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Rath A, Kieninger B, Fritsch J, Caplunik-Pratsch A, Blaas S, Ochmann M, Pfeifer M, Hartl J, Holzmann T, Schneider-Brachert W. Whole-genome sequencing reveals two prolonged simultaneous outbreaks involving Pseudomonas aeruginosa high-risk strains ST111 and ST235 with resistance to quaternary ammonium compounds. J Hosp Infect 2024; 145:155-164. [PMID: 38286239 DOI: 10.1016/j.jhin.2024.01.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Water-bearing systems are known as frequent Pseudomonas aeruginosa (PA) outbreak sources. However, many older buildings continue to have sanitary facilities in high-risk departments such as the ICU. We present two simultaneous prolonged multi-drug-resistant (MDR) PA outbreaks detected at the ICU of a pulmonology hospital, which were resolved by whole-genome sequencing (WGS). METHODS Outbreak management and investigations were initiated in August 2019 after detecting two patients with nosocomial VIM-2-positive MDR PA. The investigations involved weekly patient screenings for four months and extensive environmental sampling for 15 months. All patient and environmental isolates were collected and analysed by WGS. RESULTS From April to September 2019, we identified 10 patients with nosocomial MDR PA, including five VIM-2-positive strains. VIM-2-positive strains were also detected in nine sink drains, two toilets, and a cleaning bucket. WGS revealed that of 16 VIM-2-positive isolates, 14 were ST111 that carried qacE, or qacEΔ1 genes, whereas 13 isolates clustered (difference of ≤11 alleles by cgMLST). OXA-2 (two toilets), and OXA-2, OXA-74, PER-1 (two patients, three toilets) qacEΔ1-positive ST235 isolates dominated among VIM-2-negative isolates. The remaining seven PA strains were ST17, ST233, ST273, ST309 and ST446. Outbreak containment was achieved by replacing U-bends, and cleaning buckets, and switching from quaternary ammonium compounds (QUATs) to oxygen-releasing disinfectant products. CONCLUSION Comprehension and management of two simultaneous MDR PA outbreaks involving the high-risk strains ST111 and ST235 were facilitated by precise control due to identification of different outbreak sources per strain, and by the in-silico detection of high-level QUATs resistance in all isolates.
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Affiliation(s)
- A Rath
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.
| | - B Kieninger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - J Fritsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - A Caplunik-Pratsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - S Blaas
- Donaustauf Hospital, Centre for Pneumology, Donaustauf, Germany
| | - M Ochmann
- Donaustauf Hospital, Centre for Pneumology, Donaustauf, Germany
| | - M Pfeifer
- Donaustauf Hospital, Centre for Pneumology, Donaustauf, Germany; Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany; Hospital of the Merciful Brother Regensburg, Regensburg, Germany
| | - J Hartl
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; Hospital of the Merciful Brother "St. Barbara", Schwandorf, Germany
| | - T Holzmann
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - W Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Mottola A, Hartl J, Ralser M, Berman J. Metabolic sensing tips the balance of drug tolerance in fungal meningitis. Nat Microbiol 2024; 9:316-317. [PMID: 38316924 DOI: 10.1038/s41564-023-01595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Austin Mottola
- Shmunis School of Biomedical and Cancer Research, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Ramat Aviv, Israel
| | - Johannes Hartl
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ralser
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Department of Biochemistry, Berlin, Germany
- The Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Judith Berman
- Shmunis School of Biomedical and Cancer Research, The George S. Wise Faculty of Life Sciences, Tel Aviv University, Ramat Aviv, Israel.
- Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Ramat Aviv, Israel.
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Steinmann S, Hartl J, Weidemann S, Füssel K, Kroll C, Sebode M, Lohse AW, Schramm C. Accuracy of controlled attenuation parameter measurement for the detection of steatosis in autoimmune liver diseases. JHEP Rep 2023; 5:100898. [PMID: 37954487 PMCID: PMC10632533 DOI: 10.1016/j.jhepr.2023.100898] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 11/14/2023] Open
Abstract
Background & Aims Concurrent fatty liver disease represents an emerging challenge in the care of individuals with autoimmune liver diseases (AILD). Therefore, we aimed to validate the ultrasound-based method of controlled-attenuation parameter (CAP) as a non-invasive tool to detect hepatic steatosis in individuals with AILD. Methods The diagnostic performance of CAP to determine biopsy-proven hepatic steatosis (>5%) was assessed in individuals with AILD (autoimmune hepatitis [AIH], primary biliary cholangitis [PBC], primary biliary cholangitis [PSC], or variant syndromes) who underwent liver biopsy at the University Medical Center Hamburg-Eppendorf between 2015-2020 by calculating the area under the receiver operating characteristic (AUROC) curves. In AIH, the impact of disease activity was evaluated by assessment of CAP upon resolution of hepatic inflammation during follow-up. Results Overall, 433 individuals with AILD (AIH: 218, PBC: 51, PSC: 85, PBC/AIH: 63, PSC/AIH: 16) were included. Histologically proven steatosis was present in 90 individuals (20.8%). Steatosis was less frequently observed in people with PSC (14%) than in other AILD. CAP values correlated positively with grade of steatosis (ρ = 0.39) and the BMI (ρ = 0.53). In PBC and PSC, the ROC curves defined an AUROC of 0.81 and 0.93 for detecting steatosis at an optimal cut-off of 276 dB/m (sensitivity: 0.71; specificity: 0.82) and 254 dB/m (sensitivity: 0.91, specificity: 0.85), respectively. In AIH, the diagnostic performance of CAP was significantly lower (AUROC = 0.72, p = 0.009). However, resolution of hepatic inflammation under treatment was associated with a significant increase in CAP levels (median [IQR]: +38.0 [6-81] dB/m) and considerably improved diagnostic accuracy (AUROC = 0.85; cut-off: 288 dB/m; sensitivity: 0.67, specificity: 0.90). Conclusions In PBC and PSC, hepatic steatosis can be reliably detected by applying disease-specific thresholds of CAP. In AIH, the diagnostic accuracy of CAP is moderate at diagnosis, but improves after acute hepatitis has resolved. Impact and implications Non-invasive estimation of fat content in the liver can be performed with the ultrasound-based method of controlled-attenuation parameter (CAP). Here, we showed that the presence of a concomitant fatty liver is frequent in people with autoimmune liver diseases and we determined disease-specific thresholds of CAP to best predict the presence of a fatty liver. CAP measurement was shown to be a valid tool to detect fatty liver in individuals with PSC and PBC; however, in AIH, CAP had limited accuracy especially when significant inflammatory activity was present in the liver. In the context of substantial liver inflammation, therefore, CAP values should be interpreted with caution, and measurements should be repeated after acute hepatitis has resolved.
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Affiliation(s)
- Silja Steinmann
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER), Hamburg, Germany
| | - Johannes Hartl
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER), Hamburg, Germany
| | - Sören Weidemann
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katja Füssel
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claudia Kroll
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marcial Sebode
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER), Hamburg, Germany
| | - Ansgar Wilhelm Lohse
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER), Hamburg, Germany
- Hamburg Centre for Translational Immunology (HCTI), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
- European Reference Network for Hepatological Diseases (ERN-RARE LIVER), Hamburg, Germany
- Hamburg Centre for Translational Immunology (HCTI), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Messner CB, Demichev V, Wang Z, Hartl J, Kustatscher G, Mülleder M, Ralser M. Mass spectrometry-based high-throughput proteomics and its role in biomedical studies and systems biology. Proteomics 2023; 23:e2200013. [PMID: 36349817 DOI: 10.1002/pmic.202200013] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [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: 07/07/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
Abstract
There are multiple reasons why the next generation of biological and medical studies require increasing numbers of samples. Biological systems are dynamic, and the effect of a perturbation depends on the genetic background and environment. As a consequence, many conditions need to be considered to reach generalizable conclusions. Moreover, human population and clinical studies only reach sufficient statistical power if conducted at scale and with precise measurement methods. Finally, many proteins remain without sufficient functional annotations, because they have not been systematically studied under a broad range of conditions. In this review, we discuss the latest technical developments in mass spectrometry (MS)-based proteomics that facilitate large-scale studies by fast and efficient chromatography, fast scanning mass spectrometers, data-independent acquisition (DIA), and new software. We further highlight recent studies which demonstrate how high-throughput (HT) proteomics can be applied to capture biological diversity, to annotate gene functions or to generate predictive and prognostic models for human diseases.
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Affiliation(s)
- Christoph B Messner
- Precision Proteomics Center, Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Vadim Demichev
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ziyue Wang
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Hartl
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Kustatscher
- Wellcome Centre for Cell Biology, University of Edinburgh, Max Born Crescent, Edinburgh, Scotland, UK
| | - Michael Mülleder
- Core Facility High Throughput Mass Spectrometry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ralser
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Hartl J, Kurth F, Kappert K, Horst D, Mülleder M, Hartmann G, Ralser M. Quantitative protein biomarker panels: a path to improved clinical practice through proteomics. EMBO Mol Med 2023; 15:e16061. [PMID: 36939029 PMCID: PMC10086577 DOI: 10.15252/emmm.202216061] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/17/2023] [Indexed: 03/21/2023] Open
Abstract
The utilisation of protein biomarker panels, rather than individual protein biomarkers, offers a more comprehensive representation of human physiology. It thus has the potential to improve diagnosis, prognosis and the differentiation of responders from nonresponders in the context of precision medicine. Although several proteomic techniques exist for measuring biomarker panels, the integration of proteomics into clinical practice has been limited. In this Commentary, we highlight the significance of quantitative protein biomarker panels in clinical medicine and outline the challenges that must be addressed in order to identify the most promising panels and implement them in clinical routines to realise their medical potential. Furthermore, we argue that the absolute quantification of protein panels through targeted mass spectrometric assays remains the most promising technology for translating proteomics into routine clinical applications due to its high flexibility, low sample costs, independence from affinity reagents and low entry barriers for its integration into existing laboratory workflows.
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Affiliation(s)
- Johannes Hartl
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kai Kappert
- Institute of Diagnostic Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - David Horst
- Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Mülleder
- Core Facility-High Throughput Mass Spectrometry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, Universitätsklinikum Bonn, Bonn, Germany
| | - Markus Ralser
- Institute of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Nuffield Department of Medicine, The Wellcome Centre for Human Genetics, Oxford, UK.,Max Planck Institute for Molecular Genetics, Berlin, Germany
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Hartl J, Rüther DF, Duengelhoef PM, Brehm TT, Steinmann S, Weltzsch JP, Glaser F, Sterneck M, Sebode M, Weiler-Normann C, Lütgehetmann M, Schaub GM, Haag F, Schramm C, Wiesch JSZ, Lohse AW. Analysis of the humoral and cellular response after the third COVID-19 vaccination in patients with autoimmune hepatitis. Liver Int 2023; 43:393-400. [PMID: 35840342 PMCID: PMC9349728 DOI: 10.1111/liv.15368] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/23/2022] [Accepted: 07/12/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS To explore the humoral and T-cell response to the third COVID-19 vaccination in autoimmune hepatitis (AIH). METHODS Anti-SARS-CoV-2 antibody titers were prospectively determined in 81 AIH patients and 53 healthy age- and sex-matched controls >7 days (median 35) after the first COVID-19 booster vaccination. The spike-specific T-cell response was assessed using an activation-induced marker assay (AIM) in a subset of patients. RESULTS Median antibody levels were significantly lower in AIH compared to controls (10 908 vs. 25 000 AU/ml, p < .001), especially in AIH patients treated with MMF (N = 14, 4542 AU/ml, p = .004) or steroids (N = 27, 7326 AU/ml, p = .020). Also, 48% of AIH patients had antibody titers below the 10% percentile of the healthy controls (9194 AU/ml, p < .001). AIH patients had a high risk of failing to develop a spike-specific T-cell response (15/34 (44%) vs. 2/16 (12%), p = .05) and showed overall lower frequencies of spike-specific CD4 + T cells (median: 0.074% vs 0.283; p = .01) after the booster vaccination compared to healthy individuals. In 34/81 patients, antibody titers before and after booster vaccination were available. In this subgroup, all patients but especially those without detectable/low antibodies titers (<100 AU/ml) after the second vaccination (N = 11/34) showed a strong, 148-fold increase. CONCLUSION A third COVID-19 vaccination efficiently boosts antibody levels and T-cell responses in AIH patients and even seroconversion in patients with the absent immune response after two vaccinations, but to a lower level compared to controls. Therefore, we suggest routinely assessing antibody levels in AIH patients and offering additional booster vaccinations to those with suboptimal responses.
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Affiliation(s)
- Johannes Hartl
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Darius Ferenc Rüther
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Paul Maria Duengelhoef
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Theo Brehm
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Silja Steinmann
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Jan Philipp Weltzsch
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Fabian Glaser
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Martina Sterneck
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcial Sebode
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Christina Weiler-Normann
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Marc Lütgehetmann
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.,Department for Clinical Immunology of Infectious Diseases, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.,Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Golda Melina Schaub
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Friedrich Haag
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.,Martin-Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Hamburg Center for Translational Immunology (HCTI), Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Ansgar Wilhelm Lohse
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.,Hamburg Center for Translational Immunology (HCTI), Hamburg, Germany
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Loesken C, Maehder K, Buck L, Hartl J, Löwe B, Schramm C, Toussaint A. Understanding illness experiences of patients with primary sclerosing cholangitis: a qualitative analysis within the SOMA.LIV study. BMC Gastroenterol 2023; 23:12. [PMID: 36635643 PMCID: PMC9838018 DOI: 10.1186/s12876-023-02645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease with a largely unpredictable course. Due to limited treatment options, individuals may for many years suffer from distressing symptoms and the emotional burden of an uncertain future. The need to shift from cure to care of PSC has spurred an interest into patients' health-related quality of life. Qualitative research in this context remains scarce. Hence, this study aimed to enrich the clinical understanding about the lived experience of PSC through a qualitative approach. METHODS A total of 20 patients with PSC were recruited at a specialist centre for autoimmune liver disease in Germany and engaged in semi-structured telephone-based interviews between March and June 2022. Verbatim transcripts were interpreted using inductive thematic analysis. RESULTS An overarching concept of 'a wave-like experience' was formulated to illustrate the dual and shifting nature of living with PSC. Reflecting upon this central idea, three major themes were generated to address important aspects of participants' illness experiences: 'Invisible presence' focused on perceptions of suffering from a seemingly hidden illness that periodically reveals itself through specific trigger events. 'Embracing the threat' captured the psycho-emotional response shift to this chronic disease from a predominantly negative to a coping-oriented pattern with regular setbacks. 'Between control and constraints' uncovered restrictions that PSC enforces onto patients' lives and their desire for controllability. CONCLUSIONS The present study provides an in-depth look at the fluctuating tensions arising from a life with PSC. Insights on perceived invisibility, disease-related triggers of emotional distress and the complexity behind self-management highlight opportunities for enhanced clinical support of this patient group.
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Affiliation(s)
- Caroline Loesken
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Maehder
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Buck
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- grid.13648.380000 0001 2180 34841st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Hamburg Center for Translational Immunology (HCTI), Hamburg, Germany
| | - Bernd Löwe
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- grid.13648.380000 0001 2180 34841st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,grid.13648.380000 0001 2180 3484Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Hamburg Center for Translational Immunology (HCTI), Hamburg, Germany
| | - Anne Toussaint
- grid.13648.380000 0001 2180 3484Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Toussaint A, Buck L, Hartl J, Löwe B, Schramm C. Factors associated with severity and persistence of fatigue in patients with primary biliary cholangitis: study protocol of a prospective cohort study with a mixed-methods approach (SOMA.LIV). BMJ Open 2022; 12:e061419. [PMID: 36600365 PMCID: PMC9730385 DOI: 10.1136/bmjopen-2022-061419] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Fatigue is a common symptom and the major 'unmet need' in the management of patients with primary biliary cholangitis (PBC). To date, only few prospective studies have addressed the development of PBC-associated fatigue over time. At the same time, few biological and psychosocial risk factors and mechanisms have been identified that could explain the development and maintenance of fatigue in PBC. It is the overall aim of this study to identify factors that determine the course and severity of fatigue in PBC, and to target these factors within deliverable interventions in order to improve patients' quality of life. METHODS AND ANALYSIS To identify biological and psychosocial risk factors for severe fatigue, a prospective 12-month cohort study with one baseline and two follow-up measurements will be conducted. In a cross-sectional part, we will simultaneously examine clinically relevant biomedical and psychosocial factors and systematically assess and compare associations and interactions between these factors and fatigue in n=240 patients with PBC (a patient group severely affected by fatigue) and n=240 patients with primary sclerosing cholangitis, a control cholestatic liver disease group much less affected by fatigue. In a prospective part, we will longitudinally monitor these variables and assess their predictive value at 12-month follow-up. Within an embedded mixed-methods design, we will conduct an experimental study and qualitative interviews in patients with newly diagnosed PBC. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Hamburg Medical Association (2020-10196-BO-ff). The study will shed light onto the mechanisms underlying the evolvement and maintenance of fatigue in patients with PBC and enable the development of evidence-based intervention strategies. Findings will be disseminated through peer-reviewed publications, scientific conferences and the involvement of relevant stakeholders, patients and the lay public. TRIAL REGISTRATION NUMBER ISRCTN14379650.
