1
|
Bautz J, Stypmann J, Reiermann S, Pavenstädt HJ, Suwelack B, Stegger L, Rahbar K, Reuter S, Schäfers M. Prognostic implication of myocardial perfusion and contractile reserve in end-stage renal disease: A direct comparison of myocardial perfusion scintigraphy and dobutamine stress echocardiography. J Nucl Cardiol 2022; 29:2988-2999. [PMID: 34750727 PMCID: PMC9834353 DOI: 10.1007/s12350-021-02844-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/25/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND We aimed to compare the prognostic value of myocardial perfusion scintigraphy (MPS) and dobutamine stress echocardiography (DSE) in patients with end-stage renal disease (ESRD) without known coronary artery disease. METHODS Two-hundred twenty-nine ESRD patients who applied for kidney transplantation at our centre were prospectively evaluated by MPS and DSE. The primary endpoint was a composite of myocardial infarction (MI) or all-cause mortality. The secondary endpoint included MI or coronary revascularization (CR) not triggered by MPS or DSE at baseline. RESULTS MPS detected reversible ischemia in 31 patients (13.5%) and fixed perfusion defects in 13 (5.7%) patients. DSE discovered stress-induced wall motion abnormalities (WMAs) in 28 (12.2%) and at rest in 18 (7.9%) patients. MPS and DSE results agreed in 85.6% regarding reversible defects (κ = 0.358; P < .001) and in 90.8% regarding fixed defects (κ = 0.275; P < .001). Coronary angiography detected relevant stenosis > 50% in only 15 of 38 patients (39.5%) with pathological findings in MPS and/or DSE. At a median follow-up of 8 years and 10 months, the primary endpoint occurred in 70 patients (30.6%) and the secondary endpoint in 24 patients (10.5%). The adjusted Cox hazard ratios (HRs) for the primary endpoint were 1.77 (95% CI 1.02-3.08; P = .043) for perfusion defects in MPS and 1.36 (95% CI 0.78-2.37; P = ns) for WMA in DSE. The secondary endpoint was significantly correlated with the findings of both modalities, MPS (HR 3.21; 95% CI 1.35-7.61; P = .008) and DSE (HR 2.67; 95% CI 1.15-6.20; P = .022). CONCLUSION Perfusion defects in MPS are a stronger determinant of all-cause mortality, MI and the need for future CR compared with WMAs in DSE. Given the complementary functional information provided by MPS vs DSE, results are sometimes contradictory, which may indicate differences in the underlying pathophysiology.
Collapse
Affiliation(s)
- Joachim Bautz
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
- Department of Internal Medicine D, Nephrology, University Hospital Münster, Münster, Germany
| | - Jörg Stypmann
- Department of Cardiology, University Hospital Münster, Münster, Germany
| | - Stefanie Reiermann
- Department of Internal Medicine D, Nephrology, University Hospital Münster, Münster, Germany
| | | | - Barbara Suwelack
- Department of Internal Medicine D, Nephrology, University Hospital Münster, Münster, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Kambiz Rahbar
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany
| | - Stefan Reuter
- Department of Internal Medicine D, Nephrology, University Hospital Münster, Münster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
- European Institute for Molecular Imaging, University of Münster, Münster, Germany.
- DFG EXC 1003 'Cells in Motion' Cluster of Excellence, University of Münster, Münster, Germany.
| |
Collapse
|
2
|
Lenders M, Nordbeck P, Kurschat C, Eveslage M, Karabul N, Kaufeld J, Hennermann JB, Patten M, Cybulla M, Müntze J, Üçeyler N, Liu D, Das AM, Sommer C, Pogoda C, Reiermann S, Duning T, Gaedeke J, von Cossel K, Blaschke D, Brand SM, Alexander Mann W, Kampmann C, Muschol N, Canaan-Kühl S, Brand E. Treatment of fabry disease with migalastat-outcome from a prospective 24 months observational multicenter study (FAMOUS). Eur Heart J Cardiovasc Pharmacother 2021; 8:272-281. [PMID: 35512362 DOI: 10.1093/ehjcvp/pvab025] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/04/2021] [Accepted: 03/11/2021] [Indexed: 01/13/2023]
Abstract
AIMS Fabry disease (FD) is an X-linked lysosomal storage disorder caused by a deficiency of the lysosomal enzyme α-galactosidase A (GLA/AGAL) resulting in lysosomal accumulation of globotriaosylceramide (Gb3). Patients with amenable GLA mutations can be treated with migalastat, an oral pharmacologic chaperone increasing endogenous AGAL activity. In this prospective observational multicenter study safety as well as cardiovascular, renal, and patient-reported outcomes and disease biomarkers were assessed after 12 and 24 months of migalastat treatment under "real world" conditions. METHODS AND RESULTS 54 patients (26 females) (33 of these [61.1%] pre-treated with enzyme replacement therapy) with amenable mutations were analyzed. Treatment was generally safe and well tolerated. 153 events per 1,000 patient-years were detected. Overall left ventricular mass index decreased after 24 months (all: -7.5 ± 17.4 g/m2, p = 0.0118; females: -4.6 ± 9.1 g/m2, p = 0.0554; males: -9.9 ± 22.2 g/m2, p = 0.0699). After 24 months, females and males presented with a moderate yearly loss of eGFR (-2.6 and -4.4 ml/min/1.73 m2 per year; p = 0.0317 and p = 0.0028, respectively). FD-specific manifestations/symptoms remained stable (all p > 0.05). 76.9% of females and 50% of males suffered from pain, which has not improved under treatment. FD-specific disease scores (DS3 and MSSI) remained stable during treatment. AGAL activities and plasma lyso-Gb3 values remained stable, although some male patients presented with increasing lyso-Gb3 levels over time. CONCLUSIONS Treatment with migalastat was generally safe and resulted in most patients in an amelioration of left ventricular mass. However, due to the heterogeneity of FD phenotypes, it is advisable that the treating physician monitors the clinical response regularly.
