1
|
Stimmeder S, Leber B, Sucher R, Stiegler P. Genetic Modulation: Future Trends Toward Graft Optimization During Machine Perfusion. Transplantation 2024; 108:614-624. [PMID: 37482634 PMCID: PMC10878468 DOI: 10.1097/tp.0000000000004738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/27/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023]
Abstract
Dynamic preservation methods such as normothermic, subnormothermic, and hypothermic machine perfusion circuits have emerged as viable alternatives to conventional static cold storage. These organ perfusion technologies serve as preservation methods and enable organ assessment, reconditioning, and repair before transplantation. Gene therapy is a novel strategy with the potential to transform the field of graft optimization and treatment. Thereby specific pathways involved in the transplantation process can be targeted and modified. This review aims to provide an overview of gene delivery methods during ex vivo machine perfusion of kidney and liver grafts. Recent literature on state-of-the-art gene therapy approaches during ex situ organ preservation, especially with respect to ischemia-reperfusion injury, as well as acute and chronic graft rejection have been analyzed. Additionally, potential challenges that could affect further refinement of this therapeutic modality are outlined.
Collapse
Affiliation(s)
- Sabrina Stimmeder
- Division of General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Bettina Leber
- Division of General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Robert Sucher
- Division of General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Philipp Stiegler
- Division of General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
2
|
Leber B, Liebchen U, Rohrhofer L, Weber J, Klaus T, Scheier J, Sucher R, Stiegler P. Pharmacokinetics of immunosuppressive agents during hemoperfusion in a sheep model. Front Med (Lausanne) 2023; 10:1258661. [PMID: 37928476 PMCID: PMC10623319 DOI: 10.3389/fmed.2023.1258661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Hemoadsorption shows promising signals in organ preservation and post lung transplantation. However, its potential impact on the pharmacokinetics of immunosuppressant drugs (ID) is still unknown. Methods In this interventional study, CytoSorb® hemoperfusion was tested in healthy sheep (n = 5) against a sham extracorporeal circuit (n = 3). Seven different ID (tacrolimus (TAC), cyclosporin A (CYA), mycophenolate mofetil (MMF), everolimus (EVER), basiliximab (BAS), methylprednisolone (MP) and prednisolone (PRED)) were administered in clinically relevant doses and combinations. Their levels were measured repeatedly in blood samples from the extracorporeal circulation over 6 h following administration. Population pharmacokinetic modeling analysis (NONMEM® 7.5) was performed. Results Negligible clearance was observed for PRED and BAS. For all other substances, a saturable adsorption sub-model with linear decrease of the adsorption effect over the adsorbed amount best described the measured concentrations. The maximum absolute adsorbed amounts (95% CI) for TAC, CYA, MMF, EVER, and MP were 0.040 (0.028-0.053), 1.15 (0.39-1.91), 4.17 (2.00-6.35), 0.0163 (0.007-0.026), and 53.4 mg (20.9-85.9), respectively, indicating an adsorption of less than 5% of the daily administered dosages for all investigated substances. Discussion In this large animal model, CytoSorb® hemoperfusion appears to have a limited effect on the clearance of tested ID.
Collapse
Affiliation(s)
- Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Uwe Liebchen
- Department of Anesthesiology, LMU Hospital, Munich, Germany
| | - Lisa Rohrhofer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Jennifer Weber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | | | - Robert Sucher
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
3
|
Butkutė A, Jurkšas T, Baravykas T, Leber B, Merkininkaitė G, Žilėnaitė R, Čereška D, Gulla A, Kvietkauskas M, Marcinkevičiūtė K, Schemmer P, Strupas K. Combined Femtosecond Laser Glass Microprocessing for Liver-on-Chip Device Fabrication. Materials (Basel) 2023; 16:2174. [PMID: 36984055 PMCID: PMC10056550 DOI: 10.3390/ma16062174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Nowadays, lab-on-chip (LOC) devices are attracting more and more attention since they show vast prospects for various biomedical applications. Usually, an LOC is a small device that serves a single laboratory function. LOCs show massive potential for organ-on-chip (OOC) device manufacturing since they could allow for research on the avoidance of various diseases or the avoidance of drug testing on animals or humans. However, this technology is still under development. The dominant technique for the fabrication of such devices is molding, which is very attractive and efficient for mass production, but has many drawbacks for prototyping. This article suggests a femtosecond laser microprocessing technique for the prototyping of an OOC-type device-a liver-on-chip. We demonstrate the production of liver-on-chip devices out of glass by using femtosecond laser-based selective laser etching (SLE) and laser welding techniques. The fabricated device was tested with HepG2(GS) liver cancer cells. During the test, HepG2(GS) cells proliferated in the chip, thus showing the potential of the suggested technique for further OOC development.
Collapse
Affiliation(s)
- Agnė Butkutė
- Femtika Ltd., Keramikų Str. 2, LT-10233 Vilnius, Lithuania
- Laser Research Center, Vilnius University, Saulėtekio Ave. 10, LT-10223 Vilnius, Lithuania
| | - Tomas Jurkšas
- Femtika Ltd., Keramikų Str. 2, LT-10233 Vilnius, Lithuania
| | | | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, AT-8036 Graz, Austria
| | - Greta Merkininkaitė
- Femtika Ltd., Keramikų Str. 2, LT-10233 Vilnius, Lithuania
- Faculty of Chemistry and Geosciences, Vilnius University, Naugarduko Str. 24, LT-03225 Vilnius, Lithuania
| | | | | | - Aiste Gulla
- Institute of Clinical Medicine, Faculty of Medicine, Center of Visceral Medicine and Translational Research, Vilnius University, M. K. Čiurlionio g. 21, LT-03101 Vilnius, Lithuania
| | - Mindaugas Kvietkauskas
- Institute of Clinical Medicine, Faculty of Medicine, Center of Visceral Medicine and Translational Research, Vilnius University, M. K. Čiurlionio g. 21, LT-03101 Vilnius, Lithuania
| | - Kristina Marcinkevičiūtė
- Institute of Clinical Medicine, Faculty of Medicine, Center of Visceral Medicine and Translational Research, Vilnius University, M. K. Čiurlionio g. 21, LT-03101 Vilnius, Lithuania
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, AT-8036 Graz, Austria
| | - Kęstutis Strupas
- Institute of Clinical Medicine, Faculty of Medicine, Center of Visceral Medicine and Translational Research, Vilnius University, M. K. Čiurlionio g. 21, LT-03101 Vilnius, Lithuania
| |
Collapse
|
4
|
Aghel N, Lui M, Wang V, Khalaf D, Mian H, Hillis C, Walker I, Leber B, Lipton JH, Aljama M, Lepic K, Berg T, Garcia-Horton A, Petropoulos J, Masoom H, Leong DP. Cardiovascular events among recipients of hematopoietic stem cell transplantation-A systematic review and meta-analysis. Bone Marrow Transplant 2023; 58:478-490. [PMID: 36849807 DOI: 10.1038/s41409-023-01928-2] [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] [Received: 09/27/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 03/01/2023]
Abstract
Cardiovascular diseases are an emerging cause of mortality and morbidity in survivors of hematopoietic stem cell transplantation (HSCT); however, the incidence of cardiovascular events (CVEs) in this population is not well described. This systematic review summarizes the evidence on the incidence of CVEs in HSCT recipients. Medline and Embase were searched from inception to December 2020. Inclusion criteria were cohort studies and phase 3 randomized controlled trials that reported CVEs among adults who underwent HSCT for hematological malignancies. After reviewing 8386 citations, 57 studies were included. The incidence of CVEs at 100 days was 0.19 (95% CI: 0.17-0.21) per 100 person-days after autologous HSCT and 0.06 (95% CI: 0.05-0.07) per 100 person-days after allogeneic HSCT. This higher incidence after autologous HSCT was driven by reports of arrhythmia from one population-based study in patients with multiple myeloma. The incidence of long-term CVEs was 3.98 (95% CI; 3.44-4.63) per 1000 person-years in survivors of autologous HSCT and 3.06 (95% CI; 2.69-3.48) per 1000 person-years in survivors of allogeneic HSCT. CVEs remain an important but under-reported cause of morbidity and mortality in recipients of HSCT. Future studies are required to better understand the incidence and risk factors for CVEs in HSCT recipients.
Collapse
Affiliation(s)
- N Aghel
- Division of Cardiology, Cardio-Oncology Program, McMaster University, and Population Health Research Institute Hamilton, Hamilton, ON, Canada.
| | - M Lui
- Department of Pharmacy, Hamilton Health Sciences, Hamilton, ON, Canada
| | - V Wang
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - D Khalaf
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - H Mian
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - C Hillis
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - I Walker
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - B Leber
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - J H Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Aljama
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - K Lepic
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - T Berg
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - A Garcia-Horton
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - J Petropoulos
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - H Masoom
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - D P Leong
- Division of Cardiology, Cardio-Oncology Program, McMaster University, and Population Health Research Institute Hamilton, Hamilton, ON, Canada
| |
Collapse
|
5
|
Jakubauskas M, Jakubauskiene L, Leber B, Horvath A, Strupas K, Stiegler P, Schemmer P. Probiotic Supplementation Attenuates Chemotherapy-Induced Intestinal Mucositis in an Experimental Colorectal Cancer Liver Metastasis Rat Model. Nutrients 2023; 15:nu15051117. [PMID: 36904117 PMCID: PMC10005486 DOI: 10.3390/nu15051117] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
The use of chemotherapeutic agents is of paramount importance when treating colorectal cancer (CRC). Unfortunately, one of the most frequent chemotherapy (CTx) side effects is intestinal mucositis (IM), which may present with several clinical symptoms such as nausea, bloating, vomiting, pain, and diarrhea and even can result in life-threatening complications. There is a focused scientific effort towards developing new therapies to prevent and treat IM. The aim of this study was to assess the outcomes of probiotic supplementation on CTx-induced IM in a CRC liver metastasis rat model. Six-week-old male Wistar rats received either a multispecies probiotic or placebo mixture. On the 28th experiment day, rats received FOLFOX CTx, and afterwards, the severity of diarrhea was evaluated twice daily. Stool samples were collected for further microbiome analysis. Additionally, immunohistochemical stainings of ileum and colon samples with were performed with MPO, Ki67, and Caspase-3 antibodies. Probiotic supplementation alleviates the severity and length of CTx-induced diarrhea. Additionally, probiotics significantly reduced FOLFOX-induced weight and blood albumin loss. Furthermore, probiotic supplementation mitigated CTx-induced histological changes in the gut and promoted intestinal cell regeneration. This study shows that multispecies probiotic supplementation attenuates FOLFOX-induced IM symptoms by inhibiting apoptosis and promoting intestinal cell proliferation.
Collapse
Affiliation(s)
- Matas Jakubauskas
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio str. 21, 03101 Vilnius, Lithuania
| | - Lina Jakubauskiene
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio str. 21, 03101 Vilnius, Lithuania
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| | - Angela Horvath
- Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio str. 21, 03101 Vilnius, Lithuania
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
- Correspondence: ; Tel.: +43-316-385-84094
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| |
Collapse
|
6
|
Jakubauskas M, Jakubauskiene L, Leber B, Horvath A, Strupas K, Stiegler P, Schemmer P. Probiotic Supplementation Suppresses Tumor Growth in an Experimental Colorectal Cancer Liver Metastasis Model. Int J Mol Sci 2022; 23:ijms23147674. [PMID: 35887022 PMCID: PMC9317910 DOI: 10.3390/ijms23147674] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Colorectal cancer (CRC) ranks third in incidence and second in mortality of all cancers worldwide. At the time of primary diagnosis, around 20% of patients already have metastatic CRC and only around 20% are candidates for radical resection. Thus, most of the patients have to undergo chemotherapy (CTx). Due to chemoresistance and side effects, novel treatment additives are crucial for controlling the disease and prolonging patient survival. The aim of this study was to evaluate probiotic supplementation and its antitumorigenic effects in an experimental CRC liver metastasis model. Six-week-old male Wistar rats received either a multispecies probiotic (1.2 × 109 CFU/daily) or placebo mixture. On day 14 of the experiment, rat CRC cells (CC531) were implanted under the liver capsule later treated by FOLFOX CTx. Change in tumor volume was measured by performing micro computed tomography (micro-CT) scanning on experimental days 28 and 34. Additionally, immunohistochemical staining with anti-MPO, anti-Ki67, and anti-CD31 were performed. Tumor apoptosis was evaluated using TUNEL staining. Micro-CT image analysis indicates that probiotic supplementation significantly inhibits tumor growth. No synergistic effects between probiotic supplementation and FOLFOX CTx was observed. Reduced tumor volume was achieved by inhibiting angiogenesis, as tumor microvascular density was significantly lower in rats receiving probiotic supplementation. This study shows that a multispecies probiotic mixture significantly reduces angiogenesis and inhibits CRC liver metastasis growth in an experimental rat model.
Collapse
Affiliation(s)
- Matas Jakubauskas
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (M.J.); (L.J.); (B.L.); (P.S.)
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania;
| | - Lina Jakubauskiene
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (M.J.); (L.J.); (B.L.); (P.S.)
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania;
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (M.J.); (L.J.); (B.L.); (P.S.)
| | - Angela Horvath
- Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria;
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania;
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (M.J.); (L.J.); (B.L.); (P.S.)
- Correspondence: ; Tel.: +43-316-385-84094
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (M.J.); (L.J.); (B.L.); (P.S.)
| |
Collapse
|
7
|
Jakubauskiene L, Jakubauskas M, Razanskiene G, Leber B, Weber J, Rohrhofer L, Ramasauskaite D, Strupas K, Stiegler P, Schemmer P. Relaxin and Erythropoietin Significantly Reduce Uterine Tissue Damage during Experimental Ischemia–Reperfusion Injury. Int J Mol Sci 2022; 23:ijms23137120. [PMID: 35806125 PMCID: PMC9266669 DOI: 10.3390/ijms23137120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/07/2022] Open
Abstract
Successful uterus transplantation, a potential treatment method for women suffering from absolute uterine infertility, is negatively affected by ischemia–reperfusion injury (IRI). The aim of this study is to investigate the protective effect of relaxin (RLX) or/and erythropoietin (EPO) on experimental uterus IRI. Eighty rats, randomly assigned into eight groups (n = 10/group), were pretreated with either saline, 5 μg/kg human relaxin-2, 4000 IU/kg recombinant human erythropoietin or their combination. Ischemia was achieved by clamping the aorta and ovarian arteries for 60 min, following 120 min of reperfusion and tissue sampling. For sham animals, clamping was omitted during surgery. There were no differences in tissue histological score, malondialdehyde (MDA) and superoxide dismutase (SOD) levels, myeloperoxidase (MPO) and TUNEL-positive cell count between all sham-operated rats. Pretreatment with RLX preserved normal tissue morphology, reduced MDA levels, MPO and TUNEL-positive cell count, preserved SOD activity and upregulated NICD and HES1 gene expression when compared to the control group. Pretreatment with EPO reduced MDA levels. In conclusion, pretreatment with RLX, EPO or a combination of both EPO and RLX significantly alleviates uterine tissue damage caused by IRI.
