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Bock M, Von Schacky C, Scherr J, Lorenz E, Lechner B, Haller B, Krannich A, Halle M, Wachter R, Duvinage A, Edelmann F, Lechner K. Trans fatty acid blood levels and HFpEF phenotype: from the Aldo-DHF RCT. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2300] [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: 11/14/2022] Open
Abstract
Abstract
Background
Prognosis in HFpEF is determined by risk factor control and treatment of comorbidities. Industrially processed TFA (IP-TFA) from partially hydrogenated oils have been linked to altered lipoprotein metabolism, endothelial dysfunction, increased biomarkers of inflammation and increased NTproBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown.
Purpose
To evaluate associations of blood TFA with cardiovascular risk factors, aerobic capacity and cardiac function in patients with HFpEF.
Methods
This is a secondary analysis from the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n=404 using the HS-Omega-3-Index® methodology. Patient characteristics were; 67±8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥50%, E/e' 7.1±1.5; median NT-proBNP 158 ng/L (IQR 82–298). Multiple linear regression analyses, using sex and age as covariates, were used to describe associations of TFA with metabolic phenotype, functional capacity, echocardiographic markers for left ventricular diastolic function (LVDF), and neurohumoral activation at baseline and after 12-months-follow-up (12mFU). To account for randomization group, all analyses were repeated as sensitivity analysis with group as covariate. A significance level of α=5% was used for all tests. As all tests were hypothesis generating without confirmatory interpretation, no correction was applied to counteract the problem of multiple comparisons.
Results
Higher blood levels of the naturally occurring TFA C16:1n-7t were broadly associated with a more favorable lipid profile, lower body weight/central adiposity, lower white blood cell count and lower biochemical markers of non-alcoholic fatty liver disease at baseline/12mFU. Conversely, blood levels of the IP-TFA C18:1n9t were directly associated with lipid risk markers [triglycerides (β=19.7, p<0,001), non-HDL-C (β=7.9, p=0,001), and LDL-C (β=5.4, p=0,011)]. The two IP-TFA C18:2n6 isomers C18:2n6tt and C18:2n6ct were positively associated with HbA1c [(β=14.6, p=0,003) and (β=4.2, p=0,014) respectively]. The IP-TFA C18:2n6tt/-ct isomers were associated with lower submaximal aerobic capacity (distance covered in the 6MWT) at baseline/12mFU. No significant association was found between TFA blood levels and left ventricular filling pressures, left ventricular relaxation or neurohumoral activation. Significant effects of group allocation (spironolactone +/−) were found for the 12mFU outcomes systolic/diastolic blood pressure (all p<0.001), heart rate, E/e$'$ and HbA1c.
Conclusions
In HFpEF patients, higher blood levels of industrially processed TFA, but not of the TFA C16:1n-7t in full fat dairy and meat, were associated with a higher risk phenotype and lower aerobic capacity. Our findings support efforts to remove IP-TFA from the food supply for improving risk factor control in HFpEF patients.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): German Foundation of Heart Research
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Affiliation(s)
- M Bock
- German Heart Center of Munich, Department of Cardiology , Munich , Germany
| | - C Von Schacky
- University Hospital of Munich, Omegametrix, Martinsried, Germany , Munich , Germany
| | - J Scherr
- University Hospital Balgrist , Zurich , Switzerland
| | - E Lorenz
- German Heart Center of Munich, Department of Cardiology , Munich , Germany
| | - B Lechner
- Ludwig Maximilians University , Munich , Germany
| | - B Haller
- Technical University of Munich, Institute of AI and Informatics in Medicine , Munich , Germany
| | - A Krannich
- Charité - University Medicine Berlin , Berlin , Germany
| | - M Halle
- Technical University of Munich, Department of Prevention, Rehabilitation and Sports Medicine , Munich , Germany
| | - R Wachter
- Leipzig University Hospital, Clinic and Policlinic for Cardiology , Leipzig , Germany
| | - A Duvinage
- Technical University of Munich, Department of Prevention, Rehabilitation and Sports Medicine , Munich , Germany
| | - F Edelmann
- Charité - University Medicine Berlin, Department of Cardiology , Berlin , Germany
| | - K Lechner
- German Heart Center of Munich, Department of Cardiology , Munich , Germany
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Kreiss L, Thoma OM, Lemire S, Lechner K, Carlé B, Dilipkumar A, Kunert T, Scheibe K, Heichler C, Merten AL, Weigmann B, Neufert C, Hildner K, Vieth M, Neurath MF, Friedrich O, Schürmann S, Waldner MJ. Label-Free Characterization and Quantification of Mucosal Inflammation in Common Murine Colitis Models With Multiphoton Imaging. Inflamm Bowel Dis 2022; 28:1637-1646. [PMID: 35699622 PMCID: PMC9629455 DOI: 10.1093/ibd/izac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical challenges in inflammatory bowel diseases require microscopic in vivo evaluation of inflammation. Here, label-free imaging holds great potential, and recently, our group demonstrated the advantage of using in vivo multiphoton endomicroscopy for longitudinal animal studies. This article extends our previous work by in-depth analysis of label-free tissue features in common colitis models quantified by the multiphoton colitis score (MCS). METHODS Fresh mucosal tissues were evaluated from acute and chronic dextran sulfate sodium (DSS), TNBS, oxazolone, and transfer colitis. Label-free imaging was performed by using second harmonic generation and natural autofluorescence. Morphological changes in mucosal crypts, collagen fibers, and cellularity in the stroma were analyzed and graded. RESULTS Our approach discriminated between healthy (mean MCS = 2.5) and inflamed tissue (mean MCS > 5) in all models, and the MCS was validated by hematoxylin and eosin scoring of the same samples (85.2% agreement). Moreover, specific characteristics of each phenotype were identified. While TNBS, oxazolone, and transfer colitis showed high cellularity in stroma, epithelial damage seemed specific for chronic, acute DSS and transfer colitis. Crypt deformations were mostly observed in acute DSS. CONCLUSIONS Quantification of label-free imaging is promising for in vivo endoscopy. In the future, this could be valuable for monitoring of inflammatory pathways in murine models, which is highly relevant for the development of new inflammatory bowel disease therapeutics.
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Affiliation(s)
- Lucas Kreiss
- Address correspondence to: Lucas Kreiss, Dr.-Ing, Institute of Medical Biotechnology, Paul-Gordan-Str 3, 91052 Erlangen, Germany ()
| | | | - Sarah Lemire
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Kristina Lechner
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Birgitta Carlé
- Institute of Medical Biotechnology, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany
| | - Ashwathama Dilipkumar
- Institute of Medical Biotechnology, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany
| | - Timo Kunert
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Kristina Scheibe
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Christina Heichler
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Anna-Lena Merten
- Institute of Medical Biotechnology, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany
| | - Benno Weigmann
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Clemens Neufert
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Kai Hildner
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany,Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany
| | - Markus F Neurath
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Deutsches Zentrum Immuntherapie, Erlangen, Germany
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany,Erlangen Graduate School in Advanced Optical Technologies, Friedrich-Alexander UniversityErlangen-Nürnberg, Erlangen, Germany
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3
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Lechner K, Zeeshana M, Noack M, Ali H, Neurath M, Weigmanna B. Small but powerful: Will nanoparticles be the future state‐of‐the‐art therapy for IBD? Expert Opin Drug Deliv 2022; 19:235-245. [DOI: 10.1080/17425247.2022.2043847] [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: 11/09/2022]
Affiliation(s)
- Kristina Lechner
- Medical Clinic I, University Hospital Erlangen, Research Campus, Hartmannstr.14, 91052, Erlangen, 91052 Erlangen, Germany
| | - Mahira Zeeshana
- Department of Pharmacy, Faculty of Biological Sciences, Quaid‐i‐Azam University, Islamabad, 45320, Pakistan
| | - Maxi Noack
- Medical Clinic I, University Hospital Erlangen, Research Campus, Hartmannstr.14, 91052, Erlangen, 91052 Erlangen, Germany
| | - Hussain Ali
- Department of Pharmacy, Faculty of Biological Sciences, Quaid‐i‐Azam University, Islamabad, 45320, Pakistan
| | - Markus Neurath
- Medical Clinic I, University Hospital Erlangen, Ulmenweg 14, 91054 Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Ulmenweg 18, 91054 Erlangen, Germany
| | - Benno Weigmanna
- Medical Immunology Campus Erlangen, Medical Clinic 1, Friedrich‐Alexander University, Erlangen‐Nürnberg, Erlangen, Germany
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Worm N, Weingärtner O, Schulze C, Lechner K. [Erratum to: Saturated fatty acids and cardiovascular risk: Is a revision of the recommendations on nutrition indicated?]. Herz 2021; 47:380. [PMID: 34821954 PMCID: PMC9355922 DOI: 10.1007/s00059-021-05083-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- N Worm
- Deutsche Hochschule für Prävention und Gesundheitsmanagement, Saarbrücken, Deutschland.
