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Yildiz M, Onal Z, Yesil G, Kabil TG, Toksoy G, Poyrazoglu S, Bas F, Durmaz O, Darendeliler F. A Rare Cause of Hypergonadotropic Hypogonadism: Transaldolase Deficiency in Two Siblings. J Clin Res Pediatr Endocrinol 2023. [PMID: 36825476 DOI: 10.4274/jcrpe.galenos.2023.2022-10-4] [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] [Indexed: 02/25/2023] Open
Abstract
Transaldolase deficiency is a rare inborn autosomal recessive disorder caused by biallelic mutations in the TALDO1 gene. It is characterized by intrauterine growth restriction, dysmorphism, abnormal skin, cytopenia, hepatosplenomegaly, liver cirrhosis, endocrine problems, renal and cardiac abnormalities. We present two siblings of Turkish origin with early-onset form of transaldolase deficiency and hypergonadotropic hypogonadism in both sexes. The girl (index) was followed-up with cryptogenic cirrhosis, leukopenia and thrombocytopenia, skin abnormalities, congenital heart defects, hypercalciuria, nephrolithiasis, proteinuria, chronic kidney disease throughout childhood. She developed hypergonadotropic hypogonadism in adolescence period. Whole exome sequencing due to the multisystemic involvement revealed a previously described homozygous inframe deletion in TALDO1 gene. Her brother was born as a small for gestational age baby and was also followed-up with cryptogenic cirrhosis since his infancy, together with cytopenia, congenital heart defects, bilateral cryptorchidism, short stature, hypercalciuria, proteinuria and chronic kidney disease in childhood. He presented with testicular microlithiasis and hypergonadotropic hypogonadism in adolescence. Sanger sequencing of TALDO1 gene confirmed the presence of the same homozygous deletion with his sister. The mother was found to be a heterozygous carrier for this deletion. We describe two patients with multisystemic involvement since neonatal period who presented with an additional hypergonadotropic hypogonadism in adolescence. The diagnosis of transaldolase deficiency should be kept in mind for these patients, and they must be evaluated for gonadal functions especially during puberty.
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Affiliation(s)
- Melek Yildiz
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Zerrin Onal
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gozde Yesil
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Tugce Goksu Kabil
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Guven Toksoy
- Department of Medical Genetics, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Firdevs Bas
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ozlem Durmaz
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Feyza Darendeliler
- Department of Pediatric Endocrinology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Kolukisa B, Baser D, Akcam B, Danielson J, Eltan SB, Haliloglu Y, Sefer AP, Babayeva R, Akgun G, Charbonnier LM, Schmitz-Abe K, Demirkol YK, Zhang Y, Gonzaga-Jauregui C, Heredia RJ, Kasap N, Kiykim A, Yucel EO, Gok V, Unal E, Kisaarslan AP, Nepesov S, Baysoy G, Onal Z, Yesil G, Celkan TT, Cokugras H, Camcioglu Y, Eken A, Boztug K, Lo B, Karakoc-Aydiner E, Su HC, Ozen A, Chatila TA, Baris S. Evolution and long-term outcomes of combined immunodeficiency due to CARMIL2 deficiency. Allergy 2022; 77:1004-1019. [PMID: 34287962 PMCID: PMC9976932 DOI: 10.1111/all.15010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 05/02/2021] [Revised: 06/05/2021] [Accepted: 07/01/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Biallelic loss-of-function mutations in CARMIL2 cause combined immunodeficiency associated with dermatitis, inflammatory bowel disease (IBD), and EBV-related smooth muscle tumors. Clinical and immunological characterizations of the disease with long-term follow-up and treatment options have not been previously reported in large cohorts. We sought to determine the clinical and immunological features of CARMIL2 deficiency and long-term efficacy of treatment in controlling different disease manifestations. METHODS The presenting phenotypes, long-term outcomes, and treatment responses were