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Muthusamy K, Perez-Ortiz JM, Ligezka AN, Altassan R, Johnsen C, Schultz MJ, Patterson MC, Morava E. Neurological manifestations in PMM2-congenital disorders of glycosylation (PMM2-CDG): Insights into clinico-radiological characteristics, recommendations for follow-up, and future directions. Genet Med 2024; 26:101027. [PMID: 37955240 DOI: 10.1016/j.gim.2023.101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023] Open
Abstract
PURPOSE In the absence of prospective data on neurological symptoms, disease outcome, or guidelines for system specific management in phosphomannomutase 2-congenital disorders of glycosylation (PMM2-CDG), we aimed to collect and review natural history data. METHODS Fifty-one molecularly confirmed individuals with PMM2-CDG enrolled in the Frontiers of Congenital Disorders of Glycosylation natural history study were reviewed. In addition, we prospectively reviewed a smaller cohort of these individuals with PMM2-CDG on off-label acetazolamide treatment. RESULTS Mean age at diagnosis was 28.04 months. Developmental delay is a constant phenotype. Neurological manifestation included ataxia (90.2%), myopathy (82.4%), seizures (56.9%), neuropathy (52.9%), microcephaly (19.1%), extrapyramidal symptoms (27.5%), stroke-like episodes (SLE) (15.7%), and spasticity (13.7%). Progressive cerebellar atrophy is the characteristic neuroimaging finding. Additionally, supratentorial white matter changes were noted in adult age. No correlation was observed between the seizure severity and SLE risk, although all patients with SLE have had seizures in the past. "Off-label" acetazolamide therapy in a smaller sub-cohort resulted in improvement in speech fluency but did not show statistically significant improvement in objective ataxia scores. CONCLUSION Clinical and radiological findings suggest both neurodevelopmental and neurodegenerative pathophysiology. Seizures may manifest at any age and are responsive to levetiracetam monotherapy in most cases. Febrile seizure is the most common trigger for SLEs. Acetazolamide is well tolerated.
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Affiliation(s)
| | - Judit M Perez-Ortiz
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
| | - Anna N Ligezka
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN
| | - Ruqaiah Altassan
- Department of Medical Genomics, Centre for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Christin Johnsen
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN; Department of Pediatrics and Adolescent Medicine, University Medical Centre, Göttingen, Germany
| | | | - Marc C Patterson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN; Department of Clinical Genomics, Mayo Clinic, Rochester, MN
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Department of Medical Genetics, University Medical School, Pecs, Hungary
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2
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De Graef D, Ligezka AN, Rezents J, Mazza GL, Preston G, Schwartz K, Krzysciak W, Lam C, Edmondson AC, Johnsen C, Kozicz T, Morava E. Coagulation abnormalities in a prospective cohort of 50 patients with PMM2-congenital disorder of glycosylation. Mol Genet Metab 2023; 139:107606. [PMID: 37224763 PMCID: PMC10530657 DOI: 10.1016/j.ymgme.2023.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Given the lack of reliable data on the prevalence of bleeding abnormalities and thrombotic episodes in PMM2-CDG patients, and whether coagulation abnormalities change over time, we prospectively collected and reviewed natural history data. Patients with PMM2-CDG often have abnormal coagulation studies due to glycosylation abnormalities but the frequency of complications resulting from these has not been prospectively studied. METHODS We studied fifty individuals enrolled in the Frontiers in Congenital Disorders of Glycosylation Consortium (FCDGC) natural history study with molecularly confirmed diagnosis of PMM2-CDG. We collected data on prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelets, factor IX activity (FIX), factor XI activity (FXI), protein C activity (PC), protein S activity (PS) and antithrombin activity (AT). RESULTS Prothrombotic and antithrombotic factor activities were frequently abnormal in PMM2-CDG patients, including AT, PC, PT, INR, and FXI. AT deficiency was the most common abnormality in 83.3% of patients. AT activity was below 50% in 62.5% of all patients (normal range 80-130%). Interestingly, 16% of the cohort experienced symptoms of spontaneous bleeding and 10% had thrombosis. Stroke-like episodes (SLE) were reported in 18% of patients in our cohort. Based on the linear growth models, on average, patients did not show significant change in AT (n = 48; t(23.8) = 1.75, p = 0.09), FIX (n = 36; t(61) = 1.60, p = 0.12), FXI (n = 39; t(22.8) = 1.88, p = 0.07), PS (n = 25; t(28.8) = 1.08, p = 0.29), PC (n = 38; t(68) = 1.61, p = 0.11), INR (n = 44; t(184) = -1.06, p = 0.29), or PT (n = 43; t(192) = -0.69, p = 0.49) over time. AT activity positively correlated with FIX activity. PS activity was significantly lower in males. CONCLUSION Based on our natural history data and previous literature, we conclude that caution should be exercised when the AT levels are lower than 65%, as most thrombotic events occur in patients with AT below this level. All five, male PMM2-CDG patients in our cohort who developed thrombosis had abnormal AT levels, ranging between 19% and 63%. Thrombosis was associated with infection in all cases. We did not find significant change in AT levels over time. Several PMM2-CDG patients had an increased bleeding tendency. More long-term follow-up is necessary on coagulation abnormalities and the associated clinical symptoms to provide guidelines for therapy, patient management, and appropriate counseling. SYNOPSIS Most PMM2-CDG patients display chronic coagulation abnormalities without significant improvement, associated with a frequency of 16% clinical bleeding abnormalities, and 10% thrombotic episodes in patients with severe antithrombin deficiency.
