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Waldner B, Aldrian D, Zöggeler T, Oberacher H, Oberhuber R, Schneeberger S, Messner F, Schneider AM, Kohlmaier B, Lanzersdorfer R, Huber WD, Entenmann A, Müller T, Vogel GF. The influence of liver transplantation on the interplay between gut microbiome and bile acid homeostasis in children with biliary atresia. Hepatol Commun 2023; 7:02009842-202306010-00002. [PMID: 37184522 DOI: 10.1097/hc9.0000000000000151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/24/2022] [Accepted: 02/18/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Biliary atresia (BA) causes neonatal cholestasis and rapidly progresses into cirrhosis if left untreated. Kasai portoenterostomy may delay cirrhosis. BA remains among the most common indications for liver transplantation (LT) during childhood. Liver function and gut microbiome are interconnected. Disturbed liver function and enterohepatic signaling influence microbial diversity. We, herein, investigate the impact of LT and reestablishment of bile flow on gut microbiome-bile acid homeostasis in children with BA before (pre, n = 10), 3 months (post3m, n = 12), 12 months (post12m, n = 9), and more than 24 months (post24 + m, n = 12) after LT. METHODS We analyzed the intestinal microbiome of BA patients before and after LT by 16S-rRNA-sequencing and bioinformatics analyses, and serum primary and secondary bile acid levels. RESULTS The gut microbiome in BA patients exhibits a markedly reduced alpha diversity in pre (p = 0.015) and post3m group (p = 0.044), and approximated healthy control groups at later timepoints post12m (p = 1.0) and post24 + m (p = 0.74). Beta diversity analysis showed overall community structure similarities of pre and post3m (p = 0.675), but both differed from the post24 + m (p < 0.001). Longitudinal analysis of the composition of the gut microbiome revealed the Klebsiella genus to show increased abundance in the post24 + m group compared with an age-matched control (p = 0.029). Secondary bile acid production increased 2+ years after LT (p = 0.03). Multivariable associations of microbial communities and clinical metadata reveal several significant associations of microbial genera with tacrolimus and mycophenolate mofetil-based immunosuppressive regimens. CONCLUSIONS In children with BA, the gut microbiome shows strongly reduced diversity before and shortly after LT, and approximates healthy controls at later timepoints. Changes in diversity correlate with altered secondary bile acid synthesis at 2+ years and with the selection of different immunosuppressants.
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Affiliation(s)
- Birgit Waldner
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Denise Aldrian
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Zöggeler
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Oberacher
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Rupert Oberhuber
- Department of Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Schneeberger
- Department of Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Franka Messner
- Department of Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna M Schneider
- Department of Pediatrics, Salzburger Landeskliniken and Paracelsus Medical University, Salzburg, Austria
| | - Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Roland Lanzersdorfer
- Department of Paediatrics and Adolescent Medicine, Johannes Keppler University Linz, Linz, Austria
| | - Wolf-Dietrich Huber
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Entenmann
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Müller
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg F Vogel
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Cell Biology, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
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Greber-Platzer S, Haiden N, Hauer AC, Lanzersdorfer R, Pietschnig B, Schneider AM, Scholl-Bürgi S, Sperl W, Stenzel HC, Weghuber D, Haiden N. Österreichische Beikostempfehlungen 2022. Monatsschr Kinderheilkd 2023. [DOI: 10.1007/s00112-023-01719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Joachim A, Schwerd T, Hölz H, Sokollik C, Konrad LA, Jordan A, Lanzersdorfer R, Schmidt-Choudhury A, Hünseler C, Adam R. [Fecal Microbiota Transfer (FMT) in Children and Adolescents - Review and statement by the GPGE microbiome working group]. Z Gastroenterol 2022; 60:963-969. [PMID: 35533688 DOI: 10.1055/a-1801-0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The human microbiome and especially the gastrointestinal microbiota are associated with health and disease. Disturbance in the composition or function of fecal microbiota (dysbiosis) plays a role in the development of pediatric gastrointestinal diseases. Fecal microbiota transfer (FMT) is a special intervention, where microbiota are transferred from a healthy donor.In this review we describe the current state of knowledge for FMT in pediatric patients. There is satisfactory evidence concerning FMT in patients with recurrent C. difficile infection. For inflammatory bowel disease, few studies show a potential benefit.Adverse events occurred frequently in clinical studies, but were mostly mild and transient. There are hardly any data on long-term side effects of FMT, which are particularly significant for pediatrics. In practice, there is uncertainty as to which application route, dosage or frequency should be used. Legally, donor stool is considered a drug in German-speaking countries, for which no marketing authorization exists.In conclusion, knowledge about physiology, efficacy and side effects of FMT is insufficient and legal concerns complicate its implementation. More studies on this topic are needed urgently.