Collapse
Affiliation(s)
- Malte Lenders
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster
| | - Peter Nordbeck
- Department of Internal Medicine I, Comprehensive Heart Failure Center, and Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, Würzburg
| | - Christine Kurschat
- Department II of Internal Medicine, Center for Molecular Medicine Cologne and Center for Rare Diseases, University of Cologne, Cologne
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research (IBKF), University of Münster, Münster
| | - Nesrin Karabul
- Endokrinologikum Frankfurt, Center of Hormonal and Metabolic Diseases, Rheumatology, Osteology and Neurology, Frankfurt
| | - Jessica Kaufeld
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover
| | - Julia B Hennermann
- Villa Metabolica, Department for Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz
| | - Monica Patten
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg
| | - Markus Cybulla
- FGM, Center of Internal Medicine, Department of Nephrology and Rheumatology, Müllheim
| | - Jonas Müntze
- Department of Internal Medicine I, Comprehensive Heart Failure Center, and Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, Würzburg
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Würzburg
| | - Dan Liu
- Department of Internal Medicine I, Comprehensive Heart Failure Center, and Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, Würzburg
| | - Anibh M Das
- Department of Paediatrics, Hannover Medical School, Hannover
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg
| | - Christian Pogoda
- Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster
| | - Stefanie Reiermann
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster
| | - Thomas Duning
- Department of Neurology, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster
| | - Jens Gaedeke
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Fabry Zentrum, Zentrum für seltene Nierenerkrankungen (CeRKiD), Campus Charité Mitte, Charité - Universitätsmedizin Berlin
| | | | - Daniela Blaschke
- Department of Medicine, Division of Cardiology, Charité, Campus Virchow-Klinikum, Berlin
| | - Stefan-Martin Brand
- Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - W Alexander Mann
- Institute of Biostatistics and Clinical Research (IBKF), University of Münster, Münster
| | - Christoph Kampmann
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg, Eppendorf, Hamburg
| | - Sima Canaan-Kühl
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Fabry Zentrum, Zentrum für seltene Nierenerkrankungen (CeRKiD), Campus Charité Mitte, Charité - Universitätsmedizin Berlin
| | - Eva Brand
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster
| |
Collapse
|
3
|
Lenders M, Nordbeck P, Kurschat C, Karabul N, Kaufeld J, Hennermann JB, Patten M, Cybulla M, Müntze J, Üçeyler N, Liu D, Das AM, Sommer C, Pogoda C, Reiermann S, Duning T, Gaedeke J, Stumpfe K, Blaschke D, Brand SM, Mann WA, Kampmann C, Muschol N, Canaan-Kühl S, Brand E. Treatment of Fabry's Disease With Migalastat: Outcome From a Prospective Observational Multicenter Study (FAMOUS). Clin Pharmacol Ther 2020; 108:326-337. [PMID: 32198894 DOI: 10.1002/cpt.1832] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/11/2020] [Indexed: 01/15/2023]
Abstract
Fabry's disease (FD) is an X-linked lysosomal storage disorder caused by the deficient activity of the lysosomal enzyme α-galactosidase A (α-Gal A) leading to intracellular accumulation of globotriaosylceramide (Gb3). Patients with amenable mutations can be treated with migalastat, a recently approved oral pharmacologic chaperone to increase endogenous α-Gal A activity. We assessed safety along with cardiovascular, renal, and patient-reported outcomes and disease biomarkers in a prospective observational multicenter study after 12 months of migalastat treatment under "real-world" conditions. Fifty-nine (28 females) patients (34 (57.6%) pretreated with enzyme replacement therapy) with amenable mutations were recruited. Migalastat was generally safe and well tolerated. Females and males presented with a reduction of left ventricular mass index (primary end point) (-7.2 and -13.7 g/m2 , P = 0.0050 and P = 0.0061). FD-specific manifestations and symptoms remained stable (all P > 0.05). Both sexes presented with a reduction of estimated glomerular filtration rate (secondary end point) (-6.9 and -5.0 mL/minute/1.73 m2 ; P = 0.0020 and P = 0.0004, respectively), which was most prominent in patients with low blood pressure (P = 0.0271). α-Gal A activity increased in male patients by 15% from 29% to 44% of the normal wild-type activity (P = 0.0106) and plasma lyso-Gb3 levels were stable in females and males (P = 0.3490 and P = 0.2009). Reevaluation of mutations with poor biochemical response revealed no marked activity increase in a zero activity background. We conclude that therapy with migalastat was generally safe and resulted in an amelioration of left ventricular mass. In terms of impaired renal function, blood pressure control seems to be an unattended important goal.
