1
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Häder A, Schäuble S, Gehlen J, Thielemann N, Buerfent BC, Schüller V, Hess T, Wolf T, Schröder J, Weber M, Hünniger K, Löffler J, Vylkova S, Panagiotou G, Schumacher J, Kurzai O. Pathogen-specific innate immune response patterns are distinctly affected by genetic diversity. Nat Commun 2023; 14:3239. [PMID: 37277347 DOI: 10.1038/s41467-023-38994-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/25/2023] [Indexed: 06/07/2023] Open
Abstract
Innate immune responses vary by pathogen and host genetics. We analyze quantitative trait loci (eQTLs) and transcriptomes of monocytes from 215 individuals stimulated by fungal, Gram-negative or Gram-positive bacterial pathogens. We identify conserved monocyte responses to bacterial pathogens and a distinct antifungal response. These include 745 response eQTLs (reQTLs) and corresponding genes with pathogen-specific effects, which we find first in samples of male donors and subsequently confirm for selected reQTLs in females. reQTLs affect predominantly upregulated genes that regulate immune response via e.g., NOD-like, C-type lectin, Toll-like and complement receptor-signaling pathways. Hence, reQTLs provide a functional explanation for individual differences in innate response patterns. Our identified reQTLs are also associated with cancer, autoimmunity, inflammatory and infectious diseases as shown by external genome-wide association studies. Thus, reQTLs help to explain interindividual variation in immune response to infection and provide candidate genes for variants associated with a range of diseases.
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Affiliation(s)
- Antje Häder
- Research Group Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, 07745, Jena, Germany
| | - Sascha Schäuble
- Department of Microbiome Dynamics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, 07745, Jena, Germany
| | - Jan Gehlen
- Institute of Human Genetics, Philipps University of Marburg, 35033, Marburg, Germany
| | - Nadja Thielemann
- Institute for Hygiene and Microbiology, Julius Maximilians University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Benedikt C Buerfent
- Institute of Human Genetics, Philipps University of Marburg, 35033, Marburg, Germany
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, 53127, Bonn, Germany
| | - Vitalia Schüller
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, 53127, Bonn, Germany
| | - Timo Hess
- Institute of Human Genetics, Philipps University of Marburg, 35033, Marburg, Germany
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, 53127, Bonn, Germany
| | - Thomas Wolf
- Systems Biology and Bioinformatics Unit, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, 07745, Jena, Germany
| | - Julia Schröder
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, 53127, Bonn, Germany
| | - Michael Weber
- Research Group Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, 07745, Jena, Germany
- Systems Biology and Bioinformatics Unit, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, 07745, Jena, Germany
- Institute of Molecular Pathogenesis, Friedrich-Loeffler-Institute, 07743, Jena, Germany
| | - Kerstin Hünniger
- Research Group Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, 07745, Jena, Germany
- Institute for Hygiene and Microbiology, Julius Maximilians University of Wuerzburg, 97080, Wuerzburg, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital Wuerzburg, Josef-Schneider-Strasse 2 /C11, 97080, Wuerzburg, Germany
| | - Slavena Vylkova
- Research Group Host Fungal Interfaces, Septomics Research Center and Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, 07745, Jena, Germany
| | - Gianni Panagiotou
- Department of Microbiome Dynamics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, 07745, Jena, Germany
- Faculty of Biological Sciences, Friedrich Schiller University, 07743, Jena, Germany
- Department of Medicine and State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong SAR, China
| | - Johannes Schumacher
- Institute of Human Genetics, Philipps University of Marburg, 35033, Marburg, Germany.
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, 53127, Bonn, Germany.
| | - Oliver Kurzai
- Research Group Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, 07745, Jena, Germany.
- Institute for Hygiene and Microbiology, Julius Maximilians University of Wuerzburg, 97080, Wuerzburg, Germany.
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2
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Seif M, Kakoschke TK, Ebel F, Bellet MM, Trinks N, Renga G, Pariano M, Romani L, Tappe B, Espie D, Donnadieu E, Hünniger K, Häder A, Sauer M, Damotte D, Alifano M, White PL, Backx M, Nerreter T, Machwirth M, Kurzai O, Prommersberger S, Einsele H, Hudecek M, Löffler J. CAR T cells targeting Aspergillus fumigatus are effective at treating invasive pulmonary aspergillosis in preclinical models. Sci Transl Med 2022; 14:eabh1209. [PMID: 36170447 DOI: 10.1126/scitranslmed.abh1209] [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: 11/02/2022]
Abstract
Aspergillus fumigatus is a ubiquitous mold that can cause severe infections in immunocompromised patients, typically manifesting as invasive pulmonary aspergillosis (IPA). Adaptive and innate immune cells that respond to A. fumigatus are present in the endogenous repertoire of patients with IPA but are infrequent and cannot be consistently isolated and expanded for adoptive immunotherapy. Therefore, we gene-engineered A. fumigatus-specific chimeric antigen receptor (Af-CAR) T cells and demonstrate their ability to confer antifungal reactivity in preclinical models in vitro and in vivo. We generated a CAR targeting domain AB90-E8 that recognizes a conserved protein antigen in the cell wall of A. fumigatus hyphae. T cells expressing the Af-CAR recognized A. fumigatus strains and clinical isolates and exerted a direct antifungal effect against A. fumigatus hyphae. In particular, CD8+ Af-CAR T cells released perforin and granzyme B and damaged A. fumigatus hyphae. CD8+ and CD4+ Af-CAR T cells produced cytokines that activated macrophages to potentiate the antifungal effect. In an in vivo model of IPA in immunodeficient mice, CD8+ Af-CAR T cells localized to the site of infection, engaged innate immune cells, and reduced fungal burden in the lung. Adoptive transfer of CD8+ Af-CAR T cells conferred greater antifungal efficacy compared to CD4+ Af-CAR T cells and an improvement in overall survival. Together, our study illustrates the potential of gene-engineered T cells to treat aggressive infectious diseases that are difficult to control with conventional antimicrobial therapy and support the clinical development of Af-CAR T cell therapy to treat IPA.
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Affiliation(s)
- Michelle Seif
- Medizinische Klinik und Poliklinik II und Lehrstuhl für Zelluläre Immuntherapie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, 97080 Würzburg, Germany
| | - Tamara Katharina Kakoschke
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum der Universität München, LMU, 80337 München, Germany.,Institut für Infektionsmedizin und Zoonosen, Medizinische Fakultät, LMU, 80539 München, Germany
| | - Frank Ebel
- Institut für Infektionsmedizin und Zoonosen, Medizinische Fakultät, LMU, 80539 München, Germany
| | - Marina Maria Bellet
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, 06132 Perugia, Italy
| | - Nora Trinks
- Lehrstuhl für Biotechnologie und Biophysik, Biozentrum und RVZ - Center for Integrative and Translational Bioimaging, Julius-Maximilians-Universität Würzburg, 97074 Würzburg, Germany
| | - Giorgia Renga
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, 06132 Perugia, Italy
| | - Marilena Pariano
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, 06132 Perugia, Italy
| | - Luigina Romani
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, 06132 Perugia, Italy
| | - Beeke Tappe
- Medizinische Klinik und Poliklinik II und Lehrstuhl für Zelluläre Immuntherapie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, 97080 Würzburg, Germany
| | - David Espie
- Université de Paris, Institut Cochin, INSERM, CNRS, 75014 Paris, France.,CAR-T Cells Department, Invectys, 75013 Paris, France
| | - Emmanuel Donnadieu
- Université de Paris, Institut Cochin, INSERM, CNRS, 75014 Paris, France.,Equipe labellisée Ligue Contre le Cancer, 75014 Paris, France
| | - Kerstin Hünniger
- Institut für Hygiene und Mikrobiologie, Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany.,Fungal Septomics Research Group, Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie - Hans-Knöll-Institut (HKI), 07743 Jena, Germany
| | - Antje Häder
- Fungal Septomics Research Group, Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie - Hans-Knöll-Institut (HKI), 07743 Jena, Germany
| | - Markus Sauer
- Lehrstuhl für Biotechnologie und Biophysik, Biozentrum und RVZ - Center for Integrative and Translational Bioimaging, Julius-Maximilians-Universität Würzburg, 97074 Würzburg, Germany
| | - Diane Damotte
- Department of Pathology, Paris Centre University Hospitals, AP-HP, 75014 Paris, France.,INSERM U1138, Cordeliers Research Center, Team Cancer, Immune Control and Escape, Paris, France; University Pierre and Marie Curie, 75006 Paris, France
| | - Marco Alifano
- Department of Thoracic Surgery, Paris Centre University Hospitals, AP-HP, Paris, France; University Paris Descartes, 75014 Paris, France
| | - P Lewis White
- Public Health Wales, Microbiology Cardiff, UHW, CF14 4XW Cardiff, UK
| | - Matthijs Backx
- Public Health Wales, Microbiology Cardiff, UHW, CF14 4XW Cardiff, UK
| | - Thomas Nerreter
- Medizinische Klinik und Poliklinik II und Lehrstuhl für Zelluläre Immuntherapie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, 97080 Würzburg, Germany
| | - Markus Machwirth
- Medizinische Klinik und Poliklinik II und Lehrstuhl für Zelluläre Immuntherapie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, 97080 Würzburg, Germany
| | - Oliver Kurzai
- Institut für Hygiene und Mikrobiologie, Julius-Maximilians-Universität Würzburg, 97080 Würzburg, Germany.,Fungal Septomics Research Group, Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie - Hans-Knöll-Institut (HKI), 07743 Jena, Germany
| | - Sabrina Prommersberger
- Medizinische Klinik und Poliklinik II und Lehrstuhl für Zelluläre Immuntherapie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, 97080 Würzburg, Germany
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II und Lehrstuhl für Zelluläre Immuntherapie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, 97080 Würzburg, Germany
| | - Michael Hudecek
- Medizinische Klinik und Poliklinik II und Lehrstuhl für Zelluläre Immuntherapie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, 97080 Würzburg, Germany
| | - Jürgen Löffler
- Medizinische Klinik und Poliklinik II und Lehrstuhl für Zelluläre Immuntherapie, Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, 97080 Würzburg, Germany
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3
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Tappe B, Lauruschkat CD, Strobel L, Pantaleón García J, Kurzai O, Rebhan S, Kraus S, Pfeuffer-Jovic E, Bussemer L, Possler L, Held M, Hünniger K, Kniemeyer O, Schäuble S, Brakhage AA, Panagiotou G, White PL, Einsele H, Löffler J, Wurster S. COVID-19 patients share common, corticosteroid-independent features of impaired host immunity to pathogenic molds. Front Immunol 2022; 13:954985. [PMID: 36052094 PMCID: PMC9427195 DOI: 10.3389/fimmu.2022.954985] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 05/27/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022] Open
Abstract
Patients suffering from coronavirus disease-2019 (COVID-19) are susceptible to deadly secondary fungal infections such as COVID-19-associated pulmonary aspergillosis and COVID-19-associated mucormycosis. Despite this clinical observation, direct experimental evidence for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)-driven alterations of antifungal immunity is scarce. Using an ex-vivo whole blood stimulation assay, we challenged blood from twelve COVID-19 patients with Aspergillus fumigatus and Rhizopus arrhizus antigens and studied the expression of activation, maturation, and exhaustion markers, as well as cytokine secretion. Compared to healthy controls, T-helper cells from COVID-19 patients displayed increased expression levels of the exhaustion marker PD-1 and weakened A. fumigatus- and R. arrhizus-induced activation. While baseline secretion of proinflammatory cytokines was massively elevated, whole blood from COVID-19 patients elicited diminished release of T-cellular (e.g., IFN-γ, IL-2) and innate immune cell-derived (e.g., CXCL9, CXCL10) cytokines in response to A. fumigatus and R. arrhizus antigens. Additionally, samples from COVID-19 patients showed deficient granulocyte activation by mold antigens and reduced fungal killing capacity of neutrophils. These features of weakened anti-mold immune responses were largely decoupled from COVID-19 severity, the time elapsed since diagnosis of COVID-19, and recent corticosteroid uptake, suggesting that impaired anti-mold defense is a common denominator of the underlying SARS-CoV-2 infection. Taken together, these results expand our understanding of the immune predisposition to post-viral mold infections and could inform future studies of immunotherapeutic strategies to prevent and treat fungal superinfections in COVID-19 patients.
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Affiliation(s)
- Beeke Tappe
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Chris D. Lauruschkat
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Lea Strobel
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Jezreel Pantaleón García
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Oliver Kurzai
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
| | - Silke Rebhan
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Sabrina Kraus
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Elena Pfeuffer-Jovic
- Department of Pulmonary Medicine, Missionsärztliche Klinik Würzburg, Würzburg, Germany
| | - Lydia Bussemer
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Lotte Possler
- Department of Internal Medicine, Main-Klinik Ochsenfurt, Würzburg, Germany
| | - Matthias Held
- Department of Pulmonary Medicine, Missionsärztliche Klinik Würzburg, Würzburg, Germany
| | - Kerstin Hünniger
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
| | - Olaf Kniemeyer
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
| | - Sascha Schäuble
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
| | - Axel A. Brakhage
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
- Department of Microbiology and Molecular Biology, Institute of Microbiology, Friedrich Schiller University, Jena, Germany
| | - Gianni Panagiotou
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology–Hans -Knöll- Institute, Jena, Germany
| | - P. Lewis White
- Public Health Wales, Microbiology Cardiff, Wales, United Kingdom
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
- *Correspondence: Jürgen Löffler, ; Sebastian Wurster,
| | - Sebastian Wurster
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
- *Correspondence: Jürgen Löffler, ; Sebastian Wurster,
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Henß I, Kleinemeier C, Strobel L, Brock M, Löffler J, Ebel F. Characterization of Aspergillus terreus Accessory Conidia and Their Interactions With Murine Macrophages. Front Microbiol 2022; 13:896145. [PMID: 35783442 PMCID: PMC9245049 DOI: 10.3389/fmicb.2022.896145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
All Aspergillus species form phialidic conidia (PC) when the mycelium is in contact with the air. These small, asexual spores are ideally suited for an airborne dissemination in the environment. Aspergillus terreus and a few closely related species from section Terrei can additionally generate accessory conidia (AC) that directly emerge from the hyphal surface. In this study, we have identified galactomannan as a major surface antigen on AC that is largely absent from the surface of PC. Galactomannan is homogeneously distributed over the entire surface of AC and even detectable on nascent AC present on the hyphal surface. In contrast, β-glucans are only accessible in distinct structures that occur after separation of the conidia from the hyphal surface. During germination, AC show a very limited isotropic growth that has no detectable impact on the distribution of galactomannan. The AC of the strain used in this study germinate much faster than the corresponding PC, and they are more sensitive to desiccation than PC. During infection of murine J774 macrophages, AC are readily engulfed and trigger a strong tumor necrosis factor-alpha (TNFα) response. Both processes are not hampered by the presence of laminarin, which indicates that β-glucans only play a minor role in these interactions. In the phagosome, we observed that galactomannan, but not β-glucan, is released from the conidial surface and translocates to the host cell cytoplasm. AC persist in phagolysosomes, and many of them initiate germination within 24 h. In conclusion, we have identified galactomannan as a novel and major antigen on AC that clearly distinguishes them from PC. The role of this fungal-specific carbohydrate in the interactions with the immune system remains an open issue that needs to be addressed in future research.
