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Al Tabosh T, Liu H, Koça D, Al Tarrass M, Tu L, Giraud S, Delagrange L, Beaudoin M, Rivière S, Grobost V, Rondeau-Lutz M, Dupuis O, Ricard N, Tillet E, Machillot P, Salomon A, Picart C, Battail C, Dupuis-Girod S, Guignabert C, Desroches-Castan A, Bailly S. Impact of heterozygous ALK1 mutations on the transcriptomic response to BMP9 and BMP10 in endothelial cells from hereditary hemorrhagic telangiectasia and pulmonary arterial hypertension donors. Angiogenesis 2024; 27:211-227. [PMID: 38294582 PMCID: PMC11021321 DOI: 10.1007/s10456-023-09902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/03/2023] [Indexed: 02/01/2024]
Abstract
Heterozygous activin receptor-like kinase 1 (ALK1) mutations are associated with two vascular diseases: hereditary hemorrhagic telangiectasia (HHT) and more rarely pulmonary arterial hypertension (PAH). Here, we aimed to understand the impact of ALK1 mutations on BMP9 and BMP10 transcriptomic responses in endothelial cells. Endothelial colony-forming cells (ECFCs) and microvascular endothelial cells (HMVECs) carrying loss of function ALK1 mutations were isolated from newborn HHT and adult PAH donors, respectively. RNA-sequencing was performed on each type of cells compared to controls following an 18 h stimulation with BMP9 or BMP10. In control ECFCs, BMP9 and BMP10 stimulations induced similar transcriptomic responses with around 800 differentially expressed genes (DEGs). ALK1-mutated ECFCs unexpectedly revealed highly similar transcriptomic profiles to controls, both at the baseline and upon stimulation, and normal activation of Smad1/5 that could not be explained by a compensation in cell-surface ALK1 level. Conversely, PAH HMVECs revealed strong transcriptional dysregulations compared to controls with > 1200 DEGs at the baseline. Consequently, because our study involved two variables, ALK1 genotype and BMP stimulation, we performed two-factor differential expression analysis and identified 44 BMP9-dysregulated genes in mutated HMVECs, but none in ECFCs. Yet, the impaired regulation of at least one hit, namely lunatic fringe (LFNG), was validated by RT-qPCR in three different ALK1-mutated endothelial models. In conclusion, ALK1 heterozygosity only modified the BMP9/BMP10 regulation of few genes, including LFNG involved in NOTCH signaling. Future studies will uncover whether dysregulations in such hits are enough to promote HHT/PAH pathogenesis, making them potential therapeutic targets, or if second hits are necessary.
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Affiliation(s)
- T Al Tabosh
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - H Liu
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - D Koça
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - M Al Tarrass
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - L Tu
- Faculté de Médecine, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Université Paris-Saclay, 94276, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, 92350, Le Plessis-Robinson, France
| | - S Giraud
- Genetics Department, Femme-Mère-Enfants Hospital, Hospices Civils de Lyon, 69677, Bron, France
| | - L Delagrange
- Genetics Department, Femme-Mère-Enfants Hospital, Hospices Civils de Lyon, 69677, Bron, France
- National Reference Center for HHT, 69677, Bron, France
| | - M Beaudoin
- Genetics Department, Femme-Mère-Enfants Hospital, Hospices Civils de Lyon, 69677, Bron, France
- National Reference Center for HHT, 69677, Bron, France
| | - S Rivière
- Internal Medicine Department, CHU of Montpellier, St Eloi Hospital and Center of Clinical Investigation, INSERM, CIC 1411, 34295, Montpellier Cedex 7, France
| | - V Grobost
- Internal Medicine Department, CHU Estaing, 63100, Clermont-Ferrand, France
| | - M Rondeau-Lutz
- Internal Medicine Department, University Hospital of Strasbourg, 67091, Strasbourg Cedex, France
| | - O Dupuis
- Hôpital Lyon SUD, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69100, Villeurbanne, France
- Faculty of Medicine, Lyon University, 69921, Lyon, France
| | - N Ricard
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - E Tillet
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - P Machillot
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - A Salomon
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - C Picart
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - C Battail
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - S Dupuis-Girod
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
- Genetics Department, Femme-Mère-Enfants Hospital, Hospices Civils de Lyon, 69677, Bron, France
- National Reference Center for HHT, 69677, Bron, France
| | - C Guignabert
- Faculté de Médecine, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Université Paris-Saclay, 94276, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 «Pulmonary Hypertension: Pathophysiology and Novel Therapies», Hôpital Marie Lannelongue, 92350, Le Plessis-Robinson, France
| | - A Desroches-Castan
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France
| | - S Bailly
- Biosanté unit U1292, Grenoble Alpes University, INSERM, CEA, 38000, Grenoble, France.
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Delpon JE, Greffier J, Lacombe H, Barbe A, Bouin M, De Oliveira F, Mansuy A, Delagrange L, Fargeton AE, Beregi JP, Cottin V, Dupuis-Girod S, Si-Mohamed SA. Ultra-low dose chest CT for the diagnosis of pulmonary arteriovenous malformation in patients with hereditary hemorrhagic telangiectasia. Diagn Interv Imaging 2024:S2211-5684(24)00082-2. [PMID: 38604894 DOI: 10.1016/j.diii.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE The purpose of this study was to compare ultra-low dose (ULD) and standard low-dose (SLD) chest computed tomography (CT) in terms of radiation exposure, image quality and diagnostic value for diagnosing pulmonary arteriovenous malformation (AVM) in patients with hereditary hemorrhagic telangiectasia (HHT). MATERIALS AND METHODS In this prospective board-approved study consecutive patients with HHT referred to a reference center for screening and/or follow-up chest CT examination were prospectively included from December 2020 to January 2022. Patients underwent two consecutive non-contrast chest CTs without dose modulation (i.e., one ULD protocol [80 kVp or 100 kVp, CTDIvol of 0.3 mGy or 0.6 mGy] and one SLD protocol [140 kVp, CTDIvol of 1.3 mGy]). Objective image noises measured at the level of tracheal carina were compared between the two protocols. Overall image quality and diagnostic confidence were scored on a 4-point Likert scale (1 = insufficient to 4 = excellent). Sensitivity, specificity, positive predictive value and negative predictive value of ULD CT for diagnosing pulmonary AVM with a feeding artery of over 2 mm in diameter were calculated along with their 95% confidence intervals (CI) using SLD images as the standard of reference. RESULTS A total of 44 consecutive patients with HHT (31 women; mean age, 42 ± 16 [standard deviation (SD)] years; body mass index, 23.2 ± 4.5 [SD] kg/m2) were included. Thirty-four pulmonary AVMs with a feeding artery of over 2 mm in diameter were found with SLD images versus 35 with ULD images. Sensitivity, specificity, predictive positive value, and predictive negative value of ULD CT for the diagnosis of PAVM were 100% (34/34; 95% CI: 90-100), 96% (18/19; 95% CI: 74-100), 97% (34/35; 95% CI: 85-100) and 100% (18/18; 95% CI: 81-100), respectively. A significant difference in diagnostic confidence scores was found between ULD (3.8 ± 0.4 [SD]) and SLD (3.9 ± 0.1 [SD]) CT images (P = 0.03). No differences in overall image quality scores were found between ULD CT examinations (3.9 ± 0.2 [SD]) and SLD (4 ± 0 [SD]) CT examinations (P = 0.77). Effective radiation dose decreased significantly by 78.8% with ULD protocol, with no significant differences in noise values between ULD CT images (16.7 ± 5.0 [SD] HU) and SLD images (17.7 ± 6.6 [SD] HU) (P = 0.07). CONCLUSION ULD chest CT provides 100% sensitivity and 96% specificity for the diagnosis of treatable pulmonary AVM with a feeding artery of over 2 mm in diameter, leading to a 78.8% dose-saving compared with a standard low-dose protocol.
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Affiliation(s)
- Jean-Etienne Delpon
- Department of Radiology, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Bron, France
| | - Joel Greffier
- Department of Radiology, CHU Nîmes, University Montpellier, Medical Imaging Group Nîmes, 30029 Nîmes, France
| | - Hugo Lacombe
- Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, U1206, 69100 Villeurbanne, France; CT Clinical Science, Philips, 92150 Suresnes, France
| | - Apolline Barbe
- Imaging Department, Cellule Recherche en Imagerie, Hospices Civils de Lyon, 69677 Bron, France
| | - Morgane Bouin
- Imaging Department, Cellule Recherche en Imagerie, Hospices Civils de Lyon, 69677 Bron, France
| | - Fabien De Oliveira
- Department of Radiology, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Bron, France; Department of Radiology, CHU Nîmes, University Montpellier, Medical Imaging Group Nîmes, 30029 Nîmes, France
| | - Adeline Mansuy
- Imaging Department, Cellule Recherche en Imagerie, Hospices Civils de Lyon, 69677 Bron, France
| | - Laura Delagrange
- Imaging Department, Cellule Recherche en Imagerie, Hospices Civils de Lyon, 69677 Bron, France
| | - Anne-Emmanuelle Fargeton
- Department of Genetics and Centre National de Référence pour la Maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, 69677 Bron, France
| | - Jean-Paul Beregi
- Department of Radiology, CHU Nîmes, University Montpellier, Medical Imaging Group Nîmes, 30029 Nîmes, France
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon, INRAE, ERN-LUNG, Lyon, France
| | - Sophie Dupuis-Girod
- Department of Genetics and Centre National de Référence pour la Maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, 69677 Bron, France
| | - Salim Aymeric Si-Mohamed
- Department of Radiology, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677, Bron, France; Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, INSERM, CREATIS UMR 5220, U1206, 69100 Villeurbanne, France.
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Caillot C, Saurin JC, Hervieu V, Faoucher M, Reversat J, Decullier E, Poncet G, Bailly S, Giraud S, Dupuis-Girod S. Phenotypic characterisation of SMAD4 variant carriers. J Med Genet 2024:jmg-2023-109632. [PMID: 38575304 DOI: 10.1136/jmg-2023-109632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Both hereditary haemorrhagic telangiectasia (HHT) and juvenile polyposis syndrome (JPS) are known to be caused by SMAD4 pathogenic variants, with overlapping symptoms for both disorders in some patients. Additional connective tissue disorders have also been reported. Here, we describe carriers of SMAD4 variants followed in an HHT reference centre to further delineate the phenotype. METHODS Observational study based on data collected from the Clinical Investigation for the Rendu-Osler Cohort database. RESULTS Thirty-three participants from 15 families, out of 1114 patients with HHT, had an SMAD4 variant (3%).Regarding HHT, 26 out of 33 participants (88%) had a definite clinical diagnosis based on Curaçao criteria. Complication frequencies were as follows: epistaxis (n=27/33, 82%), cutaneous telangiectases (n=19/33, 58%), pulmonary arteriovenous malformations (n=17/32, 53%), hepatic arteriovenous malformations (AVMs) (n=7/18, 39%), digestive angiodysplasia (n=13/22, 59%). No cerebral AVMs were diagnosed.Regarding juvenile polyposis, 25 out of 31 participants (81%) met the criteria defined by Jass et al for juvenile polyposis syndrome. Seven patients (21%) had a prophylactic gastrectomy due to an extensive gastric polyposis incompatible with endoscopic follow-up, and four patients (13%) developed a digestive cancer.Regarding connective tissue disorders, 20 (61%) had at least one symptom, and 4 (15%) participants who underwent echocardiography had an aortic dilation. CONCLUSION We describe a large cohort of SMAD4 variant carriers in the context of HHT. Digestive complications are frequent, early and diffuse, justifying endoscopy every 2 years. The HHT phenotype, associating pulmonary and hepatic AVMs, warrants systematic screening. Connective tissue disorders broaden the phenotype associated with SMAD4 gene variants and justify systematic cardiac ultrasound and skeletal complications screening.
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Affiliation(s)
- Claire Caillot
- Service de Génétique et Centre de référence pour la maladie de Rendu-Osler, Femme-Mère-Enfants Hospital, Hospices Civils de Lyon, Bron, France
| | - Jean-Christophe Saurin
- Service de Gastroenterologie, Hôpital E. Herriot, Hospices Civils de Lyon, Lyon, France
- Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Valérie Hervieu
- Institut de Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Marie Faoucher
- Service de génétique, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Julie Reversat
- Service de génétique, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Evelyne Decullier
- Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Gilles Poncet
- Université Claude Bernard Lyon 1, Villeurbanne, France
- Service de Chirurgie Digestive, Hôpital E. Herriot Lyon, Hospices Civils de Lyon, Lyon, France
| | - Sabine Bailly
- Biosanté Lab, Unit U1292, Health Department of IRIG, CEA de Grenoble, Grenoble, France
| | - Sophie Giraud
- Service de génétique, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Sophie Dupuis-Girod
- Service de Génétique et Centre de référence pour la maladie de Rendu-Osler, Femme-Mère-Enfants Hospital, Hospices Civils de Lyon, Bron, France
- Biosanté Lab, Unit U1292, Health Department of IRIG, CEA de Grenoble, Grenoble, France
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4
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Tusseau M, Eyries M, Chatron N, Coulet F, Guichet A, Colin E, Demeer B, Maillard H, Thevenon J, Lavigne C, Saillour V, Paris C, De Sainte Agathe JM, Pujalte M, Guilhem A, Dupuis-Girod S, Lesca G. Genome sequencing identify chromosome 9 inversions disrupting ENG in 2 unrelated HHT families. Eur J Med Genet 2024; 68:104919. [PMID: 38355093 DOI: 10.1016/j.ejmg.2024.104919] [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: 07/25/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber disease, is a dominant inherited vascular disorder. The clinical diagnosis is based on the Curaçao criteria and pathogenic variants in the ENG and ACVRL1 genes are responsible for most cases of HHT. Four families with a negative targeted gene panel and selected by a multidisciplinary team were selected and whole-genome sequencing was performed according to the recommendations of the French National Plan for Genomic Medicine. Structural variations were confirmed by standard molecular cytogenetic analysis (FISH). In two families with a definite diagnosis of HHT, we identified two different paracentric inversions of chromosome 9, both disrupting the ENG gene. These inversions are considered as pathogenic and causative for the HHT phenotype of the patients. This is the first time structural variations are reported to cause HHT. As such balanced events are often missed by exon-based sequencing (panel, exome), structural variations may be an under-recognized cause of HHT. Genome sequencing for the detection of these events could be suggested for patients with a definite diagnosis of HHT and in whom no causative pathogenic variant was identified.
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Affiliation(s)
- M Tusseau
- Hospices Civils de Lyon, Department of Medical Genetics and National HHT Reference Center, University Hospital of Lyon, Lyon, France; Laboratoire AURAGEN, Lyon, France
| | - M Eyries
- Department of Medical Genetics, AP-HP Sorbonne University, Paris, France; Laboratoire Multisites SeqOIA, Paris, France
| | - N Chatron
- Hospices Civils de Lyon, Department of Medical Genetics and National HHT Reference Center, University Hospital of Lyon, Lyon, France; Laboratoire AURAGEN, Lyon, France
| | - F Coulet
- Department of Medical Genetics, AP-HP Sorbonne University, Paris, France; Laboratoire Multisites SeqOIA, Paris, France
| | - A Guichet
- Service de Génétique Médicale, CHU D'Angers, Angers, France
| | - E Colin
- Service de Génétique Médicale, CHU D'Angers, Angers, France
| | - B Demeer
- Genetics Department, CLAD Nord de France, CHU Amiens, France; CHIMERE, UR UPJV 7516, Université Picardie Jules Verne, Amiens, France
| | - H Maillard
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Rare Systemic Autoimmune Diseases for North and North-West France (CeRAINO), CHU Lille, 59000, Lille, France
| | | | - C Lavigne
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - V Saillour
- Laboratoire Multisites SeqOIA, Paris, France
| | - C Paris
- Laboratoire AURAGEN, Lyon, France
| | - J M De Sainte Agathe
- Department of Medical Genetics, AP-HP Sorbonne University, Paris, France; Laboratoire Multisites SeqOIA, Paris, France
| | - M Pujalte
- Hospices Civils de Lyon, Department of Medical Genetics and National HHT Reference Center, University Hospital of Lyon, Lyon, France; Laboratoire AURAGEN, Lyon, France
| | - A Guilhem
- Hospices Civils de Lyon, Department of Medical Genetics and National HHT Reference Center, University Hospital of Lyon, Lyon, France
| | - S Dupuis-Girod
- Hospices Civils de Lyon, Department of Medical Genetics and National HHT Reference Center, University Hospital of Lyon, Lyon, France
| | - G Lesca
- Hospices Civils de Lyon, Department of Medical Genetics and National HHT Reference Center, University Hospital of Lyon, Lyon, France; Laboratoire AURAGEN, Lyon, France.
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L'Huillier R, Pagnoux G, Dupuis-Girod S, Stacoffe N. Conservative management by embolization of a ruptured renal arterio-venous malformation (AVM) in Hereditary Hemorrhagic Telangiectasia (HHT). CVIR Endovasc 2024; 7:30. [PMID: 38492037 PMCID: PMC10944426 DOI: 10.1186/s42155-024-00444-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Renal arteriovenous malformation (AVM) in Hereditary Hemorrhagic Telangiectasia (HHT) is uncommon and only few cases have been described, mainly with surgical management because of uncontrolled hematuria. CASE PRESENTATION We managed a 70-year-old patient with HHT who presented with hematuria and left flank pain. Computed Tomography and ultrasound showed left renal AVM of 18 mm with clotting in the urinary tract. An external ureteral catheter was placed during 3 days to allow rinsing and facilitate elimination of clots. Given the patient's hemodynamic stability, a non-surgical management was chosen. Treatment of the AVM was performed by trans-arterial embolization using micro-coils and ethylene-vinyl alcohol copolymer. CONCLUSIONS Our case study shows a conservative management by embolization of ruptured left renal AVM revealed by hematuria in a 70-year-old patient with HHT.
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Affiliation(s)
- Romain L'Huillier
- Department of Diagnostic and Interventional Radiology, Hospices Civils de Lyon, University of Lyon, Pavillon B, Hôpital Edouard Herriot, 5 Place D'Arsonval, Lyon, 69003, France.
- LabTAU - Inserm U1032, Lyon, 69003, France.
- The French Comprehensive Liver Center, Hospices Civils de Lyon, University of Lyon, Lyon, 69004, France.
| | - Gaële Pagnoux
- Department of Diagnostic and Interventional Radiology, Hospices Civils de Lyon, University of Lyon, Pavillon B, Hôpital Edouard Herriot, 5 Place D'Arsonval, Lyon, 69003, France
| | - Sophie Dupuis-Girod
- Genetics Department and National, Hospices Civils de Lyon, HHT Reference Center Hôpital Femme-Mère-Enfant, Bron, 69677, France
- Laboratory Biology of Cancer and Infection, Inserm, CEA, Université Grenoble Alpes, Grenoble, France
| | - Nicolas Stacoffe
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, University of Lyon, Pierre-Bénite, 69495, France
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Al Tabosh T, Al Tarrass M, Tourvieilhe L, Guilhem A, Dupuis-Girod S, Bailly S. Hereditary hemorrhagic telangiectasia: from signaling insights to therapeutic advances. J Clin Invest 2024; 134:e176379. [PMID: 38357927 PMCID: PMC10866657 DOI: 10.1172/jci176379] [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] [Indexed: 02/16/2024] Open
Abstract
Hereditary hemorrhagic telangiectsia (HHT) is an inherited vascular disorder with highly variable expressivity, affecting up to 1 in 5,000 individuals. This disease is characterized by small arteriovenous malformations (AVMs) in mucocutaneous areas (telangiectases) and larger visceral AVMs in the lungs, liver, and brain. HHT is caused by loss-of-function mutations in the BMP9-10/ENG/ALK1/SMAD4 signaling pathway. This Review presents up-to-date insights on this mutated signaling pathway and its crosstalk with proangiogenic pathways, in particular the VEGF pathway, that has allowed the repurposing of new drugs for HHT treatment. However, despite the substantial benefits of these new treatments in terms of alleviating symptom severity, this not-so-uncommon bleeding disorder still currently lacks any FDA- or European Medicines Agency-approved (EMA-approved) therapies.