| | - O Weingärtner
- Klinik für Innere Medizin I, Interventionelle Kardiologie/Angiologie, Universitätsklinikum Jena, Jena, Deutschland
| | - C Schulze
- Klinik für Innere Medizin I, Interventionelle Kardiologie/Angiologie, Universitätsklinikum Jena, Jena, Deutschland
| | - K Lechner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Deutschland
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Lechner K, Mott S, Al-Saifi R, Knipfer L, Wirtz S, Atreya R, Vieth M, Rath T, Fraass T, Winter Z, August A, Luban J, Zimmermann VS, Weigmann B, Neurath MF. Targeting of the Tec Kinase ITK Drives Resolution of T Cell-Mediated Colitis and Emerges as Potential Therapeutic Option in Ulcerative Colitis. Gastroenterology 2021; 161:1270-1287.e19. [PMID: 34224738 DOI: 10.1053/j.gastro.2021.06.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The molecular checkpoints driving T cell activation and cytokine responses in ulcerative colitis (UC) are incompletely understood. Here, we studied the Tec kinase ITK in UC. METHODS We analyzed patients with inflammatory bowel disease (n = 223) and evaluated ITK activity as well as the functional effects of cyclosporine-A (CsA). In addition, 3 independent murine colitis models were used to investigate the functional role of ITK. Finally, the activity of ITK was blocked via pharmacological inhibitors and genetically engineered mice. Readout parameters were mini-endoscopy, histopathology, mucosal T cell apoptosis, and cytokine production. RESULTS We found an expansion of pITK-expressing mucosal CD4+ T cells in UC rather than Crohn's disease that correlated with disease severity. CsA suppressed activation of ITK in cultured CD4+ T cells and calcineurin-containing microclusters adjacent to the T cell receptor signaling complex. Functionally, the capacity of CsA to suppress activity of experimental colitis was critically dependent on ITK. Genetic inactivation of Itk via gene targeting or induction of allele-sensitive Itk mutants prevented experimental colitis in 3 colitis models, and treatment with pharmacological ITK blockers suppressed established colitis. In addition, ITK controlled apoptosis and activation of mucosal Th2 and Th17 lymphocytes via NFATc2 signaling pathways. CONCLUSIONS ITK activation was detected in UC and could be down-regulated in cultured T cells by CsA administration. Selective targeting of ITK emerges as an attractive approach for treatment of chronic intestinal inflammation and potentially UC by driving resolution of mucosal inflammation.
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Affiliation(s)
- Kristina Lechner
- Department of Medicine 1, University of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Stefanie Mott
- Department of Medicine 1, University of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Ragheed Al-Saifi
- Department of Medicine 1, University of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Lisa Knipfer
- Department of Medicine 1, University of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Stefan Wirtz
- Department of Medicine 1, University of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Raja Atreya
- Department of Medicine 1, University of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, University of Erlangen-Nuremberg, Erlangen Germany
| | - Timo Rath
- Department of Medicine 1, University of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | | | | | - Avery August
- Department of Microbiology and Immunology, Cornell University, Ithaca, New York
| | - Jeremy Luban
- Program in Molecular Medicine and Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Valérie S Zimmermann
- Institut de Génétique Moléculaire de Montpellier, University of Montpellier, Le Centre National de la Recherche Scientifique, Montpellier, France
| | - Benno Weigmann
- Department of Medicine 1, University of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany; Medical Immunology Campus Erlangen, Medical Clinic 1, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F Neurath
- Department of Medicine 1, University of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany; Deutsches Zentrum Immuntherapie, Erlangen, Germany.
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Von Korn P, Kia S, Lechner K, Dinges S, Duvinage A, Scherr J, Landmesser U, Halle M, Kraenkel N. Inter-individual differences in the response to an exercise training intervention in patients with metabolic syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2878] [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
Regular physical exercise and standardized exercise training (ET) programmes positively affect a number of metabolic and cardiovascular risk factors. Yet, response to ET varies between patients and between individual risk parameters. We investigated inter-individual responses regarding blood pressure, heart rate, lipids and glucose metabolism, as well as physical fitness to a 16-weeks supervised exercise training protocol in patients with metabolic syndrome (MetS).
Methods
29 MetS patients (20M/9F, age 52–70 y, BMI 24.9–38.2 kg/m2) exercised for 16 weeks in a supervised setting with varying volume and intensity. At baseline and at completion of the programme, blood pressure, heart rate, plasma lipids, glucose and insulin levels, as well as physical fitness were assessed, as were quantitative and morphological leukocyte parameters, cytokines and 86 metabolically relevant plasma proteins. Associations between individual risk parameters, leukocyte profile and plasma proteins were explored by recursive partitioning and network analysis. T-distributed stochastic neighbor embedding and hierarchical clustering were used for clustering based on cardiometabolic target parameters at 16 weeks.
Results
In the whole cohort, VO2peak increased and plasma counts of total leukocytes, neutrophils, monocytes (classical and intermediate), NK cells and effector and regulatory CD4+ lymphocytes, as well as circulating endothelial microvesicles were reduced at the end of the ET programme versus baseline. Plasma levels of carboxylesterase 1 decreased and soluble interleukin-7 receptor increased. Based on patient's cardio-metabolic parameters, three clusters were identified: cluster 1 had lower values of triglycerides, total and LDL cholesterol, cluster 2 had higher levels of triglycerides and cluster 3 had a greater heart rate recovery and lower insulin levels, but higher total and LDL cholesterol levels at follow-up. In cluster 1, absolute and relative NK cell counts were decreased and no morphological activation was observed. In cluster 2, reduced relative counts of NK-T cells were decreased, but their size was increased. In cluster 3, size of most effector leukocyte subtypes (CD8+, CD4+ Teff, NK-T, neutrophils) was increased at follow-up versus baseline. Network analysis suggested four distinct networks of (1) triglycerides, (2) VO2peak, (3) diastolic BP and (4) a cluster containing total and LDL cholesterol, insulin and HR recovery, each associated with partly distinct sets of plasma proteins and leukocyte parameters.
Conclusion
Despite improved physical fitness in all patients participating in the 16 weeks ET programme, inter-individual differences regarding cardio-metabolic target parameters and leukocyte activation was evident. Identification of specific leukocyte responses and of plasma protein “fingerprints” might help to optimize patient-specific prevention programmes, integrating medication and lifestyle optimization.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): DZHK, DSHF
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Affiliation(s)
- P Von Korn
- Technical University of Munich, Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - S Kia
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - K Lechner
- Technical University of Munich, Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - S Dinges
- Technical University of Munich, Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - A Duvinage
- Technical University of Munich, Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - J Scherr
- University of Zurich, University Center for Prevention and Sports Medicine, Zurich, Switzerland
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - M Halle
- Technical University of Munich, Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Munich, Germany
| | - N Kraenkel
- Charite - Campus Benjamin Franklin, Berlin, Germany
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Gerlach K, Lechner K, Popp V, Offensperger L, Zundler S, Wiendl M, Becker E, Atreya R, Rath T, Neurath MF, Weigmann B. The JAK1/3 inhibitor tofacitinib suppresses T cell homing and activation in chronic intestinal inflammation. J Crohns Colitis 2020; 15:jjaa162. [PMID: 32808031 DOI: 10.1093/ecco-jcc/jjaa162] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The molecular mechanism of action of the Janus kinase (JAK) inhibitor tofacitinib is poorly understood. METHODS Here, we analysed the inhibitory effect of tofacitinib on mucosal and blood T cells from patients with ulcerative colitis (UC). Furthermore tofacitinib treatment was analysed in experimental colitis models and wound healing. Additionally, tofacitinib effects were analysed in bioassays. RESULTS Tofacitinib significantly reduced T cell derived inflammatory cytokine production (Th2, Th9, Th17) in patients with active UC. Additionally, impaired expression of the homing receptors alpha4/beta1 and alpha4/beta7 as well as reduced gut homing capacity of T cells in a humanized mouse model of colitis were observed. Tofacitinib suppressed acute and chronic oxazolone colitis compared to untreated wild-type mice associated with downregulation of cytokines produced by Th2, Th9 and Th17 cells. Functionally, tofacitinib induced apoptosis of intestinal epithelial cells and prevented mucosal wound healing in vivo at higher concentration. Thus, our findings suggest that tofacitinib is quite effective in protecting from colitis by inhibition of a bundle of T cell derived cytokines like IL-5, IL-6, IL-9, IL-13 and IL-17A. CONCLUSION Application of tofacitinib emerges as an attractive concept for treatment of chronic intestinal inflammation at lower concentrations, whereas higher concentrations require attention due to prolonged wound healing.
