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Fejes R, Lutnik M, Weisshaar S, Pilat N, Wagner KH, Stüger HP, Peake JM, Woodman RJ, Croft KD, Bondonno CP, Hodgson JM, Wolzt M, Neubauer O. Increased nitrate intake from beetroot juice over 4 weeks affects nitrate metabolism, but not vascular function or blood pressure in older adults with hypertension. Food Funct 2024; 15:4065-4078. [PMID: 38546454 PMCID: PMC11034575 DOI: 10.1039/d3fo03749e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/24/2024] [Indexed: 04/23/2024]
Abstract
The decline in vascular function and increase in blood pressure with aging contribute to an increased cardiovascular disease risk. In this randomized placebo-controlled crossover study, we evaluated whether previously reported cardiovascular benefits of plant-derived inorganic nitrate via nitric oxide (NO) translate into improved vascular function and blood pressure-lowering in 15 men and women (age range: 56-71 years) with treated hypertension. We investigated the effects of a single ∼400 mg-dose at 3 hours post-ingestion (3H POST) and the daily consumption of 2 × ∼400 mg of nitrate through nitrate-rich compared with nitrate-depleted (placebo) beetroot juice over 4 weeks (4WK POST). Measurements included nitrate and nitrite in plasma and saliva; endothelial-dependent and -independent forearm blood flow (FBF) responses to acetylcholine (FBFACh) and glyceryltrinitrate (FBFGTN); and clinic-, home- and 24-hour ambulatory blood pressure. Compared to placebo, plasma and salivary nitrate and nitrite increased at 3H and 4WK POST following nitrate treatment (P < 0.01), suggesting a functioning nitrate-nitrite-NO pathway in the participants of this study. There were no differences between treatments in FBFACh and FBFGTN-area under the curve (AUC) ratios [AUC ratios after (3H POST, 4WK POST) compared with before (PRE) the intervention], or 24-hour ambulatory blood pressure or home blood pressure measures (P > 0.05). These findings do not support the hypothesis that an increased intake of dietary nitrate exerts sustained beneficial effects on FBF or blood pressure in hypertensive older adults, providing important information on the efficacy of nitrate-based interventions for healthy vascular aging. This study was registered under ClinicialTrials.gov (NCT04584372).
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Affiliation(s)
- Rebeka Fejes
- Department of Nutritional Sciences, Research Platform Active Ageing, University of Vienna, Vienna, Austria.
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, Vienna, Austria
| | - Martin Lutnik
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Stefan Weisshaar
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Nina Pilat
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Karl-Heinz Wagner
- Department of Nutritional Sciences, Research Platform Active Ageing, University of Vienna, Vienna, Austria.
| | - Hans-Peter Stüger
- Division Integrative Risk Assessment, Data and Statistics, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Jonathan M Peake
- School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - Kevin D Croft
- Medical School, University of Western Australia, Royal Perth Hospital Unit, Perth, Western Australia, Australia
| | - Catherine P Bondonno
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Royal Perth Hospital Research Foundation, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Jonathan M Hodgson
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Royal Perth Hospital Research Foundation, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oliver Neubauer
- Department of Nutritional Sciences, Research Platform Active Ageing, University of Vienna, Vienna, Austria.
- Centre for Health Sciences and Medicine, University for Continuing Education Krems, Krems, Austria
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Shafran I, Probst V, Panzenböck A, Sadushi-Kolici R, Gerges C, Wolzt M, Segel MJ, Celermajer DS, Lang IM, Skoro-Sajer N. Asymmetric Dimethylarginine and NT-proBNP Levels Provide Synergistic Information in Pulmonary Arterial Hypertension. JACC Heart Fail 2024:S2213-1779(24)00177-X. [PMID: 38573264 DOI: 10.1016/j.jchf.2024.02.013] [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] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Plasma asymmetric dimethylarginine (ADMA) is elevated in pulmonary arterial hypertension (PAH) and is associated with unfavorable outcomes. OBJECTIVES The aim of this study was to assess changes in ADMA plasma levels for monitoring disease progression and outcomes during PAH-specific therapy. METHODS ADMA was measured at baseline and after at least 6 months of follow-up using enzyme-linked immunosorbent assay and high-performance liquid chromatography. Changes in ADMA were analyzed in relation to changes in established PAH markers, including hemodynamic status, N-terminal pro-brain natriuretic peptide (NT-proBNP) and risk assessment scores. Impact on survival was assessed using Kaplan-Meier curves and Cox proportional hazards models. RESULTS Between 2008 and 2019, ADMA samples were collected prospectively from 215 patients with PAH. Change in ADMA plasma level was a predictor of disease progression and survival. ΔADMA (median -0.03 μmol/L; 95% CI: -0.145 to 0.0135) was correlated with change in mean pulmonary arterial pressure (P < 0.005; rS = 0.287) but was not significantly correlated with ΔNT-proBNP (P = 0.056; rS = 0.135). Patients with decreased ADMA plasma levels at follow-up had better 3-year and 5-year survival rates (88% and 80%, respectively, vs 72% and 53% in those without decreases in ADMA) (P < 0.005; pulmonary hypertension-related mortality or lung transplantation). Patients with decreases in both ADMA and NT-proBNP had better survival rates compared with patients in whom only 1 parameter improved (P < 0.005). ΔADMA was a significant predictor of survival in Cox regression analysis and also when corrected for ΔNT-proBNP (HRs: 1.27 and 1.35, respectively; P < 0.005). CONCLUSIONS ADMA and NT-proBNP provide synergistic prognostic information for patients with PAH. ADMA could be used as an objective and distinct biomarker for monitoring treatment response in PAH.
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Affiliation(s)
- Inbal Shafran
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; Pulmonary Institute, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victoria Probst
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Adelheid Panzenböck
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Roela Sadushi-Kolici
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Christian Gerges
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Michael J Segel
- Pulmonary Institute, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Irene Marthe Lang
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Nika Skoro-Sajer
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.
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Perkmann T, Springer DN, Mucher P, Wolzt M, Weseslindtner L, Haslacher H. Breakthrough infections with SARS-CoV-2 omicron efficiently boost antibodies from previous BNT162b2 vaccinations. J Clin Virol Plus 2023; 3:100157. [PMID: 37398629 PMCID: PMC10299948 DOI: 10.1016/j.jcvp.2023.100157] [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: 02/03/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023] Open
Abstract
Objective To investigate whether SARS-CoV-2 omicron breakthrough infection in individuals after three doses of wildtype-based BNT162b2 increases antibody levels measured by a commercially available wildtype-based immunoassay. Methods 16 of 21 individuals in a BNT162b2 vaccination cohort (recruited 129 [129-135] days after dose 3) experienced a breakthrough infection (BTI) between March and September 2022. Antibodies to the receptor binding domain (RBP) of the spike protein (Anti-S) were quantified using the wildtype-based Elecsys SARS-CoV-2 S assay (Roche). Antibody responses of triple vaccinated BTI cases were compared to triple vaccinated individuals without breakthrough infection and to 16 matched individuals after primary omicron infection. Results In the 16 individuals with primary Omicron infection, the anti-S assay returned only very low results (2.25 [0.61-5.80] U/mL). However, in individuals with BTI, Anti-S levels rose from 7,135 [5,870-17,470] U/mL to 21,705 (7,750-46,137.5) U/mL. At the same time, Anti-S concentrations decreased from 9,120 [7,480-13,480] U/mL to 3,830 (2,390-4,220) U/mL in those 5 of 21 vaccinated only. Conclusions Our data suggest that breakthrough infection with omicron can efficiently boost wild-type antibodies in individuals vaccinated with wild-type BNT162b2.
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Affiliation(s)
- Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
| | | | - Patrick Mucher
- Department of Laboratory Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | | | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria
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Sheikh Rezaei S, Gatterer C, Sulzgruber P, Hofer F, Mittlboeck H, Gavrilovic S, Loyoddin Y, Wolzt M, Schönbauer R, Speidl W, Richter B, Heinz G, Sponder M. Risk stratification and long-term outcome of patients receiving in-hospital medical emergency team critical care: experience from Austria's largest medical center. Minerva Med 2023; 114:307-315. [PMID: 36255709 DOI: 10.23736/s0026-4806.22.07780-1] [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: 06/13/2023]
Abstract
BACKGROUND We aimed to investigate predictors for long-term survival of in-hospital patients with medical emergency team (MET) consultation with or without in-hospital cardiac arrest (IHCA) in Austria's largest medical center. METHODS Data of patients, who needed an intervention of a MET between 01/2014 and 03/2020 were reviewed for this retrospective analysis. RESULTS In total, 708 MET calls were analyzed. The minimum follow-up was 7 months, the maximum 6.2 years. The main MET indications were circulatory failure (63%) followed by respiratory failure (27.1%), and bleeding events (3.5%). IHCA with subsequent cardiopulmonary resuscitation (CPR) was experienced by 425 (60%) patients. Of those, 274 (64%) reached return of spontaneous circulation (ROSC), and 221 (52%) survived the first 24-hours (median survival: 146 days) and 22.1% the first year. After adjustment for potential confounders, age (P<0.001), time to ROSC (P<0.001), a non-shockable rhythm (P=0.041), chronic kidney disease (CKD, P=0.041), peak lactate levels (P<0.001), and C-reactive protein (P=0.001) were associated with long-term all-cause mortality in IHCA patients in Cox regression analysis. The 283 MET calls (40%) which were due to other reasons than IHCA were associated with a much better 24-hours (93%) and 1-year survival (61.8%). Beside age (P<0.001), the main risk factors associated with mortality in MET patients without IHCA were comorbidities such as chronic obstructive pulmonary disease (COPD, P=0.008), CKD (P=0.001), pulmonary hypertension/chronic thromboembolic pulmonary hypertension (PH/CTEPH, P=0.024), and cancer (P=0.040). CONCLUSIONS Patients triggering MET calls have an increased mortality, especially those with IHCA. Predictors of mortality comprise age, comorbidities, and cardiac arrest-related parameters. A better characterization of MET call populations and their outcome might help to improve clinical decision making.
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Affiliation(s)
| | - Constantin Gatterer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Felix Hofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Helene Mittlboeck
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Stefan Gavrilovic
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Yannick Loyoddin
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Robert Schönbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Walter Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Bernhard Richter
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria -
| | - Michael Sponder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Haupenthal F, Rahn J, Maggi F, Gelas F, Bourgeois P, Hugo C, Jilma B, Böhmig GA, Herkner H, Wolzt M, Doberer K, Vossen M, Focosi D, Neuwirt H, Banas M, Banas B, Budde K, Viklicky O, Malvezzi P, Rostaing L, Rotmans JI, Bakker SJL, Eller K, Cejka D, Pérez AM, Rodriguez-Arias D, König F, Bond G. A multicentre, patient- and assessor-blinded, non-inferiority, randomised and controlled phase II trial to compare standard and torque teno virus-guided immunosuppression in kidney transplant recipients in the first year after transplantation: TTVguideIT. Trials 2023; 24:213. [PMID: 36949445 PMCID: PMC10032258 DOI: 10.1186/s13063-023-07216-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/02/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Immunosuppression after kidney transplantation is mainly guided via plasma tacrolimus trough level, which cannot sufficiently predict allograft rejection and infection. The plasma load of the non-pathogenic and highly prevalent torque teno virus (TTV) is associated with the immunosuppression of its host. Non-interventional studies suggest the use of TTV load to predict allograft rejection and infection. The primary objective of the current trial is to demonstrate the safety, tolerability and preliminary efficacy of TTV-guided immunosuppression. METHODS For this purpose, a randomised, controlled, interventional, two-arm, non-inferiority, patient- and assessor-blinded, investigator-driven phase II trial was designed. A total of 260 stable, low-immunological-risk adult recipients of a kidney graft with tacrolimus-based immunosuppression and TTV infection after month 3 post-transplantation will be recruited in 13 academic centres in six European countries. Subjects will be randomised in a 1:1 ratio (allocation concealment) to receive tacrolimus either guided by TTV load or according to the local centre standard for 9 months. The primary composite endpoint includes the occurrence of infections, biopsy-proven allograft rejection, graft loss, or death. The main secondary endpoints include estimated glomerular filtration rate, graft rejection detected by protocol biopsy at month 12 post-transplantation (including molecular microscopy), development of de novo donor-specific antibodies, health-related quality of life, and drug adherence. In parallel, a comprehensive biobank will be established including plasma, serum, urine and whole blood. The date of the first enrolment was August 2022 and the planned end is April 2025. DISCUSSION The assessment of individual kidney transplant recipient immune function might enable clinicians to personalise immunosuppression, thereby reducing infection and rejection. Moreover, the trial might act as a proof of principle for TTV-guided immunosuppression and thus pave the way for broader clinical applications, including as guidance for immune modulators or disease-modifying agents. TRIAL REGISTRATION EU CT-Number: 2022-500024-30-00.