Collapse
Affiliation(s)
- Malte Lenders
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, Comprehensive Heart Failure Center, and Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, Würzburg, Germany
| | - Christine Kurschat
- Department II of Internal Medicine, Center for Molecular Medicine Cologne and Center for Rare Diseases, University of Cologne, Cologne, Germany
| | - Nesrin Karabul
- Endokrinologikum Frankfurt, Center of Hormonal and Metabolic Diseases, Rheumatology, Osteology and Neurology, Frankfurt, Germany
| | - Jessica Kaufeld
- Department of Nephrology and Hypertension, Hannover Medical School, Germany
| | - Julia B Hennermann
- Villa Metabolica, Department for Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Monica Patten
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Markus Cybulla
- Department of Nephrology and Rheumatology, FGM, Center of Internal Medicine, Müllheim, Germany
| | - Jonas Müntze
- Department of Internal Medicine I, Comprehensive Heart Failure Center, and Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, Würzburg, Germany
| | - Nurcan Üçeyler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Dan Liu
- Department of Internal Medicine I, Comprehensive Heart Failure Center, and Fabry Center for Interdisciplinary Therapy (FAZIT), University of Würzburg, Würzburg, Germany
| | - Anibh M Das
- Department of Paediatrics, Hannover Medical School, Hannover, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Christian Pogoda
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Stefanie Reiermann
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Thomas Duning
- Department of Neurology, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - Jens Gaedeke
- Department of Medicine, Division of Nephrology, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Katharina Stumpfe
- Department of Pediatrics, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| | - Daniela Blaschke
- Department of Medicine, Division of Cardiology, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Stefan-Martin Brand
- Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| | - W Alexander Mann
- Endokrinologikum Frankfurt, Center of Hormonal and Metabolic Diseases, Rheumatology, Osteology and Neurology, Frankfurt, Germany
| | - Christoph Kampmann
- Villa Metabolica, Department for Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Nicole Muschol
- Department of Pediatrics, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| | - Sima Canaan-Kühl
- Department of Medicine, Division of Nephrology, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Eva Brand
- Department of Internal Medicine D, and Interdisciplinary Fabry Center (IFAZ), University Hospital Münster, Münster, Germany
| |
Collapse
|
4
|
Krämer J, Lenders M, Canaan-Kühl S, Nordbeck P, Üçeyler N, Blaschke D, Duning T, Reiermann S, Stypmann J, Brand SM, Gottschling T, Störk S, Wanner C, Sommer C, Brand E, Weidemann F. Fabry disease under enzyme replacement therapy-new insights in efficacy of different dosages. Nephrol Dial Transplant 2019; 33:1362-1372. [PMID: 29186537 DOI: 10.1093/ndt/gfx319] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/11/2017] [Indexed: 11/13/2022] Open
Abstract
Background Fabry patients on reduced dose of agalsidase-beta or after switch to agalsidase-alfa show a decline in estimated glomerular filtration rate (eGFR) and an increase of the Mainz Severity Score Index. Methods In this prospective observational study, we assessed end-organ damage and clinical symptoms in 112 patients who had received agalsidase-beta (1.0 mg/kg) for >1 year, who were (i) non-randomly assigned to continue this treatment regime (regular-dose group, n = 37); (ii) received a reduced dose of agalsidase-beta and subsequent switch to agalsidase-alfa (0.2 mg/kg) or a direct switch to 0.2 mg/kg agalsidase-alfa (switch group, n = 38); or (iii) were re-switched to agalsidase-beta after receiving agalsidase-alfa for at least 12 months (re-switch group, n = 37) with a median follow-up of 53 (38-57) months. Results eGFR of patients in the regular-dose group remained stable. Patients in the switch group showed an annual eGFR loss of - 4.6 ± 9.1 mL/min/1.73 m2 (P < 0.05). Patients in the re-switch group also had an eGFR loss of - 2.2 ± 4.4 mL/min/1.73 m2 after re-switch to agalsidase-beta, but to a lower degree compared with the switch group (P < 0.05). Patients in the re-switch group suffered less frequently from diarrhoea (relative risk 0.42; 95% confidence interval 0.19-0.93; P = 0.02). Lyso-Gb3 remained stable in the switch (P = 0.97) and the regular-dose (P = 0.48) groups, but decreased in the re-switch group after change of the therapy regimen (P < 0.05). Conclusions After switch to agalsidase-alfa, Fabry patients experienced a continuous decline in eGFR, while this decline was attenuated in patients who were re-switched to agalsidase-beta. Decreasing lyso-Gb3 levels may indicate a better treatment response in the latter group.
Collapse
Affiliation(s)
- Johannes Krämer
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital and University of Würzburg, Würzburg, Germany.,Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Germany
| | - Malte Lenders
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster, University Hospital Münster, Münster, Germany
| | - Sima Canaan-Kühl
- Department of Medicine, Division of Nephrology, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital and University of Würzburg, Würzburg, Germany
| | - Nurcan Üçeyler
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital and University of Würzburg, Würzburg, Germany.,Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Daniela Blaschke
- Department of Medicine, Division of Cardiology, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Thomas Duning
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Stefanie Reiermann
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster, University Hospital Münster, Münster, Germany
| | - Jörg Stypmann
- Department of Cardiovascular Medicine, Division of Cardiology, University Hospital Münster, Münster, Germany
| | - Stefan-Martin Brand
- Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, University Hospital Münster, Münster, Germany
| | | | - Stefan Störk
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital and University of Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital and University of Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital and University of Würzburg, Würzburg, Germany.,Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster, University Hospital Münster, Münster, Germany
| | - Frank Weidemann
- Department of Internal Medicine I, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy (FAZIT), University Hospital and University of Würzburg, Würzburg, Germany.,Katharinen-Hospital Unna, Unna, Germany
| |
Collapse
|
5
|
Lenders M, Weidemann F, Kurschat C, Canaan-Kühl S, Duning T, Stypmann J, Schmitz B, Reiermann S, Krämer J, Blaschke D, Wanner C, Brand SM, Brand E. Alpha-Galactosidase A p.A143T, a non-Fabry disease-causing variant. Orphanet J Rare Dis 2016; 11:54. [PMID: 27142856 PMCID: PMC4855861 DOI: 10.1186/s13023-016-0441-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 01/25/2016] [Accepted: 04/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fabry disease (FD) is an X-linked multisystemic disorder with a heterogeneous phenotype. Especially atypical or late-onset type 2 phenotypes present a therapeutical dilemma. METHODS To determine the clinical impact of the alpha-Galactosidase A (GLA) p.A143T/ c.427G > A variation, we retrospectively analyzed 25 p.A143T patients in comparison to 58 FD patients with other missense mutations. RESULTS p.A143T patients suffering from stroke/ transient ischemic attacks had slightly decreased residual GLA activities, and/or increased lyso-Gb3 levels, suspecting FD. However, most male p.A143T patients presented with significant residual GLA activity (~50 % of reference), which was associated with normal lyso-Gb3 levels. Additionally, p.A143T patients showed less severe FD-typical symptoms and absent FD-typical renal and cardiac involvement in comparison to FD patients with other missense mutations. Two tested female p.A143T patients with stroke/TIA did not show skewed X chromosome inactivation. No accumulation of neurologic events in family members of p.A143T patients with stroke/transient ischemic attacks was observed. CONCLUSIONS We conclude that GLA p.A143T seems to be most likely a neutral variant or a possible modifier instead of a disease-causing mutation. Therefore, we suggest that p.A143T patients with stroke/transient ischemic attacks of unknown etiology should be further evaluated, since the diagnosis of FD is not probable and subsequent ERT or chaperone treatment should not be an unreflected option.