evaluated prospectively in 15 CARMIL2-deficient patients, including 13 novel cases. Lymphocyte subpopulations, protein expression, regulatory T (Treg), and circulating T follicular helper (cTFH ) cells were analyzed. Three-dimensional (3D) migration assay was performed to determine T-cell shape. RESULTS Mean age at disease onset was 38 ± 23 months. Main clinical features were skin manifestations (n = 14, 93%), failure to thrive (n = 10, 67%), recurrent infections (n = 10, 67%), allergic symptoms (n = 8, 53%), chronic diarrhea (n = 4, 27%), and EBV-related leiomyoma (n = 2, 13%). Skin manifestations ranged from atopic and seborrheic dermatitis to psoriasiform rash. Patients had reduced proportions of memory CD4+ T cells, Treg, and cTFH cells. Memory B and NK cells were also decreased. CARMIL2-deficient T cells exhibited reduced T-cell proliferation and cytokine production following CD28 co-stimulation and normal morphology when migrating in a high-density 3D collagen gel matrix. IBD was the most severe clinical manifestation, leading to growth retardation, requiring multiple interventional treatments. All patients were alive with a median follow-up of 10.8 years (range: 3-17 years). CONCLUSION This cohort provides clinical and immunological features and long-term follow-up of different manifestations of CARMIL2 deficiency.
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Affiliation(s)
- Burcu Kolukisa
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Dilek Baser
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Bengu Akcam
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Jeffrey Danielson
- Human Immunological Diseases Section, Laboratory of
Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA,Clinical Genomics Program, NIAID, NIH, Bethesda, MD,
USA
| | - Sevgi Bilgic Eltan
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Yesim Haliloglu
- Erciyes University School of Medicine, Department of
Medical Biology, Kayseri, Turkey
| | - Asena Pinar Sefer
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Royale Babayeva
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Gamze Akgun
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Louis-Marie Charbonnier
- Boston Children’s Hospital and Department of
Pediatrics, Harvard Medical School, Division of Immunology, Boston, MA, USA
| | - Klaus Schmitz-Abe
- Boston Children’s Hospital, Division of Immunology
and Newborn Medicine, Harvard Medical School, Boston, MA, USA
| | - Yasemin Kendir Demirkol
- Genomic Laboratory (GLAB), Umraniye Teaching and Research
Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yu Zhang
- Human Immunological Diseases Section, Laboratory of
Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA,Clinical Genomics Program, NIAID, NIH, Bethesda, MD,
USA
| | | | - Raul Jimenez Heredia
- Ludwig Boltzmann Institute for Rare and Undiagnosed
Diseases, Vienna, Austria,St. Anna Children’s Cancer Research Institute
(CCRI), Vienna, Austria
| | - Nurhan Kasap
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Ayca Kiykim
- Istanbul University-Cerrahpasa, Faculty of Medicine,
Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Esra Ozek Yucel
- Istanbul University, Istanbul Faculty of Medicine,
Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Veysel Gok
- Erciyes University School of Medicine, Pediatric
Hematology and Oncology, Kayseri, Turkey
| | - Ekrem Unal
- Erciyes University School of Medicine, Pediatric
Hematology and Oncology, Kayseri, Turkey
| | | | - Serdar Nepesov
- Medipol University Medical Faculty, Department of
Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Gokhan Baysoy
- Medipol University Medical Faculty, Department of
Pediatric Gastroenterology, Istanbul, Turkey
| | - Zerrin Onal
- Istanbul University, Istanbul Faculty of Medicine,
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul,
Turkey
| | - Gozde Yesil
- Istanbul University, Istanbul Faculty of Medicine,
Department of Medical Genetics, Istanbul, Turkey
| | - Tulin Tiraje Celkan
- Istanbul University-Cerrahpasa, Faculty of Medicine,
Division of Pediatric Hematology and Oncology, Istanbul, Turkey
| | - Haluk Cokugras