Collapse
Affiliation(s)
- Lina Jakubauskiene
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania; (G.R.); (D.R.); (K.S.)
| | - Matas Jakubauskas
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania; (G.R.); (D.R.); (K.S.)
| | - Gintare Razanskiene
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania; (G.R.); (D.R.); (K.S.)
- National Centre of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, P. Baublio Str. 5, 08406 Vilnius, Lithuania
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
| | - Jennifer Weber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
| | - Lisa Rohrhofer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
| | - Diana Ramasauskaite
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania; (G.R.); (D.R.); (K.S.)
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio Str. 21, 03101 Vilnius, Lithuania; (G.R.); (D.R.); (K.S.)
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
- Correspondence: ; Tel.: +43-316-385-84094
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (L.J.); (M.J.); (B.L.); (J.W.); (L.R.); (P.S.)
| |
Collapse
|
8
|
Leber B, Schlechter S, Weber J, Rohrhofer L, Niedrist T, Aigelsreiter A, Stiegler P, Schemmer P. Experimental long-term sub-normothermic machine perfusion for non-allocable human liver grafts: first data towards feasibility. Eur Surg 2022. [DOI: 10.1007/s10353-022-00756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Summary
Background
Patients with end-stage liver disease can only be cured by liver transplantation. Due to the gap between demand and supply, surgeons are forced to use expanded criteria donor (ECD) organs, which are more susceptible to ischemia–reperfusion injury (IRI). Therefore, enhanced storing techniques are required. Machine perfusion (MP) has moved into the spotlight of research because of its feasibility for investigating liver function prior to implantation. However, as the perfect MP protocol has not yet been found, we aimed to investigate the potential of sub-normothermic (SN)MP in this field.
Methods
Non-allocable human livers were subjected to 24 h of SNMP at 21 °C after delivery to the study team. Perfusion was performed with Custodiol® (Dr. Franz Köhler Chemie, Bensheim, Germany) or Belzer MPS® (Bridge to Life Europe, London, UK) and perfusate liver parameters were determined. For determination of biliary conditions, pH, glucose, and HCO3- levels were measured.
Results
Liver parameters were slightly increased irrespective of perfusate or reason for liver rejection during 24 h of perfusion. Six livers failed to produce bile completely, whereas the remaining 10 livers produced between 2.4 ml and 179 ml of bile. Biliary carbonate was increased in all but one liver. The bile-glucose-to-perfusate-glucose ratio was near 1 for most of the organs and bile pH was above 7 in all but one case.
Conclusion
This study provides promising data on the feasibility of long-term SNMP as a tool to gain time during MP to optimize ECD organs to decrease the gap between organ demand and supply.
Long-term (24 h) sub-normothermic liver machine perfusion seems to be possible, although some adjustments to the protocol might be necessary to improve the general outcome. This has so far been shown for normothermic machine perfusion, bearing some drawbacks compared to the sub-normothermic variant.
Collapse
|
9
|
Balazs I, Horvath A, Leber B, Feldbacher N, Sattler W, Rainer F, Fauler G, Vermeren S, Stadlbauer V. Serum bile acids in liver cirrhosis promote neutrophil dysfunction. Clin Transl Med 2022; 12:e735. [PMID: 35220689 PMCID: PMC8882235 DOI: 10.1002/ctm2.735] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Irina Balazs
- Department of Internal MedicineDivision of Gastroenterology and HepatologyMedical University of GrazGrazAustria
- Center for Biomarker Research in Medicine (CBmed)GrazAustria
| | - Angela Horvath
- Department of Internal MedicineDivision of Gastroenterology and HepatologyMedical University of GrazGrazAustria
- Center for Biomarker Research in Medicine (CBmed)GrazAustria
| | - Bettina Leber
- Department of SurgeryDivision of Transplantation SurgeryMedical University of GrazGrazAustria
| | - Nicole Feldbacher
- Department of Internal MedicineDivision of Gastroenterology and HepatologyMedical University of GrazGrazAustria
- Center for Biomarker Research in Medicine (CBmed)GrazAustria
| | - Wolfgang Sattler
- Gottfried Schatz Research Center (for Cell Signaling, Metabolism and Aging)Division of Molecular Biology and BiochemistryMedical University of GrazGrazAustria
- Center for Explorative LipidomicsBioTechMed GrazGrazAustria
| | - Florian Rainer
- Department of Internal MedicineDivision of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - Günter Fauler
- Clinical Institute of Medical and Chemical Laboratory DiagnosticsMedical University of GrazGrazAustria
| | - Sonja Vermeren
- Centre for Inflammation Research, Institute for Regeneration and RepairUniversity of EdinburghEdinburghUK
| | - Vanessa Stadlbauer
- Department of Internal MedicineDivision of Gastroenterology and HepatologyMedical University of GrazGrazAustria
- Center for Biomarker Research in Medicine (CBmed)GrazAustria
| |
Collapse
|
10
|
Zulpaite R, Miknevicius P, Leber B, Strupas K, Stiegler P, Schemmer P. Ex-vivo Kidney Machine Perfusion: Therapeutic Potential. Front Med (Lausanne) 2022; 8:808719. [PMID: 35004787 PMCID: PMC8741203 DOI: 10.3389/fmed.2021.808719] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/06/2021] [Indexed: 01/11/2023] Open
Abstract
Kidney transplantation remains the gold standard treatment for patients suffering from end-stage kidney disease. To meet the constantly growing organ demands grafts donated after circulatory death (DCD) or retrieved from extended criteria donors (ECD) are increasingly utilized. Not surprisingly, usage of those organs is challenging due to their susceptibility to ischemia-reperfusion injury, high immunogenicity, and demanding immune regulation after implantation. Lately, a lot of effort has been put into improvement of kidney preservation strategies. After demonstrating a definite advantage over static cold storage in reduction of delayed graft function rates in randomized-controlled clinical trials, hypothermic machine perfusion has already found its place in clinical practice of kidney transplantation. Nevertheless, an active investigation of perfusion variables, such as temperature (normothermic or subnormothermic), oxygen supply and perfusate composition, is already bringing evidence that ex-vivo machine perfusion has a potential not only to maintain kidney viability, but also serve as a platform for organ conditioning, targeted treatment and even improve its quality. Many different therapies, including pharmacological agents, gene therapy, mesenchymal stromal cells, or nanoparticles (NPs), have been successfully delivered directly to the kidney during ex-vivo machine perfusion in experimental models, making a big step toward achievement of two main goals in transplant surgery: minimization of graft ischemia-reperfusion injury and reduction of immunogenicity (or even reaching tolerance). In this comprehensive review current state of evidence regarding ex-vivo kidney machine perfusion and its capacity in kidney graft treatment is presented. Moreover, challenges in application of these novel techniques in clinical practice are discussed.
Collapse
Affiliation(s)
- Ruta Zulpaite
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Povilas Miknevicius
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
11
|
Jakubauskas M, Jakubauskiene L, Leber B, Strupas K, Stiegler P, Schemmer P. Machine Perfusion in Liver Transplantation: A Systematic Review and Meta-Analysis. Visc Med 2021; 38:243-254. [PMID: 36160822 PMCID: PMC9421699 DOI: 10.1159/000519788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/31/2021] [Accepted: 09/12/2021] [Indexed: 11/27/2022] Open
Abstract
Background Liver transplantation (LTx) is the only treatment option for patients with end-stage liver disease. Novel organ preservation techniques such as hypothermic machine perfusion (HMP) or normothermic machine perfusion (NMP) are under investigation in order to improve organ quality from extended criteria donors and donors after circulatory death. The aim of this study was to systematically review the literature reporting LTx outcomes using NMP or HMP compared to static cold storage (SCS). Methods The following data were retrieved: graft primary nonfunction rate, early allograft dysfunction (EAD) rate, biliary complication rate, and 12-month graft and patient survival. A total of 15 studies were included (6 NMP and 9 HMP studies), and meta-analysis was performed only for HMP studies because NMP had considerable differences. Results The systematic review showed the potential of NMP to reduce graft injury and lower the liver graft discard rate. The performed quantitative analyses showed that the use of HMP reduces the rate of EAD (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.34–0.76; p = 0.001; I2 = 0%) and non-anastomotic biliary strictures (OR 0.34; 95% CI 0.17–0.67; p = 0.002; I2 = 0%) compared to SCS. Conclusion Our systematic review and meta-analysis revealed that the use of HMP reduces the rate of EAD and non-anastomotic biliary strictures compared to SCS.
Collapse
Affiliation(s)
- Matas Jakubauskas
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Lina Jakubauskiene
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- *Philipp Stiegler,
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
12
|
Jakubauskiene L, Jakubauskas M, Stiegler P, Leber B, Schemmer P, Strupas K. Ischemic Preconditioning for Liver Transplantation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Visc Med 2021; 37:329-337. [PMID: 34722716 DOI: 10.1159/000516608] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/08/2021] [Indexed: 01/01/2023] Open
Abstract
Background In recent decades, liver transplantation (LTx) has increased the survival and quality of life of patients with end-stage organ failure. Unfortunately, LTx is limited due to the shortage of donors. A lot of effort is put into finding new ways to reduce ischemia-reperfusion injury (IRI) in liver grafts to increase the number of suitable organs procured from expanded-criteria donors (ECD). The aim of this study was to systematically review the literature reporting LTx outcomes when using ischemic preconditioning (IPC) or remote ischemic preconditioning (RIPC) to reduce IRI in liver grafts. Methods A literature search was performed in the MEDLINE, Web of Science, and EMBASE databases. The following combination was used: "Liver" OR "Liver Transplantation" AND "Ischemic preconditioning" OR "occlusion" OR "clamping" OR "Pringle." The following outcome data were retrieved: the rates of graft primary nonfunction (PNF), retransplantation, graft loss, and mortality; stay in hospital and the intensive care unit; and postoperative serum liver damage parameters. Results The initial search retrieved 4,522 potentially relevant studies. After evaluating 17 full-text articles, a total of 9 randomized controlled trials (RCTs) were included (7 IPC and 2 RIPC studies) in the qualitative synthesis; the meta-analysis was only performed on the data from the IPC studies. RIPC studies had considerable methodological differences. The meta-analysis revealed the beneficial effect of IPC when comparing postoperative aspartate aminotransferase (AST) corresponding to a statistically lower mortality rate in the IPC group (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.27-0.98; p = 0.04). Conclusion IPC lowers postoperative AST levels and reduces the mortality rate; however, data on the benefits of RIPC are lacking.
Collapse
Affiliation(s)
- Lina Jakubauskiene
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Matas Jakubauskas
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | | |
Collapse
|
13
|
Bausys A, Maneikyte J, Leber B, Weber J, Feldbacher N, Strupas K, Dschietzig TB, Schemmer P, Stiegler P. Custodiol ® Supplemented with Synthetic Human Relaxin Decreases Ischemia-Reperfusion Injury after Porcine Kidney Transplantation. Int J Mol Sci 2021; 22:ijms222111417. [PMID: 34768845 PMCID: PMC8583819 DOI: 10.3390/ijms222111417] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 01/04/2023] Open
Abstract
Objective. Ischemia-reperfusion injury (IRI) is inevitable after kidney transplantation (KT), impairing outcomes. Relaxin-2 (RLX) is a promising insulin-related peptide hormone that protects against renal IRI in rodents, although large animal models are needed before RLX can be tested in a human setting. Methods. In this blinded, randomized, and placebo-controlled experimental study kidneys from 19 donor pigs were retrieved after perfusion with Custodiol® ± RLX (5 or 20 nmol/L) and underwent static cold storage (SCS) for 24 and 48 h, respectively. Subsequently, KT was performed after unilateral right nephrectomy. Study outcomes included markers for kidney function, oxidative stress, lipid peroxidation, and endothelial cell damage. PCR analysis for oxidative stress and apoptosis-related gene panels as well as immunohistochemistry were performed. Results. RLX upregulated SOD2 and NFKB expression to 135% (p = 0.042) and 125% (p = 0.019), respectively, while RIPK1 expression was downregulated to 82% (p = 0.016) of corresponding controls. Further RLX significantly downregulated RIPK1 and MLKL expression and decreased the number of Caspase 3- and MPO-positive cells in grafts after SCS. Conclusions. RLX supplemented Custodiol® significantly decreased IRI via both antioxidant and anti-apoptotic mechanisms. Clinical trials are warranted to implement synthetic human RLX as a novel additive to preservation solutions against IRI.
Collapse
Affiliation(s)
- Augustinas Bausys
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
- Department of Abdominal Surgery, National Cancer Institute, 10224 Vilnius, Lithuania
| | - Juste Maneikyte
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
- Correspondence: ; Tel.: +43-316-385-81181
| | - Jennifer Weber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
| | - Nicole Feldbacher
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | - Thomas Bernd Dschietzig
- Relaxera GmbH & Co. KG, 64625 Bensheim, Germany;
- MHB Medizinische Hochschule Brandenburg, 16816 Neuruppin, Germany
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (A.B.); (J.M.); (J.W.); (N.F.); (P.S.); (P.S.)
| |
Collapse
|
14
|
Aghel N, Lui M, Mian H, Khalaf D, Hillis C, Petropoulos J, Wang V, Leber B, Lipton J, Walker I, Leong D. Cardiovascular events among recipients of hematopoietic stem cell transplantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2876] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Allogeneic and autologous hematopoietic stem cell transplantation (HSCT) are potential curative treatments for several hematological malignancies (1). Survival after HSCT has improved over the last decade, but survivors remain at risk for health issues after transplantation. Cardiovascular complications after HSCT are increasingly recognized (2). Cardiovascular diseases may be an important cause of mortality and morbidity in patients after HSCT owing to the toxicities of the cancer therapies; however, the incidence of cardiovascular events (CVEs) in this population has not been completely characterized. The objective of this systematic review is to summarize the evidence on the incidence of CVEs in HSCT recipients.