Collapse
Affiliation(s)
- Malte Lenders
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Frank Weidemann
- Department of Medicine, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy (FAZIT), University of Wuerzburg, Wuerzburg, Germany.,Katharinen-Hospital Unna, Unna, Germany
| | - Christine Kurschat
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Sima Canaan-Kühl
- Department of Medicine, Division of Nephrology, University Hospital Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Thomas Duning
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Jörg Stypmann
- Department of Cardiovascular Medicine, Division of Cardiology, University Hospital Muenster, Muenster, Germany
| | - Boris Schmitz
- Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, University Hospital Muenster, Muenster, Germany
| | - Stefanie Reiermann
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany
| | - Johannes Krämer
- Department of Medicine, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy (FAZIT), University of Wuerzburg, Wuerzburg, Germany.,Department of Pediatrics an Adolescence Medicine, University of Ulm, Ulm, Germany
| | - Daniela Blaschke
- Department of Medicine, Division of Cardiology, University Hospital Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Christoph Wanner
- Department of Medicine, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy (FAZIT), University of Wuerzburg, Wuerzburg, Germany
| | - Stefan-Martin Brand
- Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, University Hospital Muenster, Muenster, Germany
| | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, University Hospital Muenster, Albert-Schweitzer-Campus 1, D-48149, Muenster, Germany.
| |
Collapse
|
6
|
Lenders M, Canaan-Kühl S, Krämer J, Duning T, Reiermann S, Sommer C, Stypmann J, Blaschke D, Üçeyler N, Hense HW, Brand SM, Wanner C, Weidemann F, Brand E. Patients with Fabry Disease after Enzyme Replacement Therapy Dose Reduction and Switch-2-Year Follow-Up. J Am Soc Nephrol 2015; 27:952-62. [PMID: 26185201 DOI: 10.1681/asn.2015030337] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/10/2015] [Indexed: 02/05/2023] Open
Abstract
Because of the shortage of agalsidase-β supply between 2009 and 2012, patients with Fabry disease either were treated with reduced doses or were switched to agalsidase-α. In this observational study, we assessed end organ damage and clinical symptoms with special focus on renal outcome after 2 years of dose-reduction and/or switch to agalsidase-α. A total of 89 adult patients with Fabry disease who had received agalsidase-β (1.0 mg/kg body wt) for >1 year were nonrandomly assigned to continue this treatment regimen (regular-dose group, n=24), to receive a reduced dose of 0.3-0.5 mg/kg and a subsequent switch to 0.2 mg/kg agalsidase-α (dose-reduction-switch group, n=28), or to directly switch to 0.2 mg/kg agalsidase-α (switch group, n=37) and were followed-up for 2 years. We assessed clinical events (death, myocardial infarction, severe arrhythmia, stroke, progression to ESRD), changes in cardiac and renal function, Fabry-related symptoms (pain, hypohidrosis, diarrhea), and disease severity scores. Determination of renal function by creatinine and cystatin C-based eGFR revealed decreasing eGFRs in the dose-reduction-switch group and the switch group. The Mainz Severity Score Index increased significantly in these two groups (P=0.02 and P<0.001, respectively), and higher frequencies of gastrointestinal pain occurred during follow-up. In conclusion, after 2 years of observation, all groups showed a stable clinical disease course with respect to serious clinical events. However, patients under agalsidase-β dose-reduction and switch or a direct switch to agalsidase-α showed a decline of renal function independent of the eGFR formula used.
Collapse
Affiliation(s)
- Malte Lenders
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster
| | | | - Johannes Krämer
- Department of Pediatrics and Adolescent Medicine, University of Ulm, Ulm, Germany; Department of Medicine, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy and
| | | | - Stefanie Reiermann
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster
| | - Claudia Sommer
- Department of Medicine, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy and Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Jörg Stypmann
- Department of Cardiovascular Medicine, Division of Cardiology
| | - Daniela Blaschke
- Department of Medicine, Division of Cardiology, Charité, Campus Virchow-Klinikum, Berlin, Germany
| | - Nurcan Üçeyler
- Department of Medicine, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy and Department of Neurology, University of Würzburg, Würzburg, Germany
| | | | - Stefan-Martin Brand
- Institute of Sports Medicine, Molecular Genetics of Cardiovascular Disease, University Hospital Münster, Münster, Germany
| | - Christoph Wanner
- Department of Medicine, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy and
| | - Frank Weidemann
- Department of Medicine, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy and Katharinen-Hospital Unna, Unna, Germany
| | - Eva Brand
- Internal Medicine D, Department of Nephrology, Hypertension and Rheumatology, Interdisciplinary Fabry Center Münster,
| |
Collapse
|
7
|
Weidemann F, Krämer J, Duning T, Lenders M, Canaan-Kühl S, Krebs A, Guerrero González H, Sommer C, Üçeyler N, Niemann M, Störk S, Schelleckes M, Reiermann S, Stypmann J, Brand SM, Wanner C, Brand E. Patients with Fabry disease after enzyme replacement therapy dose reduction versus treatment switch. J Am Soc Nephrol 2014; 25:837-49. [PMID: 24556354 DOI: 10.1681/asn.2013060585] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Because of the shortage of agalsidase-beta in 2009, many patients with Fabry disease were treated with lower doses or were switched to agalsidase-alfa. This observational study assessed end-organ damage and clinical symptoms during dose reduction or switch to agalsidase-alfa. A total of 105 adult patients with Fabry disease who had received agalsidase-beta (1.0 mg/kg body weight) for ≥1 year were nonrandomly assigned to continue this treatment regimen (regular-dose group, n=38), receive a reduced dose of 0.3-0.5 mg/kg (dose-reduction group, n=29), or switch to 0.2 mg/kg agalsidase-alfa (switch group) and were followed prospectively for 1 year. We assessed clinical events (death, myocardial infarction, severe arrhythmia, stroke, progression to ESRD); changes in cardiac, renal, and neurologic function; and Fabry-related symptoms (neuropathic pain, hypohidrosis, diarrhea, and disease severity scores). Organ function and Fabry-related symptoms remained stable in the regular-dose group. In contrast, estimated GFR decreased by about 3 ml/min per 1.73 m(2) (P=0.01) in the dose-reduction group, and the median albumin-to-creatinine ratio increased from 114 (0-606) mg/g to 216 (0-2062) mg/g (P=0.03) in the switch group. Furthermore, mean Mainz Severity Score Index scores and frequencies of pain attacks, chronic pain, gastrointestinal pain, and diarrhea increased significantly in the dose-reduction and switch groups. In conclusion, patients receiving regular agalsidase-beta dose had a stable disease course, but dose reduction led to worsening of renal function and symptoms. Switching to agalsidase-alfa is safe, but microalbuminuria may progress and Fabry-related symptoms may deteriorate.