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Affiliation(s)
- Tala Al Tabosh
- Biosanté Unit U1292, Grenoble Alpes University, INSERM, CEA, Grenoble, France
| | - Mohammad Al Tarrass
- Biosanté Unit U1292, Grenoble Alpes University, INSERM, CEA, Grenoble, France
| | - Laura Tourvieilhe
- Hospices Civils de Lyon, National HHT Reference Center and Genetics Department, Femme-Mère-Enfants Hospital, Bron, France
| | - Alexandre Guilhem
- Hospices Civils de Lyon, National HHT Reference Center and Genetics Department, Femme-Mère-Enfants Hospital, Bron, France
- TAI-IT Autoimmunité Unit RIGHT-UMR1098, Burgundy University, INSERM, EFS-BFC, Besancon, France
| | - Sophie Dupuis-Girod
- Biosanté Unit U1292, Grenoble Alpes University, INSERM, CEA, Grenoble, France
- Hospices Civils de Lyon, National HHT Reference Center and Genetics Department, Femme-Mère-Enfants Hospital, Bron, France
| | - Sabine Bailly
- Biosanté Unit U1292, Grenoble Alpes University, INSERM, CEA, Grenoble, France
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Dupuis-Girod S, Rivière S, Lavigne C, Fargeton AE, Gilbert-Dussardier B, Grobost V, Leguy-Seguin V, Maillard H, Mohamed S, Decullier E, Roux A, Bernard L, Saurin JC, Saroul N, Faure F, Cartier C, Altwegg R, Laccourreye L, Oberti F, Beaudoin M, Dhelens C, Desvignes C, Azzopardi N, Paintaud G, Hermann R, Chinet T. Efficacy and safety of intravenous bevacizumab on severe bleeding associated with hemorrhagic hereditary telangiectasia: A national, randomized multicenter trial. J Intern Med 2023; 294:761-774. [PMID: 37592715 DOI: 10.1111/joim.13714] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND Bevacizumab-a humanized monoclonal antibody-has been widely used to treat patients with hereditary hemorrhagic telangiectasia (HHT), but no randomized trial has yet been conducted. METHODS This study is a double-blind multicenter randomized phase 2 trial with a 1:1 active-treatment-to-placebo ratio. We included patients over the age of 18 with a confirmed diagnosis and the need for at least four red blood cell (RBC) units transfused in the 3 months before study enrollment. Bevacizumab was administered at a dose of 5 mg/kg every 14 days with a total of six injections. The primary efficacy criterion was a decrease of at least 50% in the cumulative number of RBC units transfused in a 3-month period before and after treatment. RESULTS A total of 24 patients (12 in each group) were included and randomized at 4 different centers. In intention-to-treat analysis, 63.6% of patients (7/11) in the bevacizumab group versus 33.3% of patients (4/12) in the placebo group decreased the number of blood transfusions by at least 50% (p = 0.22). Hemoglobin levels significantly improved at 6 months in the bevacizumab versus placebo group (p = 0.02). The pharmacokinetics study revealed that patients with high exposure to bevacizumab had a significant decrease in RBC transfusions (p = 0.03). Fifty-nine adverse events were observed, 34 in the placebo arm versus 25 in the bevacizumab arm. CONCLUSION Though the present trial was underpowered, patients with HHT receiving bevacizumab required numerically fewer red blood cell transfusions than those receiving placebo, particularly those with high exposure.
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Affiliation(s)
- Sophie Dupuis-Girod
- Service de Génétique et centre de référence de la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, Bron, France
- Inserm, CEA, Laboratory Biology of Cancer and Infection, Université Grenoble Alpes, Grenoble, France
| | - Sophie Rivière
- Service de Médecine Interne A, Centre Hospitalier Universitaire, Montpellier, France
| | - Christian Lavigne
- Service de médecine interne-Immunologie clinique, CHU d'Angers, Angers cedex 09, France
| | - Anne-Emmanuelle Fargeton
- Service de Génétique et centre de référence de la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, Bron, France
| | | | - Vincent Grobost
- Service de Médecine Interne CHU Estaing, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | | | - Hélène Maillard
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Shirine Mohamed
- Département de Médecine interne et Immunologie Clinique, CHRU BRABOIS, Vandoeuvre-lès-Nancy, France
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- Faculté de médecine, Université Lyon 1, Lyon, France
| | - Adeline Roux
- Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- Faculté de médecine, Université Lyon 1, Lyon, France
| | | | - Jean-Christophe Saurin
- Faculté de médecine, Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service d'Hépato-gastroentérologie, Hôpital E. Herriot, Lyon, France
| | - Nicolas Saroul
- CHU Clermont Ferrand, Hôpital Gabriel Montpied, Service d'ORL, Clermont-Ferrand, France
| | - Frédéric Faure
- Hospices Civils de Lyon, Hôpital E. Herriot, Service d'ORL, Lyon, France
| | - Cesar Cartier
- Service d'ORL Centre Hospitalier Universitaire, Montpellier, France
| | - Romain Altwegg
- Service Hépatogastroentérologie CHU St Eloi, Montpellier, France
| | | | - Frédéric Oberti
- Service Hépatogastroentérologie, UPRES EA 3859, Faculté de médecine, CHU Angers and Laboratoire HIFIH, Angers, France
| | - Marjolaine Beaudoin
- Service de Génétique et centre de référence de la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, Bron, France
| | - Carole Dhelens
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Pharmacie à Usage Intérieur, Lyon, France
| | - Céline Desvignes
- CHRU de Tours, Plateforme Recherche, Centre Pilote de suivi Biologique des traitements par Anticorps (CePiBAc), Tours, France
- EA 4245 Transplantation, Immunologie, Inflammation (T2I), Université de Tours, Tours, France
| | | | - Gilles Paintaud
- EA 4245 Transplantation, Immunologie, Inflammation (T2I), Université de Tours, Tours, France
- Service de Pharmacologie Médicale, CHRU de Tours, Tours, France
| | - Ruben Hermann
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service d'ORL et centre de référence de la maladie de Rendu-Osler, Bron, France
| | - Thierry Chinet
- Centre Rendu-Osler, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Université de Versailles SQY, Boulogne, France
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Eker OF, Dupuis-Girod S, Shovlin CL, Boccardi E. Comment on Kilian et al. Comparing Characteristics and Treatment of Brain Vascular Malformations in Children and Adults with HHT. J. Clin. Med. 2023, 12, 2704. J Clin Med 2023; 12:7179. [PMID: 38002793 PMCID: PMC10672674 DOI: 10.3390/jcm12227179] [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] [Received: 10/04/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
We read with interest the recent article by Killian et al. regarding the characteristics and treatment of brain vascular malformations (VMs) in children and adults with hereditary hemorrhagic telangiectasia (HHT) [...].
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Affiliation(s)
- Omer F. Eker
- Hospices Civils de Lyon, 69006 Lyon, France;
- CREATIS Laboratory, INSA-Lyon, 69621 Villeurbanne, France
| | | | - Claire L. Shovlin
- Imperial College London, London W12 0NN, UK;
- Imperial College Healthcare National Health Service Trust, London W12 0HS, UK
| | - Edoardo Boccardi
- Department of Neuroradiology, Grande Ospedale Maggiore Niguarda, 20162 Milan, Italy;
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9
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Grobost V, Hammi S, Pereira B, Guilhem A, Duffau P, Seguier J, Parrot A, Gautier G, Alric L, Kerjouan M, Le Guillou X, Simon D, Chaussavoine L, Rondeau-Lutz M, Leguy-Seguin V, Delagrange L, Lavigne C, Maillard H, Dupuis-Girod S. Antiplatelet and anticoagulant therapies in hereditary hemorrhagic telangiectasia: A large French cohort study (RETROPLACOTEL). Thromb Res 2023; 229:107-113. [PMID: 37437516 DOI: 10.1016/j.thromres.2023.07.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/02/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND It is unclear whether hereditary hemorrhagic telangiectasia (HHT) patients can tolerate antithrombotic therapies (AT) including antiplatelet (AP) and/or anticoagulant (AC) agents. OBJECTIVES Primary endpoint was tolerance to AT in HHT. Secondary endpoints were to identify factors associated with major bleeding events (MBE) and premature discontinuation of AT. METHODS Retrospective multicenter study in French national HHT Registry patients exposed to AT. RESULTS We included 126 patients with 180 courses of AT. Median follow-up was 24 [11-52] months. Mean age was 65.6 ± 13.1 years. The first 3 months of AT exposure had an increased risk of hospitalization for hemorrhage (p < 0.001) and transfusions (p < 0.001). MBE (n = 63) occurred more frequently in the first 3 months of AT exposure (p < 0.001). Premature discontinuation of AT occurred in 61 cases. Rate of premature discontinuation was 29 % under both AP and AT therapy but significantly higher under dual AP therapy (n = 4/7, 57 % p = 0.008). Risk factors for MBE were: age ≥ 60 years (HR 2.34 [1.12;4.87], p = 0.023), prior hospitalization in the 3 months before starting AT for hemorrhage (HR 3.59 [1.93;6.66], p < 0.001) or transfusion (HR 3.15 [1.61;6.18], p = 0.001), previous history of gastro-intestinal bleeding (HR 2.71 [1.57;4.65], p < 0.001) or MBE (HR 4.62 [2.68;7.98], p < 0.001). Frequency of MBE did not differ between groups except for a higher risk in the dual AP group (HR 3.92 [1.37;11.22], p = 0.011). CONCLUSION Tolerance of AC or AP therapy was similar in HHT population but not dual AP therapy. We identified risk factors for MBE occurrence or premature discontinuation under AT.
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Affiliation(s)
- Vincent Grobost
- Service de Médecine Interne, Clermont-Ferrand University Hospital, CHU Estaing, 63000 Clermont-Ferrand, France.
| | - Sami Hammi
- Department of Internal Medicine, Angers University Hospital, 49100 Angers, France
| | - Bruno Pereira
- Biostatistics Unit, Clermont-Ferrand University Hospital, 63000 Clermont-Ferrand, France
| | - Alexandre Guilhem
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence de la maladie de Rendu-Osler, 69677 Bron, France
| | - Pierre Duffau
- Bordeaux University Hospital, Internal Medicine and Clinical Immunology Department, Université de Bordeaux, CNRS ImmunoConcEpT UMR 5164, 33000 Bordeaux, France
| | - Julie Seguier
- Département de Médecine Interne, Marseille University Hospital, 13000 Marseille, France
| | - Antoine Parrot
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie et Centre de Compétence de la Maladie de Rendu Osler, Hôpital Tenon, 75020 Paris, France
| | - Giovanni Gautier
- Nantes Université, Nantes University Hospital, Department of Internal and Vascular Medicine, 44000 Nantes, France
| | - Laurent Alric
- Internal Medicine-Digestive Medicine, CHU Rangueil Toulouse 3 University, 31000 Toulouse, France
| | - Mallorie Kerjouan
- Service de Pneumologie, Hôpital Pontchaillou, CHU Rennes, 35000 Rennes, France
| | - Xavier Le Guillou
- Medical Genetics Department, University Hospital of Poitiers, 86000 Poitiers, France
| | - Delphine Simon
- Service de Médecine Interne, CHU Charles Nicolle, 76000 Rouen, France
| | - Laurent Chaussavoine
- Centre Hospitalier Universitaire de Caen Normandie, Service de Médecine Vasculaire, 14000 Caen, France
| | - Murielle Rondeau-Lutz
- Service de Médecine Interne, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67 091 Strasbourg cedex, France
| | | | - Laura Delagrange
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence de la maladie de Rendu-Osler, 69677 Bron, France
| | - Christian Lavigne
- Department of Internal Medicine, Angers University Hospital, 49100 Angers, France
| | - Hélène Maillard
- Department of Internal Medicine and Clinical Immunology, Referral Centre for rare systemic autoimmune diseases for North and North-West France (CeRAINO), CHU Lille, 59000, Lille, France
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et centre de référence de la maladie de Rendu-Osler, 69677 Bron, France
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10
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Guilhem A, Dupuis-Girod S, Espitia O, Rivière S, Seguier J, Kerjouan M, Lavigne C, Maillard H, Magro P, Alric L, Lipsker D, Parrot A, Leguy V, Vanlemmens C, Guibaud L, Vikkula M, Eyries M, Valette PJ, Giraud S. Seven cases of hereditary haemorrhagic telangiectasia-like hepatic vascular abnormalities associated with EPHB4 pathogenic variants. J Med Genet 2023; 60:905-909. [PMID: 36813543 DOI: 10.1136/jmg-2022-109107] [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: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND EPHB4 loss of function is associated with type 2 capillary malformation-arteriovenous malformation syndrome, an autosomal dominant vascular disorder. The phenotype partially overlaps with hereditary haemorrhagic telangiectasia (HHT) due to epistaxis, telangiectases and cerebral arteriovenous malformations, but a similar liver involvement has never been described. METHODS Members of the French HHT network reported their cases of EPHB4 mutation identified after an initial suspicion of HHT. Clinical, radiological and genetic characteristics were analysed. RESULTS Among 21 patients with EPHB4, 15 had a liver imaging, including 7 with HHT-like abnormalities (2 female patients and 5 male patients, ages 43-69 years). Atypical epistaxis and telangiectases were noted in two cases each. They were significantly older than the eight patients with normal imaging (median: 51 vs 20 years, p<0.0006).The main hepatic artery was dilated in all the cases (diameter: 8-11 mm). Six patients had hepatic telangiectases. All kind of shunts were described (arteriosystemic: five patients, arterioportal: two patients, portosystemic: three patients). The overall liver appearance was considered as typical of HHT in six cases.Six EPHB4 variants were classified as pathogenic and one as likely pathogenic, with no specific hot spot. CONCLUSION EPHB4 loss-of-function variants can be associated with HHT-like hepatic abnormalities and should be tested for atypical HHT presentations.
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Affiliation(s)
- Alexandre Guilhem
- Service de Génétique, Centre de Référence pour la maladie de Rendu-Osler, CHU Lyon, Lyon, France
| | - Sophie Dupuis-Girod
- Service de Génétique, Centre de Référence pour la maladie de Rendu-Osler, CHU Lyon, Lyon, France
- Laboratory Biology of Cancer and Infection, CEA de Grenoble, Grenoble, France
| | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Sophie Rivière
- Médecine Interne et Maladies Multi-Organiques, CHU Montpellier, Montpellier, France
| | - Julie Seguier
- Département de Médecine Interne, Hôpital de la Timone, Marseille, France
| | | | | | - Hélène Maillard
- Service de Médecine Interne et Immunologie Clinique, CHU Lille, Lille, France
| | - Pascal Magro
- Service de Pneumologie, Hôpital Bretonneau, Tours, France
| | - Laurent Alric
- Médecine Interne, Département des Maladies Digestives, CHU Toulouse, Toulouse, France
| | - Dan Lipsker
- Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Vanessa Leguy
- Service de Médecine Interne et Immunologie Clinique, CHU Dijon, Dijon, France
| | - Claire Vanlemmens
- Service Hépatologie et soins intensifs digestifs, CHU Besancon, Besancon, France
| | - Laurent Guibaud
- Service d'Imagerie Médicale Pédiatrique et Foetale, CHU Lyon, Lyon, France
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, Bruxelles, Belgium
| | - Melanie Eyries
- Genetics, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Paris, France
| | | | - Sophie Giraud
- Service de Génétique, Centre de Référence pour la maladie de Rendu-Osler, CHU Lyon, Lyon, France
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11
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Sénémaud J, Gaudry M, Jouve E, Blanchard A, Milleron O, Dulac Y, Olivier-Faivre L, Stephan D, Odent S, Lanéelle D, Dupuis-Girod S, Jondeau G, Bal-Theoleyre L. Primary Non-Aortic Lesions Are Not Rare in Marfan Syndrome and Are Associated with Aortic Dissection Independently of Age. J Clin Med 2023; 12:jcm12082902. [PMID: 37109238 PMCID: PMC10141376 DOI: 10.3390/jcm12082902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE The study sought to estimate the prevalence of primary non-aortic lesions (PNAL) unrelated to extension of aortic dissection (AD) in a cohort of patients with Marfan syndrome (MFS). METHODS Adult patients presenting with pathogenic FBN1 mutations and an available pan-aortic contrast-enhanced CTA in eight French MFS clinics from April to October 2018 were included. Clinical and radiological data, particularly the presence of aortic lesions and PNAL (including aneurysm and ectasia), were retrospectively analyzed. RESULTS Out of 138 patients, 28 (20.3%) had PNAL. In total, 27 aneurysms in 13 patients and 41 ectasias in 19 patients were reported mainly in the subclavian, iliac, and vertebral segments. Four patients (31%) with aneurysms and none with ectasia required prophylactic intervention during follow-up (median: 46 months). In multivariate analysis, factors associated with PNAL were history of AD (OR = 3.9, 95%CI: 1.3-12.1, p = 0.018), history of previous descending aortic surgery (OR = 10.3, 95%CI: 2.2-48.3, p = 0.003) and age (per 10 years OR = 1.6, 95%CI: 1.1-2.4, p = 0.008). CONCLUSION PNAL is not rare in MFS patients with evolutive aortic disease. Natural history may differ between aneurysms and ectasia, emphasizing the need for standardized definitions and systematic screening for PNAL.
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Affiliation(s)
- Jean Sénémaud
- Service de Chirurgie Vasculaire, Thoracique et de Transplantation Pulmonaire, AP-HP, CHU Bichat, 75018 Paris, France
| | - Marine Gaudry
- Service de Chirurgie Vasculaire, AP-HM, CHU La Timone, 13385 Marseille, France
| | - Elisabeth Jouve
- Service d'Evaluation Médicale, AP-HM, CHU La Conception, 13005 Marseille, France
| | - Arnaud Blanchard
- Centre de Référence Constitutif Pour le Syndrome de Marfan et Apparentés, Centre Aorte Timone, AP-HM, CHU La Timone Adultes, 13014 Marseille, France
| | - Olivier Milleron
- Centre National de Référence Pour le Syndrome de Marfan et Apparentés, VASCERN HTAD European Reference Centre, Service de Cardiologie, AP-HP, CHU Bichat, INSERM U 1148 LVTS, Université de Paris, 75014 Paris, France
| | - Yves Dulac
- Centre de Référence Constitutif Pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU de Toulouse, 31300 Toulouse, France
| | - Laurence Olivier-Faivre
- Centre de Compétence Pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU de Dijon, 21000 Dijon, France
| | - Dominique Stephan
- Centre de Compétence Pour le Syndrome de Marfan et Apparentés, CHU Nouvel Hôpital Civil, 67000 Strasbourg, France
| | - Sylvie Odent
- Centre de Compétence Pour le Syndrome de Marfan et Apparentés, Hôpital Sud, CHU de Rennes, 35200 Rennes, France
| | - Damien Lanéelle
- Centre de Compétence Pour le Syndrome de Marfan et Apparentés, CHU de la Côte de Nacre, 14033 Caen, France
| | - Sophie Dupuis-Girod
- Centre de Compétence Pour le Syndrome de Marfan et Apparentés, CHU Hôpital Louis Pradel, 69500 Lyon, France
| | - Guillaume Jondeau
- Centre National de Référence Pour le Syndrome de Marfan et Apparentés, VASCERN HTAD European Reference Centre, Service de Cardiologie, AP-HP, CHU Bichat, INSERM U 1148 LVTS, Université de Paris, 75014 Paris, France
| | - Laurence Bal-Theoleyre
- Centre de Référence Constitutif Pour le Syndrome de Marfan et Apparentés, Centre Aorte Timone, AP-HM, CHU La Timone Adultes, 13014 Marseille, France
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12
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Parrot A, Barral M, Amiot X, Bachmeyer C, Wagner I, Eyries M, Alamowitch S, Ederhy S, Epaud R, Dupuis-Girod S, Cadranel J. [Hereditary hemorrhagic telangiectasia]. Rev Mal Respir 2023; 40:391-405. [PMID: 37062633 DOI: 10.1016/j.rmr.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/26/2023] [Indexed: 04/18/2023]
Abstract
Hereditary hemorrhagic telangiectasia, also known as Rendu-Osler - Weber disease, is a rare, autosomal dominant vascular disease, with prevalence of 1/5,000. The condition is characterized by muco-cutaneous telangiectasias, which are responsible for a hemorrhagic syndrome of variable severity, as well as arteriovenous malformations (AVMs) appearing in the lungs, the liver, and the nervous system. They can be the source of shunts, which may be associated with high morbidity (neurological ischemic stroke, brain abscess, high-output heart failure, biliary ischemia…). It is therefore crucial to establish a clinical diagnosis using the Curaçao criteria or molecular diagnosis based on genetic analysis of the ENG, ACVRL1, SMAD4 and GDF2 genes. In most cases, multidisciplinary management allows patients to have normal life expectancy. Advances in interventional radiology and better understanding of the pathophysiology of angiogenesis have resulted in improved therapeutic management. Anti-angiogenic treatments, such as bevacizumab (BVZ, an anti-VEGF antibody), have proven to be effective in cases involving bleeding complications and severe liver damage with cardiac repercussions. Other anti-angiogenic agents are currently being investigated, including tyrosine kinase inhibitors.