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Affiliation(s)
- Frederik Haupenthal
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jette Rahn
- Coordination Center for Clinical Trials, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Fanny Gelas
- bioMérieux SA, Centre Christophe Merieux, Grenoble, France
| | | | - Christian Hugo
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Clinical Trials Coordination Centre, Medical University of Vienna, Vienna, Austria
| | - Konstantin Doberer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Matthias Vossen
- Division of Infectious diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Hannes Neuwirt
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Miriam Banas
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Banas
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Klemens Budde
- Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ondrej Viklicky
- Transplant Center, Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Paolo Malvezzi
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, CHU-Grenoble-Alpes, Grenoble, France
| | - Lionel Rostaing
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, CHU-Grenoble-Alpes, Grenoble, France
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Cejka
- Ordensklinikum Linz GmbH Elisabethinen, Linz, Austria
| | - Alberto Molina Pérez
- Institute for Advanced Social Studies, Spanish National Research Council, Madrid, Spain
| | | | - Franz König
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Gregor Bond
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
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Irrgeher J, Berger T, Tchaikovsky A, Tschegg C, Gouya G, Lechner P, Retzmann A, Opper C, Firbas C, Freissmuth M, Peschel-Credner K, Anderle K, Meisslitzer C, Wolzt M, Prohaska T. Enriched stable 204Pb as tracer at ultra-low levels in clinical investigations. Anal Bioanal Chem 2023; 415:255-268. [PMID: 36136113 PMCID: PMC9823027 DOI: 10.1007/s00216-022-04311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 01/11/2023]
Abstract
The potential of enriched Pb (204Pb) was assessed to monitor pathways of trace levels of Pb in the pg range within the human body via isotope pattern variation in situations where natural lead cannot be used as a tracer due to regulatory limitations. Isotope ratio measurements were accomplished by means of (multi-collector) inductively coupled plasma mass spectrometry including a comparison of single and multi-collector ICP-MS for low-level 204Pb assessment. Isotopic pattern results from a blend of a large quantity of the element with a natural isotopic composition and an enriched stable isotope at orders of magnitude lower levels pose a nontrivial analytical problem. Isotope pattern deconvolution was successfully applied as mathematical tool based on multiple linear regressions. The method allowed for deconvolving the isotope pattern from measured isotope ratios without knowing the quantities of different isotope sources incorporated and mixed into the sample at levels of < 1 pg 204Pb/g blood. The objective of this manuscript is to evaluate and summarize the analytical aspects for Pb isotope pattern deconvolution based on the results of a clinical trial, where a 204Pb-enriched isotope tracer was applied to investigate the bioavailability of orally applied Pb along with purified clinoptilolite tuff as potential supplement. This unique approach allows to reduce tracer amounts to harmless levels to human health, which are in accordance with the legal regulative to study enrichment levels of < 0.01% in human blood.
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Affiliation(s)
- Johanna Irrgeher
- Department of General, Analytical and Physical Chemistry, Montanuniversität Leoben, Franz-Josef-Straße 18, 8700 Leoben, Austria
| | - Thomas Berger
- Glock Health Science and Research GmbH, Hausfeldstraße 17, 2232 Deutsch-Wagram, Austria
| | | | - Cornelius Tschegg
- Glock Health Science and Research GmbH, Hausfeldstraße 17, 2232 Deutsch-Wagram, Austria
| | - Ghazaleh Gouya
- Gouya Insights, Elisabethstrasse 22/12, 1010 Vienna, Austria
| | - Peter Lechner
- LGS-INSIGHTS GmbH, Elisabethstrasse 22/12, 1010 Vienna, Austria
| | - Anika Retzmann
- Department of General, Analytical and Physical Chemistry, Montanuniversität Leoben, Franz-Josef-Straße 18, 8700 Leoben, Austria
| | - Christine Opper
- Department of General, Analytical and Physical Chemistry, Montanuniversität Leoben, Franz-Josef-Straße 18, 8700 Leoben, Austria ,TB Unterfrauner GmbH, Umseerstraße 39, 3040 Neulengbach, Austria
| | - Christa Firbas
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Freissmuth
- Institute of Pharmacology and the Gaston H. Glock Research Laboratories for Exploratory Drug Development, Center of Physiology and Pharmacology, Medical University of Vienna, Währingerstrasse 13a, Vienna, Austria
| | | | - Karolina Anderle
- Institute of Pharmacology and the Gaston H. Glock Research Laboratories for Exploratory Drug Development, Center of Physiology and Pharmacology, Medical University of Vienna, Währingerstrasse 13a, Vienna, Austria
| | - Claudia Meisslitzer
- Glock Health Science and Research GmbH, Hausfeldstraße 17, 2232 Deutsch-Wagram, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Prohaska
- Department of General, Analytical and Physical Chemistry, Montanuniversität Leoben, Franz-Josef-Straße 18, 8700 Leoben, Austria
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7
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Perkmann T, Mucher P, Ösze D, Müller A, Perkmann-Nagele N, Koller T, Radakovics A, Flieder I, Repl M, Marculescu R, Wolzt M, Wagner OF, Binder CJ, Haslacher H. Comparison of five Anti-SARS-CoV-2 antibody assays across three doses of BNT162b2 reveals insufficient standardization of SARS-CoV-2 serology. J Clin Virol 2023; 158:105345. [PMID: 36462465 PMCID: PMC9694346 DOI: 10.1016/j.jcv.2022.105345] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/29/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the comparability of WHO standard referenced commercial SARS-CoV-2 antibody tests over three doses of BNT162b2 vaccine and up to 14 months. METHODS 114 subjects (without previous SARS-CoV-2 infection or immunosuppressive medication) vaccinated with three doses of BNT162b2 were included in this study. Antibody levels were quantified 3 weeks after the first dose, 5-6 weeks and 7 months after the second dose, and 4-5 weeks and 4 months after the third dose using the Roche Elecsys SARS-CoV-2 S, the Abbott SARS-CoV-2 IgG II Quant, the DiaSorin LIAISON SARS-CoV-2 TrimericS IgG, the GenScript cPASS sVNT and the TECO sVNT assays. RESULTS For each time point analyzed, systematic differences are evident between the results in BAU/mL of the three antibody binding assays. The assay ratios change in a time-dependent manner even beyond administering the third dose (Roche measuring 9 and 3 times higher than Abbott and DiaSorin, respectively). However, changes decrease in magnitude with increasing time intervals from the first dose. IgG-based assays show better agreement across them than with Roche (overall correlations: Abbott x DiaSorin: ρ = 0.94 vs. Abbott x Roche: ρ=0.89, p < 0.0001; DiaSorin x Roche: ρ = 0.87, p < 0.0001), but results are not interchangeable. The sVNTs suggest an underestimation of antibody levels by Roche and slight overestimation by both IgG assays after the first vaccine dose. CONCLUSIONS Standardization of SARS-CoV-2 antibody binding assays still needs to be improved to allow reliable use of variable assay systems for longitudinal analyses.
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Affiliation(s)
- Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Mucher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Darlene Ösze
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria; FH Campus Wien University of Applied Sciences, Vienna, Austria
| | - Antonia Müller
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Thomas Koller
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Astrid Radakovics
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Ines Flieder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Manuela Repl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oswald F Wagner
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
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Anderle K, Wolzt M, Moser G, Keip B, Peter J, Meisslitzer C, Gouya G, Freissmuth M, Tschegg C. Safety and efficacy of purified clinoptilolite-tuff treatment in patients with irritable bowel syndrome with diarrhea: Randomized controlled trial. World J Gastroenterol 2022; 28:6573-6588. [PMID: 36569277 PMCID: PMC9782844 DOI: 10.3748/wjg.v28.i46.6573] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/09/2022] [Accepted: 11/16/2022] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder with poor response to treatment. IBS with predominant diarrhea (IBS-D) is accompanied by abdominal pain as well as high stool frequency and urgency. Purified clinoptilolite-tuff (PCT), which is approved by the Food and Drug Administration for use as a dietary supplement with the brand name G-PUR®, has previously shown therapeutic potential in other indications based on its physical adsorption capacity.
AIM To assess whether symptoms of IBS-D can be ameliorated by oral treatment with PCT.
METHODS In this randomized, placebo-controlled, double-blind pilot study, 30 patients with IBS-D diagnosis based on Rome IV criteria were enrolled. Following a 4-wk run-in phase, 14 patients were randomized to receive a 12-wk treatment with G-PUR® (2 g three times daily), and 16 patients received placebo. The relief from IBS-D symptoms as measured by the proportion of responders according to the Subject’s Global Assessment (SGA) of Relief was assessed as the primary outcome. For the secondary outcomes, validated IBS-D associated symptom questionnaires, exploratory biomarkers and microbiome data were collected.
RESULTS The proportions of SGA of Relief responders after 12 wk were comparable in both groups, namely 21% in the G-PUR® group and 25% in the placebo group. After 4 wk of treatment, 36% of patients in the G-PUR® group vs 0% in the placebo group reported complete or considerable relief. An improvement in daily abdominal pain was noted in 94% vs 83% (P = 0.0353), and the median number of days with diarrhea per week decreased by 2.4 d vs 0.3 d in the G-PUR® and placebo groups, respectively. Positive trends were observed for 50% of responders in the Bristol Stool Form Scale. Positive trends were also noted for combined abdominal pain and stool consistency response and the Perceived Stress Questionnaire score. Only 64% in the G-PUR® group compared to 86% in the placebo group required rescue medication intake during the study. Stool microbiome studies showed a minor increase in diversity in the G-PUR® group but not in the placebo group. No PCT-related serious adverse events were reported.
CONCLUSION In this randomized, double-blind, placebo-controlled study, the PCT product, G-PUR®, demonstrated safety and clinical benefit towards some symptoms of IBS-D, representing a promising novel treatment option for these patients.
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Affiliation(s)
- Karolina Anderle
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna 1090, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna 1090, Austria
| | - Gabriele Moser
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Bettina Keip
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Johannes Peter
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Claudia Meisslitzer
- Glock Health, Science and Research GmbH, Deutsch-Wagram 2232, Lower Austria, Austria
| | | | - Michael Freissmuth
- Institute of Pharmacology and the Gaston H. Glock Research Laboratories for Exploratory Drug Development, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna 1090, Austria
| | - Cornelius Tschegg
- Glock Health, Science and Research GmbH, Deutsch-Wagram 2232, Lower Austria, Austria
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9
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Sheikh Rezaei S, Litschauer B, Anderle K, Maurer S, Beyers PJ, Reichardt B, Wolzt M. Antibiotic prescription after tooth extraction in adults: a retrospective cohort study in Austria. BMC Oral Health 2022; 22:519. [PMID: 36404324 PMCID: PMC9677908 DOI: 10.1186/s12903-022-02556-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Broad spectrum antibiotics are often used for the prophylaxis of infectious endocarditis and treatment of odontogenic infections, but there are limited data related to antibiotic use and adherence to prescription guidelines. METHODS: Data from patients with tooth extraction between 2014 and 2018 were selected from a database of a regional health insurance fund. We created three data sets, one based on all tooth extractions, one on multiple teeth extractions, and one including only single tooth extraction. After data collection, descriptive analysis was carried out. The differences in prescription pattern of antibiotic medicine were tested by χ2 test, Student´s t-test or ANOVA. RESULTS From 43,863 patients with tooth extraction, 53% were female, and 3,983 patients (9.1%) filled a prescription for antibiotic medicine. From 43,863 patients, 157 patients (0.4%) had endocarditis risk, but only 8 patients of these (5.1%) filled an antibiotic prescription. In total, 9,234 patients had multiple and 34,437 patients had only one tooth extraction. Patients with more than one tooth extraction received more often antibiotic treatment (10.7%) compared to those with single tooth extractions (χ2 = 36; p < 0,001). Patients with more than one tooth extraction were older, however, younger patients received antibiotics more frequently (t = 28,774, p = 0.001). There was no relationship with endocarditis risk status. Clindamycin and amoxicillin/clavulanic acid were the most frequently prescribed antibiotic medicines. CONCLUSIONS In this retrospective cohort study, dentists did not discriminate prophylactic antibiotic prescription with regard to endocarditis risk status. A factor influencing prescribing behaviour of antibiotic medicines was the number of extracted teeth.
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Affiliation(s)
- Safoura Sheikh Rezaei
- grid.22937.3d0000 0000 9259 8492Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 13, 1090 Vienna, Austria
| | - Brigitte Litschauer
- grid.22937.3d0000 0000 9259 8492Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 13, 1090 Vienna, Austria
| | - Karolina Anderle
- grid.22937.3d0000 0000 9259 8492Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 13, 1090 Vienna, Austria
| | - Stephanie Maurer
- grid.22937.3d0000 0000 9259 8492Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 13, 1090 Vienna, Austria
| | - Patrick Jan Beyers
- grid.22937.3d0000 0000 9259 8492Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 13, 1090 Vienna, Austria
| | - Berthold Reichardt
- Austrian Social Health Insurance Fund, Österreichische Gesundheitskasse, 7000 Eisenstadt, Austria
| | - Michael Wolzt
- grid.22937.3d0000 0000 9259 8492Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 13, 1090 Vienna, Austria
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10
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Niederdöckl J, Oppenauer J, Schnaubelt S, Cacioppo F, Buchtele N, Warenits AM, Laggner R, Schütz N, Bögl MS, Ruzicka G, Gupta S, Lutnik M, Sheikh Rezaei S, Wolzt M, Herkner H, Domanovits H, Laggner AN, Schwameis M, Hijazi Z. The ABC-Stroke Score Refines Stroke Risk Stratification in Patients With Atrial Fibrillation at the Emergency Department. Front Med (Lausanne) 2022; 9:830580. [PMID: 35833107 PMCID: PMC9271836 DOI: 10.3389/fmed.2022.830580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
AimsTo evaluate the performance of the ABC (Age, Biomarkers, Clinical history) and CHA2DS2-VASc stroke scores under real-world conditions in an emergency setting.Methods and ResultsThe performance of the biomarker-based ABC-stroke score and the clinical variable-based CHA2DS2-VASc score for stroke risk assessment were prospectively evaluated in a consecutive series of 2,108 patients with acute symptomatic atrial fibrillation at a tertiary care emergency department. Performance was assessed according to methods for the development and validation of clinical prediction models by Steyerberg et al. and the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis. During a cumulative observation period of 3,686 person-years, the stroke incidence rate was 1.66 per 100 person-years. Overall, the ABC-stroke and CHA2DS2-VASc scores revealed respective c-indices of 0.64 and 0.55 for stroke prediction. Risk-class hazard ratios comparing moderate to low and high to low were 3.51 and 2.56 for the ABC-stroke score and 1.10 and 1.62 for the CHA2DS2-VASc score. The ABC-stroke score also provided improved risk stratification in patients with moderate stroke risk according to the CHA2DS2-VASc score, who lack clear recommendations regarding anticoagulation therapy (HR: 4.35, P = 0.001). Decision curve analysis indicated a superior net clinical benefit of using the ABC-stroke score.ConclusionIn a large, real-world cohort of patients with acute atrial fibrillation in the emergency department, the ABC-stroke score was superior to the guideline-recommended CHA2DS2-VASc score at predicting stroke risk and refined risk stratification of patients labeled moderate risk by the CHA2DS2-VASc score, potentially easing treatment decision-making.
