Background. We describe early and typical nonendocrine symptoms of Multiple Endocrine Neoplasia t... more Background. We describe early and typical nonendocrine symptoms of Multiple Endocrine Neoplasia type 2B (MEN2B) presented in our patients with de novo M918T mutation in the RET proto-oncogene in early childhood, however, the diagnosis of MEN2B and medullary thyroid carcinoma (MTC) was confirmed late, in the second decade of life. In this paper, we emphasize the possibility of growth retardation, growth hormone (GH) deficiency and ovarian teratoma as a new symptom of MEN2B. Case Reports. Advanced MTC with palpable mass on the neck and nonendocrine symptoms such as marfanoid habitus, thickened lips, mucosal neuromas led to the diagnosis in case 1 at the age of 13 years and GH deficiency and nonendocrine symptoms in case 2 at the age of 11 years. The earliest feature of MEN2B was alacrima and constipation. Patient 1 was operated on for a slipped femoral capital epiphysis and for a cystic ovarian teratoma. Conclusions. Improved awareness of nonendocrine signs of MEN2B could lead to earlier diagnosis, when surgical cure of MTC is possible. Alacrima is the first sign of MEN2B. We confirmed the possibility of growth retardation and GH deficiency in MEN2B, which had been previously rarely described. We suggest that patients with MEN2B may develop cystic ovarian teratoma, to the best of our knowledge, which has never been described so far in the literature. The results of this study could be used to guide further diagnosing of MENB2 at the early stage for better clinical outcome. We emphasize that MEN2B carries a risk for development of cystic ovarian teratoma as a novel tumor in this disease.
Background. The complete androgen insensitivity syndrome (CAIS) is a rare genetic disorder causin... more Background. The complete androgen insensitivity syndrome (CAIS) is a rare genetic disorder causing insensitivity to androgens in a person with female phenotype and 46,XY karyotype due to a mutation in the androgen receptor gene located on chromosome X. These children are born with female external genitalia, and females are transmitters. Case Report. We illustrate an unexpected diagnosis of CAIS in two siblings during examination for short stature, and describe transmission/carriers in the family along with ethical aspects. Conclusion. A genetic examination could have earlier revealed the transmission of c.2495G>Tp.(Arg832Leu) mutation in exon 7. Our experience highlights the possibility of prenatal testing for the management of pregnancy in a family with a history of CAIS. The implications of prenatal testing in relation to CAIS with clearer explication of ethical and clinical issues warrant further investigation.
Thiamine-responsive megaloblastic anemia (TRMA) is a rare autosomal recessive disorder caused by ... more Thiamine-responsive megaloblastic anemia (TRMA) is a rare autosomal recessive disorder caused by mutations in the SLC19A2 gene. To date at least 43 mutations have been reported for the gene encoding a plasma membrane thiamine transporter protein (THTR-1). TRMA has been reported in less than 80 cases worldwide. Here, we illustrate 2 female patients with TRMA first diagnosed in the Czech Republic and in central Europe being confirmed by sequencing of the THTR-1 gene SLC19A2. Both subjects are compound heterozygotes with 3 different mutations in the SLC19A2 gene. In case 2, the SLC19A2 intron 1 mutation c.204+2T>G has never been reported before. TRMA subjects are at risk of diabetic ketoacidosis during intercurrent disease and arrythmias. Thiamine supplementation has prevented hematological disorders over a few years in both pediatric subjects, and improved glycaemic control of diabetes mellitus. Patient 1 was suffering from hearing loss and rod-cone dystrophy at the time of diagnos...
ABSTRACT Our patient with CML failed to produce any cytogenetic response after initial therapies.... more ABSTRACT Our patient with CML failed to produce any cytogenetic response after initial therapies. Cytogenetic analysis revealed clonal evolution in Ph-positive (Ph+) clone with trisomy 8. The treatment was changed to imatinib mesylate (IM) and the 1st complete cytogenetic remission of CML was achieved. Two Ph-negative (Ph-) clones were detected by G-banding after the reduction of Ph+ cells. The first Ph- clone had trisomy 8 as the only chromosomal aberration and we did not observe any influence on the course of CML. The second Ph- clone had inv(3)(q21q26) as the only chromosomal aberration and was associated with the development of AML. The patient underwent induction chemotherapy, consolidation chemotherapy and allo-HSCT.
