Daniel Kamin

Boston Children's Hospital, Boston, Massachusetts, United States

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Publications (17)110.41 Total impact

  • Journal of Allergy and Clinical Immunology 02/2015; 136(3). DOI:10.1016/j.jaci.2014.12.1940 · 11.48 Impact Factor
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    ABSTRACT: Although autoimmune atrophic gastritis is classically a disease of elderly adults, recent studies have described the disease in younger adults, particularly in those with other autoimmune diseases and iron-deficiency anemia. Atrophic gastritis in pediatrics is a rare and possibly underdiagnosed entity that has been primarily reported as single-case reports. This retrospective study of atrophic gastritis not associated with Helicobacter pylori infection was performed to further expand the knowledge of clinical presentation, pathologic findings, and natural history of this disease in the pediatric population. Twelve patients with a histologic diagnosis of atrophic gastritis were identified, with an age range of 8 months to 18 years. Seven had other autoimmune diseases and/or immunodeficiency. Atrophy was confined to the oxyntic mucosa in 10 patients, with intramucosal inflammation in a diffuse or basal-predominant pattern. Active inflammation was present in 7 patients. Pseudopyloric, intestinal, or squamous/mucinous metaplasia was seen at initial biopsy or on follow-up in 8 patients, and enterochromaffin-like cell hyperplasia was seen in 5. One patient developed an adenocarcinoma during the follow-up period of 10 years. Two false-negative diagnoses were retrospectively identified. In the majority of cases, the possibility of atrophic gastritis was not raised by the submitting physician, and the endoscopic findings were not specific. Therefore, accurate diagnosis requires a high degree of suspicion on the part of the pathologist, and the diagnosis should be considered particularly in patients with a clinical history of other autoimmune diseases or iron-deficiency anemia.
    American Journal of Surgical Pathology 01/2015; 39(6). DOI:10.1097/PAS.0000000000000378 · 5.15 Impact Factor
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    ABSTRACT: A 17-month old male presented to our hospital with severe failure to thrive (3.9kg, z-score -10.98), hepatosplenomegaly and persistent, severe diarrhea. His immune work-up revealed extremely low B and NK cells, with normal immunoglobulin and protective antibody titers. Liver biopsy showed CD8+ T cell infiltration, occasional non-necrotizing granulomas without evidence of hemophagocytosis and marked portal fibrosis. GI tract abnormalities included duodenal villous atrophy, inflammation of the terminal ileum, and severe, diffuse colitis with deep ulcerations. Two months of systemic corticosteroids and parenteral nutrition failed to produce clinical improvement or intestinal mucosal healing on repeat endoscopy. In this context, the TNF-α inhibitor adalimumab was chosen to address the ongoing IBD-like intestinal inflammation. Subsequently, gene sequencing identified a frameshift mutation leading to premature termination in the BIR3 domain of XIAP characteristic of X-linked lymphoproliferative disorder type 2. The patient has done well on adalimumab with resolution of diarrhea, significant weight gain, (7.38kg at 22mo, z-score -5.04) decreases in inflammatory markers and tolerance of oral nutrition. This case adds to the reported population of XIAP deficient patients presenting predominantly with colitis and suggests a role for TNF-α inhibitors as a temporizing therapy.
    2013 Clinical Immunology Society Annual Meeting; 04/2013
  • Journal of Clinical Immunology 04/2013; 33(3):678-678. · 3.18 Impact Factor
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    ABSTRACT: We report an adolescent with chronic, recurrent upper gastrointestinal bleeding in whom extensive prior investigations failed to reveal the source of bleeding. Angiography accurately identified a bleeding Dieulafoy lesion of the duodenum which was successfully embolized. The clinical history, angiographic appearances and treatment of this rare lesion are presented.