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Affiliation(s)
- Isabell Henß
- Institute for Infectious Diseases and Zoonoses, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christoph Kleinemeier
- Institute for Infectious Diseases and Zoonoses, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lea Strobel
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Matthias Brock
- Fungal Genetics and Biology, School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Frank Ebel
- Institute for Infectious Diseases and Zoonoses, Ludwig-Maximilians-University Munich, Munich, Germany
- *Correspondence: Frank Ebel
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Hannemann M, Wilmes D, Dombrowski F, Löffler J, Kaminski A, Hummel A, Ulm L, Bohnert J, Rickerts V, Springer J, Lode HN, Ehlert K. Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report. Front Pediatr 2022; 10:1060663. [PMID: 36533236 PMCID: PMC9755516 DOI: 10.3389/fped.2022.1060663] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Invasive mold infections are a well-known and life-threatening condition after allogeneic hematopoietic stem cell transplantation (HSCT). While Aspergillus species are recognized as predominant pathogens, Fusarium species should also be considered due to their broad environmental distribution and the expected poor outcome of invasive fusariosis. Particularly, splenic rupture as a complication of disseminated disease has not been reported yet. CASE PRESENTATION Two weeks after allogeneic HSCT for severe aplastic anemia, a 16-year-old boy presented with painful, erythematous skin nodules affecting the entire integument. As disseminated mycosis was considered, treatment with liposomal amphotericin B and voriconazole (VCZ) was initiated. Invasive fusariosis was diagnosed after histological and previously unpublished polymerase chain reaction-based examination of skin biopsies. Microbiological tests revealed Fusarium solani species. Despite stable neutrophil engraftment and uninterrupted treatment with VCZ, he developed mold disease-associated splenic rupture with hypovolemic shock and fungal endocarditis. The latter induced a cardiac thrombus and subsequent embolic cerebral infarctions with unilateral hemiparesis. Following cardiac surgery, the patient did not regain consciousness because of diffuse cerebral ischemia, and he died on day +92 after HSCT. CONCLUSION Invasive fusariosis in immunocompromised patients is a life-threatening condition. Despite antimycotic treatment adapted to antifungal susceptibility testing, the patient reported here developed uncommon manifestations such as splenic rupture and fungal endocarditis.
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Affiliation(s)
- Maurice Hannemann
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Dunja Wilmes
- Division for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
| | - Frank Dombrowski
- Institute of Pathology, University Medicine Greifswald, Greifswald, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Alexander Kaminski
- Department for Heart and Vascular Surgery, Klinikum Karlsburg, Karlsburg, Germany
| | - Astrid Hummel
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Lena Ulm
- Institute of Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Jürgen Bohnert
- Institute of Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Volker Rickerts
- Division for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
| | - Jan Springer
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Holger N Lode
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
| | - Karoline Ehlert
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany
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6
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Trinks N, Reinhard S, Drobny M, Heilig L, Löffler J, Sauer M, Terpitz U. Subdiffraction-resolution fluorescence imaging of immunological synapse formation between NK cells and A. fumigatus by expansion microscopy. Commun Biol 2021; 4:1151. [PMID: 34608260 PMCID: PMC8490467 DOI: 10.1038/s42003-021-02669-y] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Expansion microscopy (ExM) enables super-resolution fluorescence imaging on standard microscopes by physical expansion of the sample. However, the investigation of interactions between different organisms such as mammalian and fungal cells by ExM remains challenging because different cell types require different expansion protocols to ensure identical, ideally isotropic expansion of both partners. Here, we introduce an ExM method that enables super-resolved visualization of the interaction between NK cells and Aspergillus fumigatus hyphae. 4-fold expansion in combination with confocal fluorescence imaging allows us to resolve details of cytoskeleton rearrangement as well as NK cells' lytic granules triggered by contact with an RFP-expressing A. fumigatus strain. In particular, subdiffraction-resolution images show polarized degranulation upon contact formation and the presence of LAMP1 surrounding perforin at the NK cell-surface post degranulation. Our data demonstrate that optimized ExM protocols enable the investigation of immunological synapse formation between two different species with so far unmatched spatial resolution.
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Affiliation(s)
- Nora Trinks
- Department of Biotechnology and Biophysics, Theodor-Boveri-Institute, Biocenter, Julius Maximilian University, Würzburg, Germany
| | - Sebastian Reinhard
- Department of Biotechnology and Biophysics, Theodor-Boveri-Institute, Biocenter, Julius Maximilian University, Würzburg, Germany
| | - Matthias Drobny
- Department of Internal Medicine II, WÜ4i, University Hospital Würzburg, Würzburg, Germany
| | - Linda Heilig
- Department of Internal Medicine II, WÜ4i, University Hospital Würzburg, Würzburg, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, WÜ4i, University Hospital Würzburg, Würzburg, Germany
| | - Markus Sauer
- Department of Biotechnology and Biophysics, Theodor-Boveri-Institute, Biocenter, Julius Maximilian University, Würzburg, Germany
| | - Ulrich Terpitz
- Department of Biotechnology and Biophysics, Theodor-Boveri-Institute, Biocenter, Julius Maximilian University, Würzburg, Germany.
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Docherty M, Regnier SA, Capkun G, Balp MM, Ye Q, Janssens N, Tietz A, Löffler J, Cai J, Pedrosa MC, Schattenberg JM. Development of a novel machine learning model to predict presence of nonalcoholic steatohepatitis. J Am Med Inform Assoc 2021; 28:1235-1241. [PMID: 33684933 PMCID: PMC8200272 DOI: 10.1093/jamia/ocab003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 08/12/2020] [Accepted: 01/14/2021] [Indexed: 12/20/2022] Open
Abstract
Objective To develop a computer model to predict patients with nonalcoholic steatohepatitis (NASH) using machine learning (ML). Materials and Methods This retrospective study utilized two databases: a) the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) nonalcoholic fatty liver disease (NAFLD) adult database (2004-2009), and b) the Optum® de-identified Electronic Health Record dataset (2007-2018), a real-world dataset representative of common electronic health records in the United States. We developed an ML model to predict NASH, using confirmed NASH and non-NASH based on liver histology results in the NIDDK dataset to train the model. Results Models were trained and tested on NIDDK NAFLD data (704 patients) and the best-performing models evaluated on Optum data (~3,000,000 patients). An eXtreme Gradient Boosting model (XGBoost) consisting of 14 features exhibited high performance as measured by area under the curve (0.82), sensitivity (81%), and precision (81%) in predicting NASH. Slightly reduced performance was observed with an abbreviated feature set of 5 variables (0.79, 80%, 80%, respectively). The full model demonstrated good performance (AUC 0.76) to predict NASH in Optum data. Discussion The proposed model, named NASHmap, is the first ML model developed with confirmed NASH and non-NASH cases as determined through liver biopsy and validated on a large, real-world patient dataset. Both the 14 and 5-feature versions exhibit high performance. Conclusion The NASHmap model is a convenient and high performing tool that could be used to identify patients likely to have NASH in clinical settings, allowing better patient management and optimal allocation of clinical resources.
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Affiliation(s)
| | | | | | | | - Qin Ye
- ZS, Princeton, New Jersey, USA
| | | | | | | | | | | | - Jörn M Schattenberg
- Metabolic Liver Research Program. I. Department of Medicine, University Medical Center, Mainz, Germany
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8
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Cruciani M, White PL, Mengoli C, Löffler J, Morton CO, Klingspor L, Buchheidt D, Maertens J, Heinz WJ, Rogers TR, Weinbergerova B, Warris A, Lockhart DEA, Jones B, Cordonnier C, Donnelly JP, Barnes RA. The impact of anti-mould prophylaxis on Aspergillus PCR blood testing for the diagnosis of invasive aspergillosis. J Antimicrob Chemother 2021; 76:635-638. [PMID: 33374010 DOI: 10.1093/jac/dkaa498] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/29/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The performance of the galactomannan enzyme immunoassay (GM-EIA) is impaired in patients receiving mould-active antifungal therapy. The impact of mould-active antifungal therapy on Aspergillus PCR testing needs to be determined. OBJECTIVES To determine the influence of anti-mould prophylaxis (AMP) on the performance of PCR blood testing to aid the diagnosis of proven/probable invasive aspergillosis (IA). METHODS As part of the systematic review and meta-analysis of 22 cohort studies investigating Aspergillus PCR blood testing in 2912 patients at risk of IA, subgroup analysis was performed to determine the impact of AMP on the accuracy of Aspergillus PCR. The incidence of IA was calculated in patients receiving and not receiving AMP. The impact of two different positivity thresholds (requiring either a single PCR positive test result or ≥2 consecutive PCR positive test results) on accuracy was evaluated. Meta-analytical pooling of sensitivity and specificity was performed by logistic mixed-model regression. RESULTS In total, 1661 (57%) patients received prophylaxis. The incidence of IA was 14.2%, significantly lower in the prophylaxis group (11%-12%) compared with the non-prophylaxis group (18%-19%) (P < 0.001). The use of AMP did not affect sensitivity, but significantly decreased specificity [single PCR positive result threshold: 26% reduction (P = 0.005); ≥2 consecutive PCR positive results threshold: 12% reduction (P = 0.019)]. CONCLUSIONS Contrary to its influence on GM-EIA, AMP significantly decreases Aspergillus PCR specificity, without affecting sensitivity, possibly as a consequence of AMP limiting the clinical progression of IA and/or leading to false-negative GM-EIA results, preventing the classification of probable IA using the EORTC/MSGERC definitions.
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Affiliation(s)
| | | | | | - J Löffler
- University of Wuerzburg, Wuerzburg, Germany
| | - C O Morton
- Western Sydney University, Sydney, Australia
| | | | | | - J Maertens
- Department of Microbiology, Immunology, and Transplantation, KULeuven, Leuven, Belgium
| | - W J Heinz
- University of Wuerzburg, Wuerzburg, Germany
| | - T R Rogers
- Trinity College Dublin, St James's Hospital Campus, Dublin, Ireland
| | - B Weinbergerova
- Department of Internal Medicine - Haematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - A Warris
- MRC Centre for Medical Mycology, University of Exeter, UK
| | | | - B Jones
- Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | | | - J P Donnelly
- University of Nijmegen, Nijmegen, The Netherlands
| | - R A Barnes
- Cardiff University School of Medicine, Cardiff, UK
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9
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Vali Y, Lee J, Boursier J, Spijker R, Löffler J, Verheij J, Brosnan MJ, Böcskei Z, Anstee QM, Bossuyt PM, Zafarmand MH, Levick C, Duffin K, Hyde C, Bauer T, Bedossa P, Leeming D, Daly A, Hanf R, Ortiz P, Oresic M, Schuppan D, Hanauer G, Chen Y, Shumbayawonda E, Bjerring PN, Zwinderman K. Enhanced liver fibrosis test for the non-invasive diagnosis of fibrosis in patients with NAFLD: A systematic review and meta-analysis. J Hepatol 2020; 73:252-262. [PMID: 32275982 DOI: 10.1016/j.jhep.2020.03.036] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [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: 10/16/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The enhanced liver fibrosis (ELF) test has been proposed for the non-invasive assessment of advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). We performed a systematic review to estimate the accuracy of this test against biopsy. METHODS In this systematic review, we searched MEDLINE, Embase, Web of Science and the Cochrane Library for studies that included patients with NAFLD and that used both liver biopsy (as the reference standard) and the ELF test. Two authors independently screened the references, extracted the data and assessed the quality of included studies. Due to the variation in reported thresholds, we used a multiple thresholds random effects model for meta-analysis (diagmeta R-package). RESULTS The meta-analysis of 11 studies reporting advanced fibrosis and 5 studies reporting significant fibrosis showed that the ELF test had a sensitivity of >0.90 for excluding fibrosis at a threshold of 7.7. However, as a diagnostic test at high thresholds, the test only achieved specificity and positive predictive value >0.80 in very high prevalence settings (>50%). To achieve a specificity of 0.90 for advanced and significant fibrosis, thresholds of 10.18 (sensitivity: 0.57) and 9.86 (sensitivity: 0.55) were required, respectively. CONCLUSION The ELF test showed high sensitivity but limited specificity to exclude advanced and significant fibrosis at low cut-offs. The diagnostic performance of the test at higher thresholds was found to be more limited in low-prevalence settings. We conclude that clinicians should carefully consider the likely disease prevalence in their practice setting and adopt suitable test thresholds to achieve the desired performance. LAY SUMMARY The enhanced liver fibrosis test has been suggested as a non-invasive blood test to aid the diagnosis of severe liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Our study results showed that the test has a high negative predictive value, especially in populations with low disease prevalence (likely encountered in primary care); so, it can exclude advanced fibrosis in patients with NAFLD. However, when prevalence is low, the positive predictive value of the enhanced liver fibrosis test is low, suggesting that additional strategies may be needed to make a positive diagnosis in such settings.
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Affiliation(s)
- Yasaman Vali
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, The Netherlands.
| | - Jenny Lee
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Jérôme Boursier
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES EA3859, Angers University, Angers, France
| | - René Spijker
- Medical Library AMC, Amsterdam, the Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Joanne Verheij
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - M Julia Brosnan
- Internal Medicine Research Unit, Pfizer Inc, Cambridge, MA, USA
| | - Zsolt Böcskei
- Sanofi R&D, Translational Sciences Unit, Chilly Mazarin, France
| | - Quentin M Anstee
- The Newcastle Liver Research Group, Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Mohammad Hadi Zafarmand
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, The Netherlands
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10
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Schmidt S, Ebner F, Rosen K, Kniemeyer O, Brakhage AA, Löffler J, Seif M, Springer J, Schlosser J, Scharek-Tedin L, Scheffold A, Bacher P, Kühl AA, Rösler U, Hartmann S. The domestic pig as human-relevant large animal model to study adaptive antifungal immune responses against airborne Aspergillus fumigatus. Eur J Immunol 2020; 50:1712-1728. [PMID: 32558930 DOI: 10.1002/eji.201948524] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/16/2020] [Accepted: 06/18/2020] [Indexed: 01/26/2023]
Abstract
Pulmonary mucosal immune response is critical for preventing opportunistic Aspergillus fumigatus infections. Although fungus-specific CD4+ T cells in blood are described to reflect the actual host-pathogen interaction status, little is known about Aspergillus-specific pulmonary T-cell responses. Here, we exploit the domestic pig as human-relevant large animal model and introduce antigen-specific T-cell enrichment in pigs to address Aspergillus-specific T cells in the lung compared to peripheral blood. In healthy, environmentally Aspergillus-exposed pigs, the fungus-specific T cells are detectable in blood in similar frequencies as observed in healthy humans and exhibit a Th1 phenotype. Exposing pigs to 106 cfu/m3 conidia induces a long-lasting accumulation of Aspergillus-specific Th1 cells locally in the lung and also systemically. Temporary immunosuppression during Aspergillus-exposure showed a drastic reduction in the lung-infiltrating antifungal T-cell responses more than 2 weeks after abrogation of the suppressive treatment. This was reflected in blood, but to a much lesser extent. In conclusion, by using the human-relevant large animal model the pig, this study highlights that the blood clearly reflects the mucosal fungal-specific T-cell reactivity in environmentally exposed as well as experimentally exposed healthy pigs. But, immunosuppression significantly impacts the mucosal site in contrast to the initial systemic immune response.
