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Boctor D, Fenton T, Shourounis J, Galante G, Hassan W, Goulet O, Lambe C. The prevalence of feeding difficulties and potential risk factors in children with intestinal failure. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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2
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Boctor D, Fenton T, Hassan W, Shourounis J, Galante G, Goulet O, Lambe C. Eating behaviours in children with intestinal failure. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.117] [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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3
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Lambe C, Talbotec C, Kapel N, Goulet O. OR54: The Reve Study, Preliminary Results. A Monocentric Single-Arm Study to Characterize the Long-Term Safety and Efficacy of GLP-2 Analog (Teduglutide) in the Management of Short Bowel Syndrome in Pediatric Patients on Home-Parenteral Nutrition. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32526-9] [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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Mihatsch W, Fewtrell M, Goulet O, Molgaard C, Picaud JC, Senterre T. Reply letter to the comment of Christmann V on 2018 ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Calcium, phosphorus and magnesium. Clin Nutr 2019; 38:2465-2466. [PMID: 31421871 DOI: 10.1016/j.clnu.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 11/17/2022]
Affiliation(s)
- W Mihatsch
- Department of Pediatrics, Ulm University, Ulm and Helios Hospital, Pforzheim, Germany.
| | - M Fewtrell
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - O Goulet
- CHU Paris - Hôpital Necker-Enfants Malades, Paris, France
| | - C Molgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rigshospitalet, Denmark; Pediatric Nutrition Unit, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - J-C Picaud
- Service de Néonatologie et réanimation néonatale, Hôpital de la Croix-Rousse, Lyon, France; Department of Pediatrics, Claude Bernard University, Lyon, France
| | - T Senterre
- Service Universitaire de Néonatologie, Centre Hospitalier Régional (CHR) de la Citadelle, Liège, Belgium; Centre Hospitalier Universitaire (CHU) de Liège, Liege University, Liège, Belgium
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Mihatsch W, Fewtrell M, Goulet O, Molgaard C, Picaud JC, Senterre T, Braegger C, Bronsky J, Cai W, Campoy C, Carnielli V, Darmaun D, Decsi T, Domellöf M, Embleton N, Fewtrell M, Fidler Mis N, Franz A, Goulet O, Hartman C, Hill S, Hojsak I, Iacobelli S, Jochum F, Joosten K, Kolaček S, Koletzko B, Ksiazyk J, Lapillonne A, Lohner S, Mesotten D, Mihályi K, Mihatsch WA, Mimouni F, Mølgaard C, Moltu SJ, Nomayo A, Picaud JC, Prell C, Puntis J, Riskin A, Saenz De Pipaon M, Senterre T, Shamir R, Simchowitz V, Szitanyi P, Tabbers MM, Van Den Akker CH, Van Goudoever JB, Van Kempen A, Verbruggen S, Wu J, Yan W. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Calcium, phosphorus and magnesium. Clin Nutr 2018; 37:2360-2365. [DOI: 10.1016/j.clnu.2018.06.950] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/12/2022]
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6
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Duclaux-Loras R, Charbit-Henrion F, Neven B, Nowak J, Collardeau-Frachon S, Malcus C, Ray PF, Moshous D, Beltrand J, Goulet O, Cerf-Bensussan N, Lachaux A, Rieux-Laucat F, Ruemmele FM. Clinical Heterogeneity of Immune Dysregulation, Polyendocrinopathy, Enteropathy, X-Linked Syndrome: A French Multicenter Retrospective Study. Clin Transl Gastroenterol 2018; 9:201. [PMID: 30385752 PMCID: PMC6212456 DOI: 10.1038/s41424-018-0064-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/08/2018] [Indexed: 02/06/2023] Open
Abstract
Objective Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is an autoimmune disease caused by mutations in the forkhead box protein 3 gene (FOXP3), which encodes a key regulator of immune tolerance. The aim of this study was to describe the clinical heterogeneity of the disease in a national French cohort. Methods Multicenter retrospective study of patients diagnosed with IPEX syndrome caused by mutations in FOXP3. Results Thirty children from 26 families were included. Age at disease onset (median [first to third quartile]) was 1.5 mo [0–84] and at death 3.5 years [0–10.5] (n = 15) indicating a high heterogeneity. Initial presentation was diarrhoea (68%), type 1 diabetes (T1D; 25%), skin lesions (7%) and nephropathy (3%). During the course of the disease the following main symptoms were observed: diarrhoea (100%), skin lesions (85%), T1DM (50%), severe food allergies (39%), haematological disorders (28%), nephropathies (25%), hepatitis (14%) as well as the presence of a variety of autoantibodies. Immunosuppressive mono- or combination therapy led to improvement in eight children. Three boys displayed a stable disease course without any immunosuppressive medication. Overall 10-year survival rate was 43% (42% in transplanted patients and 52% in patients on immunosuppressive therapy). Five out of 22 identified FOXP3 mutations have not been described yet: c.−23 + 1G > A, c.−23 + 5G > A, c.264delC, c.1015C > T and c.1091A > G. The first two produced atypical, attenuated phenotypes. Missense and frameshift mutations affecting the forkhead domain were associated with poor survival (Gehan–Wilcoxon p = 0.002). Conclusion The broad phenotypic heterogeneity of IPEX raises questions about modifying factors and justifies early FOXP3 sequencing in suspected cases.
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Affiliation(s)
- R Duclaux-Loras
- Department of Paediatric GastroenterologyHepatology and Nutrition, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France. .,Université Paris Descartes-Sorbonne Paris Cité, Paris, France. .,INSERM, UMR1163, Laboratory of Intestinal Immunityand Imagine Institute, Paris, France.
