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Weins AB, Kerzel S, Schnopp C. Schwere atopische Dermatitis im frühen Kindesalter: Besonderheiten, Herausforderungen und neue Perspektiven in der Versorgung. J Dtsch Dermatol Ges 2024; 22:350-356. [PMID: 38451004 DOI: 10.1111/ddg.15344_g] [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: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 03/08/2024]
Abstract
ZusammenfassungDie atopische Dermatitis ist die häufigste chronische Hauterkrankung im Kindesalter mit einer Prävalenz von 10% bei Kleinkindern unter 2 Jahren, wovon etwa 15% einen hohen Schweregrad aufweisen. „Kinder sind keine kleinen Erwachsenen“, dies trifft für die schwere frühkindliche atopische Dermatitis in besonderem Maße zu. Innerhalb dieser sensiblen Lebensphase zeigen sich alterstypische Facetten der Erkrankung (psychosozial, neurokognitiv, klinisch‐morphologisch), die Unterschiede im Management mit sich bringen.Besondere Bedeutung hat die Identifikation von Säuglingen und Kleinkindern mit früh‐persistierendem, schwerem Verlauf mit Blick auf eine erstmals für diese Altersgruppe zugelassene Systemtherapie: sowohl für die unmittelbare Versorgung der Hauterkrankung als auch unter dem Aspekt einer möglichen Prävention von Begleiterkrankungen. Da der „atopische Phänotyp“ klinische Überlappungen zum Spektrum der Immundefekte aufweist, ist die korrekte Einordnung des Hautbefundes bei therapierefraktärem Ekzem essenziell. In dieser Arbeit beschreiben wir eine alltagstaugliche Strategie, um anhand anamnestischer Warnhinweise, dermatologischer Leitbefunde und Labordiagnostik eine Abgrenzung von ekzematösen Hauterscheinungen bei primären Immundefekten vorzunehmen. Dazu geben wir aktuelle Empfehlungen zum Management des schweren frühkindlichen atopischen Ekzems, auch in Bezug auf die Indikation zur Systemtherapie.
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Affiliation(s)
- Andreas Benedikt Weins
- Klinik für Kinder- und Jugendmedizin, Universitätsklinik Augsburg
- KIDZ SKIN | Praxis für Kinder- und Jugenddermatologie, Ulm
| | - Sebastian Kerzel
- Krankenhaus Barmherzige Brüder, Klinik und Poliklinik für Kinder- und Jugendmedizin, Abteilung für Pädiatrische Pneumologie und Allergologie, Regensburg
| | - Christina Schnopp
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München
- Praxis Burgstraße, München
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2
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Weins AB, Kerzel S, Schnopp C. Severe atopic dermatitis in early infancy: characteristics, challenges and new perspectives in clinical practice. J Dtsch Dermatol Ges 2024; 22:350-355. [PMID: 38450908 DOI: 10.1111/ddg.15344] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/22/2023] [Indexed: 03/08/2024]
Abstract
Atopic dermatitis (AD) is the most common skin disease in infants and children with a prevalence of 10% in the first two years of life. In this age group up to 15% are severely affected. "Children are not little adults" - this applies in particular to infants with severe atopic dermatitis. Age-specific clinical aspects (psychosocial, neurocognitive, morphological) of the disease require an adjusted disease management. Considering recent approval of systemic treatment options, early identification of infants and children with severe and early persistent disease is of particular importance also in view of possible prevention of atopic comorbidity. As several inborn errors of immunity (IEI) share features of the atopic phenotype, it is essential for clinicians to distinguish signs of immunodeficiency from severe AD. Here, we describe a practical approach on the basis of clinical history and key dermatological and laboratory findings. Furthermore, this paper is aimed at providing an update on general management of severe AD in early infancy, including recommendations for systemic treatment.
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Affiliation(s)
- Andreas Benedikt Weins
- Department of Pediatrics, University Hospital Augsburg, Augsburg, Germany
- KIDZ SKIN | Practice for Pediatric Dermatology, Ulm, Germany
| | - Sebastian Kerzel
- Barmherzige Brüder Hospital, Department of Pediatrics, Section for Pediatric Pneumonology and Allergology, Regensburg, Germany
| | - Christina Schnopp
- Department of Dermatology and Allergology am Biederstein, Technical University Munich, Munich, Germany
- Practice Burgstraße, Munich, Germany
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Fonfara M, Hartmann J, Stölzl D, Sander N, Harder I, Rodriguez E, Hübenthal M, Mazur C, Kerzel S, Kabesch M, Schmitt J, Emmert H, Suhrkamp I, Weidinger S. Stratum corneum and microbial biomarkers precede and characterize childhood atopic dermatitis. J Eur Acad Dermatol Venereol 2024. [PMID: 38421042 DOI: 10.1111/jdv.19932] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Atopic dermatitis (AD) is the most common paediatric inflammatory skin disease. There are currently no robust biomarkers that could reliably predict its manifestation, and on the molecular level, it is less well characterized than adult AD. OBJECTIVES This study aimed to extend previous findings and provide evidence for distinct changes of the epidermal proteome and microbiome preceding the onset of AD as well as characterizing early AD. METHODS We longitudinally analysed epidermal biomarker levels and microbial profiles in a cohort of 50 neonates at high risk for AD, who had participated in a randomized controlled trial on early emollient use for AD prevention. RESULTS About 26% of the infants developed AD until month 24 with an average age of 10 month at disease onset. In children with later AD, IL-1Ra, TNFβ, IL-8, IL-18, IL-22, CCL2, TARC, TSLP and VEGFa showed increased levels prior to disease manifestation with levels of IL-1Ra, TNFβ and VEGFa already increased shortly after birth. Further, children with later AD displayed a delayed maturation and differentially composed skin microbiome prior to AD onset. At manifestation, levels of multiple Th2, Th17/22 and Th1-associated biomarkers as well as innate immunity markers were elevated, and abundances of commensal Streptococcus species were reduced in favour of Staphylococcus epidermidis. CONCLUSIONS Our results indicate that elevations of proinflammatory stratum corneum biomarkers and alterations of the skin microbiome precede paediatric AD and characterize the disease at onset.
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Affiliation(s)
- Melina Fonfara
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jan Hartmann
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Dora Stölzl
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nicole Sander
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Inken Harder
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Elke Rodriguez
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Hübenthal
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Carsten Mazur
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Clinic St. Hedwig, Regensburg, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Clinic St. Hedwig, Regensburg, Germany
| | - Jochen Schmitt
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Hila Emmert
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ina Suhrkamp
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
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Stehling F, Wendt A, Berger M, Kerzel S, Vlajnic D, Fuchs H, Gunst L. [Emergency Care Plans for the Management of Emergencies in Children on Home Mechanical Ventilation]. Klin Padiatr 2024; 236:57-63. [PMID: 38286407 PMCID: PMC10883754 DOI: 10.1055/a-2235-7805] [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] [Indexed: 01/31/2024]
Abstract
In pediatrics chronic respiratory insufficiency is increasingly treated on an outpatient basis with home mechanical ventilation. Nursing and medical teams with different structures take care of the often complex ill children in the outpatient setting. Structured treatment processes, especially emergency plans for the management of respiratory emergencies of home mechanical ventilated children are lacking. This article is a proposal for emergency management of respiratory infections, emergencies of non-invasively ventilated and invasively ventilated, tracheotomized children. In addition to resuscitation measures according to ERC/AHA, the focus is primarily on secretion management, as well as on the handling of ventilators and devices.
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Affiliation(s)
- Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center,
University Hospital Essen, Essen, Germany
| | - Anke Wendt
- Department of Pediatric Respiratory Medicine, Immunology and Critical
Care Medicine, Charite University Hospital Berlin, Berlin, Germany
| | - Michael Berger
- Division of Pediatric Surgery, Department of General, Abdominal and
Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Hospital
Regensburg, Regensburg, Germany
| | - Dejan Vlajnic
- Department of Pediatrics, Vest Children's Hospital Datteln,
Datteln, Germany
| | - Hans Fuchs
- Center for Pediatrics, Department of Neonatology, Medical Center,
University of Freiburg, Freiburg im Breisgau, Germany
| | - Lennart Gunst
- Center for Pediatrics, Department of Neonatology, Medical Center,
University of Freiburg, Freiburg im Breisgau, Germany
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Grote H, Hoffmann A, Kerzel S, Lukasik H, Maier C, Mallon C, Schlegtendal A, Schwarzbach M, van Ackeren K, Volkenstein S, Brinkmann F. Subjective Smell Disturbances in Children with Sars-Cov-2 or Other Viral Infections do not Correspond with Olfactory Test Results. Klin Padiatr 2024; 236:129-138. [PMID: 38262421 DOI: 10.1055/a-2208-6245] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Olfactory dysfunction associated with SARS-CoV-2 infection in children has not been verified by a validated olfactory test. We aimed to determine whether these complaints are objectifiable (test-based hyposmia), how often they occur during acute SARS-CoV-2 infection compared to other upper respiratory tract infections (URTI), as well as in children recovered from COVID-19 compared to children with long COVID. METHODS Olfactory testing (U-sniff test; hyposmia<8 points) and survey-based symptom assessments were performed in 434 children (5-17 years; 04/2021-06/2022). 186 symptom-free children served as controls. Of the children with symptoms of acute respiratory tract infection, SARS-CoV-2 PCR test results were positive in 45 and negative in 107 children (URTI group). Additionally, 96 children were recruited at least 4 weeks (17.6±15.2 weeks) after COVID-19, of whom 66 had recovered and 30 had developed long COVID. RESULTS Compared to controls (2.7%), hyposmia frequency was increased in all other groups (11-17%, p<0.05), but no between-group differences were observed. Only 3/41 children with hyposmia reported complaints, whereas 13/16 children with complaints were normosmic, with the largest proportion being in the long-COVID group (23%, p<0.05). CONCLUSION Questionnaires are unsuitable for assessing hyposmia frequency in children. Olfactory complaints and hyposmia are not specific for SARS-CoV-2 infection. The number of complaints in the long-COVID group could result from aversive olfactory perception, which is undetectable with the U-sniff test.
