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Naehrig S, Schulte-Hubbert B, Hafkemeyer S, Hammermann J, Dumke M, Sieber S. Chronic inhaled antibiotic therapy in people with cystic fibrosis with Pseudomonas aeruginosa infection in Germany. Pulm Pharmacol Ther 2023; 80:102214. [PMID: 37003541 DOI: 10.1016/j.pupt.2023.102214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/16/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Several clinical guidelines recommend chronic inhaled therapy for pwCF (people with cystic fibrosis) and chronic Pseudomonas aeruginosa infection of the lungs. METHODS To demonstrate what kind of therapy regimens are used in Germany, we retrospectively analysed chronic inhaled antibiotic therapy within the cohort of the German CF Registry in 2020. For comparison we also analysed the use of inhaled antibiotics in pwCF with intermittent Pseudomonas or without Pseudomonas infection. RESULTS A total of 1960 pwCF had chronic P. aeruginosa infection and were retrospectively evaluated. Almost 90% (n = 1751) received at least one inhaled antibiotic. The most commonly used inhaled antibiotic was colistin solution for inhalation (55.2%), followed by aztreonam solution for inhalation (32.6%) and tobramycin solution for Inhalation (30%). Almost 56% of adults and 44% of children alternated two antibiotics for inhalation. In children, alternating colistin + tobramycin was the most often used regimen. In adults, only 23% used colistin + tobramycin; there was a wide range of treatment regimens among adults using two inhaled antibiotics alternately. 2456 pwCF had no Pseudomonas infection, but almost 24% had a chronic inhaled antibiotic therapy, while 56% of 361 pwCF and intermittent chronic Pseudomonas infection had a chronic inhaled antibiotic therapy. CONCLUSION In all three groups the most commonly used inhaled antibiotic was colistin solution for inhalation. Almost 56% of adults and 44% of children with chronic Pseudomonas infection alternated two antibiotics for inhalation. It will be interesting to see how the introduction of the highly effective modulator elexacaftor/tezacaftor/ivacaftor will change the use of inhaled antibiotics.
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Affiliation(s)
- S Naehrig
- University Hospital of the Ludwig Maximilians University Munich (LMU), Department of Internal Medicine V, Cystic Fibrosis Center for Adults, Munich, Germany.
| | - B Schulte-Hubbert
- Division of Pulmonology, Medical Department I, Cystic Fibrosis Center, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - S Hafkemeyer
- Mukoviszidose Institut gGmbH (MI), Bonn, Germany
| | - J Hammermann
- Children's Hospital, Cystic Fibrosis Center, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - M Dumke
- STAT-UP Statistical Consulting & Services, Munich, Germany
| | - S Sieber
- STAT-UP Statistical Consulting & Services, Munich, Germany
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Schwarz C, Schulte-Hubbert B, Bend J, Abele-Horn M, Baumann I, Bremer W, Brunsmann F, Dieninghoff D, Eickmeier O, Ellemunter H, Fischer R, Grosse-Onnebrink J, Hammermann J, Hebestreit H, Hogardt M, Hügel C, Hug M, Illing S, Jung A, Kahl B, Koitschev A, Mahlberg R, Mainz JG, Mattner F, Mehl A, Möller A, Muche-Borowski C, Nüßlein T, Puderbach M, Renner S, Rietschel E, Ringshausen FC, Schmidt S, Sedlacek L, Sitter H, Smaczny C, Tümmler B, Vonberg R, Wielpütz MO, Wilkens H, Wollschläger B, Zerlik J, Düesberg U, van Koningsbruggen-Rietschel S. [CF Lung Disease - a German S3 Guideline: Module 2: Diagnostics and Treatment in Chronic Infection with Pseudomonas aeruginosa]. Pneumologie 2018; 72:347-392. [PMID: 29758578 DOI: 10.1055/s-0044-100191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Cystic Fibrosis (CF) is the most common autosomal-recessive genetic disease affecting approximately 8000 people in Germany. The disease is caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene leading to dysfunction of CFTR, a transmembrane chloride channel. This defect causes insufficient hydration of the epithelial lining fluid which leads to chronic inflammation of the airways. Recurrent infections of the airways as well as pulmonary exacerbations aggravate chronic inflammation, lead to pulmonary fibrosis and tissue destruction up to global respiratory insufficiency, which is responsible for the mortality in over 90 % of patients. The main aim of pulmonary treatment in CF is to reduce pulmonary inflammation and chronic infection. Pseudomonas aeruginosa (Pa) is the most relevant pathogen in the course of CF lung disease. Colonization and chronic infection are leading to additional loss of pulmonary function. There are many possibilities to treat Pa-infection. This is a S3-clinical guideline which implements a definition for chronic Pa-infection and demonstrates evidence-based diagnostic methods and medical treatment for Pa-infection in order to give guidance for individual treatment options.
