Skip to main content
Erschienen in: European Journal of Nutrition 2/2013

01.03.2013 | Original Contribution

Influence of breastfeeding versus formula feeding on lymphocyte subsets in infants at risk of coeliac disease: the PROFICEL study

verfasst von: Tamara Pozo-Rubio, Amalia Capilla, Jorge R. Mujico, Giada de Palma, Ascensión Marcos, Yolanda Sanz, Isabel Polanco, Maria Dolores García-Novo, Gemma Castillejo, Carmen Ribes-Koninckx, Vicente Varea, Francesc Palau, Luis Ortigosa, Luis Peña-Quintana, Esther Nova

Erschienen in: European Journal of Nutrition | Ausgabe 2/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

In addition to genetic risk, environmental factors might influence coeliac disease (CD) development. We sought to assess the effect of the interaction between milk-feeding practices and the HLA-DQ genotype on peripheral lymphocyte subsets and their activation markers in infants at familial risk for CD.

Methods

170 newborns were classified in 3 different genetic risk groups (high risk, HR; intermediate risk, IR; and low risk, LR) after DQB1 and DQA1 typing. Lymphocyte subsets were studied at the age of 4 months by flow cytometry analysis.

Results

79 infants were receiving exclusive breastfeeding (BF) and 91 partial breastfeeding or formula feeding (FF). Regarding genetic risk, 40 infants were classified in HR group, 75 in IR group and 55 in LR group. Two-way ANOVA did not show significant interactions between the type of milk feeding and genetic risk group on the lymphocyte subsets analysed. One-way ANOVA for milk-feeding practice alone showed that the percentage of CD4 + CD25+ cells was significantly higher in BF group than in FF group (BF, 10.92 ± 2.71; FF, 9.94 ± 2.96; p = 0.026), and absolute counts of CD4 + CD38+ cells were significantly higher in FF group than in BF group (FF, 2,881.23 ± 973.48; BF, 2,557.95 ± 977.06; p = 0.038). One-way ANOVA for genetic risk alone showed that absolute counts of NK cells were significantly higher in IR group than HR and LR groups (IR, 539.24 ± 340.63; HR, 405.01 ± 239.53; LR, 419.86 ± 262.85; p = 0.028).