Our retrospective analysis was performed on 376 consecutive patients diagnosed with AML. A total ... more Our retrospective analysis was performed on 376 consecutive patients diagnosed with AML. A total of 256 (68%) were treated with standard "7+3" induction and high-dose cytarabine and mitoxantrone containing "4+3" consolidation/intensification regimens. Our study focused on patients with presumably very poor prognosis - patients, who did not achieve complete cytogenetic remission (CRc). Twenty-five AML patients without CRc were further analysed for clinical and laboratory parameters. Firstly, the subgroups with or without morphologic CR were compared. Similar cytogenetic abnormalities were observed in both with myelodysplasia related changes being the most common. Complex karyotype with deletion of 5q constituted approximately a third of all karyotypes in both subgroups. There were 1 patient with intermediate risk cytogenetics in the subgroup without morphologic CR and 5 patients in the subgroup with morphologic CR. Interestingly, in 4/25 patients subclones were di...
International angiology : a journal of the International Union of Angiology, 2013
The aim of this paper was to assess the prevalence of concurrent deep vein thrombosis (DVT) and/o... more The aim of this paper was to assess the prevalence of concurrent deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in the patients with superficial vein thrombosis (SVT) of the legs and to find factors significantly and independently associated with coincident DVT/PE. In the setting of a tertiary referral hospital, patients with SVT, attending vascular clinic, underwent physical examination, laboratory testing and leg vein ultrasound (in the case of clinically suspected PE also perfusion/ventilation lung scan or/and helical CT pulmonary angiography). In statistical analysis, we used unpaired t-test, non-parametric Wilcoxon rank sum test, stepwise logistic regression and multivariable logistic regression model. We examined 138 patients (age 61.4 ± 13.9 years, 36.2% men), with ST mostly on varicose veins (89.9%). The prevalence of concurrent DVT/PE was 34.1%. Neither the clinical manifestation nor SVT localization differed significantly between the group with isolated SVT and ...
Background: Factor V Leiden (FVL) supposedly carries relatively higher risk of deep vein thrombos... more Background: Factor V Leiden (FVL) supposedly carries relatively higher risk of deep vein thrombosis (DVT), compared to the risk of pulmonary embolism (PE). Aim: To prove this paradox in a group of patients with various clinical presentation of venous thromboembolism (VTE). Materials and methods: We retrospectively evaluated clinical pattern of VTE in patients who had been referred to vascular clinic shortly after an acute VTE event. In FVL positive and FVL negative groups we compared the prevalence of isolated symptomatic DVT (proximal or distal) and symptomatic PE with/without DVT, and, moreover, asymptomatic DVT or PE. Results: Of 575 patients (mean age 57 years, 50.1% women), 120 were FVL positive and those had significantly higher prevalence of isolated symptomatic DVT, compared to symptomatic PE with/without DVT. Proximal DVT location was significantly more frequent in FVL carriers. The prevalence of asymptomatic PE did not differ between the two groups. The rate of asymptomatic DVT tended to be higher in FVL negative group. In a multivariate analysis, we confirmed FVL to be positively associated with isolated DVT presentation (odds ratio OR 1.757; 95% confidence interval (CI) 1.148-2.690). On the contrary, increasing age and unprovoked nature of VTE event carried a higher risk of symptomatic PE. Conclusions: We confirmed FVL to be significantly associated with isolated symptomatic DVT despite higher prevalence of proximal DVT in FVL carriers. The fact of relatively lower risk of PE in FVL positive patients might have clinical implication. However, mechanisms of FVL paradox remain to be elucidated.