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Affiliation(s)
- C Schwarz
- Charité - Universitätsmedizin Berlin, Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Christiane Herzog Zentrum, Berlin
| | - B Schulte-Hubbert
- Medizinische Klinik und Poliklinik I, Pneumologie, Universitätsklinikum Dresden
| | - J Bend
- Mukoviszidose Institut, Bonn
| | - M Abele-Horn
- Universität Würzburg, Institut für Hygiene und Mikrobiologie
| | - I Baumann
- Universität Heidelberg, Hals-Nasen-Ohrenklinik, Heidelberg
| | | | - F Brunsmann
- Charité Universitätsmedizin Berlin, Deutschland (Patientenvertreter)
| | - D Dieninghoff
- Kliniken der Stadt Köln, Lungenklinik, Lehrstuhl der Universität Witten Herdecke
| | - O Eickmeier
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Christiane Herzog CF-Zentrum, Frankfurt
| | - H Ellemunter
- Tirolkliniken GmbH, Department für Kinderheilkunde Pädiatrie III, Innsbruck, Österreich
| | - R Fischer
- Zentrum für erwachsene Mukoviszidose-Patienten München-West
| | - J Grosse-Onnebrink
- Universitätsklinikum Münster UKM; Klinik für Kinder- und Jugendmedizin; Allgemeine Pädiatrie Mukoviszidose-Ambulanz, Münster
| | - J Hammermann
- Universitäts-Mukoviszidose-Zentrum "Christiane Herzog", Dresden
| | | | - M Hogardt
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Frankfurt
| | - C Hügel
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Inneren Medizin, Frankfurt, Deutschland
| | - M Hug
- Universitätsklinikum Freiburg, Apotheke des Klinikums Freiburg
| | - S Illing
- Olgahospital - Kinderklinik - CF-Zentrum/Jugendliche/Erwachsene Stuttgart
| | - A Jung
- Kinderspital Zürich, Abteilung Pneumologie, Zürich, Schweiz
| | - B Kahl
- Universitätsklinikum Münster UKM, Institut für Medizinische Mikrobiologie, Münster
| | - A Koitschev
- Klinikum Stuttgart - Standort Olgahospital, Klinik für Hals-Nasen-Ohrenkrankheiten, Stuttgart
| | - R Mahlberg
- Klinikum Mutterhaus der Borromäerinnen, Abteilung Innere Medizin, Trier
| | - J G Mainz
- Universitätsklinikum Jena, Mukoviszidosezentrum/Pädiatrische Pneumologie, Jena
| | - F Mattner
- Kliniken der Stadt Köln, Institut für Hygiene, Köln
| | - A Mehl
- Charité - Universitätsmedizin Berlin, Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Christiane Herzog Zentrum, Berlin
| | - A Möller
- Pneumologie und CF Ambulanz der Universitäts-Kinderklinik Zürich, Schweiz
| | - C Muche-Borowski
- Philipps-Universität Marburg, AWMF-Institut für Medizinisches Wissensmanagement, Marburg und Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Allgemeinmedizin, Hamburg
| | - T Nüßlein
- Gemeinschaftsklinikum Mittelrhein, Klinik für Kinder- und Jugendmedizin Koblenz und Mayen
| | - M Puderbach
- Hufeland Klinikum, Abteilung für Diagnostische und Interventionelle Radiologie, Bad Langensalza
| | - S Renner
- Allgemeines Universitätskrankenhaus, Klinik für Kinder- und Jugendheilkunde, CF Ambulanz, Wien, Österreich
| | - E Rietschel
- Mukoviszidose-Zentrum Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universität zu Köln
| | - F C Ringshausen
- Medizinische Hochschule Hannover, Klinik für Pneumologie und Deutsches Zentrum für Lungenforschung (DZL), Hannover
| | - S Schmidt
- Ernst-Moritz-Arndt Universität Greifswald, Zentrum für Kinder- und Jugendmedizin; Mukoviszidose Zentrum Mecklenburg/Vorpommern, Greifswald
| | - L Sedlacek
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover
| | - H Sitter
- Philipps-Universität Marburg, Institut für theoretische Medizin, Marburg
| | - C Smaczny
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Inneren Medizin, Frankfurt, Deutschland
| | - B Tümmler
- Medizinische Hochschule Hannover, Klinische Forschergruppe OE 6710, Klinik für Pädiatrische Pneumologie und Neonatologie
| | - R Vonberg
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover
| | - M O Wielpütz
- Diagnostische und Interventionelle Radiologie Universitätsklinikum Heidelberg, Heidelberg
| | - H Wilkens
- Universitätsklinikum des Saarlandes, Medizinische Klinik V, Pneumologie, Allergologie und Beatmungsmedizin, Homburg
