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  • 1
    In: Journal of Neurology, Springer Science and Business Media LLC, Vol. 268, No. 11 ( 2021-11), p. 3969-3974
    Abstract: Serum neurofilament light chain (sNfL) is an established biomarker of neuro-axonal damage in multiple neurological disorders. Raised sNfL levels have been reported in adults infected with pandemic coronavirus disease 2019 (COVID-19). Levels in children infected with COVID-19 have not as yet been reported. Objective To evaluate whether sNfL is elevated in children contracting COVID-19. Methods Between May 22 and July 22, 2020, a network of outpatient pediatricians in Bavaria, Germany, the Coronavirus antibody screening in children from Bavaria study network (CoKiBa), recruited healthy children into a cross-sectional study from two sources: an ongoing prevention program for 1–14 years, and referrals of 1–17 years consulting a pediatrician for possible infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We determined sNfL levels by single molecule array immunoassay and SARS-CoV-2 antibody status by two independent quantitative methods. Results Of the 2652 included children, 148 (5.6%) were SARS-CoV-2 antibody positive with asymptomatic to moderate COVID-19 infection. Neurological symptoms—headache, dizziness, muscle aches, or loss of smell and taste—were present in 47/148 cases (31.8%). Mean sNfL levels were 5.5 pg/ml (SD 2.9) in the total cohort, 5.1 (SD 2.1) pg/ml in the children with SARS-CoV-2 antibodies, and 5.5 (SD 3.0) pg/ml in those without. Multivariate regression analysis revealed age—but neither antibody status, antibody levels, nor clinical severity—as an independent predictor of sNfL. Follow-up of children with pediatric multisystem inflammatory syndrome ( n  = 14) showed no association with sNfL. Conclusions In this population study, children with asymptomatic to moderate COVID-19 showed no neurochemical evidence of neuronal damage.
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
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    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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  • 2
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 4254-4254
    Abstract: Background: Langerhans cell histiocytosis (LCH) is a disorder characterized by lesions that include CD207+ dendritic cells along with an inflammatory infiltrate, ranging from a single lesion to potentially fatal multi-system disease. Empirically derived chemotherapy with vinblastine and prednisone still represents the standard of care, curing fewer than 50% of patients. As a result of the discovery of activating mutations in the MAPK-pathway, BRAF inhibitors seem to be a novel therapeutic option. In LCH patients who were refractory to (or not eligible for) conventional chemotherapy we administered a multi-targeted therapeutic approach targeting the deregulation of homeostatic pathways in LCH, e.g. notch, thereby simultaneously modulating tumor-associated inflammation, angiogenesis and immune response. The present retrospective analysis reports a single-center experience with a biomodulatory therapy in a cohort of patients with refractory LCH. Methods: At the University Hospital Regensburg seven patients with multi-system LCH (2 female/5 male, including two pediatric patients), ranging from 11 months to 77 years old, were selected for compassionate use treatment with a biomodulatory therapy schedule (Br J Haematol. 2005;128:730-2). Six patients have been refractory to up to three different standard regimens. One patient was not eligible for conventional therapy due to severe comorbidities. The biomodulatory metronomic therapy consisted of low dose trofosfamide, pioglitazone, a PPAR alpha/gamma agonist, etoricoxib, a COX-2 inhibitor and low-dose dexamethasone. Each drug was administered daily until disease progression or in case of complete remission for additional 6 months. Treatment response was reported using the criteria established in the Histiocyte Society Evaluation and Treatment Guidelines. Results: All of the patients in our cohort showed response to treatment as determined clinically, by CT/MRI scans and re-biopsies. Two of them developed a complete remission, three regression of disease and two stable disease. To date, none of the patients developed progressive disease (representing a progression-free-survival of 10 to 55 months until now). In one patient a dose reduction had to be made due to leukopenia. No other significant adverse events have been observed. Conclusion: Biomodulatory metronomic therapy demonstrated high activity against multi-system LCH with minimal toxicity even in refractory patients following multiple systemic chemotherapies. Long-lasting disease control was achieved in all of the treated patients. Confirmation of efficacy should be evaluated in a prospective trial. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