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Affiliation(s)
- A Parrot
- Service de pneumologie, centre de compétence de la maladie de Rendu-Osler, hôpital Tenon, AP-HP, 75020 Paris, France.
| | - M Barral
- Service de radiologie, hôpital Tenon, AP-HP, 75020 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
| | - X Amiot
- Service de gastroentérologie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Bachmeyer
- Service de médecine interne, hôpital Tenon, AP-HP, 75020 Paris, France
| | - I Wagner
- Service d'ORL, hôpital Tenon, AP-HP, 75020 Paris, France
| | - M Eyries
- Service de génétique, hôpital de la Pitié-Salpetrière, AP-HP, 75020 Paris, France
| | - S Alamowitch
- Service des urgences cérébrovasculaires, hôpital de la Pitié-Salpetrière, AP-HP, 75020 Paris, France
| | - S Ederhy
- Service de cardiologie et GRC no 27, hôpital Saint-Antoine, AP-HP, 75020 Paris, France
| | - R Epaud
- Service de pédiatrie, centre intercommunaux de Créteil, Créteil, France
| | - S Dupuis-Girod
- Service de génétique, centre de référence pour la maladie de Rendu-Osler, hospices civils de Lyon, hôpital Mère-Enfant, 69500 Bron, France
| | - J Cadranel
- Service de pneumologie, centre de compétence de la maladie de Rendu-Osler, hôpital Tenon, AP-HP, 75020 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
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Delagrange L, Dupuis O, Dupuis-Girod S. Obstetrical and neonatal complications in Hereditary haemorrhagic telangiectasia: Clarifications on fetal outcomes: Response to letter to the editor: Obstetrical and neonatal complications in hereditary haemorrhagic telangiectasia: A letter (Sarkar A, Singh N, Sharma P, Sivaranjani PS): Response to letter to the editor: Obstetrical and neonatal complications in hereditary haemorrhagic telangiectasia: A letter (Sarkar A, Singh N, Sharma P, Sivaranjani PS). BJOG 2023; 130:690-692. [PMID: 36872070 DOI: 10.1111/1471-0528.17420] [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] [Received: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 03/07/2023]
Affiliation(s)
- L Delagrange
- Hospices Civils de Lyon, Centre de Référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France
| | - O Dupuis
- Hospices Civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital Lyon-Sud, Pierre-Bénite, France.,Faculté de Médecine, Université de Lyon, Lyon, France
| | - S Dupuis-Girod
- Hospices Civils de Lyon, Centre de Référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France.,Inserm, CEA, BIG-Biologie du Cancer et de l'Infection, Université Grenoble Alpes, Grenoble, France
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14
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Delagrange L, Dupuis O, Fargeton AE, Bernard L, Decullier E, Dupuis-Girod S. Obstetrical and neonatal complications in hereditary haemorrhagic telangiectasia: A retrospective study. BJOG 2023; 130:303-311. [PMID: 36156839 PMCID: PMC10092409 DOI: 10.1111/1471-0528.17303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/30/2022] [Accepted: 09/15/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To retrospectively describe a large series of pregnancies in women with hereditary haemorrhagic telangiectasia followed in our reference centre, plus neonatal outcomes, to better understand the risks of complications and to improve their prevention. DESIGN A retrospective descriptive study conducted through a phone questionnaire. SETTING Reference centre for hereditary haemorrhagic telangiectasia in Lyon, France. POPULATION Women meeting the following criteria: (1) alive and aged ≥18 years; (2) with a definite clinical and/or genetic diagnosis of hereditary haemorrhagic telangiectasia; and (3) with at least one full-term pregnancy. MAIN OUTCOME MEASURES Maternal and perinatal outcomes of pregnancies in women with hereditary haemorrhagic telangiectasia. RESULTS Five hundred and sixty-two pregnancies were reported in 207 women with hereditary haemorrhagic telangiectasia. A total of 271 complications (48.2%) were registered. Of these, 149 (55%) non-specific complications, 110 (40.6%) non-severe specific complications and 12 (4.4%) severe specific complications were registered. There were four cases of haemoptysis and two cases of transient ischaemic attack related to pulmonary arteriovenous malformations. Four patients had severe decompensated dyspnoea, related to pulmonary arteriovenous malformations in three cases and to pulmonary arteriovenous malformations associated with severe hepatic arteriovenous malformations in one case. Hepatobiliary necrosis occurred in one case. Epidural or spinal anaesthesia was performed in 139 of 452 deliveries (31%), without complications. There were 12 reports of congenital anomalies in 461 live births (3%). CONCLUSIONS Most pregnancies in hereditary haemorrhagic telangiectasia women are uneventful; complications are rare but can be severe. Women thus need to be educated about screening and possible pregnancy-related risks before becoming pregnant.
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Affiliation(s)
- Laura Delagrange
- Hospices Civils de Lyon, Centre de référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France
| | - Olivier Dupuis
- Hospices Civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital Lyon-Sud, Pierre-Bénite, France.,Faculté de Médecine, Université de Lyon, Lyon, France
| | - Anne-Emmanuelle Fargeton
- Hospices Civils de Lyon, Centre de référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France
| | - Lorraine Bernard
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France.,Université Lyon 1, Lyon, France
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France.,Université Lyon 1, Lyon, France
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Centre de référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France.,Université Grenoble Alpes, INSERM, CEA, BIG-Biologie du Cancer et de l'Infection, Grenoble, France
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Dupuis-Girod S, Shovlin CL, Kjeldsen AD, Mager HJ, Sabba C, Droege F, Fargeton AE, Fialla AD, Gandolfi S, Hermann R, Lenato GM, Manfredi G, Post MC, Rennie C, Suppressa P, Sure U, Crocione C, Blom R, Botella LM, Brocca F, Coxall C, Druckman KT, Erasme D, Federici P, Grabowski C, Lundgren M, Søderman T, Woods D, E B. European Reference Network for Rare Vascular Diseases (VASCERN): When and how to use intravenous bevacizumab in Hereditary Haemorrhagic Telangiectasia (HHT)? Eur J Med Genet 2022; 65:104575. [DOI: 10.1016/j.ejmg.2022.104575] [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] [Received: 11/30/2021] [Revised: 06/09/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022]
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Sénémaud J, Gaudry M, Blanchard A, Dulac Y, Faivre L, Stephan D, Odent S, Lanéelle D, Dupuis-Girod S, Jondeau G, Bal-Theoleyre L. Peripheral arterial lesions of Marfan’s the disease: Analysis of a multicentric 138 patients cohort. Ann Vasc Surg 2022. [DOI: 10.1016/j.avsg.2022.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Le TTT, Martinent G, Dupuis-Girod S, Parrot A, Contis A, Riviere S, Chinet T, Grobost V, Espitia O, Dussardier-Gilbert B, Alric L, Armengol G, Maillard H, Leguy-Seguin V, Leroy S, Rondeau-Lutz M, Lavigne C, Mohamed S, Chaussavoine L, Magro P, Seguier J, Kerjouan M, Fourdrinoy S. Development and validation of a quality of life measurement scale specific to hereditary hemorrhagic telangiectasia: the QoL-HHT. Orphanet J Rare Dis 2022; 17:281. [PMID: 35854330 PMCID: PMC9295423 DOI: 10.1186/s13023-022-02426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) disease is a rare genetic disorder with symptoms and complications that can significantly affect patients’ daily lives. To date, no scale has been validated to assess the specific symptoms of this disease on the quality of life (QOL) of HHT patients. This makes it difficult for clinicians to accurately measure the quality of life of patients with HHT. The present study aims to develop and validate a QOL measurement tool specific to HHT disease: the QOL questionnaire in HHT (QoL-HHT). Methods A quantitative, non-interventional, multi-center study involving HHT patients in twenty French HHT expert centers was conducted. A calibration sample of 415 HHT patients and a validation sample of 228 HHT patients voluntarily participated in the study. Data were analyzed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Exploratory Structural Equation Modeling (ESEM) analyses, reliability analyses, and correlational analyses. Results The EFA, CFA and ESEM results allowed us to provide evidence of the factorial structure of a questionnaire composed of 24 items measuring 6 domains of QOL: Physical limitations, social relationships, concern about bleeding, relationship with the medical profession, experience of symptoms, and concern about the evolution of the disease. Cronbach’s alpha coefficients (> 0.70) demonstrated reliable internal consistency of all the QoL-HHT scores (dimensions). The results of the test–retest provided further evidence of the reliability of the QOL-HHT scores over time. Correlational analyses provided evidence for the convergent validity of the QoL-HHT scores. Conclusions We developed a simple and quick self-assessment tool to measure quality of life specific to HHT disease. This study demonstrated reliability and validity of our QoL-HHT scores. It is a very promising tool to evaluate the impact of HHT disease on all aspects of the quality of life of HHT patients in order to offer them individualized medico-psycho-social support. Trial registration: ClinicalTrials, NCT03695874. Registered 04 October 2018, https://www.clinicaltrials.gov/ct2/show/NCT03695874 Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02426-2.
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Affiliation(s)
- Thi Thao Truc Le
- Laboratoire de Psychologie sur les Dynamiques Relationnelles et Processus Identitaires (EA 7458), Université de Bourgogne-Franche-Comté, 3 Allée des Stades Universitaires, 21000, Dijon, France
| | - Guillaume Martinent
- Laboratoire sur les Vulnérabilités et l'Innovation dans le Sport (EA 7428), Université de Lyon, Université Claude Bernard Lyon 1, 27-29 bd du 11 Novembre 1918, 69622, Villeurbanne, France
| | - Sophie Dupuis-Girod
- Service de génétique clinique, Centre de Référence pour la Maladie de Rendu-Osler, Hospices Civils de Lyon, HFME Bâtiment A1, 59 bd Pinel, 69677, Bron Cedex, France
| | - Antoine Parrot
- Service de pneumologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4 rue de Chine, 75790, Paris Cedex 20, France
| | - Anne Contis
- Service de médecine interne, Hôpital Saint André, 1 rue Jean Burguet, 33000, Bordeaux, France
| | - Sophie Riviere
- Service de médecine interne, CHU de Montpellier Hôpital St Eloi, Avenue A. Fliche, 34295, Montpellier Cedex 5, France
| | - Thierry Chinet
- Consultation Maladie de Rendu-Osler, CHU Ambroise Paré, 9 av Charles de Gaulle, 92104, Boulogne Billancourt, France
| | - Vincent Grobost
- Service de médecine interne, CHU Estaing, 1 rue Lucie et Raymond Aubrac, 63100, Clermont-Ferrand, France
| | - Olivier Espitia
- Service de médecine interne - médecine vasculaire, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | | | - Laurent Alric
- Service de médecine interne, CHU Rangueil, 1 av du Pr Jean Poulhès, 31059, Toulouse Cedex 9, France
| | - Guillaume Armengol
- Service de médecine interne, CHU de Rouen Ch. Nicolle, , 1 rue de Germont, 76031, Rouen Cedex, France
| | - Hélène Maillard
- Service de médecine interne, Hôpital Huriez, 1 rue Michel Polonovski, 59037, LILLE Cedex, France
| | - Vanessa Leguy-Seguin
- Service de médecine interne, Hôpital Le Bocage, 2 Bd Maréchal de Lattre de Tassigny, BP 77908, 21079, Dijon Cedex, France
| | - Sylvie Leroy
- Service de pneumologie, CHU de Nice, 30 av de la Voie Romaine, 06002, Nice Cedex, France
| | - Murielle Rondeau-Lutz
- Service de médecine interne, CHU de Strasbourg Nouvel Hôpital Civil, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Christian Lavigne
- Service de médecine interne, CHU d'Angers, 4 rue Larrey, 49933, Angers Cedex 09, France
| | - Shirine Mohamed
- Service de médecine interne, CHU de Nancy, Hôpital Brabois, Rue du Morvan, 54511, Vandoeuvre Les Nancy, France
| | - Laurent Chaussavoine
- Service de médecine vasculaire, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France
| | - Pascal Magro
- Service de pneumologie, CHRU de Tours Hôpital Bretonneau, 2 bd Tonnellé, 37044, Tours Cedex 9, France
| | - Julie Seguier
- Service de médecine interne, Hôpital de La Timone, 264 rue Saint Pierre, 13385, Marseille Cedex 05, France
| | - Mallorie Kerjouan
- Service de pneumologie, CHU de Rennes Hôpital Pontchaillou, 2 rue Henri Le Guilloux, 35033, Rennes Cedex 09, France
| | - Sylvie Fourdrinoy
- Service de génétique clinique, Centre de Référence pour la Maladie de Rendu-Osler, Hospices Civils de Lyon, HFME Bâtiment A1, 59 bd Pinel, 69677, Bron Cedex, France.
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Shovlin CL, Buscarini E, Sabbà C, Mager HJ, Kjeldsen AD, Pagella F, Sure U, Ugolini S, Torring PM, Suppressa P, Rennie C, Post MC, Patel MC, Nielsen TH, Manfredi G, Lenato GM, Lefroy D, Kariholu U, Jones B, Fialla AD, Eker OF, Dupuis O, Droege F, Coote N, Boccardi E, Alsafi A, Alicante S, Dupuis-Girod S. The European Rare Disease Network for HHT Frameworks for management of hereditary haemorrhagic telangiectasia in general and speciality care. Eur J Med Genet 2022; 65:104370. [PMID: 34737116 DOI: 10.1016/j.ejmg.2021.104370] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 06/22/2021] [Revised: 09/24/2021] [Accepted: 10/26/2021] [Indexed: 12/22/2022]
Abstract
Hereditary haemorrhagic telangiectasia (HHT) is a complex, multisystemic vascular dysplasia affecting approximately 85,000 European Citizens. In 2016, eight founding centres operating within 6 countries, set up a working group dedicated to HHT within what became the European Reference Network on Rare Multisystemic Vascular Diseases. By launch, combined experience exceeded 10,000 HHT patients, and Chairs representing 7 separate specialties provided a median of 24 years' experience in HHT. Integrated were expert patients who focused discussions on the patient experience. Following a 2016-2017 survey to capture priorities, and underpinned by more than 40 monthly meetings, and new data acquisitions, VASCERN HHT generated position statements that distinguish expert HHT care from non-expert HHT practice. Leadership was by specialists in the relevant sub-discipline(s), and 100% consensus was required amongst all clinicians before statements were published or disseminated. One major set of outputs targeted all healthcare professionals and their HHT patients, and include the new Orphanet definition; Do's and Don'ts for common situations; Outcome Measures suitable for all consultations; COVID-19; and anticoagulation. The second output set span aspects of vascular pathophysiology where greater understanding will assist organ-specific specialist clinicians to provide more informed care to HHT patients. These cover cerebral vascular malformations and screening; mucocutaneous telangiectasia and differential diagnosis; anti-angiogenic therapies; circulatory interplays between anaemia and arteriovenous malformations; and microbiological strategies to counteract loss of normal pulmonary capillary function. Overall, the integrated outputs, and documented current practices, provide frameworks for approaches that augment the health and safety of HHT patients in diverse health-care settings.
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Affiliation(s)
- C L Shovlin
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK; National Heart and Lung Institute, Imperial College London, UK.
| | - E Buscarini
- VASCERN HHT Reference Centre, ASST Maggiore Hospital, Crema, Italy.
| | - C Sabbà
- VASCERN HHT Reference Centre, Centro Sovraziendale Malattie Rare, "Frugoni" Internal Medicine Unit, University of Bari "A. Moro", Italy.
| | - H J Mager
- VASCERN HHT Reference Centre, St Antonius Ziekenhuis, Nieuwegein, Netherlands.
| | - A D Kjeldsen
- VASCERN HHT Reference Centre, Odense University Hospital, Syddansk Universitet, Odense, Denmark.
| | - F Pagella
- VASCERN HHT Reference Centre, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - U Sure
- VASCERN HHT Reference Centre, Essen University Hospital, Essen, Germany; Department of Neurosurgery and Spine Surgery, University Hospital Essen, Germany.
| | - S Ugolini
- VASCERN HHT Reference Centre, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
| | - P M Torring
- VASCERN HHT Reference Centre, Odense University Hospital, Syddansk Universitet, Odense, Denmark.
| | - P Suppressa
- VASCERN HHT Reference Centre, Centro Sovraziendale Malattie Rare, "Frugoni" Internal Medicine Unit, University of Bari "A. Moro", Italy.
| | - C Rennie
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK.
| | - M C Post
- VASCERN HHT Reference Centre, St Antonius Ziekenhuis, Nieuwegein, Netherlands; Department of Cardiology, University Medical Center Utrecht, The Netherlands.
| | - M C Patel
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK.
| | - T H Nielsen
- VASCERN HHT Reference Centre, Odense University Hospital, Syddansk Universitet, Odense, Denmark.
| | - G Manfredi
- VASCERN HHT Reference Centre, ASST Maggiore Hospital, Crema, Italy.
| | - G M Lenato
- VASCERN HHT Reference Centre, Centro Sovraziendale Malattie Rare, "Frugoni" Internal Medicine Unit, University of Bari "A. Moro", Italy.
| | - D Lefroy
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK.
| | - U Kariholu
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK.
| | - B Jones
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK.
| | - A D Fialla
- VASCERN HHT Reference Centre, Odense University Hospital, Syddansk Universitet, Odense, Denmark.
| | - O F Eker
- VASCERN HHT Reference Centre, Hospices Civils de Lyon, Lyon, France.
| | - O Dupuis
- VASCERN HHT Reference Centre, Hospices Civils de Lyon, Lyon, France.
| | - F Droege
- VASCERN HHT Reference Centre, Essen University Hospital, Essen, Germany; Department of ENT Surgery, University Hospital Essen, Germany.
| | - N Coote
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK.
| | - E Boccardi
- VASCERN HHT Reference Centre, ASST Maggiore Hospital, Crema, Italy; Niguarda Hospital, Milan, Italy.
| | - A Alsafi
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK.
| | - S Alicante
- VASCERN HHT Reference Centre, ASST Maggiore Hospital, Crema, Italy.
| | - S Dupuis-Girod
- VASCERN HHT Reference Centre, Hospices Civils de Lyon, Lyon, France.
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Guilhem A, Portalès P, Dupuis-Girod S, Rivière S, Vincent T. Altered expressions of CXCR4 and CD26 on T-helper lymphocytes in hereditary hemorrhagic telangiectasia. Orphanet J Rare Dis 2021; 16:511. [PMID: 34906163 PMCID: PMC8670161 DOI: 10.1186/s13023-021-02139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic disease characterized by a deregulated neo-angiogenesis. Besides a mainly vascular phenotype (muco-cutaneous telangiectases, arteriovenous malformations), a specific risk of infection is suggested by case series of severe and atypical infections as well as by reports of decreased T and natural killer (NK) lymphocyte counts. As some evidence supports a dysregulation of the CXCR4/CXCL12 chemotactic axis of HHT endothelial cells, we hypothesized that a similar phenomenon could occur on lymphocytes. Methods Eighteen HHT patients with history of severe infection (HSI) were matched in age and sex with 18 HHT without HSI and 18 healthy control subjects (HC). We assessed the cell count and the surface expression of CXCR4 and CD26 (CXCL12 inactivating peptidase) of circulating T-helper and T-cytotoxic lymphocytes (including naive, memory and activated subsets) and NK cells. Results The overall HHT group of 36 patients exhibited a reduction of circulating T-helper lymphocytes compared to HC (median: 517 vs. 1026 cells/mm3, p < 0.0001), correlated with age (r = − 0.46, p = 0.005), requirement of intravenous iron or blood transfusions (median: 291 vs. 627 cells/mm3, p = 0.03) and CXCR4 surface expression (r = 0.353, p = 0.0345). CXCR4 and CD26 membrane expression were both decreased on HHT T-helper lymphocytes (median MFI ratio: 4.49 vs. 5.74 for CXCR4 and 3.21 vs. 4.33 for CD26, p = 0.03 and 0.0018 respectively) with an unchanged CXCR4/CD26 ratio. The HHT group with HSI had a higher CXCR4/CD26 ratio on the total T-lymphocyte population, as well as on the T-helper population and its naive subset (median on naive T-helper cells: 2.34 vs. 1.32, p = 0.0002). Conclusions Our findings support a dysregulation of the CXCL12/CXCR4 chemotaxis of T-helper lymphocytes in HHT patients, potentially linked to their T-helper lymphopenia and susceptibility to infection. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02139-y.