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Affiliation(s)
- Hanna Grote
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
- Department of Pediatric Pneumology and Allergology, University Children's Hospital Regensburg at Campus St. Hedwig, University Regensburg, University Hospital Regensburg, Germany
| | - Anna Hoffmann
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergology, University Children's Hospital Regensburg at Campus St. Hedwig, University Regensburg, University Hospital Regensburg, Germany
| | - Hannah Lukasik
- Department of Ear, Nose and Throat, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Christoph Maier
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Claire Mallon
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Anne Schlegtendal
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Michaela Schwarzbach
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Konstantin van Ackeren
- Department of Ear, Nose and Throat, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Stefan Volkenstein
- Department of Ear, Nose and Throat, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
| | - Folke Brinkmann
- Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany
- Department of Paediatric Pneumology, University Hospital Schleswig Holstein Campus Lübeck, Lübeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research, Lübeck, Germany
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Schäfer HL, Barker M, Follmann P, Günther A, Hörning A, Kaiser-Labusch P, Kerzel S, Maier C, Roth S, Schmidt C, Schütz K, Stehling F, Struffert M, Timmesfeld N, Vöhringer P, Brinkmann F. Pediatric multi-drug-resistant tuberculosis in Germany - diagnostic and therapeutic challenges of an "orphan disease". Eur J Pediatr 2023; 182:5167-5179. [PMID: 37707590 PMCID: PMC10640426 DOI: 10.1007/s00431-023-05167-x] [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: 04/28/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/15/2023]
Abstract
Delay in diagnosing multidrug-resistant tuberculosis (MDR-pTB) in children prolongs time to effective treatment. Data on risk factors for pediatric MDR from low-incidence countries are scarce. Retrospective nationwide case-control study to analyze MDR-pTB cases in Germany between 2010 and 2020 in comparison to a drug-susceptible (DS)-pTB group. We included 52 MDR cases (24 tuberculosis (TB), 28 TB infection (TBI); mean age 7.3 years) and 56 DS cases (31 TB, 26 TBI; mean age 7.9 years). Groups were similar for sex, household size, and migration background. Compared to the DS group, more children with MDR were born in the Commonwealth of Independent States (CIS) (22% MDR-pTB vs. 13% DS-pTB, n.s.) and had more MDR index cases (94% MDR-pTB, 5% DS-pTB, p < 0.001). The interval between first healthcare contact and initiation of effective therapy was significantly longer in MDR-pTB (47 days) than in DS-pTB (11 days, p < 0.001), correlating with disease progression. Treatment for MDR-pTB was successful in 74%, but 22% experienced long-term adverse effects (e.g., hepatopathy, hearing loss). CONCLUSIONS Close contact to MDR cases or birth in MDR-TB-high-incidence countries are risk factors for MDR-pTB. Early identification of potential MDR index cases by contact investigation, and susceptibility testing in children from high-burden MDR-TB countries are essential for timely diagnosis and treatment, reducing the severity of disease and treatment side effects. TRIAL REGISTRATION Deutsches Register Klinischer Studien ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023817 ), DRKS00023817, 2020-09-08. WHAT IS KNOWN •Management of children with MDR-TB remains challenging due to difficulties in diagnosing MDR-TB (lack of information on MDR index case, lack of microbiological confirmation in paucibacillary disease). •Choice of treatment regimen and monitoring of side effects. WHAT IS NEW •Children with an MDR-TB index or born in a MDR-TB-high-incidence country are at higher risk of developing MDR-TB in a low incidence country. •The time lag to initiate treatment in MDR-TB is longer than in DS-TB and MDR-TB treatment involves a higher risk of adverse effects in longer treatment regimens especially with injectables.
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Affiliation(s)
- Hannah-Lena Schäfer
- Department of Pediatric Pulmonology, Ruhr University Bochum, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Alexandrinenstraße 5, Bochum, 44791, Germany.
| | - Michael Barker
- Department of Pediatrics, Heckeshorn Lung Unit, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Peter Follmann
- Klinik für Kinder- und Jugendmedizin, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Annette Günther
- Department of Pediatrics, Heckeshorn Lung Unit, Helios Klinikum Emil von Behring, Berlin, Germany
| | | | | | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, Campus St. Hedwig, Regensburg, Germany
| | - Christoph Maier
- Department of Pediatric Pulmonology, Ruhr University Bochum, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Alexandrinenstraße 5, Bochum, 44791, Germany
| | - Samra Roth
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, Campus St. Hedwig, Regensburg, Germany
| | - Christian Schmidt
- Klinik für Kinder- und Jugendmedizin, St. Vinzenz-Hospital, Dinslaken, Germany
| | - Katharina Schütz
- Klinik für Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Florian Stehling
- Centre for Pediatrics, University Hospital Essen, Essen, Germany
| | - Marie Struffert
- Department of Pediatric Pulmonology, Ruhr University Bochum, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Alexandrinenstraße 5, Bochum, 44791, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, Bochum, Germany
| | - Paul Vöhringer
- Franz-Lust-Klinik für Kinder- und Jugendmedizin Städtisches Klinikum, Karlsruhe, Germany
| | - Folke Brinkmann
- Department of Pediatric Pulmonology, Ruhr University Bochum, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Alexandrinenstraße 5, Bochum, 44791, Germany
- Division of Pediatric Pulmonology and Allergology, German Center for Lung Research (ARCN, DZL), University Children's Hospital, Luebeck, Germany
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Harder I, Stölzl D, Sander N, Hartmann J, Rodriguez E, Mazur C, Kerzel S, Kabesch M, Küster D, Schmitt J, Fölster-Holst R, Gerdes S, Emmert H, Weidinger S. Effects of Early Emollient Use in Children at High Risk of Atopic Dermatitis: A German Pilot Study. Acta Derm Venereol 2023; 103:adv5671. [PMID: 37246806 DOI: 10.2340/actadv.v103.5671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/06/2023] [Indexed: 05/30/2023] Open
Abstract
Several small studies have indicated that daily emollient use from birth might delay, suppress or prevent atopic dermatitis (AD). Two larger trials did not confirm this; however, a recent smaller study indicated a protective effect if daily emollient use is used in the first 2 months of life. Further research is needed to evaluate the effect of emollient use on development of AD. The current study randomly assigned 50 newborns who were at high risk of developing AD (1:1) to receive general infant skin-care advice (control group), or skin-care advice plus emollient with advice to apply emollient at least once daily until 1 year of age (intervention group). Repeated skin examinations, skin physiology measurements and skin microbiome profiling were performed. Of the children in the intervention and control groups, 28% and 24%, respectively, developed AD (adjusted Relative Risk (RR) 1.19, p = 0.65, adjusted risk difference 0.05). Skin pH decreased and transepidermal water loss and stratum corneum hydration increased over time in both groups with no significant differences. In the intervention group skin microbiome alpha diversity increased earlier, and the abundance of Streptococcus and Staphylococcus species were significantly reduced at month 1. Daily early emollient use in children with high risk of AD was safe, but it did not significantly reduce the risk of developing AD or impact skin physiology development.
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Affiliation(s)
- Inken Harder
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel.
| | - Dora Stölzl
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Nicole Sander
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan Hartmann
- 1Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Elke Rodriguez
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Carsten Mazur
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Clinic St. Hedwig, Regensburg, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Clinic St. Hedwig, Regensburg, Germany
| | - Denise Küster
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center of Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Regina Fölster-Holst
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sascha Gerdes
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Hila Emmert
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
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Fill Malfertheiner S, Postpischil J, Gaertner VD, Brandstetter S, Metcalfe AJ, Seelbach-Göbel B, Apfelbacher C, Melter M, Kabesch M, Kerzel S. Maternal knowledge of recommendations for safe infant sleep and intentions for implementation - a cross sectional analysis of data from the KUNO-Kids birth cohort study. J Perinat Med 2023; 51:423-431. [PMID: 36173665 DOI: 10.1515/jpm-2022-0349] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Despite major advances in prevention, sudden infant death syndrome (SIDS) remains an important cause of infant mortality. The aim of our study was to determine actual knowledge and intentions to implement SIDS prevention measures among new mothers and to identify potential knowledge gaps for improved postpartum counselling strategies. METHODS Data was collected in a standardized interview from participants of the KUNO-Kids birth cohort study before discharge from maternity ward. The mothers did not receive any specific teaching prior to the interview. RESULTS The majority of 2,526 interviewed mothers were able to actively report important recommendations for safe infant sleep, including the exclusive face-up position. However, 154 mothers (9%) intended to position the newborn face-down sometimes or often. The most frequently envisaged sleeping furniture was a bedside sleeper (n=1,144, 47%), but 2.2% of mothers indicated that the intended default sleeping place for the newborn would be the parents' bed (which is discouraged by the recommendations). For 43% of the infants (n=1,079), mothers planned to have loose objects in the bed and 189 mothers (7%) intended to use a loose blanket. 22% of infants (n=554) will live in a household with a smoker. Multivariate regression showed a significant association of "good knowledge" with maternal age and with not being a single parent, whereas the household size was negatively associated. CONCLUSION Although the majority of mothers in our birth cohort were aware of many recommendations for safe infant sleep, our data also uncovered weaknesses in SIDS prevention knowledge and point to specific areas with potential for improved counselling.
