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Elsner L, Heimann L, Geisler A, Dieringer B, Knoch KP, Hinze L, Klingel K, Solimena M, Kurreck J, Fechner H. Fast Track Adaptation of Oncolytic Coxsackie B3 Virus to Resistant Colorectal Cancer Cells - a Method to Personalize Virotherapy. Biol Proced Online 2024; 26:11. [PMID: 38664647 PMCID: PMC11044309 DOI: 10.1186/s12575-024-00237-2] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The efficacy of oncolytic viruses (OV) in cancer treatment depends on their ability to successfully infect and destroy tumor cells. However, patients' tumors vary, and in the case of individual insensitivity to an OV, therapeutic efficacy is limited. Here, we present a protocol for rapid generation of tumor cell-specific adapted oncolytic coxsackievirus B3 (CVB3) with enhanced oncolytic potential and a satisfactory safety profile. This is achieved by combining directed viral evolution (DVE) with genetic modification of the viral genome and the use of a microRNA-dependent regulatory tool. METHODS The oncolytic CVB3 variant PD-H was adapted to the refractory colorectal carcinoma cell line Colo320 through serial passaging. XTT assays and virus plaque assays were used to determine virus cytotoxicity and virus replication in vitro. Recombinant PD-H variants were generated through virus mutagenesis. Apoptosis was detected by Western blots, Caspase 3/7 assays, and DAPI staining. The therapeutic efficacy and safety of the adapted recombinant OV PD-SK-375TS were assessed in vivo using a subcutaneous Colo320 xenograft mouse model. RESULTS PD-H was adapted to the colorectal cancer cell line Colo320 within 10 passages. Sequencing of passage 10 virus P-10 revealed a heterogenous virus population with five nucleotide mutations resulting in amino acid substitutions. The genotypically homogeneous OV PD-SK was generated by inserting the five detected mutations of P-10 into the genome of PD-H. PD-SK showed significantly stronger replication and cytotoxicity than PD-H in Colo320 cells, but not in other colorectal carcinoma cell lines. Increase of apoptosis induction was detected as key mechanisms of Colo320 cell-specific adaptation of PD-SK. For in vivo safety PD-SK was engineered with target sites of the miR-375 (miR-375TS) to exclude virus replication in normal tissues. PD-SK-375TS, unlike the PD-H-375TS not adapted homolog suppressed the growth of subcutaneous Colo320 tumors in nude mice without causing any side effects. CONCLUSION Taken together, here we present an optimized protocol for the rapid generation of tumor cell-specific adapted oncolytic CVB3 based on the oncolytic CVB3 strain PD-H. The protocol is promising for the generation of personalized OV for tumor therapy and has the potential to be applied to other OV.
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Affiliation(s)
- Leslie Elsner
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Lisanne Heimann
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Anja Geisler
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Babette Dieringer
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Klaus-Peter Knoch
- Paul Langerhans Institute Dresden and German Center for Diabetes Research (DZD e.V.), Helmholtz Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Luisa Hinze
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Liebermeisterstr. 8, 72076, Tübingen, Germany
| | - Michel Solimena
- Paul Langerhans Institute Dresden and German Center for Diabetes Research (DZD e.V.), Helmholtz Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jens Kurreck
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Henry Fechner
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
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Gioia G, Schrutka L, Jozwiak-Nozdrzykowska J, Kresoja KP, Gunold H, Klingel K, Thiele H, Bonderman D, Lurz P, Rommel KP. Transthyretin amyloid cardiomyopathy among patients with heart failure and preserved ejection fraction: the AMY score. ESC Heart Fail 2024. [PMID: 38613409 DOI: 10.1002/ehf2.14786] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 03/03/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
AIMS Transthyretin 'wild-type' amyloid cardiomyopathy (ATTRwt-CM) is a differential diagnosis of heart failure with preserved ejection fraction (HFpEF). The clinical work-up for ATTRwt-CM is challenging. Considering a combination of clinical variables specific for ATTRwt-CM might aid in identifying patients at risk. METHODS AND RESULTS Sixty patients (78 ± 6 years, 8% female) were diagnosed with ATTRwt-CM by endomyocardial biopsy. Preserved ejection fraction (LVEF >45%) was present in 41 of the patients. Those were 1:1 propensity score age- and sex-matched to a cohort of patients with HFpEF. ATTRwt-CM patients had less obesity (P = 0.01) and higher septal thickness (IVSd, P < 0.01) as well as more diastolic dysfunction (E/e', P < 0.01). On multivariable regression IVSd > 14 mm, E/e' > 14 and absence of obesity (P > 0.01 for all) were identified as predictors for ATTRwt-CM. A weighted point-based score was derived with IVSd > 14 mm = 1 point; absence of obesity = 2 points; and E/e' > 14 = 3 points. Area under the curve (AUC) for the summation score was 0.91 (0.84-0.97, P < 0.01) and a score of more than 3 points predicted ATTRwt-CM with good sensitivity (78%) and specificity (90%). The score was validated in an external cohort of 142 patients with ATTRwt-CM and 419 HFpEF patients showing sufficient accuracy (AUC 0.91, 0.88-0.94, P < 0.01). A value greater than 3 points demonstrated a high sensitivity (93%) and a negative predictive value of 97%. CONCLUSIONS A score based on basic clinical and echocardiographic features helps to distinguish ATTRwt-CM from typical HFpEF. This could facilitate the diagnostic work-up for these patients and enable earlier disease screening on a large scale.
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Affiliation(s)
- Guglielmo Gioia
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | - Lore Schrutka
- Department of Internal Medicine II, Medical University of Vienna, Wien, Austria
| | | | - Karl-Patrik Kresoja
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | - Hilka Gunold
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | - Karin Klingel
- Kardiopathologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Holger Thiele
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | | | - Philipp Lurz
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
| | - Karl-Philipp Rommel
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig, Germany
- Cardiovacular Research Foundation, New York, NY, USA
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Musigk N, Suwalski P, Golpour A, Fairweather D, Klingel K, Martin P, Frustaci A, Cooper LT, Lüscher TF, Landmesser U, Heidecker B. The inflammatory spectrum of cardiomyopathies. Front Cardiovasc Med 2024; 11:1251780. [PMID: 38464847 PMCID: PMC10921946 DOI: 10.3389/fcvm.2024.1251780] [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] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024] Open
Abstract
Infiltration of the myocardium with various cell types, cytokines and chemokines plays a crucial role in the pathogenesis of cardiomyopathies including inflammatory cardiomyopathies and myocarditis. A more comprehensive understanding of the precise immune mechanisms involved in acute and chronic myocarditis is essential to develop novel therapeutic approaches. This review offers a comprehensive overview of the current knowledge of the immune landscape in cardiomyopathies based on etiology. It identifies gaps in our knowledge about cardiac inflammation and emphasizes the need for new translational approaches to improve our understanding thus enabling development of novel early detection methods and more effective treatments.
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Affiliation(s)
- Nicolas Musigk
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Phillip Suwalski
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Ainoosh Golpour
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Department of Environmental Health Sciences and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States
| | - Karin Klingel
- Cardiopathology Institute for Pathology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Pilar Martin
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Centro de Investigación Biomédica en Red Cardiovascular (CIBER-CV, ISCIII), Madrid, Spain
| | | | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Thomas F. Lüscher
- GZO-Zurich Regional Health Centre, Wetzikon & Cardioimmunology, Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Bettina Heidecker
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
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Kespohl M, Goetzke CC, Althof N, Bredow C, Kelm N, Pinkert S, Bukur T, Bukur V, Grunz K, Kaur D, Heuser A, Mülleder M, Sauter M, Klingel K, Weiler H, Berndt N, Gaida MM, Ruf W, Beling A. TF-FVIIa PAR2-β-Arrestin in Mouse Signaling Sustains Organ Dysfunction in Coxsackievirus B3 Infection. Arterioscler Thromb Vasc Biol 2024. [PMID: 38385286 DOI: 10.1161/atvbaha.123.320157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Accumulating evidence implicates the activation of G-protein-coupled PARs (protease-activated receptors) by coagulation proteases in the regulation of innate immune responses. METHODS Using mouse models with genetic alterations of the PAR2 signaling platform, we have explored contributions of PAR2 signaling to infection with coxsackievirus B3, a single-stranded RNA virus provoking multiorgan tissue damage, including the heart. RESULTS We show that PAR2 activation sustains correlates of severe morbidity-hemodynamic compromise, aggravated hypothermia, and hypoglycemia-despite intact control of the virus. Following acute viral liver injury, canonical PAR2 signaling impairs the restoration process associated with exaggerated type I IFN (interferon) signatures in response to viral RNA recognition. Metabolic profiling in combination with proteomics of liver tissue shows PAR2-dependent reprogramming of liver metabolism, increased lipid droplet storage, and gluconeogenesis. PAR2-sustained hypodynamic compromise, reprograming of liver metabolism, as well as imbalanced IFN responses are prevented in β-arrestin coupling-deficient PAR2 C-terminal phosphorylation mutant mice. Thus, wiring between upstream proteases and immune-metabolic responses results from biased PAR2 signaling mediated by intracellular recruitment of β-arrestin. Importantly, blockade of the TF (tissue factor)-FVIIa (coagulation factor VIIa) complex capable of PAR2 proteolysis with the NAPc2 (nematode anticoagulant protein c2) mitigated virus-triggered pathology, recapitulating effects seen in protease cleavage-resistant PAR2 mice. CONCLUSIONS These data provide insights into a TF-FVIIa signaling axis through PAR2-β-arrestin coupling that is a regulator of inflammation-triggered tissue repair and hemodynamic compromise in coxsackievirus B3 infection and can potentially be targeted with selective coagulation inhibitors.
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Affiliation(s)
- Meike Kespohl
- Institute of Biochemistry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. (M.K., C.B., N.K., S.P., A.B.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner site Berlin, Germany (M.K., A.B., K.G., D.K., W.R.)
| | - Carl Christoph Goetzke
- Department of Pediatrics, Division of Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. (C.C.G.)
- Clinician Scientist Program, BIH Academy, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Germany (C.C.G.)
- German Rheumatism Research Center, Leibniz Association, Berlin, Germany (C.C.G.)
| | - Nadine Althof
- German Federal Institute for Risk Assessment, Berlin, Germany (N.A.)
| | - Clara Bredow
- Institute of Biochemistry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. (M.K., C.B., N.K., S.P., A.B.)
| | - Nicolas Kelm
- Institute of Biochemistry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. (M.K., C.B., N.K., S.P., A.B.)
| | - Sandra Pinkert
- Institute of Biochemistry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. (M.K., C.B., N.K., S.P., A.B.)
| | - Thomas Bukur
- Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz (TRON), Germany (T.B., V.B.)
| | - Valesca Bukur
- Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz (TRON), Germany (T.B., V.B.)
| | - Kristin Grunz
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner site Berlin, Germany (M.K., A.B., K.G., D.K., W.R.)
- University Medical Center Mainz, Center for Thrombosis and Hemostasis, Germany (K.G., D.K., W.R.)
| | - Dilraj Kaur
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner site Berlin, Germany (M.K., A.B., K.G., D.K., W.R.)
- University Medical Center Mainz, Center for Thrombosis and Hemostasis, Germany (K.G., D.K., W.R.)
| | - Arnd Heuser
- Max-Delbrueck-Center for Molecular Medicine, Animal Phenotyping Platform, Berlin, Germany (A.H.)
| | - Michael Mülleder
- Core Facility High-Throughput Mass Spectrometry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. (M.M.)
| | - Martina Sauter
- University Hospital Tuebingen, Institute for Pathology and Neuropathology, Cardiopathology, Germany (M.S., K.K.)
| | - Karin Klingel
- University Hospital Tuebingen, Institute for Pathology and Neuropathology, Cardiopathology, Germany (M.S., K.K.)
| | | | - Nikolaus Berndt
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany (N.B.)
- German Institute of Human Nutrition Potsdam-Rehbruecke, Department of Molecular Toxicology, Nuthetal, Germany (N.B.)
- Deutsches Herzzentrum der Charité, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany (N.B.)
| | - Matthias M Gaida
- University Medical Center Mainz, Institute for Pathology, Johannes-Gutenberg-Universität Mainz, Germany (M.M.G.)
- University Medical Center Mainz, Research Center for Immunotherapy, Johannes-Gutenberg-Universität Mainz, Germany (M.M.G.)
- Joint Unit Immunopathology, Institute of Pathology, University Medical Center, Johannes Gutenberg University of Mainz, Germany (M.M.G.)
- TRON, Mainz, Germany (M.M.G.)
| | - Wolfram Ruf
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner site Berlin, Germany (M.K., A.B., K.G., D.K., W.R.)
- University Medical Center Mainz, Center for Thrombosis and Hemostasis, Germany (K.G., D.K., W.R.)
| | - Antje Beling
- Institute of Biochemistry, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany. (M.K., C.B., N.K., S.P., A.B.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner site Berlin, Germany (M.K., A.B., K.G., D.K., W.R.)
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Lewis RI, Seuthe K, Lennartz S, Weber JP, Kreuzberg N, Klingel K, Bröckelmann PJ. Case Report: Sudden very late-onset near fatal PD1 inhibitor-associated myocarditis with out-of-hospital cardiac arrest after >2.5 years of pembrolizumab treatment. Front Cardiovasc Med 2024; 11:1328378. [PMID: 38440207 PMCID: PMC10909844 DOI: 10.3389/fcvm.2024.1328378] [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] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/25/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Immune checkpoint inhibitors have advanced the outcomes of many different types of cancer. A rare but extraordinarily severe complication of these agents resembles immune checkpoint inhibitor-related myocarditis, which typically occurs within the first few weeks after treatment initiation with a mortality of 25%-50%. Case report A 57-year-old woman had uneventfully received pembrolizumab for metastatic non-small cell lung cancer for over 2.5 years and was admitted after an out-of-hospital cardiac arrest due to ventricular fibrillation. After successful cardiopulmonary resuscitation, the initial diagnostic work-up showed elevated cardiac enzymes and a limited left-ventricular ejection fraction, while coronary angiography did not show relevant stenosis. Despite cardiac MRI being unsuggestive of myocarditis, myocardial biopsies were obtained and histologically confirmed anti-PD-1 antibody-associated myocarditis. After the initiation of prednisone at 1 mg/kg body weight, the patient gradually recovered and was discharged three weeks later with markedly improved cardiac function. Conclusion This case resembles the first description of a very late onset irMyocarditis, occurring over 2.5 years after the start of treatment. It demonstrates the importance of contemplating that severe immune-related toxicities with a sudden onset clinical presentation may occur even after long uneventful periods of anti-PD-1 immune checkpoint inhibitor treatment. Furthermore, it underlines the critical importance of myocardial biopsies in this setting, especially when cardiac MRI remains inconclusive. Moreover, it demonstrates the necessity and benefits of early immunosuppressive treatment if immune-related myocarditis is considered a differential diagnosis.
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Affiliation(s)
- Richard I. Lewis
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Katharina Seuthe
- Department III of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Simon Lennartz
- Department of Radiology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jan-Phillip Weber
- Center for Hematology and Oncology, Oncology Cologne, Cologne, Germany
| | - Nicole Kreuzberg
- Department of Dermatology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Paul J. Bröckelmann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Bredow C, Thery F, Wirth EK, Ochs S, Kespohl M, Kleinau G, Kelm N, Gimber N, Schmoranzer J, Voss M, Klingel K, Spranger J, Renko K, Ralser M, Mülleder M, Heuser A, Knobeloch KP, Scheerer P, Kirwan J, Brüning U, Berndt N, Impens F, Beling A. ISG15 blocks cardiac glycolysis and ensures sufficient mitochondrial energy production during Coxsackievirus B3 infection. Cardiovasc Res 2024:cvae026. [PMID: 38309955 DOI: 10.1093/cvr/cvae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 02/05/2024] Open
Abstract
AIMS Virus infection triggers inflammation and, may impose nutrient shortage to the heart. Supported by type I interferon (IFN) signaling, cardiomyocytes counteract infection by various effector processes, with the IFN-stimulated gene of 15 kDa (ISG15) system being intensively regulated and protein modification with ISG15 protecting mice Coxsackievirus B3 (CVB3) infection. The underlying molecular aspects how the ISG15 system affects the functional properties of respective protein substrates in the heart are unknown. METHODS AND RESULTS Based on the protective properties due to protein ISGylation, we set out a study investigating CVB3-infected mice in depth and found cardiac atrophy with lower cardiac output in ISG15-/- mice. By mass spectrometry, we identified the protein targets of the ISG15 conjugation machinery in heart tissue and explored how ISGylation affects their function. The cardiac ISGylome showed a strong enrichment of ISGylation substrates within glycolytic metabolic processes. Two control enzymes of the glycolytic pathway, hexokinase 2 (HK2) and phosphofructokinase muscle form (PFK1), were identified as bona fide ISGylation targets during infection. In an integrative approach complemented with enzymatic functional testing and structural modeling, we demonstrate that protein ISGylation obstructs the activity of HK2 and PFK1. Seahorse-based investigation of glycolysis in cardiomyocytes revealed that, by conjugating proteins, the ISG15 system prevents the infection-/IFN-induced upregulation of glycolysis. We complemented our analysis with proteomics-based advanced computational modeling of cardiac energy metabolism. Our calculations revealed an ISG15-dependent preservation of the metabolic capacity in cardiac tissue during CVB3 infection. Functional profiling of mitochondrial respiration in cardiomyocytes and mouse heart tissue by Seahorse technology showed an enhanced oxidative activity in cells with a competent ISG15 system. CONCLUSIONS Our study demonstrates that ISG15 controls critical nodes in cardiac metabolism. ISG15 reduces the glucose demand, supports higher ATP production capacity in the heart, despite nutrient shortage in infection, and counteracts cardiac atrophy and dysfunction.