    Journal of Pediatric Surgery 01/2013; 48(1):e39-e41. DOI:10.1016/j.jpedsurg.2012.10.055 · 1.39 Impact Factor
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    ABSTRACT: Children with intestinal failure (IF) are at risk for small bowel bacterial overgrowth (SBBO) because of anatomical and other factors. We sought to identify risk factors for SBBO confirmed by quantitative duodenal culture. A single-center retrospective record review of children who had undergone endoscopic evaluation for SBBO (defined as bacterial growth in duodenal fluid of >10(5) colony-forming unit per mL) was performed. We reviewed 57 children with median (25th-75th percentile) age 5.0 (2.0-9.2) years. Diagnoses included motility disorders (28%), necrotizing enterocolitis (16%), atresias (16%), gastroschisis (14%), and Hirschsprung disease (10.5%). Forty patients (70%) had confirmed SBBO. Univariate analysis showed no significant differences between patients with and without SBBO for the following variables: age, sex, diagnosis, presence of ileocecal valve, and antacid use. Patients receiving parenteral nutrition (PN) were more likely to have SBBO (70% vs 35%, P = .02). Multiple logistic regression analysis confirmed that PN administration was independently associated with SBBO (adjusted odds ratio, 5.1; adjusted 95% confidence interval, 1.4-18.3; P = .01). SBBO was not related to subsequent risk of catheter-related bloodstream infection (CRBSI). SBBO is strongly and independently associated with PN use. Larger prospective cohorts and more systematic sampling techniques are needed to better determine the relationship between SBBO and gastrointestinal function.
    Journal of Pediatric Surgery 06/2012; 47(6):1150-4. DOI:10.1016/j.jpedsurg.2012.03.019 · 1.39 Impact Factor
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    ABSTRACT: Gastrointestinal dysmotility is common in pediatric short-bowel syndrome, leading to prolonged parenteral nutrition dependence. There is limited literature regarding the safety and efficacy of cisapride for this indication. The aim of the study was to describe the safety and efficacy of cisapride for enteral intolerance in pediatric short-bowel syndrome. Open-labeled pilot study in a limited access program for cisapride. Indications were short-bowel syndrome with underlying dysmotility and difficulty advancing enteral feeds despite standard therapies and without evidence of anatomic obstruction. Patients received cisapride 0.1 to 0.2 mg/kg per dose for 3 to 4 doses per day. We collected electrocardiogram, nutrition, and anthropometric data prospectively at study visits. Ten patients with mean (SD) age of 30.3 (30.5) months were enrolled in our multidisciplinary pediatric intestinal rehabilitation program. Median (interquartile range [IQR]) duration of follow-up was 8.7 (3.1-14.3) months. Median (IQR) residual bowel length was 102 (85-130) cm. Median (IQR) citrulline level was 14.5 (10.5-31.3) μmol/L. Diagnoses included isolated gastroschisis (n = 3), gastroschisis with intestinal atresia (n = 4), necrotizing enterocolitis (n = 2), and long-segment Hirschsprung disease (n = 1). Six subjects had at least 1 prior bowel-lengthening procedure. Median (IQR) change in percentage enteral energy intake was 19.9% (15.4%-29.8%) during follow-up (P = 0.01). Seven patients improved in enteral tolerance during treatment and 2 were weaned completely from parenteral nutrition. Complications during therapy were prolonged corrected QT interval (n = 2), gastrointestinal bleeding (n = 2), D-lactic acidosis (n = 1), and death due to presumed sepsis (n = 1). Longitudinal analysis (general estimating equation model) showed a strong positive association between cisapride duration and improved enteral tolerance. Mean percentage of enteral intake increased by 2.9% for every month of cisapride treatment (P < 0.0001). Cisapride is a potentially useful therapy in patients with pediatric short-bowel syndrome with gastrointestinal dysmotility. We observed modest improvement in feeding tolerance where prior treatments failed; however, patients treated with cisapride require careful cardiac monitoring because corrected QT prolongation occurred in 20% of our cohort.
