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Aytekin A, Cassese S, Kufner S, Ndrepepa G, Voll F, Rheude T, Seguchi M, Coughlan JJ, Pinieck S, Joner M, Fusaro M, Kastrati A, Xhepa E. Clinical and angiographic outcomes following percutaneous treatment of non-occlusive vs. chronically total occluded coronary lesions. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent advancements in recanalization techniques, introduction of dedicated equipment and elaboration of systematic algorithmic approaches have significantly improved procedural success of coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) procedures. However, despite their undisputable merits in terms of procedural success, direct comparisons of mid-term clinical and angiographic outcomes following CTO and non-CTO-PCI are missing.
Purpose
The aim of this study was to assess the clinical and angiographic outcomes of patients undergoing successful CTO-PCI as compared to a propensity matched cohort of patients undergoing PCI of non-occlusive coronary lesions.
Methods
All consecutive patients undergoing successful CTO recanalization procedures at our center between 2015 and 2018 were included (N=453; 472 lesions). For matching purposes, all patients undergoing non-CTO-PCI present in our database were included (N=14733; 23458 lesions). A 1-to-1 nearest neighbour matching using baseline clinical and angiographic variables was performed to identify one patient undergoing non-CTO-PCI (N=453; 472 vessels) for each patient undergoing CTO-PCI (N=453; 472 vessels). Surveillance angiography was scheduled at 6–9 months and clinical follow-up was performed up to 12 months. The primary clinical endpoint of interest was the incidence of major adverse cardiovascular events (MACE), a composite of all-cause death, myocardial infarction (MI) and target lesion revascularization (TLR). The secondary angiographic endpoint was in-segment binary restenosis.
Results
Patients undergoing CTO-PCI displayed a tendency towards higher degrees of binary restenosis at surveillance angiography as compared to those undergoing non-CTO-PCI (CTO vs. non-CTO: 30.5% vs. 24.0%; P=0.058), despite not meeting statistical significance. Of note, the incidence of occlusive restenosis was low and comparable between groups (2.2% vs. 1.4%; P=0.603). At 12 months follow-up, MACE occurred in 83 patients (19.7%) in the CTO-PCI and 59 patients (14.1%) in the non-CTO-PCI group (hazard ratio [HR] = 1.44; 95% confidence interval [CI]: 1.03–2.01; P=0.033). TLR rates were significantly higher following CTO- as compared to non-CTO-PCI (17.2% vs. 10.3%; HR=1.72 [1.18–2.51], P=0.005). The incidence of all-cause death (2.6% vs. 3.3%; P=0.548) and MI (0.5% vs. 1.4%; P=0.177) was not significantly different between the groups.
Conclusion
In this large, propensity-matched comparison of clinical and angiographic outcomes following CTO- vs. non-CTO-PCI, we found CTO-PCI to be associated with a higher MACE rate at 12 months, primarily driven by significantly higher TLR rates. The incidence of occlusive restenosis was low and comparable between groups.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Aytekin
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Cassese
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Kufner
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - G Ndrepepa
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - F Voll
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - T Rheude
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - M Seguchi
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - J J Coughlan
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Pinieck
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - M Joner
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - M Fusaro
- Klinik Vincentinum , Augsburg , Germany
| | - A Kastrati
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - E Xhepa
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
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2
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Lahu S, Presch A, Ndrepepa G, Bernlochner I, Joner M, Xhepa E, Kufner S, Sager HB, Mayer K, Kessler T, Laugwitz KL, Schunkert H, Neumann FJ, Kastrati A, Cassese S. Ticagrelor or prasugrel in patients with acute coronary syndrome and high bleeding risk. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The relative efficacy and safety of more potent P2Y12 inhibitors in patients with acute coronary syndrome (ACS) and high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI) remains unclear.
Purpose
To study the treatment effect of ticagrelor and prasugrel in PCI patients presenting with ACS and HBR.
