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Boeckhaus J, Mohr L, Dihazi H, Tönshoff B, Weber LT, Pape L, Latta K, Fehrenbach H, Lange-Sperandio B, Kettwig M, Staude H, König S, John-Kroegel U, Gellermann J, Hoppe B, Galiano M, Haffner D, Rhode H, Gross O. Ratio of Urinary Proteins to Albumin Excretion Shifts Substantially during Progression of the Podocytopathy Alport Syndrome, and Spot Urine Is a Reliable Method to Detect These Pathologic Changes. Cells 2023; 12:cells12091333. [PMID: 37174733 PMCID: PMC10177071 DOI: 10.3390/cells12091333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/12/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
The urinary albumin- and protein-to-creatinine ratios (UACR and UPCR, respectively) are key endpoints in most clinical trials assessing risk of progression of chronic kidney disease (CKD). For the first time, the current study compares the UACR versus the UPCR head-to-head at early stages of CKD, taking use of the hereditary podocytopathy Alport syndrome (AS) as a model disease for any CKD. Urine samples originated from the prospective randomized, controlled EARLY PRO-TECT Alport trial (NCT01485978). Urine samples from 47 children with confirmed diagnoses of AS at very early stages of CKD were divided according to the current stage of AS: stage 0 (UACR < 30 mg/g), stage 1 (30-300 mg/g) or stage 2 (>300 mg/g). The range of estimated glomerular filtration rate was 75-187.6 mL/min. The mean age was 10.4 ± 4.5 years. In children at stage 0, proteinuria in spot urine, confirmed in 24 h urine, was almost ten times higher than albuminuria (106.4 ± 42.2 vs. 12.5 ± 9.7; p < 0.05); it was "only" about three times higher in stage 1 (328.5 ± 210.1 vs. 132.3 ± 80.5; p < 0.05) and almost equal in stage 2 (1481.9 ± 983.4 vs. 1109.7 ± 873.6; p = 0.36). In 17 children, UACRs and UPCRs were measured simultaneously in 24 h urine and spot urine in the same study visit. Interestingly, the UACR (and UPCR) in 24 h urine vs. in spot urine varied by less than 10% (266.8 ± 426.4 vs. 291.2 ± 530.2). In conclusion, our study provides the first evidence that in patients with normal glomerular filtration rate (GFR) and low amounts of albuminuria, especially in children with podocytopathies such as AS, measuring the UACR and UPCR in spot urine is a reliable and convenient alternative to 24 h urine collection. Our study advocates both the UACR and the UPCR as relevant diagnostic biomarkers in future clinical trials in children with glomerular diseases because the UPCR seems to be a very significant parameter at very early stages of podocytopathies. The German Federal Ministry of Education and Research funded this trial (01KG1104).
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Affiliation(s)
- Jan Boeckhaus
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Lea Mohr
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Hassan Dihazi
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany
- Department of Pediatrics II, University Childrens' Hospital, University of Duisburg-Essen, 45147 Essen, Germany
| | - Kay Latta
- Clementine Kinderhospital Frankfurt, 60316 Frankfurt, Germany
| | - Henry Fehrenbach
- Pediatric Nephrology, Children's Hospital, 87700 Memmingen, Germany
| | | | - Matthias Kettwig
- Clinic of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Hagen Staude
- Pediatric Nephrology, University Children's Hospital Rostock, 18057 Rostock, Germany
| | - Sabine König
- University Children's Hospital Münster, 48149 Münster, Germany
| | - Ulrike John-Kroegel
- Division of Pediatric Nephrology, University Children's Hospital, 07743 Jena, Germany
| | - Jutta Gellermann
- Pediatric Nephrology, Charité Children's Hospital, 10117 Berlin, Germany
| | - Bernd Hoppe
- Division of Pediatric Nephrology, Department of Pediatrics, University of Bonn, 53121 Bonn, Germany
| | - Matthias Galiano
- Department of Pediatrics and Adolescent Medicine, University Hospital, Friedrich-Alexander-University Erlangen, 91054 Erlangen, Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany
| | - Heidrun Rhode
- Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Oliver Gross
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
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Feldkötter M, Thys S, Adams A, Becker I, Büscher R, Pohl M, Schild R, Pape L, Schmitt CP, Taylan C, Wygoda S, Klaus G, Fehrenbach H, Montoya C, Konrad M, Billing H, Schaar B, Hoppe B. Correction to: Endurance-oriented training program with children and adolescents on maintenance hemodialysis to enhance dialysis efficacy-DiaSport. Pediatr Nephrol 2021; 36:4013-4014. [PMID: 34505193 PMCID: PMC9172685 DOI: 10.1007/s00467-021-05206-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/20/2022]
Affiliation(s)
- Markus Feldkötter
- grid.412341.10000 0001 0726 4330Pediatric Nephrology Unit, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Sarah Thys
- grid.7752.70000 0000 8801 1556Institute of Sport Science, Bundeswehr University Munich, Munich, Germany
| | - Anne Adams
- grid.411097.a0000 0000 8852 305XInstitute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany
| | - Ingrid Becker
- grid.411097.a0000 0000 8852 305XInstitute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany
| | - Rainer Büscher
- grid.5718.b0000 0001 2187 5445Pediatric Nephrology, Pediatrics II, University of Duisburg-Essen, Essen, Germany
| | - Martin Pohl
- grid.5963.9Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Raphael Schild
- grid.13648.380000 0001 2180 3484Pediatric Nephrology, University Children’s Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Pape
- grid.10423.340000 0000 9529 9877Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Claus Peter Schmitt
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Christina Taylan
- grid.6190.e0000 0000 8580 3777Pediatric Nephrology, Children’s and Adolescents’ Hospital, University of Cologne, Cologne, Germany
| | - Simone Wygoda
- grid.459389.a0000 0004 0493 1099KfH Center of Pediatric Nephrology, St Georg Hospital, Leipzig, Germany
| | - Günter Klaus
- KfH Center of Pediatric Nephrology, Department of Pediatric Nephrology, Marburg, Germany
| | - Henry Fehrenbach
- grid.488549.cPediatric Nephrology, Children’s Hospital, Memmingen, Germany
| | - Carmen Montoya
- KfH Center of Pediatric Nephrology, Children’s Hospital Munich, Schwabing, Munich, Germany
| | - Martin Konrad
- grid.16149.3b0000 0004 0551 4246Department of General Pediatrics, University Children’s Hospital, Münster, Germany
| | - Heiko Billing
- grid.488549.cUniversity Children’s Hospital, Tübingen, Germany
| | - Bettina Schaar
- grid.7752.70000 0000 8801 1556Institute of Sport Science, Bundeswehr University Munich, Munich, Germany
| | - Bernd Hoppe
- Children's Hospital, University of Bonn, Bonn, Germany. .,Kindernierenzentrum Bonn, Bonn, Germany.
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Feldkötter M, Thys S, Adams A, Becker I, Büscher R, Pohl M, Schild R, Pape L, Schmitt CP, Taylan C, Wygoda S, Klaus G, Fehrenbach H, Montoya C, Konrad M, Billing H, Schaar B, Hoppe B. Endurance-oriented training program with children and adolescents on maintenance hemodialysis to enhance dialysis efficacy-DiaSport. Pediatr Nephrol 2021; 36:3923-3932. [PMID: 34117528 PMCID: PMC8599370 DOI: 10.1007/s00467-021-05114-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/07/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pediatric patients spend significant time on maintenance hemodialysis (HD) and traveling. They are often not capable of participating in sports activities. To assess the effects of exercise training during HD on dialysis efficacy in children and adolescents, we set up a multi-center randomized controlled trial (RCT). METHODS Patients on HD, age 6 to 18 years, were randomized either to 3× weekly bicycle ergometer training or to no training during HD for 12 weeks. Change in single-pool Kt/V (spKt/V) was the primary outcome parameter. RESULTS We randomized 54 patients of whom 45 qualified (23 in the intervention and 22 in the waiting control group, 14.5 ± 3.01 years, 32 male and 13 female) for the intention-to-treat (ITT) population. Only 26 patients finished study per-protocol (PP). Training was performed for an average of 11.96 weeks (0.14-13.14) at 2.08 ± 0.76 times per week and for a weekly mean of 55.52 ± 27.26 min. Single-pool Kt/V was similar in the intervention compared to the control group (1.70 [0.33] vs. 1.79 [0.55]) at V0 and (1.70 [0.36] vs. 1.71 [0.51]) at V1; secondary endpoints also showed no difference in both ITT and PP analysis. No significant adverse events were reported. No bleeding or needle dislocation occurred in 1670 training sessions. CONCLUSIONS Intradialytic bicycle training is safe, but does not improve dialysis efficacy and physical fitness. However, the study can be considered underpowered, particularly because of high dropout rates. Future studies need better strategies to increase motivation and compliance and other more effective/intensive exercise measures should be evaluated. TRIAL REGISTRATION The trial was registered in ClinicalTrials.Gov ( Clinicaltrials.gov identifier: NCT01561118) on March 22, 2012.
