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Hentschel F, Mollenhauer G, Siemssen B, Paasch C, Mantke R, Lüth S. Placing vacuum sponges in esophageal anastomotic leaks - how we do it. Langenbecks Arch Surg 2024; 409:86. [PMID: 38441680 PMCID: PMC10914858 DOI: 10.1007/s00423-024-03272-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE Endoluminal vacuum sponge therapy has dramatically improved the treatment of anastomotic leaks in esophageal surgery. However, the blind insertion of vacuum sponge kits like Eso-Sponge® via an overtube and a pusher can be technically difficult. METHODS We therefore insert our sponges under direct visual control by a nonstandard "piggyback" technique that was initially developed for the self-made sponge systems preceding these commercially available kits. RESULTS Using this technique, we inserted or changed 56 Eso-Sponges® in seven patients between 2018 and 2023. Apart from one secondary sponge dislocation, no intraprocedural complications were encountered. One patient died due to unrelated reasons. In all others, the defects healed and they were dismissed from the hospital. Long-term follow-up showed three strictures that were successfully treated by dilatation. CONCLUSION We conclude that sponge placement via piggyback technique is a fast, safe, and successful alternative to the standard method of insertion.
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Affiliation(s)
- Florian Hentschel
- Brandenburg Medical School (Theodor Fontane), Brandenburg, Germany.
- Zentrum für Innere Medizin II, Hochschulklinikum Brandenburg der MHB, Hochstr. 29, 14770, Brandenburg an der Havel, Germany.
| | - Götz Mollenhauer
- Brandenburg Medical School (Theodor Fontane), Brandenburg, Germany
| | | | - Christoph Paasch
- Brandenburg Medical School (Theodor Fontane), Brandenburg, Germany
- Shouldice Hospital, Thornhill, ON, Canada
| | - René Mantke
- Brandenburg Medical School (Theodor Fontane), Brandenburg, Germany
| | - Stefan Lüth
- Brandenburg Medical School (Theodor Fontane), Brandenburg, Germany
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Anastasiou OE, Caruntu FA, Curescu MG, Yalcin K, Akarca US, Gürel S, Zeuzem S, Erhardt A, Lüth S, Papatheodoridis GV, Keskin O, Port K, Radu M, Celen MK, Idilman R, Heidrich B, Mederacke I, von der Leyen H, Kahlhöfer J, von Karpowitz M, Hardtke S, Cornberg M, Yurdaydin C, Wedemeyer H. Five-year follow-up of 96 weeks peginterferon plus tenofovir disoproxil fumarate in hepatitis D. Liver Int 2024; 44:139-147. [PMID: 37787009 DOI: 10.1111/liv.15745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND & AIMS Until recently, pegylated interferon-alfa-2a (PEG-IFNa) therapy was the only treatment option for patients infected with hepatitis D virus (HDV). Treatment with PEG-IFNa with or without tenofovir disoproxil fumarate (TDF) for 96 weeks resulted in HDV RNA suppression in 44% of patients at the end of therapy but did not prevent short-term relapses within 24 weeks. The virological and clinical long-term effects after prolonged PEG-IFNa-based treatment of hepatitis D are unknown. METHODS In the HIDIT-II study patients (including 40% with liver cirrhosis) received 180 μg PEG-IFNa weekly plus 300 mg TDF once daily (n = 59) or 180 μg PEG-IFNa weekly plus placebo (n = 61) for 96 weeks. Patients were followed until week 356 (5 years after end of therapy). RESULTS Until the end of follow-up, 16 (13%) patients developed liver-related complications (PEG-IFNa + TDF, n = 5 vs PEG-IFNa + placebo, n = 11; p = .179). Achieving HDV suppression at week 96 was associated with decreased long-term risk for the development of hepatocellular carcinoma (p = .04) and hepatic decompensation (p = .009). Including complications irrespective of PEG-IFNa retreatment status, the number of patients developing serious complications was similar with (3/18) and without retreatment with PEG-IFNa (16/102, p > .999) but was associated with a higher chance of HDV-RNA suppression (p = .024, odds ratio 3.9 [1.3-12]). CONCLUSIONS Liver-related clinical events were infrequent and occurred less frequently in patients with virological responses to PEG-IFNa treatment. PEG-IFNa treatment should be recommended to HDV-infected patients until alternative therapies become available. Retreatment with PEG-IFNa should be considered for patients with inadequate response to the first course of treatment. CLINICAL TRIAL REGISTRATION NCT00932971.
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Affiliation(s)
- Olympia E Anastasiou
- Institute for Virology, Medical Faculty of the University of Duisburg-Essen, Essen, Germany
| | | | | | - Kendal Yalcin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | | | - Selim Gürel
- Uludağ University Medical Faculty, Bursa, Turkey
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt am Main, Germany
| | - Andreas Erhardt
- Heinrich Heine University, Dusseldorf, Germany
- Petrus Hospital, Wuppertal, Germany
| | - Stefan Lüth
- Department of Gastroenterology, Diabetology and Hepatology, University Hospital Brandenburg, Brandenburg Medical School (Theodor Fontane), Brandenburg, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, The Brandenburg Medical School Theodor Fontane and the University of Potsdam, Potsdam, Germany
| | | | - Onur Keskin
- Ankara University Medical School, Ankara, Turkey
| | | | - Monica Radu
- Institutul de Boli Infectioase, Bucharest, Romania
| | | | | | | | | | - Heiko von der Leyen
- Hannover Medical School, Hannover, Germany
- Orgenesis, Inc, Germantown, Maryland, USA
| | - Julia Kahlhöfer
- Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- D-SOLVE Consortium an EU Horizon Europe funded project (No 101057917), Hannover, Germany
| | | | - Svenja Hardtke
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Cornberg
- Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- D-SOLVE Consortium an EU Horizon Europe funded project (No 101057917), Hannover, Germany
- German Center for Infection Research, Partner Site Hannover-Braunschweig, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology & Hepatology, Koc University Medical School, Istanbul, Turkey
| | - Heiner Wedemeyer
- Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- D-SOLVE Consortium an EU Horizon Europe funded project (No 101057917), Hannover, Germany
- German Center for Infection Research, Partner Site Hannover-Braunschweig, Hannover, Germany
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Staffeldt L, Mattert G, Riecken K, Rövenstrunk G, Volkmar A, Heumann A, Moustafa M, Jücker M, Fehse B, Schumacher U, Lüth S, Kah J. Generating Patient-Derived HCC Cell Lines Suitable for Predictive In Vitro and In Vivo Drug Screening by Orthotopic Transplantation. Cells 2023; 13:82. [PMID: 38201286 PMCID: PMC10778205 DOI: 10.3390/cells13010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/14/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Hepatocellular carcinoma (HCC) results in high mortality due to ineffective systemic therapy. Human immortalized cell lines are commonly used to study anti-tumor effects in the context of new anti-tumor therapies and tumor biology. As immortalized cell lines have limited biological relevance and heterogeneity compared to primary cells, patient-derived tumor tissues, and corresponding immune cells are the gold standards for studying the complexity of individual tumor entities. However, culturing primary HCC cells has a low success rate. Here, we aimed to establish a reproducible approach to preserve the patient-derived liver cancer cells for in vitro and in vivo studies. The underlying study aimed to establish an in vitro pre-screening platform to test treatment options' effectivity and dosage, e.g., for new substances, autologous modified immune cells, or combined therapies in HCC. We initially employed 15 surgical resection specimens from patients with different HCC entities for isolation and preservation. The isolated liver cancer cells from four HCC-diagnosed patients were used for orthotopic transplantation into the healthy liver of immunodeficient mice, allowing them to grow for six months before human liver cancer cells were isolated and cultured. As a result, we generated and characterized four new primary-like liver cancer cell lines. Compared to immortalized HCC cell lines, freshly generated liver cancer cells displayed individual morphologies and heterogeneous protein-level characteristics. We assessed their ability to proliferate, migrate, form spheroids, and react to common medications compared to immortalized HCC cell lines. All four liver cancer cell lines exhibit strong migration and colony-forming characteristics in vitro, comparable to extensively investigated immortalized HCC cell lines. Moreover, the four etiological different liver cancer cell lines displayed differences in the response to 5-FU, Sorafenib, Axitinib, and interferon-alpha treatment, ranking from non-responders to responders depending on the applicated medication. In sum, we generated individual patient-derived liver cancer cell lines suitable for predictive in vitro drug screenings and for xenograft transplantations to realize the in vivo investigation of drug candidates. We overcame the low cultivation success rate of liver cancer cells derived from patients and analyzed their potential to serve a pre-clinical model.
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Affiliation(s)
- Lisa Staffeldt
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany (U.S.)
| | - Gregor Mattert
- Brandenburg Medical School, Center for Translational Medicine, 14770 Brandenburg an der Havel, Germany; (G.M.); (G.R.)
| | - Kristoffer Riecken
- Research Department Cell and Gene Therapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Götz Rövenstrunk
- Brandenburg Medical School, Center for Translational Medicine, 14770 Brandenburg an der Havel, Germany; (G.M.); (G.R.)
| | - Anika Volkmar
- Brandenburg Medical School, Center for Translational Medicine, 14770 Brandenburg an der Havel, Germany; (G.M.); (G.R.)
| | - Asmus Heumann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Mohamed Moustafa
- Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Manfred Jücker
- Center for Experimental Medicine, Institute of Biochemistry and Signal Transduction, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Boris Fehse
- Research Department Cell and Gene Therapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- German Center for Infection Research, Hamburg-Lübeck-Borstel Partner Site, 38124 Braunschweig, Germany
| | - Udo Schumacher
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany (U.S.)
- Medical School Berlin, Mecklenburgische Straße 57, 14197 Berlin, Germany
| | - Stefan Lüth
- Brandenburg Medical School, Center for Translational Medicine, 14770 Brandenburg an der Havel, Germany; (G.M.); (G.R.)
- Department of Gastroenterology, University Hospital Brandenburg, 14770 Brandenburg an der Havel, Germany
| | - Janine Kah
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany (U.S.)
- Brandenburg Medical School, Center for Translational Medicine, 14770 Brandenburg an der Havel, Germany; (G.M.); (G.R.)
- Department of Gastroenterology, University Hospital Brandenburg, 14770 Brandenburg an der Havel, Germany
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Mainz JG, Barucha A, Huang P, Bechinger L, Duckstein F, Polte L, Sadrieh P, Nährlich L, Eickmeier O, Van Dullemen S, Eschenhagen P, Schwarz C, Lüth S, Zagoya C, Graepler-Mainka U. Dynamics of abdominal symptoms during the start of a new therapy with elexacaftor/tezacaftor/ivacaftor using the novel CFAbd-day2day questionnaire. Front Pharmacol 2023; 14:1167407. [PMID: 38026920 PMCID: PMC10658783 DOI: 10.3389/fphar.2023.1167407] [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: 03/07/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Elexacaftor-tezacaftor-ivacaftor (ETI) is a novel, highly effective CFTR modulator combination proven to enhance lung function and body weight in people with cystic fibrosis (pwCF) carrying a F508del mutation. Recently, we revealed significant reductions in abdominal symptoms (AS) in German, British, and Irish pwCF after 24-26 weeks of ETI using the CFAbd-Score, the first patient-reported outcome measure (PROM) specifically developed and validated for pwCF following FDA guidelines. Notably, many pwCF reported marked changes in their AS during the first days of the new treatment. To capture these immediate effects, we developed the CFAbd-day2day, a CF-specific GI-diary, following FDA and COSMIN guidelines. Aim: To prospectively capture the immediate dynamics of AS using the CFAbd-day2day 14 days before and 14-28 days after ETI initiation. In addition, we aim to provide validation steps of the novel PROM concerning sensitivity to changes. Methods: To develop the CFAbd-day2day, focus groups (community voice = pwCF and their proxies and CF specialists from different fields) were repeatedly consulted. Before and during the new ETI therapy, pwCF prospectively scored AS on a daily basis with the CFAbd-day2day. Results: Altogether, 45 pwCF attended in five CF centers prospectively completed the CFAbd-day2day before (mean ± sd:14 ± 7 days) and after (mean ± sd: 28 ± 23 days) ETI initiation. On the one hand, cumulative scores significantly decreased during the 3-4-week time frame after ETI initiation, compared to 2 weeks prior to therapy. On the other hand, many patients who revealed a relatively stable level of AS before ETI reported changes during the first days of treatment with the highly effective CFTR modulators. Factors like pain and flatulence increased in up to 21% of patients during the first 14 days of therapy, but they improved during days 15-27. Conclusion: The CFAbd-day2day, specifically developed and in the process of validation to prospectively capture GI symptoms in pwCF, provides new substantial insights into the dynamics of AS in pwCF receiving a new treatment with ETI. This novel tool is also helpful in prospectively monitoring patients with specific GI problems. International implementation and further validation steps of the diary are ongoing.