ABSTRACT Our patient with CML failed to produce any cytogenetic response after initial therapies.... more ABSTRACT Our patient with CML failed to produce any cytogenetic response after initial therapies. Cytogenetic analysis revealed clonal evolution in Ph-positive (Ph+) clone with trisomy 8. The treatment was changed to imatinib mesylate (IM) and the 1st complete cytogenetic remission of CML was achieved. Two Ph-negative (Ph-) clones were detected by G-banding after the reduction of Ph+ cells. The first Ph- clone had trisomy 8 as the only chromosomal aberration and we did not observe any influence on the course of CML. The second Ph- clone had inv(3)(q21q26) as the only chromosomal aberration and was associated with the development of AML. The patient underwent induction chemotherapy, consolidation chemotherapy and allo-HSCT.
Journal of Pediatric Gastroenterology and Nutrition, 2006
Our pilot study aimed to determine the effect of tumor necrosis factor-alpha (TNF-alpha) 308 G--&... more Our pilot study aimed to determine the effect of tumor necrosis factor-alpha (TNF-alpha) 308 G-->A promoter single-nucleotide polymorphism in pediatric inflammatory bowel disease (IBD), its influence on inflammatory activity and the clinical manifestations. We obtained genomic DNA from 164 subjects, 82 with long-standing IBD aged 8 to 18 years: 46 with Crohn disease (CD) and 36 with ulcerative colitis (UC). Eighty-two healthy children served as the control population. Genotyping was determined by using a restriction enzyme-based assay. TNF-alpha 308 G-->A polymorphism was assessed in terms of inflammatory (C-reactive protein [CRP]) and disease activity. The latter was assessed by the Pediatric Crohn's Disease Activity Index (PCDAI) and the Truelove index for CD and UC, respectively. Significant differences in TNF-alpha 308 A polymorphism were found between the IBD group and controls (P < 0.05) and the UC group and controls (P < 0.001). No differences were noted between TNF-alpha 308 A polymorphism and clinical characteristics in UC. The frequency of the -308 A allele of TNF was not different in CD compared with that in the control group. The frequency of TNF-alpha 308 A genotype was significantly higher in CD patients with predominantly stenosing/penetrating disease compared with patients without complications (P < 0.001) and healthy controls (P < 0.01). In CD patients, those carrying TNF -308 A had a significant increase in CRP (P < 0.05) and the PCDAI (P < 0.05). In CD, CRP levels strongly correlated with the PCDAI (r = 0.6150, P < 0.001). In UC, significant differences among the mean levels of CRP (P < 0.05) and disease activity (P < 0.001) related to TNF-alpha 308 A polymorphism were found. Allele distribution (odds ratio, 12.9; CI, 1.18-140.81, P < 0.001) and CRP serum levels (odds ratio, 1.020; CI, 1.00-1.04, P < 0.001) were independently associated with CD complications. Although not necessarily dictating IBD initiation, the TNF-alpha 308 A polymorphism may play a role in modifying the CD phenotype. The polymorphism may influence disease activity as well as more intense inflammatory activity in both forms of IBD and may modify the progression of chronic digestive tract inflammation.
The translocation t(2;11)(p21;q23) is associated with de novo myelodysplastic syndromes (MDS) and... more The translocation t(2;11)(p21;q23) is associated with de novo myelodysplastic syndromes (MDS) and has an overall frequency of approximately 1%. The outcome of MDS patients with this translocation is not clear until now, because most of the clinical data addressing the t(2;11)(p21;q23) has been collected without investigating the status of the mixed lineage leukemia (MLL) gene. In this report, we present seven new patients with MDS diagnosis and the t(2;11)(p21;q23) in bone marrow cells; all of them without MLL gene rearrangement. They were found in two databases consisting of 1185 patients of two Czech institutions. These patients tended to be younger and showed a strong male predominance. A cytological and histological assessment of bone marrow at diagnosis revealed only mild MDS with marked dysplasia in megakaryopoiesis. Similar to other primary abnormalities in MDS (e.g. deletion of 11q), the t(2;11)(p21;q23) was frequently associated with deletion of 5q. Our results stress the common clinicopathological features of this entity and indicate that the t(2;11)(p21;q23) may be associated with a good prognosis for MDS patients (median survival 72 months).