- Istanbul University-Cerrahpasa, Faculty of Medicine,
Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Yildiz Camcioglu
- Istanbul University-Cerrahpasa, Faculty of Medicine,
Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Ahmet Eken
- Erciyes University School of Medicine, Department of
Medical Biology, Kayseri, Turkey
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed
Diseases, Vienna, Austria,St. Anna Children’s Cancer Research Institute
(CCRI), Vienna, Austria
| | - Bernice Lo
- Sidra Medicine, Research Branch, Division of
Translational Medicine, Doha, Qatar,College of Health and Life Sciences, Hamad Bin Khalifa
University, Doha, Qatar
| | - Elif Karakoc-Aydiner
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Helen C. Su
- Human Immunological Diseases Section, Laboratory of
Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA,Clinical Genomics Program, NIAID, NIH, Bethesda, MD,
USA
| | - Ahmet Ozen
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Talal A. Chatila
- Boston Children’s Hospital and Department of
Pediatrics, Harvard Medical School, Division of Immunology, Boston, MA, USA
| | - Safa Baris
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
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3
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van Wessel DBE, Thompson RJ, Gonzales E, Jankowska I, Sokal E, Grammatikopoulos T, Kadaristiana A, Jacquemin E, Spraul A, Lipiński P, Czubkowski P, Rock N, Shagrani M, Broering D, Algoufi T, Mazhar N, Nicastro E, Kelly DA, Nebbia G, Arnell H, Björn Fischler, Hulscher JBF, Serranti D, Arikan C, Polat E, Debray D, Lacaille F, Goncalves C, Hierro L, Muñoz Bartolo G, Mozer-Glassberg Y, Azaz A, Brecelj J, Dezsőfi A, Calvo PL, Grabhorn E, Sturm E, van der Woerd WJ, Kamath BM, Wang JS, Li L, Durmaz Ö, Onal Z, Bunt TMG, Hansen BE, Verkade HJ. Genotype correlates with the natural history of severe bile salt export pump deficiency. J Hepatol 2020; 73:84-93. [PMID: 32087350 DOI: 10.1016/j.jhep.2020.02.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [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: 09/27/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Mutations in ABCB11 can cause deficiency of the bile salt export pump (BSEP), leading to cholestasis and end-stage liver disease. Owing to the rarity of the disease, the associations between genotype and natural history, or outcomes following surgical biliary diversion (SBD), remain elusive. We aimed to determine these associations by assembling the largest genetically defined cohort of patients with severe BSEP deficiency to date. METHODS This multicentre, retrospective cohort study included 264 patients with homozygous or compound heterozygous pathological ABCB11 mutations. Patients were categorized according to genotypic severity (BSEP1, BSEP2, BSEP3). The predicted residual BSEP transport function decreased with each category. RESULTS Genotype severity was strongly associated with native liver survival (NLS, BSEP1 median 20.4 years; BSEP2, 7.0 years; BSEP3, 3.5 years; p <0.001). At 15 years of age, the proportion of patients with hepatocellular carcinoma was 4% in BSEP1, 7% in BSEP2 and 34% in BSEP3 (p = 0.001). SBD was associated with significantly increased NLS (hazard ratio 0.50; 95% CI 0.27-0.94: p = 0.03) in BSEP1 and BSEP2. A serum bile acid concentration below 102 μmol/L or a decrease of at least 75%, each shortly after SBD, reliably predicted NLS of ≥15 years following SBD (each p <0.001). CONCLUSIONS The genotype of severe BSEP deficiency strongly predicts long-term NLS, the risk of developing hepatocellular carcinoma, and the chance that SBD will increase NLS. Serum bile acid parameters shortly after SBD can predict long-term NLS. LAY SUMMARY This study presents data from the largest genetically defined cohort of patients with severe bile salt export pump deficiency to date. The genotype of patients with severe bile salt export pump deficiency is associated with clinical outcomes and the success of therapeutic interventions. Therefore, genotypic data should be used to guide personalized clinical care throughout childhood and adulthood in patients with this disease.