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Affiliation(s)
- Jochen G. Mainz
- CF-Center, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
- Medizinische Hochschule Brandenburg (MHB), Universitätsklinikum, Brandenburg an der Havel, Germany
| | - Anton Barucha
- CF-Center, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
- Medizinische Hochschule Brandenburg (MHB), Universitätsklinikum, Brandenburg an der Havel, Germany
| | - Pu Huang
- CF-Center, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
- Medizinische Hochschule Brandenburg (MHB), Universitätsklinikum, Brandenburg an der Havel, Germany
| | - Lilith Bechinger
- CF-Center, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
- Medizinische Hochschule Brandenburg (MHB), Universitätsklinikum, Brandenburg an der Havel, Germany
| | - Franziska Duckstein
- CF-Center, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
- Medizinische Hochschule Brandenburg (MHB), Universitätsklinikum, Brandenburg an der Havel, Germany
| | - Louise Polte
- CF-Center, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
- Medizinische Hochschule Brandenburg (MHB), Universitätsklinikum, Brandenburg an der Havel, Germany
| | - Pauline Sadrieh
- CF-Center, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
- Medizinische Hochschule Brandenburg (MHB), Universitätsklinikum, Brandenburg an der Havel, Germany
| | - Lutz Nährlich
- CF Center for Children Justus-Liebig-Universität Gießen, Universitätsklinikum Gießen-Marburg GmbH, Gießen, Germany
| | - Olaf Eickmeier
- Division of Allergy, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, University Hospital, Frankfurt, Germany
| | - Suzanne Van Dullemen
- Division of Allergy, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, University Hospital, Frankfurt, Germany
| | | | | | - Stefan Lüth
- Department of Gastroenterology, Brandenburg Medical School (Theodor Fontane), Brandenburg an der Havel, Germany
| | - Carlos Zagoya
- CF-Center, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
- Medizinische Hochschule Brandenburg (MHB), Universitätsklinikum, Brandenburg an der Havel, Germany
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Dinkelborg K, Kahlhöfer J, Dörge P, Yurdaydin C, Hardtke S, Caruntu FA, Curescu MG, Yalcin K, Akarca US, Gürel S, Zeuzem S, Erhardt A, Lüth S, Papatheodoridis GV, Keskin O, Port K, Radu M, Celen MK, Idilman R, Weber K, Stift J, Wittkop U, Heidrich B, Mederacke I, von der Leyen H, Dienes HP, Cornberg M, Koch A, Manns MP, Wedemeyer H, Deterding K. Quality-of-life scores improve after 96 weeks of PEG-IFNa-2a treatment of hepatitis D: An analysis of the HIDIT-II trial. Liver Int 2023; 43:1663-1676. [PMID: 37183524 DOI: 10.1111/liv.15602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND & AIMS Infection with the hepatitis D virus (HDV) causes the most severe form of viral hepatitis with a high risk to develop clinical complications of liver disease. In addition, hepatitis delta has been shown to be associated with worse patient-reported outcomes. Until recently, only pegylated interferon alfa could be used to treat hepatitis delta. METHODS Here, we investigated quality of life (QOL) as assessed by the Short Form 36 Health Survey (SF-36) in patients undergoing antiviral therapy with pegylated interferon alfa (PEG-IFNa-2a)-based treatment in the HIDIT-II trial. HIDIT-II was a randomized prospective trial exploring PEG-IFNa-2a with tenofovir disoproxil (TDF) or placebo for 96 weeks in patients with compensated hepatitis delta. Surveys completed by 83 study participants before, during, and after treatments were available. RESULTS Overall, we observed a reduced QOL of HDV patients compared with a reference population, both in physical as well as mental scores. Interestingly, PEG-IFNa-2a treatment showed only minor impairment of the QOL during therapy. Moreover, HDV-RNA clearance was not associated with relevant changes in physical or social SF-36 scores, whereas an improvement of fibrosis during treatment was associated with increased QOL. Overall, slight improvements of the QOL scores were observed 24 weeks after the end of treatment as compared with baseline. TDF co-treatment had no influence on QOL. CONCLUSIONS Overall, our findings suggest that PEG-IFNa-2a was reasonably tolerated even over a period of 96 weeks by hepatitis D patients reporting SF-36 questionnaires. Of note, several patients may benefit from PEG-IFNa-2a-based therapies with off-treatment improvements in quality of life.
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Affiliation(s)
- Katja Dinkelborg
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- TWINCORE, Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Julia Kahlhöfer
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
| | - Petra Dörge
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
- Department of Internal Medicine, Koc University Medical School, Istanbul, Turkey
| | - Svenja Hardtke
- German Center for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- Institute for Infection Research and Vaccine Development, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Kendal Yalcin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | | | - Selim Gürel
- Uludağ University Medical Faculty, Bursa, Turkey
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt am Main, Germany
| | | | - Stefan Lüth
- Institute for Infection Research and Vaccine Development, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Onur Keskin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Kerstin Port
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Monica Radu
- Institutul de Boli Infectioase, Bucharest, Romania
| | | | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Kristina Weber
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | - Judith Stift
- Department of Pahology, Institute for Infection Research and Vaccine Development, Medical University of Vienna, Vienna, Austria
| | | | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
- Excellence Cluster Resist, Hannover Medical School, Hannover, Germany
| | - Ingmar Mederacke
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Hans Peter Dienes
- Department of Pahology, Institute for Infection Research and Vaccine Development, Medical University of Vienna, Vienna, Austria
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), HepNet Study-House/German Liver Foundation, Hannover, Germany
- German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
- Center for Individualized Infection Medicine (CIIM), Hannover, Germany
| | - Armin Koch
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
- Excellence Cluster Resist, Hannover Medical School, Hannover, Germany
- D-SOLVE Consortium, Hannover, Germany
| | - Katja Deterding
- Department of Gastroenterology, Hepatology, Infectious Diseases, and Endocrinology, Hannover Medical School, Hannover, Germany
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Dammermann W, von Menges A, Singethan K, Pischke S, Ritter O, Lüth S, Ullrich S. Increased Seroprevalence of Campylobacter jejuni, but not HEV, in healthcare workers in gastroenterological endoscopy. Z Gastroenterol 2022; 60:1763-1769. [PMID: 35697063 DOI: 10.1055/a-1833-8917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The exposure of healthcare workers (HCW) to fecal-orally transmitted pathogens like hepatitis E Virus (HEV), Campylobacter jejuni or Helicobacter pylori is still not known. The potential risk for employees or patients to acquire these infections through asymptomatic infected healthcare personnel has not yet been studied. Physicians and nurses in gastroenterology working in endoscopic workspaces were recruited. Employees from cardiology, presumed to possess a lower exposure, served as controls. The cytomegalovirus (CMV) seroprevalence was analyzed as a control pathogen without fecal-oral route of transmission. This study provides an objective view onto the potential exposure risk for HCW and patients in endoscopic workspaces. We hypothesize that HCW in gastroenterological endoscopy show a higher seroprevalence for fecal-oral pathogens like HEV, C. jejuni and H. pylori compared to HCW in cardiology. OBJECTIVE Primary objective was the assessment of antibody titers against HEV, C. jejuni and H. pylori in serum of HCW from gastroenterological endoscopy as well as cardiology. As a secondary objective we analyzed the seroprevalence against CMV. METHODS 65 HCW were from gastroenterological endoscopy (n=42) and cardiology (n=23) in three medical centers in the German federal states of Brandenburg, Hamburg and Schleswig-Holstein and were prospectively studied. Antibody titers were determined via ELISA in serum. RESULTS HCW in gastroenterological endoscopy showed a significantly higher C. jejuni seroprevalence for IgG (19.1 %) compared to HCW from the field of cardiology (8.7 %; p=0.04). IgA titers against C. jejuni were negligible. HEV seroprevalence for IgG did not differ significantly between HCW in gastroenterological endoscopy (7.1 %) and cardiology (8.7 %), respectively. IgA and IgM titers against HEV were also negligible. All other antibody titers against CMV and H. pylori showed no significant difference. CONCLUSIONS Only the C. jejuni seroprevalence was significantly increased in HCW from the field of gastroenterological endoscopy. HEV seroprevalence showed no differences. The results for CMV and H. pylori were without pathological findings. However, there is no elevated risk for HEV exposure in medical staff working at an endoscopy unit, but for C. jejuni the protective measures might need to be improved.
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Affiliation(s)
- Werner Dammermann
- Faculty of Health Sciences Brandenburg, Brandenburg an der Havel, Germany.,Center for Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea von Menges
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Singethan
- Bundeswehr Institute of Microbiology, München, Germany.,Center for Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Sven Pischke
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Ritter
- Faculty of Health Sciences Brandenburg, Brandenburg an der Havel, Germany.,Center for Internal Medicine I, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Stefan Lüth
- Center for Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg an der Havel, Germany
| | - Sebastian Ullrich
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Tabori H, Schneider J, Lüth S, Zagoya C, Barucha A, Lehmann T, Kauf E, Barth A, Mainz JG. Elevated Levels of Toxic Bile Acids in Serum of Cystic Fibrosis Patients with CFTR Mutations Causing Pancreatic Insufficiency. Int J Mol Sci 2022; 23:ijms232012436. [PMID: 36293293 PMCID: PMC9603931 DOI: 10.3390/ijms232012436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/16/2022] Open
Abstract
Hepatobiliary involvement is a hallmark in cystic fibrosis (CF), as the causative CF Transmembrane Conductance Regulator (CFTR) defect is expressed in the biliary tree. However, bile acid (BA) compositions in regard to pancreatic insufficiency, which is present at an early stage in about 85% of CF patients, have not been satisfactorily understood. We assess the pattern of serum BAs in people with CF (pwCF) without CFTR modulator therapy in regard to pancreatic insufficiency and the CFTR genotype. In 47 pwCF, 10 free and 12 taurine- and glycine-conjugated BAs in serum were prospectively assessed. Findings were related to genotype, pancreatic insufficiency prevalence (PIP)-score, and hepatic involvement indicated by serum liver enzymes, as well as clinical and ultrasound criteria for CF-related liver disease. Serum concentrations of total primary BAs and free cholic acid (CA) were significantly higher in pwCF with higher PIP-scores (p = 0.025, p = 0.009, respectively). Higher total BAs were seen in pwCF with PIP-scores ≥0.88 (p = 0.033) and with pancreatic insufficiency (p = 0.034). Free CA was higher in patients with CF-related liver involvement without cirrhosis, compared to pwCF without liver disease (2.3-fold, p = 0.036). pwCF with severe CFTR genotypes, as assessed by the PIP-score, reveals more toxic BA compositions in serum. Subsequent studies assessing changes in BA homeostasis during new highly effective CFTR-modulating therapies are of high interest.
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Affiliation(s)
- Harold Tabori
- Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, 14770 Brandenburg an der Havel, Germany
- Internal Medicine, Alexianer Hedwigshöhe Hospital, 12526 Berlin, Germany
| | - Jochen Schneider
- Cystic Fibrosis Centre, Jena University Hospital, 07740 Jena, Germany
| | - Stefan Lüth
- Department of Gastroenterology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg an der Havel, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, Brandenburg Medical School Theodor Fontane, University of Potsdam, 14469 Potsdam, Germany
| | - Carlos Zagoya
- Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, 14770 Brandenburg an der Havel, Germany
| | - Anton Barucha
- Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, 14770 Brandenburg an der Havel, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Jena University Hospital, 07743 Jena, Germany
| | - Eberhard Kauf
- Cystic Fibrosis Centre, Jena University Hospital, 07740 Jena, Germany
| | - Astrid Barth
- Institut für Pharmakologie und Toxikologie, Jena University Hospital, 07743 Jena, Germany
| | - Jochen G. Mainz
- Cystic Fibrosis Center, Brandenburg Medical School (MHB) University, Klinikum Westbrandenburg, 14770 Brandenburg an der Havel, Germany
- Cystic Fibrosis Centre, Jena University Hospital, 07740 Jena, Germany
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, Brandenburg Medical School Theodor Fontane, University of Potsdam, 14469 Potsdam, Germany
- Correspondence: ; Tel.: +49-3381-411800; Fax: +49-3381-411809
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8
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Hentschel F, Schwarz T, Lüth S, Schreyer AG. Psoas muscle index predicts time to rehospitalization in liver cirrhosis: An observational study. Medicine (Baltimore) 2022; 101:e30259. [PMID: 36086704 PMCID: PMC10980440 DOI: 10.1097/md.0000000000030259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/15/2022] [Indexed: 12/30/2022] Open
Abstract
Sarcopenia is frequent in liver cirrhosis (LC) where it is associated with morbidity and mortality. However, prognostic scores such as model for end-stage liver disease (MELD), MELD-sodium (MELD-Na), or Child-Turcotte-Pugh (CTP) do not contain sarcopenia as a variable. For this study, we utilized psoas muscle index (PMI) to objectively determine sarcopenia in hospitalized LC patients, and evaluated it as a predictor of time between discharge and readmission in LC. Abdominal computed tomography and magnetic resonance imaging scans of 65 consecutive LC patients were retrospectively examined to determine PMI. MELD, MELD-Na, and CTP were calculated from clinical data. PMI was then combined with CTP to form an experimental score: CTP sarcopenia (CTPS). For PMI alone and for each score, correlation with time between discharge and readmission for liver-related complications was calculated. PMI was also tested for correlation with sex, body mass index (BMI), MELD, MELD-Na, and CTP. CTPS was most closely correlated with time to readmission (R = 0.730; P < .001), followed by CTP (R = 0.696; P < .001), MELD-Na (R = 0.405; P = .009), and PMI alone (R = 0.388; P = .01). Correlation with MELD (R = 0.354; P = .05) was lowest. Additionally, there were significant differences in PMI between male and female individuals (5.16 vs 4.54 cm2/m2; P = .04) and in BMI between sarcopenic and nonsarcopenic individuals (29.63 vs 25.88 kg/m2; P = .009). Sarcopenia is an independent short-term prognostic factor in LC. By combining data on sarcopenia with CTP, we created an experimental score that predicts time to readmission better than MELD, MELD-Na, or CTP.
