nelson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Erik K Alexander
- Division of Endocrinology, Hypertension and Diabetes, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine; School of Public Health; Anhui Medical University, Hefei, Anhui, China
| | - Kris G Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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Genet SAAM, van den Wildenberg SAH, Broeren MAC, van Dongen JLJ, Brunsveld L, Scharnhorst V, van de Kerkhof D. Quantification of the lung cancer tumor marker CYFRA 21-1 using protein precipitation, immunoaffinity bottom-up LC-MS/MS. Clin Chem Lab Med 2024; 62:720-728. [PMID: 37886827 DOI: 10.1515/cclm-2023-0795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES Numerous studies have proven the potential of cytokeratin 19 fragment 21-1 (CYFRA 21-1) detection in the (early) diagnosis and treatment monitoring of non-small cell lung cancer (NSCLC). Conventional immunoassays for CYFRA 21-1 quantification are however prone to interferences and lack diagnostic sensitivity and standardization. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is an emerging approach based on a different, often superior, detection principle, which may improve the clinical applicability of CYFRA 21-1 in cancer diagnostics. Therefore, we developed and validated a protein precipitation, immunoaffinity (IA) LC-MS/MS assay for quantitative analysis of serum CYFRA 21-1. METHODS Selective sample preparation was performed using ammonium sulfate (AS) precipitation, IA purification, tryptic digestion and LC-MS/MS quantification using a signature peptide and isotopically labeled internal standard. The workflow was optimized and validated according to EMA guidelines and results were compared to a conventional immunoassay. RESULTS Significant interference effects were seen during IA purification, which were sufficiently solved by performing AS precipitation prior to IA purification. A linear calibration curve was obtained in the range of 1.0-100 ng/mL (R2=0.98). Accuracy and precision were well within acceptance criteria. In sera of patients suspected of lung cancer, the method showed good correlation with the immunoassay. CONCLUSIONS A robust AS precipitation-IA LC-MS/MS assay for the quantification of serum CYFRA 21-1 was developed. With this assay, the clinically added value of LC-MS/MS-based detection over immunoassays can be further explored.
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Affiliation(s)
- Sylvia A A M Genet
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Expert Center Clinical Chemistry, Eindhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Sebastian A H van den Wildenberg
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Expert Center Clinical Chemistry, Eindhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Maarten A C Broeren
- Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Expert Center Clinical Chemistry, Eindhoven, The Netherlands
| | - Joost L J van Dongen
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Expert Center Clinical Chemistry, Eindhoven, The Netherlands
| | - Luc Brunsveld
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Expert Center Clinical Chemistry, Eindhoven, The Netherlands
| | - Volkher Scharnhorst
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Expert Center Clinical Chemistry, Eindhoven, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Daan van de Kerkhof
- Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
- Expert Center Clinical Chemistry, Eindhoven, The Netherlands
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5
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Genet SAAM, Visser E, Youssef-El Soud M, Belderbos HNA, Stege G, de Saegher MEA, Westeinde SCV', Brunsveld L, Broeren MAC, van de Kerkhof D, Eduati F, van den Borne BEEM, Scharnhorst V. Strengths and challenges in current lung cancer care: Timeliness and diagnostic procedures in six Dutch hospitals. Lung Cancer 2024; 189:107477. [PMID: 38271919 DOI: 10.1016/j.lungcan.2024.107477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Timely diagnosis of lung cancer (LC) is crucial to achieve optimal patient care and outcome. Moreover, the number of procedures required to obtain a definitive diagnosis can have a large influence on the life expectancy of a patient. Here, adherence with existing Dutch guidelines for timeliness and type and number of invasive and imaging procedures was assessed. MATERIALS AND METHODS 1096 patients with suspected LC were enrolled in this multicenter prospective study (NL9146). The overall survival, time from referral to the first appointment with the pulmonologist, time to diagnosis and treatment, and the number of imaging and invasive procedures were evaluated. Patients were divided into different diagnostic groupsearly- and advanced stage non-small-cell lung cancer (NSCLC), small-cell lung cancer (SCLC), large cell neuroendocrine carcinoma of the lung (LCNEC), patients without LC and patients without a definitive diagnosis. RESULTS The majority of patients (66 %) received a definitive diagnosis within 5 weeks, although the time to diagnosis of early-stage LC patients and patients without LC was significantly longer comparted to advanced stage LC. An increase in invasive procedures was seen for early-stage LC compared to advanced stage LC and for 13 % of the advanced stage non-squamous NSCLC patients up to three additional invasive procedures were performed solely to obtain sufficient material for NGS. For patients without a definitive diagnosis, 50 % did undergo at least one invasive procedure, while 11 % did not wish to undergo any invasive procedures. CONCLUSION These insights could aid in improved LC diagnostics and efficient implementation of new techniques like liquid biopsy and artificial intelligence. This may lead to more timely LC care, a decreased number of invasive procedures, less variability between the diagnostic trajectory of different patients and aid in obtaining a definitive diagnosis for all patients.
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Affiliation(s)
- Sylvia A A M Genet
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Esther Visser
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands
| | | | | | | | | | | | - Luc Brunsveld
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Maarten A C Broeren
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands
| | - Daan van de Kerkhof
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands
| | - Federica Eduati
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands; Eindhoven Artificial Intelligence Systems Institute, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Volkher Scharnhorst
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands; Eindhoven Artificial Intelligence Systems Institute, Eindhoven University of Technology, Eindhoven, The Netherlands.
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6
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Osinga JAJ, Derakhshan A, Feldt-Rasmussen U, Huang K, Vrijkotte TGM, Männistö T, Bassols J, López-Bermejo A, Aminorroaya A, Vafeiadi M, Broeren MAC, Palomaki GE, Ashoor G, Chen L, Lu X, Taylor PN, Tao FB, Brown SJ, Sitoris G, Chatzi L, Vaidya B, Popova PV, Vasukova EA, Kianpour M, Suvanto E, Grineva EN, Hattersley A, Pop VJM, Nelson SM, Walsh JP, Nicolaides KH, D’Alton ME, Poppe KG, Chaker L, Bliddal S, Korevaar TIM. TSH and FT4 Reference Interval Recommendations and Prevalence of Gestational Thyroid Dysfunction: Quantification of Current Diagnostic Approaches. J Clin Endocrinol Metab 2024; 109:868-878. [PMID: 37740543 PMCID: PMC10876390 DOI: 10.1210/clinem/dgad564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/14/2023] [Accepted: 09/21/2023] [Indexed: 09/24/2023]
Abstract
CONTEXT Guidelines recommend use of population- and trimester-specific thyroid-stimulating hormone (TSH) and free thyroxine (FT4) reference intervals (RIs) in pregnancy. Since these are often unavailable, clinicians frequently rely on alternative diagnostic strategies. We sought to quantify the diagnostic consequences of current recommendations. METHODS We included cohorts participating in the Consortium on Thyroid and Pregnancy. Different approaches were used to define RIs: a TSH fixed upper limit of 4.0 mU/L (fixed limit approach), a fixed subtraction from the upper limit for TSH of 0.5 mU/L (subtraction approach) and using nonpregnancy RIs. Outcome measures were sensitivity and false discovery rate (FDR) of women for whom levothyroxine treatment was indicated and those for whom treatment would be considered according to international guidelines. RESULTS The study population comprised 52 496 participants from 18 cohorts. Compared with the use of trimester-specific RIs, alternative approaches had a low sensitivity (0.63-0.82) and high FDR (0.11-0.35) to detect women with a treatment indication or consideration. Sensitivity and FDR to detect a treatment indication in the first trimester were similar between the fixed limit, subtraction, and nonpregnancy approach (0.77-0.11 vs 0.74-0.16 vs 0.60-0.11). The diagnostic performance to detect overt hypothyroidism, isolated hypothyroxinemia, and (sub)clinical hyperthyroidism mainly varied between FT4 RI approaches, while the diagnostic performance to detect subclinical hypothyroidism varied between the applied TSH RI approaches. CONCLUSION Alternative approaches to define RIs for TSH and FT4 in pregnancy result in considerable overdiagnosis and underdiagnosis compared with population- and trimester-specific RIs. Additional strategies need to be explored to optimize identification of thyroid dysfunction during pregnancy.