| | - B Wollschläger
- Martin-Luther-Universität Halle, Universitätsklinik und Poliklinik für Innere Medizin I/Pneumologie, Halle
| | - J Zerlik
- Altonaer Kinderkrankenhaus gGmbH, Abteilung Physiotherapie, Hamburg
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Weidler S, Stopsack K, Hammermann J, Lee-Kirsch M, Stopsack M. ePS01.5 Immunoreactive trypsinogen (IRT) and pancreatitis-associated protein (PAP) concentrations depend on age at blood collection. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30192-8] [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: 11/28/2022]
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Hammermann J, Stopsack M. 12 Twenty years of newborn screening for cystic fibrosis in Eastern Saxony in Germany. J Cyst Fibros 2016. [DOI: 10.1016/s1569-1993(16)30252-1] [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: 10/21/2022]
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Hübsch M, Ulbrich K, Hammermann J. 46 Microbiological airway flora in children with cystic fibrosis in the first year of life (To treat or not to treat, that's the question!). J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30223-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hammermann J, Ulbrich K, Schulte-Hubbert B. 18 The first date with patients detected by newborn screening – what do we see? J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60155-7] [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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Schulte-Hubbert B, Ulbrich K, Hammermann J. Schwangerschaft und Cystische Fibrose aus pneumologischer Sicht. Pneumologie 2014. [DOI: 10.1055/s-0034-1367975] [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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Junge S, Wiedemann B, Tümmler B, Dübbers A, Küster P, Nofer J, Ellemunter H, Mainz J, Heuer E, Sextro W, Körner-Rettberg C, Ballmann M, Mellies U, Hammermann J, Teschler H, Szczepanski R, Tegtmeyer F, Graepler-Mainka U, Riethmueller J, Wald A, Wollschläger B, Staab D, Schuster A, Becker K, Peters G, Kahl B. WS19.9 A prospective multicenter study to dissect Staphylococcus aureus-colonization from infection in cystic fibrosis patients. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60122-8] [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: 11/26/2022]
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Mense L, Bauer S, Hammermann J. 23 Sweat testing in a tertiary clinic – reasons, results and methodology. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Hammermann J, Böhm A, Marx K. 27 Who wants sweat tests and why? J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Hammermann J, Stopsack M, Wiedemann B, Ulbrich K. 15 year newborn screening for cystic fibrosis in Eastern Saxony — Outcome of patients in correlation to an unscreened population. Clin Biochem 2011. [DOI: 10.1016/j.clinbiochem.2011.03.073] [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: 11/29/2022]
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13
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Hedrich CM, Leszczynska A, Hammermann J, Bau V, Gahr M. Chorioretinitis in a 7-year-old African girl, probably related to JSSc resolving to methotrexate therapy. Klin Padiatr 2011; 223:92-4. [PMID: 21294066 DOI: 10.1055/s-0030-1270438] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Juvenile systemic sclerosis (JSSc) is a rare but severe multi-system connective tissue disease of unknown etiology. It is one of the most difficult to treat rheumatic diseases in childhood and characterized by thickening and fibrosis of the skin and associated with fibrosis of internal organs. Eye involvement has rarely been reported. In a 7-year-old African girl, who presented with chorioretinitis and subsequently developed JSSc we discuss the possible association of chorioretinitis with JSSc and the putative implications of scleroderma vascular disease in the development of this complication and review the existing literature.