Conclusion

Lymphocyte subset profiles in the early stages of life could be modulated by milk-feeding practices and genetic risk separately. Breastfeeding might have a positive immunomodulatory effect on lymphocyte subsets in infants at risk of CD.
Literatur
4.
Zurück zum Zitat Bourgey M, Calcagno G, Tinto N, Gennarelli D, Margaritte-Jeannin P, Greco L, Limongelli MG, Esposito O, Marano C, Troncone R, Spampanato A, Clerget-Darpoux F, Sacchetti L (2007) HLA related genetic risk for coeliac disease. Gut 56(8):1054–1059. doi:10.1136/gut.2006.108530 CrossRef Bourgey M, Calcagno G, Tinto N, Gennarelli D, Margaritte-Jeannin P, Greco L, Limongelli MG, Esposito O, Marano C, Troncone R, Spampanato A, Clerget-Darpoux F, Sacchetti L (2007) HLA related genetic risk for coeliac disease. Gut 56(8):1054–1059. doi:10.​1136/​gut.​2006.​108530 CrossRef
5.
Zurück zum Zitat Karell K, Louka AS, Moodie SJ, Ascher H, Clot F, Greco L, Ciclitira PJ, Sollid LM, Partanen J (2003) HLA types in celiac disease patients not carrying the DQA1*05-DQB1*02 (DQ2) heterodimer: results from the European genetics cluster on celiac disease. Hum Immunol 64(4):469–477CrossRef Karell K, Louka AS, Moodie SJ, Ascher H, Clot F, Greco L, Ciclitira PJ, Sollid LM, Partanen J (2003) HLA types in celiac disease patients not carrying the DQA1*05-DQB1*02 (DQ2) heterodimer: results from the European genetics cluster on celiac disease. Hum Immunol 64(4):469–477CrossRef
7.
8.
Zurück zum Zitat Williams AM, Bland PW, Phillips AC, Turner S, Brooklyn T, Shaya G, Spicer RD, Probert CS (2004) Intestinal alpha beta T cells differentiate and rearrange antigen receptor genes in situ in the human infant. J Immunol 173(12):7190–7199 Williams AM, Bland PW, Phillips AC, Turner S, Brooklyn T, Shaya G, Spicer RD, Probert CS (2004) Intestinal alpha beta T cells differentiate and rearrange antigen receptor genes in situ in the human infant. J Immunol 173(12):7190–7199
9.
Zurück zum Zitat Niers L, Stasse-Wolthuis M, Rombouts FM, Rijkers GT (2007) Nutritional support for the infant’s immune system. Nutr Rev 65(8 Pt 1):347–360CrossRef Niers L, Stasse-Wolthuis M, Rombouts FM, Rijkers GT (2007) Nutritional support for the infant’s immune system. Nutr Rev 65(8 Pt 1):347–360CrossRef
11.
Zurück zum Zitat Schack-Nielsen L, Michaelsen KF (2007) Advances in our understanding of the biology of human milk and its effects on the offspring. J Nutr 137(2):503S–510S Schack-Nielsen L, Michaelsen KF (2007) Advances in our understanding of the biology of human milk and its effects on the offspring. J Nutr 137(2):503S–510S
12.
Zurück zum Zitat de Vries E, de Bruin-Versteeg S, Comans-Bitter WM, de Groot R, Hop WC, Boerma GJ, Lotgering FK, van Dongen JJ (2000) Longitudinal survey of lymphocyte subpopulations in the first year of life. Pediatr Res 47(4 Pt 1):528–537CrossRef de Vries E, de Bruin-Versteeg S, Comans-Bitter WM, de Groot R, Hop WC, Boerma GJ, Lotgering FK, van Dongen JJ (2000) Longitudinal survey of lymphocyte subpopulations in the first year of life. Pediatr Res 47(4 Pt 1):528–537CrossRef
13.
Zurück zum Zitat Comans-Bitter WM, de Groot R, van den Beemd R, Neijens HJ, Hop WC, Groeneveld K, Hooijkaas H, van Dongen JJ (1997) Immunophenotyping of blood lymphocytes in childhood. Reference values for lymphocyte subpopulations. J Pediatr 130(3):388–393CrossRef Comans-Bitter WM, de Groot R, van den Beemd R, Neijens HJ, Hop WC, Groeneveld K, Hooijkaas H, van Dongen JJ (1997) Immunophenotyping of blood lymphocytes in childhood. Reference values for lymphocyte subpopulations. J Pediatr 130(3):388–393CrossRef
14.