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  • 3
    In: Blood, American Society of Hematology, Vol. 118, No. 21 ( 2011-11-18), p. 4000-4000
    Abstract: Abstract 4000 Serial transplantation of patient derived acute lymphoblastic leukaemia (ALL) blasts continues to contribute to our understanding of the biology of leukaemia stem cells (LSC). Refinement of techniques, and in particular intrafemoral injection and development of the highly immunocompromised NOD/scid IL2Rγ null (NSG) mouse have demonstrated B precursor ALL propagating cells to be both common and present in diverse immunophenotypes. These studies must now be complemented by interrogation of the biological pathways underpinning leukaemia stem cell behaviour and clonal propagation in ALL. We have developed a lentiviral based approach to such studies, using the transfer vector pSLIEW, encoding both enhanced green fluorescent protein (EGFP) and firefly luciferase (luc). We have recently replaced a bone marrow stromal feeder based transduction protocol with a feeder free protocol, removing the risk of co-transduction of feeder cells. Using the feeder free protocol, we have achieved transduction of primary (n=4) and primograft (n=3) material with between 13.0 and 51.4% eGFP positive cells. Transplantation of transduced cells by intrafemoral injection into NSG mice resulted in engraftment and disease dissemination. This process was monitored using an IVIS Spectrum bioluminescence imaging system. This technique demonstrated progression of disease to the contralateral femur, spleen, CNS and vertebrae. Disease progression was also monitored by serial bone marrow punctures and 5-colour flow cytometry, which demonstrated no immunophenotypic bias amongst the transduced cells. Flow cytometry of harvested bone marrow and spleen showed between 5.5% and 10.2% eGFP positive cells representing only a moderate decrease from 26.3% eGFP positivity at initial transplantation. This confirms the relative resistance of the SFFV promoter to silencing, making this approach suitable for serial transplantation. Harvested bone marrow and splenic cells were re-transplanted at 5.5 × 103 – 1.0 × 104 SLIEW+ cells per mouse (total 1 × 105 cells transplanted). Bioluminescent imaging has shown engraftment and dissemination of leukaemia within five weeks, confirming transduction of the leukaemia stem cell compartment. Further development of the pSLIEW vector to include shRNA sequences now offers the potential for functional studies using patient derived material, transduced with a single lentivector construct and serially engrafted in the NSG assay for leukaemic stem cell maintenance. We believe that this approach will allow us to investigate the genetic programmes underpinning leukaemia stem cell self-renewal. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2011
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  • 4
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 1421-1421
    Abstract: Abstract 1421 Poster Board I-444 Conflicting results in the field of cancer stem cells have reignited debate regarding the frequency and identity of cells with the ability to self renew and to propagate the complete phenotype of the malignancy. Initially it was suggested by different studies that cancer stem cells represent only a small minority of the malignant population and that the immunophenotypes of these cells resemble a rather immature type in the cell hierarchy. More recent data from our own and other groups have challenged these findings by demonstrating that cells at different maturity levels within the leukemic hierarchy have cancer stem cell abilities and that the frequency of the leukemia maintaining cell is higher than previously thought (Cancer Cell 2008, 14(1), p47-58). We use an in vivo NOD/scid IL2Rγnull (NSG) mouse intra-femoral transplant model to determine the clonogenicity of sorted candidate leukemic stem cell populations, characterized by specific immunophenotypes. We selected the surface markers CD10 and CD20, in order to differentiate between rather immature and more mature cells. Furthermore we carried out limiting dilution experiments on sorted (CD20) and unsorted leukemic blasts to investigate the frequency of the proposed leukemic stem cells. Flow sorted ALL blasts of CD19+CD20low and CD19+CD20high as well as of CD19+CD10low and CD19+CD10high immunophenotype were transplanted into NSG mice. Sorts were performed on primary patient material and on leukemic blasts that had been harvested following prior passage in mice. Different subtypes of ALL were included (high risk: BCR/ABL (t9;22) positive (patients L4967, L4951, L49101, L8849, L2510), high hyperdiploid/MRD positive high risk (L754, L835), intermediate risk: high WBC/MRD negative (L736, L784), age 