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Affiliation(s)
| | - Anna N Ligezka
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA; Department of Medical Diagnostics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland
| | - Joseph Rezents
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Gina L Mazza
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
| | - Graeme Preston
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Kaitlin Schwartz
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Wirginia Krzysciak
- Department of Medical Diagnostics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9, 30-688 Krakow, Poland
| | - Christina Lam
- Section of Biochemical Genetics, Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, USA
| | - Andrew C Edmondson
- Section of Biochemical Genetics, Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Christin Johnsen
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA; Department of Pediatric and Adolescent Medicine, University Medicine Göttingen, Göttingen, Germany
| | - Tamas Kozicz
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Medical Genetics, University of Pecs, Pecs, Hungary.
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Shah R, Johnsen C, Pletcher BA, Edmondson AC, Kozicz T, Morava E. Long-term outcomes in ALG13-Congenital Disorder of Glycosylation. Am J Med Genet A 2023; 191:1626-1631. [PMID: 36930724 PMCID: PMC10175127 DOI: 10.1002/ajmg.a.63179] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/19/2023]
Abstract
ALG13-CDG is a rare X-linked disorder of N-linked glycosylation. Given the lack of long-term outcome data in ALG13-CDG, we collected natural history data and reviewed individuals surviving to young adulthood with confirmed pathogenic variants in ALG13 in our own cohort and in the literature. From the 14 ALG13-CDG patients enrolled into our Frontiers of Congenital Disorders of Glycosylation Consortium natural history study only two patients were older than 16 years; one of these two females is so far unreported. From the 52 patients described in the medical literature with confirmed pathogenic variants in ALG13 only five patients were older than 16 years (all females), in addition to the new, unreported patient from our natural history study. Two male patients have died due to ALG13-CDG, and there were no surviving males older than 16 years with a confirmed ALG13-CDG diagnosis. Our adolescent and young adult cohort of six patients presented with epilepsy, muscular hypotonia, speech, and developmental delay. Intellectual disability was present in all female patients with ALG13-CDG. Unreported features included ataxia, neuropathy, and severe gastrointestinal symptoms requiring G/J tube placement. In addition, two patients from our natural history study developed unilateral hearing loss. Skeletal abnormalities were found in four patients, including osteopenia and scoliosis. Major health problems included persistent seizures in three patients. Ketogenic diet was efficient for seizures in three out of four patients. Although all patients were mobile, they all had severe communication problems with mostly absent speech and were unable to function without parental support. In summary, long-term outcome in ALG13-CDG includes gastrointestinal and skeletal involvement in addition to a chronic, mostly non-progressive neurologic phenotype.
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Affiliation(s)
- Rameen Shah
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christin Johnsen
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatrics, University Clinic of Göttingen, Göttingen, Germany
| | - Beth A Pletcher
- Department of Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Andrew C Edmondson
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tamas Kozicz
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Anatomy, University of Pecs Medical School, Pecs, Hungary
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medical Genetics, University of Pecs Medical School, Pecs, Hungary
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4
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Radenkovic S, Johnsen C, Schulze A, Lail G, Guilder L, Schwartz K, Schultz M, Mercimek-Andrews S, Boyer S, Morava E. Novel insights into the phenotype and long-term D-gal treatment in PGM1-CDG: a case series. Ther Adv Rare Dis 2023; 4:26330040221150269. [PMID: 37181075 PMCID: PMC10032428 DOI: 10.1177/26330040221150269] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/20/2022] [Indexed: 05/16/2023]
Abstract
Phosphoglucomutase-1-congenital disorder of glycosylation (PGM1-CDG) (OMIM: 614921) is a rare autosomal recessive inherited metabolic disease caused by the deficiency of the PGM1 enzyme. Like other CDGs, PGM1-CDG has a multisystemic presentation. The most common clinical findings include liver involvement, rhabdomyolysis, hypoglycemia, and cardiac involvement. Phenotypic severity can vary, though cardiac presentation is usually part of the most severe phenotype, often resulting in early death. Unlike the majority of CDGs, PGM1-CDG has a treatment: oral D-galactose (D-gal) supplementation, which significantly improves many aspects of the disorder. Here, we describe five PGM1-CDG patients treated with D-gal and report both on novel clinical symptoms in PGM1-CDG as well as the effects of the D-gal treatment. D-gal resulted in notable clinical improvement in four patients, though the efficacy of treatment varied between the patients. Furthermore, there was a significant improvement or normalization in transferrin glycosylation, liver transaminases and coagulation factors in three patients, creatine kinase (CK) levels in two, while hypoglycemia resolved in two patients. One patient discontinued the treatment due to urinary frequency and lack of clinical improvement. Furthermore, one patient experienced recurrent episodes of rhabdomyolysis and tachycardia even on higher doses of therapy. D-gal also failed to improve the cardiac function, which was initially abnormal in three patients, and remains the biggest challenge in treating PGM1-CDG. Together, our findings expand the phenotype of PGM1-CDG and underline the importance of developing novel therapies that would specifically treat the cardiac phenotype in PGM1-CDG.