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Affiliation(s)
- Clara Bredow
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biochemistry, Berlin, Germany
| | - Fabien Thery
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
- VIB-UGent Center for Medical Biotechnology, Ghent, Belgium
| | - Eva Katrin Wirth
- Deutsches Zentrum für Herz-Kreislauf-Forschung, partner site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Endocrinology, Diabetes and Nutrition, Berlin, Germany
| | - Sarah Ochs
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biochemistry, Berlin, Germany
| | - Meike Kespohl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biochemistry, Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung, partner site Berlin, Berlin, Germany
| | - Gunnar Kleinau
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Physics and Biophysics, Group Protein X-ray Crystallography and Signal Transduction, Charitéplatz 1, Berlin, Germany
| | - Nicolas Kelm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biochemistry, Berlin, Germany
| | - Niclas Gimber
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Advanced Medical Bioimaging Core Facility, Berlin, Germany
| | - Jan Schmoranzer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Advanced Medical Bioimaging Core Facility, Berlin, Germany
| | - Martin Voss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biochemistry, Berlin, Germany
| | - Karin Klingel
- University of Tübingen, Cardiopathology, Institute for Pathology and Neuropathology, Tübingen, Germany
| | - Joachim Spranger
- Deutsches Zentrum für Herz-Kreislauf-Forschung, partner site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Endocrinology, Diabetes and Nutrition, Berlin, Germany
| | - Kostja Renko
- German Federal Institute for Risk Assessment (BfR), German Centre for the Protection of Laboratory Animals (Bf3R), Berlin, Germany
| | - Markus Ralser
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Core Facility - High-Throughput Mass Spectrometry, Berlin, Germany
| | - Michael Mülleder
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Core Facility - High-Throughput Mass Spectrometry, Berlin, Germany
| | - Arnd Heuser
- Animal Phenotyping Platform, Max-Delbrueck-Center for Molecular Medicine, Berlin, Germany
| | - Klaus-Peter Knobeloch
- University of Freiburg, Institute of Neuropathology, Freiburg, Germany
- CIBSS - Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Patrick Scheerer
- Deutsches Zentrum für Herz-Kreislauf-Forschung, partner site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Physics and Biophysics, Group Protein X-ray Crystallography and Signal Transduction, Charitéplatz 1, Berlin, Germany
| | - Jennifer Kirwan
- Berlin Institute of Health (BIH) @ Charité, Metabolomics Platform, Berlin, Germany
- Max-Delbrück-Center (MDC) for Molecular Medicine, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Ulrike Brüning
- Berlin Institute of Health (BIH) @ Charité, Metabolomics Platform, Berlin, Germany
- Max-Delbrück-Center (MDC) for Molecular Medicine, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Nikolaus Berndt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Francis Impens
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
- VIB-UGent Center for Medical Biotechnology, Ghent, Belgium
- VIB Proteomics Core, Ghent, Belgium
| | - Antje Beling
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biochemistry, Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung, partner site Berlin, Berlin, Germany
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7
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Mattig I, Steudel T, Klingel K, Barzen G, Frumkin D, Spethmann S, Romero Dorta E, Stangl K, Heidecker B, Landmesser U, Knebel F, Canaan-Kühl S, Hahn K, Brand A. Right heart and left atrial strain to differentiate cardiac amyloidosis and Fabry disease. Sci Rep 2024; 14:2445. [PMID: 38291191 DOI: 10.1038/s41598-024-52890-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
Echocardiographic differentiation of cardiac amyloidosis (CA) and Fabry disease (FD) is often challenging using standard echocardiographic parameters. We retrospectively analyzed the diagnostic accuracy of right heart and left atrial strain parameters to discriminate CA from FD using receiver operating characteristic curve analyses and logistic regression models. A total of 47 FD and 88 CA patients with left ventricular wall thickening were analyzed. The comparison of both cardiomyopathies revealed significantly reduced global and free wall longitudinal right ventricular strain (RVS; global RVS: CA - 13 ± 4%, n = 67, vs. FD - 18 ± 4%, n = 39, p < 0.001) as well as right atrial strain (RAS; reservoir RAS: CA 12 ± 8%, n = 70, vs. FD 26 ± 9%, n = 40, p < 0.001) and left atrial strain (LAS) in CA patients. Individually, global RVS as well as phasic LAS and RAS showed the highest diagnostic accuracy to distinguish CA and FD. The best diagnostic accuracy was achieved by combining the age, basal RV diameter, global RVS, and reservoir and conduit RAS (area under the curve 0.96 [95% CI 0.90-1.00]). Differential echocardiographic diagnostic work-up of patients with suspected CA or FD can be improved by integrating structural and functional parameters of the right heart and the left atrium.Trial registration: DRKS00027403.
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Affiliation(s)
- Isabel Mattig
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Chariteplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
| | - Tilman Steudel
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Chariteplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Gina Barzen
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Chariteplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - David Frumkin
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Chariteplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Spethmann
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Chariteplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Elena Romero Dorta
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Chariteplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Stangl
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Chariteplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Bettina Heidecker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Ulf Landmesser
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Fabian Knebel
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Chariteplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
- Sana Klinikum Lichtenberg, Innere Medizin II: Schwerpunkt Kardiologie, Berlin, Germany
| | - Sima Canaan-Kühl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Medizinische Klinik Mit Schwerpunkt Nephrologie Und Internistische Intensivmedizin, Fabry Zentrum, Zentrum für Seltene Nierenerkrankungen (CeRKiD), Campus Charité Mitte, Berlin, Germany
| | - Katrin Hahn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Neurologie und Experimentelle Neurologie, Berlin, Germany
| | - Anna Brand
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Charité Mitte, Chariteplatz 1, 10117, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Amyloidosis Center Charité Berlin (ACCB), Charité - Universitätsmedizin Berlin, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany.
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8
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Rolfs N, Huber C, Schwarzkopf E, Mentzer D, Keller-Stanislawski B, Opgen-Rhein B, Frede W, Rentzsch A, Hecht T, Boehne M, Grafmann M, Kiski D, Graumann I, Foth R, Voges I, Schweigmann U, Ruf B, Fischer M, Wiegand G, Klingel K, Pickardt T, Friede T, Messroghli D, Schubert S, Seidel F. Clinical course and follow-up of pediatric patients with COVID-19 vaccine-associated myocarditis compared to non-vaccine-associated myocarditis within the prospective multicenter registry-"MYKKE". Am Heart J 2024; 267:101-115. [PMID: 37956921 DOI: 10.1016/j.ahj.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Since the onset of widespread COVID-19 vaccination, increased incidence of COVID-19 vaccine-associated myocarditis (VA-myocarditis) has been noted, particularly in male adolescents. METHODS Patients <18 years with suspected myocarditis following COVID-19 vaccination within 21 days were enrolled in the PedMYCVAC cohort, a substudy within the prospective multicenter registry for pediatric myocarditis "MYKKE." Clinical data at initial admission, 3- and 9-months follow-up were monitored and compared to pediatric patients with confirmed non-vaccine-associated myocarditis (NVA-myocarditis) adjusting for various baseline characteristics. RESULTS From July 2021 to December 2022, 56 patients with VA-myocarditis across 15 centers were enrolled (median age 16.3 years, 91% male). Initially, 11 patients (20%) had mildly reduced left ventricular ejection fraction (LVEF; 45%-54%). No incidents of severe heart failure, transplantation or death were observed. Of 49 patients at 3-months follow-up (median (IQR) 94 (63-118) days), residual symptoms were registered in 14 patients (29%), most commonly atypical intermittent chest pain and fatigue. Diagnostic abnormalities remained in 23 patients (47%). Of 21 patients at 9-months follow-up (259 (218-319) days), all were free of symptoms and diagnostic abnormalities remained in 9 patients (43%). These residuals were mostly residual late gadolinium enhancement in magnetic resonance imaging. Patients with NVA-myocarditis (n=108) more often had symptoms of heart failure (P = .003), arrhythmias (P = .031), left ventricular dilatation (P = .045), lower LVEF (P < .001) and major cardiac adverse events (P = .102). CONCLUSIONS Course of COVID-19 vaccine-associated myocarditis in pediatric patients seems to be mild and differs from non-vaccine-associated myocarditis. Due to a considerable number of residual symptoms and diagnostic abnormalities at follow-up, further studies are needed to define its long-term implications.
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Affiliation(s)
- Nele Rolfs
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Cynthia Huber
- Medical Statistics, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Eicke Schwarzkopf
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dirk Mentzer
- Paul-Ehrlich-Institut - Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | | | - Bernd Opgen-Rhein
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wiebke Frede
- Pediatric Cardiology and Congenital Heart Defects, Center for Pediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Axel Rentzsch
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg (Saar), Germany
| | - Tobias Hecht
- Center of Congenital Heart Disease and Pediatric Cardiology, Heart- and Diabetes Center NRW and University Clinic of Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Martin Boehne
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Maria Grafmann
- Department of Pediatric Cardiology, Children's Heart Clinic, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Kiski
- Department of Pediatric Cardiology, University Hospital Muenster, Muenster, Germany
| | - Iva Graumann
- Department of Pediatrics, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Rudi Foth
- Department of Pediatric Cardiology, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Luebeck/Kiel, Kiel, Germany
| | | | - Bettina Ruf
- Department of Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | - Gesa Wiegand
- Department of Pediatric Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Tim Friede
- Medical Statistics, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Daniel Messroghli
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Stephan Schubert
- Center of Congenital Heart Disease and Pediatric Cardiology, Heart- and Diabetes Center NRW and University Clinic of Ruhr-University Bochum, Bad Oeynhausen, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Franziska Seidel
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
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9
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Stanelle-Bertram S, Beck S, Mounogou NK, Schaumburg B, Stoll F, Al Jawazneh A, Schmal Z, Bai T, Zickler M, Beythien G, Becker K, de la Roi M, Heinrich F, Schulz C, Sauter M, Krasemann S, Lange P, Heinemann A, van Riel D, Leijten L, Bauer L, van den Bosch TPP, Lopuhaä B, Busche T, Wibberg D, Schaudien D, Goldmann T, Lüttjohann A, Ruschinski J, Jania H, Müller Z, Pinho Dos Reis V, Krupp-Buzimkic V, Wolff M, Fallerini C, Baldassarri M, Furini S, Norwood K, Käufer C, Schützenmeister N, von Köckritz-Blickwede M, Schroeder M, Jarczak D, Nierhaus A, Welte T, Kluge S, McHardy AC, Sommer F, Kalinowski J, Krauss-Etschmann S, Richter F, von der Thüsen J, Baumgärtner W, Klingel K, Ondruschka B, Renieri A, Gabriel G. CYP19A1 mediates severe SARS-CoV-2 disease outcome in males. Cell Rep Med 2023; 4:101152. [PMID: 37572667 PMCID: PMC10518605 DOI: 10.1016/j.xcrm.2023.101152] [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: 07/12/2022] [Revised: 05/10/2023] [Accepted: 07/18/2023] [Indexed: 08/14/2023]
Abstract
Male sex represents one of the major risk factors for severe COVID-19 outcome. However, underlying mechanisms that mediate sex-dependent disease outcome are as yet unknown. Here, we identify the CYP19A1 gene encoding for the testosterone-to-estradiol metabolizing enzyme CYP19A1 (also known as aromatase) as a host factor that contributes to worsened disease outcome in SARS-CoV-2-infected males. We analyzed exome sequencing data obtained from a human COVID-19 cohort (n = 2,866) using a machine-learning approach and identify a CYP19A1-activity-increasing mutation to be associated with the development of severe disease in men but not women. We further analyzed human autopsy-derived lungs (n = 86) and detect increased pulmonary CYP19A1 expression at the time point of death in men compared with women. In the golden hamster model, we show that SARS-CoV-2 infection causes increased CYP19A1 expression in the lung that is associated with dysregulated plasma sex hormone levels and reduced long-term pulmonary function in males but not females. Treatment of SARS-CoV-2-infected hamsters with a clinically approved CYP19A1 inhibitor (letrozole) improves impaired lung function and supports recovery of imbalanced sex hormones specifically in males. Our study identifies CYP19A1 as a contributor to sex-specific SARS-CoV-2 disease outcome in males. Furthermore, inhibition of CYP19A1 by the clinically approved drug letrozole may furnish a new therapeutic strategy for individualized patient management and treatment.
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Affiliation(s)
| | - Sebastian Beck
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Nancy Kouassi Mounogou
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Berfin Schaumburg
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Fabian Stoll
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Amirah Al Jawazneh
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Zoé Schmal
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Tian Bai
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Martin Zickler
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Georg Beythien
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Kathrin Becker
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Madeleine de la Roi
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Fabian Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Schulz
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Martina Sauter
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Susanne Krasemann
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Core Facility Experimental Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philine Lange
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Debby van Riel
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Lonneke Leijten
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Lisa Bauer
- Department of Viroscience, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Boaz Lopuhaä
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tobias Busche
- Medical School East Westphalia-Lippe & Center for Biotechnology (CeBiTec), Bielefeld University, Bielefeld, Germany
| | - Daniel Wibberg
- Microbial Genomics and Biotechnology, Center for Biotechnology (CeBiTec), Bielefeld University, Bielefeld, Germany
| | - Dirk Schaudien
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover, Germany
| | - Torsten Goldmann
- Pathology of the University Medical Center Schleswig-Holstein, Campus Lübeck and the Research Center Borstel, Research Center Borstel, Leibniz Center for Medicine and Biosciences, German Center for Lung Research (DZL), Borstel, Germany
| | - Anna Lüttjohann
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Jenny Ruschinski
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Hanna Jania
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | - Zacharias Müller
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany
| | | | - Vanessa Krupp-Buzimkic
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany; Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Martin Wolff
- Early Life Origins of Chronic Lung Disease, Research Center Borstel, Leibniz Lung Center, Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Chiara Fallerini
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy; Medical Genetics, University of Siena, Siena, Italy
| | - Margherita Baldassarri
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy; Medical Genetics, University of Siena, Siena, Italy
| | - Simone Furini
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Katrina Norwood
- Department for Computational Biology of Infection Research, Helmholtz Center for Infection Research, Braunschweig, Germany; Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Braunschweig, Germany
| | - Christopher Käufer
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Maren von Köckritz-Blickwede
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany; Department of Biochemistry, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Maria Schroeder
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, Member of the German Center for Lung Research, Hannover, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alice C McHardy
- German Center for Infection Research (DZIF), Braunschweig, Germany; Department for Computational Biology of Infection Research, Helmholtz Center for Infection Research, Braunschweig, Germany; Braunschweig Integrated Centre of Systems Biology (BRICS), Technische Universität Braunschweig, Braunschweig, Germany; Cluster of Excellence RESIST (EXC 2355), Hannover Medical School, Hannover, Germany
| | - Frank Sommer
- Division Men's Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörn Kalinowski
- Microbial Genomics and Biotechnology, Center for Biotechnology (CeBiTec), Bielefeld University, Bielefeld, Germany
| | - Susanne Krauss-Etschmann
- Early Life Origins of Chronic Lung Disease, Research Center Borstel, Leibniz Lung Center, Member of the German Center for Lung Research (DZL), Borstel, Germany; Institute for Experimental Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Franziska Richter
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Jan von der Thüsen
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandra Renieri
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy; Medical Genetics, University of Siena, Siena, Italy; Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Gülsah Gabriel
- Department for Viral Zoonoses - One Health, Leibniz Institute of Virology, Hamburg, Germany; Institute of Virology, University of Veterinary Medicine Hannover, Hannover, Germany; German Center for Infection Research (DZIF), Braunschweig, Germany.
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10
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Heymans S, Lakdawala NK, Tschöpe C, Klingel K. Dilated cardiomyopathy: causes, mechanisms, and current and future treatment approaches. Lancet 2023; 402:998-1011. [PMID: 37716772 DOI: 10.1016/s0140-6736(23)01241-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/20/2023] [Accepted: 06/13/2023] [Indexed: 09/18/2023]
Abstract
Dilated cardiomyopathy is conventionally defined as the presence of left ventricular or biventricular dilatation or systolic dysfunction in the absence of abnormal loading conditions (eg, primary valve disease) or significant coronary artery disease sufficient to cause ventricular remodelling. This definition has been recognised as overly restrictive, as left ventricular hypokinesis without dilation could be the initial presentation of dilated cardiomyopathy. The causes of dilated cardiomyopathy comprise genetic (primary dilated cardiomyopathy) or acquired factors (secondary dilated cardiomyopathy). Acquired factors include infections, toxins, cancer treatment, endocrinopathies, pregnancy, tachyarrhythmias, and immune-mediated diseases. 5-15% of patients with acquired dilated cardiomyopathy harbour a likely pathogenic or pathogenic gene variant (ie, gene mutation). Therefore, the diagnostic tests and therapeutic approach should always consider both genetic and acquired factors. This Seminar will focus on the current multidimensional diagnostic and therapeutic approach and discuss the underlying pathophysiology that could drive future treatments aiming to repair or replace the existing gene mutation, or target the specific inflammatory, metabolic, or pro-fibrotic drivers of genetic or acquired dilated cardiomyopathy.
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Affiliation(s)
- Stephane Heymans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, University of Maastricht & Maastricht University Medical Centre, Maastricht, Netherlands; Department of Cardiovascular Sciences, Centre for Vascular and Molecular Biology, KU Leuven, Leuven, Belgium
| | - Neal K Lakdawala
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carsten Tschöpe
- Department of Cardiology, Angiology, and Intensive Medicine (CVK), German Heart Center of the Charité (DHZC), Charité Universitätsmedizin, Berlin, Germany; Berlin Institute of Health (BIH) Center for Regenerative Therapies (BCRT), Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany.
