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Pieper T, Roth KDR, Glaser V, Riet T, Buitrago-Molina LE, Hagedorn M, Lieber M, Hust M, Noyan F, Jaeckel E, Hardtke-Wolenski M. Generation of Chimeric Antigen Receptors against Tetraspanin 7. Cells 2023; 12:1453. [PMID: 37296574 PMCID: PMC10252682 DOI: 10.3390/cells12111453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/10/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
Adoptive transfer of antigen-specific regulatory T cells (Tregs) has shown promising results in the treatment of autoimmune diseases; however, the use of polyspecific Tregs has limited effects. However, obtaining a sufficient number of antigen-specific Tregs from patients with autoimmune disorders remains challenging. Chimeric antigen receptors (CARs) provide an alternative source of T cells for novel immunotherapies that redirect T cells independently of the MHC. In this study, we aimed to generate antibody-like single-chain variable fragments (scFv) and subsequent CARs against tetraspanin 7 (TSPAN7), a membrane protein highly expressed on the surface of pancreatic beta cells, using phage display technology. We established two methods for generating scFvs against TSPAN7 and other target structures. Moreover, we established novel assays to analyze and quantify their binding abilities. The resulting CARs were functional and activated specifically by the target structure, but could not recognize TSPAN7 on the surface of beta cells. Despite this, this study demonstrates that CAR technology is a powerful tool for generating antigen-specific T cells and provides new approaches for generating functional CARs.
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Affiliation(s)
- Tom Pieper
- Department of Gastroenterology, Hepatology, Infectious Diseases & Endocrinology, Hannover Medical School, 30625 Hannover, Germany
| | - Kristian Daniel Ralph Roth
- Institut für Biochemie, Biotechnologie und Bioinformatik, Abteilung Medizinische Biotechnologie, Technische Universität Braunschweig, 38106 Braunschweig, Germany
| | - Viktor Glaser
- Department of Gastroenterology, Hepatology, Infectious Diseases & Endocrinology, Hannover Medical School, 30625 Hannover, Germany
| | - Tobias Riet
- Department of Gastroenterology, Hepatology, Infectious Diseases & Endocrinology, Hannover Medical School, 30625 Hannover, Germany
- Department I of Internal Medicine, Tumor Genetics, University Hospital of Cologne, Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50933 Cologne, Germany
| | - Laura Elisa Buitrago-Molina
- Department of Gastroenterology, Hepatology, Infectious Diseases & Endocrinology, Hannover Medical School, 30625 Hannover, Germany
| | - Maike Hagedorn
- Department of Gastroenterology, Hepatology, Infectious Diseases & Endocrinology, Hannover Medical School, 30625 Hannover, Germany
| | - Maren Lieber
- Department of Gastroenterology, Hepatology, Infectious Diseases & Endocrinology, Hannover Medical School, 30625 Hannover, Germany
| | - Michael Hust
- Institut für Biochemie, Biotechnologie und Bioinformatik, Abteilung Medizinische Biotechnologie, Technische Universität Braunschweig, 38106 Braunschweig, Germany
| | - Fatih Noyan
- Department of Gastroenterology, Hepatology, Infectious Diseases & Endocrinology, Hannover Medical School, 30625 Hannover, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology, Infectious Diseases & Endocrinology, Hannover Medical School, 30625 Hannover, Germany
- Department of Liver Transplantation, Multi Organ Transplant Program, University Health Network, University of Toronto, Toronto, ON M5T 0S8, Canada
| | - Matthias Hardtke-Wolenski
- Department of Gastroenterology, Hepatology, Infectious Diseases & Endocrinology, Hannover Medical School, 30625 Hannover, Germany
- Institute of Medical Microbiology, University Hospital Essen, University Duisburg-Essen, 47057 Essen, Germany
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Dywicki J, Buitrago‐Molina LE, Noyan F, Davalos‐Misslitz AC, Hupa‐Breier KL, Lieber M, Hapke M, Schlue J, Falk CS, Raha S, Prinz I, Koenecke C, Manns MP, Wedemeyer H, Hardtke‐Wolenski M, Jaeckel E. The Detrimental Role of Regulatory T Cells in Nonalcoholic Steatohepatitis. Hepatol Commun 2022; 6:320-333. [PMID: 34532981 PMCID: PMC8793993 DOI: 10.1002/hep4.1807] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 12/26/2022] Open
Abstract
Nonalcoholic steatohepatitis (NASH) is induced by steatosis and metabolic inflammation. While involvement of the innate immune response has been shown, the role of the adaptive immune response in NASH remains controversial. Likewise, the role of regulatory T cells (Treg) in NASH remains unclear although initial clinical trials aim to target these regulatory responses. High-fat high-carbohydrate (HF-HC) diet feeding of NASH-resistant BALB/c mice as well as the corresponding recombination activating 1 (Rag)-deficient strain was used to induce NASH and to study the role of the adaptive immune response. HF-HC diet feeding induced strong activation of intrahepatic T cells in BALB/c mice, suggesting an antigen-driven effect. In contrast, the effects of the absence of the adaptive immune response was notable. NASH in BALB/c Rag1-/- mice was substantially worsened and accompanied by a sharp increase of M1-like macrophage numbers. Furthermore, we found an increase in intrahepatic Treg numbers in NASH, but either adoptive Treg transfer or anti-cluster of differentiation (CD)3 therapy unexpectedly increased steatosis and the alanine aminotransferase level without otherwise affecting NASH. Conclusion: Although intrahepatic T cells were activated and marginally clonally expanded in NASH, these effects were counterbalanced by increased Treg numbers. The ablation of adaptive immunity in murine NASH led to marked aggravation of NASH, suggesting that Tregs are not regulators of metabolic inflammation but rather enhance it.
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Affiliation(s)
- Janine Dywicki
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Laura Elisa Buitrago‐Molina
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
- Department of Gastroenterology and HepatologyEssen University HospitalUniversity Duisburg‐EssenEssenGermany
| | - Fatih Noyan
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Ana C. Davalos‐Misslitz
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Katharina L. Hupa‐Breier
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Maren Lieber
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Martin Hapke
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Jerome Schlue
- Institute of PathologyHannover Medical SchoolHannoverGermany
| | - Christine S. Falk
- Institute of Transplant ImmunologyHannover Medical SchoolHannoverGermany
| | - Solaiman Raha
- Institute of ImmunologyHannover Medical SchoolHannoverGermany
| | - Immo Prinz
- Institute of ImmunologyHannover Medical SchoolHannoverGermany
- Institute of Systems ImmunologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Christian Koenecke
- Institute of ImmunologyHannover Medical SchoolHannoverGermany
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell TransplantationHannover Medical SchoolHannoverGermany
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
| | - Heiner Wedemeyer
- Department of Gastroenterology and HepatologyEssen University HospitalUniversity Duisburg‐EssenEssenGermany
| | - Matthias Hardtke‐Wolenski
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
- Department of Gastroenterology and HepatologyEssen University HospitalUniversity Duisburg‐EssenEssenGermany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology, and EndocrinologyHannover Medical SchoolHannoverGermany
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Buitrago-Molina LE, Dywicki J, Noyan F, Schepergerdes L, Pietrek J, Lieber M, Schlue J, Manns MP, Wedemeyer H, Jaeckel E, Hardtke-Wolenski M. Anti-CD20 Therapy Alters the Protein Signature in Experimental Murine AIH, but Not Exclusively towards Regeneration. Cells 2021; 10:cells10061471. [PMID: 34208308 PMCID: PMC8231180 DOI: 10.3390/cells10061471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Autoimmune hepatitis (AIH) is a chronic autoimmune inflammatory disease that usually requires lifelong immunosuppression. Frequent recurrences after the discontinuation of therapy indicate that intrahepatic immune regulation is not restored by current treatments. Studies of other autoimmune diseases suggest that temporary depletion of B cells can improve disease progression in the long term. Methods: We tested a single administration of anti-CD20 antibodies to reduce B cells and the amount of IgG to induce intrahepatic immune tolerance. We used our experimental murine AIH (emAIH) model and treated the mice with anti-CD20 during the late stage of the disease. Results: After treatment, the mice showed the expected reductions in B cells and serum IgGs, but no improvements in pathology. However, all treated animals showed a highly altered serum protein expression pattern, which was a balance between inflammation and regeneration. Conclusions: In conclusion, anti-CD20 therapy did not produce clinically measurable results because it triggered inflammation, as well as regeneration, at the proteomic level. This finding suggests that anti-CD20 is ineffective as a sole treatment for AIH or emAIH.