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Affiliation(s)
- Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Buck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- I. Department of Medicine and Martin Zeitz Centre for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Yu JSL, Heineike BM, Hartl J, Aulakh SK, Correia-Melo C, Lehmann A, Lemke O, Agostini F, Lee CT, Demichev V, Messner CB, Mülleder M, Ralser M. Inorganic sulfur fixation via a new homocysteine synthase allows yeast cells to cooperatively compensate for methionine auxotrophy. PLoS Biol 2022; 20:e3001912. [PMID: 36455053 PMCID: PMC9757880 DOI: 10.1371/journal.pbio.3001912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/16/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
The assimilation, incorporation, and metabolism of sulfur is a fundamental process across all domains of life, yet how cells deal with varying sulfur availability is not well understood. We studied an unresolved conundrum of sulfur fixation in yeast, in which organosulfur auxotrophy caused by deletion of the homocysteine synthase Met17p is overcome when cells are inoculated at high cell density. In combining the use of self-establishing metabolically cooperating (SeMeCo) communities with proteomic, genetic, and biochemical approaches, we discovered an uncharacterized gene product YLL058Wp, herein named Hydrogen Sulfide Utilizing-1 (HSU1). Hsu1p acts as a homocysteine synthase and allows the cells to substitute for Met17p by reassimilating hydrosulfide ions leaked from met17Δ cells into O-acetyl-homoserine and forming homocysteine. Our results show that cells can cooperate to achieve sulfur fixation, indicating that the collective properties of microbial communities facilitate their basic metabolic capacity to overcome sulfur limitation.
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Affiliation(s)
- Jason S. L. Yu
- Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Benjamin M. Heineike
- Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Johannes Hartl
- Department of Biochemistry, Charité Universitätsmedizin, Berlin, Germany
| | - Simran K. Aulakh
- Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Clara Correia-Melo
- Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Andrea Lehmann
- Department of Biochemistry, Charité Universitätsmedizin, Berlin, Germany
| | - Oliver Lemke
- Department of Biochemistry, Charité Universitätsmedizin, Berlin, Germany
| | - Federica Agostini
- Department of Biochemistry, Charité Universitätsmedizin, Berlin, Germany
| | - Cory T. Lee
- Department of Biochemistry, Charité Universitätsmedizin, Berlin, Germany
| | - Vadim Demichev
- Department of Biochemistry, Charité Universitätsmedizin, Berlin, Germany
| | - Christoph B. Messner
- Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, United Kingdom
| | - Michael Mülleder
- Core Facility—High Throughput Mass Spectrometry, Charité Universitätsmedizin, Berlin, Germany
| | - Markus Ralser
- Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, United Kingdom
- Department of Biochemistry, Charité Universitätsmedizin, Berlin, Germany
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10
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Wang Z, Tober-Lau P, Farztdinov V, Lemke O, Schwecke T, Steinbrecher S, Muenzner J, Kriedemann H, Sander LE, Hartl J, Mülleder M, Ralser M, Kurth F. The human host response to monkeypox infection: a proteomic case series study. EMBO Mol Med 2022; 14:e16643. [PMID: 36169042 PMCID: PMC9641420 DOI: 10.15252/emmm.202216643] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/23/2022] Open
Abstract
The rapid rise of monkeypox (MPX) cases outside previously endemic areas prompts for a better understanding of the disease. We studied the plasma proteome of a group of MPX patients with a similar infection history and clinical manifestation typical for the current outbreak. We report that MPX in this case series is associated with a strong plasma proteomic response among nutritional and acute phase response proteins. Moreover, we report a correlation between plasma proteins and disease severity. Contrasting the MPX host response with that of COVID‐19, we find a range of similarities, but also important differences. For instance, CFHR1 is induced in COVID‐19, but suppressed in MPX, reflecting the different roles of the complement system in the two infectious diseases. Of note, the spatial overlap in response proteins suggested that a COVID‐19 biomarker panel assay could be repurposed for MPX. Applying a targeted protein panel assay provided encouraging results and distinguished MPX cases from healthy controls. Hence, our results provide a first proteomic characterization of the MPX human host response and encourage further research on protein‐panel assays in emerging infectious diseases.
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Affiliation(s)
- Ziyue Wang
- Department of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pinkus Tober-Lau
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Vadim Farztdinov
- Core Facility High Throughput Mass Spectrometry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Lemke
- Department of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Schwecke
- Department of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Steinbrecher
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Muenzner
- Department of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helene Kriedemann
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Leif Erik Sander
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Johannes Hartl
- Department of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Mülleder
- Core Facility High Throughput Mass Spectrometry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Ralser
- Department of Biochemistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,The Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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11
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Wang Z, Cryar A, Lemke O, Tober-Lau P, Ludwig D, Helbig ET, Hippenstiel S, Sander LE, Blake D, Lane CS, Sayers RL, Mueller C, Zeiser J, Townsend S, Demichev V, Mülleder M, Kurth F, Sirka E, Hartl J, Ralser M. A multiplex protein panel assay for severity prediction and outcome prognosis in patients with COVID-19: An observational multi-cohort study. EClinicalMedicine 2022; 49:101495. [PMID: 35702332 PMCID: PMC9181834 DOI: 10.1016/j.eclinm.2022.101495] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Global healthcare systems continue to be challenged by the COVID-19 pandemic, and there is a need for clinical assays that can help optimise resource allocation, support treatment decisions, and accelerate the development and evaluation of new therapies. METHODS We developed a multiplexed proteomics assay for determining disease severity and prognosis in COVID-19. The assay quantifies up to 50 peptides, derived from 30 known and newly introduced COVID-19-related protein markers, in a single measurement using routine-lab compatible analytical flow rate liquid chromatography and multiple reaction monitoring (LC-MRM). We conducted two observational studies in patients with COVID-19 hospitalised at Charité - Universitätsmedizin Berlin, Germany before (from March 1 to 26, 2020, n=30) and after (from April 4 to November 19, 2020, n=164) dexamethasone became standard of care. The study is registered in the German and the WHO International Clinical Trials Registry (DRKS00021688). FINDINGS The assay produces reproducible (median inter-batch CV of 10.9%) absolute quantification of 47 peptides with high sensitivity (median LLOQ of 143 ng/ml) and accuracy (median 96.8%). In both studies, the assay reproducibly captured hallmarks of COVID-19 infection and severity, as it distinguished healthy individuals, mild, moderate, and severe COVID-19. In the post-dexamethasone cohort, the assay predicted survival with an accuracy of 0.83 (108/130), and death with an accuracy of 0.76 (26/34) in the median 2.5 weeks before the outcome, thereby outperforming compound clinical risk assessments such as SOFA, APACHE II, and ABCS scores. INTERPRETATION Disease severity and clinical outcomes of patients with COVID-19 can be stratified and predicted by the routine-applicable panel assay that combines known and novel COVID-19 biomarkers. The prognostic value of this assay should be prospectively assessed in larger patient cohorts for future support of clinical decisions, including evaluation of sample flow in routine setting. The possibility to objectively classify COVID-19 severity can be helpful for monitoring of novel therapies, especially in early clinical trials. FUNDING This research was funded in part by the European Research Council (ERC) under grant agreement ERC-SyG-2020 951475 (to M.R) and by the Wellcome Trust (IA 200829/Z/16/Z to M.R.). The work was further supported by the Ministry of Education and Research (BMBF) as part of the National Research Node 'Mass Spectrometry in Systems Medicine (MSCoresys)', under grant agreements 031L0220 and 161L0221. J.H. was supported by a Swiss National Science Foundation (SNSF) Postdoc Mobility fellowship (project number 191052). This study was further supported by the BMBF grant NaFoUniMedCOVID-19 - NUM-NAPKON, FKZ: 01KX2021. The study was co-funded by the UK's innovation agency, Innovate UK, under project numbers 75594 and 56328.
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Affiliation(s)
- Ziyue Wang
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Am Chariteplatz 1, 10117 Berlin, Germany
| | - Adam Cryar
- Inoviv, Mappin House, 4 Winsley St, London, United Kingdom
| | - Oliver Lemke
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Am Chariteplatz 1, 10117 Berlin, Germany
| | - Pinkus Tober-Lau
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Daniela Ludwig
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Am Chariteplatz 1, 10117 Berlin, Germany
| | - Elisa Theresa Helbig
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Stefan Hippenstiel
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Leif-Erik Sander
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health at the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Christoph Mueller
- Agilent Technologies Sales & Services GmbH & Co. KG, Waldbronn, Germany
| | - Johannes Zeiser
- Agilent Technologies Sales & Services GmbH & Co. KG, Waldbronn, Germany
| | - StJohn Townsend
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Am Chariteplatz 1, 10117 Berlin, Germany
| | - Vadim Demichev
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Am Chariteplatz 1, 10117 Berlin, Germany
| | - Michael Mülleder
- Core Facility – High-Throughput Mass Spectrometry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Am Chariteplatz 1, 10117 Berlin, Germany
| | - Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, and Department of Medicine I, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Corresponding author: Florian Kurth, Charité - Universitätsmedizin Berlin, Department of Infectious Diseases and Respiratory Medicine, Augustenburger Platz 1, 13353 Berlin, Germany. Tel.: +49 (0)30 450 553052.
| | - Ernestas Sirka
- Inoviv, Mappin House, 4 Winsley St, London, United Kingdom
- Corresponding author: Ernestas Sirka, Inoviv, Mappin House, 4 Winsley St, London W1W 8HF, United Kingdom, Tel.: +44 (0)20 3239 0178.
| | - Johannes Hartl
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Am Chariteplatz 1, 10117 Berlin, Germany
- Corresponding author: Johannes Hartl, Charité – Universitätsmedizin Berlin, Department of Biochemistry, Charitéplatz 1, 10117 Berlin, Germany. Tel.: +49 (0)30 450 528317.
| | - Markus Ralser
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Am Chariteplatz 1, 10117 Berlin, Germany
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK
- Corresponding author: Markus Ralser, Charité – Universitätsmedizin Berlin, Department of Biochemistry, Charitéplatz 1, 10117 Berlin, Germany. Tel.: +49 (0)30 450 528141
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12
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Yu JSL, Correia-Melo C, Zorrilla F, Herrera-Dominguez L, Wu MY, Hartl J, Campbell K, Blasche S, Kreidl M, Egger AS, Messner CB, Demichev V, Freiwald A, Mülleder M, Howell M, Berman J, Patil KR, Alam MT, Ralser M. Microbial communities form rich extracellular metabolomes that foster metabolic interactions and promote drug tolerance. Nat Microbiol 2022; 7:542-555. [PMID: 35314781 PMCID: PMC8975748 DOI: 10.1038/s41564-022-01072-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 01/28/2022] [Indexed: 12/30/2022]
Abstract
Microbial communities are composed of cells of varying metabolic capacity, and regularly include auxotrophs that lack essential metabolic pathways. Through analysis of auxotrophs for amino acid biosynthesis pathways in microbiome data derived from >12,000 natural microbial communities obtained as part of the Earth Microbiome Project (EMP), and study of auxotrophic–prototrophic interactions in self-establishing metabolically cooperating yeast communities (SeMeCos), we reveal a metabolically imprinted mechanism that links the presence of auxotrophs to an increase in metabolic interactions and gains in antimicrobial drug tolerance. As a consequence of the metabolic adaptations necessary to uptake specific metabolites, auxotrophs obtain altered metabolic flux distributions, export more metabolites and, in this way, enrich community environments in metabolites. Moreover, increased efflux activities reduce intracellular drug concentrations, allowing cells to grow in the presence of drug levels above minimal inhibitory concentrations. For example, we show that the antifungal action of azoles is greatly diminished in yeast cells that uptake metabolites from a metabolically enriched environment. Our results hence provide a mechanism that explains why cells are more robust to drug exposure when they interact metabolically. Using microbiome data analysis and a self-establishing metabolically cooperating yeast community model, the authors show that the presence of auxotrophs in a microbial community increases metabolic interactions between cells and fosters antimicrobial drug tolerance.
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Affiliation(s)
- Jason S L Yu
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK
| | - Clara Correia-Melo
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK.,Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Francisco Zorrilla
- Medical Research Council Toxicology Unit, University of Cambridge, Cambridge, UK.,Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Lucia Herrera-Dominguez
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK.,Department of Biochemistry, Charité University Medicine, Berlin, Germany
| | - Mary Y Wu
- High-Throughput Screening, The Francis Crick Institute, London, UK
| | - Johannes Hartl
- Department of Biochemistry, Charité University Medicine, Berlin, Germany
| | - Kate Campbell
- Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Sonja Blasche
- Medical Research Council Toxicology Unit, University of Cambridge, Cambridge, UK.,Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Marco Kreidl
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK
| | - Anna-Sophia Egger
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK
| | - Christoph B Messner
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK.,Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Vadim Demichev
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK.,Department of Biochemistry, University of Cambridge, Cambridge, UK
| | - Anja Freiwald
- Department of Biochemistry, Charité University Medicine, Berlin, Germany.,Core Facility - High Throughput Mass Spectrometry, Charité University Medicine, Berlin, Germany
| | - Michael Mülleder
- Core Facility - High Throughput Mass Spectrometry, Charité University Medicine, Berlin, Germany
| | - Michael Howell
- High-Throughput Screening, The Francis Crick Institute, London, UK
| | - Judith Berman
- Shmunis School of Biomedical and Cancer Research, George S. Wise Faculty of Life Sciences, Tel Aviv University, Ramat Aviv, Israel
| | - Kiran R Patil
- Medical Research Council Toxicology Unit, University of Cambridge, Cambridge, UK.,Structural and Computational Biology Unit, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Mohammad Tauqeer Alam
- Department of Biology, College of Science, United Arab Emirates University, Al-Ain, UAE. .,Warwick Medical School, University of Warwick, Coventry, UK.
| | - Markus Ralser
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK. .,Department of Biochemistry, Charité University Medicine, Berlin, Germany. .,Core Facility - High Throughput Mass Spectrometry, Charité University Medicine, Berlin, Germany.
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13
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Duengelhoef P, Hartl J, Rüther D, Steinmann S, Brehm TT, Weltzsch JP, Glaser F, Schaub GM, Sterneck M, Sebode M, Weiler-Normann C, Addo MM, Lütgehetmann M, Haag F, Schramm C, Schulze Zur Wiesch J, Lohse AW. SARS-CoV-2 vaccination response in patients with autoimmune hepatitis and autoimmune cholestatic liver disease. United European Gastroenterol J 2022; 10:319-329. [PMID: 35289983 PMCID: PMC9004241 DOI: 10.1002/ueg2.12218] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
Background/Aims In this observational study, we explored the humoral and cellular immune response to SARS‐CoV‐2 vaccination in patients with autoimmune hepatitis (AIH) and patients with cholestatic autoimmune liver disease (primary sclerosing cholangitis [PSC] and primary biliary cholangitis [PBC]). Methods Anti‐SARS‐CoV‐2 antibody titers were determined using the DiaSorin LIAISON and Roche immunoassays in 103 AIH, 64 PSC, and 61 PBC patients and 95 healthy controls >14 days after the second COVID‐19 vaccination. The spike‐specific T‐cell response was assessed using an activation‐induced marker assay (AIM) in a subset of individuals. Results Previous SARS‐CoV‐2 infection was frequently detected in AIH but not in PBC/PSC (10/112 (9%), versus 4/144 (2.7%), p = 0.03). In the remaining patients, seroconversion was measurable in 97% of AIH and 99% of PBC/PSC patients, respectively. However, in 13/94 AIH patients antibody levels were lower than in any healthy control, which contributed to lower antibody levels of the total AIH cohort when compared to PBC/PSC or controls (641 vs. 1020 vs. 1200 BAU/ml, respectively). Notably, antibody levels were comparably low in AIH patients with (n = 85) and without immunosuppression (n = 9). Also, antibody titers significantly declined within 7 months after the second vaccination. In the AIM assay of 20 AIH patients, a spike‐specific T‐cell response was undetectable in 45% despite a positive serology, while 87% (13/15) of the PBC/PSC demonstrated a spike‐specific T‐cell response. Conclusion Patients with AIH show an increased SARS‐CoV‐2 infection rate as well as an impaired B‐ and T‐cell response to SARS‐CoV‐2 vaccine compared to PBC and PSC patients, even in the absence of immunosuppression. Thus, antibody responses to vaccination in AIH patients need to be monitored and early booster immunizations considered in low responders.
