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Hoeter K, Neuberger E, Fischer S, Herbst M, Juškevičiūtė E, Enders K, Rossmann H, Sprinzl MF, Simon P, Bodenstein M, Schaefer M. Evidence for the utility of cfDNA plasma concentrations to predict disease severity in COVID-19: a retrospective pilot study. PeerJ 2023; 11:e16072. [PMID: 37744227 PMCID: PMC10512938 DOI: 10.7717/peerj.16072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/20/2023] [Indexed: 09/26/2023] Open
Abstract
Background COVID-19 is a worldwide pandemic caused by the highly infective SARS-CoV-2. There is a need for biomarkers not only for overall prognosis but also for predicting the response to treatments and thus for improvements in the clinical management of patients with COVID-19. Circulating cell-free DNA (cfDNA) has emerged as a promising biomarker in the assessment of various pathological conditions. The aim of this retrospective and observational pilot study was to investigate the range of cfDNA plasma concentrations in hospitalized COVID-19 patients during the first wave of SARS-CoV-2 infection, to relate them to established inflammatory parameters as a correlative biomarker for disease severity, and to compare them with plasma levels in a healthy control group. Methods Lithium-Heparin plasma samples were obtained from COVID-19 patients (n = 21) during hospitalization in the University Medical Centre of Mainz, Germany between March and June 2020, and the cfDNA concentrations were determined by quantitative PCR yielding amplicons of long interspersed nuclear elements (LINE-1). The cfDNA levels were compared with those of an uninfected control group (n = 19). Results Plasma cfDNA levels in COVID-19 patients ranged from 247.5 to 6,346.25 ng/ml and the mean concentration was 1,831 ± 1,388 ng/ml (± standard deviation), which was significantly different from the levels of the uninfected control group (p < 0.001). Regarding clinical complications, the highest correlation was found between cfDNA levels and the myositis (p = 0.049). In addition, cfDNA levels correlated with the "WHO clinical progression scale". D-Dimer and C-reactive protein (CRP) were the clinical laboratory parameters with the highest correlations with cfDNA levels. Conclusion The results of this observational pilot study show a wide range in cfDNA plasma concentrations in patients with COVID-19 during the first wave of infection and confirm that cfDNA plasma concentrations serve as a predictive biomarker of disease severity in COVID-19.
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Affiliation(s)
- Katharina Hoeter
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Elmo Neuberger
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes-Gutenberg Universität Mainz, Mainz, Germany
| | - Susanne Fischer
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Manuel Herbst
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Ema Juškevičiūtė
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes-Gutenberg Universität Mainz, Mainz, Germany
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Kira Enders
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes-Gutenberg Universität Mainz, Mainz, Germany
| | - Heidi Rossmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin F. Sprinzl
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Perikles Simon
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Johannes-Gutenberg Universität Mainz, Mainz, Germany
| | - Marc Bodenstein
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Michael Schaefer
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
- Focus Program Translational Neurosciences (FTN), Johannes Gutenberg-University, Mainz, Germany
- Research Center for Immunotherapy, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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Griemert T, Siegel E, Brandstetter M, Straub BK, Kreft A, Galle PR, Sprinzl MF. Entamoeba histolytica-associated proctitis and ileitis mimicking Crohn's disease-A case report. Clin Case Rep 2023; 11:e6833. [PMID: 37220511 PMCID: PMC10199808 DOI: 10.1002/ccr3.6833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/28/2022] [Accepted: 12/05/2022] [Indexed: 05/25/2023] Open
Abstract
We report about a proctitis and ileitis terminalis, leading to the misdiagnosis of Chron's disease, in a male patient who has sex with men. Molecular multiplex analysis identified Entamoeba histolytica as the underlying cause. We provide diagnostic images, clues and pitfalls for diagnosis of E. histolytica associated proctitis.
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Affiliation(s)
- Thomas Griemert
- Department of Internal Medicine IUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Ekkehard Siegel
- Institute of MicrobiologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Moritz Brandstetter
- Institute of MicrobiologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Beate K. Straub
- Institute of PathologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Andreas Kreft
- Institute of PathologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Peter R. Galle
- Department of Internal Medicine IUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Martin F. Sprinzl
- Department of Internal Medicine IUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
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3
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Appel KS, Maier D, Hopff SM, Mitrov L, Stecher M, Scherer M, Geisler R, Hagen M, Haas K, Reese JP, Jiru-Hillmann S, Miljukov O, Jakob CEM, Nunes de Miranda SM, Meybohm P, Hanß S, Erber J, Winter C, Tebbe JJ, Stellbrink C, Khodamoradi Y, Schmidt J, Hanses F, Scheer C, Blaschke S, Göpel S, Kluge S, Witzke O, Römmele C, Krawczyk M, Teufel A, Schmid J, Pape D, Schütte C, Tausche K, Milovanovic M, Krug N, Tepasse PR, Verket M, Hamprecht A, Tasci S, Hower M, Jensen BEO, Sprinzl MF, Zimmermann T, Vehreschild JJ. 1886. External Validation of the 4C Mortality Score and the qSOFA for Different Variants of Concerns of SARS-CoV-2 Using Data of the NAPKON Cross-Sectoral Cohort Platform (SUEP). Open Forum Infect Dis 2022. [PMCID: PMC9752978 DOI: 10.1093/ofid/ofac492.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Numerous predictive clinical scores with varying discriminatory performance have been developed in the context of the current coronavirus disease 2019 (COVID-19) pandemic. To support clinical application, we test the transferability of the frequently applied 4C mortality score (4C score) to the German prospective Cross-Sectoral Platform (SUEP) of the National Pandemic Cohort Network (NAPKON) compared to the non COVID-19 specific quick sequential organ failure assessment score (qSOFA). Our project aims to externally validate these two scores, stratified for the most prevalent variants of concerns (VOCs) of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in Germany. Methods A total of 685 adults with polymerase chain reaction (PCR)-detected SARS-CoV-2 infection were included from NAPKON-SUEP. Patients were recruited from 11/2020 to 03/2022 at 34 university and non-university hospitals across Germany. Missing values were complemented using multiple imputation. Predictive performance for in-hospital mortality at day of baseline visit was determined by area under the curve (AUC) with 95%-confidence interval (CI) stratified by VOCs of SARS-CoV-2 (alpha, delta, omicron) (Figure 1).
Study flow chart with inclusion criteria and methodological workflow. ![]() Results Preliminary results suggest a high predictive performance of the 4C score for in-hospital mortality (Table 1). This applies for the overall cohort (AUC 0.813 (95%CI 0.738-0.888)) as well as the VOC-strata (alpha: AUC 0.859 (95%CI 0.748-0.970); delta: AUC 0.769 (95%CI 0.657-0.882); omicron: AUC 0.866 (95%CI 0.724-1.000)). The overall mortality rates across the defined 4C score risk groups are 0.3% (low), 3.2% (intermediate), 11.6% (high), and 49.5% (very high). The 4C score performs significantly better than the qSOFA (Chi2-test: p=0.001) and the qSOFA does not seem to be a suitable tool in this context.
Discriminatory performance of the 4C Mortality Score and the qSOFA score within the validation cohort NAPKON-SUEP stratified by the Variant of Concerns of SARS-CoV-2. ![]() Conclusion Despite its development in the early phase of the pandemic and improved treatment, external validation of the 4C score in NAPKON-SUEP indicates a high predictive performance for in-hospital mortality across all VOCs. However, since the qSOFA was not specifically designed for this predictive issue, it shows low discriminatory performance, as in other validation studies. Any interpretations regarding the omicron stratum are limited due to the sample size. Disclosures Daniel Pape, Dr., Advanz Pharma Germany: Support for attending meetings and/or travel for ECCMID 2021 Martin Hower, n/a, MSD: Advisor/Consultant|Trogarzo: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant Björn-Erik O. Jensen, Dr. med., GILEAD: Advisor/Consultant|GILEAD: Lectures, Travel|GSK: Lectures, Travel Jörg J. Vehreschild, Univ.-Prof. Dr. med., Ärztekammer Nordrhein: Honoraria|Academy for Infectious Medicine, University Manchester: Honoraria|Astellas Pharma: Grant/Research Support|Astellas Pharma: Honoraria|Back Bay Strategies: Honoraria|Basilea: Grant/Research Support|Basilea: Honoraria|Deutsches Zetrum für Luft- und Raumfahrt (DLR): Grant/Research Support|German Centre for Infection Research (DZIF): Grant/Research Support|German Centre for Infection Research (DZIF): Honoraria|German Federal Ministry of Education and Research (BMBF): Grant/Research Support|German Society for Infectious Diseases (DGI): Honoraria|German Society for Internal Medicine (DGIM): Honoraria|GILEAD: Advisor/Consultant|GILEAD: Grant/Research Support|GILEAD: Honoraria|Janssen: Honoraria|Merck / MSD: Grant/Research Support|Merck / MSD: Honoraria|Molecular Health: Honoraria|Netzwerk Universitätsmedizin: Honoraria|NordForsk: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Rigshospitalet Copenhagen: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|University Hospital Aachen: Honoraria|University Hospital Freiburg/ Congress and Communication: Honoraria|University of Bristol: Grant/Research Support.
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Affiliation(s)
- Katharina S Appel
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany, Frankfurt am Main, Hessen, Germany
| | - Daniel Maier
- University Hospital Frankfurt, Frankfurt am Main, Germany,German Cancer Consortium (DKTK), Heidelberg, Germany, Frankfurt am Main, Hessen, Germany
| | - Sina M Hopff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Köln, Nordrhein-Westfalen, Germany
| | - Lazar Mitrov
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Köln, Nordrhein-Westfalen, Germany
| | - Melanie Stecher
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany, Cologne, Nordrhein-Westfalen, Germany
| | - Margarete Scherer
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany, Frankfurt am Main, Hessen, Germany
| | - Ramsia Geisler
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany, Frankfurt am Main, Hessen, Germany
| | - Marina Hagen
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany, Frankfurt am Main, Hessen, Germany
| | - Kirsten Haas
- Insitute for Clinical Epidemiology and Biometry, Julius Maximilians Universität Würzburg, Würzburg, Bayern, Germany
| | - Jens-Peter Reese
- Insitute for Clinical Epidemiology and Biometry, Julius Maximilians Universität Würzburg, Würzburg, Bayern, Germany
| | - Steffi Jiru-Hillmann
- Insitute for Clinical Epidemiology and Biometry, Julius Maximilians Universität Würzburg, Würzburg, Bayern, Germany
| | - Olga Miljukov
- Insitute for Clinical Epidemiology and Biometry, Julius Maximilians Universität Würzburg, Würzburg, Bayern, Germany
| | - Carolin E M Jakob
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany, Cologne, Nordrhein-Westfalen, Germany
| | - Susana M Nunes de Miranda
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Köln, Nordrhein-Westfalen, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Würzburg, Bayern, Germany
| | - Sabine Hanß
- University Medical Center Göttingen, Department of Medical Informatics, Göttingen, Germany, Göttingen, Niedersachsen, Germany
| | - Johanna Erber
- Technical University of Munich, School of Medicine – University Hospital, Department of Internal Medicine, Gastroenterology, Munich, Bayern, Germany
| | - Christof Winter
- Technical University of Munich, School of Medicine – University Hospital, Institute for Clinical Chemistry and Pathobiochemistry, Munich, Bayern, Germany
| | - Johannes J Tebbe
- University Medical Center East Westphalia-Lippe, Klinikum Lippe, Department of Gastroenterology and Infectious Disease, Lippe, Nordrhein-Westfalen, Germany
| | - Christoph Stellbrink
- Bielefeld University, Medical School and University Medical Center East Westphalia-Lippe, Klinikum Bielefeld, Academic Department of Cardiology, Bielefeld, Nordrhein-Westfalen, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt am Main, Germany, Frankfurt am Main, Hessen, Germany
| | - Julia Schmidt
- Insitute for Clinical Epidemiology and Biometry, Julius Maximilians Universität Würzburg, Würzburg, Bayern, Germany
| | - Frank Hanses
- Emergency Department and Department for Infection Control and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany, Regensburg, Bayern, Germany
| | - Christian Scheer
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Sabine Blaschke
- Emergency Department, University Medical Center Göttingen, FRG, Göttingen, Niedersachsen, Germany
| | - Siri Göpel
- Department of Internal Medicine I, Infectious Diseases, Tübingen University Hospital, Tübingen, Germany,German Centre for Infection Research (DZIF), Clinical Research Unit for healthcare associated infections, Tübingen, Germany, Tübingen, Baden-Wurttemberg, Germany
| | - Stefan Kluge
- Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, Universitymedicine Essen, University Duisburg-Essen, Germany, Essen, Nordrhein-Westfalen, Germany
| | - Christoph Römmele
- Clinic for Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany, Augsburg, Bayern, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany, Homburg, Saarland, Germany
| | - Andreas Teufel
- Department of Medicine II, Division of Hepatology, Division of Bioinformatics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany,Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany, Mannheim, Baden-Wurttemberg, Germany
| | - Jonas Schmid
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Medicine I, Erlangen, Germany, Erlangen, Bayern, Germany
| | - Daniel Pape
- Department of Internal Medicine I, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Schleswig-Holstein, Germany
| | - Christian Schütte
- Dept. of Medicine I, St. Josef-Hospital, Ruhr-University of Bochum Medical School, Bochum, Nordrhein-Westfalen, Germany
| | - Kristin Tausche
- Department of Internal Medicine I, Pulmonology, Carl- Gustav-Carus University Dresden, Germany, Dresden, Sachsen, Germany
| | - Milena Milovanovic
- Medical Clinic 1, Malteser Krankenhaus St. Franziskus Hospital, Flensburg, Germany, Flensburg, Schleswig-Holstein, Germany
| | - Natalie Krug
