Browsing by Subject "Lung diseases"

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    Accuracy of Chest Computed Tomography in Distinguishing Cystic Pleuropulmonary Blastoma From Benign Congenital Lung Malformations in Children
    (American Medical Association, 2022-06-01) Engwall-Gill, Abigail J.; Chan, Sherwin S.; Boyd, Kevin P.; Saito, Jacqueline M.; Fallat, Mary E.; St. Peter, Shawn D.; Bolger-Theut, Stephanie; Crotty, Eric J.; Green, Jared R.; Hulett Bowling, Rebecca L.; Kumbhar, Sachin S.; Rattan, Mantosh S.; Young, Cody M.; Canner, Joseph K.; Deans, Katherine J.; Gadepalli, Samir K.; Helmrath, Michael A.; Hirschl, Ronald B.; Kabre, Rashmi; Lal, Dave R.; Landman, Matthew P.; Leys, Charles M.; Mak, Grace Z.; Minneci, Peter C.; Wright, Tiffany N.; Kunisaki, Shaun M.; Midwest Pediatric Surgery Consortium; Surgery, School of Medicine
    Importance: The ability of computed tomography (CT) to distinguish between benign congenital lung malformations and malignant cystic pleuropulmonary blastomas (PPBs) is unclear. Objective: To assess whether chest CT can detect malignant tumors among postnatally detected lung lesions in children. Design, setting, and participants: This retrospective multicenter case-control study used a consortium database of 521 pathologically confirmed primary lung lesions from January 1, 2009, through December 31, 2015, to assess diagnostic accuracy. Preoperative CT scans of children with cystic PPB (cases) were selected and age-matched with CT scans from patients with postnatally detected congenital lung malformations (controls). Statistical analysis was performed from January 18 to September 6, 2020. Preoperative CT scans were interpreted independently by 9 experienced pediatric radiologists in a blinded fashion and analyzed from January 24, 2019, to September 6, 2020. Main outcomes and measures: Accuracy, sensitivity, and specificity of CT in correctly identifying children with malignant tumors. Results: Among 477 CT scans identified (282 boys [59%]; median age at CT, 3.6 months [IQR, 1.2-7.2 months]; median age at resection, 6.9 months [IQR, 4.2-12.8 months]), 40 cases were extensively reviewed; 9 cases (23%) had pathologically confirmed cystic PPB. The median age at CT was 7.3 months (IQR, 2.9-22.4 months), and median age at resection was 8.7 months (IQR, 5.0-24.4 months). The sensitivity of CT for detecting PPB was 58%, and the specificity was 83%. High suspicion for malignancy correlated with PPB pathology (odds ratio, 13.5; 95% CI, 2.7-67.3; P = .002). There was poor interrater reliability (κ = 0.36 [range, 0.06-0.64]; P < .001) and no significant difference in specific imaging characteristics between PPB and benign cystic lesions. The overall accuracy rate for distinguishing benign vs malignant lesions was 81%. Conclusions and relevance: This study suggests that chest CT, the current criterion standard imaging modality to assess the lung parenchyma, may not accurately and reliably distinguish PPB from benign congenital lung malformations in children. In any cystic lung lesion without a prenatal diagnosis, operative management to confirm pathologic diagnosis is warranted.
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    From bench to bedside: preclinical evaluation of a self-inactivating gammaretroviral vector for the gene therapy of X-linked chronic granulomatous disease
    (Mary Ann Liebert, 2013-06) Stein, Stefan; Scholz, Simone; Schwäble, Joachim; Sadat, Mohammed A.; Modlich, Ute; Schultze-Strasser, Stephan; Diaz, Margarita; Chen-Wichmann, Linping; Müller-Kuller, Uta; Brendel, Christian; Fronza, Raffaele; Kaufmann, Kerstin B.; Naundorf, Sonja; Pech, Nancy K.; Travers, Jeffrey B.; Matute, Juan D.; Presson, Robert G.; Sandusky, George E.; Kunkel, Hana; Rudolf, Eva; Dillmann, Adelina; von Kalle, Christof; Kühlcke, Klaus; Baum, Christopher; Schambach, Axel; Dinauer, Mary C.; Schmidt, Manfred; Grez, Manuel; Pediatrics, School of Medicine
    Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by impaired antimicrobial activity in phagocytic cells. As a monogenic disease affecting the hematopoietic system, CGD is amenable to gene therapy. Indeed in a phase I/II clinical trial, we demonstrated a transient resolution of bacterial and fungal infections. However, the therapeutic benefit was compromised by the occurrence of clonal dominance and malignant transformation demanding alternative vectors with equal efficacy but safety-improved features. In this work we have developed and tested a self-inactivating (SIN) gammaretroviral vector (SINfes.gp91s) containing a codon-optimized transgene (gp91(phox)) under the transcriptional control of a myeloid promoter for the gene therapy of the X-linked form of CGD (X-CGD). Gene-corrected cells protected X-CGD mice from Aspergillus fumigatus challenge at low vector copy numbers. Moreover, the SINfes.gp91s vector generates substantial amounts of superoxide in human cells transplanted into immunodeficient mice. In vitro genotoxicity assays and longitudinal high-throughput integration site analysis in transplanted mice comprising primary and secondary animals for 11 months revealed a safe integration site profile with no signs of clonal dominance.