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Affiliation(s)
- Jan Niederdöckl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Julia Oppenauer
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Filippo Cacioppo
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Roberta Laggner
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Nikola Schütz
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Magdalena S. Bögl
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerhard Ruzicka
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Sophie Gupta
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Lutnik
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Anton N. Laggner
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
- *Correspondence: Michael Schwameis
| | - Ziad Hijazi
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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11
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Deinsberger J, Marquart E, Nizet S, Meisslitzer C, Tschegg C, Uspenska K, Gouya G, Niederdöckl J, Freissmuth M, Wolzt M, Weber B. Topically administered purified clinoptilolite-tuff for the treatment of cutaneous wounds: a prospective, randomized phase I clinical trial. Wound Repair Regen 2022; 30:198-209. [PMID: 35043507 PMCID: PMC9306511 DOI: 10.1111/wrr.12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/17/2021] [Accepted: 01/01/2022] [Indexed: 12/20/2022]
Abstract
In an ageing society, chronic ulcers pose an increasingly relevant healthcare issue associated with significant morbidity and an increasing financial burden. Hence, there is an unmet medical need for novel, cost‐effective therapies that improve healing of chronic cutaneous wounds. This prospective, randomised, open‐label, phase I trial investigated the safety and tolerability of topically administered purified clinoptilolite‐tuff (PCT), mainly consisting of the naturally occurring zeolite‐mineral clinoptilolite, in artificial wounds in healthy male volunteers compared to the standard of care (SoC). We found that topically administered PCT was safe for therapeutic application in acute wounds in healthy male volunteers. No significant differences in wound healing or wound conditions were observed compared to SoC‐treated wounds. However, we found a significantly higher proportion of CD68‐positive cells and a significantly lower proportion of α‐smooth muscle actin‐positive cells in PCT‐treated wounds. Scanning electron microscopy revealed PCT particles in the restored dermis in some cases. However, these did not impede wound healing or clinical symptoms. Hence, purified PCT could represent an attractive, cost‐effective wound treatment promoting the process of healing.
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Affiliation(s)
- Julia Deinsberger
- Department of Dermatology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Elias Marquart
- Department of Dermatology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephane Nizet
- Glock Health, Science and Research GmbH, Hausfeldstraße 17, 2232, Deutsch-Wagram, Austria
| | - Claudia Meisslitzer
- Glock Health, Science and Research GmbH, Hausfeldstraße 17, 2232, Deutsch-Wagram, Austria
| | - Cornelius Tschegg
- Glock Health, Science and Research GmbH, Hausfeldstraße 17, 2232, Deutsch-Wagram, Austria
| | | | - Ghazaleh Gouya
- Gouya-Insights, Elisabethstraße 22/12, 1010, Vienna, Austria
| | - Jan Niederdöckl
- Department of Clinical Pharmacology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Michael Freissmuth
- Center for Physiology and Pharmacology, Institute of Pharmacology, Gaston H. Glock Laboratories for Exploratory Drug Research, Medical University of Vienna, Waehringer Straße 13a, 1090, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Benedikt Weber
- Department of Dermatology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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12
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Perkmann T, Perkmann-Nagele N, Koller T, Mucher P, Radakovics A, Wolzt M, Wagner OF, Binder CJ, Haslacher H. Serum antibody response to BNT162b2 after natural SARS-CoV-2 infection. Eur J Clin Invest 2021; 51:e13632. [PMID: 34337738 PMCID: PMC8420280 DOI: 10.1111/eci.13632] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/16/2021] [Accepted: 05/30/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is preliminary evidence that individuals with previous SARS-CoV-2 infections exhibit a more pronounced antibody response. However, these assumptions have not yet been supported by data obtained through various CE-marked tests. This study aimed to close this gap. METHODS Sixty-nine seronegatives and 12 individuals post-SARS-CoV-2 infection (tested by CE-labelled Roche NC immunoassay or PCR-confirmed assay) were included 21 ± 1 days after receiving the first dose of the Pfizer/BioNTech BNT162b2 vaccine. Antibody response to viral spike protein (S) was assessed by CE-labelled Roche S and DiaSorin S1/S2 assays and by a surrogate virus neutralization test (sVNT). RESULTS After a single dose of BNT162b2, individuals after natural SARS-CoV-2 infection presented with markedly higher anti-S levels than naïve individuals (Roche S: 9078.5 BAU/mL [5267.0-24 298.5] vs 79.6 [24.7-142.3]; and DiaSorin S1/S2: 1465.0 AU/mL [631.0-5365.0] vs 63.7 [47.8-87.5]) and showed all the maximum observed inhibition activity in the sVNT (98%), without overlaps between groups. There was a trend for higher responses in those with a more distant infection, although not statistically significant. The relative antibody increase after dose 2 was significantly higher among naïve individuals (25-fold), but antibody levels remained below that of seropositives. CONCLUSIONS Compared with naïve individuals, seropositives after natural SARS-CoV-2 infection presented with a substantially higher antibody response already after dose 1 of BNT162b2, as measured by two CE-marked in vitro diagnostic tests and a sVNT. These results should stimulate discussion and research on whether individuals after previous SARS-CoV-2 infection would benefit from a two-part vaccination schedule or whether these currently much-needed second doses could be saved.
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Affiliation(s)
- Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Thomas Koller
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Mucher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Astrid Radakovics
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oswald F Wagner
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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13
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Bielesz B, Lorenz M, Monteforte R, Prikoszovich T, Gabriel M, Wolzt M, Gleiss A, Hörl WH, Sunder-Plassmann G. Comparison of Iron Dosing Strategies in Patients Undergoing Long-Term Hemodialysis: A Randomized Controlled Trial. Clin J Am Soc Nephrol 2021; 16:1512-1521. [PMID: 34470831 PMCID: PMC8499011 DOI: 10.2215/cjn.03850321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/07/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Whether iron supplementation in patients on hemodialysis could be delivered by less frequent but higher single doses compared with the currently more common higher-frequency schedules of lower single iron doses is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We carried out an open-label, randomized, controlled noninferiority trial over 40 weeks in patients on prevalent hemodialysis (n=142). We administered in total 2 g iron as 100 mg iron sucrose biweekly in a continuous (20 × 100 mg) fashion or 500 mg ferric carboxymaltose every 10 weeks in a periodic (4 × 500 mg) fashion. The primary end point was the change in hemoglobin at week 40 from baseline with a noninferiority margin of -0.8 g/dl. Secondary end points were changes in ferritin, transferrin, transferrin saturation, and erythropoiesis-stimulating agent use. RESULTS In total, 108 patients completed the study. At 40 weeks, hemoglobin changed by -0.27 g/dl (95% confidence interval, -0.64 to 0.09) in the iron sucrose arm and by -0.74 g/dl (95% confidence interval, -1.1 to -0.39) in the ferric carboxymaltose arm compared with baseline. Noninferiority was not established in the per-protocol population as hemoglobin changes compared with baseline differed by -0.47 g/dl (95% confidence interval, -0.95 to 0.01) in the ferric carboxymaltose arm compared with the iron sucrose arm. Proportional changes from baseline to week 40 differed by -31% (98.3% confidence interval, -52 to -0.1) for ferritin, by 1% (98.3% confidence interval, -7 to 10) for transferrin, and by -27% (98.3% confidence interval, -39 to -13) for transferrin saturation in the ferric carboxymaltose arm compared with the iron sucrose arm. Erythropoiesis-stimulating agent dosing did not differ between groups. The overall number of adverse events was similar; however, more infections were observed in the iron sucrose arm. CONCLUSIONS An equal cumulative dose of ferric carboxymaltose administered less frequently did not meet noninferiority for maintaining hemoglobin levels compared with iron sucrose administered more frequently. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Comparison Study of Two Iron Compounds for Treatment of Anemia in Hemodialysis Patients (COPEFER), NCT02198495.
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Affiliation(s)
- Bernhard Bielesz
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Rossella Monteforte
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | | | | | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical Statistics, Informatics, and Intelligent Systems, Institute of Clinical Biometrics, Medical University of Vienna, Vienna, Austria
| | - Walter H. Hörl
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
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14
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Grisold A, Rinner W, Paul A, Gabriel H, Klickovic U, Wolzt M, Krenn M, Zimprich F, Bsteh G, Sycha T. Estimation of patent foramen ovale size using transcranial Doppler ultrasound in patients with ischemic stroke. J Neuroimaging 2021; 32:97-103. [PMID: 34591348 PMCID: PMC9292169 DOI: 10.1111/jon.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Patent foramen ovale (PFO)is associated with cryptogenic stroke, especially in young adults. Transcranial Doppler (TCD) ultrasound is used as a screening tool before transesophageal echocardiography (TEE). However, the use of Valsalva maneuver (VM) to identify a right-to-left-shunt underlies interindividual variability. Here, we aimed to assess whether a pressure-controlled standardization of VM is useful to estimate PFO size. METHODS We included patients aged 18-80 years with a PFO according to TEE. Subjects underwent TCD with microembolic signals (MES) counted under four pressure conditions (i.e., at rest, 15 mbar, 40 mbar, and maximum expiratory pressure). Findings were correlated with TEE-based PFO size. The predictive value of TCD at rest and VM-based TCD for PFO size estimation was assessed by stepwise multivariate linear regression models and multiple cross-tab-analyses. RESULTS We screened 203 subjects after a cerebrovascular event, of which 78 (48 males [61.5%], median age 55 years [22-80]) with PFO were included. We found an association between MES count and expiratory pressure (p < .001). Predefined MES count categories at TCD pressure conditions correlated significantly with PFO size measured by TEE. We propose a PFO size estimation model based on TCD at rest and under VM, which classified PFO size correctly in 64.1% with the highest accuracy for small PFOs. CONCLUSION Our data provide evidence that TCD with step-wise barometric standardization allows an estimation of PFO size with good accuracy. Though TCD will not replace TEE in future, this might be of clinical value in circumstances where TEE cannot be easily performed.
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Affiliation(s)
- Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Walter Rinner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Paul
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Harald Gabriel
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Uros Klickovic
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Sycha
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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15
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Perkmann T, Perkmann-Nagele N, Koller T, Mucher P, Radakovics A, Marculescu R, Wolzt M, Wagner OF, Binder CJ, Haslacher H. Anti-Spike Protein Assays to Determine SARS-CoV-2 Antibody Levels: a Head-to-Head Comparison of Five Quantitative Assays. Microbiol Spectr 2021; 9:e0024721. [PMID: 34190591 PMCID: PMC8552734 DOI: 10.1128/spectrum.00247-21] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [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: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Reliable quantification of the antibody response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly relevant, e.g., for identifying possible vaccine failure and estimating the time of protection. Therefore, we evaluated five different anti-SARS-CoV-2 antibody assays regarding the quantification of anti-spike (S) antibodies. Sera from 69 SARS-CoV-2-naive individuals 21 ± 1 days after vaccination with a single dose of BNT162b2 (Pfizer/BioNTech) were tested using the following quantitative assays: Roche S total antibody, DiaSorin trimeric spike IgG, DiaSorin S1/S2 IgG, Abbott II IgG, and Serion/Virion IgG. Results were further compared to the percent inhibition calculated from a surrogate virus neutralization test (sVNT). Individual values were distributed over several orders of magnitude for all assays. Although the assays were in good overall agreement (ρ = 0.80 to 0.94), Passing-Bablok regression revealed systematic constant and proportional differences, which could not be eliminated by converting the results to binding antibody units (BAU) per milliliter, as suggested by the manufacturers. Seven (10%) individuals had negative sVNT results (i.e., <30% inhibition). These samples were identified by most assays and yielded significantly lower binding antibody levels. Although all assays showed good correlation, they were not interchangeable, even when converted to BAU per milliliter using the WHO international standard for SARS-CoV-2 immunoglobulin. This highlights the need for further standardization of SARS-CoV-2 serology. IMPORTANCE Reliable quantification of the antibody response to SARS-CoV-2 is highly relevant, e.g., for identifying possible vaccine failure and estimating the time of protection. We compared the performance of five CE marked tests that quantify antibodies against the viral spike protein. Our findings suggest that, although all assays showed good correlation, their results were not interchangeable, even when converted to BAU per milliliter using the WHO international standard for SARS-CoV-2 immunoglobulin. This highlights the need for further standardization of SARS-CoV-2 serology.
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Affiliation(s)
- Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Thomas Koller
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Mucher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Astrid Radakovics
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oswald F. Wagner
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph J. Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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16
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Preinreich J, Sheikh Rezaei S, Mittlböck M, Greisenegger S, Reichardt B, Wolzt M. Oral anticoagulant therapy and outcome in patients with stroke. A retrospective nation-wide cohort study in Austria 2012-2017. Pharmacoepidemiol Drug Saf 2021; 30:1332-1338. [PMID: 34021676 PMCID: PMC8453954 DOI: 10.1002/pds.5296] [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: 12/30/2020] [Revised: 05/09/2021] [Accepted: 05/19/2021] [Indexed: 01/17/2023]
Abstract
Purpose Patients with stroke are at high risk of recurrence of vascular events. Non‐vitamin K oral anticoagulant (NOAC) and vitamin K antagonists (VKA) are used as secondary prophylaxis. The aim of this study was to evaluate the utilization of NOAC and VKA, and their impact on re‐stroke or death in Austria. Methods We analyzed retrospective data between 2012 and 2017 from medical services covered by the health insurance funds, which provides health care for all residents in Austria. Patients without anticoagulant medication 3 months preceding the index event were eligible. Results 76 354 patients were discharged with a hospital diagnosis of stroke. From these, 16 436 patients with a median age of 78 years received VKA or NOAC. After adjustment, the recurrence of stroke was less frequent in patients with NOAC compared to those with VKA (HR 0.87; 95%CI 0.77–0.97). However, there was no difference in mortality rate after adjustment for age, sex, and co‐morbidities for patients with NOAC (HR 1.0; 95%CI 0.92–1.08). Diabetes (HR 1.25, 95%CI 1.08–1.45; HR 1.25, 95% CI 1.13–1.38) and cardiovascular disease (HR 1.43, 95%CI 1.24–1.65; HR 1.27, 95%CI 1.16–1.39) were significantly associated with re‐stroke or death. Younger age (p = 0.0028; HR 0.99, 95%CI 0.99–0.99) was significantly associated with re‐stroke, and advanced age (p < 0.0001; HR 1.09, 95%CI 1.08–1.09) with death. Conclusion NOAC prescription is related with a reduced risk of re‐stroke but increased mortality compared to patients with VKA. The event risk is associated with diabetes, cardiovascular disease and age.