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Affiliation(s)
- Katharina Gerlach
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Kristina Lechner
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Vanessa Popp
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Laura Offensperger
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Sebastian Zundler
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
- Deutsches Zentrum Immuntherapie DZI, Erlangen, Germany
| | - Maximilian Wiendl
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Emily Becker
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Raja Atreya
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
- Deutsches Zentrum Immuntherapie DZI, Erlangen, Germany
| | - Timo Rath
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
| | - Markus F Neurath
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
- Deutsches Zentrum Immuntherapie DZI, Erlangen, Germany
| | - Benno Weigmann
- Department of Medicine, University Clinic of Erlangen-Nuremberg, Kussmaul Campus for Medical Research, Erlangen, Germany
- Medical Immunology Campus Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Dickinson M, Briones Mejjide J, Herrera A, González Barca E, Ghosh N, Cordoba R, Rutherford S, Advani R, Bournazou E, Labriola-Tompkins E, Friess T, Chesne E, Brouwer-Visser J, Lechner K, Brennan B, Nueesch E, De Mario M, Hutchings M. BET INHIBITOR RG6146, VENETOCLAX, AND RITUXIMAB IS A HIGHLY ACTIVE REGIMEN IN RELAPSED/REFRACTORY (R/R) DLBCL: INITIAL REPORT OF PHASE 1B SAFETY, BIOMARKER, AND RESPONSE DATA. Hematol Oncol 2019. [DOI: 10.1002/hon.131_2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M. Dickinson
- Department of Haematology; Peter MacCallum Cancer Centre; Melbourne Australia
| | - J. Briones Mejjide
- Hematology Department; Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes; Barcelona Spain
| | - A.F. Herrera
- Department of Hematology and Hematopoietic Cell Transplantation; City of Hope National Medical Center; Duarte United States
| | - E. González Barca
- Haematology; Institut Català d'Oncologia, L'Hospitalet de Llobregat; Barcelona Spain
| | - N. Ghosh
- Department of Hematologic Oncology and Blood Disorders; Levine Cancer Institute-Morehead; Charlotte United States
| | - R. Cordoba
- Department of Haematology; Fundacion Jimenez Diaz University Hospital; Madrid Spain
| | - S.C. Rutherford
- Meyer Cancer Center, Division of Hematology and Medical Oncology; New York Presbyterian Hospital/Weill Cornell Medicine; New York United States
| | - R. Advani
- Blood and Marrow Transplant Program; Stanford Cancer Center; Palo Alto United States
| | - E. Bournazou
- Roche Pharma Research and Early Development; Roche Innovation Center New York; New York United States
| | - E. Labriola-Tompkins
- Roche Pharma Research and Early Development; Roche Innovation Center New York; New York United States
| | - T. Friess
- Roche Pharma Research and Early Development; Roche Innovation Center Munich; Penzberg Germany
| | - E. Chesne
- Roche Pharma Research and Early Development; Roche Innovation Center Basel; Basel Switzerland
| | - J. Brouwer-Visser
- Roche Pharma Research and Early Development; Roche Innovation Center New York; New York United States
| | - K. Lechner
- Roche Pharma Research and Early Development; Roche Innovation Center Munich; Penzberg Germany
| | - B. Brennan
- Roche Pharma Research and Early Development; Roche Innovation Center New York; New York United States
| | - E. Nueesch
- Roche Pharma Research and Early Development; Roche Innovation Center Basel; Basel Switzerland
| | - M. De Mario
- Roche Pharma Research and Early Development; Roche Innovation Center New York; New York United States
| | - M. Hutchings
- Department of Haematology and Phase 1 Unit, Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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9
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Radulovic K, Ayata CK, Mak'Anyengo R, Lechner K, Wuggenig P, Kaya B, Hruz P, Gomez de Agüero M, Broz P, Weigmann B, Niess JH. NLRP6 Deficiency in CD4 T Cells Decreases T Cell Survival Associated with Increased Cell Death. J Immunol 2019; 203:544-556. [PMID: 31152078 DOI: 10.4049/jimmunol.1800938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 05/07/2019] [Indexed: 12/27/2022]
Abstract
The nucleotide-binding oligomerization domain (NOD)-like receptors belong to the family of pattern recognition receptors (PRRs). NOD-like receptors play a role in regulation of innate immune response by recognition of both pathogen-associated molecular patterns that are engulfed during phagocytic process and danger-associated molecular patterns that are mainly byproducts of cell stress mediated response. NOD-like family pyrin domain containing 6 (NLRP6) is one of the 14 pyrin domain-containing receptors. NLRP6 is highly expressed by epithelial and goblet cells to regulate epithelial renewal and mucus production in mice and humans, but its function in T cells is rather unknown. Increased caspase-1 activation and cell death were observed in mouse Nlrp6-deficient T cells following adoptive transfer into Rag2-deficient mice, indicating that Nlrp6 deficiency in CD4+ T cells led to decreased survival.
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Affiliation(s)
- Katarina Radulovic
- Department of Biomedicine, University of Basel, CH-4031 Basel, Switzerland.,Unité de Recherche Clinique, Centre Hospitalier de Valenciennes, 59322 Valenciennes, France
| | - C Korcan Ayata
- Department of Biomedicine, University of Basel, CH-4031 Basel, Switzerland
| | - Rachel Mak'Anyengo
- Department of Biomedicine, University of Basel, CH-4031 Basel, Switzerland
| | - Kristina Lechner
- Department of Medicine I, University Medical Center, 91054 Erlangen, Germany
| | - Philipp Wuggenig
- Department of Biomedicine, University of Basel, CH-4031 Basel, Switzerland
| | - Berna Kaya
- Department of Biomedicine, University of Basel, CH-4031 Basel, Switzerland
| | - Petr Hruz
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, CH-4031 Basel, Switzerland
| | - Mercedes Gomez de Agüero
- Department of Biomedical Research, Maurice Müller Laboratories, University of Bern, CH-3008 Bern, Switzerland; and
| | - Petr Broz
- Department of Biochemistry, University of Lausanne, 1066 Epalinges, Switzerland
| | - Benno Weigmann
- Department of Medicine I, University Medical Center, 91054 Erlangen, Germany
| | - Jan Hendrik Niess
- Department of Biomedicine, University of Basel, CH-4031 Basel, Switzerland; .,University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, CH-4031 Basel, Switzerland
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10
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Breddin K, Loew D, Lechner K, Überla K, Walter E. Secondary Prevention of Myocardial Infarction Comparison of Acetylsalicylic Acid, Phenprocoumon and Placebo. Thromb Haemost 2019. [DOI: 10.1055/s-0039-1687191] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Rintelen C, Pabinger I, Knöbl P, Lechner K, Mannhatter C. Probability of Recurrence of Thrombosis in Patients with and without Factor V Leiden. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1650249] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryActivated protein C (APC) resistance is a common risk factor for venous thromboembolism and is associated with the replacement of Arg 506 by Gin in the factor V gene (factor V Leiden). We investigated the risk of recurrence of venous thromboembolism in APC resistant patients heterozygous and homozygous for FV Leiden and compared these patient groups with a group of patients, who had a history of venous thromboembolism, but had neither APC resistance nor the FV Leiden mutation. APC resistance was determined in frozen blood samples from patients with a history of venous thromboembolism, who were not receiving oral anticoagulant (OAC) treatment. The plasma samples were collected between 1984 and 1991. Twenty-one patients in whom APC resistance was found in the stored plasma samples were reinvestigated in 1994 (5 males, 16 females, median [m] age 49 years, range 21-71 years). Twenty-one sex and age matched patients with venous thromboembolism (5 males, 16 females, age m = 50 years, range 25-73 years) investigated during the same time period who had a normal APC resistance test served as a control group. Patients with APC resistance as well as controls were reinvestigated for the presence of FV Leiden by genetic analysis in 1994. Of the 21 APC resistant patients, 5 were homozygous and 16 heterozygous for FV Leiden. Before the study entry homozygous patients had a significantly higher recurrence rate (5/5 patients) compared to the control group, in heterozygous patients (9/16) and controls (9/21) the recurrence rate was not significantly different.The total observation time was 21 years in patients with homozygous FV Leiden, 83 years in patients with heterozygous FV Leiden and 108 years in controls, excluding the time when patients were on OAC treatment. During the observation time the recurrence rate was highest in patients with homozygous FV Leiden (9.5 % per patient per year), but was similar in patients with heterozygous FV Leiden (4.8% per patient per year) and controls (5% per patient per year). Two of five (40%) homozygous patients, 4/16 (25%) heterozygous and 5/21 (24%) controls had at least one recurrent event during the observation period. The probability for development of thrombosis in the Kaplan-Meyer-Plot analysis was not different between the three groups.Bearing limitations of our study in mind (retrospective design, relatively small patient number) we conclude that the risk of recurrence after a thromboembolic event is not higher in patients with heterozygous FV Leiden than in patients without this mutation. Thus, it appears that the identification of heterozygous FV Leiden mutation is not an indication for long-term OAC treatment. Also, long-term OAC treatment cannot generally be recommended for homozygous patients with a single thromboembolic event. More definitive conclusions will require larger prospective studies.
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Affiliation(s)
- C Rintelen
- The First Department of Medicine, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - I Pabinger
- The First Department of Medicine, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - P Knöbl
- The First Department of Medicine, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - K Lechner
- The First Department of Medicine, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - Ch Mannhatter
- Department of Laboratory Medicine, Division of Molecular Biology, University of Vienna, Austria
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12
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Pabinger I, Schneider B, Scharrer I, Hach-Wunderle V, Lechner K, Eichinger S, Kyrle PA, Vinazzer H, Lämmle B, Demarmels-Biasiutti F, Tilsner V, Marx G, Scifricd E, Gabelmann A, Aspöck G, Fischer M, Halbmaycr WM. Thrombotic Risk of Women with Hereditary Antithrombin III-, Protein C- and Protein S-Deficiency Taking Oral Contraceptive Medication. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642480] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe thrombotic risk of women with a heterozygous natural clotting inhibitor deficiency taking oral contraceptives (OC) has not been evaluated. Therefore, a retrospective collaborative controlled cohort-study was carried out in 8 coagulation laboratories and thrombosis units in Austria, Germany and Switzerland.The incidence of thromboembolism in 48 females heterozygous for hereditary type I deficiency of antithrombin ITT (n = 1.5), protein C. (n = 16) or protein S (n = 17), who had taken OC at least once in their life were compared with that of 48 deficient women, who had never taken OC (controls). Diagnosis of the deficiency state was made in the participating centers. Data on the onset and duration of OC intake and the date and site of thrombotic events were obtained from a questionnaire filled in by the patient or a physician during a visit at a participating center. The observation period in the OC patients was started with onset of OC intake and was terminated when a thromboembolic event had occurred or when OC medication were discontinued. In the patients without OC, the observation period began at an age matched to that of the OC patient and ended when a thromboembolic event had occurred or was continued as long as the corresponding OC patient was on treatment.In AT Ill-deficient females the probability for thrombosis was significantly higher for patients taking OC compared to the non-OC-patients (Wilcoxon test p = 0.004, Log Rank test p = 0.005). In patients with protein C- ((3-error 0.8) and protein S-deficiency ((3-error 0.05) there was no significant difference between the OC- and non-OC-group. The incidence of thrombosis/patient year in AT III-, PC- and PS-deficient females on OC was 27.5%, 12% and 6.5%, respectively and 3.4%, 6.9% and 8.6%, respectively, in the control patients.We conclude that females with hereditary antithrombin Ill-deficiency are at high risk for venous thromboembolism when taking OC. Therefore, OC should be strictly avoided in these females and AT III measurement is mandatory in female relatives of AT Ill-deficient patients at young age before starting OC. There is no evidence for an excess thrombotic risk by OC intake in PS-deficient females. In protein C-deficient women OC medication was not associated with a significant increase of thrombosis, but an increased risk cannot be excluded.