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Affiliation(s)
- Florian Hentschel
- Department of Gastroenterology and Hepatology, University Medical Center Brandenburg, Brandenburg, Germany
| | - Theresa Schwarz
- Brandenburg Medical School, University Medical Center Brandenburg, Brandenburg, Germany
| | - Stefan Lüth
- Department of Gastroenterology and Hepatology, University Medical Center Brandenburg, Brandenburg, Germany
| | - Andreas G. Schreyer
- Department of Radiology, University Medical Center Brandenburg, Brandenburg, Germany
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9
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Dammermann W, Seckinger B, Füller D, Lüth S, Hentschel F. Insulin‐like growth factor 1 and dehydroepiandrosterone levels in alcoholic liver cirrhosis. JGH Open 2022; 6:723-726. [PMID: 36262536 PMCID: PMC9575319 DOI: 10.1002/jgh3.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/15/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Werner Dammermann
- Department of Gastroenterology and Hepatology Brandenburg Medical School (Theodor Fontane) Brandenburg Germany
| | - Benedikt Seckinger
- Department of Gastroenterology and Hepatology Brandenburg Medical School (Theodor Fontane) Brandenburg Germany
| | - David Füller
- Department of Gastroenterology and Hepatology Brandenburg Medical School (Theodor Fontane) Brandenburg Germany
| | - Stefan Lüth
- Department of Gastroenterology and Hepatology Brandenburg Medical School (Theodor Fontane) Brandenburg Germany
| | - Florian Hentschel
- Department of Gastroenterology and Hepatology Brandenburg Medical School (Theodor Fontane) Brandenburg Germany
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10
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Hentschel F, Hirschmann C, Lüth S. Epidermoid Metaplasia in Diffuse Esophageal Intramural Pseudodiverticulosis. Case Rep Gastroenterol 2022; 16:94-96. [PMID: 35431765 PMCID: PMC8958623 DOI: 10.1159/000522184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Florian Hentschel
- Department of Gastroenterology, Brandenburg Medical School (Theodor Fontane), Brandenburg, Germany
- *Florian Hentschel,
| | - Christian Hirschmann
- Department of Pathology, Brandenburg Medical School (Theodor Fontane), Brandenburg, Germany
| | - Stefan Lüth
- Department of Gastroenterology, Brandenburg Medical School (Theodor Fontane), Brandenburg, Germany
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11
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Fründt T, Leuffert J, Groth S, Rösch T, Steurer S, Lohse AW, Ullrich S, Lüth S. Low incidence of colonic complications after severe Shiga toxin-producing E. coli O104:H4 infection. Z Gastroenterol 2021; 60:1104-1110. [PMID: 34820797 DOI: 10.1055/a-1545-5322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In summer 2011, Shiga toxin producing Escherichia coli (EHEC) serotype O104:H4 caused the most severe EHEC outbreak in Germany to date. The case of a previously recovered patient with symptomatic postinflammatory colonic stenosis following EHEC- infection prompted us to conduct a prospective study to assess the macro- and microscopic intestinal long-term damage in a cohort of patients who had suffered from severe EHEC colitis. METHODS Following EHEC infection in 2011, 182 patients were offered to participate in this study between January 2013 and October 2014 as part of the post-inpatient follow-up care at the University Medical Center Hamburg-Eppendorf and to undergo colonoscopy with stepwise biopsies. Prior to colonoscopy, medical history and persistent post-infectious complaints were assessed. RESULTS Out of 182 patients, 22 (12%) participated in the study, 18 (82%) were female. All patients had been hospitalized due severe EHEC enterocolitis: 20 patients (90%) had subsequently developed hemolytic uremic syndrome (HUS), 16 patients (72%) had additionally required dialysis. On assessment prior to colonoscopy, all patients denied any abdominal complaints before EHEC-infection but 8 (36%) patients reported persistent post-infectious symptoms. According to the ROME IV criteria, 4 (18%) patients met the definition for post-infectious irritable bowel syndrome (PI-IBS). In all patients with persistent symptoms, colonoscopies and histological examination were unremarkable. Only in one symptom-free patient, biopsy revealed a locally limited cryptitis of the caecum, while all patients without complaints had inconspicuous histological and endoscopical findings. CONCLUSION Following infection colonic stenosis is a serious but rare long-term complication in patients who had suffered from severe enterocolitis. However, a significant proportion of these patients develop PI-IBS.
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Affiliation(s)
- Thorben Fründt
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Leuffert
- Department of Anatomy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thomas Rösch
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Ullrich
- Department of Gastroenterology, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Stefan Lüth
- Zentrum für Innere Medizin II, Städtisches Klinikum Brandenburg GmbH, Brandenburg an der Havel, Germany
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12
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Affiliation(s)
- Florian Hentschel
- Department of Gastroenterology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Andreas Georg Schreyer
- Department of Radiology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Stefan Lüth
- Department of Gastroenterology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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13
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Finkenzeller T, Lenhart S, Reinwald M, Lüth S, Dendl LM, Paetzel C, Szczypien N, Klawonn F, Von Meyer A, Schreyer AG. Risk to Radiology Staff for Occupational COVID-19 Infection in a High-Risk and a Low-Risk Region in Germany: Lessons from the "First Wave". ROFO-FORTSCHR RONTG 2021; 193:537-543. [PMID: 33694146 DOI: 10.1055/a-1393-6668] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The recent COVID-19 pandemic has resulted in an increasing overload of the medical system. Healthcare workers (HCW) in radiology departments are exposed to a high infection risk similar to HCWs in the ICU or dedicated COVID wards. The goal of our paper is to evaluate the prevalence of IgG antibody against SARS-CoV-2 among radiology HCWs in two different hospitals and regions in Germany with a low and high COVID-19 prevalence and to compare it to the prevalence in other clinical personnel. Additionally, we assessed the number of radiological procedures performed in patients with a positive PCR test (C+) followed by a short review of the risk for nosocomial infections of radiology HCWs. MATERIALS AND METHODS During the first COVID-19 wave between March and July 2020, we evaluated a region with one of the highest COVID-19 rates (776-1570/100 000) in Germany (Hospital A). Additionally, we assessed Hospital B in a region with a low prevalence (65/100 000). We tested the serum prevalence of SARS-CoV-2 IgG antibodies among the whole staff with a subgroup analysis for radiology in both hospitals. We calculated the total number of different radiological procedures performed in C+ patients. RESULTS In Hospital A 594 PCR-proven C+ patients were treated resulting in 2723 radiological procedures. 24 % (n = 6) of the radiology technicians and 13.35 (n = 2) of radiologists had a positive IgG test. The rates were similar to positive rates in HCWs in COVID-19 wards and ICUs within the hospital. The most frequently performed procedures in C+ patients were chest X-rays (3.17/patient) and CT examinations (1.15/patient). In Hospital B 50 C+ patients were treated, resulting in 64 radiological procedures. None of the HCWs tested IgG positive. The most frequently performed examinations were also chest X-rays (1.04/patient) and CT (0.2/patient). CONCLUSION HCWs in radiology have a high occupational infection risk similar to that of HCWs in ICUs and dedicated COVID wards. KEY POINTS · The risk of acquiring COVID-19 increases with the amount of contact with infected individuals.. · The occupational risk of a SARS-CoV-2 infection for radiology staff is similar to that of nurses and physicians in COVID wards.. · Hygiene concepts and medical resources have to be adapted for further COVID outbreaks.. · Reporting of an occupational disease can be considered in the case of seropositive staff.. CITATION FORMAT · Finkenzeller T, Lenhart S, Reinwald M et al. Risk to Radiology Staff for Occupational COVID-19 Infection in a High-Risk and a Low-Risk Region in Germany: Lessons from the "First Wave". Fortschr Röntgenstr 2021; 193: 537 - 543.
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Affiliation(s)
| | - Stephan Lenhart
- Department of Radiology and Neuroradiology, Hospital Weiden, Germany
| | - Mark Reinwald
- Department of Hematology and Oncology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
| | - Stefan Lüth
- Clinic for Gastroenterology, Diabetology & Hepatology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
| | - Lena Marie Dendl
- Department of Radiology, Brandenburg Medical School Theodor Fontane, Treuenbrietzen, Germany, Department of Radiology, Johanniter Specialty Clinic Treuenbrietzen, Treuenbrietzen, Germany.,Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
| | - Christian Paetzel
- Department of Radiology and Neuroradiology, Hospital Weiden, Germany
| | - Natasza Szczypien
- Institute for Information Engineering, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
| | - Frank Klawonn
- Biostatistics, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Alexander Von Meyer
- Institute for Laboratory Medicine, Medical Microbiology and Technical Hygienics, Munich Municipal Hospital Group, München, Germany
| | - Andreas G Schreyer
- Institute for Diagnostic and Interventional Radiology, Brandenburg Medical School Theodor Fontane, Brandenburg a. d. Havel, Germany
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14
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Bremer B, Anastasiou OE, Hardtke S, Caruntu FA, Curescu MG, Yalcin K, Akarca US, Gürel S, Zeuzem S, Erhardt A, Lüth S, Papatheodoridis GV, Radu M, Idilman R, Manns MP, Cornberg M, Yurdaydin C, Wedemeyer H. Residual low HDV viraemia is associated HDV RNA relapse after PEG-IFNa-based antiviral treatment of hepatitis delta: Results from the HIDIT-II study. Liver Int 2021; 41:295-299. [PMID: 33217778 DOI: 10.1111/liv.14740] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/20/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022]
Abstract
The role of low levels of HDV-RNA during and after interferon therapy of hepatitis D is unknown. We re-analysed HDV RNA in 372 samples collected in the HIDIT-2 trial (Wedemeyer et al, Lancet Infectious Diseases 2019) with the Robogene assay (RA; Jena Analytics). Data were compared with the previously reported in-house assay (IA). We detected HDV-RNA in one-third of samples previously classified as undetectable using the highly sensitive RA. Low HDV viraemia detectable at week 48 or week 96 was associated with a high risk for post-treatment relapse, defined as HDV RNA positivity in both assays at week 120. HDV RNA relapses occurred in 10/15 (67%) patients with detectable low HDV RNA at week 48 and in 10/13 (77%) patients with low viraemia samples at week 96. In contrast, the post-treatment relapse rate was lower in patients with undetectable HDV RNA in both assays during treatment.
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Affiliation(s)
- Birgit Bremer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Olympia E Anastasiou
- Institute for Virology, Essen University Hospital and Medical Faculty of the University of Duisburg-Essen, Essen, Germany
| | - Svenja Hardtke
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany
| | | | | | - Kendal Yalcin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | | | - Selim Gürel
- Uludağ University Medical Faculty, Bursa, Turkey
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt/Main, Germany
| | | | - Stefan Lüth
- Center of Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School, Brandenburg, Germany
| | | | - Monica Radu
- National Institute for Infectious Diseases Prof.Dr.Matei Bals, Bucharest, Romania
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey.,Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany.,Department of Gastroenterology and Hepatology, Essen University Hospital and Medical Faculty of the University of Duisburg-Essen, Essen, Germany
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15
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Anastasiou OE, Yurdaydin C, Maasoumy B, Hardtke S, Caruntu FA, Curescu MG, Yalcin K, Akarca US, Gürel S, Zeuzem S, Erhardt A, Lüth S, Papatheodoridis GV, Radu M, Liebig S, Bantel H, Bremer B, Manns MP, Cornberg M, Wedemeyer H. A transient early HBV-DNA increase during PEG-IFNα therapy of hepatitis D indicates loss of infected cells and is associated with HDV-RNA and HBsAg reduction. J Viral Hepat 2021; 28:410-419. [PMID: 33185325 DOI: 10.1111/jvh.13439] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/02/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022]
Abstract
HBV-DNA levels are low or even undetectable in the majority HDV-infected patients. The impact of PEG-IFNα on HBV-DNA kinetics in HDV-infected patients has not been studied in detail. We analysed data of a prospective treatment trial where 120 HDV-RNA-positive patients were randomized to receive PEG-IFNα-2a plus tenofovir-disoproxil-fumarate (PEG-IFNα/TDF, n = 59) or placebo (PEG-IFNα/PBO; n = 61) for 96 weeks. At week 96, HBV-DNA was still quantifiable in 71% of PEG-IFNα/PBO-treated patients but also in 76% of PEG-IFNα/TDF-treated patients, despite low HBV-DNA baseline values. Surprisingly, a transient HBV-DNA increase between weeks 12 and 36 was observed in 12 in PEG-IFNα/TDF-treated and 12 PEG-IFNα/PBO-treated patients. This increase was positively associated with HBsAg loss [(P = 0.049, odds ratio (OR) 5.1] and HDV-RNA suppression (P = 0.007, OR 4.1) at week 96. Biochemical markers of cell death (M30 and ALT) were higher during the HBV-DNA peak but no distinct systemic immune pattern could be observed by screening 91 soluble inflammatory markers. In conclusion, an early increase in HBV-DNA during PEG-IFNα-2a therapy occurred in more than 20% of patients, even in TDF-treated patients. This transient HBV-DNA rise may indicate PEG-IFNα-induced cell death and lead to long-term HDV-RNA suppression and HBsAg loss.
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Affiliation(s)
- Olympia E Anastasiou
- Institute of Virology, Essen University Hospital and Medical Faculty of the University of Duisburg-Essen, Duisburg, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology and Hepatology, Koç University Medical School, Istanbul, Turkey
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Svenja Hardtke
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany
| | | | - Manuela G Curescu
- Spitalul Clinic de Boli Infectioase, University of Medicine and Pharmacy Timisoara, Timisoara, România, Romania
| | - Kendal Yalcin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | | | - Selim Gürel
- Uludağ University Medical Faculty, Bursa, Turkey
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt/Main, Germany
| | | | - Stefan Lüth
- Center of Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School, Brandenburg, Germany
| | | | - Monica Radu
- National Institute for Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania
| | - Stephanie Liebig
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heike Bantel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Birgit Bremer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Center for Infectious Disease Research (DZIF), HepNet Study-House, Hannover, Germany.,Dept. of Gastroenterology and Hepatology, Essen University Hospital and Medical Faculty of the University of Duisburg-Essen, Duisburg, Germany
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16
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Abstract
INTRODUCTION With 250 published cases worldwide, diffuse esophageal intramural pseudo-diverticulosis (DEIPD) is a poorly understood disease. The aim of this study was to determine the prevalence of DEIPD in our own population, identify risk factors and clinical symptoms, and characterize its typical endoscopic signs. METHODS Retrospective search in our center's endoscopic and clinical database. Reviewing of all cases by re-examining stored endoscopic photographs. Reviewing of all cases regarding age, sex, risk factors, comorbidities, histology, and clinical symptoms. RESULTS In a population of 150.000 we found 21 cases of DEIPD. Mean age was 56 ± 10 years. 86% were males, 76% had alcohol abuse, 57% had nicotine abuse, 38% had arteriosclerosis, 33% had COPD, 29% had malignancies, 24% had liver cirrhosis, 19% had impaired kidney function, and 15% had diabetes. Dysphagia was present in 62% and food bolus impaction (single or repeated) in 48%. Endoscopically, 95% of patients had multiple (> 4), small (0.25-2.5 mm) pseudodiverticle openings in the esophageal wall. In 62%, openings were aligned longitudinally. 86% showed edematous swelling of mucosa ("frosted glass look"), 76% showed a fine-grained pattern of small (10-100 µm) red dots ("faux uni pattern"), and 76% had a rigid, narrow lumen with multiple rings ("trachealization"). CONCLUSION With a prevalence of approximately 5 to 50/100.000, DEIPD may be more frequent than previously estimated. It preferably affects middle-aged male alcoholics. Key symptoms are chronic dysphagia and food impaction. Typical endoscopic findings are multiple, small, longitudinally aligned pseudodiverticle openings, frosted glass look, faux uni pattern, and trachealization of the esophagus.