Methods
This post-hoc analysis of the ISAR-REACT 5 trial included patients with ACS undergoing PCI, randomized to ticagrelor or prasugrel, in whom HBR was defined as per Academic Research Consortium criteria. The primary (efficacy) endpoint was the composite of all-cause death, myocardial infarction, or stroke. The secondary (safety) endpoint was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Outcomes were assessed 12 months after randomisation.
Results
Out of the 3,239 patients included in this analysis, 486 fulfilled the criteria for ARC-HBR definition (HBR group; ticagrelor, n=230 and prasugrel, n=256), whilst 2,753 did not (non-HBR group; ticagrelor, n=1,375 and prasugrel, n=1,378). Compared to the non-HBR group, the HBR group had a higher risk for the primary (hazard ratio [HR]=3.57, 95% confidence interval [CI], 2.79–4.57, p<0.001), and secondary endpoint (HR=2.94 [2.17–3.99], p<0.001). In the HBR group, the primary (HR=1.09; [0.73–1.62]) and secondary (HR=1.18 [0.67–2.08]) endpoints were not statistically different between patients assigned to ticagrelor and prasugrel. In the non-HBR group, the primary endpoint (HR=1.62 [1.19–2.20]) occurred more frequently in patients assigned to ticagrelor as compared to patients assigned to prasugrel, without difference in safety (HR=1.08 [0.74–1.58]). There was no treatment allocation-by-HBR status interaction with respect to the primary (p for interaction = 0.123), or secondary (p for interaction = 0.803) endpoints.
Conclusions
In patients with ACS undergoing PCI, HBR status increased both ischemic and bleeding risks without significant impact on the relative efficacy or safety of ticagrelor versus prasugrel. These results warrant confirmation in larger cohorts.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK)Deutsches Herzzentrum München
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Affiliation(s)
- S Lahu
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - A Presch
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - G Ndrepepa
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - I Bernlochner
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I , Munich , Germany
| | - M Joner
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - E Xhepa
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - S Kufner
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - H B Sager
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - K Mayer
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - T Kessler
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - K L Laugwitz
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik Innere Medizin I , Munich , Germany
| | - H Schunkert
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology II , Bad Krozingen , Germany
| | - A Kastrati
- German Heart Center Munich, Technical University of Munich , Munich , Germany
| | - S Cassese
- German Heart Center Munich, Technical University of Munich , Munich , Germany
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3
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Scalamogna M, Lahu S, Ndrepepa G, Mayer K, Gewalt S, Menichelli M, Bernlochner I, Joner M, Xhepa E, Kufner S, Laugwitz KL, Neumann FJ, Schunkert H, Kastrati A, Cassese S. Ticagrelor or prasugrel in patients with acute coronary syndrome and prior myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To investigate the efficacy and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome (ACS) and prior myocardial infarction (MI).
Background
The efficacy and safety of ticagrelor versus prasugrel in ACS patients with prior MI remains unstudied.
Methods
Patients with ACS scheduled for an invasive strategy and randomized to ticagrelor or prasugrel in the ISAR-REACT 5 trial with available information concerning prior MI were included in the present analysis. The primary endpoint was the composite of all-cause death, myocardial infarction, or stroke; the secondary endpoint was Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding. Endpoints were assessed 12 months after randomization.
Results
A total of 4,015 patients were included in this analysis (prior MI= 631 patients; no prior MI = 3,384 patients). As compared to patients without prior MI, the primary endpoint occurred more frequently in patients with prior MI (12.6% vs. 7.2%; hazard ratio [HR] = 1.78, 95% confidence interval [CI] 1.38–2.29; p= <0.001) without significant difference in terms of secondary endpoint between groups (5.8% vs. 5.7%; HR=1.02 [0.71–1.45]; p=0.921). Patients with prior MI randomized to ticagrelor versus prasugrel displayed higher risk for primary (HR=1.62 [1.03–2.55]) but not secondary endpoint (HR=1.28 [0.56–2.91]). Patients without prior MI randomized to ticagrelor or prasugrel displayed no significant difference in terms of primary (HR=1.28 [0.99–1.65]) or secondary endpoints (HR=1.13 [0.82–1.55]). There was no treatment assignment-by-prior MI status interaction with respect to the primary (p for interaction = 0.373) and the secondary (p for interaction= 0.786) endpoints.