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Affiliation(s)
- Laura Elisa Buitrago-Molina
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (L.E.B.-M.); (J.D.); (F.N.); (L.S.); (M.L.); (M.P.M.); (H.W.); (E.J.)
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Janine Dywicki
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (L.E.B.-M.); (J.D.); (F.N.); (L.S.); (M.L.); (M.P.M.); (H.W.); (E.J.)
| | - Fatih Noyan
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (L.E.B.-M.); (J.D.); (F.N.); (L.S.); (M.L.); (M.P.M.); (H.W.); (E.J.)
| | - Lena Schepergerdes
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (L.E.B.-M.); (J.D.); (F.N.); (L.S.); (M.L.); (M.P.M.); (H.W.); (E.J.)
| | - Julia Pietrek
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Maren Lieber
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (L.E.B.-M.); (J.D.); (F.N.); (L.S.); (M.L.); (M.P.M.); (H.W.); (E.J.)
| | - Jerome Schlue
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany;
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (L.E.B.-M.); (J.D.); (F.N.); (L.S.); (M.L.); (M.P.M.); (H.W.); (E.J.)
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (L.E.B.-M.); (J.D.); (F.N.); (L.S.); (M.L.); (M.P.M.); (H.W.); (E.J.)
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (L.E.B.-M.); (J.D.); (F.N.); (L.S.); (M.L.); (M.P.M.); (H.W.); (E.J.)
| | - Matthias Hardtke-Wolenski
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (L.E.B.-M.); (J.D.); (F.N.); (L.S.); (M.L.); (M.P.M.); (H.W.); (E.J.)
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
- Correspondence: ; Tel.: +49-201-723-6081; Fax: +49-201-723-6915
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Hupa-Breier KL, Dywicki J, Hartleben B, Wellhöner F, Heidrich B, Taubert R, Mederacke YSE, Lieber M, Iordanidis K, Manns MP, Wedemeyer H, Hardtke-Wolenski M, Jaeckel E. Dulaglutide Alone and in Combination with Empagliflozin Attenuate Inflammatory Pathways and Microbiome Dysbiosis in a Non-Diabetic Mouse Model of NASH. Biomedicines 2021; 9:biomedicines9040353. [PMID: 33808404 PMCID: PMC8066839 DOI: 10.3390/biomedicines9040353] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 12/15/2022] Open
Abstract
Dysregulation of glucose homeostasis plays a major role in the pathogenesis of non-alcoholic steatohepatitis (NASH) as it activates proinflammatory and profibrotic processes. Beneficial effects of antiglycemic treatments such as GLP-1 agonist or SGLT-2 inhibitor on NASH in patients with diabetes have already been investigated. However, their effect on NASH in a non-diabetic setting remains unclear. With this aim, we investigated the effect of long-acting GLP1-agonist dulaglutide and SGLT-2 inhibitor empagliflozin and their combination in a non-diabetic mouse model of NASH. C57BL/6 mice received a high-fat-high-fructose (HFHC) diet with a surplus of cholesterol for 16 weeks. After 12 weeks of diet, mice were treated with either dulaglutide, empagliflozin or their combination. Dulaglutide alone and in combination with empagliflozin led to significant weight loss, improved glucose homeostasis and diminished anti-inflammatory and anti-fibrotic pathways. Combination of dulaglutide and empagliflozin further decreased MoMFLy6CHigh and CD4+Foxp3+ T cells. No beneficial effects for treatment with empagliflozin alone could be shown. While no effect of dulaglutide or its combination with empaglifozin on hepatic steatosis was evident, these data demonstrate distinct anti-inflammatory effects of dulaglutide and their combination with empagliflozin in a non-diabetic background, which could have important implications for further treatment of NASH.
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Affiliation(s)
- Katharina Luise Hupa-Breier
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
- Correspondence: ; Tel.: +49-(0)-511-532-6992
| | - Janine Dywicki
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
| | - Björn Hartleben
- Department of Pathology, Hannover Medical School, 30625 Hannover, Germany;
| | - Freya Wellhöner
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
| | - Richard Taubert
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
| | - Young-Seon Elisabeth Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
| | - Maren Lieber
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
| | - Konstantinos Iordanidis
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
| | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
| | - Matthias Hardtke-Wolenski
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
- Department of Gastroenterology and Hepatology, Essen University Hospital, University Duisburg-Essen, 45147 Essen, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; (J.D.); (F.W.); (B.H.); (R.T.); (Y.S.M.); (M.L.); (K.I.); (M.P.M.); (H.W.); (M.H.-W.); (E.J.)
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Alele D, Lieber M, Slewion S, Dottino A, Camanor S, Beddoe A. Overcoming data collection challenges for breast and cervical cancer in a resource poor setting: Postwar cancer registration in Liberia. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.677] [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: 11/16/2022]
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Dywicki J, Buitrago-Molina LE, Pietrek J, Lieber M, Broering R, Khera T, Schlue J, Manns MP, Wedemeyer H, Jaeckel E, Hardtke-Wolenski M. Autoimmune hepatitis induction can occur in the liver. Liver Int 2020; 40:377-381. [PMID: 31724273 DOI: 10.1111/liv.14296] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 12/11/2022]
Abstract
The priming of T cells in the liver is widely accepted. Nonetheless, it is controversial whether immune activation in autoimmune hepatitis (AIH) occurs in the liver or in the spleen. To address this issue, we splenectomized mice and induced experimental murine AIH (emAIH) with an adenovirus (Ad)-expressing formiminotransferase cyclodeaminase (FTCD). Post-splenectomy, the experimental mice developed emAIH to a higher extent than the control mice. In addition, splenectomized mice harboured more intrahepatic B cells and a disproportionately small number of regulatory T cells (Tregs) within a reduced T cell population at the site of inflammation. These results imply that the spleen is not the site of AIH induction. In contrast, the spleen seems to have a protective function since the pathological score was more severe in splenectomized animals. These findings have important implications for the aetiology of AIH.
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Affiliation(s)
- Janine Dywicki
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Laura Elisa Buitrago-Molina
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Julia Pietrek
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Maren Lieber
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ruth Broering
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Tanvi Khera
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jerome Schlue
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Matthias Hardtke-Wolenski
- Department of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany.,Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Tenspolde M, Zimmermann K, Weber LC, Hapke M, Lieber M, Dywicki J, Frenzel A, Hust M, Galla M, Buitrago-Molina LE, Manns MP, Jaeckel E, Hardtke-Wolenski M. Regulatory T cells engineered with a novel insulin-specific chimeric antigen receptor as a candidate immunotherapy for type 1 diabetes. J Autoimmun 2019; 103:102289. [PMID: 31176558 DOI: 10.1016/j.jaut.2019.05.017] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 12/14/2022]
Abstract
Adoptive immunotherapy with ex vivo expanded, polyspecific regulatory T cells (Tregs) is a promising treatment for graft-versus-host disease. Animal transplantation models used by us and others have demonstrated that the adoptive transfer of allospecific Tregs offers greater protection from graft rejection than that of polyclonal Tregs. This finding is in contrast to those of autoimmune models, where adoptive transfer of polyspecific Tregs had very limited effects, while antigen-specific Tregs were promising. However, antigen-specific Tregs in autoimmunity cannot be isolated in sufficient numbers. Chimeric antigen receptors (CARs) can modify T cells and redirect their specificity toward needed antigens and are currently clinically used in leukemia patients. A major benefit of CAR technology is its "off-the-shelf" usability in a translational setting in contrast to major histocompatibility complex (MHC)-restricted T cell receptors. We used CAR technology to redirect T cell specificity toward insulin and redirect T effector cells (Teffs) to Tregs by Foxp3 transduction. Our data demonstrate that our converted, insulin-specific CAR Tregs (cTregs) were functional stable, suppressive and long-lived in vivo. This is a proof of concept for both redirection of T cell specificity and conversion of Teffs to cTregs.