Collapse
Affiliation(s)
- Frank Weidemann
- Department of Medicine, Divisions of Cardiology and Nephrology, Comprehensive Heart Failure Center, Fabry Center for Interdisciplinary Therapy, and
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Di Marco GS, König M, Stock C, Wiesinger A, Hillebrand U, Reiermann S, Reuter S, Amler S, Köhler G, Buck F, Fobker M, Kümpers P, Oberleithner H, Hausberg M, Lang D, Pavenstädt H, Brand M. High phosphate directly affects endothelial function by downregulating annexin II. Kidney Int 2012; 83:213-22. [PMID: 22913982 DOI: 10.1038/ki.2012.300] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hyperphosphatemia is associated with increased cardiovascular risk in patients with renal disease and in healthy individuals. Here we tested whether high phosphate has a role in the pathophysiology of cardiovascular events by interfering with endothelial function, thereby impairing microvascular function and angiogenesis. Protein expression analysis found downregulation of annexin II in human coronary artery endothelial cells, an effect associated with exacerbated shedding of annexin II-positive microparticles by the cells exposed to high phosphate media. EAhy926 endothelial cells exposed to sera from hyperphosphatemic patients also display decreased annexin II, suggesting a negative correlation between serum phosphate and annexin II expression. By using endothelial cell-based assays in vitro and the chicken chorioallantoic membrane assay in vivo, we found that angiogenesis, vessel wall morphology, endothelial cell migration, capillary tube formation, and endothelial survival were impaired in a hyperphosphatemic milieu. Blockade of membrane-bound extracellular annexin II with a specific antibody mimicked the effects of high phosphate. In addition, high phosphate stiffened endothelial cells in vitro and in rats in vivo. Thus, our results link phosphate and adverse clinical outcomes involving the endothelium in both healthy individuals and patients with renal disease.
Collapse
|
9
|
Yi Chun DX, Alexandre H, Edith B, Nacera O, Julie P, Chantal J, Eric R, Zhang X, Jin Y, Miravete M, Dissard R, Klein J, Gonzalez J, Caubet C, Pecher C, Pipy B, Bascands JL, Mercier-Bonin M, Schanstra J, Buffin-Meyer B, Claire R, Rigothier C, Richard D, Sebastien L, Moin S, Chantal B, Christian C, Jean R, Migliori M, Migliori M, Cantaluppi V, Mannari C, Medica D, Giovannini L, Panichi V, Goldwich A, Alexander S, Andre G, Amann K, Migliorini A, Sagrinati C, Angelotti ML, Mulay SR, Ronconi E, Peired A, Romagnani P, Anders HJ, Chiang WC, Lai CF, Peng WH, Wu CF, Chang FC, Chen YT, Lin SL, Chen YM, Wu KD, Lu KS, Tsai TJ, Virgine O, Qing Feng F, Zhang SY, Dominique D, Vincent A, Marina C, Philippe L, Georges G, Pawlak A, Sahali D, Matsumoto S, Kiyomoto H, Ichimura A, Dan T, Nakamichi T, Tsujita T, Akahori K, Ito S, Miyata T, Xie S, Zhang B, Shi W, Yang Y, Nagasu H, Satoh M, Kidokoro K, Nishi Y, Ihoriya C, Kadoya H, Sasaki T, Kashihara N, Wu CF, Chang FC, Chen YT, Chou YH, Duffield J, Lin SL, Rocca C, Rocca C, Gregorini M, Corradetti V, Valsania T, Bedino G, Bosio F, Pattonieri EF, Esposito P, Sepe V, Libetta C, Rampino T, Dal Canton A, Bedino G, Gregorini M, Corradetti V, Rocca C, Pattonieri EF, Valsania T, Bosio F, Esposito P, Sepe V, Libetta C, Rampino T, Dal Canton A, Omori H, Kawada N, Inoue K, Ueda Y, Yamamoto R, Matsui I, Kaimori J, Takabatake Y, Moriyama T, Isaka Y, Rakugi H, Wasilewska A, Taranta-Janusz K, Deebek W, Kuroczycka-Saniutycz E, Lee AS, Lee AS, Lee JE, Jung YJ, Kang KP, Lee S, Kim W, Arfian N, Emoto N, Yagi K, Nakayama K, Hartopo AB, Nugrahaningsih DA, Yanagisawa M, Hirata KI, Munoz-Felix JM, Lopez-Novoa JM, Martinez-Salgado C, Oujo B, Munoz-Felix JM, Arevalo M, Bernabeu C, Perez-Barriocanal F, Lopez-Novoa JM, Jesper K, Nathalie V, Pierre G, Yi Chun DX, Alexandre H, Eric R, Iyoda M, Shibata T, Matsumoto K, Shindo-Hirai Y, Kuno Y, Wada Y, Akizawa T, Schwartz I, Schwartz D, Prot Bertoye C, Prot Bertoye C, Terryn S, Claver J, Beghdadi WB, Monteiro R, Blank U, Devuyst O, Daugas E, Van Beneden K, Geers C, Pauwels M, Mannaerts I, Van den Branden C, Van Grunsven LA, Seckin I, Pekpak M, Uzunalan M, Uruluer B, Kokturk S, Ozturk Z, Sonmez H, Yaprak E, Furuno Y, Tsutsui M, Morishita T, Shimokawa H, Otsuji Y, Yanagihara N, Kabashima N, Ryota S, Kanegae K, Miyamoto T, Nakamata J, Ishimatsu N, Tamura M, Nakagawa T, Nakagawa T, Ichikawa K, Miyamoto M, Takabayashi D, Yamazaki H, Kakeshita K, Koike T, Kagitani S, Tomoda F, Hamashima T, Ishii Y, Inoue H, Sasahara M, El Machhour F, Kerroch M, Mesnard L, Chatziantoniou C, Dussaule JC, Inui K, Sasai F, Maruta Y, Nishiwaki H, Kawashima E, Inoue Y, Yoshimura A, Matsumoto K, Matsumoto K, Iyoda M, Shibata T, Wada Y, Shindo-Hirai Y, Kuno Y, Akizawa T, Musacchio E, Priante G, Valvason C, Sartori L, Baggio B, Kim JH, Gross O, Diana R, Gry DH, Asimal B, Johanna T, Imke SE, Lydia W, Gerhard-Anton M, Hassan D, Cano JL, Griera M, Olmos G, Martin P, Cortes MA, Lopez-Ongil S, Rodriguez-Puyol D, DE Frutos S, Gonzalez M, DE Frutos S, Cano JL, Luengo A, Martin P, Rodriguez-Puyol M, Calleros L, Lupica R, Lacquaniti A, Donato V, Maggio R, Mastroeni C, Lucisano S, Cernaro V, Fazio MR, Quartarone A, Buemi M, Kacik M, Goedicke