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Affiliation(s)
- Alexandre Guilhem
- CHU de Montpellier, Médecine interne et maladies multi-organiques de l'adulte, Hôpital Saint Eloi, Montpellier, France.
| | - Pierre Portalès
- CHU de Montpellier, Laboratoire d'immunologie, Hôpital Saint Eloi, Montpellier, France
| | - Sophie Dupuis-Girod
- Centre National de référence Maladie de Rendu-Osler, Service de génétique Hôpital Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Sophie Rivière
- CHU de Montpellier, Médecine interne et maladies multi-organiques de l'adulte, Hôpital Saint Eloi, Montpellier, France
| | - Thierry Vincent
- CHU de Montpellier, Laboratoire d'immunologie, Hôpital Saint Eloi, Montpellier, France
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20
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Al-Samkari H, Kasthuri RS, Parambil JG, Albitar HA, Almodallal YA, Vázquez C, Serra MM, Dupuis-Girod S, Wilsen CB, McWilliams JP, Fountain EH, Gossage JR, Weiss CR, Latif MA, Issachar A, Mei-Zahav M, Meek ME, Conrad M, Rodriguez-Lopez J, Kuter DJ, Iyer VN. An international, multicenter study of intravenous bevacizumab for bleeding in hereditary hemorrhagic telangiectasia: the InHIBIT-Bleed study. Haematologica 2021; 106:2161-2169. [PMID: 32675221 PMCID: PMC8327711 DOI: 10.3324/haematol.2020.261859] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 06/04/2020] [Indexed: 12/13/2022] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT, Osler-Weber-Rendu disease) is a rare multisystem vascular disorder that causes chronic gastrointestinal bleeding, epistaxis, and severe anemia. Bevacizumab, an anti-vascular endothelial growth factor antibody, may be effective to treat bleeding in HHT. This international, multicenter, retrospective study evaluated the use of systemic bevacizumab to treat HHTassociated bleeding and anemia at 12 HHT treatment centers. Hemoglobin, Epistaxis Severity Score (ESS), red cell units transfused, and intravenous iron infusions before and after treatment were evaluated using paired means testing and mixed-effects linear models. Bevacizumab was given to 238 HHT patients for a median of 12 (range, 1-96) months. Compared with pretreatment, bevacizumab increased mean hemoglobin by 3.2 g/dL (95% confidence interval: 2.9-3.5 g/dL); i.e., from a mean hemoglobin of 8.6 (8.5-8.8) g/dL to 11.8 (11.5-12.1) g/dL; P<0.0001) and decreased the ESS by 3.4 (3.2-3.7) points (mean ESS 6.8 [6.6-7.1] versus 3.4 [3.2-3.7]; P<0.0001) during the first year of treatment. Compared with 6 months before treatment, the number of red blood cell units transfused decreased by 82% (median of 6.0 [interquartile range, 0.0-13.0] units versus 0 [0.0-1.0] units; P<0.0001) and iron infusions decreased by 70% (median of 6.0 [1.0-18.0] infusions versus 1.0 [0.0-4.0] infusions, P<0.0001) during the first 6 months of bevacizumab treatment. Outcomes were similar regardless of the underlying pathogenic mutation. Following initial induction infusions, continuous/scheduled bevacizumab maintenance achieved higher hemoglobin and lower ESS than intermittent/as-needed maintenance but with more drug exposure. Bevacizumab was well tolerated: hypertension, fatigue, and proteinuria were the most common adverse events. Venous thromboembolism occurred in 2% of patients. In conclusion, systemic bevacizumab was safe and effective for managing chronic bleeding and anemia in HHT.
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Affiliation(s)
- Hanny Al-Samkari
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raj S Kasthuri
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Hasan A Albitar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Carolina Vázquez
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo M Serra
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sophie Dupuis-Girod
- Centre de Reference pour la maladie de Rendu-Osler, Hospices Civils de Lyon, Lyon, France
| | - Craig B Wilsen
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Justin P McWilliams
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Evan H Fountain
- Division of Pulmonary, Critical Care, and Sleep Medicine, Augusta University, Augusta, GA, USA
| | - James R Gossage
- Division of Pulmonary, Critical Care, and Sleep Medicine, Augusta University, Augusta, GA, USA
| | - Clifford R Weiss
- Div. of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Muhammad A Latif
- Div. of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Assaf Issachar
- Schneider Children's Medical Center of Israel, Tel Aviv University, Israel
| | - Meir Mei-Zahav
- Schneider Children's Medical Center of Israel, Tel Aviv University, Israel
| | - Mary E Meek
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Miles Conrad
- Dept. of Radiology, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Josanna Rodriguez-Lopez
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David J Kuter
- Division of Hematology, Massachusetts General Hospital, Boston, MA, USA
| | - Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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21
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Margelidon-Cozzolino V, Cottin V, Dupuis-Girod S, Traclet J, Ahmad K, Mornex JF, Turquier S. Pulmonary hypertension in hereditary haemorrhagic telangiectasia is associated with multiple clinical conditions. ERJ Open Res 2021; 7:00078-2020. [PMID: 33532461 PMCID: PMC7836486 DOI: 10.1183/23120541.00078-2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022] Open
Abstract
Hereditary haemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disorder. The prevalence of pulmonary hypertension (PH) in the course of the disease is considered to be lower than 10% [1–4]. As previously reported, the increase in pulmonary arterial pressure in this setting may result from different mechanisms: isolated high flow state; PH due to left heart disease secondary to high cardiac output in the presence of hepatic arteriovenous malformations (post-capillary PH, clinical classification group 2); or pulmonary vascular remodelling (pre-capillary PH) [1–3]. For the latter mechanism, a diagnosis of heritable pulmonary arterial hypertension (group 1.2) could be applicable, as genetic mutations in the transforming growth factor-β (TGF-β) signalling pathway (ALK1, ENG) are always found [5]. Multiple clinical conditions are combined with genetic mutations to contribute to the development of pulmonary vascular remodelling in hereditary haemorrhagic telangiectasia. A systematic aetiological evaluation is required for these patients.https://bit.ly/34V7HPy
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Affiliation(s)
- Victor Margelidon-Cozzolino
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
| | - Vincent Cottin
- Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
| | - Sophie Dupuis-Girod
- National Reference Centre for Hereditary Hemorrhagic Telangiectasia, Dept of Genetic Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France and Univ. Grenoble Alpes, Inserm, CEA, BIG-Biologie du Cancer et de l'Infection, Grenoble, France
| | - Julie Traclet
- Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
| | - Kais Ahmad
- Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
| | - Jean-François Mornex
- Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
| | - Ségolène Turquier
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,Competence Centre for Severe Pulmonary Hypertension, Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, UMR754, Claude Bernard University Lyon 1, Lyon, France
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22
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Faughnan ME, Mager JJ, Hetts SW, Palda VA, Lang-Robertson K, Buscarini E, Deslandres E, Kasthuri RS, Lausman A, Poetker D, Ratjen F, Chesnutt MS, Clancy M, Whitehead KJ, Al-Samkari H, Chakinala M, Conrad M, Cortes D, Crocione C, Darling J, de Gussem E, Derksen C, Dupuis-Girod S, Foy P, Geisthoff U, Gossage JR, Hammill A, Heimdal K, Henderson K, Iyer VN, Kjeldsen AD, Komiyama M, Korenblatt K, McDonald J, McMahon J, McWilliams J, Meek ME, Mei-Zahav M, Olitsky S, Palmer S, Pantalone R, Piccirillo JF, Plahn B, Porteous MEM, Post MC, Radovanovic I, Rochon PJ, Rodriguez-Lopez J, Sabba C, Serra M, Shovlin C, Sprecher D, White AJ, Winship I, Zarrabeitia R. Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia. Ann Intern Med 2020; 173:989-1001. [PMID: 32894695 DOI: 10.7326/m20-1443] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
DESCRIPTION Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease with an estimated prevalence of 1 in 5000 that is characterized by the presence of vascular malformations (VMs). These result in chronic bleeding, acute hemorrhage, and complications from shunting through VMs. The goal of the Second International HHT Guidelines process was to develop evidence-based consensus guidelines for the management and prevention of HHT-related symptoms and complications. METHODS The guidelines were developed using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) framework and GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The guidelines expert panel included expert physicians (clinical and genetic) in HHT from 15 countries, guidelines methodologists, health care workers, health care administrators, patient advocacy representatives, and persons with HHT. During the preconference process, the expert panel generated clinically relevant questions in 6 priority topic areas. A systematic literature search was done in June 2019, and articles meeting a priori criteria were included to generate evidence tables, which were used as the basis for recommendation development. The expert panel subsequently convened during a guidelines conference to conduct a structured consensus process, during which recommendations reaching at least 80% consensus were discussed and approved. RECOMMENDATIONS The expert panel generated and approved 6 new recommendations for each of the following 6 priority topic areas: epistaxis, gastrointestinal bleeding, anemia and iron deficiency, liver VMs, pediatric care, and pregnancy and delivery (36 total). The recommendations highlight new evidence in existing topics from the first International HHT Guidelines and provide guidance in 3 new areas: anemia, pediatrics, and pregnancy and delivery. These recommendations should facilitate implementation of key components of HHT care into clinical practice.
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Affiliation(s)
- Marie E Faughnan
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, and University of Toronto, Toronto, Ontario, Canada (M.E.F.)
| | | | - Steven W Hetts
- University of California, San Francisco, San Francisco, California (S.W.H., M.C.)
| | | | | | | | - Erik Deslandres
- Centre Hospitalier de l'Université de Montréal, Hôtel-Dieu, Montreal, Quebec, Canada (E.D.)
| | - Raj S Kasthuri
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (R.S.K., J.D.)
| | - Andrea Lausman
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (A.L., R.P.)
| | - David Poetker
- Froedtert and Medical College of Wisconsin, Milwaukee, Wisconsin (D.P., P.F.)
| | - Felix Ratjen
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (F.R.)
| | - Mark S Chesnutt
- VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (M.S.C.)
| | | | - Kevin J Whitehead
- University of Utah Medical Center, Salt Lake City, Utah (K.J.W., J.M.)
| | - Hanny Al-Samkari
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (H.A.)
| | - Murali Chakinala
- Washington University School of Medicine, St. Louis, Missouri (M.C., K.K., J.F.P., A.J.W.)
| | - Miles Conrad
- University of California, San Francisco, San Francisco, California (S.W.H., M.C.)
| | - Daniel Cortes
- St. Michael's Hospital and Unity Health Toronto, Toronto, Canada (D.C.)
| | | | - Jama Darling
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (R.S.K., J.D.)
| | | | | | | | - Patrick Foy
- Froedtert and Medical College of Wisconsin, Milwaukee, Wisconsin (D.P., P.F.)
| | - Urban Geisthoff
- University Hospital of Marburg and Phillips University Marburg, Marburg, Germany (U.G.)
| | | | - Adrienne Hammill
- Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, Ohio (A.H.)
| | - Ketil Heimdal
- Oslo University Hospital, Rikshospitalet, Oslo, Norway (K.H.)
| | | | | | | | | | - Kevin Korenblatt
- Washington University School of Medicine, St. Louis, Missouri (M.C., K.K., J.F.P., A.J.W.)
| | - Jamie McDonald
- University of Utah Medical Center, Salt Lake City, Utah (K.J.W., J.M.)
| | | | - Justin McWilliams
- University of California, Los Angeles, Los Angeles, California (J.M.)
| | - Mary E Meek
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (M.E.M.)
| | - Meir Mei-Zahav
- Schneider Children's Medical Center of Israel and Sackler School of Medicine of Tel Aviv University, Tel Aviv, Israel (M.M.)
| | | | | | - Rose Pantalone
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (A.L., R.P.)
| | - Jay F Piccirillo
- Washington University School of Medicine, St. Louis, Missouri (M.C., K.K., J.F.P., A.J.W.)
| | | | | | - Marco C Post
- St. Antonius Hospital, Nieuwegein, and University Medical Center Utrecht, Utrecht, the Netherlands (M.C.P.)
| | - Ivan Radovanovic
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada (I.R.)
| | - Paul J Rochon
- University of Colorado Hospital, Aurora, Colorado (P.J.R.)
| | | | | | - Marcelo Serra
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (M.S.)
| | | | | | - Andrew J White
- Washington University School of Medicine, St. Louis, Missouri (M.C., K.K., J.F.P., A.J.W.)
| | - Ingrid Winship
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia (I.W.)
| | - Roberto Zarrabeitia
- Hospital Sierrallana (Servicio Cántabro de Salud), Torrelavega, Spain (R.Z.)
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Giraud S, Bardel C, Dupuis-Girod S, Carette MF, Gilbert-Dussardier B, Riviere S, Saurin JC, Eyries M, Patri S, Decullier E, Calender A, Lesca G. Sequence variations of ACVRL1 play a critical role in hepatic vascular malformations in hereditary hemorrhagic telangiectasia. Orphanet J Rare Dis 2020; 15:254. [PMID: 32962750 PMCID: PMC7507685 DOI: 10.1186/s13023-020-01533-2] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal dominant disorder characterized by multiple telangiectases and caused by germline disease-causing variants in the ENG (HHT1), ACVRL1 (HHT2) and, to a lesser extent MADH4 and GDF2, which encode proteins involved in the TGF-β/BMP9 signaling pathway. Common visceral complications of HHT are caused by pulmonary, cerebral, or hepatic arteriovenous malformations (HAVMs). There is large intrafamilial variability in the severity of visceral involvement, suggesting a role for modifier genes. The objective of the present study was to investigate the potential role of ENG, ACVRL1, and of other candidate genes belonging to the same biological pathway in the development of HAVMs. Methods We selected 354 patients from the French HHT patient database who had one disease causing variant in either ENG or ACVRL1 and who underwent hepatic exploration. We first compared the distribution of the different types of variants with the occurrence of HAVMs. Then, we genotyped 51 Tag-SNPs from the Hap Map database located in 8 genes that encode proteins belonging to the TGF-β/BMP9 pathway (ACVRL1, ENG, GDF2, MADH4, SMAD1, SMAD5, TGFB1, TGFBR1), as well as in two additional candidate genes (PTPN14 and ADAM17). We addressed the question of a possible genetic association with the occurrence of HAVMs. Results The proportion of patients with germline ACVRL1 variants and the proportion of women were significantly higher in HHT patients with HAVMs. In the HHT2 group, HAVMs were more frequent in patients with truncating variants. Six SNPs (3 in ACVRL1, 1 in ENG, 1 in SMAD5, and 1 in ADAM17) were significantly associated with HAVMs. After correction for multiple testing, only one remained significantly associated (rs2277383). Conclusions In this large association study, we confirmed the strong relationship between ACVRL1 and the development of HAVMs. Common polymorphisms of ACVRL1 may also play a role in the development of HAVMs, as a modifying factor, independently of the disease-causing variants.
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Affiliation(s)
- Sophie Giraud
- Hospices Civils de Lyon, Service de Génétique, Groupement Hospitalier Est, 69677, Bron, France
| | - Claire Bardel
- Service de Biostatistique-Bioinformatique, plateforme de séquençage à haut débit, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, F-69100, Villeurbanne, France
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Service de Génétique, Groupement Hospitalier Est, 69677, Bron, France.,Centre de Référence National pour la maladie de Rendu-Osler, Groupement Hospitalier Est, Bron, France
| | | | | | - Sophie Riviere
- CHU de Montpellier, Service de Médecine Interne, Hôpital St Eloi, Montpellier, France
| | - Jean-Christophe Saurin
- Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Hospices Civils de Lyon, Service de Gastro-Entérologie, Hôpital E. Herriot, Lyon, France
| | - Mélanie Eyries
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, GH Pitié-Salpêtrière, Paris, France
| | - Sylvie Patri
- CHU la Milétrie, Laboratoire de Génétique, Poitiers, France
| | - Evelyne Decullier
- Unité de recherche clinique du pole IMER of the Hospices Civils de Lyon, Lyon, France
| | - Alain Calender
- Hospices Civils de Lyon, Service de Génétique, Groupement Hospitalier Est, 69677, Bron, France.,Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.,Equipe EA7426, Immunopathologie des voies respiratoires, Université Lyon 1, Lyon, France
| | - Gaëtan Lesca
- Hospices Civils de Lyon, Service de Génétique, Groupement Hospitalier Est, 69677, Bron, France. .,Université Claude Bernard Lyon 1, Université de Lyon, Villeurbanne, France.
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Silvain C, Thévenot T, Colle I, Vilgrain V, Dupuis-Girod S, Buscarini E, Valla D, Hillaire S, Dutheil D, Sitbon O, Bureau C, Plessier A. Hereditary hemorrhagic telangiectasia and liver involvement: Vascular liver diseases: position papers from the francophone network for vascular liver diseases, the French Association for the Study of the Liver (AFEF), and ERN-rare liver. Clin Res Hepatol Gastroenterol 2020; 44:426-432. [PMID: 32276767 DOI: 10.1016/j.clinre.2020.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/03/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Christine Silvain
- Department of Gastroenterology and Hepatology, University Hospital of Poitiers, 2, rue de la Milétrie - CS 90577, 86021 Poitiers, France.
| | - Thierry Thévenot
- Department of Hepatology and intensive digestive care, Jean Minjoz Hospital, 3, boulevard Alexandre Fleming, 25030 Besançon, France
| | - Isabelle Colle
- Department of Gastroenterology and Hepatology, Algemeen Stedelijk Ziekenhuis ASZ campus Aalst, 9300 Aalst (Alost), Belgium
| | - Valérie Vilgrain
- Department of radiology, Beaujon Hospital, AP-HP, 100, boulevard du Général Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases (FILFOIE), Saint-Antoine Hospital, APHP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Department of genetic and Reference Center for Hereditary Hemorrhagic Telangiectasia, -Hôpital Femme Mère Enfant, 59, boulevard Pinel, 69677 Bron, France
| | - Elisabetta Buscarini
- Department of Gastroenterology and Reference Center for Hereditary Hemorrhagic Telangiectasia, Maggiore Hospital, ASST Crema, Largo Ugo Dossena, 2, 26013 Crema CR, Italy
| | - Dominique Valla
- Department of Hepatology and reference center of vascular liver diseases, Beaujon Hospital, AP-HP, 100, boulevard du Général Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases (FILFOIE), Saint-Antoine Hospital, APHP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Reference center of vascular liver diseases, European Reference Network (ERN) Rare-Liver
| | - Sophie Hillaire
- Department of Internal Medicine, Foch Hospital, 40, rue Worth, 92150 Suresnes, France
| | - Danielle Dutheil
- Association of patients with vascular liver diseases (AMVF), Beaujon Hospital, Department of Hepatology, 100, boulevard du Général Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases (FILFOIE), Saint-Antoine Hospital, APHP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Olivier Sitbon
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Christophe Bureau
- Department of Gastroenterology and Hepatology, Rangueil Hospital, University Hospital of Toulouse, 1, avenue du Professeur Jean Poulhès, 31400 Toulouse, France; French Network for Rare Liver Diseases (FILFOIE), Saint-Antoine Hospital, APHP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Aurélie Plessier
- Department of Hepatology and reference center of vascular liver diseases, Beaujon Hospital, AP-HP, 100, boulevard du Général Leclerc, 92118 Clichy, France; French Network for Rare Liver Diseases (FILFOIE), Saint-Antoine Hospital, APHP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France; Reference center of vascular liver diseases, European Reference Network (ERN) Rare-Liver
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Dupuis-Girod S. Intravenous Bevacizumab in Hereditary Hemorrhagic Telangiectasia: A Role That Is Still to Be Defined. Mayo Clin Proc 2020; 95:1565-1566. [PMID: 32753127 DOI: 10.1016/j.mayocp.2020.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/24/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Sophie Dupuis-Girod
- Hôpital Femme-Mère-Enfants, Service de Génétique et Centre de Référence National pour la maladie de Rendu-Osler, Bron, France.
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Eker OF, Boccardi E, Sure U, Patel MC, Alicante S, Alsafi A, Coote N, Droege F, Dupuis O, Fialla AD, Jones B, Kariholu U, Kjeldsen AD, Lefroy D, Lenato GM, Mager HJ, Manfredi G, Nielsen TH, Pagella F, Post MC, Rennie C, Sabbà C, Suppressa P, Toerring PM, Ugolini S, Buscarini E, Dupuis-Girod S, Shovlin CL. European Reference Network for Rare Vascular Diseases (VASCERN) position statement on cerebral screening in adults and children with hereditary haemorrhagic telangiectasia (HHT). Orphanet J Rare Dis 2020; 15:165. [PMID: 32600364 PMCID: PMC7322871 DOI: 10.1186/s13023-020-01386-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 02/26/2020] [Accepted: 03/22/2020] [Indexed: 12/13/2022] Open
Abstract
Hereditary haemorrhagic telangiectasia (HHT) is a multisystemic vascular dysplasia inherited as an autosomal dominant trait. Approximately 10 % of patients have cerebral vascular malformations, a proportion being cerebral arteriovenous malformations (AVMs) and fistulae that may lead to potentially devastating consequences in case of rupture. On the other hand, detection and treatment related-risks are not negligible, and immediate. While successful treatment can be undertaken in individual cases, current data do not support the treatment of unruptured AVMs, which also present a low risk of bleeding in HHT patients. Screening for these AVMs is therefore controversial. Structured discussions, distinctions of different cerebrovascular abnormalities commonly grouped into an “AVM” bracket, and clear guidance by neurosurgical and neurointerventional radiology colleagues enabled the European Reference Network for Rare Vascular Disorders (VASCERN-HHT) to develop the following agreed Position Statement on cerebral screening: 1) First, we emphasise that neurological symptoms suggestive of cerebral AVMs in HHT patients should be investigated as in general neurological and emergency care practice. Similarly, if an AVM is found accidentally, management approaches should rely on expert discussions on a case-by-case basis and individual risk-benefit evaluation of all therapeutic possibilities for a specific lesion. 2) The current evidence base does not favour the treatment of unruptured cerebral AVMs, and therefore cannot be used to support widespread screening of asymptomatic HHT patients. 3) Individual situations encompass a wide range of personal, cultural and clinical states. In order to enable informed patient choice, and avoid conflicting advice, particularly arising from non-neurovascular interpretations of the evidence base, we suggest that all HHT patients should have the opportunity to discuss knowingly brain screening issues with their healthcare provider. 4) Any screening discussions in asymptomatic individuals should be preceded by informed pre-test review of the latest evidence regarding preventative and therapeutic efficacies of any interventions. The possibility of harm due to detection of, or intervention on, a vascular malformation that would not have necessarily caused any consequence in later life should be stated explicitly. We consider this nuanced Position Statement provides a helpful, evidence-based framework for informed discussions between healthcare providers and patients in an emotionally charged area.