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Affiliation(s)
- Ingrid Pabinger
- Institute for Medical Statistics, University of Vienna, Austria
| | - Barbara Schneider
- First Department of Medicine, Division of Hematology and Blood Coagulation and Institute for Medical Statistics, University of Vienna, Austria
| | - I Scharrer
- Dept. of Angiology, Dept. Med., University Hospital, Frankfurt, Germany
| | - V Hach-Wunderle
- Dept. of Angiology, Dept. Med., University Hospital, Frankfurt, Germany
| | - K Lechner
- Dept. of Hematology and Blood Coagulation, First Dept. Med., University Hospital Vienna, Austria
| | - S Eichinger
- Dept. of Hematology and Blood Coagulation, First Dept. Med., University Hospital Vienna, Austria
| | - P A Kyrle
- Dept. of Hematology and Blood Coagulation, First Dept. Med., University Hospital Vienna, Austria
| | - H Vinazzer
- Blood Coagulation Laboratory, Linz, Austria
| | - B Lämmle
- Central Hematology Laboratory, Inselspital, University Hospital Bern, Switzerland
| | | | - V Tilsner
- Dept. of Surgery, University Hospital Hamburg, Germany
| | - G Marx
- Dept. of Surgery, University Hospital Hamburg, Germany
| | - E Scifricd
- Medical University Clinic III, Ulrn, Germany
| | - A Gabelmann
- Medical University Clinic III, Ulrn, Germany
| | - G Aspöck
- Central Laboratory, Krankenhaus Weis, Austria
| | - M Fischer
- Central Laboratory, Krankenhaus der Stadt Wien-Lainz, Vienna, Austria
| | - W M Halbmaycr
- Central Laboratory, Krankenhaus der Stadt Wien-Lainz, Vienna, Austria
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13
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Eichinger S, Pabinger I, Hartl H, Stain C, Mayerhofer S, Schweiger C, Kier P, Schwarzinger I, Kyrle PA, Lechner K. Azidothymidine (AZT) in the Treatment of Symptomatic HIV-1-Infected Hemophiliacs. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1647263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryTwenty-one immunodeficiency virus 1 (HIV 1)-positive hemophilic patients were treated with Azidothymidine (AZT) for symptomatic HIV infection. The median observation period was 20.5 months.At 25 months the probability of survival was 82%, the probability of progression of disease from CDC III or IV C2 to IV C1 (AIDS) was 20% in patients on continuous AZT treatment and 50% in patients with intermption of treatment. Three patients developed severe leukopenia and 3 patients severe anemii during AZT treatment. In 1 patient a dose-dependent striking increase of transaminases during AZT treatment was observed. In 7 patients treatment was intermpted, in 1 patient because of anemia, in 1 because of pruritus and in 5 patients because of noncompliance.No signiticant changes in the consumption of clotting factor concentrates and number of bleeding episodes before and during AZT treatment were noted.We conclude, that both hematological and non-hematological side effects of AZT in HIV 1-infected hemophilic patientr ur. comparable to those seen in other risk groups . AzT does not increase the bleeding tendency in this patient group.
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Affiliation(s)
- S Eichinger
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - I Pabinger
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - H Hartl
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - C Stain
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - S Mayerhofer
- The First Department of Dermatology, Univeisity of Vienna, Vienna, Austria
| | - C Schweiger
- The Department of Clinical Chemistry, Univeisity of Vienna, Vienna, Austria
| | - P Kier
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - I Schwarzinger
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - P A Kyrle
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
| | - K Lechner
- The First Department of Medicine, Division of Haematology and Blood Coagulation, Univeisity of Vienna, Vienna, Austria
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14
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Kyrle PA, Minar E, Brenner B, Eichler HG, Heistinger M, Marosi L, Lechner K. Thromboxane A2 and Prostacyclin Generation in the Microvasculature of Patients with Atherosclerosis – Effect of Low-Dose Aspirin. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryGeneration of thromboxane A2 (TxA2) and prostacyclin (PGI2) at the site of platelet-vessel wall interaction, i.e. in blood emerging from a standardized injury of the microvasculature made to determine skin bleeding time was investigated in 7 patients with atherosclerosis (angiographically verified obstructions of the femoral arteries) and in 7 normal control subjects apparently free of atherosclerotic lesions. Similar amounts of TxA2 (measured as thromboxane B2, TxB2) were generated at the site of plug formation in the patients with peripheral vascular disease (PVD) and in the control subjects. Significantly lower levels of PGI2 (measured as 6-keto-prostaglandin F1α, 6-keto- PGF1α) were found in blood from an injury of the microvasculature in the patients compared with the controls. These data do not suggest a major role of the platelet prostaglandin metabolism in the development of atherosclerosis. However, decreased synthesis of PGI2 by endothelial cells might contribute to the development and/or progression of atherosclerotic lesions. In the patients with PVD, low-dose aspirin (50 mg/day for 7 days) resulted in a >90% inhibition of the TxB2 production at the site of plug formation. Following low-dose aspirin 6-keto-PcF1α levels were below 20 pg/ml (limit of sensitivity of our radioimmunoassay procedure) in the majority of the samples.We therefore conclude that in patients with PVD a decreased synthesis of PGI2 by endothelial cells might contribute to the progression of atherosclerosis. Furthermore, low-dose aspirin treatment results in a similar inhibition of the platelet prostaglandin generation as recently observed in healthy subjects.
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Affiliation(s)
- P A Kyrle
- The Department of Internal Medicine I, University of Vienna, Vienna, Austria
| | - E Minar
- The Department of Internal Medicine I, University of Vienna, Vienna, Austria
| | - B Brenner
- The Department of Internal Medicine I, University of Vienna, Vienna, Austria
| | - H G Eichler
- The Department of Internal Medicine I, University of Vienna, Vienna, Austria
| | - M Heistinger
- The Department of Internal Medicine I, University of Vienna, Vienna, Austria
| | - L Marosi
- The Department of Internal Medicine I, University of Vienna, Vienna, Austria
| | - K Lechner
- The Department of Internal Medicine I, University of Vienna, Vienna, Austria
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15
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Irsigler K, Lechner K, Deutsch E. Studies on Tissue Thromboplastin II. Species Specificity*). Thromb Haemost 2018. [DOI: 10.1055/s-0038-1654851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Summary1. Purified brain tissue thromboplastins of human, bovine and chicken origin have been tested on homologous and heterologous plasmas.2. Purified brain tissue thromboplastin is species specific.3. Lipid extracts from purified brain tissue thromboplastin prepared with pyridin show a negligable residual species specificity, probably caused by a slight contamination with brain tissue thromboplastin.4. The activity curves of our lipid extracts differ from typical curves expected for lipid activators by a less distinct inhibition in high concentrations probably caused by a different composition of petrol-ether and pyridin extracts.5. The protein part of tissue thromboplastin does not activate prothrombin in any system.6. The protein part of tissue thromboplastin of one species could be combined with the lipid part of another species to form an active tissue thromboplastin.7. The species specificity of these combinations was determined by the source of protein used.
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16
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Abstract
ZusammenfassungAls spontane (nichthämophile) Faktor-Vlll-lnhibitoren werden Antikörper gegen Faktor VIII bei zuvor gerinnungsnormalen Patienten bezeichnet. Meist ist der F-Vlll-Mangel schwer und dementsprechend die Blutungsneigung ausgeprägt. Die Pathogenese ist heterogen. Laborchemisch findet sich typischerweise eine verlängerte aPTT und ein isolierter F-Vlll-Mangel. Die Antikörper sind polyklonal und zumeist Typ-Il-Inhibitoren. Die Therapie gliedert sich in die Beherrschung der akuten Blutung (hochkonzentrierte humane F-Vlll-Konzentrate, porciner F VIII, aktivierte Prothrombinkomplexpräparate, rekombinanter F Vlla, evtl. zusätzlich Plasmapherese und Immunadsorption - zur Reduktion des Inhibitors) und in die Langzeitreduktion des Titers mit Immunsuppressiva.