S, Eggert H, Hoyer JD, Wurm S, Wurm S, Steege A, Banas M, Kurtz A, Banas B, Lasagni L, Lazzeri E, Peired A, Angelotti ML, Ronconi E, Romoli S, Romagnani P, Schaefer I, Teng B, Worthmann K, Haller H, Schiffer M, Prattichizzo C, Netti GS, Rocchetti MT, Cormio L, Carrieri G, Stallone G, Grandaliano G, Ranieri E, Gesualdo L, Kucher A, Smirnov A, Parastayeva M, Beresneva O, Kayukov I, Zubina I, Ivanova G, Abed A, Schlekenbach L, Foglia B, Chatziantoniou C, Kwak B, Chadjichristos C, Queisser N, Schupp N, Brand S, Himer L, Himer L, Szebeni B, Sziksz E, Saijo S, Kis E, Prokai A, Banki NF, Fekete A, Tulassay T, Vannay A, Hegner B, Schaub T, Lange C, Dragun D, Klinkhammer BM, Rafael K, Monika M, Anna M, Van Roeyen C, Boor P, Eva Bettina B, Simon O, Esther S, Floege J, Kunter U, Hegner B, Janke D, Schaub T, Lange C, Jankowski J, Dragun D, Hayashi M, Takamatsu I, Horimai C, Yoshida T, Seno DI Marco G, Koenig M, Stock C, Reiermann S, Amler S, Koehler G, Fobker M, Buck F, Pavenstaedt H, Lang D, Brand M, Plotnikov E, Morosanova M, Pevzner I, Zorova L, Pulkova N, Zorov D, Wornle M, Ribeiro A, Belling F, Merkle M, Nakazawa D, Nishio S, Shibasaki S, Tomaru U, Akihiro I, Kobayashi I, Imanishi Y, Kurajoh M, Nagata Y, Yamagata M, Emoto M, Michigami T, Ishimura E, Inaba M, Nishi Y, Satoh M, Sasaki T, Kashihara N, Wu CC, Lu KC, Chen JS, Chu P, Lin YF, Eller K, Schroll A, Banas M, Kirsch A, Huber J, Weiss G, Theurl I, Rosenkranz AR, Zawada A, Rogacev K, Achenbach M, Fliser D, Held G, Heine GH, Miyamoto Y, Iwao Y, Watanabe H, Kadowaki D, Ishima Y, Chuang VTG, Sato K, Otagiri M, Maruyama T, Ueda Y, Iwatani H, Isaka Y, Watanabe H, Honda D, Miyamoto Y, Noguchi T, Kadowaki D, Ishima Y, Tanaka M, Tanaka H, Fukagawa M, Otagiri M, Maruyama T, Wornle M, Ribeiro A, Pircher J, Koppel S, Mannell H, Krotz F, Merkle M, Virzi GM, Bolin C, Cruz D, Scalzotto E, De Cal M, Vescovo G, Ronco C, Virzi GM, Bolin C, Cruz D, Scalzotto E, De Cal M, Vescovo G, Ronco C, Grobmayr R, Lech M, Ryu M, Anders HJ, Aoshima Y, Mizobuchi M, Ogata H, Kumata C, Nakazawa A, Kondo F, Ono N, Koiwa F, Kinugasa E, Akizawa T, Freisinger W, Lale N, Lampert A, Ditting T, Heinlein S, Schmieder RE, Veelken R, Nave H, Perthel R, Suntharalingam M, Bode-Boger S, Beutel G, Kielstein J, Rodrigues-Diez R, Rodrigues-Diez R, Rayego-Mateos S, Lavoz C, Stark Aroeira LG, Orejudo M, Alique M, Ortiz A, Egido J, Ruiz-Ortega M, Oskar W, Rusan C, Schaub T, Hegner B, Dragun D, Padberg JS, Wiesinger A, Brand M, Seno DI Marco G, Reuter S, Grabner A, Kentrup D, Lukasz A, Oberleithner H, Pavenstadt H, Kumpers P, Eberhardt HU, Skerka C, Chen Q, Hallstroem T, Hartmann A, Kemper MJ, Zipfel PF, N'gome-Sendeyo K, Fan QF, Zhang SY, Pawlak A, Sahali D, Wornle M, Ribeiro A, Merkle M, Toblli J, Toblli J, Cao G, Giani JF, Dominici FP, Kim JS, Yang JW, Kim MK, Han BG, Choi SO. Experimental pathology. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs241] [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: 11/13/2022] Open
|
10
|
Bartels V, Hillebrand U, Kosch M, Hausberg M, Kisters K, Di Marco GS, Reiermann S, Pavenstaedt H, Lang D. Influence of erythropoietin on arterial stiffness and endothelial function in renal transplant recipients. Am J Nephrol 2012; 36:355-61. [PMID: 23038220 DOI: 10.1159/000343140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 09/01/2012] [Indexed: 01/14/2023]
Abstract
BACKGROUND/AIMS Recent retrospective studies suggest an association of therapy with erythropoiesis-stimulating agents (ESAs) and increased mortality in renal transplant recipients (RTR). Large artery structure and function are significantly impaired in RTR which contributes to their high cardiovascular morbidity and could be altered by erythropoietin. We aimed to examine the influence of ESA therapy on large artery stiffness and endothelial function in RTR. METHODS 63 RTR with chronic allograft dysfunction and renal anemia were randomized to a group receiving darbepoetin alfa (Dar) and a control group (Co). At baseline and after 8 months of treatment (cumulative Dar dose 11.1 µg/kg b.w.) brachial and common carotid artery distensibility coefficients, aortic pulse wave velocity, brachial artery flow-mediated and nitroglycerin-mediated vasodilation were measured as well as the following biomarkers of vascular function: vWF, sVCAM, sICAM, E-selectin, t-PA and PAI-1. RESULTS 23 patients in the Dar group and 17 patients in the Co group were available for per-protocol analysis. Hemoglobin increased significantly from 10.9 to 12.6 g/dl after 8 months in the Dar group, whereas it remained stable at 11.3 g/dl in the Co group. Effects on large artery stiffness, endothelial function and biomarkers of vascular function did not differ significantly between the two groups. CONCLUSION Therapy with Dar during 8 months did not significantly impact parameters of large artery stiffness and endothelial function in RTR. These data suggest that therapy with erythropoietin does not deteriorate arterial stiffness and endothelial function in RTR.
Collapse
Affiliation(s)
- Valerie Bartels