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11
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Schuetz T, Schiller D, Klingel K, Gattermeier M, Poelzl G. Unicentric Castleman's disease associated with malignant cardiac Amyloid-A amyloidosis: a case report. Eur Heart J Case Rep 2023; 7:ytad451. [PMID: 37719003 PMCID: PMC10500416 DOI: 10.1093/ehjcr/ytad451] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
Background Unicentric Castleman's disease (UCD), a lymphoproliferative disorder characterized by enlargement of the lymph nodes, is a rare cause of Amyloid-A amyloidosis. While patients usually present with impaired kidney function and proteinuria, heart involvement is neither common nor the main cause of signs and symptoms. Case summary We present a patient who was admitted to the hospital for impaired exercise capacity. Diagnostic work-up revealed severe left ventricular hypertrophy suggestive of cardiac amyloidosis. Although Congo red staining of endomyocardial biopsies was initially negative, subsequent immunohistochemical staining against serum amyloid A finally confirmed the diagnosis of cardiac amyloidosis. 18F-fluorodeoxyglucose positron emission tomography/computed tomography revealed a tumour located in dorsal of the duodenum. Fine-needle aspiration biopsy of the tumour was suggestive but could not confirm the presence of UCD beyond reasonable doubt. Rapid worsening of heart failure symptoms warranted urgent surgical tumourectomy, which resulted in immediate post-operative lowering of serum amyloid protein. However, post-operative cardiogenic shock could not be stabilized even with veno-arterial extracorporeal membrane oxygenation, and the patient eventually died. The UCD of the hyaline vascular (HV) subtype was confirmed by pathologic work-up of the excised tumour. Discussion This case report presents for the first time a patient with malignant cardiac Amyloid-A amyloidosis caused by unicentric Castleman's disease of the HV subtype. Since the disease progresses swiftly, rapid diagnosis is essential for potential curative treatment.
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Affiliation(s)
- Thomas Schuetz
- Department of Internal Medicine III—Cardiology and Angiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Dietmar Schiller
- Department of Internal Medicine IV, Elisabethinen Hospital, Seilerstätte 4, 4010 Linz, Austria
| | - Karin Klingel
- Cardiopathology Department, Institute for Pathology and Neuropathology, Tübingen University Hospital, Liebermeisterstr. 8, 72076 Tübingen, Germany
| | - Martin Gattermeier
- Department of Internal Medicine, Landesklinikum Waidhofen/Ybbs, Ybbsitzerstraße 112, 3340 Waidhofen an der Ybbs, Austria
| | - Gerhard Poelzl
- Department of Internal Medicine III—Cardiology and Angiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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12
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Reithmann C, Kling T, Metani M, Klingel K, Ulbrich M. Endomyocardial substrate of ventricular arrhythmias in patients with autoimmune rheumatic diseases. J Cardiovasc Electrophysiol 2023; 34:1850-1858. [PMID: 37554105 DOI: 10.1111/jce.16036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/25/2023] [Accepted: 08/01/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Delayed enhancement-magnetic resonance imaging (DE-MRI) has demonstrated that nonischemic cardiomyopathy is mainly characterized by intramural or epicardial fibrosis whereas global endomyocardial fibrosis suggests cardiac involvement in autoimmune rheumatic diseases or amyloidosis. Conduction disorders and sudden cardiac death are important manifestations of autoimmune rheumatic diseases with cardiac involvement but the substrates of ventricular arrhythmias in autoimmune rheumatic diseases have not been fully elucidated. METHODS AND RESULTS 20 patients with autoimmune rheumatic diseases presenting with ventricular tachycardia (VT) (n = 11) or frequent ventricular extrasystoles (n = 9) underwent DE-MRI and/or endocardial electroanatomical mapping of the left ventricle (LV). Ten patients with autoimmune rheumatic diseases underwent VT ablation. Global endomyocardial fibrosis without myocardial thickening and unrelated to coronary territories was detected by DE-MRI or electroanatomical voltage mapping in 9 of 20 patients with autoimmune rheumatic diseases. In the other patients with autoimmune rheumatic diseases, limited regions of predominantly epicardial (n = 4) and intramyocardial (n = 5) fibrosis or only minimal fibrosis (n = 2) were found using DE-MRI. Endocardial low-amplitude diastolic potentials and pre-systolic Purkinje or fascicular potentials, mostly within fibrotic areas, were identified as the targets of successful VT ablation in 7 of 10 patients with autoimmune rheumatic diseases. CONCLUSION Global endomyocardial fibrosis can be a tool to diagnose severe cardiac involvement in autoimmune rheumatic diseases and may serve as the substrate of ventricular arrhythmias in a substantial part of patients.
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Affiliation(s)
- Christopher Reithmann
- Medizinische Klinik 1, HELIOS Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, München, Germany
| | - Theresia Kling
- Medizinische Klinik 1, HELIOS Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, München, Germany
| | - Manjola Metani
- Medizinische Klinik 1, HELIOS Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, München, Germany
| | - Karin Klingel
- Department of Kardiopathologie, Institut für Pathologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Michael Ulbrich
- Medizinische Klinik 1, HELIOS Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, München, Germany
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13
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Stanasiuk C, Milting H, Homm S, Persson J, Holtz L, Wittmer A, Fox H, Laser T, Knöll R, Pohl GM, Paluszkiewicz L, Jakob T, Bachmann-Mennenga B, Henzler D, Grautoff S, Veit G, Klingel K, Hori E, Kellner U, Karger B, Schlepper S, Pfeiffer H, Gummert J, Gärtner A, Tiesmeier J. Blood taken immediately after fatal resuscitation attempts yields higher quality DNA for genetic studies as compared to autopsy samples. Int J Legal Med 2023; 137:1569-1581. [PMID: 36773088 PMCID: PMC10421769 DOI: 10.1007/s00414-023-02966-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND The out-of-hospital cardiac arrest (OHCA) in the young may be associated with a genetic predisposition which is relevant even for genetic counseling of relatives. The identification of genetic variants depends on the availability of intact genomic DNA. DNA from autopsy may be not available due to low autopsy frequencies or not suitable for high-throughput DNA sequencing (NGS). The emergency medical service (EMS) plays an important role to save biomaterial for subsequent molecular autopsy. It is not known whether the DNA integrity of samples collected by the EMS is better suited for NGS than autopsy specimens. MATERIAL AND METHODS DNA integrity was analyzed by standardized protocols. Fourteen blood samples collected by the EMS and biomaterials from autopsy were compared. We collected 172 autopsy samples from different tissues and blood with postmortem intervals of 14-168 h. For comparison, DNA integrity derived from blood stored under experimental conditions was checked against autopsy blood after different time intervals. RESULTS DNA integrity and extraction yield were higher in EMS blood compared to any autopsy tissue. DNA stability in autopsy specimens was highly variable and had unpredictable quality. In contrast, collecting blood samples by the EMS is feasible and delivered comparably the highest DNA integrity. CONCLUSIONS Isolation yield and DNA integrity from blood samples collected by the EMS is superior in comparison to autopsy specimens. DNA from blood samples collected by the EMS on scene is stable at room temperature or even for days at 4 °C. We conclude that the EMS personnel should always save a blood sample of young fatal OHCA cases died on scene to enable subsequent genetic analysis.
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Affiliation(s)
- Caroline Stanasiuk
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Hendrik Milting
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany.
| | - Sören Homm
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Jan Persson
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Lars Holtz
- Emergency Department, Herford Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Axel Wittmer
- Institute for Pathology, Herford Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Thorsten Laser
- Center for Congenital Heart Diseases, Heart and Diabetes Center NRW, 32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Ralph Knöll
- Karolinska Institute, University Hospital, Myocardial Genetic, 14157, Huddinge, Sweden
| | - Greta Marie Pohl
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Lech Paluszkiewicz
- Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Thomas Jakob
- Intensive Care and Emergency Medicine, Herford Hospital, Campus OWL, Ruhr-University Bochum, University Clinic for Anesthesiology, Bochum, Germany
- Present address: Clinic for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Bielefeld Hospital, University Hospital Eastern Westphalia-Lippe, Bielefeld University, Bielefeld, Germany
| | - Bernd Bachmann-Mennenga
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Dietrich Henzler
- Intensive Care and Emergency Medicine, Herford Hospital, Campus OWL, Ruhr-University Bochum, University Clinic for Anesthesiology, Bochum, Germany
| | - Steffen Grautoff
- Emergency Department, Herford Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Gunter Veit
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, University Hospital Tuebingen, D-72076, Tuebingen, Germany
| | - Erika Hori
- Institute for Pathology, Johannes Wesling Hospital Minden, MKK-Hospital, D-32429 Minden, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Udo Kellner
- Institute for Pathology, Johannes Wesling Hospital Minden, MKK-Hospital, D-32429 Minden, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Bernd Karger
- Institute for Forensic Medicine, University Hospital, Wilhelms-University Muenster, Muenster, Germany
| | - Stefanie Schlepper
- Institute for Forensic Medicine, University Hospital, Wilhelms-University Muenster, Muenster, Germany
| | - Heidi Pfeiffer
- Institute for Forensic Medicine, University Hospital, Wilhelms-University Muenster, Muenster, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Anna Gärtner
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Jens Tiesmeier
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Luebbecke MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
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14
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Granai M, Warm V, Vogelsberg A, Milla J, Greif K, Vogel U, Bakchoul T, Rosenberger P, Quintanilla-Martinez L, Schürch CM, Klingel K, Fend F, Bösmüller H. Impact of P-selectin-PSGL-1 Axis on Platelet-Endothelium-Leukocyte Interactions in Fatal COVID-19. J Transl Med 2023; 103:100179. [PMID: 37224922 PMCID: PMC10202465 DOI: 10.1016/j.labinv.2023.100179] [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: 01/13/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Abstract
In critically ill patients infected with SARS-CoV-2, early leukocyte recruitment to the respiratory system was found to be orchestrated by leukocyte trafficking molecules accompanied by massive secretion of proinflammatory cytokines and hypercoagulability. Our study aimed to explore the interplay between leukocyte activation and pulmonary endothelium in different disease stages of fatal COVID-19. Our study comprised 10 COVID-19 postmortem lung specimens and 20 control lung samples (5 acute respiratory distress syndrome, 2 viral pneumonia, 3 bacterial pneumonia, and 10 normal), which were stained for antigens representing the different steps of leukocyte migration: E-selectin, P-selectin, PSGL-1, ICAM1, VCAM1, and CD11b. Image analysis software QuPath was used for quantification of positive leukocytes (PSGL-1 and CD11b) and endothelium (E-selectin, P-selectin, ICAM1, VCAM1). Expression of IL-6 and IL-1β was quantified by RT-qPCR. Expression of P-selectin and PSGL-1 was strongly increased in the COVID-19 cohort compared with all control groups (COVID-19:Controls, 17:23, P < .0001; COVID-19:Controls, 2:75, P < .0001, respectively). Importantly, P-selectin was found in endothelial cells and associated with aggregates of activated platelets adherent to the endothelial surface in COVID-19 cases. In addition, PSGL-1 staining disclosed positive perivascular leukocyte cuffs, reflecting capillaritis. Moreover, CD11b showed a strongly increased positivity in COVID-19 compared with all controls (COVID-19:Controls, 2:89; P = .0002), indicating a proinflammatory immune microenvironment. Of note, CD11b exhibited distinct staining patterns at different stages of COVID-19 disease. Only in cases with very short disease course, high levels of IL-1β and IL-6 mRNA were observed in lung tissue. The striking upregulation of PSGL-1 and P-selectin reflects the activation of this receptor-ligand pair in COVID-19, increasing the efficiency of initial leukocyte recruitment, thus promoting tissue damage and immunothrombosis. Our results show that endothelial activation and unbalanced leukocyte migration play a central role in COVID-19 involving the P-selectin-PSGL-1 axis.
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Affiliation(s)
- Massimo Granai
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Verena Warm
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Antonio Vogelsberg
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Jakob Milla
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Karen Greif
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Ulrich Vogel
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Tamam Bakchoul
- Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany; Centre for Clinical Transfusion Medicine Tübingen ZKT gGmbH, University of Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany
| | | | - Christian M Schürch
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Falko Fend
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany.
| | - Hans Bösmüller
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
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15
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Latus H, Raap R, Klingel K, Happel C, Moysich A, Khalil M, Kerst G, Milla J, Skrzypek S, Thul J, Jux C, Schranz D, Apitz C. Left Ventricular Physiology and Ventricular-Vascular Interactions in Young Patients After Heart Transplantation. J Am Heart Assoc 2023:e028766. [PMID: 37382105 DOI: 10.1161/jaha.122.028766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background In patients after heart transplantation, systemic arterial hypertension and enhanced central aortic stiffness contribute to increased ventricular afterload, which might lead to graft dysfunction. The aim of our study was to characterize systemic arterial elastance and its impact on left ventricular function and ventriculo-arterial coupling in a cohort of children, adolescents, and young adults after heart transplantation using invasive conductance catheter technique. Methods and Results Thirty patients who had heart transplants (age, 20.0±6.5 years, 7 female) underwent invasive cardiac catheterization including pressure-volume loop analysis. Load-independent parameters of systolic (ventricular elastance [Ees]) and diastolic (ventricular compliance) function as well as systemic arterial elastance (Ea, end-systolic pressure/stroke volume) and ventriculo-arterial coupling (Ea/Ees) were assessed at baseline level and during dobutamine infusion (10 μg/kg/min). Ees showed an appropriate increase under inotropic stimulation from 0.43 (0.11-2.52) to 1.00 (0.20-5.10) mm Hg/mL/m2 (P<0.0001), whereas ventricular compliance remained rather unchanged (0.16±0.10 mm Hg/mL/m2 to 0.12±0.07 mm Hg/mL/m2; P=0.10). Ventriculo-arterial coupling Ea/Ees was abnormal at rest and did not improve significantly under dobutamine (1.7 [0.6-6.7] to 1.3 [0.5-4.9], P=0.70) due to a simultaneous rise in Ea from 0.71 (0.37-2.82) to 1.10 (0.52-4.03) mm Hg/mL/m2 (P<0.0001). Both Ees and ventricular compliance were significantly associated with Ea at baseline and under dobutamine infusion. Conclusions Patients who underwent heart transplantation show impaired ventriculo-arterial coupling at rest and under inotropic stimulation despite preserved left ventricular contractile reserve. An abnormal response in vascular function resulting in increased afterload seems to represent an important factor that may play a role for the development of late graft failure.
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Affiliation(s)
- Heiner Latus
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
- Clinic for Pediatric Cardiology and Congenital Heart Disease Klinikum Stuttgart Germany
| | - Ramona Raap
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
| | - Karin Klingel
- Cardiopathology Institute for Pathology and Neuropathology, University Hospital Tübingen Tübingen Germany
| | - Christoph Happel
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
- Department of Pediatric Cardiology Hannover Medical School Hannover Germany
| | - Axel Moysich
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
| | - Markus Khalil
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
| | - Gunter Kerst
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
- Clinic for Pediatric Cardiology and Congenital Heart Disease Klinikum Stuttgart Germany
| | - Jakob Milla
- Cardiopathology Institute for Pathology and Neuropathology, University Hospital Tübingen Tübingen Germany
| | - Susanne Skrzypek
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
| | - Josef Thul
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
| | - Christian Jux
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
| | - Dietmar Schranz
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
| | - Christian Apitz
- Pediatric Heart Centre, Centre for Congenital Heart Disease Giessen Germany
- Department of Pediatric Cardiology University Children's Hospital Ulm Ulm Germany
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16
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Bohné M, Bohnen S, Willems S, Klingel K, Kivelitz D, Bahlmann E. Acute Lymphocytic Myocarditis in a Young Male Post-COVID-19. Case Rep Cardiol 2023; 2023:7646962. [PMID: 37397607 PMCID: PMC10310455 DOI: 10.1155/2023/7646962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/10/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Background Lymphocytic myocarditis is a rare form of myocarditis, associated with a high mortality rate due to a high risk of sudden cardiac death. Lymphocytic myocarditis might present as a relevant extrapulmonary manifestation after coronavirus disease 2019 (COVID-19) infection. Case presentation. We report a case of a 26-year-old male with lymphocytic myocarditis, presenting with a 1-month history of increasing fatigue, palpitations, and shortness of breath. Eight weeks before, he was tested positive for SARS-CoV-2. He had received 2-dose schedule of the COVID-19 mRNA vaccine Comirnaty® (BioNTech/Pfizer) 6 months prior to his admission. Diagnostic work-up by echocardiography and cardiac magnetic resonance (CMR) imaging demonstrated a severely reduced left ventricular function and a strong midmyocardial late gadolinium enhancement (LGE). Histology and immunohistology of the endomyocardial biopsies revealed an acute lymphocytic myocarditis. Immunosuppressive therapy with a steroid taper in combination with azathioprine 300 mg/day was initiated. The patient was equipped with a LifeVest®. On day 17, a non-sustained ventricular tachycardia was documented. Follow-up CMR imaging after 3 months showed a slightly improved systolic left ventricular function, and a strong LGE was still detectable. Conclusions The case highlights the significance of recognizing lymphocytic myocarditis correlated to COVID-19. It is important to be vigilant also of a later presentation of cardiomyopathy in patients diagnosed with COVID-19 due to high mortality without immediate support.
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Affiliation(s)
- Mintje Bohné
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Sebastian Bohnen
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Dietmar Kivelitz
- Department of Radiology, Asklepios Clinic St. Georg, Hamburg, Semmelweis University, Budapest, Asklepios CampusHamburg, Germany
| | - Edda Bahlmann
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
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17
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Geisler A, Dieringer B, Elsner L, Klingel K, Klopfleisch R, Vornlocher HP, Kurreck J, Fechner H. Lipid nanoparticle-encapsulated, chemically modified anti-adenoviral siRNAs inhibit hepatic adenovirus infection in immunosuppressed Syrian hamsters. Mol Ther Nucleic Acids 2023; 32:923-936. [PMID: 37346978 PMCID: PMC10280093 DOI: 10.1016/j.omtn.2023.05.016] [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] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/10/2023] [Indexed: 06/23/2023]
Abstract
RNA interference has demonstrated its potential as an antiviral therapy for treatment of human adenovirus (hAd) infections. The only existing viral vector-based system for delivery of anti-adenoviral artificial microRNAs available for in vivo use, however, has proven to be inefficient in therapeutic applications. In this study, we investigated the potential of stabilized small interfering RNA (siRNA) encapsulated in lipid nanoparticles (LNPs) for treatment of hepatic hAd serotype 5 (hAd5) infection in an hAd infection model using immunosuppressed Syrian hamsters. The siRNA sipTPmod directed against the adenoviral pre-terminal protein (pTP) and containing 2'-O-methyl modifications as well as phosphorothioate linkages effectively inhibited hAd5 infection in vitro. In light of this success, sipTPmod was encapsulated in LNPs containing the cationic lipid XL-10, which enables hepatocyte-specific siRNA transfer, and injected intravenously into hAd5-infected immunosuppressed Syrian hamsters. This resulted in a significant reduction of liver hAd5 titers, a trend toward reduced liver injury and inflammation, and reduction of viral titers in the blood and spleen compared with hAd5-infected animals that received a non-silencing siRNA. These effects were demonstrated in animals infected with low and moderate doses of hAd5. These data demonstrate that hepatic hAd5 infection can be successfully treated with anti-adenoviral sipTPmod encapsulated in LNPs.
