An integrated molecular risk score early in life for subsequent childhood asthma risk.

BACKGROUND Numerous children present with early wheeze symptoms, yet solely a subgroup develops childhood asthma. Early identification of children at risk is key for clinical monitoring, timely patient-tailored treatment, and preventing chronic, severe sequelae. For early prediction of childhood asthma, we aimed to define an integrated risk score combining established risk factors with genome-wide molecular markers at birth, complemented by subsequent clinical symptoms/diagnoses (wheezing, atopic dermatitis, food allergy). METHODS Three longitudinal birth cohorts (PAULINA/PAULCHEN, n = 190 + 93 = 283, PASTURE, n = 1133) were used to predict childhood asthma (age 5-11) including epidemiological characteristics and molecular markers: genotype, DNA methylation and mRNA expression (RNASeq/NanoString). Apparent (ap) and optimism-corrected (oc) performance (AUC/R2) was assessed leveraging evidence from independent studies (Naïve-Bayes approach) combined with high-dimensional logistic regression models (LASSO). RESULTS Asthma prediction with epidemiological characteristics at birth (maternal asthma, sex, farm environment) yielded an ocAUC = 0.65. Inclusion of molecular markers as predictors resulted in an improvement in apparent prediction performance, however, for optimism-corrected performance only a moderate increase was observed (upto ocAUC = 0.68). The greatest discriminate power was reached by adding the first symptoms/diagnosis (up to ocAUC = 0.76; increase of 0.08, p = .002). Longitudinal analysis of selected mRNA expression in PASTURE (cord blood, 1, 4.5, 6 years) showed that expression at age six had the strongest association with asthma and correlation of genes getting larger over time (r = .59, p < .001, 4.5-6 years). CONCLUSION Applying epidemiological predictors alone showed moderate predictive abilities. Molecular markers from birth modestly improved prediction. Allergic symptoms/diagnoses enhanced the power of prediction, which is important for clinical practice and for the design of future studies with molecular markers

Funktionelle Analyse von Mutanten des LPS-bindenden Proteins (LBP)

LBP vermittelt im Wirtsorganismus die direkte Immunantwort auf bakterielle Liganden wie das Lipopolysaccharid (LPS) von Gram-negativen oder Lipopeptide von Gram-positiven Bakterien. In dieser Arbeit wurde die Funktionsweise von LBP weiter aufgeklärt. Im ersten Teil der Arbeit wurde eine natürlich vorkommende Mutation des LBP (c998t), die an Position 333 zu einem Austausch der Aminosäure Prolin zu Leucin führt, hinsichtlich ihrer Auswirkungen auf Struktur und Funktionalität des Proteins untersucht. Westernblot-Analysen des rekombinant hergestellten Proteins und humaner Seren von Mutationsträgern weisen auf einen Zerfall des mutierten Proteins hin. Es kommt zu einer Beeinträchtigung der Bindung bakterieller Liganden und einer deutlichen Reduktion der LBP-vermittelten Zytokinausschüttung von Immunzellen. Der hier untersuchte Polymorphismus hat eine Allelfrequenz von 0,072 in einer gesunden europäischen Population. Genotypanalysen von Patientengruppen zeigten, dass es durch die Mutation zu einer deutlich erhöhten Mortalität bei Patienten mit septischen Komplikationen und einer durch Gram-negative Erreger verursachten Pneumonie kommt. Unsere Ergebnisse zur eingeschränkten Funktion des LBP-c998t bieten eine erste Erklärung dafür, wie diese Mutation vermutlich die Fähigkeit, Krankheiten zu bewältigen, beeinträchtigt. Innerhalb dieser Arbeit ging es um die Analyse der Bindung von bakteriellen Liganden an LBP. Dabei wurde eine potentiell gemeinsame Bindungsstelle für Liganden untersucht, die von Gram-positiven und Gram-negativen Bakterien stammen und später von den Toll-like Rezeptoren (TLRs) 2 und -4 erkannt werden. Dazu wurden Bindungsversuche zwischen Lipopeptiden und LPS mit einer zweiten LBP-Variante (LBP-E94/95) durchgeführt. Beim LPS führt dies zu einem Bindungsverlust. Auch für die Lipopeptide war durch die Mutationen die Interaktion mit LBP beeinträchtigt, was die These einer gemeinsamen Bindungsstelle von TLR2- und TLR4-Liganden an das Protein weiter unterstützt.LBP enhances the innate immune reaction against bacterial ligands like LPS from gram negative or lipopeptides from gram positive bacteria in the host. Here we investigated the function of LBP using two recombinant mutants of the protein. The first part of this work examines a natural occurring mutation of LBP (c998t) leading to an amino acid exchange of proline to leucine at position 333 with regard to the impact on structure and function of the protein. Western blot analyses of the recombinant protein and sera obtained from individuals differing in the LBP genotype indicate the disaggregation of the mutated protein. Thereby binding of bacterial ligands to LBP is diminished and the LBP mediated cytokine secretion of immune cells is reduced. The gene polymorphism leading to the occurrence of the mutation is present with an allelic frequence of 0.072. A recent study has shown that this LBP-SNP led to a higher mortality in patients with septic complications and gram negative pneumonia. The results presented here, showing the negative impact on the function of LBP due to the mutation, may therefore be a first explanation on how this mutation affects the ability of people to deal with disease. Within this work binding of ligands to LBP was also explored. It was investigated whether ligands which are later recognized by Toll-like receptors (TLRs) 2 and – 4 share a common binding site on LBP. Assays with immobilized lipopeptides and LPS were performed with a second mutated LBP (LBP-E94/95). LPS binding to LBP is diminished completely. Here we showed that binding of lipopeptide to LBP is affected likewise, furthermore supporting the hypothesis of a common binding site for TLR2- and TLR4- ligands

Oxygen targets and 6-month outcome after out of hospital cardiac arrest: a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial

International audienceAbstract Background Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO 2 ) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO 2 with patients’ outcome. Methods Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO 2  300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO 2 -AUC), for hyperoxemia was significantly associated with mortality ( p = 0.003). Conclusions In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration : clinicaltrials.gov NCT02908308 , Registered September 20, 2016

Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients: a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

International audienc