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Affiliation(s)
- Markus Feldkötter
- Pediatric Nephrology Unit, University Children's Hospital Zurich, Zurich, Switzerland
| | - Sarah Thys
- Institute of Sport Science, Bundeswehr University Munich, Munich, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, Cologne, Germany
| | - Rainer Büscher
- Pediatric Nephrology, Pediatrics II, University of Duisburg-Essen, Essen, Germany
| | - Martin Pohl
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Raphael Schild
- Pediatric Nephrology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Claus Peter Schmitt
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany
| | - Christina Taylan
- Pediatric Nephrology, Children's and Adolescents' Hospital, University of Cologne, Cologne, Germany
| | - Simone Wygoda
- KfH Center of Pediatric Nephrology, St Georg Hospital, Leipzig, Germany
| | - Günter Klaus
- KfH Center of Pediatric Nephrology, Department of Pediatric Nephrology, Marburg, Germany
| | | | - Carmen Montoya
- KfH Center of Pediatric Nephrology, Children's Hospital Munich Schwabing, Munich, Germany
| | - Martin Konrad
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | | | - Bettina Schaar
- Institute of Sport Science, Bundeswehr University Munich, Munich, Germany
| | - Bernd Hoppe
- Children's Hospital, University of Bonn, Bonn, Germany.
- Kindernierenzentrum Bonn, Bonn, Germany.
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Boeckhaus J, Hoefele J, Riedhammer KM, Tönshoff B, Ehren R, Pape L, Latta K, Fehrenbach H, Lange-Sperandio B, Kettwig M, Hoyer P, Staude H, Konrad M, John U, Gellermann J, Hoppe B, Galiano M, Gessner M, Pohl M, Bergmann C, Friede T, Gross O. Precise variant interpretation, phenotype ascertainment, and genotype-phenotype correlation of children in the EARLY PRO-TECT Alport trial. Clin Genet 2020; 99:143-156. [PMID: 33040356 DOI: 10.1111/cge.13861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/04/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
Early initiation of therapy in patients with Alport syndrome (AS) slows down renal failure by many years. Genotype-phenotype correlations propose that the location and character of the individual's variant correlate with the renal outcome and any extra renal manifestations. In-depth clinical and genetic data of 60/62 children who participated in the EARLY PRO-TECT Alport trial were analyzed. Genetic variants were interpreted according to current guidelines and criteria. Genetically solved patients with X-linked inheritance were then classified according to the severity of their COL4A5 variant into less-severe, intermediate, and severe groups and disease progress was compared. Almost 90% of patients were found to carry (likely) pathogenic variants and classified as genetically solved cases. Patients in the less-severe group demonstrated a borderline significant difference in disease progress compared to those in the severe group (p = 0.05). While having only limited power according to its sample size, an obvious strength is the precise clinical and genetic data of this well ascertained cohort. As in published data differences in clinical progress were shown between patients with COL4A5 less-severe and severe variants. Therefore, clinical and segregational data are important for variant (re)classification. Genetic testing should be mandatory allowing early diagnosis and therapy of AS.
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Affiliation(s)
- Jan Boeckhaus
- Clinic for Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Julia Hoefele
- Institute of Human Genetics, Klinikumrechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Korbinian M Riedhammer
- Institute of Human Genetics, Klinikumrechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.,Department of Nephrology, Klinikumrechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Rasmus Ehren
- Pediatric Nephrology, Children's and Adolescents' Hospital, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Kay Latta
- Clementine Kinderhospital Frankfurt, Frankfurt, Germany
| | | | | | - Matthias Kettwig
- Clinic of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Hoyer
- Pediatric Nephrology, Pediatrics II, University of Duisburg-Essen, Essen, Germany
| | - Hagen Staude
- Pediatric Nephrology, University Children's Hospital Rostock, Rostock, Germany
| | - Martin Konrad
- University Children's Hospital Münster, Münster, Germany
| | - Ulrike John
- Division of Pediatric Nephrology, University Children's Hospital, Jena, Germany
| | - Jutta Gellermann
- Pediatric Nephrology, Charité Children's Hospital, Berlin, Germany
| | - Bernd Hoppe
- Division of Pediatric Nephrology, Department of Pediatrics, University of Bonn, Bonn, Germany
| | - Matthias Galiano
- Department of Pediatrics and Adolescent Medicine, University Hospital, Friedrich-Alexander-University Erlangen, Erlangen, Germany
| | - Michaela Gessner
- Pediatric Nephrology, Children's and Adolescents' Hospital, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Department of General Pediatrics, University of Tuebingen, Tuebingen, Germany
| | - Michael Pohl
- Division of Pediatric Nephrology, University Children's Hospital, Jena, Germany.,Klinik für Kinder- und Jugendmedizin, Klinikum St. Georg, Leipzig, Germany
| | - Carsten Bergmann
- Medizinische Genetik Mainz, Limbach Genetics, Mainz, Germany.,Department of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Oliver Gross
- Clinic for Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
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von Schnakenburg C, Feneberg R, Plank C, Zimmering M, Arbeiter K, Bald M, Fehrenbach H, Griebel M, Licht C, Konrad M, Timmermann K, Kemper MJ. Percutaneous Endoscopic Gastrostomy in Children on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080602600111] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [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
ObjectiveInsertion of percutaneous endoscopic gastrostomies (PEG) in patients on chronic peritoneal dialysis (PD) has been reported to be contraindicated due to an increased risk of morbidity and mortality. However, no systematic survey on this topic has yet been published.DesignRetrospective multicenter study.Setting23 pediatric dialysis units associated with the working group Arbeitsgemeinschaft für Pädiatrische Nephrologie (APN).Data SourceA structured questionnaire on clinical details of PD patients who had undergone PEG insertion or open gastrostomy (OG) since 1994 was distributed to all pediatric dialysis units of the APN.Results27 PD patients (20 males) from 12 centers in whom PEG insertion was performed after Tenckhoff catheter introduction were evaluated. Age at intervention ranged from 0.25 to 10.9 years (median 1.3 years). Most patients were malnourished, with standard deviation score (SDS) for body weight between –4.2 and –0.6 (median -2.2). Major complications were early peritonitis <7 days after PEG in 10/27 (37%) patients, episodes of fungal peritonitis in 7/27 (26%) patients, 4 cessations of PD and change to hemodialysis, and 2 associated deaths. However, in 14 patients, no such problems were encountered and, in 4 patients, early peritonitis effectively treated with intraperitoneal antibiotics was the only major complication. Thus, in 18/27 (67%) patients, PD was successfully reinitiated shortly after PEG insertion. Among all participating centers, only two OG procedures were reported during the study period, illustrating a clear preference for the PEG over the OG procedure among members of the APN.ConclusionPEG insertion following PD initiation carries a high risk for fungal peritonitis and potential PD failure; however, complication rates in this largest reported series were lower than previously described. Antibiotic and anti-fungal prophylaxis, withholding PD for 2 – 3 days, and gastrostomy placement by an experienced endoscopy team are suggested precautions for lowering the risk of associated complications. When gastrostomy placement does not occur prior to or at the time of initiating PD, the risks and benefits of percutaneous versus open placement must be carefully weighed.