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Affiliation(s)
- Silvia Radenkovic
- Department of Clinical Genomics, Mayo Clinic,
55905 Rochester, MN, USA
| | - Christin Johnsen
- Department of Clinical Genomics, Mayo Clinic,
Rochester, MN, USA
| | - Andreas Schulze
- Department of Biochemistry, University of
Toronto, Toronto, ON, Canada
- Hospital for Sick Children and Department of
Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Gurnoor Lail
- Hospital for Sick Children and Department of
Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Laura Guilder
- Hospital for Sick Children and Department of
Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Kaitlin Schwartz
- Department of Clinical Genomics, Mayo Clinic,
Rochester, MN, USA
| | - Matthew Schultz
- Biochemical Genetics Laboratory, Department of
Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | | | - Suzanne Boyer
- Department of Clinical Genomics, Mayo Clinic,
Rochester, MN, USA
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic,
Rochester, MN, USA
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5
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Muylle E, Jiang H, Johnsen C, Byeon SK, Ranatunga W, Garapati K, Zenka RM, Preston G, Pandey A, Kozicz T, Fang F, Morava E. TRIT1 defect leads to a recognizable phenotype of myoclonic epilepsy, speech delay, strabismus, progressive spasticity, and normal lactate levels. J Inherit Metab Dis 2022; 45:1039-1047. [PMID: 36047296 PMCID: PMC9826177 DOI: 10.1002/jimd.12550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/11/2023]
Abstract
TRIT1 defect is a rare, autosomal-recessive disorder of transcription, initially described as a condition with developmental delay, myoclonic seizures, and abnormal mitochondrial function. Currently, only 13 patients have been reported. We reviewed the genetic, clinical, and metabolic aspects of the disease in all known patients, including two novel, unrelated TRIT1 cases with abnormalities in oxidative phosphorylation complexes I and IV in fibroblasts. Taken together the features of all 15 patients, TRIT1 defect could be identified as a potentially recognizable syndrome including myoclonic epilepsy, speech delay, strabismus, progressive spasticity, and variable microcephaly, with normal lactate levels. Half of the patients had oxidative phosphorylation complex measurements and had multiple complex abnormalities.
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Affiliation(s)
- Ewout Muylle
- Department of Clinical GenomicsMayo ClinicRochesterMinnesotaUSA
| | - Huafang Jiang
- Department of NeurologyBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | | | - Seul Kee Byeon
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | | | - Kishore Garapati
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
- Institute of Bioinformatics, International Technology ParkBangaloreKarnatakaIndia
- Manipal Academy of Higher EducationManipalKarnatakaIndia
| | - Roman M. Zenka
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Graeme Preston
- Department of Clinical GenomicsMayo ClinicRochesterMinnesotaUSA
| | - Akhilesh Pandey
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Tamas Kozicz
- Department of Clinical GenomicsMayo ClinicRochesterMinnesotaUSA
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
| | - Fang Fang
- Department of NeurologyBeijing Children's Hospital, Capital Medical University, National Center for Children's HealthBeijingChina
| | - Eva Morava
- Department of Clinical GenomicsMayo ClinicRochesterMinnesotaUSA
- Department of Laboratory Medicine and PathologyMayo ClinicRochesterMinnesotaUSA
- Department of Medical GeneticsUniversity of Pecs Medical SchoolPecsHungary
- Department of BiophysicsUniversity of Pecs Medical SchoolPecsHungary
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6
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Boyer SW, Johnsen C, Morava E. Nutrition interventions in congenital disorders of glycosylation. Trends Mol Med 2022; 28:463-481. [PMID: 35562242 DOI: 10.1016/j.molmed.2022.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 12/13/2022]
Abstract
Congenital disorders of glycosylation (CDG) are a group of more than 160 inborn errors of metabolism affecting multiple pathways of protein and lipid glycosylation. Patients present with a wide range of symptoms and therapies are only available for very few subtypes. Specific nutritional treatment options for certain CDG types include oral supplementation of monosaccharide sugars, manganese, uridine, or pyridoxine. Additional management includes specific diets (i.e., complex carbohydrate or ketogenic diet), iron supplementation, and albumin infusions. We review the dietary management in CDG with a focus on two subgroups: N-linked glycosylation defects and GPI-anchor disorders.
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Affiliation(s)
- Suzanne W Boyer
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Christin Johnsen
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA.
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7
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Muthusamy K, Ligezka A, Johnsen C, Boyer S, Morava-Kozicz E. eP028: Neurological manifestations in PMM2 related congenital disorders of glycosylation (CDG): Insights into clinico-radiological characteristics and recommendations for follow-up. Genet Med 2022. [DOI: 10.1016/j.gim.2022.01.066] [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] Open
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8
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Ligezka AN, Radenkovic S, Saraswat M, Garapati K, Ranatunga W, Krzysciak W, Yanaihara H, Preston G, Brucker W, McGovern RM, Reid JM, Cassiman D, Muthusamy K, Johnsen C, Mercimek-Andrews S, Larson A, Lam C, Edmondson AC, Ghesquière B, Witters P, Raymond K, Oglesbee D, Pandey A, Perlstein EO, Kozicz T, Morava E. Sorbitol Is a Severity Biomarker for PMM2-CDG with Therapeutic Implications. Ann Neurol 2021; 90:887-900. [PMID: 34652821 DOI: 10.1002/ana.26245] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Epalrestat, an aldose reductase inhibitor increases phosphomannomutase (PMM) enzyme activity in a PMM2-congenital disorders of glycosylation (CDG) worm model. Epalrestat also decreases sorbitol level in diabetic neuropathy. We evaluated the genetic, biochemical, and clinical characteristics, including the Nijmegen Progression CDG Rating Scale (NPCRS), urine polyol levels and fibroblast glycoproteomics in patients with PMM2-CDG. METHODS We performed PMM enzyme measurements, multiplexed proteomics, and glycoproteomics in PMM2-deficient fibroblasts before and after epalrestat treatment. Safety and efficacy of 0.8 mg/kg/day oral epalrestat were studied in a child with PMM2-CDG for 12 months. RESULTS PMM enzyme activity increased post-epalrestat treatment. Compared with controls, 24% of glycopeptides had reduced abundance in PMM2-deficient fibroblasts, 46% of which improved upon treatment. Total protein N-glycosylation improved upon epalrestat treatment bringing overall glycosylation toward the control fibroblasts' glycosylation profile. Sorbitol levels were increased in the urine of 74% of patients with PMM2-CDG and correlated with the presence of peripheral neuropathy, and CDG severity rating scale. In the child with PMM2-CDG on epalrestat treatment, ataxia scores improved together with significant growth improvement. Urinary sorbitol levels nearly normalized in 3 months and blood transferrin glycosylation normalized in 6 months. INTERPRETATION Epalrestat improved PMM enzyme activity, N-glycosylation, and glycosylation biomarkers in vitro. Leveraging cellular glycoproteome assessment, we provided a systems-level view of treatment efficacy and discovered potential novel biosignatures of therapy response. Epalrestat was well-tolerated and led to significant clinical improvements in the first pediatric patient with PMM2-CDG treated with epalrestat. We also propose urinary sorbitol as a novel biomarker for disease severity and treatment response in future clinical trials in PMM2-CDG. ANN NEUROL 2021.
