A longitudinal follow-up of autoimmune polyendocrine syndrome type 1

Source:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971337/Context: Autoimmune polyendocrine syndrome type 1 (APS1) is a childhood-onset monogenic disease defined by the presence of two of the three major components: hypoparathyroidism, primary adrenocortical insuffi- ciency, and chronic mucocutaneous candidiasis (CMC). Information on longitudinal follow-up of APS1 is sparse. Objective: To describe the phenotypes of APS1 and correlate the clinical features with autoantibody profiles and autoimmune regulator ( AIRE) mutations during extended follow-up (1996–2016). Patients: All known Norwegian patients with APS1. Results: Fifty-two patients from 34 families were identified. The majority presented with one of the major disease components during childhood. Enamel hypoplasia, hypoparathyroidism, and CMC were the most frequent compo- nents.Withage,mostpatientspresentedthreetofivediseasemanifestations,althoughsomehadmilderphenotypes diagnosed in adulthood. Fifteen of the patients died during follow-up (median age at death, 34 years) or were deceasedsiblingswithahighprobabilityofundisclosedAPS1.Allexceptthreehadinterferon- )autoantibodies,and allhadorgan-specificautoantibodies.Themostcommon AIRE mutationwasc.967_979del13,foundinhomozygosity in 15 patients. A mild phenotype was associated with the splice mutation c.879 1G A. Primary adrenocortical insufficiency and type 1 diabetes were associated with protective human leucocyte antigen genotypes. Conclusions: Multiple presumable autoimmune manifestations, in particular hypoparathyroidism, CMC, and enamel hypoplasia, should prompt further diagnostic workup using autoantibody analyses (eg, interferon- ) and AIRE sequencing to reveal APS1, even in adults. Treatment is complicated, and mortality is high. Structured follow-up should be performed in a specialized center

Evalueringsrapport kompetansehevingsprosjektet 'STYRK-DIA - Bedre diabetesbehandling ved helse- og velferdssentrene i Helse Midt-Norge'

Bakgrunn: Samhandlingsreformen forventer mer aktiv samhandling om pasientbehandling mellom spesialist- og kommunehelsetjenesten. Spesialisthelsetjenesten har veilederansvar og kommunene har ansvar for å sette i verk tiltak for forebygging og behandling av diabetes i befolkningen. Formål: Prosjektet ‘STYRK-DIA – Bedre diabetesbehandling ved helse- og velferdssentrene i Helse Midt-Norge’ er et delprosjekt hvor hovedmålet var å bidra til kompetanseheving innen diabetesbehandling hos helsepersonell (sykepleiere, hjelpepleiere, helsefagarbeidere, vernepleiere, omsorgsarbeidere, assistenter, miljøarbeidere og ergoterapeuter) i kommunehelsetjenesten. Bedre diabetesbehandling vil kunne øke livskvaliteten og redusere diabeteskomplikasjoner hos brukere av hjemmesykepleien og sykehjem. Metode: I dette prosjektet har en diabetessykepleier (spesialutdannet sykepleier ved høgskole/universitet) arbeidet med kompetanseheving i kommunene, og det er undersøkt praksis før og etter undervisningen ved hjelp av spørreskjema og fokusgruppeintervju. Tiltak: Målet med arbeidet har vært å avdekke behov, evaluere hvilken effekt kompetanseheving innen temaet vil ha, samt gi faglig begrunnede forslag til videre tiltak. Vi håper arbeidet vil være til nytte for både brukerne, helsepersonell, kommunene, spesialisthelsetjenesten og andre som skal planlegge og gjennomføre tiltak innen diabetesbehandling. Resultat: Resultatene av dette prosjektet viste at det var mangelfull kompetanse innen diabetesbehandling i kommunehelsetjenesten, noe som går ut over den enkelte bruker. Undersøkelsen viste at økt kompetanse hos helsepersonell ga mer trygghet og trivsel på arbeidsplassen og trolig bedre livskvalitet hos brukerne. Konklusjon: Generelt sett viste denne studien stor mangel på kunnskap innen diabetesbehandling i kommunehelsetjenesten. Det har vist seg vanskelig å mobilisere helse- og velferdssentrene til å øke kompetansen blant helsepersonell. I tillegg til Trondheim kommune var det kun 10 av 19 kommuner som takket ja til tilbudet. Av disse 10 var undervisningen obligatorisk i en kommune. En må stille spørsmål ved om ledelsen i kommunene og kommunehelsetjenesten er klar over de alvorlige komplikasjoner denne diagnosen kan innebære for brukerne. Tilrådning: Kommunene bør sørge for at helsepersonell får faglig oppdatering i diabetesbehandling i arbeidstiden. Det tilrås å ansette en diabetessykepleier som har ansvar for faglig oppdatering av helsepersonell, oppfølging av brukerne samt være med i et tverrfaglig diabetesteam med sikte på å forebygge overvekt. Dette vil spare samfunnet for store kostnader. Små kommuner anbefales å ha et økonomisk samarbeid med andre kommuner for å dekke lønnskostnadene for diabetessykepleier. Det tilrås at det blir mer fokus på diabetesbehandling i utdannelsen av helsefagarbeidere, sykepleiere og leger

Interleukin 1 receptor antagonist is associated with changes in body composition during physiological GH substitution in patients with adult-onset growth hormone deficiency.