| | - F Charbit-Henrion
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,INSERM, UMR1163, Laboratory of Intestinal Immunityand Imagine Institute, Paris, France.,Department of Pediatric, Gastroenterology Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - B Neven
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paediatric Haemato-Immunology Unit, Paris, France
| | - J Nowak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - S Collardeau-Frachon
- Department of Pathology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - C Malcus
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratory of Immunology, Lyon, France
| | - P F Ray
- Genetic Epigenetic and Therapies of Infertility, Institute for Advanced Biosciences, Inserm U1209, CNRS UMR 5309, Université Grenoble Alpes, 38000, Grenoble, France.,CHU de Grenoble, UF de Biochimie Génétique et Moléculaire, Grenoble, F-38000, France
| | - D Moshous
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paediatric Haemato-Immunology Unit, Paris, France
| | - J Beltrand
- Assistance Publique - Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Pediatric EndocrinologyDiabetology and Gynecology Department, Paris, France
| | - O Goulet
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,INSERM, UMR1163, Laboratory of Intestinal Immunityand Imagine Institute, Paris, France.,Department of Pediatric, Gastroenterology Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - N Cerf-Bensussan
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,INSERM, UMR1163, Laboratory of Intestinal Immunityand Imagine Institute, Paris, France
| | - A Lachaux
- Department of Paediatric GastroenterologyHepatology and Nutrition, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - F Rieux-Laucat
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,INSERM UMR 1163, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Paris, France
| | - F M Ruemmele
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,INSERM, UMR1163, Laboratory of Intestinal Immunityand Imagine Institute, Paris, France.,Department of Pediatric, Gastroenterology Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
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7
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Dabbas M, Khen-Dunlop N, Goulet O, Aigrain Y. Health and nutritional status following laparoscopic adjustable gastric banding (LAGB) in severely obese adolescents: Ten years after. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1123] [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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8
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Petit LM, Rabant M, Canioni D, Suberbielle-Boissel C, Goulet O, Chardot C, Lacaille F. Impacts of donor-specific anti-HLA antibodies and antibody-mediated rejection on outcomes after intestinal transplantation in children. Pediatr Transplant 2017; 21. [PMID: 28084679 DOI: 10.1111/petr.12847] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
Abstract
AMR is a risk factor for graft failure after SBTx. We studied impact of DSAs and AMR in 22 children transplanted between 2008 and 2012 (11 isolated SBTx, 10 liver inclusive Tx, and one modified multivisceral Tx). Three patients never developed DSA, but DSAs were found in seven in the pre-Tx period and de novo post-Tx in 19 children. Pathology revealed cellular rejection (15/19), with vascular changes and C4d+. Patients were treated with IV immunoglobulins, plasmapheresis, and steroids. Rescue therapy included antithymocyte globulins, rituximab, eculizumab, and bortezomib. Pathology and graft function normalized in 13 patients, graft loss occurred in two, and death in seven. At the end of the follow-up, 15 children were alive (68%), 13 with functioning graft (59%). Prognosis factors for poor outcome after Tx were the presence of symptoms at AMR suspicion (P +.033). DSAs were often found following SBTx, mostly de novo. Resistant ACR or severe AMR is still difficult to differentiate, with a high need for immunosuppression in both. DSAs may precede development of severe disease and pathology features on the graft: relationship and correlation need to be better investigated with larger groups before and after Tx.
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Affiliation(s)
- L-M Petit
- Unité d'Hépato-Gastroentérologie et Nutrition Pédiatriques, Hôpitaux Universitaires de Genève, Geneve, Switzerland
| | - M Rabant
- Service d'Anatomopathologie, Hôpital Necker Enfants Malades, Paris, France
| | - D Canioni
- Service d'Anatomopathologie, Hôpital Necker Enfants Malades, Paris, France
| | | | - O Goulet
- Service d'Hépato-Gastroentérologie et Nutrition Pédiatriques, Hôpital Necker Enfants Malades, Paris, France
| | - C Chardot
- Service de Chirurgie Viscérale Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
| | - F Lacaille
- Service d'Hépato-Gastroentérologie et Nutrition Pédiatriques, Hôpital Necker Enfants Malades, Paris, France
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Lambe C, Grosso C, Talbotec C, Abi Nader E, Goulet O. PT10.6: Evaluation of Intestinal Failure in Children by Using Citrulline Levels and Parenteral Nutrition Dependency Index. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30343-0] [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: 11/26/2022]
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10
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Abi Nader E, Acramel A, Lambe C, Talbotec C, Manzali E, Colomb-Jung V, Goulet O. PT10.4: Bone Health and Growth of Children Receiving Long-Term Parenteral Nutrition. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30341-7] [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: 10/21/2022]
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11
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Acramel A, Berrabah S, Postaire M, Lengliné H, Lambe C, Talbotec C, Poisson C, Rocha A, Goulet O. SUN-P192: Drugs Compatibility with Parenteral Nutrition. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30535-0] [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: 11/16/2022]
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12
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Goulet O. MON-P224: Home Parenteral Nutrition (Home-PN) in France: A National Survey. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30858-5] [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: 11/27/2022]
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Abi Nader E, Lambe C, Talbotec F, Lacaille F, Pigneur B, Garnier-Lengliné H, Petit LM, Poisson C, Rocha A, Corriol O, Acramel A, Colomb-Jung V, Goulet O. Résultats au long cours de la nutrition parentérale à domicile en pédiatrie. NUTR CLIN METAB 2016. [DOI: 10.1016/j.nupar.2016.01.022] [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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14
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Bocquet A, Turck D, Briend A, Chouraqui JP, Darmaun D, Dupont C, Feillet F, Frelut ML, Girardet JP, Hankard R, Goulet O, Rieu D, Rozé JC, Simeoni U, Vidailhet M. [Are infant formulae named "taking over from breastfeeding" useful?]. Arch Pediatr 2015; 22:1213-6. [PMID: 26552623 DOI: 10.1016/j.arcped.2015.09.020] [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] [Received: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Affiliation(s)
- A Bocquet
- Université de Franche-Comté, 25000 Besançon, France.
| | - D Turck
- Université de Lille et Inserm U995, 59037 Lille, France
| | - A Briend
- Institut de recherche pour le développement, 13572 Marseille, France
| | | | - D Darmaun
- Université Nantes-Atlantique, 44300 Nantes, France
| | - C Dupont
- Université Paris Descartes, 75006 Paris, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M L Frelut
- Endocrinologie-diabète de l'enfant, hôpitaux universitaires Paris-Sud, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - J P Girardet
- Université Pierre-et-Marie-Curie-Paris 6, 75005 Paris, France
| | - R Hankard
- Université de Tours et Inserm U1069, 37000 Tours, France
| | - O Goulet
- Université Paris Descartes, 75006 Paris, France
| | - D Rieu
- Université Montpellier-1, 34000 Montpellier, France
| | - J C Rozé
- Université Nantes-Atlantique, 44300 Nantes, France
| | - U Simeoni
- Université de Lausanne, CH-1011, Lausanne, Suisse
| | - M Vidailhet
- Université Paris Descartes, 75006 Paris, France
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Billiauws L, Armengol Debeir L, Poullenot F, Luton D, Corcos O, Goulet O, Lerebours E, Joly F. MON-PP119: Pregnancy is Possible During Long Term Home Parenteral Nutrition in Patients Having Chronic Intestinal Failure. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30551-3] [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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Abi Nader E, Colomb-Jung V, Lambe C, Talbotec C, Lacaille F, Pigneur B, Garnier-Lengline H, Petit L, Rocha A, Poisson C, Corriol O, Goulet O. CO-06 – Nutrition parentérale à domicile et insuffisance intestinale. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30110-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: 11/24/2022]
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17
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Turck D, Dupont C, Vidailhet M, Bocquet A, Briend A, Chouraqui JP, Darmaun D, Feillet F, Frelut ML, Girardet JP, Hankard R, Goulet O, Rieu D, Rozé JC, Simeoni U. [Complementary feeding: Evolving concepts and recommendations]. Arch Pediatr 2015; 22:457-60. [PMID: 25865427 DOI: 10.1016/j.arcped.2015.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- D Turck
- Université de Lille, Inserm U995, 59037 Lille, France.