Methods
Medline and Embase were searched from inception to December 2020 without language restriction. Two authors independently screened the titles and abstracts. Inclusion criteria were: cohort studies and phase 3 randomized controlled trials that reported CVEs (i.e., heart failure, arrythmias, acute coronary syndrome, and stroke) or cardiovascular death among adults who underwent HSCT for a hematological malignancy. All-cause mortality, relapse-related mortality, and non-relapse-related mortality (NRM) were also collected. Studies in which the follow up period was not started immediately after HSCT were excluded due to the risk of immortal bias.
Results
Of 8151 nonduplicate articles, 30 studies including 14019 individuals post autologous HSCT, and 22 studies including 31049 individuals post allogeneic HSCT met the inclusion criteria.
The cumulative incidence of CVEs in the first 100 days post autologous HSCT was 9% and arrhythmia (i.e., atrial fibrillation) was the most common CVE. In recipients of allogeneic HSCT, the 100-day cumulative incidence of CVEs was 3%, and heart failure (HF) was the most common reported CVE. In recipients of autologous and allogeneic HSCT, cardiovascular death was responsible for 43% and 10% of NRM within 100 days, respectively (Table 1).
The incidence of CVEs was 4.96 per 1000-person years (95% CI; 4.21–5.80) in long-term survivors (beyond 100-days) of autologous HSCT, and HF was the most common CVE in this population. In long-term survivors of allogeneic HSCT, the incidence of CVEs was 1.90 per 1000-person years (95% CI: 1.59–2.24). Cardiovascular death was the most frequently reported CVE in long-term survivors of allogeneic HSCT (Table 2).
Conclusion
CVEs remain a major cause of non relapse morbidity and mortality in recipients of HSCT, especially recipients of autologous HSCT within the first 100 days. Future studies are needed to identify the risk factors for CVEs that are specific to HSCT recipients.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- N Aghel
- McMaster University, Medicine-Cardiology, Hamilton, Canada
| | - M Lui
- Hamilton Health Sciences, Hamilton, Canada
| | - H Mian
- McMaster University, Division of Hematology, Department of Oncology, Hamilton, Canada
| | - D Khalaf
- McMaster University, Division of Hematology, Department of Oncology, Hamilton, Canada
| | - C Hillis
- McMaster University, Division of Hematology, Department of Oncology, Hamilton, Canada
| | - J Petropoulos
- McMaster University, Health Sciences Library, Hamilton, Canada
| | - V Wang
- McMaster University, Hamilton, Canada
| | - B Leber
- McMaster University, Division of Hematology, Department of Oncology, Hamilton, Canada
| | - J Lipton
- Princess Margaret Hospital, Department of Medical Oncology and Hematology, Toronto, Canada
| | - I Walker
- McMaster University, Medicine, Hamilton, Canada
| | - D Leong
- Population Health Research Institute, Medicine-Cardiology, Hamilton, Canada
| |
Collapse
|
15
|
Mauerhofer C, Grumet L, Schemmer P, Leber B, Stiegler P. Combating Ischemia-Reperfusion Injury with Micronutrients and Natural Compounds during Solid Organ Transplantation: Data of Clinical Trials and Lessons of Preclinical Findings. Int J Mol Sci 2021; 22:ijms221910675. [PMID: 34639016 PMCID: PMC8508760 DOI: 10.3390/ijms221910675] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 02/07/2023] Open
Abstract
Although extended donor criteria grafts bear a higher risk of complications such as graft dysfunction, the exceeding demand requires to extent the pool of potential donors. The risk of complications is highly associated with ischemia-reperfusion injury, a condition characterized by high loads of oxidative stress exceeding antioxidative defense mechanisms. The antioxidative properties, along with other beneficial effects like anti-inflammatory, antiapoptotic or antiarrhythmic effects of several micronutrients and natural compounds, have recently emerged increasing research interest resulting in various preclinical and clinical studies. Preclinical studies reported about ameliorated oxidative stress and inflammatory status, resulting in improved graft survival. Although the majority of clinical studies confirmed these results, reporting about improved recovery and superior organ function, others failed to do so. Yet, only a limited number of micronutrients and natural compounds have been investigated in a (large) clinical trial. Despite some ambiguous clinical results and modest clinical data availability, the vast majority of convincing animal and in vitro data, along with low cost and easy availability, encourage the conductance of future clinical trials. These should implement insights gained from animal data.
Collapse
Affiliation(s)
- Christina Mauerhofer
- Department of Science and Product Development, pro medico HandelsGmbH, Liebenauer Tangente 6, 8041 Graz, Austria; (C.M.); (L.G.)
| | - Lukas Grumet
- Department of Science and Product Development, pro medico HandelsGmbH, Liebenauer Tangente 6, 8041 Graz, Austria; (C.M.); (L.G.)
| | - Peter Schemmer
- Division of Transplant Surgery, Department of Surgery, Medical University, 8036 Graz, Austria; (P.S.); (B.L.)
| | - Bettina Leber
- Division of Transplant Surgery, Department of Surgery, Medical University, 8036 Graz, Austria; (P.S.); (B.L.)
| | - Philipp Stiegler
- Division of Transplant Surgery, Department of Surgery, Medical University, 8036 Graz, Austria; (P.S.); (B.L.)
- Correspondence: (P.S.)
| |
Collapse
|
16
|
Savona M, Mccloskey J, Griffiths E, Yee K, Al-Kali A, Zeidan A, Deeg H, Patel P, Sabloff M, Keating MM, Dao KH, Zhu N, Gabrail N, Fazal S, Maly J, Odenike O, Kantarjian H, Dezern A, O’Connell C, Roboz G, Busque L, Wells R, Amin H, Randhawa J, Leber B, Hao Y, Keer H, Azab M, Manero GG. Topic: AS08-Treatment/AS08a-Current treatment options - Hypomethylating agents. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106681.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
17
|
Leitch H, Ezzat H, Merkeley H, Buckstein R, Zhu N, Nevill T, Olney H, Yee K, Leber B, Keating MM, Hilaire ES, Kumar R, Delage R, Geddes M, Storring J, Shamy A, Elemary M, Wells R. Topic: AS08-Treatment/AS08j-Supportive care - Iron overload. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106681.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
18
|
Miknevicius P, Zulpaite R, Leber B, Strupas K, Stiegler P, Schemmer P. The Impact of Probiotics on Intestinal Mucositis during Chemotherapy for Colorectal Cancer: A Comprehensive Review of Animal Studies. Int J Mol Sci 2021; 22:ijms22179347. [PMID: 34502251 PMCID: PMC8430988 DOI: 10.3390/ijms22179347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/26/2021] [Accepted: 08/21/2021] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is the second most commonly diagnosed cancer in females (incidence 16.4/10,000) and the third in males (incidence 23.4/10,000) worldwide. Surgery, chemotherapy (CTx), radiation therapy (RTx), or a combined treatment of those are the current treatment modalities for primary CRC. Chemotherapeutic drug-induced gastrointestinal (GIT) toxicity mainly presents as mucositis and diarrhea. Preclinical studies revealed that probiotic supplementation helps prevent CTx-induced side effects by reducing oxidative stress and proinflammatory cytokine production and promoting crypt cell proliferation. Moreover, probiotics showed significant results in preventing the loss of body weight (BW) and reducing diarrhea. However, further clinical studies are needed to elucidate the exact doses and most promising combination of strains to reduce or prevent chemotherapy-induced side effects. The aim of this review is to overview currently available literature on the impact of probiotics on CTx-induced side effects in animal studies concerning CRC treatment and discuss the potential mechanisms based on experimental studies’ outcomes.
Collapse
Affiliation(s)
- Povilas Miknevicius
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria; (P.M.); (R.Z.); (B.L.); (P.S.)
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Ruta Zulpaite
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria; (P.M.); (R.Z.); (B.L.); (P.S.)
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria; (P.M.); (R.Z.); (B.L.); (P.S.)
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria; (P.M.); (R.Z.); (B.L.); (P.S.)
- Correspondence: ; Tel.: +43-316-385-84094
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria; (P.M.); (R.Z.); (B.L.); (P.S.)
| |
Collapse
|
19
|
Groiss S, Somvilla I, Daxböck C, Fuchs J, Lang-Olip I, Stiegler P, Leber B, Liegl-Atzwanger B, Brislinger D. Quantification of increased MUC5AC expression in airway mucus of smoker using an automated image-based approach. Microsc Res Tech 2021; 85:5-18. [PMID: 34288207 DOI: 10.1002/jemt.23879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
Microscopic analysis of mucus quantity and composition is crucial in research and diagnostics on muco-obstructive diseases. Currently used image-based methods are unable to extract concrete numeric values of mucosal proteins, especially on the expression of the key mucosal proteins MUC5AC and MUC5B. Since their levels increase under pathologic conditions such as extensive exposure to cigarette smoke, it is imperative to quantify them to improve treatment strategies of pulmonary diseases. This study presents a simple, image-based, and high-processing computational method that allows determining the ratio of MUC5AC and MUC5B within the overall airway mucus while providing information on their spatial distribution. The presented pipeline was optimized for automated downstream analysis using a combination of bright field and immunofluorescence imaging suitable for tracheal and bronchial tissue samples, and air-liquid interface (ALI) cell cultures. To validate our approach, we compared tracheal tissue and ALI cell cultures of isolated primary normal human bronchial epithelial cells derived from smokers and nonsmokers. Our data indicated 18-fold higher levels of MUC5AC in submucosal glands of smokers covering about 8% of mucosal areas compared to <1% in nonsmoking individuals, confirming results of previous studies. We further identified a subpopulation of nonsmokers with slightly elevated glandular MUC5AC levels suggesting moderate exposure to second-hand smoke or fine particulate air pollution. Overall, this study demonstrates a novel, user-friendly and freely available tool for digital pathology and the analysis of therapeutic interventions tested in ALI cell cultures.
Collapse
Affiliation(s)
- Silvia Groiss
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Ina Somvilla
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Christine Daxböck
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Julia Fuchs
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Ingrid Lang-Olip
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Philipp Stiegler
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Bettina Leber
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Bernadette Liegl-Atzwanger
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular for Molecular Biomedicine, Medical University Graz, Graz, Austria
| | - Dagmar Brislinger
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| |
Collapse
|
20
|
Kvietkauskas M, Zitkute V, Leber B, Strupas K, Stiegler P, Schemmer P. Dietary Melatonin and Glycine Decrease Tumor Growth through Antiangiogenic Activity in Experimental Colorectal Liver Metastasis. Nutrients 2021; 13:nu13062035. [PMID: 34199311 PMCID: PMC8231877 DOI: 10.3390/nu13062035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/06/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023] Open
Abstract
Despite multimodal treatment strategies, clinical outcomes of advanced stage colorectal cancer (CRC) patients remain poor. Neoadjuvant/adjuvant chemotherapy efficacy is limited due to chemoresistance, toxicity, and negative side effects. Since both melatonin and glycine have anti-cancer activities without relevant side effects, this study was designed to investigate their combined effects in experimental CRC liver metastases. CRC metastasis with CC531 cells were induced in male Wistar rats. Melatonin and glycine alone or their combination were supplemented for 14 days (n = 100). Blood parameters, a micro-computed tomography scan (tumor volume over time), and immunohistochemistry for Ki67 and CD31 expression in tumor tissue were compared between groups. Melatonin and glycine alone significantly reduced the tumor volume by 63.2% (p = 0.002) and 43% (p = 0.044) over time, respectively, while tumor volume increased by 8.7% in the controls. Moreover, treatment with melatonin and glycine alone reduced the tumor proliferation index. Most interestingly, the combination therapy did not have any influence on the above-mentioned tumor parameters. The leukocyte count was significantly increased with melatonin at the end of the experiment (p = 0.012) which was due to a high lymphocytes count. Tumor microvascular density was significantly reduced in all treatment groups. The results of this study suggest an inhibitory function for melatonin and glycine alone in the case of CRC liver metastasis growth by acting as natural antiangiogenic molecules, followed by angiogenesis-dependent cancer proliferation and immunomodulation.
Collapse
Affiliation(s)
- Mindaugas Kvietkauskas
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (M.K.); (V.Z.); (B.L.); (P.S.)
- Faculty of Medicine, Vilnius University, Ciurlionio 21, 03101 Vilnius, Lithuania;
| | - Viktorija Zitkute
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (M.K.); (V.Z.); (B.L.); (P.S.)
- Faculty of Medicine, Vilnius University, Ciurlionio 21, 03101 Vilnius, Lithuania;
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (M.K.); (V.Z.); (B.L.); (P.S.)
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, Ciurlionio 21, 03101 Vilnius, Lithuania;
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (M.K.); (V.Z.); (B.L.); (P.S.)
- Correspondence: ; Tel.: +43-316-385-83232
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria; (M.K.); (V.Z.); (B.L.); (P.S.)
| |
Collapse
|
21
|
Kvietkauskas M, Zitkute V, Leber B, Strupas K, Stiegler P, Schemmer P. The Role of Metabolomics in Current Concepts of Organ Preservation. Int J Mol Sci 2020; 21:ijms21186607. [PMID: 32927605 PMCID: PMC7555311 DOI: 10.3390/ijms21186607] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022] Open
Abstract
In solid organ transplantation (Tx), both survival rates and quality of life have improved dramatically over the last few decades. Each year, the number of people on the wait list continues to increase, widening the gap between organ supply and demand. Therefore, the use of extended criteria donor grafts is growing, despite higher susceptibility to ischemia-reperfusion injury (IRI) and consecutive inferior Tx outcomes. Thus, tools to characterize organ quality prior to Tx are crucial components for Tx success. Innovative techniques of metabolic profiling revealed key pathways and mechanisms involved in IRI occurring during organ preservation. Although large-scale trials are needed, metabolomics appears to be a promising tool to characterize potential biomarkers, for the assessment of graft quality before Tx and evaluate graft-related outcomes. In this comprehensive review, we summarize the currently available literature on the use of metabolomics in solid organ Tx, with a special focus on metabolic profiling during graft preservation to assess organ quality prior to Tx.