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Affiliation(s)
- Daan B E van Wessel
- Pediatric Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | | | - Emmanuel Gonzales
- Service d'Hépatologie et de Transplantation Hépatique Pédiatriques, Bicêtre Hôspital, AP-HP, Université Paris-Sud, Paris Saclay, Inserm UMR-S 1174, France; European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Irena Jankowska
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Gastroenterology, Hepatology, Nutritional Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Etienne Sokal
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Université; Catholique de Louvain, Cliniques St Luc, Brussels, Belgium
| | | | | | - Emmanuel Jacquemin
- Service d'Hépatologie et de Transplantation Hépatique Pédiatriques, Bicêtre Hôspital, AP-HP, Université Paris-Sud, Paris Saclay, Inserm UMR-S 1174, France
| | - Anne Spraul
- Service de Biochemie, Bicêtre Hôspital, AP-HP, Université Paris-Sud, Paris Saclay, Inserm UMR-S 1174, France
| | - Patryk Lipiński
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Gastroenterology, Hepatology, Nutritional Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Czubkowski
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Gastroenterology, Hepatology, Nutritional Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Nathalie Rock
- Université; Catholique de Louvain, Cliniques St Luc, Brussels, Belgium
| | - Mohammad Shagrani
- Liver & SB Transplant & Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - Dieter Broering
- Liver & SB Transplant & Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Talal Algoufi
- Liver & SB Transplant & Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Nejat Mazhar
- Liver & SB Transplant & Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Deirdre A Kelly
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Liver Unit, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - Gabriella Nebbia
- Servizio Di Epatologia e Nutrizione Pediatrica, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Henrik Arnell
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Pediatric Digestive Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Björn Fischler
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Pediatric Digestive Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jan B F Hulscher
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Paediatric Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Daniele Serranti
- Paediatric and Liver Unit, Meyer Children's University Hospital of Florence
| | - Cigdem Arikan
- Koc University School of Medicine, Paediatric GI and Hepatology Liver Transplantation Centre, Kuttam System in Liver Medicine, Istanbul, Turkey
| | - Esra Polat
- Hospital Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Dominique Debray
- Unité; d'hépatologie Pédiatrique et Transplantation, Hôpital Necker, Paris, France
| | - Florence Lacaille
- Unité; d'hépatologie Pédiatrique et Transplantation, Hôpital Necker, Paris, France
| | - Cristina Goncalves
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Coimbra University Hospital Center, Coimbra, Portugal
| | - Loreto Hierro
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Pediatric Liver Service, La Paz University Hospital, Madrid, Spain
| | - Gema Muñoz Bartolo
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); Pediatric Liver Service, La Paz University Hospital, Madrid, Spain
| | - Yael Mozer-Glassberg
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Centre of Israel
| | - Amer Azaz
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Jernej Brecelj
- Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, and Department of Paediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Antal Dezsőfi
- 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Pier Luigi Calvo
- Pediatic Gastroenterology Unit, Regina Margherita Children's Hospital, Azienda Ospedaliera Città Della Salute e Della Scienza University Hospital, Torino, Italy
| | - Enke Grabhorn
- Klinik Für Kinder- Und Jugendmedizin, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - Ekkehard Sturm
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER); University Children's Hospital Tübingen, Tübingen, Germany
| | - Wendy J van der Woerd
- Wilhelmina Children's Hospital, University Medical Centre Utrecht, Paediatric Gastroenterology, Hepatology and Nutrition, Utrecht, The Netherlands
| | - Binita M Kamath
- The Hospital for Sick Children and the University of Toronto, Toronto, Canada
| | - Jian-She Wang
- Children's Hospital of Fudan University, Shanghai, China
| | - Liting Li
- Children's Hospital of Fudan University, Shanghai, China
| | - Özlem Durmaz
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Zerrin Onal
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ton M G Bunt
- Pediatric Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Bettina E Hansen
- Toronto Centre for Liver Disease, University Health Network, Canada; IHPME, University of Toronto, Canada
| | - Henkjan J Verkade
- Pediatric Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, The Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).