| | - C Dupont
- Université Paris Descartes, 75006 Paris, France
| | | | - A Bocquet
- Université de Franche-Comté, 25000 Besançon, France
| | - A Briend
- Institut de recherche pour le développement, 13572 Marseille, France
| | | | - D Darmaun
- Université Nantes-Atlantique, 44300 Nantes, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M-L Frelut
- Endocrinologie-diabète de l'enfant, hôpitaux universitaires Paris-Sud, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre France
| | - J-P Girardet
- Université Pierre-et-Marie-Curie-Paris 6, 75005 Paris, France
| | - R Hankard
- Université de Tours, Inserm U1069, 37000 Tours, France
| | - O Goulet
- Université Paris Descartes, 75006 Paris, France
| | - D Rieu
- Université Montpellier-1, 34000 Montpellier, France
| | - J-C Rozé
- Université Nantes-Atlantique, 44300 Nantes, France
| | - U Simeoni
- Université de Lausanne, 1011 Lausanne, Suisse
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Besancon A, Ferneiny M, Gitiaux C, Brochard K, Quartier P, Brousse N, Goulet O, Salomon R, Dupic L, Bader-Meunier B, Bodemer C. Formes graves de dermatomyosites juvéniles en réanimation : présentation, prise en charge et évolution. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.068] [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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Girardet JP, Rieu D, Bocquet A, Bresson JL, Briend A, Chouraqui JP, Darmaun D, Dupont C, Frelut ML, Hankard R, Goulet O, Simeoni U, Turck D, Vidailhet M. Les enfants consomment-ils trop de sel ? Arch Pediatr 2014; 21:521-8. [DOI: 10.1016/j.arcped.2014.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/14/2014] [Indexed: 01/11/2023]
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20
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Ganousse-Mazeron S, Lacaille F, Colomb-Jung V, Talbotec C, Ruemmele F, Sauvat F, Chardot C, Canioni D, Jan D, Revillon Y, Goulet O. Assessment and outcome of children with intestinal failure referred for intestinal transplantation. Clin Nutr 2014; 34:428-35. [PMID: 25015836 DOI: 10.1016/j.clnu.2014.04.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [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: 12/22/2012] [Revised: 04/16/2014] [Accepted: 04/18/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Chronic intestinal failure (CIF) requires long term parenteral nutrition (PN) and, in some patients, intestinal transplantation (ITx). Indications and timing for ITx remain poorly defined. In the present study we aimed to analyze causes and outcome of children with CIF. METHODS 118 consecutive patients referred to our institution were assessed by a multidisciplinary team and four different categories were defined retrospectively based on their clinical course: Group 1: patients with reversible intestinal failure; group 2: patients unsuitable for ITx, group 3: patients listed for ITx; group 4: patients stable under PN. Analysis involved comparison between groups for nutritional status, central venous catheter (CVC) related complications, liver disease, and outcome after transplantation by using non parametric tests, Mann-Whitney tests, Kruskal-Wallis, Wilcoxon signed rank tests and chi square distribution for percentage. RESULTS 118 children (72 boys) with a median age of 15 months at referral (2 months-16 years) were assessed. Etiology of IF was short bowel syndrome [n = 47], intractable diarrhea of infancy [n = 37], total intestinal aganglionosis [n = 18], and chronic intestinal pseudoobstruction [n = 17]. Most patients (89.8%) were totally PN dependent, with 48 children (40.7%) on home-PN prior to admission. Nutritional status was poor with a median body weight at -1.5 z-score (ranges: -5 to +2.5) and median length at -2.0 z-score (ranges: -5.5 to +2.3). The mean number of CVC inserted per patient was 5.2 (range 1-20) and the mean number of CRS per patient was 5.5 (median: 5; range 0-12) Fifty-five patients (46.6%) had thrombosis of ≥2 main venous axis. At admission 34.7% of patients had elevated bilirubin (≥50 μmol/l), and 19.5% had platelets <100,000/ml, and 15% had both. Liver biopsy performed in 79 children was normal (n = 4), or showed F1 or F2 fibrosis (n = 29), bridging fibrosis F3 (n = 20), or cirrhosis (n = 26). Group 1 included 10 children finally weaned from PN (7-years survival: 100%). Group 2 included 12 children with severe liver disease and associated disorders unsuitable for transplantation (7-years survival: 16.6%). Group 3 included 66 patients (56%) who were listed for small bowel or liver-small bowel transplantation, 62/66 have been transplanted (7 years survival: 74.6%). Factors influencing outcome after liver-ITx were body weight (p < .004), length (p < .001), pre-Tx bilirubin plasma level (p < .001) and thrombosis (p < .01) for isolated ITx, Group 4 included 30 children (25.4%) with irreversible IF considered as potential candidates for isolated ITx. Four children were lost from follow up and 3 died within 2 years (survival 88.5%). Among potential candidates, the following parameters improved significantly during the first 12 months of follow up: Body weight (p.0001), length (p < .0001) and bilirubin (p < .0001). CONCLUSIONS many patients had a poor nutritional status with severe complications especially liver disease. PN related complications were the most relevant indication for ITx, but also a negative predictor for outcome. Early patient referral for Tx-assessment might help to identify and separate children with irreversible IF from children with transient IF or uncomplicated long-term PN, allowing to adapt a patient-based treatment strategy including or not ITx.
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Affiliation(s)
- S Ganousse-Mazeron
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - F Lacaille
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - V Colomb-Jung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - C Talbotec
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - F Ruemmele
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - F Sauvat
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - C Chardot
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - D Canioni
- Department of Pathology, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - D Jan
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - Y Revillon
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France
| | - O Goulet
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France.
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Artru S, Lacaille F, Lambe C, Talbotec C, Pigneur B, Lengline H, Gastineau S, Ruemmele F, Chardot C, Irtan S, Colomb V, Goulet O. O28 Syndrome de grêle ultracourt (SGUC) : comparaison entre nutrition parentérale prolongée et transplantation intestinale. NUTR CLIN METAB 2013. [DOI: 10.1016/s0985-0562(13)70300-5] [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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Goulet O, Olieman J, Ksiazyk J, Spolidoro J, Tibboe D, Köhler H, Yagci RV, Falconer J, Grimble G, Beattie RM. Neonatal short bowel syndrome as a model of intestinal failure: physiological background for enteral feeding. Clin Nutr 2012; 32:162-71. [PMID: 23159212 DOI: 10.1016/j.clnu.2012.09.007] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 08/26/2012] [Accepted: 09/12/2012] [Indexed: 01/17/2023]
Abstract
Intestinal failure (IF) is a well identified clinical condition, which is characterised by the reduction of functional gut capacity below the minimum needed for adequate digestion and absorption of nutrients for normal growth in children. Short bowel syndrome (SBS) is the leading cause of IF in neonates, infants and young children usually as a result of extensive intestinal resection during the neonatal period. Simultaneously maintaining optimal nutritional status and achieving intestinal adaptation is a clinical challenge in short bowel patients. Both growth and development of the child as well as gut adaptation should be considered synergistically as primary outcome parameters. Enteral nutrition (EN) can be introduced orally and/or by tube feeding (TF). Several controversies over nutritional treatment of children with SBS related intestinal failure remain. As reported from different centres around the world, most practices are more "experienced based" rather than "evidence based". This is partly due to the small number of patients with this condition. This review (based on a consensus) discusses the physiological principles and nutritional management, including the type of diet and route of delivery. Perspectives in optimizing intestinal adaptation and reducing the consequences of small intestinal bacterial overgrowth are also discussed.