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Affiliation(s)
- Stefanie Schmidt
- Institute of Immunology, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Friederike Ebner
- Institute of Immunology, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Kerstin Rosen
- Institute for Animal Hygiene and Environmental Health, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Olaf Kniemeyer
- Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute (HKI), Jena, Germany
| | - Axel A Brakhage
- Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute (HKI), Jena, Germany
| | - Jürgen Löffler
- Department of Microbiology and Molecular Biology, Institute for Microbiology, Friedrich Schiller University Jena, Jena, Germany
| | - Michelle Seif
- Department of Microbiology and Molecular Biology, Institute for Microbiology, Friedrich Schiller University Jena, Jena, Germany
| | - Jan Springer
- Department of Microbiology and Molecular Biology, Institute for Microbiology, Friedrich Schiller University Jena, Jena, Germany
| | - Josephine Schlosser
- Institute of Immunology, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Lydia Scharek-Tedin
- Institute of Immunology, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Alexander Scheffold
- Medizinische Klinik & Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Petra Bacher
- Medizinische Klinik & Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
- Institute for Immunology, Christian-Albrechts-Universität zu Kiel and Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Anja A Kühl
- Institute for Clinical Molecular Biology, Christian-Albrechts-Universität zu Kiel and Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, iPATH.Berlin, Berlin, Germany
| | - Uwe Rösler
- Institute for Animal Hygiene and Environmental Health, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | - Susanne Hartmann
- Institute of Immunology, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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11
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Springer J, Löffler J, Einsele H, White PL. The screening of blood by Aspergillus PCR and galactomannan ELISA precedes BAL detection in patients with proven and probable IA. Med Mycol 2020; 58:856-858. [DOI: 10.1093/mmy/myaa007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/23/2020] [Accepted: 02/17/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Early detection of Aspergillus infection has the potential to facilitate a more effective management of invasive disease. Data from probable/proven cases of invasive aspergillosis (IA) with a positive galactomannan enzyme-linked immunosorbent assay (GM) bronchoalveolar lavage fluid (BALF) was analyzed in respect to serum GM and/or polymerase chain reaction (PCR) screening of blood samples prior to, or concurrent with bronchoscopy. Concurrent serum GM testing is less sensitive than BALF itself. Nevertheless screening of blood using GM or PCR testing detected IA cases earlier (GM: 42% or PCR: 56%), particularly when combined (GM/PCR: 73%). Therefore, regular screening facilitates and improves early detection of IA in patients suffering from acute leukemia.
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Affiliation(s)
- Jan Springer
- Medizinische Klinik und Poliklinik II, University Hospital Wuerzburg, Germany
| | - Jürgen Löffler
- Medizinische Klinik und Poliklinik II, University Hospital Wuerzburg, Germany
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, University Hospital Wuerzburg, Germany
| | - P Lewis White
- Public Health Wales Microbiology, Cardiff, United Kingdom
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12
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Marolda A, Hünniger K, Böttcher S, Vivas W, Löffler J, Figge MT, Kurzai O. Candida Species-Dependent Release of IL-12 by Dendritic Cells Induces Different Levels of NK Cell Stimulation. J Infect Dis 2020; 221:2060-2071. [DOI: 10.1093/infdis/jiaa035] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/25/2020] [Indexed: 01/20/2023] Open
Abstract
Abstract
Background
Candida albicans and Candida glabrata are the 2 most prevalent Candida species causing bloodstream infections. Patterns of innate immune activation triggered by the 2 fungi differ considerably.
Methods
To analyze human natural killer (NK) cell activation by both species, we performed ex vivo whole-blood infection assays and confrontation assays with primary human NK cells.
Results
C. albicans was a stronger activator for isolated human NK cells than C. glabrata. In contrast, activation of blood NK cells, characterized by an upregulated surface exposure of early activation antigen CD69 and death receptor ligand TRAIL, as well as interferon-γ (IFN-γ) secretion, was more pronounced during C. glabrata infection. NK cell activation in blood is mediated by humoral mediators released by other immune cells and does not depend on direct activation by fungal cells. Cross-talk between Candida-confronted monocyte-derived dendritic cells (moDC) and NK cells resulted in the same NK activation phenotype as NK cells in human blood. Blocking experiments and cytokine substitution identified interleukin-12 as a critical mediator in regulation of primary NK cells by moDC.
Conclusions
Activation of human NK cells in response to Candida in human blood mainly occurs indirectly by mediators released from monocytic cells.
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Affiliation(s)
- Alessandra Marolda
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Kerstin Hünniger
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Sarah Böttcher
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Wolfgang Vivas
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Marc Thilo Figge
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Oliver Kurzai
- Fungal Septomics, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
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13
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Seif M, Einsele H, Löffler J. CAR T Cells Beyond Cancer: Hope for Immunomodulatory Therapy of Infectious Diseases. Front Immunol 2019; 10:2711. [PMID: 31824500 PMCID: PMC6881243 DOI: 10.3389/fimmu.2019.02711] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [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: 09/17/2019] [Accepted: 11/05/2019] [Indexed: 12/27/2022] Open
Abstract
Infectious diseases are still a significant cause of morbidity and mortality worldwide. Despite the progress in drug development, the occurrence of microbial resistance is still a significant concern. Alternative therapeutic strategies are required for non-responding or relapsing patients. Chimeric antigen receptor (CAR) T cells has revolutionized cancer immunotherapy, providing a potential therapeutic option for patients who are unresponsive to standard treatments. Recently two CAR T cell therapies, Yescarta® (Kite Pharma/Gilead) and Kymriah® (Novartis) were approved by the FDA for the treatments of certain types of non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia, respectively. The success of adoptive CAR T cell therapy for cancer has inspired researchers to develop CARs for the treatment of infectious diseases. Here, we review the main achievements in CAR T cell therapy targeting viral infections, including Human Immunodeficiency Virus, Hepatitis C Virus, Hepatitis B Virus, Human Cytomegalovirus, and opportunistic fungal infections such as invasive aspergillosis.
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Affiliation(s)
- Michelle Seif
- Department of Internal Medicine II, University Hospital Wuerzburg, Würzburg, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Wuerzburg, Würzburg, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital Wuerzburg, Würzburg, Germany
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14
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Zoran T, Weber M, Springer J, White PL, Bauer J, Schober A, Löffler C, Seelbinder B, Hünniger K, Kurzai O, Scherag A, Schäuble S, Morton CO, Einsele H, Linde J, Löffler J. Treatment with etanercept and low monocyte concentration contribute to the risk of invasive aspergillosis in patients post allogeneic stem cell transplantation. Sci Rep 2019; 9:17231. [PMID: 31754120 PMCID: PMC6872713 DOI: 10.1038/s41598-019-53504-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 10/19/2018] [Accepted: 10/29/2019] [Indexed: 12/16/2022] Open
Abstract
Invasive aspergillosis (IA) is a life-threatening complication among allogeneic hematopoietic stem cell transplant (alloSCT) recipients. Despite well known risk factors and different available assays, diagnosis of invasive aspergillosis remains challenging. 103 clinical variables from patients with hematological malignancies and subsequent alloSCT were collected. Associations between collected variables and patients with (n = 36) and without IA (n = 36) were investigated by applying univariate and multivariable logistic regression. The predictive power of the final model was tested in an independent patient cohort (23 IA cases and 25 control patients). Findings were investigated further by in vitro studies, which analysed the effect of etanercept on A. fumigatus-stimulated macrophages at the gene expression and cytokine secretion. Additionally, the release of C-X-C motif chemokine ligand 10 (CXCL10) in patient sera was studied. Low monocyte concentration (p = 4.8 × 10−06), severe GvHD of the gut (grade 2–4) (p = 1.08 × 10−02) and etanercept treatment of GvHD (p = 3.5 × 10−03) were significantly associated with IA. Our studies showed that etanercept lowers CXCL10 concentrations in vitro and ex vivo and down-regulates genes involved in immune responses and TNF-alpha signaling. Our study offers clinicians new information regarding risk factors for IA including low monocyte counts and administration of etanercept. After necessary validation, such information may be used for decision making regarding antifungal prophylaxis or closely monitoring patients at risk.
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Affiliation(s)
- Tamara Zoran
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany.,Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Michael Weber
- Friedrich Löffler Institute, Institute of Molecular Pathogenesis, Jena, Germany.,Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Jan Springer
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany
| | | | - Joachim Bauer
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany
| | - Annika Schober
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany
| | - Claudia Löffler
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany
| | - Bastian Seelbinder
- Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - Kerstin Hünniger
- Septomics Research Centre, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany.,Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Oliver Kurzai
- Septomics Research Centre, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany.,Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, University Hospital, Jena, Germany
| | - Sascha Schäuble
- Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany
| | - C Oliver Morton
- Western Sydney University, School of Science and Health, Campbelltown, NSW, 2560, Australia
| | - Hermann Einsele
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany
| | - Jörg Linde
- Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena, Germany.,Friedrich Löffler Institute, Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - Jürgen Löffler
- University Hospital Würzburg, Medical Hospital II, WÜ4i, Würzburg, Germany.
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15
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Maurer M, Giménez-Arnau AM, Sussman G, Metz M, Baker DR, Bauer A, Bernstein JA, Brehler R, Chu CY, Chung WH, Danilycheva I, Grattan C, Hébert J, Katelaris C, Makris M, Meshkova R, Savic S, Sinclair R, Sitz K, Staubach P, Wedi B, Löffler J, Barve A, Kobayashi K, Hua E, Severin T, Janocha R. Ligelizumab for Chronic Spontaneous Urticaria. N Engl J Med 2019; 381:1321-1332. [PMID: 31577874 DOI: 10.1056/nejmoa1900408] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the majority of patients with chronic spontaneous urticaria, most currently available therapies do not result in complete symptom control. Ligelizumab is a next-generation high-affinity humanized monoclonal anti-IgE antibody. Data are limited regarding the dose-response relationship of ligelizumab and the efficacy and safety of ligelizumab as compared with omalizumab and placebo in patients who have moderate-to-severe chronic spontaneous urticaria that is inadequately controlled with H1-antihistamines at approved or increased doses, alone or in combination with H2-antihistamines or leukotriene-receptor antagonists. METHODS In a phase 2b dose-finding trial, we randomly assigned patients to receive ligelizumab at a dose of 24 mg, 72 mg, or 240 mg, omalizumab at a dose of 300 mg, or placebo, administered subcutaneously every 4 weeks for a period of 20 weeks, or a single 120-mg dose of ligelizumab. Disease symptoms of hives, itch, and angioedema were monitored by means of weekly activity scores. The main objective was to determine a dose-response relationship for the complete control of hives (indicated by a weekly hives-severity score of 0, on a scale from 0 to 21, with higher scores indicating greater severity); the primary end point of this response was assessed at week 12. Complete symptom control was indicated by a weekly urticaria activity score of 0 (on a scale from 0 to 42, with higher scores indicating greater severity). Safety was analyzed throughout the trial. RESULTS A total of 382 patients underwent randomization. At week 12, a total of 30%, 51%, and 42% of the patients treated with 24 mg, 72 mg, and 240 mg, respectively, of ligelizumab had complete control of hives, as compared with 26% of the patients in the omalizumab group and no patients in the placebo group. A dose-response relationship was established. At week 12, a total of 30%, 44%, and 40% of the patients treated with 24 mg, 72 mg, and 240 mg, respectively, of ligelizumab had complete control of symptoms, as compared with 26% of the patients in the omalizumab group and no patients in the placebo group. In this small and short trial, no safety concerns regarding ligelizumab or omalizumab emerged. CONCLUSIONS A higher percentage of patients had complete control of symptoms of chronic spontaneous urticaria with ligelizumab therapy of 72 mg or 240 mg than with omalizumab or placebo. (Funded by Novartis Pharma; ClinicalTrials.gov number, NCT02477332.).
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Affiliation(s)
- Marcus Maurer
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Ana M Giménez-Arnau
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Gordon Sussman
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Martin Metz
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Diane R Baker
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Andrea Bauer
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Jonathan A Bernstein
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Randolf Brehler
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Chia-Yu Chu
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Wen-Hung Chung
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Inna Danilycheva
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Clive Grattan
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Jacques Hébert
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Constance Katelaris
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Michael Makris
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Raisa Meshkova
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Sinisa Savic
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Rodney Sinclair
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Karl Sitz
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Petra Staubach
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Bettina Wedi
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Jürgen Löffler
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Avantika Barve
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Kenneth Kobayashi
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Eva Hua
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Thomas Severin
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
| | - Reinhold Janocha
- From the Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin (M. Maurer, M. Metz), the Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden (A. Bauer), the Department of Dermatology, University Hospital Münster, Münster (R.B.), the Department of Dermatology, University Medical Center Mainz, Mainz (P.S.), and the Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover (B.W.) - all in Germany; the Dermatology Department, Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma Barcelona, Barcelona (A.M.G.-A.); the Division of Allergy and Clinical Immunology, St. Michael's Hospital and University of Toronto, Toronto (G.S.), Service d'Allergie, Centre Hospitalier Université Laval-Centre Hospitalier Universitaire de Québec, Quebec, QC (J.H.), and the Department of Medicine, University of Ottawa, Ottawa (K.K.) - all in Canada; Baker Allergy Asthma and Dermatology Clinic, Portland, OR (D.R.B.); University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology, Rheumatology, and Allergy and Bernstein Clinical Research Center, Cincinnati (J.A.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine (C.-Y.C.), and the Department of Dermatology, Chang Gung Memorial Hospital (W.-H.C.), Taipei, Taiwan; the National Research Center-Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow (I.D.), and the Department of Clinical Immunology and Allergology, Smolensk State Medical University, Smolensk (R.M.) - both in Russia; St. John's Institute of Dermatology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London (C.G.), and the National Institute for Health Research-Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, and the Department of Clinical Immunology and Allergy, St. James's University Hospital, Leeds (S.S.) - all in the United Kingdom; the School of Medicine, Western Sydney University, and the Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW (C.K.), and Sinclair Dermatology and the Epworth Hospital, Melbourne, VIC (R.S.) - all in Australia; the Second Department of Dermatology and Venereology, Attikon University Hospital, Athens (M. Makris); Little Rock Allergy and Asthma Clinic, Little Rock, AR (K.S.); Novartis Pharma, Basel, Switzerland (J.L., T.S., R.J.); Novartis Pharmaceuticals, East Hanover, NJ (A. Barve, K.K.); and Shanghai Novartis Trading, Shanghai, China (E.H.)