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, Germany, Leipzig, Sachsen, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B for Gastroenterology, Hepatology, Endocrinology, Clinical Infectiology, Münster, Germany, Münster, Nordrhein-Westfalen, Germany
| | - Marlo Verket
- Department of Medicine I, Clinical Study Center, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Axel Hamprecht
- University Medical Clinic of Medical Microbiology and Virology, Department of Human Medicine, University Oldenburg, Germany, Oldenburg, Niedersachsen, Germany
| | - Selcuk Tasci
- Department of Pulmonology, Helios Klinikum, Siegburg, Germany, Siegburg, Nordrhein-Westfalen, Germany
| | - Martin Hower
- Department of Pneumology, Infectiology, Internal Medicine and Intensive Care, Klinikum Dortmund GmbH, Dortmund, Dortmund, Nordrhein-Westfalen, Germany
| | - Björn-Erik O Jensen
- Department of Gastroenterology, Hepatology and Infectiology, Heinrich-Heine-University, Duesseldorf, Germany, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Martin F Sprinzl
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany, Mainz, Rheinland-Pfalz, Germany
| | - Tim Zimmermann
- Department of Internal Medicine II, Gastroenterology and Hepatology, Klinikum Worms, Germany, Worms, Rheinland-Pfalz, Germany
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Kremer WM, Labenz C, Kuchen R, Sagoschen I, Bodenstein M, Schreiner O, Wörns MA, Sivanathan V, Weinmann A, Galle PR, Sprinzl MF. Sonographic assessment of low muscle quantity identifies mortality risk during COVID-19: a prospective single-centre study. J Cachexia Sarcopenia Muscle 2022; 13:169-179. [PMID: 34881516 PMCID: PMC8818698 DOI: 10.1002/jcsm.12862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Assessment of muscle quantity by sonographic muscle indices could help identify patients at risk for fatal outcome during coronavirus disease-2019 (COVID-19). The aim of this study was to explore sonographic muscle indices as predictors of COVID-19 outcome and to test the feasibility of sonographic muscle measurement in an isolation context. METHODS Muscle indices, derived from the psoas muscle or thigh muscles, were quantified by sonography in a cohort of patients without COVID-19 to obtain reference values for low muscle quantity. Gender-specific median of different muscle indices were defined as threshold value for low muscle quantity. The prognostic relevance of low muscle quantity, was prospectively explored in two cohorts of hospitalized COVID-19 patients. Optimal muscle index cutoff values predictive for 30 day mortality during COVID-19 were determined by receiver operating characteristic-area under the curve and Youden index calculation. Muscle quantity and known prognostic factors of COVID-19 were analysed by multivariable log-regression. RESULTS Compared with other muscle indices, the psoas muscle area index (PMAI) showed the most favourable characteristics to predict outcome of COVID-19 disease. Sonographic morphometry of patients without COVID-19 (n = 136) revealed a gender-specific median for PMAI (male: 291.1 mm2 /m2 , female 260.6 mm2 /m2 ) as threshold value of low muscle quantity. Subsequently, COVID-19 patients (Cohort I: n = 58; Cohort II: n = 55) were prospectively assessed by bedside sonography. The studied COVID-19 patients developed a critical course of disease in 22.4% (Cohort I: n = 13/58) and 34.5% (Cohort II: n = 20/55). Mortality rate reached 12.1% (Cohort I: n = 7/58) and 20.0% (Cohort I: n = 11/55) within 30 days of follow up. COVID-19 patients with a PMAI below the gender-specific median showed a higher 30 day mortality in both COVID-19 cohorts (log rank, P < 0.05). The optimal PMAI cutoff value (206 mm2 /m2 ) predicted 30 day mortality of hospitalized COVID-19 patients with a sensitivity of 72% and specificity of 78.5% (receiver operating characteristic-area under the curve: 0.793, 95% confidence interval 0.671-0.914, P = 0.008). Multivariable log-regression analysis of PMAI, age, gender, BMI and comorbidities confirmed an independent association of low PMAI with 30 day mortality of COVID-19 patients (P = 0.018). CONCLUSIONS Sonographic morphometry provides reliable muscle quantification under hygienic precautions and allows risk stratification of patients with COVID-19.
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Affiliation(s)
- Wolfgang M Kremer
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christian Labenz
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Robert Kuchen
- Institute of Medical Biometry, Epidemiology and Informatics of the Johannes Gutenberg-University, Mainz, Germany
| | - Ingo Sagoschen
- Center for Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc Bodenstein
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Oliver Schreiner
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus A Wörns
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Visvakanth Sivanathan
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Clinical Registry Unit, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin F Sprinzl
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.,Clinical Registry Unit, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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5
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Emmenegger M, Kumar SS, Emmenegger V, Malinauskas T, Buettner T, Rose L, Schierack P, Sprinzl MF, Sommer CJ, Lackner KJ, Aguzzi A, Roggenbuck D, Frauenknecht KBM. Anti-prothrombin autoantibodies enriched after infection with SARS-CoV-2 and influenced by strength of antibody response against SARS-CoV-2 proteins. PLoS Pathog 2021; 17:e1010118. [PMID: 34860860 PMCID: PMC8673606 DOI: 10.1371/journal.ppat.1010118] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/15/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022] Open
Abstract
Antiphospholipid antibodies (aPL), assumed to cause antiphospholipid syndrome (APS), are notorious for their heterogeneity in targeting phospholipids and phospholipid-binding proteins. The persistent presence of Lupus anticoagulant and/or aPL against cardiolipin and/or β2-glycoprotein I have been shown to be independent risk factors for vascular thrombosis and pregnancy morbidity in APS. aPL production is thought to be triggered by-among other factors-viral infections, though infection-associated aPL have mostly been considered non-pathogenic. Recently, the potential pathogenicity of infection-associated aPL has gained momentum since an increasing number of patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been described with coagulation abnormalities and hyperinflammation, together with the presence of aPL. Here, we present data from a multicentric, mixed-severity study including three cohorts of individuals who contracted SARS-CoV-2 as well as non-infected blood donors. We simultaneously measured 10 different criteria and non-criteria aPL (IgM and IgG) by using a line immunoassay. Further, IgG antibody response against three SARS-CoV-2 proteins was investigated using tripartite automated blood immunoassay technology. Our analyses revealed that selected non-criteria aPL were enriched concomitant to or after an infection with SARS-CoV-2. Linear mixed-effects models suggest an association of aPL with prothrombin (PT). The strength of the antibody response against SARS-CoV-2 was further influenced by SARS-CoV-2 disease severity and sex of the individuals. In conclusion, our study is the first to report an association between disease severity, anti-SARS-CoV-2 immunoreactivity, and aPL against PT in patients with SARS-CoV-2.
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Affiliation(s)
- Marc Emmenegger
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | | | - Vishalini Emmenegger
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland
| | - Tomas Malinauskas
- Division of Structural Biology, Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | | | - Laura Rose
- GA Generic Assays GmbH, Dahlewitz, Germany
| | - Peter Schierack
- Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Faculty of Health Sciences Brandenburg, University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Martin F. Sprinzl
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Clemens J. Sommer
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Adriano Aguzzi
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - Dirk Roggenbuck
- GA Generic Assays GmbH, Dahlewitz, Germany
- Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Faculty of Health Sciences Brandenburg, University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Katrin B. M. Frauenknecht
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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6
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Hollerbach A, Müller-Calleja N, Pedrosa D, Canisius A, Sprinzl MF, Falter T, Rossmann H, Bodenstein M, Werner C, Sagoschen I, Münzel T, Schreiner O, Sivanathan V, Reuter M, Niermann J, Galle PR, Teyton L, Ruf W, Lackner KJ. Pathogenic lipid-binding antiphospholipid antibodies are associated with severity of COVID-19. J Thromb Haemost 2021; 19:2335-2347. [PMID: 34242469 PMCID: PMC8420426 DOI: 10.1111/jth.15455] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19)-associated coagulopathy is a hallmark of disease severity and poor prognosis. The key manifestations of this prothrombotic syndrome-microvascular thrombosis, stroke, and venous and pulmonary clots-are also observed in severe and catastrophic antiphospholipid syndrome. Antiphospholipid antibodies (aPL) are detectable in COVID-19 patients, but their association with the clinical course of COVID-19 remains unproven. OBJECTIVES To analyze the presence and relevance of lipid-binding aPL in hospitalized COVID-19 patients. METHODS Two cohorts of 53 and 121 patients from a single center hospitalized for PCR-proven severe acute respiratory syndrome-coronavirus 2 infection were analyzed for the presence of aPL and clinical severity of COVID-19. RESULTS We here demonstrate that lipid-binding aPL are common in COVID-19. COVID-19 patients with lipid-binding aPL have higher median concentrations of C-reactive protein and D-dimer, and are more likely to have a critical clinical course and fatal outcome. Lipid-binding aPL isolated from COVID-19 patients target the recently described cell surface complex of lysobisphosphatidic acid (LBPA) with the protein C receptor (EPCR) to induce prothrombotic and inflammatory responses in monocytes and endothelial cells. We show that B1a cells producing lipid-reactive aPL of the IgG isotype circulate in the blood of COVID-19 patients. In vivo, COVID-19 aPL accelerate thrombus formation in an experimental mouse model dependent on the recently delineated signaling pathway involving EPCR-LBPA. CONCLUSIONS COVID-19 patients rapidly expand B1a cells secreting pathogenic lipid-binding aPL with broad thrombotic and inflammatory effects. The association with markers of inflammation and coagulation, clinical severity, and mortality suggests a causal role of aPL in COVID-19-associated coagulopathy.
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Affiliation(s)
- Anne Hollerbach
- Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University Medical Center Mainz, Germany
| | - Nadine Müller-Calleja
- Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University Medical Center Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Denise Pedrosa
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Antje Canisius
- Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University Medical Center Mainz, Germany
| | - Martin F Sprinzl
- Department of Medicine I, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Tanja Falter
- Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University Medical Center Mainz, Germany
| | - Heidi Rossmann
- Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University Medical Center Mainz, Germany
| | - Marc Bodenstein
- Department of Anesthesiology, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Christian Werner
- Department of Anesthesiology, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Ingo Sagoschen
- Department of Cardiology, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Oliver Schreiner
- Department of Medicine I, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Visvakanth Sivanathan
- Department of Medicine I, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Michael Reuter
- Department of Medicine I, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Johannes Niermann
- Department of Medicine I, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Peter R Galle
- Department of Medicine I, Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
| | - Luc Teyton
- Department of Immunology and Microbiology, Scripps Research, La Jolla, California, USA
| | - Wolfram Ruf
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Medical Center Mainz, Mainz, Germany
- Department of Immunology and Microbiology, Scripps Research, La Jolla, California, USA
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University Medical Center Mainz, Germany
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7
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Sprinzl MF, Feist C, Koch S, Kremer WM, Lackner KJ, Weinmann A, Galle PR. Cost evaluation of PAGE-B risk score guided HCC surveillance in patients with treated chronic hepatitis B. BMC Health Serv Res 2021; 21:846. [PMID: 34419018 PMCID: PMC8379870 DOI: 10.1186/s12913-021-06794-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background The PAGE-B score (Platelet Age GEnder–HBV) selects chronic hepatitis B (cHB) patients showing no relevant 5-year risk for hepatocellular carcinoma (HCC). We, therefore, explored potential cost reduction following the introduction of a PAGE-B tailored ultrasound screening in a single center cohort of cHB patients receiving stable antiviral therapy. Methods cHB patients attending throughout the year 2018 were documented. Patients eligible for PAGE-B score were classified into high (≥18 points), intermediate (10–17 points) and low (≤9 points) HCC risk groups. Patients of the low HCC risk group could postpone HCC screening to reduce HCC screening expenses. Full costs for hepatic ultrasound were assessed. Results Throughout the year cHB patients (n = 607) attended our clinic, which included PAGE-B eligible patients (n = 227, 37.4%) of whom n = 94 (15.8%) were allocated to the low HCC risk group. Sonographic HCC screening during a median exam time of 12.4 min (IQR 9.2–17.2) resulted in total costs of 22.82 Euro/exam. Additional opportunistic expenses caused by patient’s lost earnings or productivity were 15.6–17.5 €/exam and 26.7 €/exam, respectively. Following a PAGE-B tailored HCC screening at our institution annual full costs for cHB patients could be reduced by 15.51%, which equals a cost reduction by 1.91% for our total sonography unit. In comparison, 1.35% up to 7.65% of HBV-infected patients of Caucasian descent could postpone HCC screening according to population-based estimates from Germany. Conclusions PAGE-B risk score adapted screening for HCC is an efficient and cost neutral tool to reduce costs for sonography in Caucasian patients with chronic hepatitis B receiving antiviral treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06794-6.