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Affiliation(s)
- O Goulet
- Department of Pediatric Gastroenterology-Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Failure Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris Descartes, France.
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Vidailhet M, Mallet E, Bocquet A, Bresson JL, Briend A, Chouraqui JP, Darmaun D, Dupont C, Frelut ML, Ghisolfi J, Girardet JP, Goulet O, Hankard R, Rieu D, Simeoni U, Turck D. Vitamin D: still a topical matter in children and adolescents. A position paper by the Committee on Nutrition of the French Society of Paediatrics. Arch Pediatr 2012; 19:316-28. [PMID: 22284232 DOI: 10.1016/j.arcped.2011.12.015] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 12/16/2011] [Indexed: 12/29/2022]
Abstract
The aims of the present position paper by the Committee on Nutrition of the French Society of Paediatrics were to summarize the recently published data on vitamin D in infants, children and adolescents, i.e., on metabolism, physiological effects, and requirements and to make recommendations on supplementation after careful review of the evidence. Scientific evidence indicates that calcium and vitamin D play key roles in bone health. The current evidence, limited to observational studies, however, does not support other benefits for vitamin D. More targeted research should continue, especially interventional studies. In the absence of any underlying risk of vitamin D deficiency, the recommendations are as follows: pregnant women: a single dose of 80,000 to 100,000 IU at the beginning of the 7th month of pregnancy; breastfed infants: 1000 to 1200 IU/day; children less than 18 months of age, receiving milk supplemented with vitamin D: an additional daily dose of 600 to 800 IU; children less than 18 months of age receiving milk not supplemented with vitamin D: daily dose of 1000 to 1200 IU; children from 18 months to 5 years of age: 2 doses of 80,000 to 100,000 IU every winter (November and February). In the presence of an underlying risk of vitamin D deficiency (dark skin; lack of exposure of the skin to ultraviolet B [UVB] radiation from sunshine in summer; skin disease responsible for decreased exposure of the skin to UVB radiation from sunshine in summer; wearing skin-covering clothes in summer; intestinal malabsorption or maldigestion; cholestasis; renal insufficiency; nephrotic syndrome; drugs [rifampicin; antiepileptic treatment: phenobarbital, phenytoin]; obesity; vegan diet), it may be justified to start vitamin D supplementation in winter in children 5 to 10 years of age as well as to maintain supplementation of vitamin D every 3 months all year long in children 1 to 10 years of age and in adolescents. In some pathological conditions, doses of vitamin D can be increased. If necessary, the determination of 25(OH) vitamin D serum concentration will help determine the level of vitamin D supplementation.
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Affiliation(s)
- M Vidailhet
- Service de pédiatrie et génétique clinique, hôpital d'enfants, université Henri-Poincaré, allée du Morvan, 54511 Vandœuvre-les-Nancy, France.
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Rubio A, Pigneur B, Garnier-Lengliné H, Talbotec C, Schmitz J, Canioni D, Goulet O, Ruemmele FM. The efficacy of exclusive nutritional therapy in paediatric Crohn's disease, comparing fractionated oral vs. continuous enteral feeding. Aliment Pharmacol Ther 2011; 33:1332-9. [PMID: 21507029 DOI: 10.1111/j.1365-2036.2011.04662.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nutritional therapy has an established role as induction therapy in paediatric Crohn's disease. However, compliance is the main difficulty and may be greatly influenced by the administration route. AIM To analyse the efficiency of exclusive nutrition to induce remission in children with Crohn's disease comparing fractionated oral vs. continuous enteral feeding. METHODS The medical records of 106 patients treated by exclusive nutritional therapy [Modulen IBD (R)] by either oral or continuous enteral route were reviewed retrospectively. Comparative analyses of remission rates, changes in anthropometry, Paediatric Crohn's disease Activity Index (PCDAI), laboratory indices and compliance rates were performed. RESULTS On exclusive enteral nutrition, at 8 weeks, 34/45 patients achieved remission in the oral group (75% on intention-to-treat analysis) and 52/61 (85%) in the enteral nutrition group (P = 0.157). All patients showed a significant decrease in disease severity assessed by PCDAI (P < 0.0001) and significant improvements in anthropometric measures and inflammatory indices. No difference was observed whether Modulen IBD was administered orally or by continuous enteral feeding, apart from weight gain, which was greater in the enteral group (P = 0.041). In a subgroup of patients, mucosal healing was evidenced on follow-up endoscopies showing a clear correlation to remission. Compliance rates (87% and 90%) were similar. Nevertheless, noncompliant patients had lower mucosal healing and remission rates. CONCLUSIONS These retrospective data suggest that the use of fractionated oral nutritional therapy might be as efficacious as continuous enteral administration to induce remission and mucosal healing in children with Crohn's disease. However, appropriate prospective clinical trials are needed to confirm these findings.
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Affiliation(s)
- A Rubio
- Pediatric Gastroenterology Unit, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, INSERM, Université Paris Descartes, France
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Ghisolfi J, Vidailhet M, Fantino M, Bocquet A, Bresson JL, Briend A, Chouraqui JP, Darmaun D, Dupont C, Frelut ML, Girardet JP, Goulet O, Hankard R, Rieu D, Turck D. Lait de vache ou lait de croissance : quel lait recommander pour les enfants en bas âge (1–3 ans) ? Arch Pediatr 2011; 18:355-8. [DOI: 10.1016/j.arcped.2010.12.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 12/29/2010] [Indexed: 11/15/2022]
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Dupont-Lucas C, Bellaïche M, Mouterde O, Bernard O, Besnard M, Campeotto F, Languepin J, Mosca A, Goulet O, Vannerom PY, Mougenot JF, Cardey J, Cézard JP, Viala J. [Capsule endoscopy in children: which are the best indications?]. Arch Pediatr 2011; 17:1264-72. [PMID: 20627490 DOI: 10.1016/j.arcped.2010.04.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 01/18/2010] [Accepted: 04/27/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND STUDY AIMS Capsule endoscopy (CE) is a novel and noninvasive means of investigating the small bowel. In children, the best CE indications have not yet been fully appraised. The aim of this study was to evaluate the diagnostic yield of CE in different pediatric pathologies. PATIENTS AND METHODS We retrospectively reviewed every CE performed in children in two French pediatric hospitals between March 2002 and June 2009. Seventy-nine CEs were performed on 70 children (mean age, 10.6 years; range, 2.2-18.0); 52 boys and 18 girls. The indications were iron deficiency anemia (24%), obscure gastrointestinal bleeding (14%), polyposis syndromes (16%), suspected Crohn disease (15%), unresponsive Crohn disease (10%), graft-versus-host disease (10%), and other (10%). RESULTS Of the 79 CEs, 69 reached the cecum (87%). Only one occlusion occurred in a case of stenosing Crohn disease, requiring surgical removal. In addition, technical difficulties led to an incomplete small bowel study in 12 cases (16%). The CE showed small bowel lesions in 42 cases (53%). The diagnostic yield was 27% in obscure gastrointestinal bleeding, 37% in iron-deficiency anemia, 42% in suspected Crohn disease, 88% in unresponsive Crohn disease, 62% in polyposis syndromes, and 88% in graft-versus-host disease. CONCLUSION In children, CE is well tolerated and can be performed in children as young as 2.2 years of age. Its diagnostic yield is highest in polyposis syndromes, unresponsive Crohn disease, and graft-versus-host disease.