Collapse
Affiliation(s)
- Mindaugas Kvietkauskas
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, Graz 8036, Austria; (M.K.); (V.Z.); (B.L.); (P.S.)
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania;
| | - Viktorija Zitkute
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, Graz 8036, Austria; (M.K.); (V.Z.); (B.L.); (P.S.)
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania;
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, Graz 8036, Austria; (M.K.); (V.Z.); (B.L.); (P.S.)
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania;
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, Graz 8036, Austria; (M.K.); (V.Z.); (B.L.); (P.S.)
- Correspondence: ; Tel.: +43-316-385-84094
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Auenbruggerpl. 2, Graz 8036, Austria; (M.K.); (V.Z.); (B.L.); (P.S.)
| |
Collapse
|
22
|
Blesl A, Jüngst C, Lammert F, Fauler G, Rainer F, Leber B, Feldbacher N, Stromberger S, Wildburger R, Spindelböck W, Fickert P, Horvath A, Stadlbauer V. Secondary Sclerosing Cholangitis in Critically Ill Patients Alters the Gut-Liver Axis: A Case Control Study. Nutrients 2020; 12:E2728. [PMID: 32906634 PMCID: PMC7551864 DOI: 10.3390/nu12092728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/12/2022] Open
Abstract
Secondary sclerosing cholangitis in critically ill patients (SC-CIP) occurs after long-term intensive care treatment. This study aimed to assess the gut-liver axis in SC-CIP. Stool microbiome composition, gut permeability, bacterial translocation and serum bile acid profiles of 18 SC-CIP patients compared to 11 patients after critical illness without liver disease (CIP controls), 21 patients with cirrhosis and 21 healthy controls were studied. 16S rDNA was isolated from stool and sequenced using the Illumina technique. Diamine oxidase, zonulin, soluble CD14 (sCD14) and lipopolysaccharide binding protein were measured in serum and calprotectin in stool. Serum bile acids were analyzed by high-performance liquid chromatography-mass spectrometry (HPLC-MS). Reduced microbiome alpha diversity and altered beta diversity were seen in SC-CIP, CIP controls and cirrhosis compared to healthy controls. SC-CIP patients showed a shift towards pathogenic taxa and an oralization. SC-CIP, CIP controls and cirrhotic patients presented with impaired gut permeability, and biomarkers of bacterial translocation were increased in SC-CIP and cirrhosis. Total serum bile acids were elevated in SC-CIP and cirrhosis and the bile acid profile was altered in SC-CIP, CIP controls and cirrhosis. In conclusions, observed alterations of the gut-liver axis in SC-CIP cannot solely be attributed to liver disease, but may also be secondary to long-term intensive care treatment.
Collapse
Affiliation(s)
- Andreas Blesl
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.R.); (N.F.); (W.S.); (P.F.); (A.H.); (V.S.)
| | - Christoph Jüngst
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Zürich, 8032 Zürich, Switzerland;
- Department of Medicine II, Saarland University Medical Center, Saarland University, 66421 Homburg, Germany;
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, 66421 Homburg, Germany;
| | - Günter Fauler
- Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, 8036 Graz, Austria;
| | - Florian Rainer
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.R.); (N.F.); (W.S.); (P.F.); (A.H.); (V.S.)
| | - Bettina Leber
- Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, 8036 Graz, Austria;
| | - Nicole Feldbacher
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.R.); (N.F.); (W.S.); (P.F.); (A.H.); (V.S.)
| | - Silvia Stromberger
- AUVA Rehabilitation Clinic Tobelbad, 8144 Tobelbad, Austria; (S.S.); (R.W.)
| | - Renate Wildburger
- AUVA Rehabilitation Clinic Tobelbad, 8144 Tobelbad, Austria; (S.S.); (R.W.)
| | - Walter Spindelböck
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.R.); (N.F.); (W.S.); (P.F.); (A.H.); (V.S.)
| | - Peter Fickert
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.R.); (N.F.); (W.S.); (P.F.); (A.H.); (V.S.)
| | - Angela Horvath
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.R.); (N.F.); (W.S.); (P.F.); (A.H.); (V.S.)
| | - Vanessa Stadlbauer
- Division for Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; (F.R.); (N.F.); (W.S.); (P.F.); (A.H.); (V.S.)
| |
Collapse
|
23
|
Maneikyte J, Bausys A, Leber B, Feldbacher N, Hoefler G, Kolb-Lenz D, Strupas K, Stiegler P, Schemmer P. Dietary Glycine Prevents FOLFOX Chemotherapy-Induced Heart Injury: A Colorectal Cancer Liver Metastasis Treatment Model in Rats. Nutrients 2020; 12:nu12092634. [PMID: 32872376 PMCID: PMC7551625 DOI: 10.3390/nu12092634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/08/2020] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction: FOLFOX chemotherapy (CTx) is used for the treatment of colorectal liver metastasis (CRLM). Side effects include rare cardiotoxicity, which may limit the application of FOLFOX. Currently, there is no effective strategy to prevent FOLFOX-induced cardiotoxicity. Glycine has been shown to protect livers from CTx-induced injury and oxidative stress, and it reduces platelet aggregation and improves microperfusion. This study tested the hypothesis of glycine being cardioprotective in a rat model of FOLFOX in combination with CRLM. Materials and Methods: The effect of glycine was tested in vitro on human cardiac myocytes (HCMs). To test glycine in vivo Wag/Rij rats with induced CRLM were treated with FOLFOX ±5% dietary glycine. Left ventricle ejection fraction (LVEF), myocardial fibrosis, and apoptosis, also heart fatty acid binding protein (h-FABP) and brain natriuretic peptide levels were monitored. PCR analysis for Collagen type I, II, and brain natriuretic peptide (BNP) in the heart muscle was performed. Results: In vitro glycine had no effect on HCM cell viability. Treatment with FOLFOX resulted in a significant increase of h-FABP levels, increased myocardial fibrosis, and apoptosis as well as increased expression of type I Collagen. Furthermore, FOLFOX caused a decrease of LVEF by 10% (p = 0.028). Dietary glycine prevented FOLFOX-induced myocardial injury by preserving the LVEF and reducing the levels of fibrosis (p = 0.012) and apoptosis (p = 0.015) in vivo. Conclusions: Data presented here demonstrate for the first time that dietary glycine protects the heart against FOLFOX-induced injury during treatment for CRLM.
Collapse
Affiliation(s)
- Juste Maneikyte
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (J.M.); (A.B.); (B.L.); (N.F.); (P.S.)
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Augustinas Bausys
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (J.M.); (A.B.); (B.L.); (N.F.); (P.S.)
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
- National Cancer Institute, 08406 Vilnius, Lithuania
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (J.M.); (A.B.); (B.L.); (N.F.); (P.S.)
| | - Nicole Feldbacher
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (J.M.); (A.B.); (B.L.); (N.F.); (P.S.)
| | - Gerald Hoefler
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8010 Graz, Austria;
| | - Dagmar Kolb-Lenz
- Institute of Cell Biology, Histology and Embryology, Medical University Graz, 8010 Graz, Austria;
- Center for Medical Research, Core Facility Ultrastructure Analysis, Medical University Graz, 8010 Graz, Austria
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (J.M.); (A.B.); (B.L.); (N.F.); (P.S.)
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (J.M.); (A.B.); (B.L.); (N.F.); (P.S.)
- Correspondence: ; Tel.: +43-316-385-84094
| |
Collapse
|
24
|
Stadlbauer V, Engertsberger L, Komarova I, Feldbacher N, Leber B, Pichler G, Fink N, Scarpatetti M, Schippinger W, Schmidt R, Horvath A. Dysbiosis, gut barrier dysfunction and inflammation in dementia: a pilot study. BMC Geriatr 2020; 20:248. [PMID: 32690030 PMCID: PMC7372911 DOI: 10.1186/s12877-020-01644-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 07/09/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Dementia is an increasing public health threat worldwide. The pathogenesis of dementia has not been fully elucidated yet. Inflammatory processes are hypothesized to play an important role as a driver for cognitive decline but the origin of inflammation is not clear. We hypothesize that disturbances in gut microbiome composition, gut barrier dysfunction, bacterial translocation and resulting inflammation are associated with cognitive dysfunction in dementia. METHODS To test this hypothesis, a cohort of 23 patients with dementia and 18 age and sex matched controls without cognitive impairments were studied. Gut microbiome composition, gut barrier dysfunction, bacterial translocation and inflammation were assessed from stool and serum samples. Malnutrition was assessed by Mini Nutritional Assessment Short Form (MNA-SF), detailed information on drug use was collected. Microbiome composition was assessed by 16S rRNA sequencing, QIIME 2 and Calypso 7.14 tools. RESULTS Dementia was associated with dysbiosis characterized by differences in beta diversity and changes in taxonomic composition. Gut permeability was increased as evidenced by increased serum diamine oxidase (DAO) levels and systemic inflammation was confirmed by increased soluble cluster of differentiation 14 levels (sCD14). BMI and statin use had the strongest impact on microbiome composition. CONCLUSION Dementia is associated with changes in gut microbiome composition and increased biomarkers of gut permeability and inflammation. Lachnospiraceae NK4A136 group as potential butyrate producer was reduced in dementia. Malnutrition and drug intake were factors, that impact on microbiome composition. Increasing butyrate producing bacteria and targeting malnutrition may be promising therapeutic targets in dementia. TRIAL REGISTRATION NCT03167983 .
Collapse
Affiliation(s)
- Vanessa Stadlbauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. .,Center of Biomarker Research in Medicine (CBmed), Graz, Austria.
| | - Lara Engertsberger
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Irina Komarova
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Nicole Feldbacher
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Center of Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Bettina Leber
- Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Gerald Pichler
- Department of Neurology, Geriatric Health Centers Graz, Albert Schweitzer Hospital, Graz, Austria
| | - Nicole Fink
- Department of Neurology, Geriatric Health Centers Graz, Albert Schweitzer Hospital, Graz, Austria
| | - Monika Scarpatetti
- Department of Neurology, Geriatric Health Centers Graz, Albert Schweitzer Hospital, Graz, Austria
| | - Walter Schippinger
- Department of Neurology, Geriatric Health Centers Graz, Albert Schweitzer Hospital, Graz, Austria
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Angela Horvath
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Center of Biomarker Research in Medicine (CBmed), Graz, Austria
| |
Collapse
|
25
|
Kvietkauskas M, Zitkute V, Leber B, Strupas K, Stiegler P, Schemmer P. The role of melatonin in colorectal cancer treatment: a comprehensive review. Ther Adv Med Oncol 2020; 12:1758835920931714. [PMID: 32733605 PMCID: PMC7370547 DOI: 10.1177/1758835920931714] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/04/2020] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most common types of cancer worldwide, known as the second leading cause of cancer-related deaths annually. Currently, multimodal treatment strategies, including surgical resection, combined with chemotherapy and radiotherapy, have been used as conventional treatments in patients with CRC. However, clinical outcome of advanced stage disease remains relatively discouraging, due mainly to appearance of CRC chemoresistance, toxicity, and other detrimental side effects. New strategies to overcome these limitations are essential. During the last decades, melatonin (MLT) has been shown to be a potent antiproliferative, anti-metastatic agent with cytotoxic effects on different types of human malignancies, including CRC. Hence, this comprehensive review compiles the available experimental and clinical data analyzing the effects of MLT treatment in CRC patients and its underlying molecular mechanisms.
Collapse
Affiliation(s)
- Mindaugas Kvietkauskas
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Viktorija Zitkute
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Transplant Center Graz, Medical University of Graz, Auenbruggerplatz 29, Graz, 8036, Austria
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
26
|
Zitkute V, Kvietkauskas M, Leber B, Strupas K, Stiegler P, Schemmer P. Ischemia and reperfusion injury in uterus transplantation: A comprehensive review. Transplant Rev (Orlando) 2020; 34:100550. [PMID: 32498979 DOI: 10.1016/j.trre.2020.100550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 01/26/2023]
Abstract
Uterus transplantation (UTx) is the only available treatment for human beings who cannot carry children out to term. However, despite several clinical studies with a very limited number of UTx many issues have to be addressed. Up to date, there is a limited number of successful UTx with livebirth and the majority was achieved with live donors. Wide clinical application is inherently limited by the lack of organs, ischemia/reperfusion injury (IRI) as well as immunosuppression after UTx. The objective of this comprehensive literature review is to discuss these arising limitations of UTx with main focus on strategies to reduce IRI. This review showed, that usage of immunosuppressants, opioids or supplements, like amino acids, protects uterus from IRI, improving rising level of antioxidants and decreasing level of oxidative stress markers. The available data of experimental and clinical studies was compiled and will be discussed.
Collapse
Affiliation(s)
- Viktorija Zitkute
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Mindaugas Kvietkauskas
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria; Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | | | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
| |
Collapse
|
27
|
Kvietkauskas M, Leber B, Strupas K, Stiegler P, Schemmer P. Machine Perfusion of Extended Criteria Donor Organs: Immunological Aspects. Front Immunol 2020; 11:192. [PMID: 32180769 PMCID: PMC7057848 DOI: 10.3389/fimmu.2020.00192] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/24/2020] [Indexed: 12/20/2022] Open
Abstract
Due to higher vulnerability and immunogenicity of extended criteria donor (ECD) organs used for organ transplantation (Tx), the discovery of new treatment strategies, involving tissue allorecognition pathways, is important. The implementation of machine perfusion (MP) led to improved estimation of the organ quality and introduced the possibility to achieve graft reconditioning prior to Tx. A significant number of experimental and clinical trials demonstrated increasing support for MP as a promising method of ECD organ preservation compared to classical static cold storage. MP reduced ischemia-reperfusion injury resulting in the protection from inadequate activation of innate immunity. However, there are no general agreements on MP protocols, and clinical application is limited. The objective of this comprehensive review is to summarize literature on immunological effects of MP of ECD organs based on experimental studies and clinical trials.
