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Merav L, Ofek Shlomai N, Oiknine-Djian E, Caplan O, Livneh A, Sido T, Peri A, Shtoyer A, Amir E, Ben Meir K, Daitch Y, Rivkin M, Kripper E, Fogel I, Horowitz H, Greenberger S, Cohen M, Geal-Dor M, Gordon O, Averbuch D, Ergaz-Shaltiel Z, Eventov Friedman S, Wolf DG, Yassour M. Implementation of pooled saliva tests for universal screening of cCMV infection. Nat Med 2024; 30:1111-1117. [PMID: 38459181 PMCID: PMC11031397 DOI: 10.1038/s41591-024-02873-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024]
Abstract
Congenital cytomegalovirus (cCMV) is the most common intrauterine infection, leading to neurodevelopmental disabilities. Universal newborn infant screening of cCMV has been increasingly advocated. In the absence of a high-throughput screening test, which can identify all infected newborn infants, the development of an accurate and efficient testing strategy has remained an ongoing challenge. Here we assessed the implementation of pooled saliva polymerase chain reaction (PCR) tests for universal screening of cCMV, in two hospitals of Jerusalem from April 2022 through April 2023. During the 13-month study period, 15,805 infants (93.6% of all live newborn infants) were screened for cCMV using the pooled approach that has since become our routine screening method. The empirical efficiency of the pooling was six (number of tested newborn infants per test), thereby sparing 83% of the saliva tests. Only a minor 3.05 PCR cycle loss of sensitivity was observed for the pooled testing, in accordance with the theoretical prediction for an eight-sample pool. cCMV was identified in 54 newborn infants, with a birth prevalence of 3.4 per 1,000; 55.6% of infants identified with cCMV were asymptomatic at birth and would not have been otherwise targeted for screening. The study demonstrates the wide feasibility and benefits of pooled saliva testing as an efficient, cost-sparing and sensitive approach for universal screening of cCMV.
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Affiliation(s)
- Lior Merav
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Noa Ofek Shlomai
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Orit Caplan
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ayala Livneh
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tal Sido
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amir Peri
- Computing Department of Laboratories and Institutes, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Aviad Shtoyer
- Computing Department of Laboratories and Institutes, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eden Amir
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Kerem Ben Meir
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Yutti Daitch
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mila Rivkin
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Esther Kripper
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Irit Fogel
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hadar Horowitz
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sraya Greenberger
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mevaseret Cohen
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Miriam Geal-Dor
- Speech and Hearing Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
| | - Oren Gordon
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Pediatric Infectious Diseases, Pediatric Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Diana Averbuch
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Pediatric Infectious Diseases, Pediatric Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zivanit Ergaz-Shaltiel
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Smadar Eventov Friedman
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
- Hebrew University Faculty of Medicine, Jerusalem, Israel.
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel.
| | - Moran Yassour
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Heitner T, Livneh A, Vargas M, Lorber J, Karmeli R, Landesberg A. Novel noninvasive indices of perfusion dynamics wave analysis detect above knee arterial stenosis in the presence of widespread arteriosclerosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Peripheral arterial disease (PAD) is a leading cause of vascular morbidity and mortality. The Ankle Brachial Index (ABI) is a common index for screening and monitoring PAD. The AHA and ECS guidelines recommend measuring the ABI for assessing atherosclerotic cardiovascular risk. However, the ABI sensitivity is low, especially in the elderly and diabetics with arteriosclerosis. The restenosis rate after revascularization is high and there is an unmet need for continuous monitoring for detection of restenoses in these patients. ABI requires Doppler Ultrasound measurements.
Purpose
We hypothesized that monitoring the arterial perfusion dynamics instead of the peak systolic pressure, could improve PAD surveillance and management.
Methods
A novel method for quantifying the arterial perfusion dynamic from impedance plethysmography measurements was developed. A novel segmentation of the arterial perfusion upstroke has revealed that it consists of two characteristic phases, an initial slow phase that is followed by a fast vigorous rise. The phase transition point was defined by the maximum acceleration time point (MAT). The slow phase duration was denoted as the `Perfusion Deficit Index` (PDI). The arterial perfusion signals were derived from calves of PAD patients that were admitted for revascularization. We compared the novel PDI and MAT indices with measured ABI before and after the revascularizations.
Results
Sixteen patients with isolated above-knee stenoses were recruited and treated in eighteen legs. The perfusion signals before the revascularization were characterized by prolonged PDI, and overt shortening of the PDI was observed after successful revascularization, as depicted in Figure 1. The PDI was significantly negatively correlated with the ABI. In patients with satisfactory postoperative increase in ABI (>0.15) the PDI dropped from 105±33 ms to 26±16 ms (n=13, p<0.001). The “pulse transit time” (PTT) that relates to arteriosclerosis did not change between measurements in all the patients. Thus, the measurement of the PTT and PDI can differentiate between the two elements of atherosclerosis: generalized arteriosclerosis and development of localized arterial narrowing. Interestingly, in the contralateral untreated leg the ABI and PDI had a similar significantly negative correlation, without significant difference before and after the procedures. Assessment of the ABI and PDI abilities to detect focal stenosis revealed that the PDI detected stenosis with 91% sensitivity and 85% specificity, while the ABI only had 74% sensitivity and 85% specificity (Figure 2).