〉 10 years (L803)). CD20 sorts were performed on primary patient material (L4951, L49101, L754, L835 and L776), on secondary samples harvested from engrafted primary mice (L4967, L4951, L2510, L736 and L754) and on tertiary samples harvested from engrafted secondary mice (L4967 and L736). In total 151 mice were transplanted, with 122 showing engraftment in consecutive bone marrow punctures or in bone marrow harvests. CD10 sorts were performed on primary patient material (L784 and L49101) and on secondary samples harvested from engrafted primary mice (L4951, L8849, L2510 and L803) with 31 out of 52 mice transplanted with sorted material showing engraftment as seen with CD20 sorted cells. Blasts of all selected immunophenotypes were able to engraft the leukemia in unconditioned NSG mice as determined by 5 color flow cytometry. In particular, sorted cells of both fractions were able to reconstitute the complete phenotype of the leukemia. Harvested cells from engrafted mice could then be re-sorted into high and low antigen expressing fractions and successfully re-engrafted on secondary and tertiary mice. Cell purities of transplanted cells were usually higher than 90% (range 67-100%). The ability of all populations to serially engraft mice demonstrates long-term self-renewal capacity. Two additional patients were used in the limiting dilution assays (high WBC/t(4;11) high risk (L826); low WBC/MRD negative low risk (L792)) and experiments were performed on primary unsorted and secondary sorted material. Cell numbers necessary for ALL engraftment differed between individual leukemias but as little as 100 cells proved to be sufficient in one unsorted and in both the CD19+CD20low and CD19+CD20high fractions (Table 1). Mice transplanted with 10 cells only are still under observation. Table 1 Patient Transplant Population Cell dose Mice engrafted/transplanted L4951 Secondary CD20 high 500 3/3 CD20 low 3/3 CD20 high 100 3/3 CD20 low 3/3 L2510 Secondary CD20 high 3,000 2/4 CD20 low 4/4 CD20 high 300 0/4 CD20 low 1/4 L49101 Primary Unsorted 500 3/4 100 0/4 L792 Primary Unsorted 1,000 5/5 100 1/5 L826 Primary Unsorted 1,000 3/4 100 0/4 In conclusion we present strong evidence that leukemia-propagating cells are much more prevalent than previously thought and that blasts of diverse immunophenotype are able to serially reconstitute the complete leukemia in immune-deficient mice. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
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  • 5
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 5356-5356
    Abstract: Fungal infections (FI) remain a major threat for patients during allogeneic stem cell transplantation (SCT). There is an ongoing controversy regarding the best fungal prophylaxis. The current study was performed to retrospectively compare three different antifungal medications (itraconazole (ITRA), fluconazole (FLU), and amphotericin B (AMB) preparations) during SCT with regard to FI, survival and complications (toxicity, GVHD, engraftment). 116 children (mean age 10.1 years, female n=48, mean body weight (bw) 27.5 kg) transplanted between March 1998 and August 2003 with complete clinical, microbiological and radiological data were included. Four patients receiving a different antifungal medication (combination therapy ± caspofungin) were excluded. The underlying diseases included acute and chronic leukemias (n=71), inborn metabolic or immunological diseases, lymphomas and bone marrow failure syndromes. In 53 children (46%) a matched family donor was available; in 45 patients (39%) a matched unrelated donor was chosen. In the remaining patients alternative donors (haploidentical, mismatch-related or -unrelated, cord-blood) were selected. Forty children received FLU, 23 patients received AMB-preparations, and 53 children received ITRA. ITRA was given intravenously from day +3 after SCT (10mg/kg bw for 3 days as “loading”, afterwards 5mg/kg bw) until oral medication (ITRA solution) became possible. All prophylactic regimen were continued until day +100 after SCT. In AMB patients FLU was administered after discharge. The three groups did not differ with regard to demographic data, underlying diseases or type of transplantation, only the follow-up period was significantly shorter in the ITRA group. We observed three new FI in the FLU/AMB group (fusariosis n=1, aspergillosis n=2) and one new FI in the ITRA group (candidiasis n=1) (p = 0.377). A change of the antimycotic regimen was necessary in 27/40 (68%) of the FLU, in 21% of the ITRA and in 30% of the AMB patients. Toxicity was minimal in the FLU and ITRA groups and only rarely necessitated a change of the prophylaxis. At day +100 after SCT, 10/63 (16%) of the patients in the FLU/AMB group and 4/53 (8%) in the ITRA group had died (p = 0.139). At the end of the study period (12-31-2004) we