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16
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Srivastava M, Bencurova E, Gupta SK, Weiss E, Löffler J, Dandekar T. Aspergillus fumigatus Challenged by Human Dendritic Cells: Metabolic and Regulatory Pathway Responses Testify a Tight Battle. Front Cell Infect Microbiol 2019; 9:168. [PMID: 31192161 PMCID: PMC6540932 DOI: 10.3389/fcimb.2019.00168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/10/2018] [Accepted: 05/06/2019] [Indexed: 12/18/2022] Open
Abstract
Dendritic cells (DCs) are antigen presenting cells which serve as a passage between the innate and the acquired immunity. Aspergillosis is a major lethal condition in immunocompromised patients caused by the adaptable saprophytic fungus Aspergillus fumigatus. The healthy human immune system is capable to ward off A. fumigatus infections however immune-deficient patients are highly vulnerable to invasive aspergillosis. A. fumigatus can persist during infection due to its ability to survive the immune response of human DCs. Therefore, the study of the metabolism specific to the context of infection may allow us to gain insight into the adaptation strategies of both the pathogen and the immune cells. We established a metabolic model of A. fumigatus central metabolism during infection of DCs and calculated the metabolic pathway (elementary modes; EMs). Transcriptome data were used to identify pathways activated when A. fumigatus is challenged with DCs. In particular, amino acid metabolic pathways, alternative carbon metabolic pathways and stress regulating enzymes were found to be active. Metabolic flux modeling identified further active enzymes such as alcohol dehydrogenase, inositol oxygenase and GTP cyclohydrolase participating in different stress responses in A. fumigatus. These were further validated by qRT-PCR from RNA extracted under these different conditions. For DCs, we outlined the activation of metabolic pathways in response to the confrontation with A. fumigatus. We found the fatty acid metabolism plays a crucial role, along with other metabolic changes. The gene expression data and their analysis illuminate additional regulatory pathways activated in the DCs apart from interleukin regulation. In particular, Toll-like receptor signaling, NOD-like receptor signaling and RIG-I-like receptor signaling were active pathways. Moreover, we identified subnetworks and several novel key regulators such as UBC, EGFR, and CUL3 of DCs to be activated in response to A. fumigatus. In conclusion, we analyze the metabolic and regulatory responses of A. fumigatus and DCs when confronted with each other.
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Affiliation(s)
- Mugdha Srivastava
- Department of Bioinformatics, Biocenter, University of Würzburg, Würzburg, Germany
| | - Elena Bencurova
- Department of Bioinformatics, Biocenter, University of Würzburg, Würzburg, Germany
| | - Shishir K Gupta
- Department of Bioinformatics, Biocenter, University of Würzburg, Würzburg, Germany
| | - Esther Weiss
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Thomas Dandekar
- Department of Bioinformatics, Biocenter, University of Würzburg, Würzburg, Germany.,EMBL Heidelberg, Structural and Computational Biology, Heidelberg, Germany
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17
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Decker C, Wurster S, Lazariotou M, Hellmann AM, Einsele H, Ullmann AJ, Löffler J. Analysis of the in vitro activity of human neutrophils against Aspergillus fumigatus in presence of antifungal and immunosuppressive agents. Med Mycol 2019; 56:514-519. [PMID: 29420763 DOI: 10.1093/mmy/myx069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 09/15/2017] [Indexed: 12/22/2022] Open
Abstract
Neutrophils are essential in the first line defense against moulds. This in vitro study assessed different neutrophil effector mechanisms in the presence of clinically relevant antifungal and immunosuppressive agents. Therapeutic concentrations of liposomal amphotericin B led to reduced IL-8 and oxidative burst response to the synthetic stimulus PMA, whereas no major alterations of oxidative burst, phagocytosis, or cytokine response to germinated stages of Aspergillus fumigatus and no supra-additive effects of antifungal and immunosuppressive drugs were observed. Conventional and liposomal amphotericin B as well as voriconazole, however, led to reduced neutrophil extracellular trap formation in response to A. fumigatus germ tubes.
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Affiliation(s)
- Christina Decker
- University Hospital of Wuerzburg, Department of Internal Medicine II, Wuerzburg
| | - Sebastian Wurster
- University Hospital of Wuerzburg, Department of Internal Medicine II, Wuerzburg
| | - Maria Lazariotou
- University Hospital of Wuerzburg, Department of Internal Medicine II, Wuerzburg
| | - Anna-Maria Hellmann
- University Hospital of Wuerzburg, Department of Internal Medicine II, Wuerzburg
| | - Hermann Einsele
- University Hospital of Wuerzburg, Department of Internal Medicine II, Wuerzburg
| | - Andrew J Ullmann
- University Hospital of Wuerzburg, Department of Internal Medicine II, Wuerzburg
| | - Jürgen Löffler
- University Hospital of Wuerzburg, Department of Internal Medicine II, Wuerzburg
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18
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Frindte K, Pape R, Werner K, Löffler J, Knief C. Temperature and soil moisture control microbial community composition in an arctic-alpine ecosystem along elevational and micro-topographic gradients. ISME J 2019; 13:2031-2043. [PMID: 30952996 DOI: 10.1038/s41396-019-0409-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 11/09/2022]
Abstract
Microbial communities in arctic-alpine soils show biogeographic patterns related to elevation, but the effect of fine-scale heterogeneity and possibly related temperature and soil moisture regimes remains unclear. We collected soil samples from different micro-topographic positions and elevational levels in two mountain regions of the Scandes, Central Norway. Microbial community composition was characterized by 16S rRNA gene amplicon sequencing and was dependent on micro-topography and elevation. Underlying environmental drivers were identified by integration of microbial community data with a comprehensive set of site-specific long-term recorded temperature and soil moisture data. Partial least square regression analysis allowed the description of ecological response patterns and the identification of the important environmental drivers for each taxonomic group. This demonstrated for the first time that taxa responding to elevation were indeed most strongly defined by temperature, rather than by other environmental factors. Micro-topography affected taxa were primarily controlled by temperature and soil moisture. In general, 5-year datasets had higher explanatory power than 1-year datasets, indicating that the microbial community composition is dependent on long-term developments of near-ground temperature and soil moisture regimes and possesses a certain resilience, which is in agreement with an often observed delayed response in global warming studies in arctic-alpine regions.
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Affiliation(s)
- K Frindte
- Institute of Crop Science and Resource Conservation (INRES), Molecular Biology of the Rhizosphere, Nussallee 13, 53115, Bonn, Germany.
| | - R Pape
- Department of Geography, University of Bonn, Meckenheimer Allee 166, 53115, Bonn, Germany
| | - K Werner
- Institute of Crop Science and Resource Conservation (INRES), Molecular Biology of the Rhizosphere, Nussallee 13, 53115, Bonn, Germany.,Beuth Hochschule für Technik, Seestraße 64, 13347, Berlin, Germany
| | - J Löffler
- Department of Geography, University of Bonn, Meckenheimer Allee 166, 53115, Bonn, Germany
| | - C Knief
- Institute of Crop Science and Resource Conservation (INRES), Molecular Biology of the Rhizosphere, Nussallee 13, 53115, Bonn, Germany
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19
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Page L, Weis P, Müller T, Dittrich M, Lazariotou M, Dragan M, Waaga-Gasser AM, Helm J, Dandekar T, Einsele H, Löffler J, Ullmann AJ, Wurster S. Evaluation of Aspergillus and Mucorales specific T-cells and peripheral blood mononuclear cell cytokine signatures as biomarkers of environmental mold exposure. Int J Med Microbiol 2018; 308:1018-1026. [PMID: 30201279 DOI: 10.1016/j.ijmm.2018.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 06/18/2018] [Revised: 08/10/2018] [Accepted: 09/02/2018] [Indexed: 12/20/2022] Open
Abstract
Mold specific T-cells have been described as a supportive biomarker to monitor invasive mycoses and mold exposure. This study comparatively evaluated frequencies and cytokine profiles of Aspergillus fumigatus and Mucorales reactive T-cells depending on environmental mold exposure. Peripheral blood mononuclear cells (PBMCs) obtained from 35 healthy donors were stimulated with mycelial lysates of A. fumigatus and three human pathogenic Mucorales species. CD154+ specific T-cells were quantified by flow cytometry. In a second cohort of 20 additional donors, flow cytometry was complemented by 13-plex cytokine assays. Mold exposure of the subjects was determined using a previously established questionnaire. Highly exposed subjects exhibited significantly greater CD154+A. fumigatus and Mucorales specific naïve and memory T-helper cell frequencies. Significant correlation (r = 0.48 - 0.79) was found between A. fumigatus and Mucorales specific T-cell numbers. Logistic regression analyses revealed that combined analysis of mold specific T-cell frequencies and selected cytokine markers (A. fumigatus: IL-5 and TNF-α, R. arrhizus: IL-17A and IL-13) significantly improves classification performance, resulting in 75-90 % predictive power using 10-fold cross-validation. In conclusion, mold specific T-cell frequencies and their cytokine signatures offer promising potential in the assessment of environmental mold exposure. The cytokines identified in this pilot study should be validated in the clinical setting, e. g. in patients with hypersensitivity pneumonitis.
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Affiliation(s)
- Lukas Page
- University Hospital of Wuerzburg, Department of Internal Medicine II, Division of Infectious Diseases, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
| | - Philipp Weis
- University Hospital of Wuerzburg, Department of Internal Medicine II, Division of Infectious Diseases, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
| | - Tobias Müller
- University of Wuerzburg, Biocenter, Department of Bioinformatics, Am Hubland, 97074 Wuerzburg, Germany
| | - Marcus Dittrich
- University of Wuerzburg, Biocenter, Department of Bioinformatics, Am Hubland, 97074 Wuerzburg, Germany
| | - Maria Lazariotou
- University Hospital of Wuerzburg, Department of Internal Medicine II, Division of Infectious Diseases, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
| | - Mariola Dragan
- University Hospital of Wuerzburg, Department of Surgery I, Oberduerrbacher Str. 6, 97080 Wuerzburg, Germany
| | - Ana Maria Waaga-Gasser
- University Hospital of Wuerzburg, Department of Surgery I, Oberduerrbacher Str. 6, 97080 Wuerzburg, Germany
| | - Johanna Helm
- University Hospital of Wuerzburg, Department of Internal Medicine II, Division of Infectious Diseases, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
| | - Thomas Dandekar
- University of Wuerzburg, Biocenter, Department of Bioinformatics, Am Hubland, 97074 Wuerzburg, Germany
| | - Hermann Einsele
- University Hospital of Wuerzburg, Department of Internal Medicine II, Division of Infectious Diseases, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
| | - Jürgen Löffler
- University Hospital of Wuerzburg, Department of Internal Medicine II, Division of Infectious Diseases, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
| | - Andrew J Ullmann
- University Hospital of Wuerzburg, Department of Internal Medicine II, Division of Infectious Diseases, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
| | - Sebastian Wurster
- University Hospital of Wuerzburg, Department of Internal Medicine II, Division of Infectious Diseases, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany; The University of Texas MD Anderson Cancer Center, Department of Infectious Diseases, 1515 Holcombe Boulevard, Houston, Texas, 77030, United States.
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Ruhnke M, Behre G, Buchheidt D, Christopeit M, Hamprecht A, Heinz W, Heussel CP, Horger M, Kurzai O, Karthaus M, Löffler J, Maschmeyer G, Penack O, Rieger C, Rickerts V, Ritter J, Schmidt-Hieber M, Schuelper N, Schwartz S, Ullmann A, Vehreschild JJ, von Lilienfeld-Toal M, Weber T, Wolf HH. Diagnosis of invasive fungal diseases in haematology and oncology: 2018 update of the recommendations of the infectious diseases working party of the German society for hematology and medical oncology (AGIHO). Mycoses 2018; 61:796-813. [PMID: 30098069 DOI: 10.1111/myc.12838] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 01/05/2023]
Abstract
Invasive fungal diseases (IFD) are a primary cause of morbidity and mortality in patients with haematological malignancies. These infections are mostly life-threatening and an early diagnosis and initiation of appropriate antifungal therapy are essential for the clinical outcome. Most commonly, Aspergillus and Candida species are involved. However, other Non-Aspergillus moulds are increasingly identified in case of documented IFD. For definite diagnosis of IFD, a combination of diagnostic tools have to be applied, including conventional mycological culture and non-conventional microbiological tests such as antibody/antigen and molecular tests, as well as histopathology and radiology. Although varying widely in cancer patients, the risk of invasive fungal infection is highest in those with allogeneic stem cell transplantation and those with acute leukaemia and markedly lower in patients with solid cancer. Since the last edition of Diagnosis of Invasive Fungal Diseases recommendations of the German Society for Hematology and Oncology in 2012, integrated care pathways have been proposed for the management and therapy of IFDs with either a diagnostic driven strategy as opposed to a clinical or empirical driven strategy. This update discusses the impact of this additional evidence and effective revisions.