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Affiliation(s)
- Joris A J Osinga
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and clinical Sciences, Copenhagen University, 1172 Copenhagen, Denmark
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, 230032 Anhui, China
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Tuija Männistö
- Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90570 Oulu, Finland
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, 17007 Girona, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, 17007 Girona, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, 17003 Girona, Spain
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, 81745-33871 Isfahan, Iran
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, 710 03 Crete, Greece
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Hematology, Máxima Medical Centre, 5504 DB Veldhoven, The Netherlands
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, RI 02903, USA
| | - Ghalia Ashoor
- Harris Birthright Research Center for Fetal Medicine, King’s College Hospital, SE5 9RS London, UK
| | - Liangmiao Chen
- Department of Endocrinology and Rui’an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, 325035 Wenzhou, China
| | - Xuemian Lu
- Department of Endocrinology and Rui’an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, 325035 Wenzhou, China
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, CF10 3EU Cardiff, UK
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 230032 Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, 230032 Anhui, China
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, 6009 Nedlands, Perth, Australia
| | - Georgiana Sitoris
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Lida Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, EX1 2LU Exeter, UK
| | - Polina V Popova
- Institute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia
- World-Class Research Center for Personalized Medicine, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia
| | - Elena A Vasukova
- Institute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia
| | - Maryam Kianpour
- Departament de Ciències Mèdiques, Universitat de Girona, 17003 Girona, Spain
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, 90570 Oulu, Finland
| | - Elena N Grineva
- Institute of Endocrinology, Almazov National Medical Research Centre, 197341 Saint Petersburg, Russia
| | - Andrew Hattersley
- Molecular Medicine, University of Exeter Medical School, Royal Devon & Exeter Hospital, EX3 0AW Exeter, UK
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, 5000 LE Tilburg, The Netherlands
| | - Scott M Nelson
- School of Medicine, University of Glasgow, G12 8QQ Glasgow, UK
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, 6009 Nedlands, Perth, Australia
- Medical School, University of Western Australia, Crawley, WA 6009, Australia
| | - Kypros H Nicolaides
- Department of Women and Children’s Health, Faculty of Life Sciences and Medicine King’s College London, SE5 9RS London, UK
| | - Mary E D’Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, NewYork, NY 10032, USA
| | - Kris G Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
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7
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van Aalen EA, de Vries IR, Hanckmann ETL, Stevens JRF, Romagnoli TR, Derijks LJJ, Broeren MAC, Merkx M. Point-of-care therapeutic drug monitoring of tumour necrosis factor-α inhibitors using a single step immunoassay. Sens Diagn 2023; 2:1492-1500. [PMID: 38013761 PMCID: PMC10633107 DOI: 10.1039/d3sd00131h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/04/2023] [Indexed: 11/29/2023]
Abstract
Therapeutic drug monitoring (TDM) of tumor necrosis factor-α (TNFα)-inhibitors adalimumab and infliximab is important to establish optimal drug dose and maximize treatment efficacy. Currently, TDM is primarily performed with ELISA techniques in clinical laboratories, resulting in a long sample-to-result workflow. Point-of-care (POC) detection of these therapeutic antibodies could significantly decrease turnaround times and allow for user-friendly home-testing. Here, we adapted the recently developed bioluminescent dRAPPID (dimeric Ratiometric Plug-and-Play Immunodiagnostics) sensor platform to allow POC TDM of infliximab and adalimumab. We applied the two best performing dRAPPID sensors, with limit-of-detections of 1 pM and 17 pM, to measure the infliximab and adalimumab levels in 49 and 40 patient serum samples, respectively. The analytical performance of dRAPPID was benchmarked with commercial ELISAs and yielded Pearson's correlation coefficients of 0.93 and 0.94 for infliximab and adalimumab, respectively. Furthermore, a dedicated bioluminescence reader was fabricated and used as a readout device for the TDM dRAPPID sensors. Subsequently, infliximab and adalimumab patient serum samples were measured with the TDM dRAPPID sensors and bioluminescence reader, yielding Pearson's correlation coefficients of 0.97 and 0.86 for infliximab and adalimumab, respectively, and small proportional differences with ELISA (slope was 0.97 ± 0.09 and 0.96 ± 0.20, respectively). The adalimumab and infliximab dRAPPID sensors, in combination with the dedicated bioluminescence reader, allow for ease-of-use TDM with a fast turnaround time and show potential for POC TDM outside of clinical laboratories.
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Affiliation(s)
- Eva A van Aalen
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands +31 40 247 4728
- Institute for Complex Molecular Systems, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands
| | - Ivar R de Vries
- Department of Electrical Engineering, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands
| | - Eva T L Hanckmann
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands +31 40 247 4728
- Institute for Complex Molecular Systems, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands
| | - Jeannot R F Stevens
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands +31 40 247 4728
- Institute for Complex Molecular Systems, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands
| | - Thomas R Romagnoli
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands +31 40 247 4728
- Institute for Complex Molecular Systems, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands
| | - Luc J J Derijks
- Department of Clinical Pharmacy and Pharmacology, Máxima Medical Center P.O. Box 7777 5500 MB Veldhoven The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center P.O. Box 5800 6202 AZ Maastricht The Netherlands
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Center P.O. Box 7777 5500 MB Veldhoven The Netherlands
| | - Maarten Merkx
- Laboratory of Chemical Biology, Department of Biomedical Engineering, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands +31 40 247 4728
- Institute for Complex Molecular Systems, Eindhoven University of Technology P.O. Box 513 5600 MB Eindhoven The Netherlands
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8
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Derakhshan A, Shu H, Broeren MAC, Kortenkamp A, Lindh CH, Demeneix B, Peeters RP, Bornehag CG, Korevaar TIM. Association of endocrine disrupting chemicals exposure with human chorionic gonadotropin concentrations in pregnancy. Environ Int 2023; 178:108091. [PMID: 37459690 DOI: 10.1016/j.envint.2023.108091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Human chorionic gonadotropin (hCG) is produced by the placenta and plays an essential role in the maintenance of pregnancy. Endocrine disrupting chemicals (EDCs) have the potential to interfere with functions related to the production and secretion of hCG; however associations between exposure to EDCs and hCG concentrations in humans remain to be elucidated. OBJECTIVES To investigate the association of urinary, serum and plasma concentrations of EDCs during pregnancy with serum hCG concentrations. METHODS We utilized data form the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study. We investigated the association of 26 EDCs measured in early pregnancy urine or blood with serum hCG concentrations using multi-variable adjusted linear regression models per EDC and Weighted Quantile Sum (WQS) regression with repeated holdout validation for the EDCs mixture. RESULTS In 2,039 included women, higher exposure to bisphenol A was associated with lower hCG (beta [95% CI]: -0.06 [-0.11 to -0.002]) while higher triclosan exposure was associated with a higher hCG (0.02 [0.003 to 0.04]). Higher exposure to several phthalates, including mono-ethyl and mono-butyl phthalates (MEP and MBP) as well as metabolites of di-2-ethylhexyl phthalate (DEHP) was associated with a lower hCG (beta [95% CI] for sum of DEHP metabolites: -0.13 [-0.19 to -0.07]). Likewise, higher exposure to several polychlorinated biphenyls (PCBs) was associated with a lower hCG. In the WQS regression, each quartile increase in the EDCs mixture was associated with -0.27 lower hCG (95% CI: -0.34 to -0.19). DISCUSSION Higher exposure to several EDCs during pregnancy was associated with a lower hCG; and despite the small effect sizes, still indicating that the exposure may negatively affect production or secretion of hCG by the placenta. Our results provide the impetus for future experimental studies to investigate the placenta as a target organ for adverse effects of EDCs.
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Affiliation(s)
- Arash Derakhshan
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands
| | - Huan Shu
- Department of Public Health, Karlstad University, Sweden
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, De Run 4600, The Netherlands
| | - Andreas Kortenkamp
- Division of Environmental Sciences, College of Health, Medicine and Life Sciences, Brunel University, London, Uxbridge, UK
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Barbara Demeneix
- Laboratoire d'Evolution des Régulations Endocriniennes, CNRS/Muséum National d'Histoire Naturelle, 57 Rue Cuvier, 75005 Paris, France
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands
| | - Carl-Gustaf Bornehag
- Department of Public Health, Karlstad University, Sweden; Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Tim I M Korevaar
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands.
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9
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Genet SAAM, Wolfs JRE, Vu CBAK, Wolter M, Broeren MAC, van Dongen J, Brunsveld L, Scharnhorst V, van de Kerkhof D. Analysis of Neuron-Specific enolase isozymes in human serum using immunoaffinity purification and liquid chromatography-tandem mass spectrometry quantification. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1223:123701. [PMID: 37086508 DOI: 10.1016/j.jchromb.2023.123701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/24/2023]
Abstract
Neuron-specific enolase (NSE) is a promising small-cell lung cancer (SCLC) biomarker composed of αγ and γγ isozyme dimers. As the conventional immunoassays are prone to interferences and cannot differentiate between the isozymes, we developed a multiplex immunoaffinity (IA) liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay for the quantification of NSEα and NSEγ in human serum. A calibrator was prepared by performing cold denaturation of recombinantly expressed αα and γγ enolase dimers to induce a new dimer equilibrium that was determined to be approximately 1αγ:1γγ:1αα. Selective sample purification was achieved by performing IA extraction using an antibody specific towards NSEγ. The isolated αγ and γγ dimers were denatured and trypsin digested to allow quantification of the selected signature peptides and their corresponding isotopically labelled peptide internal standard. The obtained linear dynamic ranges were determined to be 1.5-56 ng/mL and 0.64-167 ng/mL for NSEα and NSEγ (R2 = 0.88 and 0.97 respectively). Validation of the assay showed acceptable accuracy and precision for NSEα and NSEγ. The method was successfully applied to patient serum in which both isozymes were detected. Compared to the conventional immunoassay, substantially lower total NSE concentrations were measured in IA LC-MS/MS. With this multiplex IA LC-MS/MS assay, the clinical value of quantifying the individual isozymes can be explored. In addition, together with the calibrator described here, it may be applied to standardize NSE immunoassays across different platforms.
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Affiliation(s)
- Sylvia A A M Genet
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands; Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Jur R E Wolfs
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Chris B A K Vu
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Madita Wolter
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Maarten A C Broeren
- Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Joost van Dongen
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Luc Brunsveld
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Volkher Scharnhorst
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands; Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Daan van de Kerkhof
- Laboratory of Chemical Biology, Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands; Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands.
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Visser E, Genet SAAM, de Kock RPPA, van den Borne BEEM, Youssef-El Soud M, Belderbos HNA, Stege G, de Saegher MEA, van 't Westeinde SC, Brunsveld L, Broeren MAC, van de Kerkhof D, Deiman BALM, Eduati F, Scharnhorst V. Liquid biopsy-based decision support algorithms for diagnosis and subtyping of lung cancer. Lung Cancer 2023; 178:28-36. [PMID: 36773458 DOI: 10.1016/j.lungcan.2023.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/11/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Pathologic subtyping of tissue biopsies is the gold standard for the diagnosis of lung cancer (LC), which could be complicated in cases of e.g. inconclusive tissue biopsies or unreachable tumors. The diagnosis of LC could be supported in a minimally invasive manner using protein tumor markers (TMs) and circulating tumor DNA (ctDNA) measured in liquid biopsies (LBx). This study evaluates the performance of LBx-based decision-support algorithms for the diagnosis of LC and subtyping into small- and non-small-cell lung cancer (SCLC and NSCLC) aiming to directly impact clinical practice. MATERIALS AND METHODS In this multicenter prospective study (NL9146), eight protein TMs (CA125, CA15.3, CEA, CYFRA 21-1, HE4, NSE, proGRP and SCCA) and ctDNA mutations in EGFR, KRAS and BRAF were analyzed in blood of 1096 patients suspected of LC. The performance of individual and combined TMs to identify LC, NSCLC or SCLC was established by evaluating logistic regression models at pre-specified positive predictive values (PPV) of ≥95% or ≥98%. The most informative protein TMs included in the multi-parametric models were selected by recursive feature elimination. RESULTS Single TMs could identify LC, NSCLC and SCLC patients with 46%, 25% and 40% sensitivity, respectively, at pre-specified PPVs. Multi-parametric models combining TMs and ctDNA significantly improved sensitivities to 65%, 67% and 50%, respectively. CONCLUSION In patients suspected of LC, the LBx-based decision-support algorithms allowed identification of about two-thirds of all LC and NSCLC patients and half of SCLC patients. These models therefore show clinical value and may support LC diagnostics, especially in patients for whom pathologic subtyping is impossible or incomplete.