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Onal Z, Balkaya S, Ersen A, Mutlu N, Onal H, Adal E. Possible effects of neonatal vitamin B12 status on TSH-screening program: a cross-sectional study from Turkey. J Pediatr Endocrinol Metab 2017; 30:551-555. [PMID: 28350538 DOI: 10.1515/jpem-2016-0066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 02/22/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In this study we evaluated whether vitamin B12 deficiency affects neonatal screening (NS) for congenital hypothyroidism (CH). METHODS A cross-sectional study conducted from 2010 to 2011. A total of 10,740 infants were born in our hospital in this period. Thyroid-stimulating hormone (TSH) was tested for NS and neonates with abnormal screening results (TSH>20 mIU/L) were re-examined. Two hundred and twenty-nine re-called subjects (re-call rate 2.3%) were compared to 77 randomly selected newborns with normal TSH screening among these term newborns in terms of serum TSH, free T4, vitamin B12 and homocysteine status. RESULTS Of the 229 re-called subjects, 11 infants with CH and 21 infants with transient TSH elevation were detected. In the normal TSH screening group, only two infants were diagnosed with transient TSH elevation. Mean serum B12 levels were 126.4±48.7 pg/mL and 211.9±127.9 pg/mL in the positive TSH-screening group and the control group, respectively. There was a significant difference between positive and normal TSH-screening groups in regard to serum TSH, free T4, serum B12 and homocysteine levels. CONCLUSIONS We found a significant vitamin B12 deficiency in positive TSH-screening infants. Beside the crucial role of vitamin B12 in newborns, deficiency seems to increase the recall rates of infants in an NS program for CH.
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Affiliation(s)
- Zerrin Onal
- Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul
| | - Seda Balkaya
- Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul
| | - Atilla Ersen
- Department of Pediatrics, Okmeydani Training and Research Hospital, Istanbul
| | - Neval Mutlu
- Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul
| | - Hasan Onal
- Department of Pediatric Metabolic Diseases, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul
| | - Erdal Adal
- Department of Pediatric Endocrinology and Metabolism, Medipol University, Istanbul
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5
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Onal Z, Ersen A, Bayramoglu E, Yaroglu Kazancı S, Onal H, Adal E. Seroprotection status of hepatitis B and measles vaccines in children with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2016; 29:1013-7. [PMID: 27658137 DOI: 10.1515/jpem-2015-0211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 07/18/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is speculated to have an impaired immunological response to vaccines. This paper aimed to investigate the presence of specific antibodies against hepatitis B virus (HBV) and measles in diabetic children who had been immunized according to the standard national calendar of immunization. METHODS Two hundred and one diabetic children and 140 healthy controls were prospectively evaluated. Antibodies against hepatitis B (anti-HBs) and measles were detected in all individuals who completed the vaccination schedule. We noted onset of T1DM, duration of the disease, diabetes-related autoantibodies and mean HbA1c levels. RESULTS Some 72.6% of diabetics and 82.1% of controls had anti-HBs (+) (p=0.04). We found a reduced efficacy of measles vaccination in anti-HBs (-) diabetic children (p=0.009), even though there was no significant difference between the study and control groups. Onset of the disease was earlier in anti-HBs (-) diabetics than in controls (p=0.038). No difference with respect to other parameters was found. CONCLUSIONS Our data showed a reduced seroprotection rate for HBV vaccination in diabetic children and for measles with anti-HBs (-) diabetics. Larger studies should be encouraged to confirm the vaccine efficacy in diabetic children and to elucidate possible pathogenic mechanisms.