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Affiliation(s)
- Jasmina Preinreich
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Martina Mittlböck
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Berthold Reichardt
- Austrian Health Insurance Fund, Burgenland, Eisenstadt, Burgenland, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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17
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Wampl S, Körner T, Valkovič L, Trattnig S, Wolzt M, Meyerspeer M, Schmid AI. Investigating the effect of trigger delay on cardiac 31P MRS signals. Sci Rep 2021; 11:9268. [PMID: 33927234 PMCID: PMC8085231 DOI: 10.1038/s41598-021-87063-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/22/2021] [Indexed: 01/15/2023] Open
Abstract
The heart’s geometry and its metabolic activity vary over the cardiac cycle. The effect of these fluctuations on phosphorus (31P) magnetic resonance spectroscopy (MRS) data quality and metabolite ratios was investigated. 12 healthy volunteers were measured using a 7 T MR scanner and a cardiac 31P-1H loop coil. 31P chemical shift imaging data were acquired untriggered and at four different times during the cardiac cycle using acoustic triggering. Signals of adenosine-triphosphate (ATP), phosphocreatine (PCr), inorganic phosphate (Pi) and 2,3-diphosphoglycerate (2,3-DPG) and their fit quality as Cramér-Rao lower bounds (CRLB) were quantified including corrections for contamination by 31P signals from blood, flip angle, saturation and total acquisition time. The myocardial filling factor was estimated from cine short axis views. The corrected signals of PCr and \documentclass[12pt]{minimal}
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\begin{document}$$\gamma$$\end{document}γ-ATP were higher during end-systole and lower during diastasis than in untriggered acquisitions (\documentclass[12pt]{minimal}
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\begin{document}$$P<0.05$$\end{document}P<0.05). Signal intensities of untriggered scans were between those with triggering to end-systole and diastasis. Fit quality of PCr and \documentclass[12pt]{minimal}
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\begin{document}$$\gamma$$\end{document}γ-ATP peaks was best during end-systole when blood contamination of ATP and Pi signals was lowest. While metabolite ratios and pH remained stable over the cardiac cycle, signal amplitudes correlated strongly with myocardial voxel filling. Triggering of cardiac 31P MRS acquisitions improves signal amplitudes and fit quality if the trigger delay is set to end-systole. We conclude that triggering to end-systole is superior to triggering to diastasis.
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Affiliation(s)
- Stefan Wampl
- Medical University of Vienna, High Field MR Center, Center for Medical Physics and Biomedical Engineering, Vienna, 1090, Austria
| | - Tito Körner
- Medical University of Vienna, High Field MR Center, Center for Medical Physics and Biomedical Engineering, Vienna, 1090, Austria
| | - Ladislav Valkovič
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), RDM Cardiovascular Medicine, University of Oxford, Oxford, OX3 9DU, United Kingdom.,Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, 814 04, Slovakia
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, High Field MR Center, Vienna, 1090, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, 1090, Austria
| | - Martin Meyerspeer
- Medical University of Vienna, High Field MR Center, Center for Medical Physics and Biomedical Engineering, Vienna, 1090, Austria
| | - Albrecht Ingo Schmid
- Medical University of Vienna, High Field MR Center, Center for Medical Physics and Biomedical Engineering, Vienna, 1090, Austria.
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18
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Sheikh Rezaei S, Šinkovec H, Schöberl A, Rinner C, Heinze G, Wolzt M, Gall W. Utilization of potentially inappropriate medication and risk of adverse drug events among older adults with chronic renal insufficiency: a population-wide cohort study. BMC Geriatr 2021; 21:117. [PMID: 33568102 PMCID: PMC7877037 DOI: 10.1186/s12877-021-02057-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of potentially inappropriate medication (PIM) in population of older adults may result in adverse drug events (ADE) already after short term exposure, especially when it is prescribed to patients with chronic kidney disease (CKD). In order to limit ADE in the treatment of older adults PIM lists have been constructed as a source of information for healthcare professionals. The aim of this study was to estimate the utilization of PIM and incidence of ADE in older adults (≥70 years) with CKD. METHODS We conducted a retrospective population-wide cohort study including patients from Lower Austria who were 70 years or older and diagnosed with CKD in the period from 2008 to 2011. Utilization of PIM was estimated from prescriptions filled by target population. We estimated risks of hospitalization due to ADE within 30 days after incident PIM prescription and compared them to a PIM-free control group by using marginal structural models (MSM). RESULTS We identified 11,547 patients (women: 50.6%, median age in 2008: 78 years) who fulfilled the inclusion criteria. In total 24.7 and 8.1% of all prescriptions from that period contained a medication with a substance listed in the EU (7)-PIM and AT-PIM list, respectively. Proton pump inhibitors and Ginkgo biloba were the most often prescribed PIMs in this population. 94.6 and 79.3% patients filled at least one EU(7)-PIM and AT-PIM prescription, respectively. Despite the relatively high utilization of PIM there was only a low incidence of clinically relevant ADE. No event type exceeded the threshold level of 1% in the analysis of risks of ADE after filling a prescription for PIM. Nevertheless, MSM analysis showed an increased risk for 11 drugs and reduced risk for 4 drugs. CONCLUSIONS PIM prescription was common among older adults with CKD, however, only a small number of these drugs eventually led to hospitalization due to ADE within 30 days after incident PIM was filled. In the absence of a clinically important PIM-related increase in risk, an assessment of potential ADE severity to a PIM list by using a warning score system seems prudent.
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Affiliation(s)
- Safoura Sheikh Rezaei
- Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Hana Šinkovec
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Alexander Schöberl
- Section for Medical Information Management, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Christoph Rinner
- Section for Medical Information Management, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Georg Heinze
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Walter Gall
- Section for Medical Information Management, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
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19
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Oberbauer R, Edinger M, Berlakovich G, Kalhs P, Worel N, Heinze G, Wolzt M, Lion T, Wekerle T. A Prospective Controlled Trial to Evaluate Safety and Efficacy of in vitro Expanded Recipient Regulatory T Cell Therapy and Tocilizumab Together With Donor Bone Marrow Infusion in HLA-Mismatched Living Donor Kidney Transplant Recipients (Trex001). Front Med (Lausanne) 2021; 7:634260. [PMID: 33585521 PMCID: PMC7873436 DOI: 10.3389/fmed.2020.634260] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/31/2020] [Indexed: 12/28/2022] Open
Abstract
Background: The induction of donor-specific immunological tolerance could improve outcome after kidney transplantation. However, no tolerance protocol is available for routine clinical use. Chimerism-based regimens hold promise, but their widespread application is impeded in part by unresolved safety issues. This study tests the hypothesis that therapy with polyclonal recipient regulatory T cells (Tregs) and anti-IL6R (tocilizumab) leads to transient chimerism and achieves pro-tolerogenic immunomodulation in kidney transplant recipients also receiving donor bone marrow (BM) without myelosuppressive conditioning of the recipient. Methods/design: A prospective, open-label, controlled, single-center, phase I/IIa academic study is performed in HLA-mismatched living donor kidney transplant recipients. Study group: Recipients of the study group receive in vitro expanded recipient Tregs and a donor bone marrow cell infusion within 3 days after transplantation and tocilizumab for the first 3 weeks post-transplant. In addition they are treated with thymoglobulin, belatacept, sirolimus, and steroids as immunosuppression. Starting 6 months post-transplant, sirolimus and steroids are withdrawn in a step-wise manner in stable patients. Control group: Recipients of the control group are treated with thymoglobulin, belatacept, sirolimus, and steroids as immunosuppression. Co-primary endpoints of safety (impaired graft function [eGFR <35 mL/min/1.73 m2], graft-vs.-host disease or patient death by 12 months) and efficacy (total leukocyte donor chimerism within 28 days post-transplant) are assessed. Secondary endpoints include frequency of biopsy-proven acute rejection episodes and subclinical rejection episodes on surveillance biopsies, assessment of kidney graft function, and the evaluation whether the study protocol leads to detectable changes in the immune system indicative of pro-tolerogenic immune modulation. Discussion: The results of this trial will provide evidence whether treatment with recipient Tregs and donor BM is feasible, safe and efficacious in leading to transient chimerism. If successful, this combination cell therapy has the potential to become a novel treatment option for immunomodulation in organ transplantation without the toxicities associated with myelosuppressive recipient conditioning. Trial registration: European Clinical Trials Database EudraCT Nr 2018-003142-16 and clinicaltrials.gov NCT03867617.
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Affiliation(s)
- Rainer Oberbauer
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Matthias Edinger
- University Hospital Regensburg, Department of Internal Medicine III & Regensburg Center for Interventional Immunology (RCI), Regensburg, Germany
| | - Gabriela Berlakovich
- Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Kalhs
- Bone Marrow Transplant Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Nina Worel
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Georg Heinze
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Clinical Trials Coordination Centre, Medical University of Vienna, Vienna, Austria
| | - Thomas Lion
- St. Anna Children's Cancer Research Institute, Vienna, Austria.,Ludwig Boltzmann Institute for Hematology & Oncology, Medical University of Vienna, Vienna, Austria.,Labdia Labordiagnostik GmbH, Vienna, Austria.,Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Thomas Wekerle
- Section of Transplantation Immunology, Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria
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20
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Pany A, Wohlgenannt M, Klopprogge S, Wolzt M, Heuser T, Kotisch H, Valenta C, Klang V. Effect of hydroxypropyl-β-cyclodextrin in fluid and semi-solid submicron emulsions on physiological skin parameters during regular in vivo application. Int J Cosmet Sci 2021; 43:263-268. [PMID: 33236374 PMCID: PMC8246995 DOI: 10.1111/ics.12674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 01/30/2023]
Abstract
Objective The aim of the present study was to evaluate the effect of hydroxypropyl‐β‐cyclodextrin (HP‐β‐CD) in cosmetic submicron emulsions and submicron emulsion gels on physiological skin parameters during regular application in a clinical set‐up. Methods Formulation morphology was investigated using cryo‐transmission electron microscopy. Stability of the employed formulations was determined by photon correlation spectroscopy, measurement of pH and rheological properties. Effect on physiological skin parameters was evaluated during regular application over four weeks in a parallel group study (n = 15, healthy forearm skin) with a Corneometer, Sebumeter, skin‐pH‐Meter, Aquaflux and an Epsilon sensor. Confocal Raman spectroscopy was employed to monitor urea and NMF levels. Results Both submicron emulsions and gels showed satisfying storage stability irrespective of cyclodextrin incorporation. No statistically significant effects on skin barrier function and any of the observed parameters were obtained, indicating good skin tolerability of all tested formulations. Conclusion Results suggest good skin tolerability of the developed cosmetic submicron emulsions and gels with HP‐β‐CD.
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Affiliation(s)
- Astrid Pany
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Life Sciences, University of Vienna, Althanstraße 14, 1090, Vienna, Austria
| | - Marie Wohlgenannt
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Life Sciences, University of Vienna, Althanstraße 14, 1090, Vienna, Austria
| | - Safoura Klopprogge
- Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Thomas Heuser
- Vienna Biocenter Core Facilities GmbH, Dr. Bohr Gasse 3, 1030, Vienna, Austria
| | - Harald Kotisch
- Vienna Biocenter Core Facilities GmbH, Dr. Bohr Gasse 3, 1030, Vienna, Austria
| | - Claudia Valenta
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Life Sciences, University of Vienna, Althanstraße 14, 1090, Vienna, Austria.,Research Platform "Characterisation of Drug Delivery Systems on Skin and Investigation of Involved Mechanisms", University of Vienna, Vienna, Austria
| | - Victoria Klang
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Life Sciences, University of Vienna, Althanstraße 14, 1090, Vienna, Austria.,Research Platform "Characterisation of Drug Delivery Systems on Skin and Investigation of Involved Mechanisms", University of Vienna, Vienna, Austria
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21
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Traby L, Kollars M, Kaider A, Siller-Matula JM, Steinbrecher O, Wolzt M, Kyrle PA, Eichinger S. Differential Effects of Clopidogrel With or Without Aspirin on Platelet Reactivity and Coagulation Activation: A Randomized Trial in Healthy Volunteers. Clin Pharmacol Ther 2020; 109:1546-1554. [PMID: 33141921 DOI: 10.1002/cpt.2106] [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] [Received: 04/30/2020] [Accepted: 10/22/2020] [Indexed: 11/05/2022]
Abstract
Dual antiplatelet therapy (DAPT) is standard in acute coronary syndrome but confers a bleeding risk. To compare effects of clopidogrel single antiplatelet therapy (SAPT) with clopidogrel-based DAPT on hemostatic system activation we conducted a randomized clinical trial in 44 volunteers (clopidogrel (d1: 600 mg, d2-6: 150 mg) ± aspirin (100 mg)). Multiple electrode aggregometry-adenosine diphosphate (MEA-ADP) and MEA-arachidonic acid (MEA-AA) triggered aggregometry, vasodilator-stimulated phosphoprotein (VASP), beta thromboglobulin, p-selectin, thromboxane B2 , d-Dimer, prothrombin fragment 1.2 (f1.2), and a phospholipid-dependent clotting time were measured in venous blood. Changes are described by mean differences (Δmean (95% confidence interval (CI)) or geometric mean ratios (95% CI)). DAPT and SAPT comparably and significantly decreased MEA-ADP at 2 hours (-60% vs. -63%; P = 0.35, Δmean -4.9, 95% CI -15.4 to 5.5). At 24 hours (-59% vs. -47%, P = 0.04, Δmean -11.1, 95% CI -21.7 to -0.4]) and 8 days (-61% vs. -53%, P = 0.04, Δmean -11.3, 95% CI -22.0 to -0.6). Both treatments significantly reduced VASP and MEA-AA after 2 hours and 8 days. DAPT inhibited MEA-AA significantly stronger at 2 hours (-77% vs. -30%; P < 0.0001, Δmean -39.6, 95% CI -54.2 to -25.0), at 24 hours (-80% vs. -27%, P < 0.0001, Δmean -47.8, 95% CI -62.3 to -33.3), and 8 days (-79% vs. -27%, P < 0.0001, Δmean -48.9, 95% CI -62.5 to -35.4). Neither treatment significantly influenced beta thromboglobulin or p-selectin. DAPT abolished and SAPT reduced thromboxane B2 after 24 hours and 8 days. The d-Dimer was reduced by DAPT (0.94, 95% CI 0.89-1.00, P = 0.04) at 2 hours but not after 24 hours and 8 days. SAPT did not decrease d-Dimer. Neither treatment affected f1.2. DAPT and SAPT comparably affect platelet and coagulation activation in venous blood.