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Affiliation(s)
- C Dupont-Lucas
- Service de pédiatrie, hôpital Femme-Enfant-Hématologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 09, France.
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Galmiche L, Jaubert F, Sauvat F, Sarnacki S, Goulet O, Assouline Z, Vedrenne V, Lebre AS, Boddaert N, Brousse N, Chrétien D, Munnich A, Rötig A. Normal oxidative phosphorylation in intestinal smooth muscle of childhood chronic intestinal pseudo-obstruction. Neurogastroenterol Motil 2011; 23:24-9, e1. [PMID: 20879992 DOI: 10.1111/j.1365-2982.2010.01595.x] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic intestinal pseudo-obstruction (CIPO) is a severe disease of the digestive tract motility. In pediatric population, CIPO remains of unknown origin for most patients. Chronic intestinal pseudo-obstruction is also a common feature in the course of mitochondrial oxidative phosphorylation disorders related for some patients to mutations in TYMP, POLG1, mtDNA tRNA(leu(UUR)) or tRNA(lys) genes. We hypothesized that CIPOs could be the presenting symptom of respiratory chain enzyme deficiency and thus we investigated oxidative phosphorylation in small bowel and/or colon smooth muscle of primary CIPO children. METHODS We studied eight children with CIPO and 12 pediatric controls. We collected clinical, radiological and pathological data and measured respiratory chain enzymatic activity in isolated smooth muscle of the small bowel and/or the colon. We also sequenced TYMP, POLG, mtDNA tRNA(leu(UUR)) and tRNA(lys) genes. KEY RESULTS Neither pathological nor radiological data were in favor of a mitochondrial dysfunction. No respiratory chain enzyme deficiency was detected in CIPO children. In myogenic CIPO, respiratory enzymes and citrate synthase activities were increased in small bowel and/or colon whereas no abnormality was noted in neurogenic and unclassified CIPO. Levels of enzyme activities were higher in control small bowel than in control colon muscle. Sequencing of TYMP, POLG, mtDNA tRNA(leu(UUR)) and tRNA(lys) genes and POLG gene did not reveal mutation for any of the patients. CONCLUSIONS & INFERENCES The normal enzymatic activities as the lack of radiological and genetic abnormalities indicate that, at variance with adult patients, oxidative phosphorylation deficiency is not a common cause of childhood CIPO.
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Affiliation(s)
- L Galmiche
- Department of Pathology and Tumorothèque, Faculty of Medicine, Hôpital Necker Enfants-Malades and Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
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Affiliation(s)
- P B Sullivan
- Oxford University Department of Paediatrics, Oxford Children's Hospital, Oxford, OX3 9DU, UK.
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Goulet O. Nutrition in paediatric Crohn’s disease. South African Journal of Clinical Nutrition 2010. [DOI: 10.1080/16070658.2010.11734267] [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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Goulet O. Intestinal failure in childhood. South African Journal of Clinical Nutrition 2010. [DOI: 10.1080/16070658.2010.11734259] [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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Rubio A, Ponvert C, Goulet O, Scheinmann P, De Blic J. Allergic and nonallergic hypersensitivity reactions to silicone: a report of one case. Allergy 2009; 64:1555-1556. [PMID: 19624558 DOI: 10.1111/j.1398-9995.2009.02086.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ghisolfi J, Turck D, Vidailhet M, Girardet JP, Bocquet A, Bresson JL, Chouraqui JP, Darmaun D, Dupont C, Frelut ML, Goulet O, Rieu D, Rigo J. [Promotion of breastfeeding and information to parents on infant formulas: are these 2 communication policies really incompatible?]. Arch Pediatr 2009; 16:971-5. [PMID: 19497715 DOI: 10.1016/j.arcped.2009.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 03/31/2009] [Indexed: 11/30/2022]
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El Taguri A, Dabbas Tyan M, Goulet O, Ricour C. The use of body mass index for measurement of fat mass in children is highly dependant on abdominal fat. East Mediterr Health J 2009. [DOI: 10.26719/2009.15.3.563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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El Taguri A, Dabbas-Tyan M, Goulet O, Ricour C. The use of body mass index for measurement of fat mass in children is highly dependant on abdominal fat. East Mediterr Health J 2009; 15:563-573. [PMID: 19731772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We examined the relationship between body fat and body mass index (BMI) in a multiethnic population of obese children. BMI z-scores were compared to DEXA measures of whole body composition and regional fat distribution. Fat mass index (FMI) was best predicted by the equation: 1/[(0.159- 0.013 x percentile of total abdominal fat)- (0.01 x BMI z-score)], where percentile of abdominal fat ranges from 1 to 5. Predicted FMI had high agreement with FMI measured by DEXA. There were no detectable differences in this relation between different ethnic groups. Both BMI and abdominal fat should be used as a proxy to determine adiposity.
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Affiliation(s)
- A El Taguri
- Service de gastroenterologie et nutrition pédiatrique, Hôpital Necker Enfants malades, Paris, France.
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Ruemmele FM, Bier D, Marteau P, Rechkemmer G, Bourdet-Sicard R, Walker WA, Goulet O. Clinical evidence for immunomodulatory effects of probiotic bacteria. J Pediatr Gastroenterol Nutr 2009; 48:126-41. [PMID: 19179874 DOI: 10.1097/mpg.0b013e31817d80ca] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Close, tightly orchestrated interactions between the intestinal epithelium and the mucosa-associated immune system are critical for normal intestinal absorptive and immunological functions. Recent data indicate that commensal intestinal microbiota represents a major modulator of intestinal homeostasis. This review analyzes the process of intestinal colonization and the interaction of microbiota with the intestinal epithelium and mucosal immune system, with special reference to the first years of extrauterine life. Dysregulation of the symbiotic interaction between intestinal microbiota and the mucosa may result in a pathological condition with potential clinical repercussions. Based on the concept that there is a beneficial and symbiotic relation between the host and endogenous microbiota, strategies aimed at directly modulating intestinal microbiota with regard to disease prevention or treatment have been developed. One strategy involves administering viable probiotic bacteria. Clinical evidence for the beneficial effect of probiotics in the prevention and/or treatment of necrotizing enterocolitis, infectious and antibiotic-associated diarrhea, allergic diseases, and inflammatory bowel disorders is reviewed herein.