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Affiliation(s)
- Florian Hentschel
- Center for Internal Medicine II, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
- Zentrum für Innere Medizin II, Hochschulklinikum Brandenburg der MHB, Hochstr. 29, 14770, Brandenburg an der Havel, Germany.
| | - Stefan Lüth
- Center for Internal Medicine II, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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17
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Wedemeyer H, Yurdaydin C, Hardtke S, Caruntu FA, Curescu MG, Yalcin K, Akarca US, Gürel S, Zeuzem S, Erhardt A, Lüth S, Papatheodoridis GV, Keskin O, Port K, Radu M, Celen MK, Idilman R, Weber K, Stift J, Wittkop U, Heidrich B, Mederacke I, von der Leyen H, Dienes HP, Cornberg M, Koch A, Manns MP. Peginterferon alfa-2a plus tenofovir disoproxil fumarate for hepatitis D (HIDIT-II): a randomised, placebo controlled, phase 2 trial. Lancet Infect Dis 2020; 19:275-286. [PMID: 30833068 DOI: 10.1016/s1473-3099(18)30663-7] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/28/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis D is the most severe form of chronic viral hepatitis. Treatment guidelines recommend 1 year of peginterferon alfa, which is effective in 25-30% of patients only. Whether prolonged therapy with peginterferon alfa-2a for 96 weeks and combination therapy with tenofovir disoproxil fumarate (TDF) would increase hepatitis D virus (HDV) RNA suppression is unknown. We aimed to explore whether prolonged treatment of HDV with 96 weeks of peginterferon would increase HDV RNA response rates and reduces post-treatment relapses. METHODS We did two parallel, investigator-initiated, multicentre, double-blind randomised, controlled trials at 14 study sites in Germany, Greece, Romania, and Turkey. Patients with chronic HDV infection and compensated liver disease who were aged 18 years or older were eligible for inclusion. All patients were HBsAg positive for at least 7 months, anti-HDV positive for at least 3 months, and HDV-RNA positive at the local laboratory at the screening visit. Patients were ineligible if alanine aminotransferase levels were higher than ten times above the upper limit of normal and if platelet counts were lower than 90 000 per μL, or if they had received interferon therapy or treatment with a nucleoside and nucleotide analogue within the preceding 6 months. Patients were randomly assigned by blinded stratified block randomisation (1:1) to receive 180 μg of peginterferon alfa-2a weekly plus either TDF (300 mg once daily) or placebo for 96 weeks. The primary endpoint was the percentage of patients with undetectable HDV RNA at the end of treatment assessed by intention to treat. The trials are registered as NCT00932971 and NCT01088659. FINDINGS Between June 24, 2009, and Feb 28, 2011, we randomly assigned 59 HDV RNA-positive patients to receive peginterferon alfa-2a plus TDF and 61 to receive peginterferon alfa-2a plus placebo, including 48 (40%) patients with cirrhosis to the two treatment groups (23 in the peginterferon alfa-2a plus TDF group and 25 in the peginterferon alfa-2a plus placebo group). The primary endpoint was achieved in 28 (48%) of 59 patients in the peginterferon alfa-2a plus TDF group and in 20 (33%) of 61 patients in the peginterferon alfa-2a plus placebo group (odds ratio 1·84, 95% CI 0·86-3·91, p=0·12). We recorded 944 adverse events (459 in the peginterferon alfa-2a plus TDF group and 485 in the peginterferon alfa-2a plus placebo group). The most common adverse events were haematological, behavioural (eg, fatigue), musculoskeletal, influenza-like syndromes, and psychiatric complaints. INTERPRETATION Addition of TDF resulted in no significant improvement in HDV RNA response rates at the end of treatment. These findings highlight that alternative treatment options are needed for hepatitis D. FUNDING The HepNet Study-House (a project of the German Liver Foundation founded by the German Liver Foundation, the German Ministry for Education and Research, and the German Center for Infectious Disease Research), Hoffmann-La Roche, and Gilead Sciences.
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Affiliation(s)
- Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infectious Disease Research, HepNet Study-House, Hannover, Germany; Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany; Medical Faculty of the University of Duisburg-Essen, Essen, Germany.
| | - Cihan Yurdaydin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey; Department of Internal Medicine, Koc University Medical School, Istanbul, Turkey
| | - Svenja Hardtke
- German Center for Infectious Disease Research, HepNet Study-House, Hannover, Germany
| | | | | | - Kendal Yalcin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | | | - Selim Gürel
- Uludağ University Medical Faculty, Bursa, Turkey
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt am Main, Germany
| | | | - Stefan Lüth
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Onur Keskin
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Kerstin Port
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Monica Radu
- Institutul de Boli Infectioase, Bucharest, Romania
| | | | - Ramazan Idilman
- Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
| | - Kristina Weber
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | | | | | - Benjamin Heidrich
- German Center for Infectious Disease Research, HepNet Study-House, Hannover, Germany
| | - Ingmar Mederacke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiko von der Leyen
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Hannover Clinical Trial Center, Hannover, Germany
| | | | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Armin Koch
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center for Infectious Disease Research, HepNet Study-House, Hannover, Germany
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18
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Bockmann JH, Grube M, Hamed V, von Felden J, Landahl J, Wehmeyer M, Giersch K, Hall MT, Murray JM, Dandri M, Lüth S, Lohse AW, Lütgehetmann M, Schulze Zur Wiesch J. High rates of cirrhosis and severe clinical events in patients with HBV/HDV co-infection: longitudinal analysis of a German cohort. BMC Gastroenterol 2020; 20:24. [PMID: 32000689 PMCID: PMC6993357 DOI: 10.1186/s12876-020-1168-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background Chronic hepatitis delta virus (HDV) infection causes severe liver disease which often leads to cirrhosis and hepatocellular carcinoma (HCC). Aim of this study was to establish the disease severity and prognostic factors for disease outcome by analysing frequencies of clinical events and their correlation with baseline virological and biochemical parameters as well as interferon and nucleos(t)ide analogue treatment choice. Methods We studied a single-centre cohort of 49 anti-HDAg-positive patients with HBsAg persistence for at least 6 months. Virological and biochemical parameters, interferon and nucleos(t)ide analogue treatment choice as well as clinical events during follow-up were analysed by retrospective chart review (mean follow-up time 3 years, range 0.25–7.67 years). Results Severe clinical events occurred in 11/49 hepatitis D patients, including HCC (8/49), death (8/49) or liver transplantation (2/49). HCCs only occurred secondary to liver cirrhosis and their event rates in this cohort of hepatitis D patients did not differ from a matched HBV mono-infected cohort with comparable frequency of liver cirrhosis. A stepwise multivariate logistic regression revealed low platelet count (p = 0. 0290) and older age (p = 0.0337) correlating most strongly with overall clinical events, while serum HDV RNA positivity at baseline did not correlate with any clinical outcome. Interferon-free but not nucleos(t)ide analogue-free patient care correlated with the occurrence of HCC at logistic regression, although only 3/18 interferon-treated patients demonstrated repeatedly negative HDV PCR results post therapy. Conclusions Our data indicate that progressive liver disease at baseline plays a major role as predictive factor for overall clinical outcome of hepatitis D patients. In particular, HCC risk may not be underestimated in hepatitis D virus RNA negative hepatitis D patients with advanced liver fibrosis.
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Affiliation(s)
- Jan-Hendrik Bockmann
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany. .,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany.
| | - Marcel Grube
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany
| | - Vanessa Hamed
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany
| | - Johann von Felden
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany
| | - Johanna Landahl
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany
| | - Malte Wehmeyer
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany
| | - Katja Giersch
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany
| | - Michaela T Hall
- School of Mathematics and Statistics, UNSW Sydney, Sydney, Australia.,Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - John M Murray
- School of Mathematics and Statistics, UNSW Sydney, Sydney, Australia.,Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Maura Dandri
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany
| | - Stefan Lüth
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany.,Center of Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Ansgar W Lohse
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany
| | - Marc Lütgehetmann
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany.,Institute of Microbiology, Virology and Hygiene, University Medical Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- 1st Department of Internal Medicine, University Medical Hospital Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany.,German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel site, Hamburg, Germany
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19
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Bröker K, Sinelnikov E, Gustavus D, Schumacher U, Pörtner R, Hoffmeister H, Lüth S, Dammermann W. Mass Production of Highly Active NK Cells for Cancer Immunotherapy in a GMP Conform Perfusion Bioreactor. Front Bioeng Biotechnol 2019; 7:194. [PMID: 31457007 PMCID: PMC6700243 DOI: 10.3389/fbioe.2019.00194] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/24/2019] [Indexed: 11/13/2022] Open
Abstract
NK cells have emerged as promising candidates for cancer immunotherapy, especially due to their ability to fight circulating tumor cells thereby preventing metastases formation. Hence several studies have been performed to generate and expand highly cytotoxic NK cells ex vivo, e.g., by using specific cytokines to upregulate both their proliferation and surface expression of distinct activating receptors. Apart from an enhanced activity, application of NK cells as immunotherapeutic agent further requires sufficient cell numbers and a high purity. All these parameters depend on a variety of different factors including the starting material, additives like cytokines as well as the culture system. Here we analyzed PBMC-derived NK cells of five anonymized healthy donors expanded under specific conditions in an innovative perfusion bioreactor system with respect to their phenotype, IFNγ production, and cytotoxicity in vitro. Important features of the meander type bioreactors used here are a directed laminar flow of medium and control of relevant process parameters. Cells are cultivated under "steady state" conditions in perfusion mode. Our data demonstrate that expansion of CD3+ T cell depleted PBMCs in our standardized system generates massive amounts of highly pure (>85%) and potent anti-cancer active NK cells. These cells express a variety of important receptors driving NK cell recruitment, adhesion as well as activation. More specifically, they express the chemokine receptors CXCR3, CXCR4, and CCR7, the adhesion molecules L-selectin, LFA-1, and VLA-4, the activating receptors NKp30, NKp44, NKp46, NKG2D, DNAM1, and CD16 as well as the death ligands TRAIL and Fas-L. Moreover, the generated NK cells show a strong IFNγ expression upon cultivation with K562 tumor cells and demonstrate a high cytotoxicity toward leukemic as well as solid tumor cell lines in vitro. Altogether, these characteristics promise a high clinical potency of thus produced NK cells awaiting further evaluation.
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Affiliation(s)
- Katharina Bröker
- Center of Internal Medicine II, Brandenburg Medical School, University Hospital Brandenburg, Brandenburg, Germany.,Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Udo Schumacher
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Pörtner
- Institute of Bioprocess and Biosystems Engineering, Hamburg University of Technology, Hamburg, Germany
| | | | - Stefan Lüth
- Center of Internal Medicine II, Brandenburg Medical School, University Hospital Brandenburg, Brandenburg, Germany.,Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, The Brandenburg Medical School Theodor Fontane, The University of Potsdam, Potsdam, Germany
| | - Werner Dammermann
- Center of Internal Medicine II, Brandenburg Medical School, University Hospital Brandenburg, Brandenburg, Germany.,Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus - Senftenberg, The Brandenburg Medical School Theodor Fontane, The University of Potsdam, Potsdam, Germany
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20
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Abstract
Sclerosing Cholangitis of the Critically Ill (SC-CIP) is a relatively new entity within the spectrum of secondary cholangitis that develops in the wake of intensive care therapy with mechanical ventilation and catecholamine treatment. It is caused by ischemic or immunologic injury to small bile ducts that becomes self-aggravating and persists beyond the end of the intensive care stay. Early clinical and laboratory findings show acute cholangitis with elevated CRP, gamma GT, AP, and bilirubin. ERCP shows damaged intrahepatic bile ducts with irregular calibers and biliary casts. The following phase is chronic and oligosymptomatic. Still, all laboratory parameters will stay mildly elevated and ERCP and MRCP will show progressive loss of small bile ducts. Long-term prognosis is poor. Even with UDCA therapy, most patients will develop liver cirrhosis within months or years.
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Affiliation(s)
- Florian Hentschel
- Zentrum für Innere Medizin II, Städtisches Klinikum Brandenburg GmbH, Brandenburg an der Havel, Germany
| | - Till Bornscheuer
- Zentrum für Innere Medizin II, Städtisches Klinikum Brandenburg GmbH, Brandenburg an der Havel, Germany
| | - Stefan Lüth
- Zentrum für Innere Medizin II, Städtisches Klinikum Brandenburg GmbH, Brandenburg an der Havel, Germany
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21
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Abstract
L-Ornithine L-aspartate (LOLA), a stable salt of L-ornithine and L-aspartate, readily dissociates into its constituent amino acids that are readily absorbed by active transport, distributed, and metabolized. L-ornithine serves as an intermediary in the urea cycle in periportal hepatocytes in the liver and as an activator of carbamoyl phosphate synthetase, and, like L-aspartate, by transamination to glutamate via glutamine synthetase in perivenous hepatocytes as well as by skeletal muscle and brain. By way of these metabolic pathways, both amino acids participate in reactions whereby the ammonia molecule is incorporated into urea and glutamine and it is the nature, cellular, and biological location of these pathways that underpins the application of LOLA as an effective ammonia-lowering strategy widely used for the management and treatment of hepatic encephalopathy. These metabolic pathways were elucidated based upon studies in experimental animals and were confirmed by studies in patients with severe liver diseases. More recent studies suggest that LOLA may have additional direct hepatoprotective properties. Moreover, its use may result in improvements in skeletal muscle function in cirrhosis.
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Affiliation(s)
- Gerald Kircheis
- Department of Gastroenterology, Hepatology and Diabetology, Brandenburg Medical School, Center of Internal Medicine II, University Hospital Brandenburg, Hochstraße 29, 14770, Brandenburg an der Havel, Germany.
| | - Stefan Lüth
- Department of Gastroenterology, Hepatology and Diabetology, Brandenburg Medical School, Center of Internal Medicine II, University Hospital Brandenburg, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
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22
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Abstract
Because of its high incidence gastroesophageal reflux disease (GERD) is at the forefront of medical attention. On the other hand, vigilance for rare inflammatory diseases of the esophagus, such as herpes esophagitis, radiation-induced esophagitis, eosinophilic esophagitis, pseudodiverticulosis and Crohn's disease is low. Moreover, these entities are rarely distinguishable from GERD by clinical features alone. For all atypical and treatment refractory supposedly reflux diseases, the diagnosis should therefore be questioned and re-evaluated by endoscopy. When the macroscopic findings of esophagoscopy are ambiguous biopsies can be performed and histological examination then often leads to a definitive diagnosis. This is particularly important because the required treatment of rare forms of esophagitis often significantly differs from that of GERD.