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Affiliation(s)
- Sara Fill Malfertheiner
- University Department of Obstetrics and Gynecology at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Janina Postpischil
- Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Vincent D Gaertner
- Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany.,Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zürich, Switzerland
| | - Susanne Brandstetter
- KUNO University Children's Hospital Regensburg, University of Regensburg, Regensburg, Germany.,WECARE Research and Development Campus Regensburg at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Alan J Metcalfe
- Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Birgit Seelbach-Göbel
- University Department of Obstetrics and Gynecology at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Christian Apfelbacher
- WECARE Research and Development Campus Regensburg at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research (ISMHSR), Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Michael Melter
- KUNO University Children's Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Michael Kabesch
- Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany.,WECARE Research and Development Campus Regensburg at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Sebastian Kerzel
- Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
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Poets CF, Paditz E, Erler T, Hübler A, Jückstock J, Quante M, Pauluschke-Fröhlich J, Schlüter B, Hoch B, Kerzel S, Abou-Dakn M, Schneider B, Wiater A. Prävention des plötzlichen Säuglingstods (SIDS, „sudden infant death syndrome“, ICD 10: R95). Monatsschr Kinderheilkd 2023. [DOI: 10.1007/s00112-023-01724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
ZusammenfassungDieser Beitrag fasst die Datenlage zu den wichtigsten Handlungsanweisungen für Eltern bezüglich der Gewährleistung einer sicheren Schlafumgebung für Säuglinge zusammen. Hierzu gehören folgende: 1. Legen Sie Ihr Kind zum Schlafen auf den Rücken; benutzen Sie dabei eine feste und waagerechte Unterlage. 2. Legen Sie Ihr Kind tagsüber, solange es wach ist und Sie es gut beobachten können, regelmäßig für kurze Zeit auch auf den Bauch. 3. Vermeiden Sie Überwärmung: Während der Nacht ist eine Raumtemperatur von 18 °C optimal, anstelle einer Bettdecke empfiehlt sich die Verwendung eines Baby-Schlafsacks in altersentsprechender Größe. 4. Falls Sie keinen Schlafsack verwenden möchten, achten Sie darauf, dass Ihr Kind nicht mit dem Kopf unter die Bettdecke rutschen kann, indem Sie es so ins Bett legen, dass es mit den Füßen am Fußende anstößt. 6. Verzichten Sie auf Kopfkissen, Fellunterlagen, „Nestchen“, gepolsterte Bettumrandungen und größere Kuscheltiere, mit denen sich Ihr Kind überdecken könnte. 7. Wickeln Sie Ihr Kind zum Schlafen nicht fest ein. 8. lassen Sie Ihr Kind bei sich im Zimmer, aber im eigenen Kinderbett schlafen. 9. Achten Sie auf eine rauchfreie Umgebung für Ihr Kind auch schon während der gesamten Schwangerschaft. 10. Stillen Sie im 1. Lebensjahr, möglichst mindestens 4 bis 6 Monate. 11. Bieten Sie Ihrem Kind zum Schlafengehen einen Schnuller an. 12. Diese Empfehlungen gelten auch für die Zeit unmittelbar nach Geburt: Sollte Ihr Kind auf Ihrem Körper liegen, achten Sie darauf, dass es stets freie Atemwege hat.
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10
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Kiefer A, Duppel U, Schützenmeier A, Lang T, Kittel J, Kabesch M, Kerzel S. Button Battery Ingestions cause the Majority of Severe Complications. Klin Padiatr 2023; 235:90-97. [PMID: 36758576 DOI: 10.1055/a-2007-1686] [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: 02/11/2023]
Abstract
BACKGROUND Foreign body ingestion in children is a clinically important reason for presentation to the emergency department. The individual outcome ranges from benign spontaneous courses to severe complications. Fatal outcomes occur rarely and complications are related to patient's age as well as type and location of the foreign body. The aim of our present study was to evaluate the outcome of children and adolescents with foreign body ingestion with a focus on complications, which mainly occurred after button battery ingestion. METHODS We reviewed medical records of patients between 0 and 18 years of age who had presented to the paediatric emergency department of our hospital with suspected foreign body ingestion between January 2011 and March 2021 (123 months). Clinical, imaging, and endoscopic data as well as treatment modalities were analysed. RESULTS In the ten10 year period under review, a total of 1,162 children and adolescents (6 months - 18 years) presented to our emergency room with suspected foreign body ingestion. Among those, 398 ingestions (34%) could be verified radiologically and/or endoscopically, while in the remaining 764 cases (66%) the suspicion could not be confirmed. The majority of patients with verified ingestion (n=324; 81%) presented with ingestion of a metallic foreign body. We observed 55 cases with verified ingestion of a button battery. Five of these cases had severe complications, with a near-fatal course in two patients who developed an oesophageal-tracheal fistula. CONCLUSION In contrast to all other ingestions of foreign bodies in children, button battery ingestions lead to mucosal damage and severe complications in a significant number of children.
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Affiliation(s)
- Alexander Kiefer
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Uta Duppel
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Alexander Schützenmeier
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Thomas Lang
- Department of Paediatrics, Pediatric Gastroenterology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Jochen Kittel
- Department of Paediatrics, Pediatric Gastroenterology, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Michael Kabesch
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Sebastian Kerzel
- Department of Paediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
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11
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Brunner J, Fill Malfertheiner S, Brandstetter S, Seelbach-Göbel B, Apfelbacher C, Melter M, Kabesch M, Baessler A, Arndt P, Berneburg M, Böse-O’Reilly S, Brunner R, Buchalla W, Franke A, Häusler S, Heid I, Herr C, Högler W, Kerzel S, Koller M, Leitzmann M, Rothfuß D, Rösch W, Schaub B, Weber BHF, Weidinger S, Wellmann S. Prevalences of cardiometabolic risk and lifestyle factors in young parents: evidence from a German birth cohort study. BMC Cardiovasc Disord 2022; 22:469. [DOI: 10.1186/s12872-022-02915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Studies show that parents significantly impact their children’s health through their cardiometabolic risk profile and health behavior. There is only little information about the prevalence of cardiometabolic risk factors and lifestyle factors among new parents yet. The aims of this study are therefore to evaluate the prevalences of cardiometabolic risk factors in parents of infants in Germany and to examine their lifestyle and health behavior.
Methods
In the KUNO-Kids health study, an ongoing birth cohort, parents (n = 930 mothers and 769 fathers) were asked about cardiometabolic risk factors (obesity/hypertension/type 2 diabetes mellitus) and lifestyle factors (dietary/sports/smoking habits/alcohol consumption) during the first year after the birth of their children via questionnaires. Chi-square as well as fisher exact tests were conducted to analyse associations between lifestyle factors and cardiometabolic risk factors.
Results
34.2% of mothers and 58.5% of fathers were overweight or obese. In 11.8% of the families, at least one parent suffered from hypertension, in 2.4% from type 2 diabetes mellitus. One year after delivery, 8.5% of mothers were smoking, 6.9% showed a risky alcohol consumption (> 10 g/d). 16.0% of fathers were smoking 4 weeks after childbirth, 10.7% showed risky alcohol consumption (> 20 g/d). 21.6% of mothers carried out sports activity for more than 2 h a week then. Parental hypertension was linked to a higher prevalence of risky alcohol consumption, obesity to a lower prevalence of daily fruits consumption.
Conclusions
Cardiometabolic risk factors were widespread among new parents with obesity and overweight having the highest prevalences. A considerable number of parents also practiced an unhealthy lifestyle showing that there is potential for improvement to promote the healthy development of their children.
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12
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Lange L, Gernert S, Berger M, Arens A, Rache L, Delissen J, Yavuz ST, Millner-Uhlemann M, Wiesenäcker D, Neustädter I, Reese I, Utz P, Schuster A, Adelsberger D, Ziegert M, Kerzel S, Finger A. Different Patterns of Foods Triggering FPIES in Germany. J Allergy Clin Immunol Pract 2022; 10:1063-1069. [PMID: 34942384 DOI: 10.1016/j.jaip.2021.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/18/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated gastrointestinal food allergy mainly affecting infants and young children. Allergic FPIES reactions differ from IgE-mediated food allergies, for example, regarding elicitors and clinical course. OBJECTIVE The aim of our study was to describe causative agents and development of tolerance in German children with FPIES. METHODS We conducted a retrospective survey on children with FPIES from 14 centers in Germany assessing a 6-year period. RESULTS We analyzed 142 patients with 190 FPIES reactions, 130 of which met acute FPIES criteria and 60 were defined as chronic FPIES. The most frequent eliciting food for acute FPIES was cow's milk, followed by fish, vegetables (eg, potato, pumpkin), meats (eg, beef), and grains. A total of 119 children reacted to 1 food only, 16 children to 2 or 3 foods, and 7 children to ≥4 foods. In chronic FPIES, all but 4 exclusively breastfed infants reacted to cow's milk feeding. IgE sensitization to the triggering food was found in 21 of 152 (14%) cases. Two children developed additional IgE-mediated symptoms upon a food challenge. Time to proof of tolerance was shortest in cow's milk-induced FPIES, and it was shorter in chronic than in acute FPIES. CONCLUSION In our national survey, we identified triggers for acute FPIES that partially differ from those reported internationally. Mainly foods introduced early in infant nutrition triggered acute reactions. Time to proven tolerance was shown to be contingent on FPIES symptomatology and on the triggering food. These data should be considered regarding nutritional advice for infants with FPIES.
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Affiliation(s)
- Lars Lange
- Department of Pediatrics, St. Marien-Hospital, Bonn, Germany.
| | - Sunhild Gernert
- Department of Pediatrics, St. Marien-Hospital, Bonn, Germany
| | - Moritz Berger
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Alisa Arens
- Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | | | - Julia Delissen
- Department of Paediatrics, Children's Hospital Amsterdamer Straße, Cologne, Germany
| | - S Tolga Yavuz
- Department of Pediatric Allergy, Childen's Hospital, University of Bonn, Bonn, Germany
| | | | - David Wiesenäcker
- Department of Pediatrics, Kinderklinik München Schwabing, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Irena Neustädter
- Department of Pediatrics and Pediatric Intensive Care, Cnopfsche Kinderklinik, Nuremberg, Germany
| | - Imke Reese
- Dietary Counseling and Nutrition Therapy Centre, Munich, Germany
| | - Philipp Utz
- Children's University Hospital, Tuebingen, Germany
| | - Antje Schuster
- Department of Paediatrics, University Hospital, Düsseldorf, Germany
| | - Deborah Adelsberger
- Department of Pediatric Pneumology and Allergology, Klinikum Oldenburg, Medical Campus of University Oldenburg, Oldenburg, Germany
| | - Mandy Ziegert
- Department of Pediatric Allergology, German Red Cross Hospital, Berlin, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, St. Hedwig Campus, Regensburg, Germany
| | - Antje Finger
- Department of Pediatrics, St. Marien-Hospital, Bonn, Germany
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13
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Urban C, Kiefer A, Conradt R, Kabesch M, Lex C, Zacharasiewicz A, Kerzel S. Validation of the LEOSound® monitor for standardized detection of wheezing and cough in children. Pediatr Pulmonol 2022; 57:551-559. [PMID: 34800333 DOI: 10.1002/ppul.25768] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 08/18/2021] [Revised: 10/29/2021] [Accepted: 11/18/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND A hallmark of many respiratory conditions is the presence of nocturnal symptoms. Nevertheless, especially in children there is currently still a huge diagnostic gap in detecting nighttime symptoms, which leads to an underestimation of the frequency in clinical practise. METHODS We evaluated the clinical applicability and determined the formal test characteristics of the LEOSound ® system, a device for digital long-time recording and automated detection of acoustic airway events. Airway sounds were recorded overnight in 115 children and adolescents (1-17 years) with and without respiratory conditions. The automated classification for "cough" and "wheezing" was subsequently validated against the manual acoustic reassessment by an expert physician. RESULTS The general acceptance was good across all age groups and a technically successful recording was obtained in 98 children, corresponding to 92,976 sound epochs (à 30 s) or a total of 774 h of lung sounds. We found a sensitivity of 89% and a specificity of 99% for the automated detection of cough. For detection of wheezing, sensitivity and specificity were both 98%. The cough index and the wheeze index (events per hour) of individual patients showed a strong positive correlation (cough: rS = 0.85, wheeze: rS = 0.95) and a sufficient agreement of the two assessment methods in the Bland-Altman analysis. CONCLUSION Our data show that the LEOSound® is a suitable device for standardized detection of cough and wheezing and hence a promising diagnostic tool to detect nocturnal respiratory symptoms, especially in children. However, a validation process to reduce false positive classifications is essential in clinical routine use.
