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Muggli B, Lechleiter A. [Surgical proctology - what is common is common]. Ther Umsch 2021; 78:499-507. [PMID: 34704474 DOI: 10.1024/0040-5930/a001302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Surgical proctology - what is common is common Abstract. Proctological diseases are extremely common and are often suppressed or concealed by the patients out of shame and unfortunately mostly neglected by the surgeons. This may have to do with the fact that the genesis of these clinical pictures can be completely different and can range from neurological disorders to embryonic maldevelopment to traumatically caused defects. Probably for this reason, in the past proctology was approached by different disciplines with inconsistent therapeutic approaches and non-standardized methods. However, interdisciplinarity is of utmost importance in this field of medicine. Only through a good interaction of the different disciplines in diagnostics and therapy can the best possible outcome be achieved for our patients. The highest good for the life of those affected and one of the most important factors in therapy is the preservation of continence.
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Affiliation(s)
- Beat Muggli
- Praxis Beat Muggli Chirurgie, Belegarzt Lindenhofspital Bern
| | - Antje Lechleiter
- Universitäre Klinik für Viszerale Chirurgie und Medizin, Inselspital Bern
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Adamczyk A, Pastille E, Kehrmann J, Vu VP, Geffers R, Wasmer MH, Kasper S, Schuler M, Lange CM, Muggli B, Rau TT, Klein D, Hansen W, Krebs P, Buer J, Westendorf AM. GPR15 Facilitates Recruitment of Regulatory T Cells to Promote Colorectal Cancer. Cancer Res 2021; 81:2970-2982. [PMID: 33727229 DOI: 10.1158/0008-5472.can-20-2133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022]
Abstract
Colorectal cancer is one of the most frequent malignancies worldwide. Despite considerable progress in early detection and treatment, there is still an unmet need for novel antitumor therapies, particularly in advanced colorectal cancer. Regulatory T cells (Treg) are increased in the peripheral blood and tumor tissue of patients with colorectal cancer. Recently, transient ablation of tumor-associated Tregs was shown to foster CD8+ T-cell-mediated antitumoral immunity in murine colorectal cancer models. However, before considering therapies on targeting Tregs in patients with cancer, detailed knowledge of the phenotype and features of tumor-associated Tregs is indispensable. Here, we demonstrate in a murine model of inflammation-induced colorectal cancer that tumor-associated Tregs are mainly of thymic origin and equipped with a specific set of molecules strongly associated with enhanced migratory properties. Particularly, a dense infiltration of Tregs in mouse and human colorectal cancer lesions correlated with increased expression of the orphan chemoattractant receptor GPR15 on these cells. Comprehensive gene expression analysis revealed that tumor-associated GPR15+ Tregs have a Th17-like phenotype, thereby producing IL17 and TNFα. Gpr15 deficiency repressed Treg infiltration in colorectal cancer, which paved the way for enhanced antitumoral CD8+ T-cell immunity and reduced tumorigenesis. In conclusion, GPR15 represents a promising novel target for modifying T-cell-mediated antitumoral immunity in colorectal cancer. SIGNIFICANCE: The G protein-coupled receptor 15, an unconventional chemokine receptor, directs Tregs into the colon, thereby modifying the tumor microenvironment and promoting intestinal tumorigenesis.See related commentary by Chakraborty and Zappasodi, p. 2817.
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Affiliation(s)
- Alexandra Adamczyk
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eva Pastille
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Kehrmann
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vivian P Vu
- Institute of Pathology, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Robert Geffers
- Genome Analytics, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Marie-Hélène Wasmer
- Institute of Pathology, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Beat Muggli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tilman T Rau
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Diana Klein
- Institute for Cell Biology (Cancer Research), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wiebke Hansen
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philippe Krebs
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Jan Buer
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Astrid M Westendorf
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Pastille E, Wasmer MH, Adamczyk A, Vu VP, Mager LF, Phuong NNT, Palmieri V, Simillion C, Hansen W, Kasper S, Schuler M, Muggli B, McCoy KD, Buer J, Zlobec I, Westendorf AM, Krebs P. The IL-33/ST2 pathway shapes the regulatory T cell phenotype to promote intestinal cancer. Mucosal Immunol 2019; 12:990-1003. [PMID: 31165767 PMCID: PMC7746527 DOI: 10.1038/s41385-019-0176-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 02/08/2023]
Abstract
The composition of immune infiltrates strongly affects the prognosis of patients with colorectal cancer (CRC). Interleukin (IL)-33 and regulatory T cells (Tregs) in the tumor microenvironment have been separately implicated in CRC; however their contribution to intestinal carcinogenesis is still controversial. Here, we reveal that IL-33 signaling promotes CRC by changing the phenotype of Tregs. In mice with CRC, tumor-infiltrating Tregs preferentially upregulate IL-33 receptor (ST2), and IL-33/ST2 signaling positively correlates with tumor number and size. Transcriptomic and flow cytometry analyses demonstrate that ST2 expression induces a more activated and migratory phenotype in FOXP3+ Tregs, which favors their accumulation in the tumor environment. Consequently, genetic ablation of St2 reduces Treg infiltration and concomitantly enhances the frequencies of effector CD8+ T cells, thereby restraining CRC. Mechanistically, IL-33 curtails IL-17 production by FOXP3+ Tregs and inhibits Th17 differentiation. In humans, numbers of activated ST2-expressing Tregs are increased in blood and tumor lesions of CRC patients, suggesting a similar mode of regulation. Together, these data indicate a central role of IL-33/ST2 signaling in shaping an immunosuppressive environment during intestinal tumorigenesis. Blockade of this pathway may provide a strategy to modulate the composition of CRC immune infiltrates.