X-linked Charcot-Marie-Tooth (CMTX) disease is a hereditary motor and sensory neuropathy caused b... more X-linked Charcot-Marie-Tooth (CMTX) disease is a hereditary motor and sensory neuropathy caused by mutations in the gap junction beta 1 gene (GJB1 codes for connexin 32). In this study we report six novel mutations p.Met1Arg, p.Leu9Phe, p.Ser17Tyr, p.Val63Phe, p.Val170Ile, and p.Leu212Phe in GJB1 and their phenotypic expression. These mutations affect both intracellular and extracellular parts of the GJB1 protein. The screened patients had previously excluded the duplication=deletion on 17p11.2 and the male-to-male transfer in the pedigree. Except p.Val170Ile, all reported mutations segregated with the CMT phenotype in the families and caused CMTX1 neuropathy. Mutations were not found in 200 control DNA samples. Additionally, we performed in silico analysis of the novel mutations with the program PANTHER. The PANTHER scored five mutations, all but p.Val170Ile, as likely deleterious and supported the pathogenicity of the found mutations. These results provided evidence that these five mutations are causative for CMTX1.
Objective: To determine whether folate treatment, besides decreasing homocysteine (tHcy), improve... more Objective: To determine whether folate treatment, besides decreasing homocysteine (tHcy), improves coagulation status, oxidative stress and endothelial dysfunction and whether these depend on genetic polymorphism of the enzyme methylenetetrahydrofolate reductase (MTHFR). Methods: Fifty-seven volunteers (males 30, females 27, mean age 61.2 years) with high coronary risk or manifest atherosclerotic disease and tHcy concentration of at least 20 lmol/l participated in an open, prospective study-1 month of placebo period, followed by 2 months of treatment with folate 10 mg daily. Concentrations of tHcy were measured using high-pressure liquid chromatography with fluorescence detection. Other variables were measured using commercial kits, and polymorphism of MTHFR was detected using a polymerase chain reaction. Results: Folate treatment resulted in a significant decrease of tHcy and fibrinogen, while plasminogen and antithrombin III significantly increased. Glutathione peroxidase, glutathione and superoxide dismutase significantly increased after the folate treatment; moreover, malonyldialdehyde and von Willebrand factor decreased concomitantly. The individual MTHFR polymorphism did not influence the outcomes of folate treatment. Conclusion: Folate treatment resulted not only in tHcy decrease, but also in an improvement of hypercoagulation, oxidative stress and endothelial dysfunction. The sufficiently high dose of folate seems to be able to decrease plasma tHcy in all three individual MTHFR polymorphism groups, to almost the same post-treatment concentrations.
Objectives: Several prospective studies reported that fibrates might increase blood total homocys... more Objectives: Several prospective studies reported that fibrates might increase blood total homocysteine (tHcy) concentrations. Because of this adverse effect, elevated tHcy could potentially compromise the cardiovascular benefit resulting from lipid-lowering by fibrates. In our study we aimed to find out whether the folate co-administration would modify the fibrate-induced elevation of tHcy. Methods: Twenty-four volunteers (m17, f7; mean age 54.9 years) with total cholesterol ‡6 mmol/l and triglycerides less than 5 mmol/l, with normal blood pressure, normal blood glucose and without any pharmacotherapy and/or clinical vascular or metabolic disease, were included in an open, randomised, prospective, crossover study. We measured lipids, tHcy, folate, vitamin B12 and renal function markers after diet, after a 6-month administration of 200 mg of fenofibrate (3 months in monotherapy followed by 3 months in combination with 10 mg of folate) and further on after an identical period of fluvastatin administration (3 months of 40 mg followed by 3 months of 80 mg). Results: Fenofibrate in monotherapy, beside the expected lipid-lowering effect, increased tHcy from 10.0 to 14.2 lmol/l (p<0.001). Co-administration of folate decreased tHcy to 10.6 lmol/l. In contrast, fluvastatin did not significantly influence the tHcy concentrations. Conclusion: Co-administration of folate to fenofibrate therapy has the potential to reverse the fibrate-induced elevation of tHcy.