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Affiliation(s)
- Christof Urban
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany.,Alpenklinik Santa Maria, Bad Hindelang, Germany
| | - Alexander Kiefer
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Regina Conradt
- Division of Pneumology, Department of Internal Medicine, Intensive Care and Sleep Medicine, Philipps-University Marburg, Marburg, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Christiane Lex
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Angela Zacharasiewicz
- Department of Pediatrics and Adolescent Medicine, Wilhelminenspital, Teaching Hospital of the University of Vienna, Vienna, Austria
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
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14
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Santos-Valente E, Buntrock-Döpke H, Abou Taam R, Arasi S, Bakirtas A, Lozano Blasco J, Bønnelykke K, Craiu M, Cutrera R, Deschildre A, Elnazir B, Fleming L, Frey U, Gappa M, Nieto García A, Skamstrup Hansen K, Hanssens L, Jahnz-Rozyk K, Jesenak M, Kerzel S, Kopp MV, Koppelman GH, Krivec U, MacLeod KA, Mäkelä M, Melén E, Mezei G, Moeller A, Moreira A, Pohunek P, Minić P, Rutjes NWP, Sammut P, Schwerk N, Szépfalusi Z, Turkalj M, Tzotcheva I, Ulmeanu A, Verhulst S, Xepapadaki P, Niggel J, Vijverberg S, Maitland-van der Zee AH, Potočnik U, Reinartz SM, van Drunen CM, Kabesch M. Biologicals in childhood severe asthma: the European PERMEABLE survey on the status quo. ERJ Open Res 2021; 7:00143-2021. [PMID: 34409097 PMCID: PMC8365152 DOI: 10.1183/23120541.00143-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/11/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction Severe asthma is a rare disease in children, for which three biologicals, anti-immunoglobulin E, anti-interleukin-5 and anti-IL4RA antibodies, are available in European countries. While global guidelines exist on who should receive biologicals, knowledge is lacking on how those guidelines are implemented in real life and which unmet needs exist in the field. In this survey, we aimed to investigate the status quo and identify open questions in biological therapy of childhood asthma across Europe. Methods Structured interviews regarding experience with biologicals, regulations on access to the different treatment options, drug selection, therapy success and discontinuation of therapy were performed. Content analysis was used to analyse data. Results We interviewed 37 experts from 25 European countries and Turkey and found a considerable range in the number of children treated with biologicals per centre. All participating countries provide public access to at least one biological. Most countries allow different medical disciplines to prescribe biologicals to children with asthma, and only a few restrict therapy to specialised centres. We observed significant variation in the time point at which treatment success is assessed, in therapy duration and in the success rate of discontinuation. Most participating centres intend to apply a personalised medicine approach in the future to match patients a priori to available biologicals. Conclusion Substantial differences exist in the management of childhood severe asthma across Europe, and the need for further studies on biomarkers supporting selection of biologicals, on criteria to assess therapy response and on how/when to end therapy in stable patients is evident. This study reveals enormous differences in therapy with biologicals for childhood severe asthma across Europe, and demonstrates the urgent need for harmonisation in medication choice, definition of therapy success and how/when to discontinue treatmenthttps://bit.ly/3tnJMTY
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Affiliation(s)
- Elisangela Santos-Valente
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Heike Buntrock-Döpke
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany.,Member of the Research and Development Campus Regensburg (WECARE) at the Hospital St Hedwig of the Order of St John, Regensburg, Germany
| | - Rola Abou Taam
- Service de pneumologie pédiatrique, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - Arzu Bakirtas
- Dept of Pediatrics, Division of Pediatric Allergy and Asthma, Gazi University School of Medicine, Ankara, Turkey
| | - Jaime Lozano Blasco
- Dept of Pediatric Allergy and Clinical Immunology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Klaus Bønnelykke
- Dept of Pediatrics, Herlev and Gentofte Hospital, University Hospital Copenhagen, Denmark
| | - Mihai Craiu
- Respiratory Dept, National Institute for Mother and Child Health "Alessandrescu-Rusescu", Bucharest, Romania
| | - Renato Cutrera
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Dept of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antoine Deschildre
- University of Lille, CHU Lille, Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, Lille, France
| | - Basil Elnazir
- Children's Health Ireland (CHI) at Tallaght University Hospital, Dublin, Ireland.,Trinity College, Dublin, Ireland
| | - Louise Fleming
- Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK.,Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Urs Frey
- University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Monika Gappa
- Evangelisches Krankenhaus Düsseldorf, Children's Hospital, Düsseldorf, Germany
| | - Antonio Nieto García
- Pediatric Allergy and Pneumology Unit, Children's Hospital La Fe and Health Research Institute La Fe, Valencia, Spain
| | | | - Laurence Hanssens
- Service de Pneumologie-Allergologie, Centre de reference de Mucoviscidose de l'ULB, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Karina Jahnz-Rozyk
- Dept of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
| | - Milos Jesenak
- Dept of Paediatrics, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia.,Dept of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovakia
| | - Sebastian Kerzel
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany
| | - Matthias V Kopp
- University Children's Hospital Bern, Inselspital, University of Bern, Switzerland.,German Center for Lung Research DZL, Airway Center North (ARCN) Lübeck and Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Gerard H Koppelman
- Dept of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, University of Groningen, Beatrix Children's Hospital, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Uros Krivec
- Dept of Paediatric Pulmology, University Children's Hospital Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Mika Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Erik Melén
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Györgyi Mezei
- Allergy Unit, First Dept of Pediatrics, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland
| | - Andre Moreira
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Petr Pohunek
- Pediatric Pulmonology, Pediatric Dept, 2nd Faculty of Medicine, Charles University, Prague, University Hospital Motol, Prague, Czech Republic
| | - Predrag Minić
- Mother and Child Health Institute of Serbia, Belgrade, Serbia
| | - Niels W P Rutjes
- Dept of Paediatric Pulmonology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick Sammut
- Dept of Paediatrics, Respiratory Medicine and Allergy, Mater Dei Hospital, Malta
| | - Nicolaus Schwerk
- Dept of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,German Center for Lung Research, Biomedical Research in End Stage and Obstructive Lung Disease/BREATH, German Center for Lung Research, Hannover, Germany
| | - Zsolt Szépfalusi
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Dept of Pediatrics and Adolescent Medicine, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Mirjana Turkalj
- Srebrnjak Children's Hospital, Zagreb, and School of Medicine, University of Osijek "Josip Juraj Strossmayer", Osijek, and Catholic University of Croatia, Zagreb, Croatia
| | - Iren Tzotcheva
- Dept of Pediatrics, University Hospital for Emergency Medicine "N. I. Pirogov", Medical University, Sofia, Bulgaria
| | - Alexandru Ulmeanu
- "Grigore Alexandrescu" Emergency Hospital for Children, Bucharest, Romania
| | - Stijn Verhulst
- Dept of Pediatrics, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paraskevi Xepapadaki
- Allergy Dept, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Susanne Vijverberg
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anke H Maitland-van der Zee
- Dept of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Dept of Paediatric Respiratory Medicine and Allergy, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Uroš Potočnik
- Laboratory for Biochemistry, Molecular Biology and Genomics, Faculty of Chemistry and Chemical Engineering, University of Maribor, Maribor, Slovenia.,Centre for Human Molecular Genetics and Pharmacogenomics, Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Susanne M Reinartz
- Dept of Otorhinolaryngology, Tergooi Hospitals, Hilversum, the Netherlands
| | - Cornelis M van Drunen
- Dept of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Michael Kabesch
- Dept of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO) at the Hospital St Hedwig of the Order of St John, University of Regensburg, Regensburg, Germany.,Member of the Research and Development Campus Regensburg (WECARE) at the Hospital St Hedwig of the Order of St John, Regensburg, Germany
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15
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Stutz R, Meyer C, Kaiser E, Goedicke-Fritz S, Schroeder HW, Bals R, Haertel C, Rogosch T, Kerzel S, Zemlin M. Attenuated asthma phenotype in mice with a fetal-like antigen receptor repertoire. Sci Rep 2021; 11:14199. [PMID: 34244568 PMCID: PMC8270943 DOI: 10.1038/s41598-021-93553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/21/2021] [Indexed: 11/09/2022] Open
Abstract
We hypothesized that the scarcity of N-nucleotides might contribute to the inability of the neonate to mount a robust allergic immune response. To test this, we used terminal deoxyribunucleotidyl Transferase deficient (TdT-/-) mice, which express "fetal-like" T cell receptor and immunoglobulin repertoires with largely germline-encoded CDR3 regions. Intraperitoneal sensitization was followed by aerosol provocation with either PBS or the allergen OVA in both TdT-/- mice and wild-type mice to develop allergic respiratory inflammation. The effects of this procedure were investigated by lung function test, immunological analysis of serum and brochoalveolar lavage. The local TH2 cytokine milieu was significantly attenuated in TdT-/- mice. Within this group, the induction of total IgE levels was also significantly reduced after sensitization. TdT-/- mice showed a tendency toward reduced eosinophilic inflow into the bronchial tubes, which was associated with the elimination of respiratory hyperreactivity. In conclusion, in a murine model of allergic airway inflammation, the expression of fetal-like antigen receptors was associated with potent indications of a reduced ability to mount an asthma phenotype. This underlines the importance of somatically-generated antigen-receptor repertoire diversity in type one allergic immune responses and suggests that the fetus may be protected from allergic responses, at least in part, by controlling N addition.