Zurück zum Zitat Panaro A, Amati A, di Loreto M, Felle R, Ferrante M, Papadia AM, Porfido N, Gambatesa V, Dell’Osso A, Lucivero G (1991) Lymphocyte subpopulations in pediatric age. Definition of reference values by flow cytometry. Allergol Immunopathol Madr 19(3):109–112 Panaro A, Amati A, di Loreto M, Felle R, Ferrante M, Papadia AM, Porfido N, Gambatesa V, Dell’Osso A, Lucivero G (1991) Lymphocyte subpopulations in pediatric age. Definition of reference values by flow cytometry. Allergol Immunopathol Madr 19(3):109–112
15.
Zurück zum Zitat Shearer WT, Rosenblatt HM, Gelman RS, Oyomopito R, Plaeger S, Stiehm ER, Wara DW, Douglas SD, Luzuriaga K, McFarland EJ, Yogev R, Rathore MH, Levy W, Graham BL, Spector SA (2003) Lymphocyte subsets in healthy children from birth through 18 years of age: the Pediatric AIDS Clinical Trials Group P1009 study. J Allergy Clin Immunol 112(5):973–980. doi:10.1016/j.jaci.2003.07.003 CrossRef Shearer WT, Rosenblatt HM, Gelman RS, Oyomopito R, Plaeger S, Stiehm ER, Wara DW, Douglas SD, Luzuriaga K, McFarland EJ, Yogev R, Rathore MH, Levy W, Graham BL, Spector SA (2003) Lymphocyte subsets in healthy children from birth through 18 years of age: the Pediatric AIDS Clinical Trials Group P1009 study. J Allergy Clin Immunol 112(5):973–980. doi:10.​1016/​j.​jaci.​2003.​07.​003 CrossRef
16.
Zurück zum Zitat Jackson DG, Bell JI (1990) Isolation of a cDNA encoding the human CD38 (T10) molecule, a cell surface glycoprotein with an unusual discontinuous pattern of expression during lymphocyte differentiation. J Immunol 144(7):2811–2815 Jackson DG, Bell JI (1990) Isolation of a cDNA encoding the human CD38 (T10) molecule, a cell surface glycoprotein with an unusual discontinuous pattern of expression during lymphocyte differentiation. J Immunol 144(7):2811–2815
17.
Zurück zum Zitat Carver JD, Pimentel B, Wiener DA, Lowell NE, Barness LA (1991) Infant feeding effects on flow cytometric analysis of blood. J Clin Lab Anal 5(1):54–56CrossRef Carver JD, Pimentel B, Wiener DA, Lowell NE, Barness LA (1991) Infant feeding effects on flow cytometric analysis of blood. J Clin Lab Anal 5(1):54–56CrossRef
18.
Zurück zum Zitat Cummins AG, Eglinton BA, Gonzalez A, Roberton DM (1994) Immune activation during infancy in healthy humans. J Clin Immunol 14(2):107–115CrossRef Cummins AG, Eglinton BA, Gonzalez A, Roberton DM (1994) Immune activation during infancy in healthy humans. J Clin Immunol 14(2):107–115CrossRef
19.
Zurück zum Zitat Hawkes JS, Neumann MA, Gibson RA (1999) The effect of breast feeding on lymphocyte subpopulations in healthy term infants at 6 months of age. Pediatr Res 45(5 Pt 1):648–651CrossRef Hawkes JS, Neumann MA, Gibson RA (1999) The effect of breast feeding on lymphocyte subpopulations in healthy term infants at 6 months of age. Pediatr Res 45(5 Pt 1):648–651CrossRef
21.
Zurück zum Zitat Donat E, Planelles D, Capilla-Villanueva A, Montoro JA, Palau F, Ribes-Koninckx C (2009) Allelic distribution and the effect of haplotype combination for HLA type II loci in the celiac disease population of the Valencian community (Spain). Tissue Antigens 73(3):255–261. doi:10.1111/j.1399-0039.2008.01191.x CrossRef Donat E, Planelles D, Capilla-Villanueva A, Montoro JA, Palau F, Ribes-Koninckx C (2009) Allelic distribution and the effect of haplotype combination for HLA type II loci in the celiac disease population of the Valencian community (Spain). Tissue Antigens 73(3):255–261. doi:10.​1111/​j.​1399-0039.​2008.​01191.​x CrossRef
22.
Zurück zum Zitat Berrington JE, Barge D, Fenton AC, Cant AJ, Spickett GP (2005) Lymphocyte subsets in term and significantly preterm UK infants in the first year of life analysed by single platform flow cytometry. Clin Exp Immunol 140(2):289–292. doi:10.1111/j.1365-2249.2005.02767.x CrossRef Berrington JE, Barge D, Fenton AC, Cant AJ, Spickett GP (2005) Lymphocyte subsets in term and significantly preterm UK infants in the first year of life analysed by single platform flow cytometry. Clin Exp Immunol 140(2):289–292. doi:10.​1111/​j.​1365-2249.​2005.​02767.​x CrossRef