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Affiliation(s)
- Ludwig Traby
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marietta Kollars
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Statistics Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Jolanta Maria Siller-Matula
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.,Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland
| | | | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Sabine Eichinger
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
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22
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Weisshaar S, Brandt L, Litschauer B, Sheik-Rezaei S, Moser L, Nirnberger G, Kühberger E, Bauer U, Firbas C, Gouya G, Wolzt M, Fischer G. Dose-dependent naloxone-induced morphine withdrawal symptoms in opioid-dependent males-a double-blinded, randomized study. Br J Clin Pharmacol 2020; 86:1610-1619. [PMID: 32145041 PMCID: PMC7373709 DOI: 10.1111/bcp.14271] [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] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/01/2019] [Accepted: 02/26/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Oral opioid preparations combined with naloxone are intended to induce a transient acute withdrawal syndrome to avoid intravenous misuse. This trial aimed to establish an appropriate morphine–naloxone dose ratio for an abuse‐deterrent oral opioid formulation. Methods In a randomized, double‐blinded, 2 × 2 cross‐over trial, 43 patients with opioid use disorder were challenged with intravenous morphine HCl Ph.Eur. (75 mg; [morphine mono]) or morphine HCl Ph.Eur. and naloxone HCl Ph.Eur. at ratios of 100:1 (75 mg: 0.75 mg; [morphine–naloxone 100:1]) or 200:1 (75 mg: 0.375 mg; [morphine–naloxone 200:1]). Acute naloxone‐induced opioid withdrawal was evaluated using subjective (Short Opiate Withdrawal Scale–German [SOWS‐G]) and observer‐rated (Objective Opiate Withdrawal Scale [OOWS], Wang scale) questionnaires, and physiological parameters. For statistical analysis, the area under the curve between baseline and 20 minutes after drug administration of the outcome variables was calculated. Results Intravenous morphine–naloxone caused rapid withdrawal symptoms. Coadministration of naloxone dose‐dependently (morphine–naloxone 100:1 > morphine–naloxone 200:1) increased SOWS‐G, OOWS and Wang Scale area under the curve when compared to morphine mono, respectively (all P < .0001). A similar response was detectable for changes of pupil diameter. Blood pressure and respiratory rate changed heterogeneously, and heart rate was unaltered by morphine without or with naloxone. Conclusion Morphine–naloxone 100:1 effectively suppresses the pleasurable effects of intravenous morphine and results in an aversive withdrawal reaction. A lower naloxone concentration as used in morphine–naloxone 200:1 does not appear to be appropriate to prevent intravenous morphine misuse.
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Affiliation(s)
- Stefan Weisshaar
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Laura Brandt
- Department of Applied Psychology: Work, Education & Economy, Faculty of Psychology, University of Vienna, Vienna, Austria.,Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Brigitte Litschauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Safoura Sheik-Rezaei
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Laura Moser
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Christa Firbas
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ghazaleh Gouya
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Gabriele Fischer
- Center for Public Health, Medical University of Vienna, Vienna, Austria
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23
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Kutzsche J, Jürgens D, Willuweit A, Adermann K, Fuchs C, Simons S, Windisch M, Hümpel M, Rossberg W, Wolzt M, Willbold D. Safety and pharmacokinetics of the orally available antiprionic compound PRI-002: A single and multiple ascending dose phase I study. Alzheimers Dement (N Y) 2020; 6:e12001. [PMID: 32211506 PMCID: PMC7087413 DOI: 10.1002/trc2.12001] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION PRI-002 is an orally available anti-amyloid beta (Aβ) prionic compound developed for direct disassembly of toxic Aβ oligomers relevant to Alzheimer's disease. METHODS Two placebo-controlled clinical phase I trials with oral dosing of PRI-002 were conducted in healthy young subjects: A single ascending dose trial (4, 12, 36, 108, or 320 mg PRI-002 or placebo) in 40 participants followed by a multiple ascending dose study with daily 160 mg PRI-002 for 14 days or 320 mg for 28 days in 24 participants. The main objectives were safety, tolerability, and evaluation of pharmacokinetic (PK) parameters. RESULTS PRI-002 was safe and well tolerated after single and multiple oral administration up to the highest doses. PRI-002 was absorbed rapidly and drug exposure increased proportional to dose. During repeated daily administration, the drug accumulated by a factor of about three. Steady-state conditions were reached after 1 to 2 weeks. CONCLUSIONS The safety and PK results encourage further clinical development of PRI-002.
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Affiliation(s)
- Janine Kutzsche
- Structural Biochemistry (ICS‐6)Institute of Complex SystemsJülichGermany
| | - Dagmar Jürgens
- Structural Biochemistry (ICS‐6)Institute of Complex SystemsJülichGermany
| | - Antje Willuweit
- Medical Imaging Physics (INM‐4)Institute of Neuroscience and MedicineJülichGermany
| | | | - Carola Fuchs
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Stefanie Simons
- Structural Biochemistry (ICS‐6)Institute of Complex SystemsJülichGermany
- Heinrich‐Heine‐Universität DüsseldorfInstitut für Physikalische BiologieDüsseldorfGermany
| | | | | | | | - Michael Wolzt
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
| | - Dieter Willbold
- Structural Biochemistry (ICS‐6)Institute of Complex SystemsJülichGermany
- Heinrich‐Heine‐Universität DüsseldorfInstitut für Physikalische BiologieDüsseldorfGermany
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24
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Niess F, Schmid AI, Bogner W, Wolzt M, Carlier P, Trattnig S, Moser E, Meyerspeer M. Interleaved 31 P MRS/ 1 H ASL for analysis of metabolic and functional heterogeneity along human lower leg muscles at 7T. Magn Reson Med 2019; 83:1909-1919. [PMID: 31846116 PMCID: PMC7065182 DOI: 10.1002/mrm.28088] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 06/11/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE MR offers the unique possibility to noninvasively investigate cellular energy metabolism via 31P MRS, while blood perfusion, which provides oxygen and substrates to the tissue, is accessible by arterial spin labeling (ASL) 1H MRI. Because metabolic and hemodynamic parameters are linked, it would be desirable to study them simultaneously. A 3D-resolved method is presented that allows such measurements with high spatiotemporal resolution and has the potential to discern differences along an exercising muscle. METHODS Multi-voxel localized 31 P MRS was temporally interleaved with multi-slice pASL 1H MRI. Phosphorus spectra were collected from two adjacent positions in gastrocnemius medialis (GM) during rest, submaximal plantar flexion exercise and recovery, while perfusion and T 2 * -weighted axial images were acquired at the same time. Seventeen healthy volunteers (9 f / 8 m) were studied at 7 T. RESULTS An increase of postexercise perfusion and T 2 * -weighted signal in GM positively correlated with end-exercise PCr depletion and pH drop. At proximal positions functional and metabolic activity was higher than distally, that is, perfusion increase and peak T 2 * -weighted signal, end-exercise PCr depletion, end-exercise pH, and PCr recovery time constant were significantly different. An NOE-induced SNR increase of approximately 20 % (P < .001), at rest, was found in interleaved 31 P spectra, when comparing to 31 P-only acquisitions. CONCLUSIONS A technique for fast, simultaneous imaging of muscle functional heterogeneity in ASL, T 2 * and acquisition of time-resolved 31 P MRS data is presented. These single exercise recovery experiments can be used to investigate local variations during disease progression in patients suffering from vascular or muscular diseases.
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Affiliation(s)
- Fabian Niess
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria
| | - Albrecht Ingo Schmid
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Bogner
- High Field MR Center, Medical University of Vienna, Vienna, Austria.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Siegfried Trattnig
- High Field MR Center, Medical University of Vienna, Vienna, Austria.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ewald Moser
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria
| | - Martin Meyerspeer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,High Field MR Center, Medical University of Vienna, Vienna, Austria
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Andreas M, Arzl P, Mitterbauer A, Ballarini NM, Kainz FM, Kocher A, Laufer G, Wolzt M. Response by Andreas et al to Letter Regarding Article, "Electrical Stimulation of the Greater Auricular Nerve to Reduce Postoperative Atrial Fibrillation". Circ Arrhythm Electrophysiol 2019; 12:e008067. [PMID: 31826646 DOI: 10.1161/circep.119.008067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin Andreas
- Department of Cardiac Surgery (M.A., P.A., A.M., F.-M.K., A.K., G.L.), Medical University of Vienna, Austria
| | - Philipp Arzl
- Department of Cardiac Surgery (M.A., P.A., A.M., F.-M.K., A.K., G.L.), Medical University of Vienna, Austria
| | - Andreas Mitterbauer
- Department of Cardiac Surgery (M.A., P.A., A.M., F.-M.K., A.K., G.L.), Medical University of Vienna, Austria
| | - Nicolas M Ballarini
- Center for Medical Statistics, Informatics, and Intelligence Systems, Section for Medical Statistics (N.M.B.), Medical University of Vienna, Austria
| | - Frieda-Maria Kainz
- Department of Cardiac Surgery (M.A., P.A., A.M., F.-M.K., A.K., G.L.), Medical University of Vienna, Austria
| | - Alfred Kocher
- Department of Cardiac Surgery (M.A., P.A., A.M., F.-M.K., A.K., G.L.), Medical University of Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery (M.A., P.A., A.M., F.-M.K., A.K., G.L.), Medical University of Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology (M.W.), Medical University of Vienna, Austria
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Stix G, Wolzt M, Domanovits H, Kadlecová P, Husch B, Trebs M, Hodisch J, Unger M, Krumpl G. Open-Label Two-Dose Pilot Study of Landiolol for the Treatment of Atrial Fibrillation/Atrial Flutter in Caucasian Patients. Circ J 2019; 84:33-42. [PMID: 31813897 DOI: 10.1253/circj.cj-19-0661] [Citation(s) in RCA: 4] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND We investigated for the first time the suitability of landiolol, an ultra-short-acting β1-specific β-blocker, for the treatment of atrial fibrillation/atrial flutter (AF/AFL) in Caucasian patients.Methods and Results:The 20 study patients received landiolol as a continuous infusion (starting dose 40 µg/kg/min) with (B+CI) or without (CI) a preceding bolus dose (100 µg/kg/min administered over 1 min) in a prospective open-label study. The primary endpoint was the proportion of patients with sustained heart rate (HR) reduction ≥20% or to <90 beats/min within 16 min of starting the CI. Secondary endpoints were the pharmacodynamics, pharmacokinetics, AF/AFL symptoms, safety and tolerability of landiolol. At 16 min, HR was reduced in all patients treated with landiolol. The primary endpoint was met by 60% of patients in the CI group and 40% in the B+CI group without a significant group difference. Overall reduction of AF/AFL symptoms at 16 min was 72%. Safety and local tolerability of landiolol were excellent, and no serious adverse events occurred. CONCLUSIONS Continuous infusion of landiolol with a starting dose of 40 µg/kg/min is suitable for the acute treatment of tachycardic AF/AFL in Caucasian patients. Administration of a preceding bolus seems unnecessary.
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Affiliation(s)
- Guenter Stix
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna
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Traby L, Kollars M, Kaider A, Siller-Matula JM, Wolkersdorfer MF, Wolzt M, Kyrle PA, Eichinger S. Differential Effects of Ticagrelor With or Without Aspirin on Platelet Reactivity and Coagulation Activation: A Randomized Trial in Healthy Volunteers. Clin Pharmacol Ther 2019; 107:415-422. [PMID: 31442298 PMCID: PMC7006887 DOI: 10.1002/cpt.1616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/12/2019] [Accepted: 07/29/2019] [Indexed: 01/04/2023]
Abstract
Dual antiplatelet therapy (DAPT) is standard in acute coronary heart disease but confers a bleeding risk. To compare the effects of ticagrelor‐monotherapy with ticagrelor‐based DAPT on hemostatic system activation, we conducted a randomized controlled trial in 44 volunteers using a loading‐dose regimen and measured platelet‐aggregometry triggered by adenosine diphosphate (multiple electrode aggregometry (MEA)‐ADP) and arachidonic acid (MEA‐AA), the vasodilator‐stimulated phosphoprotein (VASP), prothrombin fragment 1.2 (f1.2), and d‐Dimer. Ticagrelor‐based DAPT and ticagrelor‐monotherapy significantly decreased MEA‐ADP (Δmean: −51.4 (−56.9; −45.8) and −46.2 (−51.7; −40.7)) and VASP (Δmean: −70.3 (−76.2; −64.4) and −69.6 (−75.5; −63.7)) at 2 hours and over 24 hours. MEA‐AA was reduced significantly by both treatments (Δmean: −72.9 (−80.6; −65.3) and −25.7 (−33.3; −18.0)) at 2 hours, and stronger by ticagrelor‐based DAPT over 24 hours. Both treatments decreased f1.2 (geometric mean ratio (GMR): 0.92 (0.84; 1.01) and 0.88 (0.80; 0.96)) and d‐Dimer (GMR: 0.89 (0.86; 0.92) and 0.91 (0.88; 0.94)) at 2 hours and d‐Dimer over 24 hours. Ticagrelor‐monotherapy and ticagrelor‐based DAPT comparably affect hemostatic system activation.