Background. We describe early and typical nonendocrine symptoms of Multiple Endocrine Neoplasia t... more Background. We describe early and typical nonendocrine symptoms of Multiple Endocrine Neoplasia type 2B (MEN2B) presented in our patients with de novo M918T mutation in the RET proto-oncogene in early childhood, however, the diagnosis of MEN2B and medullary thyroid carcinoma (MTC) was confirmed late, in the second decade of life. In this paper, we emphasize the possibility of growth retardation, growth hormone (GH) deficiency and ovarian teratoma as a new symptom of MEN2B. Case Reports. Advanced MTC with palpable mass on the neck and nonendocrine symptoms such as marfanoid habitus, thickened lips, mucosal neuromas led to the diagnosis in case 1 at the age of 13 years and GH deficiency and nonendocrine symptoms in case 2 at the age of 11 years. The earliest feature of MEN2B was alacrima and constipation. Patient 1 was operated on for a slipped femoral capital epiphysis and for a cystic ovarian teratoma. Conclusions. Improved awareness of nonendocrine signs of MEN2B could lead to earlier diagnosis, when surgical cure of MTC is possible. Alacrima is the first sign of MEN2B. We confirmed the possibility of growth retardation and GH deficiency in MEN2B, which had been previously rarely described. We suggest that patients with MEN2B may develop cystic ovarian teratoma, to the best of our knowledge, which has never been described so far in the literature. The results of this study could be used to guide further diagnosing of MENB2 at the early stage for better clinical outcome. We emphasize that MEN2B carries a risk for development of cystic ovarian teratoma as a novel tumor in this disease.
Background. The complete androgen insensitivity syndrome (CAIS) is a rare genetic disorder causin... more Background. The complete androgen insensitivity syndrome (CAIS) is a rare genetic disorder causing insensitivity to androgens in a person with female phenotype and 46,XY karyotype due to a mutation in the androgen receptor gene located on chromosome X. These children are born with female external genitalia, and females are transmitters. Case Report. We illustrate an unexpected diagnosis of CAIS in two siblings during examination for short stature, and describe transmission/carriers in the family along with ethical aspects. Conclusion. A genetic examination could have earlier revealed the transmission of c.2495G>Tp.(Arg832Leu) mutation in exon 7. Our experience highlights the possibility of prenatal testing for the management of pregnancy in a family with a history of CAIS. The implications of prenatal testing in relation to CAIS with clearer explication of ethical and clinical issues warrant further investigation.
Thiamine-responsive megaloblastic anemia (TRMA) is a rare autosomal recessive disorder caused by ... more Thiamine-responsive megaloblastic anemia (TRMA) is a rare autosomal recessive disorder caused by mutations in the SLC19A2 gene. To date at least 43 mutations have been reported for the gene encoding a plasma membrane thiamine transporter protein (THTR-1). TRMA has been reported in less than 80 cases worldwide. Here, we illustrate 2 female patients with TRMA first diagnosed in the Czech Republic and in central Europe being confirmed by sequencing of the THTR-1 gene SLC19A2. Both subjects are compound heterozygotes with 3 different mutations in the SLC19A2 gene. In case 2, the SLC19A2 intron 1 mutation c.204+2T>G has never been reported before. TRMA subjects are at risk of diabetic ketoacidosis during intercurrent disease and arrythmias. Thiamine supplementation has prevented hematological disorders over a few years in both pediatric subjects, and improved glycaemic control of diabetes mellitus. Patient 1 was suffering from hearing loss and rod-cone dystrophy at the time of diagnos...
ABSTRACT Our patient with CML failed to produce any cytogenetic response after initial therapies.... more ABSTRACT Our patient with CML failed to produce any cytogenetic response after initial therapies. Cytogenetic analysis revealed clonal evolution in Ph-positive (Ph+) clone with trisomy 8. The treatment was changed to imatinib mesylate (IM) and the 1st complete cytogenetic remission of CML was achieved. Two Ph-negative (Ph-) clones were detected by G-banding after the reduction of Ph+ cells. The first Ph- clone had trisomy 8 as the only chromosomal aberration and we did not observe any influence on the course of CML. The second Ph- clone had inv(3)(q21q26) as the only chromosomal aberration and was associated with the development of AML. The patient underwent induction chemotherapy, consolidation chemotherapy and allo-HSCT.