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Affiliation(s)
- Michel Tenspolde
- Dept. of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Katharina Zimmermann
- Dept. of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Leonie C Weber
- Dept. of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Hapke
- Dept. of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Maren Lieber
- Dept. of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Janine Dywicki
- Dept. of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andre Frenzel
- Technische Universität Braunschweig, Institut für Biochemie, Biotechnologie und Bioinformatik, Abteilung Biotechnologie, Braunschweig, Germany; YUMAB GmbH, Science Campus Braunschweig-Süd, Inhoffenstr. 7, 38124, Braunschweig, Germany
| | - Michael Hust
- Technische Universität Braunschweig, Institut für Biochemie, Biotechnologie und Bioinformatik, Abteilung Biotechnologie, Braunschweig, Germany; YUMAB GmbH, Science Campus Braunschweig-Süd, Inhoffenstr. 7, 38124, Braunschweig, Germany
| | - Melanie Galla
- Institute of Experimental Haematology, Hannover Medical School, Hannover, Germany
| | - Laura E Buitrago-Molina
- Dept. of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael P Manns
- Dept. of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Elmar Jaeckel
- Dept. of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany
| | - Matthias Hardtke-Wolenski
- Dept. of Gastroenterology, Hepatology & Endocrinology, Hannover Medical School, Hannover, Germany; Dept. of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Lieber M, Behr M, Eichinger S, Eichinger W, Kühl H. First Transcatheter SAPIEN 3 Valve-in-Valve Implantation in an Early Degenerated Lotus Valve Prosthesis. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Lieber
- Klinikum Bogenhausen, Herzchirurgie, München, Germany
| | - M. Behr
- Klinikum Harlaching, Kardiologie, München, Germany
| | - S. Eichinger
- Klinikum Bogenhausen, Herzchirurgie, München, Germany
| | - W. Eichinger
- Klinikum Bogenhausen, Herzchirurgie, München, Germany
| | - H. Kühl
- Klinikum Harlaching, Kardiologie, München, Germany
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Beddoe A, Afzal O, Lieber M, Jallah W, McIntosh C, Dottino P. Training Health Workers to Provide Cervical Cancer Screening: Comparison
of Educational Strategies in Liberia, South Africa and Grenada. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.117] [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: 11/27/2022] Open
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10
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Eichinger S, Wilhelm M, Lieber M, Kotetishvili N, Eichinger W. Management and Outcome of Transcatheter Aortic Valve Implantation Requiring Surgical Intervention Focusing on the Time Interval between Complication Onset and Establishing Cardiopulmonary Bypass. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - M. Lieber
- Klinikum Bogenhausen, Munich, Germany
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11
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Afzal O, Lieber M, Du Preez C, Pearlman Shapiro M, Marie Beddoe A. Reproductive healthcare needs of sex workers in Rural South Africa: a
community assessment. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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12
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Gohar F, Orak B, Jeske M, Lieber M, von Bernuth H, Giese A, Weissbarth-Riedel E, Haas P, Dressler F, Holzinger D, Lohse P, Neudorf U, Lainka E, Kallinich T, Foell D, Wittkowski H. FRI0515 Neutrophil-Specific S100A12 Phenotype Correlates to Genotype in Familial Mediterranean Fever. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3467] [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: 11/04/2022]
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13
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Schleger S, Szolnoky J, Lieber M, Eichinger W. Severe Complications during Transcatheter Aortic Valve Implantation Requiring Surgical Intervention. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Schleger S, Lieber M, Rieber J, Eichinger W, Szolnoky J. Hybrid Approach for Conventionally Inoperable Patients with Severe Aortic Valve Stenosis and Coronary Artery Disease. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Orak B, Kallinich T, Lieber M, von Bernuth H, Wittkowski H, Foell D. PW01-008 – The inflammasome and secretory pathways in FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3953093 DOI: 10.1186/1546-0096-11-s1-a61] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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Schleger S, Szolnoky J, Lieber M, Eichinger W. Complications during transcatheter aortic valve intervention requiring the use of extracorporal circulation: A single center experience. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Schleger S, Kasel M, Lieber M, Antoni D, Hoffmann E, Eichinger W. Transapical Edwards Sapien treatment of an insufficient Corevalve. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297819] [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: 10/14/2022]
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18
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Hui F, Schuette A, Spiotta A, Lieber M, Moskowitz S, Dion J, Tong F, Barrow D, Cawley M. O-027 Antithrombotic states and outcomes in patients with aneurysmal subarachnoid hemorrhage. J Neurointerv Surg 2011. [DOI: 10.1136/neurintsurg-2011-010097.27] [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: 11/04/2022]
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Sack S, Schelp MK, Poppe S, Weber M, Krüger T, Geith S, Lieber M, Schleger S, Eichinger W, Menne J. [Aortic valve stenosis: transcatheter aortic valve implantation (TAVI) – transarterial or transapical approach]. Dtsch Med Wochenschr 2011; 136:417-26; quiz 427-30. [PMID: 21344357 DOI: 10.1055/s-0031-1274524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The calcified aortic stenosis is the dominating valve disease. Patients affected are most common elderly people in the 8 (th) or 9 (th) decade of their life who often show associated comorbidities like reduced left ventricular function, impaired renal function, pulmonary hypertension, and further diseases (Diabetes mellitus, stroke, COPD). In many cases perioperative morbidity and mortality are too high for surgical valve replacement and up to 30 % of patients are rejected. Nevertheless, prognosis of aortic stenosis is worse if the typical symptoms like dyspnea on exertion, syncope, and angina occur. The transcatheter aortic valve implantation is a new method treating this particular group of patients. The aortic valve bioprothesis consists of a balloon-expandable stent or a self-expandable frame, in which a valve of bovine or porcine pericardium is incorporated. The implantation is performed by retrograde access via the femoral or subclavian artery; the balloon-expandable prosthesis can also be implanted by transapical approach. Recently, the PARTNER trial and other studies demonstrate a high implantation success rate and better survival in comparison to standard therapy but exhibit also cerebral vascular and peripheral vascular complications. A further reduction of the available delivery systems and new types of valves which are under experimental tests and clinical evaluation contribute to this development.
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Affiliation(s)
- S Sack
- Klinik für Kardiologie, Pneumologie, Internistische Intensivmedizin und Zentrale Notaufnahme, Sektion Innere Medizin, Klinikum Schwabing, Städtisches Klinikum München GmbH, München.