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Affiliation(s)
- Anna N Ligezka
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN.,Department of Medical Diagnostics, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - Silvia Radenkovic
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN.,Laboratory of Hepatology, Department of CHROMETA, KU Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium.,Metabolomics Expertise Center, VIB-KU Leuven, Leuven, Belgium
| | - Mayank Saraswat
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.,Institute of Bioinformatics, Bangalore, India.,Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Kishore Garapati
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.,Institute of Bioinformatics, Bangalore, India.,Manipal Academy of Higher Education (MAHE), Manipal, India.,Center for Molecular Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | - Wirginia Krzysciak
- Department of Medical Diagnostics, Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | | | - Graeme Preston
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN
| | - William Brucker
- Department of Pediatrics, Human Genetics, Rhode Island Hospital, Providence, RI
| | - Renee M McGovern
- Division of Oncology Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Joel M Reid
- Division of Oncology Research, Mayo Clinic College of Medicine, Rochester, MN
| | - David Cassiman
- Laboratory of Hepatology, Department of CHROMETA, KU Leuven, Leuven, Belgium.,Department of Paediatrics, Metabolic Disease Center, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Saadet Mercimek-Andrews
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Genetics, University of Alberta, Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Austin Larson
- Section of Clinical Genetics and Metabolism, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Christina Lam
- Division of Genetic Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.,Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA
| | - Andrew C Edmondson
- Section of Biochemical Genetics, Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bart Ghesquière
- Department of Oncology, KU Leuven, Leuven, Belgium.,Metabolomics Expertise Center, VIB-KU Leuven, Leuven, Belgium
| | - Peter Witters
- Department of Paediatrics, Metabolic Disease Center, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Kimiyo Raymond
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Devin Oglesbee
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Akhilesh Pandey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Tamas Kozicz
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.,Department of Paediatrics, Metabolic Disease Center, University Hospitals Leuven, Leuven, Belgium
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9
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Johnsen C, Edmondson AC. Manifestations and Management of Hepatic Dysfunction in Congenital Disorders of Glycosylation. Clin Liver Dis (Hoboken) 2021; 18:54-66. [PMID: 34584669 PMCID: PMC8450475 DOI: 10.1002/cld.1105] [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] [Received: 02/11/2021] [Accepted: 02/21/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Andrew C. Edmondson
- Division of Human GeneticsDepartment of PediatricsChildren’s Hospital of PhiladelphiaPhiladelphiaPA
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10
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Witters P, Edmondson AC, Lam C, Johnsen C, Patterson MC, Raymond KM, He M, Freeze HH, Morava E. Spontaneous improvement of carbohydrate-deficient transferrin in PMM2-CDG without mannose observed in CDG natural history study. Orphanet J Rare Dis 2021; 16:102. [PMID: 33632285 PMCID: PMC7908710 DOI: 10.1186/s13023-021-01751-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022] Open
Abstract
A recent report on long-term dietary mannose supplementation in phosphomannomutase 2 deficiency (PMM2-CDG) claimed improved glycosylation and called for double-blind randomized study of the dietary supplement in PMM2-CDG patients. A lack of efficacy of short-term mannose supplementation in multiple prior reports challenge this study’s conclusions. Additionally, some CDG types have previously been reported to demonstrate spontaneous improvement in glycosylated biomarkers, including transferrin. We have likewise observed improvements in transferrin glycosylation without mannose supplementation. This observation questions the reliability of transferrin as a therapeutic outcome measure in clinical trials for PMM2-CDG. We are concerned that renewed focus on mannose therapy in PMM2-CDG will detract from clinical trials of more promising therapies. Approaches to increase efficiency of clinical trials and ultimately improve patients’ lives requires prospective natural history studies and identification of reliable biomarkers linked to clinical outcomes in CDG. Collaborations with patients and families are essential to identifying meaningful study outcomes.
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Affiliation(s)
- Peter Witters
- Department of Paediatrics and Metabolic Center, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - Andrew C Edmondson
- Department of Pediatrics, Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christina Lam
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA, USA.,Center of Integrated Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Christin Johnsen
- Department of Clinical Genomics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | | | - Kimiyo M Raymond
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Miao He
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hudson H Freeze
- Human Genetics Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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11
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Johnsen C, Sengeloev M, Joergensen P, Bruun N, Modin D, Alhakak A, Schou M, Gislason G, Fritz-Hansen T, Shah A, Biering-Soerensen T. Prognostic value of global longitudinal layer specific strain for patients with heart failure with reduced ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0117] [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: 11/12/2022] Open
Abstract
Abstract
Background
Novel echocardiographic software allows for layer-specific evaluation of myocardial deformation by 2-dimensional speckle tracking echocardiography. Endocardial, epicardial- and whole wall global longitudinal strain (GLS) may be superior to conventional echocardiographic parameters in predicting all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF).