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Affiliation(s)
- Anja Geisler
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - Babette Dieringer
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - Leslie Elsner
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Robert-von-Ostertag-Straße 15, 14163 Berlin, Germany
| | | | - Jens Kurreck
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - Henry Fechner
- Department of Applied Biochemistry, Institute of Biotechnology, Technische Universität Berlin, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
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18
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Fishbein GA, Leone O, Basso C, Fallon JT, Klingel K, Tan C. Commentary on why implementing and standardizing histologic diagnosis of myocarditis is crucial for the clinical setting and patient care. Cardiovasc Pathol 2023; 64:107515. [PMID: 36592720 DOI: 10.1016/j.carpath.2022.107515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
Histological examination of endomyocardial biopsy or myocardium at autopsy is key to the diagnosis of myocarditis. Among pathologists there is currently extensive variability in routine practice and criteria used to define, diagnose, and report myocarditis as well as to achieve consensus on cases. Two manuscripts emphasizing the need to standardize and implement histopathological diagnostic criteria for myocarditis are reviewed.
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Affiliation(s)
- Gregory A Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Ornella Leone
- Department of Pathology, Cardiovascular and Cardiac Transplant Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University Hospital of Padua, Padua, Italy
| | - John T Fallon
- Department of Pathology and Laboratory Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Karin Klingel
- Cardiopathology, Institute for Pathology University Hospital Tübingen, Tübingen, Germany
| | - Carmela Tan
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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19
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Paul T, Klingel K, Tschöpe C, Bertram H, Seidel F. Leitlinie Myokarditis der Deutschen Gesellschaft für
Pädiatrische Kardiologie. Klin Padiatr 2023; 235:e1-e15. [PMID: 37094605 DOI: 10.1055/a-2039-2604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
This consensus statement presents updated recommendations on diagnosis and treatment of myocarditis in childhood.
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Affiliation(s)
- Thomas Paul
- Universitätsmedizin Göttingen Klinik für Pädiatrische Kardiologie und Intensivmedizin, Göttingen, Deutschland
| | - Karin Klingel
- Universitätshospital Tübingen, Institut für Pathologie und Neuropathologie, Tübingen, Deutschland
| | - Carsten Tschöpe
- Charité Universitätsmedizin Berlin, Kardiologie, Berlin, Deutschland
| | - Harald Bertram
- Medizinische Hochschule Hannover, Klinik für Pädiatrische Kardiologie und Pädiatrische Intensivmedizin, Hannover, Deutschland
| | - Franziska Seidel
- Charité Universitätsmedizn Berlin, Pädiatrische Kardiologie, Berlin, Deutschland
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20
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Rolfs N, Seidel F, Opgen-Rhein B, Böhne M, Wannenmacher B, Hecht T, Mannert J, Reineker K, Rentzsch A, Grafmann M, Wiegand G, Kiski D, Fischer M, Ruf B, Papakostas K, Hellwig R, Foth R, Kaestner M, Kramp J, Voges I, Blank A, Tarusinov G, Schweigmann U, Oezcan S, Graumann I, Knirsch W, Pickardt T, Schwarzkopf E, Klingel K, Messroghli D, Schubert S. Mechanical Circulatory Support, Heart Transplantation and Death in a Large-Scale Population of the Multicenter Registry for Suspected Pediatric Myocarditis - "MYKKE". J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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21
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Ueberham L, Hagendorff A, Klingel K, Paetsch I, Jahnke C, Kluge T, Ebbinghaus H, Hindricks G, Laufs U, Dinov B. Pathophysiological Gaps, Diagnostic Challenges, and Uncertainties in Cardiac Sarcoidosis. J Am Heart Assoc 2023; 12:e027971. [PMID: 36892055 PMCID: PMC10111513 DOI: 10.1161/jaha.122.027971] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Cardiac sarcoidosis can mimic any cardiomyopathy in different stages. Noncaseating granulomatous inflammation can be missed, because of the nonhomogeneous distribution in the heart. The current diagnostic criteria show discrepancies and are partly nonspecific and insensitive. Besides the diagnostic pitfalls, there are controversies in the understanding of the causes, genetic and environmental background, and the natural evolution of the disease. Here, we review the current pathophysiological aspects and gaps that are relevant for future cardiac sarcoidosis diagnostics and research.
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Affiliation(s)
- Laura Ueberham
- Klinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig Leipzig Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig Leipzig Germany
| | - Karin Klingel
- Cardiopathology Institute for Pathology, Eberhard Karls Universität Tübingen Tübingen Germany
| | - Ingo Paetsch
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Cosima Jahnke
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Theresa Kluge
- Klinik und Poliklinik für Nuklearmedizin Universitätsklinikum Leipzig Leipzig Germany
| | - Hans Ebbinghaus
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Gerhard Hindricks
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig Leipzig Germany
| | - Borislav Dinov
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
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22
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Rohrbeck M, Hoerr V, Piccini I, Greber B, Schulte JS, Hübner SS, Jeworutzki E, Theiss C, Matschke V, Stypmann J, Unger A, Ho HT, Disse P, Strutz-Seebohm N, Faber C, Müller FU, Ludwig S, Rescher U, Linke WA, Klingel K, Busch K, Peischard S, Seebohm G. Pathophysiological Mechanisms of Cardiac Dysfunction in Transgenic Mice with Viral Myocarditis. Cells 2023; 12:cells12040550. [PMID: 36831217 PMCID: PMC9954433 DOI: 10.3390/cells12040550] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Viral myocarditis is pathologically associated with RNA viruses such as coxsackievirus B3 (CVB3), or more recently, with SARS-CoV-2, but despite intensive research, clinically proven treatment is limited. Here, by use of a transgenic mouse strain (TG) containing a CVB3ΔVP0 genome we unravel virus-mediated cardiac pathophysiological processes in vivo and in vitro. Cardiac function, pathologic ECG alterations, calcium homeostasis, intracellular organization and gene expression were significantly altered in transgenic mice. A marked alteration of mitochondrial structure and gene expression indicates mitochondrial impairment potentially contributing to cardiac contractile dysfunction. An extended picture on viral myocarditis emerges that may help to develop new treatment strategies and to counter cardiac failure.
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Affiliation(s)
- Matthias Rohrbeck
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, D-48149 Münster, Germany
| | - Verena Hoerr
- Translational Research Imaging Center, Clinic of Radiology, University Hospital Münster, D-48149 Münster, Germany
| | - Ilaria Piccini
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, D-48149 Münster, Germany
| | - Boris Greber
- Human Stem Cell Pluripotency Laboratory, Max Planck Institute for Molecular Biomedicine, D-48149 Münster, Germany
- Chemical Genomics Centre of the Max Planck Society, 44227 Dortmund, Germany
| | - Jan Sebastian Schulte
- Institute of Pharmacology and Toxicology, University Hospital Münster, D-48149 Münster, Germany
| | - Sara-Sophie Hübner
- Translational Research Imaging Center, Clinic of Radiology, University Hospital Münster, D-48149 Münster, Germany
| | - Elena Jeworutzki
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, D-48149 Münster, Germany
| | - Carsten Theiss
- Department of Cytology, Institute of Anatomy, Ruhr-University Bochum, D-44780 Bochum, Germany
| | - Veronika Matschke
- Department of Cytology, Institute of Anatomy, Ruhr-University Bochum, D-44780 Bochum, Germany
| | - Jörg Stypmann
- Department of Cardiovascular Medicine, Division of Cardiology, University Clinic Münster, 48149 Münster, Germany
| | - Andreas Unger
- Institute of Physiology II, Faculty of Medicine, University of Münster, D-48149 Münster, Germany
| | - Huyen Tran Ho
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, D-48149 Münster, Germany
| | - Paul Disse
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, D-48149 Münster, Germany
| | - Nathalie Strutz-Seebohm
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, D-48149 Münster, Germany
| | - Cornelius Faber
- Translational Research Imaging Center, Clinic of Radiology, University Hospital Münster, D-48149 Münster, Germany
| | - Frank Ulrich Müller
- Institute of Pharmacology and Toxicology, University Hospital Münster, D-48149 Münster, Germany
| | - Stephan Ludwig
- Institute of Virology Münster (IVM), Centre for Molecular Biology of Inflammation (ZMBE), University of Münster, D-48149 Münster, Germany
| | - Ursula Rescher
- Research Group Regulatory Mechanisms of Inflammation, Institute of Medical Biochemistry, Centre for Molecular Biology of Inflammation, University of Muenster, 48149 Muenster, Germany
| | - Wolfgang A. Linke
- Institute of Physiology II, Faculty of Medicine, University of Münster, D-48149 Münster, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital of Tübingen, D-72076 Tübingen, Germany
| | - Karin Busch
- Institute of Integrative Cell Biology and Physiology, Faculty of Biology, University of Muenster, Schlossplatz 5, 48149 Muenster, Germany
| | - Stefan Peischard
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, D-48149 Münster, Germany
- Correspondence: (S.P.); (G.S.); Tel.: +49-(0)-251/83-58255 (S.P.); +49-(0)-251/83-58251 (G.S.); Fax: +49-(0)-251/83-58257 (S.P. & G.S.)
| | - Guiscard Seebohm
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, D-48149 Münster, Germany
- Correspondence: (S.P.); (G.S.); Tel.: +49-(0)-251/83-58255 (S.P.); +49-(0)-251/83-58251 (G.S.); Fax: +49-(0)-251/83-58257 (S.P. & G.S.)
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23
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Bräutigam K, Reinhard S, Wartenberg M, Forster S, Greif K, Granai M, Bösmüller H, Klingel K, Schürch CM. Comprehensive analysis of SARS-CoV-2 receptor proteins in human respiratory tissues identifies alveolar macrophages as potential virus entry site. Histopathology 2023; 82:846-859. [PMID: 36700825 DOI: 10.1111/his.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023]
Abstract
AIMS COVID-19 has had enormous consequences on global health-care and has resulted in millions of fatalities. The exact mechanism and site of SARS-CoV-2 entry into the body remains insufficiently understood. Recently, novel virus receptors were identified, and alveolar macrophages were suggested as a potential viral entry cell type and vector for intra-alveolar virus transmission. Here, we investigated the protein expression of 10 well-known and novel virus entry molecules along potential entry sites in humans using immunohistochemistry. METHODS AND RESULTS Samples of different anatomical sites from up to 93 patients were incorporated into tissue microarrays. Protein expression of ACE2, TMPRSS2, furin, CD147, C-type lectin receptors (CD169, CD209, CD299), neuropilin-1, ASGR1 and KREMEN1 were analysed. In lung tissues, at least one of the three receptors ACE2, ASGR1 or KREMEN1 was expressed in the majority of cases. Moreover, all the investigated molecules were found to be expressed in alveolar macrophages, and co-localisation with SARS-CoV-2 N-protein was demonstrated using dual immunohistochemistry in lung tissue from a COVID-19 autopsy. While CD169 and CD209 showed consistent protein expression in sinonasal, conjunctival and bronchiolar tissues, neuropilin-1 and ASGR1 were mostly absent, suggesting a minor relevance of these two molecules at these specific sites. CONCLUSION Our results extend recent discoveries indicating a role for these molecules in virus entry at different anatomical sites. Moreover, they support the notion of alveolar macrophages being a potential entry cell for SARS-CoV-2.
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Affiliation(s)
| | - Stefan Reinhard
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Stefan Forster
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Karen Greif
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Massimo Granai
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Hans Bösmüller
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Karin Klingel
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Christian M Schürch
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
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24
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Lu ZA, Aubry MC, Fallon JT, Fishbein MC, Giordano C, Klingel K, Leone O, Rizzo S, Veinot JP, Halushka MK. Myocarditis and endomyocardial biopsy: achieving consensus diagnosis on 100 cases. Cardiovasc Pathol 2023; 62:107492. [PMID: 36404460 DOI: 10.1016/j.carpath.2022.107492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/06/2022] [Accepted: 10/21/2022] [Indexed: 12/13/2022] Open
Abstract
The two histopathology benchmarks used to diagnose myocarditis are the Dallas Criteria, developed in 1984 and the European Society of Cardiology criteria, developed in 2013, which added immunohistochemistry for the detection of CD3+ T cells (lymphocytes) and CD68+ macrophages. Despite their near universal acceptance, the extent to which pathologists use these criteria or their own criteria to consistently render the diagnosis of myocarditis on endomyocardial biopsy (EMB) is unknown. We digitally scanned slides from 100 heart biopsies, including a trichrome stain and immunostaining, that were chosen as representative of myocarditis, non-myocarditis, and borderline myocarditis, as diagnosed per one institution's use of the Dallas Criteria. Eight blinded international cardiovascular experts were asked to render diagnoses and offer a confidence score on each case. No clinical histories were shared. There was full initial agreement across all experts on 37 cases (16 myocarditis and 21 non-myocarditis) and moderate consensus on 35 cases. After individual inquiries and group discussion, consensus was reached on 90 cases. Diagnostic confidence was highest among the myocarditis diagnoses, lowest for borderline cases, and significantly different between the three diagnostic categories (myocarditis, borderline myocarditis, non-myocarditis; P-value=8.49 × 10-57; ANOVA). Diagnosing myocarditis, particularly in cases with limited inflammation and injury, remains a challenge even for experts in the field. Intermediate cases, termed "borderline" in the Dallas Criteria, represent those for which consensus is particularly hard to achieve. To increase consistency for the histopathologic diagnosis of myocarditis, we will need more specifically defined criteria, more granular descriptions of positive and negative features, clarity on how to incorporate immunohistochemistry findings, and improved nomenclature.
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Affiliation(s)
- Zhen A Lu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Christine Aubry
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - John T Fallon
- Department of Pathology and Laboratory Medicine, ECU Brody School of Medicine, Greenville, NC, USA
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ornella Leone
- Cardiovascular and Cardiac Transplant Pathology Unit, Department of Pathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefania Rizzo
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - John P Veinot
- Department of Pathology and Laboratory Medicine; University of Ottawa, Ottawa, Ontario, Canada
| | - Marc K Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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25
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Bohné M, Bohnen S, Voigt HC, van der Schalk H, Chung DU, Willems S, Klingel K, Kivelitz D, Bahlmann E. Systemic thrombo-embolic events in a middle-aged male with Loeffler endocarditis without peripheral eosinophilia-a case report. BMC Cardiovasc Disord 2022; 22:541. [PMID: 36510139 PMCID: PMC9742649 DOI: 10.1186/s12872-022-02911-3] [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] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/23/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Loeffler-endocarditis (LE) is considered a chronic restrictive cardiomyopathy and manifestation of eosinophilic myocarditis characterized by eosinophilic infiltration. LE is a rare underdiagnosed disease and associated with high morbidity and mortality. CASE PRESENTATION We report a case of a 46-year-old man suffering from LE associated with thromboembolic events without peripheral eosinophilia. The patient presented with typical clinical signs of acute onset of limb ischaemia, predominantly on the right limb, indicating immediate iliacal thrombectomy and due to a severe compartment syndrome additional fasciotomy. Total occlusion also of left popliteal artery suggesting an impaired chronic and aggravated impaired perfusion indicated also urgent left sided revascularization. Subsequent echocardiography revealed severe left ventricular dysfunction with a striking amount of spontaneous echo-contrast, noticeable in the left ventricular cavity. Furthermore the initial CT scan demonstrated asymptomatic left kidney- and brain infarctions. Diagnostic workup including endomyocardial biopsy (EMB) of the left ventricle, uncovered an underlying LE without peripheral eosinophilia. CONCLUSIONS This case demonstrates and highlights the findings, treatment and outcome of a patient with LE and associated thrombo-embolic events without peripheral eosinophilia and emphazises the importance of awareness for LE in patients presenting with an acute cardiac decompensation and thrombo-embolic events. EMB should be performed early in unstable patients unsuitable for cardiovascular magnetic resonance imaging.