Conclusions
Patients with ACS and prior MI are at higher risk for recurrent ischemic but not bleeding events. The history of MI does not affect the relative efficacy and safety of ticagrelor versus prasugrel in patients with ACS.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center for Cardiovascular Research (DZHK)Deutsches Herzzentrum München
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Affiliation(s)
- M Scalamogna
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Lahu
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - G Ndrepepa
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - K Mayer
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Gewalt
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | | | - I Bernlochner
- Hospital right the Isar, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - M Joner
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - E Xhepa
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Kufner
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - K L Laugwitz
- Hospital right the Isar, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen , Bad Krozingen , Germany
| | - H Schunkert
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - A Kastrati
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
| | - S Cassese
- German Heart Center Muenchen Technical University of Munich , Munich , Germany
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4
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Voll F, Kuna C, Kufner S, Cassese S. [Technical armamentarium for chronic total occlusion of coronary vessels]. Herz 2021; 46:406-418. [PMID: 34398249 DOI: 10.1007/s00059-021-05053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
Percutaneous revascularization of chronic total occlusion (CTO) of coronary vessels represents a major challenge for contemporary interventional cardiologists. In the last decade there has been an unprecedented effort towards the standardization of revascularization procedures for CTO of coronary vessels. This endeavour has been possible by virtue of the growing interest of various cardiological societies for this patient group. Along with supportive endovascular technologies and percutaneous devices specifically dedicated to this interventional target, the increasing experience of interventionalists enabled continuously growing success for revascularization of CTO of coronary vessels. This review article highlights the currently available tools as well as technologies, techniques and strategies for the percutaneous recanalization of CTO of coronary vessels.
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Affiliation(s)
- F Voll
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland
| | - C Kuna
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland
| | - S Kufner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland
| | - S Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, München, Deutschland.
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5
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Xhepa E, Bresha J, Joner M, Rivero F, Nano N, Cuesta J, Ndrepepa G, Cassese S, Bastante Valiente T, Kufner S, Garcia-Guimaraes M, Perez-Vizcayno M, Gonzalo N, Alfonso F, Kastrati A. Influence of treatment modality and neointimal characteristics on optical coherence tomography on clinical outcomes of in-stent restenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In-stent restenosis (ISR) represents the more frequent modality of stent failure. The currently recommended treatment strategies are represented by repeat drug-eluting stent (DES) implantation or drug-coated balloon (DCB) angioplasty. Optical coherence tomography can display important information regarding mechanisms of stent failure as well as neointimal characterization.
Purpose
Aim of the present study was to determine the impact of treatment modality (DES vs. DCB) as well as neointimal characteristics (homogeneous vs. non-homogeneous) as determined by intravascular OCT, on clinical outcomes and explore whether there is an interaction between neointimal pattern of ISR and treatment modality.
Methods
Patients presenting with ischemic symptoms and/or evidence of myocardial ischemia in three European centers and undergoing intravascular OCT prior to percutaneous coronary intervention (PCI) for ISR, were retrospectively included in this study. Characterization of neointimal tissue was performed at the frame displaying the maximal %AS as well as the 5 preceding and following analyzed frames. Each frame was subdivided in 4 quadrants (90°) and the neointimal characteristics separately characterized for each of them. Based on its optical characteristics, neointimal tissue was categorized as homogeneous, heterogeneous, layered or neoatherosclerosis.
Based on the dominant neointimal type, the study population was divided in two groups, (predominantly homogeneous and non-homogeneous). Primary endpoints of the study were represented by major adverse cardiac events (MACE) and its idividual components (death, cardiac death, myocardial infarction and target lesion revascularization (TLR)) at 2 years follow-up.