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Affiliation(s)
- Paul Duengelhoef
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Darius Rüther
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Silja Steinmann
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Thomas T Brehm
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Partner Site Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (DZIF), Hamburg, Germany
| | - Jan Philipp Weltzsch
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Fabian Glaser
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - G M Schaub
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Partner Site Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (DZIF), Hamburg, Germany
| | - Martina Sterneck
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcial Sebode
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Christina Weiler-Normann
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Marylyn M Addo
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Partner Site Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (DZIF), Hamburg, Germany.,Department for Clinical Immunology of Infectious Diseases, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Marc Lütgehetmann
- Partner Site Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (DZIF), Hamburg, Germany.,Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friedrich Haag
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.,Martin-Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Hamburg Center for Translational Immunology (HCTI), Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Partner Site Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (DZIF), Hamburg, Germany
| | - Ansgar W Lohse
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.,Partner Site Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research (DZIF), Hamburg, Germany.,Hamburg Center for Translational Immunology (HCTI), Hamburg, Germany
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14
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Wang Z, Mülleder M, Batruch I, Chelur A, Textoris-Taube K, Schwecke T, Hartl J, Causon J, Castro-Perez J, Demichev V, Tate S, Ralser M. High-throughput proteomics of nanogram-scale samples with Zeno SWATH MS. eLife 2022; 11:83947. [PMID: 36449390 PMCID: PMC9711518 DOI: 10.7554/elife.83947] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
The possibility to record proteomes in high throughput and at high quality has opened new avenues for biomedical research, drug discovery, systems biology, and clinical translation. However, high-throughput proteomic experiments often require high sample amounts and can be less sensitive compared to conventional proteomic experiments. Here, we introduce and benchmark Zeno SWATH MS, a data-independent acquisition technique that employs a linear ion trap pulsing (Zeno trap pulsing) to increase the sensitivity in high-throughput proteomic experiments. We demonstrate that when combined with fast micro- or analytical flow-rate chromatography, Zeno SWATH MS increases protein identification with low sample amounts. For instance, using 20 min micro-flow-rate chromatography, Zeno SWATH MS identified more than 5000 proteins consistently, and with a coefficient of variation of 6%, from a 62.5 ng load of human cell line tryptic digest. Using 5 min analytical flow-rate chromatography (800 µl/min), Zeno SWATH MS identified 4907 proteins from a triplicate injection of 2 µg of a human cell lysate, or more than 3000 proteins from a 250 ng tryptic digest. Zeno SWATH MS hence facilitates sensitive high-throughput proteomic experiments with low sample amounts, mitigating the current bottlenecks of high-throughput proteomics.
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Affiliation(s)
- Ziyue Wang
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu BerlinBerlinGermany
| | - Michael Mülleder
- Core Facility – High-Throughput Mass Spectrometry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Core Facility – High-Throughput Mass SpectrometryBerlinGermany
| | | | | | - Kathrin Textoris-Taube
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu BerlinBerlinGermany,Core Facility – High-Throughput Mass Spectrometry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Core Facility – High-Throughput Mass SpectrometryBerlinGermany
| | - Torsten Schwecke
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu BerlinBerlinGermany
| | - Johannes Hartl
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu BerlinBerlinGermany
| | | | | | - Vadim Demichev
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu BerlinBerlinGermany
| | | | - Markus Ralser
- Department of Biochemistry, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu BerlinBerlinGermany,The Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
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15
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Vowinckel J, Hartl J, Marx H, Kerick M, Runggatscher K, Keller MA, Mülleder M, Day J, Weber M, Rinnerthaler M, Yu JSL, Aulakh SK, Lehmann A, Mattanovich D, Timmermann B, Zhang N, Dunn CD, MacRae JI, Breitenbach M, Ralser M. The metabolic growth limitations of petite cells lacking the mitochondrial genome. Nat Metab 2021; 3:1521-1535. [PMID: 34799698 PMCID: PMC7612105 DOI: 10.1038/s42255-021-00477-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/10/2021] [Indexed: 12/25/2022]
Abstract
Eukaryotic cells can survive the loss of their mitochondrial genome, but consequently suffer from severe growth defects. 'Petite yeasts', characterized by mitochondrial genome loss, are instrumental for studying mitochondrial function and physiology. However, the molecular cause of their reduced growth rate remains an open question. Here we show that petite cells suffer from an insufficient capacity to synthesize glutamate, glutamine, leucine and arginine, negatively impacting their growth. Using a combination of molecular genetics and omics approaches, we demonstrate the evolution of fast growth overcomes these amino acid deficiencies, by alleviating a perturbation in mitochondrial iron metabolism and by restoring a defect in the mitochondrial tricarboxylic acid cycle, caused by aconitase inhibition. Our results hence explain the slow growth of mitochondrial genome-deficient cells with a partial auxotrophy in four amino acids that results from distorted iron metabolism and an inhibited tricarboxylic acid cycle.
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Affiliation(s)
- Jakob Vowinckel
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, Cambridge, UK
- Biognosys AG, Schlieren, Switzerland
| | - Johannes Hartl
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, Cambridge, UK
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Biochemistry, Berlin, Germany
| | - Hans Marx
- Department of Biotechnology, University of Natural Resources and Life Sciences Vienna, Vienna, Austria
| | - Martin Kerick
- Sequencing Core Facility, Max Planck Institute for Molecular Genetics and Max Planck Unit for the Science of Pathogens, Berlin, Germany
- Institute of Parasitology and Biomedicine 'López-Neyra' (IPBLN, CSIC), Granada, Spain
| | - Kathrin Runggatscher
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, Cambridge, UK
| | - Markus A Keller
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, Cambridge, UK
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Mülleder
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, Cambridge, UK
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Biochemistry, Berlin, Germany
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK
| | - Jason Day
- Department of Earth Sciences, University of Cambridge, Cambridge, UK
| | - Manuela Weber
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Mark Rinnerthaler
- Department of Biosciences, University of Salzburg, Salzburg, Austria
| | - Jason S L Yu
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK
| | - Simran Kaur Aulakh
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK
| | - Andrea Lehmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Biochemistry, Berlin, Germany
| | - Diethard Mattanovich
- Department of Biotechnology, University of Natural Resources and Life Sciences Vienna, Vienna, Austria
| | - Bernd Timmermann
- Sequencing Core Facility, Max Planck Institute for Molecular Genetics and Max Planck Unit for the Science of Pathogens, Berlin, Germany
| | - Nianshu Zhang
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, Cambridge, UK
| | - Cory D Dunn
- Institute of Biotechnology, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Molecular Biology and Genetics, Koç University, İstanbul, Turkey
| | - James I MacRae
- Metabolomics Laboratory, The Francis Crick Institute, London, UK
| | | | - Markus Ralser
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, Cambridge, UK.
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Biochemistry, Berlin, Germany.
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, London, UK.
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16
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Hartl J, Serpas L, Wang Y, Rashidfarrokhi A, Perez OA, Sally B, Sisirak V, Soni C, Khodadadi-Jamayran A, Tsirigos A, Caiello I, Bracaglia C, Volpi S, Ghiggeri GM, Chida AS, Sanz I, Kim MY, Belmont HM, Silverman GJ, Clancy RM, Izmirly PM, Buyon JP, Reizis B. Autoantibody-mediated impairment of DNASE1L3 activity in sporadic systemic lupus erythematosus. J Exp Med 2021; 218:e20201138. [PMID: 33783474 PMCID: PMC8020718 DOI: 10.1084/jem.20201138] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/18/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022] Open
Abstract
Antibodies to double-stranded DNA (dsDNA) are prevalent in systemic lupus erythematosus (SLE), particularly in patients with lupus nephritis, yet the nature and regulation of antigenic cell-free DNA (cfDNA) are poorly understood. Null mutations in the secreted DNase DNASE1L3 cause human monogenic SLE with anti-dsDNA autoreactivity. We report that >50% of sporadic SLE patients with nephritis manifested reduced DNASE1L3 activity in circulation, which was associated with neutralizing autoantibodies to DNASE1L3. These patients had normal total plasma cfDNA levels but showed accumulation of cfDNA in circulating microparticles. Microparticle-associated cfDNA contained a higher fraction of longer polynucleosomal cfDNA fragments, which bound autoantibodies with higher affinity than mononucleosomal fragments. Autoantibodies to DNASE1L3-sensitive antigens on microparticles were prevalent in SLE nephritis patients and correlated with the accumulation of cfDNA in microparticles and with disease severity. DNASE1L3-sensitive antigens included DNA-associated proteins such as HMGB1. Our results reveal autoantibody-mediated impairment of DNASE1L3 activity as a common nongenetic mechanism facilitating anti-dsDNA autoreactivity in patients with severe sporadic SLE.
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Affiliation(s)
- Johannes Hartl
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Lee Serpas
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Yueyang Wang
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Ali Rashidfarrokhi
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Oriana A. Perez
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Benjamin Sally
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Vanja Sisirak
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Le Centre national de la recherche scientifique - unité mixte de recherche 5164, ImmunoConcEpt, Universite ´de Bordeaux, Bordeaux, France
| | - Chetna Soni
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Alireza Khodadadi-Jamayran
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Applied Bioinformatics Laboratories, New York University School of Medicine, New York, NY
| | - Aristotelis Tsirigos
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Applied Bioinformatics Laboratories, New York University School of Medicine, New York, NY
| | - Ivan Caiello
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Claudia Bracaglia
- Division of Rheumatology, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Stefano Volpi
- Centro per le Malattie Autoinfiammatorie e Immunodeficienze, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Gian Marco Ghiggeri
- Division of Nephrology, Dialysis and Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Giannina Gaslini, Genoa, Italy
| | - Asiya Seema Chida
- Division of Rheumatology, Department of Medicine, Lowance Center for Human Immunology, Emory University, Atlanta, GA
| | - Ignacio Sanz
- Division of Rheumatology, Department of Medicine, Lowance Center for Human Immunology, Emory University, Atlanta, GA
| | - Mimi Y. Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - H. Michael Belmont
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Gregg J. Silverman
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Robert M. Clancy
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Peter M. Izmirly
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Jill P. Buyon
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Boris Reizis
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY
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17
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Derben FC, Engel B, Zachou K, Hartl J, Hartleben B, Bantel H, Schramm C, Dalekos GN, Manns MP, Jaeckel E, Taubert R. CK-18 cell death markers improve the prediction of histological remission in autoimmune hepatitis during biochemical remission. Liver Int 2021; 41:123-127. [PMID: 33043565 DOI: 10.1111/liv.14699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/30/2020] [Accepted: 10/06/2020] [Indexed: 12/14/2022]
Abstract
Incomplete histological remission of autoimmune hepatitis (AIH) is associated with a reduced long-term survival and an increased relapse rate even during biochemical remission (BR). The aim of this international multicentre study was to explore the diagnostic fidelity of cytokeratin-18 cell death markers to noninvasively detect incomplete histological remission. Thereby, cytokeratin-18 cell death marker M65 but not ALT and immunoglobulins was significantly higher in patients with incomplete histological remission (mHAI ≥ 4) compared to those with mHAI ≤ 3. M65 levels > 305 U/L, identified in the training cohort, facilitated the noninvasive detection of incomplete histological remission with a sensitivity of 75% and negative predictive value of 86% in the validation cohort. While BR with M65 < 305 U/L suggested complete histological remission (86%), BR with M65 > 305 U/L reduced the rate of histological remission to 60%. In conclusion, M65 may help to better select patients for or to reduce surveillance liver biopsies in the future.
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Affiliation(s)
- Finn C Derben
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Bastian Engel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Kalliopi Zachou
- Institute of Internal Medicine and Hepatology, Larissa, Greece.,Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Johannes Hartl
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Björn Hartleben
- Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Heike Bantel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Christoph Schramm
- 1st Department of Medicine, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.,Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - George N Dalekos
- Institute of Internal Medicine and Hepatology, Larissa, Greece.,Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
| | - Richard Taubert
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
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18
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Li J, Rinnerthaler M, Hartl J, Weber M, Karl T, Breitenbach-Koller H, Mülleder M, Vowinckel J, Marx H, Sauer M, Mattanovich D, Ata Ö, De S, Greslehner GP, Geltinger F, Burhans B, Grant C, Doronina V, Ralser M, Streubel MK, Grabner C, Jarolim S, Moßhammer C, Gourlay CW, Hasek J, Cullen PJ, Liti G, Ralser M, Breitenbach M. Slow Growth and Increased Spontaneous Mutation Frequency in Respiratory Deficient afo1- Yeast Suppressed by a Dominant Mutation in ATP3. G3 (Bethesda) 2020; 10:4637-4648. [PMID: 33093184 PMCID: PMC7718765 DOI: 10.1534/g3.120.401537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
A yeast deletion mutation in the nuclear-encoded gene, AFO1, which codes for a mitochondrial ribosomal protein, led to slow growth on glucose, the inability to grow on glycerol or ethanol, and loss of mitochondrial DNA and respiration. We noticed that afo1- yeast readily obtains secondary mutations that suppress aspects of this phenotype, including its growth defect. We characterized and identified a dominant missense suppressor mutation in the ATP3 gene. Comparing isogenic slowly growing rho-zero and rapidly growing suppressed afo1- strains under carefully controlled fermentation conditions showed that energy charge was not significantly different between strains and was not causal for the observed growth properties. Surprisingly, in a wild-type background, the dominant suppressor allele of ATP3 still allowed respiratory growth but increased the petite frequency. Similarly, a slow-growing respiratory deficient afo1- strain displayed an about twofold increase in spontaneous frequency of point mutations (comparable to the rho-zero strain) while the suppressed strain showed mutation frequency comparable to the respiratory-competent WT strain. We conclude, that phenotypes that result from afo1- are mostly explained by rapidly emerging mutations that compensate for the slow growth that typically follows respiratory deficiency.
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Affiliation(s)
- Jing Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Universite Cote d'Azur, CNRS, Inserm, IRCAN, Nice, France
| | | | - Johannes Hartl
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, 80 Tennis Court Rd, Cambridge CB2 1GA, UK
- Department of Biochemistry, Charité University Medicine, Berlin Germany
| | - Manuela Weber
- Department of Biosciences, University of Salzburg, Austria
| | - Thomas Karl
- Department of Biosciences, University of Salzburg, Austria
| | | | - Michael Mülleder
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, 80 Tennis Court Rd, Cambridge CB2 1GA, UK
- Department of Biochemistry, Charité University Medicine, Berlin Germany
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, 1Midland Rd, London NW1 1AT, UK
| | - Jakob Vowinckel
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, 80 Tennis Court Rd, Cambridge CB2 1GA, UK
- Biognosys AG, Wagistrasse 21, 8952 Schlieren, Switzerland
| | - Hans Marx
- Institute of Microbiology and Microbial Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences, Muthgasse 18, A-1190 Vienna, Austria
| | - Michael Sauer
- Institute of Microbiology and Microbial Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences, Muthgasse 18, A-1190 Vienna, Austria
| | - Diethard Mattanovich
- Institute of Microbiology and Microbial Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences, Muthgasse 18, A-1190 Vienna, Austria
- ACIB GmbH, Austrian Centre of Industrial Biotechnology, Muthgasse 11, A-1190 Vienna, Austria
| | - Özge Ata
- Institute of Microbiology and Microbial Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences, Muthgasse 18, A-1190 Vienna, Austria
- ACIB GmbH, Austrian Centre of Industrial Biotechnology, Muthgasse 11, A-1190 Vienna, Austria
| | - Sonakshi De
- Institute of Microbiology and Microbial Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences, Muthgasse 18, A-1190 Vienna, Austria
- ACIB GmbH, Austrian Centre of Industrial Biotechnology, Muthgasse 11, A-1190 Vienna, Austria
| | | | | | - Bill Burhans
- Department of Molecular and Cellular Biology, Roswell Park Cancer Institute, Buffalo, New York
| | - Chris Grant
- Faculty of Biology, Medicine, and Health, University of Manchester, Manchester M13 9PT, UK
| | | | - Meryem Ralser
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, 1Midland Rd, London NW1 1AT, UK
| | | | | | | | | | - Campbell W Gourlay
- Department of Biosciences, University of Kent, Canterbury Kent CT2 7NJ, United Kingdom
| | - Jiri Hasek
- Institute of Microbiology of the Czech Academy of Sciences, Videnska 1083, Prague 4 142 20, Czech Republic
| | - Paul J Cullen
- Department of Biological Sciences, University at Buffalo, NY 14260
| | - Gianni Liti
- Institute for Research on Cancer and Ageing of Nice (IRCAN), CNRS, INSERM, Université Côte d'Azur, 06107 NICE, France
| | - Markus Ralser
- Department of Biochemistry and Cambridge Systems Biology Centre, University of Cambridge, 80 Tennis Court Rd, Cambridge CB2 1GA, UK
- Department of Biochemistry, Charité University Medicine, Berlin Germany
- The Molecular Biology of Metabolism Laboratory, The Francis Crick Institute, 1Midland Rd, London NW1 1AT, UK
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19
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Shyp V, Dubey BN, Böhm R, Hartl J, Nesper J, Vorholt JA, Hiller S, Schirmer T, Jenal U. Reciprocal growth control by competitive binding of nucleotide second messengers to a metabolic switch in Caulobacter crescentus. Nat Microbiol 2020; 6:59-72. [PMID: 33168988 DOI: 10.1038/s41564-020-00809-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 10/02/2020] [Indexed: 12/13/2022]
Abstract
Bacteria use small signalling molecules such as (p)ppGpp or c-di-GMP to tune their physiology in response to environmental changes. It remains unclear whether these regulatory networks operate independently or whether they interact to optimize bacterial growth and survival. We report that (p)ppGpp and c-di-GMP reciprocally regulate the growth of Caulobacter crescentus by converging on a single small-molecule-binding protein, SmbA. While c-di-GMP binding inhibits SmbA, (p)ppGpp competes for the same binding site to sustain SmbA activity. We demonstrate that (p)ppGpp specifically promotes Caulobacter growth on glucose, whereas c-di-GMP inhibits glucose consumption. We find that SmbA contributes to this metabolic switch and promotes growth on glucose by quenching the associated redox stress. The identification of an effector protein that acts as a central regulatory hub for two global second messengers opens up future studies on specific crosstalk between small-molecule-based regulatory networks.