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Affiliation(s)
- Florian Hentschel
- Zentrum für Innere Medizin II, Hochschulklinikum Brandenburg, Medizinische Hochschule Brandenburg, Hochstr. 29, 14770, Brandenburg an der Havel, Deutschland.
| | - Stefan Lüth
- Zentrum für Innere Medizin II, Hochschulklinikum Brandenburg, Medizinische Hochschule Brandenburg, Hochstr. 29, 14770, Brandenburg an der Havel, Deutschland
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23
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Abstract
The global incidence and prevalence of eosinophilic gastrointestinal diseases is rising. Clinically, acute eosinophilic esophagitis cannot be distinguished from other causes of esophagitis. Endoscopic findings like rings, webs or furrows have a lower sensitivity than previously assumed. An improvement of symptoms by proton-pump inhibitors also doesn't rule out the diagnosis - it has to be confirmed histologically. Early therapy will prevent later complications like strictures and motility disorders. The presentation of eosinophilic gastroenteritris/colitis is even less specific. Common cause seems to be a Th2-mediated food allergy. Successful therapies include allergen-free diets and topic steroids. Additionally, in the case of proton-pump inhibitor-responsive eosinophilic esophagitis, proton pump inhibitors do not only block gastral acid production, but may also have a direct inhibitory effect on Th2-immunity. Therefore, Th2-specific biologicals have theoretical advantages, but they could not really convince in first clinical studies.
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24
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Bröker K, Terzenbach R, Bentzien F, Lüth S, Dammermann W. Complement factors C3a and C5a mimick a proinflammatory microenvironment and increase HBV IGRA sensitivity. J Transl Med 2019; 17:6. [PMID: 30602374 PMCID: PMC6317231 DOI: 10.1186/s12967-018-1752-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 12/21/2018] [Indexed: 12/13/2022] Open
Abstract
Background Hepatitis B virus (HBV) infections represent a global health problem and chronic hepatitis B (CHB) leads to liver cirrhosis and hepatocellular carcinoma. Thus, timely diagnosis of hepatitis B is crucial to ensure adequate treatment. We developed a powerful and rapid whole blood-based cytokine release assay assessing cellular immune responses to HBV antigens. IL-2 and IFNγ release in this assay depicts hepatitis B vaccination status. Of note, CHB goes along with elevated C5a concentrations in plasma. We aim at mimicking the proinflammatory microenvironment associated with HBV infection to enhance the diagnostic quality of our HBV specific cytokine release assay. We specifically investigated the potential of the complement factors C3a and C5a as costimulators and analyzed their potential effects on activation marker expression on T cells and antigen presenting cells. Results Whole blood from 87 healthy individuals (n = 59 hepatitis B vaccinated, n = 28 unvaccinated) was stimulated with HBV surface antigen (HBsAg) in presence or absence of C3a or C5a, respectively. Further, C3a and C5a were used in combination to investigate potential synergistic effects. IL-2 and IFNγ levels in plasma were quantified using ELISA. Complement factor C5a specifically enhances HBsAg-mediated IL-2 (690.3 ± 195.4 pg/ml vs. 789.4 ± 216.5 pg/ml) and IFNγ (146.0 ± 43.1 pg/ml vs. 336.7 ± 67.9 pg/ml) responses in whole blood. Similar cytokine levels were measured when both C3a and C5a were used. With a diagnostic specificity of 90% the IFNγ release assay reached a diagnostic sensitivity of 49.2% upon whole blood stimulation with HBsAg alone, but of 78.9% when HBsAg was combined with C3a and C5a. Conclusions Innate signals mediated via complement pathways contribute to HBV-specific cellular immune responses. The massively improved diagnostic sensitivity of the IFNγ release assay after addition of C3a and C5a demonstrates that these effects render whole blood-based cytokine release assays even more potent as screening tools in HBV immunology and HBV vaccination studies. Electronic supplementary material The online version of this article (10.1186/s12967-018-1752-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katharina Bröker
- Center of Internal Medicine II, Brandenburg Medical School, University Hospital Brandenburg, Hochstrasse 29, 14770, Brandenburg, Germany.,Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Robin Terzenbach
- Center of Internal Medicine II, Brandenburg Medical School, University Hospital Brandenburg, Hochstrasse 29, 14770, Brandenburg, Germany.,Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Frank Bentzien
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Stefan Lüth
- Center of Internal Medicine II, Brandenburg Medical School, University Hospital Brandenburg, Hochstrasse 29, 14770, Brandenburg, Germany
| | - Werner Dammermann
- Center of Internal Medicine II, Brandenburg Medical School, University Hospital Brandenburg, Hochstrasse 29, 14770, Brandenburg, Germany. .,Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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25
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Dammermann W, Mihajlov V, Middendorf B, Mellmann A, Karch H, Lüth S, Ullrich S. Anti-Shiga toxin 2 antibodies in enterohemorrhagic Escherichia coli O104:H4 infected patients may predict hemolytic uremic syndrome. J Gastroenterol Hepatol 2018; 33:1353-1356. [PMID: 29280264 DOI: 10.1111/jgh.14082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/21/2017] [Accepted: 12/19/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM An outbreak of Shiga toxin 2 (Stx2) producing enterohemorrhagic and enteroaggregative Escherichia coli O104:H4 infection in May 2011 in Germany caused enterocolitis and an unprecedented high 22% rate of hemolytic uremic syndrome (HUS). We hypothesized that anti-Stx2 IgM or IgG titers might predict HUS development. METHODS Thirty-two patients infected with enterohemorrhagic Escherichia coli O104:H4 (HUS: n = 23; non-HUS: n = 9) were retrospectively screened for anti-Stx2 IgM/IgG and matched with clinical data regarding HUS development, fever, superinfection, dialysis, neurological symptoms, intensive care, antibiotic treatment, and plasmapheresis. RESULTS Only HUS patients showed a prominent Stx2-specific humoral response in the early acute phase. Despite a strong trend towards prediction of HUS development, statistical analysis revealed no significant correlation between high IgM/IgG titers and further key clinical parameters such as fever, superinfection, neurological symptoms, antibiotic treatment, and plasmapheresis. CONCLUSIONS Anti-Stx2 antibodies seem to accompany or even precede HUS development.
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Affiliation(s)
- Werner Dammermann
- Center of Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School, Brandenburg, Germany.,Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Valentin Mihajlov
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Middendorf
- Institute of Hygiene and National Consulting Laboratory for Hemolytic Uremic Syndrome (HUS), University Hospital Münster, Münster, Germany
| | - Alexander Mellmann
- Institute of Hygiene and National Consulting Laboratory for Hemolytic Uremic Syndrome (HUS), University Hospital Münster, Münster, Germany
| | - Helge Karch
- Institute of Hygiene and National Consulting Laboratory for Hemolytic Uremic Syndrome (HUS), University Hospital Münster, Münster, Germany
| | - Stefan Lüth
- Center of Internal Medicine II, University Hospital Brandenburg, Brandenburg Medical School, Brandenburg, Germany
| | - Sebastian Ullrich
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,I. Department of Medicine, Asklepios Klinik Altona, Hamburg, Germany
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26
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Albersmeier JP, Bremer JP, Dammermann W, Lüth S, Hagenmüller F, Rüther C, Otto H, Nielsen AM, Schumacher U, Ullrich S. Outcome and clinical course of EHEC O104 infection in hospitalized patients: A prospective single center study. PLoS One 2018; 13:e0191544. [PMID: 29420567 PMCID: PMC5805174 DOI: 10.1371/journal.pone.0191544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/08/2018] [Indexed: 12/05/2022] Open
Abstract
Objectives Shiga-toxin producing O157:H7 Entero Haemorrhagic E. coli [STEC/EHEC] are the most common cause of Haemolytic Uraemic Syndrome [HUS] related to infectious haemorrhagic colitis. Nearly all recommendations on long term treatment of EHEC infections refer to this strain. The 2011 outbreak in Northern Europe was the first of this dimension to be caused by the serotype O104:H4. We report on the 3.5 year follow up of 61 patients diagnosed with symptomatic EHEC O104:H4 infection in spring 2011. Methods Patients with EHEC O104 infection were followed in a monocentric, prospective observational study at four time points: 4, 12, 24 and 36 months. These data include the patients’ histories, clinical findings, and complications. Results Sixty-one patients suffering from EHEC O104:H4 associated enterocolitis participated in the study at the time of hospital discharge. The mean age of patients was 43 ± 2 years, 37 females and 24 males. 48 patients participated in follow up 1 [FU 1], 34 patients in follow up 2 [FU 2], 23 patients in follow up 3 [FU 3] and 18 patients in follow up 4 [FU 4]. Out of 61 patients discharged from the hospital and included in the study, 54 [84%] were examined at least at one additional follow up. Serum creatinine decreased significantly between discharge and FU 1 from 1.3 ± 0.1 mg/dl to 0.7 ± 0.1 mg/dl [p = 0.0045]. From FU 1 until FU 4, no further change in creatinine levels could be observed. The patients need of antihypertensive medications decreased significantly [p = 0.0005] between discharge and FU 1 after four months. From FU 1 until FU 3, 24 months later, no further significant change in antihypertensive treatment was observed. Conclusions Our findings suggest that patients free of pathological findings at time of discharge do not need a specific follow up. Patients with persistent health problems at hospital discharge should be clinically monitored over four months to evaluate chronic organ damage. Progressive or new emerging renal damage could not be observed over time in any patient.
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Affiliation(s)
- J. P. Albersmeier
- Anatomie und Experimentelle Morphologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - J. P. Bremer
- Abteilung für Rheumatologie und Immunology, Klinikum Bad Bramstedt, Bad Bramstedt, Germany
| | - W. Dammermann
- Center of Internal Medicine II, Brandenburg Medical School, Campus Brandenburg a.d.H., Brandenburg an der Havel, Germany
| | - S. Lüth
- Center of Internal Medicine II, Brandenburg Medical School, Campus Brandenburg a.d.H., Brandenburg an der Havel, Germany
| | - F. Hagenmüller
- I. Medizinische Klinik, Asklepios Klinik Altona, Hamburg, Germany
| | - C. Rüther
- I. Medizinische Klinik, Asklepios Klinik Altona, Hamburg, Germany
| | - H. Otto
- I. Medizinische Klinik, Asklepios Klinik Altona, Hamburg, Germany
| | - A. M. Nielsen
- I. Medizinische Klinik, Asklepios Klinik Altona, Hamburg, Germany
| | - U. Schumacher
- Anatomie und Experimentelle Morphologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
| | - S. Ullrich
- Anatomie und Experimentelle Morphologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Germany
- * E-mail:
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Wehmeyer MH, Dammermann W, Seiz O, Zinser ME, Galante A, Lohse AW, Sterneck M, Nashan B, Herden U, Lüth S. Chronic pancreatitis in patients with liver cirrhosis negatively affects graft survival after liver transplantation. Pancreatology 2017; 17:898-904. [PMID: 28939443 DOI: 10.1016/j.pan.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 09/03/2017] [Accepted: 09/11/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Limited data exists concerning the coincidence of chronic pancreatitis (CP) and liver cirrhosis with respect to the patient outcome after liver transplantation (LT). The aim of the study was to identify risk factors for graft loss after liver transplantation and to evaluate the impact of CP on graft survival. METHODS We analyzed the data of 421 cirrhotic patients who underwent evaluation for primary liver transplantation from January 2007 to January 2014. Diagnosis of CP based on morphologic findings which were graded according to the Cambridge and Manchester classification. (Graft) survival after LT was analyzed by Cox regression analysis. Recipient- and donor-related risk factors for graft loss were evaluated using univariate and multivariate analysis. RESULTS 40/421 cirrhotic patients suffered from CP (9.5%). 250/421 (59.4%) patients underwent LT between January 2007 and January 2014. In total, 89 patients died or were in need of a re-transplantation during follow-up until August 2017. Patients with CP (N = 26) were at increased risk for graft loss after LT (hazard ratio = 2.183; 95% confidence interval = 1.232-3.868). CP (P = 0.001), a MELD score ≥24 (P = 0.021), absence of esophageal or gastrical varices (P = 0.018), the age of the donor (P = 0.008) and infections after transplantation (P = 0.030) were independent risk factors for organ loss after transplantation in the multivariate Cox regression analysis. CONCLUSION Patients with chronic pancreatitis are at increased risk for graft loss after LT. A high MELD score, the absence of esophageal or gastrical varices, an advanced donor age and post-transplant infections negatively affect graft survival, too.
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Affiliation(s)
- Malte H Wehmeyer
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Werner Dammermann
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany; Center of Internal Medicine II, Brandenburg Medical School Theodor Fontane, Germany.
| | - Oliver Seiz
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Madeleine E Zinser
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Antonio Galante
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Ansgar W Lohse
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Martina Sterneck
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - Björn Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Uta Herden
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Stefan Lüth
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany; Center of Internal Medicine II, Brandenburg Medical School Theodor Fontane, Germany
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Dammermann W, Polywka S, Dettmann I, Mindorf S, Komorowski L, Wehmeyer M, Schulze Zur Wiesch J, Stöcker W, Lüth S. Autoantibodies against "rods and rings"-related IMPDH2 in hepatitis C genotype 1 and DAA therapy in a "real life" cohort. Med Microbiol Immunol 2017; 206:379-382. [PMID: 28815296 DOI: 10.1007/s00430-017-0516-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 05/03/2017] [Accepted: 08/08/2017] [Indexed: 01/18/2023]
Abstract
Autoantibodies against inosine-5'-monophosphate-dehydrogenase-2 (IMPDH2; "rods and rings" pattern) develop in chronic hepatitis C (CHC) patients under treatment with peg-interferon (IFN) and ribavirin (RBV), an inhibitor of IMPDH2. We investigated the influence of the alternative therapy with direct-acting antivirals (DAA)/ribavirin on anti-IMPDH2 autoantibody generation and the use of anti-IMPDH2 development as a marker for therapy outcome (sustained virologic response, SVR). We analyzed a "real life" cohort of 104 unselected CHC genotype 1 (GT1) patients treated with IFN/first-generation DAA/RBV prospectively compared to a historic cohort of 59 IFN/RBV-treated CHC GT1 patients. First-generation DAA were boceprevir (BOC) or telaprevir (TPR). Serum autoantibodies were tested by indirect immunofluorescence (IFA) using recombinant IMPDH2 expressing HEK293 cells and native HEp2-cells as substrates. 64/163 (39%) CHC patients turned anti-IMPDH2 positive during therapy, but only 43/163 (26%) showed also "rods and rings" structures. 99/163 (61%) were tested as anti-IMPDH2 negative. 53/104 (51%) CHC patients undergoing IFN/DAA/RBV therapy were anti-IMPDH2 positive and 38/104 (37%) were in parallel anti-"rods and rings" positive. HCV clearance/SVR rate after IFN/DAA/RBV therapy and anti-IMPDH2 status were not significantly dependent. CHC GT1 patients treated with IFN/first-generation DAA/RBV developed anti-IMPDH2 autoantibodies comparable to previous studies including patients under IFN/RBV therapy. Anti-IMPDH2 titers show no use as a marker for therapy outcome in CHC GT1 patients.