23.
Zurück zum Zitat Peters U, Schneeweiss S, Trautwein EA, Erbersdobler HF (2001) A case-control study of the effect of infant feeding on celiac disease. Ann Nutr Metab 45(4):135–142CrossRef Peters U, Schneeweiss S, Trautwein EA, Erbersdobler HF (2001) A case-control study of the effect of infant feeding on celiac disease. Ann Nutr Metab 45(4):135–142CrossRef
24.
Zurück zum Zitat Ivarsson A, Hernell O, Stenlund H, Persson LA (2002) Breast-feeding protects against celiac disease. Am J Clin Nutr 75(5):914–921 Ivarsson A, Hernell O, Stenlund H, Persson LA (2002) Breast-feeding protects against celiac disease. Am J Clin Nutr 75(5):914–921
26.
Zurück zum Zitat Kimpimaki T, Erkkola M, Korhonen S, Kupila A, Virtanen SM, Ilonen J, Simell O, Knip M (2001) Short-term exclusive breastfeeding predisposes young children with increased genetic risk of Type I diabetes to progressive beta-cell autoimmunity. Diabetologia 44(1):63–69CrossRef Kimpimaki T, Erkkola M, Korhonen S, Kupila A, Virtanen SM, Ilonen J, Simell O, Knip M (2001) Short-term exclusive breastfeeding predisposes young children with increased genetic risk of Type I diabetes to progressive beta-cell autoimmunity. Diabetologia 44(1):63–69CrossRef
27.
Zurück zum Zitat McLoughlin RM, Calatroni A, Visness CM, Wallace PK, Cruikshank WW, Tuzova M, Ly NP, Ruiz-Perez B, Kattan M, Bloomberg GR, Lederman H, Gern JE, Gold DR (2011) Longitudinal relationship of early life immunomodulatory T cell phenotype and function to development of allergic sensitization in an urban cohort. Clin Exp Allergy J Br Soc Allergy Clin Immunol. doi:10.1111/j.1365-2222.2011.03882.x McLoughlin RM, Calatroni A, Visness CM, Wallace PK, Cruikshank WW, Tuzova M, Ly NP, Ruiz-Perez B, Kattan M, Bloomberg GR, Lederman H, Gern JE, Gold DR (2011) Longitudinal relationship of early life immunomodulatory T cell phenotype and function to development of allergic sensitization in an urban cohort. Clin Exp Allergy J Br Soc Allergy Clin Immunol. doi:10.​1111/​j.​1365-2222.​2011.​03882.​x
28.
Zurück zum Zitat Brugman S, Visser JT, Hillebrands JL, Bos NA, Rozing J (2009) Prolonged exclusive breastfeeding reduces autoimmune diabetes incidence and increases regulatory T-cell frequency in bio-breeding diabetes-prone rats. Diabetes Metab Res Rev 25(4):380–387. doi:10.1002/dmrr.953 CrossRef Brugman S, Visser JT, Hillebrands JL, Bos NA, Rozing J (2009) Prolonged exclusive breastfeeding reduces autoimmune diabetes incidence and increases regulatory T-cell frequency in bio-breeding diabetes-prone rats. Diabetes Metab Res Rev 25(4):380–387. doi:10.​1002/​dmrr.​953 CrossRef
29.
Zurück zum Zitat Mosconi E, Rekima A, Seitz-Polski B, Kanda A, Fleury S, Tissandie E, Monteiro R, Dombrowicz DD, Julia V, Glaichenhaus N, Verhasselt V (2010) Breast milk immune complexes are potent inducers of oral tolerance in neonates and prevent asthma development. Mucosal Immunol 3(5):461–474. doi:10.1038/mi.2010.23 CrossRef Mosconi E, Rekima A, Seitz-Polski B, Kanda A, Fleury S, Tissandie E, Monteiro R, Dombrowicz DD, Julia V, Glaichenhaus N, Verhasselt V (2010) Breast milk immune complexes are potent inducers of oral tolerance in neonates and prevent asthma development. Mucosal Immunol 3(5):461–474. doi:10.​1038/​mi.​2010.​23 CrossRef
31.