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Affiliation(s)
- Omer F Eker
- VASCERN HHT Reference Centre, Hospices Civils de Lyon, Lyon, France.
| | - Edoardo Boccardi
- Niguarda Hospital, Milan, Italy and VASCERN HHT Reference Centre, Crema, Italy
| | - Ulrich Sure
- VASCERN HHT Reference Centre, Essen University Hospital, Essen, Germany
| | - Maneesh C Patel
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK
| | - Saverio Alicante
- VASCERN HHT Reference Centre, ASST Maggiore Hospital, Crema, Italy
| | - Ali Alsafi
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK
| | - Nicola Coote
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK
| | - Freya Droege
- VASCERN HHT Reference Centre, Essen University Hospital, Essen, Germany
| | - Olivier Dupuis
- VASCERN HHT Reference Centre, Hospices Civils de Lyon, Lyon, France
| | - Annette Dam Fialla
- VASCERN HHT Reference Centre, Odense Universitetshospital, Syddansk Universitet, Odense, Denmark
| | - Bryony Jones
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK
| | - Ujwal Kariholu
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK
| | - Anette D Kjeldsen
- VASCERN HHT Reference Centre, Odense Universitetshospital, Syddansk Universitet, Odense, Denmark
| | - David Lefroy
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK
| | - Gennaro M Lenato
- VASCERN HHT Reference Centre, "Frugoni" Internal Medicine Unit, University of Bari "A. Moro", Policlinico, Bari, Italy
| | - Hans Jurgen Mager
- VASCERN HHT Reference Centre, St Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Guido Manfredi
- VASCERN HHT Reference Centre, ASST Maggiore Hospital, Crema, Italy
| | - Troels H Nielsen
- VASCERN HHT Reference Centre, Odense Universitetshospital, Syddansk Universitet, Odense, Denmark
| | - Fabio Pagella
- VASCERN HHT Reference Centre, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marco C Post
- VASCERN HHT Reference Centre, St Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Catherine Rennie
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK
| | - Carlo Sabbà
- VASCERN HHT Reference Centre, "Frugoni" Internal Medicine Unit, University of Bari "A. Moro", Policlinico, Bari, Italy.
| | - Patrizia Suppressa
- VASCERN HHT Reference Centre, "Frugoni" Internal Medicine Unit, University of Bari "A. Moro", Policlinico, Bari, Italy
| | - Pernille M Toerring
- VASCERN HHT Reference Centre, Odense Universitetshospital, Syddansk Universitet, Odense, Denmark
| | - Sara Ugolini
- VASCERN HHT Reference Centre, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | | | - Claire L Shovlin
- VASCERN HHT Reference Centre, Imperial College Healthcare National Health Service Trust, London, UK and Imperial College London, London, UK.
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Monin P, Reynaud N, Hanna N, Dupuis-Girod S, Till M, Arnaud P, Labalme A, Alix E, Poizat-Amar C, Faoucher M, Ravella L, Debost B, Obadia JF, Zech JC, Boileau C, Sanlaville D, Edery P, Putoux A, Schluth-Bolard C. A Case of Trisomy 13 Mosaicism Presenting with a Severe Aortic Root Dilatation and Marfanoid Habitus due to an Unpredictable Cytogenetic Mechanism. Cytogenet Genome Res 2020; 160:72-79. [PMID: 32187601 DOI: 10.1159/000506319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2020] [Indexed: 11/19/2022] Open
Abstract
In this report, we present a new case of mosaic trisomy 13 with prolonged survival, firstly detected by array-CGH analysis which was carried out because of moderate intellectual disability with postaxial hexadactyly, dermatologic features, ventricular septal defect, bicuspid aortic valve, and aortic dystrophy in a 19-year-old male patient. In a subset of 15% of the cells, the patient carried a derivative chromosome 10 generated by a nonreciprocal (10;13) translocation inherited from his healthy mother who carried the translocation in a balanced and homogeneous state. FISH analyses showed interstitial telomeric sequences at the breakpoints. To our knowledge, this is the second report of a patient with trisomy 13 mosaicism displaying a severe aortic root dilatation. We also discuss the mechanisms which could explain the mosaic state, the most likely one being related to the instability of the interstitial telomere.
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Zech JC, Putoux A, Decullier E, Fargeton AE, Edery P, Plauchu H, Dupuis-Girod S. Classifying Ectopia Lentis in Marfan Syndrome into Five Grades of Increasing Severity. J Clin Med 2020; 9:jcm9030721. [PMID: 32155956 PMCID: PMC7141252 DOI: 10.3390/jcm9030721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/12/2020] [Accepted: 02/27/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: To describe a five-grade classification of ectopia lentis in Marfan syndrome (MFS) and to evaluate the positive predictive value of the early grades of ectopia lentis. Methods: We prospectively included MFS patients and their healthy relatives. The anterior segment examination was classified into grades 0 to 5, and we studied the sensitivity, specificity, and positive predictive value of ectopia lentis in this classification. Results: Seventy-four MFS patients and thirty-six healthy controls were examined. In the MFS group, grades 1, 2, 3, and 4 were present in 15, 24, 17, and 7 patients, respectively, whereas 11 patients in this group did not present ectopia lentis. In the control group, grades 0 and 1 were observed in 30 and 6 individuals, respectively. Sensitivity to ectopia lentis of at least grade 2 was 64.9%, with 100% specificity, whereas sensitivity to ectopia lentis of at least grade 1 was 85.1%, with 83.3% specificity. The positive predictive value of ectopia lentis that was greater than or equal to grade 2 was 100%, whereas that of ectopia lentis greater than or equal to grade 1 was 91.3%. Conclusions: High positive predictive values s were found to be associated with grades 2 and higher of the five-grade classification of ectopia lentis. This classification should help to harmonize clinical practices for this major feature of MFS.
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Affiliation(s)
| | - Audrey Putoux
- Service de Génétique, Unité de Génétique Clinique, Centre Labellisé Anomalies du Développement, Hospices Civils de Lyon, 69500 Bron, France; (A.P.); (P.E.)
- Centre de Recherche en Neurosciences de Lyon, Equipe GENDEV, INSERM U1028, UMR CNRS 5292, Université Claude Bernard Lyon 1, 69500 Bron, France
| | - Evelyne Decullier
- Unité de Recherche Clinique, Pôle Santé Publique, Hospices Civils de Lyon, 69003 Lyon, France;
| | - Anne-Emmanuelle Fargeton
- Service de Génétique, Unité de Génétique Clinique, Centre de Compétence Syndrome de Marfan et Apparentés, Hospices Civils de Lyon, 69500 Bron, France; (H.P.); (S.D.-G.)
- Correspondence:
| | - Patrick Edery
- Service de Génétique, Unité de Génétique Clinique, Centre Labellisé Anomalies du Développement, Hospices Civils de Lyon, 69500 Bron, France; (A.P.); (P.E.)
- Centre de Recherche en Neurosciences de Lyon, Equipe GENDEV, INSERM U1028, UMR CNRS 5292, Université Claude Bernard Lyon 1, 69500 Bron, France
| | - Henri Plauchu
- Service de Génétique, Unité de Génétique Clinique, Centre de Compétence Syndrome de Marfan et Apparentés, Hospices Civils de Lyon, 69500 Bron, France; (H.P.); (S.D.-G.)
| | - Sophie Dupuis-Girod
- Service de Génétique, Unité de Génétique Clinique, Centre de Compétence Syndrome de Marfan et Apparentés, Hospices Civils de Lyon, 69500 Bron, France; (H.P.); (S.D.-G.)
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Dupuis O, Delagrange L, Dupuis-Girod S. Hereditary haemorrhagic telangiectasia and pregnancy: a review of the literature. Orphanet J Rare Dis 2020; 15:5. [PMID: 31910869 PMCID: PMC6947864 DOI: 10.1186/s13023-019-1286-z] [Citation(s) in RCA: 17] [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: 10/16/2019] [Accepted: 12/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited genetic vascular disorder that has prevalence of 1:5000 to 1:8000, and which is characterised by recurrent epistaxis, cutaneous telangiectasia, and arteriovenous malformations (AVMs) that affect many organs including the lungs, gastrointestinal tract, liver, and central nervous system. The aim here was to carry out a review of the literature on HHT complications during pregnancy in order to guide management decisions. Main body A literature review was carried out to analyse all publications on complications that occurred during pregnancy in women with HHT. The PubMed/Medline and Scopus databases were searched. The complications observed in HHT women during pregnancy were then described. The authors identified 5 case series and 31 case reports that describe the evolution of 1577 pregnancies in 630 women with HHT. The overall maternal death rate described in the case series was estimated at 1.0% of pregnancies in the case series and 2 maternal deaths occurred in 31 pregnancy case reports. Severe maternal complications occurred in 2.7 to 6.8% of pregnancies in the case series. Severe complications occurred mostly in the second and third trimester in non-diagnosed and non-screened HHT patients. Severe complications were related to visceral involvement. The most frequent complications were related to pulmonary arteriovenous malformations (PAVMs) (haemothorax (n = 10), haemoptysis (n = 4), and severe hypoxaemia (n = 3)). Neurological complications were related to PAVMs in one case (right to left shunt) and to cerebral arteriovenous malformations (CAVM) and intracranial haemorrhage in 2 cases. Complications were related to hepatic arteriovenous malformations (HAVMs) in 8 cases (acutely decompensated heart failure due to hepatic involvement (n = 1), dyspnoea related to heart failure (n = 5), and hepatobiliary necrosis (n = 2)). Conclusion Based on the literature review, most pregnancies in HHT women occur normally. However, these pregnancies should be considered high-risk, given the potential life-threatening events related to AVM rupture. Furthermore, there is currently no international consensus regarding the medical follow-up of pregnancy in women with HHT and the aim here was to carry out a review of the literature in order to guide screening and management decisions for this rare disease.
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Affiliation(s)
- Olivier Dupuis
- Hospices Civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital Lyon-Sud, Pierre-Bénite, France.,Université de Lyon, Faculté de médecine, Lyon, France
| | - Laura Delagrange
- Hospices Civils de Lyon, Centre de Référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Bron, France
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Centre de Référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Bron, France. .,Université Grenoble Alpes, Inserm, CEA, BIG-Biologie du Cancer et de l'Infection, Grenoble, France.
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30
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Robert F, Desroches-Castan A, Bailly S, Dupuis-Girod S, Feige JJ. Future treatments for hereditary hemorrhagic telangiectasia. Orphanet J Rare Dis 2020; 15:4. [PMID: 31910860 PMCID: PMC6945546 DOI: 10.1186/s13023-019-1281-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
Hereditary Hemorrhagic Telangiectasia (HHT), also known as Rendu-Osler syndrome, is a genetic vascular disorder affecting 1 in 5000–8000 individuals worldwide. This rare disease is characterized by various vascular defects including epistaxis, blood vessel dilations (telangiectasia) and arteriovenous malformations (AVM) in several organs. About 90% of the cases are associated with heterozygous mutations of ACVRL1 or ENG genes, that respectively encode a bone morphogenetic protein receptor (activin receptor-like kinase 1, ALK1) and a co-receptor named endoglin. Less frequent mutations found in the remaining 10% of patients also affect the gene SMAD4 which is part of the transcriptional complex directly activated by this pathway. Presently, the therapeutic treatments for HHT are intended to reduce the symptoms of the disease. However, recent progress has been made using drugs that target VEGF (vascular endothelial growth factor) and the angiogenic pathway with the use of bevacizumab (anti-VEGF antibody). Furthermore, several exciting high-throughput screenings and preclinical studies have identified new molecular targets directly related to the signaling pathways affected in the disease. These include FKBP12, PI3-kinase and angiopoietin-2. This review aims at reporting these recent developments that should soon allow a better care of HHT patients.
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Affiliation(s)
- Florian Robert
- Univ. Grenoble Alpes, Inserm, CEA, Laboratory Biology of Cancer and Infection, F-38000, Grenoble, France
| | - Agnès Desroches-Castan
- Univ. Grenoble Alpes, Inserm, CEA, Laboratory Biology of Cancer and Infection, F-38000, Grenoble, France
| | - Sabine Bailly
- Univ. Grenoble Alpes, Inserm, CEA, Laboratory Biology of Cancer and Infection, F-38000, Grenoble, France
| | - Sophie Dupuis-Girod
- Univ. Grenoble Alpes, Inserm, CEA, Laboratory Biology of Cancer and Infection, F-38000, Grenoble, France.,Hospices Civils de Lyon, Service de Génétique, Hôpital Femme-Mère-Enfants, F-69677, Bron, France.,Centre National de Référence pour la Maladie de Rendu-Osler, F-69677, Bron, France
| | - Jean-Jacques Feige
- Univ. Grenoble Alpes, Inserm, CEA, Laboratory Biology of Cancer and Infection, F-38000, Grenoble, France.
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Shovlin C, Bamford K, Sabbà C, Mager HJ, Kjeldsen A, Droege F, Buscarini E, Dupuis-Girod S. Prevention of serious infections in hereditary hemorrhagic telangiectasia: roles for prophylactic antibiotics, the pulmonary capillaries-but not vaccination. Haematologica 2019; 104:e85-e86. [PMID: 30705116 DOI: 10.3324/haematol.2018.209791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Claire Shovlin
- Respiratory Medicine, and VASCERN HHT European Reference Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London; NHLI Vascular Science, Imperial College London, UK
| | - Kathleen Bamford
- Department of Microbiology and VASCERN HHT European Reference Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Carlo Sabbà
- Center for Rare Diseases, "Frugoni" Internal Medicine Unit, Interdepartmental HHT Center, Interdisciplinary Department of Medicine and VASCERN HHT European Reference Centre, University of Bari School of Medicine, Italy
| | - Hans-Jurgen Mager
- Department of Pulmonology and VASCERN HHT European Reference Centre, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
| | - Anette Kjeldsen
- Department of Otorhinolaryngology and VASCERN HHT European Reference Centre, Odense University Hospital, University of Southern Denmark, Denmark
| | - Freya Droege
- Department of Otorhinolaryngology and VASCERN HHT European Reference Centre, Essen University Hospital, Germany
| | - Elisabetta Buscarini
- Gastroenterology Department and VASCERN HHT European Reference Centre, Maggiore Hospital, ASST Crema, Italy
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique, and VASCERN HHT European Reference Centre/centre de Référence pour la maladie de Rendu-Osler, France, and Université de Lyon, Faculté de médecine, France
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32
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Hascoet S, Edouard T, Plaisancie J, Arnoult F, Milleron O, Stheneur C, Chevallier B, Zordan C, Odent S, Bal L, Faivre L, Leheup B, Dupuis-Girod S, Ruidavets JB, Acar P, Ferrieres J, Jondeau G, Dulac Y. Incidence of cardiovascular events and risk markers in a prospective study of children diagnosed with Marfan syndrome. Arch Cardiovasc Dis 2019; 113:40-49. [PMID: 31735609 DOI: 10.1016/j.acvd.2019.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 07/21/2019] [Accepted: 09/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the incidence of cardiovascular events (CVEs) and their associated risk markers in children with Marfan syndrome (MFS). AIMS To assess the incidence of CVEs and determine risk markers in a cohort diagnosed with Marfan syndrome during childhood and followed for several years. METHODS From a French multicentre nationwide database, 462 patients with MFS diagnosed during childhood were included prospectively. Patients' files were screened for a period of 20 years (1993-2013). CVEs (e.g. death, aortic dissection, cardiac valve or aortic root surgery) were assessed during the prospective follow-up. RESULTS Median (interquartile range) age at the end of follow-up was 17.2 (11.1-21.3) years. CVEs were reported for 35 participants (7.6%; 95% confidence interval [CI] 5.3-10.4%). First CVEs were prophylactic aortic root surgery (n=29), aortic dissection (n=4; two aged <18 years) and death (n=2). Kaplan-Meier cumulative incidence of CVEs was 5.3% (95% CI 3.3-8.7%) during childhood (aged≤18 years) and 19.4% (95% CI 13.3-27.9%) at 25years of age. The cumulative rate of CVEs was higher in case of Valsalva sinus Z-score increase of≥0.1 per year (P=0.0003), maximal Valsalva sinus diameter growth speed ≥5mm per year (P=0.03), aortic regurgitation≥2 (P=0.0005) and maximal Valsalva sinus Z-score≥3 before 16 years of age (P<0.0001). In a multivariable Cox proportional analysis, the Valsalva sinus Z-score remained significantly related to outcome. Considering aortic root evolution, aortic regurgitation, age at diagnosis and beta-blocker therapy were related to Valsalva sinus Z-score evolution during follow-up. CONCLUSIONS CVEs in children with MFS are mainly related to prophylactic aortic root surgery. Aortic dissections are rarely observed in children. The Valsalva sinus Z-score is a strong indicator of subsequent CVEs in children with MFS. Attention to follow-up and beta-blocker observance may be warranted in high-risk children.
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Affiliation(s)
- Sebastien Hascoet
- Department of Paediatric Cardiology and Paediatric Endocrinology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU Toulouse, 31300 Toulouse, France; Department of Congenital Heart Diseases, Centre Constitutif Réseau M3C (Maladies Rares Cardiopathies Congénitales Complexes), Hôpital Marie Lannelongue, Paris-Sud Université, 92350 Plessis-Robinson, France.
| | - Thomas Edouard
- Department of Paediatric Cardiology and Paediatric Endocrinology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU Toulouse, 31300 Toulouse, France
| | - Julie Plaisancie
- Department of Paediatric Cardiology and Paediatric Endocrinology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU Toulouse, 31300 Toulouse, France
| | - Florence Arnoult
- Department of Cardiology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital Bichat, AP-HP, 75018 Paris, France
| | - Olivier Milleron
- Department of Cardiology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital Bichat, AP-HP, 75018 Paris, France; Inserm U1148, 75877 Paris, France
| | - Chantal Stheneur
- Department of Cardiology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital Bichat, AP-HP, 75018 Paris, France; Inserm U1148, 75877 Paris, France; Department of Paediatrics, Hôpital Ambroise Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | | | - Cécile Zordan
- Department of Clinical Genetics, Centre de Compétence pour le Syndrome de Marfan et Apparentés, CHU Bordeaux, 33000 Bordeaux, France
| | - Sylvie Odent
- Department of Clinical Genetics, Centre de Compétence pour le Syndrome de Marfan et Apparentés, Hôpital Sud CHU, 35200 Rennes, France
| | - Laurence Bal
- Department of Clinical Genetics and Aortic Diseases, Centre de Compétence pour le Syndrome de Marfan et Apparentés, Hôpital de la Timone, AP-HM, 13005 Marseille, France
| | - Laurence Faivre
- Department of Clinical Genetics, Centre de Compétence pour le Syndrome de Marfan et Apparentés, Hôpital d'enfants, CHU, Université de Bourgogne Franche Comté, 21070 Dijon, France
| | - Bruno Leheup
- Department of Clinical Genetics, Centre de Compétence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants Brabois, CHU Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Sophie Dupuis-Girod
- Department of Clinical Genetics, Hospices Civils de Lyon, Centre de Compétence pour le Syndrome de Marfan et Apparentés, Hôpital Femme-Mère-Enfants, 69677 Bron, France
| | - Jean-Bernard Ruidavets
- Department of Epidemiology, 31073 Toulouse; Inserm/UPS UMR 1048, I2MC, 31432 Toulouse, France; CHU de Toulouse, 31059 Toulouse, France
| | - Philippe Acar
- Department of Paediatric Cardiology and Paediatric Endocrinology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU Toulouse, 31300 Toulouse, France
| | - Jean Ferrieres
- Department of Epidemiology, 31073 Toulouse; Inserm/UPS UMR 1048, I2MC, 31432 Toulouse, France; CHU de Toulouse, 31059 Toulouse, France
| | - Guillaume Jondeau
- Department of Cardiology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital Bichat, AP-HP, 75018 Paris, France; Inserm U1148, 75877 Paris, France
| | - Yves Dulac
- Department of Paediatric Cardiology and Paediatric Endocrinology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU Toulouse, 31300 Toulouse, France
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33
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Andrejecsk JW, Hosman AE, Botella LM, Shovlin CL, Arthur HM, Dupuis-Girod S, Buscarini E, Hughes CCW, Lebrin F, Mummery CL, Post MC, Mager JJ. Executive summary of the 12th HHT international scientific conference. Angiogenesis 2019; 21:169-181. [PMID: 29147802 DOI: 10.1007/s10456-017-9585-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hereditary hemorrhagic telangiectasia is an autosomal dominant trait affecting approximately 1 in 5000 people. A pathogenic DNA sequence variant in the ENG, ACVRL1 or SMAD4 genes, can be found in the majority of patients. The 12th International Scientific HHT Conference was held on June 8-11, 2017 in Dubrovnik, Croatia to present and discuss the latest scientific achievements, and was attended by over 200 scientific and clinical researchers. In total 174 abstracts were accepted of which 58 were selected for oral presentations. This article covers the basic science and clinical talks, and discussions from three theme-based workshops. We focus on significant emergent themes and unanswered questions. Understanding these topics and answering these questions will help to define the future of HHT research and therapeutics, and ultimately bring us closer to a cure.