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Affiliation(s)
- Ludwig Traby
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marietta Kollars
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kaider
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | | | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Paul A Kyrle
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sabine Eichinger
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Andreas M, Oeser C, Kainz FM, Shabanian S, Aref T, Bilban M, Messner B, Heidtmann J, Laufer G, Kocher A, Wolzt M. Intravenous Heme Arginate Induces HO-1 (Heme Oxygenase-1) in the Human Heart. Arterioscler Thromb Vasc Biol 2019; 38:2755-2762. [PMID: 30354231 DOI: 10.1161/atvbaha.118.311832] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective- HO-1 (heme oxygenase-1) induction may prevent or reduce ischemia-reperfusion injury. We previously evaluated its in vivo induction after a single systemic administration of heme arginate in peripheral blood mononuclear cells. The current trial was designed to assess the pharmacological tissue induction of HO-1 in the human heart with heme arginate in vivo. Approach and Results- Patients planned for conventional aortic valve replacement received placebo (n=8), 1 mg/kg (n=7) or 3 mg/kg (n=9) heme arginate infused intravenously 24 hours before surgery. A biopsy of the right ventricle was performed directly before aortic cross-clamping and after cross-clamp release. In addition, the right atrial appendage was partially removed for analysis. HO-1 protein and mRNA concentrations were measured in tissue samples and in peripheral blood mononuclear cells before to and up to 72 hours after surgery. No study medication-related adverse events occurred. A strong, dose-dependent effect on myocardial HO-1 mRNA levels was observed (right ventricle: 7.9±5.0 versus 88.6±49.1 versus 203.6±148.7; P=0.002 and right atrium: 10.8±8.8 versus 229.8±173.1 versus 392.7±195.7; P=0.001). This was paralleled by a profound increase of HO-1 protein concentration in atrial tissue (8401±3889 versus 28 585±10 692 versus 29 022±8583; P<0.001). Surgery and heme arginate infusion significantly increased HO-1 mRNA concentration in peripheral blood mononuclear cells ( P<0.001). HO-1 induction led to a significant increase of postoperative carboxyhemoglobin (1.7% versus 1.4%; P=0.041). No effect on plasma HO-1 protein levels could be detected. Conclusions- Myocardial HO-1 mRNA and protein can be dose-dependently induced by heme arginate. Protective effects of this therapeutic strategy should be evaluated in upcoming clinical trials. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02314780.
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Affiliation(s)
- Martin Andreas
- From the Department of Cardiac Surgery (M.A., C.O., F.-M.K., S.S., T.A., B.M., J.H., G.L., A.K.), Medical University of Vienna, Austria
| | - Claudia Oeser
- From the Department of Cardiac Surgery (M.A., C.O., F.-M.K., S.S., T.A., B.M., J.H., G.L., A.K.), Medical University of Vienna, Austria
| | - Frieda-Maria Kainz
- From the Department of Cardiac Surgery (M.A., C.O., F.-M.K., S.S., T.A., B.M., J.H., G.L., A.K.), Medical University of Vienna, Austria
| | - Shiva Shabanian
- From the Department of Cardiac Surgery (M.A., C.O., F.-M.K., S.S., T.A., B.M., J.H., G.L., A.K.), Medical University of Vienna, Austria
| | - Tandis Aref
- From the Department of Cardiac Surgery (M.A., C.O., F.-M.K., S.S., T.A., B.M., J.H., G.L., A.K.), Medical University of Vienna, Austria
| | - Martin Bilban
- Department of Laboratory Medicine (M.B.), Medical University of Vienna, Austria
- Department of Clinical Pharmacology (M.B., M.W.), Medical University of Vienna, Austria
| | - Barbara Messner
- From the Department of Cardiac Surgery (M.A., C.O., F.-M.K., S.S., T.A., B.M., J.H., G.L., A.K.), Medical University of Vienna, Austria
| | - Julian Heidtmann
- From the Department of Cardiac Surgery (M.A., C.O., F.-M.K., S.S., T.A., B.M., J.H., G.L., A.K.), Medical University of Vienna, Austria
| | - Guenther Laufer
- From the Department of Cardiac Surgery (M.A., C.O., F.-M.K., S.S., T.A., B.M., J.H., G.L., A.K.), Medical University of Vienna, Austria
| | - Alfred Kocher
- From the Department of Cardiac Surgery (M.A., C.O., F.-M.K., S.S., T.A., B.M., J.H., G.L., A.K.), Medical University of Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology (M.B., M.W.), Medical University of Vienna, Austria
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Sheikh Rezaei S, Mittlböck M, Reichardt B, Wolzt M. SSRI co-medication with NOAC or VKA does not increase hospitalisation for bleeding: A retrospective nationwide cohort study in Austria 2010-2015. Int J Geriatr Psychiatry 2019; 34:1194-1199. [PMID: 30968457 PMCID: PMC6767374 DOI: 10.1002/gps.5117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/31/2018] [Accepted: 04/05/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Non-vitamin K oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) are used for the prophylaxis and treatment of thromboembolic events. A potential drug-drug interaction and increased bleeding events have been reported with co-medication of selective serotonin receptor inhibitors (SSRIs) and VKA. The aim of this study was to investigate the bleeding risk of a coprescription of NOAC or VKA with SSRI. METHODS Patients with prescription of NOAC or VKA and an antidepressant drug therapy (ADTx) were selected from the drug reimbursement database of 13 Austrian health insurance funds. For this cohort, hospital discharge diagnoses for gastrointestinal bleeding, cerebral haemorrhage, and bleeding anaemia between 2010 and 2015 were analysed. RESULTS Data were available from 50 196 female and 31 308 male patients. Among these, 892 patients had 987 hospitalisations with bleeding events. The most frequent bleeding cases were gastrointestinal bleedings with 588 events (59.6%), followed by cerebral haemorrhage with 344 (34.8%), and bleeding anaemia with 55 events (5.6%), respectively. The risk of bleeding events was similar between SSRI and other ADTx, when combined with oral anticoagulants (p = 0.51). Concomitant treatment of patients with SSRI or other ADTx and NOAC was associated with an increased bleeding risk compared with cotreatment with VKA (1.21, 95% CI: 1.05-1.40; p = 0.0097). CONCLUSION Co-medication of SSRI with VKA or NOAC has little if any impact on hospital discharge diagnoses for bleeding events compared with cotreatment of those anticoagulants with other antidepressant medications.
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Affiliation(s)
| | - Martina Mittlböck
- Center for Medical Statistics, Informatics and Intelligent SystemsMedical University of ViennaViennaAustria
| | | | - Michael Wolzt
- Department of Clinical PharmacologyMedical University of ViennaViennaAustria
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Gremmel T, Niessner A, Domanovits H, Frossard M, Sengölge G, Steinlechner B, Sycha T, Wolzt M, Pabinger I. Correction to: Non-vitamin K antagonist oral anticoagulants in patients with an increased risk of bleeding. Wien Klin Wochenschr 2019; 131:135. [PMID: 30796518 DOI: 10.1007/s00508-019-1467-8] [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: 12/01/2022]
Abstract
Correction to: Wien Klin Wochenschr 2018 https://doi.org/10.1007/s00508-018-1381-5 Unfortunately, the original version of this article contained two mistakes.The text passage "It should be mentioned here that in the case of apixaban, dose adjustment is not based on GFR. A lower dosage of apixaban ….
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Affiliation(s)
- Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria.
| | - Alexander Niessner
- Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Frossard
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Gürkan Sengölge
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Barbara Steinlechner
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Sycha
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Sheikh Rezaei S, Weisshaar S, Litschauer B, Gouya G, Ohrenberger G, Wolzt M. ADMA and NT pro-BNP are associated with overall mortality in elderly. Eur J Clin Invest 2019; 49:e13041. [PMID: 30365159 PMCID: PMC6587535 DOI: 10.1111/eci.13041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/28/2018] [Revised: 08/20/2018] [Accepted: 10/22/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increased asymmetrical dimethylarginine (ADMA) and NT pro-BNP concentrations have been associated with mortality in patients with cardiovascular (CV) disease and the general population. The use of these prognostic markers in an older population is not established yet. The aim of the present study was to investigate the prognostic value of age, sex, BMI, co-medication and CV laboratory risk markers in geriatric care patients. MATERIALS AND METHODS In this prospective observational single-centre cohort study data of long-term geriatric care patients were collected. Blood samples were collected between 14.09.2009 and 16.12.2009, and mortality was recorded up to 90 months. ADMA, its symmetric isomer SDMA, L-arginine, NT pro-BNP and CRP were determined at study entry. Simple associations of risk factors for survival period were explored by Spearman correlation coefficient. Significant univariate predictors for survival period were used in the Cox proportional hazard model. RESULTS A total of 481 patients were screened, and data from 449 patients were analysed. A total of 381 patients died during the observation period. Full data sets from 344 patients were used for Cox regression analysis. Male sex, older age, lower BMI, use of neuroleptic medicine, peripheral artery disease, and elevated plasma concentrations of ADMA, NT pro-BNP, and CRP were significant predictors of mortality. CONCLUSION The concentration of ADMA and NT pro-BNP may be used as an early risk marker for overall mortality in geriatric care. Neuroleptic medicine is associated with increased mortality in this population.
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Affiliation(s)
| | - Stefan Weisshaar
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Brigitte Litschauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ghazaleh Gouya
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Crevenna R, Kainberger F, Wiltschke C, Marosi C, Wolzt M, Cenik F, Keilani M. Cancer rehabilitation: current trends and practices within an Austrian University Hospital Center. Disabil Rehabil 2018; 42:2-7. [PMID: 30328719 DOI: 10.1080/09638288.2018.1514665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Cancer rehabilitation has the goal to improve functional status, quality of life, participation, and can improve quality of patient-centered programs and health care efficiencies. In Austria, inpatient cancer rehabilitation is well established but outpatient rehabilitation has not yet established well.Methods: The present article is describing current rehabilitation in practice and focuses on cancer rehabilitation in Austria, namely bringing together a descriptive account of current trends and practices within an Austrian University Hospital Center (General Hospital of Vienna linked to the Medical University of Vienna) and the Comprehensive Cancer Centre (CCC) Vienna, Austria.Results: Cancer Rehabilitation in the described Austrian University Hospital Center is well developed due to the help of all different clinics dealing with cancer patients and of the opinion leaders of the CCC Vienna. The Department of Physical Medicine, Rehabilitation, and Occupational Medicine of the Medical University of Vienna as a part of the CCC Vienna with his "Pioneer-Status" and the described milestones has been integrated in the national cancer rehabilitation concept of our country from the beginning.Conclusions: Also in Austria, Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multiprofessional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitation.Implications for rehabilitationCancer rehabilitation is an important part in the treatment and care of cancer patients with the goal to improve functional status, quality of life, and participationCancer rehabilitation helps cancer survivors to be integrated in their normal live, namely to increase social participation and/or workabilityThe field of Physical Medicine and Rehabilitation with competencies in diagnostic and therapy as well as of coordination of the multi-professional and interdisciplinary rehabilitation teams is an important part of cancer rehabilitationInterventions and treatment approaches from the field of Physical Medicine and rehabilitation include the application of Physical Modalities like electrotherapy, thermotherapy, balneology and climatic therapy, phototherapy, and mechanotherapy Cancer rehabilitation has to be early integrated into the cancer care continuum.
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Affiliation(s)
- Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuro- and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Wiltschke
- Department of Internal Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Internal Medicine I/Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Fadime Cenik
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
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Rezaei SS, Rinner C, Ratajczak P, Grossmann W, Gall W, Wolzt M. Use of beta-blocker is associated with lower mortality in patients with coronary artery disease with or without COPD. Clin Respir J 2018; 12:2627-2634. [PMID: 30276967 DOI: 10.1111/crj.12968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/03/2018] [Accepted: 09/09/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Beta-blockers are indicated for secondary prevention of coronary artery disease (CAD). However, in patients with co-morbidity of chronic obstructive pulmonary disease (COPD) an underuse of beta-blocker has been reported. MATERIALS AND METHODS Prescription and demographic data and information on hospital discharge diagnoses from 13 Austrian health insurance funds for the years 2006-2007 were analyzed. The primary end point was all-cause mortality of patients with CAD with or without COPD and its association with use of beta-blockers. RESULTS In 2006 and 2007, 65717 patients (37% female, 63% male) were discharged with a diagnosis of CAD. Among these patients, 46% had a co-diagnosis of COPD, 24% had diabetes, and 75% received beta-blockers. Use of beta-blockers was comparable in CAD patients with COPD and without COPD with 77% and 74%, respectively. Thousand eight hundred seventy-two (8.1%) and 1473 (5.6%) patients with and without COPD, who used beta-blockers died within months in 2006 and 2007. Thousand five hundred fifty-three (22.0%) and 1862 (22.2%) of patients with and without COPD and without beta-blockers died during the corresponding time period. DISCUSSION Use of beta-blockers was similar in patients with CAD with or without co-diagnosis of COPD. However, mortality of beta-blocker users was markedly lower than that of nonusers in patients with CAD with or without COPD.
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Affiliation(s)
| | - Christoph Rinner
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Paulina Ratajczak
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Walter Gall
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Wolf M, Klang V, Stojcic T, Fuchs C, Wolzt M, Valenta C. NLC versus nanoemulsions: Effect on physiological skin parameters during regular in vivo application and impact on drug penetration. Int J Pharm 2018; 549:343-351. [DOI: 10.1016/j.ijpharm.2018.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/30/2018] [Accepted: 08/08/2018] [Indexed: 12/22/2022]
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35
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Gremmel T, Niessner A, Domanovits H, Frossard M, Sengölge G, Steinlechner B, Sycha T, Wolzt M, Pabinger I. Non-vitamin K antagonist oral anticoagulants in patients with an increased risk of bleeding. Wien Klin Wochenschr 2018; 130:722-734. [PMID: 30128955 PMCID: PMC6290726 DOI: 10.1007/s00508-018-1381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 07/30/2018] [Indexed: 12/24/2022]
Abstract
The non-vitamin K antagonist oral anticoagulants (NOACs) have considerably changed clinical practice and are increasingly being used as an alternative to vitamin K antagonists (VKAs) for 3 main reasons: 1) an improved benefit-risk ratio (in particular lower rates of intracranial bleeding), 2) a more predictable effect without the need for routine monitoring, and 3) fewer food and drug interactions compared with VKAs. Currently, there are four NOACs available: the factor Xa inhibitors apixaban, edoxaban, and rivaroxaban, and the thrombin inhibitor dabigatran. This consensus paper reviews the properties and usage of NOACs in a number of high-risk patient populations, such as patients with chronic kidney disease, patients ≥80 years of age and others and provides guidance for the use of NOACs in patients at risk of bleeding.
