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Alparslan Bekir S, Tuncay E, Gungor S, Yalcinsoy M, Sogukpinar Ö, Gundogus B, Aksoy E, Agca M, Agca Altunbey S, Turker H, Karakurt Z. Can red blood cell distribution width (RDW) level predict the severity of acute exacerbation of chronic obstructive pulmonary disease (AECOPD)? Int J Clin Pract 2021; 75:e14730. [PMID: 34383359 DOI: 10.1111/ijcp.14730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung pulmonary diseases (COPD). There are limited data about RDW levels in acute exacerbation of COPD (AECOPD). AIM/OBJECTIVE The association of the RDW levels with the severity of AECOPD was evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU)). METHODS Cross sectional retrospective study was designed in tertiary care hospital for chest diseases in 2015. Previously COPD diagnosed patients admitted to hospital outpatient-clinic, ward and ICU due to AECOPD were included in the study. Patients demographics, RDW, biomarkers (CRP, RDW, Neutrophil to lymphocyte ratio (NLR), platelet to mean platelet volume (PLT-MPV)) C-CRP, biochemistry values were recorded from hospital electronic system. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11%-0.15% (normal). Neutrophil to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Biomarker values were compared according to where AECOPD was treated. RESULTS 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RDW values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (P < .001). In outpatient to ward and ICU, low RDW values were significantly increased (31%, 66%, 83%, respectively) and high RDW values significantly decreased (54%, 24%, 10%) (P < .001). According to attack severity, low RDW values were determined. CONCLUSION Patients with AECOPD, lower RDW values should be considered carefully. Lower RDW can be used for decision of COPD exacerbation severity and follow up treatment response.
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Affiliation(s)
- Sumeyye Alparslan Bekir
- Department of Pulmonary Diseases, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey
| | - Eylem Tuncay
- Department of Pulmonary Diseases, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sinem Gungor
- Department of Pulmonary Diseases, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Yalcinsoy
- Department of Pulmonary Disease, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Özlem Sogukpinar
- Department of Pulmonary Diseases, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey
| | - Baran Gundogus
- Department of Pulmonary Diseases, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey
| | - Emine Aksoy
- Department of Pulmonary Diseases, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey
| | - Meltem Agca
- Department of Pulmonary Diseases, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey
| | | | - Hatice Turker
- Department of Pulmonary Diseases, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zuhal Karakurt
- Department of Pulmonary Diseases, Health Sciences University Sureyyapasa Pulmonary Disease and Pulmonary Surgery Training and Research Hospital, Istanbul, Turkey
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Rennert C, Tauber C, Fehrenbach P, Heim K, Bettinger D, Sogukpinar Ö, Schuch A, Zecher BF, Bengsch B, Lang SA, Bronsert P, Björkström NK, Fichtner-Feigl S, Schultheiss M, Thimme R, Hofmann M. Adaptive Subsets Limit the Anti-Tumoral NK-Cell Activity in Hepatocellular Carcinoma. Cells 2021; 10:cells10061369. [PMID: 34199483 PMCID: PMC8227986 DOI: 10.3390/cells10061369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/14/2021] [Accepted: 05/28/2021] [Indexed: 12/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a global health burden with increasing incidence, poor prognosis and limited therapeutic options. Natural killer (NK) cells exhibit potent anti-tumoral activity and therefore represent potential targets for immunotherapeutic approaches in HCC treatment. However, the anti-tumoral activity of NK cells in HCC associated with different etiologies, and the impact of the heterogeneous NK cell subset, e.g., adaptive and conventional subsets, are not understood in detail. By comparatively analyzing the NK-cell repertoire in 60 HCC patients, 33 liver cirrhosis patients and 36 healthy donors (HD), we show in this study that the NK-cell repertoire is linked to HCC etiology, with increased frequencies of adaptive NK cells in Hepatitis B virus (HBV)-associated HCC. Adaptive NK cells exhibited limited anti-tumoral activity toward liver cancer cells; however, this was not a result of a specific NK-cell impairment in HCC but rather represented an intrinsic feature, since the characteristics of circulating and intra-tumoral adaptive NK cells were conserved between HD, HCC and liver cirrhosis patients. Hence, the expansion of adaptive NK cells with reduced anti-tumoral activity, detectable in HBV-associated HCC, may have implications for tumor surveillance and therapy.