Collapse
Affiliation(s)
- Mindaugas Kvietkauskas
- Department of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Bettina Leber
- Department of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | | | - Philipp Stiegler
- Department of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- Department of General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
28
|
Horvath A, Leber B, Feldbacher N, Steinwender M, Komarova I, Rainer F, Blesl A, Stadlbauer V. The effects of a multispecies synbiotic on microbiome-related side effects of long-term proton pump inhibitor use: A pilot study. Sci Rep 2020; 10:2723. [PMID: 32066847 PMCID: PMC7026433 DOI: 10.1038/s41598-020-59550-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/28/2019] [Accepted: 01/30/2020] [Indexed: 02/07/2023] Open
Abstract
Side effects of proton pump inhibitors (PPI) can be linked to the changes in the intestinal microbiome that occur during therapy, especially in long-term users. Therefore, the microbiome might also be a key player in the reduction of PPI side effects. We tested the effects of a three-month intervention with a multispecies synbiotic on intestinal inflammation, gut barrier function, microbiome composition, routine laboratory parameters and quality of life in patients with long-term PPI therapy. Thirty-six patients received a daily dose of a multispecies synbiotic for three months and were clinically observed without intervention for another three months. After intervention 17% of patients reached normal calprotectin levels; the overall reduction did not reach statistical significance (−18.8 ng/mg; 95%CI: −50.5; 12.9, p = 0.2). Elevated zonulin levels could be significantly reduced (−46.3 ng/mg; 95%CI: −71.4; −21.2; p < 0.001). The abundance of Stomatobaculum in the microbiome was reduced and Bacillus increased during the intervention. Furthermore, albumin, alkaline phosphatase and thrombocyte count were significantly increased and aspartate transaminase was significantly decreased during intervention. Gastrointestinal quality of life showed significant improvements. In conclusion, microbiome-related side effects of long-term PPI use can be substantially reduced by synbiotic intervention. Further studies are warranted to optimize dosage and duration of the intervention.
Collapse
Affiliation(s)
- Angela Horvath
- Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria. .,Center for Biomarker Research in Medicine (CBmed), Graz, Austria.
| | - Bettina Leber
- Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Nicole Feldbacher
- Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Markus Steinwender
- Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Irina Komarova
- Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Florian Rainer
- Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Andreas Blesl
- Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Vanessa Stadlbauer
- Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| |
Collapse
|
29
|
Starkman R, Alibhai S, Wells RA, Geddes M, Zhu N, Keating MM, Leber B, Chodirker L, Sabloff M, Christou G, Leitch HA, St-Hilaire E, Finn N, Shamy A, Yee K, Storring J, Nevill T, Delage R, Elemary M, Banerji V, Lenis M, Kirubananthaan A, Mamedov A, Zhang L, Rockwood K, Buckstein R. An MDS-specific frailty index based on cumulative deficits adds independent prognostic information to clinical prognostic scoring. Leukemia 2019; 34:1394-1406. [PMID: 31811236 DOI: 10.1038/s41375-019-0666-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/30/2019] [Accepted: 11/17/2019] [Indexed: 12/21/2022]
Abstract
The frailty index (FI) is based on the principle that the more deficits an individual has, the greater their risk of adverse outcomes. It is expressed as a ratio of the number of deficits present to the total number of deficits considered. We developed an MDS-specific FI using a prospective MDS registry and assessed its ability to add prognostic power to conventional prognostic scores in MDS. The 42 deficits included in this FI included measurements of physical performance, comorbidities, laboratory values, instrumental activities of daily living, quality of life and performance status. Of 644 patients, 440 were eligible for FI calculation. The median FI score was 0.25 (range 0.05-0.67), correlated with age and IPSS/IPSS-R risk scores and discriminated overall survival. With a follow-up of 20 months, survival was 27 months (95% CI 24-30.4). By multivariate analysis, age >70, FI, transfusion dependence, and IPSS were significant covariates associated with OS. The incremental discrimination improvement of the frailty index was 37%. We derived a prognostic score with five risk groups and distinct survivals ranging from 7.4 months to not yet reached. If externally validated, the MDS-FI could be used as a tool to refine the risk stratification of current clinical prognostication models.
Collapse
Affiliation(s)
- R Starkman
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S Alibhai
- Geriatric Medicine/Oncology, University Health Network, Toronto, ON, Canada
| | - R A Wells
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Geddes
- Hematology/Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - N Zhu
- Hematology/Oncology, University of Alberta Hospital, Edmonton, AB, Canada
| | - M M Keating
- Hematology/Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - B Leber
- Hematology/Oncology, Juravinski Cancer Center, Hamilton, ON, Canada
| | - L Chodirker
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Sabloff
- Hematology/Oncology, University of Ottawa, Ottawa, ON, Canada
| | - G Christou
- Hematology/Oncology, University of Ottawa, Ottawa, ON, Canada
| | - H A Leitch
- Hematology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - E St-Hilaire
- Hematology/Oncology, Dr. Georges-L-Dumont University Centre, Moncton, NB, Canada
| | - N Finn
- Hematology/Oncology, Dr. Georges-L-Dumont University Centre, Moncton, NB, Canada
| | - A Shamy
- Hematology/Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - K Yee
- Hematology/Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - J Storring
- Hematology/Oncology, McGill University Health Centre-Royal Victoria Hospital, Montreal, QC, Canada
| | - T Nevill
- Hematology/Oncology, Vancouver General Hospital, Vancouver, BC, Canada
| | - R Delage
- Hematology/Oncology, Centre de recherche du CHU de Quebec-Universite Laval, Quebec City, QC, Canada
| | - M Elemary
- Hematology, Saskatoon Cancer Centre, Saskatoon, SK, Canada
| | - V Banerji
- Hematology/Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - M Lenis
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Kirubananthaan
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - A Mamedov
- Hematology Clinical Trials, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Zhang
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - K Rockwood
- Geriatric Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - R Buckstein
- Hematology/Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| |
Collapse
|
30
|
Horvath A, Leber B, Feldbacher N, Tripolt N, Rainer F, Blesl A, Trieb M, Marsche G, Sourij H, Stadlbauer V. Effects of a multispecies synbiotic on glucose metabolism, lipid marker, gut microbiome composition, gut permeability, and quality of life in diabesity: a randomized, double-blind, placebo-controlled pilot study. Eur J Nutr 2019; 59:2969-2983. [PMID: 31729622 PMCID: PMC7501130 DOI: 10.1007/s00394-019-02135-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/04/2019] [Indexed: 01/08/2023]
Abstract
Purpose Diabesity, the combination of obesity and type 2 diabetes, is an ever-growing global health burden. Diabesity-associated dysbiosis of the intestinal microbiome has gained attention as a potential driver of disease and, therefore, a possible therapeutic target by means of pro- or prebiotic supplementation. This study tested the effects of a multispecies synbiotic (i.e. a combination of probiotics and prebiotics) on glucose metabolism, gut microbiota, gut permeability, neutrophil function and quality of life in treatment-experienced diabesity patients. Methods A randomized, double-blind, placebo-controlled pilot study with 26 diabesity patients was conducted in which patients received a daily dose of a multispecies probiotic and a prebiotic (or a placebo) for 6 months. Results There were no changes in glucose metabolism or mixed meal tolerance test responses throughout the study. The analysis of secondary outcomes revealed beneficial effects on hip circumference [− 1 (95% CI − 4; 3) vs +3 (− 1; 8) cm, synbiotics vs. placebo, respectively, p = 0.04], serum zonulin [− 0.04 (− 0.2; 0.1) vs +0.3 (− 0.05; 0.6) ng/ml, p = 0.004)] and the physical role item of the SF36 quality of life assessment [+ 5.4 (− 1.7; 12.5) vs − 5.0 (− 10.1; 0.2) points, p = 0.02] after 3 months of intervention, and lipoprotein (a) [− 2.1 (− 5.7; 1.6) vs +3.4 (− 0.9; 7.9) mg/dl, p = 0.02] after 6 months. There were no significant differences in alpha or beta diversity of the microbiome between groups or time points. Conclusions Glucose metabolism as the primary outcome was unchanged during the intervention with a multispecies synbiotic in patients with diabesity. Nevertheless, synbiotics improved some symptoms and biomarkers of type 2 diabetes and aspects of quality of life suggesting a potential role as adjuvant tool in the management of diabesity. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00394-019-02135-w) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Angela Horvath
- Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. .,Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010, Graz, Austria.
| | - Bettina Leber
- Division of Transplantation Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Nicole Feldbacher
- Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010, Graz, Austria
| | - Norbert Tripolt
- Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Florian Rainer
- Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Andreas Blesl
- Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Markus Trieb
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria
| | - Gunther Marsche
- Division of Pharmacology, Otto Loewi Research Center, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria
| | - Harald Sourij
- Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010, Graz, Austria.,Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Zayed Center for Health Sciences (ZCHS), UAE University, Al-Ain, UAE
| | - Vanessa Stadlbauer
- Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| |
Collapse
|
31
|
Horvath A, Rainer F, Bashir M, Leber B, Schmerboeck B, Klymiuk I, Groselj-Strele A, Durdevic M, Freedberg DE, Abrams JA, Fickert P, Stiegler P, Stadlbauer V. Biomarkers for oralization during long-term proton pump inhibitor therapy predict survival in cirrhosis. Sci Rep 2019; 9:12000. [PMID: 31427714 PMCID: PMC6700098 DOI: 10.1038/s41598-019-48352-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 02/06/2019] [Accepted: 07/31/2019] [Indexed: 02/07/2023] Open
Abstract
Proton pump inhibitors (PPI) are an invaluable therapy option for acid related diseases; however, PPI therapy is also linked to a series of side effects in cirrhosis, such as microbiome alterations, spontaneous bacterial peritonitis and hepatic encephalopathy. Decision tools to balance benefits and risks of PPI therapy are largely missing. In this study, we tested gut-derived biomarkers to identify PPI-associated dysbiosis, its association with gut barrier function and liver-related mortality. In this observational study, faecal microbiome composition data obtained from 16S rDNA sequencing of 90 cirrhotic patients with and without long-term PPI use and additional potential biomarkers identified from the literature were evaluated for their predictive value regarding PPI-associated dysbiosis and liver-related three-year mortality. In addition, faecal calprotectin, faecal zonulin and serum lipopolysaccharides were assessed as markers for intestinal inflammation, gut permeability and bacterial translocation. Streptococcus salivarius, Veillonella parvula and the genus Streptococcus were significantly increased in patients with long-term PPI therapy and performed well as biomarkers for PPI-associated dysbiosis (accuracy: 74%, 72% and 74%, respectively). The abundance of Streptococcus salivarius was linked to intestinal inflammation and gut barrier dysfunction, whereas the abundance of Veillonella parvula showed associations with liver disease severity; both were independent predictors for liver-related three-year mortality. Gut-derived biomarkers of PPI-associated dysbiosis are linked to worse outcome and a potential option to evaluate the risks of adverse events during long-term PPI therapy.
Collapse
Affiliation(s)
- Angela Horvath
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria. .,Center for Biomarker Research in Medicine (CBmed), Graz, Austria.
| | - Florian Rainer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Mina Bashir
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Bettina Leber
- Department of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Bianca Schmerboeck
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Ingeborg Klymiuk
- Center for Medical Research, Core Facility Molecular Biology, Medical University of Graz, Graz, Austria
| | - Andrea Groselj-Strele
- Center for Medical Research, Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
| | - Marija Durdevic
- Center for Medical Research, Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
| | - Daniel E Freedberg
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, USA
| | - Julian A Abrams
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, USA
| | - Peter Fickert
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Philipp Stiegler
- Department of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Vanessa Stadlbauer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| |
Collapse
|
32
|
Maneikyte J, Bausys A, Leber B, Horvath A, Feldbacher N, Hoefler G, Strupas K, Stiegler P, Schemmer P. Dietary glycine decreases both tumor volume and vascularization in a combined colorectal liver metastasis and chemotherapy model. Int J Biol Sci 2019; 15:1582-1590. [PMID: 31360101 PMCID: PMC6643216 DOI: 10.7150/ijbs.35513] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
Rationale: Chemotherapy (CTx) with FOLFOX is indicated prior to resection of liver metastases; however, its effect is limited due to chemoresistance and its toxicity prevents from aggressive surgery needed in some cases. Hepatoprotective glycine has been shown to have anti-tumorigenic properties in various cancers. Thus, this study was designed to evaluate the effects of glycine combined with FOLFOX on colorectal liver metastases (CRLM). Methods: The effect of glycine combined with 5-fluorouracil and oxaliplatin was investigated in vitro on colorectal cancer (CC531). Further, Wag/Rij rats with CRLM were treated with 5% dietary glycine ± FOLFOX. µCT liver scan, anti-Ki67, and anti-CD31 were compared. Results: Glycine alone and combined with CTx has no effect on both CC531 viability in vitro and tumor proliferation in vivo; however, glycine significantly decreased tumor volume to about 42-35% of controls in vivo (p<0.05) with a 60% decreased tumor microvascular density (MVD) (p=0.004). Further glycine doesn't counteract anti-tumor properties of CTx. Conclusions: This study nicely demonstrates that glycine inhibits the growth of CRLM and does not decrease CTx effectiveness. Underlying mechanisms most likely include a decreased tumor MVD. Clinical trials are warranted to implement non-toxic hepatoprotective glycine in novel anti-cancer strategies in humans.