Results
A total of 197 patients undergoing OCT prior to PCI for ISR were included in this study. 100 patients were classified as having predominantly homogeneous and 97 as having predominantly non-homogeneous neointima.
No association was found between predominant OCT pattern (homogenous vs. non-homogenous) and MACE at 2 years follow-up (HR=1.01, 95% CI: 0.59–1.75; p=0.94), or the individual MACE components. Analogously, no significant differences in terms of MACE at 2 years were found between predominantly homogeneous vs. non-homogeneous neointima in the patient subgroup receiving a DES (p=0.10) and in that undergoing DCB treatment (p=0.11).
However, a significant interaction was found between neointimal tissue pattern and treatment modality in terms of MACE (p=0.02) aa well as death or MI (p=0.016). Predominantly non-homogeneous neointima in patients treated with DCB was associated with a higher incidence of MACE.
Conclusions
Our results indicate that there is a significant interaction between treatment modality of ISR (DES vs. DCB) and neointimal pattern as determined by intravascular OCT. These results land initial support to an OCT-guided treatment of ISR and should be confirmed by larger trials.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Xhepa
- Deutsches Herzzentrum Muenchen Technical University of Munich, Munich, Germany
| | - J Bresha
- Deutsches Herzzentrum Muenchen Technical University of Munich, Munich, Germany
| | - M Joner
- Deutsches Herzzentrum Muenchen Technical University of Munich, Munich, Germany
| | - F Rivero
- University Hospital De La Princesa, Madrid, Spain
| | - N Nano
- Deutsches Herzzentrum Muenchen Technical University of Munich, Munich, Germany
| | - J Cuesta
- University Hospital De La Princesa, Madrid, Spain
| | - G Ndrepepa
- Deutsches Herzzentrum Muenchen Technical University of Munich, Munich, Germany
| | - S Cassese
- Deutsches Herzzentrum Muenchen Technical University of Munich, Munich, Germany
| | | | - S Kufner
- Deutsches Herzzentrum Muenchen Technical University of Munich, Munich, Germany
| | | | | | - N Gonzalo
- Hospital Clinic San Carlos, Madrid, Spain
| | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
| | - A Kastrati
- Deutsches Herzzentrum Muenchen Technical University of Munich, Munich, Germany
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Kufner S, Ferenc M, Schlundt C, Hoppmann P, Abdel-Wahab M, Cassese S, Joner M, Xhepa E, Fusaro M, Schunkert H, Laugwitz KL, Neumann FJ, Byrne RA, Kastrati A. P4559Outcome after single-layer polytetrafluoroethylene-covered stent implantation for the treatment of coronary artery perforation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Kufner
- Deutsches Herzzentrum München, Munich, Germany
| | - M Ferenc
- University Heart Center Freiburg-Bad Krozingen, Cardiology, Bad Krozingen, Germany
| | - C Schlundt
- University Hospital Erlangen, Erlangen, Germany
| | - P Hoppmann
- Technical University of Munich, 1. medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Munich, Germany
| | - M Abdel-Wahab
- University Heart Center Freiburg-Bad Krozingen, Cardiology, Bad Krozingen, Germany
| | - S Cassese
- Deutsches Herzzentrum München, Munich, Germany
| | - M Joner
- Deutsches Herzzentrum München, Munich, Germany
| | - E Xhepa
- Deutsches Herzzentrum München, Munich, Germany
| | - M Fusaro
- Deutsches Herzzentrum München, Munich, Germany
| | - H Schunkert
- Deutsches Herzzentrum München, Munich, Germany
| | - K.-L Laugwitz
- Technical University of Munich, 1. medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Munich, Germany
| | - F.-J Neumann
- University Heart Center Freiburg-Bad Krozingen, Cardiology, Bad Krozingen, Germany
| | - R A Byrne
- Deutsches Herzzentrum München, Munich, Germany
| | - A Kastrati
- Deutsches Herzzentrum München, Munich, Germany
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Xhepa E, Byrne RA, Rivero F, Rroku A, Cuesta J, Kufner S, Bastante Valiente T, Cassese S, Garcia-Guimaraes M, Schunkert H, Joner M, Perez-Vizcayno MJ, Gonzalo N, Alfonso F, Kastrati A. P2273Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Xhepa
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - R A Byrne
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - F Rivero
- University Hospital De La Princesa, Madrid, Spain
| | - A Rroku
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - J Cuesta
- University Hospital De La Princesa, Madrid, Spain
| | - S Kufner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | | | - S Cassese
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | | | - H Schunkert