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Schmidtler FW, Gundling F, Schuster T, Richter SA, Lieber M, Hoffmann E, Kemkes BM, Eichinger W, Gansera B. Cardiac surgery in patients with chronic liver cirrhosis – Uncalculatable risk or justified therapy? A retrospective survival-rate analysis of 47 patients within 8 years. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sukhotnik I, Riskin A, Bader D, Lieber M, Shamian B, Coran AG, Mogilner J. Possible importance of increased intra-abdominal pressure for the development of necrotizing enterocolitis. Eur J Pediatr Surg 2009; 19:307-10. [PMID: 19750455 DOI: 10.1055/s-0029-1231070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 10/20/2022]
Abstract
BACKGROUND/PURPOSE Despite extensive clinical and laboratory investigations, many aspects of the pathogenesis of necrotizing enterocolitis (NEC) remain unclear. In the present work we describe 5 neonates with NEC in whom intra-abdominal pressure (IAP) was measured to investigate the potential role of abdominal compartment syndrome (ACS) in the development of NEC and to correlate the severity of NEC with the value of IAP. METHODS IAP pressure was determined in two groups - Group A consisting of five patients without NEC (Control) and Group B consisting of five patients who developed NEC - by measuring the urinary bladder pressure (UBP). The correlation between increased IAP and severity of NEC, complications of NEC and indications for surgery was investigated. RESULTS In four patients from Group B, the general condition deteriorated despite aggressive supportive treatment, and a laparotomy was performed. These neonates demonstrated a significant increase (compared to Control patients) in UBP (9.0+/-2.5 vs. 4.8+/-1.4 mmHg, p=0.001), which increased progressively with exacerbation of NEC and reached a peak value of 13.3+/-2.4 mmHg before operation. The elevated IAP was accompanied by hemodynamic instability in all patients, respiratory instability in 3 patients and decreased urinary output in one patient. One patient remained unstable and died 6 h after operation. In the fifth patient from Group B, intestinal obstruction developed two weeks after NEC and did not result in increased IAP. CONCLUSIONS Our results suggest that IAP is associated with an exacerbation of NEC. Thus, this study provides further information which may improve our understanding of the pathogenic process of NEC.
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Affiliation(s)
- I Sukhotnik
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Laboratory of intestinal adaptation and recovery , Dept of Pediatric Surgery, Bnai Zion Medical Center, Haifa, Israel.
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22
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Schmidtler FW, Soyez R, Schuster T, Hashemi A, Lieber M, Hoffmann E, Kemkes BM, Gansera B. Long-term outcome of CABG – patients after previous mediastinal irradiation due to cancer. A retrospective survival-rate-analysis of 125 patients within 14 years. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Schmidtler F, Tischler I, Lieber M, Weingartner J, Angelis I, Wenke K, Kemkes B, Gansera B. Cardiac Surgery for Octogenarians - a Suitable Procedure? Twelve-Year Operative and Post-Hospital Mortality in 641 Patients over 80 Years of Age. Thorac Cardiovasc Surg 2008; 56:14-9. [DOI: 10.1055/s-2007-965642] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Syrakas C, Gansera B, Weingartner J, Lieber M, Kemkes BM. Left ventricular aneurysm resection in the era of coronary stenting – an ancient surgical technique for treatment of postinfarction heart failure? Long term results of patients with left ventricular restoration. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Schmidtler F, Angelis I, Gansera B, Lieber M, Kemkes BM. Resettling of patent left internal thoracic artery grafts from LAD to a new territory – a surgical strategy to reserve right internal thoracic artery as a second arterial conduit for the LAD in redos. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Schmidtler F, Gansera B, Lieber M, Tischler I, Weingartner J, Kemkes BM. Octogenerians in cardiac surgery – a suitable procedure? Twelve-year results in operative- and post-hospital mortality of 641 patients over 80 years of age. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Abstract
Arterial thromboembolism (TE) in the absence of current or recent history of a central catheter is a rare condition in newborn period. We report a case of severe lower extremities arterial TE of unclear etiology in a full-term neonate. By adding hyperbaric oxygenation to thrombolytic and antithrombotic therapy, we achieved improved perfusion of the upper leg tissues, preserving the knee and enabling below-the-knee amputation.
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Affiliation(s)
- J Wiebers
- Division of Neonatology & Developmental Biology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA 90095, USA
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28
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Bläser S, Röseler S, Rempp H, Bartsch I, Bauer H, Lieber M, Lessmann E, Weingarten L, Busse A, Huber M, Zieger B. Human endothelial cell septins: SEPT11 is an interaction partner of SEPT5. J Pathol 2006; 210:103-10. [PMID: 16767699 DOI: 10.1002/path.2013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The septin SEPT11 is a novel member of the highly conserved septin family. Septins are cytoskeletal GTPases, which form heteropolymeric complexes. They are involved in cytokinesis and other cellular processes, such as vesicle trafficking and exocytosis. SEPT11 has strong homology to SEPT8. Previously, we identified the interaction of SEPT5 and SEPT8. Using the yeast two-hybrid system, we now demonstrate that SEPT11 partners with SEPT5. The molecular interaction of SEPT11 with SEPT5 was verified by coprecipitation of SEPT5 and SEPT11 from lysates of the human T-cell leukaemia cell line JURKAT and by fluorescence resonance energy transfer. The interaction between SEPT5 and SEPT11 requires the GTP-binding domain and the C-terminal extension. Western analysis in various mouse and human tissues revealed that expression of SEPT11 is restricted to the same tissues as those expressing SEPT5, suggesting that SEPT11 and SEPT5 are components of a cell-specific septin complex. SEPT5, which is expressed in human umbilical vein endothelial cells (HUVECs), has been reported to play an important role in exocytosis. We now report that HUVECs also express SEPT11. Given the interactivity between SEPT5 and SEPT11 as shown above and their coexpression in HUVECs, it may be that a complex formed by these two proteins is involved in the exocytosis mechanism in HUVECs.
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Affiliation(s)
- S Bläser
- Department of Paediatrics and Adolescent Medicine, University Hospital Freiburg, Mathildenstrasse 1, D-79106 Germany
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29
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Diehl B, Najm I, LaPresto E, Prayson R, Ruggieri P, Mohamed A, Ying Z, Lieber M, Babb T, Bingaman W, Lüders HO. Temporal lobe volumes in patients with hippocampal sclerosis with or without cortical dysplasia. Neurology 2004; 62:1729-35. [PMID: 15159469 DOI: 10.1212/01.wnl.0000127301.33384.36] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Recent MRI-based volume reconstruction studies in intractable temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) suggested atrophy that extends to the adjacent neocortical areas. OBJECTIVE To study the extent of temporal lobe volume (TLV) abnormalities in patients with pathologically confirmed HS (with or without cortical dysplasia [CD]) who underwent anterior temporal lobectomy for the treatment of drug-resistant TLE. METHODS Fifty patients (right TLE: n = 24; left TLE: n = 26) were found to have HS (hippocampal cell loss of >30%). Associated neocortical CD was seen in 20 patients (43%). MRI-based TLVs and hippocampal and hemispheric volume reconstructions in all patients were compared between pathologic groups and with volumes acquired from 10 age-matched control subjects. RESULTS TLVs ipsilateral to the epileptogenic zone in patients with TLE were smaller than TLVs in control subjects (p < 0.01). In patients with left TLE, TLVs ipsilateral to the epileptogenic zone were smaller than contralateral TLVs (left: 66.6 +/- 8.3 cm3, right: 74.9 +/- 10.0 cm3; p < 0.001). In patients with right TLE, there were no significant asymmetries. The contralateral TLVs (regardless of the side of surgery) were smaller in the HS + CD group than the HS group (HS + CD group: 74.9 +/- 8.6 cm3, HS group: 79.7 +/- 6.6 cm3; p < 0.05). Patients with HS + CD had a tendency to have less hippocampal atrophy and slightly smaller TLVs ipsilateral to the epileptogenic zone, accounting for significantly smaller TLV/hippocampal volume ratios compared with patients with HS alone. CONCLUSIONS Drug-resistant TLE due to HS is associated with extrahippocampal temporal lobe atrophy. The presence of bilateral temporal lobe atrophy is suggestive of a more widespread (bilateral) temporal lobe involvement in patients with HS and CD.