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Affiliation(s)
- Christian von Schnakenburg
- Department for Pediatrics and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany
- Arbeitsgemeinschaft für Pädiatrische Nephrologie, (APN)
| | | | | | | | | | - Martin Bald
- Arbeitsgemeinschaft für Pädiatrische Nephrologie, (APN)
| | | | | | | | - Martin Konrad
- Arbeitsgemeinschaft für Pädiatrische Nephrologie, (APN)
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Webering S, Lindner K, König P, Fehrenbach H. Low level Carbon Black nanoparticle (CBNP) exposure of the lung does not aggravate experimental asthma in mice. Pneumologie 2018. [DOI: 10.1055/s-0038-1660918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Webering
- Research Center Borstel, Priority Area Asthma & Allergy, Division of Experimental Pneumology, Borstel
- Airway Research Center North (ARCN), German Center for Lung Research (DZL)
| | - K Lindner
- Institute of Anatomy, University of Lübeck (UzL), Lübeck
- Airway Research Center North (ARCN), German Center for Lung Research (DZL)
| | - P König
- Institute of Anatomy, University of Lübeck (UzL), Lübeck
- Airway Research Center North (ARCN), German Center for Lung Research (DZL)
| | - H Fehrenbach
- Research Center Borstel, Priority Area Asthma & Allergy, Division of Experimental Pneumology, Borstel
- Airway Research Center North (ARCN), German Center for Lung Research (DZL)
- Leibniz Research Association Nanosafety, Leibniz Association, Berlin, Germany
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Ehlers JC, Bartel S, Vock C, Fehrenbach H. An in vitro model of human bronchial epithelial cells for the investigation of the role of the airway epithelium in asthma exacerbations. Pneumologie 2018. [DOI: 10.1055/s-0037-1619393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- JC Ehlers
- Division of Experimental Pneumology, Research Center Borstel, Airway Research Center North, Member of the German Center for Lung Research and Member of the Leibniz Research Association Health Technologies
| | - S Bartel
- Division of Early Life Origins of Cld, Research Center Borstel, Airway Research Center North, Member of the German Center for Lung Research and Member of the Leibniz Research Association Health Technologies
| | - C Vock
- Division of Experimental Pneumology, Research Center Borstel, Airway Research Center North, Member of the German Center for Lung Research and Member of the Leibniz Research Association Health Technologies
| | - H Fehrenbach
- Division of Experimental Pneumology, Research Center Borstel, Airway Research Center North, Member of the German Center for Lung Research and Member of the Leibniz Research Association Health Technologies
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Tabeling C, Herbert J, Boiarina E, Hocke AC, Sewald K, Lamb DJ, Wollin SL, Fehrenbach H, Kübler WM, Braun A, Suttorp N, Weissmann N, Witzenrath M. Die Milztyrosinkinase SYK reguliert die pulmonale Vasokonstriktion. Pneumologie 2018. [DOI: 10.1055/s-0037-1619299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C Tabeling
- Med. Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin
| | - J Herbert
- Med. Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin
| | - E Boiarina
- Med. Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin
| | - AC Hocke
- Med. Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin
| | - K Sewald
- Fraunhofer-Institut für Toxikologie und Experimentelle Medizin, Hannover
| | - DJ Lamb
- Department Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach
| | - SL Wollin
- Department Respiratory Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach
| | - H Fehrenbach
- Experimentelle Pneumologie, Programmbereich Asthma und Allergie, Forschungszentrum Borstel
| | - WM Kübler
- Institut für Physiologie, Charité Universitätsmedizin Berlin
| | - A Braun
- Fraunhofer-Institut für Toxikologie und Experimentelle Medizin, Hannover
| | - N Suttorp
- Med. Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin
| | - N Weissmann
- Excellence Cluster Cardio-Pulmonary System, Justus-Liebig-Universität Gießen
| | - M Witzenrath
- Med. Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin
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Hennies I, Gimpel C, Gellermann J, Möller K, Mayer B, Dittrich K, Büscher AK, Hansen M, Aulbert W, Wühl E, Nissel R, Schalk G, Weber LT, Pohl M, Wygoda S, Beetz R, Klaus G, Fehrenbach H, König S, Staude H, Beringer O, Bald M, Walden U, von Schnakenburg C, Bertram G, Wallot M, Häffner K, Wiech T, Hoyer PF, Pohl M. Presentation of pediatric Henoch-Schönlein purpura nephritis changes with age and renal histology depends on biopsy timing. Pediatr Nephrol 2018; 33:277-286. [PMID: 28983704 DOI: 10.1007/s00467-017-3794-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 08/02/2017] [Accepted: 08/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study correlates the clinical presentation of Henoch-Schönlein purpura nephritis (HSPN) with findings on initial renal biopsy. METHODS Data from 202 pediatric patients enrolled in the HSPN registry of the German Society of Pediatric Nephrology reported by 26 centers between 2008 and 2014 were analyzed. All biopsy reports were re-evaluated for the presence of cellular crescents or chronic pathological lesions (fibrous crescents, glomerular sclerosis, tubular atrophy >5%, and interstitial fibrosis >5%). RESULTS Patients with HSPN with cellular glomerular crescents were biopsied earlier after onset of nephritis (median 24 vs 36 days, p = 0.04) than those without, whereas patients with chronic lesions were biopsied later (57 vs 19 days, p < 0.001) and were older (10.3 vs 8.6 years, p = 0.01) than those without. Patients biopsied more than 30 days after the onset of HSPN had significantly more chronic lesions (52 vs 22%, p < 0.001), lower eGFR (88 vs 102 ml/min/1.73m2, p = 0.01), but lower proteinuria (2.3 vs 4.5 g/g, p < 0.0001) than patients biopsied earlier. Children above 10 years of age had lower proteinuria (1.98 vs 4.58 g/g, p < 0.001), lower eGFR (86 vs 101 ml/min/1.73m2, p = 0.002) and were biopsied significantly later after onset of nephritis (44 vs 22 days, p < 0.001) showing more chronic lesions (45 vs 30%, p = 0.03). Proteinuria and renal function at presentation decreased with age. CONCLUSIONS In summary, we find an age-dependent presentation of HSPN with a more insidious onset of non-nephrotic proteinuria, impaired renal function, longer delay to biopsy, and more chronic histopathological lesions in children above the age of 10 years. Thus, HSPN presents more like Immunoglobulin A (IgA) nephritis in older than in younger children.
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Affiliation(s)
- Imke Hennies
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany
| | - Charlotte Gimpel
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Jutta Gellermann
- Department of Pediatric Nephrology, Charité University Hospital, Berlin, Germany
| | - Kristina Möller
- Department of Pediatrics, Klinikum Links der Weser, Bremen, Germany
| | - Brigitte Mayer
- Children's Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Anja K Büscher
- Department of Pediatrics II, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Matthias Hansen
- KfH Center of Pediatric Nephrology, Clementine Children's Hospital, Frankfurt, Germany
| | - Wiebke Aulbert
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Richard Nissel
- Children's Hospital, Städtisches Klinikum, Karlsruhe, Germany
| | - Gessa Schalk
- Pediatric Nephrology Unit, University Children's Hospital, Zurich, Switzerland
| | - Lutz T Weber
- Department of Pediatrics, University Hospital of Cologne, Cologne, Germany
| | | | - Simone Wygoda
- KfH Center of Pediatric Nephrology, St Georg Hospital, Leipzig, Germany
| | - Rolf Beetz
- Department of Pediatrics, Division of Pediatric Nephrology, Mainz University Medical Center, Mainz, Germany
| | - Günter Klaus
- KfH Center of Pediatric Nephrology, University Hospital Marburg, Marburg, Germany
| | - Henry Fehrenbach
- KfH Center of Pediatric Nephrology, Children's Hospital Memmingen, Memmingen, Germany
| | - Sabine König
- University Children's Hospital Münster, Münster, Germany
| | - Hagen Staude
- University Children's Hospital, Rostock, Germany
| | | | - Martin Bald
- Children's Hospital, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Ulrike Walden
- Department of Pediatrics II, Children's Hospital Augsburg, Augsburg, Germany
| | | | - Gunhard Bertram
- Krankenhaus St Elisabeth und St Barbara, Klinik für Kinder- und Jugendmedizin, Halle (Saale), Germany
| | - Michael Wallot
- Department of Pediatrics, Bethanien Hospital, Moers, Germany
| | - Karsten Häffner
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Thorsten Wiech
- Nephropathology Section, Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter F Hoyer
- Department of Pediatrics II, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Pohl
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany.