Zurück zum Zitat Admyre C, Johansson SM, Qazi KR, Filen JJ, Lahesmaa R, Norman M, Neve EP, Scheynius A, Gabrielsson S (2007) Exosomes with immune modulatory features are present in human breast milk. J Immunol 179(3):1969–1978 Admyre C, Johansson SM, Qazi KR, Filen JJ, Lahesmaa R, Norman M, Neve EP, Scheynius A, Gabrielsson S (2007) Exosomes with immune modulatory features are present in human breast milk. J Immunol 179(3):1969–1978
32.
Zurück zum Zitat Perez-Cano FJ, Dong H, Yaqoob P (2010) In vitro immunomodulatory activity of Lactobacillus fermentum CECT5716 and Lactobacillus salivarius CECT5713: two probiotic strains isolated from human breast milk. Immunobiology 215(12):996–1004. doi:10.1016/j.imbio.2010.01.004 CrossRef Perez-Cano FJ, Dong H, Yaqoob P (2010) In vitro immunomodulatory activity of Lactobacillus fermentum CECT5716 and Lactobacillus salivarius CECT5713: two probiotic strains isolated from human breast milk. Immunobiology 215(12):996–1004. doi:10.​1016/​j.​imbio.​2010.​01.​004 CrossRef
33.
Zurück zum Zitat Zhou YJ, Gao J, Yang HM, Yuan XL, Chen TX, He ZJ (2010) The role of the lactadherin in promoting intestinal DCs development in vivo and vitro. Clin Dev Immunol 2010:357541. doi:10.1155/2010/357541 CrossRef Zhou YJ, Gao J, Yang HM, Yuan XL, Chen TX, He ZJ (2010) The role of the lactadherin in promoting intestinal DCs development in vivo and vitro. Clin Dev Immunol 2010:357541. doi:10.​1155/​2010/​357541 CrossRef
34.
Zurück zum Zitat Newburg DS, Peterson JA, Ruiz-Palacios GM, Matson DO, Morrow AL, Shults J, Guerrero ML, Chaturvedi P, Newburg SO, Scallan CD, Taylor MR, Ceriani RL, Pickering LK (1998) Role of human-milk lactadherin in protection against symptomatic rotavirus infection. Lancet 351(9110):1160–1164CrossRef Newburg DS, Peterson JA, Ruiz-Palacios GM, Matson DO, Morrow AL, Shults J, Guerrero ML, Chaturvedi P, Newburg SO, Scallan CD, Taylor MR, Ceriani RL, Pickering LK (1998) Role of human-milk lactadherin in protection against symptomatic rotavirus infection. Lancet 351(9110):1160–1164CrossRef
35.
Zurück zum Zitat Newburg DS (1999) Human milk glycoconjugates that inhibit pathogens. Curr Med Chem 6(2):117–127 Newburg DS (1999) Human milk glycoconjugates that inhibit pathogens. Curr Med Chem 6(2):117–127
36.
Zurück zum Zitat Peterson JA, Scallan CD, Ceriani RL, Hamosh M (2001) Structural and functional aspects of three major glycoproteins of the human milk fat globule membrane. Adv Exp Med Biol 501:179–187CrossRef Peterson JA, Scallan CD, Ceriani RL, Hamosh M (2001) Structural and functional aspects of three major glycoproteins of the human milk fat globule membrane. Adv Exp Med Biol 501:179–187CrossRef
37.
38.
Zurück zum Zitat Stene LC, Honeyman MC, Hoffenberg EJ, Haas JE, Sokol RJ, Emery L, Taki I, Norris JM, Erlich HA, Eisenbarth GS, Rewers M (2006) Rotavirus infection frequency and risk of celiac disease autoimmunity in early childhood: a longitudinal study. Am J Gastroenterol 101(10):2333–2340. doi:10.1111/j.1572-0241.2006.00741.x CrossRef Stene LC, Honeyman MC, Hoffenberg EJ, Haas JE, Sokol RJ, Emery L, Taki I, Norris JM, Erlich HA, Eisenbarth GS, Rewers M (2006) Rotavirus infection frequency and risk of celiac disease autoimmunity in early childhood: a longitudinal study. Am J Gastroenterol 101(10):2333–2340. doi:10.​1111/​j.​1572-0241.​2006.​00741.​x CrossRef
39.
Zurück zum Zitat Guandalini S (2007) The influence of gluten: weaning recommendations for healthy children and children at risk for celiac disease. Nestle Nutr Workshop Ser Pediatr Program 60:139–151. doi:10.1159/0000106366 (Discussion 151–135)CrossRef Guandalini S (2007) The influence of gluten: weaning recommendations for healthy children and children at risk for celiac disease. Nestle Nutr Workshop Ser Pediatr Program 60:139–151. doi:10.​1159/​0000106366 (Discussion 151–135)CrossRef
40.