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Affiliation(s)
- Martin F Sprinzl
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. .,Institute for Laboratory Medicine and Clinical Chemistry, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Christina Feist
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Sandra Koch
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Wolfgang M Kremer
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Karl J Lackner
- Institute for Laboratory Medicine and Clinical Chemistry, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Arndt Weinmann
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Peter R Galle
- Medical Department I, University Medical Center of the Johanne Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
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8
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Schwaegermann MK, Hobohm L, Rausch J, Reuter M, Griemert TF, Sivanathan V, Falter T, Sprinzl MF, Lackner KJ, Galle PR, Konstantinides S, Theobald M, von Auer C. COVID-19 as a Potential Trigger for Immune Thrombotic Thrombocytopenic Purpura and Reason for an Unusual Treatment: A Case Report. Hamostaseologie 2021. [PMID: 34327693 DOI: 10.1055/a-1497-1054] [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: 10/20/2022] Open
Abstract
Immune thrombotic thrombocytopenic purpura (iTTP) is a rare autoimmune disorder characterized by severely reduced activity of the von Willebrand factor (VWF)-cleaving protease ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) due to autoantibodies. This leads to the development of pathogenic multimers of VWF, causing a thrombotic microangiopathy with decreased number of platelets, hemolysis, and life-threatening tissue ischemia of mostly brain, heart, and kidneys. Standard treatment of iTTP involves daily plasma exchange to remove ultra large multimers of VWF, inhibitors, substituting ADAMTS13, and the accompaniment of an immunosuppressive treatment with steroids. Recently, caplacizumab was approved for iTTP. Caplacizumab is a nanobody binding the A1 domain of VWF, blocking its interaction with glycoprotein Ib-IX-V platelet receptor and therefore preventing platelet aggregation. VWF activities may serve as therapeutic drug monitoring of caplacizumab, whereas ADAMTS13 activities may be used for biomarkers to guide caplacizumab treatment modalities and overall treatment duration. Additional immunosuppressive treatment by inhibiting autoantibody formation (e.g., the use of Rituximab, a chimeric monoclonal antibody directed against the B-cell antigen CD20) is a further treatment option. Infections are well-known causes for an acute episode for patients with iTTP. The novel SARS-CoV-2 virus is mainly associated with acute respiratory distress as well as diffuse endothelial inflammation and increased coagulopathy. However, little is known about an infection with SARS-CoV-2 virus triggering iTTP relapses. We herein report the case of an acute iTTP episode accompanying a SARS-CoV-2 infection.
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Affiliation(s)
- Marie-Kristin Schwaegermann
- Department of Internal Medicine III, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Centre of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Johanna Rausch
- Department of Internal Medicine III, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Michael Reuter
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Thomas-Friedrich Griemert
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Visvakanth Sivanathan
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Tanja Falter
- Institute of Laboratory Medicine and Clinical Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Martin F Sprinzl
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Institute of Laboratory Medicine and Clinical Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Karl J Lackner
- Institute of Laboratory Medicine and Clinical Chemistry, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stavros Konstantinides
- Centre of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Matthias Theobald
- Department of Internal Medicine III, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Charis von Auer
- Department of Internal Medicine III, Comprehensive Cancer Center, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,Centre of Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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9
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Weber M, Padmanabhan Nair V, Bauer T, Sprinzl MF, Protzer U, Vincendeau M. Increased HERV-K(HML-2) Transcript Levels Correlate with Clinical Parameters of Liver Damage in Hepatitis C Patients. Cells 2021; 10:cells10040774. [PMID: 33807462 PMCID: PMC8065411 DOI: 10.3390/cells10040774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 12/23/2022] Open
Abstract
Chronic hepatitis C virus (HCV) infection is closely associated with a plethora of diseases, including cancers and autoimmune disorders. However, the distinct triggers and cellular networks leading to such HCV-derived diseases are poorly understood. Around 8% of the human genome consists of human endogenous retroviruses. They are usually silenced but can be reactivated by environmental conditions, including viral infections. Our current understanding indicates that the activation of one specific family-namely, HERV-K(HML-2)-is linked to distinct pathologies, including cancer and autoimmunity. In this study, we analyzed the transcription levels of HERV-K(HML-2) in 42 HCV-infected patients receiving direct-acting antiviral therapies. Samples from the start of treatment until 12 weeks post-treatment were investigated. Our results show increased HERV-K(HML-2) transcript levels in patients with HCV-derived liver cirrhosis throughout the observation period. Several clinical parameters specifying poor liver function are positively correlated with HERV-K(HML-2) expression. Of note, patients without a sustained viral clearance showed a drastic increase in HERV-K(HML-2) transcript levels. Together, our data suggest that increased HERV-K(HML-2) expression is correlated with reduced liver function as well as therapy success in HCV-infected patients.
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Affiliation(s)
- Melanie Weber
- Institute of Virology, HelmholtzZentrum München, Neuherberg 85764, Germany; (M.W.); (V.P.N.); (T.B.)
| | - Vidya Padmanabhan Nair
- Institute of Virology, HelmholtzZentrum München, Neuherberg 85764, Germany; (M.W.); (V.P.N.); (T.B.)
| | - Tanja Bauer
- Institute of Virology, HelmholtzZentrum München, Neuherberg 85764, Germany; (M.W.); (V.P.N.); (T.B.)
- Institute of Virology, Technische Universität München, Munich 81675, Germany
- German Center for Infection Research (DZIF), Partner Site, Munich 81675, Germany
| | - Martin F. Sprinzl
- Medical Department, University Hospital Mainz, Mainz 55131, Germany;
| | - Ulrike Protzer
- Institute of Virology, HelmholtzZentrum München, Neuherberg 85764, Germany; (M.W.); (V.P.N.); (T.B.)
- Institute of Virology, Technische Universität München, Munich 81675, Germany
- German Center for Infection Research (DZIF), Partner Site, Munich 81675, Germany
- Correspondence: (U.P.); (M.V.)
| | - Michelle Vincendeau
- Institute of Virology, HelmholtzZentrum München, Neuherberg 85764, Germany; (M.W.); (V.P.N.); (T.B.)
- Correspondence: (U.P.); (M.V.)
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10
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Czauderna C, Schmidtmann I, Koch S, Pilz L, Heinrich S, Otto G, Mittler J, Lang H, Kloeckner R, Düber C, Sprinzl MF, Worns MA, Galle PR, Marquardt JU, Weinmann A. High pre-treatment static and dynamic alpha-fetoprotein values predict reduced overall survival in hepatocellular carcinoma. United European Gastroenterol J 2020; 9:2050640620972611. [PMID: 33226301 PMCID: PMC8259127 DOI: 10.1177/2050640620972611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/13/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma is one of the most lethal cancers worldwide. Novel prognostic and/or predictive biomarkers are urgently needed to improve patient management. Alpha-fetoprotein is a well-established and widely used biomarker for hepatocellular carcinoma. However, diagnostic accuracy of static alpha-fetoprotein values is limited and the clinical potential is a matter of ongoing scientific discussion. OBJECTIVE We here evaluated the prognostic impact of pre-treatment static and dynamic alpha-fetoprotein variables on overall survival of hepatocellular carcinoma patients in a Western cohort. METHODS Patients with confirmed hepatocellular carcinoma (n = 809) treated at the Johannes Gutenberg-University Mainz between 1998 and 2014 and two available pre-treatment alpha-fetoprotein-values (AFP-slope) were retrospectively analysed. Clinico-pathological baseline parameters, pre-treatment static values and AFP-slope were assessed. Prognostic impact was determined by Kaplan-Meier analyses and Cox regression models. RESULTS High static and dynamic alpha-fetoprotein variables prior to therapy were associated with reduced survival rates of hepatocellular carcinoma patients. Several known clinical parameters such as Child-Pugh B (p < 0.01) and C stage (p < 0.001), portal vein thrombosis (p < 0.001) and extrahepatic spread (p < 0.001) were confirmed as independent predictors for overall survival. Addition of static and/or dynamic alpha-fetoprotein variable resulted in higher time-dependent area under the curves. Notably, in patients with more favourable prognosis, AFP-slope prior to therapy was a slightly stronger predictor for overall survival compared with static alpha-fetoprotein values. CONCLUSION Static and dynamic alpha-fetoprotein variables prior to therapy are predictive for overall survival of hepatocellular carcinoma patients. Addition of AFP-slope to established prognostic parameters might improve prognostic classification for a subgroup of hepatocellular carcinoma patients with preserved liver function and without portal vein tumour thrombosis.
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Affiliation(s)
- Carolin Czauderna
- Department of Internal Medicine IJohannes Gutenberg UniversityMainzGermany
- Department of Medicine IUniversity Medical Centre SchleswigHolstein—Campus LübeckLübeckGermany
| | - Irene Schmidtmann
- Institute of Medical BiostatisticsEpidemiology and Informatics (IMBEI)Johannes Gutenberg UniversityMainzGermany
- Department of General, Visceral and Transplant SurgeryJohannes Gutenberg UniversityMainzGermany
| | - Sandra Koch
- Department of Internal Medicine IJohannes Gutenberg UniversityMainzGermany
| | - Lukas Pilz
- Department of Internal Medicine IJohannes Gutenberg UniversityMainzGermany
| | - Sophia Heinrich
- Department of Internal Medicine IJohannes Gutenberg UniversityMainzGermany
| | - Gerd Otto
- Department of General, Visceral and Transplant SurgeryJohannes Gutenberg UniversityMainzGermany
| | - Jens Mittler
- Department of General, Visceral and Transplant SurgeryJohannes Gutenberg UniversityMainzGermany
| | - Hauke Lang
- Department of General, Visceral and Transplant SurgeryJohannes Gutenberg UniversityMainzGermany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional RadiologyJohannes Gutenberg UniversityMainzGermany
| | - Christoph Düber
- Department of Diagnostic and Interventional RadiologyJohannes Gutenberg UniversityMainzGermany
| | - Martin F. Sprinzl
- Department of Internal Medicine IJohannes Gutenberg UniversityMainzGermany
| | - Marcus A. Worns
- Department of Internal Medicine IJohannes Gutenberg UniversityMainzGermany
| | - Peter R. Galle
- Department of Internal Medicine IJohannes Gutenberg UniversityMainzGermany
| | - Jens U. Marquardt
- Department of Internal Medicine IJohannes Gutenberg UniversityMainzGermany
- Department of Medicine IUniversity Medical Centre SchleswigHolstein—Campus LübeckLübeckGermany
| | - Arndt Weinmann
- Department of Internal Medicine IJohannes Gutenberg UniversityMainzGermany
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11
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Affiliation(s)
- Christian Labenz
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin F Sprinzl
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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12
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Schattenberg JM, Labenz C, Wörns MA, Menge P, Weinmann A, Galle PR, Sprinzl MF. Patterns of liver injury in COVID-19 - a German case series. United European Gastroenterol J 2020; 8:814-819. [PMID: 32588791 PMCID: PMC7435007 DOI: 10.1177/2050640620931657] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Reports of liver injury in patients with novel coronavirus disease 2019 (COVID-19) are emerging from China and the USA. A wide variety of liver function test abnormalities and few cases of severe liver failure have been reported. No data on the hepatic phenotype from Europe are available at current. METHODS We report a case series of 44 consecutive patients hospitalized for COVID-19 in Germany. RESULTS At the time of admission, aspartate aminotransferase greater than the upper limit of normal was present in 70%, while alanine aminotransferase was elevated in 15.8%. Markers of cholestatic liver injury were altered only in a minority of patients. During hospitalization, 31% and 22% experienced increasing aspartate aminotransferase and alanine aminotransferase, respectively, when transaminases were normal at admission. Severe liver injury defined by 3×> upper limit of normal was observed in 9.1% over a mean time of 10.5 days. Importantly, patients exhibited cytotoxicity including lactate dehydrogenase and creatinine kinase elevations, but no signs of relevant liver function impairment. CONCLUSION In summary, in a case series of hospitalized patients in Germany, cytotoxicity in the absence of severe liver dysfunction at admission and only few cases suggestive of severe liver injury during hospital were observed.
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Affiliation(s)
- Jörn M Schattenberg
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
- Metabolic Liver Research Program, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Christian Labenz
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
- Metabolic Liver Research Program, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Philipp Menge
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Arndt Weinmann
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter R Galle
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin F. Sprinzl
- Department of Medicine, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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13
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Labenz C, Kremer WM, Schattenberg JM, Wörns MA, Toenges G, Weinmann A, Galle PR, Sprinzl MF. Clinical Frailty Scale for risk stratification in patients with SARS-CoV-2 infection. J Investig Med 2020; 68:1199-1202. [PMID: 32641351 PMCID: PMC7418620 DOI: 10.1136/jim-2020-001410] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Abstract
Predictive factors for adverse outcomes in patients with COVID-19 are urgently needed. Data related to the applicability of the Clinical Frailty Scale (CFS) for risk stratification in patients with COVID-19 are currently lacking. We investigated the ability of CFS to predict need for mechanical ventilation and the duration of hospital stays in European patients with COVID-19. In total, 42 patients with confirmed COVID-19 infection admitted to the University Medical Center Mainz between March 3 and April 15 2020 were included into this validation study and data were retrospectively analyzed. CFS was assessed at admission in all patients. Patients were followed for need for mechanical ventilation and time to hospital discharge. At admission, the median CFS was 3 (range: 1–7) and 14 (33.3%) patients were considered as at least pre-frail (CFS >3). 24 (57.1%) patients were discharged from hospital after a median time of 7 days (IQR 4–8). 12 (28.6%) patients developed acute respiratory distress syndrome and required mechanical ventilation. In multivariable Cox regression analyses, higher CFS scores (HR 1.659, 95% CI 1.090 to 2.525, p=0.018) were an independent predictor for a higher risk of mechanical ventilation after adjusting for age, Charlson Comorbidity Index and quick sepsis-related organ failure score. Additionally, lower CFS scores (HR 0.554, 95% CI 0.312 to 0.983, p=0.043) were associated with earlier discharge from hospital. In conclusion, this report demonstrates the usefulness of the CFS for risk stratification at hospital admission in patients with COVID-19.