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Affiliation(s)
- Esther Visser
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands.
| | - Sylvia A A M Genet
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Remco P P A de Kock
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | | | | | | | | | | | | | - Luc Brunsveld
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Maarten A C Broeren
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Daan van de Kerkhof
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Birgit A L M Deiman
- Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands
| | - Federica Eduati
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands; Eindhoven Artificial Intelligence Systems Institute, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Volkher Scharnhorst
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands; Eindhoven Artificial Intelligence Systems Institute, Eindhoven University of Technology, Eindhoven, the Netherlands
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11
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Hulsbosch LP, Boekhorst MGBM, Gigase FAJ, Broeren MAC, Krabbe JG, Maret W, Pop VJM. The first trimester plasma copper-zinc ratio is independently related to pregnancy-specific psychological distress symptoms throughout pregnancy. Nutrition 2022; 109:111938. [PMID: 36736090 DOI: 10.1016/j.nut.2022.111938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/23/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES High plasma copper (Cu) and low zinc (Zn) levels have been associated with depression. However, most studies used low sample sizes and a cross-sectional design, and perinatal data are scarce. We investigated the possible association between pregnancy-specific psychological distress and the plasma CuZn ratio using a prospective design. METHODS Pregnancy-specific distress symptoms were assessed at each trimester by means of the Tilburg Pregnancy Distress Scale, negative affect subscale, in 2036 pregnant women. Cu and Zn were assessed at 12 wk of gestation in plasma samples by inductively coupled plasma mass spectrometry. Growth mixture modeling determined trajectories of women's pregnancy-specific negative affect (P-NA) symptoms, which were entered in a multiple logistic regression analysis as dependent variable and the CuZn ratio as independent variable. RESULTS Two P-NA symptom classes were found: 1) persistently low (n = 1820) and 2) persistently high (n = 216). A higher CuZn ratio was independently associated with persistently high P-NA symptom scores (odds ratio = 1.52; 95% confidence interval, 1.13-2.04) after adjustment for confounders. A sensitivity analysis was performed excluding all women with high P-NA scores at 12 wk (>1 SD above the mean P-NA score). In the 1719 remaining women, a higher CuZn ratio significantly predicted the development of increasing P-NA symptom scores after adjustment for confounders (odds ratio = 1.40; 95% confidence interval, 1.04-1.95). CONCLUSIONS A higher CuZn plasma ratio is an independent determinant of developing pregnancy-specific distress symptoms throughout pregnancy, suggesting that micronutrients could be used as novel biomarkers for psychological distress research of perinatal mood disorders.
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Affiliation(s)
- Lianne P Hulsbosch
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
| | - Myrthe G B M Boekhorst
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Frederieke A J Gigase
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maarten A C Broeren
- Laboratory for Clinical Chemistry and Haematology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Johannes G Krabbe
- Department of Clinical Chemistry and Laboratory Medicine, Medisch Spectrum Twente, Medlon BV, Enschede, the Netherlands
| | - Wolfgang Maret
- Department of Nutritional Sciences, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Victor J M Pop
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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12
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Pop VJ, Hulsbosch LP, Boekhorst MGBM, Broeren MAC, Krabbe JG, Wiersinga WM. Hypothyroid Symptoms Throughout Pregnancy Are Predominantly Associated with Thyroxine and Not with Thyrotropin Concentrations. Thyroid 2022; 32:1249-1258. [PMID: 35999708 DOI: 10.1089/thy.2022.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: It is unclear whether levels of hypothyroid symptoms in pregnant women with (sub)clinical thyroid dysfunction differ from euthyroid controls and whether free thyroxine (fT4)/thyrotropin (TSH) changes throughout pregnancy affect hypothyroid symptom levels. The objective was twofold: (1) To compare hypothyroid symptom levels between thyroid dysfunction subgroups and a carefully defined reference group; (2) to assess the association between fT4/TSH changes throughout pregnancy and hypothyroid symptom levels adjusted for depressive symptoms. Methods: The current study was a longitudinal prospective cohort study in 1800 healthy pregnant women. At each trimester of pregnancy, hypothyroid symptoms were assessed with a 12-item symptom hypothyroidism checklist and depressive symptoms with the Edinburgh Depression Scale. Thyroid dysfunction was defined using the 2.5-97.5th fT4/TSH percentile of thyroid peroxidase antibodies-negative women. Euthyroid controls consisted of women with appropriate fT4 levels within the 10-90th percentile and with a normal TSH level. Hypothyroid symptom mean scores were compared between controls and several thyroid dysfunction subgroups. Growth mixture modeling was performed to evaluate possible longitudinal trajectories of hypothyroid and depressive symptoms. The association between hypothyroid symptom trajectories (adjusted for depression) and fT4/TSH changes was assessed with multivariate logistic regression analysis. Results: Women with overt hypothyroidism (fT4 < 2.5th, TSH >97.5th) and hypothyroxinemia (fT4 < 2.5th, TSH: 2.5-97.5th) showed higher hypothyroid symptom levels compared with the euthyroid controls and women with subclinical hypothyroidism (SCH, fT4: 2.5-97.5th, TSH >97.5th), because 82% of these SCH women had fT4 levels in the euthyroid range. Two groups of hypothyroid and depressive symptoms were defined: a persistently low and persistently high symptom group. fT4 decreased in 98% of the women from the first to third trimester and per unit pmol/L fT4 decrease (not TSH increase), the likelihood to present persistently high hypothyroid symptoms increased with 46%, adjusted for depression. Conclusions: A properly defined euthyroid control group distinguishes women with hypothyroid symptoms. An fT4 decrease toward end term is associated with persistently high hypothyroid symptom levels. Clinicians should be aware of the importance of fT4 stratification in SCH women.
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Affiliation(s)
- Victor J Pop
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Lianne P Hulsbosch
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Myrthe G B M Boekhorst
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Maarten A C Broeren
- Laboratory for Clinical Chemistry and Hematology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Johannes G Krabbe
- Department of Clinical Chemistry and Laboratory Medicine, Medisch Spectrum Twente, Medlon BV, Enschede, The Netherlands
| | - Wilmar M Wiersinga
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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13
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Osinga JAJ, Derakhshan A, Palomaki GE, Ashoor G, Männistö T, Maraka S, Chen L, Bliddal S, Lu X, Taylor PN, Vrijkotte TGM, Tao FB, Brown SJ, Ghafoor F, Poppe K, Veltri F, Chatzi L, Vaidya B, Broeren MAC, Shields BM, Itoh S, Mosso L, Popova PV, Anopova AD, Kishi R, Aminorroaya A, Kianpour M, López-Bermejo A, Oken E, Pirzada A, Vafeiadi M, Bramer WM, Suvanto E, Yoshinaga J, Huang K, Bassols J, Boucai L, Feldt-Rasmussen U, Grineva EN, Pearce EN, Alexander EK, Pop VJM, Nelson SM, Walsh JP, Peeters RP, Chaker L, Nicolaides KH, D’Alton ME, Korevaar TIM. TSH and FT4 Reference Intervals in Pregnancy: A Systematic Review and Individual Participant Data Meta-Analysis. J Clin Endocrinol Metab 2022; 107:2925-2933. [PMID: 35861700 PMCID: PMC9516198 DOI: 10.1210/clinem/dgac425] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 12/02/2022]
Abstract
CONTEXT Interpretation of thyroid function tests during pregnancy is limited by the generalizability of reference intervals between cohorts due to inconsistent methodology. OBJECTIVE (1) To provide an overview of published reference intervals for thyrotropin (TSH) and free thyroxine (FT4) in pregnancy, (2) to assess the consequences of common methodological between-study differences by combining raw data from different cohorts. METHODS (1) Ovid MEDLINE, EMBASE, and Web of Science were searched until December 12, 2021. Studies were assessed in duplicate. (2) The individual participant data (IPD) meta-analysis was performed in participating cohorts in the Consortium on Thyroid and Pregnancy. RESULTS (1) Large between-study methodological differences were identified, 11 of 102 included studies were in accordance with current guidelines; (2) 22 cohorts involving 63 198 participants were included in the meta-analysis. Not excluding thyroid peroxidase antibody-positive participants led to a rise in the upper limits of TSH in all cohorts, especially in the first (mean +17.4%; range +1.6 to +30.3%) and second trimester (mean +9.8%; range +0.6 to +32.3%). The use of the 95th percentile led to considerable changes in upper limits, varying from -10.8% to -21.8% for TSH and -1.2% to -13.2% for FT4. All other additional exclusion criteria changed reference interval cut-offs by a maximum of 3.5%. Applying these findings to the 102 studies included in the systematic review, 48 studies could be used in a clinical setting. CONCLUSION We provide an overview of clinically relevant reference intervals for TSH and FT4 in pregnancy. The results of the meta-analysis indicate that future studies can adopt a simplified study setup without additional exclusion criteria.