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Affiliation(s)
| | | | - Raphael Böhm
- Biozentrum, University of Basel, Basel, Switzerland
| | - Johannes Hartl
- Institute of Microbiology, ETH Zurich, Zürich, Switzerland
| | - Jutta Nesper
- Biozentrum, University of Basel, Basel, Switzerland
| | | | | | | | - Urs Jenal
- Biozentrum, University of Basel, Basel, Switzerland.
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20
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Kunzmann LK, Schoknecht T, Poch T, Henze L, Stein S, Kriz M, Grewe I, Preti M, Hartl J, Pannicke N, Peiseler M, Sebode M, Zenouzi R, Horvatits T, Böttcher M, Petersen BS, Weiler-Normann C, Hess LU, Ahrenstorf AE, Lunemann S, Martrus G, Fischer L, Li J, Carambia A, Kluwe J, Huber S, Lohse AW, Franke A, Herkel J, Schramm C, Schwinge D. Monocytes as Potential Mediators of Pathogen-Induced T-Helper 17 Differentiation in Patients With Primary Sclerosing Cholangitis (PSC). Hepatology 2020; 72:1310-1326. [PMID: 33090557 DOI: 10.1002/hep.31140] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/22/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS T cells from patients with primary sclerosing cholangitis (PSC) show a prominent interleukin (IL)-17 response upon stimulation with bacteria or fungi, yet the reasons for this dominant T-helper 17 (Th17) response in PSC are not clear. Here, we analyzed the potential role of monocytes in microbial recognition and in skewing the T-cell response toward Th17. APPROACH AND RESULTS Monocytes and T cells from blood and livers of PSC patients and controls were analyzed ex vivo and in vitro using transwell experiments with cholangiocytes. Cytokine production was measured using flow cytometry, enzyme-linked immunosorbent assay, RNA in situ hybridization, and quantitative real-time PCR. Genetic polymorphisms were obtained from ImmunoChip analysis. Following ex vivo stimulation with phorbol myristate acetate/ionomycin, PSC patients showed significantly increased numbers of IL-17A-producing peripheral blood CD4+ T cells compared to PBC patients and healthy controls, indicating increased Th17 differentiation in vivo. Upon stimulation with microbes, monocytes from PSC patients produced significantly more IL-1β and IL-6, cytokines known to drive Th17 cell differentiation. Moreover, microbe-activated monocytes induced the secretion of Th17 and monocyte-recruiting chemokines chemokine (C-C motif) ligand (CCL)-20 and CCL-2 in human primary cholangiocytes. In livers of patients with PSC cirrhosis, CD14hiCD16int and CD14loCD16hi monocytes/macrophages were increased compared to alcoholic cirrhosis, and monocytes were found to be located around bile ducts. CONCLUSIONS PSC patients show increased Th17 differentiation already in vivo. Microbe-stimulated monocytes drive Th17 differentiation in vitro and induce cholangiocytes to produce chemokines mediating recruitment of Th17 cells and more monocytes into portal tracts. Taken together, these results point to a pathogenic role of monocytes in patients with PSC.
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Affiliation(s)
- Lilly Kristin Kunzmann
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Schoknecht
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Poch
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Henze
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Stein
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marvin Kriz
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ilka Grewe
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Max Preti
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Pannicke
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Peiseler
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcial Sebode
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roman Zenouzi
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Horvatits
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marius Böttcher
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Britt-Sabina Petersen
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Leonard U Hess
- Leibniz Institute for Experimental Virology, Heinrich Pette Institute, Hamburg, Germany
| | | | - Sebastian Lunemann
- Leibniz Institute for Experimental Virology, Heinrich Pette Institute, Hamburg, Germany
| | - Gloria Martrus
- Leibniz Institute for Experimental Virology, Heinrich Pette Institute, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jun Li
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonella Carambia
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Kluwe
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samuel Huber
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Johannes Herkel
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Centre for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dorothee Schwinge
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Pape S, Gevers TJG, Vrolijk JM, van Hoek B, Bouma G, van Nieuwkerk CMJ, Taubert R, Jaeckel E, Manns MP, Papp M, Sipeki N, Stickel F, Efe C, Ozaslan E, Purnak T, Nevens F, Kessener DJN, Kahraman A, Wedemeyer H, Hartl J, Schramm C, Lohse AW, Heneghan MA, Drenth JPH. High discontinuation rate of azathioprine in autoimmune hepatitis, independent of time of treatment initiation. Liver Int 2020; 40:2164-2171. [PMID: 32410363 PMCID: PMC7496382 DOI: 10.1111/liv.14513] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Guidelines regarding treatment for autoimmune hepatitis (AIH) favour two strategies for azathioprine (AZA) introduction: concurrent with steroids at induction or delayed by 2-4 weeks. The safety and efficacy of both strategies have been unexplored. METHODS We established a cohort of 900 AIH patients from 12 centres in 7 European countries. There were 631 patients who used AZA as part of the therapeutic regimen. We distinguished two groups: patients with early AZA (<2 weeks) or delayed AZA initiation (≥2 weeks). Primary outcome was discontinuation of AZA in the first year of treatment. Cox regression and propensity score matching was performed to determine difference in outcomes between groups. RESULTS Patients with early AZA initiation had significantly lower transaminases and bilirubin at baseline. Discontinuation rates of AZA did not differ between early and delayed starters (16.6% vs 14.2%), which did not reach statistical significance (hazard ratio 0.97, 95% confidence interval 0.61-1.55, P = .90). Stratification according to baseline disease activity or propensity score matching did not alter the results. Main reason for AZA discontinuation was intolerance to treatment (14.0% vs 13.2%, P = .78) with nausea and vomiting as main side effects. AIH remission rates were comparable among groups. CONCLUSION The discontinuation rate of AZA in AIH treatment is ~15% in the first year of treatment. Early or delayed AZA initiation does not differ in remission and discontinuation rates in AIH induction therapy. Our data suggest that either strategy may be used as part of AIH treatment.
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Affiliation(s)
- Simon Pape
- Department of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenThe Netherlands,European Reference Network RARE‐LIVERHamburgGermany
| | - Tom J. G. Gevers
- Department of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenThe Netherlands,European Reference Network RARE‐LIVERHamburgGermany
| | - Jan Maarten Vrolijk
- Department of Gastroenterology and HepatologyRijnstate HospitalArnhemThe Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and HepatologyLeiden University Medical CenterLeidenThe Netherlands
| | - Gerd Bouma
- Department of Gastroenterology and HepatologyVU University Medical CenterAmsterdamThe Netherlands
| | | | - Richard Taubert
- Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany,European Reference Network RARE‐LIVERHamburgGermany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany,European Reference Network RARE‐LIVERHamburgGermany
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany,European Reference Network RARE‐LIVERHamburgGermany
| | - Maria Papp
- Division of GastroenterologyDepartment of Internal MedicineFaculty of MedicineUniversity of DebrecenDebrecenHungary
| | - Nora Sipeki
- Division of GastroenterologyDepartment of Internal MedicineFaculty of MedicineUniversity of DebrecenDebrecenHungary
| | - Felix Stickel
- Department of Gastroenterology and HepatologyUniversity Hospital of ZurichZurichSwitzerland
| | - Cumali Efe
- Department of GastroenterologyHarran University HospitalUrfaTurkey
| | - Ersan Ozaslan
- Department of GastroenterologyNumune Research and Education HospitalAnkaraTurkey
| | - Tugrul Purnak
- Department of GastroenterologyHacettepe UniversityAnkaraTurkey
| | - Frederik Nevens
- Department of Gastroenterology and HepatologyUniversity Hospital KU LeuvenLeuvenBelgium,European Reference Network RARE‐LIVERHamburgGermany
| | - Dominik J. N. Kessener
- Department of Gastroenterology and HepatologyUniversity Clinic of Essen DuisburgEssenGermany
| | - Alisan Kahraman
- Department of Gastroenterology and HepatologyUniversity Clinic of Essen DuisburgEssenGermany
| | - Heiner Wedemeyer
- Department of Gastroenterology and HepatologyUniversity Clinic of Essen DuisburgEssenGermany
| | - Johannes Hartl
- 1st Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany,European Reference Network RARE‐LIVERHamburgGermany
| | - Christoph Schramm
- 1st Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany,Martin Zeitz Centre for Rare DiseasesUniversity Medical Centre Hamburg‐EppendorfHamburgGermany,European Reference Network RARE‐LIVERHamburgGermany
| | - Ansgar W. Lohse
- 1st Department of Internal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany,European Reference Network RARE‐LIVERHamburgGermany
| | - Michael A. Heneghan
- Institute of Liver StudiesKing's College HospitalLondonUK,European Reference Network RARE‐LIVERHamburgGermany
| | - Joost P. H. Drenth
- Department of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenThe Netherlands,European Reference Network RARE‐LIVERHamburgGermany
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22
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Nguyen BD, Cuenca V M, Hartl J, Gül E, Bauer R, Meile S, Rüthi J, Margot C, Heeb L, Besser F, Escriva PP, Fetz C, Furter M, Laganenka L, Keller P, Fuchs L, Christen M, Porwollik S, McClelland M, Vorholt JA, Sauer U, Sunagawa S, Christen B, Hardt WD. Import of Aspartate and Malate by DcuABC Drives H 2/Fumarate Respiration to Promote Initial Salmonella Gut-Lumen Colonization in Mice. Cell Host Microbe 2020; 27:922-936.e6. [PMID: 32416061 PMCID: PMC7292772 DOI: 10.1016/j.chom.2020.04.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 09/13/2019] [Revised: 02/16/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022]
Abstract
Initial enteropathogen growth in the microbiota-colonized gut is poorly understood. Salmonella Typhimurium is metabolically adaptable and can harvest energy by anaerobic respiration using microbiota-derived hydrogen (H2) as an electron donor and fumarate as an electron acceptor. As fumarate is scarce in the gut, the source of this electron acceptor is unclear. Here, transposon sequencing analysis along the colonization trajectory of S. Typhimurium implicates the C4-dicarboxylate antiporter DcuABC in early murine gut colonization. In competitive colonization assays, DcuABC and enzymes that convert the C4-dicarboxylates aspartate and malate into fumarate (AspA, FumABC), are required for fumarate/H2-dependent initial growth. Thus, S. Typhimurium obtains fumarate by DcuABC-mediated import and conversion of L-malate and L-aspartate. Fumarate reduction yields succinate, which is exported by DcuABC in exchange for L-aspartate and L-malate. This cycle allows S. Typhimurium to harvest energy by H2/fumarate respiration in the microbiota-colonized gut. This strategy may also be relevant for commensal E. coli diminishing the S. Typhimurium infection.
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Affiliation(s)
- Bidong D Nguyen
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | | | - Johannes Hartl
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Ersin Gül
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Rebekka Bauer
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Susanne Meile
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Joel Rüthi
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Céline Margot
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Laura Heeb
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Franziska Besser
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Pau Pérez Escriva
- Institute of Molecular Systems Biology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Céline Fetz
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Markus Furter
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Leanid Laganenka
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Philipp Keller
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Lea Fuchs
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Matthias Christen
- Institute of Molecular Systems Biology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Steffen Porwollik
- Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine, CA 92697-4025, USA
| | - Michael McClelland
- Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine, CA 92697-4025, USA
| | - Julia A Vorholt
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Uwe Sauer
- Institute of Molecular Systems Biology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland
| | - Shinichi Sunagawa
- Institute of Microbiology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland.
| | - Beat Christen
- Institute of Molecular Systems Biology, D-BIOL, ETH Zürich, 8093 Zürich, Switzerland.
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23
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Pape S, Gevers TJG, Vrolijk JM, van Hoek B, Bouma G, van Nieuwkerk CMJ, Taubert R, Jaeckel E, Manns MP, Papp M, Sipeki N, Stickel F, Efe C, Ozaslan E, Purnak T, Nevens F, Kessener DJN, Kahraman A, Wedemeyer H, Hartl J, Schramm C, Lohse AW, Drenth JPH, Heneghan MA. Rapid Response to Treatment of Autoimmune Hepatitis Associated With Remission at 6 and 12 Months. Clin Gastroenterol Hepatol 2020; 18:1609-1617.e4. [PMID: 31715274 DOI: 10.1016/j.cgh.2019.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 08/09/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Changes in serum levels of transaminases immediately after initiation of treatment for autoimmune hepatitis (AIH) might be associated with biochemical markers of remission and liver-related events. We assessed the outcomes of patients with vs without rapid response to treatment of AIH in a large international cohort. METHODS We performed a retrospective cohort study, collecting data from 2 independent cohorts of adults with AIH from 12 centers in 7 countries in Europe. We collected information on patient demographics; serologic, histologic, and biochemical analyses; and treatment. We used a receiver operating characteristic curve and Youden index to calculate the optimal percentage decrease in level of aspartate aminotransferase (AST) after 8 weeks of treatment that associated with normalization of transaminase levels after 26 weeks of treatment with predniso(lo)ne (primary outcome) in the first (discovery) cohort (n = 370). We evaluated the results in the second (validation) cohort (n = 370). Secondary outcomes were liver-related death or transplantation. We performed univariate and multivariable logistic and Cox regression with correction for confounders. RESULTS A significant decrease in level of AST after 8 weeks of treatment was significantly associated with normalization of transaminase levels at 26 and 52 weeks (P < .001); a decrease of more than 80% in level of AST was associated with optimal normalization. In both cohorts, rapid responders (≥80% decrease in level of AST after 8 weeks) were more likely to achieve normalization of transaminases at 26 and 52 weeks when compared to non-rapid responders. Rapid responders in the discovery cohort had lower risk of liver-related death or transplantation (adjusted hazard ratio 0.18; 95% CI 0.05-0.63; P = .007), although this was not confirmed in the validation cohort. Results from measurement of alanine aminotransferase did not differ significantly from those of AST for the primary outcome. Slow responders (without normalization of transaminases after 1 year) had the highest risk of liver transplantation or liver-related death. CONCLUSIONS In a retrospective study of patients with AIH, we found that a rapid response to treatment, based on level of AST after 8 weeks, associates with normalization of transaminase levels in the following year. Patients with a rapid response also have a lower risk of liver-related death or transplantation than patients without this rapid response.