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Affiliation(s)
- Christian Labenz
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Wolfgang M Kremer
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Martin F Sprinzl
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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14
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Sprinzl MF, Kirstein MM, Koch S, Seib ML, Weinmann-Menke J, Lang H, Düber C, Toenges G, Zöller D, Marquardt JU, Wörns MA, Galle PR, Vogel A, Pinter M, Weinmann A. Improved Prediction of Survival by a Risk Factor-Integrating Inflammatory Score in Sorafenib-Treated Hepatocellular Carcinoma. Liver Cancer 2019; 8:387-402. [PMID: 31768347 PMCID: PMC6873091 DOI: 10.1159/000492628] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 08/01/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS Inflammation affects progression of hepatocellular carcinoma (HCC). We therefore postulate that systemic inflammatory markers could help to predict prognosis in HCC patients receiving sorafenib therapy. METHODS Overall survival (OS) of HCC patients receiving palliative sorafenib treatment was correlated with the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), C-reactive protein to albumin ratio (CAR), Glasgow prognostic score (GPS) and the modified GPS (mGPS) along with clinicopathological parameters. Predictors of OS were assessed by multivariable Cox regression and receiver operating characteristics and area under the curve (ROC-AUC) analyses. RESULTS Patients receiving sorafenib (n = 120) for advanced HCC (Barcelona Clinic Liver Cancer stage C) were explored by retrospective analysis. Findings were subsequently validated by a second HCC cohort (n = 113) receiving sorafenib at two independent treatment centers. Multivariable assessment across these HCC cohorts confirmed a stable association of CAR (p ≤ 0.001), GPS (p ≤ 0.01) and mGPS (p ≤ 0.004) with OS. This study also identified Eastern Cooperative Oncology Group (ECOG) performance score (p < 0.001) and portal thrombosis (p = 0.002) as prognostic factors and uncovered an inconsistent OS association of NLR and PLR in HCC patients. Additional combined analysis of ECOG, portal thrombosis and GPS within an extended score (GPS-EP) was associated with OS (p = 0.021), which was confirmed within the validation cohort (p = 0.001). In sorafenib-treated HCC, the ROC-AUC value for the prediction of 12-month survival was 0.761 (CAR >/≤0.37 cut-off, p < 0.001), 0.766 (GPS, p < 0.001) and 0.754 (mGPS, p < 0.001), respectively. In comparison to this, GPS-EP achieved a higher AUC of 0.826 (0.746-0.907) for the 12-month survival prediction, resulting in a 64.4% sensitivity and 83.3% specificity at a > 2 point cut-off. CONCLUSIONS Inflammatory scores obtained before sorafenib treatment initiation are associated with OS in advanced HCC. Their combination with other risk factors improves prediction of 3- and 12-month survival, which could guide treatment decisions in selected patient subgroups.
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Affiliation(s)
- Martin F. Sprinzl
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,Clinical Registry Unit, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,*Dr. Martin F. Sprinzl and Dr. Arndt Weinmann, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, DE–55131 Mainz (Germany), E-Mail and
| | - Martha M. Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Sandra Koch
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,Clinical Registry Unit, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marie-Luise Seib
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Julia Weinmann-Menke
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,Clinical Registry Unit, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniela Zöller
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Jens U. Marquardt
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter R. Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Matthias Pinter
- Department of Gastroenterology, Department of Internal Medicine III, Medical University, Vienna, Austria
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany,Clinical Registry Unit, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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15
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Labenz C, Beul L, Toenges G, Schattenberg JM, Nagel M, Sprinzl MF, Nguyen-Tat M, Zimmermann T, Huber Y, Marquardt JU, Galle PR, Wörns MA. Validation of the simplified Animal Naming Test as primary screening tool for the diagnosis of covert hepatic encephalopathy. Eur J Intern Med 2019; 60:96-100. [PMID: 30131209 DOI: 10.1016/j.ejim.2018.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/13/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Diagnosis of covert hepatic encephalopathy (CHE) is time consuming in clinical practice. Recently, a new diagnostic tool - the simplified Animal Naming Test (S-ANT1) - was presented with promising results in an Italian cohort. The aim of the present study was to validate S-ANT1 in a cohort of cirrhotic patients from a German tertiary referral centre. METHODS 143 cirrhotic patients and 37 healthy controls were enrolled. Hepatic encephalopathy (HE) grade 1 (HE1) was clinically diagnosed according to the West-Haven Criteria. Critical flicker frequency and Psychometric Hepatic Encephalopathy Score were used to detect minimal HE (MHE). All participants were additionally examined by S-ANT1. RESULTS 58 (40.6%) patients presented with CHE (40 MHE, 18 HE1). S-ANT1 was lowest in patients with HE1, followed by patients with MHE, patients without CHE, and healthy controls, respectively (each p < 0.05). Naming <20 animals discriminated best between patients with and without CHE in ROC analysis (with Youden's index). With a cut-off value of ≥23 mentioned animal names further testing for CHE could be avoided in 38.5% of patients with a negative predictive value of 84%. CONCLUSIONS S-ANT1 may become an important first screening tool for the assessment of CHE in clinical practice.
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Affiliation(s)
- Christian Labenz
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Larissa Beul
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Gerrit Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Michael Nagel
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin F Sprinzl
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc Nguyen-Tat
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Tim Zimmermann
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Yvonne Huber
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Jens U Marquardt
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
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16
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Foerster F, Mittler J, Darstein F, Heise M, Marquardt JU, Wörns MA, Weinmann A, Sälter L, Hoppe-Lotichius M, Heinrich S, Kloeckner R, Pitton MB, Schattenberg JM, Sprinzl MF, Düber C, Otto G, Lang H, Galle PR, Zimmermann T. Recipient liver function before liver transplantation influences post-transplantation survival in patients with HCC. Eur J Intern Med 2018; 55:57-65. [PMID: 29859798 DOI: 10.1016/j.ejim.2018.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/05/2018] [Accepted: 05/20/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Liver transplantation (LT) is a complex yet curative treatment for a subset of patients with hepatocellular carcinoma (HCC). Due to donor organ shortage, patients with HCC need to be carefully selected for LT. In European countries, selection of patients is based on the Milan criteria, and donor organs are allocated by Eurotransplant. In order to optimize the utilization of available liver grafts, the outcome of HCC patients after LT needs to be closely monitored and evaluated. METHODS We assessed the outcome of 304 HCC patients who underwent LT at a tertiary medical center over a period of nearly 20 years (February 1998 until June 2017). RESULTS The 5-, 10- and 15-year survival rates were 62, 47 and 30%, respectively. The strongest survival-determining factor was tumour recurrence. Apart from a high tumour grading, the pre-LT MELD score was significantly and negatively associated with survival after LT. CONCLUSION Our results confirm the importance of recurrence for the outcome of HCC patients after LT and highlight the relevance of HCC patients' liver function before LT. Our findings encourage efforts to identify prognostically relevant factors for LT in HCC with the overall goal of refining the organ allocation system and maximizing the survival benefit after LT.
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Affiliation(s)
- Friedrich Foerster
- Department of Internal Medicine I, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Jens Mittler
- Department of General and Abdominal Surgery, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Felix Darstein
- Department of Internal Medicine I, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Michael Heise
- Department of General and Abdominal Surgery, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Jens U Marquardt
- Department of Internal Medicine I, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Marcus-Alexander Wörns
- Department of Internal Medicine I, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Lina Sälter
- Department of Internal Medicine I, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Maria Hoppe-Lotichius
- Department of General and Abdominal Surgery, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Stefan Heinrich
- Department of General and Abdominal Surgery, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Michael B Pitton
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Martin F Sprinzl
- Department of Internal Medicine I, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Gerd Otto
- Department of General and Abdominal Surgery, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Hauke Lang
- Department of General and Abdominal Surgery, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany
| | - Tim Zimmermann
- Department of Internal Medicine I, University Medical Center Mainz, Germany; Interdiscliplinary Transplantation Center (ITx), Mainz, Germany.
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17
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Labenz C, Baron JS, Toenges G, Schattenberg JM, Nagel M, Sprinzl MF, Nguyen-Tat M, Zimmermann T, Huber Y, Marquardt JU, Galle PR, Wörns MA. Prospective evaluation of the impact of covert hepatic encephalopathy on quality of life and sleep in cirrhotic patients. Aliment Pharmacol Ther 2018; 48:313-321. [PMID: 29863286 DOI: 10.1111/apt.14824] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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] [Received: 04/01/2018] [Revised: 04/23/2018] [Accepted: 05/07/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Minimal hepatic encephalopathy (HE) and HE grade 1 (HE1) according to the West Haven criteria have recently been grouped as one entity named-covert HE- (CHE). Data regarding the impact of CHE on health-related quality of life (HRQoL) and sleep quality are controversial. AIM First, to determine whether CHE affects HRQoL and sleep quality of cirrhotic patients and second, whether minimal HE (MHE) and HE1 affect HRQoL and sleep quality to a comparable extent. METHODS A total of 145 consecutive cirrhotic patients were enrolled. HE1 was diagnosed clinically according to the West Haven criteria. Critical flicker frequency and the Psychometric Hepatic Encephalopathy Score were used to detect MHE. Chronic Liver Disease Questionnaire (CLDQ) was used to assess HRQoL and Pittsburgh Sleep Quality Index (PSQI) was applied to assess sleep quality. RESULTS Covert HE was detected in 59 (40.7%) patients (MHE: n = 40; HE1: n = 19). Multivariate analysis identified CHE (P < 0.001) and female gender (P = 0.006) as independent predictors of reduced HRQoL (CLDQ total score). CHE (P = 0.021), low haemoglobin (P = 0.024) and female gender (P = 0.003) were identified as independent predictors of poor sleep quality (PSQI total score). Results of CLDQ and PSQI were comparable in patients with HE1 and MHE (CLDQ: 4.6 ± 0.9 vs 4.5 ± 1.2, P = 0.907; PSQI: 11.3 ± 3.8 vs 9.9 ± 5.0, P = 0.3). CONCLUSION Covert HE was associated with impaired HRQoL and sleep quality. MHE and HE1 affected both outcomes to a comparable extent supporting the use of CHE as a clinically useful term for patients with both entities of HE in clinical practice.
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Affiliation(s)
- C Labenz
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - J S Baron
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - G Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - J M Schattenberg
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M Nagel
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M F Sprinzl
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M Nguyen-Tat
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - T Zimmermann
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Y Huber
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - J U Marquardt
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - P R Galle
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M-A Wörns
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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18
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Castven D, Fischer M, Becker D, Heinrich S, Andersen JB, Strand D, Sprinzl MF, Strand S, Czauderna C, Heilmann-Heimbach S, Roessler S, Weinmann A, Wörns MA, Thorgeirsson SS, Galle PR, Matter MS, Lang H, Marquardt JU. Adverse genomic alterations and stemness features are induced by field cancerization in the microenvironment of hepatocellular carcinomas. Oncotarget 2018; 8:48688-48700. [PMID: 28415775 PMCID: PMC5564717 DOI: 10.18632/oncotarget.16231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/03/2017] [Indexed: 12/13/2022] Open
Abstract
Hepatocellular Carcinoma (HCC) commonly develops in chronically damaged liver tissues. The resulting regenerative and inflammatory processes create an adverse milieu that promotes tumor-initiation and progression. A better understanding of the hepatic tumor-microenvironment interaction might infer profound therapeutic implications. Integrative whole genome and transcriptome analyses of different tumor regions, the invasive tumor border and tumor-surrounding liver (SL) were performed to identify associated molecular alterations and integrated with our existing HCC database. Expression levels and localization of established CSC markers were assessed in pre-neoplastic lesions and confirmed in two independent patient cohorts using qRT-PCR, immunohistochemistry and immunofluorescence. Our results indicate that genomic and transcriptomic profiles between SL and different tumor regions are quite distinct. Progressive increase in genetic alterations and activation of pathways related to proliferation as well as apoptosis were observed in the tumor tissue, while activation of stemness markers was present in cirrhotic SL and continuously decreased from pre-neoplastic lesions to HCC. Interestingly, the invasive tumor border was characterized by inflammatory and EMT-related gene sets as well as activation of pro-survival signaling. Consistently, integration of gene expression signatures with two independent HCC databases containing 300 HCCs revealed that border signatures are predictive of HCC patient survival. Prognostic significance of the permissive liver microenvironment might be a consequence of a pro-oncogenic field effect that is caused by chronic regenerative processes. Activation of key oncogenic features and immune-response signaling indicates that the cross-talk between tumor and microenvironment might be a promising therapeutic and/or preventive target.