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Affiliation(s)
- Joris A J Osinga
- Correspondence: Joris Osinga, MD, Erasmus MC, Generation R, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
| | - Arash Derakhshan
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, RI 02905, USA
| | - Ghalia Ashoor
- Harris Birthright Research Center for Fetal Medicine, King’s College Hospital, London, UK
| | - Tuija Männistö
- Northern Finland Laboratory Center Nordlab and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Spyridoula Maraka
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA
- Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Liangmiao Chen
- Department of Endocrinology and Rui’an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sofie Bliddal
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Xuemian Lu
- Department of Endocrinology and Rui’an Center of the Chinese-American Research Institute for Diabetic Complications, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter N Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China
| | - Suzanne J Brown
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Farkhanda Ghafoor
- Department of Research and Innovation, Shalamar Institute of Health Sciences, Lahore, Pakistan
| | - Kris Poppe
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Flora Veltri
- Endocrine Unit, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lida Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, CA 90089, USA
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital NHS Foundation Trust, University of Exeter Medical School, Exeter, UK
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Beverley M Shields
- Department of Medical Statistics, University of Exeter Medical School, Exeter, UK
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Lorena Mosso
- Departments of Endocrinology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Polina V Popova
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
- Department of Internal Diseases and Endocrinology, St. Petersburg Pavlov State Medical University, Saint Petersburg, Russian Federation
- World-Class Research Center for Personalized Medicine, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Anna D Anopova
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Kianpour
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, Spain
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Amna Pirzada
- Shifa Institute of Medical Technology, Shifa International Hospital, Islamabad, Pakistan
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eila Suvanto
- Department of Obstetrics and Gynecology and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Jun Yoshinaga
- Faculty of Life Sciences, Toyo University, Gunma, Japan
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, Scientific Research Center in Preventive Medicine; School of Public Health; Anhui Medical University, China
| | - Judit Bassols
- Maternal-Fetal Metabolic Research Group, Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta Hospital, Girona, Spain
| | - Laura Boucai
- Department of Medicine, Division of Endocrinology, Memorial Sloan-Kettering Cancer Center, Weill Cornell University, New York, NY 10065, USA
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Elena N Grineva
- Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts 02118, USA
| | - Erik K Alexander
- Division of Endocrinology, Hypertension and Diabetes, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 0211, USA
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | | | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kypros H Nicolaides
- Department of Women and Children’s Health, Faculty of Life Sciences and Medicine King’s College London, London, UK
| | - Mary E D’Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York 10032, USA
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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14
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Derakhshan A, Kortenkamp A, Shu H, Broeren MAC, Lindh CH, Peeters RP, Bornehag CG, Demeneix B, Korevaar TIM. Association of per- and polyfluoroalkyl substances with thyroid homeostasis during pregnancy in the SELMA study. Environ Int 2022; 167:107420. [PMID: 35870378 DOI: 10.1016/j.envint.2022.107420] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To investigate the association of exposure to per- and polyfluoroalkyl substances (PFAS) during early pregnancy with markers of the maternal thyroid system. METHODS Serum concentrations of seven PFAS as well as thyroid stimulating hormone (TSH), free and total thyroxine (FT4 and TT4), free and total triiodothyronine (FT3 and TT3) were measured in pregnant women in early pregnancy in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study. Outcomes were concentrations of TSH and thyroid hormones, FT4/FT3 or TT4/TT3 ratios, TSH/FT4 ratio as a marker of the negative feedback loop, TT4/FT4 or TT3/FT3 ratios as markers of the binding of thyroid hormones to binding proteins. RESULTS The study population comprised 2,008 women with median (95% range) gestational age of 10 (6-14) weeks. There was no association between PFAS and TSH. Higher PFNA, PFDA, PFHpA and PFOA levels were associated with a higher FT4 (largest effect estimate for PFDA: β [95% CI]: 0.27 [0.10 to 0.45], P = 0.002). Higher PFUnDA levels, but no other PFAS, were associated with a lower FT3 (β [95% CI]: -0.05 [-0.09 to -0.01], P = 0.005). Higher PFUnDA levels were associated with lower TT4 (β [95% CI]: -1.58 [-3.07 to -0.09]) and there was an inverted U-shaped association of PFOS with TT4 (P = 0.03). Higher PFDA, PFUnDA, PFHpA levels were associated with a lower TT3. Overall, higher PFAS concentrations were associated with a higher FT4/FT3 ratio and a higher TT4/TT3 ratio. There was no association of PFAS with the TSH/FT4 ratio. Higher concentrations of several PFAS were associated with lower TT4/FT4 and TT3/FT3 ratios. CONCLUSIONS These findings translate results from experimental studies suggesting that exposure to PFAS may interfere with the thyroid system during pregnancy. Further experimental studies should take into account human evidence to better understand the potential underlying mechanisms of thyroid disruption by PFAS exposure.
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Affiliation(s)
- Arash Derakhshan
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE, Rotterdam, The Netherlands; Department of internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE, Rotterdam, the Netherlands
| | - Andreas Kortenkamp
- Division of Environmental Sciences, College of Health, Medicine and Life Sciences, Brunel University, London, Uxbridge, UK
| | - Huan Shu
- Department of Public Health, Karlstad University, Sweden
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, De Run, 4600, The Netherlands
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, 22363 Lund, Sweden
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE, Rotterdam, The Netherlands; Department of internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE, Rotterdam, the Netherlands
| | - Carl-Gustaf Bornehag
- Department of Public Health, Karlstad University, Sweden; Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Barbara Demeneix
- Laboratoire d'Evolution des Régulations Endocriniennes, CNRS/Muséum National d'Histoire Naturelle, 57 Rue Cuvier, 75005 Paris, France
| | - Tim I M Korevaar
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE, Rotterdam, The Netherlands; Department of internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE, Rotterdam, the Netherlands.
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15
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Derakhshan A, Shu H, Broeren MAC, Lindh CH, Peeters RP, Kortenkamp A, Demeneix B, Bornehag CG, Korevaar TIM. Association of phthalate exposure with thyroid function during pregnancy. Environ Int 2021; 157:106795. [PMID: 34358912 DOI: 10.1016/j.envint.2021.106795] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/01/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The extent of thyroid disruptive effects of phthalates during pregnancy remains unclear. AIM To investigate the association of maternal urinary phthalates with markers of the thyroid system during early pregnancy. METHODS Urinary concentrations of phthalate metabolites and serum concentrations of thyroid stimulating hormone (TSH), free and total thyroxine (FT4 and TT4) and free and total triiodothyronine (FT3 and TT3) were measured in pregnant women in early pregnancy in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy study (2007-ongoing), a population-based prospective cohort. RESULTS In the 1,996 included women, higher di-ethyl-hexyl phthalate (DEHP) metabolites were associated with a lower FT4 (β [SE] for the molar sum: -0.13 [0.06], P = 0.03) and a higher TSH/FT4 ratio (0.003 [0.001], P = 0.03). Higher concentrations of di-iso-nonyl phthalate (DINP) metabolites were associated with a lower TT4 (β [SE] for the molar sum: 0.93 [0.44], P = 0.03) as well as with lower TT4/FT4 and TT4/TT3 ratios. Higher metabolites of both dibutyl and butyl-benzyl phthalate (DBP and BBzP) were associated with lower T4/T3 ratio (free and total) and higher FT4/TT4 and FT3/TT3 ratios. A higher diisononyl cyclohexane dicarboxylate (DINCH) metabolite concentration was associated with a higher TT3. CONCLUSIONS These results translate results from experimental studies suggesting that exposure to phthalates may interfere with the thyroid system during pregnancy. This is also true for compounds that have been introduced to replace known disruptive phthalates. Further experimental studies should take into account the human evidence to better investigate the potential underlying mechanisms of thyroid disruption by phthalates.
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Affiliation(s)
- Arash Derakhshan
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands
| | - Huan Shu
- Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, De Run 4600, the Netherlands
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, 22363 Lund, Sweden
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands
| | - Andreas Kortenkamp
- Division of Environmental Sciences, College of Health, Medicine and Life Sciences, Brunel University, London, Uxbridge, UK
| | - Barbara Demeneix
- Laboratoire d'Evolution des Régulations Endocriniennes, CNRS/Muséum National d'Histoire Naturelle, 57 Rue Cuvier, 75005 Paris, France
| | - Carl-Gustaf Bornehag
- Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden; Icahn School of Medicine at Mount Sinai, New York City, NY 10029-6574, USA
| | - Tim I M Korevaar
- Academic Center for Thyroid Diseases, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands; Department of Internal Medicine, Erasmus MC, Dr. Molewaterplein 15, 3051 GE Rotterdam, the Netherlands.
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16
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Abstract
BACKGROUND The aetiology of nausea and vomiting during pregnancy (NVP) is multifactorial, but the relative contribution of biological and psychological determinants is insufficiently understood. We examined the association of human chorionic gonadotropin (hCG), thyroid hormones (thyroid-stimulating hormone and thyroxin) and psychological factors with NVP. METHODS Blood chemistry and psychological measures were obtained in 1682 pregnant women participating in the Holistic Approach to Pregnancy and the first Postpartum Year (HAPPY) study between 12 and 14 weeks of gestation. The presence of NVP was measured using the Pregnancy-Unique Quantification of Emesis scale. Depressive symptoms were assessed using the Edinburgh Depression Scale. Multivariable logistic regression analyses were used to investigate the independent role of hCG, thyroid hormones and depression as related to NVP, adjusting for age, body mass index, education, parity, smoking status, unplanned pregnancy and history of depression. RESULTS Elevated levels of NVP were observed in 318 (18.9%) participants. High hCG levels [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.11-1.95], elevated depressive symptoms in the first trimester (OR = 1.67, 95% CI = 1.15-2.43) and a history of depression (OR = 1.53, 95% CI = 1.11-2.11) were independently related to high NVP. Multiparity (OR = 1.47, 95% CI = 1.12-1.92) and younger age (OR = 0.91, 95% CI = 0.87-0.94) were also associated with high NVP, whereas (sub)clinical hyperthyroidism was not related to high NVP. CONCLUSIONS The current study is the first to demonstrate that a combination of hCG hormone and psychological factors are independently related to nausea and vomiting during early pregnancy.