- Department II of Internal Medicine, University of Cologne, DE–50937 Cologne, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Sullivan M, Rybicki LA, Winter A, Hoffmann MM, Reiermann S, Linke H, Arbeiter K, Patzer L, Budde K, Hoppe B, Zeier M, Lhotta K, Bock A, Wiech T, Gaspert A, Fehr T, Woznowski M, Berisha G, Malinoc A, Goek ON, Eng C, Neumann HPH. Age-related penetrance of hereditary atypical hemolytic uremic syndrome. Ann Hum Genet 2011; 75:639-47. [PMID: 21906045 DOI: 10.1111/j.1469-1809.2011.00671.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hereditary atypical hemolytic uremic syndrome (aHUS), a dramatic disease frequently leading to dialysis, is associated with germline mutations of the CFH, CD46, or CFI genes. After identification of the mutation in an affected aHUS patient, single-site gene testing of relatives is the preventive care perspective. However, clinical data for family counselling are scarce. From the German-Speaking-Countries-aHUS-Registry, 33 index patients with mutations were approached for permission to offer relatives screening for their family-specific mutations and to obtain demographic and clinical data. Mutation screening was performed using direct sequencing. Age-adjusted penetrance of aHUS was calculated for each gene in index cases and in mutation-positive relatives. Sixty-one relatives comprising 41 parents and 20 other relatives were enrolled and mutations detected in 31/61. In total, 40 research participants had germline mutations in CFH, 19 in CD46 and in 6 CFI. Penetrance at age 40 was markedly reduced in mutation-positive relatives compared to index patients overall with 10% versus 67% (P < 0.001); 6% vs. 67% (P < 0.001) in CFH mutation carriers and 21% vs. 70% (P= 0.003) in CD46 mutation carriers. Age-adjusted penetrance for hereditary aHUS is important to understand the disease, and if replicated in the future, for genetic counselling.
Collapse
Affiliation(s)
- Maren Sullivan
- Department of Nephrology, Section of Preventive Medicine, University Medical Center, Albert-Ludwigs-University, Freiburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Bartels V, Hillebrand U, Reiermann S, Kosch M, Kisters K, Lang D, Di Marco G, Pavenstädt H, Hausberg M. INFLUENCE OF ERYTHROPOIETIN ON VASCULAR FUNCTION IN RENAL TRANSPLANT RECIPIENTS. J Hypertens 2011. [DOI: 10.1097/00004872-201106001-00155] [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]
|
13
|
Kreusser W, Reiermann S, Vogelbusch G, Bartual J, Schulze-Lohoff E. Effect of different synthetic membranes on laboratory parameters and survival in chronic haemodialysis patients. NDT Plus 2010; 3:i12-i19. [PMID: 27046088 PMCID: PMC4813822 DOI: 10.1093/ndtplus/sfq032] [Citation(s) in RCA: 7] [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] [Indexed: 11/12/2022] Open
Abstract
Background. A number of studies suggested that the type of dialysis membrane is associated with differences in long-term outcome of patients undergoing haemodialysis, both in terms of morbidity and mortality. In the majority of dialysis units, synthetic membranes are being used. However, no studies are available so far for comparison between different biocompatible membranes. Therefore, we studied the influence of high- and low-flux polysulphone membranes (PS) in comparison with polymethylmethacrylate (PMMA) membranes on mortality and morbidity on the basis of various laboratory parameters. Methods. In a cohort study, data of 260 consecutive haemodialysis patients entering our dialysis unit in the years 2003-07 were collected, comparing 435 PS patient-years and 85 PMMA patient-years. PMMA membranes (n = 33) were used for those patients who did not tolerate (e.g. for pruritus) PS membranes (n = 227). Low-flux dialysers (n = 233) were compared with high-flux (n = 37). Laboratory values were evaluated by unpaired t-test, and mortality was evaluated by log-rank test and Cox regression analysis adjusted for age, diabetes and laboratory parameters. Results. Patients in our dialysis unit had a high cardiovascular risk as demonstrated by a proportion of 63% of peripheral arterial disease. Despite this, cumulative survival was almost 60% after 5 years on dialysis. It was slightly but not significantly higher in patients on PMMA (68%) compared with PS dialysers (54%) and on high-flux (61%) versus low-flux membranes (54%). After accounting for the confounding effect of age and diabetes in the multivariate Cox regression analysis, there was no impact of the membranes used (high- or low-flux, PMMA or PS) on survival. Only age at the onset of dialysis showed a significant influence on survival (P ≤ 0.001). Independent predictors of mortality in all patients in the multivariate Cox regression analysis were age, haemoglobin, leucocytes, C-reactive protein (CRP) and creatinine. Laboratory parameters between the high- and low- flux groups were not different. PS-treated patients showed significantly (P ≤ 0.05) higher values for leucocytes, thrombocytes, ferritin, and CRP and lower values for haemoglobin, transferrin, creatinine, uric acid, creatine kinase (CK), and sodium than PMMA-treated patients. Irrespective of the membrane used, in deceased patients, the following laboratory values were higher than for patients alive: leucocytes, thrombocytes, ferritin and CRP; the following were lower: haemoglobin, iron, total protein, urea, creatinine, uric acid and CK. Conclusions. The data