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Affiliation(s)
- B Diehl
- Department of Neurology, The Cleveland Clinic Foundation, OH 44195, USA.
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Gansera B, Gillrath G, Lieber M, Angelis I, Schmidtler F, Kemkes BM. Are Men Treated Better Than Women? Outcome of Male Versus Female Patients After CABG Using Bilateral Internal Thoracic Arteries. Thorac Cardiovasc Surg 2004; 52:261-7. [PMID: 15470606 DOI: 10.1055/s-2004-821154] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Apart from smaller native coronary arteries a lower number of anastomoses and a lower ITA incidence have been suggested as being responsible for the increased mortality in female patients compared to males. The aim of this study was to clarify whether the outcome of females might be a consequence of a different regimen in anastomosis and ITA frequency. METHODS We evaluated operative data and early outcome of 6906 patients with isolated CABG operated between 1/96 - 7/03 3064 out of 5381 males received bilateral ITA (BITA) vs. 750 of 1525 females. Single ITA (SITA) was performed in 2126 males and 704 females. RESULTS Demographic and operative data: average age for male patients was 64.0 +/- 9.2 years, for females 68.5 +/- 8.6 years ( p < 0.05). The prevalence of diabetes mellitus was significantly higher in females (34.6 % vs. 27.4 %, p < 0.01). Body mass index (BMI, 26.6 vs. 27.4 mean), incidence of main stem stenosis (23.0 % vs. 23.5 %), ejection fraction < 40 % (7.8 % vs. 10.1 %), urgent or emergent operations (13.1 % vs. 11.3 %) and number of performed anastomoses (3.2 vs. 3.5 mean) showed no significant difference between males and females. Total ITA frequency did not differ (95.3 % vs. 96.5 %), but BITA frequency was significantly higher (56.9 % vs. 49.2 %, p < 0.01) in male patients. Overall 30-day mortality was 2.8 % for males vs. 4.1 % ( p < 0.05) for females. Cardiac-related mortality was significantly higher in female patients (2.6 % vs. 1.1 %, p < 0.01). Non-cardiac-related mortality did not differ significantly. Graft-related mortality for males and females revealed 2.7 % in the BITA, 3.3 % in the SITA group and 6.9 % for patients without ITAs and reached statistical significance ( p < 0.01) for SITA or BITA vs. the no-ITA group, but not for BITA vs. SITA grafting. Nevertheless cardiac-related mortality in male and female patients without an ITA graft was more than two-fold higher compared to these with single ITAs and more than three-fold higher compared to those with BITA grafting. CONCLUSIONS Female gender, frequently associated with diabetes mellitus, presents a predictor for increased mortality in CABG. A discrimination of women with respect to a restriction of ITA grafting could be confirmed only for bilateral ITAs. The superior results of bilateral ITA grafts are independent of gender.
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Affiliation(s)
- B Gansera
- Department of Cardiovascular Surgery, City Hospital Munich-Bogenhausen, Munich, Germany.
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31
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Schmidtler F, Gansera B, Wenke K, Lieber M, Kemkes BM. Cardiac surgery in octogenerians – Uncalculatable risk or justified therapy? Retrospective analysis of 590 patients over 80 years of age. Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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32
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Diehl B, Najm I, Ruggieri P, Tkach J, Mohamed A, Morris H, Wyllie E, Fisher E, Duda J, Lieber M, Bingaman W, Lüders HO. Postictal diffusion-weighted imaging for the localization of focal epileptic areas in temporal lobe epilepsy. Epilepsia 2001; 42:21-8. [PMID: 11207781 DOI: 10.1046/j.1528-1157.2001.19500.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Diffusion-weighted MR imaging (DWI) is a novel technique to delineate focal areas of cytotoxic edema of various etiologies. We hypothesized that DWI may also detect the epileptogenic region and adjacent areas during the ictal and early postictal periods in patients with temporal lobe epilepsy (TLE). METHODS We studied patients with intractable TLE (n = 9), due to hippocampal sclerosis (HS, n = 7), left mesial temporal lobe tumor (n = 1), and of unknown etiology (n = 1). Informed consent was obtained before inclusion in the study. All patients with single short seizures were scanned immediately after EEG-documented seizures (between 45 and 150 min); one of two patients in status was scanned 14 h after cessation of seizures. DWI results were analyzed visually and by calculating apparent diffusion coefficient (ADC) maps. RESULTS We found significant decreases in ADC postictally in one of six patients with TLE due to HS and single short seizures. One patient with an incompletely resected temporal lobe tumor also exhibited ADC abnormalities. One patient in focal status epilepticus revealed a decrease in ADC, and one patient with a continuous aura had no DWI abnormality. CONCLUSIONS Postictal DWI technique may occasionally help delineate epileptic areas in some patients with TLE. Yield is low in patients with HS and single short seizures: it may be higher in patients with tumor or status epilepticus.
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Affiliation(s)
- B Diehl
- Department of Neurology, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, Ohio 44195, U.S.A.
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Abstract
Recent work indicates that mutations in a cytidine deaminase homologue ablate both immunoglobulin class switch recombination and somatic hypermutation. These findings now explain cases of autosomal hyper-IgM syndrome and reveal that critical components for key functions of B cells require RNA editing.
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Affiliation(s)
- M Lieber
- Departments of Pathology, Biochemistry, Microbiology and Biology, University of Southern California School of Medicine, Los Angeles, California 90098, USA.
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Davidson JC, Einstein DM, Baker ME, Herts BR, Remer EM, Kolonick RM, Doinoff CJ, Lieber M. Feasibility of instructing radiology technologists in the performance of gastrointestinal fluoroscopy. AJR Am J Roentgenol 2000; 175:1449-52. [PMID: 11044061 DOI: 10.2214/ajr.175.5.1751449] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to determine if dedicated gastrointestinal technologists could be trained to properly perform esophagography and double-contrast barium enema examinations. SUBJECTS AND METHODS Ninety-four patients undergoing double-contrast barium enema examinations and 123 patients undergoing esophagographic examinations were included in the study. The study was conducted over a 4-month period, with examinations performed by eight gastrointestinal technologists, 10 radiology residents, and four staff radiologists. Four random lists were generated for each set of examinations. Each staff gastrointestinal radiologist, who was unaware of who had performed the examination, independently scored the representative radiographs. RESULTS For the double-contrast barium enema examinations, no statistically significant differences were found between the technologists and residents for amount of barium used, degree of distention, cecal opacification, and quality of spot radiographs. The technologist-performed examinations had a statistically significant lower mean fluoroscopy time (3.2 min, compared with 4.0 min for staff radiologists and 5.7 min for residents). For the esophagrams, no statistically significant differences between technologists and residents were found for single-contrast esophagrams; radiographs of the gastric cardia; assessment of motility, reflux, and transit of a solid bolus; and fluoroscopy time. Double-contrast esophagrams obtained by technologists received a better mean score than did those of the residents. CONCLUSION Radiology technologists can be trained to perform high-quality esophagography and double-contrast barium enema examinations without an unacceptably high radiation dose.