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Affiliation(s)
- Werner Dammermann
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. .,University Hospital Brandenburg, Brandenburg Medical School, Center of Internal Medicine II, Hochstrasse 29, 14770, Brandenburg, Germany.
| | - Susanne Polywka
- Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Inga Dettmann
- Institute of Experimental Immunology, EUROIMMUN AG, Seekamp 31, 23560, Lübeck, Germany
| | - Swantje Mindorf
- Institute of Experimental Immunology, EUROIMMUN AG, Seekamp 31, 23560, Lübeck, Germany
| | - Lars Komorowski
- Institute of Experimental Immunology, EUROIMMUN AG, Seekamp 31, 23560, Lübeck, Germany
| | - Malte Wehmeyer
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Winfried Stöcker
- Institute of Experimental Immunology, EUROIMMUN AG, Seekamp 31, 23560, Lübeck, Germany
| | - Stefan Lüth
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,University Hospital Brandenburg, Brandenburg Medical School, Center of Internal Medicine II, Hochstrasse 29, 14770, Brandenburg, Germany
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Dammermann W, Dornbrack J, Bröker K, Bentzien F, Lüth S. CpG oligonucleotides increase HBV-specific cytokine responses in whole blood and enhance cytokine release assay sensitivity. J Virol Methods 2017; 248:195-201. [PMID: 28739303 DOI: 10.1016/j.jviromet.2017.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/28/2017] [Accepted: 07/19/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic hepatitis B leads to liver cirrhosis and hepatocellular carcinoma. To develop a therapeutic vaccine for chronic hepatitis B patients it is necessary to assess cellular immune responses to hepatitis B virus (HBV) antigens. We investigated the potential of toll-like receptor (TLR) 9 agonists, i.e. CpG oligonucleotides, as costimulators to increase diagnostic sensitivity and specificity of our HBV- specific cytokine release assay. METHODS Whole blood from 80 healthy individuals (n=51 hepatitis B vaccinated, n=29 unvaccinated) was stimulated with hepatitis B surface antigen (HBsAg) or hepatitis B core antigen (HBcAg) in presence or absence of CpG oligonucleotides. IL2 and IFNγ secretion in plasma was assessed using ELISA. RESULTS CpG oligonucleotides specifically enhanced HBsAg-mediated IL2 (276±79pg/ml vs. 320±82pg/ml) and IFNγ (77±35pg/ml vs. 401±121pg/ml) responses in whole blood. When IFNγ release was considered as readout depicting the hepatitis B vaccination status, the according assay reached a diagnostic sensitivity of 61% without, but of 76% with additional CpG oligonucleotide stimulation at a diagnostic specificity of 90%. CONCLUSIONS We show that innate signals mediated via TLRs contribute to HBV-specific cellular immune responses. CpG oligonucleotides can be used to make whole blood based cytokine release assays even more powerful as screening tools in HBV immunology.
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Affiliation(s)
- Werner Dammermann
- Brandenburg Medical School, University Hospital Brandenburg, Center of Internal Medicine II, Hochstrasse 29, 14770 Brandenburg, Germany; Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Julia Dornbrack
- Brandenburg Medical School, University Hospital Brandenburg, Center of Internal Medicine II, Hochstrasse 29, 14770 Brandenburg, Germany; Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Katharina Bröker
- Brandenburg Medical School, University Hospital Brandenburg, Center of Internal Medicine II, Hochstrasse 29, 14770 Brandenburg, Germany; Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Frank Bentzien
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Stefan Lüth
- Brandenburg Medical School, University Hospital Brandenburg, Center of Internal Medicine II, Hochstrasse 29, 14770 Brandenburg, Germany.
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30
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Dammermann W, Polywka S, Dettmann I, Mindorf S, Komorowski L, Wehmeyer M, Schulze zur Wiesch J, Stöcker W, Lüth S. Development of autoantibodies against “rings and rods”-associated IMPDH2 in chronic hepatitis C genotype 1 infection during protease inhibitor based triple therapy in a “real life” cohort. Z Gastroenterol 2016. [DOI: 10.1055/s-0036-1597391] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- W Dammermann
- Brandenburg Medical School, Center of Internal Medicine II, Brandenburg an der Havel, Germany
| | - S Polywka
- University Medical Center Hamburg-Eppendorf, Department of Medical Microbiology, Virology and Hygiene, Hamburg, Germany
| | - I Dettmann
- Euroimmun AG, Institute of Experimental Immunology, Lübeck, Germany
| | - S Mindorf
- Euroimmun AG, Institute of Experimental Immunology, Lübeck, Germany
| | - L Komorowski
- Euroimmun AG, Institute of Experimental Immunology, Lübeck, Germany
| | - M Wehmeyer
- University Medical Center Hamburg-Eppendorf, 1. Department of Medicine, Hamburg, Germany
| | - J Schulze zur Wiesch
- University Medical Center Hamburg-Eppendorf, 1. Department of Medicine, Hamburg, Germany
| | - W Stöcker
- Euroimmun AG, Institute of Experimental Immunology, Lübeck, Germany
| | - S Lüth
- Brandenburg Medical School, Center of Internal Medicine II, Brandenburg an der Havel, Germany
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31
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Neumann K, Karimi K, Meiners J, Voetlause R, Steinmann S, Dammermann W, Lüth S, Asghari F, Wegscheid C, Horst AK, Tiegs G. A Proinflammatory Role of Type 2 Innate Lymphoid Cells in Murine Immune-Mediated Hepatitis. J Immunol 2016; 198:128-137. [PMID: 27872212 DOI: 10.4049/jimmunol.1600418] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 10/20/2016] [Indexed: 12/24/2022]
Abstract
Type 2 innate lymphoid cells (ILC2) mediate inflammatory immune responses in the context of diseases triggered by the alarmin IL-33. In recent years, IL-33 has been implicated in the pathogenesis of immune-mediated liver diseases. However, the immunoregulatory function of ILC2s in the inflamed liver remains elusive. Using the murine model of Con A-induced immune-mediated hepatitis, we showed that selective expansion of ILC2s in the liver was associated with highly elevated hepatic IL-33 expression, severe liver inflammation, and infiltration of eosinophils. CD4+ T cell-mediated tissue damage and subsequent IL-33 release were responsible for the activation of hepatic ILC2s that produced the type 2 cytokines IL-5 and IL-13 during liver inflammation. Interestingly, ILC2 depletion correlated with less severe hepatitis and reduced accumulation of eosinophils in the liver, whereas adoptive transfer of hepatic ILC2s aggravated liver inflammation and tissue damage. We further showed that, despite expansion of hepatic ILC2s, 3-d IL-33 treatment before Con A challenge potently suppressed development of immune-mediated hepatitis. We found that IL-33 not only activated hepatic ILC2s but also expanded CD4+ Foxp3+ regulatory T cells (Treg) expressing the IL-33 receptor ST2 in the liver. This Treg subset also accumulated in the liver during resolution of immune-mediated hepatitis. In summary, hepatic ILC2s are poised to respond to the release of IL-33 upon liver tissue damage through expression of type 2 cytokines thereby participating in the pathogenesis of immune-mediated hepatitis. Inflammatory activity of ILC2s might be regulated by IL-33-elicited ST2+ Tregs that also arise in immune-mediated hepatitis.
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Affiliation(s)
- Katrin Neumann
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany; and
| | - Khalil Karimi
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany; and
| | - Jana Meiners
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany; and
| | - Ruth Voetlause
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany; and
| | - Silja Steinmann
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany; and
| | - Werner Dammermann
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany
| | - Stefan Lüth
- 1. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany
| | - Farahnaz Asghari
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany; and
| | - Claudia Wegscheid
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany; and
| | - Andrea K Horst
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany; and
| | - Gisa Tiegs
- Institute of Experimental Immunology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany; and
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Behrendt P, Lüth S, Dammermann W, Drave S, Brown RJP, Todt D, Schnoor U, Steinmann E, Wedemeyer H, Pischke S, Iking-Konert C. Exacerbation of hepatitis E virus infection during anti-TNFα treatment. Joint Bone Spine 2016; 84:217-219. [PMID: 27836355 DOI: 10.1016/j.jbspin.2016.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 06/10/2016] [Accepted: 09/21/2016] [Indexed: 12/30/2022]
Abstract
Chronic hepatitis E virus (HEV) infection may occur in immunocompromised patients. Previous studies report that different immunosuppressive agents interfere with viral replication. However, the role of TNFα in HEV infection is currently unknown. Here, we describe a case of severe exacerbation of a chronic HEV infection in a patient undergoing treatment with a TNFα-inhibitor for psoriatic arthritis despite potent anti-HEV T-cell responses. We used state-of-the-art HEV cell culture methods to test antiviral effects of different drugs and a cytokine release assay to assess HEV specific T cell immunity. In addition standard tools of our diagnostics laboratory were employed. In vitro data confirmed inhibition of HEV replication by TNFα, which could be abolished by addition of TNFα inhibitors. Thus, TNFα may play a critical role in the control of HEV replication. We therefore recommend exclusion of HEV infection prior to initiation of TNFα-inhibitor therapy.
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Affiliation(s)
- Patrick Behrendt
- TWINCORE, Center for Experimental and Clinical Infection Research, Division of Experimental Virology, 30625 Hannover, Germany; Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; German Center for Infection Research, 30625 Hannover, Germany.
| | - Stefan Lüth
- Department of Gastroenterology and Hepatology, Medicine I, University Medical Center Hamburg-Eppendorf, 20038 Hamburg, Germany; Medical School Brandenburg, University Medical Center II, 14770 Brandenburg an der Havel, Germany
| | - Werner Dammermann
- Department of Gastroenterology and Hepatology, Medicine I, University Medical Center Hamburg-Eppendorf, 20038 Hamburg, Germany
| | - Svenja Drave
- TWINCORE, Center for Experimental and Clinical Infection Research, Division of Experimental Virology, 30625 Hannover, Germany
| | - Richard J P Brown
- TWINCORE, Center for Experimental and Clinical Infection Research, Division of Experimental Virology, 30625 Hannover, Germany
| | - Daniel Todt
- TWINCORE, Center for Experimental and Clinical Infection Research, Division of Experimental Virology, 30625 Hannover, Germany
| | - Ulrike Schnoor
- Department of Nephrology and Rheumatology, Medicine III, University Medical Center Hamburg-Eppendorf, 20038 Hamburg, Germany
| | - Eike Steinmann
- TWINCORE, Center for Experimental and Clinical Infection Research, Division of Experimental Virology, 30625 Hannover, Germany
| | - Heiner Wedemeyer
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany; German Center for Infection Research, 30625 Hannover, Germany
| | - Sven Pischke
- Department of Gastroenterology and Hepatology, Medicine I, University Medical Center Hamburg-Eppendorf, 20038 Hamburg, Germany
| | - Christof Iking-Konert
- Department of Nephrology and Rheumatology, Medicine III, University Medical Center Hamburg-Eppendorf, 20038 Hamburg, Germany
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Carambia A, Freund B, Schwinge D, Bruns OT, Salmen SC, Ittrich H, Reimer R, Heine M, Huber S, Waurisch C, Eychmüller A, Wraith DC, Korn T, Nielsen P, Weller H, Schramm C, Lüth S, Lohse AW, Heeren J, Herkel J. Nanoparticle-based autoantigen delivery to Treg-inducing liver sinusoidal endothelial cells enables control of autoimmunity in mice. J Hepatol 2015; 62:1349-56. [PMID: 25617499 DOI: 10.1016/j.jhep.2015.01.006] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/19/2014] [Accepted: 01/05/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS It is well-known that the liver can induce immune tolerance, yet this knowledge could, thus far, not be translated into effective treatments for autoimmune diseases. We have previously shown that liver sinusoidal endothelial cells (LSECs) could substantially contribute to hepatic tolerance through their ability to induce CD4+ Foxp3+ regulatory T cells (Tregs). Here, we explored whether the Treg-inducing potential of LSECs could be harnessed for the treatment of autoimmune disease. METHODS We engineered a polymeric nanoparticle (NP) carrier for the selective delivery of autoantigen peptides to LSECs in vivo. In the well-characterized autoimmune disease model of experimental autoimmune encephalomyelitis (EAE), we investigated whether administration of LSEC-targeting autoantigen peptide-loaded NPs could protect mice from autoimmune disease. RESULTS We demonstrate that NP-based autoantigen delivery to LSECs could completely and permanently prevent the onset of clinical EAE. More importantly, in a therapeutic approach, mice with already established EAE improved rapidly and substantially following administration of a single dose of autoantigen peptide-loaded NPs, whereas the control group deteriorated. Treatment efficacy seemed to depend on Tregs. The Treg frequencies in the spleens of mice treated with autoantigen peptide-loaded NPs were significantly higher than those in vehicle-treated mice. Moreover, NP-mediated disease control was abrogated after Treg depletion by repeated administration of Treg-depleting antibody. CONCLUSION Our findings provide proof of principle that the selective delivery of autoantigen peptides to LSECs by NPs can induce antigen-specific Tregs and enable effective treatment of autoimmune disease. These findings highlight the importance of Treg induction by LSECs for immune tolerance.