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10
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Warejko JK, Tan W, Daga A, Schapiro D, Lawson JA, Shril S, Lovric S, Ashraf S, Rao J, Hermle T, Jobst-Schwan T, Widmeier E, Majmundar AJ, Schneider R, Gee HY, Schmidt JM, Vivante A, van der Ven AT, Ityel H, Chen J, Sadowski CE, Kohl S, Pabst WL, Nakayama M, Somers MJG, Rodig NM, Daouk G, Baum M, Stein DR, Ferguson MA, Traum AZ, Soliman NA, Kari JA, El Desoky S, Fathy H, Zenker M, Bakkaloglu SA, Müller D, Noyan A, Ozaltin F, Cadnapaphornchai MA, Hashmi S, Hopcian J, Kopp JB, Benador N, Bockenhauer D, Bogdanovic R, Stajić N, Chernin G, Ettenger R, Fehrenbach H, Kemper M, Munarriz RL, Podracka L, Büscher R, Serdaroglu E, Tasic V, Mane S, Lifton RP, Braun DA, Hildebrandt F. Whole Exome Sequencing of Patients with Steroid-Resistant Nephrotic Syndrome. Clin J Am Soc Nephrol 2018; 13:53-62. [PMID: 29127259 PMCID: PMC5753307 DOI: 10.2215/cjn.04120417] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [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: 04/13/2017] [Accepted: 09/12/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Steroid-resistant nephrotic syndrome overwhelmingly progresses to ESRD. More than 30 monogenic genes have been identified to cause steroid-resistant nephrotic syndrome. We previously detected causative mutations using targeted panel sequencing in 30% of patients with steroid-resistant nephrotic syndrome. Panel sequencing has a number of limitations when compared with whole exome sequencing. We employed whole exome sequencing to detect monogenic causes of steroid-resistant nephrotic syndrome in an international cohort of 300 families. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Three hundred thirty-five individuals with steroid-resistant nephrotic syndrome from 300 families were recruited from April of 1998 to June of 2016. Age of onset was restricted to <25 years of age. Exome data were evaluated for 33 known monogenic steroid-resistant nephrotic syndrome genes. RESULTS In 74 of 300 families (25%), we identified a causative mutation in one of 20 genes known to cause steroid-resistant nephrotic syndrome. In 11 families (3.7%), we detected a mutation in a gene that causes a phenocopy of steroid-resistant nephrotic syndrome. This is consistent with our previously published identification of mutations using a panel approach. We detected a causative mutation in a known steroid-resistant nephrotic syndrome gene in 38% of consanguineous families and in 13% of nonconsanguineous families, and 48% of children with congenital nephrotic syndrome. A total of 68 different mutations were detected in 20 of 33 steroid-resistant nephrotic syndrome genes. Fifteen of these mutations were novel. NPHS1, PLCE1, NPHS2, and SMARCAL1 were the most common genes in which we detected a mutation. In another 28% of families, we detected mutations in one or more candidate genes for steroid-resistant nephrotic syndrome. CONCLUSIONS Whole exome sequencing is a sensitive approach toward diagnosis of monogenic causes of steroid-resistant nephrotic syndrome. A molecular genetic diagnosis of steroid-resistant nephrotic syndrome may have important consequences for the management of treatment and kidney transplantation in steroid-resistant nephrotic syndrome.
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Affiliation(s)
- Jillian K Warejko
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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11
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Prüfe J, Dierks ML, Bethe D, Oldhafer M, Müther S, Thumfart J, Feldkötter M, Büscher A, Sauerstein K, Hansen M, Pohl M, Drube J, Thiel F, Rieger S, John U, Taylan C, Dittrich K, Hollenbach S, Klaus G, Fehrenbach H, Kranz B, Montoya C, Lange-Sperandio B, Ruckenbrod B, Billing H, Staude H, Brunkhorst R, Rusai K, Pape L, Kreuzer M. Transition structures and timing of transfer from paediatric to adult-based care after kidney transplantation in Germany: a qualitative study. BMJ Open 2017; 7:e015593. [PMID: 28606904 PMCID: PMC5734418 DOI: 10.1136/bmjopen-2016-015593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents' lives with an increased risk for non-adherence and allograft failure. Still, the transition process of adolescents and young adults living with a kidney transplant in Germany is not well defined. The present research aims to assess transition-relevant structures for this group of young people. Special attention is paid to the timing of the process. SETTING In an observational study, we visited 21 departments of paediatric nephrology in Germany. Participants were doctors (n=19), nurses (n=14) and psychosocial staff (n=16) who were responsible for transition in the relevant centres. Structural elements were surveyed using a short questionnaire. The experiential viewpoint was collected by interviews which were transcribedverbatim before thematic analysis was performed. RESULTS This study highlights that professionals working within paediatric nephrology in Germany are well aware of the importance of successful transition. Key elements of transitional care are well understood and mutually agreed on. Nonetheless, implementation within daily routine seems challenging, and the absence of written, structured procedures may hamper successful transition. CONCLUSIONS While professionals aim for an individual timing of transfer based on medical, social, emotional and structural aspects, rigid regulations on transfer age as given by the relevant health authorities add on to the challenge. TRIAL REGISTRATION NUMBER ISRCTN Registry no 22988897; results (phase I) and pre-results (phase II).
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Affiliation(s)
- Jenny Prüfe
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Marie-Luise Dierks
- Department of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover, Germany
| | - Dirk Bethe
- Division of Paediatric Nephrology, Centre for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Silvia Müther
- Berliner TransitionsProgramm (BTP), DRK-Kliniken (German Red Cross Hospitals) Berlin Westend, Berlin, Germany
| | - Julia Thumfart
- Department of Paediatric Nephrology, Charité, Berlin, Germany
| | | | - Anja Büscher
- Department of Paediatrics II, Essen University Hospital, Essen, Germany
| | | | - Matthias Hansen
- KfH Centre of Paediatric Nephrology, Clementine Children’s Hospital, Frankfurt, Germany
| | - Martin Pohl
- Department of General Paediatrics, Adolescent Medicine and Neonatology, Freiburg University Hospital, Freiburg, Germany
| | - Jens Drube
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Florian Thiel
- University Children’s Hospital Eppendorf, Hamburg, Germany
| | - Susanne Rieger
- Division of Paediatric Nephrology, Centre for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike John
- University Children’s Hospital, Jena, Germany
| | - Christina Taylan
- Department of Paediatric Nephrology, University Hospital of Cologne, Cologne, Germany
| | | | - Sabine Hollenbach
- KfH Centres of Paediatric Nephrology, St. Georg Hospital, Leipzig, Germany
| | - Günter Klaus
- KfH Centres of Paediatric Nephrology, University Hospital of Marburg, Marburg, Germany
| | - Henry Fehrenbach
- KfH Centre of Paediatric Nephrology, Children’s Hospital Memmingen, Memmingen, Germany
| | - Birgitta Kranz
- University Children’s Hospital Münster, Münster, Germany
| | - Carmen Montoya
- KfH Centre of Paediatric Nephrology, University Children’s Hospital, München, Germany
| | | | - Bettina Ruckenbrod
- Children’s Hospital, Olgahospital Klinikum Stuttgart, Stuttgart, Germany
| | - Heiko Billing
- University Children’s Hospital Tübingen, Tübingen, Germany
| | - Hagen Staude
- University Children’s Hospital, Rostock, Germany
| | - Reinhard Brunkhorst
- KfH Centre of Nephrology, Hospitals of the Hannover Region, Hannover, Germany
| | | | - Lars Pape
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Martin Kreuzer
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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Schröder A, Lunding L, Webering S, Vock C, Raedler D, Schaub B, Fehrenbach H, Wegmann M. IL-1R1 but not IL-18BP contributes to the beneficial effects of IL-37 on allergic asthma. Pneumologie 2017. [DOI: 10.1055/s-0037-1598370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Schröder
- Division of Asthma Mouse Models, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North, Member of the German Center for Lung Research
| | - L Lunding
- Division of Asthma Mouse Models, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North, Member of the German Center for Lung Research
| | - S Webering
- Division of Experimental Pneumology, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North, Member of the German Center for Lung Research
| | - C Vock
- Division of Experimental Pneumology, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North, Member of the German Center for Lung Research
| | - D Raedler
- Department of Pulmonary & Allergy, University Children's Hospital Munich, LMU Munich, Comprehensive Pneumology Center-Munich, Member of the German Center for Lung Research
| | - B Schaub
- Department of Pulmonary & Allergy, University Children's Hospital Munich, LMU Munich, Comprehensive Pneumology Center-Munich, Member of the German Center for Lung Research
| | - H Fehrenbach
- Division of Experimental Pneumology, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North, Member of the German Center for Lung Research
| | - M Wegmann
- Division of Asthma Mouse Models, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North, Member of the German Center for Lung Research
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13
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Wehling C, Amon O, Bommer M, Hoppe B, Kentouche K, Schalk G, Weimer R, Wiesener M, Hohenstein B, Tönshoff B, Büscher R, Fehrenbach H, Gök ÖN, Kirschfink M. Monitoring of complement activation biomarkers and eculizumab in complement-mediated renal disorders. Clin Exp Immunol 2016; 187:304-315. [PMID: 27784126 DOI: 10.1111/cei.12890] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 12/18/2022] Open
Abstract
Various complement-mediated renal disorders are treated currently with the complement inhibitor eculizumab. By blocking the cleavage of C5, this monoclonal antibody prevents cell damage caused by complement-mediated inflammation. We included 23 patients with atypical haemolytic uraemic syndrome (aHUS, n = 12), C3 glomerulopathies (C3G, n = 9) and acute antibody-mediated renal graft rejection (AMR, n = 2), treated with eculizumab in 12 hospitals in Germany. We explored the course of complement activation biomarkers and the benefit of therapeutic drug monitoring of eculizumab. Complement activation was assessed by analysing the haemolytic complement function of the classical (CH50) and the alternative pathway (APH50), C3 and the activation products C3d, C5a and sC5b-9 prior to, 3 and 6 months after eculizumab treatment. Eculizumab concentrations were determined by a newly established specific enzyme-linked immunosorbent assay (ELISA). Serum eculizumab concentrations up to 1082 μg/ml point to drug accumulation, especially in paediatric patients. Loss of the therapeutic antibody via urine with concentrations up to 56 μg/ml correlated with proteinuria. In aHUS patients, effective complement inhibition was demonstrated by significant reductions of CH50, APH50, C3d and sC5b-9 levels, whereas C5a levels were only reduced significantly after 6 months' treatment. C3G patients presented increased C3d and consistently low C3 levels, reflecting ongoing complement activation and consumption at the C3 level, despite eculizumab treatment. A comprehensive complement analysis together with drug monitoring is required to distinguish mode of complement activation and efficacy of eculizumab treatment in distinct renal disorders. Accumulation of the anti-C5 antibody points to the need for a patient-orientated tailored therapy.