Collapse
Affiliation(s)
- Juste Maneikyte
- General, Visceral and Transplant Surgery, Dept. of Surgery, Medical University of Graz, Austria.,Faculty of Medicine, Vilnius University, Lithuania
| | - Augustinas Bausys
- General, Visceral and Transplant Surgery, Dept. of Surgery, Medical University of Graz, Austria.,Faculty of Medicine, Vilnius University, Lithuania.,National Cancer Institute, Vilnius, Lithuania
| | - Bettina Leber
- General, Visceral and Transplant Surgery, Dept. of Surgery, Medical University of Graz, Austria
| | - Angela Horvath
- Gastroenterology and Hepatology, Dept. of Internal Medicine, Medical University of Graz, Austria
| | - Nicole Feldbacher
- General, Visceral and Transplant Surgery, Dept. of Surgery, Medical University of Graz, Austria
| | - Gerald Hoefler
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Austria
| | | | - Philipp Stiegler
- General, Visceral and Transplant Surgery, Dept. of Surgery, Medical University of Graz, Austria
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Dept. of Surgery, Medical University of Graz, Austria
| |
Collapse
|
33
|
Stadlbauer V, Horvath A, Komarova I, Schmerboeck B, Feldbacher N, Wurm S, Klymiuk I, Durdevic M, Rainer F, Blesl A, Stryeck S, Madl T, Stiegler P, Leber B. A single alcohol binge impacts on neutrophil function without changes in gut barrier function and gut microbiome composition in healthy volunteers. PLoS One 2019; 14:e0211703. [PMID: 30707717 PMCID: PMC6358085 DOI: 10.1371/journal.pone.0211703] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/15/2019] [Indexed: 12/31/2022] Open
Abstract
Alcohol binge drinking is a dangerous drinking habit, associated with neurological problems and inflammation. The impact of a single alcohol binge on innate immunity, gut barrier and gut microbiome was studied. In this cohort study 15 healthy volunteers received 2 ml vodka 40% v/v ethanol/kg body weight. Neutrophil function was studied by flow cytometry; markers of gut permeability and inflammation (lactulose/mannitol/sucrose test, zonulin, calprotectin, diamino-oxidase) were studied with NMR spectroscopy and enzyme-linked immunosorbent assay in urine, stool and serum respectively. Bacterial products in serum were quantified using different reporter cell lines. Gut microbiome composition was studied by 16S rDNA sequencing and bioinformatics analysis. After a single alcohol binge, neutrophils were transiently primed and the response to E.coli stimulation with reactive oxygen species (ROS) production was transiently increased, on the other hand the percentage of neutrophils that did not perform phagocytosis increased. No changes in gut permeability, inflammatory biomarker, bacterial translocation and microbiome composition could be detected up to 4 hours after a single alcohol binge or on the next day. A single alcohol binge in young, healthy volunteers transiently impacts on neutrophil function. Although the exact biological consequence of this finding is not clear yet, we believe that this strengthens the importance to avoid any alcohol binge drinking, even in young, otherwise healthy persons.
Collapse
Affiliation(s)
- Vanessa Stadlbauer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Angela Horvath
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Irina Komarova
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Bianca Schmerboeck
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Nicole Feldbacher
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Sonja Wurm
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Ingeborg Klymiuk
- Center for Medical Research, Core Facility Molecular Biology, Medical University of Graz, Graz, Austria
| | - Marija Durdevic
- Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
| | - Florian Rainer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Andreas Blesl
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Sarah Stryeck
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - Tobias Madl
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - Philipp Stiegler
- Department of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Bettina Leber
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
- Department of Transplantation Surgery, Medical University of Graz, Graz, Austria
| |
Collapse
|
34
|
Stadlbauer V, Horvath A, Komarova I, Schmerboeck B, Feldbacher N, Klymiuk I, Durdevic M, Rainer F, Blesl A, Stiegler P, Leber B. Dysbiosis in early sepsis can be modulated by a multispecies probiotic: a randomised controlled pilot trial. Benef Microbes 2019; 10:265-278. [PMID: 30694100 DOI: 10.3920/bm2018.0067] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The gut is hypothesised to play an important role in the development and progression of sepsis. It is however unknown whether the gut microbiome and the gut barrier function is already altered early in sepsis development and whether it is possible to modulate the microbiome in early sepsis. Therefore, a randomised, double blind, placebo-controlled pilot study to examine the alterations of the microbiome and the gut barrier in early sepsis and the influence of a concomitant probiotic intervention on dysbiosis at this early stage of the disease was conducted. Patients with early sepsis, defined as fulfilling the sepsis definition from the 2012 Surviving Sepsis Campaign guidelines but without signs of organ failure, received multispecies probiotic (Winclove 607 based on Omnibiotic® 10 AAD) for 28 days. Gut microbiome composition, function, gut barrier and bacterial translocation were studied. Patients with early sepsis had a significantly lower structural and functional alpha diversity, clustered differently and showed structural alterations on all taxonomic levels. Gut permeability was unaltered but endotoxin, endotoxin binding proteins and peptidoglycans were elevated in early sepsis patients compared to controls. Probiotic intervention successfully increased probiotic strains in stool and led to an improvement of functional diversity. Microbiome composition and function are altered in early sepsis. Probiotic intervention successfully modulates the microbiome and is therefore a promising tool for early intervention in sepsis.
Collapse
Affiliation(s)
- V Stadlbauer
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - A Horvath
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.,2 Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010 Graz, Austria
| | - I Komarova
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - B Schmerboeck
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.,2 Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010 Graz, Austria
| | - N Feldbacher
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - I Klymiuk
- 3 Center for Medical Research, Core Facility Molecular Biology, Medical University of Graz, Graz, Austria
| | - M Durdevic
- 4 Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
| | - F Rainer
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - A Blesl
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - P Stiegler
- 5 Department of Transplantation Surgery, Medical University Graz, Auenbruggerplatz 29/E, 8036 Graz, Austria
| | - B Leber
- 2 Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010 Graz, Austria.,5 Department of Transplantation Surgery, Medical University Graz, Auenbruggerplatz 29/E, 8036 Graz, Austria
| |
Collapse
|
35
|
Stiegler P, Bausys A, Leber B, Strupas K, Schemmer P. Impact of Melatonin in Solid Organ Transplantation-Is It Time for Clinical Trials? A Comprehensive Review. Int J Mol Sci 2018; 19:ijms19113509. [PMID: 30413018 PMCID: PMC6274782 DOI: 10.3390/ijms19113509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022] Open
Abstract
Solid organ transplantation is the "gold standard" for patients with end-stage organ disease. However, the supply of donor organs is critical, with an increased organ shortage over the last few years resulting in a significant mortality of patients on waiting lists. New strategies to overcome the shortage of organs are urgently needed. Some experimental studies focus on melatonin to improve the donor pool and to protect the graft; however, current research has not reached the clinical level. Therefore, this review provides a comprehensive overview of the data available, indicating that clinical evaluation is warranted.
Collapse
Affiliation(s)
- Philipp Stiegler
- Department General, Visceral and Transplant Surgery, Medical University of Graz, Graz 8036, Austria.
- Transplant Center Graz, Medical University of Graz, Graz 8036, Austria.
| | - Augustinas Bausys
- Department General, Visceral and Transplant Surgery, Medical University of Graz, Graz 8036, Austria.
- Transplant Center Graz, Medical University of Graz, Graz 8036, Austria.
- Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania.
- Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius 08660, Lithuania.
| | - Bettina Leber
- Transplant Center Graz, Medical University of Graz, Graz 8036, Austria.
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania.
| | - Peter Schemmer
- Department General, Visceral and Transplant Surgery, Medical University of Graz, Graz 8036, Austria.
- Transplant Center Graz, Medical University of Graz, Graz 8036, Austria.
| |
Collapse
|
36
|
Rainer F, Horvath A, Sandahl TD, Leber B, Schmerboeck B, Blesl A, Groselj-Strele A, Stauber RE, Fickert P, Stiegler P, Møller HJ, Grønbæk H, Stadlbauer V. Soluble CD163 and soluble mannose receptor predict survival and decompensation in patients with liver cirrhosis, and correlate with gut permeability and bacterial translocation. Aliment Pharmacol Ther 2018; 47:657-664. [PMID: 29266346 PMCID: PMC6333289 DOI: 10.1111/apt.14474] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/13/2017] [Accepted: 11/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Activated hepatic macrophages play a key role in inflammation and fibrosis progression in chronic liver disease. AIM To assess the prognostic value of soluble (s)CD163 and mannose receptor (sMR) in cirrhotic patients and explore associations with markers of intestinal permeability (lactulose-mannitol ratio, diamine oxidase), bacterial translocation (endotoxin, lipopolysaccharide-binding protein) and markers of systemic immune activation (interleukin-6, interleukin-8, sCD14). METHODS We prospectively investigated 101 cirrhotic patients (Child-Pugh class A: n = 72, Child-Pugh classes B and C: n = 29) and 31 healthy controls. Patients were observed for a median follow-up of 37 months. RESULTS Median plasma levels of sCD163 and soluble mannose receptor were significantly elevated in cirrhotic patients (P < .001) and increased with disease severity (sCD163 in healthy controls = 1.3, Child-Pugh class A = 4.2, Child-Pugh classes B and C = 8.4 mg/L; sMR in healthy controls = 15.8, Child-Pugh class A = 36.5, Child-Pugh classes B and C = 66.3 μg/dL). A total of 21 patients died during the observation period. Patients with sCD163 levels above 5.9 mg/L showed significantly reduced survival (survival rate after 36 months: 71% versus 98%, P < .001). Patients with soluble mannose receptor levels above 45.5 μg/dL developed significantly more complications of cirrhosis within 12 months (73% versus 9%, P < .001). Furthermore, both variables correlated with the lactulose-mannitol ratio, diamine oxidase, lipopolysaccharide and interleukin-8. CONCLUSION Our data demonstrate the prognostic value of sCD163 in predicting long-term survival in patients with liver cirrhosis and identify soluble mannose receptor as a prognostic marker for occurrence of cirrhosis-associated complications. The correlation between gut barrier dysfunction and activation of macrophages points towards a link between them.
Collapse
Affiliation(s)
- F. Rainer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - A. Horvath
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria,Department of Transplantation Surgery, Medical University of Graz, Austria,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - T. D. Sandahl
- Departments of Hepatology and Gastroenterology, and Clinical Biochemistry, Denmark
| | - B. Leber
- Department of Transplantation Surgery, Medical University of Graz, Austria,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - B. Schmerboeck
- Department of Transplantation Surgery, Medical University of Graz, Austria,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - A. Blesl
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - A. Groselj-Strele
- Core Facility Computational Bioanalytics, Medical University of Graz, Austria
| | - R. E. Stauber
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - P. Fickert
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - P. Stiegler
- Department of Transplantation Surgery, Medical University of Graz, Austria
| | - H. J. Møller
- Departments of Hepatology and Gastroenterology, and Clinical Biochemistry, Denmark
| | - H. Grønbæk
- Departments of Hepatology and Gastroenterology, and Clinical Biochemistry, Denmark
| | - V. Stadlbauer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria
| |
Collapse
|
37
|
Stadlbauer V, Horvath A, Ribitsch W, Schmerböck B, Schilcher G, Lemesch S, Stiegler P, Rosenkranz AR, Fickert P, Leber B. Structural and functional differences in gut microbiome composition in patients undergoing haemodialysis or peritoneal dialysis. Sci Rep 2017; 7:15601. [PMID: 29142271 PMCID: PMC5688134 DOI: 10.1038/s41598-017-15650-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/31/2017] [Indexed: 01/28/2023] Open
Abstract
Complications of end-stage renal disease (ESRD) are critically related to inflammation. The gut microbiome is a key driver of inflammation. Since dialysis modalities may differently influence the gut microbiome, we aimed to compare the effects of haemodialysis (HD) and peritoneal dialysis (PD) on patients' gut microbiome composition and function. We therefore studied faecal microbiome composition and function as well as inflammation and gut permeability in 30 patients with ESRD (15 HD, 15 PD) and compared to 21 healthy controls. We found an increase in potentially pathogenic species and a decrease in beneficial species in patients on HD and to a lesser extend in patients on PD when compared to controls. These changes in taxonomic composition also resulted in differences in predicted metagenome functions of the faecal microbiome. In HD but not in PD, changes in microbiome composition were associated with an increase in c-reactive protein (CRP) but not with intestinal inflammation or gut permeability. In conclusion microbiome composition in ESRD differs from healthy controls but also between modes of dialysis. These differences are associated with systemic inflammation and cannot completely be explained by dialysis vintage. The mode of renal replacement therapy seems to be an important driver of dysbiosis in ESRD.