Purpose
The purpose of this study was to investigate the prognostic value of endocardial-, epicardial- and whole wall GLS in patients with HFrEF in relation to all-cause mortality.
Methods
We included and analyzed transthoracic echocardiographic examinations from 1,015 patients with HFrEF. The echocardiographic images were analyzed, and conventional and novel echocardiographic parameters were obtained. A p value in a 2-sided test <0.05 was considered statistically significant. Cox proportional hazards regression models were constructed, and both univariable and multivariable hazard ratios (HRs) were calculated.
Results
During a median follow-up time of 40 months, 171 patients (16.8%) died. A lower endocardial (HR 1.17; 95% CI (1.11–1.23), per 1% decrease, p<0.001), epicardial (HR 1.20; 95% CI (1.13–1.27), per 1% decrease, p<0.001), and whole wall (HR 1.20; 95% CI (1.14–1.27), per 1% decrease, p<0.001) GLS were all associated with higher risk of death (Figure 1). Both endocardial (HR 1.12; 95% CI (1.01–1.23), p=0.027), epicardial (HR 1.13; 95% CI (1.01–1.26), p=0.040) and whole wall (HR 1.13; 95% CI (1.01–1.27), p=0.030) GLS remained independent predictors of mortality in the multivariable models after adjusting for significant clinical parameters (age, sex, total cholesterol, mean arterial pressure, heart rate, ischemic cardiomyopathy, percutaneous transluminal coronary angioplasty and diabetes) and conventional echocardiographic parameters (left ventricular (LV) ejection fraction, LV mass index, left atrial volume index, deceleration time, E/e', E-velocity, E/A ratio and tricuspid annular plane systolic excursion). No other echocardiographic parameters remained an independent predictors after adjusting. Furthermore, endocardial, epicardial and whole wall GLS had the highest C-statistics of all the echocardiographic parameters.
Conclusion
Endocardial, epicardial and whole wall GLS are independent predictors of all-cause mortality in patients with HFrEF. Furthermore, endocardial, epicardial and whole wall GLS were superior prognosticators of all-cause mortality compared with all other echocardiographic parameters.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Herlev and Gentofte Hospital
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Affiliation(s)
- C Johnsen
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Sengeloev
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P Joergensen
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - N Bruun
- University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark
| | - D Modin
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - A Alhakak
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Schou
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G Gislason
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Fritz-Hansen
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - A Shah
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Boston, United States of America
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12
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Klemm HU, Weber TF, Johnsen C, Begemann PGC, Meinertz T, Ventura R. Anatomical variations of the right coronary artery may be a source of difficult block and conduction recurrence in catheter ablation of common-type atrial flutter. Europace 2010; 12:1608-15. [DOI: 10.1093/europace/euq320] [Citation(s) in RCA: 7] [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: 11/13/2022] Open
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13
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Kroneman A, Harris J, Vennema H, Duizer E, van Duynhoven Y, Gray J, Iturriza M, Böttiger B, Falkenhorst G, Johnsen C, von Bonsdorff CH, Maunula L, Kuusi M, Pothier P, Gallay A, Schreier E, Koch J, Szücs G, Reuter G, Krisztalovics K, Lynch M, McKeown P, Foley B, Coughlan S, Ruggeri FM, Di Bartolo I, Vainio K, Isakbaeva E, Poljsak-Prijatelj M, Grom AH, Bosch A, Buesa J, Fauquier AS, Hernandéz-Pezzi G, Hedlund KO, Koopmans M. Data quality of 5 years of central norovirus outbreak reporting in the European Network for food-borne viruses. J Public Health (Oxf) 2007; 30:82-90. [PMID: 18089585 DOI: 10.1093/pubmed/fdm080] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The food-borne viruses in Europe (FBVE) network database was established in 1999 to monitor trends in outbreaks of gastroenteritis due to noroviruses (NoVs), to identify major transmission routes of NoV infections within and between participating countries and to detect diffuse international food-borne outbreaks. METHODS We reviewed the total of 9430 NoV outbreak reports from 13 countries with date of onset between 1 January 2002 and 1 January 2007 for representativeness, completeness and timeliness against these objectives. RESULTS Rates of reporting ranged from a yearly average of 1.8 in 2003 to 11.6 in 2006. Completeness of reporting of an agreed minimum dataset improved over the years, both for epidemiological and virological data. For the 10 countries that provided integrated (epidemiological AND virological) reporting over the 5-year period, the completeness of the minimum dataset rose from 15% in 2003 to 48% in 2006. Two countries have not been able to combine both data types due to the structure of the national surveillance system (England and Wales and Germany). Timeliness of reporting (median days between the onset of an outbreak and the date of reporting to the FBVE database) differed greatly between countries, but gradually improved to 47 days in 2006. CONCLUSION The outbreaks reported to the FBVE reflect the lack of standardization of surveillance systems across Europe, making direct comparison of data between countries difficult. However, trends in reported outbreaks per country, distribution of NoV genotypes, and detection of diffuse international outbreaks were used as background data in acute questions about NoV illness and the changing genotype distribution during the 5-year period, shown to be of added value. Integrated reporting is essential for these objectives, but could be limited to sentinel countries with surveillance systems that allow this integration. For successful intervention in case of diffuse international outbreaks, completeness and timeliness of reporting would need to be improved and expanded to countries that presently do not participate.
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Affiliation(s)
- A Kroneman
- National Institute for Public Health and Environment, Center for Infectious Disease Control, Postbus 1, 3720 BA Bilthoven, The Netherlands.