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Affiliation(s)
- Markus Ruhnke
- Department of Haematology & Oncology, Paracelsus-Klinik, Osnabrück, Germany
| | - Gerhard Behre
- Department of Haematology & Oncology, Universitätsklinik Leipzig, Leipzig, Germany
| | - Dieter Buchheidt
- Department of Internal Medicine III, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany
| | - Maximilian Christopeit
- Department for Stem Cell Transplantation, University Medical Center Eppendorf, Hamburg, Germany
| | - Axel Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Werner Heinz
- Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany
| | - Claus-Peter Heussel
- Department of Interventional & Diagnostic Radiology, Thorax Centre, University Hospital of Heidelberg, Heidelberg, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Oliver Kurzai
- National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knoell-Institute, Jena and Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Meinolf Karthaus
- Deparment of Haematology & Oncology, Municipal Hospital Neuperlach, Munich, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany
| | - Georg Maschmeyer
- Department of Haematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Municipal Hospital, Potsdam, Germany
| | - Olaf Penack
- Division of Haematology & Oncology, Department of Internal Medicine, Charité University Medicine, Berlin, Germany
| | | | - Volker Rickerts
- Konsiliarlabor Für Kryptokokkose und Seltene Systemmykosen, Robert-Koch-Institut Berlin, Berlin, Germany
| | - Jörg Ritter
- Division of Haematology & Oncology, Department of Paediatrics, University Hospital of Münster, Münster, Germany
| | - Martin Schmidt-Hieber
- Division of Haematology & Oncology, Department of Internal Medicine, Charité University Medicine, Berlin, Germany
| | - Nikolai Schuelper
- Department of Haematology and Medical Oncology, Göttingen University Medical Centre, Göttingen, Germany
| | - Stefan Schwartz
- Division of Haematology & Oncology, Department of Internal Medicine, Charité University Medicine, Berlin, Germany
| | - Andrew Ullmann
- Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany
| | - Jörg Janne Vehreschild
- Department of Internal Medicine I, German Centre for Infection Research, partner-site Bonn-Cologne, University Hospital of Cologne, Cologne, Germany
| | - Marie von Lilienfeld-Toal
- Department of Internal Medicine II, National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knoell-Institute, Universitätsklinik Jena, Jena, Germany
| | - Thomas Weber
- Department of Internal Medicine IV, Universitätsklinik Halle, Halle, Germany
| | - Hans H Wolf
- Department of Internal Medicine IV, Universitätsklinik Halle, Halle, Germany
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21
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Springer J, McCormick Smith I, Hartmann S, Winkelmann R, Wilmes D, Cornely O, Kessel J, Löffler J, Rickerts V. Identification of Aspergillus and Mucorales in formalin-fixed, paraffin-embedded tissue samples: Comparison of specific and broad-range fungal qPCR assays. Med Mycol 2018; 57:308-313. [DOI: 10.1093/mmy/myy041] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/09/2018] [Accepted: 05/17/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Springer
- University of Würzburg, Dept. for internal Medicine II, Würzburg, Germany
| | | | - S Hartmann
- Goethe University Frankfurt, Dr. Senckenberg Institute of Pathology
| | - R Winkelmann
- Goethe University Frankfurt, Dr. Senckenberg Institute of Pathology
| | - D Wilmes
- Robert Koch Institut, Berlin, Germany
| | - O Cornely
- University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS Köln), German Centre for Infection Research (DZIF), Cologne, Germany
| | - J Kessel
- Goethe University Frankfurt, Dept. for internal Medicine II
| | - J Löffler
- University of Würzburg, Dept. for internal Medicine II, Würzburg, Germany
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22
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Lauruschkat CD, Wurster S, Page L, Lazariotou M, Dragan M, Weis P, Ullmann AJ, Einsele H, Löffler J. Susceptibility of A. fumigatus-specific T-cell assays to pre-analytic blood storage and PBMC cryopreservation greatly depends on readout platform and analytes. Mycoses 2018; 61:549-560. [PMID: 29611226 DOI: 10.1111/myc.12780] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 01/16/2018] [Revised: 03/08/2018] [Accepted: 03/25/2018] [Indexed: 01/18/2023]
Abstract
Mould-specific T cells detectable by flow cytometry or ELISPOT were proposed as a novel biomarker in invasive aspergillosis. To define protocols facilitating sample shipment and longitudinal analysis, this study evaluated the susceptibility of different functional assays for A. fumigatus-specific T-cell quantification and characterisation to pre-analytic delays. PBMCs from 6 healthy donors were analysed after immediate isolation, after 6 hours whole blood storage or after cryopreservation using 3 different common media. Functional responses to A. fumigatus lysate stimulation were comparatively assessed by flow cytometry, ELISPOT and 14-plex cytokine assay. After 6 hours pre-analytic storage, all functional assays showed reduced detection rates, higher coefficients of variation (CV) and widely varying individual recovery indices of specific T-cell response. While cryopreservation resulted in sufficient yields and largely unaltered cellular composition, outcomes of functional readouts significantly differed from freshly processed samples. For CD154-based flow cytometry, only cryopreservation in RPMI supplemented with autologous serum resulted in satisfactory detection rates and CVs. For ELISPOT and cytokine secretion assays, none of the cryopreservation protocols provided sufficient concordance with immediately processed samples. Even using the same readout platform, individual analytes widely varied in their susceptibility to cryopreservation, highlighting that distinct optimisation is required depending on the downstream assay.
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Affiliation(s)
- Chris D Lauruschkat
- Division of Infectious Diseases, Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Sebastian Wurster
- Division of Infectious Diseases, Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Lukas Page
- Division of Infectious Diseases, Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Maria Lazariotou
- Division of Infectious Diseases, Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Mariola Dragan
- Department of Surgery I, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Philipp Weis
- Division of Infectious Diseases, Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Andrew J Ullmann
- Division of Infectious Diseases, Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Hermann Einsele
- Division of Infectious Diseases, Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Jürgen Löffler
- Division of Infectious Diseases, Department of Internal Medicine II, University Hospital of Wuerzburg, Wuerzburg, Germany
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23
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Ullmann AJ, Aguado JM, Arikan-Akdagli S, Denning DW, Groll AH, Lagrou K, Lass-Flörl C, Lewis RE, Munoz P, Verweij PE, Warris A, Ader F, Akova M, Arendrup MC, Barnes RA, Beigelman-Aubry C, Blot S, Bouza E, Brüggemann RJM, Buchheidt D, Cadranel J, Castagnola E, Chakrabarti A, Cuenca-Estrella M, Dimopoulos G, Fortun J, Gangneux JP, Garbino J, Heinz WJ, Herbrecht R, Heussel CP, Kibbler CC, Klimko N, Kullberg BJ, Lange C, Lehrnbecher T, Löffler J, Lortholary O, Maertens J, Marchetti O, Meis JF, Pagano L, Ribaud P, Richardson M, Roilides E, Ruhnke M, Sanguinetti M, Sheppard DC, Sinkó J, Skiada A, Vehreschild MJGT, Viscoli C, Cornely OA. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect 2018; 24 Suppl 1:e1-e38. [PMID: 29544767 DOI: 10.1016/j.cmi.2018.01.002] [Citation(s) in RCA: 780] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 02/06/2023]
Abstract
The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported. Combinations of antifungals as primary treatment options are not recommended. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy. Secondary prophylaxis is strongly recommended in high-risk patients. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.
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Affiliation(s)
- A J Ullmann
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J M Aguado
- Infectious Diseases Unit, University Hospital Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - S Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - D W Denning
- The National Aspergillosis Centre, Wythenshawe Hospital, Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, ECMM Excellence Centre of Medical Mycology, Manchester, UK; The University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; European Confederation of Medical Mycology (ECMM)
| | - A H Groll
- Department of Paediatric Haematology/Oncology, Centre for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - K Lagrou
- Department of Microbiology and Immunology, ECMM Excellence Centre of Medical Mycology, University Hospital Leuven, Leuven, Belgium; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - C Lass-Flörl
- Institute of Hygiene, Microbiology and Social Medicine, ECMM Excellence Centre of Medical Mycology, Medical University Innsbruck, Innsbruck, Austria; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R E Lewis
- Infectious Diseases Clinic, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy; ESCMID Fungal Infection Study Group (EFISG)
| | - P Munoz
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - P E Verweij
- Department of Medical Microbiology, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - A Warris
- MRC Centre for Medical Mycology, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - F Ader
- Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France; Inserm 1111, French International Centre for Infectious Diseases Research (CIRI), Université Claude Bernard Lyon 1, Lyon, France; European Respiratory Society (ERS)
| | - M Akova
- Department of Medicine, Section of Infectious Diseases, Hacettepe University Medical School, Ankara, Turkey; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M C Arendrup
- Department Microbiological Surveillance and Research, Statens Serum Institute, Copenhagen, Denmark; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R A Barnes
- Department of Medical Microbiology and Infectious Diseases, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK; European Confederation of Medical Mycology (ECMM)
| | - C Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; European Respiratory Society (ERS)
| | - S Blot
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia; European Respiratory Society (ERS)
| | - E Bouza
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R J M Brüggemann
- Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG)
| | - D Buchheidt
- Medical Clinic III, University Hospital Mannheim, Mannheim, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Cadranel
- Department of Pneumology, University Hospital of Tenon and Sorbonne, University of Paris, Paris, France; European Respiratory Society (ERS)
| | - E Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini Children's Hospital, Genoa, Italy; ESCMID Fungal Infection Study Group (EFISG)
| | - A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India; European Confederation of Medical Mycology (ECMM)
| | - M Cuenca-Estrella
- Instituto de Salud Carlos III, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - G Dimopoulos
- Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; European Respiratory Society (ERS)
| | - J Fortun
- Infectious Diseases Service, Ramón y Cajal Hospital, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J-P Gangneux
- Univ Rennes, CHU Rennes, Inserm, Irset (Institut de Recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Garbino
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - W J Heinz
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - R Herbrecht
- Department of Haematology and Oncology, University Hospital of Strasbourg, Strasbourg, France; ESCMID Fungal Infection Study Group (EFISG)
| | - C P Heussel
- Diagnostic and Interventional Radiology, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany; European Confederation of Medical Mycology (ECMM)
| | - C C Kibbler
- Centre for Medical Microbiology, University College London, London, UK; European Confederation of Medical Mycology (ECMM)
| | - N Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, St Petersburg, Russia; European Confederation of Medical Mycology (ECMM)
| | - B J Kullberg
- Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - C Lange
- International Health and Infectious Diseases, University of Lübeck, Lübeck, Germany; Clinical Infectious Diseases, Research Centre Borstel, Leibniz Center for Medicine & Biosciences, Borstel, Germany; German Centre for Infection Research (DZIF), Tuberculosis Unit, Hamburg-Lübeck-Borstel-Riems Site, Lübeck, Germany; European Respiratory Society (ERS)
| | - T Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany; European Confederation of Medical Mycology (ECMM)
| | - J Löffler
- Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O Lortholary
- Department of Infectious and Tropical Diseases, Children's Hospital, University of Paris, Paris, France; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Maertens
- Department of Haematology, ECMM Excellence Centre of Medical Mycology, University Hospital Leuven, Leuven, Belgium; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Department of Medicine, Ensemble Hospitalier de la Côte, Morges, Switzerland; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Centre of Expertise in Mycology Radboudumc/CWZ, ECMM Excellence Centre of Medical Mycology, Nijmegen, Netherlands; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - L Pagano
- Department of Haematology, Universita Cattolica del Sacro Cuore, Roma, Italy; European Confederation of Medical Mycology (ECMM)
| | - P Ribaud
- Quality Unit, Pôle Prébloc, Saint-Louis and Lariboisière Hospital Group, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M Richardson
- The National Aspergillosis Centre, Wythenshawe Hospital, Mycology Reference Centre Manchester, Manchester University NHS Foundation Trust, ECMM Excellence Centre of Medical Mycology, Manchester, UK; The University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - E Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M Ruhnke
- Department of Haematology and Oncology, Paracelsus Hospital, Osnabrück, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M Sanguinetti
- Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli - Università Cattolica del Sacro Cuore, Rome, Italy; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - D C Sheppard
- Division of Infectious Diseases, Department of Medicine, Microbiology and Immunology, McGill University, Montreal, Canada; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - J Sinkó
- Department of Haematology and Stem Cell Transplantation, Szent István and Szent László Hospital, Budapest, Hungary; ESCMID Fungal Infection Study Group (EFISG)
| | - A Skiada
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - M J G T Vehreschild
- Department I of Internal Medicine, ECMM Excellence Centre of Medical Mycology, University Hospital of Cologne, Cologne, Germany; Centre for Integrated Oncology, Cologne-Bonn, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; European Confederation of Medical Mycology (ECMM)
| | - C Viscoli
- Ospedale Policlinico San Martino and University of Genova (DISSAL), Genova, Italy; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM)
| | - O A Cornely
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM); ESCMID European Study Group for Infections in Compromised Hosts (ESGICH).
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24
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Abstract
Fungal hyphae constitute a special challenge for the immune system, since they are too large to be phagocytosed. This review summarizes our current knowledge on those immune cells that are able to attack and eliminate hyphae and we discuss the different means that are employed by these cells in order to kill hyphae.
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Affiliation(s)
- Jürgen Löffler
- Medical Hospital II, WÜ4i, University Hospital Wuerzburg, Germany
| | - Frank Ebel
- Institute for Infectious Diseases and Zoonoses, Ludwig-Maximilians-University, Munich, Germany.
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25
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Saraiva JP, Oswald M, Biering A, Röll D, Assmann C, Klassert T, Blaess M, Czakai K, Claus R, Löffler J, Slevogt H, König R. Fungal biomarker discovery by integration of classifiers. BMC Genomics 2017; 18:601. [PMID: 28797245 PMCID: PMC5553868 DOI: 10.1186/s12864-017-4006-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 08/02/2017] [Indexed: 02/01/2023] Open
Abstract
Background The human immune system is responsible for protecting the host from infection. However, in immunocompromised individuals the risk of infection increases substantially with possible drastic consequences. In extreme, systemic infection can lead to sepsis which is responsible for innumerous deaths worldwide. Amongst its causes are infections by bacteria and fungi. To increase survival, it is mandatory to identify the type of infection rapidly. Discriminating between fungal and bacterial pathogens is key to determine if antifungals or antibiotics should be administered, respectively. For this, in situ experiments have been performed to determine regulation mechanisms of the human immune system to identify biomarkers. However, these studies led to heterogeneous results either due different laboratory settings, pathogen strains, cell types and tissues, as well as the time of sample extraction, to name a few. Methods To generate a gene signature capable of discriminating between fungal and bacterial infected samples, we employed Mixed Integer Linear Programming (MILP) based classifiers on several datasets comprised of the above mentioned pathogens. Results When combining the classifiers by a joint optimization we could increase the consistency of the biomarker gene list independently of the experimental setup. An increase in pairwise overlap (the number of genes that overlap in each cross-validation) of 43% was obtained by this approach when compared to that of single classifiers. The refined gene list was composed of 19 genes and ranked according to consistency in expression (up- or down-regulated) and most of them were linked either directly or indirectly to the ERK-MAPK signalling pathway, which has been shown to play a key role in the immune response to infection. Testing of the identified 12 genes on an unseen dataset yielded an average accuracy of 83%. Conclusions In conclusion, our method allowed the combination of independent classifiers and increased consistency and reliability of the generated gene signatures. Electronic supplementary material The online version of this article (doi:10.1186/s12864-017-4006-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- João Pedro Saraiva
- Network Modelling, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Beutenbergstraße 11a, Jena, Germany.,Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Marcus Oswald
- Network Modelling, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Beutenbergstraße 11a, Jena, Germany.,Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Antje Biering
- Network Modelling, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Beutenbergstraße 11a, Jena, Germany.,Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Daniela Röll
- Network Modelling, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Beutenbergstraße 11a, Jena, Germany.,Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Cora Assmann
- Septomics Research Centre, Jena University Hospital, Jena, Germany
| | - Tilman Klassert
- Septomics Research Centre, Jena University Hospital, Jena, Germany
| | - Markus Blaess
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | | | - Ralf Claus
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | | | - Hortense Slevogt
- Septomics Research Centre, Jena University Hospital, Jena, Germany
| | - Rainer König
- Network Modelling, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Beutenbergstraße 11a, Jena, Germany. .,Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.
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26
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Wurster S, Thielen V, Weis P, Walther P, Elias J, Waaga-Gasser AM, Dragan M, Dandekar T, Einsele H, Löffler J, Ullmann AJ. Mucorales spores induce a proinflammatory cytokine response in human mononuclear phagocytes and harbor no rodlet hydrophobins. Virulence 2017; 8:1708-1718. [PMID: 28783439 DOI: 10.1080/21505594.2017.1342920] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 10/19/2022] Open
Abstract
Mucormycoses are life-threatening infections in immunocompromised patients. This study characterizes the response of human mononuclear cells to different Mucorales and Ascomycota. PBMC, monocytes, and monocyte derived dendritic cells (moDCs) from healthy donors were stimulated with resting and germinated stages of Mucorales and Ascomycota. Cytokine response and expression of activation markers were studied. Both inactivated germ tubes and resting spores of Rhizopus arrhizus and other human pathogenic Mucorales species significantly stimulated mRNA synthesis and secretion of proinflammatory cytokines. Moreover, R. arrhizus spores induced the upregulation of co-stimulatory molecules on moDCs and a specific T-helper cell response. Removal of rodlet hydrophobins by hydrofluoric acid treatment of A. fumigatus conidia resulted in enhanced immunogenicity, whereas the cytokine response of PBMCs to dormant R. arrhizus spores was not influenced by hydrofluoric acid. Scanning electron micrographs of Mucorales spores did not exhibit any morphological correlates of rodlet hydrophobins. Taken together, this study revealed striking differences in the response of human mononuclear cells to resting stages of Ascomycota and Mucorales, which may be explained by absence of an immunoprotective hydrophobin layer in Mucorales spores.
