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Horgan C, Bitetti S, Newbould M, Sethuraman C, Fagbemi A, Kala A, Williams N, Wynn R. Non-Graft-versus-Host Disease Enterocolitis Following Cord Blood Transplantation is Real, with Poorly Understood Pathophysiology, and Requires Distinct Management, with Eventual Resolution without Immune Suppression. Transplant Cell Ther 2024; 30:440.e1-440.e9. [PMID: 38052367 DOI: 10.1016/j.jtct.2023.11.023] [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: 08/19/2023] [Revised: 11/14/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
Enterocolitis is common after cord blood transplantation (CBT) and a specific, non-graft-versus-host disease (GVHD) entity with specific histopathologic features ("cord colitis") has been described in some cases in selected series. Immune suppression is not without risk, and we have used it only when biopsy features are consistent with classical GVHD. In the absence of biopsy features of classical GVHD, our management of intestinal failure has been supportive, and we have withdrawn immune suppression to allow immune reconstitution and better prevent relapse of malignant disease and reduce infectious complications. We evaluated our approach over an 11-year period in a retrospective study of all patients at our large pediatric CBT center who experienced intestinal failure necessitating endoscopy and biopsy in the post-CBT period. We conducted a blinded histopathologic review of gastrointestinal (GI) biopsy specimens from all patients who had undergone GI endoscopy for intestinal failure in the post-CBT period. Patient records were evaluated to determine clinical HSCT course and outcome data, including mortality, relapse, and infection, as well as the duration of immune suppression and parenteral nutrition. Out of 144 patients who underwent CBT during the study period, 25 (17%) experienced intestinal failure requiring endoscopy. Thirteen patients were diagnosed with acute GVHD after blinded review of biopsy specimens, and 12 patients had non-GVHD enterocolitis. Management in the absence of GVHD on GI biopsy is supportive, with withdrawal of immune suppression in patients with malignant disease and continuing in accordance with institutional practice in those with nonmalignant disease. Compared with the GVHD cohort, the non-GVHD enterocolitis cohort had superior overall survival (91% versus 41%; P = .04) and a shorter duration of immune suppression (mean, 112 days versus 180 days; P = .049), reflecting these different management approaches. These results demonstrate that different histopathologic findings in those with intestinal failure after CBT likely indicates a different etiology from GVHD and mandates a different clinical management strategy to achieve optimal clinical outcomes.
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Affiliation(s)
- Claire Horgan
- Department of Paediatric Bone Marrow Transplant and Cellular Therapy, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Stefania Bitetti
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Melanie Newbould
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Chitra Sethuraman
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Andrew Fagbemi
- Department of Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Adnan Kala
- Department of Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Nicola Williams
- Department of Paediatric Bone Marrow Transplant and Cellular Therapy, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Robert Wynn
- Department of Paediatric Bone Marrow Transplant and Cellular Therapy, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
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Kellaway SG, Mosinska K, Mohamed Z, Ryan A, Richardson S, Newbould M, Banerjee I, Dunne MJ, Cosgrove KE. Correction: Increased proliferation and altered cell cycle regulation in pancreatic stem cells derived from patients with congenital hyperinsulinism. PLoS One 2019; 14:e0223999. [PMID: 31600346 PMCID: PMC6786567 DOI: 10.1371/journal.pone.0223999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Craigie RJ, Salomon-Estebanez M, Yau D, Han B, Mal W, Newbould M, Cheesman E, Bitetti S, Mohamed Z, Sajjan R, Padidela R, Skae M, Flanagan S, Ellard S, Cosgrove KE, Banerjee I, Dunne MJ. Clinical Diversity in Focal Congenital Hyperinsulinism in Infancy Correlates With Histological Heterogeneity of Islet Cell Lesions. Front Endocrinol (Lausanne) 2018; 9:619. [PMID: 30386300 PMCID: PMC6199412 DOI: 10.3389/fendo.2018.00619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/27/2018] [Indexed: 01/11/2023] Open
Abstract
Background: Congenital Hyperinsulinism (CHI) is an important cause of severe and persistent hypoglycaemia in infancy and childhood. The focal form (CHI-F) of CHI can be potentially cured by pancreatic lesionectomy. While diagnostic characteristics of CHI-F pancreatic histopathology are well-recognized, correlation with clinical phenotype has not been established. Aims: We aimed to correlate the diversity in clinical profiles of patients with islet cell organization in CHI-F pancreatic tissue. Methods: Clinical datasets were obtained from 25 patients with CHI-F due to ABCC8/KCNJ11 mutations. 18F-DOPA PET-CT was used to localize focal lesions prior to surgery. Immunohistochemistry was used to support protein expression studies. Results: In 28% (n = 7) of patient tissues focal lesions were amorphous and projected into adjoining normal pancreatic tissue without clear delineation from normal tissue. In these cases, severe hypoglycaemia was detected within, on average, 2.8 ± 0.8 (range 1-7) days following birth. By contrast, in 72% (n = 18) of tissues focal lesions were encapsulated within a defined matrix capsule. In this group, the onset of severe hypoglycaemia was generally delayed; on average 46.6 ± 14.3 (range 1-180) days following birth. For patients with encapsulated lesions and later-onset hypoglycaemia, we found that surgical procedures were curative and less complex. Conclusion: CHI-F is associated with heterogeneity in the organization of focal lesions, which correlates well with clinical presentation and surgical outcomes.
