A PIBF molekula tumornövekedésben, ill. a terhesség fenntartásában szerepet játszó régióinak azonosítása = Localization of the active centers accounting for the biological activity of the PIBF molecule

Progesteron-Indukált Blokkoló Factor (PIBF) in vivo a cytokintermelés befolyásolásán keresztül valósulnak meg. A molekula fenti hatásokért felelős regióinak azonosítása céljából a PIBF különböző részeit reprezentáló konstrukciókat állítottunk elő és vizsgáltunk ezek biológiai hatásait. A PIBF az IL-4 kiváltotta jelátvitelhez hasonlóan STAT6 valamint Jak1 foszforilációt indukál és gátolja a STAT4 foszforilálódását. STAT6 deficiens sejtekben a PIBF cytoknitermelésre kifejtett hatásai nem érvényesülnek. Megállapítottuk, hogy a PIBF-indukálta jelátvitel feltétele az IL-4R alpha lánca és a GPI-horgonyzott PIBF receptor által alkotott receptorkomplex megléte. A molekula N terminális részén található PN1 peptid a PIBF-hez hasonló jelátvitelt indukált és szignifikánsan fokozta a lymphocyták IL-10 termelését. Az NK aktivitást kizárólag a 48 kDa PIBF szakasz csökkentette szignifikáns mértékben. Egereket immunizáltunk PIBF-el, ill. A peptidekkel, majd a megfelelő ellenanyagszint kialakulása után az egereket a pároztattuk, vagy intraperitonealisan SP-2 myelomasejtekkel oltottuk őket. A terhesség kimenetelére gyakorolt hatást a beágyazódott, peték számával-, a tumornövekedésre kifejtett hatást pedig a hasüregből kinyerhető élő, ill. elpusztult tumorsejtek arányával jellemeztük. PIBF neutralizáló ellenanyagok jelenléte gátolja a pete beágyazódását. A PN1 és PN3 peptiddel történő immunizálás hatására szignifikánsan fokozódott a daganatsejtek pusztulása. | The Progesterone-Induced Blocking Factor (PIBF) exerts its in vivo effects by acting on cytokine production. In attempt to identify the biologically active regions of PIBF, five costructs (PN1, PN2, PN3, PN4 and PN5), representing different parts of of the molecule were designed for further functional testing. We have shown that PIBF signaling depends on the presence of a functional heterodimer receptor, consisting of the alpha chain of the IL-4 receptor and the GPI-anchored PIBF receptor. PIBF induces the phophorylation of STAT6 and of Jak1, while the phosphorylation of STAT4 is inhibited. The cytokine effects of PIBF are significantly reduced in STAT6 deficient cells. The N-terminal PN1 peptide induced STAT6 phosphorylation, and IL-10 production of peripheral lymphocytes was significantly increased in the presence of PN1. NK activity was not affected by either of the peptides. Mice were immunized with PIBF and the constructs. When neutralizing antibodies developed, the mice were mated, or injected i.p. with SP-2 myeloma cells. The effect of anti-PIBF or anti-peptide antibodies on pregnancy was determined by counting implantation sites, whereas that on tumor cell growth- by determining the ratio of dead and viable tumor cells recovered from the peritoneal cavity. We have shown that PIBF neutralizing antibodies interfered with implantation. Anti PN1 and PN3 neutralizing antibodies significantly increased the number of dead tumor cells

GCKR gene functional variants in type 2 diabetes and metabolic syndrome: do the rare variants associate with increased carotid intima-media thickness?

BACKGROUND: Recent studies revealed that glucokinase regulatory protein (GCKR) variants (rs780094 and rs1260326) are associated with serum triglycerides and plasma glucose levels. Here we analyzed primarily the association of these two variants with the lipid profile and plasma glucose levels in Hungarian subjects with type 2 diabetes mellitus and metabolic syndrome; and also correlated the genotypes with the carotid intima-media thickness records. METHODS: A total of 321 type 2 diabetic patients, 455 metabolic syndrome patients, and 172 healthy controls were genotyped by PCR-RFLP. RESULTS: Both GCKR variants were found to associate with serum triglycerides and with fasting plasma glucose. However, significant association with the development of type 2 diabetes mellitus and metabolic syndrome could not be observed. Analyzing the records of the patients, a positive association of prevalence the GCKR homozygous functional variants and carotid intima-media thickness was found in the metabolic syndrome patients. CONCLUSIONS: Our results support that rs780094 and rs1260326 functional variants of the GCKR gene are inversely associated with serum triglycerides and fasting plasma glucose levels, as it was already reported for diabetic and metabolic syndrome patients in some other populations. Besides this positive replication, as a novel feature, our preliminary findings also suggest a cardiovascular risk role of the GCKR minor allele carriage based on the carotid intima-media thickness association