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Affiliation(s)
| | - Tobias Schwerd
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universtität München, LMU München, München, Germany
| | - Hannes Hölz
- Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinikum der Universtität München, LMU München, München, Germany
| | - Christiane Sokollik
- Abteilung Pädiatrische Gastroenterologie, Hepatologie und Ernährung, Universitätsklinik für Kinderheilkunde, Inselspital, Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Lukas Alfons Konrad
- Klinik für Neonatologie und allgemeine Pädiatrie, Gesundheit Nordhessen, Klinikum Kassel, Kassel, Germany
| | - Alexander Jordan
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim, Mannheim, Germany
| | | | - Anjona Schmidt-Choudhury
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Germany
| | | | - Rüdiger Adam
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim, Mannheim, Germany
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Haiden N, Greber-Platzer S, Haiden N, Hauer AC, Lanzersdorfer R, Pietschnig B, Schneider AM, Scholl-Bürgi S, Sperl W, Stenzel C, Weghuber D, Zwiauer K, Eibensteiner F. Stufenkonzepte bei Säuglingsmilchen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01173-1] [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: 11/30/2022]
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Laurer E, Grünberger J, Naidoo U, Lanzersdorfer R, Wimleitner M, Tischlinger K, Högler W. Recombinant human parathyroid hormone (1-84) replacement therapy in a child with hypoparathyroidism. Bone 2021; 144:115834. [PMID: 33359892 DOI: 10.1016/j.bone.2020.115834] [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] [Received: 08/16/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
First line conventional therapy of hypoparathyroidism comprises oral calcium and active vitamin D analogues. This approach may fail to correct hypocalcemia and hyperphosphatemia caused by the absence of parathyroid hormone and carries the risk of long-term complications including ectopic calcifications and renal damage. Full-length recombinant human parathyroid hormone (rhPTH[1-84]) is approved for the treatment of hypoparathyroidism in adults refractory to conventional therapy. To date, there is no data in children. Here, we report the successful use of rhPTH(1-84) in a 5-year old girl with hypoparathyroidism and concomitant chronic diarrhea manifesting as part of the autoimmune polyglandular syndrome type 1. Prior to starting rhPTH(1-84), the patient had been on conventional and later on rhPTH(1-34) continuous pump therapy. Conventional therapy failed to meet serum and urinary calcium target levels, whilst the pump therapy wasn't well tolerated and posed handling difficulties. Dose optimization for rhPTH(1-84) was informed by serum ionized calcium, spot urinary calcium-to-creatinine ratio and 24-hour urinary calcium excretion. Twice-daily subcutaneous injections of rhPTH(1-84) with a total dose of 3.35 μg/kg/d was well-tolerated, raised serum ionized calcium to target range (1.05-1.15 mmol/L) and normalized serum phosphate levels. Urinary calcium excretion was slightly above the recommended limit of 4 mg/kg/24 h, but improved compared to conventional therapy, with no evidence of nephrocalcinosis. Twice-daily administration stabilized serum calcium and phosphate levels compared to once-daily injections. rhPTH(1-84) treatment was well tolerated and the girl did not manifest any acute clinical complications of hypoparathyroidism throughout the entire observation period. Our experience with this case indicates that rhPTH(1-84) may be a physiological hormone replacement for managing hypoparathyroidism in children.
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Affiliation(s)
- Elisabeth Laurer
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria.