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Affiliation(s)
- C Wehling
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - O Amon
- Department of Pediatric Nephrology, University Hospital Tübingen, Germany
| | - M Bommer
- Department of Hematology and Oncology, ALB FILS Hospital Göppingen, Germany
| | - B Hoppe
- Department of Pediatric Nephrology, University Hospital Bonn, Germany
| | - K Kentouche
- Department of Pediatric Immunology, University Hospital Jena, Germany
| | - G Schalk
- Department of Pediatric Nephrology, University Children's Hospital Zurich, Switzerland
| | - R Weimer
- Department of Internal Medicine, University of Giessen, Germany
| | - M Wiesener
- Department of Nephrology and Hypertension, University Hospital Erlangen, Germany
| | - B Hohenstein
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany
| | - B Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Germany
| | - R Büscher
- Department of Pediatric Nephrology, University Hospital Essen, Germany
| | - H Fehrenbach
- Department of Pediatric Nephrology, Hospital Memmingen, Germany
| | - Ö-N Gök
- Department of Internal Medicine IV, University Hospital Freiburg, Germany
| | - M Kirschfink
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
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14
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Wolff M, Hammer B, Reuter S, Bartel S, Krauss-Etschmann S, Fehrenbach H. Identification of biomarkers predicting COPD exacerbations. Pneumologie 2016. [DOI: 10.1055/s-0036-1584638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Schröder A, Lunding L, Webering S, Vock C, Raedler D, Schaub B, Fehrenbach H, Wegmann M. Immunomodulatory role of IL-37 in asthma pathogenesis. Pneumologie 2016. [DOI: 10.1055/s-0036-1584619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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16
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Webering S, Fehrenbach H. NanoCOLT-Modulatory effects of modified carbon black nanoparticles in a mouse model of allergic asthma. Pneumologie 2016. [DOI: 10.1055/s-0036-1584384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Vock C, Yildirim AÖ, Wagner C, Schlick S, Lunding LP, Lee CG, Elias JA, Fehrenbach H, Wegmann M. Distal airways are protected from goblet cell metaplasia by diminished expression of IL-13 signalling components. Clin Exp Allergy 2016; 45:1447-58. [PMID: 25772331 DOI: 10.1111/cea.12526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Increased mucus production is a critical factor impairing lung function in patients suffering from bronchial asthma, the most common chronic inflammatory lung disease worldwide. OBJECTIVE This study aimed at investigating whether goblet cell (GC) metaplasia and mucus production are differentially regulated in proximal and distal airways. METHODS Female Balb/c mice were sensitized to ovalbumin (OVA) and challenged with an OVA-aerosol on two consecutive days for 1 week (acute) or 12 weeks (chronic). Real-time RT-PCR analysis was applied on microdissected airways. RESULTS In acutely and chronically OVA-challenged mice, GC metaplasia and mucus production were observed in proximal but not in distal airways. In contrast, inflammation reflected by the infiltration of eosinophils and expression of the TH2-type cytokines IL-4 and IL-13 was increased in both proximal and distal airways. Abundance of IL-13Rα1 was lower in distal airways of healthy control mice. Under acute and chronic OVA-exposure, activation of IL-13Rα1-dependent signalling cascade, reflected by Spdef and Foxo3A transcription factors, was attenuated in distal compared to proximal airways. CONCLUSION AND CLINICAL RELEVANCE These data indicate that distal airways might be less sensitive to IL-13-induced GC metaplasia and mucus production through lower expression of IL-13Rα1 and attenuated activation of downstream signalling. This might represent a protective strategy to prevent mucus plugging of distal airways and thus impaired ventilation of attached alveoli.
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Affiliation(s)
- C Vock
- Division of Experimental Pneumology, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research, Borstel, Germany
| | - A Ö Yildirim
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum München, German Center for Lung Research, Neuherberg, Germany
| | - C Wagner
- Division of Invertebrate Models, Priority Area Asthma & Allergy, Research Center Borstel, Borstel, Germany
| | - S Schlick
- Division of Experimental Pneumology, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research, Borstel, Germany
| | - L P Lunding
- Division of Asthma Mouse Models, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research, Borstel, Germany
| | - C G Lee
- Frank L. Day Professor of Biology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - J A Elias
- Frank L. Day Professor of Biology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - H Fehrenbach
- Division of Experimental Pneumology, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research, Borstel, Germany
| | - M Wegmann
- Division of Asthma Mouse Models, Priority Area Asthma & Allergy, Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research, Borstel, Germany
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18
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Höcker B, Zencke S, Pape L, Krupka K, Köster L, Fichtner A, Dello Strologo L, Guzzo I, Topaloglu R, Kranz B, König J, Bald M, Webb NJA, Noyan A, Dursun H, Marks S, Ozcakar ZB, Thiel F, Billing H, Pohl M, Fehrenbach H, Schnitzler P, Bruckner T, Ahlenstiel-Grunow T, Tönshoff B. Impact of Everolimus and Low-Dose Cyclosporin on Cytomegalovirus Replication and Disease in Pediatric Renal Transplantation. Am J Transplant 2016; 16:921-9. [PMID: 26613840 DOI: 10.1111/ajt.13649] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/16/2015] [Accepted: 11/20/2015] [Indexed: 01/25/2023]
Abstract
In order to investigate the hypothesis that the mammalian target of rapamycin inhibitor everolimus (EVR) shows anticytomegalovirus (CMV) activity in pediatric patients, we analyzed the impact of EVR-based immunosuppressive therapy on CMV replication and disease in a large cohort (n = 301) of pediatric kidney allograft recipients. The EVR cohort (n = 59), who also received low-dose cyclosporin, was compared with a control cohort (n = 242), who was administered standard-dose cyclosporin or tacrolimus and an antimetabolite, mostly mycophenolate mofetil (91.7%). Multivariate analysis revealed an 83% lower risk of CMV replication in the EVR cohort than in the control cohort (p = 0.005). In CMV high-risk (donor+/recipient-) patients (n = 88), the EVR-based regimen was associated with a significantly lower rate of CMV disease (0% vs. 14.3%, p = 0.046) than the standard regimen. In patients who had received chemoprophylaxis with (val-)ganciclovir (n = 63), the CMV-free survival rates at 1 year and 3 years posttransplant (100%) were significantly (p = 0.015) higher in the EVR cohort (n = 15) than in the control cohort (n = 48; 1 year, 75.0%; 3 years, 63.3%). Our data suggest that in pediatric patients at high risk of CMV, an EVR-based immunosuppressive regimen is associated with a lower risk of CMV disease than a standard-dose calcineurin inhibitor-based regimen.