Conclusions
The PD can be used for assessing revascularization outcome and monitoring atherosclerosis severity. The MAT and PDI are novel sensitive and specific indices for detecting arterial stenoses, even in the presence of arteriosclerosis, unlike the ABI. The applicability of this simple to use method for screening and telemedicine should be further validated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Heitner
- Technion - Israel Institute of Technology, Biomedical Engineering , Haifa , Israel
| | - A Livneh
- Technion - Israel Institute of Technology, Biomedical Engineering , Haifa , Israel
| | - M Vargas
- Hadassah University Medical Center, Vascular Surgery , Jerusalem , Israel
| | - J Lorber
- Hadassah University Medical Center, Vascular Surgery , Jerusalem , Israel
| | - R Karmeli
- Hadassah University Medical Center, Vascular Surgery , Jerusalem , Israel
| | - A Landesberg
- Technion - Israel Institute of Technology, Biomedical Engineering , Haifa , Israel
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Livneh A, Heitner T, Landesberg A. Towards noninvasive early detection and classification of peripheral arterial disease stenosis severity by perfusion dynamics and artificial intelligence. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent guidelines suggest Ankle-Brachial Index (ABI) measurement for assessing and reducing cardiovascular risk. PAD patients suffer from generalized arterial stiffening (arteriosclerosis) and develop threatening arterial stenosis foci. ABI cannot differentiate between the two, and detecting focal stenosis is especially challenging in the elderly and diabetics suffering from severe arteriosclerosis. Thus, better diagnostic tools are required for early detection of severe arterial stenosis in order to improve patient management reduce atherosclerotic cardiovascular risk and amputation rates.
Purpose
We hypothesized that quantifying the peripheral perfusion dynamics would provide more sensitive indices for monitoring atherosclerotic disease severity. Thus, we compared the utility of ABI, impedance-plethysmography (IPG), and photoplethysmography (PPG) in detecting and classifying arterial-stenosis using machine learning and artificial intelligence.
Methods
Arterial stenosis was emulated in supine lying healthy consenting volunteers (n=31) by inflating a blood-pressure cuff around their thigh to 45 and 90 mmHg for six minutes. We quantified the perfusion dynamics by IPG and PPG signal analyses in the time-frequency domain. The induced stenosis levels were classified by artificial intelligence using novel indices.
Results
Hallux O2-saturation remained intact (96±3%, p=0.4) even during 90 mmHg thigh-cuff compression. The baseline ABI (1.19±0.01) remained unchanged during 45 mmHg compression, slightly declined (1.12±0.02) upon 90 mmHg compression; but, all ABI values were above the 0.9 threshold. The pulse transit time, a well-established index of arteriosclerosis, remained unchanged. Conversely, upon stenosis emulation (compression), the IPG immediately recorded a significant proportional phase delay between the compressed and contralateral legs and a significant proportional correlation decline. At baseline, the IPG phase-difference between legs over the 2–4 Hz band was 1.79±0.48° and grew to 29.5±2.4° and 71.2±1.8° upon 45 and 90 mmHg compression (p<0.001). The IPG inter leg correlation at the 4–6 Hz band declined from 0.962±0.005 at baseline to 0.857±0.012 and 0.676±0.015 during 45 and 90 mmHg compression (p<0.001). The PPG phase difference grew significantly and proportionally upon compression (p<0.001, n=28) but without a significant correlation decline. A neural-network classifier achieved 100% accuracy in classifying baseline and each compression level based on the IPG phase and correlation. The best classifier achieved only 81.25% accuracy, 83.33% sensitivity, and 90% Specificity based on the PPG.
Conclusion
Our perfusion-dynamic indices outperformed the ABI, and the IPG outperformed the PPG in detecting and classifying emulated stenosis. Differentiation between arteriosclerosis and arterial stenosis may be of immense clinical merit. Therefore, this simple, noninvasive method merits clinical evaluation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Livneh
- Technion - Israel Institute of Technology, Faculty of Biomedical Engineering , Haifa , Israel
| | - T Heitner
- Technion - Israel Institute of Technology, Faculty of Biomedical Engineering , Haifa , Israel
| | - A Landesberg
- Technion - Israel Institute of Technology, Faculty of Biomedical Engineering , Haifa , Israel
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Pekar-Zlotin M, Levinsohn-Tavor O, Livneh A, Sher O, Melcer Y, Maymon R. Honeycomb appearance of fetal myofibromatosis. Ultrasound Obstet Gynecol 2019; 53:549-551. [PMID: 29749081 DOI: 10.1002/uog.19082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Affiliation(s)
- M Pekar-Zlotin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel
| | - O Levinsohn-Tavor
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel
| | - A Livneh
- Department of Neonatolgy, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel
| | - O Sher
- Bone and Soft Tissue Pathology Division, Department of Pathology, Sourasky Medical Center, Tel Aviv, Israel
- all affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel
| | - R Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel
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Schulman S, Langevitz P, Livneh A, Martinowitz U, Seligsohn U, Varon D. Cyclosporine Therapy for Acquired Factor VIII Inhibitor in a Patient with Systemic Lupus Erythematosus. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650581] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe case of a 27-year-old woman with systemic lupus erythematosus and development of an autoantibody against factor VIII during an exacerbation of her underlying disorder is described. Attempts to eliminate the antibody with high dose gammaglobulin and repeated courses of cyclophosphamide failed, whereafter she received cyclosporine in increasing doses. When therapeutic serum levels of cyclosporine were achieved (150-350 ng/ml) the inhibitor rapidly decreased and disappeared with a concomitant normalization of the factor VIII levels. Treatment with cyclosporine was subsequently reduced and discontinued after one year, and at present no inhibitor is detectable. In view of the successful results with cyclosporine treatment in 4 of 6 previous cases and in all 3 previous cases with autoimmune disorders, this regimen should be evaluated in a systematic manner as a potential first line drug in patients with acquired hemophilia and an underlying autoimmune disorder.