of 260 severely ill haemodialysis patients showed a slightly, but not significantly, reduced mortality in patients treated with PMMA membranes in comparison with PS and with high-flux membranes compared with low-flux. High- or low-flux membranes exhibited no difference in laboratory values. However, in PMMA patients, laboratory data with respect to inflammation, anaemia and nutrition were significantly improved compared with the PS group. A similarly positive laboratory pattern was seen in patients alive compared with patients deceased with both membrane types. The favourable effect of PMMA membranes may be explained by the reduced activation of catabolic components and inflammation, which, in turn, would result in an improved nutrition and better response to recombinant human erythropoietin.
Collapse
Affiliation(s)
| | - Stefanie Reiermann
- Department of Internal Medicine D , University of Muenster, Muenster , Germany
| | - Gert Vogelbusch
- Department of Nephrology , Marien-Hospital , Duisburg Germany
| | - Josè Bartual
- Department of Nephrology , Marien-Hospital , Duisburg Germany
| | | |
Collapse
|
14
|
Reuter S, Reiermann S, Wörner R, Schröter R, Edemir B, Buck F, Henning S, Peter-Katalinic J, Vollenbröker B, Amann K, Pavenstädt H, Schlatter E, Gabriëls G. IF/TA-related metabolic changes--proteome analysis of rat renal allografts. Nephrol Dial Transplant 2010; 25:2492-501. [PMID: 20176611 DOI: 10.1093/ndt/gfq043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic allograft nephropathy, now more specifically termed interstitial fibrosis and tubular atrophy without evidence of any specific aetiology (IF/TA), is still an important cause of late graft loss. There is no effective therapy for IF/TA, in part due to the disease's multifactorial nature and its incompletely understood pathogenesis. METHODS We used a differential in-gel electrophoresis and mass spectrometry technique to study IF/TA in a renal transplantation model. Dark Agouti (DA) kidneys were allogeneically transplanted to Wistar-Furth (DA-WF, aTX) rats. Syngeneic grafts (DA-DA, sTX) served as controls. Nine weeks after transplantation, blood pressure, renal function and electrolytes were studied, in addition to real-time PCR, western blot analysis, histology and immunohistochemistry. RESULTS In contrast to sTX, the aTX developed IF/TA-dependent renal damage. Ten differentially regulated proteins were identified by 2D gel analysis and mass spectrometry, whereupon five proteins are mainly related to oxidative stress (aldo-keto reductase, peroxiredoxin-1, NAD(+)-dependent isocitrate dehydrogenase, iron-responsive element-binding protein-1 and serum albumin), two participate in cytoskeleton organization (l-plastin and ezrin) and three are assigned to metabolic functions (creatine kinase, ornithine aminotransferase and fructose-1,6-bisphosphatase). CONCLUSION The proteins related to IF/TA and involved in oxidative stress, cytoskeleton organization and metabolic functions may correspond with novel therapeutic targets.
Collapse
Affiliation(s)
- Stefan Reuter
- Department of Medicine D, University of Münster, Münster, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Wiedebusch S, Reiermann S, Steinke C, Muthny FA, Pavenstaedt HJ, Schoene-Seifert B, Senninger N, Suwelack B, Buyx AM. Quality of life, coping, and mental health status after living kidney donation. Transplant Proc 2009; 41:1483-8. [PMID: 19545662 DOI: 10.1016/j.transproceed.2009.02.102] [Citation(s) in RCA: 39] [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] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
Abstract
The main aim of the study was to explore well-being after donation. This retrospective, cross-sectional study of 161 living kidney donors (104 women; response rate 81.4%) who were aged between 32 and 80 years (x = 56.3; standard deviation = 10.9) included responses to standardized questionnaires concerning quality of life (QOL), coping, and mental health status. Most donors recovered fully from donation within 6 months (90.8%). Donor willingness to donate again (96.1%) was high. Their relationship to the recipient did not change (67.9%) or even improved (27.5%) in most cases. Donor QOL (as assessed by the Short-Form [SF]-36) did not differ from healthy norms. In 25% of donors, screening with the Hospital Anxiety and Depression Scale revealed anxious and/or depressive symptoms above the clinical cutoff score. Donor predominant coping style with their recipient's renal disease was "active problem-focused coping." The component scores of the SF-36 correlated positively with sociodemographic and self-reported medical parameters, coping, and mental health status. Although living kidney donation again proved to be a treatment without negative impact on donor QOL, the results underlined the importance of screening for donor mental health status and coping both in the evaluation process and after the procedure.
Collapse
Affiliation(s)
- S Wiedebusch
- Department of Medical Psychology, University Hospital Muenster, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Reiermann S. [A new tool for job evaluation]. Sygeplejersken 1972; 72:10-3. [PMID: 4489326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|