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Affiliation(s)
- Simon Pape
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom J G Gevers
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Maarten Vrolijk
- Department of Gastroenterology and Hepatology, Rijnstate hospital, Arnhem, The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerd Bouma
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Carin M J van Nieuwkerk
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Richard Taubert
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Maria Papp
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Nora Sipeki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | - Cumali Efe
- Department of Gastroenterology, Harran University Hospital, Urfa, Turkey
| | - Ersan Ozaslan
- Department of Gastroenterology, Numune Research and Education Hospital, Ankara, Turkey
| | - Tugrul Purnak
- Department of Gastroenterology, Hacettepe University, Ankara, Turkey
| | - Frederik Nevens
- Department of Gastroenterology and Hepatology, University Hospital KU Leuven, Leuven, Belgium
| | - Dominik J N Kessener
- Department of Gastroenterology and Hepatology, University Clinic of Essen Duisburg-Essen, Duisburg-Essen, Germany
| | - Alisan Kahraman
- Department of Gastroenterology and Hepatology, University Clinic of Essen Duisburg-Essen, Duisburg-Essen, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology and Hepatology, University Clinic of Essen Duisburg-Essen, Duisburg-Essen, Germany
| | - Johannes Hartl
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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24
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Sebode M, Reike-Kunze M, Weidemann S, Zenouzi R, Hartl J, Peiseler M, Liwinski T, Schulz L, Weiler-Normann C, Sterneck M, Lohse AW, Schramm C. Metamizole: An underrated agent causing severe idiosyncratic drug-induced liver injury. Br J Clin Pharmacol 2020; 86:1406-1415. [PMID: 32080881 PMCID: PMC7319009 DOI: 10.1111/bcp.14254] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 11/12/2019] [Revised: 01/03/2020] [Accepted: 01/19/2020] [Indexed: 12/13/2022] Open
Abstract
Aims Drug‐induced liver injury (DILI) is a heterogenous entity leading to liver damage. We have analysed the frequency, biochemical and histological patterns and clinical courses of DILI cases due to metamizole at our tertiary care centre in Hamburg, Germany. Methods Consecutive patients with DILI who presented to our clinic were analysed retrospectively. Causes of acute hepatitis other than DILI were excluded. Results In total, 154 DILI cases were admitted to our centre from 2008 to 2017. After phenprocoumon, metamizole was the second most frequent putative agent causing DILI (23 of all 154 DILI cases, 14,9%). The biochemical pattern on admission of metamizole‐induced DILI cases was hepatocellular with median levels of alanine transaminase (779 U/L, 64–3532 U/L) by far exceeding median alkaline phosphatase levels (131 U/L, 42–578 U/L). In 17 of the 23 cases (74%) liver biopsy was performed. Moderate to severe inflammatory histological activity and severe centrilobular necrosis (>30%) was present in 76.5 and 35.3%, respectively. Metamizole was involved in 2 DILI cases progressing to acute liver failure, then receiving liver transplantation and still alive at time of assessment. Our data were supported by re‐exposure in 4 patients. Furthermore, a database search for metamizole‐induced liver injury in the European Medicines Agency's database identified about 300 reports on suspected metamizole‐induced DILI in Europe. Conclusion Elevation of liver enzymes or acute liver failure are not mentioned in the German drug label of metamizole as potential side effects. Our study reveals that in Germany and Europe, metamizole is a frequent and underrated agent causing DILI.
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Affiliation(s)
- Marcial Sebode
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Germany
| | - Martin Reike-Kunze
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sören Weidemann
- Department of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Roman Zenouzi
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Germany
| | - Johannes Hartl
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Germany
| | - Moritz Peiseler
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Germany
| | - Timur Liwinski
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Germany
| | - Lisa Schulz
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Germany
| | - Christina Weiler-Normann
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Germany.,Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Sterneck
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,University Transplant Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Germany
| | - Christoph Schramm
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Germany.,Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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25
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Hartl J, Miquel R, Zachou K, Wong GW, Asghar A, Pape S, Sebode M, Peiseler M, Zenouzi R, Ehlken H, Krech T, Weiler-Normann C, Drenth JPH, Oo YH, Dalekos GN, Heneghan M, Schramm C, Lohse AW. Features and outcome of AIH patients without elevation of IgG. JHEP Rep 2020; 2:100094. [PMID: 32280942 PMCID: PMC7139106 DOI: 10.1016/j.jhepr.2020.100094] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 12/27/2022] Open
Abstract
Background & Aims High IgG levels are considered a hallmark of autoimmune hepatitis (AIH). A subgroup of patients with AIH has IgG within the normal range despite evidence of clinical disease activity. The clinical significance of this biomarker has not been explored. Methods In a European multicentre study we compared biochemical, clinical and histological features from patients with AIH and normal IgG-values at diagnosis to an age- and sex-matched control group of patients with typical AIH presenting with elevated IgG. Data were assessed at diagnosis, after 12 months of therapy and at last follow-up. Results Out of 1,318 patients with AIH, 130 (10%) had normal IgG at presentation. Histological and biochemical parameters at diagnosis, as well as treatment response, showed no difference between groups. Stable remission off treatment was achieved more commonly in the normal IgG group than in the typical AIH group (24 vs. 8%; p = 0.0012). Patients of the control group not only had higher IgG levels (29.5 ± 5.8 vs. 12.5 ± 3.2 g/L; p <0.0001), but also a higher IgG/IgA ratio (9.3 ± 6.9 vs. 5.4 ± 2.4; p <0.0001) at diagnosis. The IgG/IgA ratio only declined in patients with typical AIH and was no longer different between groups after 12 months (6.3 ± 4.3 vs. 5.5 ± 2.2; p = 0.1), indicating a selective increase of IgG in typical AIH and its suppression by immunosuppression. Autoantibody titres were higher in the typical AIH group, but not when controlled for IgG levels. Conclusions Compared to AIH with typical biochemical features, patients with normal IgG levels at diagnosis (i) show similar biochemical, serological and histological features and comparable treatment response, (ii) appear to lack the selective elevation of serum IgG levels observed in typical active AIH disease, (iii) may represent a subgroup with a higher chance of successful drug withdrawal. Lay summary A characteristic feature of autoimmune hepatitis (AIH) is an elevation of immunoglobulin G (IgG), which is therefore used as a major diagnostic criterion, as well as to monitor treatment response. Nevertheless, normal IgG does not preclude the diagnosis of AIH. Therefore, we herein assessed the features of patients with AIH and normal IgG in a large multicentre study. This study demonstrates that about 10% of all patients with AIH have normal IgG; these patients are indistinguishable from other patients with AIH with respect to biochemical markers, liver histology, disease severity and treatment response, but might represent a subgroup with a higher chance of remission after drug withdrawal. Patients with AIH and normal IgG comprise around 10% of all patients with AIH. These patients are indistinguishable from patients with typical AIH by biochemical markers or liver histology. They have no selective IgG elevation, with lower IgG and IgA levels than patients with typical AIH. These patients might represent a subgroup in whom there is a high chance of successful drug withdrawal.
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Key Words
- AIH, autoimmune hepatitis
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AMA, anti-mitochondrial antibody
- ANA, anti-nuclear antibody
- AST, aspartate aminotransferase
- Anti-SLA/LP, anti-soluble liver antigen and anti-liver-pancreas antibodies
- INR, international normalized ratio
- LKM, liver kidney microsomal antigen
- SMA, smooth muscle antibody
- autoimmune hepatitis
- drug withdrawal
- hypergammaglobulinemia
- immunoglobulin G
- immunoglobulins
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Affiliation(s)
- Johannes Hartl
- First Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases
| | - Rosa Miquel
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Kalliopi Zachou
- Institute of Internal Medicine and Hepatology, Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Larissa, Greece
| | - Guan-Wee Wong
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Asma Asghar
- Centre for Liver and Gastroenterology Research, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Simon Pape
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands.,European Reference Network on Hepatological Diseases
| | - Marcial Sebode
- First Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases
| | - Moritz Peiseler
- First Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases
| | - Roman Zenouzi
- First Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases
| | - Hanno Ehlken
- Department of Interdisciplinary Endoscopy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases
| | - Till Krech
- Department of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Weiler-Normann
- First Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands.,European Reference Network on Hepatological Diseases
| | - Ye H Oo
- Centre for Liver and Gastroenterology Research, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom.,Liver Transplant and Hepatobiliary Unit, University Hospital of Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Centre for Rare Diseases, Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom.,European Reference Network on Hepatological Diseases
| | - George Nikolaos Dalekos
- Institute of Internal Medicine and Hepatology, Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Larissa, Greece
| | - Michael Heneghan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Christoph Schramm
- First Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases
| | - Ansgar Wilhelm Lohse
- First Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases
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26
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Wolf N, Bussmann M, Koch-Koerfges A, Katcharava N, Schulte J, Polen T, Hartl J, Vorholt JA, Baumgart M, Bott M. Molecular Basis of Growth Inhibition by Acetate of an Adenylate Cyclase-Deficient Mutant of Corynebacterium glutamicum. Front Microbiol 2020; 11:87. [PMID: 32117117 PMCID: PMC7026483 DOI: 10.3389/fmicb.2020.00087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/15/2020] [Indexed: 01/02/2023] Open
Abstract
In Corynebacterium glutamicum, cyclic adenosine monophosphate (cAMP) serves as an effector of the global transcriptional regulator GlxR. Synthesis of cAMP is catalyzed by the membrane-bound adenylate cyclase CyaB. In this study, we investigated the consequences of decreased intracellular cAMP levels in a ΔcyaB mutant. While no growth defect of the ΔcyaB strain was observed on glucose, fructose, sucrose, or gluconate alone, the addition of acetate to these growth media resulted in a severe growth inhibition, which could be reversed by plasmid-based cyaB expression or by supplementation of the medium with cAMP. The effect was concentration- and pH-dependent, suggesting a link to the uncoupling activity of acetate. In agreement, the ΔcyaB mutant had an increased sensitivity to the protonophore carbonyl cyanide m-chlorophenyl hydrazone (CCCP). The increased uncoupler sensitivity correlated with a lowered membrane potential of acetate-grown ΔcyaB cells compared to wild-type cells. A reduced membrane potential affects major cellular processes, such as ATP synthesis by F1F O -ATP synthase and numerous transport processes. The impaired membrane potential of the ΔcyaB mutant could be due to a decreased expression of the cytochrome bc 1-aa 3 supercomplex, which is the major contributor of proton-motive force in C. glutamicum. Expression of the supercomplex genes was previously reported to be activated by GlxR-cAMP. A suppressor mutant of the ΔcyaB strain with improved growth on acetate was isolated, which carried a single mutation in the genome leading to an Ala131Thr exchange in GlxR. Introduction of this point mutation into the original ΔcyaB mutant restored the growth defect on acetate. This supported the importance of GlxR for the phenotype of the ΔcyaB mutant and, more generally, of the cAMP-GlxR system for the control of energy metabolism in C. glutamicum.
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Affiliation(s)
- Natalie Wolf
- IBG-1: Biotechnology, Institute of Bio- and Geosciences, Forschungszentrum Jülich, Jülich, Germany
| | - Michael Bussmann
- IBG-1: Biotechnology, Institute of Bio- and Geosciences, Forschungszentrum Jülich, Jülich, Germany
| | - Abigail Koch-Koerfges
- IBG-1: Biotechnology, Institute of Bio- and Geosciences, Forschungszentrum Jülich, Jülich, Germany
| | - Nino Katcharava
- IBG-1: Biotechnology, Institute of Bio- and Geosciences, Forschungszentrum Jülich, Jülich, Germany
| | - Julia Schulte
- IBG-1: Biotechnology, Institute of Bio- and Geosciences, Forschungszentrum Jülich, Jülich, Germany
| | - Tino Polen
- IBG-1: Biotechnology, Institute of Bio- and Geosciences, Forschungszentrum Jülich, Jülich, Germany
| | - Johannes Hartl
- Institute of Microbiology, ETH Zürich, Zurich, Switzerland
| | | | - Meike Baumgart
- IBG-1: Biotechnology, Institute of Bio- and Geosciences, Forschungszentrum Jülich, Jülich, Germany
| | - Michael Bott
- IBG-1: Biotechnology, Institute of Bio- and Geosciences, Forschungszentrum Jülich, Jülich, Germany
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27
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Hartl J, Kiefer P, Kaczmarczyk A, Mittelviefhaus M, Meyer F, Vonderach T, Hattendorf B, Jenal U, Vorholt JA. Untargeted metabolomics links glutathione to bacterial cell cycle progression. Nat Metab 2020; 2:153-166. [PMID: 32090198 PMCID: PMC7035108 DOI: 10.1038/s42255-019-0166-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/17/2019] [Indexed: 12/21/2022]
Abstract
Cell cycle progression requires the coordination of cell growth, chromosome replication, and division. Consequently, a functional cell cycle must be coupled with metabolism. However, direct measurements of metabolome dynamics remained scarce, in particular in bacteria. Here, we describe an untargeted metabolomics approach with synchronized Caulobacter crescentus cells to monitor the relative abundance changes of ~400 putative metabolites as a function of the cell cycle. While the majority of metabolite pools remains homeostatic, ~14% respond to cell cycle progression. In particular, sulfur metabolism is redirected during the G1-S transition, and glutathione levels periodically change over the cell cycle with a peak in late S phase. A lack of glutathione perturbs cell size by uncoupling cell growth and division through dysregulation of KefB, a K+/H+ antiporter. Overall, we here describe the impact of the C. crescentus cell cycle progression on metabolism, and in turn relate glutathione and potassium homeostasis to timely cell division.
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Affiliation(s)
- Johannes Hartl
- ETH Zurich, Institute of Microbiology, Zurich, Switzerland.
| | - Patrick Kiefer
- ETH Zurich, Institute of Microbiology, Zurich, Switzerland
| | | | | | - Fabian Meyer
- ETH Zurich, Institute of Microbiology, Zurich, Switzerland
| | - Thomas Vonderach
- ETH Zurich, Laboratory of Inorganic Chemistry, Zurich, Switzerland
| | - Bodo Hattendorf
- ETH Zurich, Laboratory of Inorganic Chemistry, Zurich, Switzerland
| | - Urs Jenal
- Biozentrum of the University of Basel, Basel, Switzerland
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28
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Bovensiepen CS, Schakat M, Sebode M, Zenouzi R, Hartl J, Peiseler M, Li J, Henze L, Woestemeier A, Schramm C, Lohse AW, Herkel J, Weiler-Normann C. TNF-Producing Th1 Cells Are Selectively Expanded in Liver Infiltrates of Patients with Autoimmune Hepatitis. J Immunol 2019; 203:3148-3156. [PMID: 31685647 DOI: 10.4049/jimmunol.1900124] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 10/03/2019] [Indexed: 12/23/2022]
Abstract
Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease that is believed to be driven by a CD4+ T cell response to liver Ags. However, the pathogenic function of CD4+ effector T cells in AIH is not fully understood. To characterize liver-infiltrating lymphocytes in AIH, we determined the cytokine production of infiltrating cells obtained from biopsy material by quantitative RT-PCR and flow cytometry. A cytokine quantitiative RT-PCR array of AIH specimens revealed that TNF was the most strongly upregulated cytokine, as compared with control livers. To confirm this finding, we determined the frequencies of TNF-producing CD4+ T cells in peripheral blood and in liver biopsy specimens in comparison with those of CD4+ T cells producing IFN-γ or IL-17. In AIH, TNF-producing CD4+ T cells were significantly expanded, both in blood and liver, whereas IL-17-producing CD4+ T cells were not. However, the majority of the TNF-producing CD4+ T cells in AIH also produced IFN-γ, suggesting that TNF producers might represent a pathogenic activation state of Th1 cells. Ag-specific stimulation of PBMC from AIH patients with the AIH-associated autoantigen SEPSECS resulted in significant TNF production only in patients manifesting SLA/LP autoantibodies targeting SEPSEC but not in healthy individuals who do not manifest this reactivity. Taken together, our findings indicated that TNF-producing CD4+ T cells are expanded in AIH, both in blood and in liver. TNF-producing CD4+ T cells in AIH seem to be aberrantly activated Th1 cells. Our findings provide a rationale for therapeutic efforts using TNF blockade in AIH.