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Affiliation(s)
- S Schulman
- The Institute of Thrombosis and Hemostasis and National Hemophilia Center, Department of Hematology, Tel-Hashomer, Israel
| | - P Langevitz
- Department of Internal Medicine, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - A Livneh
- Department of Internal Medicine, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - U Martinowitz
- The Institute of Thrombosis and Hemostasis and National Hemophilia Center, Department of Hematology, Tel-Hashomer, Israel
| | - U Seligsohn
- The Institute of Thrombosis and Hemostasis and National Hemophilia Center, Department of Hematology, Tel-Hashomer, Israel
| | - D Varon
- The Institute of Thrombosis and Hemostasis and National Hemophilia Center, Department of Hematology, Tel-Hashomer, Israel
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6
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Kaplan B, Golderman S, Ganelin‐Cohen E, Miniovitch A, Korf E, Ben‐Zvi I, Livneh A, Flechter S. Immunoglobulin free light chains in saliva: a potential marker for disease activity in multiple sclerosis. Clin Exp Immunol 2018; 192:7-17. [PMID: 29194592 PMCID: PMC5842412 DOI: 10.1111/cei.13086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Accepted: 11/20/2017] [Indexed: 11/27/2022] Open
Abstract
A new procedure was developed and applied to study immunoglobulin free light chains (FLC) in saliva of healthy subjects and patients with multiple sclerosis (MS). The procedure was based on a Western blot analysis for detection and semiquantitative evaluation of monomeric and dimeric FLCs. The FLC indices accounting for the total FLC levels and for the monomer/dimer ratios of κ and λ FLC were calculated, and the cut-off values of the FLC indices were determined to distinguish healthy state from MS disease. The obtained FLC index values were statistically different in the saliva of three groups: active MS patients, MS patients in remission and healthy subjects groups. Our FLC monomer-dimer analysis allowed differentiation between healthy state and active MS with specificity of 100% and a sensitivity of 88·5%. The developed technique may serve as a new non-invasive complementary tool to evaluate the disease state by differentiating active MS from remission with sensitivity of 89% and specificity of 80%.
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Affiliation(s)
- B. Kaplan
- Heller Institute of Medical Research, Sheba Medical CenterTel‐Hashomer, Ramat GanIsrael
| | - S. Golderman
- Heller Institute of Medical Research, Sheba Medical CenterTel‐Hashomer, Ramat GanIsrael
| | - E. Ganelin‐Cohen
- Institute of Pediatric Neurology, Schneider Children's Medical CenterPetach TikvaIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - A. Miniovitch
- Multiple Sclerosis Clinical Research and Therapy Service, Assaf‐Harofeh Medical CenterTzrifin, Israel
| | - E. Korf
- Dental ClinicsKiryat OnoIsrael
| | - I. Ben‐Zvi
- Heller Institute of Medical Research, Sheba Medical CenterTel‐Hashomer, Ramat GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - A. Livneh
- Heller Institute of Medical Research, Sheba Medical CenterTel‐Hashomer, Ramat GanIsrael
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - S. Flechter
- Sackler School of MedicineTel‐Aviv UniversityTel‐AvivIsrael
- Multiple Sclerosis Clinical Research and Therapy Service, Assaf‐Harofeh Medical CenterTzrifin, Israel
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7
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Shtrasburg S, Gal R, Gruys E, Perl S, Martin BM, Kaplan B, Koren R, Nyska A, Pras M, Livneh A. An Ancillary Tool for the Diagnosis of Amyloid A Amyloidosis in a Variety of Domestic and Wild Animals. Vet Pathol 2016; 42:132-9. [PMID: 15753466 DOI: 10.1354/vp.42-2-132] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Immunohistochemistry, the standard method for diagnosing amyloid A (AA) amyloidosis, is limited in animals because it requires a large array of animal-specific anti-AA antibodies, not commercially available. The Shtrasburg method (SH method) is a highly specific and sensitive technique, helping in the diagnosis and determination of AA amyloidosis in humans. The aim of this study is to determine whether the SH method is applicable in the diagnosis of AA amyloidosis in a variety of animals. Tissue samples were obtained from animals suffering from spontaneous or experimentally induced AA amyloidosis (mice, hamsters, guinea pigs, cheetahs, cats, cows, ducks, a dog, a goose, a chicken, and a turaco). Detection of the amyloid and quantitative evaluation were performed using Congo red staining, and specific AA typing was performed by the potassium permanganate technique. The studied tissues were subjected to the SH method, which confirmed the AA nature of the amyloid deposit, by displaying in polyacrylamide gel electrophoresis protein bands consistent with the molecular weight of the species-specific AA, in all the animals examined, except mice, hamsters, and guinea pigs. N-terminal analysis of these bands corroborated their AA origin. We conclude that the SH method may be used as an ancillary simple tool for the diagnosis of AA amyloidosis in a large number of domestic and wild animals. Moreover, our findings further increase the feasibility of applying this method in humans.
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Affiliation(s)
- S Shtrasburg
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer 52621, Israel.