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Affiliation(s)
- Charlotte Rennert
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
| | - Catrin Tauber
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
- Faculty of Biology, University of Freiburg, Schänzlestraße 1, 79104 Freiburg, Germany
| | - Pia Fehrenbach
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
- Faculty of Biology, University of Freiburg, Schänzlestraße 1, 79104 Freiburg, Germany
| | - Kathrin Heim
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
- Faculty of Biology, University of Freiburg, Schänzlestraße 1, 79104 Freiburg, Germany
| | - Dominik Bettinger
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
| | - Özlem Sogukpinar
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
| | - Anita Schuch
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
- Faculty of Biology, University of Freiburg, Schänzlestraße 1, 79104 Freiburg, Germany
| | - Britta Franziska Zecher
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
- Department of Medicine I, Faculty of Medicine, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Bertram Bengsch
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
| | - Sven A. Lang
- Department of General and Visceral Surgery, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (S.A.L.); (S.F.-F.)
- Department of General, Visceral and Transplantation Surgery, Faculty of Medicine, University Hospital Aachen, University of Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Peter Bronsert
- Institute of Pathology, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany;
- Tumorbank, Comprehensive Cancer Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Niklas K. Björkström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Alfred Nobels Allé 8, 141 52 Huddinge, Sweden;
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (S.A.L.); (S.F.-F.)
| | - Michael Schultheiss
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
| | - Robert Thimme
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
| | - Maike Hofmann
- Department of Medicine II, Faculty of Medicine, University Hospital Freiburg, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; (C.R.); (C.T.); (P.F.); (K.H.); (D.B.); (Ö.S.); (A.S.); (B.F.Z.); (B.B.); (M.S.); (R.T.)
- Correspondence:
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Schuch A, Salimi Alizei E, Heim K, Wieland D, Kiraithe MM, Kemming J, Llewellyn-Lacey S, Sogukpinar Ö, Ni Y, Urban S, Zimmermann P, Nassal M, Emmerich F, Price DA, Bengsch B, Luxenburger H, Neumann-Haefelin C, Hofmann M, Thimme R. Phenotypic and functional differences of HBV core-specific versus HBV polymerase-specific CD8+ T cells in chronically HBV-infected patients with low viral load. Gut 2019; 68:905-915. [PMID: 30622109 DOI: 10.1136/gutjnl-2018-316641] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A hallmark of chronic HBV (cHBV) infection is the presence of impaired HBV-specific CD8+ T cell responses. Functional T cell exhaustion induced by persistent antigen stimulation is considered a major mechanism underlying this impairment. However, due to their low frequencies in chronic infection, it is currently unknown whether HBV-specific CD8+ T cells targeting different epitopes are similarly impaired and share molecular profiles indicative of T cell exhaustion. DESIGN By applying peptide-loaded MHC I tetramer-based enrichment, we could detect HBV-specific CD8+ T cells targeting epitopes in the HBV core and the polymerase proteins in the majority of 85 tested cHBV patients with low viral loads. Lower detection rates were obtained for envelope-specific CD8+ T cells. Subsequently, we performed phenotypic and functional in-depth analyses. RESULTS HBV-specific CD8+ T cells are not terminally exhausted but rather exhibit a memory-like phenotype in patients with low viral load possibly reflecting weak ongoing cognate antigen recognition. Moreover, HBV-specific CD8+ T cells targeting core versus polymerase epitopes significantly differed in frequency, phenotype and function. In particular, in comparison with core-specific CD8+ T cells, a higher frequency of polymerase-specific CD8+ T cells expressed CD38, KLRG1 and Eomes accompanied by low T-bet expression and downregulated CD127 indicative of a more severe T cell exhaustion. In addition, polymerase-specific CD8+ T cells exhibited a reduced expansion capacity that was linked to a dysbalanced TCF1/BCL2 expression. CONCLUSIONS Overall, the molecular mechanisms underlying impaired T cell responses differ with respect to the targeted HBV antigens. These results have potential implications for immunotherapeutic approaches in HBV cure.
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Affiliation(s)
- Anita Schuch
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Elahe Salimi Alizei
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Chemistry and Pharmacy, University of Freiburg, Freiburg, Germany
| | - Kathrin Heim
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Dominik Wieland
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Muthamia Kiraithe
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Janine Kemming
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Sian Llewellyn-Lacey
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Özlem Sogukpinar
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yi Ni
- Department of Infectious Diseases, Molecular Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stephan Urban
- Department of Infectious Diseases, Molecular Virology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Infection Research (DZIF), Partner Site Heidelberg, Heidelberg, Germany
| | - Peter Zimmermann
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Michael Nassal
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Emmerich
- Institute for Cell and Gene Therapy, University Hospital Freiburg, Freiburg, Germany
| | - David A Price
- Institute of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Bertram Bengsch
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hendrik Luxenburger
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maike Hofmann
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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