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Affiliation(s)
- Claudia S Bovensiepen
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Miriam Schakat
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Marcial Sebode
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Roman Zenouzi
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Johannes Hartl
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Moritz Peiseler
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jun Li
- Department of Hepatobiliary Surgery and Transplantation, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany.,Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; and
| | - Lara Henze
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Anna Woestemeier
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; and
| | - Christoph Schramm
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany.,Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Johannes Herkel
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christina Weiler-Normann
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; .,Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
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29
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Pape S, Gevers TJG, Belias M, Mustafajev IF, Vrolijk JM, van Hoek B, Bouma G, van Nieuwkerk CMJ, Hartl J, Schramm C, Lohse AW, Taubert R, Jaeckel E, Manns MP, Papp M, Stickel F, Heneghan MA, Drenth JPH. Predniso(lo)ne Dosage and Chance of Remission in Patients With Autoimmune Hepatitis. Clin Gastroenterol Hepatol 2019; 17:2068-2075.e2. [PMID: 30625402 DOI: 10.1016/j.cgh.2018.12.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/30/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with autoimmune hepatitis (AIH) commonly receive induction therapy with predniso(lo)ne followed by maintenance therapy with azathioprine. European Association for Study of the Liver clinical practice guidelines advise a predniso(lo)ne dose range of 0.50-1 mg/kg/day, which leaves room for practice variation. We performed a multicenter study to determine the efficacy of different dose ranges of predniso(lo)ne induction therapy in a large European cohort of patients with AIH. METHODS We performed a retrospective cohort study using a comparative effectiveness design. We collected data from 451 adults with AIH who began treatment from 1978 through 2017 at 9 centers in 5 European countries. We assigned patients to a high-dose group (initial predniso(lo)ne dose ≥0.50 mg/kg/day; n = 281) or a low-dose group (<0.50 mg/kg/day; n = 170). Logistic regression was performed to determine difference in outcomes between the groups. The primary outcome was normal serum levels of transaminases at 6 months after initiation of therapy. RESULTS There was no significant difference in rates of normalization of transaminases between the high-dose predniso(lo)ne group and the low-dose group (70.5% vs 64.7%; P = .20). After multivariable logistic regression with correction for confounders, there was no difference in the likelihood of normalization of transaminases between the groups (odds ratio, 1.21; 95% CI, 0.78-1.87; P = .38). Patients given an initial high dose of predniso(lo)ne received more predniso(lo)ne over time than patients started on a lower dose (median doses over 6 months: 3780 mg vs 2573 mg) (P < .01). CONCLUSIONS In a retrospective study of patients with AIH in Europe, we found that the dose of predniso(lo)ne to induce remission in patients with AIH is less relevant than assumed. An initial predniso(lo)ne dose below 0.50 mg/kg/day substantially decreases unnecessary exposure to predniso(lo)ne in patients with AIH.
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Affiliation(s)
- Simon Pape
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom J G Gevers
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michail Belias
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilyas F Mustafajev
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Maarten Vrolijk
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerd Bouma
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Carin M J van Nieuwkerk
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes Hartl
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Christoph Schramm
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- 1(st) Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard Taubert
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Maria Papp
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | - Michael A Heneghan
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
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30
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Sebode M, Wigger J, Filpe P, Fischer L, Weidemann S, Krech T, Weiler-Normann C, Peiseler M, Hartl J, Tolosa E, Herkel J, Schramm C, Lohse AW, Arrenberg P. Inflammatory Phenotype of Intrahepatic Sulfatide-Reactive Type II NKT Cells in Humans With Autoimmune Hepatitis. Front Immunol 2019; 10:1065. [PMID: 31191516 PMCID: PMC6546815 DOI: 10.3389/fimmu.2019.01065] [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: 02/28/2019] [Accepted: 04/25/2019] [Indexed: 01/06/2023] Open
Abstract
Background: Natural Killer T (NKT) cells are CD1d-restricted innate-like T cells that can rapidly release stored cytokines upon recognition of lipid antigens. In mice, type I NKT cells seem to promote liver inflammation, whereas type II NKT cells seem to restrict hepatitis. Here, we aimed at characterizing the role of human type I and type II NKT in patients with autoimmune hepatitis (AIH). Methods: NKT cells were analyzed by flow cytometry in peripheral blood and liver of AIH patients and control groups. α-galactosylceramide-loaded or sulfatide-loaded tetramers were used to detect type I or II NKT cells, respectively. Hepatic CD1d was stained by in situ-hybridization of liver biopsies. Results and Conclusions: Type II NKT cells were more prevalent in human peripheral blood and liver than type I NKT cells. In AIH patients, the frequency of sulfatide-reactive type II NKT cells was significantly increased in peripheral blood (0.11% of peripheral blood leukocytes) and liver (3.78% of intrahepatic leukocytes) compared to healthy individuals (0.05% and 1.82%) and patients with drug-induced liver injury (0.06% and 2.03%; p < 0.05). Intrahepatic type II NKT cells of AIH patients had a different cytokine profile than healthy subjects with an increased frequency of TNFα (77.8% vs. 59.1%, p < 0.05), decreased IFNγ (32.7% vs. 63.0%, p < 0.05) and a complete lack of IL-4 expressing cells (0% vs. 2.1%, p < 0.05). T cells in portal tracts expressed significantly more CD1d-RNA in AIH livers compared to controls. This study supports that in contrast to their assumed protective role in mice, human intrahepatic, sulfatide-reactive type II NKT cells displayed a proinflammatory cytokine profile in patients with AIH. Infiltrating T cells in portal areas of AIH patients overexpressed CD1d and could thereby activate type II NKT cells.
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Affiliation(s)
- Marcial Sebode
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Jennifer Wigger
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pamela Filpe
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sören Weidemann
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Krech
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Weiler-Normann
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.,Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Peiseler
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Johannes Hartl
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Eva Tolosa
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Herkel
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany.,Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Philomena Arrenberg
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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31
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Horvatits T, Ozga AK, Westhölter D, Hartl J, Manthey CF, Lütgehetmann M, Rauch G, Kriston L, Lohse AW, Bendall R, Wedemeyer H, Dalton HR, Pischke S. Hepatitis E seroprevalence in the Americas: A systematic review and meta-analysis. Liver Int 2018; 38:1951-1964. [PMID: 29660259 DOI: 10.1111/liv.13859] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS While hepatitis E virus infections are a relevant topic in Europe, knowledge about epidemiology of hepatitis E virus infections in the USA and Latin America is still limited. Aim of this study was to estimate anti-hepatitis E virus IgG seroprevalence in the Americas and to assess whether low socioeconomic status is associated with hepatitis E virus exposure. METHODS We performed a systematic review and meta-analysis. Literature search was performed in PubMed for articles published 01/1994-12/2016. Prevalence was estimated using a mixed-effects model and reported in line with PRISMA reporting guidelines. RESULTS Seroprevalence was significantly higher in the USA than in Latin America, independently of assay, patient cohort, methodological quality or study year (OR: 1.82 (1.06-3.08), P = .03). Patients in the USA had a more than doubled estimated seroprevalence (up to 9%, confidence interval 5%-15.6%) than those in Brazil (up to 4.2%, confidence interval 2.4%-7.1%; OR: 2.27 (1.25-4.13); P = .007) and Mixed Caribbean (up to 1%, OR: 8.33 (1.15-81.61); P = .04). A comparison with published data from Europe demonstrated that anti-hepatitis E virus seroprevalence in the USA and Europe did not differ significantly (OR: 1.33 (0.81-2.19), P = .25), while rate in South America was significantly lower than that in Europe (OR: 0.67 (0.45-0.98), P = .04). CONCLUSIONS Hepatitis E virus is common in the USA. Surprisingly, the risk of hepatitis E virus exposure was low in many South American countries. Seroprevalence did not differ significantly between Europe and the USA. Hence, hepatitis E virus is not limited to countries with low sanitary standards, and a higher socioeconomic status does not protect populations from hepatitis E virus exposure.
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Affiliation(s)
- Thomas Horvatits
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Westhölter
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin F Manthey
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany
| | - Geraldine Rauch
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany
| | - Richard Bendall
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro, UK
| | - Heiner Wedemeyer
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany.,Department of Gastroenterology, Hepatology, University Hospital of Essen, Essen, Germany
| | - Harry R Dalton
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro, UK
| | - Sven Pischke
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel and Heidelberg Partner sites, Hamburg, Germany
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32
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Peiseler M, Reiners D, Pinnschmidt HO, Sebode M, Jung F, Hartl J, Zenouzi R, Ehlken H, Groth S, Schachschal G, Rösch T, Weiler-Normann C, Lohse AW, Schramm C. Risk of endoscopic biliary interventions in primary sclerosing cholangitis is similar between patients with and without cirrhosis. PLoS One 2018; 13:e0202686. [PMID: 30125307 PMCID: PMC6101401 DOI: 10.1371/journal.pone.0202686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/26/2018] [Accepted: 08/06/2018] [Indexed: 12/12/2022] Open
Abstract
Background Endoscopic retrograde cholangiography (ERC) is a mainstay of therapy in patients with primary sclerosing cholangitis (PSC) and obstructive cholestasis. Patients with liver cirrhosis have an increased risk of surgical complications and are more susceptible to infections. Since PSC often progresses to cirrhosis, we aimed to assess whether ERC is associated with increased risk of complications in patients with PSC and cirrhosis. Methods Out of 383 patients with PSC, 208 patients received endoscopic treatment between 2009–2017. Seventy patients had cirrhosis when ERC was performed and 138 patients had no signs of cirrhosis. Overall, 663 ERC procedures were analysed, with 250 ERC in patients with cirrhosis and 413 ERC in patients without cirrhosis. Data were analysed retrospectively from a prospectively acquired database using repeated measures logistic regression. Results Overall, 40 procedure-related complications were documented in 663 ERC interventions (6%). The rate of complications was similar between patients with and without cirrhosis (4.4% vs. 7.0%). First-time ERC was associated with a higher risk of complications (17.5% vs. 4.9%). Biliary sphincterotomy, stent placement and female sex, but not presence of liver cirrhosis, were identified as risk factors for overall complications in multivariate analysis. Patients without cirrhosis showed a significant decline of ALP and bilirubin levels after the first two interventions. In contrast, in patients with cirrhosis, ALP and bilirubin levels did not significantly decline after ERC. Conclusions In patients with PSC, cirrhosis was not a risk factor for post-ERC complications. Therefore, cirrhosis should not preclude endoscopic intervention in patients with clear clinical indication.
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Affiliation(s)
- Moritz Peiseler
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- * E-mail: (MP); (CS)
| | - David Reiners
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hans O. Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marcial Sebode
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Jung
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Roman Zenouzi
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hanno Ehlken
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Department of Interdisciplinary Endoscopy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Groth
- Department of Interdisciplinary Endoscopy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Schachschal
- Department of Interdisciplinary Endoscopy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Weiler-Normann
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W. Lohse
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- * E-mail: (MP); (CS)
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33
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Meyer F, Keller P, Hartl J, Gröninger OG, Kiefer P, Vorholt JA. Methanol-essential growth of Escherichia coli. Nat Commun 2018; 9:1508. [PMID: 29666370 PMCID: PMC5904121 DOI: 10.1038/s41467-018-03937-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [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: 11/23/2017] [Accepted: 03/22/2018] [Indexed: 12/22/2022] Open
Abstract
Methanol represents an attractive substrate for biotechnological applications. Utilization of reduced one-carbon compounds for growth is currently limited to methylotrophic organisms, and engineering synthetic methylotrophy remains a major challenge. Here we apply an in silico-guided multiple knockout approach to engineer a methanol-essential Escherichia coli strain, which contains the ribulose monophosphate cycle for methanol assimilation. Methanol conversion to biomass was stoichiometrically coupled to the metabolization of gluconate and the designed strain was subjected to laboratory evolution experiments. Evolved strains incorporate up to 24% methanol into core metabolites under a co-consumption regime and utilize methanol at rates comparable to natural methylotrophs. Genome sequencing reveals mutations in genes coding for glutathione-dependent formaldehyde oxidation (frmA), NAD(H) homeostasis/biosynthesis (nadR), phosphopentomutase (deoB), and gluconate metabolism (gntR). This study demonstrates a successful metabolic re-routing linked to a heterologous pathway to achieve methanol-dependent growth and represents a crucial step in generating a fully synthetic methylotrophic organism. Engineering synthetic methylotrophy remains challenging. Here, the authors engineer a methanol-essential E. coli by an in silico-guided multiple knockout approach and show a laboratory evolved strain can incorporate up to 24% methanol into core metabolites during growth.
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Affiliation(s)
- Fabian Meyer
- Institute of Microbiology, Department of Biology, ETH Zurich, Zurich, 8093, Switzerland
| | - Philipp Keller
- Institute of Microbiology, Department of Biology, ETH Zurich, Zurich, 8093, Switzerland
| | - Johannes Hartl
- Institute of Microbiology, Department of Biology, ETH Zurich, Zurich, 8093, Switzerland
| | - Olivier G Gröninger
- Institute of Microbiology, Department of Biology, ETH Zurich, Zurich, 8093, Switzerland
| | - Patrick Kiefer
- Institute of Microbiology, Department of Biology, ETH Zurich, Zurich, 8093, Switzerland
| | - Julia A Vorholt
- Institute of Microbiology, Department of Biology, ETH Zurich, Zurich, 8093, Switzerland.
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Hartl J, Ehlken H, Sebode M, Peiseler M, Krech T, Zenouzi R, von Felden J, Weiler-Normann C, Schramm C, Lohse AW. Usefulness of biochemical remission and transient elastography in monitoring disease course in autoimmune hepatitis. J Hepatol 2018; 68:754-763. [PMID: 29180000 DOI: 10.1016/j.jhep.2017.11.020] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [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: 06/16/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Liver fibrosis regression but also progression may occur in patients with autoimmune hepatitis (AIH) under treatment. There is a need for non-invasive surrogate markers for fibrosis development in AIH to better guide immunosuppressive treatment. The aims of the study were to assess the impact of complete biochemical remission defined as normalisation of aminotransferases and IgG on histological activity and fibrosis development, and the value of repeat transient elastography (TE) measurement for monitoring disease progression in AIH. METHODS A total of 131 liver biopsies from 60 patients with AIH and more than 900 TE from 125 patients with AIH, 130 with primary biliary cholangitis (PBC) and 100 with primary sclerosing cholangitis (PSC), were evaluated. Time intervals between TE were at least 12 months. Patients with AIH were treated for at least six months at first TE. RESULTS In contrast to PBC and PSC, a decrease of liver stiffness (LS) was observed in the whole group of patients with AIH (-6.2%/year; 95% CI -12.6% to -0.2%; p = 0.04). The largest decrease of LS was observed in patients with severe fibrosis at baseline (F4: -11.7%/year; 95% CI -19% to -3.5%; p = 0.006). Complete biochemical remission was strongly linked to regression of LS ("remission": -7.5%/year vs. "no remission": +1.7%/year, p <0.001). Similarly, complete biochemical remission predicted low histological disease activity and was the only independent predictor for histological fibrosis regression (relative risk3.66; 95% CI1.54-10.2; p = 0.001). Patients with F3/F4-fibrosis, who remained in biochemical remission showed a considerable decrease of fibrosis stage (3.7 ± 0.5 to 1.8 ± 1.7; p = 0.007) on histological follow-up. CONCLUSIONS This study demonstrates that complete biochemical remission is a reliable predictor of a good prognosis in AIH and leads to fibrosis regression that can be monitored by TE. LAY SUMMARY Autoimmune hepatitis is an inflammatory disease of the liver, which often progresses to cirrhosis if left untreated or in the case of insufficient treatment response. Current guidelines have defined biochemical remission (normalisation of biochemical markers for liver inflammation) as a major goal in the treatment of AIH. However, data on the prognostic relevance of this definition are scarce. Herein, we demonstrate that the current definition of biochemical remission is a reliable surrogate for low disease activity on histological assessment and for a beneficial long-term disease course. In addition, we establish transient elastography, a non-invasive ultrasound-based method of measuring scarring of liver tissue, as a reliable tool to monitor disease course in AIH.
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Affiliation(s)
- Johannes Hartl
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany.
| | - Hanno Ehlken
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; Interdisciplinary Endoscopy Unit, University Hospital, Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marcial Sebode
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - Moritz Peiseler
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - Till Krech
- Institute for Pathology, University Hospital, Hamburg, Eppendorf (UKE), Hamburg, Germany
| | - Roman Zenouzi
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - Johann von Felden
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - Christina Weiler-Normann
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; Martin-Zeitz Center for Rare Diseases, University Hospital, Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christoph Schramm
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; Martin-Zeitz Center for Rare Diseases, University Hospital, Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ansgar W Lohse
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
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Zenouzi R, von der Gablentz J, Heldmann M, Göttlich M, Weiler-Normann C, Sebode M, Ehlken H, Hartl J, Fellbrich A, Siemonsen S, Schramm C, Münte TF, Lohse AW. Patients with primary biliary cholangitis and fatigue present with depressive symptoms and selected cognitive deficits, but with normal attention performance and brain structure. PLoS One 2018; 13:e0190005. [PMID: 29320524 PMCID: PMC5761833 DOI: 10.1371/journal.pone.0190005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023] Open
Abstract
Background In primary biliary cholangitis (PBC) fatigue is a major clinical challenge of unknown etiology. By demonstrating that fatigue in PBC is associated with an impaired cognitive performance, previous studies have pointed out the possibility of brain abnormalities underlying fatigue in PBC. Whether structural brain changes are present in PBC patients with fatigue, however, is unclear. To evaluate the role of structural brain abnormalities in PBC patients severely affected from fatigue we, therefore, performed a case-control cerebral magnetic resonance imaging (cMRI) study and correlated changes of white and grey brain matter with the cognitive and attention performance. Methods 20 female patients with PBC and 20 female age-matched controls were examined in this study. The assessment of fatigue, psychological symptoms, cognitive and attention performance included clinical questionnaires, established cognition tests and a computerized test battery of attention performance. T1-weighted cMRI and diffusion tensor imaging (DTI) scans were acquired with a 3 Tesla scanner. Structural brain alterations were investigated with voxel-based morphometry (VBM) and DTI analyses. Results were correlated to the cognitive and attention performance. Results Compared to healthy controls, PBC patients had significantly higher levels of fatigue and associated psychological symptoms. Except for an impairment of verbal fluency, no cognitive or attention deficits were found in the PBC cohort. The VBM and DTI analyses revealed neither major structural brain abnormalities in the PBC cohort nor correlations with the cognitive and attention performance. Conclusions Despite the high burden of fatigue and selected cognitive deficits, the attention performance of PBC patients appears to be comparable to healthy people. As structural brain alterations do not seem to be present in PBC patients with fatigue, fatigue in PBC must be regarded as purely functional. Future studies should evaluate, whether functional brain changes underlie fatigue in PBC.
