Disease Manifestations and Complications in Dutch X-Linked Hypophosphatemia Patients

X-linked hypophosphatemia (XLH) is the most common monogenetic cause of chronic hypophosphatemia, characterized by rickets and osteomalacia. Disease manifestations and treatment of XLH patients in the Netherlands are currently unknown. Characteristics of XLH patients participating in the Dutch observational registry for genetic hypophosphatemia and acquired renal phosphate wasting were analyzed. Eighty XLH patients, including 29 children, were included. Genetic testing, performed in 78.8% of patients, showed a PHEX mutation in 96.8%. Median (range) Z-score for height was − 2.5 (− 5.5; 1.0) in adults and − 1.4 (− 3.7; 1.0) in children. Many patients were overweight or obese: 64.3% of adults and 37.0% of children. All children received XLH-related medication e.g., active vitamin D, phosphate supplementation or burosumab, while 8 adults used no medication. Lower age at start of XLH-related treatment was associated with higher height at inclusion. Hearing loss was reported in 6.9% of children and 31.4% of adults. Knee deformities were observed in 75.0% of all patients and osteoarthritis in 51.0% of adult patients. Nephrocalcinosis was observed in 62.1% of children and 33.3% of adults. Earlier start of XLH-related treatment was associated with higher risk of nephrocalcinosis and detection at younger age. Hyperparathyroidism longer than six months was reported in 37.9% of children and 35.3% of adults. This nationwide study confirms the high prevalence of adiposity, hearing loss, bone deformities, osteoarthritis, nephrocalcinosis and hyperparathyroidism in Dutch XLH patients. Early start of XLH-related treatment appears to be beneficial for longitudinal growth but may increase development of nephrocalcinosis.</p

Differential Temporal and Spatial Progerin Expression during Closure of the Ductus Arteriosus in Neonates

Closure of the ductus arteriosus (DA) at birth is essential for the transition from fetal to postnatal life. Before birth the DA bypasses the uninflated lungs by shunting blood from the pulmonary trunk into the systemic circulation. The molecular mechanism underlying DA closure and degeneration has not been fully elucidated, but is associated with apoptosis and cytolytic necrosis in the inner media and intima. We detected features of histology during DA degeneration that are comparable to Hutchinson Gilford Progeria syndrome and ageing. Immunohistochemistry on human fetal and neonatal DA, and aorta showed that lamin A/C was expressed in all layers of the vessel wall. As a novel finding we report that progerin, a splicing variant of lamin A/C was expressed almost selectively in the normal closing neonatal DA, from which we hypothesized that progerin is involved in DA closure. Progerin was detected in 16.2%±7.2 cells of the DA. Progerin-expressing cells were predominantly located in intima and inner media where cytolytic necrosis accompanied by apoptosis will develop. Concomitantly we found loss of α-smooth muscle actin as well as reduced lamin A/C expression compared to the fetal and non-closing DA. In cells of the adjacent aorta, that remains patent, progerin expression was only sporadically detected in 2.5%±1.5 of the cells. Data were substantiated by the detection of mRNA of progerin in the neonatal DA but not in the aorta, by PCR and sequencing analysis. The fetal DA and the non-closing persistent DA did not present with progerin expressing cells. Our analysis revealed that the spatiotemporal expression of lamin A/C and progerin in the neonatal DA was mutually exclusive. We suggest that activation of LMNA alternative splicing is involved in vascular remodeling in the circulatory system during normal neonatal DA closure

The role of the electrocardiographic phenotype in risk stratification for sudden cardiac death in childhood hypertrophic cardiomyopathy.

AIMS: The 12-lead electrocardiogram (ECG) is routinely performed in children with hypertrophic cardiomyopathy (HCM). An ECG risk score has been suggested as a useful tool for risk stratification, but this has not been independently validated. This aim of this study was to describe the ECG phenotype of childhood HCM in a large, international, multi-centre cohort and investigate its role in risk prediction for arrhythmic events. METHODS AND RESULTS: Data from 356 childhood HCM patients with a mean age of 10.1 years (±4.5) were collected from a retrospective, multi-centre international cohort. Three hundred and forty-seven (97.5%) patients had ECG abnormalities at baseline, most commonly repolarization abnormalities (n = 277, 77.8%); left ventricular hypertrophy (n = 240, 67.7%); abnormal QRS axis (n = 126, 35.4%); or QT prolongation (n = 131, 36.8%). Over a median follow-up of 3.9 years (interquartile range 2.0-7.7), 25 (7%) had an arrhythmic event, with an overall annual event rate of 1.38 (95% CI 0.93-2.04). No ECG variables were associated with 5-year arrhythmic event on univariable or multivariable analysis. The ECG risk score threshold of >5 had modest discriminatory ability [C-index 0.60 (95% CI 0.484-0.715)], with corresponding negative and positive predictive values of 96.7% and 6.7. CONCLUSION: In a large, international, multi-centre cohort of childhood HCM, ECG abnormalities were common and varied. No ECG characteristic, either in isolation or combined in the previously described ECG risk score, was associated with 5-year sudden cardiac death risk. This suggests that the role of baseline ECG phenotype in improving risk stratification in childhood HCM is limited