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Affiliation(s)
- B Höcker
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - S Zencke
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - L Pape
- Hanover Medical School, Hanover, Germany
| | - K Krupka
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | - L Köster
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany.,Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - A Fichtner
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
| | | | - I Guzzo
- IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - R Topaloglu
- Department of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - B Kranz
- Department of General Pediatrics, Pediatric Nephrology, University Children's Hospital, Münster, Germany
| | - J König
- Department of General Pediatrics, Pediatric Nephrology, University Children's Hospital, Münster, Germany
| | - M Bald
- Olga Children's Hospital, Clinic of Stuttgart, Stuttgart, Germany
| | - N J A Webb
- Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Center, Manchester, UK
| | - A Noyan
- Department of Pediatric Nephrology, Adana Teaching and Research Center, Baskent University, Adana, Turkey
| | - H Dursun
- Department of Pediatric Nephrology, Adana Teaching and Research Center, Baskent University, Adana, Turkey
| | - S Marks
- Great Ormond Street Hospital, London, UK
| | - Z B Ozcakar
- Ankara University Faculty of Medicine, Ankara, Turkey
| | - F Thiel
- University Children's Hospital, Hamburg, Germany
| | - H Billing
- University Children's Hospital, Tübingen, Germany
| | - M Pohl
- University Children's Hospital, Freiburg, Germany
| | | | - P Schnitzler
- Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | | | - B Tönshoff
- Department of Pediatrics I, University Children's Hospital, Heidelberg, Germany
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Webering S, Lunding L, Vock C, Fehrenbach H, Wegmann M. The α-melanocyte stimulating hormone diminishes allergic airway inflammation through melanocortin receptor 5. Pneumologie 2016. [DOI: 10.1055/s-0036-1571990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schröder A, Lunding L, Webering S, Vock C, Raedler D, Schaub B, Fehrenbach H, Wegmann M. IL-37 ameliorates experimental asthma via a mechanism that is independent from IL-18 signaling. Pneumologie 2016. [DOI: 10.1055/s-0036-1572306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kreuzer M, Prüfe J, Oldhafer M, Bethe D, Dierks ML, Müther S, Thumfart J, Hoppe B, Büscher A, Rascher W, Hansen M, Pohl M, Kemper MJ, Drube J, Rieger S, John U, Taylan C, Dittrich K, Hollenbach S, Klaus G, Fehrenbach H, Kranz B, Montoya C, Lange-Sperandio B, Ruckenbrodt B, Billing H, Staude H, Heindl-Rusai K, Brunkhorst R, Pape L. Transitional Care and Adherence of Adolescents and Young Adults After Kidney Transplantation in Germany and Austria: A Binational Observatory Census Within the TRANSNephro Trial. Medicine (Baltimore) 2015; 94:e2196. [PMID: 26632907 PMCID: PMC4674210 DOI: 10.1097/md.0000000000002196] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transition from child to adult-oriented care is widely regarded a challenging period for young people with kidney transplants and is associated with a high risk of graft failure. We analyzed the existing transition structures in Germany and Austria using a questionnaire and retrospective data of 119 patients transferred in 2011 to 2012. Most centers (73%) confirmed agreements on the transition procedure. Patients' age at transfer was subject to regulation in 73% (18 years). Median age at transition was 18.3 years (16.5-36.7). Median serum creatinine increased from 123 to 132 μmol/L over the 12 month observation period before transfer (P = 0.002). A total of 25/119 patients showed increased creatinine ≥ 20% just before transfer. Biopsy proven rejection was found in 10/119 patients. Three patients lost their graft due to chronic graft nephropathy.Mean coefficient of variation (CoV%) of immunosuppression levels was 0.20 ± 0.1. Increased creatinine levels ≥ 20% just before transfer were less frequently seen in patients with CoV < 0.20 (P = 0.007). The majority of pediatric nephrology centers have internal agreements on transitional care. More than half of the patients had CoV of immunosuppression trough levels consistent with good adherence. Although, 20% of the patients showed increase in serum creatinine close to transfer.
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Affiliation(s)
- Martin Kreuzer
- From the Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School (MK, JP, JD, LP); German Society of Transition Medicine, Hannover (MK, MO, SM, LP); Division of Pediatric Nephrology, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Heidelberg (DB, SR); Department of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, Hannover (M-LD); Berliner Transitions Programm (BTP), DRK-Kliniken (German Red Cross hospitals) Berlin Westend (SM); Department of Pediatric Nephrology, Charité, Berlin (JT); University Hospital of Bonn, Bonn (BH); Department of Pediatrics II, Essen University Hospital, Essen (AB); Childrens' Hospital, University of Erlangen, Erlangen (WR); KfH Center of Pediatric Nephrology, Clementine Childrens' Hospital, Frankfurt (MH); Department of General Pediatrics, Adolescent Medicine and Neonatology, Freiburg University Hospital, Freiburg (MP); University Childrens' Hospital Eppendorf, Hamburg (MJK); University Childrens' Hospital, Jena (UJ); Pediatric Nephrology, University Hospital of Cologne, Cologne (CT); University Childrens' Hospital (KD); KfH Center of Pediatric Nephrology, St. Georg Hospital, Leipzig (SH); KfH Center of Pediatric Nephrology, University Hospital of Marburg, Marburg (GK); KfH Center of Pediatric Nephrology, Childrens' Hospital Memmingen, Memmingen (HF); University Childrens' Hospital Münster (BK); KfH Center of Pediatric Nephrology, University Childrens' Hospital München Schwabing (CM); Dr. von Haunersches Kinderspital, Ludwigs Maximilian University, Munich (BL-S); Childrens' Hospital, Olgahospital Klinikum Stuttgart, Stuttgart (BR); University Childrens' Hospital Tübingen, Tübingen (HB); University Childrens' Hospital, Rostock, Germany (HS); University Childrens' Hospital, Vienna, Austria (KH-R); and KfH Center of Nephrology, Hospitals of the Hannover Region, Hannover, Germany (RB)
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Roos A, Weis J, Korinthenberg R, Fehrenbach H, Häusler M, Züchner S, Mache C, Hubmann H, Auer-Grumbach M, Senderek J. Inverted formin 2-related Charcot-Marie-Tooth disease: extension of the mutational spectrum and pathological findings in Schwann cells and axons. J Peripher Nerv Syst 2015; 20:52-9. [DOI: 10.1111/jns.12106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/22/2015] [Accepted: 02/07/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Andreas Roos
- Institute of Neuropathology; RWTH Aachen University Hospital; Aachen Germany
- Department of Bioanalytics; Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V. Dortmund; Dortmund Germany
| | - Joachim Weis
- Institute of Neuropathology; RWTH Aachen University Hospital; Aachen Germany
| | | | | | - Martin Häusler
- Department of Pediatrics; RWTH Aachen University Hospital; Aachen Germany
| | - Stephan Züchner
- Dr. John T. Macdonald Foundation, Department of Human Genetics and John P. Hussman Institute for Human Genomics; University of Miami Miller School of Medicine; Miami FL USA
| | - Christoph Mache
- Department of Pediatrics; Medical University Graz; Graz Austria
| | - Holger Hubmann
- Department of Pediatrics; Medical University Graz; Graz Austria
| | | | - Jan Senderek
- Friedrich-Baur Institute, Department of Neurology; Ludwig-Maximilians University Munich; Munich Germany
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Gee HY, Zhang F, Ashraf S, Kohl S, Sadowski CE, Vega-Warner V, Zhou W, Lovric S, Fang H, Nettleton M, Zhu JY, Hoefele J, Weber LT, Podracka L, Boor A, Fehrenbach H, Innis JW, Washburn J, Levy S, Lifton RP, Otto EA, Han Z, Hildebrandt F. KANK deficiency leads to podocyte dysfunction and nephrotic syndrome. J Clin Invest 2015; 125:2375-84. [PMID: 25961457 DOI: 10.1172/jci79504] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 04/16/2015] [Indexed: 01/28/2023] Open
Abstract
Steroid-resistant nephrotic syndrome (SRNS) is a frequent cause of progressive renal function decline and affects millions of people. In a recent study, 30% of SRNS cases evaluated were the result of monogenic mutations in 1 of 27 different genes. Here, using homozygosity mapping and whole-exome sequencing, we identified recessive mutations in kidney ankyrin repeat-containing protein 1 (KANK1), KANK2, and KANK4 in individuals with nephrotic syndrome. In an independent functional genetic screen of Drosophila cardiac nephrocytes, which are equivalents of mammalian podocytes, we determined that the Drosophila KANK homolog (dKank) is essential for nephrocyte function. RNAi-mediated knockdown of dKank in nephrocytes disrupted slit diaphragm filtration structures and lacuna channel structures. In rats, KANK1, KANK2, and KANK4 all localized to podocytes in glomeruli, and KANK1 partially colocalized with synaptopodin. Knockdown of kank2 in zebrafish recapitulated a nephrotic syndrome phenotype, resulting in proteinuria and podocyte foot process effacement. In rat glomeruli and cultured human podocytes, KANK2 interacted with ARHGDIA, a known regulator of RHO GTPases in podocytes that is dysfunctional in some types of nephrotic syndrome. Knockdown of KANK2 in cultured podocytes increased active GTP-bound RHOA and decreased migration. Together, these data suggest that KANK family genes play evolutionarily conserved roles in podocyte function, likely through regulating RHO GTPase signaling.