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14
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Klemm HU, Ventura R, Steven D, Johnsen C, Rostock T, Lutomsky B, Risius T, Meinertz T, Willems S. Catheter Ablation of Multiple Ventricular Tachycardias After Myocardial Infarction Guided by Combined Contact and Noncontact Mapping. Circulation 2007; 115:2697-704. [PMID: 17502573 DOI: 10.1161/circulationaha.106.668673] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Insights gained from noncontact mapping of ventricular tachycardia (VT) have not been systematically applied to contact maps. This study sought to unify both techniques for an individualized approach to the patient with multiple ischemic VTs irrespective of cycle length.
Methods and Results—
For 12 consecutive patients with chronic myocardial infarction and recurrent VT, bipolar contact maps were acquired during sinus or paced rhythm. Additional noncontact maps were obtained during 48 induced VTs (cycle length 192 to 579 ms). Endocardial exit sites were superimposed on contact maps and verified by pace-mapping. Radiofrequency lesions were extended for critical borders defined by multiple neighboring exits and followed the isovoltage contour line of contact maps. Nine critical borders were identified in 8 patients and constituted the substrate for 31 VTs. The voltage at exit sites was 0.8 mV (range 0.1 to 2.3). Noncontact maps revealed 23±18% of isthmus conduction. Thirty-seven (77%) of all and 83% of clinically documented VTs were rendered noninducible irrespective of cycle length by application of 27 radiofrequency lesions (range 18 to 56). Spontaneous transitions between distinct VTs along critical borders were demonstrated in 4 patients. Pace-mapping reproduced the QRS morphology of 81% of VTs and was associated with successful ablation (
P
<0.01). Noninducibility of any sustained VT was reached for 8 (67%) patients. During 15 months (range 5 to 28) of follow-up, 8 patients remained without recurrence, and VT episodes were reduced in the other 4 patients (
P
<0.01). VT cycle length was not predictive for acute or long-term success.
Conclusion—
The combined approach of contact and noncontact mapping effectively defines critical borders as the substrate of multiple VTs without limitation for unstable VTs.
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Affiliation(s)
- Hanno U Klemm
- Department of Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.
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15
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Klemm HU, Steven D, Johnsen C, Ventura R, Rostock T, Lutomsky B, Risius T, Meinertz T, Willems S. Catheter motion during atrial ablation due to the beating heart and respiration: Impact on accuracy and spatial referencing in three-dimensional mapping. Heart Rhythm 2007; 4:587-92. [PMID: 17467625 DOI: 10.1016/j.hrthm.2007.01.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 01/10/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND The accuracy of three-dimensional mapping systems is affected by cardiac contraction and respiration. OBJECTIVE The study sought to determine relative motion of cardiac and thoracic structures to assess positional errors and guide the choice of an optimized spatial reference. METHODS Motion of catheters placed at the coronary sinus (CS), pulmonary vein (PV) ostia, left atrial (LA) isthmus and roof, cavotricuspid isthmus (CTI), and right atrial appendage (RAA) were recorded for 30 patients using Ensite-NavX. The right subclavian vein, left brachiocephalic vein, azygos vein, pulmonary arteries, and a static reference were included. The displacement from a mean position was calculated for each pair of sites. Respiration effects were assessed by the shift of the motion curve during in- and expiration phases. RESULTS The PVs showed a mean interpair displacement of 4.1 +/- 0.2 mm and a shift of 5.0 +/- 0.5 mm. Proximal CS references for all LA structures (4.0 +/- 1.1 mm) were superior to the static reference (4.9 +/- 0.7 mm; P = .01). In addition, the shift due to respiration was less pronounced at 3.5 +/- 0.8 mm versus 4.9 +/- 0.5 mm (P = .004), respectively. Motion of extracardiac vessels was influenced by a mean shift of 6.8 +/- 1 mm. The remote subclavian and brachiocephalic veins were more affected (7.6 +/- 0.7 mm) than the pulmonary arteries (5.9 +/- 0.4 mm; P = .002). For the CTI, a minimized mean displacement of less than 4.6 +/- 2.0 mm relative to the proximal CS, RAA, and azygos vein was found. CONCLUSION Respiration is the major source of relative motion, which increases with distance from the heart. For LA procedures, a proximal CS reference position is superior to a static reference position.
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Affiliation(s)
- Hanno U Klemm
- Department of Cardiology, University Heart Center, Hamburg-Eppendorf, Germany.
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16
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DeMarco R, Johnsen C, Fukuda D, Deffenbaugh O. Content validity of a Scale to measure silencing and affectivity among women living with HIV/AIDS. J Assoc Nurses AIDS Care 2001; 12:77-88. [PMID: 11486723 DOI: 10.1016/s1055-3290(06)60219-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 11/26/2022]
Abstract
This study measured quantitatively and explored qualitatively silencing behaviors and affectivity (mood) in women living with HIV/AIDS and confirmed the validity of the Silencing the Self Scale and the Positive and Negative Affect Scale. Silencing behaviors are interpersonal communication styles that suppress personal needs and feelings to preserve relationships with others. Silencing behaviors serve as protective strategies that allow one to divorce oneself from an overbearing culture. Affectivity is a way of measuring one's personal mood state by a positive to negative continuum. The results indicate that the women silenced themselves profoundly, especially when it came to putting the needs of their children or dependents before their own. The women also had high levels of negative affectivity. The research findings from this study extend nursing knowledge by addressing the unique social processes of women living with HIV/AIDS within health care service structures and significant social groups. Further exploration of "silencing" as a phenomenon of this group through measurement and experience will help define specific interventions that are meaningful to and for women living with HIV/AIDS.