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8
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Roitman AJ, Zvi IB, Kukuy O, Livneh A. Factors affecting cardiovascular morbidity in young FMF patients. A comparative analysis in colchicine treated FMF patients with and without cardiovascular disease. Pediatr Rheumatol Online J 2015. [PMCID: PMC4596969 DOI: 10.1186/1546-0096-13-s1-o47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Shinar Y, Giat E, Cohen R, Livneh A. Assessment of the pathogenicity of the p.K695R and p.A744S Mediterranean fever gene variants. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599689 DOI: 10.1186/1546-0096-13-s1-p122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Lidar M, Livneh A, Zvi IB, Cohen R, Berkun Y, Hashkes P, Peleg H, Kessel A, Almog R, Kali L, Slobodin G, Rozenbaum M, Shinar Y. The clinical phenotype of Israeli patients with Q703K mutation in the NLRP3 gene. Pediatr Rheumatol Online J 2015. [PMCID: PMC4596999 DOI: 10.1186/1546-0096-13-s1-p42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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11
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Kukuy O, Leiba A, Mendel L, Benor A, Giat E, Perski O, Feld O, Kessel Y, Ben Zvi I, Lidar M, Livneh A. Arterial stiffness as a model to dissect chronic inflammation in FMF. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599843 DOI: 10.1186/1546-0096-13-s1-p93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Pras E, Dahan S, Epstein A, Zvi IB, Marek-Yagel D, Shinar Y, Lidar M, Livneh A. Over representation of the A allele in the IL23R rs1004819 polymorphism in M694V homozygote non-responsive FMF patients. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599124 DOI: 10.1186/1546-0096-13-s1-p87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Dechtman ID, Ben-Zvi I, Yael S, Cohen R, Nachum E, Lipey A, Sternik L, Kachel E, Kassif Y, Shinfeld A, Spigelstein D, Lavee J, Raanani E, Livneh A. MEFV mutation carriage as possible predisposition factor for the development of Post Pericardiotomy Syndrome (PPS). Pediatr Rheumatol Online J 2015. [PMCID: PMC4599978 DOI: 10.1186/1546-0096-13-s1-p76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Ben-Zvi I, Shinar Y, Cohen R, Grossman C, Kukuy O, Livneh A. Genetic analysis of MEFV mutation negative familial Mediterranean fever for non-MEFV mutations is rarely effective. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597027 DOI: 10.1186/1546-0096-13-s1-p26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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15
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Ben-David H, Hornung V, Ebert T, Livneh A, Ben-Zvi I. Toll like receptor 2 is overexpressed in FMF patients during attacks and inhibited by colchicine treatment. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599924 DOI: 10.1186/1546-0096-13-s1-p74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Ben-Zvi I, Kassel Y, Kukuy O, Herskovizh C, Grossman C, Livneh A. Featuring the phenotype of the FMF prototype. Pediatr Rheumatol Online J 2015. [PMCID: PMC4598881 DOI: 10.1186/1546-0096-13-s1-p78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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17
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Affiliation(s)
- D Zemer
- Heller Institute of Medical Research, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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18
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Twig G, Livneh A, Vivante A, Afek A, Derazne E, Leiba A, Ben-Ami Shor D, Meydan C, Ben-Zvi I, Tzur D, Furer A, Imazio M, Adler Y, Amital H. THU0376 Cardiovascular and Metabolic Risk Factors in Inherited Auto-Inflammation. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4242] [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: 11/03/2022]
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Özen S, Kuemmerle-Deschner J, Cantarini L, Cimaz R, Quartier P, Gül A, Koné-Paut I, Spalding S, Zeft A, Simon A, Hashkes P, Hentgen V, Kallinich T, Savic S, Foeldvari I, Frenkel J, Machein U, Livneh A, Lachmann H. OP0119 Patient Journey and Treatment Route to Use of First Biologic in Rare Autoinflammatory Diseases: an International Retrospective Chart Review. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3251] [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: 11/04/2022]
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Demirkaya E, Acikel C, Gul A, Gattorno M, Ben-Chetrit E, Ozdogan H, Hashkes P, Polat A, Livneh A, Ozen S. PReS-FINAL-2328: Developing and validating the new severity score for FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC4043518 DOI: 10.1186/1546-0096-11-s2-p318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Feld O, Ben Zvi I, Kukuy OL, Livneh A. P01-035 – Long-term IV colchicine in oral colchicines failure. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952948 DOI: 10.1186/1546-0096-11-s1-a39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nussinovitch U, Livneh A. P01-027 – Normal HRV in colchicine-resistant FMF patients. Pediatr Rheumatol Online J 2013. [PMCID: PMC3953105 DOI: 10.1186/1546-0096-11-s1-a31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ben-Zvi I, Herskovizh C, Kassel Y, Livneh A. P01-032 – Characterization of genetic-negative FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952386 DOI: 10.1186/1546-0096-11-s1-a36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Epstein A, Ben-Zvi I, Shinar Y, Lidar M, Ben-Horin S, Livneh A. P01-033 – Co-occurance of Crohn’s disease and FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952131 DOI: 10.1186/1546-0096-11-s1-a37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kukuy OL, Livneh A, Ben-David A, Kopolovic J, Volkov A, Shinar Y, Holtzman E, Dinour D, Ben-Zvi I. P01-030 – Proteinuria in FMF – prediction of nephropathy type. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952644 DOI: 10.1186/1546-0096-11-s1-a34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shinar Y, Breuer G, Livneh A, Hashkes P. P02-033 - CAPS diagnosis and treatment in an Israeli family. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952257 DOI: 10.1186/1546-0096-11-s1-a140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Shinar Y, Berkun Y, Livneh A, Padeh S. P01-037 – Genetic analysis practice prior to FMF diagnosis. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952173 DOI: 10.1186/1546-0096-11-s1-a41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ben-Zvi I, Kukuy OL, Lidar M, Feld O, Perski O, Kivity S, Langevitz P, Pistrom B, Livneh A. P01-031 – Anakinra for colchicine resistant FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952364 DOI: 10.1186/1546-0096-11-s1-a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Brenner R, Kivity S, Shinar Y, liphshitz I, Ben-Chetrit E, Livneh A, Zvi B. P01-034 – Cancer in FMF: a population based study Israel. Pediatr Rheumatol Online J 2013. [PMCID: PMC3953103 DOI: 10.1186/1546-0096-11-s1-a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Demirkaya E, Acikel C, Gul A, Gattorno M, Ben-Chetrit E, Ozdogan H, Hashkes P, Polat A, Karadag O, Livneh A, Ozen S. PW01-028 – Developing a new severity score for FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952476 DOI: 10.1186/1546-0096-11-s1-a81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ben-Zvi I, Krichely-Vachdi T, Feld O, Lidar M, Kivity S, Livneh A. THU0390 Prolonged disease-free interval in familial mediterranean fever: A distinct subset with unique clinical, demographic and molecular characteristics. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2355] [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: 11/04/2022]
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Berkun Y, Wason S, Brik R, Butbul Y, Ben-Chetrit E, Hashkes P, Livneh A, Ozen S, Ozdogan H, Faulkner R, Davis M. Pharmacokinetics and Colchicine in Pediatric and Adult Patients with Familial Mediterranean Fever. Int J Immunopathol Pharmacol 2012; 25:1121-30. [DOI: 10.1177/039463201202500429] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study sought to determine the appropriate starting dose of colchicine in children aged 2 to 4 years with familial Mediterranean fever (FMF) based on steady-state pharmacokinetics in pediatric patients with FMF ⩾2 to <16 years and adult patients with FMF ⩾16 to ⩽65 years. Outpatients received colchicine for 90 days starting with a fixed dose for 14 days (blood sampling days 14 and 15). After starting doses of colchicine (0.6 mg/day [⩾2 to <4 years], 0.9 mg/day [⩾4 to <6 years], 0.9 mg/day [⩾6 to <12 years], 1.2 mg/day [⩾12 to <16 years], and 1.2 mg/day [⩾16 to ⩽65 years]), the observed steady-state pharmacokinetic parameters were comparable across age groups, despite the higher doses of colchicine on a mg/kg/day basis in the younger age groups. An exception occurred with once-daily colchicine, whereby mean Cmax for colchicine was higher in patients 4 to <6 years (9.4 ng/mL) compared with the younger and older age groups (6.1–6.7 ng/mL). Mean AUC0-24h values in children 2 to <4, 6 to <12, and 12 to <16 years were similar to those in adults. However, mean AUC0-24h values in children 4 to <6 years were 25% higher than those observed in adults. The results show that the recommended starting dose for children 2–4 years and 4–6 years should be 0.6 mg/day (half the US adult dose). Children aged 6 to <12 years should receive 0.9 mg/day (i.e. three-quarters of the US adult dose). The safety of colchicine in children 2 to <4 years was comparable to that in older children and adults.
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Affiliation(s)
- Y. Berkun
- Department of Pediatrics, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - S. Wason
- Mutual Pharmaceutical Company, Inc., now part of Takeda Pharmaceuticals USA Inc. Deerfteld, IL, USA
| | - R. Brik
- Rambam Medical Centre, Haifa, Israel
| | - Y. Butbul
- Rambam Medical Centre, Haifa, Israel
| | - E. Ben-Chetrit
- Department of Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | - A. Livneh
- Sheba Medical Center, Tel Hashomer, Israel
| | - S. Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - H. Ozdogan
- Istanbul University, Cerrahpasa Medical Center, Istanbul, Turkey
| | - R. Faulkner
- Mutual Pharmaceutical Company, Inc., now part of Takeda Pharmaceuticals USA Inc. Deerfteld, IL, USA
| | - M.W. Davis
- Mutual Pharmaceutical Company, Inc., now part of Takeda Pharmaceuticals USA Inc. Deerfteld, IL, USA
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Eshed I, Kushnir T, Livneh A, Langevitz P, Ben-Zvi I, Konen E, Lidar M. Exertional leg pain as a manifestation of occult spondyloarthropathy in familial Mediterranean fever: an MRI evaluation. Scand J Rheumatol 2012; 41:482-6. [DOI: 10.3109/03009742.2012.698301] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shinar Y, Obici L, Aksentijevich I, Bennetts B, Austrup F, Ceccherini I, Costa JM, De Leener A, Gattorno M, Kania U, Kone-Paut I, Lezer S, Livneh A, Moix I, Nishikomori R, Ozen S, Phylactou L, Risom L, Rowczenio D, Sarkisian T, van Gijn ME, Witsch-Baumgartner M, Morris M, Hoffman HM, Touitou I. Guidelines for the genetic diagnosis of hereditary recurrent fevers. Ann Rheum Dis 2012; 71:1599-605. [PMID: 22661645 PMCID: PMC3500529 DOI: 10.1136/annrheumdis-2011-201271] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [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] [Indexed: 12/11/2022]
Abstract
Hereditary recurrent fevers (HRFs) are a group of monogenic autoinflammatory diseases characterised by recurrent bouts of fever and serosal inflammation that are caused by pathogenic variants in genes important for the regulation of innate immunity. Discovery of the molecular defects responsible for these diseases has initiated genetic diagnostics in many countries around the world, including the Middle East, Europe, USA, Japan and Australia. However, diverse testing methods and reporting practices are employed and there is a clear need for consensus guidelines for HRF genetic testing. Draft guidelines were prepared based on current practice deduced from previous HRF external quality assurance schemes and data from the literature. The draft document was disseminated through the European Molecular Genetics Quality Network for broader consultation and amendment. A workshop was held in Bruges (Belgium) on 18 and 19 September 2011 to ratify the draft and obtain a final consensus document. An agreed set of best practice guidelines was proposed for genetic diagnostic testing of HRFs, for reporting the genetic results and for defining their clinical significance.