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Affiliation(s)
- Ross J. Craigie
- Paediatric Surgery, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Maria Salomon-Estebanez
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Daphne Yau
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Bing Han
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Walaa Mal
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Melanie Newbould
- Paediatric Histopathology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Edmund Cheesman
- Paediatric Histopathology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Stefania Bitetti
- Paediatric Histopathology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Zainab Mohamed
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Rakesh Sajjan
- Nuclear Medicine, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Raja Padidela
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Mars Skae
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Sarah Flanagan
- Molecular Genetics, Royal Devon & Exeter NHS Foundation Trust, University of Exeter Medical School, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Sian Ellard
- Molecular Genetics, Royal Devon & Exeter NHS Foundation Trust, University of Exeter Medical School, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Karen E. Cosgrove
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Indraneel Banerjee
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Mark J. Dunne
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- *Correspondence: Mark J. Dunne
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Han B, Mohamed Z, Estebanez MS, Craigie RJ, Newbould M, Cheesman E, Padidela R, Skae M, Johnson M, Flanagan S, Ellard S, Cosgrove KE, Banerjee I, Dunne MJ. Atypical Forms of Congenital Hyperinsulinism in Infancy Are Associated With Mosaic Patterns of Immature Islet Cells. J Clin Endocrinol Metab 2017; 102:3261-3267. [PMID: 28605545 PMCID: PMC5587070 DOI: 10.1210/jc.2017-00158] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/02/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVES We aimed to characterize mosaic populations of pancreatic islet cells from patients with atypical congenital hyperinsulinism in infancy (CHI-A) and the expression profile of NKX2.2, a key transcription factor expressed in β-cells but suppressed in δ-cells in the mature pancreas. PATIENTS/METHODS Tissue was isolated from three patients with CHI-A following subtotal pancreatectomy. CHI-A was diagnosed on the basis of islet mosaicism and the absence of histopathological hallmarks of focal and diffuse CHI (CHI-D). Immunohistochemistry was used to identify and quantify the proportions of insulin-secreting β-cells and somatostatin-secreting δ-cells in atypical islets, and results were compared with CHI-D (n = 3) and age-matched control tissues (n = 3). RESULTS In CHI-A tissue, islets had a heterogeneous profile. In resting/quiescent islets, identified by a condensed cytoplasm and nuclear crowding, β-cells were reduced to <50% of the total cell numbers in n = 65/70 islets, whereas δ-cell numbers were increased with 85% of islets (n = 49/57) containing >20% δ-cells. In comparison, all islets in control tissue (n = 72) and 99% of CHI-D islets (n = 72) were composed of >50% β-cells, and >20% δ-cells were found only in 12% of CHI-D (n = 8/66) and 5% of control islets (n = 3/60). Active islets in CHI-A tissue contained proportions of β-cells and δ-cells similar to those of control and CHI-D islets. Finally, when compared with active islets, quiescent islets had a twofold higher prevalence of somatostatin/NKX2.2+ coexpressed cells. CONCLUSIONS Marked increases in NKX2.2 expression combined with increased numbers of δ-cells strongly imply that an immature δ-cell profile contributed to the pathobiology of CHI-A.