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Affiliation(s)
- C M Hedrich
- Rheumatologie und Immunologie, Klinik und Poliklinik für Kinder- und Jugendmedizin, Dresden, Germany.
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Hammermann J, Stopsack M, Wiedemann B. 12 Years of newborn screening for cystic fibrosis in Eastern Saxony – Correlation with an unscreened German population. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60031-8] [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: 11/16/2022]
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Stopsack M, Hammermann J. Newborn screening for cystic fibrosis by IRT/PAP-combination. J Cyst Fibros 2010. [DOI: 10.1016/s1569-1993(10)60022-7] [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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Rolinck-Werninghaus C, Wolf H, Liebke C, Baars JC, Lange J, Kopp MV, Hammermann J, Leupold W, Bartels P, Gruebl A, Bauer CP, Schnitker J, Wahn U, Niggemann B. A prospective, randomized, double-blind, placebo-controlled multi-centre study on the efficacy and safety of sublingual immunotherapy (SLIT) in children with seasonal allergic rhinoconjunctivitis to grass pollen. Allergy 2004; 59:1285-93. [PMID: 15507097 DOI: 10.1111/j.1398-9995.2004.00627.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [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: 12/16/2022]
Abstract
BACKGROUND Especially in childhood, sublingual immunotherapy (SLIT) could offer advantages over subcutaneous therapy. However, limited data on its efficacy is available. METHODS In four German centres 97 children (age 3-14 years) with allergic rhinoconjunctivitis to grass pollen were enrolled in a prospective, double-blind trial comparing SLIT (Pangramin SLIT; ALK-SCHERAX, 0.5 microg major allergens, three times per week, 32 months) with placebo. Primary endpoint was a multiple symptom-medication score for changes in seasonal diary entries between the first and third year of the study (SLIT n=39; placebo n=38). RESULTS The multiple symptom-medication score was significantly reduced by SLIT to 77.3% of the placebo group (P=0.0498). The subsequent analysis of the single endpoints did not reveal significant differences for symptom scores in favour of SLIT (85.1% of placebo group; P=0.22). However, the medication score improved significantly (67.1% of placebo group; P=0.0025). Furthermore, secondary endpoints assessing in vivo immune responses did not differ significantly between the groups. However, retrospective analysis showed some inhomogeneity for clinical and in vitro parameters at the beginning of the study. Allergic side effects with possible relation to the study drug were reported in both groups (SLIT 49%, placebo 27%, P=0.026). CONCLUSION Our study indicates that SLIT had a positive effect on the reduction of a multiple symptom-medication score, mainly by significantly reducing rescue medication use, but had no significant effect on symptoms alone in children with rhinoconjunctivitis to grass pollen compared with a placebo.
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Rolinck-Werninghaus C, Hamelmann E, Keil T, Kulig M, Koetz K, Gerstner B, Kuehr J, Zielen S, Schauer U, Kamin W, Von Berg A, Hammermann J, Weinkauf B, Weidinger G, Stenglein S, Wahn U. The co-seasonal application of anti-IgE after preseasonal specific immunotherapy decreases ocular and nasal symptom scores and rescue medication use in grass pollen allergic children. Allergy 2004; 59:973-9. [PMID: 15291906 DOI: 10.1111/j.1398-9995.2004.00552.x] [Citation(s) in RCA: 67] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Specific immunotherapy (SIT) and treatment with anti-immunoglobulin (Ig)E antibody are complementary approaches to treat allergic rhinoconjunctivitis, which may be used for single or combined treatment. OBJECTIVE A randomized, double-blind, placebo-controlled trial was conducted to compare the efficacy of single and combined treatment with SIT and anti-IgE (Omalizumab) in reducing symptom severity and rescue medication use. METHODS A total of 221 subjects with birch and grass pollen allergic rhinoconjunctivitis aged 6-17 years were analysed during the grass pollen season. Group A (SITbirch + placebo) served as a reference group obtaining no effective treatment for grass pollen allergy. Group B received anti-IgE monotherapy during grass pollen season, group C SIT grass pollen monotherapy, and group D the combined treatment of SIT and Omalizumab. RESULTS Preseasonal treatment with grass pollen SIT alone compared with SIT with the nonrelated allergen did not reduce symptoms or rescue medication use. Anti-IgE monotherapy significantly diminished rescue medication use and number of symptomatic days. The combined treatment with SIT and anti-IgE showed superior efficacy on symptom severity compared with anti-IgE alone. CONCLUSIONS Co-seasonal Omalizumab therapy showed considerable effects in children with seasonal allergic rhinitis. The combination of SIT plus Omalizumab was clinically superior to each treatment alone during the first year of observation.