    Journal of pediatric gastroenterology and nutrition 05/2011; 52(5):590-4. DOI:10.1097/MPG.0b013e3181fe2d7a · 2.63 Impact Factor
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    ABSTRACT: We report 3 patients with periosteal new bone formation consistent with hypertrophic osteoarthropathy (HOA), in the context of intestinal allograft rejection. Patient 1 developed thick periosteal new bone formation of the right arm during a prolonged episode of intestinal acute cellular rejection (ACR) 2 months posttransplant. Patient 2 developed ankle pain and swelling during an episode of severe ACR. Plain films showed periosteal new bone formation of the left ankle. In patient 3, the right wrist became swollen during an episode of moderate ACR, whereas plain films demonstrated mild periosteal reaction. Patients 2 and 3 had resolution of their symptoms once the ACR resolved with treatment. This is the first case series of HOA occurring in association with intestinal ACR. We speculate that an immune-mediated process is responsible for the bone disease. Further inquiry will help establish if HOA is related to transplant status, intestinal inflammation, or allograft rejection in general.
    Journal of Pediatric Surgery 11/2010; 45(11):e19-22. DOI:10.1016/j.jpedsurg.2010.07.019 · 1.39 Impact Factor
  • Daniel S Kamin · Sandra Burchett · Heung Bae Kim
    New England Journal of Medicine 09/2009; 361(7):725; author reply 725. · 55.87 Impact Factor
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    Debora Duro · Daniel Kamin
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    ABSTRACT: Short bowel syndrome is at once a surgical, medical, and a disorder, with potential for life-threatening complications as well as eventual independence from artificial nutrition. Navigating through the diagnostic and therapeutic decisions is ideally accomplished by a multidisciplinary team comprised of nutrition, pharmacy, social work, medicine, and surgery. Early identification of patients at risk for long-term PN-dependency is the first step towards avoiding severe complications. Close monitoring of nutritional status, steady and early introduction of enteral nutrition, and aggressive prevention, diagnosis and treatment of infections such as line sepsis, and bacterial overgrowth can significantly improve prognosis. Intestinal transplantation is an emerging treatment that may be considered when intestinal failure is irreversible and children are suffering from serious complications related to TPN administration.
    Colombia Medica 01/2009; · 0.36 Impact Factor
  • Debora Duro · Daniel Kamin · Christopher Duggan
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    ABSTRACT: Short bowel syndrome (SBS) is a malabsorptive state occuring as a result of surgical resection or congenital disease of a significant portion of the small intestine . The amount of resection or remaining bowel generally dictates the degree of malabsorption and consequentely the need for specialized enteral nutrition or parenteral nutrition (PN). Intestinal failure in the context of SBS is defined as a dependence on PN to maintain minimal energy and fluid requirement for growth in children. Common causes of SBS in infants and children include necrotizing enterocolitis, midgut volvulus, intestinal atresia, and gastroschisis. Early identification of patients at risk for long-term PN dependency is the first step toward avoiding severe complications. Close monitoring of nutritional status, steady and early introduction of enteral nutrition, and aggressive prevention, diagnosis, and treatment of infections such as central venous catheter sepsis and bacterial overgrowth can significantly improve the prognosis. Intestinal transplantation is an emerging treatment that may be considered when intestinal failure is irreversible and children are experiencing serious complications related to TPN administration.
    Journal of pediatric gastroenterology and nutrition 09/2008; 47 Suppl 1(Suppl 1):S33-6. DOI:10.1097/MPG.0b013e3181819007 · 2.63 Impact Factor
  • Helen M Pappa · Elana Bern · Daniel Kamin · Richard J Grand
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    ABSTRACT: The purpose of this review is to report on the vitamin D status and its relationship with bone health in individuals with gastrointestinal and liver disorders. In addition, recommendations regarding replacement and maintenance of optimal vitamin D stores, as well as the state of knowledge regarding its effect on the disease through its actions on the immune system, will be reviewed. The scientific community has revised upward the serum levels of vitamin D considered optimal, and doses of vitamin D much larger than those currently recommended may be needed to maintain these levels, especially in individuals with gastrointestinal and liver disorders. The relationship between vitamin D and bone health in this population is controversial. The role of vitamin D in the regulation of the immune system continues to be elucidated. Hypovitaminosis D is prevalent among individuals with gastrointestinal and liver disease. Although replacement and supplementation guidelines have not been well defined, practitioners should aim for a serum 25-hydroxyvitamin D level of at least 32 ng/ml. The contribution of vitamin D to the bone health of these individuals and its role in altering disease course through its actions on the immune system remain to be elucidated.