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Affiliation(s)
- Bing Han
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Zainab Mohamed
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PT, United Kingdom
- Paediatric Endocrinology, The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Maria Salomon Estebanez
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PT, United Kingdom
- Paediatric Endocrinology, The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Ross J. Craigie
- Paediatric Surgery, Central Manchester University Hospitals NHS Foundation Trust (CMFT) and The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Melanie Newbould
- Paediatric Histopathology, Central Manchester University Hospitals NHS Foundation Trust (CMFT) and The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Edmund Cheesman
- Paediatric Histopathology, Central Manchester University Hospitals NHS Foundation Trust (CMFT) and The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Raja Padidela
- Paediatric Endocrinology, The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Mars Skae
- Paediatric Endocrinology, The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Matthew Johnson
- Molecular Genetics, Royal Devon and Exeter NHS Foundation Trust, University of Exeter Medical School, Royal Devon and Exeter Hospital, Exeter EX2 5DW, United Kingdom
| | - Sarah Flanagan
- Molecular Genetics, Royal Devon and Exeter NHS Foundation Trust, University of Exeter Medical School, Royal Devon and Exeter Hospital, Exeter EX2 5DW, United Kingdom
| | - Sian Ellard
- Molecular Genetics, Royal Devon and Exeter NHS Foundation Trust, University of Exeter Medical School, Royal Devon and Exeter Hospital, Exeter EX2 5DW, United Kingdom
| | - Karen E. Cosgrove
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Indraneel Banerjee
- Paediatric Endocrinology, The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Mark J. Dunne
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PT, United Kingdom
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Abstract
In England and Wales, it is usually lawful for those with parental responsibility to consent to treatment on children who have not acquired legal capacity, providing that they are acting in the child's best interests. Whilst in most instances this process is unproblematic and the decisions made are non-controversial, there are troubling examples where this is more problematic. The difficulties for a family with a child who has an intersex condition will be considered to illustrate that there may be cases of medical and surgical treatment where even though both parents and doctors agree on a course of action in good faith, the treatment administered may not necessarily be in the best interests of the child. Sometimes, procedures carried out on an infant apparently in their best interests may later be a cause of regret to the child as an adult. The law in England and Wales will be examined to investigate other examples of controversial treatments of young children involving legal interventions to consider whether there are any parallels and what the implications of these might be to the intersex child. A model suggested by a Columbian legal case from 1995 is discussed. The courts ruled that infantile sex assignment surgery is lawful only following very stringent consent procedures. The possibility is considered that guidelines defining the consent procedure may afford some protection for the intersex child.
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Affiliation(s)
- Melanie Newbould
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Central Manchester University Hospitals, Oxford Road, Manchester M13 9WL, UK
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Lum SH, Turner A, Guiver M, Bonney D, Martland T, Davies E, Newbould M, Brown J, Morfopoulou S, Breuer J, Wynn R. An emerging opportunistic infection: fatal astrovirus (VA1/HMO-C) encephalitis in a pediatric stem cell transplant recipient. Transpl Infect Dis 2016; 18:960-964. [PMID: 27632248 DOI: 10.1111/tid.12607] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/11/2016] [Accepted: 06/29/2016] [Indexed: 12/12/2022]
Abstract
Neuroinvasive astrovirus (VA1-HMO-C) is an emerging life-threatening infection in immunocompromised hosts. We describe an 8-month-old child who died of VA1/HMO-C encephalitis following bone marrow transplantation. The diagnosis was only made post-mortem using RNA deep sequencing of the brain. Repeat analysis of the post-mortem brain tissue using polymerase chain reaction specific primers for VA1/HMO-C was positive. Astrovirus VA1/HMO-C should be included in the evaluation of patients with similar encephalitis.