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Affiliation(s)
- Eva Pastille
- 0000 0001 2187 5445grid.5718.bInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marie-Hélène Wasmer
- 0000 0001 0726 5157grid.5734.5Institute of Pathology, University of Bern, Bern, Switzerland ,0000 0001 0726 5157grid.5734.5Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Alexandra Adamczyk
- 0000 0001 2187 5445grid.5718.bInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vivian P. Vu
- 0000 0001 0726 5157grid.5734.5Institute of Pathology, University of Bern, Bern, Switzerland ,0000 0001 0726 5157grid.5734.5Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Lukas F. Mager
- 0000 0004 1936 7697grid.22072.35Department of Physiology and Pharmacology, Snyder Institute of Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nhi Ngo Thi Phuong
- 0000 0001 2187 5445grid.5718.bInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vittoria Palmieri
- 0000 0001 2187 5445grid.5718.bInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Cedric Simillion
- 0000 0001 0726 5157grid.5734.5Department of Clinical Research, University of Bern, Bern, Switzerland ,0000 0001 0726 5157grid.5734.5Interfaculty Bioinformatics Unit and Swiss Institute of Bioinformatics, University of Bern, Bern, Switzerland
| | - Wiebke Hansen
- 0000 0001 2187 5445grid.5718.bInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Kasper
- 0000 0001 2187 5445grid.5718.bDepartment of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany ,0000 0001 0262 7331grid.410718.bGerman Cancer Consortium (DKTK), Partner site University Hospital Essen, Essen, Germany
| | - Martin Schuler
- 0000 0001 2187 5445grid.5718.bDepartment of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany ,0000 0001 0262 7331grid.410718.bGerman Cancer Consortium (DKTK), Partner site University Hospital Essen, Essen, Germany
| | - Beat Muggli
- 0000 0001 0726 5157grid.5734.5Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kathy D. McCoy
- 0000 0004 1936 7697grid.22072.35Department of Physiology and Pharmacology, Snyder Institute of Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jan Buer
- 0000 0001 2187 5445grid.5718.bInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Inti Zlobec
- 0000 0001 0726 5157grid.5734.5Institute of Pathology, University of Bern, Bern, Switzerland
| | - Astrid M. Westendorf
- 0000 0001 2187 5445grid.5718.bInstitute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philippe Krebs
- 0000 0001 0726 5157grid.5734.5Institute of Pathology, University of Bern, Bern, Switzerland
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Inderbitzin D, Muggli B, Ringger A, Beldi G, Gass M, Gloor B, Uehlinger D, Regli B, Reichen J, Candinas D. Molecular absorbent recirculating system for the treatment of acute liver failure in surgical patients. J Gastrointest Surg 2005; 9:1155-61; discussion 1161-2. [PMID: 16269387 DOI: 10.1016/j.gassur.2005.07.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [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: 05/21/2005] [Revised: 07/28/2005] [Accepted: 07/29/2005] [Indexed: 01/31/2023]
Abstract
The Molecular Adsorbent Recirculating System (MARS) represents an attractive artificial liver support system for the treatment of liver insufficiency. However, neither indications for MARS treatment (i.e., after extended liver resection) nor criteria for discontinuation of therapy have been evaluated. Therefore, we analyzed the clinical data of all our surgical patients who received MARS treatment for acute liver failure (n = 7). The aim of the study was to identify prognostic indicators for survival. Four of 174 patients resected for hepatic malignancy at our institution received a total of 13 MARS treatments. Two additional patients were successfully bridged to orthotopic liver transplantation with seven MARS treatments and one patient was MARS supported after liver transplantation of a steatotic graft with three MARS treatments. Five of the seven patients survived and were dismissed an average of 31 days, ranging from 17 to 47 days, after the final MARS treatment. No technical complications or adverse effects were observed during the MARS treatments. Important prognostic factors for hepatic recovery and survival were indocyanin green plasma disappearance rates greater than 5%/min and an increase in clotting factor V levels after each MARS treatment. We conclude that MARS therapy can be an effective treatment of postoperative liver insufficiency in the surgical hepatobiliary unit.
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Affiliation(s)
- Daniel Inderbitzin
- Department of Visceral and Transplant Surgery, University Hospital Bern, Switzerland.
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