    Current opinion in gastroenterology 04/2008; 24(2):176-83. DOI:10.1097/MOG.0b013e3282f4d2f3 · 4.29 Impact Factor
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    ABSTRACT: Serial transverse enteroplasty (STEP) is a novel surgical therapy for short bowel syndrome and is being used with increasing frequency worldwide. Because no single center is likely to obtain sufficient experience for meaningful analysis, we created the International STEP Data Registry to allow for larger, multicenter patient accrual and followup. This report describes patient characteristics, operative parameters, and early results of STEP in the first 38 patients enrolled in the International STEP Data Registry. After IRB approval, data were entered online through password-protected enrollment and followup forms. Patient and procedural characteristics were analyzed. Pre- and postoperative small bowel length and enteral feeding tolerance were compared with the paired t-test. Between September 1, 2004, and April 30, 2006, 19 centers from 3 countries enrolled 38 patients. Median followup from STEP procedure to analysis was 12.6 months (range 0 to 66.9 months). Indications for STEP were short bowel syndrome (SBS, n=29), bacterial overgrowth (n=6), and neonatal atresia (n=3). Mean small intestine length was substantially increased in all groups (68+/-44 cm versus 115+/-87 cm, p < 0.0001, n=27). Notable complications included intraoperative staple line leak (n=2), bowel obstruction (n=2), and fluid collection or abscess (n=3). Late outcomes included progression to transplantation (n=3) and mortality (n=3). For the short bowel syndrome cohort, enteral tolerance was notably increased from 31%+/-31% to 67%+/-37% of calories (p < 0.01, n=21). STEP has been performed at multiple centers with minimal complications and encouraging outcomes. Indications for the procedure have broadened beyond short bowel syndrome to include bacterial overgrowth and neonatal intestinal obstruction with dilated proximal intestine. Continued accrual and followup of patients in the International STEP Data Registry will elucidate the longterm safety and efficacy of the procedure, with the goal of improved patient selection and operative timing.
    Journal of the American College of Surgeons 03/2007; 204(3):365-71. DOI:10.1016/j.jamcollsurg.2006.12.033 · 5.12 Impact Factor
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    ABSTRACT: Altered fat distribution is associated with insulin resistance in HIV, but little is known about regional glucose metabolism in fat and muscle depots in this patient population. The aim of the present study was to quantify regional fat, muscle, and whole body glucose disposal in HIV-infected men with lipoatrophy. Whole body glucose disposal was determined by hyperinsulinemic clamp technique (80 mU x m(-2) x min(-1)) in 6 HIV-infected men and 5 age/weight-matched healthy volunteers. Regional glucose uptake in muscle and subcutaneous (SAT) and visceral adipose tissue (VAT) was quantified in fasting and insulin-stimulated states using 2-deoxy-[18F]fluoro-D-glucose positron emission tomography. HIV-infected subjects with lipoatrophy had significantly increased glucose uptake into SAT (3.8 +/- 0.4 vs. 2.3 +/- 0.5 micromol x kg tissue(-1) x min(-1), P < 0.05) in the fasted state. Glucose uptake into VAT did not differ between groups. VAT area was inversely related with whole body glucose disposal, insulin sensitivity, and muscle glucose uptake during insulin stimulation. VAT area was highly predictive of whole body glucose disposal (r2 = 0.94, P < 0.0001). This may be mediated by adiponectin, which was significantly associated with VAT area (r = -0.75, P = 0.008), and whole body glucose disposal (r = 0.80, P = 0.003). This is the first study to directly demonstrate increased glucose uptake in subcutaneous fat of lipoatrophic patients, which may partially compensate for loss of SAT. Furthermore, we demonstrate a clear relationship between VAT and glucose metabolism in multiple fat and muscle depots, suggesting the critical importance of this depot in the regulation of glucose and highlighting the significant potential role of adiponectin in this process.