Genes in the Ureteric Budding Pathway: Association Study on Vesico-Ureteral Reflux Patients

Vesico-ureteral reflux (VUR) is the retrograde passage of urine from the bladder to the urinary tract and causes 8.5% of end-stage renal disease in children. It is a complex genetic developmental disorder, in which ectopic embryonal ureteric budding is implicated in the pathogenesis. VUR is part of the spectrum of Congenital Anomalies of the Kidney and Urinary Tract (CAKUT). We performed an extensive association study for primary VUR using a two-stage, case-control design, investigating 44 candidate genes in the ureteric budding pathway in 409 Dutch VUR patients. The 44 genes were selected from the literature and a set of 567 single nucleotide polymorphisms (SNPs) capturing their genetic variation was genotyped in 207 cases and 554 controls. The 14 SNPs with p<0.005 were included in a follow-up study in 202 cases and 892 controls. Of the total cohort, ∼50% showed a clear-cut primary VUR phenotype and ∼25% had both a duplex collecting system and VUR. We also looked for association in these two extreme phenotype groups. None of the SNPs reached a significant p-value. Common genetic variants in four genes (GREM1, EYA1, ROBO2 and UPK3A) show a trend towards association with the development of primary VUR (GREM1, EYA1, ROBO2) or duplex collecting system (EYA1 and UPK3A). SNPs in three genes (TGFB1, GNB3 and VEGFA) have been shown to be associated with VUR in other populations. Only the result of rs1800469 in TGFB1 hinted at association in our study. This is the first extensive study of common variants in the genes of the ureteric budding pathway and the genetic susceptibility to primary VUR

A lower bound on intergalactic magnetic fields from time variability of 1ES 0229+200 from MAGIC and Fermi/LAT observations

Extended and delayed emission around distant TeV sources induced by the effects of propagation of gamma rays through the intergalactic medium can be used for the measurement of the intergalactic magnetic field (IGMF). We search for delayed GeV emission from the hard-spectrum TeV blazar 1ES 0229+200 with the goal to detect or constrain the IGMF-dependent secondary flux generated during the propagation of TeV gamma rays through the intergalactic medium. We analyze the most recent MAGIC observations over a 5 year time span and complement them with historic data of the H.E.S.S. and VERITAS telescopes along with a 12-year long exposure of the Fermi/LAT telescope. We use them to trace source evolution in the GeV-TeV band over one-and-a-half decade in time. We use Monte Carlo simulations to predict the delayed secondary gamma-ray flux, modulated by the source variability, as revealed by TeV-band observations. We then compare these predictions for various assumed IGMF strengths to all available measurements of the gamma-ray flux evolution. We find that the source flux in the energy range above 200 GeV experiences variations around its average on the 14 years time span of observations. No evidence for the flux variability is found in 1-100 GeV energy range accessible to Fermi/LAT. Non-detection of variability due to delayed emission from electromagnetic cascade developing in the intergalactic medium imposes a lower bound of B>1.8e-17 G for long correlation length IGMF and B>1e-14 G for an IGMF of the cosmological origin. Though weaker than the one previously derived from the analysis of Fermi/LAT data, this bound is more robust, being based on a conservative intrinsic source spectrum estimate and accounting for the details of source variability in the TeV energy band. We discuss implications of this bound for cosmological magnetic fields which might explain the baryon asymmetry of the Universe.Comment: 10 pages, 5 figures, accepted to A&A. Corresponding authors: Ievgen Vovk, Paolo Da Vela (mailto:[email protected]) and Andrii Neronov (mailto:[email protected]

Long-term multi-wavelength study of 1ES 0647+250

The BL Lac object 1ES 0647+250 is one of the few distant $\gamma$-ray emitting blazars detected at very high energies (VHE, $\gtrsim$100 GeV) during a non-flaring state. It was detected with the MAGIC telescopes during its low activity in the years 2009-2011, as well as during three flaring activities in the years 2014, 2019 and 2020, with the highest VHE flux in the latter epoch. An extensive multi-instrument data set was collected within several coordinated observing campaigns throughout these years. We aim to characterise the long-term multi-band flux variability of 1ES 0647+250, as well as its broadband spectral energy distribution (SED) during four distinct activity states selected in four different epochs, in order to constrain the physical parameters of the blazar emission region under certain assumptions. We evaluate the variability and correlation of the emission in the different energy bands with the fractional variability and the Z-transformed Discrete Correlation Function, as well as its spectral evolution in X-rays and $\gamma$ rays. Owing to the controversy in the redshift measurements of 1ES 0647+250 reported in the literature, we also estimate its distance in an indirect manner through the comparison of the GeV and TeV spectra from simultaneous observations with Fermi-LAT and MAGIC during the strongest flaring activity detected to date. Moreover, we interpret the SEDs from the four distinct activity states within the framework of one-component and two-component leptonic models, proposing specific scenarios that are able to reproduce the available multi-instrument data.Comment: 20 pages, 7 figures. Accepted in A&A. Corresponding authors: Jorge Otero-Santos; Daniel Morcuende; Vandad Fallah Ramazani; Daniela Dorner; David Paneque (mailto: [email protected]