observed 17/63 (27%) deaths in the FLU/AMB group compared to 6/53 (8%) in the ITRA group (p & lt; 0.029), with a median follow-up of 5.7 years in the AMB, 4.5 years in the FLU and 2.0 years in the ITRA group. In three children the FI was regarded as the cause of death (not in the candidemia-patient), in the remaining patients relapse (n=5), viral infections (n=6), SCT-related toxicity (n=4) and other infection (n=5) were the cause of death without statistical differences between the groups. The incidence of acute and chronic graft versus host disease (GVHD) differed not significantly between the study groups but the time to engraftment (leukocyte count & gt; 1000/μl) lasted significantly longer in the ITRA group (14.8 days vs. 19.3 days, p & lt; 0.000). Our results indicate that ITRA (oral and intravenous) starting on day 3 after SCT is a safe prophylaxis in pediatric SCT, the analysis of FI is hampered by low numbers. The issues of survival (ITRA group performed better than AMB/FLU) and engraftment (ITRA group longer than AMB/FLU) will be addressed by longer follow-up during ongoing studies.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
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  • 6
    In: Blood, American Society of Hematology, Vol. 127, No. 16 ( 2016-04-21), p. 1998-2006
    Abstract: More than 75% of primary diagnostic BCP-ALL samples engraft in the CNS in xenograft models. We find no evidence for selective trafficking to the CNS but show that CNS entry is a generic property of BCP-ALL cells.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
    detail.hit.zdb_id: 1468538-3
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  • 7
    In: BMC Medical Genetics, Springer Science and Business Media LLC, Vol. 6, No. 1 ( 2005-12)
    Type of Medium: Online Resource
    ISSN: 1471-2350
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2005
    detail.hit.zdb_id: 2041359-2
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  • 8
    In: EMBO Molecular Medicine, EMBO, Vol. 5, No. 1 ( 2013-01), p. 38-51
    Type of Medium: Online Resource
    ISSN: 1757-4676 , 1757-4684
    URL: Issue
    Language: English
    Publisher: EMBO
    Publication Date: 2013
    detail.hit.zdb_id: 2485479-7
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  • 9
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 1348-1348
    Abstract: There is an ongoing controversy as to whether cancer is always maintained by a rare population of highly specialized cancer stem cells or whether cancer-propagating cells may be more abundant in some cancer types. We have previously shown that in a heterogeneous group of childhood ALL different blast populations, regardless of their expression of the progenitor/stem cell marker CD34 or the lymphoid differentiation antigen CD19, contain leukemia-initiating activity (Cancer Cell 2008, 14(1), 47–58). By profiling B cell transcription factor expression, these different populations appeared to mirror stages of normal B cell development. Here we extend our experiments to another lymphoid differentiation marker, CD20, to provide further evidence that ALL blasts at different stages of maturation possess the ability to re-initiate the leukemia. Patient Transplant Mice Population Cell dose Engrafted L736 Secondary 9 CD20High 10.000–100.000 6 11 CD20−/Low 10 Tertiary 4 CD20High 10.000 4 4 CD20−/Low 1 L754 Primary 4 CD20High 100.000 2 4 CD20−/Low 3 Secondary 11 CD20High 5.000-100.000 9 11 CD20−/Low 7 A67 Secondary 6 CD20High 9.000-20.000 6 6 CD20−/Low 6 Unsorted bone marrow cells from 3 different ALL patients (L736, L754 and A67) were transplanted into 12 primary mice. Bone marrow was harvested from leukemic mice and flow sorted candidate populations (CD19+CD20−/Low and CD19+CD20High) were re-transplanted into 52 secondary and 8 tertiary mice. As expected from our previous experiments both CD19+CD20−/Low and CD19+CD20High cells were able to re-establish the disease in unconditioned NOD/scid y−/− mice (see table). Leukemic engraftment ranged from 0.5 to 73% as determined by flow cytometry on bone marrow aspirates. Both populations re-established the complete phenotype of the original leukemia including CD20−/Low and CD20High blasts. These results were confirmed by directly sorting primary ALL blasts from L754 without prior passage in the mice. Cell purity after flow sorting was high (81–99%) and low numbers of cells engrafted (5000 for both CD19+CD20−/Low and CD19+CD20High). The three patients reflected different ALL subtypes (L736 intermediate risk ALL: high WBC/MRD low risk, L754:high hyperdiploid/MRD high risk; and A67: high risk ALL/t(9;22)). In conclusion, these results confirm our previous observation that ALL blasts irrespective of the expression of lymphoid differentiation markers are able to engraft immune-deficient mice. Therefore, leukemia-propagating cells in childhood ALL may be more abundant than previously thought.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