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Affiliation(s)
- Antonella Carambia
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Freund
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dorothee Schwinge
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver T Bruns
- Department of Electron Microscopy and Micro Technology, Heinrich-Pette Institute, Hamburg, Germany
| | - Sunhild C Salmen
- Institute of Physical Chemistry, University of Hamburg, Hamburg, Germany
| | - Harald Ittrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolph Reimer
- Department of Electron Microscopy and Micro Technology, Heinrich-Pette Institute, Hamburg, Germany
| | - Markus Heine
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samuel Huber
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - David C Wraith
- Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Thomas Korn
- Department of Neurology, TU München, München, Germany
| | - Peter Nielsen
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Horst Weller
- Institute of Physical Chemistry, University of Hamburg, Hamburg, Germany
| | - Christoph Schramm
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Lüth
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joerg Heeren
- Department of Biochemistry and Molecular Cell Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Herkel
- Department of Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Dammermann W, Bentzien F, Stiel EM, Kühne C, Ullrich S, Schulze Zur Wiesch J, Lüth S. Development of a novel IGRA assay to test T cell responsiveness to HBV antigens in whole blood of chronic Hepatitis B patients. J Transl Med 2015; 13:157. [PMID: 25968473 PMCID: PMC4465460 DOI: 10.1186/s12967-015-0513-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 05/04/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Interferon gamma release assays (IGRA) have been developed to support easy and fast diagnosis of diseases like tuberculosis, and CMV in transplant patients. IGRAs focus on cellular immunity especially memory T cells and thus also allow rapid screening prior to complex flow cytometric testing. Here, we describe a novel, sensitive whole blood based cytokine release assay capable of assessing T cell responsiveness to HBV antigens in Hepatitis B patients and assessing hepatitis B vaccination status in healthy individuals. METHODS Seventy two chronic Hepatitis B patients (CHB), 8 acute hepatitis B patients (AHB) and 80 healthy controls (HC) were tested by ELISA for IFNγ- and IL2-secretion in whole blood after challenge with synthetic peptide libraries of hepatitis B core antigen (HBcAg) or hepatitis B surface antigen (HBsAg). RESULTS The developed IGRA test reliably differentiated between Hepatitis B patients, vaccinees and unvaccinated healthy controls. Treatment naïve and treated CHB patients showed a weaker IFNγ response to HBcAg (16 ± 5 and 35 ± 28 pg/ml, respectively) compared to the AHB group (82 ± 39 pg/ml), whereas HC remained unresponsive (6 ± 1 pg/ml). IL2 levels after HBcAg challenge were also higher in the AHB group compared to naive and treated CHB as well as HC (47 ± 21 vs. 12 ± 3, 15 ± 10 and 12 ± 9 pg/ml, respectively). HBsAg stimulation led to increased IFNγ and IL2 levels in the AHB group (33 ± 12 and 22 ± 12 pg/ml) and even higher levels in HC due to a high hepatitis B vaccination rate (41 ± 10 and 167 ± 58 pg/ml). Naive and treated CHB patients developed no or only weaker IFNγ or IL2 responses to HBsAg (5 ± 2 and 12 ± 7 pg/ml, for naive CHB, 12 ± 10 and 18 ± 15 pg/ml, for treated CHB). For HC, IL2 release after HBsAg stimulation depicted hepatitis B vaccination status with a diagnostic sensitivity and specificity of 85 % and 90 %. CONCLUSION Our novel whole blood based cytokine release assay constitutes an easy and robust tool for screening HBV specific cellular immunity as alternative to flow cytometry or ELISPOT assays.
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Affiliation(s)
- Werner Dammermann
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Frank Bentzien
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Eva-Maria Stiel
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Claudia Kühne
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Sebastian Ullrich
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Julian Schulze Zur Wiesch
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany. .,German Center for Infection Research (DZIF), partner site Hamburg, Hamburg, Germany. .,Heinrich Pette Institute - Leibniz Institute for Experimental Virology, Hamburg, Germany.
| | - Stefan Lüth
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany. .,German Center for Infection Research (DZIF), partner site Hamburg, Hamburg, Germany.
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35
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Dammermann W, Bochmann D, Bentzien F, Komorowski L, Steinhagen K, Ullrich S, van Lunzen J, Lüth S. CMV specific cytokine release assay in whole blood is optimized by combining synthetic CMV peptides and toll like receptor agonists. J Immunol Methods 2014; 414:82-90. [PMID: 25450001 DOI: 10.1016/j.jim.2014.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/21/2014] [Accepted: 10/23/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Interferon gamma release assays (IGRAs) are widely used to detect pathogen specific cellular immunity. Cytomegalovirus (CMV) is the foremost problematic viral infection in immunocompromised patients such as transplant or HIV infected patients. CMV antibody ELISAs are not able to predict CMV specific cellular immunity during immunosuppression. We developed a CMV specific IGRA comparing synthetic CMV peptides, native lysate and recombinant antigen. In addition, TLR agonists were tested to enhance CMV antigen immunogenicity. METHODS 397 healthy controls (HC) were stratified according to CMV IgM and IgG serostatus and subsequently tested for IFNγ- and IL2-secretion in whole blood after challenge with synthetic, native or recombinant CMV antigens and TLR agonists by ELISA. The selected TLR agonists were lipopolysaccharide (LPS), lipoteichoic acid (LTA), peptidoglycan (PGN), zymosan (Zym), polyinosinic-polycytidylic acid (Poly(I:C)), flagellin (Fla), R848, loxoribine (Lox) and bropirimine (Bro). RESULTS Synthetic pp65 peptides elicited strong IFNγ responses in CMV seropositive, but not seronegative HC (6418 vs. 13 pg/ml). Native lysates and recombinant pp65 induced equally high IFNγ responses in seropositive (35,877 and 26,428 pg/ml) and increased background IFNγ expression in seronegative HC (43 and 1148 pg/ml). Diagnostic sensitivity and specificity with regard to anti-CMV serology reached 100% for synthetic pp65 and native CMV lysate, but 57% and 100% for recombinant pp65, respectively. TLR agonists LTA and Poly(I:C) augmented IFNγ responses after challenge with synthetic pp65 peptide, native lysate or recombinant pp65 in seropositive HC. Seronegative HC remained unaffected. IL2 production was negligible compared to IFNγ. CONCLUSION IGRAs using synthetic CMV peptides or native lysate showed the best cytokine signal to noise ratio compared to recombinant antigen and TLR agonists LTA and Poly(I:C) constitute potential costimulating reagents.
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Affiliation(s)
- Werner Dammermann
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - David Bochmann
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Frank Bentzien
- Department of Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Lars Komorowski
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Katja Steinhagen
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Sebastian Ullrich
- Department of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan van Lunzen
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Stefan Lüth
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Carambia A, Freund B, Schwinge D, Bruns OT, Salmen SC, Ittrich H, Reimer R, Heine M, Huber S, Waurisch C, Eychmüller A, Wraith DC, Korn T, Nielsen P, Weller H, Schramm C, Lüth S, Lohse AW, Heeren J, Herkel J. Control of autoimmune neuroinflammation by nanoparticle-based myelin-antigen delivery to liver sinusoidal endothelial cells. J Neuroimmunol 2014. [DOI: 10.1016/j.jneuroim.2014.08.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wranke A, Heidrich B, Ernst S, Calle Serrano B, Caruntu FA, Curescu MG, Yalcin K, Gürel S, Zeuzem S, Erhardt A, Lüth S, Papatheodoridis GV, Bremer B, Stift J, Grabowski J, Kirschner J, Port K, Cornberg M, Falk CS, Dienes HP, Hardtke S, Manns MP, Yurdaydin C, Wedemeyer H. Anti-HDV IgM as a marker of disease activity in hepatitis delta. PLoS One 2014; 9:e101002. [PMID: 25072849 PMCID: PMC4114528 DOI: 10.1371/journal.pone.0101002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/30/2014] [Indexed: 12/16/2022] Open
Abstract
Background Hepatitis delta frequently leads to liver cirrhosis and hepatic decompensation. As treatment options are limited, there is a need for biomarkers to determine disease activity and to predict the risk of disease progression. We hypothesized that anti-HDV IgM could represent such a marker. Methods Samples of 120 HDV-infected patients recruited in an international multicenter treatment trial (HIDIT-2) were studied. Anti-HDV IgM testing was performed using ETI-DELTA-IGMK-2-assay (DiaSorin). In addition, fifty cytokines, chemokines and angiogenetic factors were measured using multiplex technology (Bio-Plex System). A second independent cohort of 78 patients was studied for the development of liver-related clinical endpoints (decompensation, HCC, liver transplantation or death; median follow up of 3.0 years, range 0.6–12). Results Anti-HDV IgM serum levels were negative in 18 (15%), low (OD<0.5) in 76 (63%), and high in 26 (22%) patients of the HIDIT-2 cohort. Anti-HDV IgM were significantly associated with histological inflammatory (p<0.01) and biochemical disease activity (ALT, AST p<0.01). HDV replication was independent from anti-HDV IgM, however, low HBV-DNA levels were observed in groups with higher anti-HDV IgM levels (p<0.01). While high IP-10 (CXCL10) levels were seen in greater groups of anti-HDV IgM levels, various other antiviral cytokines were negatively associated with anti-HDV IgM. Associations between anti-HDV IgM and ALT, AST, HBV-DNA were confirmed in the independent cohort. Clinical endpoints occurred in 26 anti-HDV IgM positive patients (39%) but in only one anti-HDV IgM negative individual (9%; p = 0.05). Conclusions Serum anti-HDV IgM is a robust, easy-to-apply and relatively cheap marker to determine disease activity in hepatitis delta which has prognostic implications. High anti-HDV IgM levels may indicate an activated interferon system but exhausted antiviral immunity.
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Affiliation(s)
- Anika Wranke
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- * E-mail: (HW); (AW)
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany
| | - Stefanie Ernst
- Institute for Biometry, Hannover Medical School, Hannover, Germany
| | - Beatriz Calle Serrano
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | | | - Kendal Yalcin
- Dicle University Medical Faculty, Diyarbakir, Turkey
| | - Selim Gürel
- Uludağ University Medical Faculty, Bursa, Turkey
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt/Main, Germany
| | | | - Stefan Lüth
- University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Birgit Bremer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Jan Grabowski
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Janina Kirschner
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Kerstin Port
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Christine S. Falk
- Institute of Transplant Immunology, IFB-Tx, Hannover Medical School, Hannover, Germany
| | | | | | - Michael P. Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- HepNet Study-House, Hannover, Germany
- Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany
| | | | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
- HepNet Study-House, Hannover, Germany
- Integrated Research and Treatment Center Transplantation, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Partner Side HepNet Study-House, Hannover, Germany
- * E-mail: (HW); (AW)
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Beisel C, Heuer M, Otto B, Jochum J, Schmiedel S, Hertling S, Degen O, Lüth S, van Lunzen J, Schulze zur Wiesch J. German cohort of HCV mono-infected and HCV/HIV co-infected patients reveals relative under-treatment of co-infected patients. AIDS Res Ther 2014; 11:16. [PMID: 25006340 PMCID: PMC4086688 DOI: 10.1186/1742-6405-11-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 06/17/2014] [Indexed: 12/16/2022] Open
Abstract
Background Current German and European HIV guidelines recommend early evaluation of HCV treatment in all HIV/HCV co-infected patients. However, there are still considerable barriers to initiate HCV therapy in everyday clinical practice. This study evaluates baseline characteristics, “intention-to-treat” pattern and outcome of therapy of HCV/HIV co-infected patients in direct comparison to HCV mono-infected patients in a “real-life” setting. Methods A large, single-center cohort of 172 unselected HCV patients seen at the Infectious Diseases Unit at the University Medical Center Hamburg-Eppendorf from 2000–2011, 88 of whom HCV/HIV co-infected, was retrospectively analyzed by chart review with special focus on demographic, clinical and virologic aspects as well as treatment outcome. Results Antiviral HCV combination therapy with PEG-interferon plus weight-adapted ribavirin was initiated in 88/172 (52%) patients of the entire cohort and in n = 36 (40%) of all HCV/HIV co-infected patients (group A) compared to n = 52 (61%) of the HCV mono-infected group (group B) (p = 0.006). There were no significant differences of the demographics or severity of the liver disease between the two groups with the exception of slightly higher baseline viral loads in group A. A sustained virologic response (SVR) was observed in 50% (n = 18) of all treated HIV/HCV co-infected patients versus 52% (n = 27) of all treated HCV mono-infected patients (p = 0.859). Genotype 1 was the most frequent genotype in both groups (group A: n = 37, group B: n = 49) and the SVR rates for these patients were only slightly lower in the group of co-infected patients (group A: n = 33%, group B: 40% p = 0.626). During the course of treatment HCV/HIV co-infected patients received less ribavirin than mono-infected patients. Conclusion Overall, treatment was only initiated in half of the patients of the entire cohort and in an even smaller proportion of HCV/HIV co-infected patients despite comparable outcome (SVR) and similar baseline characteristics. In the light of newer treatment options, greater efforts to remove the barriers to treatment that still exist for a great proportion of patients especially with HIV/HCV co-infection have to be undertaken.
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Lüth S, Fründt TW, Rösch T, Schlee C, Lohse AW. Prevention of hemolytic uremic syndrome with daily bowel lavage in patients with Shiga toxin-producing enterohemorrhagic Escherichia coli O104:H4 infection. JAMA Intern Med 2014; 174:1003-5. [PMID: 24781800 DOI: 10.1001/jamainternmed.2014.1175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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]
Affiliation(s)
- Stefan Lüth
- Department of Medicine I, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thorben W Fründt
- Department of Medicine I, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schlee
- Department of Medicine I, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine I, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Wehmeyer MH, Eißing F, Jordan S, Röder C, Hennigs A, Degen O, Hüfner A, Hertling S, Schmiedel S, Sterneck M, van Lunzen J, Lohse AW, Schulze zur Wiesch J, Lüth S. Safety and efficacy of protease inhibitor based combination therapy in a single-center "real-life" cohort of 110 patients with chronic hepatitis C genotype 1 infection. BMC Gastroenterol 2014; 14:87. [PMID: 24884400 PMCID: PMC4102246 DOI: 10.1186/1471-230x-14-87] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/28/2014] [Indexed: 12/22/2022] Open
Abstract
Background The combination of boceprevir or telaprevir with peginterferon-alfa and ribavirin for the treatment of patients infected with HCV genotype 1 has led to significantly increased rates of sustained virological response (SVR) in phase III trials. There is only limited data regarding the safety and efficacy in a “real-life” cohort. Methods We analyzed a cohort of 110 unselected HCV patients who started triple therapy from September 2011 to February 2013 by chart review with focus on the individual course of treatment, complications and outcome. We excluded 8 patients from analysis because of HIV-coinfection (N = 6) or status post liver transplant (N = 2). Importantly, 41 patients displayed F3 or F4 fibrosis, 10 patients had a history of treatment with protease/polymerase inhibitors and 15 patients were prior partial- or null-responder. Results SVR12 was achieved in 62 of the 102 patients (60.8%). A high rate of serious adverse events (N = 30) was observed in 22 patients including 2 fatalities in cirrhotic diabetes patients. Age >50 years, liver cirrhosis, bilirubin >1.1 mg/dl (P < 0.01, each), platelets <100,000/μl (P = 0.01), ASAT >100 U/l (P = 0.03) and albumin ≤35 g/l (P = 0.04) at baseline were associated with occurence of a SAE. Conclusions The frequency of SVR in a “real-life” treatment setting is slightly lower as compared to the results of the phase III trials for telaprevir or boceprevir. Importantly, we observed a high frequency of SAE in triple therapy, especially in patients with liver cirrhosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Julian Schulze zur Wiesch
- I, Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr, 52, Hamburg 20246, Germany.