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Affiliation(s)
- Darko Castven
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Michael Fischer
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Diana Becker
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Stefan Heinrich
- Department of Surgery, Johannes Gutenberg University, Mainz, Germany
| | - Jesper B Andersen
- Department of Health and Medical Science, Biotech Research and Innovation Centre, University of Copenhagen, Copenhagen, Denmark
| | - Dennis Strand
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Martin F Sprinzl
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Susanne Strand
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Carolin Czauderna
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Stefanie Heilmann-Heimbach
- Department of Genomics, Institute of Human Genetics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Stephanie Roessler
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Arndt Weinmann
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Marcus A Wörns
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Snorri S Thorgeirsson
- Laboratory of Experimental Carcinogenesis, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Peter R Galle
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | | | - Hauke Lang
- Department of Surgery, Johannes Gutenberg University, Mainz, Germany
| | - Jens U Marquardt
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
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19
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Wisskirchen K, Metzger K, Schreiber S, Asen T, Weigand L, Dargel C, Witter K, Kieback E, Sprinzl MF, Uckert W, Schiemann M, Busch DH, Krackhardt AM, Protzer U. Isolation and functional characterization of hepatitis B virus-specific T-cell receptors as new tools for experimental and clinical use. PLoS One 2017; 12:e0182936. [PMID: 28792537 PMCID: PMC5549754 DOI: 10.1371/journal.pone.0182936] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/19/2017] [Indexed: 12/17/2022] Open
Abstract
T-cell therapy of chronic hepatitis B is a novel approach to restore antiviral T-cell immunity and cure the infection. We aimed at identifying T-cell receptors (TCR) with high functional avidity that have the potential to be used for adoptive T-cell therapy. To this end, we cloned HLA-A*02-restricted, hepatitis B virus (HBV)-specific T cells from patients with acute or resolved HBV infection. We isolated 11 envelope- or core-specific TCRs and evaluated them in comprehensive functional analyses. T cells were genetically modified by retroviral transduction to express HBV-specific TCRs. CD8+ as well as CD4+ T cells became effector T cells recognizing even picomolar concentrations of cognate peptide. TCR-transduced T cells were polyfunctional, secreting the cytokines interferon gamma, tumor necrosis factor alpha and interleukin-2, and effectively killed hepatoma cells replicating HBV. Notably, our collection of HBV-specific TCRs recognized peptides derived from HBV genotypes A, B, C and D presented on different HLA-A*02 subtypes common in areas with high HBV prevalence. When co-cultured with HBV-infected cells, TCR-transduced T cells rapidly reduced viral markers within two days. Our unique set of HBV-specific TCRs with different affinities represents an interesting tool for elucidating mechanisms of TCR-MHC interaction and dissecting specific anti-HBV mechanisms exerted by T cells. TCRs with high functional avidity might be suited to redirect T cells for adoptive T-cell therapy of chronic hepatitis B and HBV-induced hepatocellular carcinoma.
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Affiliation(s)
- Karin Wisskirchen
- Institute of Virology, Technische Universität München / Helmholtz Zentrum München, Munich, Germany
- German Centre for Infection Research (DZIF), Munich partner site, Munich, Germany
- * E-mail: (UP); (KW)
| | - Kai Metzger
- Institute of Virology, Technische Universität München / Helmholtz Zentrum München, Munich, Germany
| | - Sophia Schreiber
- Institute of Virology, Technische Universität München / Helmholtz Zentrum München, Munich, Germany
| | - Theresa Asen
- Institute of Virology, Technische Universität München / Helmholtz Zentrum München, Munich, Germany
| | - Luise Weigand
- III. Medical Department, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christina Dargel
- Institute of Virology, Technische Universität München / Helmholtz Zentrum München, Munich, Germany
| | - Klaus Witter
- Laboratory for Immunogenetics and Molecular Diagnostics, Klinikum der Universität München, Munich, Germany
| | - Elisa Kieback
- Institute of Biology, Humboldt-University Berlin, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Berlin Institute of Health, Berlin, Germany
| | - Martin F. Sprinzl
- Institute of Virology, Technische Universität München / Helmholtz Zentrum München, Munich, Germany
| | - Wolfgang Uckert
- Institute of Biology, Humboldt-University Berlin, Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Berlin Institute of Health, Berlin, Germany
| | - Matthias Schiemann
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - Dirk H. Busch
- German Centre for Infection Research (DZIF), Munich partner site, Munich, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
- Focus Groups “Viral Hepatitis” and “Clinical Cell Processing and Purification”, Institute for Advanced Study, Technische Universität München, Munich, Germany
| | - Angela M. Krackhardt
- III. Medical Department, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ulrike Protzer
- Institute of Virology, Technische Universität München / Helmholtz Zentrum München, Munich, Germany
- German Centre for Infection Research (DZIF), Munich partner site, Munich, Germany
- Focus Groups “Viral Hepatitis” and “Clinical Cell Processing and Purification”, Institute for Advanced Study, Technische Universität München, Munich, Germany
- * E-mail: (UP); (KW)
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Bernuth S, Yagmur E, Schuppan D, Sprinzl MF, Zimmermann A, Schad A, Kittner JM, Weyer V, Knapstein J, Schattenberg JM, Wörns MA, Galle PR, Zimmermann T. Early changes in dynamic biomarkers of liver fibrosis in hepatitis C virus-infected patients treated with sofosbuvir. Dig Liver Dis 2016; 48:291-7. [PMID: 26514736 DOI: 10.1016/j.dld.2015.09.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 05/13/2015] [Revised: 09/08/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis C is a major cause of liver-associated mortality caused by decompensated cirrhosis and hepatocellular carcinoma. With the approval of sofosbuvir, therapeutic efficacy has markedly increased. Early changes in non-invasive biomarkers of liver fibrosis under effective antiviral therapy are widely unknown. AIM To evaluate early changes of fibrosis markers determined by enhanced liver fibrosis (ELF) scores and liver stiffness measurement (FibroScan(®)) in patients treated with sofosbuvir. METHODS A total of 32 hepatitis C patients treated prospectively with sofosbuvir were included. The ELF-panel and FibroScan measurements were performed at baseline, week 4, end-of-treatment and 12 weeks thereafter. RESULTS Antiviral therapy resulted in a biochemical and virological response within 4 weeks. Sustained virological response rate at 12-week follow-up (SVR12) was 93.8%; there was a significantly decrease from baseline to 12-week post-treatment follow-up in ELF (10.00 vs. 9.37; p=0.007) and FibroScan (8.0 vs. 6.8 kPa; p=0.016) measurements, indicating improvement of the dynamics of liver fibrosis. CONCLUSION We observed a rapid decrease in non-invasive fibrosis markers measured by ELF-scores and FibroScan in hepatitis C-infected patients receiving sofosbuvir treatment. These initial results need to be histologically confirmed by liver biopsy in the future.
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Affiliation(s)
- Sebastian Bernuth
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Eray Yagmur
- Laboratory Diagnostics Center, RWTH-University Hospital Aachen, Aachen and Medical Care Center, Dr. Stein and Colleagues, Mönchengladbach, Germany
| | - Detlef Schuppan
- Institute of Translational Immunology, University Medical Center Mainz, Germany
| | - Martin F Sprinzl
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Anca Zimmermann
- Department of Endocrinology and Metabolic Diseases, University Medical Center Mainz, Germany
| | - Arno Schad
- Institute of Pathology, Johannes Gutenberg University Mainz, Germany
| | - Jens M Kittner
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Veronika Weyer
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Germany
| | - Johanna Knapstein
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Jörn M Schattenberg
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Marcus A Wörns
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Peter R Galle
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Tim Zimmermann
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany.
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21
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Dargel C, Bassani-Sternberg M, Hasreiter J, Zani F, Bockmann JH, Thiele F, Bohne F, Wisskirchen K, Wilde S, Sprinzl MF, Schendel DJ, Krackhardt AM, Uckert W, Wohlleber D, Schiemann M, Stemmer K, Heikenwälder M, Busch DH, Richter G, Mann M, Protzer U. T Cells Engineered to Express a T-Cell Receptor Specific for Glypican-3 to Recognize and Kill Hepatoma Cells In Vitro and in Mice. Gastroenterology 2015; 149:1042-52. [PMID: 26052074 DOI: 10.1053/j.gastro.2015.05.055] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 05/16/2015] [Accepted: 05/30/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Cancer therapies are being developed based on our ability to direct T cells against tumor antigens. Glypican-3 (GPC3) is expressed by 75% of all hepatocellular carcinomas (HCC), but not in healthy liver tissue or other organs. We aimed to generate T cells with GPC3-specific receptors that recognize HCC and used them to eliminate GPC3-expressing xenograft tumors grown from human HCC cells in mice. METHODS We used mass spectrometry to obtain a comprehensive peptidome from GPC3-expressing hepatoma cells after immune-affinity purification of human leukocyte antigen (HLA)-A2 and bioinformatics to identify immunodominant peptides. To circumvent GPC3 tolerance resulting from fetal expression, dendritic cells from HLA-A2-negative donors were cotransfected with GPC3 and HLA-A2 RNA to stimulate and expand antigen-specific T cells. RESULTS Peptide GPC3367 was identified as a predominant peptide on HLA-A2. We used A2-GPC3367 multimers to detect, select for, and clone GPC3-specific T cells. These clones bound the A2-GPC3367 multimer and secreted interferon-γ when cultured with GPC3367, but not with control peptide-loaded cells. By genomic sequencing of these T-cell clones, we identified a gene encoding a dominant T-cell receptor. The gene was cloned and the sequence was codon optimized and expressed from a retroviral vector. Primary CD8(+) T cells that expressed the transgenic T-cell receptor specifically bound GPC3367 on HLA-A2. These T cells killed GPC3-expressing hepatoma cells in culture and slowed growth of HCC xenograft tumors in mice. CONCLUSIONS We identified a GPC3367-specific T-cell receptor. Expression of this receptor by T cells allows them to recognize and kill GPC3-positive hepatoma cells. This finding could be used to advance development of adoptive T-cell therapy for HCC.
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Affiliation(s)
- Christina Dargel
- Institute of Virology, Technische Universität München, Helmholtz Zentrum München, München, Germany
| | | | - Julia Hasreiter
- Institute of Virology, Technische Universität München, Helmholtz Zentrum München, München, Germany
| | - Fabio Zani
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, Garching, Germany
| | - Jan-Hendrik Bockmann
- Institute of Virology, Technische Universität München, Helmholtz Zentrum München, München, Germany; German Center for Infection Research (DZIF), Munich Site, Germany
| | - Frank Thiele
- Institute of Virology, Technische Universität München, Helmholtz Zentrum München, München, Germany; German Center for Infection Research (DZIF), Munich Site, Germany
| | - Felix Bohne
- Institute of Virology, Technische Universität München, Helmholtz Zentrum München, München, Germany
| | - Karin Wisskirchen
- Institute of Virology, Technische Universität München, Helmholtz Zentrum München, München, Germany
| | - Susanne Wilde
- Institute of Molecular Immunology, Helmholtz Zentrum München, München, Germany
| | - Martin F Sprinzl
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Germany
| | - Dolores J Schendel
- Institute of Molecular Immunology, Helmholtz Zentrum München, München, Germany; Clinical Cooperation Groups Antigen Specific Immunotherapy and Immune Monitoring, Technische Universität München, Helmholtz Zentrum München, München, Germany
| | - Angela M Krackhardt
- Clinical Cooperation Groups Antigen Specific Immunotherapy and Immune Monitoring, Technische Universität München, Helmholtz Zentrum München, München, Germany; 3rd Medical Department, University Hospital Rechts der Isar, Technische Universität München, München, Germany
| | - Wolfgang Uckert
- Max-Delbrück-Centrum for Molecular Medicine (MDC) and Institute of Biology, Humboldt University Berlin, Berlin-Buch, Germany
| | - Dirk Wohlleber
- Institute of Molecular Immunology, University Hospital Rechts der Isar, Technische Universität München, München, Germany
| | - Matthias Schiemann
- Clinical Cooperation Groups Antigen Specific Immunotherapy and Immune Monitoring, Technische Universität München, Helmholtz Zentrum München, München, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, München, Germany
| | - Kerstin Stemmer
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, Garching, Germany
| | - Mathias Heikenwälder
- Institute of Virology, Technische Universität München, Helmholtz Zentrum München, München, Germany
| | - Dirk H Busch
- German Center for Infection Research (DZIF), Munich Site, Germany; Clinical Cooperation Groups Antigen Specific Immunotherapy and Immune Monitoring, Technische Universität München, Helmholtz Zentrum München, München, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, München, Germany
| | - Günther Richter
- Department of Pediatrics, University Hospital Rechts der Isar, Technische Universität München, München, Germany
| | - Matthias Mann
- Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Ulrike Protzer
- Institute of Virology, Technische Universität München, Helmholtz Zentrum München, München, Germany; German Center for Infection Research (DZIF), Munich Site, Germany; Clinical Cooperation Groups Antigen Specific Immunotherapy and Immune Monitoring, Technische Universität München, Helmholtz Zentrum München, München, Germany.