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Affiliation(s)
- F M Ruemmele
- Department of Pediatrics, Hôpital Necker-Enfants Malades, Paris, France.
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Girardet J, Bocquet A, Bresson J, Chouraqui J, Darmaun D, Dupont C, Frelut M, Ghisolfi J, Goulet O, Rieu D, Rigo J, Thibault H, Turck D, Vidailhet M. Le programme national nutrition santé (PNNS) : quels effets sur la santé des enfants ? Arch Pediatr 2009; 16:3-6. [DOI: 10.1016/j.arcped.2008.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 10/14/2008] [Indexed: 11/26/2022]
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Sauvat F, Fusaro F, Lacaille F, Dupic L, Bourdaud N, Colomb V, Hugot JP, Aigrain Y, Goulet O, Revillon Y. Is intestinal transplantation the future of children with definitive intestinal insufficiency? Eur J Pediatr Surg 2008; 18:368-71. [PMID: 19023853 DOI: 10.1055/s-2008-1038928] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
UNLABELLED Intestinal transplantation (IT) is the newest and most difficult of organ transplantations. The first ever (1987) and the longest surviving (1989) IT were performed in our institution. However, IT still has to demonstrate its benefit to children on long-term parenteral nutrition (PN). We tried to clarify this aspect by looking back at our 13 years' experience. PATIENTS From 1994 to December 2007, 74 IT were performed in 69 children, 39 with an isolated small bowel (IT), 35 combined with a liver transplant (LITx). The indications were: short bowel syndrome (n = 25), congenital mucosal diseases (n = 22), and motility disorders (n = 22). Median age at transplantation was 5 years (1 - 17 years). Follow-up was 1 to 12 years (median 5 years). RESULTS Thirty-one children have a functioning graft (42 %), 15/39 IT, 16/35 LITx. They are at home without PN, with a good quality of life. One child is PN-dependent 1.5 years post IT. Post IT, 16 children were detransplanted: 12 early on (1 for mechanical complications, 11 because of resistant rejection; 3 less than 3 years, one 9 years post SBT (chronic rejection). In 2 noncompliant teenagers, PN was reintroduced (one was detransplanted later on). Several years post LITx, 2 children underwent bowel detransplantation due to an acute viral infection complicated with rejection. Twenty-two children died (32 %, 8 IT, 14 LITx), 18 early on from infectious or surgical complications, 4 more than 1 year post IT, 3 after retransplantation (1 in another unit). Bad prognostic factors are multiple previous surgeries, an older age (> 7 y), and chronic intestinal pseudo-obstruction. DISCUSSION Complications post IT are frequent and life-threatening, especially early on: rejection (IT), infections (LITx). Later on, the rate of complications decreases but remains significant, especially in noncompliant patients. However we describe here a 13-year learning curve; the recent results are encouraging with regard to control of rejection and viral infections. CONCLUSION Intestinal transplantation is indicated only in selected patients in whom long-term PN cannot be performed safely any more. In every child with intestinal insufficiency, the therapeutic strategy must be discussed early on in order to perform IT at the right time under optimal conditions. IT should evolve from being a "rescue" procedure to becoming a true therapeutic option.
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Affiliation(s)
- F Sauvat
- UFR Necker-Enfants Malades, University René Descartes Paris V, FAMA de Transplantation Intestinale, AP-HP and the , National Reference Centre for Rare Digestive Diseases, Paris, France.
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Halabi-Tawil M, Ruemmele FM, Fraitag S, Rieux-Laucat F, Neven B, Brousse N, De Prost Y, Fischer A, Goulet O, Bodemer C. Cutaneous manifestations of immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome. Br J Dermatol 2008; 160:645-51. [PMID: 18795917 DOI: 10.1111/j.1365-2133.2008.08835.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare disorder characterized by neonatal autoimmune enteropathy, diabetes and thyroiditis, food allergies and skin rash. IPEX syndrome is caused by mutations in FOXP3, a master control gene of regulatory T cells (Tregs), resulting in absent or dysfunctional Tregs. Data in the literature are scarce and the cutaneous manifestations are rarely depicted. OBJECTIVES To evaluate the frequency and characteristics of cutaneous manifestations found in IPEX. METHODS Retrospective single-centre study of a case series of IPEX. Patients' data were retrieved from medical files and numerous parameters concerning general and cutaneous characteristics of the disease were recorded. RESULTS Ten children with IPEX were studied. Cutaneous involvement was present in seven of 10 children; age at onset was 0-4 months, median 1.5. All patients presented with atopic dermatitis (AD). Three presented more psoriasiform lesions. Eczema was severe; most affected areas were lower limbs, trunk and face. Pruritus was present in four of seven, and painful fissurary cheilitis in four of seven. Hyper-IgE was found in seven of 10 and hypereosinophilia in five of 10. Skin biopsies showed eczematiform or psoriasiform features. Affected patients were improved by dermocorticoids; no clear improvement was obtained with immunosuppressive regimens. Other features were urticaria secondary to food allergies and staphylococcal sepsis, mostly Staphylococcus aureus and catheter related. CONCLUSIONS AD seems to be a frequent finding in IPEX syndrome, which is characterized by Treg anomalies. This hints to a possible role of Tregs in AD, which is then discussed in this study.
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Affiliation(s)
- M Halabi-Tawil
- Department of Dermatology, APHP, Nôpital Necker-Enfants Malades, Paris, France
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Desgranges M, Ruemmele FM, Duquesnes A, Ginies JL, Goulet O, Quartier P, Bader-Meunier B. Inflammatory arthritis associated with inflammatory bowel disease in children. Pediatr Rheumatol Online J 2008. [PMCID: PMC3333932 DOI: 10.1186/1546-0096-6-s1-p135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Vidailhet M, Bocquet A, Bresson JL, Briend A, Chouraqui JP, Dupont C, Darmaun D, Frelut ML, Ghisolfi J, Girardet JP, Goulet O, Putet G, Rieu D, Rigo J, Turck D. Prévention par l’acide folique des défauts de fermeture du tube neural : la question n’est toujours pas réglée. Arch Pediatr 2008; 15:1223-31. [DOI: 10.1016/j.arcped.2008.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 04/13/2008] [Indexed: 10/21/2022]
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de Serre NPM, Canioni D, Lacaille F, Talbotec C, Dion D, Brousse N, Goulet O. Evaluation of c4d deposition and circulating antibody in small bowel transplantation. Am J Transplant 2008; 8:1290-6. [PMID: 18444932 DOI: 10.1111/j.1600-6143.2008.02221.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Antibody-mediated rejection (AMR) consensus criteria are defined in kidney and heart transplantation by histological changes, circulating donor-specific antibody (DSA), and C4d deposition in affected tissue. AMR consensus criteria are not yet identified in small bowel transplantation (SBTx). We investigated those three criteria in 12 children undergoing SBTx, including one retransplantation and four combined liver-SBTx (SBTx), with a follow-up of 12 days to 2 years. All biopsies (91) were evaluated with a standardized grading scheme for acute rejection (AR), vascular lesions and C4d expression. Sera were obtained at day 0 and during the follow-up. C4d was expressed in 37% of biopsies with or without AR, but in 50% of biopsies with severe vascular lesions. In addition, vascular lesions were always associated with AR and a poor outcome. All children with AR (grade 2 or 3) observed before the third month died or lost the graft. DSA were never found in any studied sera. We found no evidence that C4d deposition was of any clinical relevance to the outcome of SBTx. However, the grading of vascular lesions may constitute a useful marker to identify AR that is potentially resistant to standard treatment, and for which an alternative therapy should be considered.