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Affiliation(s)
- J C Davidson
- Division of Radiology, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195-5103, USA
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Goske MJ, Lebowitz RL, Lieber M, Ablin D, Royal S. Pediatric radiologists: who we are and what we do. Results of a membership survey of the Society for Pediatric Radiology--1999. Pediatr Radiol 2000; 30:581-5; discussion 585-6. [PMID: 11009293 DOI: 10.1007/s002470000259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a need for reliable monitoring of workforce trends in the field of pediatric radiology by the Society for Pediatric Radiology. In addition, the Society should periodically assess itself as to its mission and relevance to its members via membership surveys. OBJECTIVE The Membership Committee of the Society for Pediatric Radiology, 1999, conducted a 54-question survey to determine the makeup of its members, job profiles, satisfaction with services of the Society for Pediatric Radiology, and its official journal, Pediatric Radiology. MATERIALS AND METHODS Seven hundred fifty surveys were given to active members of the Society for Pediatric Radiology in the United States and Canada. There were 275 surveys returned for an overall response of 37%. RESULTS Mean age of members is 48 years with 99% of respondents working. Membership is 34% female and 66% male. Women members of the Society are younger (45 vs 49 years, P = 0.0012) and work less hours (47.8 vs 51.0, P = 0.0135) than men. Fifty-seven percent of respondents practice in a freestanding children's hospital, 29% in a "children's hospital within a hospital," and 14% are in community hospitals or an office-based practice. Eighty-two percent of the responding pediatric radiologist's time is spent in performing examination on children, with only 18% spent on adult work or administration. Forty-eight percent work at more than one office. Sixty-one percent worked evenings or weekends, excluding night call. Two hundred twenty-two of 275 respondents had received a Certificate of Added Qualification. The meeting "for CME credit" was considered the most important benefit of Society membership. Most respondents read select articles in Pediatric Radiology. There was sentiment to decrease esoteric case reports in favor of review articles. Only 19% of respondents submitted their articles to Pediatric Radiology initially. CONCLUSION Pediatric radiologists are a diverse membership with the common goal of advocating for healthcare and imaging in children. Survey information given to the leadership of the Society will help the organization remain responsive to its members.
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Affiliation(s)
- M J Goske
- Section of Pediatric Radiology, Cleveland Clinic Children's Hospital, Ohio 44195, USA.
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Perl J, Tkach JA, Porras-Jimenez M, Lieber M, Obuchowski N, Ross JS, Ding XP, Ruggieri PM, Shearer DM, Khajavi K, Masaryk TJ. Hemorrhage detected using MR imaging in the setting of acute stroke: an in vivo model. AJNR Am J Neuroradiol 1999; 20:1863-70. [PMID: 10588110 PMCID: PMC7657786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND PURPOSE The treatment algorithm for acute cerebrovascular accidents has traditionally sorted these accidents as either hemorrhagic or nonhemorrhagic, and MR imaging, with its ability to allow expeditious assessment of vascular substrates and regional blood volume, is well suited for this purpose. Our purpose was to delineate the accuracy of MR imaging in acute, hemorrhagic forms of stroke during the time frame considered beneficial for intervention in an animal model. METHODS Eighteen dogs with small, iatrogenic parenchymal, subarachnoid hemorrhage (SAH), or both were serially scanned over the initial 6-hour postictal period. Confirmatory pathologic specimens and 3-hour postictal CT scans were obtained in all animals. The MR and CT studies were then interpreted in a blinded fashion by two neuroradiologists for the presence of hemorrhage. The results were subjected to receiver operating characteristic analysis. RESULTS MR imaging depicted acute parenchymal hemorrhage and SAH with a high degree of accuracy at 1.5 T. This finding was independent of each of the time points studied during the 6-hour window. For SAH, the MR accuracy for reader 1 was 0.86 (95% CI, 0.76-0.97); for reader 2, accuracy was 0.85 (95% CI, 0.71-0.99). The CT accuracy for the two readers was 0.42 (95% CI, 0.26-0.58) and 0.66 95% CI, 0.43-0.89), respectively. Fluid-attenuated inversion-recovery images improved the conspicuity of SAH on MR images and, along with spin-density-weighted spin-echo sequences, helped to establish the hemorrhagic nature. For parenchymal hemorrhage, the MR accuracy for reader 1 was 0.90 (95% CI, 0.81-0.99); for reader 2, accuracy was 0.93 (95% CI, 0.84-1.00). With CT, the accuracy of reader 1 was 0.91 (95% CI, 0.85-0.97) whereas for reader 2 accuracy was 0.76 (95% CI, 0.69-.83). Parenchymal hemorrhage detection and diagnosis was best with T2*-weighted gradient-echo images. CONCLUSION MR imaging with appropriately selected sequences appears able to provide information regarding the presence (or absence) of hemorrhage in an acute stroke model requisite to the initiation of treatment.
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Affiliation(s)
- J Perl
- Department of Diagnostic Radiology, Cleveland Clinic Foundation, OH 44195, USA
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Abstract
PURPOSE To evaluate the effectiveness of the Cragg thrombolytic brush catheter for declotting of synthetic arteriovenous dialysis shunts. MATERIALS AND METHODS In this randomized controlled trial, 77 patients with synthetic forearm loop shunts that were thrombosed were randomly assigned to undergo pharmacomechanical thrombolysis with a pulsed spray (n = 34) or a thrombolytic brush catheter (n = 43). The following findings were evaluated: declotting time, urokinase dose, procedure time, complications, and shunt patency at the first dialysis session and at 3 months. All data were collected prospectively in an unblinded manner. RESULTS The total amount of urokinase used, including secondary interventions, was 243,657 IU with the catheter versus 476,563 IU with the pulsed spray (P = .001). At 15 minutes, clot lysis was successful in 66% of the patients with the catheter versus in 19% with the pulsed spray (P = .001). At 30 minutes, clot lysis was successful in 98% with the catheter versus 47% with the pulsed spray (P = .001). Procedure complication rates and patency at 3 months were similar for the catheter and the pulsed-spray groups. CONCLUSION Use of the Cragg catheter with urokinase offered faster and more complete clot lysis than did use of the pulsed spray with urokinase. The amount of urokinase used with the catheter was half that used with the pulsed spray. Shunt patency at 3 months was similar for the two treatment methods.
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Affiliation(s)
- B L Dolmatch
- Department of Radiology, Cleveland Clinic Foundation, OH 44195, USA
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Roehrborn CG, McConnell JD, Lieber M, Kaplan S, Geller J, Malek GH, Castellanos R, Coffield S, Saltzman B, Resnick M, Cook TJ, Waldstreicher J. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology 1999; 53:473-80. [PMID: 10096369 DOI: 10.1016/s0090-4295(98)00654-2] [Citation(s) in RCA: 247] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Prostate-specific antigen (PSA) is produced exclusively in the prostate gland and is currently the most useful clinical marker for the detection of prostate cancer. In this report, we examine whether serum PSA is also a predictor of important benign prostatic hyperplasia (BPH)-related outcomes, acute urinary retention (AUR), and the need for BPH-related surgery. METHODS Three thousand forty men were treated with either placebo or finasteride in a double-blind, randomized study of 4-year duration. Serum PSA was measured at baseline, and baseline prostate volume was measured in a 10% subset of 312 men. Probabilities and cumulative incidences of AUR and BPH-related surgery, as well as reduction in risk of events with finasteride, were calculated for the entire patient population, stratified by treatment assignment, baseline serum PSA, and prostate volume. RESULTS The risk of either needing BPH-related surgery or developing AUR ranged from 8.9% to 22.0% during the 4 years in placebo-treated patients stratified by increasing prostate volume and from 7.8% to 19.9% when stratified by increasing serum PSA. In comparison with symptom scores, flow rates, and residual urine volume, receiver operating characteristic curve analyses showed that serum PSA and prostate volume were the most powerful predictors of spontaneous AUR in placebo-treated patients (area under the curve 0.70 and 0.81, respectively). Finasteride treatment reduced the relative risk of needing surgery or developing AUR by 50% to 74% and by 43% to 60% when stratified by increasing prostate volume and serum PSA, respectively. CONCLUSIONS Serum PSA and prostate volume are powerful predictors of the risk of AUR and the need for BPH-related surgery in men with BPH. Knowledge of baseline serum PSA and/or prostate volume are useful tools to aid physicians and decision makers in predicting the risk of BPH-related outcomes and choosing therapy for BPH.