Zurück zum Zitat Chirdo FG, Rumbo M, Anon MC, Fossati CA (1998) Presence of high levels of non-degraded gliadin in breast milk from healthy mothers. Scandinavian J Gastroenterol 33(11):1186–1192CrossRef Chirdo FG, Rumbo M, Anon MC, Fossati CA (1998) Presence of high levels of non-degraded gliadin in breast milk from healthy mothers. Scandinavian J Gastroenterol 33(11):1186–1192CrossRef
41.
Zurück zum Zitat Rumbo M, Chirdo FG, Anon MC, Fossati CA (1998) Detection and characterization of antibodies specific to food antigens (gliadin, ovalbumin and beta-lactoglobulin) in human serum, saliva, colostrum and milk. Clin Exp Immunol 112(3):453–458CrossRef Rumbo M, Chirdo FG, Anon MC, Fossati CA (1998) Detection and characterization of antibodies specific to food antigens (gliadin, ovalbumin and beta-lactoglobulin) in human serum, saliva, colostrum and milk. Clin Exp Immunol 112(3):453–458CrossRef
42.
Zurück zum Zitat Ozkan T, Ozeke T, Meral A (2000) Gliadin-specific IgA antibodies in breast milk. J Int Med Res 28(5):234–240 Ozkan T, Ozeke T, Meral A (2000) Gliadin-specific IgA antibodies in breast milk. J Int Med Res 28(5):234–240
43.
Zurück zum Zitat Hall MA, Norman PJ, Thiel B, Tiwari H, Peiffer A, Vaughan RW, Prescott S, Leppert M, Schork NJ, Lanchbury JS (2002) Quantitative trait loci on chromosomes 1, 2, 3, 4, 8, 9, 11, 12, and 18 control variation in levels of T and B lymphocyte subpopulations. Am J Hum Genet 70(5):1172–1182. doi:10.1086/340090 CrossRef Hall MA, Norman PJ, Thiel B, Tiwari H, Peiffer A, Vaughan RW, Prescott S, Leppert M, Schork NJ, Lanchbury JS (2002) Quantitative trait loci on chromosomes 1, 2, 3, 4, 8, 9, 11, 12, and 18 control variation in levels of T and B lymphocyte subpopulations. Am J Hum Genet 70(5):1172–1182. doi:10.​1086/​340090 CrossRef
44.
Zurück zum Zitat Amadori A, Zamarchi R, De Silvestro G, Forza G, Cavatton G, Danieli GA, Clementi M, Chieco-Bianchi L (1995) Genetic control of the CD4/CD8 T-cell ratio in humans. Nat Med 1(12):1279–1283CrossRef Amadori A, Zamarchi R, De Silvestro G, Forza G, Cavatton G, Danieli GA, Clementi M, Chieco-Bianchi L (1995) Genetic control of the CD4/CD8 T-cell ratio in humans. Nat Med 1(12):1279–1283CrossRef
45.
Zurück zum Zitat Clementi M, Forabosco P, Amadori A, Zamarchi R, De Silvestro G, Di Gianantonio E, Chieco-Bianchi L, Tenconi R (1999) CD4 and CD8 T lymphocyte inheritance. Evidence for major autosomal recessive genes. Hum Genet 105(4):337–342CrossRef Clementi M, Forabosco P, Amadori A, Zamarchi R, De Silvestro G, Di Gianantonio E, Chieco-Bianchi L, Tenconi R (1999) CD4 and CD8 T lymphocyte inheritance. Evidence for major autosomal recessive genes. Hum Genet 105(4):337–342CrossRef
46.
Zurück zum Zitat Puglisi F, Capuano P, Simone M, Verzillo F, Laurentaci C (1999) T-cell activity in HLA-associated autoimmune diseases. Panminerva Med 41(4):315–317 Puglisi F, Capuano P, Simone M, Verzillo F, Laurentaci C (1999) T-cell activity in HLA-associated autoimmune diseases. Panminerva Med 41(4):315–317
Metadaten
Titel
Influence of breastfeeding versus formula feeding on lymphocyte subsets in infants at risk of coeliac disease: the PROFICEL study
verfasst von
Tamara Pozo-Rubio
Amalia Capilla
Jorge R. Mujico
Giada de Palma
Ascensión Marcos
Yolanda Sanz
Isabel Polanco
Maria Dolores García-Novo
Gemma Castillejo
Carmen Ribes-Koninckx
Vicente Varea
Francesc Palau
Luis Ortigosa
Luis Peña-Quintana
Esther Nova
Publikationsdatum
01.03.2013
Verlag
Springer-Verlag
Erschienen in
European Journal of Nutrition / Ausgabe 2/2013
Print ISSN: 1436-6207
Elektronische ISSN: 1436-6215
DOI
https://doi.org/10.1007/s00394-012-0367-8

Weitere Artikel der Ausgabe 2/2013

European Journal of Nutrition 2/2013 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.