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Affiliation(s)
- Su Han Lum
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, UK
| | - Andrew Turner
- Clinical Virology Department, Manchester Royal Infirmary, Manchester, UK
| | - Malcolm Guiver
- Clinical Virology Department, Manchester Royal Infirmary, Manchester, UK
| | - Denise Bonney
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, UK
| | - Timorthy Martland
- Department of Neurology, Royal Manchester Children's Hospital, Manchester, UK
| | - Emma Davies
- Clinical Virology Department, Manchester Royal Infirmary, Manchester, UK
| | - Melanie Newbould
- Diagnostic Paediatric Histopathology Service, Royal Manchester Children's Hospital, Manchester, UK
| | - Julianne Brown
- Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children, London, UK
| | - Sofia Morfopoulou
- Research Department of Infection, Division of Infection and Immunity, University College of London, London, UK
| | - Judith Breuer
- Research Department of Infection, Division of Infection and Immunity, University College of London, London, UK
| | - Robert Wynn
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, UK
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Han B, Newbould M, Batra G, Cheesman E, Craigie RJ, Mohamed Z, Rigby L, Padidela R, Skae M, Mironov A, Starborg T, Kadler KE, Cosgrove KE, Banerjee I, Dunne MJ. Enhanced Islet Cell Nucleomegaly Defines Diffuse Congenital Hyperinsulinism in Infancy but Not Other Forms of the Disease. Am J Clin Pathol 2016; 145:757-68. [PMID: 27334808 PMCID: PMC4922485 DOI: 10.1093/ajcp/aqw075] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To quantify islet cell nucleomegaly in controls and tissues obtained from patients with congenital hyperinsulinism in infancy (CHI) and to examine the association of nucleomegaly with proliferation. METHODS High-content analysis of histologic sections and serial block-face scanning electron microscopy were used to quantify nucleomegaly. RESULTS Enlarged islet cell nuclear areas were 4.3-fold larger than unaffected nuclei, and the mean nuclear volume increased to approximately threefold. Nucleomegaly was a normal feature of pediatric islets and detected in the normal regions of the pancreas from patients with focal CHI. The incidence of nucleomegaly was highest in diffuse CHI (CHI-D), with more than 45% of islets containing two or more affected cells. While in CHI-D nucleomegaly was negatively correlated with cell proliferation, in all other cases, there was a positive correlation. CONCLUSIONS Increased incidence of nucleomegaly is pathognomonic for CHI-D, but these cells are nonproliferative, suggesting a novel role in the pathobiology of this condition.
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Affiliation(s)
- Bing Han
- From the Faculty of Life Sciences, University of Manchester, Manchester, UK
| | | | | | | | | | - Zainab Mohamed
- From the Faculty of Life Sciences, University of Manchester, Manchester, UK Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester, UK
| | - Lindsey Rigby
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester, UK
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester, UK
| | - Mars Skae
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester, UK
| | - Aleksandr Mironov
- From the Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Tobias Starborg
- From the Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Karl E Kadler
- From the Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Karen E Cosgrove
- From the Faculty of Life Sciences, University of Manchester, Manchester, UK
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust (CMFT), Manchester, UK
| | - Mark J Dunne
- From the Faculty of Life Sciences, University of Manchester, Manchester, UK
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Watson CM, Crinnion LA, Murphy H, Newbould M, Harrison SM, Lascelles C, Antanaviciute A, Carr IM, Sheridan E, Bonthron DT, Smith A. Deficiency of the myogenic factor MyoD causes a perinatally lethal fetal akinesia. J Med Genet 2016; 53:264-9. [PMID: 26733463 PMCID: PMC4819622 DOI: 10.1136/jmedgenet-2015-103620] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 12/01/2015] [Indexed: 12/30/2022]
Abstract
Background Lethal fetal akinesia deformation sequence (FADS) describes a clinically and genetically heterogeneous phenotype that includes fetal akinesia, intrauterine growth retardation, arthrogryposis and developmental anomalies. Affected babies die as a result of pulmonary hypoplasia. We aimed to identify the underlying genetic cause of this disorder in a family in which there were three affected individuals from two sibships. Methods Autosomal-recessive inheritance was suggested by a family history of consanguinity and by recurrence of the phenotype between the two sibships. We performed exome sequencing of the affected individuals and their unaffected mother, followed by autozygosity mapping and variant filtering to identify the causative gene. Results Five autozygous regions were identified, spanning 31.7 Mb of genomic sequence and including 211 genes. Using standard variant filtering criteria, we excluded all variants as being the likely pathogenic cause, apart from a single novel nonsense mutation, c.188C>A p.(Ser63*) (NM_002478.4), in MYOD1. This gene encodes an extensively studied transcription factor involved in muscle development, which has nonetheless not hitherto been associated with a hereditary human disease phenotype. Conclusions We provide the first description of a human phenotype that appears to result from MYOD1 mutation. The presentation with FADS is consistent with a large body of data demonstrating that in the mouse, MyoD is a major controller of precursor cell commitment to the myogenic differentiation programme.