Collapse
Affiliation(s)
- Vanessa Stadlbauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Angela Horvath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Werner Ribitsch
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Bianca Schmerböck
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Center of Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Gernot Schilcher
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sandra Lemesch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Stiegler
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Peter Fickert
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Bettina Leber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Transplantation Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Center of Biomarker Research in Medicine (CBmed), Graz, Austria
| |
Collapse
|
38
|
Stauber RE, Fauler G, Rainer F, Leber B, Posch A, Streit A, Spindelboeck W, Stadlbauer V, Kessler HH, Mangge H. Anti-HCV treatment with ombitasvir/paritaprevir/ritonavir ± dasabuvir is associated with increased bile acid levels and pruritus. Wien Klin Wochenschr 2017; 129:848-851. [DOI: 10.1007/s00508-017-1268-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/30/2017] [Indexed: 11/24/2022]
|
39
|
Hughes TP, Leber B, Cervantes F, Spector N, Pasquini R, Clementino NCD, Schwarer AP, Dorlhiac-Llacer PE, Mahon FX, Rea D, Guerci-Bresler A, Kamel-Reid S, Bendit I, Acharya S, Glynos T, Dalal D, Branford S, Lipton JH. Sustained deep molecular responses in patients switched to nilotinib due to persistent BCR-ABL1 on imatinib: final ENESTcmr randomized trial results. Leukemia 2017; 31:2529-2531. [PMID: 28862704 PMCID: PMC5668492 DOI: 10.1038/leu.2017.247] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- T P Hughes
- Division of Haematology, SA Pathology and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - B Leber
- Clinical Pathology, McMaster University, Hamilton, Ontario, Canada
| | - F Cervantes
- Department of Hematology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - N Spector
- Departamento de Clínica Médica/FM, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R Pasquini
- Division of Hematology and Medical Oncology, Federal University of Paraná, Curitiba, Brazil
| | | | - A P Schwarer
- Department of Hematology, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - F-X Mahon
- Laboratoire Hématopoïèse Leucémique et Cible Thérapeutique, Inserm U1035, Université Victor Ségalen, Bordeaux, France
| | - D Rea
- Unité de Thérapie Cellulaire et Clinique Transfusionnelle, Service des Maladies du Sang et EA3518, Hôpital Saint-Louis, Paris, France
| | - A Guerci-Bresler
- Department of Hematology, Brabois Hospital, Vandoeuvre-lès-Nancy, Vandoeuvre, France
| | - S Kamel-Reid
- Clinical Laboratory Genetics, Genome Diagnostics, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - I Bendit
- Hematology Unit, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - S Acharya
- Novartis Healthcare Pvt Ltd, Hyderabad, India
| | - T Glynos
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - D Dalal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - S Branford
- Leukaemia Unit, Centre for Cancer Biology, SA Pathology, University of South Australia and University of Adelaide, Adelaide, South Australia, Australia
| | - J H Lipton
- Blood and Marrow Transplant Service, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
40
|
Buckstein R, Balleari E, Wells R, Santini V, Salvetti C, Allione B, Danise P, Finelli C, Clavio M, Zhu N, Michelle G, Sabloff M, Leitch H, Leber B, Luca M, Latagliata R, Antonietta M, Villivà N, Piccioni A, Buccisano F. MDS-Can-It: A New Validated International ESA-Response Score that Further Refines the Predictive Power of the Nordic Scoring System. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Leitch H, Wells R, Chodirker L, Zhu N, Nevill T, Yee K, Leber B, Keating M, Sabloff M, Hilaire ES, Kumar R, Delage R, Geddes M, Storring J, Shamy A, Elemary M, Lenis M, Francis J, Zhang L, Buckstein R. Improved Survival from Transfusion Dependence in Lower-Risk MDS Receiving Iron Chelation, Adjusting for MDS and Patient Characteristics: An MDS-Can Analysis. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30396-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
42
|
Ulbing M, Kirsch AH, Leber B, Lemesch S, Münzker J, Schweighofer N, Hofer D, Trummer O, Rosenkranz AR, Müller H, Eller K, Stadlbauer V, Obermayer-Pietsch B. MicroRNAs 223-3p and 93-5p in patients with chronic kidney disease before and after renal transplantation. Bone 2017; 95:115-123. [PMID: 27866993 PMCID: PMC6326349 DOI: 10.1016/j.bone.2016.11.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/24/2016] [Accepted: 11/16/2016] [Indexed: 01/18/2023]
Abstract
Chronic kidney disease (CKD) is associated with a multifactorial dysregulation of bone and vascular calcification and closely linked to increased cardiovascular mortality and concomitant bone disease. We aimed to investigate specific microRNA (miRNA) signatures in CKD patients to find indicators for vascular calcification and/or bone mineralization changes during CKD and after kidney transplantation (KT). A miRNA array was used to investigate serum miRNA profiles in CKD patients, then selected miRNAs were quantified in a validation cohort comprising 73 patients in CKD stages 3 to 5, 67 CKD patients after KT, and 36 healthy controls. A spectrum of biochemical parameters including markers for kidney function, inflammation, glucose, and mineral metabolism was determined. The relative expression of miR-223-3p and miR-93-5p was down-regulated in patients with CKD stage 4 and 5 compared to healthy controls. This down-regulation disappeared after kidney transplantation even when lower glomerular filtration rates (eGFR) persisted. MiR-223-3p and miR-93-5p were associated with interleukin-6 (IL-6) and eGFR levels, and by trend with interleukin-8 (IL-8), C-peptide, hematocrit, and parathyroid hormone (PTH). This study contributes new knowledge of serum miRNA expression profiles in CKD, potentially reflecting pathophysiological changes of bone and calcification pathways associated with inflammation, vascular calcification, mineral and glucose metabolism. Identified miRNA signatures can contribute to future risk markers or future therapeutic targets in bone and kidney disease.
Collapse
Affiliation(s)
- M Ulbing
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria.
| | - A H Kirsch
- Dept. of Internal Medicine, Clinical Division of Nephrology, Medical University of Graz, Austria
| | - B Leber
- Dept. of Surgery, Clinical Division of Transplantation Surgery, Medical University of Graz, Austria
| | - S Lemesch
- Dept. of Internal Medicine, Clinical Division of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - J Münzker
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| | - N Schweighofer
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| | - D Hofer
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| | - O Trummer
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| | - A R Rosenkranz
- Dept. of Internal Medicine, Clinical Division of Nephrology, Medical University of Graz, Austria
| | - H Müller
- Dept. of Surgery, Clinical Division of Transplantation Surgery, Medical University of Graz, Austria
| | - K Eller
- Dept. of Internal Medicine, Clinical Division of Nephrology, Medical University of Graz, Austria
| | - V Stadlbauer
- Dept. of Internal Medicine, Clinical Division of Gastroenterology and Hepatology, Medical University of Graz, Austria.
| | - B Obermayer-Pietsch
- Dept. of Internal Medicine, Clinical Division of Endocrinology and Diabetology, Medical University of Graz, Austria
| |
Collapse
|
43
|
Lindheim L, Bashir M, Münzker J, Trummer C, Zachhuber V, Leber B, Horvath A, Pieber TR, Gorkiewicz G, Stadlbauer V, Obermayer-Pietsch B. Alterations in Gut Microbiome Composition and Barrier Function Are Associated with Reproductive and Metabolic Defects in Women with Polycystic Ovary Syndrome (PCOS): A Pilot Study. PLoS One 2017; 12:e0168390. [PMID: 28045919 PMCID: PMC5207627 DOI: 10.1371/journal.pone.0168390] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/29/2016] [Indexed: 12/22/2022] Open
Abstract
Background Polycystic ovary syndrome (PCOS) is a common female endocrinopathy of unclear origin characterized by hyperandrogenism, oligo-/anovulation, and ovarian cysts. Women with PCOS frequently display overweight, insulin resistance, and systemic low-grade inflammation. We hypothesized that endotoxemia resulting from a leaky gut is associated with inflammation, insulin resistance, fat accumulation, and hyperandrogenemia in PCOS. In this pilot study, we compared the stool microbiome, gut permeability, and inflammatory status of women with PCOS and healthy controls. Methods 16S rRNA gene amplicon sequencing was performed on stool samples from 24 PCOS patients and 19 healthy controls. Data processing and microbiome analysis were conducted in mothur and QIIME using different relative abundance cut-offs. Gut barrier integrity, endotoxemia, and inflammatory status were evaluated using serum and stool markers and associations with reproductive, metabolic, and anthropometric parameters were investigated. Results The stool microbiome of PCOS patients showed a lower diversity and an altered phylogenetic composition compared to controls. We did not observe significant differences in any taxa with a relative abundance>1%. When looking at rare taxa, the relative abundance of bacteria from the phylum Tenericutes, the order ML615J-28 (phylum Tenericutes) and the family S24-7 (phylum Bacteroidetes) was significantly lower and associated with reproductive parameters in PCOS patients. Patients showed alterations in some, but not all markers of gut barrier function and endotoxemia. Conclusion Patients with PCOS have a lower diversity and an altered phylogenetic profile in their stool microbiome, which is associated with clinical parameters. Gut barrier dysfunction and endotoxemia were not driving factors in this patient cohort, but may contribute to the clinical phenotype in certain PCOS patients.
Collapse
Affiliation(s)
- Lisa Lindheim
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- * E-mail:
| | - Mina Bashir
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
| | - Julia Münzker
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
| | - Verena Zachhuber
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
| | - Bettina Leber
- Department of Surgery, Division of Transplantation Surgery, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Angela Horvath
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University Graz, Graz, Austria
| | - Thomas R. Pieber
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Gregor Gorkiewicz
- Institute of Pathology, Medical University Graz, Graz, Austria
- BioTechMed, Interuniversity Cooperation, Graz, Austria
| | - Vanessa Stadlbauer
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University Graz, Graz, Austria
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| |
Collapse
|
44
|
Horvath A, Leber B, Schmerboeck B, Tawdrous M, Zettel G, Hartl A, Madl T, Stryeck S, Fuchs D, Lemesch S, Douschan P, Krones E, Spindelboeck W, Durchschein F, Rainer F, Zollner G, Stauber RE, Fickert P, Stiegler P, Stadlbauer V. Randomised clinical trial: the effects of a multispecies probiotic vs. placebo on innate immune function, bacterial translocation and gut permeability in patients with cirrhosis. Aliment Pharmacol Ther 2016; 44:926-935. [PMID: 27593544 PMCID: PMC5053220 DOI: 10.1111/apt.13788] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/12/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Probiotics may correct intestinal dysbiosis and proinflammatory conditions in patients with liver cirrhosis. AIM To test the effects of a multispecies probiotic on innate immune function, bacterial translocation and gut permeability. METHODS In a randomised, double blind, placebo-controlled study, stable cirrhotic out-patients either received a daily dose of a probiotic powder containing eight different bacterial strains (Ecologic Barrier, Winclove, Amsterdam, The Netherlands) (n = 44) or a placebo (n = 36) for 6 months and were followed up for another 6 months. RESULTS We found a significant but subclinical increase in neutrophil resting burst (2.6-3.2%, P = 0.0134) and neopterin levels (7.7-8.4 nmol/L, P = 0.001) with probiotics but not with placebo. Probiotic supplementation did not have a significant influence on neutrophil phagocytosis, endotoxin load, gut permeability or inflammatory markers. Ten severe infections occurred in total; one during intervention in the placebo group, and five and four after the intervention has ended in the probiotic and placebo group, respectively. Liver function showed some improvement with probiotics but not with placebo. CONCLUSIONS Probiotic supplementation significantly increased serum neopterin levels and the production of reactive oxygen species by neutrophils. These findings might explain the beneficial effects of probiotics on immune function. Furthermore, probiotic supplementation may be a well-tolerated method to maintain or even improve liver function in stable cirrhosis. However, its influence on gut barrier function and bacterial translocation in cirrhotic patients is minimal.
Collapse
Affiliation(s)
- A. Horvath
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - B. Leber
- Department of Transplantation SurgeryMedical University of GrazGrazAustria,Centre for Biomarker Research in Medicine (CBmed)GrazAustria
| | - B. Schmerboeck
- Department of Transplantation SurgeryMedical University of GrazGrazAustria
| | - M. Tawdrous
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - G. Zettel
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - A. Hartl
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - T. Madl
- Institute of Molecular Biology and BiochemistryMedical University of GrazGrazAustria
| | - S. Stryeck
- Institute of Molecular Biology and BiochemistryMedical University of GrazGrazAustria
| | - D. Fuchs
- Division of Biological ChemistryBiocentreMedical University of InnsbruckInnsbruckAustria
| | - S. Lemesch
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - P. Douschan
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - E. Krones
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - W. Spindelboeck
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - F. Durchschein
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - F. Rainer
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - G. Zollner
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - R. E. Stauber
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - P. Fickert
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - P. Stiegler
- Department of Transplantation SurgeryMedical University of GrazGrazAustria
| | - V. Stadlbauer
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| |
Collapse
|
45
|
Pasterk L, Lemesch S, Leber B, Trieb M, Curcic S, Stadlbauer V, Schuligoi R, Schicho R, Heinemann A, Marsche G. Abstract 337: Plasma Advanced-oxidized Protein Products Promote Platelet-endothelial Crosstalk and Endothelial Tissue Factor Expression. Arterioscler Thromb Vasc Biol 2016. [DOI: 10.1161/atvb.36.suppl_1.337] [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: 11/16/2022]
Abstract
Background/Aims:
End-stage renal disease (ESRD) is associated with a prothrombotic phenotype and substantial activation of platelets can occur in the course of hemodialysis. However, the underlying mechanisms for increased platelet reactivity remain unclear. Increased levels of oxidized albumin, termed “advanced oxidation protein products (AOPPs)” accumulate in subjects with renal disease.
Methods:
Platelet aggregation was assessed with platelet aggregometry. Platelet activation, formation of reactive oxygen species and tissue factor expression on the surface of platelets and endothelial cells was measured by flow cytometry. Platelet adherence was assessed under flow using the Cellix system. The oxidative status of albumin isolated from ESRD patients was determined by photometric analysis. Tissue factor levels in serum samples were determined using a commercially available ELISA kit.
Results:
Albumin isolated from hemodialysis patients as well as in vitro generated AOPP-albumin promoted platelet activation via CD36, dependent on the AOPP-content of albumin. AOPP-albumin mediated platelet activation was prevented by scavenging superoxide anions and inhibitors of phospholipase C and protein kinase C. Furthermore, AOPP and serum tissue factor levels were considerably increased in ESRD patients on hemodialysis and a significant correlation of AOPP and serum tissue factor was found.
Conclusion:
Interaction of platelet CD36 with endogenous oxidized albumin may link oxidative stress with a prothrombotic phenotype in ESRD.
Collapse
Affiliation(s)
- Lisa Pasterk
- Institute of Experimental and Clinical Pharmacology, Med Univ of Graz, Graz, Austria
| | - Sandra Lemesch
- Div of Gastroenterology and Hepatology, Dept of Internal Medicine, Med Univ of Graz, Graz, Austria
| | - Bettina Leber
- Div of Gastroenterology and Hepatology, Dept of Internal Medicine, Med Univ of Graz, Graz, Austria
| | - Markus Trieb
- Institute of Experimental and Clinical Pharmacology, Med Univ of Graz, Graz, Austria
| | - Sanja Curcic
- Institute of Experimental and Clinical Pharmacology, Med Univ of Graz, Graz, Austria
| | - Vanessa Stadlbauer
- Div of Gastroenterology and Hepatology, Dept of Internal Medicine, Med Univ of Graz, Graz, Austria
| | - Rufina Schuligoi
- Institute of Experimental and Clinical Pharmacology, Med Univ of Graz, Graz, Austria
| | - Rudolf Schicho
- Institute of Experimental and Clinical Pharmacology, Med Univ of Graz, Graz, Austria
| | - Akos Heinemann
- Institute of Experimental and Clinical Pharmacology, Med Univ of Graz, Graz, Austria
| | - Gunther Marsche
- Institute of Experimental and Clinical Pharmacology, Med Univ of Graz, Graz, Austria
| |
Collapse
|
46
|
Spindelboeck W, Horvath A, Tawdrous M, Schmerböck B, Zettel G, Posch A, Streit A, Jurse P, Lemesch S, Horn M, Wuensch G, Stiegler P, Stauber RE, Leber B, Stadlbauer V. Triple Therapy with First Generation Protease Inhibitors for Hepatitis C Markedly Impairs Function of Neutrophil Granulocytes. PLoS One 2016; 11:e0150299. [PMID: 26938078 PMCID: PMC4777445 DOI: 10.1371/journal.pone.0150299] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/11/2016] [Indexed: 01/01/2023] Open
Abstract
First-generation HCV protease inhibitors represent a milestone in antiviral therapy for chronic hepatitis C infection (CHC), but substantially increased rates of viral clearance are offset by increased rates of infection and infection-associated deaths, especially of patients with advanced liver disease. We aimed to assess whether first generation protease inhibitors interfere with neutrophil function. We included 108 consecutive, retrospective CHC patients and 44 consecutive, prospective CHC patients who were treated with peginterferon and ribavirin with or without protease inhibitors according to the guidelines in the period of November 2012 to June 2015. 33 healthy volunteers served as controls. Infection data were evaluated in all patients. Neutrophil phagocytosis, oxidative burst, elastase and diamine oxidase levels during 12 weeks of triple (n = 23) or dual therapy (n = 21) were studied in the prospective part. In the retro- and prospective cohorts patients experiencing clinically relevant infections were significantly more frequent during protease inhibitor therapy (31% and 26%) than during therapy with peginterferon and ribavirin (13% and 0%). Neutrophil phagocytosis decreased to 40% of baseline with addition of protease inhibitors to P/R but recovered 6 months after end of treatment. Protease inhibitors also seemed to reduce serum elastase levels but did not impact on gut permeability. Impaired neutrophil function during triple therapy with first generation HCV protease inhibitors may explain the high infection rate associated to these treatments and be of relevance for treatment success and patient survival.