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Affiliation(s)
- Guus W F Dekkers
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Sophie E M Truijens
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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17
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Levie D, Derakhshan A, Shu H, Broeren MAC, de Poortere RA, Peeters RP, Bornehag CG, Demeneix B, Korevaar TIM. The Association of Maternal Iodine Status in Early Pregnancy with Thyroid Function in the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy Study. Thyroid 2019; 29:1660-1668. [PMID: 31524090 DOI: 10.1089/thy.2019.0164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Severe maternal iodine deficiency can impact fetal brain development through effects on maternal and/or fetal thyroid hormone availability. The effects of mild-to-moderate iodine deficiency on thyroid function are less clear. The aim was to investigate the association of maternal urinary iodine concentration corrected for creatinine (UI/Creat) with thyroid function and autoantibodies in a mild-to-moderate iodine-deficient pregnant population. Methods: This study was embedded within the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study. Clinical reference ranges were determined by the 2.5th and 97.5th population-based percentile cutoffs. The associations of UI/Creat with thyrotropin (TSH), free thyroxine (fT4), free triiodothyronine (fT3), total T4 (TT4), and total T3 (TT3) were studied using multivariable linear regression in thyroid peroxidase antibody (TPOAb)-negative women. The association of UI/Creat with TPOAb and thyroglobulin antibody (TgAb) positivity was analyzed using multivariable logistic regression. Results: Urinary iodine and thyroid function were measured at a median (95% range) gestational age of 10 (6-14) weeks in 2009 women. The median (95% range) UI/Creat was 85 μg/g (36-386) and the UI/Creat was below 150 μg/g in 80.1% of women. Reference ranges did not differ substantially by UI/Creat. A lower UI/Creat was associated with a lower TSH (p = 0.027), a higher TT4 (p = 0.032), and with a corresponding trend toward slightly higher fT4 (p = 0.081), fT3 (p = 0.079), and TT3 (p = 0.10). UI/Creat was not associated with the fT4/fT3 (p = 0.94) or TT4/TT3 ratios (p = 0.63). Women with a UI/Creat of 150-249 μg/g had the lowest prevalence of TPOAb positivity (6.1%), while women with a UI/Creat of <150 μg/g had a higher prevalence (11.0%, odds ratio [OR] confidence interval [95% CI] 1.84 [1.07-3.20], p = 0.029). Women with a UI/Creat ≥500 μg/g showed the highest prevalence and a higher risk of TPOAb positivity, however, only a small proportion of women had such a UI/Creat (12.5%, OR, [95% CI] 2.36 [0.54-10.43], p = 0.26). Conclusions: We could not identify any meaningful differences in thyroid function reference ranges. Lower iodine availability was associated with a slightly lower TSH and a higher TT4. Women with adequate iodine intake had the lowest risk of TPOAb positivity.
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Affiliation(s)
- Deborah Levie
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Arash Derakhshan
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Huan Shu
- Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, Sweden
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Ralph A de Poortere
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Carl-Gustaf Bornehag
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara Demeneix
- UMR 7221, Laboratoire d'Evolution des Régulations Endocriniennes, CNRS/Muséum National d'Histoire Naturelle, Sorbonne Universities, Paris, France
| | - Tim I M Korevaar
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus MC, Rotterdam, The Netherlands
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18
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Broeren MAC, Krabbe JG, Boesten LS, Hokken-Koelega ACS, de Rijke YB. Impact of the Choice of IGF-I Assay and Normative Dataset on the Diagnosis and Treatment of Growth Hormone Deficiency in Children. Horm Res Paediatr 2019; 90:181-189. [PMID: 30286459 DOI: 10.1159/000493133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The analysis of insulin-like growth factor I (IGF-I) is an important tool for pediatricians in the diagnosis and treatment of growth hormone deficiency in children. However, significant differences exist in IGF-I assays and normative datasets, which can have important clinical consequences. METHODS IGF-I analyses were performed using the IDS-iSYS platform on 1,897 samples from pediatric patients (0.5-18 years old). Z-scores were calculated based on normative IGF-I data from Bidlingmaier et al. (SD-BM) [J Clin Endocrinol Metab. 2014 May; 99(5): 1712-21] and normative IGF-I data from the IGF-I harmonization program in the Netherlands (SD-NL). The differences in Z-scores were analyzed at relevant clinical decision points (-2 SD, +2 SD). These normative datasets were also compared to normative data reported by Elmlinger et al. [Clin Chem Lab Med. 2004; 42(6): 654-64]. RESULTS The difference in Z-score between SD-BM and SD-NL was highest in males between 0 and 3 years old, exceeding 2 SD. Clinically relevant discordance between both Z-scores at -2 and +2 SD was found in 12.7% of all samples. The IGF-I levels at -2 and +2 SD reported in the normative dataset of Elmlinger et al. were up to 100% higher than the IGF-I levels reported by Bidlingmaier et al. or the Dutch harmonization program. CONCLUSION Pediatricians and laboratory specialists should be aware of relevant differences that can exist between IGF-I assays and normative data. Well-defined pediatric reference ranges for the IDS-iSYS platform are highly desirable.
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Affiliation(s)
- Maarten A C Broeren
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the .,Department of Clinical Chemistry, Máxima Medical Center, Veldhoven-Eindhoven, the
| | - Johannes G Krabbe
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Clinical Chemistry and Laboratory Medicine, Medisch Spectrum Twente, Medlon BV, Enschede, the Netherlands
| | - Lianne S Boesten
- Department of Clinical Chemistry, Ysselland Ziekenhuis, Capelle aan de IJssel, the Netherlands
| | - Anita C S Hokken-Koelega
- Dutch Growth Research Foundation, Rotterdam, the Netherlands.,Department of Pediatrics, Subdivision of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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19
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Skarha J, Mínguez-Alarcón L, Williams PL, Korevaar TIM, de Poortere RA, Broeren MAC, Ford JB, Eliot M, Hauser R, Braun JM. Cross-sectional associations between urinary triclosan and serum thyroid function biomarker concentrations in women. Environ Int 2019; 122:256-262. [PMID: 30477815 PMCID: PMC6317095 DOI: 10.1016/j.envint.2018.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Exposure to the antimicrobial agent triclosan is ubiquitous. Research in animals shows that triclosan can cause decreases in thyroxine concentrations. However, the potential effects of triclosan on thyroid function in humans are unclear. OBJECTIVE To estimate the association between urinary triclosan concentrations and serum thyroid function biomarkers in women seeking assisted reproduction treatment in the Environment and Reproductive Health (EARTH) Study. METHODS We conducted a cross-sectional study of 317 women enrolled in the EARTH Study, a prospective preconception cohort that recruits Boston area couples. Using samples collected at study entry, we quantified urinary triclosan and serum thyroid function biomarker concentrations, specifically free and total thyroxine and triiodothyronine, thyroid-stimulating hormone (TSH), and thyroid antibodies. We estimated covariate-adjusted differences in thyroid function biomarkers per 10-fold increase in triclosan using linear regression models. We examined effect modification by body mass index (BMI) and infertility diagnosis. RESULTS The median urinary triclosan concentration was 7.8 μg/L (IQR: 3.0-59 μg/L). Each 10-fold increase in triclosan was inversely associated with free triidothyronine (T3) (β: -0.06 pg/mL; 95% CI: -0.1, -0.01), thyroperoxidase antibody (TPOAb) (-10%; 95% CI: -19, -0.4), and thyroglobulin antibody (TgAb) (-12%; 95% CI: -23,0.9) concentrations. BMI and infertility diagnosis modified the association of triclosan with free T3 and TPOAb, respectively. CONCLUSION Urinary triclosan concentrations were inversely associated with specific serum thyroid function biomarkers in this cohort, suggesting that triclosan may affect thyroid homeostasis and autoimmunity.
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Affiliation(s)
- Julianne Skarha
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paige L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tim I M Korevaar
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ralph A de Poortere
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, De Run 4600, 5500 MB Veldhoven, the Netherlands
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, De Run 4600, 5500 MB Veldhoven, the Netherlands
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Melissa Eliot
- Department of Epidemiology, Brown University, Providence, RI, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA.
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20
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Scharnhorst V, Schmitz EMH, van de Kerkhof D, Derijks LJJ, Broeren MAC. A value proposition for trough level-based anti-TNFα drug dosing. Clin Chim Acta 2018; 489:89-95. [PMID: 30521801 DOI: 10.1016/j.cca.2018.11.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/20/2018] [Accepted: 11/30/2018] [Indexed: 02/08/2023]
Abstract
Treatment of inflammatory bowel diseases and rheumatic disorders with anti-tumor necrosis factor alpha (TNFα) drugs is expensive, while a significant proportion of patients does not show adequate clinical response. Therapeutic drug monitoring (TDM) enables patient-specific anti-TNFα therapy. The role of laboratory tests in clinical care has recently been described in a value proposition framework. It describes care processes, stakeholders, costs, risks, benefits and patient outcomes based on the use of a laboratory test in a clinical care pathway. We have applied this concept to the use of TDM for anti-TNFα drugs, describing evidence that supports the intervention and its cost effectiveness, steps that need to be adjusted in the care pathway, possible treatment algorithms and measures to assess adoption of this framework into clinical practice. For effective TDM, an assay for measurement of drug levels together with appropriate target ranges and an anti-drug-antibody assay have to be implemented. Also, instead of only reporting the drug concentration, laboratorians, pharmacists and clinicians should deliver added value by introducing a TDM-based treatment algorithm into clinical practice. Thus, to maximize effectiveness of TDM of anti-TNFα therapy in routine care, adjustment of current care pathways and cooperation of many stakeholders are needed.
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Affiliation(s)
- V Scharnhorst
- Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands; Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Laboratory of Chemical Biology and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - E M H Schmitz
- Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands; Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands; Laboratory of Chemical Biology and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands; Clinical Laboratory, Máxima Medical Center, Veldhoven, the Netherlands
| | - D van de Kerkhof
- Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands; Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands
| | - L J J Derijks
- Department of Clinical Pharmacy and Pharmacology, Máxima Medical Center, Veldhoven, the Netherlands
| | - M A C Broeren
- Expert Center Clinical Chemistry Eindhoven, Eindhoven, the Netherlands; Clinical Laboratory, Máxima Medical Center, Veldhoven, the Netherlands
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21
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Derakhshan A, Shu H, Broeren MAC, de Poortere RA, Wikström S, Peeters RP, Demeneix B, Bornehag CG, Korevaar TIM. Reference Ranges and Determinants of Thyroid Function During Early Pregnancy: The SELMA Study. J Clin Endocrinol Metab 2018; 103:3548-3556. [PMID: 29982605 DOI: 10.1210/jc.2018-00890] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/27/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Establishing reference ranges as well as identifying and quantifying the determinants of thyroid function during pregnancy is important for proper clinical interpretation and optimizing research efforts. However, such data are sparse, specifically for triiodothyronine measurements, and most studies do not take into account thyroid antibodies or human chorionic gonadotropin. OBJECTIVE To determine reference ranges and to identify/quantify determinants of TSH, free T4 (FT4), free triiodothyronine (FT3), total T4 (TT4), and total triiodothyronine (TT3). DESIGN, SETTING, AND PARTICIPANTS This study included 2314 participants of the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy study, a population-based prospective pregnancy cohort of mother-child pairs. Reference ranges were calculated by 2.5th to 97.5th percentiles after excluding thyroperoxidase antibody (TPOAb)-positive and/or thyroglobulin antibody (TgAb)-positive women. INTERVENTION None. MAIN OUTCOME MEASURES TSH, FT4, FT3, TT4, and TT3 in prenatal serum. RESULTS After exclusion of TPOAb-positive women, reference ranges were as follows: TSH, 0.11 to 3.48 mU/L; FT4, 11.6 to 19.4 pmol/L; FT3, 3.72 to 5.92 pg/mL; TT4, 82.4 to 166.2 pmol/L; and TT3, 1.28 to 2.92 nmol/L. Additional exclusion of TgAb-positive women did not change the reference ranges substantially. Exposure to tobacco smoke, as assessed by questionnaires and serum cotinine, was associated with lower TSH and higher FT3 and TT3. Body mass index (BMI) and gestational age were the main determinants of TSH (only for BMI), FT4, FT3, TT4, and TT3. CONCLUSIONS We show that the exclusion of TgAb-positive women on top of excluding TPOAb-positive women hardly affects clinical reference ranges. We identified various relevant clinical determinants of TSH, FT4, FT3, TT4, and TT3 that could reflect endocrine-disrupting effects and/or effects on thyroid hormone transport or deiodination.