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Affiliation(s)
- Sebastian Wurster
- a Department of Internal Medicine II, Infectious Diseases , University Hospital of Würzburg , Würzburg , Germany
| | - Vanessa Thielen
- a Department of Internal Medicine II, Infectious Diseases , University Hospital of Würzburg , Würzburg , Germany
| | - Philipp Weis
- a Department of Internal Medicine II, Infectious Diseases , University Hospital of Würzburg , Würzburg , Germany
| | - Paul Walther
- b Central Facility for Electron Microscopy , University of Ulm , Ulm , Germany
| | - Johannes Elias
- c Institute for Hygiene and Microbiology (IHM) , Julius Maximilians University of Würzburg , Würzburg , Germany
| | - Ana Maria Waaga-Gasser
- d Department of Surgery I, Molecular Oncology and Immunology , University Hospital of Würzburg , Würzburg , Germany
| | - Mariola Dragan
- d Department of Surgery I, Molecular Oncology and Immunology , University Hospital of Würzburg , Würzburg , Germany
| | - Thomas Dandekar
- e Department of Bioinformatics, Biocenter , University of Würzburg , Würzburg , Germany
| | - Hermann Einsele
- a Department of Internal Medicine II, Infectious Diseases , University Hospital of Würzburg , Würzburg , Germany
| | - Jürgen Löffler
- a Department of Internal Medicine II, Infectious Diseases , University Hospital of Würzburg , Würzburg , Germany
| | - Andrew J Ullmann
- a Department of Internal Medicine II, Infectious Diseases , University Hospital of Würzburg , Würzburg , Germany
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27
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Cunha C, Gonçalves SM, Duarte-Oliveira C, Leite L, Lagrou K, Marques A, Lupiañez CB, Mesquita I, Gaifem J, Barbosa AM, Pinho Vaz C, Branca R, Campilho F, Freitas F, Ligeiro D, Lass-Flörl C, Löffler J, Jurado M, Saraiva M, Kurzai O, Rodrigues F, Castro AG, Silvestre R, Sainz J, Maertens JA, Torrado E, Jacobsen ID, Lacerda JF, Campos A, Carvalho A. IL-10 overexpression predisposes to invasive aspergillosis by suppressing antifungal immunity. J Allergy Clin Immunol 2017; 140:867-870.e9. [PMID: 28389392 DOI: 10.1016/j.jaci.2017.02.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/18/2017] [Accepted: 02/15/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Cristina Cunha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Samuel M Gonçalves
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Cláudio Duarte-Oliveira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Luís Leite
- Serviço de Transplantação de Medula Óssea, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Katrien Lagrou
- Department of Microbiology and Immunology, KU Leuven-University of Leuven, Leuven, Belgium; Department of Laboratory Medicine and National Reference Center for Medical Mycology, University Hospitals Leuven, Leuven, Belgium
| | - António Marques
- Serviço de Imuno-Hemoterapia, Hospital de Braga, Braga, Portugal
| | - Carmen B Lupiañez
- Genomic Oncology Area, GENYO, Center for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain; Hematology Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - Inês Mesquita
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Joana Gaifem
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana Margarida Barbosa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Carlos Pinho Vaz
- Serviço de Transplantação de Medula Óssea, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Rosa Branca
- Serviço de Transplantação de Medula Óssea, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Fernando Campilho
- Serviço de Transplantação de Medula Óssea, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Fátima Freitas
- Instituto Português do Sangue e Transplantação, IP, Porto, Portugal
| | - Dário Ligeiro
- Instituto Português do Sangue e Transplantação, IP, Lisbon, Portugal
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Manuel Jurado
- Genomic Oncology Area, GENYO, Center for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain; Hematology Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - Margarida Saraiva
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; IBMC-Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal
| | - Oliver Kurzai
- Septomics Research Centre, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - Fernando Rodrigues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - António G Castro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ricardo Silvestre
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Juan Sainz
- Genomic Oncology Area, GENYO, Center for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain; Hematology Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - Johan A Maertens
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Egídio Torrado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ilse D Jacobsen
- Research Group Microbial Immunology, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
| | - João F Lacerda
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisbon, Portugal; Serviço de Hematologia e Transplantação de Medula, Hospital de Santa Maria, Lisbon, Portugal
| | - António Campos
- Serviço de Transplantação de Medula Óssea, Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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28
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Dix A, Czakai K, Leonhardt I, Schäferhoff K, Bonin M, Guthke R, Einsele H, Kurzai O, Löffler J, Linde J. Specific and Novel microRNAs Are Regulated as Response to Fungal Infection in Human Dendritic Cells. Front Microbiol 2017; 8:270. [PMID: 28280489 PMCID: PMC5322194 DOI: 10.3389/fmicb.2017.00270] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 11/25/2016] [Accepted: 02/08/2017] [Indexed: 11/15/2022] Open
Abstract
Within the last two decades, the incidence of invasive fungal infections has been significantly increased. They are characterized by high mortality rates and are often caused by Candida albicans and Aspergillus fumigatus. The increasing number of infections underlines the necessity for additional anti-fungal therapies, which require extended knowledge of gene regulations during fungal infection. MicroRNAs are regulators of important cellular processes, including the immune response. By analyzing their regulation and impact on target genes, novel therapeutic and diagnostic approaches may be developed. Here, we examine the role of microRNAs in human dendritic cells during fungal infection. Dendritic cells represent the bridge between the innate and the adaptive immune systems. Therefore, analysis of gene regulation of dendritic cells is of particular significance. By applying next-generation sequencing of small RNAs, we quantify microRNA expression in monocyte-derived dendritic cells after 6 and 12 h of infection with C. albicans and A. fumigatus as well as treatment with lipopolysaccharides (LPS). We identified 26 microRNAs that are differentially regulated after infection by the fungi or LPS. Three and five of them are specific for fungal infections after 6 and 12 h, respectively. We further validated interactions of miR-132-5p and miR-212-5p with immunological relevant target genes, such as FKBP1B, KLF4, and SPN, on both RNA and protein level. Our results indicate that these microRNAs fine-tune the expression of immune-related target genes during fungal infection. Beyond that, we identified previously undiscovered microRNAs. We validated three novel microRNAs via qRT-PCR. A comparison with known microRNAs revealed possible relations with the miR-378 family and miR-1260a/b for two of them, while the third one features a unique sequence with no resemblance to known microRNAs. In summary, this study analyzes the effect of known microRNAs in dendritic cells during fungal infections and proposes novel microRNAs that could be experimentally verified.
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Affiliation(s)
- Andreas Dix
- Systems Biology/Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute Jena, Germany
| | - Kristin Czakai
- Department of Internal Medicine II, University Hospital of Würzburg Würzburg, Germany
| | - Ines Leonhardt
- Septomics Research Centre, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Friedrich Schiller UniversityJena, Germany; IMGM Laboratories GmbHMartinsried, Germany
| | - Karin Schäferhoff
- Institute of Medical Genetics and Applied Genomics, University of Tübingen Tübingen, Germany
| | | | - Reinhard Guthke
- Systems Biology/Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute Jena, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital of Würzburg Würzburg, Germany
| | - Oliver Kurzai
- Septomics Research Centre, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Friedrich Schiller UniversityJena, Germany; Center for Sepsis Control and Care, University HospitalJena, Germany; Institute for Microbiology, University of WuerzburgWuerzburg, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital of Würzburg Würzburg, Germany
| | - Jörg Linde
- Systems Biology/Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute Jena, Germany
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29
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Abstract
PCR-based detection of fungal pathogens offers a sensitive and specific tool for the diagnosis of invasive fungal infections. A large variety of different clinical specimen types can be used as original material. However, certain precautions, in addition to the published MIQE guidelines [1], need to be taken to prevent contaminations from airborne fungal spores and PCR reagents. In addition, the European Aspergillus PCR Initiative (EAPCRI) recently defined standards for Aspergillus PCR [2, 3], following these recommendations leads to superior sensitivity. The combination of fungal PCR with the galactomannan ELISA assay increases the sensitivity for the detection of Aspergillus DNA from blood, compared to a single assay only [4, 5].
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Affiliation(s)
- Jan Springer
- Medizinische Klinik II, Universitätklinikum Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany
| | - Jürgen Löffler
- Medizinische Klinik II, Universitätklinikum Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany.
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30
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Czakai K, Dittrich M, Kaltdorf M, Müller T, Krappmann S, Schedler A, Bonin M, Dühring S, Schuster S, Speth C, Rambach G, Einsele H, Dandekar T, Löffler J. Influence of Platelet-rich Plasma on the immune response of human monocyte-derived dendritic cells and macrophages stimulated with Aspergillus fumigatus. Int J Med Microbiol 2016; 307:95-107. [PMID: 27965080 DOI: 10.1016/j.ijmm.2016.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 08/02/2016] [Revised: 11/22/2016] [Accepted: 11/27/2016] [Indexed: 12/19/2022] Open
Abstract
Dendritic cells (DCs) and macrophages (MΦ) are critical for protection against pathogenic fungi including Aspergillus fumigatus. To analyze the role of platelets in the innate immune response, human DCs and MΦs were challenged with A. fumigatus in presence or absence of human platelet rich plasma (PRP). Gene expression analyses and functional investigations were performed. A systems biological approach was used for initial modelling of the DC - A. fumigatus interaction. DCs in a quiescent state together with different corresponding activation states were validated using gene expression data from DCs and MΦ stimulated with A. fumigatus. To characterize the influence of platelets on the immune response of DCs and MΦ to A. fumigatus, we experimentally quantified their cytokine secretion, phagocytic capacity, maturation, and metabolic activity with or without platelets. PRP in combination with A. fumigatus treatment resulted in the highest expression of the maturation markers CD80, CD83 and CD86 in DCs. Furthermore, PRP enhanced the capacity of macrophages and DCs to phagocytose A. fumigatus conidia. In parallel, PRP in combination with the innate immune cells significantly reduced the metabolic activity of the fungus. Interestingly, A. fumigatus and PRP stimulated MΦ showed a significantly reduced gene expression and secretion of IL6 while PRP only reduced the IL-6 secretion of A. fumigatus stimulated DCs. The in silico systems biological model correlated well with these experimental data. Different modules centrally involved in DC function became clearly apparent, including DC maturation, cytokine response and apoptosis pathways. Taken together, the ability of PRP to suppress IL-6 release of human DCs might prevent local excessive inflammatory hemorrhage, tissue infarction and necrosis in the human lung.
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Affiliation(s)
- Kristin Czakai
- Department of Internal Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Marcus Dittrich
- Department of Bioinformatics, Biocenter, University of Würzburg, Am Hubland, Würzburg, Germany
| | - Martin Kaltdorf
- Department of Bioinformatics, Biocenter, University of Würzburg, Am Hubland, Würzburg, Germany
| | - Tobias Müller
- Department of Bioinformatics, Biocenter, University of Würzburg, Am Hubland, Würzburg, Germany
| | - Sven Krappmann
- Microbiology Institute-Clinical Microbiology, Immunology and Hygiene, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Anette Schedler
- Department of Internal Medicine, University Hospital of Würzburg, Würzburg, Germany
| | | | - Sybille Dühring
- Deparment of Bioinformatics, Friedrich-Schiller-University Jena, Jena, Germany
| | - Stefan Schuster
- Deparment of Bioinformatics, Friedrich-Schiller-University Jena, Jena, Germany
| | - Cornelia Speth
- Hygiene und Medizinische Mikrobiologie, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Günter Rambach
- Hygiene und Medizinische Mikrobiologie, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Hermann Einsele
- Department of Internal Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Thomas Dandekar
- Department of Bioinformatics, Biocenter, University of Würzburg, Am Hubland, Würzburg, Germany
| | - Jürgen Löffler
- Department of Internal Medicine, University Hospital of Würzburg, Würzburg, Germany.
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31
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Zimmermann J, Kühl AA, Weber M, Grün JR, Löffler J, Haftmann C, Riedel R, Maschmeyer P, Lehmann K, Westendorf K, Mashreghi MF, Löhning M, Mack M, Radbruch A, Chang HD. T-bet expression by Th cells promotes type 1 inflammation but is dispensable for colitis. Mucosal Immunol 2016; 9:1487-1499. [PMID: 26883725 DOI: 10.1038/mi.2016.5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/03/2016] [Indexed: 02/04/2023]
Abstract
The transcription factor T-bet is highly expressed by Th cells isolated from the inflamed intestine of Crohn's disease patients, and has been regarded a critical driver of murine T cell-induced colitis. However, we show here that T-bet expression by Th cells is not required for the manifestation of T-cell-induced colitis in the presence of segmented filamentous bacteria and Helicobacter hepaticus. T-bet expression by Th cells controls their survival and localization, their repertoire of chemokine and chemokine receptor expression, the accumulation of monocytes and macrophages in the inflamed colon, and their differentiation to the M1 type, i.e., type 1 inflammation. Nevertheless, T-bet-deficient Th cells efficiently induce colitis, as reflected by weight loss, diarrhea, and colon histopathology. T-bet-deficient Th cells differentiate into Th1/17 cells, able to express IFN-γ and IL-17A upon restimulation. While neutralization of IL-17A exacerbated colitis induced by wild-type or T-bet-deficient Th cells, neutralization of IFN-γ completely abolished colitis.
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Affiliation(s)
- J Zimmermann
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - A A Kühl
- Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany
| | - M Weber
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - J R Grün
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - J Löffler
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - C Haftmann
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - R Riedel
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - P Maschmeyer
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - K Lehmann
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - K Westendorf
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - M-F Mashreghi
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - M Löhning
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - M Mack
- Universitätsklinikum Regensburg, Regensburg, Germany
| | - A Radbruch
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
| | - H D Chang
- Deutsches Rheumaforschungszentrum Berlin (DRFZ), an Institute of the Leibniz Association, Berlin, Germany
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32
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Abstract
The outcome after allogeneic haematopoietic stem cell transplantation (allo-HSCT) has significantly improved during the last decades. However, opportunistic infections such as viral and mold infections are still a major obstacle for cure. Within this field, adoptive T cell therapy against pathogens is a promising treatment approach. Recently, the techniques to develop T cell products including pathogen-specific T cells have been sophisticated and are now available in accordance to good manufacturing practice (GMP). Here, we aim to summarize current knowledge about adoptive T cell therapy against viral and mold infections.