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22
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Steinebrunner N, Sprinzl MF, Zimmermann T, Wörns MA, Zimmerer T, Galle PR, Stremmel W, Eisenbach C, Stein K, Antoni C, Schattenberg JM, Pathil A. Early virological response may predict treatment response in sofosbuvir-based combination therapy of chronic hepatitis c in a multi-center "real-life" cohort. BMC Gastroenterol 2015; 15:97. [PMID: 26239732 PMCID: PMC4523924 DOI: 10.1186/s12876-015-0328-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/28/2015] [Indexed: 12/16/2022] Open
Abstract
Background The combination of sofosbuvir (SOF), ribavirin (RBV) and peg-interferon-alfa-2a (peg-IFN-alfa-2a) as well as the combination of SOF and RBV for the treatment of patients infected with hepatitis c virus (HCV) has improved rates of sustained virological response (SVR) considerably in recent trials. However, there is only limited data concerning the efficacy and safety in a “real-life” cohort. Methods We analyzed a cohort of 119 patients with chronic HCV infection treated at four investigational sites in Germany. All patients received either a combination treatment of SOF, RBV and peg-IFN-alfa-2a or SOF and RBV. Results The rates of SVR at 12 weeks after end of treatment (SVR 12) were as follows: Among 76 patients with genotype 1 infection the SVR 12 rate was 74 % (n = 56), among 14 patients with genotype 2 infection the SVR 12 rate was 79 % (n = 11), among 24 patients with genotype 3 infection the SVR 12 rate was 92 % (n = 22) and among 5 patients with genotype 4 infection the SVR 12 rate was 80 % (n = 4). Of all 26 patients with a relapse in our cohort, 69 % (n = 18) of these patients presented with liver cirrhosis and 58 % (n = 15) were treatment experienced. Notably, the level of HCV-RNA after 4 weeks of treatment was a significant predictor of treatment response in genotype 1 patients. Patients with HCV-RNA levels ≥ 12 IU ml-1 after 4 weeks of treatment achieved SVR 12 only in 30 % (n = 17/56, p < 0.0001) of cases and treatment response was even lower with SVR 12 of 25 % (n = 5/20, p = 0.0016) in the subgroup of patients with cirrhosis. Conclusion We observed a high rate of SVR 12 with SOF-based treatment regimes, however probably due to the high number of patients with liver cirrhosis and prior treatment experience, treatment response rates were lower than in previously published trials. In genotype 1 patients the analysis of early virological response may predict treatment response in SOF-based combination therapies.
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Affiliation(s)
- Niels Steinebrunner
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
| | - Martin F Sprinzl
- Department of Internal Medicine I and Cirrhosis Center Mainz (CCM), University Medical Center Mainz, Mainz, Germany.
| | - Tim Zimmermann
- Department of Internal Medicine I and Cirrhosis Center Mainz (CCM), University Medical Center Mainz, Mainz, Germany.
| | - Marcus A Wörns
- Department of Internal Medicine I and Cirrhosis Center Mainz (CCM), University Medical Center Mainz, Mainz, Germany.
| | - Thomas Zimmerer
- Department of Internal Medicine II, University Hospital Mannheim, Mannheim, Germany.
| | - Peter R Galle
- Department of Internal Medicine I and Cirrhosis Center Mainz (CCM), University Medical Center Mainz, Mainz, Germany.
| | - Wolfgang Stremmel
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
| | - Christoph Eisenbach
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
| | - Kerstin Stein
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital of Magdeburg, Magdeburg, Germany.
| | - Christoph Antoni
- Department of Internal Medicine II, University Hospital Mannheim, Mannheim, Germany.
| | - Jörn M Schattenberg
- Department of Internal Medicine I and Cirrhosis Center Mainz (CCM), University Medical Center Mainz, Mainz, Germany.
| | - Anita Pathil
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
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23
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Darstein F, König C, Hoppe-Lotichius M, Grimm D, Knapstein J, Zimmermann A, Mittler J, Schattenberg JM, Sprinzl MF, Wörns MA, Lang H, Galle PR, Zimmermann T. New onset of diabetes after transplantation is associated with improved patient survival after liver transplantation due to confounding factor. Eur J Intern Med 2015; 26:439-44. [PMID: 26058989 DOI: 10.1016/j.ejim.2015.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/22/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The influence of NODAT on survival of liver transplant recipients has not been clarified. Therefore, we evaluated the effect of NODAT on survival in LT recipients. METHODS Data from 352 LT patients were totally analyzed. 97 patients with pretransplant diabetes mellitus were excluded, and 255 patients without diabetes mellitus at time of transplantation were included. RESULTS NODAT was diagnosed in 41 patients (16.1%). There was no difference in frequency of NODAT according to the etiology of liver cirrhosis. NODAT was associated with a higher body weight (p=0.004) and BMI (p=0.002) 5years after LT, but not with weight gain (p=0.201) or increase in BMI (p=0.335) 5years after LT. HbA1c 5years after LT was significantly higher in patients with NODAT (p=0.001), but mean HbA1c still remained lower than 6.5% (6.4(±1.2) %). Patients with NODAT showed better survival rates (log rank: p=0.002) compared to LT recipients without diabetes. According to all existing knowledge of diabetes mellitus (DM) better survival cannot be a direct effect of this disease. Our results are rather influenced by an not known confounding factor (possibly recovery from cachexia) associated with better survival and NODAT, while complications of NODAT will not appear during the relatively short postoperative time and observation period (mean follow up 6.08 (±2.67) years). CONCLUSION NODAT is frequently diagnosed in LT recipients and is associated with an improved 5year survival after LT due to a not exactly known confounding factor.
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Affiliation(s)
- F Darstein
- Hepatologie, I. Medizinische Klinik der Universitätsmedizin Mainz, Germany
| | - C König
- Klinik für Kinder- und Jugendmedizin, Marienhaus Klinikum St. Elisabeth Neuwied, Germany
| | - M Hoppe-Lotichius
- Klinik für Kinder- und Jugendmedizin, Marienhaus Klinikum St. Elisabeth Neuwied, Germany
| | - D Grimm
- Hepatologie, I. Medizinische Klinik der Universitätsmedizin Mainz, Germany
| | - J Knapstein
- Hepatologie, I. Medizinische Klinik der Universitätsmedizin Mainz, Germany
| | - A Zimmermann
- Endokrinologie und Diabetologie, I. Medizinische Klinik der Universitätsmedizin Mainz, Germany
| | - J Mittler
- Allgemein-, Viszeral- und Transplantationschirurgie der Universitätsmedizin Mainz, Germany
| | - J M Schattenberg
- Hepatologie, I. Medizinische Klinik der Universitätsmedizin Mainz, Germany
| | - M F Sprinzl
- Hepatologie, I. Medizinische Klinik der Universitätsmedizin Mainz, Germany
| | - M A Wörns
- Hepatologie, I. Medizinische Klinik der Universitätsmedizin Mainz, Germany
| | - H Lang
- Allgemein-, Viszeral- und Transplantationschirurgie der Universitätsmedizin Mainz, Germany
| | - P R Galle
- Hepatologie, I. Medizinische Klinik der Universitätsmedizin Mainz, Germany
| | - T Zimmermann
- Hepatologie, I. Medizinische Klinik der Universitätsmedizin Mainz, Germany.
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Abstract
Immune control of hepatocellular carcinoma (HCC) is executed by effector immune cells, which efficiently eliminate malignant transformed cells. However, progression of HCC clearly documents failure of tumor immune control, which led to the concept of immune subversion by the tumor environment.Particularly tumor-associated stromal cells cooperate within an inflammatory network, which is responsible for immune privilege. The stromal cell composition matures during tumor growth and is derived from surrounding noncancerous tissue or from circulating cells recruited to the tumor site. Therefore, immunosuppressive stromal cells represent heterogeneous cell lineages, including myeloid cells, lymphocytes, endothelial cells, and fibroblasts, which interact by direct cell contact, secretion of soluble factors, or production of extracellular matrix. As the stromal cells determine tumor immune control and clinical outcome of HCC, they represent a promising target for cancer immunotherapy.
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Affiliation(s)
- Martin F Sprinzl
- First Medical Department, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Peter R Galle
- First Medical Department, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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25
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Sivanathan V, Kittner JM, Sprinzl MF, Weinmann A, Koch S, Wiltink J, Nguyen-Tat M, Marquardt JU, Wörns MA, Zimmermann T, Lang H, Galle PR, Schattenberg JM. [Etiology and complications of liver cirrhosis: data from a German centre]. Dtsch Med Wochenschr 2014; 139:1758-62. [PMID: 25157862 DOI: 10.1055/s-0034-1387240] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Liver cirrhosis develops as a terminal complication of chronic liver disease. The clinical course is determined by the underlying etiology and the accompanying risk factors, which are influenced by the geographic and cultural background. METHODS A total of 236 patients (159 men, 77 women, median age 57 [22-81] years) were included for retrospective analysis between July 2012 and February 2014 using standardized questionnaires during an outpatient visit at a hepatology clinic. RESULTS The most common etiologies of liver cirrhosis were related to alcohol consumption (52 %), chronic hepatitis C (28 %) or hepatitis B (14 %) infection and NASH (nonalcoholic steatohepatitis, 6 %). At the time of presentation 55 % patients had compensated cirrhosis corresponding to Child-Turcotte-Pugh (CTP) stage A, while 45 % were in a decompensated stage (30 % CTP B and 15 % CTP C). Subgroups were analyzed for the incidence of complications and the emergence of infections. Most frequently esophageal varices (60 %) and ascites (49 %) were observed, followed by pleural effusion (14 %), hepatic encephalopathy (25 %) or hepatorenal syndrome (18 %). 16 % of patients exhibited infection based on clinical criteria. An infective agent was isolated in 38 % of all cases with infection and of those 50 % were gram positive bacteria. In multivariate analysis only the presence of ascites was an independent risk factor for infection. CONCLUSION Despite improved medical therapies for viral hepatitis, these were the most frequent causes of liver cirrhosis, closely followed by alcoholic cirrhosis. The observed complications included bacterial infection and complication related to portal hypertension.
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Affiliation(s)
- V Sivanathan
- I. Medizinische Klinik, Universitätsmedizin Mainz
| | - J M Kittner
- I. Medizinische Klinik, Universitätsmedizin Mainz
| | - M F Sprinzl
- I. Medizinische Klinik, Universitätsmedizin Mainz
| | - A Weinmann
- I. Medizinische Klinik, Universitätsmedizin Mainz
| | - S Koch
- I. Medizinische Klinik, Universitätsmedizin Mainz
| | - J Wiltink
- Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Mainz
| | - M Nguyen-Tat
- I. Medizinische Klinik, Universitätsmedizin Mainz
| | | | - M A Wörns
- I. Medizinische Klinik, Universitätsmedizin Mainz
| | - T Zimmermann
- I. Medizinische Klinik, Universitätsmedizin Mainz
| | - H Lang
- Klinik für Allgemein, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz
| | - P R Galle
- I. Medizinische Klinik, Universitätsmedizin Mainz
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26
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Lucifora J, Xia Y, Reisinger F, Zhang K, Stadler D, Cheng X, Sprinzl MF, Koppensteiner H, Makowska Z, Volz T, Remouchamps C, Chou WM, Thasler WE, Hüser N, Durantel D, Liang TJ, Münk C, Heim MH, Browning JL, Dejardin E, Dandri M, Schindler M, Heikenwalder M, Protzer U. Specific and nonhepatotoxic degradation of nuclear hepatitis B virus cccDNA. Science 2014; 343:1221-8. [PMID: 24557838 DOI: 10.1126/science.1243462] [Citation(s) in RCA: 694] [Impact Index Per Article: 69.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Current antiviral agents can control but not eliminate hepatitis B virus (HBV), because HBV establishes a stable nuclear covalently closed circular DNA (cccDNA). Interferon-α treatment can clear HBV but is limited by systemic side effects. We describe how interferon-α can induce specific degradation of the nuclear viral DNA without hepatotoxicity and propose lymphotoxin-β receptor activation as a therapeutic alternative. Interferon-α and lymphotoxin-β receptor activation up-regulated APOBEC3A and APOBEC3B cytidine deaminases, respectively, in HBV-infected cells, primary hepatocytes, and human liver needle biopsies. HBV core protein mediated the interaction with nuclear cccDNA, resulting in cytidine deamination, apurinic/apyrimidinic site formation, and finally cccDNA degradation that prevented HBV reactivation. Genomic DNA was not affected. Thus, inducing nuclear deaminases-for example, by lymphotoxin-β receptor activation-allows the development of new therapeutics that, in combination with existing antivirals, may cure hepatitis B.
