BMC Medicine at European Society for Paediatric Endocrinology (ESPE) 2018

BMC Medicine attended ESPE 2018, which this year took place in Athens. Other delegates in attendance included researchers and clinicians from across the globe. Here, some of the exciting ‘hot topics’ presented at the meeting are discussed.

Childhood obesity

A major focus of the conference was on interventions to prevent or reduce childhood obesity, as well as research to uncover the underlying mechanisms that cause it.

A major focus of the conference was on interventions to prevent or reduce childhood obesity, as well as research to uncover the underlying mechanisms that cause it. Antje Körner discussed the importance of taking environmental, (epi)genetic and pre-disposing factors into account when investigating the causes; for instance, there is an association between high maternal BMI and being born large-for-gestational-age, as well as there being a geographical overlap between fast-food outlets and high adolescent BMI. An interesting study on the QUALITY cohort, presented by Melanie Henderson, found changes across the lifespan in the gut microbiome of obese children compared to normal weight, such as abundance of roseburia in the former. Odysseas Androutsos presented the findings of the Toybox study – a global kindergarden-aged, family-based intervention to prevent childhood obesity. An interesting result was that lower socioeconomic groups within regions exhibited higher prevalence of obesity/overweight children, and unhealthy behaviours were found to be clustered in the southern regions studied. However, the intervention was successful at increasing water consumption, reducing sweet consumption, and improving physical activity during week days.

Oncofertility

Teresa Woodruff presented an excellent plenary lecture on the technological advances to overcome the detrimental effects of cancer treatments on fertility. This includes the development of a microfluidic device to mimic the behaviour of organs and model the 28-day human menstrual cycle, and ‘ovary papers’ on which ovarian follicle survival is improved.

SGA

A number of talks tackled factors associated with being born small-for-gestational-age (SGA). Francis De Zegher noted that breast feeding is better than formula feeding in this case, to encourage subcutaneous adipogenesis and thus create more space for fat storage. A proceeding discussion considered whether or not – and at what age – to begin growth hormone (GH) treatment. Anders Juul mentioned a Nordic study which showed that 1 in 3 are poor responders to treatment, and although its recommended to begin treatment between 2 and 4 years of age ‘real-world’ evidence shows that in fact the mean age for starting is 8 years. Anita Hokken-Koelega covered the long-term safety and metabolic outcomes of GH treatment, noting that 6.5 years post treatment cessation there was no negative impact on their metabolic profile (compared to untreated SGA short controls) but they did exhibit lower lean body mass. David Dunger further noted that the risk factors for type 2 diabetes mellitus and metabolic syndrome were comparable between untreated and previously treated SGA children, but added that rapid catch-up growth is associated with obesity and early puberty.

Type 1 diabetes mellitus

This interesting and engaging meeting not only showcased some key advances in the field of paediatric endocrinology, but also highlighted important areas benefiting from collaborative efforts and cross-disciplinary approaches to provide novel interventions and therapeutic options in the future.

Olga Kordonouri covered a range of modern technologies to optimise diabetes care in those with type 1 diabetes mellitus (T1DM), such as flash glucose monitoring and the hybrid closed-loop system. Anette-Gabriele Ziegler described a genetic risk score that can identify a 10-fold risk of T1DM in the general population. Tadej Battelino presented some interesting findings from a Swedish registry study, which revealed an excess mortality and cardiovascular disease in young adults with T1DM; the risk of cardiovascular disease is particular greater for women. In fact in the very young (below 10 years old), there is a 17-year difference in life expectancy between normal children and those with T1DM. This reduced life expectancy and shift towards a younger age – in addition to an increased prevalence – means that new curative treatments are highly sought after. Stefan Bornstein described a number of pancreatic replacement strategies. This includes a pancreas transplant; though this results in increased efficacy, there is a limited number of donors and it’s a major surgery. Islet transplant is less invasive than a pancreas transplant, but there are very few centres able to do it. As this occurs post total pancreatectomy, the islets are often transplanted to the liver; however, as this is not the optimal environment there is a gradual loss of islets post transplantation. Current strategies showing potential include a bioartificial pancreas and microencapsulation of islet cells. The latter has been trialled in a German non-human primate centre, and was tested in a human for almost 1 year; promisingly, this case showed improved glycaemic control and the islets survived without the need for immunosupression. Patrick Collombat also discussed methods of regenerating human β-cells by treating α-cells with GABA; this was found to reverse several rounds of chemically-induced diabetes. It still remains to be seen if these new β-cells can survive being killed off, the hope being that the rate of regeneration is sufficient to compensate for the rate of loss. A pilot study in humans is currently under way.

This interesting and engaging meeting not only showcased some key advances in the field of paediatric endocrinology, but also highlighted important areas benefiting from collaborative efforts and cross-disciplinary approaches to provide novel interventions and therapeutic options in the future.

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