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Affiliation(s)
- Mintje Bohné
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße, 20099 Hamburg, Germany
| | - Sebastian Bohnen
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße, 20099 Hamburg, Germany
| | - Hans-Christian Voigt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Hendrik van der Schalk
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße, 20099 Hamburg, Germany
| | - Da-Un Chung
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße, 20099 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße, 20099 Hamburg, Germany
| | - Karin Klingel
- grid.411544.10000 0001 0196 8249Cardiopathology, Institute for Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Dietmar Kivelitz
- Department of Radiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Edda Bahlmann
- Department of Cardiology, Asklepios Clinic St. Georg, Lohmühlenstraße, 20099 Hamburg, Germany
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26
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Gast M, Nageswaran V, Kuss AW, Tzvetkova A, Wang X, Mochmann LH, Rad PR, Weiss S, Simm S, Zeller T, Voelzke H, Hoffmann W, Völker U, Felix SB, Dörr M, Beling A, Skurk C, Leistner DM, Rauch BH, Hirose T, Heidecker B, Klingel K, Nakagawa S, Poller WC, Swirski FK, Haghikia A, Poller W. tRNA-like Transcripts from the NEAT1-MALAT1 Genomic Region Critically Influence Human Innate Immunity and Macrophage Functions. Cells 2022; 11:cells11243970. [PMID: 36552736 PMCID: PMC9777231 DOI: 10.3390/cells11243970] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022] Open
Abstract
The evolutionary conserved NEAT1-MALAT1 gene cluster generates large noncoding transcripts remaining nuclear, while tRNA-like transcripts (mascRNA, menRNA) enzymatically generated from these precursors translocate to the cytosol. Whereas functions have been assigned to the nuclear transcripts, data on biological functions of the small cytosolic transcripts are sparse. We previously found NEAT1-/- and MALAT1-/- mice to display massive atherosclerosis and vascular inflammation. Here, employing selective targeted disruption of menRNA or mascRNA, we investigate the tRNA-like molecules as critical components of innate immunity. CRISPR-generated human ΔmascRNA and ΔmenRNA monocytes/macrophages display defective innate immune sensing, loss of cytokine control, imbalance of growth/angiogenic factor expression impacting upon angiogenesis, and altered cell-cell interaction systems. Antiviral response, foam cell formation/oxLDL uptake, and M1/M2 polarization are defective in ΔmascRNA/ΔmenRNA macrophages, defining first biological functions of menRNA and describing new functions of mascRNA. menRNA and mascRNA represent novel components of innate immunity arising from the noncoding genome. They appear as prototypes of a new class of noncoding RNAs distinct from others (miRNAs, siRNAs) by biosynthetic pathway and intracellular kinetics. Their NEAT1-MALAT1 region of origin appears as archetype of a functionally highly integrated RNA processing system.
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Affiliation(s)
- Martina Gast
- Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 12200 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Site Berlin, 12200 Berlin, Germany
| | - Vanasa Nageswaran
- Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 12200 Berlin, Germany
- Institute for Chemistry and Biochemistry, Freie Universität Berlin, 12200 Berlin, Germany
| | - Andreas W Kuss
- Department of Functional Genomics, Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Ana Tzvetkova
- Department of Functional Genomics, Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, 17475 Greifswald, Germany
- Institute of Bioinformatics, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Xiaomin Wang
- Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 12200 Berlin, Germany
| | - Liliana H Mochmann
- Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 12200 Berlin, Germany
| | - Pegah Ramezani Rad
- Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 12200 Berlin, Germany
| | - Stefan Weiss
- Department of Functional Genomics, Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, 17475 Greifswald, Germany
- German Center for Cardiovascular Research (DZHK), Site Greifswald, 17487 Greifswald, Germany
| | - Stefan Simm
- Institute of Bioinformatics, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Tanja Zeller
- University Center of Cardiovascular Science, University Heart and Vascular Center, 20246 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Site Hamburg/Lübeck/Kiel, 20246 Hamburg, Germany
| | - Henry Voelzke
- German Center for Cardiovascular Research (DZHK), Site Greifswald, 17487 Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Cardiovascular Research (DZHK), Site Greifswald, 17487 Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Uwe Völker
- Department of Functional Genomics, Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, 17475 Greifswald, Germany
- German Center for Cardiovascular Research (DZHK), Site Greifswald, 17487 Greifswald, Germany
| | - Stefan B Felix
- German Center for Cardiovascular Research (DZHK), Site Greifswald, 17487 Greifswald, Germany
- Department of Cardiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Marcus Dörr
- German Center for Cardiovascular Research (DZHK), Site Greifswald, 17487 Greifswald, Germany
- Department of Cardiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Antje Beling
- German Center for Cardiovascular Research (DZHK), Site Berlin, 12200 Berlin, Germany
- Institute for Biochemistry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 12200 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Site Berlin, 12200 Berlin, Germany
| | - David-Manuel Leistner
- Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 12200 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Site Berlin, 12200 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Bernhard H Rauch
- German Center for Cardiovascular Research (DZHK), Site Greifswald, 17487 Greifswald, Germany
- Institute for Pharmacology, University Medicine Greifswald, 17487 Greifswald, Germany
- Department Human Medicine, Section Pharmacology and Toxicology, Carl von Ossietzky Universität, 26129 Oldenburg, Germany
| | - Tetsuro Hirose
- Graduate School of Frontier Biosciences, Osaka University, 1-3 Yamadaoka, Suita 565-0871, Japan
| | - Bettina Heidecker
- Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 12200 Berlin, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, Department of Pathology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Shinichi Nakagawa
- RNA Biology Laboratory, RIKEN Advanced Research Institute, Wako, Saitama 351-0198, Japan
- Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo 060-0812, Japan
| | - Wolfram C Poller
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Filip K Swirski
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Arash Haghikia
- Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 12200 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Site Berlin, 12200 Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Wolfgang Poller
- Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 12200 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Site Berlin, 12200 Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany
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27
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Heidecker B, Dagan N, Balicer R, Eriksson U, Rosano G, Coats A, Tschöpe C, Kelle S, Poland GA, Frustaci A, Klingel K, Martin P, Hare JM, Cooper LT, Pantazis A, Imazio M, Prasad S, Lüscher TF. Myocarditis following COVID-19 vaccine: incidence, presentation, diagnosis, pathophysiology, therapy, and outcomes put into perspective. A clinical consensus document supported by the Heart Failure Association of the European Society of Cardiology (ESC) and the ESC Working Group on Myocardial and Pericardial Diseases. Eur J Heart Fail 2022; 24:2000-2018. [PMID: 36065751 PMCID: PMC9538893 DOI: 10.1002/ejhf.2669] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [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: 06/04/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 01/18/2023] Open
Abstract
Over 10 million doses of COVID-19 vaccines based on RNA technology, viral vectors, recombinant protein, and inactivated virus have been administered worldwide. Although generally very safe, post-vaccine myocarditis can result from adaptive humoral and cellular, cardiac-specific inflammation within days and weeks of vaccination. Rates of vaccine-associated myocarditis vary by age and sex with the highest rates in males between 12 and 39 years. The clinical course is generally mild with rare cases of left ventricular dysfunction, heart failure and arrhythmias. Mild cases are likely underdiagnosed as cardiac magnetic resonance imaging (CMR) is not commonly performed even in suspected cases and not at all in asymptomatic and mildly symptomatic patients. Hospitalization of symptomatic patients with electrocardiographic changes and increased plasma troponin levels is considered necessary in the acute phase to monitor for arrhythmias and potential decline in left ventricular function. In addition to evaluation for symptoms, electrocardiographic changes and elevated troponin levels, CMR is the best non-invasive diagnostic tool with endomyocardial biopsy being restricted to severe cases with heart failure and/or arrhythmias. The management beyond guideline-directed treatment of heart failure and arrhythmias includes non-specific measures to control pain. Anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs, and corticosteroids have been used in more severe cases, with only anecdotal evidence for their effectiveness. In all age groups studied, the overall risks of SARS-CoV-2 infection-related hospitalization and death are hugely greater than the risks from post-vaccine myocarditis. This consensus statement serves as a practical resource for physicians in their clinical practice, to understand, diagnose, and manage affected patients. Furthermore, it is intended to stimulate research in this area.
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Affiliation(s)
- Bettina Heidecker
- Cardiology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt, Universität zu Berlin, Berlin, Germany
| | - Noa Dagan
- Clalit Health Services, Clalit Research Institute, Ramat Gan, Israel
| | - Ran Balicer
- Clalit Health Services, Clalit Research Institute, Ramat Gan, Israel
| | - Urs Eriksson
- Department of Internal Medicine, Division of Cardiology, GZO - Zurich Regional Health Center, Wetzikon & University of Zurich, Zurich, Switzerland
| | | | - Andrew Coats
- Monash University, Melbourne, Victoria, Australia.,University of Warwick, Warwick, UK
| | - Carsten Tschöpe
- Cardiology, German Heart Center, Charité - University Medicine, Berlin, Germany
| | - Sebastian Kelle
- Cardiology, German Heart Center, Charité - University Medicine, Berlin, Germany
| | | | - Andrea Frustaci
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, La Sapienza University, Rome, Italy.,IRCCS L. Spallanzani, Rome, Italy
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Pilar Martin
- Cientro Nacional de Investigationes Cardiovasculares, Madrid, Spain
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami, Miami, FL, USA
| | - Leslie T Cooper
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, USA, and Cardiology, Mayo Clinic Jacksonville, Jacksonville, FL, USA
| | - Antonis Pantazis
- Royal Brompton and Harefield Hospitals and Imperial College London, London, UK
| | - Massimo Imazio
- Cardiothoracic Department, Cardiology, Udine University Health Integrated Agency, Udine, Italy
| | - Sanjay Prasad
- Royal Brompton and Harefield Hospitals and Imperial College London, London, UK
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals and Imperial College London, London, UK.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
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28
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Thurner L, Kessel C, Fadle N, Regitz E, Seidel F, Kindermann I, Lohse S, Kos I, Tschöpe C, Kheiroddin P, Kiblboeck D, Hoffmann MC, Bette B, Carbon G, Cetin O, Preuss KD, Christofyllakis K, Bittenbring JT, Pickardt T, Fischer Y, Thiele H, Baldus S, Stangl K, Steiner S, Gietzen F, Kerber S, Deneke T, Jellinghaus S, Linke A, Ibrahim K, Grabmaier U, Massberg S, Thilo C, Greulich S, Gawaz M, Mayatepek E, Meyer-Dobkowitz L, Kindermann M, Birk E, Birk M, Lainscak M, Foell D, Lepper PM, Bals R, Krawczyk M, Mevorach D, Hasin T, Keren A, Kabesch M, Abdul-Khaliq H, Smola S, Bewarder M, Thurner B, Böhm M, Pfeifer J, Klingel K. IL-1RA Antibodies in Myocarditis after SARS-CoV-2 Vaccination. N Engl J Med 2022; 387:1524-1527. [PMID: 36130012 PMCID: PMC9513854 DOI: 10.1056/nejmc2205667] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Igor Kos
- Saarland University, Homburg, Germany
| | | | | | | | | | | | | | | | | | | | | | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Yvan Fischer
- Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | | | | | - Karl Stangl
- Charité University Medicine Berlin, Berlin, Germany
| | | | - Frank Gietzen
- Cardiovascular Center Bad Neustadt-Saale, Bad Neustadt-Saale, Germany
| | - Sebastian Kerber
- Cardiovascular Center Bad Neustadt-Saale, Bad Neustadt-Saale, Germany
| | - Thomas Deneke
- Cardiovascular Center Bad Neustadt-Saale, Bad Neustadt-Saale, Germany
| | | | - Axel Linke
- Technische Universität Dresden, Dresden, Germany
| | | | | | | | | | | | | | - Ertan Mayatepek
- University Children's Hospital Duesseldorf, Duesseldorf, Germany
| | | | | | - Einat Birk
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Merav Birk
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | | | - Dirk Foell
- University Children's Hospital Muenster, Muenster, Germany
| | | | | | | | | | - Tal Hasin
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Andre Keren
- Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Michael Kabesch
- University Children's Hospital Regensburg, Regensburg, Germany
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Elsanhoury A, Kuehl U, Klingel K, Strueben A, Morris D, Van Linthout S, Tschoepe C. Role of immunosuppression in patients with lymphocytic myocarditis and myocardial parvovirus B19 with or without human herpesvirus 6 co-presence. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Parvovirus B19 (B19V) and Human Herpesvirus 6 (HHV6) are commonly detected in endomyocardial biopsy (EMB) specimens of patients with myocarditis symptoms. Whether B19V- and HHV6-DNA belong to the cardiac bio-portfolio remains unclear [1,2]. Until today, the role of B19V-/HHV6-DNA presence in myocarditis is doubtful. Both viruses have been detected in the myocardium, even independent of cardiac inflammation. Yet, their contribution to myocarditis remains controversial. The European Society of Cardiology guidelines exclude the use of immunosuppression in patients with virus-associated myocarditis [3]. Whether myocarditis patients with the presence of B19V-DNA alone or with HHV6-DNA in EMB findings can be treated using immunosuppression, remains a delicate question for clinicians.
Methods
931 patients with unexplained heart failure symptoms underwent EMB investigation to determine the underlying cause. Patients with low-levels (<1000 copies/μg DNA) of B19V-DNA and HHV6-DNA were identified. A sub-cohort of 28 patients who suffered from chronic-persistent lymphocytic myocarditis with ongoing symptoms was treated with azathioprine 100 mg once daily and prednisolone 1 mg/kg/day tapered down by 10 mg every two weeks followed by a second EMB. Twenty out of 28 patients had B19V-DNA only (mean LVEF=38%, age=47±15) and eight patients had B19V-/HHV6-DNA copresence (mean LVEF=39%, age=42±10). Patients with systemic infections were excluded. Both cohorts received standard heart failure medications. Continuous variables are expressed as mean±SD.
Results
B19V-DNA alone and in the presence of HHV6-DNA was detectable in the EMB of 377 and 63 patients, respectively. Following the immunosuppression course, the patients with B19V-DNA only and those with B19V-/HHV6-DNA showed complete resolution of inflammation in 12/20 and 5/8 patients, New York Heart Association (NYHA) functional class improvement in 9/20 and 4/8 patients, LVEF improvement by 8.0±13.8% (p<0.05) and 8.4±9.6% (p<0.05), and a reduction of LVEDD by 3.8±6.1mm (p<0.05) and 1.0±7.7mm (p>0.05), respectively. Importantly, following immunosuppression B19V and HHV6-DNA copy numbers went down from 186±266 to 130±186 copies/μg DNA and from 71±141 to 58±143 copies/μg DNA, respectively.
Conclusion
Chronic lymphocytic myocarditis patients with persistent B19V-DNA even in co-presence of HHV6-DNA may benefit from combined immunosuppression therapy. The therapy is clinically effective and safe to reduce cardiac inflammation independent of B19V- and HHV6-DNA copy numbers. In conclusion, we show for the first time that cases with chronic lymphocytic myocarditis can be principally treated with immunosuppression, despite B19V-/HHV6-DNA EMB presence.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Berlin Institute of Health-Center for Regenerative Therapies
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Affiliation(s)
- A Elsanhoury
- Berlin Institute of Health Center for Regenerative Therapies, Cardiolovascular system , Berlin , Germany
| | - U Kuehl
- Charite University Hospital , Berlin , Germany
| | - K Klingel
- University hospital Tübingen, Cardiopathology, Institute for Pathology and Neuropathology , Tuebingen , Germany
| | - A Strueben
- Berlin Institute of Health Center for Regenerative Therapies, Cardiolovascular system , Berlin , Germany
| | - D Morris
- Charite University Hospital , Berlin , Germany
| | - S Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies, Cardiolovascular system , Berlin , Germany
| | - C Tschoepe
- Berlin Institute of Health Center for Regenerative Therapies, Cardiolovascular system , Berlin , Germany
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30
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Ammirati E, Raimondi F, Piriou N, Sardo Infirri L, Mohiddin SA, Mazzanti A, Shenoy C, Cavallari UA, Imazio M, Aquaro GD, Olivotto I, Pedrotti P, Sekhri N, Van de Heyning CM, Broeckx G, Peretto G, Guttmann O, Dellegrottaglie S, Scatteia A, Gentile P, Merlo M, Goldberg RI, Reyentovich A, Sciamanna C, Klaassen S, Poller W, Trankle CR, Abbate A, Keren A, Horowitz-Cederboim S, Cadrin-Tourigny J, Tadros R, Annoni GA, Bonoldi E, Toquet C, Marteau L, Probst V, Trochu JN, Kissopoulou A, Grosu A, Kukavica D, Trancuccio A, Gil C, Tini G, Pedrazzini M, Torchio M, Sinagra G, Gimeno JR, Bernasconi D, Valsecchi MG, Klingel K, Adler ED, Camici PG, Cooper LT. Acute Myocarditis Associated With Desmosomal Gene Variants. JACC Heart Fail 2022; 10:714-727. [PMID: 36175056 DOI: 10.1016/j.jchf.2022.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The risk of adverse cardiovascular events in patients with acute myocarditis (AM) and desmosomal gene variants (DGV) remains unknown. OBJECTIVES The purpose of this study was to ascertain the risk of death, ventricular arrhythmias, recurrent myocarditis, and heart failure (main endpoint) in patients with AM and pathogenic or likely pathogenetic DGV. METHODS In a retrospective international study from 23 hospitals, 97 patients were included: 36 with AM and DGV (DGV[+]), 25 with AM and negative gene testing (DGV[-]), and 36 with AM without genetics testing. All patients had troponin elevation plus findings consistent with AM on histology or at cardiac magnetic resonance (CMR). In 86 patients, CMR changes in function and structure were re-assessed at follow-up. RESULTS In the DGV(+) AM group (88.9% DSP variants), median age was 24 years, 91.7% presented with chest pain, and median left ventricular ejection fraction (LVEF) was 56% on CMR (P = NS vs the other 2 groups). Kaplan-Meier curves demonstrated a higher risk of the main endpoint in DGV(+) AM compared with DGV(-) and without genetics testing patients (62.3% vs 17.5% vs 5.3% at 5 years, respectively; P < 0.0001), driven by myocarditis recurrence and ventricular arrhythmias. At follow-up CMR, a higher number of late gadolinium enhanced segments was found in DGV(+) AM. CONCLUSIONS Patients with AM and evidence of DGV have a higher incidence of adverse cardiovascular events compared with patients with AM without DGV. Further prospective studies are needed to ascertain if genetic testing might improve risk stratification of patients with AM who are considered at low risk.