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Affiliation(s)
- Jillian W Andrejecsk
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA
| | - Anna E Hosman
- Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Luisa M Botella
- Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas (CSIC), and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Ramiro de Maeztu 9, 28040, Madrid, Spain
| | - Claire L Shovlin
- Vascular Science, National Heart and Lung Institute, Imperial College London, London, UK
| | - Helen M Arthur
- Institute of Genetic Medicine, Centre for Life, Newcastle University, Newcastle, NE1 3BZ, UK
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Genetic Unit and HHT Reference Center, Bron, School of Medical and University Lyon 1, Lyon, France
| | - Elisabetta Buscarini
- Gastroenterology and Endoscopy Department, Reference Center for Hereditary Hemorrhagic Telangiectasia, Maggiore Hospital, ASST Crema, Crema, Italy
| | - Christopher C W Hughes
- Department of Molecular Biology and Biochemistry, University of California Irvine, Irvine, CA, USA
| | - Franck Lebrin
- Einthoven Laboratory for Experimental Vascular Medicine, Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands. .,CNRS UMR 7587, INSERM U979, Institut Langevin, ESPCI, Paris, France.
| | - Christine L Mummery
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco C Post
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Johannes J Mager
- Department of Pulmonology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
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Zawerton A, Mignot C, Sigafoos A, Blackburn PR, Haseeb A, McWalter K, Ichikawa S, Nava C, Keren B, Charles P, Marey I, Tabet AC, Levy J, Perrin L, Hartmann A, Lesca G, Schluth-Bolard C, Monin P, Dupuis-Girod S, Guillen Sacoto MJ, Schnur RE, Zhu Z, Poisson A, El Chehadeh S, Alembik Y, Bruel AL, Lehalle D, Nambot S, Moutton S, Odent S, Jaillard S, Dubourg C, Hilhorst-Hofstee Y, Barbaro-Dieber T, Ortega L, Bhoj EJ, Masser-Frye D, Bird LM, Lindstrom K, Ramsey KM, Narayanan V, Fassi E, Willing M, Cole T, Salter CG, Akilapa R, Vandersteen A, Canham N, Rump P, Gerkes EH, Klein Wassink-Ruiter JS, Bijlsma E, Hoffer MJV, Vargas M, Wojcik A, Cherik F, Francannet C, Rosenfeld JA, Machol K, Scott DA, Bacino CA, Wang X, Clark GD, Bertoli M, Zwolinski S, Thomas RH, Akay E, Chang RC, Bressi R, Sanchez Russo R, Srour M, Russell L, Goyette AME, Dupuis L, Mendoza-Londono R, Karimov C, Joseph M, Nizon M, Cogné B, Kuechler A, Piton A, Klee EW, Lefebvre V, Clark KJ, Depienne C. Widening of the genetic and clinical spectrum of Lamb-Shaffer syndrome, a neurodevelopmental disorder due to SOX5 haploinsufficiency. Genet Med 2019; 22:524-537. [PMID: 31578471 DOI: 10.1038/s41436-019-0657-0] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Lamb-Shaffer syndrome (LAMSHF) is a neurodevelopmental disorder described in just over two dozen patients with heterozygous genetic alterations involving SOX5, a gene encoding a transcription factor regulating cell fate and differentiation in neurogenesis and other discrete developmental processes. The genetic alterations described so far are mainly microdeletions. The present study was aimed at increasing our understanding of LAMSHF, its clinical and genetic spectrum, and the pathophysiological mechanisms involved. METHODS Clinical and genetic data were collected through GeneMatcher and clinical or genetic networks for 41 novel patients harboring various types ofSOX5 alterations. Functional consequences of selected substitutions were investigated. RESULTS Microdeletions and truncating variants occurred throughout SOX5. In contrast, most missense variants clustered in the pivotal SOX-specific high-mobility-group domain. The latter variants prevented SOX5 from binding DNA and promoting transactivation in vitro, whereas missense variants located outside the high-mobility-group domain did not. Clinical manifestations and severity varied among patients. No clear genotype-phenotype correlations were found, except that missense variants outside the high-mobility-group domain were generally better tolerated. CONCLUSIONS This study extends the clinical and genetic spectrum associated with LAMSHF and consolidates evidence that SOX5 haploinsufficiency leads to variable degrees of intellectual disability, language delay, and other clinical features.
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Affiliation(s)
- Ash Zawerton
- Department of Cellular & Molecular Medicine, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Cyril Mignot
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique et de Cytogénétique; Centre de Référence Déficiences Intellectuelles de Causes Rares, GRC UPMC « Déficience Intellectuelle et Autisme », Paris, France
| | - Ashley Sigafoos
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Patrick R Blackburn
- Center for Individualized Medicine, Department of Health Science Research, and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Abdul Haseeb
- Department of Surgery, Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Shoji Ichikawa
- Department of Clinical Diagnostics, Ambry Genetics, Aliso Viejo, CA, USA
| | - Caroline Nava
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique et de Cytogénétique; Centre de Référence Déficiences Intellectuelles de Causes Rares, GRC UPMC « Déficience Intellectuelle et Autisme », Paris, France
| | - Boris Keren
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique et de Cytogénétique; Centre de Référence Déficiences Intellectuelles de Causes Rares, GRC UPMC « Déficience Intellectuelle et Autisme », Paris, France
| | - Perrine Charles
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique et de Cytogénétique; Centre de Référence Déficiences Intellectuelles de Causes Rares, GRC UPMC « Déficience Intellectuelle et Autisme », Paris, France
| | - Isabelle Marey
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique et de Cytogénétique; Centre de Référence Déficiences Intellectuelles de Causes Rares, GRC UPMC « Déficience Intellectuelle et Autisme », Paris, France
| | - Anne-Claude Tabet
- Genetics Department, Robert Debré Hospital, APHP, Paris, France.,Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
| | - Jonathan Levy
- Genetics Department, Robert Debré Hospital, APHP, Paris, France
| | - Laurence Perrin
- Genetics Department, Robert Debré Hospital, APHP, Paris, France
| | - Andreas Hartmann
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,APHP, Department of Neurology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Gaetan Lesca
- Service de Génétique, Hospices Civils de Lyon - GHE, Lyon, France.,CNRS UMR 5292, INSERM U1028, CNRL, and Université Claude Bernard Lyon 1, GHE, Lyon, France
| | - Caroline Schluth-Bolard
- Service de Génétique, Hospices Civils de Lyon - GHE, Lyon, France.,CNRS UMR 5292, INSERM U1028, CNRL, and Université Claude Bernard Lyon 1, GHE, Lyon, France
| | - Pauline Monin
- Service de Génétique, Hospices Civils de Lyon - GHE, Lyon, France
| | - Sophie Dupuis-Girod
- Service de Génétique, Hospices Civils de Lyon - GHE, Lyon, France.,Centre de référence pour la maladie de Rendu-Osler, Bron, France
| | | | | | | | - Alice Poisson
- GénoPsy, Reference Center for Diagnosis and Management of Genetic Psychiatric Disorders, Centre Hospitalier le Vinatier and EDR-Psy Team (CNRS & Lyon 1 Claude Bernard University), Lyon, France
| | - Salima El Chehadeh
- Département de Génétique Médicale, CHU de Hautepierre, Strasbourg, France
| | - Yves Alembik
- Département de Génétique Médicale, CHU de Hautepierre, Strasbourg, France
| | - Ange-Line Bruel
- INSERM 1231 LNC, Génétique des Anomalies du Développement, Université de Bourgogne-Franche Comté, Dijon, France.,FHU-TRANSLAD, Université de Bourgogne/CHU Dijon, Dijon, France
| | - Daphné Lehalle
- INSERM 1231 LNC, Génétique des Anomalies du Développement, Université de Bourgogne-Franche Comté, Dijon, France.,Centre de Génétique et Centre de Référence Maladies Rares «Anomalies du Développement de l'Interrégion Est», Hôpital d'Enfants, CHU Dijon Bourgogne, Dijon, France
| | - Sophie Nambot
- INSERM 1231 LNC, Génétique des Anomalies du Développement, Université de Bourgogne-Franche Comté, Dijon, France.,Centre de Génétique et Centre de Référence Maladies Rares «Anomalies du Développement de l'Interrégion Est», Hôpital d'Enfants, CHU Dijon Bourgogne, Dijon, France
| | - Sébastien Moutton
- INSERM 1231 LNC, Génétique des Anomalies du Développement, Université de Bourgogne-Franche Comté, Dijon, France.,Centre de Génétique et Centre de Référence Maladies Rares «Anomalies du Développement de l'Interrégion Est», Hôpital d'Enfants, CHU Dijon Bourgogne, Dijon, France
| | - Sylvie Odent
- CHU de Rennes, service de génétique clinique, Rennes, France.,Univ Rennes, CNRS, IGDR, UMR 6290, Rennes, France
| | - Sylvie Jaillard
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Christèle Dubourg
- Univ Rennes, CNRS, IGDR, UMR 6290, Rennes, France.,Service de Génétique Moléculaire et Génomique, CHU, Rennes, France
| | | | | | - Lucia Ortega
- Cook Childrens Medical Center, Fort Worth, TX, USA
| | - Elizabeth J Bhoj
- Department of Clinical Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diane Masser-Frye
- Rady Children's Hospital San Diego, Division of Genetics and Dysmorphology, San Diego, CA, USA
| | - Lynne M Bird
- Rady Children's Hospital San Diego, Division of Genetics and Dysmorphology, San Diego, CA, USA.,Department of Pediatrics, University of California-San Diego, San Diego, CA, USA
| | - Kristin Lindstrom
- Division of Genetics and Metabolism, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Keri M Ramsey
- Translational Genomics Research Institute (TGen), Center for Rare Childhood Disorders, Phoenix, AZ, USA
| | - Vinodh Narayanan
- Translational Genomics Research Institute (TGen), Center for Rare Childhood Disorders, Phoenix, AZ, USA
| | - Emily Fassi
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Marcia Willing
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Trevor Cole
- West Midlands Regional Genetics Service and Birmingham Health Partners, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Claire G Salter
- West Midlands Regional Genetics Service and Birmingham Health Partners, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,RILD Wellcome Wolfson Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Rhoda Akilapa
- North West Thames Regional Genetics Service, Northwick Park Hospital, Harrow, London, UK
| | | | - Natalie Canham
- North West Thames Regional Genetics Service, Northwick Park Hospital, London, UK.,Cheshire & Merseyside Regional Genetics Service, Liverpool Women's Hospital, Liverpool, UK
| | - Patrick Rump
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Erica H Gerkes
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Emilia Bijlsma
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Mariëtte J V Hoffer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, Netherlands
| | - Marcelo Vargas
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA.,Children's Minnesota, Minneapolis, MN, USA
| | - Antonina Wojcik
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA.,Children's Minnesota, Minneapolis, MN, USA
| | - Florian Cherik
- Service de génétique clinique, Centre de Référence Maladies Rares «Anomalies du Développement et syndromes malformatifs du Sud-Est", CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Christine Francannet
- Service de génétique clinique, Centre de Référence Maladies Rares «Anomalies du Développement et syndromes malformatifs du Sud-Est", CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Jill A Rosenfeld
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Keren Machol
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Daryl A Scott
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA.,Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Carlos A Bacino
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Xia Wang
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Gary D Clark
- Pediatrics-Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Marta Bertoli
- Northern Genetics Service-Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simon Zwolinski
- Northern Genetics Service-Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rhys H Thomas
- Institute of Neuroscience, Newcastle University, Framlington Place, Newcastle upon Tyne, UK.,Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ela Akay
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Richard C Chang
- Division of Metabolic Disorders, Children's Hospital of Orange County (CHOC), Orange, CA, USA
| | - Rebekah Bressi
- Division of Metabolic Disorders, Children's Hospital of Orange County (CHOC), Orange, CA, USA
| | | | - Myriam Srour
- Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Laura Russell
- Division of Medical Genetics, Department of Specialized Medicine, McGill University, Montreal, QC, Canada
| | - Anne-Marie E Goyette
- Child Development Program, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Lucie Dupuis
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Roberto Mendoza-Londono
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | | | - Maries Joseph
- Medical Genetics and Metabolism, Valley Children's Hospital, Madera, CA, USA
| | - Mathilde Nizon
- CHU Nantes, Service de Génétique Médicale, Nantes, France.,INSERM, CNRS, UNIV Nantes, l'institut du thorax, Nantes, France
| | - Benjamin Cogné
- CHU Nantes, Service de Génétique Médicale, Nantes, France.,INSERM, CNRS, UNIV Nantes, l'institut du thorax, Nantes, France
| | - Alma Kuechler
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Amélie Piton
- Laboratoire de Diagnostic Génétique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,IGBMC, CNRS UMR 7104/INSERM U964/Université de Strasbourg, Illkirch, France
| | | | - Eric W Klee
- Center for Individualized Medicine, Department of Health Science Research, and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Véronique Lefebvre
- Department of Surgery, Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Karl J Clark
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Christel Depienne
- INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France. .,Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany. .,IGBMC, CNRS UMR 7104/INSERM U964/Université de Strasbourg, Illkirch, France.
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Dumortier J, Guillaud O, Erard-Poinsot D, Dupuis-Girod S, Francoz C, Durand F. Hyperammonemic encephalopathy associated with hereditary hemorrhagic telangiectasia. Clin Res Hepatol Gastroenterol 2019; 43:e54-e56. [PMID: 30447907 DOI: 10.1016/j.clinre.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/10/2018] [Accepted: 10/19/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Jérôme Dumortier
- Hospices civils de Lyon, hôpital Edouard-Herriot, unité de transplantation hépatique, université Claude-Bernard Lyon 1, 69437 Lyon, France.
| | - Olivier Guillaud
- Hospices civils de Lyon, hôpital Edouard-Herriot, unité de transplantation hépatique, université Claude-Bernard Lyon 1, 69437 Lyon, France
| | - Domitille Erard-Poinsot
- Hospices civils de Lyon, hôpital Edouard-Herriot, unité de transplantation hépatique, université Claude-Bernard Lyon 1, 69437 Lyon, France
| | - Sophie Dupuis-Girod
- Hospices civils de Lyon, hôpital Femme - Mère - Enfant, service de génétique and centre de référence pour la maladie de Rendu-Osler, 69677 Bron, France
| | - Claire Francoz
- Assistance publique-hôpitaux de Paris, hôpital Beaujon, service d'hépatologie, Inserm U1149, université Paris Diderot, 92110 Clichy, France
| | - François Durand
- Assistance publique-hôpitaux de Paris, hôpital Beaujon, service d'hépatologie, Inserm U1149, université Paris Diderot, 92110 Clichy, France
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Dumortier J, Dupuis-Girod S, Valette PJ, Valent A, Guillaud O, Saurin JC, Hervieu V, Robinson P, Plauchu H, Paliard P, Boillot O, Scoazec JY. Recurrence of Hereditary Hemorrhagic Telangiectasia After Liver Transplantation: Clinical Implications and Physiopathological Insights. Hepatology 2019; 69:2232-2240. [PMID: 30549294 DOI: 10.1002/hep.30424] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/03/2018] [Indexed: 02/04/2023]
Abstract
Liver transplantation (LT) has been proposed as a curative treatment in hereditary hemorrhagic telangiectasia (HHT) with severe hepatic involvement. We provide a long-term evaluation of graft status after LT for HHT, with a focus on the risk of recurrence. The present study included all patients prospectively followed up after LT for HHT in the Lyon Liver Transplant Unit from 1993 to 2010, with a survival of more than 1 year. Protocol clinical, radiological, and histological examinations were performed at regular intervals. Fourteen patients were included (13 women and one man). Median age at LT was 52.5 years (range: 33.1-66.7). In eight patients (seven female), disease recurrence was diagnosed by abnormal radiological features, suggestive of microcirculatory disturbances. Typical vascular lesions, including telangiectasia, were demonstrated by liver biopsy in five of these patients. The median interval between LT and diagnosis of recurrence was 127 months (range: 74-184). The risk of recurrence increased over time; estimated cumulative risk was 47.9% at 15 years. Liver tissue analysis found the coexistence of an angiogenic process combined with endothelial microchimerism, as shown by the presence of vascular lining cells of recipient origin. Conclusion: The present data show that disease recurrence occurs, usually after a long delay, in a significant number of patients treated by LT for liver complications of HHT. This strongly supports the necessity of a lifelong follow-up and suggests that therapeutic strategy needs discussion and evaluation, especially of the role of potential adjuvant treatments to LT, such as antiangiogenic medications, when recurrent disease appears.
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Affiliation(s)
- Jérôme Dumortier
- Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
| | - Sophie Dupuis-Girod
- Service de Génétique and Centre de Référence Pour la Maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Pierre-Jean Valette
- Service de Radiologie Digestive, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
| | - Alexander Valent
- Département de Biologie et Pathologie Médicales, Service de Pathologie Moléculaire, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olivier Guillaud
- Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Christophe Saurin
- Service d'Hépato-gastroentérologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, and Université Claude Bernard Lyon 1, Lyon, France
| | - Valérie Hervieu
- Service Central d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
| | - Philip Robinson
- Direction de la Recherche Clinique et de l'Innovation, Hospices Civils de Lyon, Lyon, France
| | - Henri Plauchu
- Service de Génétique and Centre de Référence Pour la Maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Pierre Paliard
- Service d'Hépato-gastroentérologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, and Université Claude Bernard Lyon 1, Lyon, France
| | - Olivier Boillot
- Unité de Transplantation Hépatique, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-Yves Scoazec
- Département de Biologie et Pathologie Médicales, Service de Pathologie Moléculaire, Gustave Roussy Cancer Campus, Villejuif, France.,Service Central d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France
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37
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Schluth-Bolard C, Diguet F, Chatron N, Rollat-Farnier PA, Bardel C, Afenjar A, Amblard F, Amiel J, Blesson S, Callier P, Capri Y, Collignon P, Cordier MP, Coubes C, Demeer B, Chaussenot A, Demurger F, Devillard F, Doco-Fenzy M, Dupont C, Dupont JM, Dupuis-Girod S, Faivre L, Gilbert-Dussardier B, Guerrot AM, Houlier M, Isidor B, Jaillard S, Joly-Hélas G, Kremer V, Lacombe D, Le Caignec C, Lebbar A, Lebrun M, Lesca G, Lespinasse J, Levy J, Malan V, Mathieu-Dramard M, Masson J, Masurel-Paulet A, Mignot C, Missirian C, Morice-Picard F, Moutton S, Nadeau G, Pebrel-Richard C, Odent S, Paquis-Flucklinger V, Pasquier L, Philip N, Plutino M, Pons L, Portnoï MF, Prieur F, Puechberty J, Putoux A, Rio M, Rooryck-Thambo C, Rossi M, Sarret C, Satre V, Siffroi JP, Till M, Touraine R, Toutain A, Toutain J, Valence S, Verloes A, Whalen S, Edery P, Tabet AC, Sanlaville D. Whole genome paired-end sequencing elucidates functional and phenotypic consequences of balanced chromosomal rearrangement in patients with developmental disorders. J Med Genet 2019; 56:526-535. [PMID: 30923172 DOI: 10.1136/jmedgenet-2018-105778] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/30/2019] [Accepted: 02/20/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Balanced chromosomal rearrangements associated with abnormal phenotype are rare events, but may be challenging for genetic counselling, since molecular characterisation of breakpoints is not performed routinely. We used next-generation sequencing to characterise breakpoints of balanced chromosomal rearrangements at the molecular level in patients with intellectual disability and/or congenital anomalies. METHODS Breakpoints were characterised by a paired-end low depth whole genome sequencing (WGS) strategy and validated by Sanger sequencing. Expression study of disrupted and neighbouring genes was performed by RT-qPCR from blood or lymphoblastoid cell line RNA. RESULTS Among the 55 patients included (41 reciprocal translocations, 4 inversions, 2 insertions and 8 complex chromosomal rearrangements), we were able to detect 89% of chromosomal rearrangements (49/55). Molecular signatures at the breakpoints suggested that DNA breaks arose randomly and that there was no major influence of repeated elements. Non-homologous end-joining appeared as the main mechanism of repair (55% of rearrangements). A diagnosis could be established in 22/49 patients (44.8%), 15 by gene disruption (KANSL1, FOXP1, SPRED1, TLK2, MBD5, DMD, AUTS2, MEIS2, MEF2C, NRXN1, NFIX, SYNGAP1, GHR, ZMIZ1) and 7 by position effect (DLX5, MEF2C, BCL11B, SATB2, ZMIZ1). In addition, 16 new candidate genes were identified. Systematic gene expression studies further supported these results. We also showed the contribution of topologically associated domain maps to WGS data interpretation. CONCLUSION Paired-end WGS is a valid strategy and may be used for structural variation characterisation in a clinical setting.