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Affiliation(s)
- Roman Zenouzi
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | | | - Marcus Heldmann
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Martin Göttlich
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | | | - Marcial Sebode
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanno Ehlken
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Fellbrich
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Susanne Siemonsen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas F. Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Ansgar W. Lohse
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Weiler-Normann C, Hartl J, Weidemann S, von Pein UM, Fiedler W, Schramm C, Brinkert F, Kröger N, Christopeit M. Acute hepatitis as a prequel to very severe aplastic anemia. Z Gastroenterol 2018; 56:51-54. [PMID: 29316578 DOI: 10.1055/s-0043-121737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Severe aplastic anemia is a rare and potentially life-threatening disease of the bone marrow often requiring allogeneic hematopoietic stem cell transplantation. Pathogenesis of the disease can vary and often remains enigmatic. Occasionally, severe aplastic anemia is associated with prior severe acute hepatitis. Differential diagnosis of acute non-viral hepatitis challenges the physician as pathogenesis remains unclear.We here present a case of a young patient presenting with acute hepatitis followed by severe aplastic anemia successfully treated with allogeneic hematopoietic stem cell transplantation. Due to immunosuppressive treatment with azathioprine for acute hepatitis of putative autoimmune pathogenesis and coincident infection with parvovirus B19, diagnosis of the sequential disease of acute hepatitis followed by severe aplastic anemia was complicated. We discuss the caveats and present a review of the literature.
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Affiliation(s)
| | - Johannes Hartl
- I. Department of Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Sören Weidemann
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ute-Marie von Pein
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walter Fiedler
- II. Department of Medicine, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- I. Department of Medicine, University Medical Center of Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Brinkert
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wehmeyer MH, Hartl J, von Wulffen M, Lohse AW, Pischke S. Time trend of reported cases and publications: hepatitis E in comparison to hepatitis A - D in Germany from 2001 to 2016. Z Gastroenterol 2018; 56:29-35. [PMID: 29316575 DOI: 10.1055/s-0043-123830] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The frequency of autochthonous hepatitis E virus (HEV) infections in Western countries has increased since the millennium, probably due to a higher awareness for HEV. The aim of this study was to analyze the epidemiological situation and regional distribution of HEV in comparison to hepatitis A - D in Germany. METHODS Data of the reported cases, patients' travel histories, and the regional distribution of hepatitis A - E virus infections from 2001 to 2017 were extracted from databases of the Robert Koch Institute. The number of publications per year on each hepatitis virus was used as a surrogate parameter for scientific awareness. RESULTS The incidence of HEV infections increased from 31 reported cases in 2001 to 1991 cases in 2016 with a rate of autochthonous HEV infections of 44.4 % in 2001 and 83.9 % in 2016. In 2016, the HEV incidence was 4.4/100 000 in Eastern Germany and 2.0/100 000 in Western Germany. From 2001 to 2016, the numbers of hepatitis A and C virus infections decreased, while the number of hepatitis B virus infections initially decreased followed by an increase since 2014. The incidence of hepatitis D virus infections remained low. The incidence rates of hepatitis A - D virus infections were comparable between Eastern and Western Germany in 2016. There was a strong correlation between publications on HEV and reported HEV cases (Pearson r = 0.9803, p < 0.01). CONCLUSIONS Especially in Eastern Germany, but also in Western Germany, the rate of reported HEV cases and the scientific awareness for this disease increased strongly since 2001.
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Affiliation(s)
- Malte H Wehmeyer
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf
| | - Johannes Hartl
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf
| | | | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf.,Deutsches Zentrum für Infektionsforschung (DZIF), Hamburg site
| | - Sven Pischke
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf.,Deutsches Zentrum für Infektionsforschung (DZIF), Hamburg site
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Sebode M, Hartl J, Vergani D, Lohse AW. Autoimmune hepatitis: From current knowledge and clinical practice to future research agenda. Liver Int 2018; 38:15-22. [PMID: 28432836 DOI: 10.1111/liv.13458] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [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: 01/05/2017] [Accepted: 04/12/2017] [Indexed: 12/12/2022]
Abstract
Autoimmune hepatitis is a chronic inflammatory liver disease. Unknown triggers lead to a mainly T cell-mediated immune response targeting the liver, the main auto-antigen of which has not been identified yet. The diagnosis of autoimmune hepatitis is based on the elevation of immunoglobulin G/hypergammaglobulinemia, detection of characteristic autoantibodies as well as a typical pattern on liver histology. Exclusion of other causes of hepatitis and response to immunosuppressive treatment support the diagnosis of autoimmune hepatitis. The mainstay of autoimmune hepatitis treatment has, from its first description to the current time, consisted of predniso(lo)ne to induce remission, in combination with azathioprine, which is used to maintain it. Nonetheless, side effects and non-response with ongoing inflammation despite standard therapy demand treatment alternatives. Only through a better understanding of the pathogenesis of autoimmune hepatitis can a more selective and effective treatment be offered to patients in the future. Until this goal is reached, improvement of diagnostic approaches and optimization of current therapy rank highest on the research agenda for autoimmune hepatitis.
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Affiliation(s)
- Marcial Sebode
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Diego Vergani
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Ansgar W Lohse
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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van Eijk JJJ, Dalton HR, Ripellino P, Madden RG, Jones C, Fritz M, Gobbi C, Melli G, Pasi E, Herrod J, Lissmann RF, Ashraf HH, Abdelrahim M, Masri OABAL, Fraga M, Benninger D, Kuntzer T, Aubert V, Sahli R, Moradpour D, Blasco-Perrin H, Attarian S, Gérolami R, Colson P, Giordani MT, Hartl J, Pischke S, Lin NX, Mclean BN, Bendall RP, Panning M, Peron JM, Kamar N, Izopet J, Jacobs BC, van Alfen N, van Engelen BGM. Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy. Neurology 2017; 89:909-917. [PMID: 28768846 DOI: 10.1212/wnl.0000000000004297] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/06/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To determine the clinical phenotype and outcome in hepatitis E virus-associated neuralgic amyotrophy (HEV-NA). METHODS Cases of NA were identified in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and outcome. Cases of HEV-NA were compared with NA cases without evidence of HEV infection. RESULTS Fifty-seven cases of HEV-NA and 61 NA cases without HEV were studied. Fifty-six of 57 HEV-NA cases were anti-HEV IgM positive; 53/57 were IgG positive. In 38 cases, HEV RNA was recovered from the serum and in 1 from the CSF (all genotype 3). Fifty-one of 57 HEV-NA cases were anicteric; median alanine aminotransferase 259 IU/L (range 12-2,961 IU/L); in 6 cases, liver function tests were normal. HEV-NA cases were more likely to have bilateral involvement (80.0% vs 8.6%, p < 0.001), damage outside the brachial plexus (58.5% vs 10.5%, p < 0.01), including phrenic nerve and lumbosacral plexus injury (25.0% vs 3.5%, p = 0.01, and 26.4% vs 7.0%, p = 0.001), reduced reflexes (p = 0.03), sensory symptoms (p = 0.04) with more extensive damage to the brachial plexus. There was no difference in outcome between the 2 groups at 12 months. CONCLUSIONS Patients with HEV-NA are usually anicteric and have a distinct clinical phenotype, with predominately bilateral asymmetrical involvement of, and more extensive damage to, the brachial plexus. Involvement outside the brachial plexus is more common in HEV-NA. The relationship between HEV and NA is likely to be causal, but is easily overlooked. Patients presenting with NA should be tested for HEV, irrespective of liver function test results. Prospective treatment/outcome studies of HEV-NA are warranted.
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Affiliation(s)
- Jeroen J J van Eijk
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Harry R Dalton
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands.
| | - Paolo Ripellino
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Richard G Madden
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Catherine Jones
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Miriam Fritz
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Claudio Gobbi
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Giorgia Melli
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Emanuela Pasi
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Jenny Herrod
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Rebecca F Lissmann
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Hamad H Ashraf
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Mohamed Abdelrahim
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Omar A B A L Masri
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Montserrat Fraga
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - David Benninger
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Thierry Kuntzer
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Vincent Aubert
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Roland Sahli
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Darius Moradpour
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Hélène Blasco-Perrin
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Shahram Attarian
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Rene Gérolami
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Philippe Colson
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Maria T Giordani
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Johannes Hartl
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Sven Pischke
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Nan X Lin
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Brendan N Mclean
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Richard P Bendall
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Marcus Panning
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Jean-Marie Peron
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Nassim Kamar
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Jacques Izopet
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Bart C Jacobs
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Nens van Alfen
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
| | - Baziel G M van Engelen
- From the Jeroen Bosch Hospital (J.J.J.v.E.), 's-Hertogenbosch, the Netherlands; Royal Cornwall Hospital (H.R.D., R.G.M., C.J., J. Herrod, R.F.L., H.H.A., M.A., O.A.B.A.L.M., B.N.M., R.P.B.); European Centre for the Environment and Human Health (H.R.D., R.P.B.), University of Exeter, Truro, UK; Neurocenter of Southern Switzerland (P.R., C.G., G.M.), Lugano; Department of Neurology and Neuroscience (M.F.) and Institute for Virology (M.P.), Medical Center-University of Freiburg and Faculty of Medicine, University of Freiburg, Germany; Microbiology Department (E.P.), EOLAB (SMIC), Bellinzona, Switzerland; University Hospital Lausanne (CHUV) (M.F., D.B., T.K., V.A., R.S., D.M.), Switzerland; Université Paul Sabatier (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Centre Hospitalo-Universitaire Timone (S.A., R.G., P.C.); IHU-Méditerranée Infection (P.C.), Aix-Marseille Université, AP-HM, France; San Bortolo Hospital (M.T.G.), Vicenza, Italy; University Medical Center Hamburg-Eppendorf (J. Hartl, S.P.), Germany; Northumbria University (N.X.L.), Newcastle upon Tyne, UK; CHU Rangueil (N.K.); CHU Purpan (H.B.-P., J.-M.P., N.K., J.I.), Toulouse, France; Erasmus MC (B.C.J.), University Medical Centre Rotterdam; and Department of Neurology (N.v.A., B.G.M.v.E.), Donders Center for Medical Neuroscience, Radboudumc Nijmegen, the Netherlands
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Pischke S, Hartl J, Pas SD, Lohse AW, Jacobs BC, Van der Eijk AA. Hepatitis E virus: Infection beyond the liver? J Hepatol 2017; 66:1082-1095. [PMID: 27913223 DOI: 10.1016/j.jhep.2016.11.016] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [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: 07/07/2016] [Revised: 11/13/2016] [Accepted: 11/20/2016] [Indexed: 02/07/2023]
Abstract
Hepatitis E virus (HEV) infections are not limited to the liver but may also affect other organs. Several diseases, including Guillain-Barré syndrome, neuralgic amyotrophy, glomerulonephritis, cryoglobulinemia, pancreatitis, lymphoma, thrombopenia, meningitis, thyroiditis and myocarditis have been observed in the context of hepatitis E. To date, the definite pathophysiological links between HEV and extrahepatic manifestations are not yet established. However, it is suggested that HEV infection might be causative based on serological studies, case series, in vitro data and animal models. In particular, neuronal and renal diseases as well as pancreatitis seem to be caused by HEV, while a causative relationship between HEV and other diseases is more doubtful. Either direct cytopathic tissue damage by extrahepatic replication, or immunological processes induced by an overwhelming host immune response, are possible origins of HEV-associated extrahepatic manifestations. Hepatologists should be aware of the possibility that acute or chronically HEV-infected patients could develop extrahepatic manifestations. Neurologists, nephrologists, rheumatologists and other groups of physicians should consider HEV infection as a potential differential diagnosis when observing one of the diseases described in this review. Ribavirin and steroids have been used in small groups of patients with extrahepatic manifestations of HEV, but the efficacy of these drugs still needs to be verified by large, multicenter studies. This article comprehensively reviews the published literature regarding HEV and extrahepatic manifestations. We discuss the probability of specific extrahepatic diseases being caused by previous or ongoing HEV infection, and summarize the published knowledge about antiviral treatment in extrahepatic disorders.
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Affiliation(s)
- Sven Pischke
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Johannes Hartl
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Suzan D Pas
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Netherlands
| | - Ansgar W Lohse
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus MC University Medical Center Rotterdam, Netherlands
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Abstract
The relevance of acute hepatitis E virus (HEV) infections has been underestimated for a long time. In the past, HEV infection had been interpreted falsely as a disease limited to the tropics until the relevance of autochthonous HEV infections in the Western world became overt. Due to increased awareness, the incidence of diagnosed autochthonous HEV infections (predominantly genotype 3) in industrialized countries has risen within the last decade. The main source of infections in industrialized countries seems to be infected swine meat, while infections with the tropical HEV genotypes 1 and 2 usually are mainly transmitted fecal-orally by contaminated drinking water. In the vast majority of healthy individuals, acute HEV infection is either clinically silent or takes a benign self-limited course. In patients who develop a symptomatic HEV infection, a short prodromal phase with unspecific symptoms is followed by liver specific symptoms like jaundice, itching, uncoloured stool and darkened urine. Importantly, tropical HEV infections may lead to acute liver failure, especially in pregnant women, while autochthonous HEV infections may lead to acute-on-chronic liver failure in patients with underlying liver diseases. Immunosuppressed individuals, such as transplant recipients or human immunodeficiency virus (HIV)-infected patients, are at risk for developing chronic hepatitis E, which may lead to liver fibrosis and cirrhosis in the long term. Importantly, specific treatment options for hepatitis E are not approved by the regulation authorities, but off-label ribavirin treatment seems to be effective in the treatment of chronic HEV-infection and may reduce the disease severity in patients suffering from acute liver failure.
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Affiliation(s)
- Johannes Hartl
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246 Hamburg, Germany.
| | - Malte H Wehmeyer
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246 Hamburg, Germany.
| | - Sven Pischke
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246 Hamburg, Germany.
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Ehlken H, Wroblewski R, Corpechot C, Arrivé L, Rieger T, Hartl J, Lezius S, Hübener P, Schulze K, Zenouzi R, Sebode M, Peiseler M, Denzer UW, Quaas A, Weiler-Normann C, Lohse AW, Chazouilleres O, Schramm C. Validation of Transient Elastography and Comparison with Spleen Length Measurement for Staging of Fibrosis and Clinical Prognosis in Primary Sclerosing Cholangitis. PLoS One 2016; 11:e0164224. [PMID: 27723798 PMCID: PMC5056739 DOI: 10.1371/journal.pone.0164224] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/21/2016] [Indexed: 12/15/2022] Open
Abstract
Background Patients with primary sclerosing cholangitis (PSC) develop progressive liver fibrosis and end-stage liver disease. Non-invasive and widely available parameters are urgently needed to assess disease stage and the risk of clinical progression. Transient elastography (TE) has been reported to predict fibrosis stage and disease progression. However, these results have not been confirmed in an independent cohort and comparison of TE measurement to other non-invasive means is missing. Methods In a retrospective study we collected data from consecutive PSC patients receiving TE measurements from 2006 to 2014 (n = 139). Data from 62 patients who also underwent a liver biopsy were used to assess the performance of TE and spleen length (SL) measurement for the staging of liver fibrosis. Follow-up data from this cohort (n = 130, Hamburg) and another independent cohort (n = 80, Paris) was used to compare TE and SL as predictors of clinical outcome applying Harrel’s C calculations. Results TE measurement had a very good performance for the diagnosis and exclusion of higher fibrosis stages (≥F3: AUROC 0.95) and an excellent performance for the diagnosis and exclusion of cirrhosis (F4 vs. < F4: AUROC 0.98). Single-point TE measurement had very similar predictive power for patient outcome as previously published. In a combined cohort of PSC patients (n = 210), SL measurements had a similar performance as TE for the prediction of patient outcome (5 x cross-validated Harrel’s C 0.76 and 0.72 for SL and TE, respectively). Conclusions Baseline TE measurement has an excellent performance to diagnose higher fibrosis stages in PSC. Baseline measurements of SL and TE have similar usefulness as predictive markers for disease progression in patients with PSC.