    AJP Endocrinology and Metabolism 02/2006; 290(2):E289-98. DOI:10.1152/ajpendo.00273.2005 · 3.79 Impact Factor
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    ABSTRACT: Resistin is a recently recognized adipocytokine thought to contribute to insulin resistance. We determined resistin levels and metabolic parameters in 24 HIV-infected men and women with lipoatrophy and hyperinsulinemia and studied the effect of 12 wk of the peroxisome proliferator-activated receptor-gamma agonist rosiglitazone (4-8 mg/d) on resistin in these subjects. Participants completed metabolic testing before and after rosiglitazone including fasting determination of resistin, adiponectin, and leptin levels, serum inflammatory markers, and hyperinsulinemic euglycemic clamp testing. Resistin concentration decreased significantly after rosiglitazone (12.17 +/- 1.15 ng/ml to 10.23 +/- 1.05 ng/ml; P = 0.02), in conjunction with significant increases in adiponectin- (P < 0.001) and insulin- stimulated glucose disposal (P = 0.004). Leptin levels, as well as TNF-alpha, did not change with rosiglitazone. In summary, among HIV-infected subjects with insulin resistance and lipoatrophy, resistin levels decreased significantly after rosiglitazone. Further investigation into the physiological role of this peroxisome proliferator-activated receptor-gamma-responsive adipocytokine in the metabolic abnormalities associated with HIV is warranted.
    Journal of Clinical Endocrinology &amp Metabolism 07/2005; 90(6):3423-6. DOI:10.1210/jc.2005-0287 · 6.21 Impact Factor
  • Daniel S Kamin · Steven K Grinspoon
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    ABSTRACT: Cardiovascular risk factors, including hyperlipidemia, insulin resistance and changes in body composition have increased in association with the use of potent ARV medications. Prediction modeling, surrogate markers and hard cardiovascular endpoints suggest increased CVD in persons with HIV. The relative increase in CVD risk is still small in an absolute sense, and the overwhelming effect of ARV is positive in terms of improvement in immune function and related morbidity and mortality. Nonetheless, as HIV-positive individuals live longer on ARV medications, cardiovascular disease could become increasingly prevalent. CVD risk assessment should occur regularly, especially after initiation and change in ARV medication use. Life-style modification strategies that have been well studied in the general population (e.g. smoking cessation, diet, and increased physical activity) should be rigorously implemented. Preliminary recommendations regarding drug treatment of HIV-associated hyperlipidemia and insulin resistance can be made from a limited number of studies. Future research will develop more specific risk stratification paradigms and treatment regimes for prevention of CVD in persons with HIV infection.
    AIDS 05/2005; 19(7):641-52. DOI:10.1097/01.aids.0000166087.08822.bc · 5.55 Impact Factor
  • Daniel Kamin · Colleen Hadigan
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    ABSTRACT: The introduction of highly active antiretroviral therapy (HAART) for the treatment of HIV infection has transformed HIV/AIDS into a chronic illness and the focus of clinical management has shifted from opportunistic infections to long-term management and toxicities of therapy. Pediatric patients with HIV infection perhaps pose the greatest challenge in this arena as they potentially face many decades of living with HIV/AIDS and its therapies. Although there are numerous emerging medical complications associated with chronic HIV infection and HAART, hyperlipidemia is increasingly recognized among HIV-infected children and adults and will be the focus of this review. The nature and prevalence of lipid abnormalities in children with HIV infection is discussed, as well as possible etiologies for these abnormalities and the future management of this growing challenge for children living with HIV disease.
    Expert Review of Cardiovascular Therapy 06/2003; 1(1):143-50. DOI:10.1586/14779072.1.1.143

Publication Stats

317 Citations
110.41 Total Impact Points


  • 2007–2015
    • Boston Children's Hospital
      • • Department of Pediatrics
      • • Center for Advanced Intestinal Rehabilitation
      • • Pediatric Transplant Center
      Boston, Massachusetts, United States
  • 2012–2013
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2003–2006
    • Massachusetts General Hospital
      Boston, Massachusetts, United States
  • 2005
    • Harvard Medical School
      Boston, Massachusetts, United States