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Affiliation(s)
- Thomas Gremmel
- Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria.
| | - Alexander Niessner
- Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Frossard
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Gürkan Sengölge
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Barbara Steinlechner
- Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Sycha
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ingrid Pabinger
- Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Sheikh Rezaei S, Weisshaar SW, Litschauer B, Gouya G, Ohrenberger G, Wolzt M. P3482Plasma ADMA and nt pro–BNP concentrations are associated with overall mortality in the elderly. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Sheikh Rezaei
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - S W Weisshaar
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - B Litschauer
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - G Gouya
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | | | - M Wolzt
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
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Wolzt M, Eder M, Weltermann A, Entlicher J, Eichler HG, Kyrle PA. Comparison of the Effects of Different Low Molecular Weight Heparins on the Hemostatic System Activation In Vivo in Man. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn a double-blind, randomized, cross-over study the effects of single subcutaneous doses of 120 anti-Xa units/kg body wt. of three different low molecular weight heparin (LMWH) preparations were investigated in 15 healthy subjects by determination of thrombin-antithrombin El complex (TAT), prothrombin fragment 1.2 (fl.2), and β-thromboglobin (β-TG) in shed blood and in venous blood.Certoparin, dalteparin, and enoxaparin significantly inhibited coagulation activation marker formation in shed blood. The substantial inhibition of TAT and fl.2 formation was slightly more pronounced in response to certoparin. β-TG was decreased following certoparin and enoxaparin, but not following dalteparin. However, no difference between groups was detectable. A small but consistent decrease of fl.2 formation in venous blood was noted for all LMWHs and dalteparin and enoxaparin, but not certoparin, inhibited TAT formation. Only a minor impact of the three LMWH preparations was noted on β-TG plasma concentrations.Our data indicate that the studied LMWH preparations have a major impact on blood clotting in the activated state and inhibit in vivothe hemostatic system to a comparable extent.
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Affiliation(s)
- Michael Wolzt
- The Department of Clinical Pharmacology, Allgemeines Krankenhaus Wien, Austria
| | - Michaela Eder
- The Department of Clinical Pharmacology, Allgemeines Krankenhaus Wien, Austria
| | - Ansgar Weltermann
- The Department of Internal Medicine I/Division of Hematology and Hemostaseology Vienna University, Allgemeines Krankenhaus Wien, Austria
| | - Jesusa Entlicher
- The Department of Clinical Pharmacology, Allgemeines Krankenhaus Wien, Austria
| | - Hans-Georg Eichler
- The Department of Clinical Pharmacology, Allgemeines Krankenhaus Wien, Austria
| | - Paul A Kyrle
- The Department of Internal Medicine I/Division of Hematology and Hemostaseology Vienna University, Allgemeines Krankenhaus Wien, Austria
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Wolzt M, Weltermann A, Nieszpaur-Los M, Schneider B, Fassolt A, Lechner K, Eichler HG, Kyrle PA. Studies on the Neutralizing Effects of Protamine on Unfractionated and Low Molecular Weight Heparin (Fragmin®) at the Site of Activation of the Coagulation System in Man. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1653794] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryIn a double-blind, randomized, cross-over study the neutralizing action of protamine towards unfractionated heparin (UFH, 150 U/kg i.v.) and a low molecular weight heparin (LMWH, Fragmin®, 100 anti-Xa U/kg i.v.) was investigated in 15 healthy subjects in vitro by measuring activated partial thromboplastin time (APTT), thrombin time (TT) and anti factor Xa activity (anti-Xa) in venous blood and in vivo by determination of prothrombin fragment 1.2 (f1.2) and thrombin-antithrombin III complexes (TAT) in venous blood and in shed blood. UFH and LMWH caused a prolongation of APTT and TT, an increase in anti-Xa and significantly inhibited f1.2 and TAT formation in shed blood, whereas only a minimal effect on TAT and f1.2 formation in venous blood was noted. Administration of 1 mg protamine/100 U UFH resulted in a near complete reversal of APTT, TT and anti-Xa, whereas lower doses (0.25 and 0.5 mg) were less effective. The effects of UFH on f1.2 and TAT generation in shed blood were partially (60-70%) neutralized only by the high dose (1.0 mg). Application of 1 mg protamine/100 anti-Xa U LMWH caused a near complete reversal of both APTT and TT but had only a weak effect on anti-Xa. In shed blood, the effect of LMWH on TAT and f1.2 formation was reversed by protamine only by 14% and 23% respectively. Our data do not support the concept that to reduce the incidence of protamine’s potential clinical side effects, the administration of a lower dose of protamine than 1 mg protamine/100 U UFH is justified. Furthermore, a significant residual impairment of hemostasis is still detectable after administration of the recommended dose of protamine to neutralize the anticoagulant effects of a LMWH preparation.
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Affiliation(s)
- Michael Wolzt
- The Department of Clinical Pharmacology, Vienna, Austria
| | - Ansgar Weltermann
- Department of Internal Medicine I/Division of Hematology, Blood Clotting, Vienna, Austria
| | | | | | - Anita Fassolt
- The Department of Clinical Pharmacology, Vienna, Austria
| | - Klaus Lechner
- Department of Internal Medicine I/Division of Hematology, Blood Clotting, Vienna, Austria
| | | | - Paul A Kyrle
- Department of Internal Medicine I/Division of Hematology, Blood Clotting, Vienna, Austria
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Elchinger S, Wolzt M, Nieszpaur-Los M, Schneider B, Lechner K, Eichler HG, Kyrle PA. Effects of a Low Molecular Weight Heparin (Fragmin®) and of Unfractionated Heparin on Coagulation Activation at the Site of Plug Formation In Vivo. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648970] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe clinical benefits of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) have been shown in many trials. However, the mode of action of heparin has not been fully elucidated. Thus, we wanted to study the effects of UFH and LMWH in vivo by measuring coagulation activation markers in blood obtained directly from a vascular injury site. In a double-blind, randomized, 3-way, cross-over study 18 healthy volunteers were given UFH (150 U/kg s.c.) and 2 doses of LMWH [35 U/kg s.c. (low dose, Id), 75 U/kg s.c. (high dose, hd)]. Prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT) and fibrinopeptide A (FPA) were measured in bleeding time blood and in venous blood before and after drug application. In addition, the effects of UFH and LMWH on in vitro coagulation tests were studied. Compared to base line, UFH and both IdLMWH and hdLMWH caused significant reductions of F1+2, TAT and FPA in bleeding time blood at 2 h. A marked effect of UFH and of hdLMWH was also seen at 5 h. The inhibition of FPA generation was more pronounced after hdLMWH compared to IdLMWH. In venous blood, UFH and LMWH caused reductions of F1+2, but not of TAT and FPA. In vitro, UFH predominantly affected the anti-IIa assays (activated partial thromboplastin time, thrombin time) and LMWH mainly the anti-Xa test system. Using a technique that investigates the activated coagulation system in vivo, a time- and dose dependent inhibitory effect of heparin on coagulation activation was detectable. Therefore, in our experimental setting a preferential inhibition of a particular portion of the coagulation system by one of the two heparin preparations was not detectable.
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Affiliation(s)
- Sabine Elchinger
- The Department of Medicine I, Division of Hematology and Hemostaseology, Department of Clinical Pharmacology, and Institute of Medical Statistics and Documentation, Vienna University Hospital, Vienna, Austria
| | - Michael Wolzt
- The Department of Medicine I, Division of Hematology and Hemostaseology, Department of Clinical Pharmacology, and Institute of Medical Statistics and Documentation, Vienna University Hospital, Vienna, Austria
| | - Malgorzata Nieszpaur-Los
- The Department of Medicine I, Division of Hematology and Hemostaseology, Department of Clinical Pharmacology, and Institute of Medical Statistics and Documentation, Vienna University Hospital, Vienna, Austria
| | - Barbara Schneider
- The Department of Medicine I, Division of Hematology and Hemostaseology, Department of Clinical Pharmacology, and Institute of Medical Statistics and Documentation, Vienna University Hospital, Vienna, Austria
| | - Klaus Lechner
- The Department of Medicine I, Division of Hematology and Hemostaseology, Department of Clinical Pharmacology, and Institute of Medical Statistics and Documentation, Vienna University Hospital, Vienna, Austria
| | - Hans-Georg Eichler
- The Department of Medicine I, Division of Hematology and Hemostaseology, Department of Clinical Pharmacology, and Institute of Medical Statistics and Documentation, Vienna University Hospital, Vienna, Austria
| | - Paul A Kyrle
- The Department of Medicine I, Division of Hematology and Hemostaseology, Department of Clinical Pharmacology, and Institute of Medical Statistics and Documentation, Vienna University Hospital, Vienna, Austria
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Rezaei SS, Litschauer B, Gouya G, Baumgartner-Parzer S, Stulnig T, Wolzt M. Cardiovascular Effects of Stress During Acutely Increased Free Fatty Acids in a Randomized, Double-Blind, Cross-Over Study in Humans. Horm Metab Res 2018; 50:478-484. [PMID: 29883974 DOI: 10.1055/a-0620-8438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Increased free fatty acids stimulate sympathetic nervous system activity, impair endothelium-dependent vasodilation, and increase regional blood flow. The aim of this study was to assess if fatty acids acutely elevated by infusion of intralipid/heparin affect cardiovascular reactivity employing two stressors eliciting either a cardiac (Stroop test) or vascular (Cold Face test) dominated pressor response. Two stress tasks were performed in 20 healthy subjects (10 women, 10 men) before and during a 180-min intralipid/heparin or saline infusion as placebo on alternate trial days in a randomized crossover study design. Blood pressure, heart rate, cardiac index, and total peripheral resistance index were measured. At baseline, the Stroop test did not affect hemodynamic parameters, and the Cold Face test had an impact on hemodynamic parameters except for heart rate. Plasma fatty acids concentrations increased to 810% (t=11.0, p<0.001) of baseline and C-peptide increased by 17% (t=4.66, p<0.001) during intralipid/heparin infusion. This was paralleled by increased cardiac index (F=9.98; p<0.005 vs. saline) and reduced total peripheral resistance index (F=4.46; p<0.05 vs saline). There was no effect of intralipid/heparin or saline infusion on Stroop test or Cold Face test reactivity of hemodynamic parameters. An acute increase in free fatty acids does not affect the magnitude or pattern of stress response in healthy volunteers, but primarily alter the underlying cardiovascular tone by decreasing total peripheral resistance index and increasing cardiac index to maintain a constant blood pressure.
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Affiliation(s)
| | - Brigitte Litschauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Gazaleh Gouya
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Sabina Baumgartner-Parzer
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Thomas Stulnig
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Niess F, Fiedler GB, Schmid AI, Laistler E, Frass‐Kriegl R, Wolzt M, Moser E, Meyerspeer M. Dynamic multivoxel-localized 31 P MRS during plantar flexion exercise with variable knee angle. NMR Biomed 2018; 31:e3905. [PMID: 29578260 PMCID: PMC6001778 DOI: 10.1002/nbm.3905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 01/08/2018] [Accepted: 01/16/2018] [Indexed: 05/07/2023]
Abstract
Exercise studies investigating the metabolic response of calf muscles using 31 P MRS are usually performed with a single knee angle. However, during natural movement, the distribution of workload between the main contributors to force, gastrocnemius and soleus is influenced by the knee angle. Hence, it is of interest to measure the respective metabolic response of these muscles to exercise as a function of knee angle using localized spectroscopy. Time-resolved multivoxel 31 P MRS at 7 T was performed simultaneously in gastrocnemius medialis and soleus during rest, plantar flexion exercise and recovery in 12 healthy volunteers. This experiment was conducted with four different knee angles. PCr depletions correlated negatively with knee angle in gastrocnemius medialis, decreasing from 79±14 % (extended leg) to 35±23 %(∼40°), and positively in soleus, increasing from 20±21 % to 36±25 %; differences were significant. Linear correlations were found between knee angle and end-exercise PCr depletions in gastrocnemius medialis (R2 =0.8) and soleus (R2 =0.53). PCr recovery times and end-exercise pH changes that correlated with PCr depletion were consistent with the literature in gastrocnemius medialis and differences between knee angles were significant. These effects were less pronounced in soleus and not significant for comparable PCr depletions. Maximum oxidative capacity calculated for all knee angles was in excellent agreement with the literature and showed no significant changes between different knee angles. In conclusion, these findings confirm that plantar flexion exercise with a straight leg is a suitable paradigm, when data are acquired from gastrocnemius only (using either localized MRS or small surface coils), and that activation of soleus requires the knee to be flexed. The present study comprises a systematic investigation of the effects of the knee angle on metabolic parameters, measured with dynamic multivoxel 31 P MRS during muscle exercise and recovery, and the findings should be used in future study design.