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6
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Urganci N, Genc DB, Kose G, Onal Z, Vidin OO. Colorectal Cancer due to Constitutional Mismatch Repair Deficiency Mimicking Neurofibromatosis I. Pediatrics 2015; 136:e1047-50. [PMID: 26391938 DOI: 10.1542/peds.2015-1426] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 11/24/2022] Open
Abstract
Colorectal carcinoma (CRC) is an extremely rare tumor of childhood that can be associated with cancer predisposition syndromes. A patient with CRC related to constitutional mismatch repair deficiency (CMMRD) syndrome with features of neurofibromatosis type 1 (NF-1) is presented here. A 13-year-old boy was admitted for a 4-month history of diarrhea and rectal bleeding. The patient had extensive café au lait spots, freckling, and Lisch nodules. He fulfilled the NF-1 diagnostic criteria. Colonoscopy showed numerous polyps and a colorectal mass lesion, of which a biopsy revealed adenocarcinoma, an uncommon pathology associated with NF-1. High microsatellite instability and homozygous mutation of PMS2 gene in tumor tissue and blood lymphocytes, respectively, confirmed the diagnosis of CMMRD. Unfortunately, because family history related to CMMRD was negative, the parents denied the diagnosis and refused the therapy, and the patient was lost to follow-up. CMMRD is a rare cancer predisposition syndrome with phenotypical features resembling NF-1. The disease may be suspected in the setting of NF-1 features and CRC, high-grade brain tumors, or hematologic malignancies. Lack of family history related to CMMRD may be a major obstacle to convincing parents of the presence of an inherited disease in their progeny.
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Affiliation(s)
- Nafiye Urganci
- Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; and
| | - Dildar Bahar Genc
- Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; and
| | - Gulsen Kose
- Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; and
| | - Zerrin Onal
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ozge Ozdemir Vidin
- Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; and
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Usta M, Erkan T, Cokugras FC, Urganci N, Onal Z, Gulcan M, Kutlu T. High doses of methylprednisolone in the management of caustic esophageal burns. Pediatrics 2014; 133:E1518-24. [PMID: 24864182 DOI: 10.1542/peds.2013-3331] [Citation(s) in RCA: 52] [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: 01/31/2023] Open
Abstract
OBJECTIVE Caustic substance ingestion in childhood is a public health issue in developing countries, and several management protocols have been proposed to prevent the resulting esophageal strictures. The role of corticosteroids in preventing corrosive-induced strictures is controversial. Our aim was to study the influence of high doses of corticosteroids in preventing esophageal strictures. METHODS Eighty-three children with a mean age of 4.10 6 2.63 years and with grade IIb esophageal burns (an esophagogastroscopy was performed within 24–48 hours of injury) due to corrosive substance ingestion were enrolled in our study between 2005 and 2008. Forty-two children (study group) received methylprednisolone (1 g/1.73 m2 per day for 3 days), ranitidine, ceftriaxone, and total parenteral nutrition. Forty-one children (control group) were administered the same regimen excluding methylprednisolone. Stricture development was compared between groups based on endoscopic and radiologic findings. RESULTS During the endoscopic examination, stricture development was observed in 4 patients (10.8%) in the study group and in 12 patients (30%) in the control group. The difference was statistically significant (P = .038). The stricture development rate in the upper gastrointestinal system with barium meal was 14.3% and 45.0% in the study and control groups, respectively. The difference was statistically significant (P = .004). The duration of total parenteral nutrition was shorter in the study group compared with the control group (P = .001). High doses of methylprednisolone were well tolerated in the study group without any side effects. CONCLUSIONS High doses of methylprednisolone used for the management of grade IIb esophageal burns may reduce stricture development.