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Affiliation(s)
- Christopher M Watson
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Laura A Crinnion
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Helen Murphy
- Genomic Medicine, Manchester Academic Health Science Centre, The University of Manchester, St Mary's Hospital, Manchester, UK
| | - Melanie Newbould
- Department of Paediatric Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sally M Harrison
- School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Carolina Lascelles
- School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Agne Antanaviciute
- School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Ian M Carr
- School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Eamonn Sheridan
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - David T Bonthron
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK School of Medicine, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Audrey Smith
- Yorkshire Regional Genetics Service, St. James's University Hospital, Leeds, UK
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Salisbury RJ, Han B, Jennings RE, Berry AA, Stevens A, Mohamed Z, Sugden SA, De Krijger R, Cross SE, Johnson PPV, Newbould M, Cosgrove KE, Hanley KP, Banerjee I, Dunne MJ, Hanley NA. Altered Phenotype of β-Cells and Other Pancreatic Cell Lineages in Patients With Diffuse Congenital Hyperinsulinism in Infancy Caused by Mutations in the ATP-Sensitive K-Channel. Diabetes 2015; 64:3182-8. [PMID: 25931474 PMCID: PMC4542438 DOI: 10.2337/db14-1202] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 04/23/2015] [Indexed: 12/13/2022]
Abstract
Diffuse congenital hyperinsulinism in infancy (CHI-D) arises from mutations inactivating the KATP channel; however, the phenotype is difficult to explain from electrophysiology alone. Here we studied wider abnormalities in the β-cell and other pancreatic lineages. Islets were disorganized in CHI-D compared with controls. PAX4 and ARX expression was decreased. A tendency toward increased NKX2.2 expression was consistent with its detection in two-thirds of CHI-D δ-cell nuclei, similar to the fetal pancreas, and implied immature δ-cell function. CHI-D δ-cells also comprised 10% of cells displaying nucleomegaly. In CHI-D, increased proliferation was most elevated in duct (5- to 11-fold) and acinar (7- to 47-fold) lineages. Increased β-cell proliferation observed in some cases was offset by an increase in apoptosis; this is in keeping with no difference in INSULIN expression or surface area stained for insulin between CHI-D and control pancreas. However, nuclear localization of CDK6 and P27 was markedly enhanced in CHI-D β-cells compared with cytoplasmic localization in control cells. These combined data support normal β-cell mass in CHI-D, but with G1/S molecules positioned in favor of cell cycle progression. New molecular abnormalities in δ-cells and marked proliferative increases in other pancreatic lineages indicate CHI-D is not solely a β-cell disorder.
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Affiliation(s)
- Rachel J Salisbury
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, U.K
| | - Bing Han
- Faculty of Life Sciences, The University of Manchester, Manchester, U.K
| | - Rachel E Jennings
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, U.K. Department of Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
| | - Andrew A Berry
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, U.K
| | - Adam Stevens
- Faculty of Life Sciences, The University of Manchester, Manchester, U.K. Department of Paediatric Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
| | - Zainab Mohamed
- Faculty of Life Sciences, The University of Manchester, Manchester, U.K. Department of Paediatric Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
| | - Sarah A Sugden
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, U.K
| | - Ronald De Krijger
- Erasmus MC, Rotterdam, the Netherlands Department of Pathology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Sarah E Cross
- Diabetes Research & Wellness Foundation Human Islet Isolation Facility, Nuffield Department of Surgical Sciences and Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K
| | - Paul P V Johnson
- Diabetes Research & Wellness Foundation Human Islet Isolation Facility, Nuffield Department of Surgical Sciences and Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, U.K
| | - Melanie Newbould
- Department of Paediatric Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
| | - Karen E Cosgrove
- Faculty of Life Sciences, The University of Manchester, Manchester, U.K
| | - Karen Piper Hanley
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, U.K
| | - Indraneel Banerjee
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, U.K. Department of Paediatric Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
| | - Mark J Dunne
- Faculty of Life Sciences, The University of Manchester, Manchester, U.K.
| | - Neil A Hanley
- Centre for Endocrinology and Diabetes, Institute of Human Development, Faculty of Medical and Human Sciences, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, U.K. Department of Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K.