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Affiliation(s)
- Fabian Niess
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaAustria
- Highfield MR CenterMedical University of ViennaAustria
| | - Georg B. Fiedler
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaAustria
- Highfield MR CenterMedical University of ViennaAustria
| | - Albrecht I. Schmid
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaAustria
- Highfield MR CenterMedical University of ViennaAustria
| | - Elmar Laistler
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaAustria
- Highfield MR CenterMedical University of ViennaAustria
| | - Roberta Frass‐Kriegl
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaAustria
- Highfield MR CenterMedical University of ViennaAustria
| | - Michael Wolzt
- Department of Clinical PharmacologyMedical University of ViennaAustria
| | - Ewald Moser
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaAustria
- Highfield MR CenterMedical University of ViennaAustria
| | - Martin Meyerspeer
- Center for Medical Physics and Biomedical EngineeringMedical University of ViennaAustria
- Highfield MR CenterMedical University of ViennaAustria
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Traby L, Kaider A, Kollars M, Eichinger S, Wolzt M, Kyrle PA. Effects of clopidogrel with or without aspirin on the generation of extracellular vesicles in the microcirculation and in venous blood: A randomized placebo controlled trial. Thromb Res 2018; 167:149-155. [PMID: 29857271 DOI: 10.1016/j.thromres.2018.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/12/2018] [Accepted: 05/16/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Dual-antiplatelet therapy (DAPT) is a standard strategy in acute coronary heart disease; however, it confers a considerable bleeding risk. Single-antiplatelet therapy (SAPT) inhibits haemostatic system activation ex vivo to a similar extent as DAPT. Extracellular vesicles (EV) are procoagulant and contribute to haemostatic system activation. We aimed to investigate the effect of DAPT compared with SAPT on EV. METHODS In a randomized, double-blind, placebo-controlled trial, 44 healthy volunteers received DAPT (clopidogrel + aspirin) or SAPT (clopidogrel + placebo) for 7 days. Blood was obtained from a standardized microvascular injury and through venipuncture at baseline (BL) and at 2 h, 24 h, and 8 days after treatment initiation. The number, origin, and surface expression of EV were assessed using flow cytometry. Data are given as median (quartiles). Non-parametric tests were used to evaluate the short-term (BL vs 2 h) and long-term differences (2 h to 8 days), as well as the differences between treatment groups. RESULTS There was no difference either in the short-term effects on the number (×103 mL-1) of EV in microvascular blood between DAPT [BL: 1433 (653; 3184) vs 2 h: 862 (545; 2026), p = 0.39] and SAPT [(BL: 614 (552; 1402) vs 2 h: 1079 (781; 1538), p = 0.75)] or in the long-term effects. DAPT and SAPT did not exhibit differential short-term effects on the number and proportion (36% and 27% vs 55% and 36%) of platelet-derived EV. DAPT and SAPT resulted in a significant short-term increase in phosphatidylserine expression in microvascular blood. The effects of DAPT and SAPT on EV in venous blood were similar to those in microvascular blood. CONCLUSION DAPT and SAPT have comparable effects on the amount, origin, and surface characteristics of EV.
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Affiliation(s)
- L Traby
- Department of Medicine I, Division of Hematology and Hemostasis and Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - A Kaider
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - M Kollars
- Department of Medicine I, Division of Hematology and Hemostasis, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - S Eichinger
- Department of Medicine I, Division of Hematology and Hemostasis, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - M Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - P A Kyrle
- Department of Medicine I, Division of Hematology and Hemostasis, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Weisshaar S, Litschauer B, Kerbel T, Wolzt M. Atorvastatin combined with ticagrelor prevent ischemia-reperfusion induced vascular endothelial dysfunction in healthy young males – A randomized, placebo-controlled, double-blinded study. Int J Cardiol 2018; 255:1-7. [DOI: 10.1016/j.ijcard.2017.12.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/28/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
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Abstract
This article provides new insight on landiolol, an ultra-short acting injectable betablocker, recently approved in Europe, with regard to its pharmacokinetic and pharmacodynamic profile, along with its first experience in Caucasian healthy volunteers and patients with atrial fibrillation. Landiolol as iv formulation exhibited in an emergency setting rapid rate reduction in patients with tachycardic atrial fibrillation without pronounced blood pressure drop both in caucasian and asian populations in similar manner.
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Affiliation(s)
- Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Günter Stix
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
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Eriksson U, Mattsson C, Wolzt M, Frison L, Fager G, Gustafsson D, Sarich T. Inhibition of Thrombin Generation by the Oral Direct Thrombin Inhibitor Ximelagatran in Shed Blood from Healthy Male Subjects. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1612989] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryXimelagatran, an oral direct thrombin inhibitor, whose active form is melagatran, was studied using a model of thrombin generation in humans. Healthy male volunteers (18 per group) received ximelagatran (60 mg p.o.), dalteparin (120 IU/kg s.c.) or a control (water p.o.). Shed blood, collected after incision of the forearm with standardised bleeding time devices at pre-dose, and at 2, 4 and 10 h post-dosing, was analysed for markers of thrombin generation. Statistically significant reductions (p < 0.05) in levels of prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin complex (TAT) in shed blood were detected at 2 and 4 h post-dosing in both the ximelagatran and dalteparin groups. Shed blood F1+2 and TAT levels had returned to pre-dose levels at 10 h post-dosing. Using a shed blood model, we demonstrate that the reversible thrombin inhibitor melagatran and, therefore, oral administration of ximelagatran, inhibits thrombin generation in humans after acute activation of coagulation.
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Joukhadar C, Klein N, Prinz M, Schrolnberger C, Vukovich T, Wolzt M, Dorner G, Schmetterer L. Similar Effects of Atorvastatin, Simvastatin and Pravastatin on Thrombogenic and Inflammatory Parameters in Patients with Hypercholesterolemia. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1612902] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Background: Previous studies have suggested that statins exert beneficial effects beyond their favorable lipid lowering effect. Particularly, the modification of thrombus formation and degradation, alteration in inflammatory response, plaque stabilization and improved endothelial function are thought to be responsible for additional reduction of morbidity and mortality due to cardiovascular events. To date, however, it is still unclear whether these effects are elicited by all statins. Methods and Results: We set out to compare in a controlled, randomized, double-blind study design the effects of almost equieffective cholesterol lowering doses of three chemically and pharmacokinetically different statins (atorvastatin, simvastatin, pravastatin) on hemostatic and inflammatory markers in 99 hypercholesterolemic patients. At entry and 3 months after onset of statin therapy plasma cholesterol and von Willebrand factor antigen (vWf-Ag), fibrinogen, d-dimer, prothrombin fragment 1+2 (F1.2) and C-reactive protein (CRP) were measured. The effect on plasma values of F1.2, vWf-Ag, d-dimer and CRP was not significantly different between the three treatment groups. The effect of simvastatin on fibrinogen (p = 0.005) was more pronounced than the effects of atorvastatin (p = 0.48 n.s.) and pravastatin (p = 0.15 n.s.). Plasma levels of F1.2 and vWf-Ag (when data of all statins were pooled) were significantly reduced by 7% and 10% versus baseline, respectively. No significant reduction was observed for d-dimer (p = 0.26) and CRP (p = 0.5). Total plasma cholesterol levels decreased significantly (p <0.0001 in all groups) between 22% and 29% compared to baseline. Conclusion: The present study shows similar shortterm (3 months) effects of atorvastatin, simvastatin and pravastatin on selected hemostatic and inflammatory parameters in plasma in patients with hypercholesterolemia. Thus, chemical and pharmacological differences between statins appear to exert no major influence on these parameters.
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Wolzt M, Levi M, Sarich TC, Boström SL, Eriksson UG, Eriksson-Lepkowska M, Svensson M, Weitz JI, Elg M, Wåhlander K. Effect of recombinant factor VIIa on melagatran-induced inhibition of thrombin generation and platelet activation in healthy volunteers. Thromb Haemost 2017; 91:1090-6. [PMID: 15175794 DOI: 10.1160/th03-09-0605] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 11/05/2022]
Abstract
SummaryThe objectives were to investigate whether activation of the extrinsic coagulation cascade by recombinant factor VIIa (rFVIIa) reverses the inhibition of thrombin generation and platelet activation by melagatran, the active form of the oral direct thrombin inhibitor ximelagatran. In a single-blind, randomized, parallel-group study, volunteers (20 per group) received a 5-hour intravenous (iv) infusion to achieve steadystate melagatran plasma concentrations of approximately 0.5 µmol/L, with a single iv bolus of rFVIIa (90 µg/kg) or placebo at 60 minutes. Prothrombin fragment 1+2, thrombin-antithrombin complex, fibrinopeptide A, β-thromboglobulin, and thrombin-activatable fibrinolysis inhibitor were quantified for venous and shed blood. Activated partial thromboplastin time (APTT), prothrombin time (PT), endogenous thrombin potential, thrombus precursor protein (TpP), and plasmin-α2-antiplasmin complex concentrations were determined in venous blood. Shed blood volume was measured. Melagatran reduced markers of thrombin generation and platelet activation in shed blood and prolonged APTT. rFVIIa increased FVIIa activity, PT, and TpP in venous blood. All other parameters were unaffected. In conclusion, rFVIIa did not reverse the anticoagulant effects of high constant concentrations of melagatran. However, the potential value of higher, continuous or repeated doses of rFVIIa or its use with lower melagatran concentrations has not been excluded.
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Affiliation(s)
- Michael Wolzt
- Department of Clinical Pharmacology, Allgemeines Krankenhaus Wien, Vienna, Austria.
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Andreas M, Moayedifar R, Wieselthaler G, Wolzt M, Riebandt J, Haberl T, Angleitner P, Schlöglhofer T, Wiedemann D, Schima H, Laufer G, Zimpfer D. Response by Andreas et al to Letter Regarding Article, "Increased Thromboembolic Events With Dabigatran Compared With Vitamin K Antagonism in Left Ventricular Assist Device Patients: A Randomized Controlled Pilot Trial". Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004309. [PMID: 29030374 DOI: 10.1161/circheartfailure.117.004309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin Andreas
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Roxana Moayedifar
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Georg Wieselthaler
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Michael Wolzt
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Julia Riebandt
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Thomas Haberl
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Philipp Angleitner
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Thomas Schlöglhofer
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Dominik Wiedemann
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Heinrich Schima
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Guenther Laufer
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Daniel Zimpfer
- From Division of Cardiac Surgery (M.A., R.M., J.R., T.H., D.W., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
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Weisshaar S, Litschauer B, Eipeldauer M, Hobl EL, Wolzt M. Ticagrelor mitigates ischaemia-reperfusion induced vascular endothelial dysfunction in healthy young males - a randomized, single-blinded study. Br J Clin Pharmacol 2017; 83:2651-2660. [PMID: 28715608 DOI: 10.1111/bcp.13378] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 01/21/2023] Open
Abstract
AIMS Animal data suggest that ticagrelor but not clopidogrel protects against tissue injury. It is unclear if this effect of ticagrelor is also detectable in humans. We studied the effect of ticagrelor and clopidogrel at standard clinical doses on endothelial dysfunction in an experimental model of forearm vascular ischaemia-reperfusion (IR) injury. METHODS In a randomized, single-blinded trial, 24 subjects underwent forearm blood flow (FBF) measurements in response to the endothelium-dependent vasodilator acetylcholine (ACh) and to glyceryltrinitrate (GTN; endothelium-independent) before and after a 20 min forearm ischaemia. FBF reactivity was assessed after an oral loading dose of ticagrelor or clopidogrel and after 14 days of regular intake of maintenance doses of the study medicines. In addition, the effect on platelet inhibition was evaluated using multiple electrode aggregometry. RESULTS ACh-induced vasodilation was impaired during reperfusion and not completely normalized by acute or chronic treatment with ticagrelor or clopidogrel (post- vs. pre-ischaemia). However, ticagrelor mitigated endothelial dysfunction compared to clopidogrel after loading (FBF AChAUC ratio post- vs. pre-ischaemia: 0.83 [0.70; 0.96] vs. 0.64 [0.56; 0.72]; P = 0.024) and after chronic administration (FBF AChAUC ratio: 0.86 [0.71; 1.00] vs. 0.66 [0.55; 0.77]; P = 0.027). As expected, GTN-induced vasodilation was not affected by ischaemia. Ticagrelor or clopidogrel treatment inhibited platelet activation to a similar degree. CONCLUSION Our data indicate that ticagrelor treatment exerts a greater vascular salutary effect than clopidogrel during reperfusion after an acute vascular occlusion. IR-induced vascular injury cannot be prevented completely by administration of these antiplatelet agents at standard clinical doses.
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Affiliation(s)
- Stefan Weisshaar
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | | | | | - Eva Luise Hobl
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
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50
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Andreas M, Moayedifar R, Wieselthaler G, Wolzt M, Riebandt J, Haberl T, Angleitner P, Schlöglhofer T, Wiedemann D, Schima H, Laufer G, Zimpfer D. Increased Thromboembolic Events With Dabigatran Compared With Vitamin K Antagonism in Left Ventricular Assist Device Patients: A Randomized Controlled Pilot Trial. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003709. [PMID: 28500254 PMCID: PMC5434960 DOI: 10.1161/circheartfailure.116.003709] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/24/2017] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Left ventricular assist device–supported patients are usually anticoagulated with a combination of aspirin and vitamin K antagonists. Long-term vitamin K antagonist therapy can be complicated by unstable international normalized ratio values and patient-related compliance problems. Therefore, direct thrombin inhibitors may represent an alternative to vitamin K antagonists. Methods and Results— Thirty HeartWare ventricular assist device patients with stable renal function were planned for this prospective, randomized, open-label, single-center study. Patients were randomized to receive either phenprocoumon or dabigatran in addition to aspirin for long-term anticoagulation. Treatment duration was scheduled for 1 year and stopped after observation of a primary end point. Dabigatran dose was 110 and 75 mg BID in patients with normal or impaired renal function (glomerular filtration rate >80 mL/min or between 80 and 30 mL/min, respectively). The study was stopped prematurely for safety reasons after 16 patients (61±8 years, 1 female) were randomized. Thromboembolic events occurred in 4 subjects receiving dabigatran (50%) and in 1 receiving phenprocoumon (13%; P=0.28). No major bleeding was recorded, and no patient died during the study. Median time to treatment termination was significantly shorter in dabigatran patients (8.5 versus 12.0 months; P=0.015). Conclusions— Thromboembolic events on dabigatran led to early termination of a randomized controlled trial of dabigatran versus phenprocoumon in left ventricular assist device patients. Clinical Trial Registration— https://www.clinicaltrials.gov. Unique identifier: NCT02872649.
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Affiliation(s)
- Martin Andreas
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.).
| | - Roxana Moayedifar
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Georg Wieselthaler
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Michael Wolzt
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Julia Riebandt
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Thomas Haberl
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Philipp Angleitner
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Thomas Schlöglhofer
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Dominik Wiedemann
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Heinrich Schima
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Guenther Laufer
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
| | - Daniel Zimpfer
- From the Division of Cardiac Surgery (M.A., R.M., J.R., T.H., P.A., D.W., H.S., G.L., D.Z.), Department of Clinical Pharmacology (M.W.), and Center for Medical Physics and Biomedical Engineering and Ludwig-Boltzmann-Cluster for Cardiovascular Research (T.S., H.S.), Medical University of Vienna, Austria; and Division of Adult Cardiothoracic Surgery, University of California, San Francisco School of Medicine (G.W.)
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