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Affiliation(s)
- Shigeo Fuji
- a Department of Haematopoietic Stem Cell Transplantation , National Cancer Center Hospital , Tokyo , Japan.,b Department of Internal Medicine II , Division of Hematology/Oncology, University Hospital of Würzburg , Würzburg , Germany
| | - Jürgen Löffler
- b Department of Internal Medicine II , Division of Hematology/Oncology, University Hospital of Würzburg , Würzburg , Germany
| | - Hermann Einsele
- b Department of Internal Medicine II , Division of Hematology/Oncology, University Hospital of Würzburg , Würzburg , Germany
| | - Markus Kapp
- b Department of Internal Medicine II , Division of Hematology/Oncology, University Hospital of Würzburg , Würzburg , Germany
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33
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Affiliation(s)
- R. Pape
- Department of GeographyUniversity of Bonn Meckenheimer Allee 166 D‐53115 Bonn Germany
| | - J. Löffler
- Department of GeographyUniversity of Bonn Meckenheimer Allee 166 D‐53115 Bonn Germany
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34
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Hellwig D, Voigt J, Bouzani M, Löffler J, Albrecht-Eckardt D, Weber M, Brunke S, Martin R, Kurzai O, Hünniger K. Candida albicans Induces Metabolic Reprogramming in Human NK Cells and Responds to Perforin with a Zinc Depletion Response. Front Microbiol 2016; 7:750. [PMID: 27242763 PMCID: PMC4872603 DOI: 10.3389/fmicb.2016.00750] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 12/10/2015] [Accepted: 05/03/2016] [Indexed: 12/27/2022] Open
Abstract
As part of the innate immune system, natural killer (NK) cells are directly involved in the response to fungal infections. Perforin has been identified as the major effector molecule acting against many fungal pathogens. While several studies have shown that perforin mediated fungicidal effects can contribute to fungal clearance, neither the activation of NK cells by fungal pathogens nor the effects of perforin on fungal cells are well-understood. In a dual approach, we have studied the global gene expression pattern of primary and cytokine activated NK cells after co-incubation with Candida albicans and the transcriptomic adaptation of C. albicans to perforin exposure. NK cells responded to the fungal pathogen with an up-regulation of genes involved in immune signaling and release of cytokines. Furthermore, we observed a pronounced increase of genes involved in glycolysis and glycolysis inhibitor 2-deoxy-D-glucose impaired C. albicans induced NK cell activation. This strongly indicates that metabolic adaptation is a major part of the NK cell response to C. albicans infections. In the fungal pathogen, perforin induced a strong up-regulation of several fungal genes involved in the zinc depletion response, such as PRA1 and ZRT1. These data suggest that fungal zinc homeostasis is linked to the reaction to perforin secreted by NK cells. However, deletion mutants in PRA1 and ZRT1 did not show altered susceptibility to perforin.
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Affiliation(s)
- Daniela Hellwig
- Septomics Research Center, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute and Friedrich Schiller University Jena, Germany
| | - Jessica Voigt
- Septomics Research Center, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute and Friedrich Schiller University Jena, Germany
| | - Maria Bouzani
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg Würzburg, Germany
| | - Jürgen Löffler
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg Würzburg, Germany
| | | | - Michael Weber
- Septomics Research Center, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute and Friedrich Schiller University Jena, Germany
| | - Sascha Brunke
- Department Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute Jena, Germany
| | - Ronny Martin
- Septomics Research Center, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute and Friedrich Schiller University Jena, Germany
| | - Oliver Kurzai
- Septomics Research Center, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute and Friedrich Schiller University Jena, Germany
| | - Kerstin Hünniger
- Septomics Research Center, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute and Friedrich Schiller University Jena, Germany
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Dix A, Czakai K, Springer J, Fliesser M, Bonin M, Guthke R, Schmitt AL, Einsele H, Linde J, Löffler J. Genome-Wide Expression Profiling Reveals S100B as Biomarker for Invasive Aspergillosis. Front Microbiol 2016; 7:320. [PMID: 27047454 PMCID: PMC4800190 DOI: 10.3389/fmicb.2016.00320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 12/22/2015] [Accepted: 02/29/2016] [Indexed: 12/26/2022] Open
Abstract
Invasive aspergillosis (IA) is a devastating opportunistic infection and its treatment constitutes a considerable burden for the health care system. Immunocompromised patients are at an increased risk for IA, which is mainly caused by the species Aspergillus fumigatus. An early and reliable diagnosis is required to initiate the appropriate antifungal therapy. However, diagnostic sensitivity and accuracy still needs to be improved, which can be achieved at least partly by the definition of new biomarkers. Besides the direct detection of the pathogen by the current diagnostic methods, the analysis of the host response is a promising strategy toward this aim. Following this approach, we sought to identify new biomarkers for IA. For this purpose, we analyzed gene expression profiles of hematological patients and compared profiles of patients suffering from IA with non-IA patients. Based on microarray data, we applied a comprehensive feature selection using a random forest classifier. We identified the transcript coding for the S100 calcium-binding protein B (S100B) as a potential new biomarker for the diagnosis of IA. Considering the expression of this gene, we were able to classify samples from patients with IA with 82.3% sensitivity and 74.6% specificity. Moreover, we validated the expression of S100B in a real-time reverse transcription polymerase chain reaction (RT-PCR) assay and we also found a down-regulation of S100B in A. fumigatus stimulated DCs. An influence on the IL1B and CXCL1 downstream levels was demonstrated by this S100B knockdown. In conclusion, this study covers an effective feature selection revealing a key regulator of the human immune response during IA. S100B may represent an additional diagnostic marker that in combination with the established techniques may improve the accuracy of IA diagnosis.
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Affiliation(s)
- Andreas Dix
- Systems Biology / Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology Hans-Knöll-Institute Jena, Germany
| | - Kristin Czakai
- University Hospital Würzburg, Medical Hospital II Würzburg, Germany
| | - Jan Springer
- University Hospital Würzburg, Medical Hospital II Würzburg, Germany
| | - Mirjam Fliesser
- University Hospital Würzburg, Medical Hospital II Würzburg, Germany
| | - Michael Bonin
- IMGM Laboratories Martinsried, Germany (Formerly Department of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany)
| | - Reinhard Guthke
- Systems Biology / Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology Hans-Knöll-Institute Jena, Germany
| | - Anna L Schmitt
- University Hospital Würzburg, Medical Hospital II Würzburg, Germany
| | - Hermann Einsele
- University Hospital Würzburg, Medical Hospital II Würzburg, Germany
| | - Jörg Linde
- Systems Biology / Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology Hans-Knöll-Institute Jena, Germany
| | - Jürgen Löffler
- University Hospital Würzburg, Medical Hospital II Würzburg, Germany
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Teutschbein J, Simon S, Lother J, Springer J, Hortschansky P, Morton CO, Löffler J, Einsele H, Conneally E, Rogers TR, Guthke R, Brakhage AA, Kniemeyer O. Proteomic Profiling of Serological Responses to Aspergillus fumigatus Antigens in Patients with Invasive Aspergillosis. J Proteome Res 2016; 15:1580-91. [PMID: 26974881 DOI: 10.1021/acs.jproteome.6b00042] [Citation(s) in RCA: 12] [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] [Indexed: 02/04/2023]
Abstract
Aspergillus fumigatus is the species that most commonly causes the opportunistic infection invasive aspergillosis (IA) in patients being treated for hematological malignancies. Little is known about the A. fumigatus proteins that trigger the production of Aspergillus-specific IgG antibodies during the course of IA. To characterize the serological response to A. fumigatus protein antigens, mycelial proteins were separated by 2-D gel electrophoresis. The gels were immunoblotted with sera from patients with probable and proven IA and control patients without IA. We identified 49 different fungal proteins, which gave a positive IgG antibody signal. Most of these antigens play a role in primary metabolism and stress responses. Overall, our analysis identified 18 novel protein antigens from A. fumigatus. To determine whether these antigens can be used as diagnostic or prognostic markers or exhibit a protective activity, we employed supervised machine learning with decision trees. We identified two candidates for further analysis, the protein antigens CpcB and Shm2. Heterologously produced Shm2 induced a strongly proinflammatory response in human peripheral blood mononuclear cells after in vitro stimulation. In contrast, CpcB did not activate the immune response of PBMCs. These findings could serve as the basis for the development of an immunotherapy of IA.
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Affiliation(s)
- Janka Teutschbein
- Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute (HKI) , 07745 Jena, Germany.,Institute of Microbiology, Friedrich Schiller University , 07743 Jena, Germany
| | - Svenja Simon
- Research Group Systems Biology/Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute (HKI) , 07745 Jena, Germany
| | - Jasmin Lother
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg , 97080 Würzburg, Germany
| | - Jan Springer
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg , 97080 Würzburg, Germany
| | - Peter Hortschansky
- Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute (HKI) , 07745 Jena, Germany.,Institute of Microbiology, Friedrich Schiller University , 07743 Jena, Germany
| | - C Oliver Morton
- Department of Clinical Microbiology, Trinity College Dublin , Dublin 2, Ireland
| | - Jürgen Löffler
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg , 97080 Würzburg, Germany
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg , 97080 Würzburg, Germany
| | | | - Thomas R Rogers
- Department of Clinical Microbiology, Trinity College Dublin , Dublin 2, Ireland.,Department of Haematology, St. James's Hospital , Dublin 8, Ireland
| | - Reinhard Guthke
- Research Group Systems Biology/Bioinformatics, Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute (HKI) , 07745 Jena, Germany
| | - Axel A Brakhage
- Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute (HKI) , 07745 Jena, Germany.,Institute of Microbiology, Friedrich Schiller University , 07743 Jena, Germany
| | - Olaf Kniemeyer
- Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute (HKI) , 07745 Jena, Germany.,Institute of Microbiology, Friedrich Schiller University , 07743 Jena, Germany.,Integrated Research and Treatment Center, Center for Sepsis Control and Care Jena (CSCC), University Hospital , 07747 Jena, Germany
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Fliesser M, Wallstein M, Kurzai O, Einsele H, Löffler J. Hypoxia attenuates anti-Aspergillus fumigatusimmune responses initiated by human dendritic cells. Mycoses 2016; 59:503-8. [DOI: 10.1111/myc.12498] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/25/2016] [Accepted: 02/25/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Mirjam Fliesser
- Medical Clinic and Polyclinic II; University Hospital; Wuerzburg Germany
| | - Marion Wallstein
- Medical Clinic and Polyclinic II; University Hospital; Wuerzburg Germany
| | - Oliver Kurzai
- Septomics Research Centre; Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute; Jena Germany
| | - Hermann Einsele
- Medical Clinic and Polyclinic II; University Hospital; Wuerzburg Germany
| | - Jürgen Löffler
- Medical Clinic and Polyclinic II; University Hospital; Wuerzburg Germany
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Springer J, Goldenberger D, Schmidt F, Weisser M, Wehrle-Wieland E, Einsele H, Frei R, Löffler J. Development and application of two independent real-time PCR assays to detect clinically relevant Mucorales species. J Med Microbiol 2016; 65:227-234. [PMID: 26743820 DOI: 10.1099/jmm.0.000218] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PCR-based detection of Mucorales species could improve diagnosis of suspected invasive fungal infection, leading to a better patient outcome. This study describes two independent probe-based real-time PCR tests for detection of clinically relevant Mucorales, targeting specific fragments of the 18S and the 28S rRNA genes. Both assays have a short turnaround time, allow fast, specific and very sensitive detection of clinically relevant Mucorales and have the potential to be used as quantitative tests. They were validated on various clinical samples (fresh and formalin-fixed paraffin-embedded specimens, mainly biopsies, n = 17). The assays should be used as add-on tools to complement standard techniques; a combined approach of both real-time PCR assays has 100 % sensitivity. Genus identification by subsequent sequencing is possible for amplicons of the 18S PCR assay. In conclusion, combination of the two independent Mucorales assays described in this study, 18S and 28S, detected all clinical samples associated with proven Mucorales infection (n = 10). Reliable and specific identification of Mucorales is a prerequisite for successful antifungal therapy as these fungi show intrinsic resistance to voriconazole and caspofungin.
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Affiliation(s)
- Jan Springer
- Department for Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Daniel Goldenberger
- Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - Friderike Schmidt
- Department for Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Maja Weisser
- Clinic of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Elisabeth Wehrle-Wieland
- Clinic of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Hermann Einsele
- Department for Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
| | - Reno Frei
- Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - Jürgen Löffler
- Department for Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany
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Springer J, Lackner M, Nachbaur D, Girschikofsky M, Risslegger B, Mutschlechner W, Fritz J, Heinz W, Einsele H, Ullmann A, Löffler J, Lass-Flörl C. Prospective multicentre PCR-based Aspergillus DNA screening in high-risk patients with and without primary antifungal mould prophylaxis. Clin Microbiol Infect 2016; 22:80-86. [DOI: 10.1016/j.cmi.2015.09.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/13/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022]
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Lacour JP, Khemis A, Paul C, Ruer-Mulard M, Reguiai Z, Beylot-Barry M, Richard MA, Blauvelt A, Szepietowski J, Sirgurgeirsson B, Langley R, Tyring S, Messina I, Löffler J, Fox T, Papavassilis C, Martin L, Pinton P. Maintien de l’efficacité du sécukinumab dans le psoriasis en plaques modéré à sévère au cours de la seconde année de traitement : phase d’extension randomisée des études ERASURE et FIXTURE. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.144] [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: 11/29/2022]
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Pape R, Löffler J. Seasonality of habitat selection shown to buffer alpine reindeer pastoralism against climate variability. Ecosphere 2015. [DOI: 10.1890/es15-00169.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Fliesser M, Morton CO, Bonin M, Ebel F, Hünniger K, Kurzai O, Einsele H, Löffler J. Hypoxia-inducible factor 1α modulates metabolic activity and cytokine release in anti-Aspergillus fumigatus immune responses initiated by human dendritic cells. Int J Med Microbiol 2015; 305:865-73. [PMID: 26387061 DOI: 10.1016/j.ijmm.2015.08.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 06/30/2015] [Revised: 08/17/2015] [Accepted: 08/27/2015] [Indexed: 12/31/2022] Open
Abstract
The mold Aspergillus fumigatus causes life-threatening infections in immunocompromised patients. Over the past decade, new findings in research have improved our understanding of A. fumigatus-host interactions, including the recent identification of myeloid-expressed hypoxia-inducible factor 1α (HIF-1α) as a relevant immune-modulating transcription factor and potential therapeutic target in anti-fungal defense. However, the function of HIF-1α signaling for human anti-A. fumigatus immunity is still poorly understood, including its role in dendritic cells (DCs), which are important regulators of anti-fungal immunity. This study investigated the functional relevance of HIF-1α in the anti-A. fumigatus immune response initiated by human DCs. Hypoxic cell culture conditions were included because hypoxic microenvironments occur during A. fumigatus infections and may influence the host immune response. HIF-1α was stabilized in DCs following stimulation with A. fumigatus under normoxic and hypoxic conditions. This stabilization was partially dependent on dectin-1, the major receptor for A. fumigatus on human DCs. Using siRNA-based HIF-1α silencing combined with genome-wide transcriptional analysis, a modulatory effect of HIF-1α on the anti-fungal immune response of human DCs was identified. Specifically, the difference in the transcriptomes of HIF-1α silenced and non-silenced DCs indicated that HIF-1α contributes to DC metabolism and cytokine release in response to A. fumigatus under normoxic as well as hypoxic conditions. This was confirmed by further down-stream analyses that included metabolite analysis and cytokine profiling of a time-course infection experiment. Thereby, this study revealed a so far undescribed functional relevance of HIF-1α in human DC responses against A. fumigatus.