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Affiliation(s)
- Regine Stutz
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Christopher Meyer
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Elisabeth Kaiser
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Sybelle Goedicke-Fritz
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany.,Department of Pediatrics, Philipps-University Marburg, Marburg, Germany
| | - Harry W Schroeder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert Bals
- Department of Internal Medicine V-Pulmonology, Allergology and Critical Care Medicine, Saarland University, Saarland University Medical School, Homburg, Germany
| | - Christoph Haertel
- Department of Pediatrics, Würzburg University Medical Center, Würzburg, Germany
| | - Tobias Rogosch
- Department of Pediatrics, Philipps-University Marburg, Marburg, Germany
| | - Sebastian Kerzel
- Department of Pediatrics, Philipps-University Marburg, Marburg, Germany.,Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, Campus St. Hedwig, Regensburg, Germany
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany. .,Department of Pediatrics, Philipps-University Marburg, Marburg, Germany.
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16
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Durham K, Wethmar D, Brandstetter S, Seelbach-Göbel B, Apfelbacher C, Melter M, Kabesch M, Kerzel S. Digital Media Exposure and Predictors for Screen Time in 12-Month-Old Children: A Cross-Sectional Analysis of Data From a German Birth Cohort. Front Psychiatry 2021; 12:737178. [PMID: 34912248 PMCID: PMC8668323 DOI: 10.3389/fpsyt.2021.737178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/06/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Early exposure to digital media may affect the physical and cognitive development in young children. The American Academy of Pediatrics and national guidelines recommend no digital media use at all under the age of 18 months. The aim of our study was to determine the actual exposure to digital media in 12-month-old infants and to reveal potential risk factors for screen time. Methods: In this prospective cross-sectional survey, data was collected from the KUNO Kids birth cohort study using parent-report questionnaires regarding the media exposure of the study child. We determined age at first contact with different digital media, mean screen time on an average weekday, and the influence of major demographic and socioeconomic factors. Results: Data for screen time analysis was available for 630 children. In summary, 45% of children had already been exposed to digital media by their first birthday. The most frequent first digital media exposure was the TV (33.0%) followed by smartphones (16.9%), both most commonly exposed to around the age of 8 months. On a regular weekday, 20% of the children spent 0.5-1 h in front of a TV and 9% were exposed to a smartphone for the same time frame, compared to 31% of joint parent-child media use. Predictors for screen time were having one sibling, less living space per person, and excessive TV use in the household, the latter of which doubled the chance of the child being exposed to digital media. Conclusion: A proportion of 10% of 1-year-old children were already regularly exposed to digital media. The TV remains the most predominant device but new media, particularly smartphones, might be catching up. Our study provides further support that family TV time is a major predictor of infant screen time. Pediatric recommendations should be re-evaluated in the light of the actual exposure to digital media already in infancy and parents should be proactively counseled regarding possible effects on child development.
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Affiliation(s)
- Kira Durham
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - David Wethmar
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany.,WECARE Research and Development Campus Regensburg, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Birgit Seelbach-Göbel
- University Department of Obstetrics and Gynecology, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Christian Apfelbacher
- WECARE Research and Development Campus Regensburg, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Michael Melter
- Department of Pediatrics, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
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Kiefer A, Kerzel S. COVID-19 bei Kindern und Jugendlichen mit chronischen Lungenerkrankungen. Pneumologe 2020; 17:357-364. [PMID: 32863816 PMCID: PMC7441597 DOI: 10.1007/s10405-020-00340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Hintergrund Ziel der Arbeit Material und Methoden Ergebnisse Diskussion
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18
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Koehler U, Hildebrandt O, Fischer P, Gross V, Sohrabi K, Timmesfeld N, Peter S, Urban C, Steiß JO, Koelsch S, Kerzel S, Weissflog A. Time course of nocturnal cough and wheezing in children with acute bronchitis monitored by lung sound analysis. Eur J Pediatr 2019; 178:1385-1394. [PMID: 31321530 PMCID: PMC6694092 DOI: 10.1007/s00431-019-03426-4] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 11/02/2022]
Abstract
Cough and wheezing are the predominant symptoms of acute bronchitis. Hitherto, the evaluation of respiratory symptoms was limited to subjective methods such as questionnaires. The main objective of this study was to objectively determine the time course of cough and wheezing in children with acute bronchitis. The impact of nocturnal cough on parent's quality of life was assessed as secondary outcome. In 36 children (2-8 years), the frequency of nocturnal cough and wheezing was recorded during three nights by automated lung sound monitoring. Additionally, parents completed symptom logs, i.e., the Bronchitis Severity Score (BSS), as well as the Parent-proxy Children's Acute Cough-specific Quality of Life Questionnaire (PAC-QoL). During the first night, patients had 34.4 ± 52.3 (mean ± SD) cough epochs, which were significantly reduced in night 5 (13.5 ± 26.5; p < 0.001) and night 9 (12.8 ± 28.1; p < 0.001). Twenty-two patients had concomitant wheezing, which declined within the observation period as well. All subjective parameters (BSS, Cough log and PAC-QoL) were found to be significantly correlated with the objectively assessed cough parameters.Conclusion: Long-term recording of cough and wheezing offers a useful opportunity to objectively evaluate the time course of respiratory symptoms in children with acute bronchitis. To assess putative effects of pharmacotherapy on nocturnal bronchitis symptoms, future studies in more homogeneous patient groups are needed. What is Known: • Cough and wheezing are the predominant symptoms of acute bronchitis. • There is a diagnostic gap in long-term assessment of these respiratory symptoms, which needs to be closed to optimize individual therapies. What is New: • Long-term recording of nocturnal cough and wheezing allows for objective evaluation of respiratory symptoms in children with acute bronchitis and provides a tool to validate the efficacy of symptomatic bronchitis therapies.
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Affiliation(s)
- Ulrich Koehler
- Department of Internal Medicine, Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Gießen, Philipps-Universität, Baldingerstrasse 1, 35043 Marburg, Germany
| | - Olaf Hildebrandt
- Department of Internal Medicine, Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Gießen, Philipps-Universität, Baldingerstrasse 1, 35043 Marburg, Germany
| | - Patrick Fischer
- Faculty of Health Sciences, University of Applied Sciences, Gießen, Germany
| | - Volker Gross
- Faculty of Health Sciences, University of Applied Sciences, Gießen, Germany
| | - Keywan Sohrabi
- Faculty of Health Sciences, University of Applied Sciences, Gießen, Germany
| | - Nina Timmesfeld
- Department of Medicine, Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
| | - Saskia Peter
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg, St. Hedwig Campus, Regensburg, Germany
| | | | - Jens-Oliver Steiß
- Division of Pediatric Pulmonology and Allergy, Department of Pediatrics and Neonatology, University Hospital of Marburg and Gießen, Gießen, Germany
| | - Stephan Koelsch
- CHC Medical Affairs, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg, St. Hedwig Campus, Regensburg, Germany
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19
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Koehler U, Hildebrandt O, Walliczek-Dworschak U, Nikolaizik W, Weissflog A, Urban C, Kerzel S, Sohrabi K, Groß V. Chronischer Husten – Neue diagnostische
Perspektiven? Laryngorhinootologie 2019; 98:14-20. [DOI: 10.1055/a-0790-0777] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
ZusammenfassungChronischer Husten wird bisher größtenteils über rein subjektive Mittel erfasst
und beurteilt – zum Beispiel mithilfe von Fragebögen und/oder Tagebüchern. Die
subjektive Beurteilung stimmt jedoch oft nicht mit den objektiven Messdaten
überein. Bei Patienten mit chronischem Husten sollte daher die Basisdiagnostik
und Verlaufskontrolle jedweder medikamentösen Therapie einer Kombination aus
objektiven und subjektiven Kriterien unterzogen werden.
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Affiliation(s)
- Ulrich Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin,
Philipps-Universität
| | - Olaf Hildebrandt
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin,
Philipps-Universität
| | | | | | | | | | - Sebastian Kerzel
- Klinik für Pädiatrische Pneumologie und Allergologie,
Universitäts-Kinderklinik Ostbayern am KUNO-Standort St. Hedwig
| | | | - Volker Groß
- Fachbereich GES, Technische Hochschule Mittelhessen
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20
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Schindler TI, Wagner JJ, Goedicke-Fritz S, Rogosch T, Coccejus V, Laudenbach V, Nikolaizik W, Härtel C, Maier RF, Kerzel S, Zemlin M. T H17 Cell Frequency in Peripheral Blood Is Elevated in Overweight Children without Chronic Inflammatory Diseases. Front Immunol 2017; 8:1543. [PMID: 29201026 PMCID: PMC5696328 DOI: 10.3389/fimmu.2017.01543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/30/2017] [Indexed: 12/23/2022] Open
Abstract
Background The prevalence of obesity has dramatically increased in children in the last few decades and is associated with chronic inflammatory diseases. Fat tissue produces IL-6 and TNF-α, which are stimuli for TH17 cell differentiation. These cells are characterized by expression of the transcription factor receptor-related orphan receptor C (RORC) and by IL-17A production. In murine models, obesity has been linked with elevated TH17 cell frequencies. The aim of this study was to explore whether being overweight was associated with an elevated frequency of circulating TH17 cells or elevated messenger RNA (mRNA)-levels of IL-17A and RORC in children without chronic inflammatory diseases. Methods We studied peripheral blood samples from 15 overweight and 50 non-overweight children without a history of autoimmune diseases, asthma, atopic dermatitis or allergic rhinoconjunctivitis. TH17 cells were quantified in Ionomycin stimulated peripheral blood mononuclear cells by flow cytometry using intracellular IL-17A staining. RORC- and IL-17A expressions were measured by real-time PCR. Results We found significantly elevated TH cell frequencies in overweight children compared then on-overweight controls with 34.7 ± 1.5% of CD3+CD4+ cells versus 25.4 ± 2.4% (mean ± SEM, p = 0.0023), respectively. Moreover, TH cell frequencies correlated positively with body mass index (r = 0.42, p = 0.0005, respectively). The relative mRNA expression of RORC (p = 0.013) and IL-17A (p = 0.014) were upregulated in overweight compared to non-overweight children. Conclusion Childhood obesity is an independent factor that is associated with an elevated frequency of circulating TH17 cells and higher expression of RORC- and IL-17A-mRNA after in vitro stimulation with Ionomycin. This might be due to the inflammatory activity of the fat tissue. Studies on TH17 immunity should not only be adjusted for acute and chronic inflammatory diseases but also for overweight.