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Affiliation(s)
- Julie Lucifora
- Institute of Virology, Technische Universität München-Helmholtz Zentrum München, 81675 Munich, Germany
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27
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Sprinzl MF, Russo C, Kittner J, Allgayer S, Grambihler A, Bartsch B, Weinmann A, Galle PR, Schuchmann M, Protzer U, Bauer T. Hepatitis B virus-specific T-cell responses during IFN administration in a small cohort of chronic hepatitis B patients under nucleos(t)ide analogue treatment. J Viral Hepat 2013; 21:633-41. [PMID: 24251783 DOI: 10.1111/jvh.12189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 08/19/2013] [Indexed: 12/21/2022]
Abstract
The effect of pegylated interferon-α (IFN) add-on therapy on HBV-specific T-cell responses was evaluated in 12 patients with stable, undetectable hepatitis B virus (HBV) load under nucleos(t)ide analogue therapy. Peripheral blood mononuclear cells were isolated at week 0, 4, 8, 12, 24 and 48 of IFN add-on therapy. Quantity and quality of circulating HBV S- and core-specific CD4 and CD8 T cells were analysed ex vivo by flow cytometry. HBV S- and core-specific CD4 T-cell numbers modestly increased within 8 weeks of IFN administration (P = 0.0391 and P = 0.0195), whereas HBV-specific CD8 T cells in general showed only minor changes under IFN add-on therapy. Functionality of HBV-specific CD4 but not CD8 T cells positively correlated with serum transaminase activity. In addition, we observed an increase in CD4 T cells producing tumour necrosis factor-α (TNFα) without antigen restimulation (P = 0.0039), which correlated with elevated transaminases. During IFN add-on therapy, two patients developed an anti-HBs seroconversion, only one of whom showed a relevant increase in HBV-specific T cells. In conclusion, IFN add-on therapy of chronic hepatitis B increased HBV-specific T-cell responses and affected a previously unrecognized TNFα-monofunctional CD4 T-cell population. Although the observed T-cell responses did not correlate with HBsAg seroconversion, we expect additional insights into the immunopathogenesis of hepatitis B, following the characterization of the newly identified TNF α-monofunctional T-cell population.
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Affiliation(s)
- M F Sprinzl
- Institute of Virology, Technische Universität München / Helmholtz Zentrum München, Munich, Germany; Department of Medicine, Johannes Gutenberg University, Mainz, Germany
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28
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Kohl T, Gehrke N, Schad A, Nagel M, Wörns MA, Sprinzl MF, Zimmermann T, He YW, Galle PR, Schuchmann M, Schattenberg JM. Diabetic liver injury from streptozotocin is regulated through the caspase-8 homolog cFLIP involving activation of JNK2 and intrahepatic immunocompetent cells. Cell Death Dis 2013; 4:e712. [PMID: 23828575 PMCID: PMC3730402 DOI: 10.1038/cddis.2013.228] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 04/19/2013] [Accepted: 05/27/2013] [Indexed: 12/16/2022]
Abstract
The endemic occurrence of obesity and the associated risk factors that constitute the metabolic syndrome have been predicted to lead to a dramatic increase in chronic liver disease. Non-alcoholic steatohepatitis (NASH) has become the most frequent liver disease in countries with a high prevalence of obesity. In addition, hepatic steatosis and insulin resistance have been implicated in disease progression of other liver diseases, including chronic viral hepatitis and hepatocellular carcinoma. The molecular mechanisms underlying the link between insulin signaling and hepatocellular injury are only partly understood. We have explored the role of the antiapoptotic caspase-8 homolog cellular FLICE-inhibitory protein (cFLIP) on liver cell survival in a diabetic model with hypoinsulinemic diabetes in order to delineate the role of insulin signaling on hepatocellular survival. cFLIP regulates cellular injury from apoptosis signaling pathways, and loss of cFLIP was previously shown to promote injury from activated TNF and CD95/Apo-1 receptors. In mice lacking cFLIP in hepatocytes (flip−/−), loss of insulin following streptozotocin treatment resulted in caspase- and c-Jun N-terminal kinase (JNK)-dependent liver injury after 21 days. Substitution of insulin, inhibition of JNK using the SP600125 compound in vivo or genetic deletion of the mitogen-activated protein kinase (MAPK)9 (JNK2) in all tissues abolished the injurious effect. Strikingly, the difference in injury between wild-type and cFLIP-deficient mice occurred only in vivo and was accompanied by liver-infiltrating inflammatory cells with a trend toward increased amounts of NK1.1-positive cells and secretion of proinflammatory cytokines. Transfer of bone marrow from rag-1-deficient mice that are depleted from B and T lymphocytes prevented liver injury in flip−/− mice. These findings support a direct role of insulin on cellular survival by alternating the activation of injurious MAPK, caspases and the recruitment of inflammatory cells to the liver. Thus, increasing resistance to insulin signaling pathways in hepatocytes appears to be an important factor in the initiation and progression of chronic liver disease.
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Affiliation(s)
- T Kohl
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Sprinzl MF, Galle PR. Facing the dawn of immunotherapy for hepatocellular carcinoma. J Hepatol 2013; 59:9-10. [PMID: 23571018 DOI: 10.1016/j.jhep.2013.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 04/02/2013] [Accepted: 04/03/2013] [Indexed: 12/04/2022]
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Schuchmann M, Kittner JM, Schlaak JF, Klass DM, Eisenbach C, Berg T, Trautwein C, Günther R, Zeuzem S, Gösseringer R, Ehrlich A, Neumann K, Wachtlin D, Sprinzl MF, Zimmermann T, Böcher WO, Galle PR. No beneficial effect of all-trans retinoic acid in previous non-responder patients with chronic hepatitis C: the ATRACTION study, a phase II randomised trial. Dig Liver Dis 2013; 45:323-9. [PMID: 23245590 DOI: 10.1016/j.dld.2012.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Received: 07/14/2012] [Revised: 10/03/2012] [Accepted: 11/01/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preclinical data suggested all-trans retinoic acid (tretinoin) as a potential antiviral agent against chronic hepatitis C infection. AIMS To assess efficacy, safety, and tolerability of tretinoin in combination with peg-interferon and ribavirin in genotype-1 infected patients with prior non-response. METHOD We performed an open-label multicentre clinical trial. Patients were randomised to either receive additional tretinoin (45mg/m(2)/day) for 12 weeks (arm A), or peg-interferon and ribavirin alone (arm B). Primary endpoint was the slope of the third phase of viral decline (Mδ) as determined in an established kinetic model known to correlate with treatment outcome. Secondary endpoints were additional kinetic parameters, viral response rates, safety, and tolerability. RESULTS 27 patients in arm A and 30 patients in arm B were treated per protocol until week 12. Viral kinetic parameters did not differ. Rates of early virological response (>2log10 drop at week 12) were similar (10/27 versus 11/30 patients). In arm A, patients experienced a higher rate and intensity of adverse events, most commonly skin and mucosal dryness, and headache. CONCLUSION Addition of tretinoin was safe and acceptably well tolerated. However, it did not influence viral kinetics and thus cannot be further considered as a treatment option.
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Sprinzl MF, Weinmann A, Lohse N, Tönissen H, Koch S, Schattenberg J, Hoppe-Lotichius M, Zimmermann T, Galle PR, Hansen T, Otto G, Schuchmann M. Metabolic syndrome and its association with fatty liver disease after orthotopic liver transplantation. Transpl Int 2012; 26:67-74. [DOI: 10.1111/j.1432-2277.2012.01576.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Kittner JM, Sprinzl MF, Grambihler A, Weinmann A, Schattenberg JM, Galle PR, Schuchmann M. Adding pegylated interferon to a current nucleos(t)ide therapy leads to HBsAg seroconversion in a subgroup of patients with chronic hepatitis B. J Clin Virol 2012; 54:93-5. [PMID: 22365367 DOI: 10.1016/j.jcv.2012.01.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/21/2012] [Accepted: 01/30/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nucleos(t)ides effectively halt disease progression in hepatitis B but require long-term medication. OBJECTIVES To determine whether add-on of peg-IFN to an ongoing nucleos(t)ide therapy accelerates decline of HBsAg and induces seroconversion. STUDY DESIGN We observed HBsAg kinetics in 12 patients on a stable oral therapy with undetectable HBV-DNA who additionally received peg-IFN-alfa 2a as an individualized therapy. 3 patients were HBeAg positive. Mean baseline HBsAg was 4695 (range 16-15,120)IU/ml. RESULTS A continuous decline of HBsAg was observed in 2 patients. The slope, respectively, became detectable at week 8 or 16. HBsAg had dropped by 2.90log(10) or 4.25log(10) fold at week 48, and anti-HBs appeared at week 40 or 32. Patient A - HBe-positive, genotype A, F3 fibrosis - had been HBV-DNA negative for 10 months receiving entecavir plus tenofovir. Previous therapy with peg-IFN had been unsuccessful, but now the patient experienced HBeAg seroconversion at week 24. Patient B - HBeAg negative, genotype D, cirrhosis - had a low initial HBsAg level of 16U/l. Receiving entecavir, his HBV-DNA had previously been non-detectable for 27 months. In the remaining 10 patients HBsAg declined only by a mean of 0.09log(10) (range 0.01-0.25log(10)) after 8-24 (mean 16.4) weeks, and therefore, peg-IFN was stopped. No unexpected side effects were observed. DISCUSSION We observed that the add-on of peg-IFN induced HBsAg seroconversion in 2 out of 12 patients. Response rates may have been higher with prolongation of therapy. The add-on concept merits to be evaluated in a clinical trial.
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Affiliation(s)
- Jens M Kittner
- I. Medical Department, University Hospital Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.
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Schattenberg JM, Zimmermann T, Wörns M, Sprinzl MF, Kreft A, Kohl T, Nagel M, Siebler J, Schulze Bergkamen H, He YW, Galle PR, Schuchmann M. Ablation of c-FLIP in hepatocytes enhances death-receptor mediated apoptosis and toxic liver injury in vivo. J Hepatol 2011; 55:1272-80. [PMID: 21703207 DOI: 10.1016/j.jhep.2011.03.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 03/07/2011] [Accepted: 03/08/2011] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS Apoptosis is crucially involved in acute and chronic liver injury, including viral, cholestatic, toxic, and metabolic liver disease. Additionally, dysregulation of apoptosis signaling pathways has been implicated in hepatocarcinogenesis. The most prominent members of the apoptosis-mediating tumor necrosis factor receptor superfamily are the TNF-R1 (CD120a) and the CD95 (Apo-1/Fas) receptor. Although extensively studied, the intracellular signaling events in hepatocytes are only incompletely understood. METHODS To examine the role of the caspase-8 homolog cellular FLICE-inhibitory protein (c-FLIP) in liver injury, we generated mice with hepatocyte specific deletion of c-FLIP. Three models of acute liver injury were employed: the agonistic anti-CD95 antibody Jo2, d-galactosamine and LPS (GalN/LPS), and concanavalin A. RESULTS Conditional ablation of c-FLIP in hepatocytes augmented liver injury and cell death in all three models of liver injury. CD95- and GalN/LPS-induced liver injury was ameliorated by a pancaspase inhibitor, while ConA-induced injury was unaffected by caspase inhibition. Augmented activation of the MAPK JNK was observed in parallel to liver injury in c-FLIP knockout mice in all injury models; however, inhibition of JNK only affected TNF- and ConA-mediated injury. CONCLUSIONS In summary, c-FLIP is a central regulator of cell death in hepatocytes, involving increased activation of caspases and the MAPK JNK.
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Affiliation(s)
- Jörn M Schattenberg
- Department of Medicine, University Medical Center, Johannes Gutenberg University, 55101 Mainz, Germany.
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Moehler M, Sprinzl MF, Abdelfattah M, Schimanski CC, Adami B, Godderz W, Majer K, Flieger D, Teufel A, Siebler J, Hoehler T, Galle PR, Kanzler S. Capecitabine and irinotecan with and without bevacizumab for advanced colorectal cancer patients. World J Gastroenterol 2009; 15:449-56. [PMID: 19152449 PMCID: PMC2653366 DOI: 10.3748/wjg.15.449] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the efficacy and safety of cape-citabine plus irinotecan ± bevacizumab in advanced or metastatic colorectal cancer patients.
METHODS: Forty six patients with previously untreated, locally-advanced or metastatic colorectal cancer (mCRC) were recruited between 2001-2006 in a prospective open-label phase II trial, in German community-based outpatient clinics. Patients received a standard capecitabine plus irinotecan (CAPIRI) or CAPIRI plus bevacizumab (CAPIRI-BEV) regimen every 3 wk. Dose reductions were mandatory from the first cycle in cases of > grade 2 toxicity. The treatment choice of bevacizumab was at the discretion of the physician. The primary endpoints were response and toxicity and secondary endpoints included progression-free survival and overall survival.
RESULTS: In the CAPIRI group vs the CAPRI-Bev group there were more female than male patients (47% vs 24%), and more patients had colon as the primary tumor site (58.8% vs 48.2%) with fewer patients having sigmoid colon as primary tumor site (5.9% vs 20.7%). Grade 3/4 toxicity was higher with CAPIRI than CAPIRI-Bev: 82% vs 58.6%. Partial response rates were 29.4% and 34.5%, and tumor control rates were 70.6% and 75.9%, respectively. No complete responses were observed. The median progression-free survival was 11.4 mo and 12.8 mo for CAPIRI and CAPIRI-Bev, respectively. The median overall survival for CAPIRI was 15 mo (458 d) and for CAPIRI-Bev 24 mo (733 d). These differences were not statistically different. In the CAPIRI-Bev, group, two patients underwent a full secondary tumor resection after treatment, whereas in the CAPIRI group no cases underwent this procedure.