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17
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Abstract
ZusammenfassungErworbene Faktor-V-Inhibitoren sind eine seltene Gerinnungsstörung. Weltweit wurden bisher 72 Fälle publiziert. Die Inzidenz scheint jedoch zuzunehmen, was wahrscheinlich auf den gehäuften Einsatz von Fibrinklebern zurückzuführen ist. Diese Metaanalyse untersucht die prädiponierenden Faktoren, die Pathogenese, diagnostische Methoden, klinisches Erscheinungsbild, therapeutische Möglichkeiten und den langfristigen Verlauf aller bisher publizierten Fälle von Faktor-V-Inhibitoren.
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18
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Abstract
SummaryThe fibrinolytic capacity of 121 patients with a history of venous thrombosis and/or pulmonary embolism was studied by venous occlusion technique, at earliest 3 months after the last thromboembolic episode. After discontinuation of oral anticoagulation treatment the clinical course of the patients was followed and new thromboembolic episodes were noted. During the observation period of 56 ± 18.8 months 45 of 121 patients experienced recurrence of thrombosis. The recurrence-rate was significantly lower in patients with a post-occlusion ELT shorter than 60 min (4.8%/year) than in patients with an ELT longer than 60 min (10.3%/year). It is concluded that the fibrinolytic capacity is a useful parameter for determining the risk of recurrence in patients with venous thrombosis.
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Affiliation(s)
- C Korninger
- The 1st Department of Medicine1 (Head: Prof. Dr. Dr. h. c. E. Deutsch) Division of Haematology and Blood Coagulation, University of Vienna, Austria
| | - K Lechner
- The 1st Department of Medicine1 (Head: Prof. Dr. Dr. h. c. E. Deutsch) Division of Haematology and Blood Coagulation, University of Vienna, Austria
| | - H Niessner
- The 1st Department of Medicine1 (Head: Prof. Dr. Dr. h. c. E. Deutsch) Division of Haematology and Blood Coagulation, University of Vienna, Austria
| | - H Gössinger
- The 1st Department of Medicine1 (Head: Prof. Dr. Dr. h. c. E. Deutsch) Division of Haematology and Blood Coagulation, University of Vienna, Austria
| | - M Kundi
- The Department of Environmental Hygiene, University of Vienna, Austria
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19
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Affiliation(s)
- W R Mayr
- Institute of Blood Group Serology, (Head: Prof. Dr. P. Speiser), Div. of Hematology and Blood Coagulation, University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria
| | - K Lechner
- First Department of Medicine, (Head: Prof. Dr. Dr. h.c. E. Deutsch), Div. of Hematology and Blood Coagulation, University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria
| | - H Niessner
- First Department of Medicine, (Head: Prof. Dr. Dr. h.c. E. Deutsch), Div. of Hematology and Blood Coagulation, University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria
| | - I Pabinger-Fasching
- First Department of Medicine, (Head: Prof. Dr. Dr. h.c. E. Deutsch), Div. of Hematology and Blood Coagulation, University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria
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20
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Vikydal R, Korninger C, Kyrle PA, Niessner H, Pabinger I, Thaler E, Lechner K. The Prevalence of Hereditary Antithrombin-III Deficiency in Patients with a History of Venous Thromboembolism. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1660123] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryAntithrombin-III activity was determined in 752 patients with a history of venous thrombosis and/or pulmonary embolism. 54 patients (7.18%) had an antithrombin-III activity below the normal range. Among these were 13 patients (1.73%) with proven hereditary deficiency. 14 patients were judged to have probable hereditary antithrombin-III deficiency, because they had a positive family history, but antithrombin-III deficiency could not be verified in other members of the family. In the 27 remaining patients (most of them with only slight deficiency) hereditary antithrombin-III deficiency was unlikely. The prevalence of hereditary antithrombin-III deficiency was higher in patients with recurrent venous thrombosis.
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Affiliation(s)
- R Vikydal
- The First Department of Medicine, Division of Haematology and Blood Coagulation, University of Vienna, Austria
| | - C Korninger
- The First Department of Medicine, Division of Haematology and Blood Coagulation, University of Vienna, Austria
| | - P A Kyrle
- The First Department of Medicine, Division of Haematology and Blood Coagulation, University of Vienna, Austria
| | - H Niessner
- The First Department of Medicine, Division of Haematology and Blood Coagulation, University of Vienna, Austria
| | - I Pabinger
- The First Department of Medicine, Division of Haematology and Blood Coagulation, University of Vienna, Austria
| | - E Thaler
- The First Department of Medicine, Division of Haematology and Blood Coagulation, University of Vienna, Austria
| | - K Lechner
- The First Department of Medicine, Division of Haematology and Blood Coagulation, University of Vienna, Austria
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21
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Abstract
SummaryIn patients with severe nephrotic syndrome determinations of plasma protein C : Ag levels (8 patients: 5 adults, 3 children) and protein C activity (3 out of 8 patients) revealed significantly elevated plasma protein C concentrations. Furthermore we observed a significant inverse correlation of protein C : Ag to AT III : Ag levels. No protein C : Ag could be detected in the urine of two patients studied. We conclude from our data, that changes of plasma protein C do not contribute to the high thrombotic tendency in nephrotic syndrome.
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Affiliation(s)
- I Pabinger-Fasching
- The First Department of Internal Medicine (Head: Prof. Dr. Dr. h. c. E. Deutsch), Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - K Lechner
- The First Department of Internal Medicine (Head: Prof. Dr. Dr. h. c. E. Deutsch), Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - H Niessner
- The First Department of Internal Medicine (Head: Prof. Dr. Dr. h. c. E. Deutsch), Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - P Schmidt
- The First Department of Internal Medicine (Head: Prof. Dr. Dr. h. c. E. Deutsch), Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - E Balzar
- The Department of Pediatrics1 (Head: Prof. Dr. E. Zweymüller), University of Vienna, Austria
| | - Ch Mannhalter
- The First Department of Internal Medicine (Head: Prof. Dr. Dr. h. c. E. Deutsch), Division of Hematology and Blood Coagulation, University of Vienna, Austria
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22
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Chorba TL, Jason JM, Ramsey RB, Lechner K, Pabinger-Fasching I, Kalyanaraman VS, McDougal JS, Cabradilla CD, Tregillus LC, Lawrence DN, Evatt BL. HTLV-I Antibody Status in Hemophilia Patients Treated with Factor Concentrates Prepared from U.S. Plasma Sources and in Hemophilia Patients with AIDS. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummarySerum samples from 85 Austrian hemophilia patients treated with lyophilized factor concentrates prepared from U.S. plasma sources, 24 hemophilia patients from Georgia on a home therapy program with factor concentrates, and 10 U.S. hemophilia patients with acquired immunodeficiency syndrome (AIDS) were analyzed by two different methods for the presence of antibodies to the major internal antigen of human T-cell leukemia virus I (HTLV-I) p24. All but one, a Georgia sample, were negative. The absence of antibody to HTLV-I p24 in the serum of European hemophilia patients, of U.S. hemophilia patients with no symptoms of AIDS, and of U.S. hemophilia patients with AIDS is interpreted as an indication of the lack of ready transmissibility of HTLV-I in lyophilized factor concentrates.
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Affiliation(s)
- T L Chorba
- The Division of Host Factors, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia, USA
| | - J M Jason
- The Division of Host Factors, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia, USA
| | - R B Ramsey
- The Division of Host Factors, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia, USA
| | - K Lechner
- The Division of Hematology and Blood Coagulation, I. Department of Medicine, University of Vienna, Vienna, Austria
| | - I Pabinger-Fasching
- The Division of Hematology and Blood Coagulation, I. Department of Medicine, University of Vienna, Vienna, Austria
| | - V S Kalyanaraman
- The Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia, USA
| | - J S McDougal
- The Division of Host Factors, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia, USA
| | - C D Cabradilla
- The Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia, USA
| | - L C Tregillus
- The Division of Host Factors, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia, USA
| | - D N Lawrence
- The Division of Host Factors, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia, USA
| | - B L Evatt
- The Division of Host Factors, Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia, USA
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23
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Green D, Hougie C, Kazmier FJ, Lechner K, Mannucci PM, Rizza CR, Sultan Y. Report of the Working Party on Acquired Inhibitors of Coagulation: Studies of the “Lupus” Anticoagulant. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657341] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- D Green
- The Atherosclerosis Program/Northwestern University, Rehabilitation Institute of Chicago, Illinois
| | - C Hougie
- The University of California, San Diego, LaJolla, California
| | - F J Kazmier
- The Mayo Clinic/Special Coagulation Lab, Rochester, Minnesota, U.S.A
| | - K Lechner
- The I. Medizinische Universitätsklinik, Vienna, Austria
| | - P M Mannucci
- The Universita Degli Studi Di Milano, Milan, Italy
| | - C R Rizza
- The Oxford Haemophilia Centre, Oxford, England
| | - Y Sultan
- The Service d'Hematologie de I'Hdpital Cochin, Paris, France
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24
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Abstract
SummaryProtein C antigen was determined by Laurell rocket immunelectrophoresis in 225 patients with a history of venous thrombosis. Among these patients two females with protein C deficiency were detected. Additional studies in the families of the protein C deficient patients revealed further 7 family members with protein C deficiency. In 8 not anticoagulated patients with protein C deficiency the protein C ranged from 36 to 62% (median: 45%). In one patient on oral anticoagulant treatment protein C antigen concentration was < 10%, FII and F X were 65 and 50%, respectively. The pattern of inheritance was consistent with autosomal dominant inheritance. 5 of the 9 protein C deficient patients had severe thrombotic tendency characterized by recurrent deep venous thrombosis (n = 4), pulmonary embolism (n = 1), probable mesenteric vein thrombosis (n = 1) and superficial thrombophlebitis (n = 2). All protein C deficient patients without thrombosis were less than 17 years old.