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Affiliation(s)
| | - Johanna-Josophina Wagner
- Children's Hospital, Philipps University, Marburg, Germany.,Department of Pediatrics, Helios-Klinikum Buch, Berlin, Germany
| | - Sybelle Goedicke-Fritz
- Children's Hospital, Philipps University, Marburg, Germany.,Department of General Pediatrics and Neonatology, University Children's Hospital of Saarland, Homburg, Germany
| | - Tobias Rogosch
- Children's Hospital, Philipps University, Marburg, Germany
| | | | | | | | | | | | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, Regensburg, Germany
| | - Michael Zemlin
- Children's Hospital, Philipps University, Marburg, Germany.,Department of General Pediatrics and Neonatology, University Children's Hospital of Saarland, Homburg, Germany
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21
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Koehler U, Hildebrandt O, Walliczek-Dworschak U, Nikolaizik W, Weissflog A, Urban C, Kerzel S, Sohrabi K, Groß V. [Chronic cough - New diagnostic options for evaluation?]. Dtsch Med Wochenschr 2017; 142:47-53. [PMID: 28056477 DOI: 10.1055/s-0041-105748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ulrich Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - Olaf Hildebrandt
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | | | | | | | | | - Sebastian Kerzel
- Klinik für Pädiatrische Pneumologie und Allergologie, Universitäts-Kinderklinik Ostbayern am KUNO-Standort St. Hedwig, Regensburg
| | - Keywan Sohrabi
- Fachbereich GES, Technische Hochschule Mittelhessen, Gießen
| | - Volker Groß
- Fachbereich GES, Technische Hochschule Mittelhessen, Gießen
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22
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23
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Koehler U, Hildebrandt O, Kerzel S, Urban C, Hoehle L, Weissflog A, Nikolaizik W, Koehler J, Sohrabi K, Gross V. [Normal and Adventitious Breath Sounds]. Pneumologie 2016; 70:397-404. [PMID: 27177168 DOI: 10.1055/s-0042-106155] [Citation(s) in RCA: 1] [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: 10/21/2022]
Abstract
Auscultation of the lung is an inexpensive, noninvasive and easy-to-perform tool. It is an important part of the physical examination and is help ful to distinguish physiological respiratory sounds from pathophysiological events. Computerized lung sound analysis is a powerful tool for optimizing and quantifying electronic auscultation based on the specific lung sound spectral characteristics. The automatic analysis of respiratory sounds assumes that physiological and pathological sounds are reliably analyzed based on special algorithms. The development of automated long-term lungsound monitors enables objective assessment of different respiratory symptoms.
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Affiliation(s)
- U Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - O Hildebrandt
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - S Kerzel
- Klinik für Pädiatrische Pneumologie und Allergologie, Universitäts-Kinderklinik Ostbayern am KUNO-Standort St. Hedwig , Regensburg
| | - C Urban
- Alpenklinik Santa Maria, Bad Hindelang-Oberjoch
| | | | | | - W Nikolaizik
- Klinik für Kinder- und Jugendmedizin, Philipps-Universität, Marburg
| | | | - K Sohrabi
- Fachbereich GES, Technische Hochschule Mittelhessen, Gießen
| | - V Gross
- Fachbereich GES, Technische Hochschule Mittelhessen, Gießen
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24
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Kerzel S, Rogosch T, Struecker B, Maier RF, Kabesch M, Zemlin M. Unlike in Children with Allergic Asthma, IgE Transcripts from Preschool Children with Atopic Dermatitis Display Signs of Superantigen-Driven Activation. J Immunol 2016; 196:4885-92. [PMID: 27183570 DOI: 10.4049/jimmunol.1402889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 04/11/2016] [Indexed: 01/11/2023]
Abstract
The IgE repertoire in children with asthma reflects an adaptive B cell response, indicative of Ag-driven selection. However, the same might not apply to atopic dermatitis, which is often the first manifestation of atopy. The objective of our present study was to characterize the IgE repertoire of preschool children with atopic dermatitis with regard to signs of superantigen-like activation, clonal relationship, and indications of Ag selection. Total RNA was isolated from PBMCs of five children with atopic dermatitis. IgE transcripts were amplified, cloned, and sequenced using RT-PCR. We obtained 200 functional IgE sequences, which were compared with 1140 sequences from 11 children with asthma. Whereas variable gene segment of the H Ig chain (VH) gene usage in asthma reflected germline distribution, IgE transcripts from children with atopic dermatitis displayed a dominance of the otherwise scarcely expressed VH2 and VH4 family. Whereas IgE transcripts from children with asthma were highly mutated (7.2%), somatic mutation rate in atopic dermatitis was less than half as high (3.4%). Moreover, the proportion of transcripts that were indicative of Ag selection was reduced to 11% in atopic dermatitis (24% in asthma). In summary, IgE repertoires vary significantly between children with different atopic diseases. Compared with children with asthma, IgE transcripts from preschool children with atopic dermatitis are significantly less mutated, clonally less focused, and less indicative of Ag selection. We consider our data reconcilable with the hypothesis that a superantigen-like activation contributes to the maturation and selection of the IgE repertoire in atopic dermatitis.
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Affiliation(s)
- Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, St. Hedwig Campus, D-93049 Regensburg, Germany; and Department of Pediatrics, Philipps-University Marburg, D-35043 Marburg, Germany
| | - Tobias Rogosch
- Department of Pediatrics, Philipps-University Marburg, D-35043 Marburg, Germany
| | - Benjamin Struecker
- Department of Pediatrics, Philipps-University Marburg, D-35043 Marburg, Germany
| | - Rolf F Maier
- Department of Pediatrics, Philipps-University Marburg, D-35043 Marburg, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, St. Hedwig Campus, D-93049 Regensburg, Germany; and
| | - Michael Zemlin
- Department of Pediatrics, Philipps-University Marburg, D-35043 Marburg, Germany
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25
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Koehler U, Hildebrandt O, Walliczek U, Höhle L, Weissflog A, Heselhaus J, Kerzel S, Urban C, Sohrabi K, Gross V. Was ist für die Diagnostik und Therapieverlaufskontrolle von chronischem Husten wichtig? Pneumologie 2015; 69:588-94. [DOI: 10.1055/s-0034-1392616] [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: 10/23/2022]
Affiliation(s)
- U. Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | - O. Hildebrandt
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität, Marburg
| | | | | | | | | | - S. Kerzel
- Klinik für Pädiatrische Pneumologie und Allergologie, Universitäts-Kinderklinik Ostbayern am KUNO-Standort St. Hedwig, Regensburg
| | - C. Urban
- Klinik für Pädiatrische Pneumologie und Allergologie, Universitäts-Kinderklinik Ostbayern am KUNO-Standort St. Hedwig, Regensburg
| | - K. Sohrabi
- Fachbereich GES, Technische Hochschule Mittelhessen, Gießen
| | - V. Gross
- Fachbereich GES, Technische Hochschule Mittelhessen, Gießen
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26
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Rogosch T, Kerzel S, Dey F, Wagner JJ, Zhang Z, Maier RF, Zemlin M. IgG4 and IgE transcripts in childhood allergic asthma reflect divergent antigen-driven selection. J Immunol 2014; 193:5801-8. [PMID: 25385824 DOI: 10.4049/jimmunol.1401409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The physiologic function of the "odd" Ab IgG4 remains enigmatic. IgG4 mediates immunotolerance, as, for example, during specific immunotherapy of allergies, but it mediates tissue damage in autoimmune pemphigus vulgaris and "IgG4-related disease." Approximately half of the circulating IgG4 molecules are bispecific owing to their unique ability to exchange half-molecules. Better understanding of the interrelation between IgG4 and IgE repertoires may yield insight into the pathogenesis of allergies and into potential novel therapies that modulate IgG4 responses. We aimed to compare the selective forces that forge the IgG4 and IgE repertoires in allergic asthma. Using an IgG4-specific RT-PCR, we amplified, cloned, and sequenced IgG4 H chain transcripts of PBMCs from 10 children with allergic asthma. We obtained 558 functional IgG4 sequences, of which 286 were unique. Compared with previously published unique IgE transcripts from the same blood samples, the somatic mutation rate was significantly enhanced in IgG4 transcripts (62 versus 83%; p < 0.001), whereas fewer IgG4 sequences displayed statistical evidence of Ag-driven selection (p < 0.001). On average, the hypervariable CDRH3 region was four nucleotides shorter in IgG4 than in IgE transcripts (p < 0.001). IgG4 transcripts in the circulation of children with allergic asthma reflect some characteristics of classical Ag-driven B2 immune responses but display less indication of Ag selection than do IgE transcripts. Although allergen-specific IgG4 can block IgE-mediated allergen presentation and degranulation of mast cells, key factors that influence the Ag-binding properties of the Ab differ between the overall repertoires of circulating IgG4- and IgE-expressing cells.
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Affiliation(s)
- Tobias Rogosch
- Department of Pediatrics, Philipps-University Marburg, D-35033 Marburg, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, St. Hedwig Campus, 93053 Regensburg, Germany; and
| | - Friederike Dey
- Department of Pediatrics, Philipps-University Marburg, D-35033 Marburg, Germany
| | | | - Zhixin Zhang
- Department of Pathology and Microbiology, Eppley Institute for Research in Cancer, University of Nebraska Medical Center, Omaha, NE 68198
| | - Rolf F Maier
- Department of Pediatrics, Philipps-University Marburg, D-35033 Marburg, Germany
| | - Michael Zemlin
- Department of Pediatrics, Philipps-University Marburg, D-35033 Marburg, Germany;
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27
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Schieck M, Michel S, Suttner K, Illig T, Zeilinger S, Franke A, Vogelberg C, von Berg A, Bufe A, Heinzmann A, Laub O, Rietschel E, Simma B, Frischer T, Genuneit J, Kerzel S, Kabesch M. Genetic variation in TH17 pathway genes, childhood asthma, and total serum IgE levels. J Allergy Clin Immunol 2013; 133:888-91. [PMID: 24184148 DOI: 10.1016/j.jaci.2013.08.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/04/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Maximilian Schieck
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany; Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Sven Michel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany; Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Kathrin Suttner
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany; ZAUM - Center of Allergy and Environment, Technische Universität München and Helmholtz Center Munich, Munich, Germany; German Lung Research Center (DZL), Germany
| | - Thomas Illig
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany; Research Unit of Molecular Epidemiology, Helmholtz Center Munich, Neuherberg, Germany
| | - Sonja Zeilinger
- Research Unit of Molecular Epidemiology, Helmholtz Center Munich, Neuherberg, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Christian Vogelberg
- University Children's Hospital, Technical University Dresden, Dresden, Germany
| | - Andrea von Berg
- Research Institute for the Prevention of Allergic Diseases, Children's Department, Marien-Hospital, Wesel, Germany
| | - Albrecht Bufe
- Department of Experimental Pneumology, Ruhr-University, Bochum, Germany
| | - Andrea Heinzmann
- University Children's Hospital, Albert Ludwigs University, Freiburg, Germany
| | - Otto Laub
- Kinder- und Jugendarztpraxis Laub, Rosenheim, Germany
| | - Ernst Rietschel
- University Children's Hospital, University of Cologne, Cologne, Germany
| | - Burkhard Simma
- Children's Department, University Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | | | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany; Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany; German Lung Research Center (DZL), Germany.