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Borkhardt A, Repp R, Haas OA, Leis T, Harbott J, Kreuder J, Hammermann J, Henn T, Lampert F. Cloning and characterization of AFX, the gene that fuses to MLL in acute leukemias with a t(X;11)(q13;q23). Oncogene 1997; 14:195-202. [PMID: 9010221 DOI: 10.1038/sj.onc.1200814] [Citation(s) in RCA: 197] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the cloning and characterization of the entire AFX gene which fuses to MLL in acute leukemias with a t(X;ll)(q13;q23). AFX consists of two exons and encodes for a protein of 501 amino acids. We found that normal B- and T-cells contain similar levels of AFX mRNA and that both the MLL/AFX as well as the AFX/MLL fusion transcripts are present in the cell line and the ANLL sample with a t(X;11)(q13;q23). The single intron of the AFX gene consists of 3706 nucleotides. It contains five simple sequence repeats with lengths of at least 12 bps, a chi-like octamer sequence (GCA/TGGA/TGG) and several immunoglobulin heptamer-like sequences (GATAGTG) that are distributed throughout the entire AFX intron sequence. In the KARPAS 45 cell line the breakpoints occur at nucleotides 2913/2914 of the AFX intron and at nucleotides 4900/4901 of the breakpoint cluster region of the MLL gene. The AFX protein belongs to the forkhead protein family. It is highly homologous to the human FKHR protein, the gene of which is disrupted by the t(2;13)(q35;q14), a chromosome rearrangement characteristic of alveolar rhabdomyosarcomas. It is noteworthy that the t(X;11)(q13;q23) in the KARPAS 45 cell line and in one acute nonlymphoblastic leukemia (ANLL) disrupts the forkhead domain of the AFX protein exactly at the same amino acids as does the t(2;13)(q35;q14) in case of the FKHR protein. In addition, the 5'-part of the AFX protein contains a conserved hexapeptide motif (QIYEWM) that is homologous to the functionally important conserved hexapeptide QIYPWM upstream of the homeobox domain in Hox proteins. This motif mediates the co-operative DNA binding of Pbx family members and Hox proteins and, therefore, plays an important role in physiologic and oncogenic processes. In acute leukemias with a t(X;11)(q13;q23), this hexapeptide motif is separated from the remaining forkhead domain within the AFX protein. The predicted amino acid sequence of AFX differs significantly from the partial AFX protein sequence published previously (Genes, Chromosomes and Cancer, 1994, 11, 79-84). This discrepancy can be explained by the occurrence of two sequencing errors in the earlier work at nucleotide number 783 and 844 (loss of a cytosine residue or guanosine residue, respectively) that lead to two reading frame shifts.
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Affiliation(s)
- A Borkhardt
- Department of Pediatrics, University of Giessen, Germany
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Repp R, Borkhardt A, Gossen R, Kreuder J, Hammermann J, Lampert F. Construction of RNA standards for high-resolution automatic product analysis in quantitative competitive RT-PCR. Biotechniques 1995; 19:84, 86-8, 90. [PMID: 7545409] [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: 01/25/2023] Open
Abstract
The exponential character of PCR amplification may compromise quantitative assays because it multiplies minor sample-to-sample variations. To overcome these problems, several authors have used recombinant standard DNA or RNA molecules to be spiked into the samples in a dilution series of known copy numbers before co-amplification by PCR. To obtain an equal efficacy of reverse transcription and PCR amplification, standard and template molecules should be highly homologous. However, the limited resolution of commonly used agarose gel electrophoresis requires rather large differences in size and nucleotide sequence to separate both molecules from each other after PCR. Due to a much higher resolution, automatic post-PCR analyzing systems based on laser-induced fluorescence may help to overcome these difficulties. For using the capabilities of these systems in quantitative competitive RT-PCR, we developed a protocol to construct recombinant RNA standard molecules that only differ from the target sequence by a small deletion of 8 nucleotides. It is based on PCR-induced mutagenesis and solid-phase in vitro transcription. This protocol was applied to quantify multidrug resistance gene (MDRI) mRNA in malignant cells, but it can easily be adapted to any gene of interest.