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Affiliation(s)
- Merve Usta
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Tülay Erkan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Fugen Cullu Cokugras
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nafiye Urganci
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Zerrin Onal
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey; and
| | - Mahir Gulcan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Acibadem University Medical Faculty, Istanbul, Turkey
| | - Tufan Kutlu
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Abstract
AIM Assisted reproduction technology is used widely all over the world. There is a great concern about the morbidity of in vitro fertilization (IVF) babies, but investigations are mostly related to mechanical conditions that are attributed to multiparity. This paper aimed to investigate the effect of IVF on thyroid functions in newborns. METHODS A total of 98 healthy, term IVF newborns were evaluated between postnatal 2-4 weeks of age by screening of thyroid functions between July 2006 and April 2008. Ten subjects were assessed as a study group whose thyroid-stimulating hormone (TSH) levels were higher than 6.5 mU/L. Control group consisted of randomly selected 10 naturally conceived infants with hyperthyrotropinemia (whose TSH levels were higher than 6.5 mU/L but under 15 mU/L) with the same age. All children were thoroughly examined, and serum fT4, TSH, anti-thyroid peroxidase and anti-thyroglobulin antibodies were measured, and a thyrotropin-releasing hormone (TRH) test was performed in all subjects in both groups. RESULTS Euthyroid hyperthyrotropinemia was diagnosed in approximately 10% of IVF babies. Exaggerated TSH levels to TRH were obtained in all IVF babies (subclinical hypothyroidism) but in none of the controls. A significant difference was noted in the concentration of TSH at the 20th min between the two groups (p < 0.001). Besides, sustained and delayed TSH responses were observed in IVF babies. Neonatal screening tests were negative in both of the groups. CONCLUSION In IVF babies, despite normal neonatal screening tests, subclinical hypothyroidism might be observed that suggests the need for screening in this respect.
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Affiliation(s)
- Hasan Onal
- Division of Metabolic Diseases, Department of Pediatrics, Ministry of Health Bakirkoy Maternity and Children Education Hospital, Istanbul, Turkey.
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Abstract
Pseudohypoaldosteronism type 1 (PHA1) is a disease involving a state of renal tubular unresponsiveness to the action of aldosterone and characterized by excessive salt loss in the urine, hyperkalemia, and metabolic acidosis. In kidney, PHA1 may occur primarily by mutations in the subunits of the sodium channel or in the mineralocorticoid receptors, and secondarily by several renal disorders. Miliaria rubra and thrombocytosis are reported in a 6-month-old girl with PHA1. In patients with PHA1, miliaria rubra-like cutaneous eruptions are suggested to occur due to obstruction of eccrine sweat glands through inflammation caused by excessive sodium excretion in sweat during hyponatremic crises. The presence of thrombocytosis in patients with PHA1 has not been previously reported. A hypothesis is proposed suggesting that sympathetic activation which provides vascular tonus during sodium excretion in sweat and salt-depletion crisis may play a role in the development of eruptions and thrombocytosis in patients with PHA1.
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Affiliation(s)
- Hasan Onal
- Department of Pediatrics, Ministry of Health Bakirkoy Maternity and Children Education Hospital, Istanbul, Turkey.
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Onal H, Adal E, Ersen A, Işik O, Onal Z, Arslan G. Arachnoid cysts in childhood with endocrinological outcomes. Turk J Pediatr 2011; 53:295-300. [PMID: 21980811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Arachnoid cysts are mainly manifested with the consequent neurological disorders. Even though these cysts may interfere in many systems due to their localizations, there is little information concerning their involvement in endocrinological disorders. We emphasize endocrinological functions together with cyst localizations and neurological disorders in childhood. A total of 50 patients diagnosed with arachnoid cysts were screened for cyst localizations, neurological symptoms and endocrinological outcomes evaluated by pubertal and growth status and hypothalamopituitary insufficiency. We investigated the interactions of these parameters. Arachnoid cysts were localized mostly in the middle fossa (54%) and posterior fossa (26%). Middle fossa cysts had a strong predilection for male gender (66.7% male) and left hemispheric dominancy (77%). We detected growth hormone deficiency in six patients, obesity in six patients and central precocious puberty in one patient; cysts were in the temporal area in three of the obese cases. All patients in our study had normal levels of cortisol, thyroid hormones and prolactin. In pediatric patients with arachnoid cysts, endocrinological follow-up is crucial as neurological outcomes and further evaluations are needed, mainly to confirm pubertal and growth status.