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Shi Y, Avatapalle HB, Skae MS, Padidela R, Newbould M, Rigby L, Flanagan SE, Ellard S, Rahier J, Clayton PE, Dunne MJ, Banerjee I, Cosgrove KE. Increased plasma incretin concentrations identifies a subset of patients with persistent congenital hyperinsulinism without KATP channel gene defects. J Pediatr 2015; 166:191-4. [PMID: 25444530 DOI: 10.1016/j.jpeds.2014.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 07/30/2014] [Accepted: 09/09/2014] [Indexed: 11/26/2022]
Abstract
Congenital hyperinsulinism causes profound hypoglycemia, which may persist or resolve spontaneously. Among 13 children with congenital hyperinsulinism, elevated incretin hormone concentrations were detected in 2 with atypical, persistent disease. We suggest that incretin biomarkers may identify these patients, and that elevated hormone levels may contribute to their pathophysiology.
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Affiliation(s)
- Yanqin Shi
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Hima B Avatapalle
- Department of Pediatric Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Mars S Skae
- Department of Pediatric Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Raja Padidela
- Department of Pediatric Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Melanie Newbould
- Department of Pediatric Histopathology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Lindsey Rigby
- Department of Pediatric Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom
| | - Sian Ellard
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom
| | - Jacques Rahier
- Department of Pathology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Peter E Clayton
- Department of Pediatric Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; Manchester Academic Health Science Centre, Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom
| | - Mark J Dunne
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom
| | - Indraneel Banerjee
- Department of Pediatric Endocrinology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Karen E Cosgrove
- Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom.
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Padidela R, Fiest M, Arya V, Smith VV, Ashworth M, Rampling D, Newbould M, Batra G, James J, Wright NB, Dunne MJ, Clayton PE, Banerjee I, Hussain K. Insulinoma in childhood: clinical, radiological, molecular and histological aspects of nine patients. Eur J Endocrinol 2014; 170:741-7. [PMID: 24599222 DOI: 10.1530/eje-13-1008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Insulinomas are a rare cause of hyperinsulinaemic hypoglycaemia (HH) in children. The clinical features, investigations, management and histology of these rare pancreatic tumours in children have not been described in a large cohort of patients. METHODS We conducted a retrospective review of cases diagnosed between 2000 and 2012, presenting to two referral centres in the United Kingdom. Clinical, biochemical, imaging (magnetic resonance imaging (MRI) and 6-L-¹⁸F-fluorodihydroxyphenylalanine (¹⁸F-DOPA) PET/CT scanning) and histological data were collected. RESULTS Nine children (age range 2-14.5 years) were diagnosed during the study period at Great Ormond Street Hospital (n=5) and Royal Manchester Children's Hospital (n=4). The combination of abdominal MRI scan (7/8) and ¹⁸F-DOPA PET/CT scan (2/4) correctly localised the anatomical location of all insulinomas. Before surgery, diazoxide therapy was used to treat hypoglycaemia, but only four patients responded. After surgical resection of the insulinoma, hypoglycaemia resolved in all patients. The anatomical localisation of the insulinoma in each patient was head (n=4), uncinate process (n=4) and tail (n=2, one second lesion) of the pancreas. Histology confirmed the diagnosis of insulinoma with the presence of sheets and trabeculae of epithelioid and spindle cells staining strongly for insulin and proinsulin, but not for glucagon or somatostatin. Two children were positive for MEN1, one of whom had two separate insulinoma lesions within the pancreas. CONCLUSIONS We describe a cohort of paediatric insulinoma patients. Although rare, insulinomas should be included in the differential diagnosis of HH, even in very young children. In the absence of a single imaging modality in the preoperative period, localisation of the tumour is achieved by combining imaging techniques, both conventional and functional.