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Affiliation(s)
- Arash Derakhshan
- Academic Center for Thyroid Diseases, Erasmus MC, GE Rotterdam, Netherlands
- Department of Internal Medicine, Erasmus MC, GE Rotterdam, Netherlands
| | - Huan Shu
- Department of Environmental Science and Analytical Chemistry, Stockholm University, Stockholm, Sweden
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, DB Veldhoven, Netherlands
| | - Ralph A de Poortere
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, DB Veldhoven, Netherlands
| | - Sverre Wikström
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Erasmus MC, GE Rotterdam, Netherlands
- Department of Internal Medicine, Erasmus MC, GE Rotterdam, Netherlands
| | - Barbara Demeneix
- Laboratoire d'Evolution des Régulations Endocriniennes, Muséum National d'Histoire Naturelle, Paris, France
| | - Carl-Gustaf Bornehag
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tim I M Korevaar
- Academic Center for Thyroid Diseases, Erasmus MC, GE Rotterdam, Netherlands
- Department of Internal Medicine, Erasmus MC, GE Rotterdam, Netherlands
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22
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Schmitz EMH, Boekema PJ, Straathof JWA, van Renswouw DC, Brunsveld L, Scharnhorst V, van de Poll MEC, Broeren MAC, Derijks LJJ. Switching from infliximab innovator to biosimilar in patients with inflammatory bowel disease: a 12-month multicentre observational prospective cohort study. Aliment Pharmacol Ther 2018; 47:356-363. [PMID: 29205444 DOI: 10.1111/apt.14453] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/01/2017] [Accepted: 11/14/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infliximab biosimilars have become available for treatment of inflammatory bowel disease (IBD). However, data showing long-term safety and effectiveness of biosimilars in IBD patients are limited. AIM To study prospectively the switch from infliximab innovator to biosimilar in an IBD cohort with 12 months follow-up to evaluate safety and effectiveness. METHODS Adult IBD patients from two hospitals treated with infliximab innovator (Remicade; Janssen Biotech, Horsham , Pennsylvania, USA) were switched to infliximab biosimilar (Inflectra; Hospira, Lake Forest, Illinois, USA) as part of routine care, but in a controlled setting. Blood samples were taken just before the first, second, fourth and seventh infusion of biosimilar. Infliximab trough levels, antibodies-to-infliximab (ATI), CRP and ESR were measured and disease activity scores were calculated. RESULTS Our cohort consisted of 133 IBD patients (64% CD, 36% UC). Before switching we found widely varying infliximab levels (median 3.5 μg/mL). ATI were detected in eight patients (6%). Most patients were in remission or had mild disease (CD: 82% UC: 90%). After switching to biosimilar, 35 patients (26%) discontinued therapy within 12 months, mostly due to subjective higher disease activity (9%) and adverse events (AE, 9.8%). AE included general malaise/fatigue (n = 7), arthralgia (n = 2), skin problems (n = 2) and infusion reactions (n = 2). No differences in IFX levels, CRP, and disease activity scores were found between the four time points (P ≥ .0917). CONCLUSIONS We found no differences in drug levels and disease activity between infliximab innovator and biosimilar in our IBD cohort, indicating that biosimilars are safe and effective. The high proportions of discontinuers were mostly due to elective withdrawal or subjective disease worsening.
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Affiliation(s)
- E M H Schmitz
- Clinical Laboratory, Máxima Medical Center, Veldhoven, The Netherlands.,Expert Center Clinical Chemistry, Eindhoven, The Netherlands.,Clinical Laboratory, Catharina Hospital, Eindhoven, The Netherlands.,Laboratory of Chemical Biology and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - P J Boekema
- Department of Gastroenterology, Máxima Medical Center, Eindhoven and Veldhoven, The Netherlands
| | - J W A Straathof
- Department of Gastroenterology, Máxima Medical Center, Eindhoven and Veldhoven, The Netherlands
| | - D C van Renswouw
- Department of Clinical Pharmacy, Elkerliek Hospital, Helmond, The Netherlands
| | - L Brunsveld
- Expert Center Clinical Chemistry, Eindhoven, The Netherlands.,Laboratory of Chemical Biology and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - V Scharnhorst
- Expert Center Clinical Chemistry, Eindhoven, The Netherlands.,Clinical Laboratory, Catharina Hospital, Eindhoven, The Netherlands.,Laboratory of Chemical Biology and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - M E C van de Poll
- Department of Clinical Pharmacy and Pharmacology, Máxima Medical Center, Veldhoven, The Netherlands
| | - M A C Broeren
- Clinical Laboratory, Máxima Medical Center, Veldhoven, The Netherlands.,Expert Center Clinical Chemistry, Eindhoven, The Netherlands
| | - L J J Derijks
- Department of Clinical Pharmacy and Pharmacology, Máxima Medical Center, Veldhoven, The Netherlands
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23
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Schmitz EMH, Benoy-De Keuster S, Meier AJL, Scharnhorst V, Traksel RAM, Broeren MAC, Derijks LJJ. Therapeutic drug monitoring (TDM) as a tool in the switch from infliximab innovator to biosimilar in rheumatic patients: results of a 12-month observational prospective cohort study. Clin Rheumatol 2017; 36:2129-2134. [PMID: 28593609 DOI: 10.1007/s10067-017-3686-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 04/06/2017] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 12/14/2022]
Abstract
The objective of this study is to apply therapeutic drug monitoring (TDM) as an objective tool to monitor the switch from infliximab innovator (INX) to infliximab biosimilar (INB) in our diverse rheumatic cohort in daily clinical practice. All rheumatic patients on INX treatment (Remicade®) and ≥18 years were switched to INB (Inflectra®) as part of routine care, but in a controlled setting. Patients were monitored by taking blood samples just before the first infusion of INB (T1), and after the second (T2), fourth (T3), and seventh (T4) infusion of INB. T4 reflects the patients' status after ∼12 months. Infliximab trough levels, antibodies-to-infliximab (ATI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and validated disease activity scores (if possible) were measured. Our population consisted of 27 patients with seven different rheumatic diseases who had received INX for 143 (58-161) months (median (IQR)). Half of the patients (52%) received concomitant immunosuppressives. We found widely varying infliximab levels, with only 56% within the proposed therapeutic range of 1-5 μg/mL. One patient had very high ATI levels (>880 au/mL), and two had low ATI levels (≤30 au/mL). After switching to INB, seven patients (26%) discontinued the therapy, partially due to subjective reasons. No difference in infliximab levels, CRP levels, and disease activity scores was found between the four time points (p ≥ 0.2460). In conclusion, no pharmacokinetic or clinical differences were found between INX and INB in our diverse rheumatic cohort. TDM is a helpful tool to monitor patients switching from INX to INB.
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Affiliation(s)
- E M H Schmitz
- Clinical Laboratory, Máxima Medical Center, Veldhoven, the Netherlands.,Expert Center Clinical Chemistry, Eindhoven, the Netherlands.,Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands.,Laboratory of Chemical Biology and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - S Benoy-De Keuster
- Department of Rheumatology, Máxima Medical Center, Eindhoven and Veldhoven, the Netherlands
| | - A J L Meier
- Department of Rheumatology, Máxima Medical Center, Eindhoven and Veldhoven, the Netherlands
| | - V Scharnhorst
- Expert Center Clinical Chemistry, Eindhoven, the Netherlands.,Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands.,Laboratory of Chemical Biology and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - R A M Traksel
- Department of Rheumatology, Máxima Medical Center, Eindhoven and Veldhoven, the Netherlands
| | - M A C Broeren
- Clinical Laboratory, Máxima Medical Center, Veldhoven, the Netherlands.,Expert Center Clinical Chemistry, Eindhoven, the Netherlands
| | - L J J Derijks
- Clinical Pharmacy, Máxima Medical Center, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands.
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24
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Schmitz EMH, van de Kerkhof D, Hamann D, van Dongen JLJ, Kuijper PHM, Brunsveld L, Scharnhorst V, Broeren MAC. Therapeutic drug monitoring of infliximab: performance evaluation of three commercial ELISA kits. Clin Chem Lab Med 2017; 54:1211-9. [PMID: 26587745 DOI: 10.1515/cclm-2015-0987] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/19/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) of infliximab (IFX, Remicade®) can aid to optimize therapy efficacy. Many assays are available for this purpose. However, a reference standard is lacking. Therefore, we evaluated the analytical performance, agreement and clinically relevant differences of three commercially available IFX ELISA kits on an automated processing system. METHODS The kits of Theradiag (Lisa Tracker Infliximab), Progenika (Promonitor IFX) and apDia (Infliximab ELISA) were implemented on an automated processing system. Imprecision was determined by triplicate measurements of patient samples on five days. Agreement was evaluated by analysis of 30 patient samples and four spiked samples by the selected ELISA kits and the in-house IFX ELISA of Sanquin Diagnostics (Amsterdam, The Netherlands). Therapeutic consequences were evaluated by dividing patients into four treatment groups using cut-off levels of 1, 3 and 7 μg/mL and determining assay concordance. RESULTS Within-run and between-run imprecision were acceptable (≤12% and ≤17%, respectively) within the quantification range of the selected ELISA kits. The apDia assay had the best precision and agreement to target values. Statistically significant differences were found between all assays except between Sanquin Diagnostics and the Lisa Tracker assay. The Promonitor assay measured the lowest IFX concentrations, the apDia assay the highest. When patients were classified in four treatment categories, 70% concordance was achieved. CONCLUSIONS Although all assays are suitable for TDM, significant differences were observed in both imprecision and agreement. Therapeutic consequences were acceptable when patients were divided in treatment categories, but this could be improved by assay standardization.