    detail.hit.zdb_id: 1468538-3
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  • 10
    In: Blood, American Society of Hematology, Vol. 118, No. 21 ( 2011-11-18), p. 3449-3449
    Abstract: Abstract 3449 Despite huge advances in the treatment of paediatric acute lymphoblastic leukaemia (ALL) challenges remain. Disease in the central nervous system (CNS) continues to pose difficulties in diagnosis, prevention and treatment. Understanding the biological mechanisms of leukaemic cell entry into the CNS should allow better detection and monitoring of leukemia and may identify novel therapeutic targets for resistant and relapsed disease. We hypothesize that leukaemic cell dissemination to the CNS is associated with the abnormal expression of molecules governing physiological leukocyte trafficking i.e. chemokine receptors, selectins and integrins. To address this hypothesis we have developed a xenograft model of CNS disease using IV tail vein injection of human leukaemic cell lines and primary cells into immunodeficient (NOD/SCID/IL2R gamma null) mice. Pre-B leukaemic cell lines were seen to differ in their capacity to home to the CNS. Using Taqman low density array plates quantitative expression of a panel of chemokine receptors, selectins and integrins was compared between these cell lines. Rapid onset of CNS disease was associated with significantly higher expression of P-selectin glycoprotein ligand 1 and the chemokine receptor CCR6 both known to be essential for blood:CSF barrier transit of leukocytes (Kivisakk et al PNAS 2003, 100, 8389–8394, Reboldi et al Nat Immunology 2009, 10, 514–523). Other genes upregulated in CNS homing cells included (1) the integrins alphaM beta2 and beta 7 (2) ICAM-1 and −3 and (3) the chemokine receptors CCR1, CCR7 and CXCR3. Interestingly the chemokine receptor CXCR4 showed down-regulation when measured by qPCR and flow cytometry in CNS homing cells, with levels of receptor expression inversely proportional to the rapidity of onset of CNS disease. Furthermore in vitro studies showed that the migratory response of CXCR4 to its ligand CXCL12 was blunted or absent in cell lines which produced a more rapid onset of CNS disease. Two of the cell lines were Philadelphia positive, raising the possibility that p190 bcr-abl could be interfering with CXCR4 signalling or receptor levels as previously demonstrated for the p210 bcr-abl fusion protein (Geay et al Cancer Res 2005, 65, 2676–2683). Although non-migratory cells had higher levels of bcr-abl expression than migratory cells the blunted responses could not be reversed by treatment with the bcr-abl inhibitor imatinib. CXCR4 mutations were excluded by direct sequencing. Since functional CXCR4-CXCL12 interactions are known to be important for retention of cells in the bone marrow microenvironment (Ma et al, Immunity 1999, 10, 463–71), disruption of this interaction may be a necessary pre-requisite for cell migration to other sites. To examine potential micro-environmental influences on gene expression patterns in vivo, cells were retrieved from the CNS, bone marrow, liver, spleen and kidneys of engrafted mice using anti-human CD19 magnetic bead sorting and species specific primers for qPCR. Cells derived from the CNS had higher levels of CCR6 and the neurochemokine CX3CR1 (fractalkine receptor) compared to the original cell line in vitro and cells retrieved from other sites. Increased CCR6 may represent sub-clonal selection of CCR6 high expressors during transit across the BCSFB. Fractalkine and its receptor are highly expressed in the central nervous system and are important for maintenance of microglial-neuronal communication with fractalkine activating pro-survival signaling pathways in cells bearing its receptor (Meucci et al PNAS 2000, 97, 8075–8080). This provides a possible mechanism by which fractalkine expression would provide a competitive advantage to cells and allow survival of pre-B cells in this normally hostile microenvironment. In conclusion, we present a xenograft model of CNS leukemia and its utilization to identify increased CCR6 and P-selectin glycoprotein ligand 1 expression and reduced CXCR4 expression (and/or function) as candidate mechanisms by which leukaemic pre-B cells cross the blood:CSF barrier. In addition we propose that the Fractalkine receptor CX3CR1 may act as a potential pro-survival mechanism for pre-B cells residing in the CNS. As well as shedding light on the biology of CNS disease in pre-B cell ALL these molecules may be valid novel therapeutic targets for resistant or relapsed CNS disease. Disclosures: No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2011
    detail.hit.zdb_id: 1468538-3
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