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Affiliation(s)
- Raja Padidela
- Pediatric Endocrinology, Royal Manchester Children's Hospital, Manchester M13 9WL, UK
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Newbould M. Embryo and fetal pathology: Color atlas with ultrasound correlation. HUM FERTIL 2009. [DOI: 10.1080/14647270500229983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Olugbile A, Ludlam A, Newbould M, Sharp D. Multiple fetal anomalies: an extreme case of amniotic band syndrome. J OBSTET GYNAECOL 2004; 19:667. [PMID: 15512433 DOI: 10.1080/01443619964049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A Olugbile
- North Manchester General Hospital and Manchester Children's Hospitals, UK
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Abstract
A characteristic vasculitis is an uncommon but well-recognized complication of severe Pseudomonas aeruginosa infection in the neonate. Although it is one of the most common gram-negative organisms responsible for overall nosocomial infection, it is a rare cause of intrauterine or intrapartum infection of the newborn. We describe a fatal Pseudomonas aeruginosa infection occurring in a very premature infant with widespread skin necrosis. Although this organism is relatively uncommon in the neonate, premature infants are at increased risk of infection, with a significant associated mortality. Early recognition and treatment are therefore very important.
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Affiliation(s)
- J R Hughes
- Department of Dermatology, King's College Hospital, London, England, UK
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Seller MJ, Flinter FA, Docherty Z, Fagg N, Newbould M. Phenotypic diversity in the Smith-Lemli-Opitz syndrome. Clin Dysmorphol 1997; 6:69-73. [PMID: 9018421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The phenotype of four cases of Smith-Lemli-Opitz syndrome (SLO) with proven defects in cholesterol biosynthesis are compared, and shown to be markedly disparate even between sibs, and demonstrate the dilemma for the clinician. The advent of a biochemical test for SLO has been enormously valuable in determining which patients are truly affected by the condition, but because of the wide phenotypic variation, a diagnosis on clinical features alone remains problematic.
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Affiliation(s)
- M J Seller
- South East Thames Regional Genetics Centre, London, UK.
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Morris DJ, Corbitt G, Bailey AS, Newbould M, Smith E, Picton S, Stevens RF. Fatal disseminated adenovirus type 2 infection following bone marrow transplantation for Hurler's syndrome: a primary infection. J Infect 1993; 26:181-4. [PMID: 8473764 DOI: 10.1016/0163-4453(93)92896-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 5-month-old girl given an allogeneic bone marrow transplant for Hurler's syndrome succumbed to fatal pneumonia 5 weeks after the transplant. Adenovirus type 2 was isolated from her urine before she died. Immunoperoxidase and electron microscopical studies of liver and lungs post mortem confirmed a disseminated adenovirus infection. The serological findings and the patient's young age suggested that the infection was a primary one. The importance of considering exogenous sources of adenovirus infection in bone marrow transplant recipients is discussed.
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Affiliation(s)
- D J Morris
- Department of Virology, Booth Hall Children's Hospital, Manchester, U.K
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Abstract
Biopsy and autopsy material from the urinary bladder was studied using PAS and PAS-D techniques to identify glycogen and neutral mucins, the alcian blue/high iron diamine method to distinguish sialo- and sulphamucins and the PB/KOH/PAS technique to localize O-acylated sialomucins. All of 10 examples of normal urothelium and both of two cases of transitional carcinoma in situ contained glycogen, but no mucin. Other lesions displayed one of two patterns of mucin production: the extracellular mucin seen focally in 17 cases of cystitis cystica consisted of sialo- and/or neutral mucins only, a pattern also displayed by mucins produced in 10 of 13 examples of transitional cell carcinomas and by three of nine tumours purely or in part adenocarcinomas. The intracellular mucins expressed in five of the 17 cases of cystitis glandularis and in all of eight cases of frank intestinal metaplasia with goblet cells displayed a colonic phenotype, with production of O-acylated sialomucins. A similar profile was expressed by six adenocarcinomas and this included tumours likely to be of vesical and also of urachal origin. It is concluded that identification of O-acylated mucins cannot distinguish between primary bladder tumours and metastases from a colonic primary, or between carcinomas of vesical and urachal origin.
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Affiliation(s)
- M Newbould
- University Department of Histopathology, University Hospital of South Manchester, UK
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Newbould M. Improving appearance. Nurs Times 1987; 83:30-2. [PMID: 3645603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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