Our retrospective analysis was performed on 376 consecutive patients diagnosed with AML. A total ... more Our retrospective analysis was performed on 376 consecutive patients diagnosed with AML. A total of 256 (68%) were treated with standard "7+3" induction and high-dose cytarabine and mitoxantrone containing "4+3" consolidation/intensification regimens. Our study focused on patients with presumably very poor prognosis - patients, who did not achieve complete cytogenetic remission (CRc). Twenty-five AML patients without CRc were further analysed for clinical and laboratory parameters. Firstly, the subgroups with or without morphologic CR were compared. Similar cytogenetic abnormalities were observed in both with myelodysplasia related changes being the most common. Complex karyotype with deletion of 5q constituted approximately a third of all karyotypes in both subgroups. There were 1 patient with intermediate risk cytogenetics in the subgroup without morphologic CR and 5 patients in the subgroup with morphologic CR. Interestingly, in 4/25 patients subclones were di...
International angiology : a journal of the International Union of Angiology, 2013
The aim of this paper was to assess the prevalence of concurrent deep vein thrombosis (DVT) and/o... more The aim of this paper was to assess the prevalence of concurrent deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in the patients with superficial vein thrombosis (SVT) of the legs and to find factors significantly and independently associated with coincident DVT/PE. In the setting of a tertiary referral hospital, patients with SVT, attending vascular clinic, underwent physical examination, laboratory testing and leg vein ultrasound (in the case of clinically suspected PE also perfusion/ventilation lung scan or/and helical CT pulmonary angiography). In statistical analysis, we used unpaired t-test, non-parametric Wilcoxon rank sum test, stepwise logistic regression and multivariable logistic regression model. We examined 138 patients (age 61.4 ± 13.9 years, 36.2% men), with ST mostly on varicose veins (89.9%). The prevalence of concurrent DVT/PE was 34.1%. Neither the clinical manifestation nor SVT localization differed significantly between the group with isolated SVT and ...
Background: Factor V Leiden (FVL) supposedly carries relatively higher risk of deep vein thrombos... more Background: Factor V Leiden (FVL) supposedly carries relatively higher risk of deep vein thrombosis (DVT), compared to the risk of pulmonary embolism (PE). Aim: To prove this paradox in a group of patients with various clinical presentation of venous thromboembolism (VTE). Materials and methods: We retrospectively evaluated clinical pattern of VTE in patients who had been referred to vascular clinic shortly after an acute VTE event. In FVL positive and FVL negative groups we compared the prevalence of isolated symptomatic DVT (proximal or distal) and symptomatic PE with/without DVT, and, moreover, asymptomatic DVT or PE. Results: Of 575 patients (mean age 57 years, 50.1% women), 120 were FVL positive and those had significantly higher prevalence of isolated symptomatic DVT, compared to symptomatic PE with/without DVT. Proximal DVT location was significantly more frequent in FVL carriers. The prevalence of asymptomatic PE did not differ between the two groups. The rate of asymptomatic DVT tended to be higher in FVL negative group. In a multivariate analysis, we confirmed FVL to be positively associated with isolated DVT presentation (odds ratio OR 1.757; 95% confidence interval (CI) 1.148-2.690). On the contrary, increasing age and unprovoked nature of VTE event carried a higher risk of symptomatic PE. Conclusions: We confirmed FVL to be significantly associated with isolated symptomatic DVT despite higher prevalence of proximal DVT in FVL carriers. The fact of relatively lower risk of PE in FVL positive patients might have clinical implication. However, mechanisms of FVL paradox remain to be elucidated.