The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction

(1) Background: Besides the use of guideline-directed medical therapy (GDMT), multidisciplinary heart failure (HF) outpatient care (HFOC) is of strategic importance in HFrEF. (2) Methods: Data from 257 hospitalised HFrEF patients between 2019 and 2021 were retrospectively analysed. Application and target doses of GDMT were compared between HFOC and non-HFOC patients at discharge and at 1 year. 1-year all-cause mortality (ACM) and rehospitalisation (ACH) rates were compared using the Cox proportional hazard model. The effect of HFOC on GDMT and on prognosis after propensity score matching (PSM) of 168 patients and the independent predictors of 1-year ACM and ACH were also evaluated. (3) Results: At 1 year, the application of RASi, MRA and triple therapy (TT: RASi + βB + MRA) was higher (p < 0.05) in the HFOC group, as was the proportion of target doses of ARNI, βB, MRA and TT. After PSM, the composite of 1-year ACM or ACH was more favourable with HFOC (propensity-adjusted HR = 0.625, 95% CI = 0.401–0.974, p = 0.038). Independent predictors of 1-year ACM were age, systolic blood pressure, application of TT and HFOC, while 1-year ACH was influenced by the application of TT. (4) Conclusions: HFOC may positively impact GDMT use and prognosis in HFrEF even within the first year of its initiation

Az 1-es típusú neurofibromatosis molekuláris genetikai diagnosztikája = Molecular genetic diagnosis of neurofibromatosis type I

Az 1-es típusú neurofibromatosis autoszomális dominánsan öröklődő hamartosis, hátterében a neurofibromin-1 gén mutációi állnak. A változatos klinikai kép jellegzetességei a café-au-lait foltok, a bőr jóindulatú neurofibromái, az axillaris, inguinalis hiperpigmentációk, az íriszhamartomák, a csontrendszer deformitásai, valamint a neoplazmák kialakulásának veszélye. A neurofibromin-1 gén eltérései az esetek 50%-ában de novo mutációra vezethetőek vissza. Célkitűzés: Intézetünk 2008 óta végzi a neurofibromin-1 gén molekuláris genetikai vizsgálatát, e közleményben a tapasztalatok kerülnek összefoglalásra. Módszerek: Negyven, a neurofibromatosis klinikai tüneteit mutató beteg teljes génszekvenálása vagy multiplex ligatiofüggő amplifikációval való vizsgálata történt. Eredmények: A kóroki eltérést 31 esetben sikerült azonosítani, 8 betegben az irodalomban eddig nem ismert mutáció került detektálásra. A 8 érintettből, akiknél szekvenálással nem sikerült azonosítani a kóroki mutációt, 1 esetében egy, a teljes gént érintő deletio igazolódott. Következtetések: A neurofibromin-1 gén teljes szekvenálása a nagyobb génátrendeződések vizsgálatával kiegészítve az esetek nagy többségében alkalmas a kóroki eltérés azonosítására. Orv. Hetil., 2011, 152, 415–419. | Type 1 neurofibromatosis is an autosomal dominant hamartosis, caused by mutations of the gene neurofibromin-1. The variable clinical phenotype is characterized by café-au-lait spots, benign neurofibromas, axillary, inguinal hyperpigmentations, iris hamartomas, skeletal deformities and risk of neurofibroma-development. Pathogenic variations of neurofibromin-1 arise as de novo mutations in approx. 50% of the cases. Aims: Molecular genetic testing of neurofibromin-1 gene has been performed in our department since 2008; the following report summarizes our experiences. Methods: 40 patients, presenting symptoms of type 1 neurofibromatosis, were screened by sequencing or multiplex ligation-dependent probe amplification. Results: Pathogenic alterations were identified in 31 cases, 8 patients presented novel mutations. In 8 affected, no mutations were detected by sequencing; one of these patients had a deletion affecting the entire gene. Conclusions: Sequencing of the neurofibromin-1 gene and screening for rearrangements are useful in identifying pathogenic alterations in most of the cases. Orv. Hetil., 2011, 152, 415–419