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Affiliation(s)
- Enrico Ammirati
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.
| | - Francesca Raimondi
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C Hôpital Necker Enfants Malades, APHP Paris Cité, Paris, France
| | - Nicolas Piriou
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | | | - Saidi A Mohiddin
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Andrea Mazzanti
- Molecular Cardiology, ICS Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ugo A Cavallari
- Medical Genetics Unit, Department of Laboratory Medicine, Niguarda Hospital, Milano, Italy
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, "Santa Maria della Misericordia," Udine, Italy
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Firenze, Italy
| | | | - Neha Sekhri
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | | | | | - Giovanni Peretto
- IRCCS San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Oliver Guttmann
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | | | | | - Piero Gentile
- De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Randal I Goldberg
- The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
| | - Alex Reyentovich
- The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
| | - Christopher Sciamanna
- University of Illinois at Chicago, Advocate Christ Medical Center Cardiothoracic and Vascular Surgical Associates, Oak Lawn, Illinois, USA
| | - Sabine Klaassen
- Department of Paediatric Cardiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Poller
- Department of Paediatric Cardiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Berlin, Germany; Department of Cardiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Germany
| | - Cory R Trankle
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Antonio Abbate
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andre Keren
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Julia Cadrin-Tourigny
- Division of Electrophysiology and Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | - Rafik Tadros
- Division of Electrophysiology and Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | | | - Claire Toquet
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; Pathology Department, CHU Nantes, Nantes University, Nantes, France
| | - Lara Marteau
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Vincent Probst
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Jean Noël Trochu
- Université Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Antheia Kissopoulou
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Aurelia Grosu
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Deni Kukavica
- Molecular Cardiology, ICS Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Alessandro Trancuccio
- Molecular Cardiology, ICS Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Cristina Gil
- Cardiac Department, University Hospital Virgen Arrixaca, Murcia, Spain
| | - Giacomo Tini
- Clinic of Cardiovascular Disease, Ospedale Policlinico San Martino, Università di Genova, Genova, Italy
| | - Matteo Pedrazzini
- Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Margherita Torchio
- Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Juan Ramón Gimeno
- Cardiac Department, University Hospital Virgen Arrixaca, Murcia, Spain
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging (B4) Center, School of Medicine and Surgery, University of Milano-Bicocca, Bicocca, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging (B4) Center, School of Medicine and Surgery, University of Milano-Bicocca, Bicocca, Italy
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Eric D Adler
- Department of Cardiology, University of California-San Diego, San Diego, California, USA
| | - Paolo G Camici
- IRCCS San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA.
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Schwarz F, Klingel K, Greulich S, Gawaz M. Dyspnoe und Ödeme bei einem 79-jährigen Patienten. Innere Medizin 2022; 63:994-999. [PMID: 35925120 PMCID: PMC9399020 DOI: 10.1007/s00108-022-01358-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/01/2022]
Abstract
Hintergrund Die Transthyretin-Amyloidose (ATTR-Amyloidose) führt zur Ablagerung von unlöslichen Fibrillen im Interstitium der betroffenen Organe. Eine kardiale Beteiligung kann sich durch Dyspnoe, Ödeme, Rhythmusstörungen bis hin zur manifesten Herzinsuffizienz und Tod äußern. Fallbericht Ein 79-jähriger Mann stellte sich mit Dyspnoe sowie Gewichtszunahme vor. In der Echokardiographie Hypertrophie bei restriktiver Kardiomyopathie. In der Knochenszintigraphie Tracer-Mehranreicherung, hochverdächtig auf eine ATTR-Amyloidose, welche mittels Biopsie bestätigt werden konnte. Schlussfolgerungen Die Diagnose einer kardialen ATTR-Amyloidose stellt für den Kliniker eine Herausforderung dar und setzt dessen erhöhte Aufmerksamkeit voraus. Die Diagnosestellung sollte strukturiert erfolgen unter Einbeziehung von Labor, bildgebenden Verfahren sowie Myokardbiopsie.
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Affiliation(s)
- Frederic Schwarz
- Medizinische Klinik III (Kardiologie und Angiologie), Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - Karin Klingel
- Kardiopathologie, Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Simon Greulich
- Medizinische Klinik III (Kardiologie und Angiologie), Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland
| | - Meinrad Gawaz
- Medizinische Klinik III (Kardiologie und Angiologie), Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
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Brendel JM, Klingel K, Kübler J, Müller KAL, Hagen F, Gawaz M, Nikolaou K, Greulich S, Krumm P. Comprehensive Cardiac Magnetic Resonance to Detect Subacute Myocarditis. J Clin Med 2022; 11:jcm11175113. [PMID: 36079039 PMCID: PMC9457022 DOI: 10.3390/jcm11175113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/12/2022] [Accepted: 08/28/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Compared to acute myocarditis in the initial phase, detection of subacute myocarditis with cardiac magnetic resonance (CMR) parameters can be challenging due to a lower degree of myocardial inflammation compared to the acute phase. (2) Objectives: To systematically evaluate non-invasive CMR imaging parameters in acute and subacute myocarditis. (3) Methods: 48 patients (age 37 (IQR 28−55) years; 52% female) with clinically suspected myocarditis were consecutively included. Patients with onset of symptoms ≤2 weeks prior to 1.5T CMR were assigned to the acute group (n = 25, 52%), patients with symptom duration >2 to 6 weeks were assigned to the subacute group (n = 23, 48%). CMR protocol comprised morphology, function, 3D-strain, late gadolinium enhancement (LGE) imaging and mapping (T1, ECV, T2). (4) Results: Highest diagnostic performance in the detection of subacute myocarditis was achieved by ECV evaluation either as single parameter or in combination with T1 mapping (applying a segmental or global increase of native T1 > 1015 ms and ECV > 28%), sensitivity 96% and accuracy 91%. Compared to subacute myocarditis, acute myocarditis demonstrated higher prevalence and extent of LGE (AUC 0.76) and increased T2 (AUC 0.66). (5) Conclusions: A comprehensive CMR approach allows reliable diagnosis of clinically suspected subacute myocarditis. Thereby, ECV alone or in combination with native T1 mapping indicated the best performance for diagnosing subacute myocarditis. Acute vs. subacute myocarditis is difficult to discriminate by CMR alone, due to chronological connection and overlap of pathologic findings.
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Affiliation(s)
- Jan M. Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University of Tübingen, Liebermeisterstraße 8, 72076 Tübingen, Germany
| | - Jens Kübler
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Karin A. L. Müller
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Florian Hagen
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
| | - Simon Greulich
- Department of Internal Medicine III, Cardiology and Angiology, University of Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
- Correspondence:
| | - Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
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Callegari A, Quandt D, Schmitz A, Klingel K, Balmer C, Dave H, Kretschmar O, Knirsch W. Findings and Outcome of Transcatheter Right Ventricular Endomyocardial Biopsy and Hemodynamic Assessment in Children with Suspected Myocarditis or Cardiomyopathy. Int J Environ Res Public Health 2022; 19:10406. [PMID: 36012045 PMCID: PMC9408529 DOI: 10.3390/ijerph191610406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The study objective is assessing findings and outcome in children with suspected cardiomyopathy (CMP) or myocarditis undergoing cardiac catheterization with transcatheter right ventricular endomyocardial biopsy (RV-EMB). METHODS All consecutive children undergoing cardiac catheterization with RV-EMB for suspected CMP/myocarditis between 2002-2021 were analysed regarding clinical presentation, cardiac biomarkers, periprocedural management, hemodynamic, histological/immunohistological findings, and outcome. RESULTS Eighty-five RV-EMBs were performed in 81 patients at a median age of 6.8 (IQR 9.9) years and a bodyweight of 20 (32.2) kg. Histological/immunohistological findings of RV-EMB revealed dilated CMP in 10 (12%), chronic myocarditis in 28 (33%), healing myocarditis in 5 (6%), acute myocarditis in 9 (11%), other heart muscle diseases in 23 (27%) (7 restrictive CMP, 5 hypertrophic CMP, 4 toxic/anthracycline-induced CMP, 4 endocardfibroelastosis, 1 arrhythmogenic right ventricular CMP, 1 laminin CMP, 1 haemangioma), no conclusive histology in 7 (8%), and normal histology in 3 (4%) patients. Median LVEDP was 17 mmHg (IQR 9), LAP 15 mmHg (10), and PVR 1.83 (1.87) Wood Units/m2. There were 3 major complications (3%), all patients recovered without any sequelae. At follow-up (median 1153, IQR 1799 days) 47 (59%) patients were alive, 11 (13%) dead, 15 (18%) underwent cardiac transplantation, and 8 (9%) were lost to follow-up. Death/cardiac transplantation occurred within 3 years from RV-EMB. All patients with an acute myocarditis survived. NT-pro-BNP, echo parameters, and invasive hemodynamics correlate independently with death/cardiac transplant. CONCLUSION Hemodynamic invasive data and morphological findings in RV-EMB complete clinical diagnosis in children with suspected CMP/myocarditis and provide important information for further clinical management.
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Affiliation(s)
- Alessia Callegari
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Daniel Quandt
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Achim Schmitz
- Children’s Research Centre, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
- Division of Anesthesia, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, Eberhard Karls University Tübingen, 72074 Tubingen, Germany
| | - Christian Balmer
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Hitendu Dave
- Children’s Research Centre, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
- Congenital Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Oliver Kretschmar
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
| | - Walter Knirsch
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- Children’s Research Centre, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
- University of Zurich, 8006 Zurich, Switzerland
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Rosch S, Kresoja KP, Besler C, Fengler K, Schöber AR, von Roeder M, Lücke C, Gutberlet M, Klingel K, Thiele H, Rommel KP, Lurz P. Characteristics of Heart Failure With Preserved Ejection Fraction Across the Range of Left Ventricular Ejection Fraction. Circulation 2022; 146:506-518. [PMID: 35862208 DOI: 10.1161/circulationaha.122.059280] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recent trial data suggest that stratification of patients with heart failure with preserved ejection fraction (HFpEF) according to left ventricular ejection fraction (LVEF) provides a means for dissecting different treatment responses. However, the differential pathophysiologic considerations have rarely been described. METHODS This prospective, single-center study analyzed consecutive symptomatic patients with HFpEF diagnosed according to the 2016 European Society of Cardiology heart failure guidelines. Patients were grouped into LVEF 50% to 60% and LVEF >60% cohorts. All patients underwent cardiac magnetic resonance imaging. Transfemoral cardiac catheterization was performed to derive load-dependent and load-independent left ventricular (LV) properties on pressure-volume loop analyses. RESULTS Fifty-six patients with HFpEF were enrolled and divided into LVEF 50% to 60% (n=21) and LVEF >60% (n=35) cohorts. On cardiac magnetic resonance imaging, the LVEF >60% cohort showed lower LV end-diastolic volumes (P=0.019) and end-systolic volumes (P=0.001) than the LVEF 50% to 60% cohort; stroke volume (P=0.821) did not differ between the cohorts. Extracellular volume fraction was higher in the LVEF 50% to 60% cohort than in the LVEF >60% cohort (0.332 versus 0.309; P=0.018). Pressure-volume loop analyses demonstrated higher baseline LV contractility (end-systolic elastance, 1.85 vs 1.33 mm Hg/mL; P<0.001) and passive diastolic stiffness (β constant, 0.032 versus 0.018; P=0.004) in the LVEF >60% cohort. Ventriculo-arterial coupling (end-systolic elastance/arterial elastance) at rest was in the range of optimized stroke work in the LVEF >60% cohort but was impaired in the LVEF 50% to 60% cohort (1.01 versus 0.80; P=0.005). During handgrip exercise, patients with LVEF >60% had higher increases in end-systolic elastance (1.85 versus 0.82 mm Hg/mL; P=0.023), attenuated increases in indexed end-systolic volume (-1 versus 7 mL/m²; P<0.004), and more exaggerated increases in LV filling pressures (8 vs 5 mm Hg; P=0.023). LV stroke volume decreased in the LVEF >60% cohort (P=0.007) under exertion. CONCLUSIONS Patients with HFpEF in whom LVEF ranged from 50% to 60% demonstrated reduced contractility, impaired ventriculo-arterial coupling, and higher extracellular volume fraction. In contrast, patients with HFpEF and a LVEF >60% demonstrated a hypercontractile state with excessive LV afterload and diminished preload reserve. A LVEF-based stratification of patients with HFpEF identified distinct morphologic and pathophysiologic subphenotypes.
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Affiliation(s)
- Sebastian Rosch
- Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany
| | - Karl-Patrik Kresoja
- Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany
| | - Christian Besler
- Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany
| | - Karl Fengler
- Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany
| | - Anne Rebecca Schöber
- Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany
| | - Maximilian von Roeder
- Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany
| | - Christian Lücke
- Radiology (C.L., M.G.), Heart Center Leipzig at University of Leipzig, Germany
| | - Matthias Gutberlet
- Radiology (C.L., M.G.), Heart Center Leipzig at University of Leipzig, Germany
| | - Karin Klingel
- Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Germany (K.K.)
| | - Holger Thiele
- Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany
| | - Karl-Philipp Rommel
- Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany
| | - Philipp Lurz
- Departments of Cardiology (S.R., K.-P.K., C.B., K.F., A.R.S., M.v.R., H.T., K.-P.R., P.L.), Heart Center Leipzig at University of Leipzig, Germany
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Peischard S, Möller M, Disse P, Ho HT, Verkerk AO, Strutz-Seebohm N, Budde T, Meuth SG, Schweizer PA, Morris S, Mücher L, Eisner V, Thomas D, Klingel K, Busch K, Seebohm G. Virus-induced inhibition of cardiac pacemaker channel HCN4 triggers bradycardia in human-induced stem cell system. Cell Mol Life Sci 2022; 79:440. [PMID: 35864219 PMCID: PMC9304080 DOI: 10.1007/s00018-022-04435-7] [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: 10/08/2021] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/02/2022]
Abstract
The enterovirus Coxsackievirus B3 (CVB3) is known to be a major source for the development of cardiac dysfunctions like viral myocarditis (VMC) and dilatative cardiomyopathy (DCM), but also results in bradycardia and fatal cardiac arrest. Besides clinical reports on bradycardia and sudden cardiac death, very little is known about the influence of CVB3 on the activity of human cardiac pacemaker cells. Here, we address this issue using the first human induced pluripotent stem cell (hiPSC)-derived pacemaker-like cells, in which the expression of a transgenic non-infectious variant of CVB3 can be controlled dose- and time-dependently. We found that CVB3 drastically changed hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) distribution and function in hiPSC-derived pacemaker-like tissue. In addition, using HCN4 cell expression systems, we found that HCN4 currents were decreased with altered voltage dependency of activation when CVB3 was expressed. Increased autophagosome formation and autophagosomal HCN4 insertion was observed in hiPSC-derived pacemaker-like cells under CVB3 expression as well. Individual effects of single, non-structural CVB3 proteins were analyzed and demonstrated that CVB3 proteins 2C and 3A had the most robust effect on HCN4 activity. Treatment of cells with the Rab7 inhibitor CID 106770 or the CVB3-3A inhibitor GW5074 led to the recovery of the cytoplasmatic HCN4 accumulation into a healthy appearing phenotype, indicating that malfunctioning Rab7-directed autophagosome transport is involved in the disturbed, cytoplasmatic HCN4 accumulation in CVB3-expressing human pacemaker-like cells. Summarizing, the enterovirus CVB3 inhibits human cardiac pacemaker function by reducing the pacemaker channel plasma membrane density, an effect that can be corrected by pharmacological intervention of endocytic vesicle trafficking.
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Affiliation(s)
- Stefan Peischard
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, 48149, Münster, Germany
| | - Melina Möller
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, 48149, Münster, Germany
| | - Paul Disse
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, 48149, Münster, Germany.,GRK 2515, Chemical Biology of Ion Channels (Chembion), Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Huyen Tran Ho
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, 48149, Münster, Germany
| | - Arie O Verkerk
- Department of Medical Biology, Amsterdam University Medical Centers, University of Amsterdam, 1105, Amsterdam, The Netherlands
| | - Nathalie Strutz-Seebohm
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, 48149, Münster, Germany.,GRK 2515, Chemical Biology of Ion Channels (Chembion), Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Thomas Budde
- GRK 2515, Chemical Biology of Ion Channels (Chembion), Westfälische Wilhelms-Universität Münster, Münster, Germany.,Institute of Physiology I, Westfälische-Wilhems Universität Münster, 48149, Münster, Germany
| | - Sven G Meuth
- GRK 2515, Chemical Biology of Ion Channels (Chembion), Westfälische Wilhelms-Universität Münster, Münster, Germany.,Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Patrick A Schweizer
- Department of Cardiology, Medical University Hospital Heidelberg, 69120, Heidelberg, Germany.,HCR (Heidelberg Center for Heart Rhythm Disorders), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Silke Morris
- Institute for Integrative Cell Biology and Physiology, Department of Biology, University of Münster, 48149, Münster, Germany
| | - Lena Mücher
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, 48149, Münster, Germany
| | - Verónica Eisner
- Department of Cellular and Molecular Biology, School of Biological Sciences, Pontificia Universidad Católica de Chile, 8331150, Santiago, Chile
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital Heidelberg, 69120, Heidelberg, Germany.,HCR (Heidelberg Center for Heart Rhythm Disorders), University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital of Tuebingen, 72076, Tübingen, Germany
| | - Karin Busch
- Institute for Integrative Cell Biology and Physiology, Department of Biology, University of Münster, 48149, Münster, Germany
| | - Guiscard Seebohm
- Institute for Genetics of Heart Diseases (IfGH), Department of Cardiovascular Medicine, University Hospital Münster, 48149, Münster, Germany. .,GRK 2515, Chemical Biology of Ion Channels (Chembion), Westfälische Wilhelms-Universität Münster, Münster, Germany.