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Affiliation(s)
- C G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, 75235-9110, USA
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Davidson JC, Einstein DM, Herts BR, Balfe DM, Koehler RE, Morgan DE, Lieber M, Baker ME. Comparison of two barium suspensions for dedicated small-bowel series. AJR Am J Roentgenol 1999; 172:379-82. [PMID: 9930787 DOI: 10.2214/ajr.172.2.9930787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The in vivo radiographic features of two commercially available formulations of barium used as contrast media in dedicated small-bowel series were compared. SUBJECTS AND METHODS Fifty-six consecutive outpatients referred for a dedicated small-bowel series were randomly administered either E-Z-Paque or Entrobar. Representative survey radiographs from each examination were randomized and reviewed by six gastrointestinal radiologists from three institutions. Each observer assigned a numeric score (1 = poor, 2 = fair, 3 = good, and 4 = excellent) that rated the quality of the radiograph with respect to these characteristics: definition of fold pattern, translucency, distention, and integrity of the barium column. Statistical analysis was performed for each characteristic using Wilcoxon's two-sample rank sum test. RESULTS All six observers found a statistically significant difference between the two barium formulations for mean scores for definition of fold pattern and translucency. Mean scores for fold pattern were 3.3, 3.0, 3.2, 3.6, 3.3, and 3.4 for Entrobar and 2.1, 2.3, 2.4, 3.2, 2.6, and 2.7 for E-Z-Paque. Mean scores for translucency were 2.5, 2.7, 2.8, 3.1, 2.7, and 3.3 for Entrobar and 1.6, 1.7, 2.1, 2.3, 1.9, and 2.7 for E-Z-Paque. No statistically significant difference was found for mean score for distention or integrity of the barium column. CONCLUSION On radiographs, Entrobar was found to have superior characteristics for visualization of fold pattern and translucency but offered no advantages for distention or integrity of the barium column. Improved translucency and definition of fold pattern may translate into improved sensitivity and confidence in diagnosing small-bowel abnormality.
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Affiliation(s)
- J C Davidson
- Department of Radiology, The Cleveland Clinic Foundation, OH 44195, USA
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Piraino DW, Davros WJ, Lieber M, Richmond BJ, Schils JP, Recht MP, Grooff PN, Belhobek GH. Selenium-based digital radiography versus conventional film-screen radiography of the hands and feet: a subjective comparison. AJR Am J Roentgenol 1999; 172:177-84. [PMID: 9888764 DOI: 10.2214/ajr.172.1.9888764] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to subjectively compare the visibility of normal anatomy of the hands and feet using selenium-based digital radiography versus conventional film-screen (100-speed) radiography. SUBJECTS AND METHODS Digital and film-screen images of the hands and feet of 24 patients were obtained without an antiscatter grid using identical X-ray exposure. Each pair of images was evaluated independently by five experienced radiologists for visibility of normal anatomy using a six-point rating scale. Soft tissues, cortical bone, and trabeculae were evaluated. For each observer, "equivalence" was defined as a mean difference in image quality of less than 1 unit on the 0-5 scale used in the study. Paired t tests were also performed to determine whether the average visibility rating of one technique was statistically superior to that of the other at a .05 level of significance for each observer and at each anatomic landmark. RESULTS In all categories, selenium-based digital images were rated equivalent to film-screen images by the five observers. Using the sum of the nine landmarks, four of the five observers rated the quality of selenium-based digital images superior to that of film-screen images. CONCLUSION Subjective visibility of normal anatomy of the hands and feet using selenium-based digital radiography was similar to that achieved using conventional film-screen radiography.
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Affiliation(s)
- D W Piraino
- Department of Radiology, Cleveland Clinic Foundation, OH 44195, USA
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Neumann DR, Esselstyn CB, Madera A, Wong CO, Lieber M. Parathyroid detection in secondary hyperparathyroidism with 123I/99mTc-sestamibi subtraction single photon emission computed tomography. J Clin Endocrinol Metab 1998; 83:3867-71. [PMID: 9814460 DOI: 10.1210/jcem.83.11.5241] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
123I/99mTc-sestamibi subtraction single photon emission computed tomography (SPECT) has been proposed to detect hyperplastic parathyroid tissue, but the clinical usefulness of this technique in secondary hyperparathyroidism is uncertain. The purpose of this study was to evaluate preoperative parathyroid localization using 123I/99mTc-sestamibi subtraction SPECT in patients with renal failure and secondary hyperparathyroidism. Nineteen patients with chronic renal failure and secondary hyperparathyroidism underwent 123I/99mTc-sestamibi subtraction SPECT imaging preoperatively. None of these patients had undergone previous neck surgery. The location, weight, and histopathological results of all identified parathyroid glands were recorded. Surgery was considered successful in all patients, with resection of a total of 74 hyperplastic parathyroid glands. 123I/99mTc-sestamibi subtraction SPECT correctly identified 57 of these parathyroid glands (77% sensitivity). The mean weight among the true positive glands (n = 57) was 1031 mg (range, 45-7900 mg), and that among the false negative glands (n = 17) was 465 mg (range, 20-1800 mg). This difference between the mean weights was statistically significant (P = 0.018). There was a positive correlation between parathyroid weight and detectability with 123I/99mTc-sestamibi subtraction SPECT (Spearman correlation = 0.28; P = 0.0167). 123I/99mTc-sestamibi subtraction SPECT is able to correctly localize hyperplastic parathyroid glands in patients with renal failure and secondary hyperparathyroidism, but there is a fairly weak relationship between preoperative detection rate and anatomical parathyroid gland size.
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Affiliation(s)
- D R Neumann
- Department of Nuclear Medicine, Cleveland Clinic Foundation, Ohio 44195, USA
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Piraino DW, Davros WJ, Lieber M, Richmond BJ, Schils JP, Recht MP, Grooff PN, Belhobek GH. Direct digital versus conventional film screen radiography of the musculoskeletal system. J Digit Imaging 1998; 11:172-3. [PMID: 9735462 PMCID: PMC3453414 DOI: 10.1007/bf03168295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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McConnell J, Bruskewitz R, Walsh P, Andriole G, Lieber M, Holtgrewe H, Albertsen P, Roehrborn C, Nickel J, Wang D, Taylor A, Waldstreicher J. The Effect of Finasteride on the Risk of Acute Urinary Retention and the Need for Surgical Treatment Among Men With Benign Prostatic Hyperplasia. J Urol 1998. [DOI: 10.1016/s0022-5347(01)63115-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J.D. McConnell
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - R. Bruskewitz
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - P. Walsh
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - G. Andriole
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - M. Lieber
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - H.L. Holtgrewe
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - P. Albertsen
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - C.G. Roehrborn
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - J.C. Nickel
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - D.Z. Wang
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - A.M. Taylor
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
| | - J. Waldstreicher
- For the Finasteride Long-Term Efficacy and Safety Study Group; University of Texas Southwestern Medical Center, Dallas, Texas, University of Wisconsin Clinical Science Center, Madison, Wisconsin, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, Washington University School of Medicine, St. Louis, Missouri, Mayo Clinic, Rochester, Minnesota, University of Connecticut Health Center, Farmington, Connecticut, Queen's University, Kingston, Ontario, Canada, and
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McConnell JD, Bruskewitz R, Walsh P, Andriole G, Lieber M, Holtgrewe HL, Albertsen P, Roehrborn CG, Nickel JC, Wang DZ, Taylor AM, Waldstreicher J. The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 1998; 338:557-63. [PMID: 9475762 DOI: 10.1056/nejm199802263380901] [Citation(s) in RCA: 884] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Finasteride is known to improve urinary symptoms in men with benign prostatic hyperplasia, but the extent to which the benefit is sustained and whether finasteride reduces the incidence of related events, including the need for surgery and the development of acute urinary retention, is not known. METHODS In this double-blind, randomized, placebo-controlled trial, we studied 3040 men with moderate-to-severe urinary symptoms and enlarged prostate glands who were treated daily with 5 mg of finasteride or placebo for four years. Symptom scores (on a scale of 1 to 34), urinary flow rates, and the occurrence of outcome events were assessed every four months in 3016 men. Prostate volume was measured in a subgroup of the men. Complete data on outcomes were available for 2760 men. RESULTS During the four-year study period, 152 of the 1503 men in the placebo group (10 percent) and 69 of the 1513 men in the finasteride group (5 percent) underwent surgery for benign prostatic hyperplasia (reduction in risk with finasteride, 55 percent; 95 percent confidence interval, 41 to 65 percent). Acute urinary retention developed in 99 men (7 percent) in the placebo group and 42 men (3 percent) in the finasteride group (reduction in risk with finasteride, 57 percent; 95 percent confidence interval, 40 to 69 percent). Among the men who completed the study, the mean decreases in the symptom score were 3.3 in the finasteride group and 1.3 in the placebo group (P<0.001). Treatment with finasteride also significantly improved urinary flow rates and reduced prostate volume (P<0.001). CONCLUSIONS Among men with symptoms of urinary obstruction and prostatic enlargement, treatment with finasteride for four years reduces symptoms and prostate volume, increases the urinary flow rate, and reduces the risk of surgery and acute urinary retention.