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Affiliation(s)
- I Pabinger-Fasching
- The Division of Hematology and Blood Coagulation, First Department of Medicine, University of Vienna, Austria
| | - R M Bertina
- The Thrombosis and Hemostasis Research Unit, Leiden University Hospital, Leiden, The Netherlands
| | - K Lechner
- The Division of Hematology and Blood Coagulation, First Department of Medicine, University of Vienna, Austria
| | - H Niessner
- The Division of Hematology and Blood Coagulation, First Department of Medicine, University of Vienna, Austria
| | - Ch Korninger
- The Division of Hematology and Blood Coagulation, First Department of Medicine, University of Vienna, Austria
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25
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Lechner K, Niessner H, Bettelheim P, Deutsch E, Fasching I, Fuhrmann M, Hinterberger W, Korninger C, Neumann E, Liszka K, Knapp W, Mayr WR, Stingl G, Zeitlhuber U. T-Cell Alterations in Hemophiliacs Treated with Commercial Clotting Factor Concentrates. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1665253] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryVarious immunological parameters were determined in 46 patients with severe hemophilia A and in 9 patients with severe hemophilia B. All patients were treated over many years with commercial factor VIII or IX concentrates. Patients with severe classic hemophilia had a significantly reduced relative and absolute number of T-helper cells and a significantly increased relative and absolute number of T-suppressor cells. About half of these patients had an inverse T-helper/suppressor cell ratio. Patients with moderate hemophilia A and severe hemophilia B did not show these abnormalities. Hemophiliacs with an inverse ratio had a significantly higher concentration of serum total protein, IgG and IgM. No relationship between the amount of factor VIII concentrate administered, the HLA-type of the patient, the presence or absence of CMV-antibodies, hepatitis markers, thrombocytopenia and abnormal liver function tests to the T-cell abnormalities could be established. Lymphadenopathy was frequently associated with an inverse ratio. Indirect evidence suggests that the alterations of the immune system began in 1979/80.
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Affiliation(s)
- K Lechner
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - H Niessner
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - P Bettelheim
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - E Deutsch
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - I Fasching
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - M Fuhrmann
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - W Hinterberger
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - C Korninger
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - E Neumann
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - K Liszka
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - W Knapp
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - W R Mayr
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - G Stingl
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
| | - U Zeitlhuber
- The Division of Hematology and Blood Coagulation, First Department of Medicine; Institute of Immunology; Institute of Blood Group Serology; Department of Dermatology and Department of Pediatrics, University of Vienna, Austria
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26
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Abstract
SummaryA collaborative trial has been carried out under the auspices of the International Committee on Thrombosis and Haemostasis to compare the Bethesda and New Oxford methods of antibody assay. It was found that errors between laboratories were much greater than those within laboratories and each laboratory had a bias whereby it always rated samples high or low with respect to the other laboratories. However there was excellent agreement in the order in which laboratories ranked antibody samples and if a standard antibody sample could be provided there would be a significant improvement in numerical agreement between laboratories. On average, for this exercise, a result for a given sample in Bethesda units was 1.21 times the result in New Oxford units although it must be stressed that this ratio could vary from sample to sample.
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Affiliation(s)
- D E G Austen
- The Haemophilia Centre, Churchill Hospital, Oxford, England
| | - K Lechner
- The Medizinische Universitätsklinik, Vienna, Austria
| | - C R Rizza
- The Haemophilia Centre, Churchill Hospital, Oxford, England
| | - I L Rhymes
- The Haemophilia Centre, Churchill Hospital, Oxford, England
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27
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Lechner K, Nowotny C, Krinninger B, Zegner M, Deutsch E. Effect of Treatment with Activated Prothrombin Complex Concentrate (FEIBA) on Factor VIII-Antibody Level. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe influence of treatment with an activated prothrombin complex preparation (FEIBA) on the antibody level was studied in 10 haemophiliacs with an antibody to factor VIII. The antibody level was observed to rise at least once in five patients, while in the remaining five patients no rise occurred. In all, 6 out of 31 treatments were followed by an anamnestic rise of the antibody level, corresponding to 19.4%. A rise of the inhibitor level following FEIBA treatment is likely to occur in patients who show a marked antibody rise after factor VIII treatment (good responders), but have a low antibody level at the time of treatment. High doses of FEIBA and simultaneous transfusion of red cells may also enhance the likelihood of an anamnestic response. Stimulation of antibody production is probably due to the presence of small amounts of factor VIII in this preparation.
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Affiliation(s)
- K Lechner
- The Coagulation Laboratory First Department of Internal Medicine, University of Vienna
| | - Ch Nowotny
- The Coagulation Laboratory First Department of Internal Medicine, University of Vienna
| | - B Krinninger
- The Coagulation Laboratory First Department of Internal Medicine, University of Vienna
| | - M Zegner
- The Coagulation Laboratory First Department of Internal Medicine, University of Vienna
| | - E Deutsch
- The Coagulation Laboratory First Department of Internal Medicine, University of Vienna
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28
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Kyrle PA, Eichinger S, Pabinger I, Stümpflen A, Hirschl M, Bialonczyk C, Schneider B, Mannhalter C, Melichart M, Traxler G, Weltermann A, Speiser W, Lechner K. Prothrombin Fragment F1+2 Is not Predictive for Recurrent Venous Thromboembolism. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIt would be important to estimate in advance the risk of recurrent thrombosis. Deficiencies of antithrombin, protein C or protein S, or resistance to activated protein C are associated with a biochemically detectable prethrombotic state. It is thus far unknown whether in patients with a history of thromboembolism but without a defined clotting abnormality a heightened coagulation activation is detectable.We investigated the value of prothrombin fragment Fl+2 (FI+2) as a predictor of recurrent venous thromboembolism. Furthermore, we compared the Fl+2 levels of thrombosis patients without a defined clotting defect to those of Factor V Leiden patients with a history of venous thrombosis and to those of healthy controls. 180 patients without a defined clotting abnormality and 73 patients with Factor V Leiden were prospectively followed after discontinuation of oral anticoagulants for venous thrombosis and Fl+2 was measured at regular intervals.Recurrent venous thromboembolism occurred in 23 (9%) of the 253 patients. Before or at several time points after oral anticoagulants, no significant difference in Fl+2 levels was found in patients with and without recurrent thrombosis. Fl+2 levels at 3 weeks and prior to recurrence were not significantly different in both patient groups. Over a one-year observation period, Fl+2 levels of both patients with and without Factor V Leiden were higher than those of the controls. No difference in Fl+2 was seen between patients with and without Factor V Leiden.We conclude that monitoring of Fl+2 is not suitable for identification of individuals at risk of recurrent venous thrombosis. Permanent hemostatic system activation is detectable both in patients with a defined abnormality of the clotting system and in patients in whom a particular defect has not (yet) been identified.
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Affiliation(s)
- P A Kyrle
- The Department of Internal Medicine I, University of Vienna, Austria
| | - S Eichinger
- The Department of Internal Medicine I, University of Vienna, Austria
| | - I Pabinger
- The Department of Internal Medicine I, University of Vienna, Austria
| | - A Stümpflen
- The Department of Internal Medicine II, University of Vienna, Austria
| | - M Hirschl
- The Department of Hanuschkrankenhaus, Vienna, Austria
| | | | - B Schneider
- The department of Medical Statistics, University of Vienna, Austria
| | - C Mannhalter
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, University of Vienna, Austria
| | - M Melichart
- The Department of Internal Medicine I, University of Vienna, Austria
| | - G Traxler
- The Department of Internal Medicine I, University of Vienna, Austria
| | - A Weltermann
- The Department of Internal Medicine I, University of Vienna, Austria
| | - W Speiser
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, University of Vienna, Austria
| | - K Lechner
- The Department of Internal Medicine I, University of Vienna, Austria
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29
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Abstract
SummaryTreatment with AT III concentrates is a good example for the discrepancy between the optimistic expectations based on theoretical considerations or animal experiments and the result of clinical studies. 15 years after the introduction into clinical practice, a benefit for patients treated with AT III concentrates has not been proven. In hereditary antithrombin III deficiency, randomized clinical trials are completely lacking and only few and small sized randomized studies were performed in patients with acquired AT III deficiency. In none of these trials, a significant clinical benefit with regard to reduction of morbidity or mortality was detectable. Based on the published data, one can state that AT III concentrates may be beneficial in some special clinical situations in patients with hereditary antithrombin III deficiency (such as delivery, acute serious thromboembolic complications and postoperative thromboprophylaxis). In acquired AT III deficiency, there is no proven indication for the use of AT III concentrates.