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17
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Johnsen C, East JM, Glassman P. Management of malnutrition in the elderly and the appropriate use of commercially manufactured oral nutritional supplements. J Nutr Health Aging 2000; 4:42-6. [PMID: 10840476] [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: 02/16/2023]
Abstract
The risk of protein calorie malnutrition among the community dwelling elderly is high. If undetected or untreated malnutrition can raise risks of morbidity and mortality. Therefore, improving screening, assessment and treatment of malnutrition, particularly in ambulatory settings that serve the elderly is imperative. The aim of this paper is to briefly detail the diagnostic criteria for protein calorie malnutrition and discuss the special considerations necessary in evaluating risk and causes of malnutrition in the elderly. We conclude with a review of current management options and discuss the cost effectiveness and potential inappropriate use of commercially manufactured oral nutritional supplements.
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Affiliation(s)
- C Johnsen
- Ambulatory Care Dietitian, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
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18
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Johnsen C. Hepatitis C: the shadow epidemic. Nurs Spectr (Wash D C) 1999; 9:12-4. [PMID: 10562215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- C Johnsen
- New England Medical Center, Division of Infectious Diseases and Geographic Medicine, Boston, MA, USA
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19
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Coutant R, Landais P, Rosilio M, Johnsen C, Lahlou N, Chatelain P, Carel JC, Ludvigsson J, Boitard C, Bougnères PF. Low dose linomide in Type I juvenile diabetes of recent onset: a randomised placebo-controlled double blind trial. Diabetologia 1998; 41:1040-6. [PMID: 9754822 DOI: 10.1007/s001250051028] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The quinoline-3-carboxamide, linomide, protects non-obese diabetic mice from diabetes. The effects of linomide on insulin needs and beta cell function were studied in recent juvenile Type I diabetes in a double-blind trial. Patients with recent onset diabetes were randomly assigned to treatment with a fixed dose of 2.5 mg linomide (42 patients) or placebo (21 patients) for 1 year, in addition to insulin and diet. Glycated haemoglobin was 10-15% lower at 9 months (p = 0.003) and 12 months (p < 0.05) in the linomide group. The insulin dose was 32-40% smaller in the linomide group at 3 (p < 0.03), 6 (p < 0.02), 9 (p < 0.001) and 12 months (p = 0.01). Insulin doses correlated negatively with C peptide values (p = 0.001-0.002). The trend for higher C peptide values in the linomide group did not reach significance. In a post hoc subgroup analysis performed in 40 patients (25 from the linomide group and 15 from the placebo group) who still had detectable residual beta cell function at entry, linomide was associated with 45-59% higher C peptide value at 6 months (p < 0.05), 9 months (p < 0.05) and 12 months (p < 0.05). The main adverse effects of linomide were mild transitory anaemia (45 vs 10% in the linomide and placebo groups), thrombocytopenia (24 vs 10%), and mild joint discomfort (45 vs 5%) with no clinical signs. In conclusion, low-dose linomide reduced the insulin needs in patients with juvenile Type I diabetes of recent onset and improved beta cell function in patients who still had detectable beta cell function at entry. These results support further clinical and experimental studies to define the effects of linomide in Type I diabetes provided the safety of linomide is reliably established.
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Affiliation(s)
- R Coutant
- Department of Paediatric Endocrinology, Saint-Vincent-de-Paul Hospital, Paris, France
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20
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Affiliation(s)
- W Barfield
- Joint Program in Neonatology, Harvard Medical School, Boston, MA, USA.
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21
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Richie BE, Johnsen C. Abuse histories among newly incarcerated women in a New York City jail. J Am Med Womens Assoc (1972) 1996; 51:111-4, 117. [PMID: 8683020] [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] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article reports the findings from a study of women detained in the women's jail at Rikers Island Correctional Facility in New York City. Interviews were used to gather data on five variables: women's childhood physical and sexual abuse, victimization as adults, drug use, homelessness, and suicide. These findings were analyzed along with biological data on STDs. The conclusions suggest that an association exists between childhood physical and sexual abuse and drug use, suicide attempts, and homelessness in adulthood. The findings indicate that these experiences are common for the population under study, and that a positive association between the variables exists in a sample of incarcerated women. Implications and questions for further research are discussed.
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Abstract
OBJECTIVES To better identify inmates with tuberculosis infection at admission and to have more accurate estimates of conversion rates with annual retesting, I evaluated two-step tuberculin skin testing of newly admitted inmates at the Addiction Center of the Massachusetts Department of Corrections. METHOD In a population of inmates admitted to the Addiction Center between January and May 1994, a second tuberculin skin test was performed 1 week after the first for those who initially had a negative response. RESULTS There were 628 admissions during the study period; 51 of these inmates (8%) had a history of positive skin test results. Of the 570 initial tuberculin skin tests that were read, 12 (2.1%) had positive results. Five of 510 second tuberculin skin tests (1%) had positive results. CONCLUSION I evaluated the feasibility and utility of two-step tuberculin skin testing among newly admitted inmates at a Massachusetts correctional facility. We identified 40% more inmates with positive tuberculin skin test results after conducting 510 additional skin tests. Unlike the Addiction Center inmates, newly admitted inmates at other reception facilities are subject to interfacility transfer, and the rate of reading initial tuberculin skin tests is significantly lower than the 99% obtained at the Addiction Center. I expect serial testing to increase the identification of tuberculosis infected inmates at all facilities; however, its implementation should be deferred until a higher reading rate is obtained for the initial skin test.