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Affiliation(s)
- J D McConnell
- University of Texas Southwestern Medical Center, Dallas 75235-9110, USA
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Jenkins R, Takahashi S, DeLacey K, Bergstralh E, Lieber M. Prognostic significance of allelic imbalance of chromosome arms 7q, 8p, 16q, and 18q in stage T3N0M0 prostate cancer. Genes Chromosomes Cancer 1998; 21:131-43. [PMID: 9491325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Frequent allelic imbalance of polymorphic markers mapped to regions of the 7q, 8p, 16q, and 18q arms has been reported in prostate cancer. To better define the clinical significance of these genetic alterations, we undertook a retrospective analysis of systemic progression and survival in patients with a single stage of prostate cancer. We ascertained all 227 patients from the Mayo Clinic Radical Prostatectomy Registry who had a histologic high-grade, pathologic stage C (pT3N0M0) tumor surgically removed between 1966 and 1987. The mean follow-up of this population of patients was 7.7 years. DNAs were extracted from cancer lesions identified in 5-micron paraffin-embedded tumor sections. Control DNAs were obtained from surgically removed lymph nodes. Paired DNA samples of 153 patients were available for analysis using 16 polymorphic microsatellite markers mapped to 7q31, 8p22-p21, 16q23-qter, and 18q21-q22. The frequencies of allelic imbalance for at least one marker mapped to 7q31, 8p22-p21, 16q23-qter, and 18q21-q22 were 30, 58, 53, and 45% of all informative cases, respectively. Allelic imbalance at 7q31 strongly correlated with systemic cancer progression and to a slightly lesser extent with cancer-specific death. Eight-year systemic cancer progression-free rates were 58 and 81% for cases with and without 7q31 allelic imbalance, respectively (P < 0.001). Eight-year prostate cancer-specific survival rates were 70 and 85% with and without 7q31 allelic imbalance, respectively (P = 0.019). Multivariate analysis indicated that allelic imbalance at 7q31 is a significant independent predictor of systemic progression (P < 0.001) and possibly prostate cancer death (P = 0.029). In addition, allelic imbalance of the specific loci D7S522 (7q31.1) and D8S258 (8p22-p21.3) was strongly associated with systemic progression (P < 0.001 and P = 0.010, respectively) and with prostate cancer death (P < 0.001 and P = 0.009, respectively). The results suggest that a gene or genes mapped to 7q31.1 and possibly 8p22-p21.3 play an important role in tumor progression, and that allelic imbalances at these regions are markers for poor prognosis in prostate carcinoma.
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Affiliation(s)
- R Jenkins
- Department of Urology, Mayo Clinic and Foundation, Rochester, Minnesota, USA
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Tkach JA, Ding X, Ruggieri PM, Obuchowski NA, Lieber M, Masaryk TJ. Segmented three-dimensional echo-planar flow imaging of the cervical carotid arteries. AJNR Am J Neuroradiol 1997; 18:1339-47. [PMID: 9282867 PMCID: PMC8338008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To implement and assess the application of segmented three-dimensional echo-planar MR imaging time-of-flight flow sequences for studying the anatomy of the cervical carotid arteries at 1.5 T. METHODS The 3-D echo-planar sequences were segmented along the in-plane phase-encoding direction. Echo train lengths (ETLs) of 3 and 5 and signal bandwidths of +/-25, +/-33, and +/-50 KHz were tested along with a conventional (ETL = 1) 3-D MR flow study in six healthy volunteers and in five patients with known arteriosclerotic disease involving the carotid bifurcation as confirmed by conventional angiography. The volunteer data were used to rank the techniques with respect to vessel dimension, vessel/background contrast, and quality by four trained neuroradiologists. For the patient studies, the percentage of stenoses was measured for all MR studies and compared against the conventional angiographic data using the criteria of the North American Symptomatic Carotid Endarterectomy Trial. RESULTS Using Wilcoxon's test statistic and a significance level of .05, we found that the conventional MR flow examination was better than the segmented techniques and that the segmented techniques with ETL of 3 were superior to their counterparts with ETL of 5. For the ETL of 3 techniques, the high-bandwidth studies were inferior to their lower bandwidth counterparts; however, there was no significant difference between the performance of the medium- and low-bandwidth sequences. The patient data revealed that the segmented techniques consistently overestimated the severity of stenosis; however, in no instance did any of the segmented examinations erroneously indicate the presence of disease. CONCLUSIONS The reduction in acquisition time and the zero false-positive rate we obtained suggest that segmented 3-D echo-planar MR flow techniques may be used as a screening/locating study for cervical carotid artery disease.
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Affiliation(s)
- J A Tkach
- Department of Diagnostic Radiology, Cleveland Clinic Foundation, OH 44195, USA
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Abstract
PURPOSE To evaluate the effectiveness of hyperbaric oxygen therapy in reducing optic nerve damage in acute nonarteritic anterior ischemic optic neuropathy. METHODS Twenty-two eyes in 20 patients with acute nonarteritic anterior ischemic optic neuropathy were treated with hyperbaric oxygen (100% oxygen, 2.0 absolute atmospheres of pressure) in two 90-minute inhalation sessions per day for ten days. Changes in mean visual acuity and mean sensitivity loss were compared with those of 27 untreated control patients with acute nonarteritic anterior ischemic optic neuropathy, and proportions of patients with a change in acuity or mean sensitivity loss were compared with controls. Similar analysis was performed on subgroups based on time delay from symptom onset to therapy. RESULTS Mean values for visual acuity were increased at final examination in both groups; although the increase was greater in controls, the difference was not statistically significant. Mean visual field sensitivity loss was minimally increased; although the increase was smaller in controls, the difference between groups was not significant. There was no significant difference between groups in proportions of patients with change in acuity score or mean sensitivity loss. Stratification by time delay to therapy did not suggest that treatment within nine days produced better visual results than that for either controls or those treated later. CONCLUSIONS Hyperbaric oxygen therapy using 100% oxygen and 2.0 absolute atmospheres of pressure did not produce a significant improvement in visual acuity or visual field for patients with acute nonarteritic anterior ischemic optic neuropathy.
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Affiliation(s)
- A C Arnold
- UCLA Optic Neuropathy Center, Jules Stein Eye Institute, Department of Ophthalmology 90095-7005, USA
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