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Affiliation(s)
- K Lechner
- The Department of Medicine I, Division of Hematology/Blood Coagulation, University of Vienna, Vienna, Austria
| | - P A Kyrle
- The Department of Medicine I, Division of Hematology/Blood Coagulation, University of Vienna, Vienna, Austria
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30
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Knöbl P, Derfler K, Korninger L, Kapiotis S, Jäger U, Maier-Dobersberger T, Hörl W, Lechner K, Pabinger I. Elimination of Acquired Factor VIII Antibodies by Extracorporal Antibody-based Immunoadsorption (Ig-Therasorb®). Thromb Haemost 2018. [DOI: 10.1055/s-0038-1649876] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryTreatment of potent factor VIII antibodies is a difficult problem. In some cases a reduction ofthe antibody titer is necessary for effective treatment with human factor VIII concentrates. We describe a new method for extracorporal eliminationof factor VIII antibodies (antibody-based immunoadsorption). Blood is drawn from an antecubital vein, citrated, and plasma is separated with a rotating membrane. Plasma passes alternately through one of two columns filled with sepharose-coupled polyclonal sheep antibodies to human immunoglobulins (Ig-Therasorb00), whereas the other column is regenerated. Each cycle has a duration of 15 min. Three patients with high titer factor VIII antibodies (one hemophiliac and 2 with spontaneous antibodies; titers 29, 132, and 313 BU/ml, respectively) were treated. The average reduction of the antibody titer was 76.1 ± 17.2% per session. In each patient 4 sessions were necessary to reduce the antibody titer to < 1 BU/ml. The mean processed plasma volume was 6731 ± 640 ml and the mean duration of each session 3.9 ± 0.7 h. Serum IgG, IgA and IgM levels decreased by 75.3 ± 11.9%, 62.9 ± 19.1%, and 54.8 ± 23.8% respectively. The procedure was tolerated without any side effects. Thus, rapid elimination of factor VIII inhibitors can be achieved with antibody-based immunoadsorption, which can be lifesaving in some cases. This promising method should be evaluated in a larger number of patients.
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Affiliation(s)
- P Knöbl
- The Department of Medicine I, Division of Hematology and Hemostaseology, University of Vienna, Vienna, Austria
| | - K Derfler
- The Department of Medicine III, Division of Nephrology, University of Vienna, Vienna, Austria
| | - L Korninger
- The Department of Clinical Chemistry and Laboratory Medicine, Coagulation Laboratory, University of Vienna, Vienna, Austria
| | - S Kapiotis
- The Department of Clinical Chemistry and Laboratory Medicine, Coagulation Laboratory, University of Vienna, Vienna, Austria
| | - U Jäger
- The Department of Medicine I, Division of Hematology and Hemostaseology, University of Vienna, Vienna, Austria
| | - T Maier-Dobersberger
- The Department of Medicine I, Division of Hematology and Hemostaseology, University of Vienna, Vienna, Austria
| | - W Hörl
- The Department of Medicine III, Division of Nephrology, University of Vienna, Vienna, Austria
| | - K Lechner
- The Department of Medicine I, Division of Hematology and Hemostaseology, University of Vienna, Vienna, Austria
| | - I Pabinger
- The Department of Medicine I, Division of Hematology and Hemostaseology, University of Vienna, Vienna, Austria
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31
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Abstract
SummaryIn a retrospective study 51 published cases of post-partum factor VIII inhibitors were analyzed with regard to the outcome according to treatment. The overall outcome was favorable with 97% survival at two years. The probability of complete remission (CR, absence of the inhibitor and normalization of factor VIII activity) was almost 100% at 30 months. Steroid treatment appears to be not superior to no treatment, but patients treated with immunosuppressive drugs (cyclophosphamide, azathioprine, 6-mercaptopurine) had a significantly shorter time to CR. In the absence of a randomized trial this analysis may be helpful for decision-making in women with factor VIII post-partum inhibitors. Because of the retrospective study design, conclusions have to be regarded with caution.
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Affiliation(s)
- I Hauser
- The First Dept. of Internal Medicine, Division of Hematology and Blood Coagulation, University of Vienna, Vienna, Austria
| | - B Schneider
- The Institute of Medical Statistics and Documentation, University of Vienna, Vienna, Austria
| | - K Lechner
- The First Dept. of Internal Medicine, Division of Hematology and Blood Coagulation, University of Vienna, Vienna, Austria
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32
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Schwarzinger I, Stain-Kos M, Bettelheim R, Pabinger I, Kyrle P, Kalhs P, Kapiotis S, Jäger U, Lechner K. Recurrent, Isolated Factor X Deficiency in Myeloma: Repeated Normalization of Factor X Levels after Cytostatic Chemotherapy Followed by Late Treatment Failure Associated with the Development of Systemic Amyloidosis. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe describe the case of a 64-year-old woman with isolated severe factor X deficiency associated with kappa light chain myeloma. At the time of diagnosis there was no evidence for amyloidosis. Complete remission (CR) of myeloma as well as normalization of factor X levels were achieved after cytostatic chemotherapy. Subsequently, factor X deficiency recurred twice without any evidence for relapse of myeloma. The first time factor X normalized again following cytostatic treatment, the second time, however, factor X deficiency was refractory to chemotherapy. Finally, relapse of myeloma became evident associated with rapidly progressing, systemic amyloidosis, which was fatal within a few months. Initially, factor X infusion studies showed a normal recovery, but when amyloidosis became overt the recovery decreased to 0%. We assume that factor X deficiency was due to a binding of factor X to kappa light chains associated with the proliferation of the malignant myeloma cell clone.
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Affiliation(s)
- I Schwarzinger
- The 1st Medical Department, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - M Stain-Kos
- The 1st Medical Department, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - R Bettelheim
- The 1st Medical Department, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - I Pabinger
- The 1st Medical Department, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - P Kyrle
- The 1st Medical Department, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - P Kalhs
- The 1st Medical Department, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - S Kapiotis
- The 1st Medical Department, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - U Jäger
- The 1st Medical Department, Division of Hematology and Blood Coagulation, University of Vienna, Austria
| | - K Lechner
- The 1st Medical Department, Division of Hematology and Blood Coagulation, University of Vienna, Austria
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33
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Pabinger I, Kyrle PA, Speiser W, Stoffels U, Jung M, Lechner K. Diagnosis of Protein C Deficiency in Patients on Oral Anticoagulant Treatment: Comparison of Three Different Functional Protein C Assays. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1645056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe efficacy of three different protein C activity assays and of protein C antigen determination for the diagnosis of protein C deficiency was studied in 13 protein C deficient patients (11 with type I, 2 with type II deficiency) and in 51 presumably nondeficient patients (control group), both groups being on oral anticoagulant (OAC) treatment. For protein C activity measurement (1) the assay according to Francis (slightly modified) with thrombin activation and measurement of activated protein C in the aPTT system, (2) an assay using Protac activation and chromogenic substrate (Protac-CS) and (3) an assay using Protac activation and the aPTT system (Protac-PTT) were used. Protein C antigen was determined by Laurcll immunoelec-trophoresis. The three activity assays gave different results, with the highest values obtained by the Protac-CS assay and the lowest values by the Protac-PTT assay. The Francis assay gave intermediate results.Protein C activity and antigen values were significantly lower in protein C deficient patients compared to the control group. Protein C activity tests had a higher discriminative power than the antigen determination. After taking into account the intensity of treatment, by the Francis assay all deficient and non-deficient patients were correctly classified, by the Protac-CS and the Protac-PTT assay 2 and 4 patients, respectively, were misclas-sified and by the antigen assay 8 patients were misclassified. Calculation of the ratios of protein C activity to factor II activity was of high discriminative power.We conclude that for diagnosis of protein C deficiency protein C activity tests are superior to antigen determination not only in type II but also in type I deficient patients. Certain statistical procedures can further improve the discrimination between deficient and non-deficient patients.
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Affiliation(s)
- I Pabinger
- The I. Department of Internal Medicine, University of Vienna, Austria
| | - P A Kyrle
- The I. Department of Internal Medicine, University of Vienna, Austria
| | - W Speiser
- The I. Department of Internal Medicine, University of Vienna, Austria
| | - U Stoffels
- The I. Department of Internal Medicine, University of Vienna, Austria
| | - M Jung
- The I. Department of Internal Medicine, University of Vienna, Austria
| | - K Lechner
- The I. Department of Internal Medicine, University of Vienna, Austria
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34
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Abstract
SummaryFactor IX-antibody-neutralizing material has been estimated in plasmas of patients with acquired factor IX deficiency. In patients with liver cirrhosis and patients who had been treated with L-Asparaginase the plasma neutralized an amount of antibody expected from the biological activity. In patients treated with phenprocoumon and in one patient with biliary obstruction an excess of factor IX-antibody neutralizing material was found. This inactive factor IX probably represents a precursor molecule of factor IX.
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35
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Abstract
Summary1. Two patients with severe hemophilia B and an acquired inhibitor against factor IX are described.2. The inhibitors inactivate factor IX irreversibly. The speed of inactivation is very fast and cannot slowed down by dilution of the inhibitor or by lowering of the incubation temperature. Factor IX of serum is inactivated to a higher degree than factor IX of plasma. Factor IX inhibitors are more sensitive to dilution than factor VIII inhibitors.3. The inhibitor protein is eluted from the Sephadex G-200 column with the G-peak. On Chromatography on DEAE-cellulose two activity peaks are obtained.4. Immunologically the inhibitors belong predominantly to the immune globulins of the G-class, but it cannot be excluded that the activity is also associated with IgA. As light chains kappa chains were found in one case.