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Rogosch T, Kerzel S, Hoss K, Hoersch G, Zemlin C, Heckmann M, Berek C, Schroeder HW, Maier RF, Zemlin M. IgA response in preterm neonates shows little evidence of antigen-driven selection. J Immunol 2012; 189:5449-56. [PMID: 23105134 DOI: 10.4049/jimmunol.1103347] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
After birth, contact to environmental Ags induces the production of IgA, which represents a first line of defense for the neonate. We sought to characterize the maturation of the repertoire of IgA H chain transcripts in circulating blood B cells during human ontogeny. We found that IgA H chain transcripts were present in cord blood as early as 27 wk of gestation and that the restrictions of the primary Ab repertoire (IgM) persisted in the IgA repertoire. Thus, B cells harboring more "mature" V(H) regions were not preferred for class switch to IgA. Preterm and term neonates expressed a unique IgA repertoire, which was characterized by short CDR-H3 regions, preference of the J(H) proximal D(H)7-27 gene segment, and very few somatic mutations. During the first postnatal months, these restrictions were slowly released. Preterm birth did not measurably accelerate the maturation of the IgA repertoire. At a postconceptional age of 60 wk, somatic mutation frequency of IgA H chain transcripts reached 25% of the adult values but still showed little evidence of Ag-driven selection. These results indicate that similar to IgG, the IgA repertoire expands in a controlled manner after birth. Thus, the IgA repertoire of the newborn has distinctive characteristics that differ from the adult IgA repertoire. These observations might explain the lower affinity and specificity of neonatal IgA Abs, which could contribute to a higher susceptibility to infections and altered responses to vaccinations, but might also prevent the development of autoimmune and allergic diseases.
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Affiliation(s)
- Tobias Rogosch
- Department of Pediatrics, Philipps University Marburg, 35033 Marburg, Germany
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Rogosch T, Kerzel S, Hoi KH, Zhang Z, Maier RF, Ippolito GC, Zemlin M. Immunoglobulin analysis tool: a novel tool for the analysis of human and mouse heavy and light chain transcripts. Front Immunol 2012; 3:176. [PMID: 22754554 PMCID: PMC3384897 DOI: 10.3389/fimmu.2012.00176] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [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: 04/27/2012] [Accepted: 06/10/2012] [Indexed: 11/15/2022] Open
Abstract
Sequence analysis of immunoglobulin (Ig) heavy and light chain transcripts can refine categorization of B cell subpopulations and can shed light on the selective forces that act during immune responses or immune dysregulation, such as autoimmunity, allergy, and B cell malignancy. High-throughput sequencing yields Ig transcript collections of unprecedented size. The authoritative web-based IMGT/HighV-QUEST program is capable of analyzing large collections of transcripts and provides annotated output files to describe many key properties of Ig transcripts. However, additional processing of these flat files is required to create figures, or to facilitate analysis of additional features and comparisons between sequence sets. We present an easy-to-use Microsoft® Excel® based software, named Immunoglobulin Analysis Tool (IgAT), for the summary, interrogation, and further processing of IMGT/HighV-QUEST output files. IgAT generates descriptive statistics and high-quality figures for collections of murine or human Ig heavy or light chain transcripts ranging from 1 to 150,000 sequences. In addition to traditionally studied properties of Ig transcripts – such as the usage of germline gene segments, or the length and composition of the CDR-3 region – IgAT also uses published algorithms to calculate the probability of antigen selection based on somatic mutational patterns, the average hydrophobicity of the antigen-binding sites, and predictable structural properties of the CDR-H3 loop according to Shirai’s H3-rules. These refined analyses provide in-depth information about the selective forces acting upon Ig repertoires and allow the statistical and graphical comparison of two or more sequence sets. IgAT is easy to use on any computer running Excel® 2003 or higher. Thus, IgAT is a useful tool to gain insights into the selective forces and functional properties of small to extremely large collections of Ig transcripts, thereby assisting a researcher to mine a data set to its fullest.
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Affiliation(s)
- Tobias Rogosch
- Department of Pediatrics, Philipps-University Marburg Marburg, Germany
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Kerzel S, Zemlin M, Rogosch T, Ollert M, Renz H, Klaus G, Maier RF. Plasmapheresis prior to omalizumab administration in a 15-year-old boy with severe asthma and very high IgE levels: sustained effect over 2 years. Klin Padiatr 2011; 223:356-9. [PMID: 22012605 DOI: 10.1055/s-0031-1287824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Anti-IgE therapy with omalizumab is an innovative therapy option in patients with severe allergic asthma. However, many patients are excluded from this treatment due to very high serum IgE levels which lie above the weight-dependent cut-off for a reasonable omalizumab administration (700 kU/l). OBJECTIVE We sought to evaluate whether a preceding plasma exchange is suitable to establish the starting basis for a subsequent anti-IgE therapy in a 15 year-old boy with steroid-resistant unstable allergic asthma whose pretreatment serum IgE levels ranged between 3 000 and 8 000 kU/l. METHODS Our aim was to create a period with relatively low IgE serum concentrations, which could be overridden by a high dose of omalizumab. 3 sessions of plasmapheresis were performed and 3×3 000 ml plasma were exchanged against albumin solution. RESULTS We removed an absolute amount of 8 650 kU total IgE. During plasmapheresis, serum IgE levels markedly declined and fell below 500 kU/l. Immediately after the third plasma exchange, we started omalizumab therapy. As expected, total IgE levels began to rise again upon cessation of plasmapheresis, and after 2 months the pre-treatment values were reached. In contrast, serum concentrations of free IgE remained stable on a level of about 80 kU/l during the whole observation period. During this period, the boy displayed a considerable improvement of asthma control and an increase in quality of life. In addition, his previously poor lung function normalized. CONCLUSIONS Plasmapheresis prior to omalizumab administration is suitable to temporarily reduce grossly elevated serum IgE levels and might facilitate anti-IgE therapy in selected patients previously considered not suitable for this therapy.
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Affiliation(s)
- S Kerzel
- Department of Pediatrics, Philipps-University, Marburg, Germany.
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Kerzel S, Rogosch T, Wagner J, Preisser K, Yildirim AÖ, Fehrenbach H, Garn H, Maier RF, Schroeder HW, Zemlin M. A single DH gene segment is sufficient for the establishment of an asthma phenotype in a murine model of allergic airway inflammation. Int Arch Allergy Immunol 2011; 156:247-58. [PMID: 21720170 DOI: 10.1159/000323527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 12/06/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We have previously shown that the allergic sensitization to ovalbumin does not represent a superantigen-like immune response. In gene-targeted mice (ΔD-iD) with a single modified Diversity gene segment (D(H)) of the immunoglobulin heavy chain, enriched for charged amino acids, the asthma phenotype in a murine model was markedly alleviated compared to wild-type animals. OBJECTIVE We now sought to determine whether the confinement to a single D(H) gene segment alone leads to a reduced allergic phenotype. METHODS We examined another gene-targeted mouse strain (ΔD-DFL) with a single D(H) gene segment which encodes for neutral amino acids, thus reflecting the preferential repertoire in wild-type mice. Mice were sensitized intraperitoneally to ovalbumin. RESULTS Despite the constraint to a single D(H) gene segment, ΔD-DFL mice mounted high total and allergen-specific IgG(1) and IgE serum levels after sensitization to ovalbumin. The affinity constants of allergen-specific IgG(1) antibodies did not differ between ΔD-DFL and wild type. Following challenge with aerosolized allergen, a marked local T(H)2 cytokine response and an eosinophilic airway inflammation developed. Quantitative histology revealed increased mucus production and intense goblet cell metaplasia which were identical to those in wild type. Moreover, ΔD-DFL mice developed an airway hyperreactivity to methacholine and to the specific allergen, which both did not differ from those in wild-type animals. CONCLUSION A single D(H) gene segment is sufficient for the establishment of the asthma phenotype in a murine model of allergic airway inflammation. Thus, the allergic phenotype depends on the amino acid composition and not on the diversity of the classical antigen-binding site.
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Affiliation(s)
- Sebastian Kerzel
- Department of Pediatrics, Philipps University, Marburg, Germany.
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Rogosch T, Kerzel S, Hoß K, Hörsch G, Maier RF, Zemlin M. Postnatale Reifung des IgA Repertoires bei Frühgeborenen. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Raker V, Maxeiner J, Montermann E, Grabbe S, Taube C, Reske-Kunz A, Sudowe S, Hahn C, Mösges R, Böhm M, Becker B, Kostev K, Kothe A, Köberlein J, Koerner-Rettberg C, Heesen I, Rothoeft T, Hamelmann E, Ballmann M, Eitenmüller A, Piano L, Glowania A, Klimek L, Weber R, Hermelingmeier K, Heubach C, Koschel D, Weber CN, Höffken G, Buhl T, Meynberg H, Kaune K, Hünecke P, Schön M, Fuchs T, Pfützner W, Kneisel A, Kerzel S, Zemlin M, Kettner J, Lehnigk U, Häfner D, Narkus A. Atemwege. Allergo J 2011. [DOI: 10.1007/bf03362413] [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: 10/21/2022]
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Kerzel S, Rogosch T, Struecker B, Maier RF, Zemlin M. IgE transcripts in the circulation of allergic children reflect a classical antigen-driven B cell response and not a superantigen-like activation. J Immunol 2010; 185:2253-60. [PMID: 20660349 DOI: 10.4049/jimmunol.0902942] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Allergic asthma is the most frequent chronic disorder in childhood. Although IgE is a central effector molecule in allergic diseases, the nature of the IgE response is still under debate. The objective of our study was to clarify whether the IgE repertoire in the circulation of allergic children represents a classical Ag-driven and oligoclonal B cell response, a superantigen-like activation of a subset of B cells, or a polyclonal B-1 cell expansion. Using a highly sensitive RT-PCR method, we amplified, cloned, and sequenced IgE H chain transcripts from 13 children with allergic asthma. We gained 1366 functional IgE sequences, which currently represent the most extensive collection of human IgE transcripts. Compared to IgM transcripts from the same children, the somatic mutation rate was significantly enhanced in IgE transcripts (21 per thousand versus 72 per thousand; p < 0.001), which renders a polyclonal B-1 response unlikely. Moreover, IgE sequences displayed significantly enhanced Ag selection and hence were indicative of a classical Ag-driven immune response with affinity maturation (p < 0.001). In contrast to several recent studies, the usage pattern of variable gene segment of the H Ig chain in IgE transcripts followed the germline complexity, arguing against a superantigen-like interaction. We conclude that IgE transcripts in the circulation of children with allergic asthma reflect a classical adaptive B-2 cell response. This study provides reference data for a better characterization of the IgE response under immunomodulating therapies, such as anti-IgE therapy or allergen-specific immunotherapy.