Objective: We examined the effect of GH substitution on adipose tissue derived hormones and cytokines and sought to identify predictors for changes in body composition during therapy. Long-standing adult-onset GH deficiency (AO-GHD) is associated with increased body fat mass (FM) which, through production of hormones and inflammatory cytokines from adipose tissue, may contribute to different manifestations of the metabolic syndrome. Design, patients and measurements: Fifty-five patients with adult-onset GH deficiency (AO-GHD), (24 females, 31 males, mean age 49 years) were enrolled in a placebo-controlled, double-blind crossover study. GH therapy was individually dosed to obtain an IGF-I concentration within the normal range for age and sex. GH and placebo were administered for 9 months each, separated by a 4 month washout period. Adipose tissue derived cytokines were measured by enzyme immunoassay. Results: GH treatment was associated with a significant decrease in IL-1 receptor antagonist (IL-1Ra) compared to placebo, which correlated with declining body FM (truncal and total) after GH substitution. The change in IL-1Ra was the strongest predictor of the variation in BFM in regression models. No changes were observed for leptin, adiponectin, soluble TNF receptor 1 or interleukin (IL)-8. Conclusion: The data indicate a possible unrecognized association between IL-1Ra and changes in body composition during GH substitution, and suggest further research on the interaction between the GH-IGF axis and the IL-1 system

Clinical, Immunological, and Genetic Features of Autoimmune Primary Adrenal Insufficiency: Observations from a Norwegian Registry.

Objective: Primary adrenal insufficiency [Addison's disease (AD)] is rare, and systematic studies are few, mostly conducted on small patient samples. We aimed to determine the clinical, immunological, and genetic features of a national registry-based cohort. Design: Patients with AD identified through a nationwide search of diagnosis registries were invited to participate in a survey of clinical features, health-related quality of life (HRQoL), autoantibody assays, and human leukocyte antigen (HLA) class II typing. Results: Of 664 registered patients, 64% participated in the study. The prevalence of autoimmune or idiopathic AD in Norway was 144 per million, and the incidence was 0.44 per 100,000 per year (1993-2007). Familial disease was reported by 10% and autoimmune comorbidity by 66%. Thyroid disease was most common (47%), followed by type 1 diabetes (12%), vitiligo (11%), vitamin B12 deficiency (10%), and premature ovarian insufficiency (6.6% of women). The mean daily treatment for AD was 40.5 mg cortisone acetate and 0.1 mg fludrocortisone. The mean Short Form 36 vitality scores were significantly diminished from the norm (51 vs. 60), especially among those with diabetes. Concomitant thyroid autoimmunity did not lower scores. Anti-21-hydroxylase antibodies were found in 86%. Particularly strong susceptibility for AD was found for the DR3-DQ2/ DRB1*0404-DQ8 genotype (odds ratio, 32; P = 4 x 10(-17)), which predicted early onset. Conclusions: AD is almost exclusively autoimmune, with high autoimmune comorbidity. Both anti-21-hydroxylase antibodies and HLA class II can be clinically relevant predictors of AD. HRQoL is reduced, especially among diabetes patients, whereas thyroid disease did not have an impact on HRQoL. Treatment modalities that improve HRQoL are needed

GWAS for autoimmune Addisons disease identifies multiple risk loci and highlights AIRE in disease susceptibility

Autoimmune Addisons disease (AAD) is characterized by the autoimmune destruction of the adrenal cortex. Low prevalence and complex inheritance have long hindered successful genetic studies. We here report the first genome-wide association study on AAD, which identifies nine independent risk loci (P&amp;lt;5x10(-8)). In addition to loci implicated in lymphocyte function and development shared with other autoimmune diseases such as HLA, BACH2, PTPN22 and CTLA4, we associate two protein-coding alterations in Autoimmune Regulator (AIRE) with AAD. The strongest, p.R471C (rs74203920, OR=3.4 (2.7-4.3), P=9.0x10(-25)) introduces an additional cysteine residue in the zinc-finger motif of the second PHD domain of the AIRE protein. This unbiased elucidation of the genetic contribution to development of AAD points to the importance of central immunological tolerance, and explains 35-41% of heritability (h(2)). Autoimmune Addisons disease is a rare complex disease, which has not yet been characterized by non-biased genetic studies. Here, the authors perform the first GWAS for the disease, identifying nine loci including two coding variants in the gene Autoimmune Regulator (AIRE).Funding Agencies|Swedish National Infrastructure for Computing (SNIC) through Uppsala Multidisciplinary Center for Advanced Computational Science (UPPMAX) [sens2017513]; KG Jebsen Foundation; Research Council of NorwayResearch Council of Norway; Swedish Research CouncilSwedish Research CouncilEuropean Commission; Knut and Alice Wallenberg FoundationKnut &amp; Alice Wallenberg Foundation; Health Authorities of Western Norway; Torsten and Ragnar Soderberg Foundations; Novo Nordisk FoundationNovo Nordisk Foundation; Swedish Society for Medical Research</p

GWAS for autoimmune Addison's disease identifies multiple risk loci and highlights AIRE in disease susceptibility

Autoimmune Addison’s disease (AAD) is characterized by the autoimmune destruction of the adrenal cortex. Low prevalence and complex inheritance have long hindered successful genetic studies. We here report the first genome-wide association study on AAD, which identifies nine independent risk loci (P < 5 × 10−8). In addition to loci implicated in lymphocyte function and development shared with other autoimmune diseases such as HLA, BACH2, PTPN22 and CTLA4, we associate two protein-coding alterations in Autoimmune Regulator (AIRE) with AAD. The strongest, p.R471C (rs74203920, OR = 3.4 (2.7–4.3), P = 9.0 × 10−25) introduces an additional cysteine residue in the zinc-finger motif of the second PHD domain of the AIRE protein. This unbiased elucidation of the genetic contribution to development of AAD points to the importance of central immunological tolerance, and explains 35–41% of heritability (h2)