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Seidel F, Laser KT, Klingel K, Dartsch J, Theisen S, Pickardt T, Holtgrewe M, Gärtner A, Berger F, Beule D, Milting H, Schubert S, Klaassen S, Kühnisch J. Pathogenic Variants in Cardiomyopathy Disorder Genes Underlie Pediatric Myocarditis—Further Impact of Heterozygous Immune Disorder Gene Variants? J Cardiovasc Dev Dis 2022; 9:jcdd9070216. [PMID: 35877578 PMCID: PMC9321514 DOI: 10.3390/jcdd9070216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022] Open
Abstract
Myocarditis is an inflammatory disease of the heart. Pediatric myocarditis with the dilated cardiomyopathy (DCM) phenotype may be caused by likely pathogenic or pathogenic genetic variants [(L)P] in cardiomyopathy (CMP) genes. Systematic analysis of immune disorder gene defects has not been performed so far. We analyzed 12 patients with biopsy-proven myocarditis and the DCM phenotype together with their parents using whole-exome sequencing (WES). The WES data were filtered for rare pathogenic variants in CMP (n = 89) and immune disorder genes (n = 631). Twelve children with a median age of 2.9 (1.0–6.8) years had a mean left ventricular ejection fraction of 28% (22–32%) and myocarditis was confirmed by endomyocardial biopsy. Patients with primary immunodeficiency were excluded from the study. Four patients underwent implantation of a ventricular assist device and subsequent heart transplantation. Genetic analysis of the 12 families revealed an (L)P variant in the CMP gene in 8/12 index patients explaining DCM. Screening of recessive immune disorder genes identified a heterozygous (L)P variant in 3/12 index patients. This study supports the genetic impact of CMP genes for pediatric myocarditis with the DCM phenotype. Piloting the idea that additional immune-related genetic defects promote myocarditis suggests that the presence of heterozygous variants in these genes needs further investigation. Altered cilium function might play an additional role in inducing inflammation in the context of CMP.
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Affiliation(s)
- Franziska Seidel
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, 13353 Berlin, Germany;
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Kai Thorsten Laser
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart-and Diabetescenter NRW, University Clinic of Ruhr University Bochum, 32545 Bad Oeynhausen, Germany; (K.T.L.); (S.S.)
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, 72016 Tübingen, Germany;
| | - Josephine Dartsch
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
| | - Simon Theisen
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Thomas Pickardt
- National Register for Congenital Heart Defects, 13353 Berlin, Germany;
| | - Manuel Holtgrewe
- Core Unit Bioinformatics, Berlin Institute of Health (BIH), 10117 Berlin, Germany;
- Core Facility Bioinformatik, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Anna Gärtner
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development & Clinic for Thoracic and Cardiovascular Surgery, Heart-and Diabetescenter NRW, University Hospital of the Ruhr University Bochum, 32545 Bad Oeynhausen, Germany; (A.G.); (H.M.)
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, 13353 Berlin, Germany;
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Dieter Beule
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Core Unit Bioinformatics, Berlin Institute of Health (BIH), 10117 Berlin, Germany;
| | - Hendrik Milting
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development & Clinic for Thoracic and Cardiovascular Surgery, Heart-and Diabetescenter NRW, University Hospital of the Ruhr University Bochum, 32545 Bad Oeynhausen, Germany; (A.G.); (H.M.)
| | - Stephan Schubert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, 13353 Berlin, Germany;
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart-and Diabetescenter NRW, University Clinic of Ruhr University Bochum, 32545 Bad Oeynhausen, Germany; (K.T.L.); (S.S.)
| | - Sabine Klaassen
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Correspondence: (S.K.); (J.K.); Tel.: +49-30-9406-3319 (S.K. & J.K.); Fax: +49-30-9406-3358 (S.K. & J.K.)
| | - Jirko Kühnisch
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Correspondence: (S.K.); (J.K.); Tel.: +49-30-9406-3319 (S.K. & J.K.); Fax: +49-30-9406-3358 (S.K. & J.K.)
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Płonka J, Gawda R, Sacha J, Bugajski J, Brzostowicz T, Molsa M, Czarnik T, Klingel K, Gierlotka M. Fulminant myocarditis and acute heart failure in the light of new American Heart Association 2020 guidelines. Mechanical cardiac support and endomyocardial biopsy. What should be first? Cardiol J 2022; 29:714-717. [PMID: 35762076 PMCID: PMC9273245 DOI: 10.5603/cj.a2022.0052] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 04/11/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Joanna Płonka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland.
| | - Ryszard Gawda
- Department of Anesthesiology and Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Poland
| | - Jerzy Sacha
- Faculty of Physical Education and Physiotherapy, University of Technology, Opole, Poland
- Department of Cardiology, Opole University Hospital, Poland
| | | | | | - Maciej Molsa
- Department of Anesthesiology and Intensive Care and Regional ECMO Center, Opole University Hospital, Opole, Poland
| | - Tomasz Czarnik
- Department of Anesthesiology and Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Poland
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tuebingen, Germany
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Poland
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38
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Gaertner A, Burr L, Klauke B, Brodehl A, Laser KT, Klingel K, Tiesmeier J, Schulz U, zu Knyphausen E, Gummert J, Milting H. Compound Heterozygous FKTN Variants in a Patient with Dilated Cardiomyopathy Led to an Aberrant α-Dystroglycan Pattern. Int J Mol Sci 2022; 23:ijms23126685. [PMID: 35743126 PMCID: PMC9223741 DOI: 10.3390/ijms23126685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/13/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023] Open
Abstract
Fukutin encoded by FKTN is a ribitol 5-phosphate transferase involved in glycosylation of α-dystroglycan. It is known that mutations in FKTN affect the glycosylation of α-dystroglycan, leading to a dystroglycanopathy. Dystroglycanopathies are a group of syndromes with a broad clinical spectrum including dilated cardiomyopathy and muscular dystrophy. In this study, we reported the case of a patient with muscular dystrophy, early onset dilated cardiomyopathy, and elevated creatine kinase levels who was a carrier of the compound heterozygous variants p.Ser299Arg and p.Asn442Ser in FKTN. Our work showed that compound heterozygous mutations in FKTN lead to a loss of fully glycosylated α-dystroglycan and result in cardiomyopathy and end-stage heart failure at a young age.
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Affiliation(s)
- Anna Gaertner
- Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (L.B.); (B.K.); (A.B.); (J.T.); (U.S.); (J.G.)
- Correspondence: (A.G.); (H.M.)
| | - Lidia Burr
- Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (L.B.); (B.K.); (A.B.); (J.T.); (U.S.); (J.G.)
| | - Baerbel Klauke
- Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (L.B.); (B.K.); (A.B.); (J.T.); (U.S.); (J.G.)
| | - Andreas Brodehl
- Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (L.B.); (B.K.); (A.B.); (J.T.); (U.S.); (J.G.)
| | - Kai Thorsten Laser
- Zentrum für Angeborene Herzfehler, Herz und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (K.T.L.); (E.z.K.)
| | - Karin Klingel
- Kardiopathologie, Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Liebermeisterstraße 8, 72076 Tübingen, Germany;
| | - Jens Tiesmeier
- Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (L.B.); (B.K.); (A.B.); (J.T.); (U.S.); (J.G.)
| | - Uwe Schulz
- Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (L.B.); (B.K.); (A.B.); (J.T.); (U.S.); (J.G.)
| | - Edzard zu Knyphausen
- Zentrum für Angeborene Herzfehler, Herz und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (K.T.L.); (E.z.K.)
| | - Jan Gummert
- Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (L.B.); (B.K.); (A.B.); (J.T.); (U.S.); (J.G.)
| | - Hendrik Milting
- Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Klinik für Thorax- und Kardiovaskularchirurgie, Herz und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany; (L.B.); (B.K.); (A.B.); (J.T.); (U.S.); (J.G.)
- Correspondence: (A.G.); (H.M.)
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Westphal DS, Krafft H, Biller R, Klingel K, Gaa J, Mueller CS, Martens E. Myocarditis or inherited disease? - The multifaceted presentation of arrhythmogenic cardiomyopathy. Gene 2022; 827:146470. [PMID: 35381313 DOI: 10.1016/j.gene.2022.146470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Arrhythmogenic right ventricular cardiomyopathy (ARVC) is now usually referred to as arrhythmogenic cardiomyopathy (ACM) because of the possible left and biventricular affection. In recent years, it has been shown that early-stage ACM, especially in women carrying a disease-causing variant in the DSP gene, may present with clinical signs of myocarditis. CASE PRESENTATION The female patient was diagnosed with myocarditis based on arrhythmia and findings on magnetic resonance imaging at the age of 24 years. An additional performed myocardial biopsy confirmed a lymphocytic inflammatory reaction. Subsequently, the patient experienced cardiac arrest because of ventricular fibrillation and was resuscitated. As a result, she received an implantable cardioverter defibrillator, and repeated ablations of recurrent ventricular tachycardia were performed. After four years, molecular genetic testing identified the heterozygous, likely pathogenic nonsense variant c.4789G > T, p.(Glu1597*) in DSP (NM_004415.4). Based on this finding, ACM could be diagnosed, and a heart transplantation was performed only a few months later because of rapid disease progression. DISCUSSION Truncating variants in DSP have been associated with fulminant progression of arrhythmia. However, the currently used ARVC task force criteria are inadequate to detect DSP-associated ACM with left dominant presentation. Moreover, the initial diagnosis of myocarditis may distract from a more extensive search for other causes. Consequently, in cases of recurrent or unusually prolonged myocarditis, especially if present without detected pathogens, molecular genetic testing should be considered.
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Affiliation(s)
- Dominik S Westphal
- Department of Internal Medicine I, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany; Institute of Human Genetics, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany.
| | - Hannah Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Ruth Biller
- ARVC-Selbsthilfe e.V., Unterschleissheim, Germany; European Patient Advocacy Group of the European Reference Network ERN GUARD-Heart, Amsterdam, The Netherlands
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Jochen Gaa
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany
| | - Christoph S Mueller
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universitaet Muenchen, Munich, Germany
| | - Eimo Martens
- Department of Internal Medicine I, Klinikum rechts der Isar, School of Medicine, Technical University Munich, Germany
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Stoffers B, Bacmeister L, Braeuninger H, Warnke S, Brehm M, Kim S, Yan I, Becher M, Escher F, Klingel K, Zeller T, Kirchhof P, Blankenberg S, Westermann D, Lindner D. GPR15-mediated T cell recruitment during acute viral myocarditis is associated with improved virus elimination and outcome. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DZHK
Ernst und Berta Grimmke Stiftung
Background
Myocarditis is an inflammatory disease of the myocardium indicated by mononuclear cell infiltration. It is predominantly caused by infectious agents such as coxsackievirus B3 (CVB3). Especially in young adults, myocarditis is a major source of sudden cardiac arrest. However, its clinical course has a broad spectrum of outcomes, ranging from mild symptoms and complete recovery to cardiac dysfunction and dilated cardiomyopathy. G protein-coupled receptor 15 (GPR15) was identified as a T cell homing receptor in the context of inflammatory intestine and skin diseases. We found Gpr15 to be highly upregulated in the left ventricle (LV) 7 days after CVB3 infection in wild type (WT) mice.
Purpose
GPR15 has not been described in a cardiac context, yet. Our aim was to investigate the role of GPR15 in recruiting immune cell subsets and later in virus elimination during viral myocarditis.
Methods
Gpr15 deficient (Gpr15gfp/gfp) and WT mice were infected intraperitoneal with CVB3 to investigate the acute (6 & 7 days post infection(p.i.)) and the subacute phase (16 days p.i.) of myocarditis. To study differentially expressed genes, LV tissue was used for TaqMan analysis and RNA-sequencing. Inflammation and fibrosis were evaluated on histological level. For functional characterization, healthy and diseased mice were hemodynamically characterized 16 days p.i.. Furthermore, in vitro migration assays were used to study the interaction between GPR15 and its ligands in vitro.
Results
Infected Gpr15gfp/gfp mice exhibited higher upregulation of immune response related genes on mRNA level in the acute phase of myocarditis 7 days p.i.. For instance, Cd8a, a cytotoxic T cell marker, and Foxp3, a regulatory T cell marker, were significantly higher in infected Gpr15gfp/gfp compared to infected WT mice. Bulk RNA-sequencing confirmed that the response to virus did not decline from day 6 to 7 in infected GPR15-deficient mice as observed in infected WT mice. Subsequent gene ontology (GO) term analyses reveled enhanced chemotaxis and cytotoxic T cell-related GO terms in GPR15-deficient mice on day 7.
Among investigated T cell subsets, GPR15 was highest expressed on CD8+ T cell. Its deficiency abolished chemotaxis of T cells, especially of cytotoxic T cells, towards GPR15 ligand in vitro.
In the subacute phase of myocarditis 16 days p.i., viral persistence was observed in more than 85 % of Gpr15gfp/gfp mice. In contrast, more than 70 % of WT mice with verified viremia cleared the virus successfully. Furthermore, Gpr15gfp/gfp mice demonstrated a decreased cardiac function accompanied by increased fibrosis in comparison to WT mice.
Conclusion
Our findings indicate that despite the prolonged inflammatory response, scant virus elimination was presumably caused by decelerated recruitment of cytotoxic T cells leading to impaired outcome in the GPR15-deficient mice.
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Affiliation(s)
- B Stoffers
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - L Bacmeister
- University Hospital Heidelberg , Heidelberg , Germany
| | - H Braeuninger
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - S Warnke
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - M Brehm
- University of Siegen , Siegen , Germany
| | - S Kim
- Thomas Jefferson University , Philadelphia , United States of America
| | - I Yan
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - M Becher
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - F Escher
- Charite Universitatsmedizin Berlin , Berlin , Germany
| | - K Klingel
- University Hospital of Tuebingen, Cardiopathology, Institute of Pathology and Neuropathology , Tuebingen , Germany
| | - T Zeller
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - D Westermann
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - D Lindner
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
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Voss M, Pinkert S, Kespohl M, Gimber N, Klingel K, Schmoranzer J, Laue M, Gaida M, Kloetzel PM, Beling A. A Conserved Cysteine Residue in Coxsackievirus B3 Protein 3A with Implication for Elevated Virulence. Viruses 2022; 14:v14040769. [PMID: 35458499 PMCID: PMC9029043 DOI: 10.3390/v14040769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023] Open
Abstract
Enteroviruses (EV) are implicated in an extensive range of clinical manifestations, such as pancreatic failure, cardiovascular disease, hepatitis, and meningoencephalitis. We recently reported on the biochemical properties of the highly conserved cysteine residue at position 38 (C38) of enteroviral protein 3A and demonstrated a C38-mediated homodimerization of the Coxsackievirus B3 protein 3A (CVB3-3A) that resulted in its profound stabilization. Here, we show that residue C38 of protein 3A supports the replication of CVB3, a clinically relevant member of the enterovirus genus. The infection of HeLa cells with protein 3A cysteine 38 to alanine mutants (C38A) attenuates virus replication, resulting in comparably lower virus particle formation. Consistently, in a mouse infection model, the enhanced virus propagation of CVB3-3A wt in comparison to the CVB3-3A[C38A] mutant was confirmed and found to promote severe liver tissue damage. In contrast, infection with the CVB3-3A[C38A] mutant mitigated hepatic tissue injury and ameliorated the signs of systemic inflammatory responses, such as hypoglycemia and hypothermia. Based on these data and our previous report on the C38-mediated stabilization of the CVB3-3A protein, we conclude that the highly conserved amino acid C38 in protein 3A enhances the virulence of CVB3.
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Affiliation(s)
- Martin Voss
- Institute of Biochemistry, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.V.); (S.P.); (M.K.); (N.G.); (J.S.); (P.-M.K.)
| | - Sandra Pinkert
- Institute of Biochemistry, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.V.); (S.P.); (M.K.); (N.G.); (J.S.); (P.-M.K.)
| | - Meike Kespohl
- Institute of Biochemistry, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.V.); (S.P.); (M.K.); (N.G.); (J.S.); (P.-M.K.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner Side Berlin, 10117 Berlin, Germany
| | - Niclas Gimber
- Institute of Biochemistry, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.V.); (S.P.); (M.K.); (N.G.); (J.S.); (P.-M.K.)
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Advanced Medical Bioimaging Core Facility, 10117 Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University of Tübingen, 72016 Tübingen, Germany;
| | - Jan Schmoranzer
- Institute of Biochemistry, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.V.); (S.P.); (M.K.); (N.G.); (J.S.); (P.-M.K.)
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Advanced Medical Bioimaging Core Facility, 10117 Berlin, Germany
| | - Michael Laue
- Robert Koch Institute, Advanced Light and Electron Microscopy (ZBS 4), 13353 Berlin, Germany;
| | - Matthias Gaida
- Institute of Pathology, University Medical Center Mainz, JGU-Mainz, 55131 Mainz, Germany;
- Research Center for Immunotherapy, University Medical Center Mainz, JGU-Mainz, 55131 Mainz, Germany
- Joint Unit Immunopathology, Institute of Pathology, University Medical Center, JGU-Mainz and TRON, Translational Oncology at the University Medical Center, 55131 Mainz, Germany
| | - Peter-Michael Kloetzel
- Institute of Biochemistry, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.V.); (S.P.); (M.K.); (N.G.); (J.S.); (P.-M.K.)
| | - Antje Beling
- Institute of Biochemistry, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (M.V.); (S.P.); (M.K.); (N.G.); (J.S.); (P.-M.K.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner Side Berlin, 10117 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-528-187; Fax: +49-30-450-528-921
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Chen W, Doeblin P, Al-Tabatabaee S, Klingel K, Tanacli R, Jakob Weiß K, Stehning C, Patel AR, Pieske B, Zou J, Kelle S. Synthetic Extracellular Volume in Cardiac Magnetic Resonance Without Blood Sampling: a Reliable Tool to Replace Conventional Extracellular Volume. Circ Cardiovasc Imaging 2022; 15:e013745. [PMID: 35360924 PMCID: PMC9015035 DOI: 10.1161/circimaging.121.013745] [Citation(s) in RCA: 7] [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] [Indexed: 01/19/2023]
Abstract
Background: The calculation of extracellular volume (ECV) in cardiac magnetic resonance requires hematocrit, limiting its applicability in clinical practice. Based on the linear relationship between hematocrit and blood T1 relaxivity, a synthetic ECV could be estimated without a blood sample. We aim to develop and test regression models for synthetic ECV without blood sampling in 1.5-T and 3.0-T scanners. Methods: A total of 1101 subjects who underwent cardiac magnetic resonance scanning with native and postcontrast T1 mapping and venous hematocrit within 24 hours were retrospectively enrolled. Subjects were randomly split into derivation (n=550) and validation (n=551) subgroups for each scanner. Different regression models were derived controlling for sex, field strength, and left ventricle/right ventricle blood pool and validated in the validation group. We performed additional validation analyses in subgroups of patients with histological validation (n=17), amyloidosis (n=29), anemia (n=185), and reduced ejection fraction (n=322). Results: In the derivation group, 8 specific models and 2 common estimate models were derived. In the validation group, using specific models, synthetic ECV had high agreement with conventional ECV (R2, 0.87; P<0.0001 and R2, 0.88, P<0.0001; −0.16% and −0.10%, left ventricle and right ventricle model, respectively). Common models also performed well (R2, 0.88; P<0.0001 and R2, 0.89, P<0.0001; −0.21% and −0.18%, left ventricle and right ventricle model, respectively). Histological validation demonstrated equal performance of synthetic and measured ECV. Synthetic ECV as calculated by the common model showed a bias in the anemia cohort significantly reduced by the specific model (−2.45 to −1.28, right ventricle common and specific model, respectively). Conclusions: Synthetic ECV provided a promising way to calculate ECV without blood sampling. Specific models could provide the most accurate value, while common models could be more suitable in routine clinical practice because of their simplicity while maintaining adequate accuracy.