ABSTRACT Our patient with CML failed to produce any cytogenetic response after initial therapies.... more ABSTRACT Our patient with CML failed to produce any cytogenetic response after initial therapies. Cytogenetic analysis revealed clonal evolution in Ph-positive (Ph+) clone with trisomy 8. The treatment was changed to imatinib mesylate (IM) and the 1st complete cytogenetic remission of CML was achieved. Two Ph-negative (Ph-) clones were detected by G-banding after the reduction of Ph+ cells. The first Ph- clone had trisomy 8 as the only chromosomal aberration and we did not observe any influence on the course of CML. The second Ph- clone had inv(3)(q21q26) as the only chromosomal aberration and was associated with the development of AML. The patient underwent induction chemotherapy, consolidation chemotherapy and allo-HSCT.
Journal of Pediatric Gastroenterology and Nutrition, 2006
Our pilot study aimed to determine the effect of tumor necrosis factor-alpha (TNF-alpha) 308 G--&... more Our pilot study aimed to determine the effect of tumor necrosis factor-alpha (TNF-alpha) 308 G--&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;A promoter single-nucleotide polymorphism in pediatric inflammatory bowel disease (IBD), its influence on inflammatory activity and the clinical manifestations. We obtained genomic DNA from 164 subjects, 82 with long-standing IBD aged 8 to 18 years: 46 with Crohn disease (CD) and 36 with ulcerative colitis (UC). Eighty-two healthy children served as the control population. Genotyping was determined by using a restriction enzyme-based assay. TNF-alpha 308 G--&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;A polymorphism was assessed in terms of inflammatory (C-reactive protein [CRP]) and disease activity. The latter was assessed by the Pediatric Crohn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Disease Activity Index (PCDAI) and the Truelove index for CD and UC, respectively. Significant differences in TNF-alpha 308 A polymorphism were found between the IBD group and controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and the UC group and controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). No differences were noted between TNF-alpha 308 A polymorphism and clinical characteristics in UC. The frequency of the -308 A allele of TNF was not different in CD compared with that in the control group. The frequency of TNF-alpha 308 A genotype was significantly higher in CD patients with predominantly stenosing/penetrating disease compared with patients without complications (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and healthy controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). In CD patients, those carrying TNF -308 A had a significant increase in CRP (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and the PCDAI (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). In CD, CRP levels strongly correlated with the PCDAI (r = 0.6150, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In UC, significant differences among the mean levels of CRP (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and disease activity (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) related to TNF-alpha 308 A polymorphism were found. Allele distribution (odds ratio, 12.9; CI, 1.18-140.81, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and CRP serum levels (odds ratio, 1.020; CI, 1.00-1.04, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) were independently associated with CD complications. Although not necessarily dictating IBD initiation, the TNF-alpha 308 A polymorphism may play a role in modifying the CD phenotype. The polymorphism may influence disease activity as well as more intense inflammatory activity in both forms of IBD and may modify the progression of chronic digestive tract inflammation.
The translocation t(2;11)(p21;q23) is associated with de novo myelodysplastic syndromes (MDS) and... more The translocation t(2;11)(p21;q23) is associated with de novo myelodysplastic syndromes (MDS) and has an overall frequency of approximately 1%. The outcome of MDS patients with this translocation is not clear until now, because most of the clinical data addressing the t(2;11)(p21;q23) has been collected without investigating the status of the mixed lineage leukemia (MLL) gene. In this report, we present seven new patients with MDS diagnosis and the t(2;11)(p21;q23) in bone marrow cells; all of them without MLL gene rearrangement. They were found in two databases consisting of 1185 patients of two Czech institutions. These patients tended to be younger and showed a strong male predominance. A cytological and histological assessment of bone marrow at diagnosis revealed only mild MDS with marked dysplasia in megakaryopoiesis. Similar to other primary abnormalities in MDS (e.g. deletion of 11q), the t(2;11)(p21;q23) was frequently associated with deletion of 5q. Our results stress the common clinicopathological features of this entity and indicate that the t(2;11)(p21;q23) may be associated with a good prognosis for MDS patients (median survival 72 months).