Multiwavelength Observations of the Blazar VER J0521+211 during an Elevated TeV Gamma-Ray State

We report on a long-lasting, elevated gamma-ray flux state from VER J0521+211 observed by VERITAS, MAGIC, and Fermi-LAT in 2013 and 2014. The peak integral flux above 200 GeV measured with the nightly binned light curve is (8.8 ± 0.4) × 10-7 photons m-2 s-1, or ∼37% of the Crab Nebula flux. Multiwavelength observations from X-ray, UV, and optical instruments are also presented. A moderate correlation between the X-ray and TeV gamma-ray fluxes was observed, and the X-ray spectrum appeared harder when the flux was higher. Using the gamma-ray spectrum and four models of the extragalactic background light (EBL), a conservative 95% confidence upper limit on the redshift of the source was found to be z ≤ 0.31. Unlike the gamma-ray and X-ray bands, the optical flux did not increase significantly during the studied period compared to the archival low-state flux. The spectral variability from optical to X-ray bands suggests that the synchrotron peak of the spectral energy distribution (SED) may become broader during flaring states, which can be adequately described with a one-zone synchrotron self-Compton model varying the high-energy end of the underlying particle spectrum. The synchrotron peak frequency of the SED and the radio morphology of the jet from the MOJAVE program are consistent with the source being an intermediate-frequency-peaked BL Lac object

Searching for VHE gamma-ray emission associated with IceCube neutrino alerts using FACT, H.E.S.S., MAGIC, and VERITAS

The realtime follow-up of neutrino events is a promising approach to searchfor astrophysical neutrino sources. It has so far provided compelling evidencefor a neutrino point source: the flaring gamma-ray blazar TXS 0506+056 observedin coincidence with the high-energy neutrino IceCube-170922A detected byIceCube. The detection of very-high-energy gamma rays (VHE, $\mathrm{E} >100\,\mathrm{GeV}$) from this source helped establish the coincidence andconstrained the modeling of the blazar emission at the time of the IceCubeevent. The four major imaging atmospheric Cherenkov telescope arrays (IACTs) -FACT, H.E.S.S., MAGIC, and VERITAS - operate an active follow-up program oftarget-of-opportunity observations of neutrino alerts sent by IceCube. Thisprogram has two main components. One are the observations of known gamma-raysources around which a cluster of candidate neutrino events has been identifiedby IceCube (Gamma-ray Follow-Up, GFU). Second one is the follow-up of singlehigh-energy neutrino candidate events of potential astrophysical origin such asIceCube-170922A. GFU has been recently upgraded by IceCube in collaborationwith the IACT groups. We present here recent results from the IACT follow-upprograms of IceCube neutrino alerts and a description of the upgraded IceCubeGFU system.<br

Investigating the blazar TXS 0506+056 through sharp multi-wavelength eyes during 2017-2019

The blazar TXS 0506+056 got into the spotlight of the astrophysical community in September 2017, when a high-energy neutrino detected by IceCube (IceCube-170922A) was associated at the 3 $\sigma$ level to a $\gamma$-ray flare from this source. This multi-messenger photon-neutrino association remains, as per today, the most significant one ever observed. TXS 0506+056 was a poorly studied object before the IceCube-170922A event. To better characterize its broad-band emission, we organized a multi-wavelength campaign lasting 16 months (November 2017 to February 2019), covering the radio-band (Mets\"ahovi, OVRO), the optical/UV (ASAS-SN, KVA, REM, Swift/UVOT), the X-rays (Swift/XRT, NuSTAR), the high-energy $\gamma$ rays (Fermi/LAT) and the very-high-energy (VHE) $\gamma$ rays (MAGIC). In $\gamma$ rays, the behaviour of the source was significantly different from the 2017 one: MAGIC observations show the presence of flaring activity during December 2018, while the source only shows an excess at the 4$\sigma$ level during the rest of the campaign (74 hours of accumulated exposure); Fermi/LAT observations show several short (days-to-week timescale) flares, different from the long-term brightening of 2017. No significant flares are detected at lower energies. The radio light curve shows an increasing flux trend, not seen in other wavelengths. We model the multi-wavelength spectral energy distributions in a lepto-hadronic scenario, in which the hadronic emission emerges as Bethe-Heitler and pion-decay cascade in the X-rays and VHE $\gamma$ rays. According to the model presented here, the December 2018 $\gamma$-ray flare was connected to a neutrino emission that was too brief and not bright enough to be detected by current neutrino instruments.Comment: 18 pages, 6 figures; in press in Ap