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Affiliation(s)
- Hasan Onal
- Department of Pediatrics, Ministry of Health Bakirköy Maternity and Children Research and Training Hospital, Turkey
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Yorgancioğlu A, Türktaş H, Kalayci O, Yardim N, Buzgan T, Kocabaş A, Karlikaya C, Yildiz F, Ergün P, Mungan D, Kart L, Göktaş E, Musaonbaşioğlu S, Gündoğan A, Akdağ R, Akçay S, Akin M, Akkurt I, Altan P, Altunsu T, Arpaci N, Aydin C, Aydin S, Aydinli F, Aytaç B, Bavbek S, Biber C, Bingöl Karakoç G, Ceyhun G, Cakir B, Celik G, Cetinkaya T, Ciçek ME, Coban SC, Cobanoğlu N, Com S, Cöplü L, Demirkazik A, Doğan E, Ekmekçi EB, Elbir M, Erdoğan A, Ergüder T, Gemicioğlu B, Gögen S, Gülbahar O, Güngör H, Horzum E, Içer Y, Imamecioğlu AR, Kahraman N, Kakillioğlu T, Kalyoncu F, Karakaya M, Karakaya G, Karaodul G, Kesici C, Keskinkiliç B, Kilinç O, Kirmizitaş F, Kosdak M, Köktürk N, Metintaş M, Numanoğlu SC, Gümrükçüoğlu OF, Onal Z, Onal B, Ozacar R, Ozen HA, Ozkan S, Oztürk F, Polat H, Saçkesen C, Selçuk T, Serin G, Sönmez G, Sahin M, Sahinöz S, Sahinöz T, Simşek B, Tartan N, Toprak A, Tugay T, Tuncer A, Uçan ES, Unüvar N, Yapicikardeşler B, Yildirim N, Yol S, Yüksel H, Khaltaev N, Cruz A, Minelli E, Bateman E, Baena Cagnani C, Dahl R, Bousquet J. The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey). Tuberk Toraks 2009; 57:439-452. [PMID: 20037863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.
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Onal H, Onal Z, Ozdil M, Alhaj S. A new parameter in the differential diagnosis of bacterial and viral meningitis. Neurosciences (Riyadh) 2008; 13:91-92. [PMID: 21063298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Hasan Onal
- Department of Pediatrics, SB Bakirkoy Maternity and Childhood Diseases Training Hospital, Istanbul, Turkey. Tel. +90 (532) 5092988. Fax: +90 (212) 5883102. E-mail:
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Akkurt M, Oztürk S, Fun HK, Onal Z, Altural B. 3-Acetyl-4-benzoyl-2-methyl-5-phenyl-3,3a-dihydropyrazolo[2,3- c]pyrimidine-7(6 H)-thione. Acta Crystallogr C 2000; 56:E276-7. [PMID: 15263129 DOI: 10.1107/s0108270100007241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2000] [Accepted: 05/12/2000] [Indexed: 11/11/2022] Open
Abstract
The molecule of the title compound, C(22)H(19)N(3)O(2)S, is not planar. The dihedral angle between the two phenyl rings is 27.46 (7) degrees and in the dihydropyrazolopyrimidine ring the total puckering amplitude Q(T) is 0.526 (3) A. The structure is stabilized by both intra- and intermolecular C-H.O interaction, and by an intermolecular N-H.S hydrogen bond.
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Affiliation(s)
- M Akkurt
- Department of Physics, Faculty of Arts and Sciences, Erciyes University, 38039 Kayseri, Turkey
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