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Affiliation(s)
- Y Shinar
- Unité médicale des maladies autoinflammatoires, CHRU Montpellier, INSERM U844, Université UM1, Montpellier, France
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Shinar Y, Kosach E, Langevitz P, Zandman-Goddard G, Pauzner R, Rabinovich E, Livneh A, Lidar M. Familial Mediterranean fever gene (MEFV) mutations as a modifier of systemic lupus erythematosus. Lupus 2012; 21:993-8. [DOI: 10.1177/0961203312441048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to assess the prevalence of the Mediterranean FeVer ( MEFV) gene mutations in systemic lupus erythematosus (SLE) patients and their effect on organ involvement, as well as disease activity and severity. The frequencies of three familial Mediterranean fever-related MEFV gene mutations ( M694V, V726A and E148Q) were investigated in 70 SLE patients. Organ involvement, Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores were correlated with mutation carriage. Eleven of 70 patients (15.7%) were found to carry an MEFV mutation. A single patient harbored two mutations, E148Q and V726A, without overt familial Mediterranean fever while the rest were heterozygous carriers. Four of the 11 carried an M694V mutation, four carried V726A and two carried E148Q. The majority of MEFV mutation carriers were Sephardic while non-carriers were mainly of Ashkenazi origin (72.7% vs. 45.7% and 47.4% vs. 9.1%, respectively, p = 0.02). SLE onset was significantly earlier in MEFV carriers (27.6 ± 9.7 vs. 38.2 ± 15.5 years, in carriers vs. non-carriers, p = 0.02). Hematologic and serologic parameters were comparable among mutation carriers and non-carriers. Febrile episodes were more common among MEFV mutation carriers (45.4% vs. 15.2%, p = 0.035) and there was a trend for excess episodes of pleuritis as well (54.5% vs. 23.7%, p = 0.06 in carriers vs. non-carriers, respectively). The frequency of secondary anti-phospholipid antibody syndrome was equivalent among the groups. Conversely, compound urinary abnormalities and renal failure was not observed among MEFV carriers yet was present in 33.4% and 18.6% of non-carriers ( p = 0.027 and 0.19, respectively). SLICC damage index and SLEDAI activity index did not differ significantly between the groups. MEFV mutation carriage appears to modify the SLE disease phenotype in that it contributes to an excess of inflammatory manifestations such as fever and pleuritis on the one hand, while thwarting more severe renal involvement on the other.
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Affiliation(s)
- Y Shinar
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel
| | - E Kosach
- Department of Emergency Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - P Langevitz
- Rheumatology Unit at the Zabludowitz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - G Zandman-Goddard
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Department of Medicine C, Wolfson Medical Center, Holon, Israel
| | - R Pauzner
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Department of Medicine E, Sheba Medical Center, Tel Hashomer, Israel
| | - E Rabinovich
- Department of Medicine F, Sheba Medical Center, Tel Hashomer, Israel
| | - A Livneh
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Department of Medicine F, Sheba Medical Center, Tel Hashomer, Israel
| | - M Lidar
- Rheumatology Unit at the Zabludowitz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Department of Medicine F, Sheba Medical Center, Tel Hashomer, Israel
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Feld O, Yahalom G, Livneh A. Neurologic and other systemic manifestations in FMF: Published and own experience. Best Pract Res Clin Rheumatol 2012; 26:119-33. [DOI: 10.1016/j.berh.2012.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 01/04/2012] [Indexed: 12/15/2022]
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Lidar M, Doron A, Barzilai A, Feld O, Zaks N, Livneh A, Langevitz P. Erysipelas-like erythema as the presenting feature of familial Mediterranean fever. J Eur Acad Dermatol Venereol 2012; 27:912-5. [DOI: 10.1111/j.1468-3083.2011.04442.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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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Berkun Y, Karban A, Padeh S, Shinar Y, Pras E, Lidar M, Livneh A, Bujanover Y. NOD2/CARD 15 gene mutations in patients with Familial Mediterranean Fever. Pediatr Rheumatol Online J 2011. [PMCID: PMC3194659 DOI: 10.1186/1546-0096-9-s1-p291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Camus D, Shinar Y, Aamar S, Langevitz P, Ben-Zvi I, Livneh A, Lidar M. 'Silent' carriage of two familial Mediterranean fever gene mutations in large families with only a single identified patient. Clin Genet 2011; 82:288-91. [PMID: 21995303 DOI: 10.1111/j.1399-0004.2011.01785.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The presence of two mutations in the familial Mediterranean fever gene, without overt familial Mediterranean fever (FMF), designated as phenotype III, predisposes to developing 'silent' AA amyloidosis, recognized as phenotype II, due to the absence of medical supervision and colchicine prophylaxis. We sought to determine the prevalence of phenotype III in large families with only one subject affected with FMF, in order to assess the population at risk for transformation to phenotype II. A total of seven large families were recruited for the study. Siblings were screened for MEFV mutations and underwent a clinical interview to assess for unrecognized FMF manifestations. Phenotype III, most commonly associated with a V726A/E148Q genotype, was detected in 10% of siblings of index cases from informative families, corresponding to a 10-fold increase in comparison to the expected rate in the general population (p < 0.01). Unnoticed 'FMF-like' manifestations were detected among two siblings in the five families in which the index case was heterozygous, but in none of the siblings of the homozygous index cases. The enrichment for phenotype III and detection of occult FMF in large families, in which only a single member is afflicted with FMF, mandates routine clinical evaluation and genetic screening of siblings.