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Eisenberger T, Decker C, Hiersche M, Hamann RC, Pape L, Fehrenbach H, Decker E, Neuber S, Frank V, Bolz HJ, Toenshoff B, Mache C, Latta K, Bergmann C. FP049AN EFFICIENT AND COMPREHENSIVE STRATEGY FOR GENETIC DIAGNOSTICS OF POLYCYSTIC KIDNEY DISEASE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv167.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vock C, Wegmann M, Fehrenbach H. The role of the TGF-β pseudoreceptor Bambi in a mouse model of allergic bronchial asthma. Pneumologie 2015. [DOI: 10.1055/s-0035-1548658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Webering S, Lunding L, Fehrenbach H, Wegmann M. Treatment of airway inflammation and airway hyperresponsiveness in a mouse model of neutrophilic asthma using a RORγt-specific siRNA. Pneumologie 2015. [DOI: 10.1055/s-0035-1548659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lunding L, Webering S, Vock C, Schröder A, Raedler D, Schaub B, Fehrenbach H, Wegmann M. IL-37 requires IL18Rα and SIGIRR/IL-1R8 to ameliorate experimental allergic asthma in mice. Pneumologie 2015. [DOI: 10.1055/s-0035-1548656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wagner C, Fehrenbach H. Drosophila melanogaster – a suitable model system to study epithelial immune responses in-vivo. Pneumologie 2015. [DOI: 10.1055/s-0035-1548648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lunding L, Webering S, Vock C, Schröder A, Raedler D, Schaub B, Fehrenbach H, Wegmann M. IL-37 requires IL-18Rα and SIGIRR/IL-1R8 to diminish allergic airway inflammation in mice. Allergy 2015; 70:366-73. [PMID: 25557042 DOI: 10.1111/all.12566] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Interleukin (IL) 37 has been described as a negative regulator of innate immunity, as it reduces the activation and cytokine production of different innate immune cells. Recently, results from the CLARA childhood asthma cohort suggested an implication of IL-37 for human asthma pathogenesis. This study aimed to investigate the effects of IL-37 on allergic airway inflammation in a mouse model of experimental asthma. METHODS Peripheral blood mononuclear cells (PBMCs) of children were cultured for 48 h (anti-CD3/anti-CD28 stimulation or unstimulated), and IL-37 concentrations in supernatants were determined. Wild-type, IL-18Rα-deficient ((-/-) ), and SIGIRR(-/-) C57BL/6 mice were sensitized to ovalbumin (OVA) and challenged with OVA aerosol to induce acute experimental asthma, and IL-37 was applied intranasally prior to each OVA challenge. Airway hyper-responsiveness (AHR), airway inflammation, cytokine levels in broncho-alveolar lavage fluid, and mucus production were determined. RESULTS IL-37 production of human PBMCs was significantly lower in allergic asthmatics vs healthy children. In wild-type mice, intranasal administration of IL-37 ablated allergic airway inflammation as well as cytokine production and subsequently diminished the hallmarks of experimental asthma including mucus hyperproduction and AHR. In contrast, local application of IL-37 produced none of these effects in mice lacking either IL18Rα or SIGIRR/IL-1R8. CONCLUSIONS This study demonstrates that IL-37 is able to ablate a TH2 cell-directed allergic inflammatory response and the hallmarks of experimental asthma in mice, suggesting that IL-37 may be critical for asthma pathogenesis. Furthermore, these data suggest a mode of action of IL-37 that involves IL18Rα as well as the orphan receptor SIGIRR/IL-1R8.
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Affiliation(s)
- L. Lunding
- Division of Asthma Mouse Models; Priority Area Asthma & Allergy, Research Center Borstel; Airway Research Center North; Member of the German Center for Lung Research; Borstel Germany
| | - S. Webering
- Division of Experimental Pneumology; Priority Area Asthma & Allergy, Research Center Borstel; Airway Research Center North; Member of the German Center for Lung Research; Borstel Germany
| | - C. Vock
- Division of Experimental Pneumology; Priority Area Asthma & Allergy, Research Center Borstel; Airway Research Center North; Member of the German Center for Lung Research; Borstel Germany
| | - A. Schröder
- Division of Asthma Mouse Models; Priority Area Asthma & Allergy, Research Center Borstel; Airway Research Center North; Member of the German Center for Lung Research; Borstel Germany
| | - D. Raedler
- Department of Pulmonary & Allergy; LMU Munich, Comprehensive Pneumology Center-Munich; Member of the German Center for Lung Research; University Children's Hospital Munich; Munich Germany
| | - B. Schaub
- Department of Pulmonary & Allergy; LMU Munich, Comprehensive Pneumology Center-Munich; Member of the German Center for Lung Research; University Children's Hospital Munich; Munich Germany
| | - H. Fehrenbach
- Division of Experimental Pneumology; Priority Area Asthma & Allergy, Research Center Borstel; Airway Research Center North; Member of the German Center for Lung Research; Borstel Germany
| | - M. Wegmann
- Division of Asthma Mouse Models; Priority Area Asthma & Allergy, Research Center Borstel; Airway Research Center North; Member of the German Center for Lung Research; Borstel Germany
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Lunding L, Webering S, Vock C, Schröder A, Raedler D, Schaub B, Fehrenbach H, Wegmann M. IL-37 requires IL18Rα and SIGIRR to ameliorate experimental allergic asthma in mice. Pneumologie 2015. [DOI: 10.1055/s-0035-1544601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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31
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Webering S, Lunding L, Fehrenbach H, Wegmann M. Specific siRNA targeting RORγt inhibits airway inflammation and airway hyperresponsiveness in a mouse model of neutrophilic asthma. Pneumologie 2015. [DOI: 10.1055/s-0035-1544604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fehrenbach H, Decker C, Eisenberger T, Frank V, Hampel T, Walden U, Amann KU, Krüger-Stollfuß I, Bolz HJ, Häffner K, Pohl M, Bergmann C. Mutations in WDR19 encoding the intraflagellar transport component IFT144 cause a broad spectrum of ciliopathies. Pediatr Nephrol 2014; 29:1451-6. [PMID: 24504730 DOI: 10.1007/s00467-014-2762-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 11/20/2013] [Revised: 12/30/2013] [Accepted: 01/09/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND An emerging number of clinically and genetically heterogeneous diseases now collectively termed ciliopathies have been connected to the dysfunction of primary cilia. We describe an 8-year-old girl with a complex phenotype that did not clearly match any familiar syndrome. CASE-DIAGNOSIS/TREATMENT Hypotonia, facial dysmorphism and retardation were noted shortly after birth. Other features included short stature, mild skeletal anomalies, strabism, deafness, subdural hygroma, hepatosplenomegaly and end-stage renal failure. Renal biopsy revealed tubular atrophy, interstitial fibrosis and segmental glomerulosclerosis. After exclusion of a chromosomal abnormality by array-comparative genomic hybridization (CGH), we performed next-generation sequencing (NGS) using a customized panel that targeted 131 genes known or hypothesized to cause ciliopathies. We identified the novel homozygous WDR19 mutation c.1483G > C (p.Gly495Arg) that affects an evolutionarily highly conserved residue in the intraflagellar transport protein IFT144, is absent from databases and is predicted to be pathogenic by all bioinformatic sources used. CONCLUSION Mutations in WDR19 encoding the intraflagellar transport component IFT144 have recently been described in single families with the clinically overlapping skeletal ciliopathies Jeune and Sensenbrenner syndromes, combined or isolated nephronophthisis (NPHP) and retinitis pigmentosa (RP) (Senior-Loken syndrome). Our patient emphasizes the usefulness and efficiency of a comprehensive NGS panel approach in patients with unclassified ciliopathies. It further suggests that WDR19 mutations can cause a broad spectrum of ciliopathies that extends to Jeune and Sensenbrenner syndromes, RP and renal NPHP-like phenotypes.