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M Joner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | | | - N Gonzalo
- Hospital Clinic San Carlos, Madrid, Spain
| | - F Alfonso
- University Hospital De La Princesa, Madrid, Spain
| | - A Kastrati
- University Hospital De La Princesa, Madrid, Spain
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Colleran R, Kufner S, Rosenbeiger C, Joner M, Cassese S, Ott I, Fusaro M, Ibrahim T, Laugwitz KL, Abdel-Wahab M, Neumann F, Richardt G, Kastrati A, Byrne R. 3122Longterm comparative efficacy of drug-eluting stents versus bare metal stents in saphenous vein graft lesions: 5-year clinical follow-up of a randomized trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R. Colleran
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S. Kufner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - C. Rosenbeiger
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M. Joner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S. Cassese
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - I. Ott
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M. Fusaro
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - T. Ibrahim
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - K.-L. Laugwitz
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | | | - F.J. Neumann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - A. Kastrati
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - R.A. Byrne
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
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9
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Colleran R, Harada Y, Kufner S, Giacoppo D, Joner M, Cassese S, Ibrahim T, Laugwitz KL, Kastrati A, Byrne R. P3303Changes in high-sensitivity troponin after drug-coated balloon angioplasty for drug-eluting stent restenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R. Colleran
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - Y. Harada
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S. Kufner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - D. Giacoppo
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - M. Joner
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - S. Cassese
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - T. Ibrahim
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - K.-L. Laugwitz
- 1. medizinische Klinik, Klinikum rechts der Isar, Technische Universität, Munich, Germany
| | - A. Kastrati
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
| | - R.A. Byrne
- Deutsches Herzzentrum Technische Universitat, Munich, Germany
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10
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Kufner S, Ndrepepa G, Hoyos M, Cassese S, Byrne R, Colleran R, Fusaro M, Ott I, Laugwitz KL, Kastrati A. P4680Comparative prognostic value of postprocedural CK-MB and high-sensitivity troponin T in patients with non-ST-segment elevation myocardial infarction undergoing PCI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Koskinas K, Ndrepepa G, Raeber L, Kufner S, Karagiannis A, Zanchin T, Hieber J, Hunziker L, Byrne R, Heg D, Windecker S, Kastrati A. 5704Validation of the SCAI definition of periprocedural myocardial infarction for prediction of one-year mortality following elective percutaneous coronary interventions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Hoppmann P, Kufner S, Cassese S, Wiebe J, Schneider S, Pinieck S, Scheler L, Bernlochner I, Joner M, Schunkert H, Laugwitz KL, Kastrati A, Byrne RA. Angiographic and clinical outcomes of patients treated with everolimus-eluting bioresorbable stents in routine clinical practice: Results of the ISAR-ABSORB registry. Catheter Cardiovasc Interv 2015; 87:822-9. [PMID: 26708019 DOI: 10.1002/ccd.26346] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 06/25/2015] [Accepted: 11/08/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed to analyze angiographic and clinical results of patients undergoing BRS implantation in a real-world setting. BACKGROUND Angiographic and clinical outcome data from patients undergoing implantation of drug-eluting bioresorbable stents (BRS) in routine clinical practice is scant. METHODS Consecutive patients undergoing implantation of everolimus-eluting BRS at two high-volume centers in Munich, Germany were enrolled. Data were collected prospectively. All patients were scheduled for angiographic surveillance 6-8 months after stent implantation. Quantitative coronary angiographic analysis was performed in a core laboratory. Clinical follow-up was performed to 12 months and events