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Affiliation(s)
- Caroline Schluth-Bolard
- Service de Génétique, Hospices Civils de Lyon, Bron, France.,INSERM U1028, CNRS UMR5292, UCBL1, GENDEV Team, Neurosciences Research Center of Lyon, Bron, France
| | - Flavie Diguet
- Service de Génétique, Hospices Civils de Lyon, Bron, France.,INSERM U1028, CNRS UMR5292, UCBL1, GENDEV Team, Neurosciences Research Center of Lyon, Bron, France
| | - Nicolas Chatron
- Service de Génétique, Hospices Civils de Lyon, Bron, France.,INSERM U1028, CNRS UMR5292, UCBL1, GENDEV Team, Neurosciences Research Center of Lyon, Bron, France
| | | | - Claire Bardel
- Cellule bioinformatique de la plateforme NGS, Hospices Civils de Lyon, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR5558, Lyon 1 University, Bron, France
| | - Alexandra Afenjar
- Département de génétique et embryologie médicale, Centre de référence des déficiences intellectuelles de causes rares, AP-HP, Hôpital Armand Trousseau, Paris, France.,GRC n°19, pathologies Congénitales du Cervelet-LeucoDystrophies, AP-HP, Hôpital Armand Trousseau, Sorbonne Université, Paris, France
| | - Florence Amblard
- Laboratoire de Génétique Chromosomique, Hôpital Couple Enfant, CHU Grenoble, Grenoble, France
| | - Jeanne Amiel
- Service de Génétique Médicale, Hôpital Necker-Enfants Malades, Paris, France
| | | | | | - Yline Capri
- Département de Génétique, Hôpital Robert Debré, Paris, France
| | | | | | - Christine Coubes
- Service de Génétique, Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Benedicte Demeer
- Centre d'activité de génétique clinique, CLAD nord de France, CHU Amiens, Amiens, France
| | | | | | - Françoise Devillard
- Laboratoire de Génétique Chromosomique, Hôpital Couple Enfant, CHU Grenoble, Grenoble, France
| | | | - Céline Dupont
- Département de Génétique, Hôpital Robert Debré, Paris, France
| | - Jean-Michel Dupont
- Laboratoire de Cytogénétique Constitutionnelle, APHP-HUPC site Cochin, Paris, France
| | | | - Laurence Faivre
- Centre de référence anomalies du développement et syndromes malformatifs, FHU TRANSLAD et équipe GAD INSERM UMR1231, CHU Dijon-Bourgogne et Université de Bourgogne-Franche Comté, Dijon, France
| | | | | | - Marine Houlier
- Service de Génétique Médicale, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Sylvie Jaillard
- Laboratoire de Cytogénétique et de Biologie Cellulaire, CHU Pontchaillou, Rennes, France
| | | | - Valérie Kremer
- Laboratoire de Cytogénétique, CHU Strasbourg, Strasbourg, France
| | - Didier Lacombe
- Service de Génétique Médicale, Hôpital Pellegrin, Université de Bordeaux, MRGM INSERM U1211, CHU Bordeaux, Bordeaux, France
| | | | - Aziza Lebbar
- Laboratoire de Cytogénétique Constitutionnelle, APHP-HUPC site Cochin, Paris, France
| | - Marine Lebrun
- Service de Génétique Clinique, Chromosomique et Moléculaire, CHU Hôpital Nord, Saint-Etienne, France
| | - Gaetan Lesca
- Service de Génétique, Hospices Civils de Lyon, Bron, France.,INSERM U1028, CNRS UMR5292, UCBL1, GENDEV Team, Neurosciences Research Center of Lyon, Bron, France
| | - James Lespinasse
- Laboratoire de Génétique Chromosomique, CH Général, Chambéry, France
| | - Jonathan Levy
- Département de Génétique, Hôpital Robert Debré, Paris, France
| | - Valérie Malan
- Service de Cytogénétique, Hôpital Necker Enfants Malades, Paris, France
| | | | - Julie Masson
- Service de Génétique, Hospices Civils de Lyon, Bron, France.,INSERM U1028, CNRS UMR5292, UCBL1, GENDEV Team, Neurosciences Research Center of Lyon, Bron, France
| | - Alice Masurel-Paulet
- Centre de référence anomalies du développement et syndromes malformatifs, FHU TRANSLAD et équipe GAD INSERM UMR1231, CHU Dijon-Bourgogne et Université de Bourgogne-Franche Comté, Dijon, France
| | - Cyril Mignot
- Département de Génétique; Centre de Référence Déficience Intellectuelle de Causes Rares, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Chantal Missirian
- Laboratoire de Génétique Chromosomique, Département de Génétique Médicale, AP-HM, Marseille, France
| | - Fanny Morice-Picard
- Service de Génétique Médicale, Hôpital Pellegrin, Université de Bordeaux, MRGM INSERM U1211, CHU Bordeaux, Bordeaux, France
| | - Sébastien Moutton
- Service de Génétique Médicale, Hôpital Pellegrin, Université de Bordeaux, MRGM INSERM U1211, CHU Bordeaux, Bordeaux, France
| | - Gwenaël Nadeau
- Laboratoire de Génétique Chromosomique, CH Général, Chambéry, France.,Service de Cytogénétique, CH Valence, Valence, France
| | - Céline Pebrel-Richard
- Service de Cytogénétique Médicale, Hôpital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sylvie Odent
- Service de Génétique Clinique, CHU Rennes, Rennes, France.,CNRS, IGDR (Institut de Génétique et Développement de Rennes) UMR 6290, Université de Rennes, Rennes, France
| | | | | | - Nicole Philip
- Département de Génétique Médicale, Unité de Génétique Clinique, AP-HM, Marseille, France
| | | | - Linda Pons
- Service de Génétique, Hospices Civils de Lyon, Bron, France.,INSERM U1028, CNRS UMR5292, UCBL1, GENDEV Team, Neurosciences Research Center of Lyon, Bron, France
| | - Marie-France Portnoï
- Département de génétique et embryologie médicale, Centre de référence des déficiences intellectuelles de causes rares, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Fabienne Prieur
- Service de Génétique Clinique, Chromosomique et Moléculaire, CHU Hôpital Nord, Saint-Etienne, France
| | | | - Audrey Putoux
- Service de Génétique, Hospices Civils de Lyon, Bron, France.,INSERM U1028, CNRS UMR5292, UCBL1, GENDEV Team, Neurosciences Research Center of Lyon, Bron, France
| | - Marlène Rio
- Service de Génétique Médicale, Hôpital Necker-Enfants Malades, Paris, France
| | - Caroline Rooryck-Thambo
- Service de Génétique Médicale, Hôpital Pellegrin, Université de Bordeaux, MRGM INSERM U1211, CHU Bordeaux, Bordeaux, France
| | - Massimiliano Rossi
- Service de Génétique, Hospices Civils de Lyon, Bron, France.,INSERM U1028, CNRS UMR5292, UCBL1, GENDEV Team, Neurosciences Research Center of Lyon, Bron, France
| | - Catherine Sarret
- Service de Génétique Médicale, Hôpital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Véronique Satre
- Laboratoire de Génétique Chromosomique, Hôpital Couple Enfant, CHU Grenoble, Grenoble, France.,Equipe Génétique, Epigénétique et Thérapies de l'Infertilité, IAB, INSERM 1209, CNRS UMR5309, Grenoble, France
| | - Jean-Pierre Siffroi
- Département de génétique et embryologie médicale, Centre de référence des déficiences intellectuelles de causes rares, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Marianne Till
- Service de Génétique, Hospices Civils de Lyon, Bron, France
| | - Renaud Touraine
- Service de Génétique Clinique, Chromosomique et Moléculaire, CHU Hôpital Nord, Saint-Etienne, France
| | | | - Jérome Toutain
- Service de Génétique Médicale, Hôpital Pellegrin, Université de Bordeaux, MRGM INSERM U1211, CHU Bordeaux, Bordeaux, France
| | - Stéphanie Valence
- GRC n°19, pathologies Congénitales du Cervelet-LeucoDystrophies, AP-HP, Hôpital Armand Trousseau, Sorbonne Université, Paris, France.,Service de Neurologie Pédiatrique, Hôpital Armand Trousseau, APHP, GHUEP, Paris, France
| | - Alain Verloes
- Département de Génétique, Hôpital Robert Debré, Paris, France
| | - Sandra Whalen
- Département de génétique et embryologie médicale, Centre de référence des déficiences intellectuelles de causes rares, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Patrick Edery
- Service de Génétique, Hospices Civils de Lyon, Bron, France.,INSERM U1028, CNRS UMR5292, UCBL1, GENDEV Team, Neurosciences Research Center of Lyon, Bron, France
| | | | - Damien Sanlaville
- Service de Génétique, Hospices Civils de Lyon, Bron, France.,INSERM U1028, CNRS UMR5292, UCBL1, GENDEV Team, Neurosciences Research Center of Lyon, Bron, France
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38
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Buscarini E, Botella LM, Geisthoff U, Kjeldsen AD, Mager HJ, Pagella F, Suppressa P, Zarrabeitia R, Dupuis-Girod S, Shovlin CL. Safety of thalidomide and bevacizumab in patients with hereditary hemorrhagic telangiectasia. Orphanet J Rare Dis 2019; 14:28. [PMID: 30717761 PMCID: PMC6360670 DOI: 10.1186/s13023-018-0982-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/14/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hereditary hemorrhagic telangiectasia (HHT) is a multisystemic inherited vascular dysplasia that leads to nosebleeds and visceral arteriovenous malformations (AVMs). Anti-angiogenic drugs thalidomide and bevacizumab have been increasingly used off-label with variable results. The HHT working group within the ERN for Rare Multisystemic Vascular Diseases (VASCERN), developed a questionnaire-based retrospective capture of adverse events (AEs) classified using the Common Terminology Criteria for Adverse Events. RESULTS Sixty-nine HHT patients received bevacizumab, 37 (50.6%) for high output cardiac failure/hepatic AVMs, and 32 (49.4%) for bleeding; the 69 patients received bevacizumab for a mean of 11 months for a total of 63.8 person/years treatment. 67 received thalidomide, all for epistaxis and/or gastrointestinal bleeding; they received thalidomide for a mean of 13.4 months/patient for a total of 75 person/years treatment. AEs were reported in 58 patients, 33 with bevacizumab, 37 with thalidomide. 32 grade 1-3 AEs related to bevacizumab were reported with an average incidence rate of 50 per 100 person-years. 34 grade 1-3 AEs related to thalidomide were reported with an average incidence rate of 45.3 per 100 person-years. Bevacizumab AEs were more common in females (27 AEs in 46 women) than males (6 in 23, p < 0.001). Thalidomide AEs occurred at more similar rates in males (25 AEs in 41 men, 60.9%) and females (12 in 26 (46.2%), but were more common in ENG patients (17 in 17) than in ACVRL1 (14 in 34, p < 0.0001). For bevacizumab, the most common reports were of joint pains (7/69, 10%), headache (3/69, 4.4%) and proteinuria (2/69, 3%), and for thalidomide, peripheral neuropathy (12/67, 18%); drowsiness (8/67, 12%); and dizziness (6/67, 9%). Fatal adverse events were more common in males (p = 0.009), and in patients with ENG pathogenic variants (p = 0.012). One fatal AE was possibly related to bevacizumab (average incidence rate: 1.5 per 100 person-years); 3 fatal AEs were possibly related to thalidomide (average incidence rate: 4 per 100 person-years). CONCLUSIONS With potential increase in use of Bevacizumab and Thalidomide in HHT patients, data presented support appropriate weighing of the toxicities which can arise in HHT settings and the practice recommendations for their prevention and management.
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Affiliation(s)
| | - Luisa Maria Botella
- Department of Cell and Molecular Medicine Centro de Investigaciones Biológicas, CSIC, U707 CIBERER, Madrid, Spain
| | - Urban Geisthoff
- VASCERN HHT Reference Center, Essen University Hospital, Department of Otorhinolaryngology, University of Duisburg-Essen, Essen, Germany
| | - Anette D. Kjeldsen
- VASCERN HHT Reference Center, Odense Universitetshospital, Syddansk Universitet, Odense, Denmark
| | - Hans Jurgen Mager
- VASCERN HHT Reference Center, St Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Fabio Pagella
- VASCERN HHT Reference Center, Unità Operativa Complessa di Otorinolaringoiatria, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Patrizia Suppressa
- VASCERN HHT Reference Center, Centro sovraziendale Malattie rare, “Frugoni” Internal Medicine Unit, University of Bari “A. Moro”, Bari, Italy
| | | | - Sophie Dupuis-Girod
- VASCERN HHT Reference Center, Genetic department, Hospices Civils de Lyon, Femme-Mère-Enfants Hospital, F-69677 Bron, France
| | - Claire L. Shovlin
- VASCERN HHT Reference Center, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, and Vascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
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Margelidon-Cozzolino V, Khoutra C, Traclet J, Ahmad K, Gamondes D, Dupuis-Girod S, Cottin V. Dépistage des malformations arterio-veineuses pulmonaires dans la maladie de Rendu-Osler : quels risques pour les patients présentant des micronodules et/ou un shunt intrapulmonaire au premier dépistage ? Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Margelidon-Cozzolino V, Cottin V, Dupuis-Girod S, Ahmad K, Traclet J, Glérant J, Mornex J, Turquier S. Causes multiples des hypertensions pulmonaires associées à la maladie de Rendu–Osler. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.050] [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: 10/27/2022]
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Legrand A, Devriese M, Dupuis-Girod S, Simian C, Venisse A, Mazzella JM, Auribault K, Adham S, Frank M, Albuisson J, Jeunemaitre X. Frequency of de novo variants and parental mosaicism in vascular Ehlers–Danlos syndrome. Genet Med 2018; 21:1568-1575. [DOI: 10.1038/s41436-018-0356-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/29/2018] [Indexed: 01/23/2023] Open
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Poisson A, Lesca G, Chatron N, Favre E, Cottin V, Gamondes D, Sanlaville D, Edery P, Giraud S, Demily C, Dupuis-Girod S. 12q13.12q13.13 microdeletion encompassing ACVRL1 and SCN8A genes: Clinical report of a new contiguous gene syndrome. Eur J Med Genet 2018; 62:103565. [PMID: 30389587 DOI: 10.1016/j.ejmg.2018.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/08/2018] [Accepted: 10/28/2018] [Indexed: 11/15/2022]
Abstract
Hereditary hemorrhagic telangiectasia is usually linked to the presence of a pathogenic mutation ACVRL1 or ENG. Thus, apparently there is no benefit to perform an array CGH in case of HHT. However, ENG has been involved in a contiguous gene syndrome due to a de novo 9q33.3q34.11 microdeletion. We describe here a new contiguous gene syndrome involving ACVRL1 gene. A 50-year-old female patient had a typical clinical presentation of hereditary hemorrhagic telangiectasia (HHT) with epistaxis, cutaneous-mucous telangiectases, arteriovenous malformation. She also presented a cognitive disability. Cognitive assessment showed a heterogeneous cognitive disorder predominating in the executive sphere without intellectual deficiency. She had no peculiar morphological feature. Neurological examination disclosed the presence of contralateral mirror movements during voluntary movement of each hand. A heterozygous deletion of the whole ACVRL1 gene (exons 1 to 10) was found to be responsible for the HHT features. To investigate further the dysexecutive syndrome and the mirror movements, we performed oligonucleotide array comparative genomic hybridization (array CGH) study (180K, Agilent, Santa-Clara, CA, USA). This study revealed a de novo 1.58 Mb deletion on chromosome 12q13.12q13.13 encompassing the ACVRL1 and SCN8A genes. To our knowledge, this deletion has not been previously reported and defines a new contiguous gene syndrome. The loss of one ACVRL1 allele is likely to be responsible for the HHT phenotype, while the deletion of the SCN8A gene is likely to be the cause of the mild cognitive disorder. SCN8A haploinsufficiency might also be involved in the occurrence of mirror movements. This report highlights the benefit of searching for large rearrangements in cases including unusual symptoms in association with HHT. On the other hand, an early diagnosis of 12q13.12q13.13 microdeletion based on the presence of a dysexecutive syndrome and/or mirror movement may allow to prevent HHT complications.
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Affiliation(s)
- Alice Poisson
- GénoPsy, Center for Diagnosis and Management of Genetic Psychiatric Disorders, Centre Hospitalier le Vinatier, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR5292, INSERM U1028, Lyon 2, France.
| | - Gaetan Lesca
- Hospices Civils de Lyon, Genetic Department and Molecular Biology Laboratory, Centre de Biologie Est, Bron, F-69677, France; Université Claude Bernard Lyon 1, F-69100, Villeurbanne, France
| | - Nicolas Chatron
- Hospices Civils de Lyon, Genetic Department and Molecular Biology Laboratory, Centre de Biologie Est, Bron, F-69677, France; Université Claude Bernard Lyon 1, F-69100, Villeurbanne, France
| | - Emilie Favre
- GénoPsy, Center for Diagnosis and Management of Genetic Psychiatric Disorders, Centre Hospitalier le Vinatier, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR5292, INSERM U1028, Lyon 2, France
| | - Vincent Cottin
- Hospices Civils de Lyon, Department of Pulmonary Medicine and National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Bron, F-69677, France; Université Claude Bernard Lyon 1, F-69100, Villeurbanne, France
| | - Delphine Gamondes
- Hospices Civils de Lyon, Department of Radiology, Louis Pradel Hospital, Bron, F-69677, France
| | - Damien Sanlaville
- Hospices Civils de Lyon, Genetic Department and Molecular Biology Laboratory, Centre de Biologie Est, Bron, F-69677, France; Université Claude Bernard Lyon 1, F-69100, Villeurbanne, France
| | - Patrick Edery
- Hospices Civils de Lyon, Genetic Department and National HHT Reference Center, Femme-Mère-Enfants Hospital, Bron, F-69677, France; Université Claude Bernard Lyon 1, F-69100, Villeurbanne, France
| | - Sophie Giraud
- Hospices Civils de Lyon, Genetic Department and National HHT Reference Center, Femme-Mère-Enfants Hospital, Bron, F-69677, France
| | - Caroline Demily
- GénoPsy, Center for Diagnosis and Management of Genetic Psychiatric Disorders, Centre Hospitalier le Vinatier, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR5292, INSERM U1028, Lyon 2, France; Université Claude Bernard Lyon 1, F-69100, Villeurbanne, France
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Genetic Department and National HHT Reference Center, Femme-Mère-Enfants Hospital, Bron, F-69677, France
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Beyens A, Albuisson J, Boel A, Al-Essa M, Al-Manea W, Bonnet D, Bostan O, Boute O, Busa T, Canham N, Cil E, Coucke PJ, Cousin MA, Dasouki M, De Backer J, De Paepe A, De Schepper S, De Silva D, Devriendt K, De Wandele I, Deyle DR, Dietz H, Dupuis-Girod S, Fontenot E, Fischer-Zirnsak B, Gezdirici A, Ghoumid J, Giuliano F, Baena N, Haider MZ, Hardin JS, Jeunemaitre X, Klee EW, Kornak U, Landecho MF, Legrand A, Loeys B, Lyonnet S, Michael H, Moceri P, Mohammed S, Muiño-Mosquera L, Nampoothiri S, Pichler K, Prescott K, Rajeb A, Ramos-Arroyo M, Rossi M, Salih M, Seidahmed MZ, Schaefer E, Steichen-Gersdorf E, Temel S, Uysal F, Vanhomwegen M, Van Laer L, Van Maldergem L, Warner D, Willaert A, Collins Ii TR, Taylor A, Davis EC, Zarate Y, Callewaert B. Correction: Arterial tortuosity syndrome: 40 new families and literature review. Genet Med 2018; 21:1894-1895. [PMID: 30201961 DOI: 10.1038/s41436-018-0035-3] [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: 11/09/2022] Open
Abstract
In the published version of this paper the author Neus Baena's name was incorrectly given as Neus Baena Diez. This has now been corrected in both the HTML and PDF versions of the paper.