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Sauvat F, Fusaro F, Lacaille F, Bourdaud N, Dupic L, Colomb V, Aigrain Y, Hugot J, Goulet O, Revillon Y. SFCP-032 – Chirurgie viscérale – Etat actuel de la transplantation intestinale en France. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)71984-5] [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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Lacaille F, Vass N, Sauvat F, Canioni D, Colomb V, Talbotec C, De Serre NPM, Salomon J, Hugot JP, Cézard JP, Révillon Y, Ruemmele FM, Goulet O. Long-term outcome, growth and digestive function in children 2 to 18 years after intestinal transplantation. Gut 2008; 57:455-61. [PMID: 18079282 DOI: 10.1136/gut.2007.133389] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
OBJECTIVE Small bowel (SB) transplantation (Tx), long considered a rescue therapy for patients with intestinal failure, is now a well recognised alternative treatment strategy to parental nutrition (PN). In this retrospective study, we analysed graft functions in 31 children after SBTx with a follow-up of 2-18 years (median 7 years). PATIENTS Twelve children had isolated SBTx, 19 had combined liver-SBTx and 17 received an additional colon graft. Growth, nutritional markers, stool balance studies, endoscopy and graft histology were recorded every 2-3 years post-Tx. RESULTS All children were weaned from PN after Tx and 26 children remained PN-free. Enteral nutrition was required for 14/31 (45%) patients at 2 years post-Tx. All children had high dietary energy intakes. The degree of steatorrhoea was fairly constant, with fat and energy absorption rates of 84-89%. Growth parameters revealed at transplantation a mean height Z-score of -1.17. After Tx, two-thirds of children had normal growth, whereas in one-third, Z-scores remained lower than -2, concomitant to a delayed puberty. Adult height was normal in 5/6. Endoscopy and histology analyses were normal in asymptomatic patients. Chronic rejection occurred only in non-compliant patients. Five intestinal grafts were removed 2.5-8 years post-Tx for acute or chronic rejection. CONCLUSIONS This series indicates that long-term intestinal autonomy for up to 18 years is possible in the majority of patients after SBTx. Subnormal energy absorption and moderate steatorrhoea were often compensated for by hyperphagia, allowing normal growth and attainment of adult height. Long-term compliance is an important pre-requisite for long-term graft function.
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Affiliation(s)
- F Lacaille
- Pediatric Gastroenterology-Hepatology-Nutrition Unit, Necker-Enfants malades Hospital, 149 rue de Sèvres, 75015 Paris, France.
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Abstract
The aim of the study was to measure the changes in energy expenditure (EE) and respiratory quotient (RQ) induced by fever in children receiving total parenteral nutrition (TPN). Ten children aged 1-16 years (weight for height: 104.5 +/- 13%) were included. They underwent two EE recordings of 3 h duration using indirect calorimetry, during a febrile (38.9 +/- 0.5 degrees C) and afebrile conditions, after parameters (nutritional intake, ambient temperature) being equal. The EE, (febrile phase) was significantly higher than the EE(2) (afebrile) (2.13 +/- 0.48 vs 1.78 +/- 0.42 kcal/kg/h; P < 0.01). Increase in EE was significantly correlated with body temperature (r = 0.92, P < 0.001). The slope of the regression line indicates an increase of 16.2% in EE per degree of fever. By dividing the individual increase in EE by the individual increase in temperature, the energy expenditure during fever is 11.3% per unit rise ( degrees C). During the febrile phase urinary nitrogen excretion was significantly higher (280 +/- 90 vs 210 +/- 70 mg/kg fat free mass/day, P < 0.02). The RQ during the febrile phase (0.90 +/- 0.13) did not differ significantly from mean RQ during the afebrile phase (0.95 +/- 0.07). Fever due to infection or inflammatory process is partly responsible for an hypermetabolic state including increased EE.
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Affiliation(s)
- M Benhariz
- Department of Pediatric Gastroenterology and Nutrition, Necker-Enfants Malades University Hospital, 149 rue de Sèvres, 75743 Paris Cedex 15, France
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Uhlen S, Belbouab R, Narebski K, Goulet O, Schmitz J, Cézard JP, Turck D, Ruemmele FM. Efficacy of methotrexate in pediatric Crohn's disease: a French multicenter study. Inflamm Bowel Dis 2006; 12:1053-7. [PMID: 17075346 DOI: 10.1097/01.mib.0000235103.47280.bb] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Immunosuppressors play a major role in maintaining remission in Crohn's disease (CD). In patients who do not tolerate or escape therapy with azathioprine (AZA)/6-mercaptopurine, there is a marked need for other immunosuppressive drugs. The aim of the present study was to evaluate the efficacy and safety of methotrexate (MTX) in children with active CD. METHODS In a retrospective multicenter (n = 3) study, the efficacy of MTX to induce complete remission or a clinical improvement was analyzed in 61 children with active CD. RESULTS CD was diagnosed at a mean age of 11.1 +/- 2.3 years, and MTX was introduced 3.1 +/- 2.2 years after diagnosis. Indications to use MTX were a nonresponse to or relapse under AZA (n = 42) or AZA intolerance/toxicity (n = 19). MTX improved or induced complete remission in 49 patients (80%), of whom 18 (29.5%) relapsed after 13 +/- 10 months of treatment. Under MTX medication, complete remission was observed in 39%, 49%, and 45% at 3, 6, and 12 months, respectively. Follow-up over at least 24 months in 11 children confirmed a sustained remission on MTX monotherapy up to 40 months. Adverse reactions were observed in 14 patients (24%), requiring discontinuation of MTX in 6 children (10%) (liver enzyme elevation, n = 2; varicella-zoster, n = 1; nausea, n = 3). MTX allowed corticosteroid discontinuation in 36 patients. CONCLUSIONS MTX improved the clinical course in most pediatric CD patients who escaped or did not tolerate AZA. Short-time toxicity of MTX resulted in drug discontinuation in <10%. These data point to a beneficial and safe use of MTX in the treatment of pediatric CD.