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Affiliation(s)
- C Johnsen
- EMSA Correctional Care, Fort Lauderdale, Florida, USA
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23
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Castiglione-Gertsch M, Johnsen C, Goldhirsch A, Gelber RD, Rudenstam CM, Collins J, Lindtner J, Hacking A, Cortes-Funes H, Forbes J. The International (Ludwig) Breast Cancer Study Group Trials I-IV: 15 years follow-up. Ann Oncol 1994; 5:717-24. [PMID: 7826904 DOI: 10.1093/oxfordjournals.annonc.a058976] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.8] [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: 01/27/2023] Open
Abstract
BACKGROUND Adjuvant systemic therapy prolongs disease-free and overall survival in both pre- and postmenopausal patients. Available data shown benefit from multi-agent chemotherapy, prolonged tamoxifen treatment, and ovarian ablation, and that the combination of chemo- and endocrine therapy might be advantageous. In 1978 the International (Ludwig) Breast Cancer Study Group (IBCSG) initiated four complementary randomized controlled clinical trials to evaluate the roles of chemo-endocrine combinations or endocrine therapy alone in specific populations defined by risk (for pre- and perimenopausal patients) or by age (for postmenopausal patients). The results at 10 and 13 years' median follow-up for these trials are summarized in this report and are compared to those of the Overview meta-analysis with regard to chemo-endocrine or endocrine therapy combinations. Furthermore, types of first relapses by sites and second malignant diseases are reported. PATIENTS AND METHODS 1601 evaluable patients with node positive disease were included into the studies I-IV. In Trial I (491 premenopausal patients with 1-3 positive axillary nodes) we studied the addition of low-dose continuous prednisone (p) to a cyclophosphamide-methotrexate-fluorouracil (CMF) combination. In Trial II 327 premenopausal patients with four or more positive axillary nodes were randomized to one year CMFp or to a surgical oophorectomy followed by CMFp. In Trial III (463 postmenopausal patients 65 years old or younger), combined chemoendocrine therapy (one year of CMFp plus tamoxifen (T)) was compared to endocrine therapy (1 year of p + T) or to surgery alone. In Trial IV 320 postmenopausal patients 66 to 80 years old were treated either by surgery alone or by surgery followed by 1 year prednisone and tamoxifen. RESULTS In Trial I the addition of prednisone allowed a higher dose of cytotoxics to be administered compared with CMF alone. Despite this increased dose intensity, 13-year disease-free survival (DFS) and overall survival (OS) were similar for the two treatment groups (49% vs. 52% DFS, 59% vs. 65% OS for CMFp vs. CMF). In Trial II the addition of surgical oophorectomy to CMFp yielded an improved outcome which approached statistical significance for the subset of 107 patients known to have estrogen receptor-positive tumors (DFS, 23% vs. 15%, p = 0.13; OS, 41% vs. 30%, p = 0.12). In Trial III combined chemoendocrine therapy improved DFS and OS compared with endocrine therapy alone (p + T) given for the same duration, or no adjuvant treatment (DFS, 35% vs. 25% vs. 14%, p < 0.0001; OS, 48% vs. 36% vs. 32%, p = 0.01). In Trial IV p + T improved DFS compared with no adjuvant therapy (27% vs. 15%, p = 0.004). Despite competing risks for this elderly population, OS was also improved but the result was not statistically significant (34% vs. 22%, p = 0.08). CONCLUSIONS The overall results of these four trials indicate that the continuation of investigations on combined chemo-endocrine therapies is warranted. The prognosis of the patients, all node-positive, treated with the most effective adjuvant treatment is such that there is a large potential for improvement.
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24
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Johnsen C. Evaluation of a hepatitis B vaccine program in correctional personnel in Massachusetts. Am J Infect Control 1994. [DOI: 10.1016/0196-6553(94)90153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Abstract
BACKGROUND An increasing incidence of tuberculosis has been observed in the New York City correctional system. METHODS The diagnosis of active tuberculosis in persons within the correctional setting results in an investigation, with the identification and screening of contacts. RESULTS Thirty-four such investigations in the past 2 years in the New York City correctional system, where all inmates are screened for tuberculosis on admission, have resulted in an overall tuberculin skin test conversion rate of 6.74% in 1306 inmates. In 21 of these investigations the index had both smears and cultures positive for Mycobacterium tuberculosis and the conversion rate was 7.37% in 719 contacts tested. In seven investigations the index patient had a culture only positive for M. tuberculosis and the conversion rate was 6.58% in 243 inmates. In six investigations in which the index patients were subsequently found to have nontuberculous pneumonia or mycobacteria other than M. tuberculosis the conversion rate was 5.52% in 344 inmates. These rates are not statistically different. CONCLUSIONS Whether the observed conversions in these events or in any of the contact investigations are due to intramural spread, anergy on admission, the booster phenomenon, or incubation of disease on admission is not known. The 5.5% conversion rate in those exposed to inmates confirmed not to have tuberculosis suggests the influence of booster phenomenon and consideration of two-step testing on admission.
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Affiliation(s)
- C Johnsen
- Montefiore Rikers Island Health Services, New York, NY 11370
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26
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Affiliation(s)
- C Johnsen
- Infection Control Services, Montefiore Rikers Island Health Services, East Elmhurst, NY 11370
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27
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Abstract
Smallpox was officially declared eradicated from the world in 1980. Earlier, in 1972, over 50 nations signed the Biological Weapons Convention renouncing this entire category of weapons. Despite this international agreement, both the United States and the Soviet Union continue to vaccinate their military troops against smallpox, thus implying that each fears the other might still use it in biological warfare. Vaccination is not a harmless procedure, and vaccinia infections continue to be reported in troops and their contacts. Negotiating an end to the vaccination of troops would be a final step in ending the fear of smallpox.
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