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Affiliation(s)
- Hanno Ehlken
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.,Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Raluca Wroblewski
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christophe Corpechot
- Service d'Hépatologie, Centre de Référence des Maladies Inflammatoires des Voies Biliaires, Hôpital Saint-Antoine, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine et Université Pierre et Marie Curie, site Saint-Antoine, Paris, France
| | - Lionel Arrivé
- Service de Radiologie, Hôpital Saint-Antoine, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine et Université Pierre et Marie Curie, site Saint-Antoine, Paris, France
| | - Tim Rieger
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Johannes Hartl
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Susanne Lezius
- Department of Medical Biometry and Epidemiology, Martinistr. 52, 20246 Hamburg, Germany
| | - Peter Hübener
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Kornelius Schulze
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Roman Zenouzi
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Marcial Sebode
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Moritz Peiseler
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Ulrike W Denzer
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Alexander Quaas
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christina Weiler-Normann
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Ansgar W Lohse
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Olivier Chazouilleres
- Service d'Hépatologie, Centre de Référence des Maladies Inflammatoires des Voies Biliaires, Hôpital Saint-Antoine, Assistance Publique, Hôpitaux de Paris, Faculté de Médecine et Université Pierre et Marie Curie, site Saint-Antoine, Paris, France
| | - Christoph Schramm
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Hartl J, Denzer U, Ehlken H, Zenouzi R, Peiseler M, Sebode M, Hübener S, Pannicke N, Weiler-Normann C, Quaas A, Lohse AW, Schramm C. Transient elastography in autoimmune hepatitis: Timing determines the impact of inflammation and fibrosis. J Hepatol 2016; 65:769-775. [PMID: 27238753 DOI: 10.1016/j.jhep.2016.05.023] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [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: 02/24/2016] [Revised: 05/11/2016] [Accepted: 05/14/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS There is an unmet need for the non-invasive monitoring of fibrosis progression in patients with autoimmune hepatitis (AIH). The aim of this study was to assess the diagnostic performance of transient elastography in patients with AIH and to investigate the impact of disease activity on its diagnostic accuracy. METHODS Optimal cut-offs were defined in a prospective pilot study (n=34) and the diagnostic performance of transient elastography validated in an independent second cohort (n=60). To explore the impact of disease activity on liver stiffness, patients were stratified according to biochemical response and the time interval between start of immunosuppression and transient elastography. RESULTS Liver stiffness strongly correlated with histological fibrosis stage (pilot study: ρ=0.611, p<0.001; validation cohort: ρ=0.777, p<0.0001). ROC curves defined an area under the receiver operating curve of 0.95 for diagnosing cirrhosis at the optimal cut-off of 16kPa. The performance of transient elastography was impaired when patients were analysed in whom transient elastography was performed within 3months from start of treatment. In this setting, liver stiffness correlated with histological grading (ρ=0.558, p=0.001), but not with staging. In contrast, using the cut-off of 16kPa, the accuracy for diagnosing cirrhosis was excellent in patients treated for 6months or longer (area under the receiver operating curve 1.0). CONCLUSIONS Liver inflammation has a major impact on liver stiffness in the first months of AIH treatment. However, transient elastography has an excellent diagnostic accuracy for separating severe from non-severe fibrosis after 6months of immunosuppressive treatment. LAY SUMMARY Transient elastography is a special ultrasound scan, which assesses liver stiffness as a surrogate marker for liver fibrosis/scarring. Transient elastography has been shown to be a reliable non-invasive method to assess liver fibrosis in various chronic liver diseases, it takes less than 5min and has a high patient acceptance. The current study validated for the first time this technique in a large cohort of patients with autoimmune hepatitis (AIH) and demonstrates that it is a reliable tool to detect liver fibrosis in treated AIH. For the monitoring of potential disease progression under treatment, the validation of liver stiffness as non-invasive marker of liver fibrosis will greatly improve patient care in autoimmune hepatitis.
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Affiliation(s)
- Johannes Hartl
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - Ulrike Denzer
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; Interdisciplinary Endoscopy Unit, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hanno Ehlken
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany; Interdisciplinary Endoscopy Unit, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Roman Zenouzi
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - Moritz Peiseler
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - Marcial Sebode
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - Sina Hübener
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - Nadine Pannicke
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | | | - Alexander Quaas
- Institute for Pathology, University Hospital of Cologne, Germany
| | - Ansgar W Lohse
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany
| | - Christoph Schramm
- University Medical Centre Hamburg-Eppendorf (UKE), 1st Department of Medicine, Hamburg, Germany.
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Hartl J, Otto B, Madden RG, Webb G, Woolson KL, Kriston L, Vettorazzi E, Lohse AW, Dalton HR, Pischke S. Hepatitis E Seroprevalence in Europe: A Meta-Analysis. Viruses 2016; 8:v8080211. [PMID: 27509518 PMCID: PMC4997573 DOI: 10.3390/v8080211] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/12/2016] [Accepted: 07/25/2016] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED There have been large numbers of studies on anti-HEV IgG seroprevalence in Europe, however, the results of these studies have produced high variability of seroprevalence rates, making interpretation increasingly problematic. Therefore, the aim of this study was to develop a clearer understanding of anti-HEV IgG seroprevalence in Europe and identify risk groups for HEV exposure by a meta-analysis of published studies. METHODS All European HEV-seroprevalence studies from 2003 to 2015 were reviewed. Data were stratified by assay, geographical location, and patient cohort (general population, patients with HIV, solid-organ transplant recipients, chronic liver disease patients, and individuals in contact with swine/wild animals). Data were pooled using a mixed-effects model. RESULTS Four hundred thirty-two studies were initially identified, of which 73 studies were included in the analysis. Seroprevalence estimates ranged from 0.6% to 52.5%, increased with age, but were unrelated to gender. General population seroprevalence varied depending on assays: Wantai (WT): 17%, Mikrogen (MG): 10%, MP-diagnostics (MP): 7%, DiaPro: 4%, Abbott 2%. The WT assay reported significantly higher seroprevalence rates across all cohorts (p < 0.001). Individuals in contact with swine/wild animals had significantly higher seroprevalence rates than the general population, irrespective of assay (p < 0.0001). There was no difference between any other cohorts. The highest seroprevalence was observed in France (WT: 32%, MP: 16%) the lowest in Italy (WT: 7.5%, MP 0.9%). Seroprevalence varied between and within countries. The observed heterogeneity was attributed to geographical region (23%), assay employed (23%) and study cohort (7%). CONCLUSION Seroprevalcence rates primarily depend on the seroassy that is used, followed by the geographical region and study cohort. Seroprevalence is higher in individuals exposed to swine and/or wild animals, and increases with age.
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Affiliation(s)
- Johannes Hartl
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany.
| | - Benjamin Otto
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany.
| | - Richie Guy Madden
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK.
| | - Glynn Webb
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK.
| | - Kathy Louise Woolson
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK.
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Ansgar W Lohse
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany.
| | - Harry Richard Dalton
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK.
| | - Sven Pischke
- First Medical Department, University Medical Center Hamburg-Eppendorf, University Hospital Hamburg Eppendorf (UKE), 20246, Hamburg, Germany.
- Royal Cornwall Hospital Trust and European Centre for Environment and Human Health, University of Exeter, Truro TR1 3HD, UK.
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Pischke S, Hartl J, Roque-Afonso AM, Mallet V. Apolipoprotein E ε3 and ε4 are associated with a lower exposure to hepatitis E virus in American non-Hispanic blacks. Hepatology 2016; 64:687-8. [PMID: 27098729 DOI: 10.1002/hep.28355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sven Pischke
- First Medical Center University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- First Medical Center University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Anne-Marie Roque-Afonso
- Université Paris Descartes Sorbonne, Paris Cité,Assistance Publique Hôpitaux de Paris (APHP) Groupe Hospitalier Cochin Port Royal Unité d'Hépatologie.,Institut Pasteur, Inserm, UMS20
| | - Vincent Mallet
- Université Paris Sud.,Assistance Publique Hôpitaux de Paris (APHP) Hôpital Paul Brousse Laboratoire de Virologie.,Inserm U1193
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Ehlken H, Wroblewski R, Corpechot C, Arrivé L, Lezius S, Hartl J, Denzer UW, Lohse AW, Chazouilleres O, Schramm C. Spleen size for the prediction of clinical outcome in patients with primary sclerosing cholangitis. Gut 2016; 65:1230-2. [PMID: 26921347 DOI: 10.1136/gutjnl-2016-311452] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/09/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Hanno Ehlken
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raluca Wroblewski
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christophe Corpechot
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Reference Center for Inflammatory Biliary Diseases, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 938, Paris, France
| | - Lionel Arrivé
- Department of Radiology, Saint-Antoine Hospital, Paris, France Pierre and Marie Curie University-Paris 6. Faculté de médecine Pierre et Marie Curie, Paris France
| | - Susanne Lezius
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike W Denzer
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Olivier Chazouilleres
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Reference Center for Inflammatory Biliary Diseases, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 938, Paris, France
| | - Christoph Schramm
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hartl J, Dietrich P, Moleda L, Müller-Schilling M, Wiest R. Neuropeptide Y restores non-receptor-mediated vasoconstrictive action in superior mesenteric arteries in portal hypertension. Liver Int 2015; 35:2556-63. [PMID: 26010514 DOI: 10.1111/liv.12874] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/15/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Vascular hyporeactivity to vasoconstrictors contributes to splanchnic arterial vasodilatation and hemodynamic dysregulation in portal hypertension. Neuropeptide Y (NPY), a sympathetic cotransmitter, has been shown to improve adrenergic vascular contractility in portal hypertensive rats and markedly attenuate hyperdynamic circulation. To further characterize the NPY-effects in portal hypertension, we investigated its role for non-receptor-mediated vasoconstriction in the superior mesenteric artery (SMA) of portal vein ligated (PVL) and sham-operated rats. METHODS Ex vivo SMA perfusion of PVL and sham rats was used to analyse the effects of NPY on pressure response to non-receptor-mediated vasoconstriction. Dose-response curves to KCl (30-300 mM) were used to bypass G protein-coupled receptor mechanisms. Potential involvement of the cyclooxygenase-pathway was tested by non-selective cyclooxygenase-inhibition using indomethacin. RESULTS KCl-induced vascular contractility but not vascular sensitivity was significantly attenuated in PVL rats as compared with sham rats. Administration of NPY resulted in an augmentation of KCl-evoked vascular sensitivity being not different between study groups. However, KCl-induced vascular contractility was markedly more enhanced in PVL rats, thus, vascular response was no more significantly different between PVL and sham rats after addition of NPY. Administration of indomethacin abolished the NPY-induced enhancement of vasoconstriction. CONCLUSIONS Receptor-independent vascular contractility is impaired in mesenteric arteries in portal hypertension. NPY improves non-receptor mediated mesenteric vasoconstriction more effective in portal hypertension than in healthy conditions correcting splanchnic vascular hyporesponsiveness. This beneficial vasoactive action of NPY adds to its well known more pronounced effects on adrenergic vasoconstriction in portal hypertension making it a promising therapeutic agent in portal hypertension.
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Affiliation(s)
- Johannes Hartl
- First Medical Center University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Dietrich
- Department of Biochemistry, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lukas Moleda
- Department of Internal Medicine, University Medical Center, Regensburg, Germany
| | | | - Reiner Wiest
- Department of Visceral Surgery and Medicine, Bern University Hospital Inselspital, Bern, Switzerland
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Timm KN, Hartl J, Keller MA, Hu DE, Kettunen MI, Rodrigues TB, Ralser M, Brindle KM. Hyperpolarized [U-(2) H, U-(13) C]Glucose reports on glycolytic and pentose phosphate pathway activity in EL4 tumors and glycolytic activity in yeast cells. Magn Reson Med 2015; 74:1543-7. [PMID: 25522215 DOI: 10.1002/mrm.25561] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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: 09/06/2014] [Revised: 10/29/2014] [Accepted: 11/12/2014] [Indexed: 02/11/2024]
Abstract
PURPOSE A resonance at ∼181 ppm in the (13) C spectra of tumors injected with hyperpolarized [U-(2) H, U-(13) C]glucose was assigned to 6-phosphogluconate (6PG), as in previous studies in yeast, whereas in breast cancer cells in vitro this resonance was assigned to 3-phosphoglycerate (3PG). These peak assignments were investigated here using measurements of 6PG and 3PG (13) C-labeling using liquid chromatography tandem mass spectrometry (LC-MS/MS) METHODS: Tumor-bearing mice were injected with (13) C6 glucose and the (13) C-labeled and total 6PG and 3PG concentrations measured. (13) C MR spectra of glucose-6-phosphate dehydrogenase deficient (zwf1Δ) and wild-type yeast were acquired following addition of hyperpolarized [U-(2) H, U-(13) C]glucose and again (13) C-labeled and total 6PG and 3PG were measured by LC-MS/MS RESULTS: Tumor (13) C-6PG was more abundant than (13) C-2PG/3PG and the resonance at ∼181 ppm matched more closely that of 6PG. (13) C MR spectra of wild-type and zwf1Δ yeast cells showed a resonance at ∼181 ppm after labeling with hyperpolarized [U-(2) H, U-(13) C]glucose, however, there was no 6PG in zwf1Δ cells. In the wild-type cells 3PG was approximately four-fold more abundant than 6PG CONCLUSION: The resonance at ∼181 ppm in (13) C MR spectra following injection of hyperpolarized [U-(2) H, U-(13) C]glucose originates predominantly from 6PG in EL4 tumors and 3PG in yeast cells.
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Affiliation(s)
- Kerstin N Timm
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Johannes Hartl
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Markus A Keller
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - De-En Hu
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Mikko I Kettunen
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Tiago B Rodrigues
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Markus Ralser
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- MRC National Institute for Medical Research, The Ridgeway, Mill Hill, London, United Kingdom
| | - Kevin M Brindle
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
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49
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Affiliation(s)
- Patrick Kiefer
- Institute
of Microbiology, ETH Zurich, Zurich, Switzerland 8093
| | - Uwe Schmitt
- ID
Scientific IT Services, ETH Zurich, Zurich, Switzerland 8093
| | | | - Johannes Hartl
- Institute
of Microbiology, ETH Zurich, Zurich, Switzerland 8093
| | - Fabian Meyer
- Institute
of Microbiology, ETH Zurich, Zurich, Switzerland 8093
| | - Florian Ryffel
- Institute
of Microbiology, ETH Zurich, Zurich, Switzerland 8093
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50
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Hartl J, Kreuels B, Polywka S, Addo M, Luethgehetmann M, Dandri M, Dammermann W, Sterneck M, Lohse AW, Pischke S. Comparison of autochthonous and imported cases of hepatitis A or hepatitis E. Z Gastroenterol 2015; 53:639-43. [PMID: 26167693 DOI: 10.1055/s-0034-1399236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hepatitis A and hepatitis E are not limited to tropical countries but are also present in industrialized countries. Both infections share similar clinical features. There is no comparative study evaluating the clinical parameters of autochthonous and imported hepatitis A virus and hepatitis E virus infections. AIMS The aim of this study was to determine differences between autochthonous and imported hepatitis A virus (HAV) and hepatitis E virus (HEV) infections. METHODS Medical charts of all patients at our center with acute HAV and HEV infections were analyzed retrospectively (n = 50, study period 01/2009 - 08/2013). RESULTS Peak bilirubin (median 8.6 vs. 4.4 mg/dL, p = 0.008) and ALT levels (median 2998 vs. 1666 IU/mL, p = 0.04) were higher in patients with hepatitis A compared to hepatitis E. In comparison to autochthones hepatitis E cases, patients with imported infections had significantly higher peak values for AST, ALT, bilirubin and INR (p = 0.009, p = 0.002, p = 0.04 and p = 0.049, respectively). In HAV infection, AST levels tended to be higher in imported infections (p = 0.08). CONCLUSIONS (i) It is not possible to differentiate certainly between acute HAV and HEV infections by clinical or biochemical parameters, however, HAV infections might be associated with more cholestasis and higher ALT values. (ii) Imported HEV infections are associated with higher transaminases, INR and bilirubin levels compared to autochthonous cases and (iii) imported HAV infections tend to be associated with higher transaminases in comparison to autochthonous cases.
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Affiliation(s)
- J Hartl
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - B Kreuels
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S Polywka
- Clinical Mikrobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Addo
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Luethgehetmann
- Clinical Mikrobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Dandri
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - W Dammermann
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Sterneck
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - A W Lohse
- First Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - S Pischke
- Outpatient Clinic for Livertransplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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