CONCLUSION: Both regimens were well tolerated and offered effective tumor growth control in this outpatient setting. Severe gastrointestinal toxicities and thromboembolic events were rare and if observed were never fatal.
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Sprinzl MF, Wytopil SM, Dahmen A, Kanzler S, Galle PR, Moehler M. Docetaxel as salvage therapy in highly pretreated and drug resistant gastrointestinal carcinomas. Clin Med Oncol 2008; 2:555-61. [PMID: 21892332 PMCID: PMC3161696 DOI: 10.4137/cmo.s919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction Despite many efforts to develop new chemotherapies for metastatic upper gastrointestinal (GI) cancer, overall prognosis continues to be fatal, particularly in gastric and pancreatic cancer. Many of these patients deserve second-or third-line treatment after failure of first-line chemotherapy. Therefore, we analysed toxicity and response rate of weekly docetaxel after failed upfront regimes in these upper GI cancer patients. Patients and Methods Between 2001 and 2006, 18 patients received docetaxel based regimes (35 mg/m2 weekly) after informed consent. Response rates were determined using RECIST criteria or tumor progression if clinically evident. Toxicities were graded based on NCI CTC criteria (version 2). Most patients had gastric cancer (13/18). The remaining entities comprised of bilio-pancreatic cancer (5/18). Results Docetaxel was administered as 2nd line therapy in 28% (5/18), 3rd line therapy in 56% (10/18) and 4th or 5th line therapy in 17% (3/18). The average docetaxel dose was 38 mg/m2 (Median: 35 mg/m2) once weekly. Over a treatment duration of 14.7 weeks, the average dosage was 58 gr per patient and week. Overall, docetaxel was well tolerated with only few chemotherapy-associated toxicities (Grade 3/4), including nausea (17%), polyneuropathy (17%), anorexia (11%), neutropenia (6%) and leukopenia (17%). Docetaxel administration did not achieve any complete responses (CR) and one (5.6%) partial response (PR) was seen (1/18). In addition 5 patients (27.8%) had stable disease (SD), thus inducing a tumor control rate of 33.3% (6/18). Median progression-free survival was 2.4 months for all patients, 2.1 months in the gastric-cancer and 2.4 months in the bilio-pancreatic cancer subgroups respectively. After first docetaxel administration median survival for all patients was 4.5 months, patients with gastric cancer survived for 4.9 months whereas patients suffering from bilio-pancreatic carcinoma survived for 4.2 months. However, taken together 27% (5/18) had a remarkable overall survival of more than 2.5 years. Discussion In severely pretreated patients, with documented chemoresistant GI tumors, weekly docetaxel was well tolerated, presented good tumor control rate and overall survival. Therefore, this regimen may be used as salvage treatment in individual patients with upper GI cancers.
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Affiliation(s)
- Martin F Sprinzl
- 1st Medical Department, Johannes Gutenberg University, Mainz, Germany
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Abstract
Hepatitis C virus (HCV) re-infection of the liver graft has been recognized to be one of the most important factors that determines prognosis and outcome after liver transplantation in HCV-positive patients. Graft loss due to recurrent HCV re-cirrhosis and subsequent hepatic decompensation, which is the predominant cause of death among transplant recipients, reflects the prognostic significance of HCV re-infection. Despite better overall outcome after liver transplantation, the prognosis of HCV-infected patients has not improved during the last two decades. Recent data suggest that increased liver donor age and intensified immunosuppression of transplant patients are the most important contributors to this situation. Other prognostic factors need further confirmation to stratify risk constellations. As HCV cirrhosis has also become the leading indication for orthotopic liver transplantation, the therapeutic management of HCV re-infection is a central issue of liver transplantation. The antiviral approaches based on interferon (IFN) alpha and ribavirin combinations are still hampered by high toxicity and low efficacy. Sustained viral response rates are still as low as approximately 10-30% and further prospective clinical trials are mandatory to identify the best time point and schedule of antiviral treatment in transplant patients.
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Affiliation(s)
- Martin F Sprinzl
- Department of Internal Medicine, Johannes Gutenberg University Mainz, Mainz, Germany
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Zimmermann T, Böcher WO, Biesterfeld S, Zimmermann A, Kanzler S, Greif-Higer G, Barreiros AP, Sprinzl MF, Wörns MA, Lohse AW, Mönch C, Otto G, Galle PR, Schuchmann M. Efficacy of an escalating dose regimen of pegylated interferon alpha-2a plus ribavirin in the early phase of HCV reinfection after liver transplantation. Transpl Int 2007; 20:583-90. [PMID: 17433090 DOI: 10.1111/j.1432-2277.2007.00481.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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: 01/20/2023]
Abstract
We evaluated the safety and efficacy of an escalating dose regimen of pegylated interferon alpha-2a (PEG-IFN(alpha-2a)) and ribavirin in the early phase of recurrent hepatitis C after orthotopic liver transplantation (OLT). In this prospective study, 26 patients transplanted for hepatitis C virus cirrhosis with recurrent hepatitis C were treated 3.4 +/- 3.6 months after OLT and compared with an untreated historical control. PEG-IFN(alpha-2a) was initiated as monotherapy, following stepwise dose escalation up to 180 mug/week and the addition of ribavirin up to 1200 mg/day or maximally tolerated doses for 48 weeks. In the intent-to-treat analysis, 38% showed an early virological response (EVR), 35% an end of treatment response (ETR) and 19% a sustained virological response (SVR). SVR was associated with EVR (P = 0.0001) and cumulative PEG-IFN(alpha-2a) dose (P = 0.04). There was no significant histological improvement compared with untreated patients. There were no treatment-related serious adverse events. Adverse events included leucopenia (77%) and thrombocytopenia (46%). Three patients discontinued therapy due to side effects, fourteen were nonresponders and four relapsers. Treatment with PEG-IFN(alpha-2a) and ribavirin in the acute phase of post-transplant recurrent hepatitis C yielded an EVR of 38% and an SVR of 19%. The combination was safe and well tolerated.
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Affiliation(s)
- Tim Zimmermann
- 1st Department of Medicine, University of Mainz, Langenbeck Strasse 1, 55101 Mainz, Germany
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Abstract
Viral hepatitis is a diffuse inflammatory reaction of the liver caused by hepatotropic viruses. Among the hepatitis viruses, only hepatitis B virus and hepatitis C virus are able to persist in the host and cause chronic hepatitis. In the course of persistent infection, inflammation forms the pathogenetic basis of chronic hepatitis that can lead to nodular fibrosis, which can progress to cirrhosis and, eventually, hepatocellular carcinoma (HCC). Of the different antiviral defense systems employed by the host, apoptosis significantly contributes to the prevention of viral replication, dissemination, and persistence. Pathomorphologic studies have shown acidophilic bodies and hepatocyte dropout, features that are compatible with apoptosis. The number of hepatocytes showing features of apoptosis in patients with chronic hepatitis B and C was found to be higher than in healthy subjects, indicating that apoptosis is involved in the pathogenesis of these diseases. There are various data suggesting that hepatitis B and C viral proteins may modulate apoptosis. Vice versa, mechanisms of apoptosis inhibition might represent central survival strategies employed by the virus which, in the end, may contribute to HCC development. While the expression and retention of viral proteins in hepatocytes may influence the severity and progression of liver disease, the mechanisms of liver injury in viral hepatitis are defined to be due not only to the direct cytopathic effects of viruses, but also to the host immune response to viral proteins expressed by infected hepatocytes. However, the exact role of these observations in relation to pathogenesis remains to be established. The mechanism and systems are complex. This report aims to provide an overview and intends to cite only a small number of pertinent references.
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Affiliation(s)
- K Herzer
- Deptartment I of Internal Medicine, Mainz University, Mainz, Germany.
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Sprinzl MF, Schimanski CC, Moehler M, Schadmand-Fischer S, Galle PR, Kanzler S. Gemcitabine in combination with EGF-Receptor antibody (Cetuximab) as a treatment of cholangiocarcinoma: a case report. BMC Cancer 2006; 6:190. [PMID: 16846514 PMCID: PMC1564184 DOI: 10.1186/1471-2407-6-190] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 07/17/2006] [Indexed: 11/24/2022] Open
Abstract
Background Extensive disease of cholangiocarcinoma (CC) determines the overall outcome and limits curative resection. Despite chemotherapy, which has been introduced to improve the outcome of biliary tract malignancies, the benefit in survival is still marginal. Case presentation We report a 69-year-old patient with non-resectable CC showing hepatic metastasis and peritoneal carcinomatosis. Diagnosis was based on computed tomography, mini-laparoscopy and bioptic specimens. Histology revealed an adenocarcinoma of the biliary tract with expression of epithelial growth factor receptor. After informed consent the patient received experimental gemcitabine (1000 mg/m2) every other week and cetuximab (250 mg/m2) weekly for palliative chemotherapy. During the reported follow up (since time of first presentation) 20 cycles of chemotherapy were administered. Relevant chemotherapy-related toxicity was limited on gemcitabine-associated side effects. Predominantly, haematological toxicity (CTC, grade 3) and neutropenic fever (CTC, grade 3) promoted by catheter-related sepsis were observed. Cetuximab caused only mild skin toxicity (CTC, grade 1). Chemotherapy led to a partial response (> 30% reduction, according to RECIST) of the target lesions and disappearance of the peritoneal carcinomatosis as shown by computed tomography. Partial response occurred after 17 weeks of treatment and remained stable during the entire course of chemotherapy for 9.7 months. In parallel, Ca 19-9 serum levels, which were elevated 5-fold at time of diagnosis, returned to normal after 16 weeks of treatment. The performance status stabilized and intravenous alimentation could be discontinued. Conclusion Our experience from one patient with CC suggests, that a combination of cytotoxic chemotherapy together with cetuximab may show promising efficacy in respect to survival and quality of life. Therefore cetuximab, as a component of palliative chemotherapy in biliary tract cancer, needs further evaluation in prospective randomized trials.
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Affiliation(s)
- Martin F Sprinzl
- I. Department of Medicine, Johannes-Gutenberg University, Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany
| | - Carl C Schimanski
- I. Department of Medicine, Johannes-Gutenberg University, Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany
| | - Markus Moehler
- I. Department of Medicine, Johannes-Gutenberg University, Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany
| | - Simin Schadmand-Fischer
- Department of Radiology, Johannes-Gutenberg University, Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany
| | - Peter R Galle
- I. Department of Medicine, Johannes-Gutenberg University, Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany
| | - Stephan Kanzler
- I. Department of Medicine, Johannes-Gutenberg University, Mainz, Langenbeckstrasse 1, 55101 Mainz, Germany
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Sprinzl MF, Oberwinkler H, Schaller H, Protzer U. Transfer of hepatitis B virus genome by adenovirus vectors into cultured cells and mice: crossing the species barrier. J Virol 2001; 75:5108-18. [PMID: 11333892 PMCID: PMC114916 DOI: 10.1128/jvi.75.11.5108-5118.2001] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2000] [Accepted: 03/01/2001] [Indexed: 02/06/2023] Open
Abstract
For the study of hepatitis B virus infection, no permissive cell line or small animal is available. Stably transfected cell lines and transgenic mice which contain hepadnavirus genomes produce virus, but--unlike in natural infection--from an integrated viral transcription template. To transfer hepadnavirus genomes across the species barrier, we developed adenovirus vectors in which 1.3-fold-overlength human and duck hepatitis B virus genomes were inserted. The adenovirus-mediated genome transfer efficiently initiated hepadnavirus replication from an extrachromosomal template in established cell lines, in primary hepatocytes from various species, and in the livers of mice. Following the transfer, hepatitis B virus proteins, genomic RNA, and all replicative DNA intermediates were detected. Detection of covalently closed circular DNA in hepatoma cell lines and in primary hepatocytes indicated that an intracellular replication cycle independent from the transferred linear viral genome was established. High-titer hepatitis B virions were released into the culture medium of hepatoma cells and the various primary hepatocytes. In addition, infectious virions were secreted into the sera of mice. In conclusion, adenovirus-mediated genome transfer initiated efficient hepatitis B virus replication in cultured liver cells and in the experimental animals from an extrachromosomal template. This will allow development of small-animal systems of hepatitis B virus infection and will facilitate study of pathogenicity of wild-type and mutant viruses as well as of virus-host interaction and new therapeutic approaches.
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MESH Headings
- Adenoviridae/genetics
- Animals
- Blotting, Northern
- Blotting, Southern
- Cells, Cultured
- Cytoplasm/virology
- DNA, Viral/analysis
- Disease Models, Animal
- Ducks
- Genetic Vectors
- Genome, Viral
- Hepadnaviridae Infections/virology
- Hepatitis B Virus, Duck/genetics
- Hepatitis B Virus, Duck/pathogenicity
- Hepatitis B virus/chemistry
- Hepatitis B virus/genetics
- Hepatitis B virus/pathogenicity
- Hepatocytes/virology
- Humans
- Immunoblotting
- Kinetics
- Male
- Mice
- Mice, Inbred C57BL
- Microscopy, Phase-Contrast
- Rats
- Species Specificity
- Transfection
- Tupaia
- Viral Proteins/analysis
- Virus Replication/genetics
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Affiliation(s)
- M F Sprinzl
- Zentrum für Molekulare Biologie Heidelberg, University of Heidelberg, D-69120 Heidelberg, Federal Republic of Germany
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