X-linked Charcot-Marie-Tooth (CMTX) disease is a hereditary motor and sensory neuropathy caused b... more X-linked Charcot-Marie-Tooth (CMTX) disease is a hereditary motor and sensory neuropathy caused by mutations in the gap junction beta 1 gene (GJB1 codes for connexin 32). In this study we report six novel mutations p.Met1Arg, p.Leu9Phe, p.Ser17Tyr, p.Val63Phe, p.Val170Ile, and p.Leu212Phe in GJB1 and their phenotypic expression. These mutations affect both intracellular and extracellular parts of the GJB1 protein. The screened patients had previously excluded the duplication=deletion on 17p11.2 and the male-to-male transfer in the pedigree. Except p.Val170Ile, all reported mutations segregated with the CMT phenotype in the families and caused CMTX1 neuropathy. Mutations were not found in 200 control DNA samples. Additionally, we performed in silico analysis of the novel mutations with the program PANTHER. The PANTHER scored five mutations, all but p.Val170Ile, as likely deleterious and supported the pathogenicity of the found mutations. These results provided evidence that these five mutations are causative for CMTX1.
Objective: To determine whether folate treatment, besides decreasing homocysteine (tHcy), improve... more Objective: To determine whether folate treatment, besides decreasing homocysteine (tHcy), improves coagulation status, oxidative stress and endothelial dysfunction and whether these depend on genetic polymorphism of the enzyme methylenetetrahydrofolate reductase (MTHFR). Methods: Fifty-seven volunteers (males 30, females 27, mean age 61.2 years) with high coronary risk or manifest atherosclerotic disease and tHcy concentration of at least 20 lmol/l participated in an open, prospective study-1 month of placebo period, followed by 2 months of treatment with folate 10 mg daily. Concentrations of tHcy were measured using high-pressure liquid chromatography with fluorescence detection. Other variables were measured using commercial kits, and polymorphism of MTHFR was detected using a polymerase chain reaction. Results: Folate treatment resulted in a significant decrease of tHcy and fibrinogen, while plasminogen and antithrombin III significantly increased. Glutathione peroxidase, glutathione and superoxide dismutase significantly increased after the folate treatment; moreover, malonyldialdehyde and von Willebrand factor decreased concomitantly. The individual MTHFR polymorphism did not influence the outcomes of folate treatment. Conclusion: Folate treatment resulted not only in tHcy decrease, but also in an improvement of hypercoagulation, oxidative stress and endothelial dysfunction. The sufficiently high dose of folate seems to be able to decrease plasma tHcy in all three individual MTHFR polymorphism groups, to almost the same post-treatment concentrations.
Objectives: Several prospective studies reported that fibrates might increase blood total homocys... more Objectives: Several prospective studies reported that fibrates might increase blood total homocysteine (tHcy) concentrations. Because of this adverse effect, elevated tHcy could potentially compromise the cardiovascular benefit resulting from lipid-lowering by fibrates. In our study we aimed to find out whether the folate co-administration would modify the fibrate-induced elevation of tHcy. Methods: Twenty-four volunteers (m17, f7; mean age 54.9 years) with total cholesterol ‡6 mmol/l and triglycerides less than 5 mmol/l, with normal blood pressure, normal blood glucose and without any pharmacotherapy and/or clinical vascular or metabolic disease, were included in an open, randomised, prospective, crossover study. We measured lipids, tHcy, folate, vitamin B12 and renal function markers after diet, after a 6-month administration of 200 mg of fenofibrate (3 months in monotherapy followed by 3 months in combination with 10 mg of folate) and further on after an identical period of fluvastatin administration (3 months of 40 mg followed by 3 months of 80 mg). Results: Fenofibrate in monotherapy, beside the expected lipid-lowering effect, increased tHcy from 10.0 to 14.2 lmol/l (p<0.001). Co-administration of folate decreased tHcy to 10.6 lmol/l. In contrast, fluvastatin did not significantly influence the tHcy concentrations. Conclusion: Co-administration of folate to fenofibrate therapy has the potential to reverse the fibrate-induced elevation of tHcy.
Uploads
Papers by Ivan Subrt