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36
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Abstract
Summary1. Methods have been developed for the preparation of factor VII free of prothrombin and factor X, and of factor X with only a very low contamination with factor VII.2. Factors VII and X could be found with one stage methods in purified prothrombin prepared according to Seegers.3. Purified prothrombin was chromatographed on DE AE-cellulose. Two active fractions could be eluted, the first with the characteristics of Seegers’ DE AE-Prothrombin, the second with the characteristics of factor X.4. It was confirmed that DE AE-Prothrombin does not activate to thrombin in 25% citrate, and does not generate autoprothrombin C.5. The combination of both clotting active fractions coming from the DEAE-column restores the properties of non-chromatographed prothrombin.6. DE AE-cellulose chromatography of prothrombin does not induce a molecular change of prothrombin, but separates factor X from prothrombin.7. Factor X can be activated with tissue thromboplastin-factor VII or with high concentrated neutral salt solutions to a substance with the biological characteristics of autoprothrombin C.8. TAMe activity is generated in factor X preparations after incubation with tissue thromboplastin and calcium.9. Factor VII cannot be transformed into autoprothrombin C under the conditions tested.10. Factor VII is necessary for the activation of factor X with tissue thromboplastin but not with RVV.11. The amount of factor X available determines the amount of autoprothrombin C formed, whereas thromboplastin and factor VII influence the rate of the reaction.12. The final conclusion is that activated factor X is similar to or identical with autoprothrombin C.
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38
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Abstract
SummaryTwo cases of thrombasthenia in the same family are described in which a deficiency of glutathionreductase and a reduction of reduced glutathion was found in the platelets, but no in the erythrocytes.
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39
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Abstract
ZusammenfassungEs wird eine Methode zur Herstellung eines artifiziellen Faktor-VII-Mangelplasmas beschrieben, wobei Faktor VII von den Faktoren II und X durch Chromatographie an DEAE-Zellulose abgetrennt wird. Vergleichende Teste mit dem artifiziellen Faktor-VII-Mangelplasma und einem natürlichen Faktor-VII-Mangelplasma ergaben eine befriedigende Übereinstimmung der Werte.
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40
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41
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Böhmig HJ, Fritsch A, Kux M, Lechner G, Lechner K, Reich N, Stockinger L, Zeitelberger P. Gerinnungsveränderungen bei orthotoper Lebertransplantation am Hund. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1653543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
ZusammenfassungBei 16 Hunden wurden bei orthotopen Auto- und Homotransplantationen der Leber Gerinnungsuntersuchungen durchgeführt. Während die Anästhesie, die Präparation der Lebergefäße und Manipulationen an Leber und Lunge keine Gerinnungsveränderungen hervorriefen, kam es nach Anlegen des äußeren venösen Bypass und Entnahme der Leber zu einem Abfall von Fibrinogen, Thrombozyten, Faktor II, Faktor VIII und Antithrombin III. Diese Veränderungen werden als Ausdruck einer Verbrauchskoagulopathie angesehen. Eine leichte Fibrinolyse war gewöhnlich erst am Ende der anhepatischen Phase nachweisbar und dürfte sekundär sein. Nach Implantation der Leber war nach kurzer Latenzzeit ein Wiederanstieg der oben genannten Faktoren und der Thrombozyten zu beobachten. Die möglichen Ursachen für das Auftreten der Verbrauchsreaktion werden diskutiert.
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42
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Abstract
Summary1. In 2 patients blood coagulation inhibitors have been found. The first patient showed pancytopenia, splenomegaly and increase of macroglobulins in serum, no definite clinical diagnosis could be established. The second patient had a history of thromboembolic diseases, but appeared healthy at the time of investigation.2. Clotting time, partial thromboplastin time and prothrombin time were prolonged in both patients. All clotting factors were normal if tested in dilution. Plasma and serum of the patients prolonged the partial thromboplastin time and prothrombin time of normal plasma.3. Using partially purified clotting factors it could be shown that the inhibitors inhibit the activation of prothrombin by prothrombin activator (reaction product of F Xa+ F V+lipid). The velocity of thrombin generation and the amount of thrombin generated was reduced.4. The inhibitory activity in both cases was present in the macroglobulin peak after gel filtration, slight activity was detected also in the G-peak in case 2. After DEAEchromatography, activity appeared in both cases in those fractions which contain IgM, in case 2 also in the first protein fractions containing only IgG.5. Inhibitor activity could be reduced in both cases only be incubation with anti-IgM antiserum.6. It is concluded that the inhibitor in case 1 is IgM and in case 2 IgM-IgG.
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Lechner K, Speiser W, Pabinger I, Male C. Transient Lupus Anticoagulants in Children: Stepwise Disappearance of Diagnostic Features. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613777] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Baghestanian M, Bankl HC, Sillaber C, Sperr WR, Wojta J, Binder BR, Lechner K, Valent P. New Aspects in Thrombosis Research: Possible Role of Mast Cells as Profibrinolytic and Antithrombotic Cells. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613084] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryVenous thromboembolism represents a significant cause of morbidity worldwide. The factors that underly thrombophilia are manifold. The concept of Virchow defines the well known triad of stasis, humoral factors, and pathologies of the vascular wall. In the current article, an additional factor, the “accumulation of repair cells” is discussed. This novel concept highlights the mast cell that accumulates around thrombosed vessels and provides a number of important repair molecules including heparin, profibrinolytic tPA, and fibrinogenolytic β-tryptase. Thus, mast cell recruitment and activation may result in local thrombolysis and prevention of coagulation. In line with this concept, mast cell-deficient mice are more susceptible to lethal thrombogenic stimuli compared to normal mice. The factors (cytokines) that trigger mast cell accumulation and release of repair molecules have also been identified – the most important one appears to be stem cell factor (SCF). All in all, our novel concept suggests that the patho-physiology of thrombosis may involve a “physiologic” cell that provides the same repair molecules that are used for treatment of thrombotic disorders by the physician. Whether an altered availability of components of this cellular repair system can predispose for thrombophilia remains to be determined.
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Gerges M, Gerges C, Publig M, Skoro-Sajer N, Bonderman D, Frey M, Schwarzinger I, Lechner K, Seidl V, Alimohammadi A, Winter M, Humenberger M, Eichelberger B, Panzer S, Lang I. P5367Chronic inflammation after splenectomy is a risk factor for increased thrombotic cardiovascular events. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5367] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lechner K, Haseneder R, Repke JU. Untersuchung des Permeationsverhaltens organischer Lösemittel durch keramische Nanofiltrationsmembranen. CHEM-ING-TECH 2016. [DOI: 10.1002/cite.201650068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wosnitza CI, Lechner K, Giehring S. PAIA assays: A new bead-based assay system for high throughput protein quantification. BMC Proc 2015. [PMCID: PMC4685399 DOI: 10.1186/1753-6561-9-s9-p62] [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] [Indexed: 11/12/2022] Open
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Lechner K, Aulinger B, Brand S, Waldmann E, Parhofer KG. Hydrothermally modified slow release corn starch: a potential new therapeutic option for treating hypoglycemia in autoimmune hypoglycemia (Hirata's disease). Eur J Clin Nutr 2015; 69:1369-70. [PMID: 26373963 DOI: 10.1038/ejcn.2015.151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/27/2015] [Accepted: 07/31/2015] [Indexed: 11/09/2022]
Abstract
We report the successful treatment of autoimmune hypoglycemia in an 82-year-old non-diabetic Caucasian male with hydrothermally modified slow release corn starch, a product which is used in other conditions associated with hypoglycemia, most typically glycogen storage disease type I. An 82-year-old-Caucasian male presented with recurrent spontaneous hypoglycemia as low as 30 mg/dl following in-patient treatment for community acquired pneumonia. During a fasting-test, symptomatic hypoglycemia occurred. Plasma concentrations of c-peptide and insulin were considerably elevated. Autoimmune hypoglycemia was confirmed by the presence of insulin autoantibodies. While dietary restriction alone did not result in sufficient glucose control in this patient with autoimmune hypoglycemia, treatment with hydrothermally modified slow release corn starch led to stable euglycemia. This easy, well tolerated and non-invasive treatment may constitute a new therapeutic option for hypoglycemia in patients with autoimmune hypoglycemia who do not achieve sufficient control of hypoglycemia by dietary restriction alone.
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Affiliation(s)
- K Lechner
- Department of Medicine II, Ludwig-Maximilians-Universität München, Munich, Germany
| | - B Aulinger
- Department of Medicine II, Ludwig-Maximilians-Universität München, Munich, Germany
| | - S Brand
- Department of Medicine II, Ludwig-Maximilians-Universität München, Munich, Germany
| | - E Waldmann
- Department of Medicine II, Ludwig-Maximilians-Universität München, Munich, Germany
| | - K G Parhofer
- Department of Medicine II, Ludwig-Maximilians-Universität München, Munich, Germany
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Geissler K, Stockenhuber F, Hinterberger W, Balcke B, Lechner K. Recombinant human erythropoietin: a multipotential hemopoietic growth factor in vivo and in vitro. Contrib Nephrol 2015; 87:1-10. [PMID: 2093535 DOI: 10.1159/000419472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- K Geissler
- Abteilungen für Hämatologie, 1. Medizinische Universitätsklinik, Wien, Osterreich
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Moerlein SM, Perlmutter JS, Engelbach J, Sharp T, Kim JY, Rowland D, Laforest R, Mody P, Patel G, Lechner K, Welch MJ. Comparison of carbon-11 and fluorine-18 labeled (N-methyl)benperidol (NMB) in rodents using micropet imaging. J Labelled Comp Radiopharm 2012. [DOI: 10.1002/jlcr.25804401160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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