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Abstract
BACKGROUND AND AIMS Spontaneous bacterial peritonitis (SBP) is a life-threatening complication in patients with liver cirrhosis. The aim of this prospective study was to identify predictors of SBP in order to develop a noninvasive method to identify or exclude an episode of SBP. PATIENTS AND METHODS Three hundred and ninety-two consecutive patients, who underwent paracentesis from March 2008 through January 2012 in our department due to cirrhotic ascites, were screened. Ninety-six patients were excluded, mostly due to prior application of antibiotics. SBP was defined by an absolute neutrophil count≥250 cells/µL ascites. We evaluated various clinical and laboratory parameters as potential predictors of SBP. A scoring system was developed in a training set of 220 and validated in a second set of 76 patients. RESULTS Fifty-eight patients (26%) in the training set and 17 patients in the validation set (22%) suffered from SBP. Thrombocytopenia≤100,000 cells/µL, age>60 years and CRP>60 mg/L were identified as independent predictors of SBP. A scoring system combining these three parameters (weighting thrombocytopenia and age with 1 point each, but CRP with 2 points) reaches a positive predictive value for the diagnosis of SBP of 81.8% with a specificity of 98.8% (score≥3). The negative predictive value at a threshold of 1 point is 93.5% with a sensitivity of 87.9%. Notably, a high MELD score is not associated with SBP (p=0.3344). CONCLUSIONS Combination of age, CRP and platelet count in a simple scoring system helps in the rapid diagnosis or exclusion of SBP.
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Affiliation(s)
- Malte H Wehmeyer
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Lüth S. Chronische Hepatitis C: Neues vom amerikanischen Leberkongress AASLD. Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0033-1353964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Resheq YJ, Quaas A, von Renteln D, Schramm C, Lohse AW, Lüth S. Infiltration of peritumoural but tumour-free parenchyma with IgG4-positive plasma cells in hilar cholangiocarcinoma and pancreatic adenocarcinoma. Dig Liver Dis 2013; 45:859-65. [PMID: 23602806 DOI: 10.1016/j.dld.2013.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/18/2013] [Accepted: 03/08/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Recently, new guidelines for diagnosing IgG4-associated cholangitis have been published devaluing the diagnostic significance of IgG4-positive plasma cells and steroid trials. We sought to evaluate the utility of IgG4-positive plasma cells in discriminating IgG4-associated cholangitis from hilar cholangiocarcinoma and autoimmune pancreatitis from pancreatic adenocarcinoma under conditions when malignancy is likely to be missed. METHODS Resection specimens obtained from patients with hilar cholangiocarcinoma, pancreatic adenocarcinoma or hepatocellular carcinoma were re-evaluated for IgG4-positivity. Histological analysis focussed on peritumoural but tumour-free sections. Perioperative biochemical and clinical data were reviewed. RESULTS Nineteen patients with hilar cholangiocarcinoma and 29 patients with pancreatic adenocarcinoma were eligible for histological re-evaluation. Six of 19 (32%) patients with hilar cholangiocarcinoma and 5 of 29 (17%) patients with pancreatic adenocarcinoma were IgG4-positive (≥20 IgG4-positive plasma cells per high power field). Patients with IgG4-positive hilar cholangiocarcinoma showed significantly higher levels of serum total bilirubin (3.6mg/dl vs. 1.8mg/dl; P<0.05) and serum alanine-aminotransferase (median 343U/l vs. 63U/l, P<0.05) compared to IgG4-negative patients with hilar cholangiocarcinoma. CONCLUSIONS IgG4-positive plasma cells are of limited utility especially in distinguishing hilar cholangiocarcinoma from IgG4-associated cholangitis even when combined with clinical parameters and may be misleading under conditions when malignancy is missed.
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Affiliation(s)
- Yazid J Resheq
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Germany.
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Dammermann W, Schipper P, Ullrich S, Fraedrich K, Schulze zur Wiesch J, Fründt T, Tiegs G, Lohse A, Lüth S. Increased expression of complement regulators CD55 and CD59 on peripheral blood cells in patients with EAHEC O104:H4 infection. PLoS One 2013; 8:e74880. [PMID: 24086391 PMCID: PMC3781141 DOI: 10.1371/journal.pone.0074880] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/07/2013] [Indexed: 11/18/2022] Open
Abstract
Background An outbreak of Shiga Toxin 2 (Stx-2) producing enterohemorrhagic and enteroaggregative E.coli (EAHEC) O104H4 infection in May 2011 caused enterocolitis and an unprecedented high 22% rate of hemolytic uremic syndrome (HUS). The monoclonal anti-C5 antibody Eculizumab (ECU) has been used experimentally in EAHEC patients with HUS but treatment efficacy is uncertain. ECU can effectively prevent hemolysis in paroxysmal nocturnal hemoglobinuria (PNH) caused by a lack of complement-regulating CD55 and CD59 on blood cells. We hypothesized a low expression of CD55 and CD59, as seen in PNH, might correlate with HUS development in EAHEC patients. Methods 76 EAHEC patients (34 only gastrointestinal symptoms [GI], 23: HUS, 19: HUS and neurological symptoms [HUS/N]) and 12 healthy controls (HC) were tested for the expression of CD55 and CD59 on erythrocytes and leukocytes retrospectively. Additionally, the effect of Stx-2 on CD55 and CD59 expression on erythrocytes and leukocytes was studied ex vivo. Results CD55 expression on erythrocytes was similar in all patient groups and HC while CD59 showed a significantly higher expression in HUS and HUS/N patients compared to HC and the GI group. CD55 and CD59 expression on leukocytes and their subsets was significantly higher in all patient groups compared to HC regardless of treatment type. However, CD59 expression on erythrocytes was significantly higher in HUS and HUS/N patients treated combined with plasma separation (PS) and ECU compared to HC. Adding Stx-2 ex vivo had no effect on CD55 and CD59 expression on leukocytes from HC or patients. Conclusion HUS evolved independently from CD55 and CD59 expression on peripheral blood cells in EAHEC O104:H4 infected patients. Our data do not support a role for CD55 and CD59 in HUS development during EAHEC O104:H4 infection and point to a different mechanism within the complement system for HUS development in EAHEC patients.
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Affiliation(s)
- Werner Dammermann
- Department of Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Pim Schipper
- Department of Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Sebastian Ullrich
- Department of Anatomy and Experimental Morphology, University Medical Center Eppendorf, Hamburg, Germany
| | - Katharina Fraedrich
- Department of Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | | | - Thorben Fründt
- Department of Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Gisa Tiegs
- Institute of Experimental Immunology and Hepatology, University Medical Center Eppendorf, Hamburg, Germany
| | - Ansgar Lohse
- Department of Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Stefan Lüth
- Department of Medicine, University Medical Center Eppendorf, Hamburg, Germany
- * E-mail:
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Holzhüter J, Rösch T, Block A, Lohse AW, Lüth S. [A 44-year-old woman with hereditary nonpolyposis colon carcinoma: screening examinations for non-colonic tumors]. Internist (Berl) 2013; 54:353-8. [PMID: 23392234 DOI: 10.1007/s00108-012-3224-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 44-year-old woman presented in March 2010 for surveillance esophagogastroduodenoscopy (EGD). In October 2004, rectal cancer had been diagnosed and treated by resection of the rectum with adjuvant chemotherapy. A diagnosis of hereditary nonpolyposis colon carcinoma (HNPCC) was established on the basis of the Amsterdam II criteria. Due to a lack of clear guidelines we decided to perform annual systematic surveillance examinations of the stomach and the most frequent tumor manifestations. Until 2009, extracolonic tumors were not observed in the patient. In March 2010, EGD showed a discrete erosive lesion in the gastric antrum, which was biopsied. Most notably, the histopathological examination revealed a poorly differentiated mucinous adenocarcinoma. Due to the poor differentiation, we decided against technically possible, endoscopic resection. The patient underwent subtotal gastrectomy and is still doing fine 28 months after surgery. This case prompted us to evaluate our surveillance approach in HNPCC patients and to review the literature.
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Affiliation(s)
- J Holzhüter
- I. Medizinische Klinik, Zentrum für Innere Medizin, Universitätsklinikum Hamburg, Martinistr. 52, 20246, Hamburg, Deutschland.
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Fründt T, Höpker WW, Hagel C, Sperhake J, Isenberg A, Lüth S, Lohse A, Sauter G, Glatzel M, Püschel K. EHEC-O104:H4-Ausbruch im Sommer 2011. Rechtsmedizin (Berl) 2013. [DOI: 10.1007/s00194-013-0910-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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von Renteln D, Quaas A, Rösch T, Denzer UW, Szyrach MN, Enderle MD, Lüth S, Haas S, Trepte C, Reutter D, Schachschal G. A novel flexible cryoprobe for EUS-guided pancreatic biopsies. Gastrointest Endosc 2013; 77:784-92. [PMID: 23453293 DOI: 10.1016/j.gie.2012.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 12/18/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND EUS-guided FNA (EUS-FNA) is an established technique for the cytologic diagnosis of pancreatic disease. Attempts to obtain adequate histologic specimens have yielded variable and mostly insufficient results. OBJECTIVE To evaluate the safety, feasibility, and quality of histologic biopsy specimens obtained by using a new cryobiopsy probe and to compare them with standard EUS-FNA and (laparoscopic) trucut biopsy specimens of pancreatic tissue. DESIGN Animal non-survival study. INTERVENTION Eighty-four pancreatic biopsy specimens (12 per group) were obtained in 4 anesthetized pigs by using one of the following the 18-gauge flexible cryoprobe; a conventional, 19-gauge, EUS-FNA needle; or a rigid, trucut biopsy device (18 gauge). The latter, used in laparoscopic surgery, was considered as the criterion standard for obtaining histology specimens. MAIN OUTCOME MEASUREMENTS Specimens were evaluated for artifacts and specimen quality by a blinded pathologist who used a 7-point Likert scale to assess histologic adequacy. Biopsy size and bleeding time after biopsy also were recorded. RESULTS The new cryoprobe was equivalent to the rigid, trucut needle and superior (P < .001) to the conventional 19-gauge FNA needles with respect to artifacts, quality of the specimen, biopsy specimen size, and bleeding. LIMITATIONS Animal model. CONCLUSION EUS-guided cryobiopsy was associated with better specimen quality for histologic analysis and a shorter bleeding time compared with a conventional 19-gauge FNA needle in the animal model. It is a promising new technique for histologic examination of pancreatic tissue.
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Affiliation(s)
- Daniel von Renteln
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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von Renteln D, Quaas A, Rösch T, Denzer UW, Szyrach MN, Enderle MD, Lüth S, Haas S, Trepte C, Reutter D, Schachschal G. A Novel Flexible Cryoprobe for EUS-Guided Pancreatic Biopsies. Journal of Digestive Endoscopy 2013. [DOI: 10.1055/s-0039-1700266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Röder C, Jordan S, Hoepner L, Pudelski N, Supplieth M, Lohse AW, Schulze zur Wiesch J, Lüth S. Chronische Hepatitis C Infektion: Herausforderung Alter. Z Gastroenterol 2012. [DOI: 10.1055/s-0031-1295931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Lüth S, Schrader J, Zander S, Carambia A, Buchkremer J, Huber S, Reifenberg K, Yamamura KI, Schirmacher P, Lohse AW, Herkel J. Chronic inflammatory IFN-γ signaling suppresses hepatocarcinogenesis in mice by sensitizing hepatocytes for apoptosis. Cancer Res 2011; 71:3763-71. [PMID: 21512142 DOI: 10.1158/0008-5472.can-10-3232] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic liver inflammation is a critical component of hepatocarcinogenesis. Indeed, inflammatory mediators are believed to promote liver cancer by upholding compensatory proliferation of hepatocytes in response to tissue damage. However, inflammation can also mediate the depletion of malignant cells, but the difference between tumor-suppressive and tumor-promoting inflammation is not defined at the molecular level. Here, we analyzed the role of the major inflammatory mediator IFN-γ in chemical hepatocarcinogenesis of transgenic mice that overexpress IFN-γ in the liver; these mice manifest severe chronic inflammatory liver damage and lasting compensatory regeneration. We found that chronic exposure to IFN-γ suppressed chemical hepatocarcinogenesis, despite overt liver injury. Indeed, IFN-γ-transgenic mice had significantly fewer and significantly less advanced malignant lesions than nontransgenic mice. This tumor-suppressive effect of IFN-γ seemed to be mediated in part by its known immune activating function, indicated by infiltration of IFN-γ-transgenic livers with CD8 T cells, natural killer T cells, and natural killer cells. However, IFN-γ seemed to prevent carcinogenesis also by activating the cell-intrinsic p53 tumor suppressor pathway. Indeed, exposure to IFN-γ in vivo or in vitro was associated with accumulation of p53 in hepatocytes and the sensitization of hepatocytes to apoptosis induced by genotoxic stress. The IFN-γ-induced increase in apoptosis of hepatocytes seemed to be p53 dependent. Thus, chronic inflammation dominated by IFN-γ may prevent hepatocarcinogenesis, despite continued inflammatory liver injury and regeneration. Therefore, the carcinogenic potential of inflammation seems to be determined by type and composition of its mediators and manipulating the type of chronic inflammation may serve the prevention of cancer.
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Affiliation(s)
- Stefan Lüth
- Department of Medicine I, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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