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Abstract
BACKGROUND Though iodine deficiency in pregnancy is a matter of public-health concern, a functional measure of iodine status is lacking. The thyroid-specific protein thyroglobulin (Tg), which reflects thyroid size, has shown promise as a functional measure in studies of children and adults, but data in pregnancy are sparse. In a cohort of mildly to moderately iodine-deficient pregnant women, this study aimed to explore whether serum Tg is a sensitive functional biomarker of iodine status and to examine longitudinal change in Tg with gestational age. METHOD A total of 230 pregnant women were recruited at an antenatal clinic at 12 weeks of gestation to the Selenium in PRegnancy INTervention study, in Oxford, United Kingdom. Repeated measures of urinary iodine-to-creatinine ratio, serum thyrotropin (TSH), and Tg at 12, 20, and 35 weeks of gestation were made. Women were dichotomized by their iodine-to-creatinine ratio (<150 or ≥150 μg/g) to group them broadly as iodine deficient or iodine sufficient. Women with thyroid antibodies were excluded; data and samples were available for 191 women. RESULTS Median Tg concentrations were 21, 19, and 23 μg/L in the first, second, and third trimesters, respectively. In a linear mixed model, controlling for confounders, Tg was higher in the <150 μg/g group than it was in the ≥150 μg/g group (p < 0.001) but there was no difference in TSH (p = 0.27). Gestational week modified the effect of iodine status on TSH (p = 0.01) and Tg (p = 0.012); Tg did not increase with gestational week in the ≥150 μg/g group, but it did in the <150 μg/g group, and TSH increased more steeply in the <150 μg/g group. CONCLUSIONS Low iodine status (<150 μg/g) in pregnancy is associated with higher serum Tg, suggesting that the thyroid is hyperstimulated by iodine deficiency, which causes it to enlarge. Tg is a more sensitive biomarker of iodine status in pregnancy than is TSH.
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Affiliation(s)
- Sarah C Bath
- 1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
| | - Victor J M Pop
- 2 Department of Primary Care, University of Tilburg , Tilburg, The Netherlands
| | - Victoria L Furmidge-Owen
- 1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
- 3 Danone Nutricia Early Life Nutrition , Trowbridge, United Kingdom
| | - Maarten A C Broeren
- 4 Department of Clinical Chemistry, Máxima Medical Center , Veldhoven, The Netherlands
| | - Margaret P Rayman
- 1 Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey , Guildford, United Kingdom
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Kommers DR, Broeren MAC, Andriessen P, Oei SG, Feijs L, Bambang Oetomo S. Pilot study demonstrates that salivary oxytocin can be measured unobtrusively in preterm infants. Acta Paediatr 2017; 106:34-42. [PMID: 27666329 PMCID: PMC5215538 DOI: 10.1111/apa.13606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/08/2016] [Accepted: 09/21/2016] [Indexed: 12/16/2022]
Abstract
Aim This study assessed the feasibility and obtrusiveness of measuring salivary oxytocin in preterm infants receiving Kangaroo care, because this is a period of maximal bonding or co‐regulation. We also analysed possible influential determinants, including maternal oxytocin. Methods The saliva of preterm infants and their mothers was collected prior to, and during, Kangaroo care using cotton swabs and pooled into vials until sufficient volumes were obtained to measure oxytocin levels using a radioimmunoassay. The obtrusiveness of the infants’ collections was measured with a Likert scale. Results Saliva was collected unobtrusively prior to, and during, 30 Kangaroo care sessions in 21 preterm infants. This resulted in three vials with sufficient volumes of before‐Kangaroo care saliva and three with during‐Kangaroo care saliva. Oxytocin was detectable in all six vials. The Kangaroo care duration and the intensity of the mother–infant interaction before and during Kangaroo care seemed to be the most important determinants, and these should preferably be standardised in any future trials. Conclusion Oxytocin was measured unobtrusively in the pooled saliva of preterm infants both before and during Kangaroo care and could therefore be investigated as a biomarker in future studies.
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Affiliation(s)
- DR Kommers
- Department of Neonatology; Máxima Medical Centre; Veldhoven The Netherlands
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - MAC Broeren
- Clinical Chemistry Laboratory; Máxima Medical Centre; Veldhoven The Netherlands
| | - P Andriessen
- Department of Neonatology; Máxima Medical Centre; Veldhoven The Netherlands
- Department of Pediatrics; School for Mental Health and Neuroscience; Faculty of Health, Medicine and Life Sciences; Maastricht University Medical Center; Maastricht The Netherlands
| | - SG Oei
- Department of Electrical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Gynaecology; Máxima Medical Centre; Veldhoven The Netherlands
| | - L Feijs
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - S Bambang Oetomo
- Department of Neonatology; Máxima Medical Centre; Veldhoven The Netherlands
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
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Abstract
OBJECTIVE In current literature and guidelines, there is a tendency to define absolute TSH concentrations at which patient follow-up or even pharmaceutical intervention should be initiated. As TSH concentrations depend on the analytical method/platform used for TSH quantification, absolute cut-off values may pose threats for uniform clinical decision-making. In this study we therefore set out to clarify to what extent the method/platform and the reference values applied for TSH influence the clinical interpretation of thyroid parameters. DESIGN AND METHODS We retrospectively analyzed anonymous TSH results from the Dutch external quality assessment program (EQAS) in relation to reference values advised by different manufacturers. We also examined TSH/free thyroxin (fT4) reference ranges and prevalence of thyroid pathology among different Dutch laboratories, including four cases in which a switch in the measuring platform was made. RESULTS Our data show that interpretation of thyroid parameters is not only influenced by between-method/platform variation, but is also substantially affected by the variation in TSH/fT4 reference intervals applied in individual laboratories. Additionally, we show that the transition to a novel analytical method/platform can result in a shift in the prevalence of thyroid pathology, especially for subclinical hypothyroidism. CONCLUSIONS Subclinical hypothyroidism can be a 'laboratory-induced' condition. This is an undesirable situation in regard to the clinical implications such a diagnosis can have for patients.
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Affiliation(s)
- Karlien L M Coene
- Clinical LaboratoryCatharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The NetherlandsClinical LaboratoryMeander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The NetherlandsClinical LaboratoryMáxima Medical Center, De Run 4600, 5504 DB Veldhoven, The NetherlandsClinical LaboratorySint Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The NetherlandsClinical LaboratoryUniversity Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ayse Y Demir
- Clinical LaboratoryCatharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The NetherlandsClinical LaboratoryMeander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The NetherlandsClinical LaboratoryMáxima Medical Center, De Run 4600, 5504 DB Veldhoven, The NetherlandsClinical LaboratorySint Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The NetherlandsClinical LaboratoryUniversity Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten A C Broeren
- Clinical LaboratoryCatharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The NetherlandsClinical LaboratoryMeander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The NetherlandsClinical LaboratoryMáxima Medical Center, De Run 4600, 5504 DB Veldhoven, The NetherlandsClinical LaboratorySint Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The NetherlandsClinical LaboratoryUniversity Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Pauline Verschuure
- Clinical LaboratoryCatharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The NetherlandsClinical LaboratoryMeander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The NetherlandsClinical LaboratoryMáxima Medical Center, De Run 4600, 5504 DB Veldhoven, The NetherlandsClinical LaboratorySint Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The NetherlandsClinical LaboratoryUniversity Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Eef G W M Lentjes
- Clinical LaboratoryCatharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The NetherlandsClinical LaboratoryMeander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The NetherlandsClinical LaboratoryMáxima Medical Center, De Run 4600, 5504 DB Veldhoven, The NetherlandsClinical LaboratorySint Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The NetherlandsClinical LaboratoryUniversity Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Arjen-Kars Boer
- Clinical LaboratoryCatharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The NetherlandsClinical LaboratoryMeander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The NetherlandsClinical LaboratoryMáxima Medical Center, De Run 4600, 5504 DB Veldhoven, The NetherlandsClinical LaboratorySint Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The NetherlandsClinical LaboratoryUniversity Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Abstract
The rise in antimicrobial resistance has become a serious global health problem. Restrictive use of antibiotics seems the only option to temper this accession since research in new antibiotics has halted. Antimicrobial stewardship programmes rely on quick access to susceptibility data. This study evaluated the concept of bacterial cell count monitoring as a fast method to determine susceptibility. Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus strains were tested for amoxicillin/piperacillin and gentamicin by three conventional methods (VITEK2®, Etest® and broth-macrodilution). Bacterial cell count monitoring reliably predicted susceptibility after 90 min for Escherichia coli and after 120 min for Pseudomonas aeruginosa and Staphylococcus aureus without any minor, major or very major discrepancies. Time-to-result was reduced by 74%, 83% and 76%, respectively. Bacterial cell count monitoring shows great potential for rapid susceptibility testing.
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Affiliation(s)
- M A C Broeren
- Máxima Medical Centre, Clinical Laboratory for Chemistry and Haematology, The Netherlands
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Hermans TM, Broeren MAC, Gomopoulos N, van der Schoot P, van Genderen MHP, Sommerdijk NAJM, Fytas G, Meijer EW. Self-assembly of soft nanoparticles with tunable patchiness. Nat Nanotechnol 2009; 4:721-726. [PMID: 19893514 DOI: 10.1038/nnano.2009.232] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 07/21/2009] [Indexed: 05/28/2023]
Abstract
Details of the forces between nanoparticles determine the ways in which the nanoparticles can self-assemble into larger structures. The use of directed interactions has led to new concepts in self-assembly such as asymmetric dendrons, Janus particles, patchy colloids and colloidal molecules. Recent models that include attractive regions or 'patches' on the surface of the nanoparticles predict a wealth of intricate modes of assembly. Interactions between such particles are also important in a range of phenomena including protein aggregation and crystallization, re-entrant phase transitions, assembly of nanoemulsions and the organization of nanoparticles into nanowires. Here, we report the synthesis of 6-nm nanoparticles with dynamic hydrophobic patches and show that they can form reversible self-assembled structures in aqueous solution that become topologically more connected upon dilution. The organization is based on guest-host supramolecular chemistry with the nanoparticles composed of a hydrophobic dendrimer host molecule and water-soluble hydrophilic guest molecules. The work demonstrates that subtle changes in hierarchal composition and/or concentration can dramatically change mesoscopic ordering.