| | - Johanna Grünberger
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria
| | - Uvistra Naidoo
- South African Tuberculosis Vaccine Institute, University of Cape Town, South Africa
| | - Roland Lanzersdorfer
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria
| | - Marlene Wimleitner
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria
| | - Katharina Tischlinger
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria
| | - Wolfgang Högler
- Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Austria
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Furthner D, Ehrenmueller M, Lanzersdorfer R, Halmerbauer G, Schmitt K, Biebl A. Education, school type and screen time were associated with overweight and obesity in 2930 adolescents. Acta Paediatr 2018; 107:517-522. [PMID: 29131386 DOI: 10.1111/apa.14149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/30/2017] [Revised: 07/06/2017] [Accepted: 11/08/2017] [Indexed: 12/17/2022]
Abstract
AIM This cross-sectional study analysed the influence of socio-economic factors on screen time, overweight and obesity. METHODS We asked adolescents aged 10, 14 and 17 from 10 school types in urban and rural regions in Upper Austria to complete questionnaires from December 2012 to February 2013. Their parents were also asked to complete questionnaires. RESULTS The questionnaires were completed by 2930 adolescents and 2209 parents. Total weekend screen time was significantly associated with a higher body mass index (BMI) in 10-year-old boys (p < 0.005) and 10-year-old girls (p = 0.002), and there were significant associations between higher BMI and television time and longer weekend video game use in subjects aged 10 and 14. Higher education levels were associated with shorter daily video game use and longer computer use. Males (p < 0.0001) and adolescents from immigrant families (p < 0.0001) reported longer screen times at all ages. Lower parental education and higher parental BMI correlated significantly with longer screen time and BMI in the youngest age group. CONCLUSION The greatest weight problems were in younger adolescents, despite shorter screen times, and boys and adolescents from immigrant families reported the longest screen times. Prevention strategies need to start early.
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Affiliation(s)
- Dieter Furthner
- Department of Paediatric and Adolescent Medicine; Kepler University Hospital Linz; Linz Austria
| | | | - Roland Lanzersdorfer
- Department of Paediatric and Adolescent Medicine; Kepler University Hospital Linz; Linz Austria
| | | | - Klaus Schmitt
- Department of Paediatric and Adolescent Medicine; Kepler University Hospital Linz; Linz Austria
| | - Ariane Biebl
- Department of Paediatric and Adolescent Medicine; Kepler University Hospital Linz; Linz Austria
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Furthner D, Ehrenmüller M, Biebl A, Lanzersdorfer R, Halmerbauer G, Auer-Hackenberg L, Schmitt K. Gender differences and the role of parental education, school types and migration on the body mass index of 2930 Austrian school children : A cross-sectional study. Wien Klin Wochenschr 2017; 129:786-792. [PMID: 28831568 DOI: 10.1007/s00508-017-1247-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/20/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Austria faces increasing numbers of childhood overweight and obesity. Despite increasing numbers of studies, associations between parental body mass index (BMI) and education and the school type on overweight/obesity in students have not been reported. The objective of this study was to evaluate the influence of these parameters on the genesis of overweight/obesity in a large cohort representative of youth in Upper Austrian. METHODS A cross-sectional analysis of data from 2930 children and adolescents aged 10, 14 or 17 years from 11 different state school types was conducted. Students and their parents completed a questionnaire and heights and weights were measured. RESULTS Of the students 16.9% fulfilled the criteria for overweight and 5.6% for obesity, with the highest rates in the 10-year-olds (19.6% and 5.8%, respectively). While no gender differences were present in the youngest age group, the body mass index (BMI) during adolescence remained higher in boys but decreased significantly in girls. Male gender remained a risk factor through all calculations. Boys were overrepresented in schools with lower education levels and more often had BMIs ≥ 85th and ≥95th percentile. Higher parental education levels and lower parental BMIs were associated with lower BMIs of their offspring. Migration was an additional association factor for BMIs ≥ 85th percentile. CONCLUSION Low parental education levels, higher parental BMIs and migration background were associated with overweight and obesity in 10-year-olds. In adolescence, male gender and higher parental BMIs remained risk factors.
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Affiliation(s)
- Dieter Furthner
- Med Campus IV, Kepler University Hospital Linz, Krankenhausstraße 26-30, 4020, Linz, Austria
| | - Margit Ehrenmüller
- University of Applied Sciences Steyr, Wehrgrabengasse 1, 4400, Steyr, Austria
| | - Ariane Biebl
- Med Campus IV, Kepler University Hospital Linz, Krankenhausstraße 26-30, 4020, Linz, Austria
| | - Roland Lanzersdorfer
- Med Campus IV, Kepler University Hospital Linz, Krankenhausstraße 26-30, 4020, Linz, Austria
| | - Gerhard Halmerbauer
- University of Applied Sciences Steyr, Wehrgrabengasse 1, 4400, Steyr, Austria
| | - Lorenz Auer-Hackenberg
- Med Campus IV, Kepler University Hospital Linz, Krankenhausstraße 26-30, 4020, Linz, Austria
| | - Klaus Schmitt
- Med Campus IV, Kepler University Hospital Linz, Krankenhausstraße 26-30, 4020, Linz, Austria.
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