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Affiliation(s)
- Wensu Chen
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, China (W.C.)
| | - Patrick Doeblin
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (P.D., R.T., K.J.W., B.P., S.K.)
| | - Sarah Al-Tabatabaee
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.)
| | - Karin Klingel
- Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Germany (K.K.)
| | - Radu Tanacli
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (P.D., R.T., K.J.W., B.P., S.K.)
| | - Karl Jakob Weiß
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (P.D., R.T., K.J.W., B.P., S.K.)
| | | | - Amit R Patel
- Department of Medicine and Radiology, University of Chicago, IL (A.R.P.)
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (P.D., R.T., K.J.W., B.P., S.K.)
| | - Jiangang Zou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, China (J.Z.)
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (P.D., R.T., K.J.W., B.P., S.K.)
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Mueller M, Zwinger L, Klaassen S, Poller W, Monserrat Iglesias L, Pablo Ochoa J, Klingel K, Landmesser U, Heidecker B. Severe heart failure in the setting of inflammatory cardiomyopathy with likely pathogenic titin variant. IJC Heart & Vasculature 2022; 39:100969. [PMID: 35198726 PMCID: PMC8851269 DOI: 10.1016/j.ijcha.2022.100969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/29/2022] [Indexed: 11/21/2022]
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Mueller M, Poller W, Klingel K, Neumann T, Landmesser U, Heidecker B. Eosinophilic granulomatosis with polyangiitis (EGPA) with low activity EBV replication during the COVID 19 pandemic. IJC Heart & Vasculature 2022; 39:100968. [PMID: 35165658 PMCID: PMC8828429 DOI: 10.1016/j.ijcha.2022.100968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Melina Mueller
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, German
| | - Wolfgang Poller
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, German
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tübingen, Tübingen, Germany
| | | | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Heidecker
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Corresponding author.
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von Stillfried S, Bülow RD, Röhrig R, Meybohm P, Boor P, Böcker J, Schmidt J, Tholen P, Majeed R, Wienströer J, Weis J, Bremer J, Knüchel R, Breitbach A, Cacchi C, Freeborn B, Wucherpfennig S, Spring O, Braun G, Römmele C, Märkl B, Claus R, Dhillon C, Schaller T, Sipos E, Hirschbühl K, Wittmann M, Kling E, Kröncke T, Heppner FL, Meinhardt J, Radbruch H, Streit S, Horst D, Elezkurtaj S, Quaas A, Göbel H, Hansen T, Titze U, Lorenzen J, Reuter T, Woloszyn J, Baretton G, Hilsenbeck J, Meinhardt M, Pablik J, Sommer L, Holotiuk O, Meinel M, Mahlke N, Esposito I, Crudele G, Seidl M, Amann KU, Coras R, Hartmann A, Eichhorn P, Haller F, Lange F, Schmid KW, Ingenwerth M, Rawitzer J, Theegarten D, Birngruber CG, Wild P, Gradhand E, Smith K, Werner M, Schilling O, Acker T, Gattenlöhner S, Stadelmann C, Metz I, Franz J, Stork L, Thomas C, Zechel S, Ströbel P, Wickenhauser C, Fathke C, Harder A, Ondruschka B, Dietz E, Edler C, Fitzek A, Fröb D, Heinemann A, Heinrich F, Klein A, Kniep I, Lohner L, Möbius D, Püschel K, Schädler J, Schröder AS, Sperhake JP, Aepfelbacher M, Fischer N, Lütgehetmann M, Pfefferle S, Glatzel M, Krasemann S, Matschke J, Jonigk D, Werlein C, Schirmacher P, Domke LM, Hartmann L, Klein IM, Schwab C, Röcken C, Friemann J, Langer D, Roth W, Strobl S, Rudelius M, Stock KF, Weichert W, Delbridge C, Kasajima A, Kuhn PH, Slotta-Huspenina J, Weirich G, Barth P, Wardelmann E, Schnepper A, Evert K, Büttner A, Manhart J, Nigbur S, Bittmann I, Fend F, Bösmüller H, Granai M, Klingel K, Warm V, Steinestel K, Umathum VG, Rosenwald A, Kurz F, Vogt N. Intracranial hemorrhage in COVID-19 patients during extracorporeal membrane oxygenation for acute respiratory failure: a nationwide register study report. Crit Care 2022; 26:83. [PMID: 35346314 PMCID: PMC8958804 DOI: 10.1186/s13054-022-03945-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/04/2022] [Indexed: 12/22/2022] Open
Abstract
Background In severe cases, SARS-CoV-2 infection leads to acute respiratory distress syndrome (ARDS), often treated by extracorporeal membrane oxygenation (ECMO). During ECMO therapy, anticoagulation is crucial to prevent device-associated thrombosis and device failure, however, it is associated with bleeding complications. In COVID-19, additional pathologies, such as endotheliitis, may further increase the risk of bleeding complications. To assess the frequency of bleeding events, we analyzed data from the German COVID-19 autopsy registry (DeRegCOVID). Methods The electronic registry uses a web-based electronic case report form. In November 2021, the registry included N = 1129 confirmed COVID-19 autopsy cases, with data on 63 ECMO autopsy cases and 1066 non-ECMO autopsy cases, contributed from 29 German sites. Findings The registry data showed that ECMO was used in younger male patients and bleeding events occurred much more frequently in ECMO cases compared to non-ECMO cases (56% and 9%, respectively). Similarly, intracranial bleeding (ICB) was documented in 21% of ECMO cases and 3% of non-ECMO cases and was classified as the immediate or underlying cause of death in 78% of ECMO cases and 37% of non-ECMO cases. In ECMO cases, the three most common immediate causes of death were multi-organ failure, ARDS and ICB, and in non-ECMO cases ARDS, multi-organ failure and pulmonary bacterial ± fungal superinfection, ordered by descending frequency. Interpretation Our study suggests the potential value of autopsies and a joint interdisciplinary multicenter (national) approach in addressing fatal complications in COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03945-x.
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Seidel F, Opgen-Rhein B, Rentzsch A, Boehne M, Wannenmacher B, Boecker D, Reineker K, Grafmann M, Wiegand G, Hecht T, Kiski D, Fischer M, Papakostas K, Ruf B, Kramp J, Khalil M, Kaestner M, Steinmetz M, Fischer G, Özcan S, Freudenthal N, Schweigmann U, Hellwig R, Pickardt T, Klingel K, Messroghli D, Schubert S. Clinical characteristics and outcome of biopsy-proven myocarditis in children - Results of the German prospective multicentre registry "MYKKE". Int J Cardiol 2022; 357:95-104. [PMID: 35304189 DOI: 10.1016/j.ijcard.2022.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/08/2022] [Accepted: 03/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Heart failure (HF) due to myocarditis might not respond in the same way to standard therapy as HF due to other aetiologies. The aim of this study was to investigate the value of endomyocardial biopsies (EMB) for clinical decision-making and its relation to the outcome of paediatric patients with myocarditis. METHODS Clinical and EMB data of children with myocarditis collected for the MYKKE-registry between 2013 and 2020 from 23 centres were analysed. EMB studies included histology, immunohistology, and molecular pathology. The occurrence of major adverse cardiac events (MACE) including mechanical circulatory support (MCS), heart transplantation, and/or death was defined as a combined endpoint. RESULTS Myocarditis was diagnosed in 209/260 patients: 64% healing/chronic lymphocytic myocarditis, 23% acute lymphocytic myocarditis (AM), 14% healed myocarditis, no giant cell myocarditis. The median age was 12.8 (1.4-15.9) years. Time from symptom-onset to EMB was 11.0 (4.0-29.0) days. Children with AM and high amounts of mononuclear cell infiltrates were significantly younger with signs of HF compared to those with healing/chronic or healed myocarditis. Myocardial viral DNA/RNA detection had no significant effect on outcome. The worst event-free survival was seen in patients with healing/chronic myocarditis (24%), followed by acute (31%) and healed myocarditis (58%, p = 0.294). A weaning rate of 64% from MCS was found in AM. CONCLUSIONS EMB provides important information on the type and stage of myocardial inflammation and supports further decision-making. Children with fulminant clinical presentation, high amounts of mononuclear cell infiltrates or healing/chronic inflammation and young age have the highest risk for MACE.
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Affiliation(s)
- Franziska Seidel
- German Heart Center Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany; Charité-Universitätsmedizin Berlin, Department of Pediatric Cardiology, Berlin, Germany; Experimental and Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Germany; Charité-Universitätsmedizin Berlin, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.
| | - Bernd Opgen-Rhein
- Charité-Universitätsmedizin Berlin, Department of Pediatric Cardiology, Berlin, Germany
| | - Axel Rentzsch
- Department for Paediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Martin Boehne
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Bardo Wannenmacher
- Clinic for Paediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Dorotheé Boecker
- Department for Paediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Katja Reineker
- Department for Paediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
| | - Maria Grafmann
- Department for Paediatric Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Gesa Wiegand
- Department for Paediatric Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Hecht
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart- and Diabetescenter NRW, University Clinic of Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Daniela Kiski
- Department for Paediatric Cardiology, University Hospital Münster, Münster, Germany
| | - Marcus Fischer
- Department of Paediatric Cardiology and Paediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | | | - Bettina Ruf
- Department for Paediatric Cardiology, German Heart Centre Munich, Munich, Germany
| | - Jennifer Kramp
- Department for Paediatric Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marcus Khalil
- Department for Paediatric Cardiology, University Hospital Giessen, Giessen, Germany
| | | | - Michael Steinmetz
- Department for Paediatric Cardiology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Gunther Fischer
- Department for Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sevinc Özcan
- Pediatric Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Noa Freudenthal
- Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Regina Hellwig
- Pediatric Cardiology and Congenital Heart Defects, Center for Pediatrics, University Hospital Heidelberg, Heidelberg. Germany
| | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Daniel Messroghli
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany; Internal Medicine-Cardiology, German Heart Center, Germany; Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Schubert
- German Heart Center Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany; Department for Paediatric Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
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Schroeter MR, Klingel K, Korsten P, Hasenfuß G. Fulminant Lyme myocarditis without any other signs of Lyme disease in a 37-year-old male patient with microscopic polyangiitis-a case report. Eur Heart J Case Rep 2022; 6:ytac062. [PMID: 35291336 PMCID: PMC8916016 DOI: 10.1093/ehjcr/ytac062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022]
Abstract
Background Lyme disease is a tick-borne multisystem infection. The most common cardiac manifestation is an acute presentation of Lyme carditis, which often manifests as conduction disorder and rarely as myocarditis. Case summary We report the case of a 37-year-old male with a history of microscopic polyangiitis receiving immunosuppressive therapy. He was admitted for severe dyspnoea secondary to acute heart failure. Echocardiography and cardiac magnetic resonance imaging indicated a severely reduced left ventricular ejection fraction (LVEF) with global hypokinesia. Coronary heart disease was excluded, and endomyocardial biopsies (EMB) were performed. The left ventricular EMB revealed a rare case of fulminant Lyme carditis with evidence of typical lymphocytic myocarditis. Borrelia afzelii-DNA was detected without any relevant atrioventricular blockage or systemic signs of Lyme disease. The patient had no clinically apparent tick-borne infection or self-reported history of a tick bite. Immunological testing revealed a positive ELISA and Immunoblot for anti-Borrelia immunoglobulin G antibodies. After specific intravenous antibiotic therapy and optimized medical therapy for heart failure, the LVEF recovered, and the patient could be discharged in an improved condition. Repeat EMB a few months later revealed a dramatic regression of the cardiac inflammation and absence of Borrelia DNA in the myocardium. Discussion A severely reduced LVEF can be the primary manifestation of Lyme disease even without typical systemic findings and can have a favourable prognosis with antibiotic treatment. A thorough workup for Lyme carditis is required in patients with unexplained heart failure, particularly with EMB, especially in immunosuppressed patients.
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Affiliation(s)
- Marco R Schroeter
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
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Kiblboeck D, Klingel K, Genger M, Traxler S, Braunsteiner N, Steinwender C, Kellermair J. Myocarditis following mRNA COVID-19 vaccination: call for endomyocardial biopsy. ESC Heart Fail 2022; 9:1996-2002. [PMID: 35194974 PMCID: PMC9065833 DOI: 10.1002/ehf2.13791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/19/2021] [Revised: 10/30/2021] [Accepted: 12/14/2021] [Indexed: 12/21/2022] Open
Abstract
Acute myocarditis following mRNA COVID-19 vaccination was reported by the European Medicine Agency safety committee as a rare adverse event. We present a case series of three young male patients with suspected acute myocarditis following BNT162b2 mRNA COVID-19 vaccination including results of endomyocardial biopsies (EMB). Additionally, we analysed EMB of another 21 patients with clinically suspected acute myocarditis following vaccination to determine the pathohistological pattern. Overall, EMB revealed acute lymphocytic myocarditis in 5 (20.8%), chronic lymphocytic myocarditis in 6 (25%), cardiac sarcoidosis in 1 (4.2%), healed myocarditis in 6 (25%), and other diagnoses with cardiac damage of unclear aetiology in 6 (25%) cases. Our findings support the necessity of EMB in patients with suspected acute myocarditis following mRNA COVID-19 vaccination presenting with reduced EF to establish a correct and definite diagnosis. Concerns of these rare severe adverse events after COVID-19 immunization should not undermine its value for the global community.
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Affiliation(s)
- Daniel Kiblboeck
- Department of Cardiology, Kepler University Hospital, Med Campus III, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Martin Genger
- Department of Cardiology, Nephrology and Intensive Care, General Hospital Steyr, Steyr, Austria
| | - Selina Traxler
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Nathalie Braunsteiner
- Department of Cardiology, Nephrology and Intensive Care, General Hospital Steyr, Steyr, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Med Campus III, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Joerg Kellermair
- Department of Cardiology, Kepler University Hospital, Med Campus III, Medical Faculty, Johannes Kepler University, Linz, Austria
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Seidel F, Kuehnisch J, Klingel K, Dartsch J, Laser KT, Berger F, Thomas P, Milting H, Schubert S, Klaassen S. Pathogenic Variants in Cardiomyopathy and Not Immune Disorder Genes Cause Pediatric Myocarditis with Dilated Cardiomyopathy Phenotype. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F. Seidel
- Augustenburger Platz 1, Berlin, Deutschland
| | - J. Kuehnisch
- Experimental and Clinical Research Center Berlin, Berlin, Deutschland
| | | | - J. Dartsch
- Dzhk (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Experimental and Clinical Research Center Berlin, Berlin, Deutschland
| | | | - F. Berger
- Augustenburger Platz 1, Berlin, Deutschland
| | - P. Thomas
- Kompetenznetz Angeborene Herzfehler, Berlin, Deutschland
| | - H. Milting
- Herz- und Diabeteszentrum NRW, Georgstraße, Bad Oeynhausen, Germany, Bad Oeynhausen, Deutschland
| | | | - S. Klaassen
- Max-Delbrück-Centrum für Molekulare Medizin, Berlin, Deutschland
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Neumann F, Möllring A, Holling T, Biermann D, Kubisch C, Muntau A, Kozlik-Feldmann R, Klingel K, Santer R, Gottschalk U. Homozygosity for a 3 bp-deletion in BOLA3 Causes a Severe Cardiac Phenotype in Early Childhood with Lethal Outcome. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F. Neumann
- Department of Pediatr Cardiology, Children's Heart Clinic, Univ Med Center Eppendorf, Hamburg, Deutschland
| | - A. Möllring
- Inst of Hum Genetics, Univ Med Center Eppendorf, Hamburg, Deutschland
| | - T. Holling
- Inst of Hum Genetics, Univ Med Center Eppendorf, Hamburg, Deutschland
| | - D. Biermann
- Department for Congen & Pediatr Heart Surgery, Children's Heart Clinic, Univ Med Center Eppendorf, Hamburg, Deutschland
| | - C. Kubisch
- Inst of Hum Genetics, Univ Med Center Eppendorf, Hamburg, Deutschland
| | - A. Muntau
- Department of Pediatr, Univ Med Center Eppendorf, Hamburg, Deutschland
| | - R. Kozlik-Feldmann
- Department of Pediatr Cardiology, Children's Heart Clinic, Univ Med Center Eppendorf, Hamburg, Deutschland
| | - K. Klingel
- Cardiopathology, Inst for Pathology and Neuropathology, Univ Hospital, Tübingen, Deutschland
| | - R. Santer
- Department of Pediatr, Univ Med Center Eppendorf, Hamburg, Deutschland
| | - U. Gottschalk
- Department of Pediatr Cardiology, Children's Heart Clinic, Univ Med Center Eppendorf, Hamburg, Deutschland
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