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Affiliation(s)
- Sebastian Kerzel
- Department of Pediatrics, Philipps-University Marburg, Marburg, Germany.
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Rogosch T, Kerzel S, Sikula L, Gentil K, Liebetruth M, Schlingmann KP, Maier RF, Zemlin M. Plasma Cells and Nonplasma B Cells Express Differing IgE Repertoires in Allergic Sensitization. J I 2010; 184:4947-54. [DOI: 10.4049/jimmunol.0900859] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Michels J, Kerzel S, Gronow A, Maier RF, Haas H, Zemlin M. Das „Interleukin–4-induzierende Prinzip“ von Schistosoma mansoni-Eiern (IPSE) ist ein B-Zell-Superantigen. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rogosch T, Kerzel S, Sikula L, Schlingmann KP, Maier RF, Zemlin M. Plasmazellen und Gedächtnis-B-Zellen exprimieren nach allergischer Sensibilisierung unterschiedliche Immunglobulin E-Repertoires. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Strücker B, Rogosch T, Maier RF, Zemlin M, Kerzel S. Molekulare Charakterisierung der IgE-Antwort bei Kindern mit allergischem Asthma bronchiale. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Maskow C, Kerzel S, Rogosch T, Maier RF, Zemlin M. Analyse von B-lymphozytären Subpopulationen des darmassoziierten lymphatischen Gewebes. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kerzel S, Preißer K, Rogosch T, Schroeder Jr. HW, Maier RF, Zemlin M. Die Atemwegshyperreagibilität in einem Mausmodell des allergischen Asthma wird durch Modifikationen der klassischen Antigen-Bindungsstelle verhindert. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dey F, Kerzel S, Maier RF, Zemlin M, Rogosch T. IgG4-Antikörper werden anhand ihrer Affinität selektiert und können mit IgE um die Bindung am Allergen konkurrieren. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kerzel S, Zemlin M, Rogosch T, Klaus G, Maier RF. Plasmapherese ermöglicht eine Omalizumab-Therapie bei einem jugendlichen Asthma Patienten mit sehr hohen IgE-Serumspiegeln. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kerzel S, Wagner J, Rogosch T, Schroeder Jr. HW, Maier RF, Zemlin M. Ein singuläres DH Gen-Segment ist ausreichend für die Entwicklung eines Asthma-Phänotyps in einen murinen Modell der allergischen Atemwegsentzündung. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dehne J, Rogosch T, Maier RF, Zemlin M, Kerzel S. Allergische Kinder besitzen veränderte Lymphozyten-Subpopulationen. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Meyer K, Rogosch T, Maier RF, Zemlin M, Kerzel S. Charakterisierung des IgE-Repertoires der Milz und Lunge in einem murinen Modell des Asthma bronchiale. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Liebetruth M, Rogosch T, Gentil K, Maier RF, Zemlin M, Kerzel S. Eine Infektion mit Litomosoides sigmodontis reduziert die akute allergische Atemwegsentzündung im murinen Asthma-Modell. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abram M, Wegmann M, Fokuhl V, Sonar S, Luger EO, Kerzel S, Radbruch A, Renz H, Zemlin M. Nerve growth factor and neurotrophin-3 mediate survival of pulmonary plasma cells during the allergic airway inflammation. J Immunol 2009; 182:4705-12. [PMID: 19342646 DOI: 10.4049/jimmunol.0802814] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Allergen-specific Abs play a pivotal role in the induction and maintenance of allergic airway inflammation. During secondary immune responses, plasma cell survival and Ab production is mediated by extrinsic factors provided by the local environment (survival niches). It is unknown whether neurotrophins, a characteristic marker of allergic airway inflammation, influence plasma cell survival in the lung. Using a mouse model of allergic asthma, we found that plasma cells from the lung and spleen are distinct subpopulations exhibiting differential expression patterns of neurotrophins and their receptors (Trks). In vitro, the nerve growth factor (NGF) and neurotrophin-3 (NT3) led to a dose-dependent increase in viability of isolated pulmonary plasma cells due to up-regulation of the antiapoptotic Bcl2 pathway. In parallel, the expression of transcription factors that stimulate the production of immunoglobulins (X-box binding protein 1 and NF-kappaB subunit RelA) was enhanced in plasma cells treated with NGF and NT3. These findings were supported in vivo. When the NGF pathway was blocked by intranasal application of a selective TrkA inhibitor, sensitized mice showed reduced numbers of pulmonary plasma cells and developed lower levels of allergen-specific and total serum IgE in response to OVA inhalation. This suggests that in the allergic airway inflammation, NGF/TrkA-mediated pulmonary IgE production contributes significantly to serum-IgE levels. We conclude that the neurotrophins NGF and NT3 act as survival factors for pulmonary plasma cells and thus are important regulators of the local Ab production in the allergic airway disease.
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Affiliation(s)
- Melanie Abram
- Department of Clinical Chemistry and Molecular Diagnostics, Philipps-University Marburg, Marburg, Germany
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Kerzel S, Zemlin M, Kömhoff M, Klaus G, Maier RF. Hyperferritinemia as the Diagnostic Clue in Life-Threatening Hemophagocytic Lymphohistiocytosis. Klin Padiatr 2009; 221:318-21. [DOI: 10.1055/s-0028-1104596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kerzel S, Wagner J, Rogosch T, Yildirim AO, Sikula L, Fehrenbach H, Garn H, Maier RF, Schroeder HW, Zemlin M. Composition of the immunoglobulin classic antigen-binding site regulates allergic airway inflammation in a murine model of experimental asthma. Clin Exp Allergy 2009; 39:591-601. [PMID: 19220320 DOI: 10.1111/j.1365-2222.2008.03178.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND When bound to mast cell FcepsilonRI, IgE serves as antigen receptor for allergic reactions, permitting specific identification of the allergen. Although the core of the classic antigen-binding site is heavy chain complementarity determining region 3 (CDR-H3), recent studies suggest that allergens might also bind IgE in a superantigen-like fashion outside the classic antigen-binding site. OBJECTIVE We sought to evaluate the contribution of the classic CDR-H3-centric antigen-binding site to the development of an allergic phenotype. METHODS Using a murine model of experimental asthma, we characterized a gene-targeted mouse strain expressing an altered range of CDR-H3s (DeltaD-iD mice) in response to the hydrophobic allergen ovalbumin (OVA). Mutant and wild-type (wt) mice were sensitized intraperitoneally with OVA; non-sensitized mice served as controls. RESULTS We found the composition of the classic CDR-H3-centric antigen-binding site to be critical for the development of characteristic aspects of allergic asthma. (i) Compared with wt animals, DeltaD-iD mice showed a significantly less pronounced OVA-induced rise in allergen-specific IgE levels and hence in total serum IgE levels. (ii) In addition, DeltaD-iD mice demonstrated a significant reduction in eosinophilic airway inflammation, as well as in interleukin-4 (IL-4), IL-5 and IL-13 levels in BAL fluids. CONCLUSION Allergic sensitization and airway inflammation depend on the composition of the predominant CDR-H3 repertoire, suggesting that the classic CDR-H3-centric antigen-binding site plays a crucial role in creating the immunological interface between allergen and IgE. Our results further emphasize a central role of IgE, not only in mediating but also in regulating the allergic immune response.
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Affiliation(s)
- S Kerzel
- Department of Pediatrics, Zentrum für Kinder- und Jugendmedizin, Philipps-University Marburg, Marburg, Germany.
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Bauer K, Hummel M, Berek C, Paar C, Rosenberger C, Kerzel S, Versmold H, Zemlin M. Homology-directed recombination in IgH variable region genes from human neonates, infants and adults: implications for junctional diversity. Mol Immunol 2007; 44:2969-77. [PMID: 17292963 DOI: 10.1016/j.molimm.2007.01.003] [Citation(s) in RCA: 5] [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] [Received: 06/19/2006] [Revised: 12/28/2006] [Accepted: 01/03/2007] [Indexed: 11/19/2022]
Abstract
Homology-directed recombination, i.e. the preferential joining of gene segments at short sequence homologies, is found in 80% of IgH variable region genes from neonatal mice and causes a marked uniformity of their VH-DH- and DH-JH-junctions, which are predominated by one to three junctional sequences. To analyze the impact of homology-directed recombination on IgH gene diversity in humans, IgH rearrangements from fetuses and neonates (gestational age 20-42 weeks), infants (age 1-27 months) and adults were cloned and sequenced. As a marker of homology-directed recombination the VH-DH- and DH-JH-junctions were searched for nucleotides that could have been encoded by each of the two adjacent gene segments. Such overlapping sequences were rare (<3%) in VH-DH-junctions from newborns, infants, and adults. In contrast, overlapping sequences were found in 30% of the DH-JH-junctions from preterm neonates. Their frequency decreased with age to 19% in term neonates, 12% in infants and 4% in adults (p<0.001). Our analysis of the five most common DH-JH-combinations in neonates demonstrated that overlapping nucleotides reduced diversity: only 48% of junctions with overlapping nucleotides were different compared to 99% of junctions with N-insertions between DH and JH (p<0.001). However, homology-directed recombination had a much smaller effect on overall junctional diversity in human neonates than in neonatal mice because it rarely occurred in VH-DH-junctions and affected only 19% (term neonates) to 30% (preterm neonates) of the DH-JH-junctions. Therefore, unlike in mice, homology-directed recombination does not cause junctional uniformity in human neonates.
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Affiliation(s)
- Karl Bauer
- Department of Pediatrics, JW Goethe University, Frankfurt, Germany
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