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Affiliation(s)
- Aude Beyens
- Center For Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - Juliette Albuisson
- APH, Hôpital Européen Georges Pompidou, Centre de Référence des Maladies Vasculaires Rares, INSERM, U970, Université Descartes Paris, Sarbonne Cité, Paris, France
| | - Annekatrien Boel
- Center For Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - Mazen Al-Essa
- Pediatrics Department, Kuwait University, Kuwait City, Kuwait
| | - Waheed Al-Manea
- Pediatric Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Damien Bonnet
- Medical Genetics Service, Hôpital Necker-Enfants Malades, Paris, France
| | - Ozlem Bostan
- Department of Pediatric Cardiology, University of Uludag, Bursa, Turkey
| | - Odile Boute
- Clinical Genetics Service "Guy Fontaine," Hôpital Calmette, Lille, France
| | - Tiffany Busa
- Service de Génétique Clinique, Département de Génétique, AP-HM CHU Timone Enfants, Marseille, France
| | - Nathalie Canham
- North West Thames Regional Genetics Service, Northwick Park Hospital, Harrow, United Kingdom
| | - Ergun Cil
- Department of Pediatric Cardiology, University of Uludag, Bursa, Turkey
| | - Paul J Coucke
- Center For Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - Margot A Cousin
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Majed Dasouki
- Department of Pediatrics, University of Kansas, Kansas City, Kansas, USA
| | - Julie De Backer
- Center For Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Anne De Paepe
- Center For Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - Sofie De Schepper
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Deepthi De Silva
- Department of Physiology, University of Kelaniya, Ragama, Sri Lanka.,Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | - Inge De Wandele
- Center For Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - David R Deyle
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.,Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA.,Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Harry Dietz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique et Centre de Référence Pour la Maladie de Rendu-Osler, Université Lyon, Lyon, France
| | - Eudice Fontenot
- Division of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Björn Fischer-Zirnsak
- Institute of Medical and Human Genetics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alper Gezdirici
- Department of Medical Genetics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Jamal Ghoumid
- Department of Medical Genetics, Lille University Hospital, CHU Lille, Lille, France
| | - Fabienne Giuliano
- Department of Physical Medicine and Rehabilitation, Raymond Poincare Hospital, Garches, France
| | - Neus Baena
- Genetics Laboratory UDIAT Diagnostic Center, Parc Tauli University Hospital, Sabadell, Spain
| | | | - Joshua S Hardin
- Department of Ophthalmology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Xavier Jeunemaitre
- APH, Hôpital Européen Georges Pompidou, Centre de Référence des Maladies Vasculaires Rares, INSERM, U970, Université Descartes Paris, Sarbonne Cité, Paris, France
| | - Eric W Klee
- Service de Génétique Clinique, Département de Génétique, AP-HM CHU Timone Enfants, Marseille, France.,North West Thames Regional Genetics Service, Northwick Park Hospital, Harrow, United Kingdom.,Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
| | - Uwe Kornak
- Institute of Medical and Human Genetics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Manuel F Landecho
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Anne Legrand
- APH, Hôpital Européen Georges Pompidou, Centre de Référence des Maladies Vasculaires Rares, INSERM, U970, Université Descartes Paris, Sarbonne Cité, Paris, France
| | - Bart Loeys
- Center of Medical Genetics, University Hospital of Antwerp, Antwerp, Belgium
| | - Stanislas Lyonnet
- Medical Genetics Service, Hôpital Necker-Enfants Malades, Paris, France
| | - Helen Michael
- Paediatric Cardiology and Transition, Leeds General Infirmary, Leeds, United Kingdom
| | - Pamela Moceri
- Cardiology Department, Université Côte d'Azur, CHU de Nice et Hôpitaux Universitaires Pédiatriques Lenval, Nice, France
| | - Shehla Mohammed
- South East Thames Regional Genetics Service, Guy's Hospital, London, United Kingdom
| | | | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Karin Pichler
- Clinic for Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Katrina Prescott
- Clinical Genetics, Yorkshire Regional Genetics Service, Leeds, United Kingdom
| | - Anna Rajeb
- Institute of Medical and Human Genetics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Ramos-Arroyo
- Medical Genetics Service, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Massimiliano Rossi
- Genetic Department, Femme-Mère-Enfant Hospital, Hospices Civils de Lyon and INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, GENDEV Team, Université Claude Bernard Lyon 1, Bron, France
| | - Mustafa Salih
- Division of Pediatric Neurology, King Saud University, Riyadh, Saudi Arabia
| | | | - Elise Schaefer
- Medical Genetics Service, CHU Strasbourg, Strasbourg, France
| | | | - Sehime Temel
- Department of Histology and Embryology, Faculty of Medicine, Near East University, Lefkoşa, Cyprus.,Department of Histology and Embryology, Faculty of Medicine, University of Uludag, Bursa, Turkey.,Department of Medical Genetics, Faculty of Medicine, University of Uludag, Bursa, Turkey
| | - Fahrettin Uysal
- Department of Pediatric Cardiology, University of Uludag, Bursa, Turkey
| | - Marine Vanhomwegen
- Center For Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - Lut Van Laer
- Center of Medical Genetics, University Hospital of Antwerp, Antwerp, Belgium
| | | | - David Warner
- Department of Ophthalmology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Andy Willaert
- Center For Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - Tom R Collins Ii
- Division of Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Elaine C Davis
- Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
| | - Yuri Zarate
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Bert Callewaert
- Center For Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.
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Shovlin CL, Buscarini E, Kjeldsen AD, Mager HJ, Sabba C, Droege F, Geisthoff U, Ugolini S, Dupuis-Girod S. European Reference Network For Rare Vascular Diseases (VASCERN) Outcome Measures For Hereditary Haemorrhagic Telangiectasia (HHT). Orphanet J Rare Dis 2018; 13:136. [PMID: 30111344 PMCID: PMC6094583 DOI: 10.1186/s13023-018-0850-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022] Open
Abstract
Hereditary haemorrhagic telangiectasia (HHT) is a multisystemic vascular dysplasia that leads to nosebleeds, anaemia due to blood loss, and arteriovenous malformations (AVMs) in organs such as the lungs, liver and brain. HHT is estimated to affect 85,000 European citizens, but most health care providers have limited prior HHT exposure or training. Outcome Measures were developed and implemented by the HHT Working Group of the European Reference Network for Rare Vascular Diseases (VASCERN), in order to maximise the number of patients receiving good care. The measures specifically target areas where optimal management reduces morbidity and mortality in HHT patients, and were designed to be robust to emerging new evidence. Thresholds are the percentage of patients in particular settings who have been recommended screening, or provided with written advice. The 5 Outcome Measures cover (1) pulmonary AVM screening; (2) written nosebleed advice, (3) assessment of iron deficiency; (4) antibiotic prophylaxis prior to dental and surgical procedures for patients with pulmonary AVMs, and (5) written advice on pregnancy. They are not a blueprint for detailed HHT management, but are suitable for all clinicians to be aware of and implement. In summary, these 5 Outcome Measures provide metrics to identify healthcare providers of good care, and encourage care improvement by all healthcare providers.
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Affiliation(s)
- Claire L Shovlin
- Respiratory Medicine, and VASCERN HHT European Reference Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK. .,NHLI Vascular Science, Imperial College London, London, UK.
| | - Elisabetta Buscarini
- Gastroenterology Department and VASCERN HHT European Reference Centre, Maggiore Hospital, ASST Crema, Crema, Italy.
| | - Anette D Kjeldsen
- Department of Otorhinolaryngology and VASCERN HHT European Reference Centre, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Hans Jurgen Mager
- Department of Pulmonology and VASCERN HHT European Reference Centre, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Carlo Sabba
- Center for Rare Diseases, "Frugoni" Internal Medicine Unit, Interdepartmental HHT Center, Interdisciplinary Department of Medicine and VASCERN HHT European Reference Centre, University of Bari School of Medicine, Bari, Italy
| | - Freya Droege
- Department of Otorhinolaryngology and VASCERN HHT European Reference Centre, Essen University Hospital, Essen, Germany
| | - Urban Geisthoff
- Department of Otorhinolaryngology and VASCERN HHT European Reference Centre, Essen University Hospital, Essen, Germany.,Present address: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Sara Ugolini
- Department of Otorhinolaryngology and VASCERN HHT European Reference Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (I.R.C.C.S) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfants, Service de Génétique, and VASCERN HHT European Reference Centre/ centre de Référence pour la maladie de Rendu-Osler, F-69677, Bron, France. .,Université de Lyon, Faculté de médecine, Université Lyon 1, F-69008, Lyon, France.
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Margelidon-Cozzolino V, Khouatra C, Ahmad K, Traclet J, Chebib N, Dupuis-Girod S, Cottin V. Dépistage des malformations artérioveineuses pulmonaires dans la cohorte du centre de référence national de la maladie de Rendu-Osler. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.063] [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: 10/18/2022]
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Guilhem A, Fargeton AE, Simon AC, Duffau P, Harle JR, Lavigne C, Carette MF, Bletry O, Kaminsky P, Leguy V, Lerolle N, Roux D, Lambert M, Chinet T, Bonnet D, Dupuis-Girod S, Rivière S. Intra-venous bevacizumab in hereditary hemorrhagic telangiectasia (HHT): A retrospective study of 46 patients. PLoS One 2017; 12:e0188943. [PMID: 29190827 PMCID: PMC5708634 DOI: 10.1371/journal.pone.0188943] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/15/2017] [Indexed: 12/25/2022] Open
Abstract
Background Bevacizumab, an anti-VEGF monoclonal antibody, has recently emerged as a new option for severe forms of hereditary hemorrhagic telangiectasia (HHT). Its utilization in this orphan disease has rapidly spread despite the lack of randomized trials and international guidelines. The objective of this study is to report the main clinical data (baseline characteristics, dose schedule, efficacy, adverse events and deaths) of HHT patients treated by intravenous bevacizumab in France. Methods Retrospective observational study of HHT patients treated with bevacizumab for a severe form of the disease in the 14 centers of the French HHT network. Results Forty-six patients (median age: 68 years) were treated between March 2009 and May 2015. Ten patients were treated for high output cardiac failure, 20 patients for severe hemorrhages and 16 for both indications. The standard protocol (6 infusions of 5mg/kg every 2 weeks) was initially used in 89% of the cases but diverse strategies were subsequently applied. A clinical improvement was noted by the referent physician for 74% of the patients with a median effect’s duration of 6 months. Wound healing complications led to 2 amputations. Arthralgia/arthritis and arterial hypertension occurred in 5 patients each. One third of the patients were dead at the time of the final update, coherently with age and the poor prognosis of these highly symptomatic patients. Conclusion Intravenous bevacizumab seems to provide a clinical benefice in severe HHT patients. Precautions concerning wound healing and vascular pathologies must be respected. Prospective double blinded versus placebo trials are needed.
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Affiliation(s)
- Alexandre Guilhem
- Médecine Interne - Maladies Multi-Organiques, Hôpital Saint Eloi, Montpellier, France
- * E-mail:
| | - Anne-Emmanuelle Fargeton
- Service de Génétique - Centre de Référence National Maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France
| | | | - Pierre Duffau
- Service de Médecine Interne et Immunologie Clinique, Hôpital Saint-André, Bordeaux, France
| | - Jean-Robert Harle
- Département de Médecine Interne, Hôpital de la Timone, Marseille, France
| | - Christian Lavigne
- Médecine Interne et Maladies Vasculaires, CHU d’Angers, Angers, France
| | | | - Olivier Bletry
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Pierre Kaminsky
- Service de Médecine Interne, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France
| | - Vanessa Leguy
- Service de Médecine Interne et Immunologie Clinique, Hôpital François Mitterrand, Dijon, France
| | | | | | - Marc Lambert
- Service de Médecine Interne, Hôpital Huriez, Lille, France
| | - Thierry Chinet
- Service de Pneumologie, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Delphine Bonnet
- Service de Médecine Interne du Pôle digestif, CHU Purpan, Toulouse, France
| | - Sophie Dupuis-Girod
- Service de Génétique - Centre de Référence National Maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France
| | - Sophie Rivière
- Médecine Interne - Maladies Multi-Organiques, Hôpital Saint Eloi, Montpellier, France
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Vanlerberghe C, Jourdain AS, Dieux A, Toutain A, Callewaert B, Dupuis-Girod S, Unger S, Wright M, Isidor B, Ghoumid J, Petit F, Boutry N, Escande F, Manouvrier-Hanu S. Small patella syndrome: New clinical and molecular insights into a consistent phenotype. Clin Genet 2017; 92:676-678. [DOI: 10.1111/cge.13103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/06/2017] [Accepted: 07/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- C. Vanlerberghe
- Department of Clinical Genetics; CHU Lille; France
- Université Lille; EA7364 RADEME; Lille France
| | - A.-S. Jourdain
- Université Lille; EA7364 RADEME; Lille France
- Department of Molecular genetics; CHU Lille; France
| | - A. Dieux
- Department of Clinical Genetics; CHU Lille; France
| | - A. Toutain
- Department of Genetics; CHU Tours France
| | | | - S. Dupuis-Girod
- Department of Clinical Genetics; Groupement Hospitalier Est; Bron France
| | - S. Unger
- Department of Genetic Medicine; CHU Vaudois; Lausanne Switzerland
| | - M. Wright
- Institute of Genetic Medicine; International Centre for Life; Newcastle UK
| | - B. Isidor
- Department of Clinical Genetics, Hôpital Mère et Enfant; CHU Nantes; France
| | - J. Ghoumid
- Department of Clinical Genetics; CHU Lille; France
- Université Lille; EA7364 RADEME; Lille France
| | - F. Petit
- Department of Clinical Genetics; CHU Lille; France
- Université Lille; EA7364 RADEME; Lille France
| | - N. Boutry
- Université Lille; EA7364 RADEME; Lille France
- Department of Pediatric Radiology; CHU Lille; France
| | - F. Escande
- Université Lille; EA7364 RADEME; Lille France
- Department of Molecular genetics; CHU Lille; France
| | - S. Manouvrier-Hanu
- Department of Clinical Genetics; CHU Lille; France
- Université Lille; EA7364 RADEME; Lille France
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48
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Etievant J, Si-Mohamed S, Vinurel N, Dupuis-Girod S, Decullier E, Gamondes D, Khouatra C, Cottin V, Revel D. Pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia: Correlations between computed tomography findings and cerebral complications. Eur Radiol 2017; 28:1338-1344. [PMID: 29018941 DOI: 10.1007/s00330-017-5047-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/16/2017] [Accepted: 08/22/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Computed tomography (CT) is the modality of choice to characterise pulmonary arteriovenous malformations (PAVMs) in patients with hereditary haemorrhagic telangiectasia (HHT). Our objective was to determine if CT findings were associated with frequency of brain abscess and ischaemic stroke. METHODS This retrospective study included patients with HHT-related PAVMs. CT results, i.e. PAVM presentation (unique, multiple, disseminated or diffuse), the number of PAVMs and the largest feeding artery size, were correlated to prevalence of ischaemic stroke and brain abscess. All CTs were reviewed in consensus by two radiologists. RESULTS Of 170 patients, 73 patients had unique (42.9 %), 49 multiple (28.8 %), 36 disseminated (21.2 %) and 12 diffuse (7.1 %) PAVMs. Fifteen patients presented with brain abscess; 26 patients presented with ischaemic stroke. The number of PAVMs was significantly correlated with brain abscess (11.5 vs. 6.2, respectively; p=0.025). The mean diameter of the largest feeding artery was significantly correlated with ischaemic stroke frequency (4.9 vs. 3.2 mm, respectively; p=0.0098). CONCLUSIONS The number of PAVMs correlated significantly with risk of brain abscess, and a larger feeding artery significantly with more ischaemic strokes. These findings can lead to a better recognition and management of the PAVMs at risk of cerebral complications. KEY POINTS • Chest CT helps clinicians to facilitate appropriate PAVM management strategies. • Pulmonary arteriovenous malformation CT findings are correlated with risk of cerebral complications. • Risk of brain abscess is significantly correlated with number of PAVMs. • Risk of ischaemic stroke is significantly correlated with large feeding artery PAVMs. • Prevalence of observed of brain abscess and ischaemic stroke is 26 %.
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Affiliation(s)
- Johan Etievant
- Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Département d'Imagerie Cardiaque et Thoracique, Diagnostique et Interventionnelle, 59 Boulevard Pinel, 69500, Bron, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Salim Si-Mohamed
- Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Département d'Imagerie Cardiaque et Thoracique, Diagnostique et Interventionnelle, 59 Boulevard Pinel, 69500, Bron, France. .,Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Nicolas Vinurel
- Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Département d'Imagerie Cardiaque et Thoracique, Diagnostique et Interventionnelle, 59 Boulevard Pinel, 69500, Bron, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service de Génétique, Centre de Référence pour la maladie de Rendu-Osler, Lyon, France
| | - Evelyne Decullier
- Université Claude Bernard Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, Lyon, France
| | - Delphine Gamondes
- Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Département d'Imagerie Cardiaque et Thoracique, Diagnostique et Interventionnelle, 59 Boulevard Pinel, 69500, Bron, France
| | - Chahera Khouatra
- Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Service de pneumologie - Centre des Maladies Orphelines Pulmonaires, Lyon, France
| | - Vincent Cottin
- Université Claude Bernard Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Service de pneumologie - Centre des Maladies Orphelines Pulmonaires, Lyon, France
| | - Didier Revel
- Hospices Civils de Lyon, Hôpital Cardiologique Louis Pradel, Département d'Imagerie Cardiaque et Thoracique, Diagnostique et Interventionnelle, 59 Boulevard Pinel, 69500, Bron, France.,Université Claude Bernard Lyon 1, Villeurbanne, France
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49
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Revuz S, Decullier E, Ginon I, Lamblin N, Hatron PY, Kaminsky P, Carette MF, Lacombe P, Simon AC, Rivière S, Harlé JR, Fraisse A, Lavigne C, Leguy-Seguin V, Chaouat A, Khouatra C, Dupuis-Girod S, Hachulla E. Pulmonary hypertension subtypes associated with hereditary haemorrhagic telangiectasia: Haemodynamic profiles and survival probability. PLoS One 2017; 12:e0184227. [PMID: 28981519 PMCID: PMC5628806 DOI: 10.1371/journal.pone.0184227] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/21/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Different pulmonary hypertension (PH) mechanisms are associated with hereditary haemorrhagic telangiectasia (HHT). METHODS AND RESULTS We conducted a retrospective study of all suspected cases of PH (echocardiographically estimated systolic pulmonary artery pressure [sPAP] ≥ 40 mmHg) in patients with definite HHT recorded in the French National Reference Centre for HHT database. When right heart catheterization (RHC) was performed, PH cases were confirmed and classified among the PH groups according to the European guidelines. Among 2,598 patients in the database, 110 (4.2%) had suspected PH. Forty-seven of these 110 patients had RHC: 38/47 (81%) had a confirmed diagnosis of PH. The majority of these had isolated post-capillary PH (n = 20). We identified for the first time other haemodynamic profiles: pre-capillary pulmonary arterial hypertension (PAH) cases (n = 3) with slightly raised pulmonary vascular resistances (PVR), and combined post- and pre-capillary PH cases (n = 4). Compared to controls, survival probability was lower in patients with PAH. CONCLUSION This study revealed the diversity of PH mechanisms in HHT. The description of combined post- and pre-capillary PH with/or without high cardiac output (CO) suggests either a continuum between the pre- and post-capillary haemodynamic profiles or a different course in response to high CO.
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Affiliation(s)
- Sabine Revuz
- Département de Médecine Interne et Immunologie clinique, CHU de Brabois, Vandœuvre-lès-Nancy, France
- * E-mail:
| | | | - Isabelle Ginon
- Service d’Explorations Cardiologiques, Centre Hospitalier Lyon Sud, Pierre-Bénite, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Lamblin
- Service de Cardiologie, CHRU de Lille, Université de Lille, Lille, France
| | - Pierre-Yves Hatron
- Service de Médecine interne, CHRU de Lille, Université de Lille, Lille, France
| | - Pierre Kaminsky
- Département de Médecine Interne et Immunologie clinique, CHU de Brabois, Vandœuvre-lès-Nancy, France
| | | | - Pascal Lacombe
- Service d’Imagerie diagnostique et interventionnelle, APHP Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | | | - Sophie Rivière
- Service de Médecine interne, CHU Montpellier, Montpellier, France
| | - Jean-Robert Harlé
- Service de Médecine interne, CHU Marseille Hôpital de la Conception, Marseille, France
| | - Alain Fraisse
- Paediatric Cardiology Service, Royal Brompton and Harefield Hospitals Trust, London, United Kingdom
| | - Christian Lavigne
- Service de Médecine interne et Maladies vasculaires, CHU Angers, Angers, France
| | | | - Ari Chaouat
- Département de Pneumologie, CHU de Brabois, Vandœuvre-lès-Nancy, France
| | - Chahera Khouatra
- Service de Pneumologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Sophie Dupuis-Girod
- Service de Génétique et Centre de Référence pour la Maladie de Rendu-Osler, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Eric Hachulla
- Service de Médecine interne, CHRU de Lille, Université de Lille, Lille, France
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50
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Abstract
Hereditary hemorrhagic telangiectasia (HHT) is a dominantly inherited genetic vascular disorder with an estimated prevalence of 1 in 6,000, characterized by recurrent epistaxis, cutaneous telangiectasia, and arteriovenous malformations (AVMs) that affect many organs including the lungs, gastrointestinal tract, liver, and brain. Its diagnosis is based on the Curaçao criteria, and is considered definite if at least 3 of the 4 following criteria are fulfilled: (1) spontaneous and recurrent epistaxis, (2) telangiectasia, (3) a family history, and (4) pulmonary, liver, cerebral, spinal, or gastrointestinal AVMs. The focus of this review is on delineating how HHT affects the lung.
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Affiliation(s)
- Sophie Dupuis-Girod
- Service de génétique - centre de référence national pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Hospices Civils de Lyon, Bron, France
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