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Affiliation(s)
- D Camus
- Heller Institute of Medical Research and Medicine F, Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yahalom G, Livneh A. Multiple sclerosis in familial Mediterranean fever. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.2011.03407.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Livneh A. Practice and vision--current trends and perspectives in diagnosis of amyloidosis. Amyloid 2011; 18 Suppl 1:198-9. [PMID: 21838486 DOI: 10.3109/13506129.2011.574354074] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Livneh
- The Heller Institute of Medical Research and Medicine F, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Yahalom G, Kivity S, Lidar M, Vaknin-Dembinsky A, Karussis D, Flechter S, Ben-Chetrit E, Livneh A. Familial Mediterranean fever (FMF) and multiple sclerosis: an association study in one of the world's largest FMF cohorts. Eur J Neurol 2011; 18:1146-50. [PMID: 21299735 DOI: 10.1111/j.1468-1331.2011.03356.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE To describe and characterize the association between familial Mediterranean fever (FMF) and multiple sclerosis (MS). METHODS The patient registry of The National Center for FMF was screened for the coexistence of FMF and MS. Tel-Hashomer criteria were used for the diagnosis of FMF, and FMF severity was evaluated, using the simplified FMF severity scale. McDonald criteria were used for the diagnosis of MS, and neurologic disability was measured using the expanded disability status scale (EDSS). RESULTS We identified nine patients, affected with both FMF and MS. The onset of the FMF averaged 15.6 (3-37) years. Most patients suffered from abdominal and joint attacks, and 50% of the patients sustained a moderate to severe FMF. The onset of the MS was at an average age of 31.6 (17-50) years. Neurologic manifestations varied individually, without a dominant deficit, and the course was in a relapsing-remitting pattern in most. The median EDSS was in general of low score (3.0), apart from the patients who were homozygous for the M694V mutation, in whom the MS was more severe. Based on our case series, the frequency of MS in our FMF population is 0.075%, twice higher the expected rate in the general population (P=0.0057). CONCLUSIONS Multiple sclerosis is more common in FMF than in the general Israeli population. Homozygosity for the M694V MEFV mutation may aggravate the phenotype of MS and predispose FMF patients to develop MS.
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Affiliation(s)
- G Yahalom
- Department of Neurology, the Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Rabinovich E, Shinar Y, Leiba M, Ehrenfeld M, Langevitz P, Livneh A. Common FMF alleles may predispose to development of Behcet's disease with increased risk for venous thrombosis. Scand J Rheumatol 2009; 36:48-52. [PMID: 17454935 DOI: 10.1080/03009740600759639] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [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: 10/23/2022]
Abstract
BACKGROUND Behcet's disease (BD) is an inflammatory disorder of unknown cause, associated with vasculitis. Arterial or venous thrombosis occurs in about 25% of BD patients. Familial Mediterranean fever (FMF) is another inflammatory disorder, which stems from mutations in the FMF gene (MEFV) and shares a number of features with BD. OBJECTIVE MEFV analysis in patients with BD suggests that mutated MEFV may act as a susceptibility gene in BD. We studied the rate and the clinical correlates of MEFV mutations in Israeli BD patients. METHODS Included were 54 BD patients who satisfied the International Study Group criteria for BD. All BD patients were genotyped using polymerase chain reaction (PCR) and restriction enzyme analysis for the three most common MEFV mutations (M694V, V726A, and E148Q). The association between BD manifestations and MEFV alleles was analysed. RESULTS Twenty-one BD patients were found to carry a single MEFV mutation and three additional patients were compound heterozygotes, a frequency significantly higher than that expected for ethnically matched healthy individuals. There were no statistically significant differences between carriers and non-carriers with respect to gender, frequency of HLA B5 antigen, cutaneous lesions, joint disease, and severity score. However, carriers did experience thrombosis more often [54% vs. 17%, p<0.005, odds ratio (OR) = 6.9, 95% confidence interval (CI) 1.75-26.9] and uveitis less often (20% vs. 40%, p<0.05, OR = 0.2, 95% CI 0.04-0.92). CONCLUSIONS MEFV appears to be a susceptibility and modifier gene in BD.