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Affiliation(s)
- Thomas M Hermans
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
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Chang T, Pieterse K, Broeren MAC, Kooijman H, Spek AL, Hilbers PAJ, Meijer EW. Structural Elucidation of Dendritic Host–Guest Complexes by X-ray Crystallography and Molecular Dynamics Simulations. Chemistry 2007; 13:7883-9. [PMID: 17614308 DOI: 10.1002/chem.200700572] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 11/06/2022]
Abstract
The multiple monovalent binding of adamantyl-urea poly(propyleneimine) dendrimers with carboxylic acid-urea guests was investigated using molecular dynamics simulations and X-ray crystallography to better understand the structure and behavior of the dynamic multivalent complex in solution. The results from the two methods are consistent and suggest a preferred molecular picture of this complicated aggregate of multiple components. The guest molecules can bind to the dendrimer in a variety of ways although most involve hydrogen-bonding interactions between urea groups of the dendrimer with urea and/or carboxylic acid groups of the guest. In addition, acid-base interactions between the carboxylic acid of the guest and the tertiary amine in the interior of the dendritic host are present. Our proposed structure gives important information about the predominant dynamic interactions between the host and guest and illustrates how they fit together and interact with each other.
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Affiliation(s)
- Theresa Chang
- Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands
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Gruijters BWT, Broeren MAC, van Delft FL, Sijbesma RP, Hermkens PHH, Rutjes FPJT. Catalyst Recycling via Hydrogen-Bonding-Based Affinity Tags. Org Lett 2006; 8:3163-6. [PMID: 16836356 DOI: 10.1021/ol0607387] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
[Structure: see text] A novel procedure for catalyst recycling is described. Copper(I)-based catalysts, equipped with an affinity tag, are isolated from crude reaction mixtures on the basis of quadruple hydrogen-bonding interactions using a resin functionalized with complementary affinity tags. Recycled catalysts were successfully used to catalyze a tandem Sonogashira coupling/5-endo-dig cyclization and a Cu-catalyzed [3+2] Huisgen cycloaddition reaction in high yields.
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Affiliation(s)
- Bas W T Gruijters
- Institute for Molecules and Materials, Radboud University Nijmegen, Toernooiveld 1, NL-6525 ED Nijmegen, The Netherlands
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Broeren MAC, de Waal BFM, van Genderen MHP, Sanders HMHF, Fytas G, Meijer EW. Multicomponent host-guest chemistry of carboxylic acid and phosphonic acid based guests with dendritic hosts: an NMR study. J Am Chem Soc 2005; 127:10334-43. [PMID: 16028945 DOI: 10.1021/ja052074m] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A new way to analyze supramolecular dendritic architectures is reported by making use of (13)C NMR and (31)P NMR. Two ethylene glycol guest molecules have been synthesized containing a (13)C labeled carboxylic acid headgroup (2) and a phosphonic acid headgroup (3). The binding of these guests to urea-adamantyl modified poly(propylene imine) dendrimers has been investigated with (13)C NMR and (31)P NMR next to 1D and 2D (1)H NMR techniques. Different amounts of guest 2 have been added to fifth generation dendrimer 1e, and the observed chemical shift values in (13)C NMR were fitted to a model that assumes 1:1 binding between guest and binding site. An association constant of 400 +/- 95 M(-)(1) is obtained for guest 2 with 41 binding sites per dendrimer. When different amounts of phosphonic acid guest 3 are added to dendrimer 1e, two different signals are observed in (31)P NMR. Deconvolution gives the fractions of free and bound guest, resulting in an association constant of (4 +/- 3) x 10(4) M(-)(1) and 61 +/- 1 binding sites. A statistical analysis shows that guest 2 forms a "polydisperse supramolecular aggregate", while guest 3 is able to form a "monodisperse supramolecular aggregate" when the amount of guest is high enough. The NMR results are compared with dynamic light scattering experiments, and a remarkable agreement is found. Phosphonic acid guest 3 is able to exchange with guest 2, which is in agreement with the obtained association constants, and shows that these techniques can be used to analyze multicomponent dendritic aggregates.
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Affiliation(s)
- Maarten A C Broeren
- Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology. P.O. Box 513, 5600 MB Eindhoven, The Netherlands
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Pittelkow M, Nielsen CB, Broeren MAC, van Dongen JLJ, van Genderen MHP, Meijer EW, Christensen JB. Molecular Recognition: Comparative Study of a Tunable Host-Guest System by Using a Fluorescent Model System and Collision-Induced Dissociation Mass Spectrometry on Dendrimers. Chemistry 2005; 11:5126-35. [PMID: 15991204 DOI: 10.1002/chem.200401230] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Host-guest interactions between the periphery of adamantylurea-functionalized dendrimers (host) and ureido acetic acid derivatives (guest) were shown to be specific, strong and spatially well-defined. The binding becomes stronger when using phosphonic or sulfonic acid derivatives. In the present work we have quantified the binding constants for the host-guest interactions between two different host motifs and six different guest molecules. The host molecules, which resemble the periphery of a poly(propylene imine) dendrimer, have been fitted with an anthracene-based fluorescent probe. The two host motifs differ in terms of the length of the spacer between a tertiary amine and two ureido functionalities. The guest molecules all contain an acidic moiety (either a carboxylic acid, a phosphonic acid, or a sulfonic acid) and three of them also contain an ureido moiety capable of forming multiple hydrogen bonds to the hosts. The binding constants for all 12 host-guest complexes have been determined by using fluorescence titrations by monitoring the increase in fluorescence of the host upon protonation by the addition of the guest. The binding constants could be tuned by changing the design of the acidic part of the guest. The formation of hydrogen bonds gives, in all cases, higher association constants, demonstrating that the host is more than a proton sensor. The host with the longer spacer (propyl) shows higher association constants than the host with the shorter spacer (ethyl). The gain in association constants are higher when the urea function is added to the guests for the host with the longer spacer, indicating a better fit. Collision-induced dissociation mass spectrometry (CID-MS) is used to study the stability of the six motifs using the corresponding third generation dendrimer. A similar trend is found when the six different guests are compared.
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Affiliation(s)
- Michael Pittelkow
- Department of Chemistry, University of Copenhagen, Universitetsparken 5, 2100, Denmark
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Broeren MAC, de Waal BFM, van Dongen JLJ, van Genderen MHP, Meijer EW. The chirality of dendrimer-based supramolecular complexes. Org Biomol Chem 2005; 3:281-5. [PMID: 15632970 DOI: 10.1039/b413724h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Boc-protected L-phenylalanine has been connected to a spacer-armed ureido-acetic acid derivative, which can form multiple supramolecular complexes with urea-adamantyl modified poly(propylene imine) dendrimers in chloroform. Complexes of this guest with several generations of urea-adamantyl dendrimers were prepared. The dendrimer-guest complexes were characterized in detail by (1)H-NMR, (1)H-(1)H-NOESY spectroscopy and mass spectrometry to prove their formation. Optical rotation experiments performed on different generations of dendrimer-guest complexes showed a constant positive value. These observations indicate that, though guest molecules decrease the flexibility at the periphery of the dendrimer upon binding, the amino acid at the terminus of the guest molecule retains its high local conformational freedom. This is in agreement with values found for covalently modified spacer-armed dendrimers.
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Affiliation(s)
- Maarten A C Broeren
- Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology, P.O. Box 513, 5600, MB Eindhoven, The Netherlands
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Broeren MAC, Linhardt JG, Malda H, de Waal BFM, Versteegen RM, Meijer JT, Löwik DWPM, van Hest JCM, van Genderen MHP, Meijer EW. Noncovalent synthesis of supramolecular dendritic architectures in water. ACTA ACUST UNITED AC 2005. [DOI: 10.1002/pola.21068] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Banerjee D, Broeren MAC, van Genderen MHP, Meijer EW, Rinaldi PL. An NMR Study of the Supramolecular Chemistry of Modified Poly(propyleneimine) Dendrimers. Macromolecules 2004. [DOI: 10.1021/ma049146z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Debasish Banerjee
- Department of Chemistry, The University of Akron, Akron, Ohio 44325-3601, and Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Maarten A. C. Broeren
- Department of Chemistry, The University of Akron, Akron, Ohio 44325-3601, and Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marcel H. P. van Genderen
- Department of Chemistry, The University of Akron, Akron, Ohio 44325-3601, and Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - E. W. Meijer
- Department of Chemistry, The University of Akron, Akron, Ohio 44325-3601, and Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Peter L. Rinaldi
- Department of Chemistry, The University of Akron, Akron, Ohio 44325-3601, and Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology, Eindhoven, The Netherlands
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Broeren MAC, van Dongen JLJ, Pittelkow M, Christensen JB, van Genderen MHP, Meijer EW. Multivalency in the Gas Phase: The Study of Dendritic Aggregates by Mass Spectrometry. Angew Chem Int Ed Engl 2004. [DOI: 10.1002/ange.200453707] [Citation(s) in RCA: 10] [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: 11/08/2022]
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Broeren MAC, van Dongen JLJ, Pittelkow M, Christensen JB, van Genderen MHP, Meijer EW. Multivalency in the Gas Phase: The Study of Dendritic Aggregates by Mass Spectrometry. Angew Chem Int Ed Engl 2004; 43:3557-62. [PMID: 15293244 DOI: 10.1002/anie.200453707] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Maarten A C Broeren
- Laboratory of Macromolecular and Organic Chemistry, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
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Broeren MAC, van Dongen JLJ, Pittelkow M, Christensen JB, van Genderen MHP, Meijer EW. Titelbild: Multivalency in the Gas Phase: The Study of Dendritic Aggregates by Mass Spectrometry (Angew. Chem. 27/2004). Angew Chem Int Ed Engl 2004. [DOI: 10.1002/ange.200490086] [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: 11/11/2022]
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Broeren MAC, van Dongen JLJ, Pittelkow M, Christensen JB, van Genderen MHP, Meijer EW. Cover Picture: Multivalency in the Gas Phase: The Study of Dendritic Aggregates by Mass Spectrometry (Angew. Chem. Int. Ed. 27/2004). Angew Chem Int Ed Engl 2004. [DOI: 10.1002/anie.200490086] [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: 11/07/2022]
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