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Affiliation(s)
- S Uhlen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Children's Hospital and Faculty of Medicine, Lille, France
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Begue B, Dumant C, Bambou JC, Beaulieu JF, Chamaillard M, Hugot JP, Goulet O, Schmitz J, Philpott DJ, Cerf-Bensussan N, Ruemmele FM. Microbial induction of CARD15 expression in intestinal epithelial cells via toll-like receptor 5 triggers an antibacterial response loop. J Cell Physiol 2006; 209:241-52. [PMID: 16897777 DOI: 10.1002/jcp.20739] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
With the discovery of CARD15 as susceptibility gene for Crohn's disease (CD) a first link to a potential defect in the innate immune system was made. In this work we aimed to analyze enterocyte NOD2/CARD15 expression and regulation in response to bacterial motifs and the consequences of the most common CD-specific CARD15 mutation on antibacterial responses of normal intestinal epithelial cells (IEC). Under normal conditions, IEC lines and ileal enterocytes did not express NOD2/CARD15 mRNA or protein, contrary to IEC derived from inflammatory CD sections. In vitro analyses revealed that the simple contact with non-pathogenic commensal E. Coli K12 was sufficient to induced NOD2/CARD15 mRNA and protein in human IEC (HIEC). We identified bacterial flagellin interacting with TLR5 as major motif in this regulation of NOD2/CARD15. E. Coli mutants not expressing flagellin (DeltaFliC) failed to induce CARD15. Similarly, in HIEC transfected with a plasmid encoding dominant negative TLR5, no CARD15 induction was observed after K12 contact. Isolated TLR2 or TLR4 stimulation had no or only a marginal effect on NOD2/CARD15 expression. NOD2/CARD15 negative HIEC were unresponsive to muramyl dipeptide (MDP), but once NOD2/CARD15 was induced, HIEC and Caco2 cells responded to intra or extracellular MDP presentation with the activation of the NFkB pathway. IEC transfected with the Crohn-specific CARD15 mutant (F3020insC, FS) failed to activate NFkB after MDP-challenge, in contrast to CARD15WT IEC. In response to MDP, IEC induced a massive antibacterial peptide (ABP) response, seen in the apical release of CCL20. This was completely abolished in IEC carrying CARD15FS. These data suggest a critical role of NOD2/CARD15 in the bacterial clearance of the intestinal epithelium while CD-specific mutated NOD2/CARD15 causes an impaired epithelial barrier.
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Sauvat F, Dupic L, Caldari D, Lesage F, Cezard JP, Lacaille F, Ruemmele F, Hugot JP, Colomb V, Jan D, Hubert P, Revillon Y, Goulet O. Factors Influencing Outcome After Intestinal Transplantation in Children. Transplant Proc 2006; 38:1689-91. [PMID: 16908249 DOI: 10.1016/j.transproceed.2006.05.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We evaluated 131 patients (6 months-14 years) who experienced 21 deaths before listing, 11 continuing on the waiting list, 38 well on home parenteral nutrition, 6 off parenteral nutrition and 59 transplanted (20 girls) aged 2.5 to 15 years, (18 >7 years). They received cadaveric isolated intestine (ITx, n = 31) or liver-small bowel (LITx, n = 32), including right colon (n = 43; 23 LITx) for short bowel (n = 19), enteropathy (n = 20), Hirschsprung (n = 14), or pseudo-obstruction (n = 6). Treatment included tacrolimus, steroids, azathioprine, or interleukin-2 blockers. After 6 months to 10.5 years, the patient and graft survivals were 75% and 54%. Sixteen patients (10 LITx) died within 3 months from surgery (n = 3), bacterial (n = 5) or fungal (n = 6) sepsis, or posttransplant lymphoproliferative disorder (n = 2). Rejection occurred in 27 patients, including 10 steroid-resistant episodes requiring antilymphoglobulins. The grafts were removed due to uncontrolled rejection in seven ITx recipients. Surgical complications were observed in 38 recipients (25 LSBTx) within 2 months, including bacterial (n = 22) or fungal (n = 11) sepsis, cytomegalovirus disease (n=12), adenovirus (n = 11), or posttransplant lymphoproliferative disorder (n = 12). Forty-two children (19 LSBTx) are alive. Weaning from parenteral nutrition was achieved after 42 days (median). Factors related to death or graft loss were pre-Tx surgery (P < .01), pseudo-obstruction (P < .01), age over 7 years (P < .03), fungal sepsis (P < .03), steroid resistant rejection (P < .05), hospitalized versus home patient (P < .01), and retransplantation (P < .05). Colon transplant did not affect the outcome. Interleukin-2 blockers improved isolated ITx (P < .05). Early referral and close monitoring of intestinal failure and related disorders are mandatory to achieve successful ITx.
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Affiliation(s)
- F Sauvat
- UFR Necker-Enfants Malades, University René Descartes Paris V, FAMA de Transplantation Intestinale, AP-HP, 149 Rue de Sèvres, 757015 Paris, France
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Rieu D, Bocquet A, Bresson JL, Briend A, Chouraqui JP, Darmaun D, Dupont C, Frelut ML, Ghisolfi J, Girardet JP, Goulet O, Putet G, Rigo J, Turck D, Vidailhet M. Phyto-estrogènes et aliments à base de soja chez le nourrisson et l'enfant : la prudence est de mise. Arch Pediatr 2006; 13:1091-3. [PMID: 16862658 DOI: 10.1016/j.arcped.2005.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ruemmele FM, Sauvat F, Colomb V, Jugie M, Jan D, Canioni D, Damotte D, Sarnacki S, Brousse N, Revillon Y, Goulet O. Seventeen years after successful small bowel transplantation: long term graft acceptance without immune tolerance. Gut 2006; 55:903-4. [PMID: 16698765 PMCID: PMC1856207 DOI: 10.1136/gut.2006.093989] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Lacaille F, Moes N, Hugot JP, Cezard JP, Goulet O, Ruemmele FM. Severe dysimmune cytopenia in children treated with tacrolimus after organ transplantation. Am J Transplant 2006; 6:1072-6. [PMID: 16611346 DOI: 10.1111/j.1600-6143.2006.01304.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Rare cases of dysimmune phenomena after solid organ transplantation were described in the past. In the present series, we describe six children who developed severe dysimmune anemia or thrombocytopenia while treated with tacrolimus after liver or small bowel transplantation. All patients were off steroids or under low doses alternate day steroid medication when dysimmune cytopenia developed. All patients had positive anti-platelets antibodies and/or Coombs' positive anemia. Therapy was successful in all six patients with a rapid response to corticosteroids in three children, and to anti-CD20 monoclonal antibodies (rituximab) in the three others. The pathogenesis of these rare dysimmune/autoimmune disorders might be related to the interference of tacrolimus with T-cell functions and/or the endogenous control mechanisms of T-lymphocyte activation and down-regulation. Although rare, these complications must be known when discussing protocols of immunosuppression.
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Affiliation(s)
- F Lacaille
- Hôpital Necker-Enfants Malades, Université René-Descartes, Paris, France.
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