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Affiliation(s)
- Mirjam Fliesser
- Medical Clinic and Polyclinic II, University Hospital, 97080 Wuerzburg, Germany
| | - Charles Oliver Morton
- University of Western Sydney, School of Science and Health, Campbelltown, NSW 2560, Australia
| | - Michael Bonin
- Microarray Facility, University Hospital, 72076 Tuebingen, Germany
| | - Frank Ebel
- Institute for Infectious Diseases and Zoonoses, Ludwigs Maximilians University, 80336 Munich, Germany
| | - Kerstin Hünniger
- Septomics Research Centre, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, 07745 Jena, Germany
| | - Oliver Kurzai
- Septomics Research Centre, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, 07745 Jena, Germany
| | - Hermann Einsele
- Medical Clinic and Polyclinic II, University Hospital, 97080 Wuerzburg, Germany
| | - Jürgen Löffler
- Medical Clinic and Polyclinic II, University Hospital, 97080 Wuerzburg, Germany.
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White PL, Wingard JR, Bretagne S, Löffler J, Patterson TF, Slavin MA, Barnes RA, Pappas PG, Donnelly JP. Aspergillus Polymerase Chain Reaction: Systematic Review of Evidence for Clinical Use in Comparison With Antigen Testing. Clin Infect Dis 2015; 61:1293-303. [PMID: 26113653 PMCID: PMC4583581 DOI: 10.1093/cid/civ507] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [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: 03/17/2015] [Accepted: 06/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Aspergillus polymerase chain reaction (PCR) was excluded from the European Organisation for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) definitions of invasive fungal disease because of limited standardization and validation. The definitions are being revised. METHODS A systematic literature review was performed to identify analytical and clinical information available on inclusion of galactomannan enzyme immunoassay (GM-EIA) (2002) and β-d-glucan (2008), providing a minimal threshold when considering PCR. Categorical parameters and statistical performance were compared. RESULTS When incorporated, GM-EIA and β-d-glucan sensitivities and specificities for diagnosing invasive aspergillosis were 81.6% and 91.6%, and 76.9% and 89.4%, respectively. Aspergillus PCR has similar sensitivity and specificity (76.8%-88.0% and 75.0%-94.5%, respectively) and comparable utility. Methodological recommendations and commercial PCR assays assist standardization. Although all tests have limitations, currently, PCR is the only test with independent quality control. CONCLUSIONS We propose that there is sufficient evidence that is at least equivalent to that used to include GM-EIA and β-d-glucan testing, and that PCR is now mature enough for inclusion in the EORTC/MSG definitions.
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Affiliation(s)
- P Lewis White
- Public Health Wales, Microbiology Cardiff, United Kingdom
| | | | | | | | - Thomas F Patterson
- University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio
| | - Monica A Slavin
- Peter MacCallum Cancer Centre, University of Melbourne, Australia
| | - Rosemary A Barnes
- Infection, Immunity and Biochemistry, Cardiff University, United Kingdom
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Rambach G, Blum G, Latgé JP, Fontaine T, Heinekamp T, Hagleitner M, Jeckström H, Weigel G, Würtinger P, Pfaller K, Krappmann S, Löffler J, Lass-Flörl C, Speth C. Identification of Aspergillus fumigatus Surface Components That Mediate Interaction of Conidia and Hyphae With Human Platelets. J Infect Dis 2015; 212:1140-9. [PMID: 25810442 DOI: 10.1093/infdis/jiv191] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 12/01/2014] [Accepted: 03/06/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Platelets were recently identified as a part of innate immunity. They are activated by contact with Aspergillus fumigatus; putative consequences include antifungal defense but also thrombosis, excessive inflammation, and thrombocytopenia. We aimed to identify those fungal surface structures that mediate interaction with platelets. METHODS Human platelets were incubated with Aspergillus conidia and hyphae, isolated wall components, or fungal surface mutants. Interaction was visualized microscopically; activation was quantified by flow cytometry of specific markers. RESULTS The capacity of A. fumigatus conidia to activate platelets is at least partly due to melanin, because this effect can be mimicked with "melanin ghosts"; a mutant lacking melanin showed reduced platelet stimulating potency. In contrast, conidial hydrophobin masks relevant structures, because an A. fumigatus mutant lacking the hydrophobin protein induced stronger platelet activation than wild-type conidia. A. fumigatus hyphae also contain surface structures that interact with platelets. Wall proteins, galactomannan, chitin, and β-glucan are not the relevant hyphal components; instead, the recently identified fungal polysaccharide galactosaminogalactan potently triggered platelet activation. CONCLUSIONS Conidial melanin and hydrophobin as well as hyphal galactosaminogalactan represent important pathogenicity factors that modulate platelet activity and thus might influence immune responses, inflammation, and thrombosis in infected patients.
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Affiliation(s)
| | | | - Jean-Paul Latgé
- Unité des Aspergillus and Unité de Chimie et Biocatalyse, Institut Pasteur, Paris, France
| | - Thierry Fontaine
- Unité des Aspergillus and Unité de Chimie et Biocatalyse, Institut Pasteur, Paris, France
| | - Thorsten Heinekamp
- Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Jena
| | | | | | - Günter Weigel
- Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck, Austria
| | - Philipp Würtinger
- Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck, Austria
| | - Kristian Pfaller
- Division of Histology and Embryology, Medical University of Innsbruck
| | | | - Jürgen Löffler
- Medical Hospital II, University Hospital Würzburg, Germany
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Hünniger K, Bieber K, Martin R, Lehnert T, Figge MT, Löffler J, Guo RF, Riedemann NC, Kurzai O. A second stimulus required for enhanced antifungal activity of human neutrophils in blood is provided by anaphylatoxin C5a. J Immunol 2014; 194:1199-210. [PMID: 25539819 DOI: 10.4049/jimmunol.1401845] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Polymorphonuclear neutrophilic granulocytes (PMN) as cellular components of innate immunity play a crucial role in the defense against systemic Candida albicans infection. To analyze stimuli that are required for PMN activity during C. albicans infection in a situation similar to in vivo, we used a human whole-blood infection model. In this model, PMN activation 10 min after C. albicans infection was largely dependent on the anaphylatoxin C5a. Most importantly, C5a enabled blood PMN to overcome filament-restricted recognition of C. albicans and allowed efficient elimination of nonfilamentous C. albicans cph1Δ/efg1Δ from blood. Major PMN effector mechanisms, including oxidative burst, release of secondary granule contents and initial fungal phagocytosis could be prevented by blocking C5a receptor signaling. Identical effects were achieved using a humanized Ab specifically targeting human C5a. Phagocytosis of C. albicans 10 min postinfection was mediated by C5a-dependent enhancement of CD11b surface expression on PMN, thus establishing the C5a-C5aR-CD11b axis as a major modulator of early anti-Candida immune responses in human blood. In contrast, phagocytosis of C. albicans by PMN 60 min postinfection occurred almost independently of C5a and mainly contributed to activation of phagocytically active PMN at later time points. Our results show that C5a is a critical mediator in human blood during C. albicans infection.
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Affiliation(s)
- Kerstin Hünniger
- Septomics Research Center, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, 07745 Jena, Germany
| | - Kristin Bieber
- Septomics Research Center, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, 07745 Jena, Germany
| | - Ronny Martin
- Septomics Research Center, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, 07745 Jena, Germany
| | - Teresa Lehnert
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, 07745 Jena, Germany; Friedrich Schiller University Jena, 07743 Jena, Germany
| | - Marc Thilo Figge
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, 07745 Jena, Germany; Friedrich Schiller University Jena, 07743 Jena, Germany
| | - Jürgen Löffler
- Department of Internal Medicine II, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | | | - Niels C Riedemann
- InflaRx GmbH, 07745 Jena, Germany; Department of Anesthesiology and Intensive Care Therapy, Jena University Hospital, 07747 Jena, Germany; Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany; and
| | - Oliver Kurzai
- Septomics Research Center, Friedrich Schiller University and Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, 07745 Jena, Germany; Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany; and German National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, 07745 Jena, Germany
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Cunha C, Kurzai O, Löffler J, Aversa F, Romani L, Carvalho A. Neutrophil responses to aspergillosis: new roles for old players. Mycopathologia 2014; 178:387-93. [PMID: 25106756 DOI: 10.1007/s11046-014-9796-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 05/06/2014] [Accepted: 07/31/2014] [Indexed: 11/26/2022]
Abstract
Neutrophils are professional phagocytic cells that play a crucial role in innate immunity. Through an assortment of antifungal effector mechanisms, neutrophils are essential in controlling the early stages of fungal infection. These mechanisms range from the production of reactive oxygen intermediates and release of antimicrobial enzymes to the formation of complex extracellular traps that aid in the elimination of the fungus. Their importance in antifungal immunity is supported by the extreme susceptibility to infection of patients with primary (e.g., chronic granulomatous disease) or acquired (e.g., undergoing immunosuppressive therapy) neutrophil deficiency. More recently, common genetic variants affecting neutrophil antifungal capacity have also been disclosed as major risk factors for aspergillosis in conditions of generalized immune deficiency. The present review revisits the role of neutrophils in the host response against Aspergillus and highlights the consequences of their deficiency in susceptibility to aspergillosis.
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Affiliation(s)
- Cristina Cunha
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal
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Das Gupta M, Fliesser M, Springer J, Breitschopf T, Schlossnagel H, Schmitt AL, Kurzai O, Hünniger K, Einsele H, Löffler J. Aspergillus fumigatus induces microRNA-132 in human monocytes and dendritic cells. Int J Med Microbiol 2014; 304:592-6. [DOI: 10.1016/j.ijmm.2014.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/10/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022] Open
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Abstract
The reaction of tris(2,4-pentanedionato)europium(III) with a porphyrin H2(P)** in boiling 1,2,4-trichlorobenzene affords a so-called “redox mixture” of europium(III) bisporphyrinates, i. e. porphyrin π-radicals of the type Eu(P)2 and sandwiches EuH(P)2 in which one of the porphyrin rings is protonated. Thus, from either tetraphenylporphyrin or its dilithium derivative, or octaethylporphyrin, or a mixture of both porphyrins, the corresponding mixtures of double-deckers with two identical or two differnt porphyrin rings are obtained. The transformation of the redox mixtures into the pure tetraphenylporphyrin derivatives Eu(TPP)2, EuH(TPP)2, and the salt [NBu4] [Eu(TPP),, the separation of the octaethylporphyrin derivatives Eu(OEP)2 and EuH(OEP)2, and the purification of the “mixed” double-decker Eu(OEP)-(TPP) are described. The compounds are characterized by cyclic voltammetry, IR, UV/VIS/NIR, 1H NMR, and mass spectra. The obtained data indicate that the π-electrons of the two porphyrin rings behave as a common electronic system in which a defect electron is delocalized. However, in the “mixed” double-decker Eu(OEP) (TPP) the defect electron is more concentrated on the OEP ring, i. e. the porphyrin ring which is more easily oxidized.
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Affiliation(s)
- Johann W. Buchler
- Institut für Anorganische Chemie, Technische Hochschule Darmstadt, Hochschulstraße 10, D-6100 Darmstadt
| | - Jürgen Löffler
- Institut für Anorganische Chemie, Technische Hochschule Darmstadt, Hochschulstraße 10, D-6100 Darmstadt
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49
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Cunha C, Aversa F, Lacerda JF, Busca A, Kurzai O, Grube M, Löffler J, Maertens JA, Bell AS, Inforzato A, Barbati E, Almeida B, Santos e Sousa P, Barbui A, Potenza L, Caira M, Rodrigues F, Salvatori G, Pagano L, Luppi M, Mantovani A, Velardi A, Romani L, Carvalho A. Genetic PTX3 deficiency and aspergillosis in stem-cell transplantation. N Engl J Med 2014; 370:421-32. [PMID: 24476432 DOI: 10.1056/nejmoa1211161] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The soluble pattern-recognition receptor known as long pentraxin 3 (PTX3) has a nonredundant role in antifungal immunity. The contribution of single-nucleotide polymorphisms (SNPs) in PTX3 to the development of invasive aspergillosis is unknown. METHODS We screened an initial cohort of 268 patients undergoing hematopoietic stem-cell transplantation (HSCT) and their donors for PTX3 SNPs modifying the risk of invasive aspergillosis. The analysis was also performed in a multicenter study involving 107 patients with invasive aspergillosis and 223 matched controls. The functional consequences of PTX3 SNPs were investigated in vitro and in lung specimens from transplant recipients. RESULTS Receipt of a transplant from a donor with a homozygous haplotype (h2/h2) in PTX3 was associated with an increased risk of infection, in both the discovery study (cumulative incidence, 37% vs. 15%; adjusted hazard ratio, 3.08; P=0.003) and the confirmation study (adjusted odds ratio, 2.78; P=0.03), as well as with defective expression of PTX3. Functionally, PTX3 deficiency in h2/h2 neutrophils, presumably due to messenger RNA instability, led to impaired phagocytosis and clearance of the fungus. CONCLUSIONS Genetic deficiency of PTX3 affects the antifungal capacity of neutrophils and may contribute to the risk of invasive aspergillosis in patients treated with HSCT. (Funded by the European Society of Clinical Microbiology and Infectious Diseases and others.).
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50
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Abstract
Platelets have been shown to cover a broad range of functions. Besides their role in hemostasis, they have immunological functions and thus participate in the interaction between pathogens and host defense. Platelets have a broad repertoire of receptor molecules that enable them to sense invading pathogens and infection-induced inflammation. Consequently, platelets exert antimicrobial effector mechanisms, but also initiate an intense crosstalk with other arms of the innate and adaptive immunity, including neutrophils, monocytes/macrophages, dendritic cells, B cells and T cells. There is a fragile balance between beneficial antimicrobial effects and detrimental reactions that contribute to the pathogenesis, and many pathogens have developed mechanisms to influence these two outcomes. This review aims to highlight aspects of the interaction strategies between platelets and pathogenic bacteria, viruses, fungi and parasites, in addition to the subsequent networking between platelets and other immune cells, and the relevance of these processes for the pathogenesis of infections.
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Affiliation(s)
- Cornelia Speth
- Division of Hygiene & Medical Microbiology, Innsbruck Medical University Fritz-Pregl-Straße 3, A-6020 Innsbruck, Austria
| | - Jürgen Löffler
- Laboratory of Innate Immunity, Infection, Inflammation, University Hospital Würzburg, Würzburg, Germany
| | - Sven Krappmann
- Microbiology Institute – Clinical Microbiology, Immunology & Hygiene, University Hospital of Erlangen & Friedrich-Alexander-University Erlangen-Nürnberg, Germany
| | - Cornelia Lass-Flörl
- Division of Hygiene & Medical Microbiology, Innsbruck Medical University Fritz-Pregl-Straße 3, A-6020 Innsbruck, Austria
| | - Günter Rambach
- Division of Hygiene & Medical Microbiology, Innsbruck Medical University Fritz-Pregl-Straße 3, A-6020 Innsbruck, Austria
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