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Affiliation(s)
- R Repp
- Children's Hospital, University of Giessen, Germany
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Borkhardt A, Mitteis M, Brettreich S, Schlieben S, Hammermann J, Repp R, Kreuder J, Buchen U, Lampert F. Rapid synthesis of hybrid RNA molecules associated with leukemia-specific chromosomal translocations. Leukemia 1995; 9:719-22. [PMID: 7723408] [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: 01/26/2023]
Abstract
A number of gene arrangements have been described as characteristic abnormalities associated with different types of leukemia, and this list is still growing. In view of the biological, clinical and prognostic relevance of the pathological fusion products, techniques permitting their detection are of paramount importance in the clinical setting. In some instances, permanent leukemic cell lines carrying the abnormality of interest are available for the establishment and standardization of molecular assays. For a number of newly discovered gene rearrangements, however, this may not be the case. It is therefore of great interest for clinical laboratories to have alternative technical possibilities for the set-up of standardized molecular tests. This problem provided the stimulus to design a simple and rapid method for in vitro generation of chimeric RNA molecules corresponding to pathological fusion transcripts typical for chromosomal translocations in leukemias. Two separate fragments are generated in a four-primer multiplex PCR. Due to a PCR-generated overlap, a chimeric fragment can be synthesized in a second round of PCR. This PCR product is then purified with the help of magnetic beads. Due to the SP6 promotor sequence incorporated during the second round of PCR, transcription into RNA is easily facilitated while the template DNA is still bound to the solid phase. Following this strategy we were able to synthesize the fusion transcripts m-BCR/ABL, CBF beta/MYH11, and MLL/AFp1 which are the molecular equivalents of t(9;22)(q34,q11), inv16(p13;q22) and t(1;11)(p32;q23), respectively. The chimeric RNA will be useful as a control template in diagnostic RT-PCR strategies. It can also be further processed in translation systems leading to the corresponding chimeric oncoprotein. This approach can be easily used to create any hybrid RNA of interest.
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Affiliation(s)
- A Borkhardt
- Department of Pediatrics, Hematology and Oncology, University of Giessen, Germany
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Repp R, Borkhardt A, Haupt E, Kreuder J, Brettreich S, Hammermann J, Nishida K, Harbott J, Lampert F. Detection of four different 11q23 chromosomal abnormalities by multiplex-PCR and fluorescence-based automatic DNA-fragment analysis. Leukemia 1995; 9:210-5. [PMID: 7845020] [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: 01/27/2023]
Abstract
A nested polymerase chain reaction (PCR) protocol was developed for rapid detection of four different 11q23 abnormalities by a single PCR assay. During each of the two PCR rounds a sense primer located within exon 5 of the MLL gene at 11q23 was combined with four different antisense primers, each located within possible translocation partner genes at chromosomes 4, 6, 9, and 19, respectively. Except for the MLL primer all primers used during the second round of nested-PCR carried a characteristic fluorescence label at their 5'-end. Agarose gel analysis of the PCR products was sufficient to discriminate between the absence of any of the four MLL rearrangements and the presence of at least one of them. Discrimination of the four different MLL translocation partner genes was not possible by agarose gel analysis due to a molecular heterogeneity of the 11q23 breakpoints resulting in PCR products of variable size. For this reason, automatic fluorescence-based DNA-fragment analysis was used to exactly define the MLL translocation partner genes if a positive result had been obtained by agarose gel analysis. In patients with leukemia, this assay may enable a fast and highly sensitive detection of different 11q23 abnormalities, which usually correlate with poor clinical prognosis.
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Affiliation(s)
- R Repp
- Children's Hospital, University of Giessen, Germany
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