Az 1-es típusú neurofibromatosis ritka megjelenésű, tanulságos esetei = Unusual clinical manifestations of type 1 neurofibromatosis

Az 1-es típusú neurofibromatosis egy autoszomális dominánsan öröklődő hamartosis, hátterében a neurofibromin-1 gén mutációi állnak. A klinikai kép rendkívül változatos, jellegzetességei a café-au-lait foltok, a bőr jóindulatú neurofibromái, az axillaris/inguinalis szeplőzöttség, az irishamartomák, a csontrendszer deformitásai, valamint a főleg központi idegrendszert érintő neoplasmák kialakulásának veszélye. Mindazonáltal, a klasszikus esetek mellett számos eset diagnosztikus kihívást jelenít meg. Célkitűzés: Intézetünk 2008 óta végzi a neurofibromin-1 gén molekuláris genetikai vizsgálatát, amely során több érdekes vagy atípusos, egyben klinikailag tanulságos eset került felismerésre, ezek ismertetését tartalmazza a jelen közlemény. Eredmények, következtetés: A négy, diagnosztikus kihívást megjelenítő eset a variábilis fenotípusra és a molekuláris genetikai diagnózis jelentőségére hívja fel a figyelmet. Orv. Hetil., 2011, 152, 1965–1970. | Type 1 neurofibromatosis is an autosomal dominant hamartosis caused by mutations of the neurofibromin-1 gene. The classic features of the clinical phenotype include the presence of café-au-lait spots, neurofibromas, axillary and inguinal freckling, Lisch-nodules and deformities of the skeletal system, as well as the risk of developing multiple tumors, especially in the central nervous system. However, it is known from the literature that the phenotypic variability can pose a huge diagnostic difficulty. Aims: Our institute performs molecular genetic testing of the neurofibromin-1 gene since 2008; during this period several unusual phenotypic variants were found. Results, conclusion: The reported four cases represent interesting phenotypic variants or diagnostic challenges in which the final diagnosis was established by molecular genetic analysis. Orv. Hetil., 2011, 152, 1965–1970

Incidence, Paris classification, and follow-up in a nationwide incident cohort of pediatric patients with inflammatory bowel disease.

OBJECTIVES The aim of the study was to evaluate the incidence, baseline disease characteristics, and disease location based on the Paris classification in pediatric inflammatory bowel disease (IBD) in the Hungarian nationwide inception cohort. In addition, 1-year follow-up with therapy was analyzed. METHODS From January 1, 2007 to December 31, 2009, newly diagnosed pediatric patients with IBD were prospectively registered. Twenty-seven pediatric gastroenterology centers participated in the data collection ensuring the data from the whole country. Newly diagnosed patients with IBD younger than 18 years were reported. Disease location was classified according to the Paris classification. RESULTS A total of 420 patients were identified. The incidence rate of pediatric IBD was 7.48/10⁵ (95% confidence interval [CI] 6.34/10⁵-8.83/10⁵). The incidence for Crohn disease (CD) was 4.72/10⁵ (95% CI 3.82-5.79), for ulcerative colitis (UC) 2.32/10⁵ (95% CI 1.71-3.09), and for IBD-unclassified 0.45/10⁵ (95% CI 0.22-0.84). Most common location in CD was L3 (58.7%); typical upper gastrointestinal abnormalities (ulcer, erosion and aphthous lesion) were observed in 29.9%. Extensive colitis in patients with UC (E4, proximal to hepatic flexure) was the most common disease phenotype (57%), whereas only 5% of children had proctitis. A total of 18.6% of patients had ever severe disease (S1). Frequency of azathioprine administration at diagnosis was 29.5% in patients with CD, and this rate increased to 54.6% (130/238) at 1-year follow-up. In UC, only 3.3% received azathioprine initially, and this rate elevated to 22.5% (25/111). Use of corticosteroid decreased from 50% to 15.3% in patients with UC. Rate of bowel resection in patients with CD during the first year of follow-up was 5%. CONCLUSIONS The incidence of pediatric IBD in Hungary was among the higher range reported. This is the first large, nationwide incident cohort analyzed according to the Paris classification, which is a useful tool to determine the characteristic pediatric CD phenotype