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Affiliation(s)
- E Rabinovich
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer 52621, Israel
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Bezalel Y, Gershoni-Baruch R, Dagan E, Lidar M, Livneh A. The 3435T polymorphism in the ABCB1 gene and colchicine unresponsiveness in familial Mediterranean fever. Clin Exp Rheumatol 2009; 27:S103-S104. [PMID: 19796545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Lidar M, Doron A, Kedem R, Yosepovich A, Langevitz P, Livneh A. Appendectomy in familial Mediterranean fever: clinical, genetic and pathological findings. Clin Exp Rheumatol 2008; 26:568-573. [PMID: 18799086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Abdominal attacks of familial Mediterranean fever (FMF) may simulate acute appendicitis and bring about considerable uncertainty. The similar presentation of the two clinical entities often leads to an unnecessary appendectomy. METHODS 182 consecutive FMF patients were retrospectively reviewed for this study. Clinical and genetic data was compared between those who had undergone an appendectomy (n=71) and those who had not (n=111). RESULTS The frequency of appendectomy found in FMF was far above the reported rate in the general population (40% vs. 12-25%). The rate of non-inflamed appendectomies was extremely high (80% vs. 20%) and remained constant over time. Tertiary hospitals and improved therapeutic and diagnostic measures that have evolved over the years did not reduce misdiagnosis of acute appendicitis in FMF. Severe phenotype and homozygosity for M694V were identified as risk factors for appendectomy in FMF. A change from the regular diffuse involvement to right lower quadrant abdominal pain was found to be the best predictor of inflamed appendix in FMF patients undergoing appendectomy for suspected acute appendicitis. CONCLUSION Reliance on clinical parameters should improve diagnostic accuracy of acute appendicitis in the FMF patient population.
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Affiliation(s)
- M Lidar
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel.
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Lidar M, Zandman-Goddard G, Shinar Y, Zaks N, Livneh A, Langevitz P. Systemic lupus erythematosus and familial Mediterranean fever: a possible negative association between the two disease entities – report of four cases and review of the literature. Lupus 2008; 17:663-9. [DOI: 10.1177/0961203308089403] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Serositis is a common clinical manifestation of systemic lupus erythematosus (SLE), as well as being the hallmark of familial Mediterranean fever (FMF), the most prevalent monogenic disease in the Jewish population. We have treated four patients who suffered from both SLE and FMF since 2001 in our clinic, which also serves as the national center for FMF. Our cases illustrate both similarities and dissimilarities between the clinical manifestations of these two diseases, an aspect which should be borne in mind, especially in the young female patients. In general, it seems that co-occurrence of FMF moderates the presentation of lupus.
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Affiliation(s)
- M Lidar
- Heller Institute of Medical Research (HIMR), Rheumatology Unit and Medicine F, Sheba Medical Center (SMC), Tel Hashomer, Israel,
| | - G Zandman-Goddard
- Medicine C, Wolfson Medical Center, Holon, Israel; formerly of the Rheumatology Unit and Medicine B, SMC, Tel Hashomer, Israel
| | - Y Shinar
- Heller Institute of Medical Research (HIMR) Sheba Medical Center (SMC), Tel Hashomer, Israel
| | - N Zaks
- Heller Institute of Medical Research (HIMR), Rheumatology Unit and Medicine F, Sheba Medical Center (SMC), Tel Hashomer, Israel
| | - A Livneh
- Heller Institute of Medical Research (HIMR), Medicine F, SMC, Tel Hashomer, Israel
| | - P Langevitz
- Heller Institute of Medical Research (HIMR), Rheumatology Unit, SMC, Tel Hashomer, Israel
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Shinar Y, Livneh A, Vila Y, Pinhasov A, Zeitoun I, Achiron A. The mediterranean fever gene modifies the progression of disability in non-Ashkenazi Jewish multiple sclerosis patients. J Neurochem 2008. [DOI: 10.1046/j.1471-4159.81.s1.16_11.x] [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: 11/20/2022]
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Kukuy OL, Kopolovic J, Blau A, Ben-David A, Lotan D, Shaked M, Shinar Y, Dinour D, Langevitz P, Livneh A. Mutations in the familial Mediterranean fever gene of patients with IgA nephropathy and other forms of glomerulonephritis. Clin Genet 2007; 73:146-51. [DOI: 10.1111/j.1399-0004.2007.00945.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shinar Y, Kuchuk I, Menasherow S, Kolet M, Lidar M, Langevitz P, Livneh A. Unique spectrum of MEFV mutations in Iranian Jewish FMF patients clinical and demographic significance. Rheumatology (Oxford) 2007; 46:1718-22. [DOI: 10.1093/rheumatology/kem228] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lidar M, Livneh A. Familial Mediterranean fever: clinical, molecular and management advancements. Neth J Med 2007; 65:318-324. [PMID: 17954950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Familial Mediterranean fever (FMF), the most frequent of the periodic fever syndromes, is an autosomal recessive disease, predominantly affecting people of Mediterranean descent. The disease is caused by mutations in the MEFV gene, encoding the pyrin protein thought to be associated with the interleukin-1 related inflammation cascade. The condition manifests as attacks of serositis, commonly involving the abdomen, chest or joints, typically accompanied by fever and elevated acute phase reactants. Attacks subside spontaneously within one to three days, without residue. Continuous treatment with colchicine, at a daily dose of 1 to 2 mg, reduces attack frequency, duration and intensity in the majority of patients, and also prevents the development of secondary amyloidosis, the most dreaded complication of the disease. In this communication we review the current state of the art in the diagnosis and care of FMF patients, starting with the presentation of a typical case.
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Affiliation(s)
- M Lidar
- Heller Institute of Medical Research, Sheba Medical Centre, Tel-Hashomer, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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