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Affiliation(s)
- Henry Fehrenbach
- Department of Pediatrics, Children's Hospital Memmingen, Memmingen, Germany
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Webering S, Lunding L, Behrends J, Fehrenbach H, Wegmann M. RORγt-specific RNAi decreases allergic airway inflammation and airway hyperresponsiveness in a mouse model of neutrophilic asthma. Pneumologie 2014. [DOI: 10.1055/s-0034-1376774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Webering S, Lunding L, Vock C, Fehrenbach H, Wegmann M. α-melanocyte acts as an anti-inflammatory regulator in allergic bronchial asthma. Pneumologie 2014. [DOI: 10.1055/s-0034-1367906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vock C, Wegmann M, Fehrenbach H. The TGF-ß antagonist Bambi impacts the expression of pro-inflammatory cytokines in a mouse model of allergic bronchial asthma. Pneumologie 2014. [DOI: 10.1055/s-0034-1367908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lunding L, Webering S, Vock C, Behrends J, Hölscher C, Fehrenbach H, Wegmann M. IL-17 producing NK cells are suspected to be critical for the IL-17 dependent TLR-3 triggered aggravation of experimental asthma. Pneumologie 2014. [DOI: 10.1055/s-0034-1367781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Webering S, Lunding L, Fehrenbach H, Wegmann M. Treatment of allergic airway inflammation and airway hyperresponsiveness using RORγt specific RNAi. Pneumologie 2014. [DOI: 10.1055/s-0034-1367907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schlick S, Kopf J, Ströbele M, Fehrenbach H. Airway region-specific effects of carbon black nanoparticles (CBNP). Pneumologie 2013. [DOI: 10.1055/s-0033-1357067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fehrenbach H, Müller B, König P, Hansen T, Bockhorn H. CarbonBlack: a joint research project to establish a test system for predicting human-toxicological effects of synthetic carbon black nanoparticles*. Pneumologie 2013. [DOI: 10.1055/s-0033-1357063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Fehrenbach H. „Gute Partikel – böse Partikel“. Abschlusssymposium des NanoCare-Forschungsverbundes CarbonBlack. Pneumologie 2013. [DOI: 10.1055/s-0033-1357069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hansen T, Kopf J, Danov O, Ströbele M, Braun A, Sewald K, Bockhorn H, Fehrenbach H. In vitro and ex vivo toxicity screening for predicting toxicological effects of synthetic carbon black nanoparticles in humans. Pneumologie 2013. [DOI: 10.1055/s-0033-1357065] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schlick S, Ströbele M, Kopf J, Hansen T, Bockhorn H, Fehrenbach H. Airway region-specific effects of carbon black nanoparticles (CBNP). Pneumologie 2013. [DOI: 10.1055/s-0033-1334689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Höcker B, Fickenscher H, Delecluse HJ, Böhm S, Küsters U, Schnitzler P, Pohl M, John U, Kemper MJ, Fehrenbach H, Wigger M, Holder M, Schröder M, Billing H, Fichtner A, Feneberg R, Sander A, Köpf-Shakib S, Süsal C, Tönshoff B. Epidemiology and morbidity of Epstein-Barr virus infection in pediatric renal transplant recipients: a multicenter, prospective study. Clin Infect Dis 2012; 56:84-92. [PMID: 23042966 DOI: 10.1093/cid/cis823] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The epidemiology and morbidity of Epstein-Barr virus (EBV) infection in pediatric renal transplant recipients have been characterized insufficiently. METHODS In a prospective, multicenter study among 106 pediatric kidney allograft recipients aged 11.4 ± 5.9 years, we investigated the epidemiology of EBV infection and the relationship between EBV load, EBV serology, and EBV-related morbidity (posttransplant lymphoproliferative disease [PTLD] or symptomatic EBV infection, defined as flu-like symptoms or infectious mononucleosis). RESULTS EBV primary infection occurred in 27 of 43 (63%) seronegative patients and reactivation/reinfection in 28 of 63 (44%) seropositive patients. There was no association between the degree or duration of EBV load and EBV-related morbidity: The vast majority (17 of 18 [94%]) of patients with a high, persistent EBV load remained PTLD-free throughout a follow-up of 5.0 ± 1.3 years, while 2 of 3 (66%) patients with EBV-related PTLD exhibited only a low EBV load beforehand. Eight of 18 (44%) patients with a high, persistent EBV load remained asymptomatic during a follow-up of 5.3 ± 2.9 years. Multivariate analysis identified the EBV high-risk (D(+)/R(-)) serostatus (odds ratio [OR], 7.07; P < .05), the presence of human leukocyte antigen (HLA)-DR7 (OR, 5.65; P < .05), and the intensity of the immunosuppressive therapy (OR, 1.53; P < .01) as independent risk factors for the development of a symptomatic EBV infection. CONCLUSIONS Presence of EBV high-risk seroconstellation, HLA-DR7, and intensity of immunosuppressive therapy are significant risk factors for a symptomatic EBV infection, whereas there is no close association between the degree or duration of EBV load and EBV-related morbidity. Clinical Trials Registration. NCT00963248.
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Affiliation(s)
- Britta Höcker
- University Children's Hospital, Im Neuenheimer Feld 430, D-69120 Heidelberg, Germany
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Beck BB, Baasner A, Buescher A, Habbig S, Reintjes N, Kemper MJ, Sikora P, Mache C, Pohl M, Stahl M, Toenshoff B, Pape L, Fehrenbach H, Jacob DE, Grohe B, Wolf MT, Nürnberg G, Yigit G, Salido EC, Hoppe B. Novel findings in patients with primary hyperoxaluria type III and implications for advanced molecular testing strategies. Eur J Hum Genet 2012; 21:162-72. [PMID: 22781098 DOI: 10.1038/ejhg.2012.139] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Identification of mutations in the HOGA1 gene as the cause of autosomal recessive primary hyperoxaluria (PH) type III has revitalized research in the field of PH and related stone disease. In contrast to the well-characterized entities of PH type I and type II, the pathophysiology and prevalence of type III is largely unknown. In this study, we analyzed a large cohort of subjects previously tested negative for type I/II by complete HOGA1 sequencing. Seven distinct mutations, among them four novel, were found in 15 patients. In patients of non-consanguineous European descent the previously reported c.700+5G>T splice-site mutation was predominant and represents a potential founder mutation, while in consanguineous families private homozygous mutations were identified throughout the gene. Furthermore, we identified a family where a homozygous mutation in HOGA1 (p.P190L) segregated in two siblings with an additional AGXT mutation (p.D201E). The two girls exhibiting triallelic inheritance presented a more severe phenotype than their only mildly affected p.P190L homozygous father. In silico analysis of five mutations reveals that HOGA1 deficiency is causing type III, yet reduced HOGA1 expression or aberrant subcellular protein targeting is unlikely to be the responsible pathomechanism. Our results strongly suggest HOGA1 as a major cause of PH, indicate a greater genetic heterogeneity of hyperoxaluria, and point to a favorable outcome of type III in the context of PH despite incomplete or absent biochemical remission. Multiallelic inheritance could have implications for genetic testing strategies and might represent an unrecognized mechanism for phenotype variability in PH.
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Affiliation(s)
- Bodo B Beck
- Institute of Human Genetics, University of Cologne, Cologne, Germany
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Schlick S, Fehrenbach H. Airway region-specific effects of Carbon Black nanoparticles. Pneumologie 2012. [DOI: 10.1055/s-0032-1313582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abdullah M, Kähler D, Marwitz S, Vock C, Reiling N, Kugler C, Fehrenbach H, Pedersen F, Watz H, Rabe KF, Zabel P, Vollmer E, Dalhoff K, Goldmann T. Pulmonary Haptoglobin (pHp): a candidate gene and its validation. Pneumologie 2012. [DOI: 10.1055/s-0032-1315491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vock C, Yildirim AÖ, Wegmann M, Fehrenbach H. Region-specific regulation of mucus production in allergic asthma is dependent on IL-13R alpha 1 expression. Pneumologie 2012. [DOI: 10.1055/s-0032-1315472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lunding L, Wegmann M, Vock C, Fehrenbach H. TLR-3 triggered aggravation of experimental asthma depends on IL-17. Pneumologie 2012. [DOI: 10.1055/s-0032-1315470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Höcker B, Böhm S, Fickenscher H, Küsters U, Schnitzler P, Pohl M, John U, Kemper MJ, Fehrenbach H, Wigger M, Holder M, Schröder M, Feneberg R, Köpf-Shakib S, Tönshoff B. (Val-)Ganciclovir prophylaxis reduces Epstein-Barr virus primary infection in pediatric renal transplantation. Transpl Int 2012; 25:723-31. [DOI: 10.1111/j.1432-2277.2012.01485.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [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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