Collapse
Affiliation(s)
- Walter Spindelboeck
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Angela Horvath
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Monika Tawdrous
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Bianca Schmerböck
- Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Gabriele Zettel
- Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Andreas Posch
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Andrea Streit
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Petra Jurse
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Sandra Lemesch
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Martin Horn
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Gerit Wuensch
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Philipp Stiegler
- Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Rudolf E. Stauber
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Bettina Leber
- Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Vanessa Stadlbauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| |
Collapse
|
47
|
Stadlbauer V, Leber B, Lemesch S, Trajanoski S, Bashir M, Horvath A, Tawdrous M, Stojakovic T, Fauler G, Fickert P, Högenauer C, Klymiuk I, Stiegler P, Lamprecht M, Pieber TR, Tripolt NJ, Sourij H. Lactobacillus casei Shirota Supplementation Does Not Restore Gut Microbiota Composition and Gut Barrier in Metabolic Syndrome: A Randomized Pilot Study. PLoS One 2015; 10:e0141399. [PMID: 26509793 PMCID: PMC4625062 DOI: 10.1371/journal.pone.0141399] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/05/2015] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Metabolic syndrome is associated with disturbances in gut microbiota composition. We aimed to investigate the effect of Lactobacillus casei Shirota (LcS) on gut microbiota composition, gut barrier integrity, intestinal inflammation and serum bile acid profile in metabolic syndrome. In a single-centre, prospective, randomised controlled pilot study, 28 subjects with metabolic syndrome received either LcS for 12 weeks (n = 13) or no LcS (n = 15). Data were compared to healthy controls (n = 16). Gut microbiota composition was characterised from stool using 454 pyrosequencing of 16S rRNA genes. Serum bile acids were quantified by tandem mass spectrometry. Zonulin and calprotectin were measured in serum and stool by ELISA. Bacteroidetes/Firmicutes ratio was significantly higher in healthy controls compared to metabolic syndrome but was not influenced by LcS. LcS supplementation led to enrichment of Parabacteroides. Zonulin and calprotectin were increased in metabolic syndrome stool samples but not influenced by LcS supplementation. Serum bile acids were similar to controls and not influenced by LcS supplementation. Metabolic syndrome is associated with a higher Bacteroidetes/Firmicutes ratio and gut barrier dysfunction but LcS was not able to change this. LcS administration was associated with subtle microbiota changes at genus level. TRIAL REGISTRATION ClinicalTrials.gov NCT01182844.
Collapse
Affiliation(s)
- Vanessa Stadlbauer
- Medical University of Graz, Division of Gastroenterology and Hepatology, Graz, Austria
| | - Bettina Leber
- Medical University of Graz, Division of Transplantation Surgery, Graz, Austria
| | - Sandra Lemesch
- Medical University of Graz, Division of Gastroenterology and Hepatology, Graz, Austria
| | | | - Mina Bashir
- Medical University of Graz, Division of Endocrinology and Metabolism, Graz, Austria
| | - Angela Horvath
- Medical University of Graz, Division of Gastroenterology and Hepatology, Graz, Austria
| | - Monika Tawdrous
- Medical University of Graz, Division of Gastroenterology and Hepatology, Graz, Austria
| | - Tatjana Stojakovic
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria
| | - Günter Fauler
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria
| | - Peter Fickert
- Medical University of Graz, Division of Gastroenterology and Hepatology, Graz, Austria
| | - Christoph Högenauer
- Medical University of Graz, Division of Gastroenterology and Hepatology, Graz, Austria
| | | | - Philipp Stiegler
- Medical University of Graz, Division of Transplantation Surgery, Graz, Austria
| | - Manfred Lamprecht
- Medical University of Graz, Institute of Physiological Chemistry, Centre for Physiological Medicine, Graz, Austria
| | - Thomas R. Pieber
- Medical University of Graz, Division of Endocrinology and Metabolism, Graz, Austria
- Centre for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Norbert J. Tripolt
- Medical University of Graz, Division of Endocrinology and Metabolism, Graz, Austria
| | - Harald Sourij
- Medical University of Graz, Division of Endocrinology and Metabolism, Graz, Austria
- Centre for Biomarker Research in Medicine (CBmed), Graz, Austria
| |
Collapse
|
48
|
Lamprecht M, Bogner S, Steinbauer K, Schuetz B, Greilberger JF, Leber B, Wagner B, Zinser E, Petek T, Wallner-Liebmann S, Oberwinkler T, Bachl N, Schippinger G. Effects of zeolite supplementation on parameters of intestinal barrier integrity, inflammation, redoxbiology and performance in aerobically trained subjects. J Int Soc Sports Nutr 2015; 12:40. [PMID: 26500463 PMCID: PMC4617723 DOI: 10.1186/s12970-015-0101-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 03/09/2015] [Accepted: 10/13/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Zeolites are crystalline compounds with microporous structures of Si-tetrahedrons. In the gut, these silicates could act as adsorbents, ion-exchangers, catalysts, detergents or anti-diarrheic agents. This study evaluated whether zeolite supplementation affects biomarkers of intestinal wall permeability and parameters of oxidation and inflammation in aerobically trained individuals, and whether it could improve their performance. METHODS In a randomized, double-blinded, placebo controlled trial, 52 endurance trained men and women, similar in body fat, non-smokers, 20-50 years, received 1.85 g of zeolite per day for 12 weeks. Stool samples for determination of intestinal wall integrity biomarkers were collected. From blood, markers of redox biology, inflammation, and DNA damage were determined at the beginning and the end of the study. In addition, VO2max and maximum performance were evaluated at baseline and after 12 weeks of treatment. For statistical analyses a 2-factor ANOVA was used. RESULTS At baseline both groups showed slightly increased stool zonulin concentrations above normal. After 12 weeks with zeolite zonulin was significantly (p < 0.05) decreased in the supplemented group. IL-10 increased tendentially (p < 0.1) in the zeolite group. There were no significant changes observed in the other measured parameters. CONCLUSIONS Twelve weeks of zeolite supplementation exerted beneficial effects on intestinal wall integrity as indicated via decreased concentrations of the tight junction modulator zonulin. This was accompanied by mild anti-inflammatory effects in this cohort of aerobically trained subjects. Further research is needed to explore mechanistic explanations for the observations in this study.
Collapse
Affiliation(s)
- Manfred Lamprecht
- />Institute of Physiological Chemistry, Medical University of Graz, Graz, Austria
- />Institute of Nutrient Research and Sport Nutrition, Graz, Austria
| | - Simon Bogner
- />Institute of Nutrient Research and Sport Nutrition, Graz, Austria
| | | | | | - Joachim F. Greilberger
- />Institute of Physiological Chemistry, Medical University of Graz, Graz, Austria
- />Institute of Laboratory Sciences, Dr Greilberger GmbH, Laßnitzhöhe, Austria
| | - Bettina Leber
- />Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | | | | | - Thomas Petek
- />Medical and Chemical Laboratory diagnostics Lorenz & Petek Ltd, Graz, Austria
| | | | - Tanja Oberwinkler
- />Panaceo International Active Mineral Production GmbH, Villach, Austria
| | - Norbert Bachl
- />Institute of Sport Science, University of Vienna, Vienna, Austria
| | | |
Collapse
|
49
|
Stadlbauer V, Lang-Olip I, Leber B, Mayrhauser U, Koestenbauer S, Tawdrous M, Moche M, Sereinigg M, Seider D, Iberer F, Wiederstein-Grasser I, Portugaller RH, Stiegler P. Immunohistochemical and radiological characterization of wound healing in porcine liver after radiofrequency ablation. Histol Histopathol 2015; 31:115-29. [PMID: 26358289 DOI: 10:14670/hh-11-667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a minimal invasive therapeutic option for patients with hepatocellular carcinoma or liver metastases. We investigated RFA-induced cellular changes in the liver of pigs. MATERIAL AND METHODS Healthy pigs (n=18) were sacrificed between day 0 and 3 months after RFA. The wound healing process was evaluated by computed tomography (CT), chromotrope anilinblue (CAB) staining of large-scale and standard tissue sections. Immunohistochemistry (IHC) for heat shock protein 70, Caspase-3, Ki67, Reelin, Vinculin, Vimentin and α-SMA was perfomed. RESULTS One day after RFA, CAB staining showed cell damage and massive hyperaemia. All IHC markers were predominantly expressed at the outer borders of the lesion, except Reelin, which was mainly detected in untreated liver regions. By staining for Hsp70, the heat stress during RFA was monitored, which was most distinct 1-2 days after RFA. CT revealed decreased lesion size after one week. Development of a Vimentin and α-SMA positive fibrotic capsule was observed. CONCLUSION In the early phase signs of cell damage, apoptosis and proliferation are dominant. Reduced expression of Reelin suggests a minor role of hepatic stellate cells in the RFA zone. After one week myofibroblasts become prominent and contribute to the development of the fibrotic capsule. This elucidates the pathophysiology of RFA and could contribute to the future optimization of RFA procedures.
Collapse
Affiliation(s)
- Vanessa Stadlbauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University Graz, Austria
| | - Ingrid Lang-Olip
- Institute of Cell Biology, Histology and Embryology, Medical University Graz, Austria
| | - Bettina Leber
- Department of Surgery, Division of Transplantation Surgery, Medical University Graz, Austria.
| | - Ursula Mayrhauser
- Department of Surgery, Division of Transplantation Surgery, Medical University Graz, Austria
| | - Sonja Koestenbauer
- Department of Surgery, Division of Transplantation Surgery, Medical University Graz, Austria
| | - Monika Tawdrous
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University Graz, Austria
| | - Michael Moche
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Germany
| | - Michael Sereinigg
- Department of Surgery, Division of Transplantation Surgery, Medical University Graz, Austria
| | - Daniel Seider
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Germany
| | - Florian Iberer
- Department of Surgery, Division of Transplantation Surgery, Medical University Graz, Austria
| | - Iris Wiederstein-Grasser
- Division of Biomedical Research and Section for Surgical Research, Medical University Graz, Austria
| | | | - Philipp Stiegler
- Department of Surgery, Division of Transplantation Surgery, Medical University Graz, Austria
| |
Collapse
|
50
|
Tripolt NJ, Leber B, Triebl A, Köfeler H, Stadlbauer V, Sourij H. Effect of Lactobacillus casei Shirota supplementation on trimethylamine-N-oxide levels in patients with metabolic syndrome: An open-label, randomized study. Atherosclerosis 2015; 242:141-4. [PMID: 26188537 DOI: 10.1016/j.atherosclerosis.2015.05.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [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: 12/02/2014] [Revised: 04/14/2015] [Accepted: 05/13/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies in animal models have shown a link between ingestion of dietary phosphatidylcholine (PC), choline, l-carnitine and cardiovascular risk. Intestinal microbiota-dependent metabolism of PC and l-carnitine is involved in formation of trimethylamine (TMA), which is further metabolized to the proatherogenic compound trimethylamine-N-oxide (TMAO). It has been suggested that changes in gut microbiota by supplementation of probiotic drinks might alter TMAO levels. Hence, the aim of this analysis was to investigate the impact of Lactobacillus casei Shirota (LcS) on formation of TMAO in subjects with metabolic syndrome. METHODS In a single-center, prospective, randomized-controlled study 30 subjects with metabolic syndrome were randomized to receive either 3 times daily 6.5 × 10(9) CFU (colony-forming units) LcS (probiotic group) or not (standard therapy group) for 12 weeks. TMAO plasma levels were quantified by means of liquid chromatography and tandem mass spectrometry. RESULTS Thirteen patients in the probiotic group and 15 in the standard therapy group finished the study. Mean age was 52 ± 11 and 55 ± 9 years, respectively. TMAO levels decreased during the intervention period in both groups (from 4.66 ± 2.66 μM to 4.31 ± 2.04 μM in the probiotic group and from 4.64 ± 2.75 μM to 4.40 ± 2.14 μM in the control group). Changes in TMAO between subjects receiving LcS (-0.25 ± 2.39 μM) and controls (-0.34 ± 2.23 μM) were not significantly different (p = 0.510). CONCLUSION In conclusion, intake of LcS for 12 weeks did not affect levels of TMAO in patients with metabolic syndrome.
Collapse
Affiliation(s)
- Norbert J Tripolt
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Metabolism, Cardiovascular Diabetology Research Group, Graz, Austria.
| | - Bettina Leber
- Medical University of Graz, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Graz, Austria.
| | - Alexander Triebl
- Medical University of Graz, Center for Medical Research, Core Facility for Mass Spectrometry, Graz, Austria.
| | - Harald Köfeler
- Medical University of Graz, Center for Medical Research, Core Facility for Mass Spectrometry, Graz, Austria.
| | - Vanessa Stadlbauer
- Medical University of Graz, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Graz, Austria.
| | - Harald Sourij
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Metabolism, Cardiovascular Diabetology Research Group, Graz, Austria; Centre for Biomarker Research in Medicine (CBmed), Graz, Austria.
| |
Collapse
|