were adjudicated by independent assessors. RESULTS A total of 419 patients were studied. Mean age was 66.6 ± 10.9 years, 31.5% had diabetes mellitus, 76.1% had multivessel disease, and 39.0% presented with acute coronary syndrome; 49.0% of lesions were AHA/ACC type B2/C, 13.1% had treatment of bifurcation lesions. Mean reference vessel diameter was 2.89 ± 0.46 mm. At angiographic follow-up in-stent late loss was 0.26 ± 0.51 mm, in-segment diameter stenosis was 27.5 ± 16.1, and binary angiographic restenosis was 7.5%. At 12 months, the rate of death, myocardial infarction, or target lesion revascularization was 13.1%. Definite stent thrombosis occurred in 2.6%. CONCLUSIONS The use of everolimus-eluting BRS in routine clinical practice is associated with high antirestenotic efficacy in patients undergoing angiographic surveillance. Overall clinical outcomes at 12 months are satisfactory though stent thrombosis rates are not insignificant. Further study with longer term follow-up and larger numbers of treated patients is required before we can be sure of the role of these devices in clinical practice.
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Affiliation(s)
- P Hoppmann
- 1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - S Kufner
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - S Cassese
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - J Wiebe
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - S Schneider
- 1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - S Pinieck
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - L Scheler
- 1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - I Bernlochner
- 1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - M Joner
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
| | - H Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, am Institut für Pharmakologie und Toxikologie der Technischen Universität München Biedersteiner Str. 29, 80802, München
| | - K-L Laugwitz
- 1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany.,DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, am Institut für Pharmakologie und Toxikologie der Technischen Universität München Biedersteiner Str. 29, 80802, München
| | - A Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.,DZHK, German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, am Institut für Pharmakologie und Toxikologie der Technischen Universität München Biedersteiner Str. 29, 80802, München
| | - R A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany
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Groha P, Kufner S, Ott I, Schunkert H. [New ESH/ESC guidelines on arterial hypertension : what is new and what indications remain for renal denervation?]. Herz 2015; 39:952-6. [PMID: 25384853 DOI: 10.1007/s00059-014-4178-y] [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: 01/13/2023]
Abstract
Arterial hypertension is one of the most common diseases in the western world and one of the most important risk factors for other cardiovascular diseases. Despite widespread therapeutic options, there is still a large proportion of patients with uncontrolled hypertension. The new European guidelines on hypertension give clear lines of action for diagnosis and treatment sorted into appropriate evidence levels based on current scientific data. Such evidence is still unclear for renal denervation so that no clear recommendations can be given.
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Affiliation(s)
- P Groha
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland,
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Schulz-Schupke S, Byrne RA, ten Berg JM, Neumann FJ, Han Y, Adriaenssens T, Tolg R, Seyfarth M, Maeng M, Zrenner B, Jacobshagen C, Mudra H, von Hodenberg E, Wohrle J, Angiolillo DJ, von Merzljak B, Rifatov N, Kufner S, Morath T, Feuchtenberger A, Ibrahim T, Janssen PWA, Valina C, Li Y, Desmet W, Abdel-Wahab M, Tiroch K, Hengstenberg C, Bernlochner I, Fischer M, Schunkert H, Laugwitz KL, Schomig A, Mehilli J, Kastrati A. ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. Eur Heart J 2015; 36:1252-63. [DOI: 10.1093/eurheartj/ehu523] [Citation(s) in RCA: 321] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/11/2014] [Indexed: 11/14/2022] Open
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15
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Schulz S, Richardt G, Laugwitz KL, Morath T, Neudecker J, Hoppmann P, Mehran R, Gershlick AH, Tolg R, Anette Fiedler K, Abdel-Wahab M, Kufner S, Schneider S, Schunkert H, Ibrahim T, Mehilli J, Kastrati A, Kastrati A, Mehilli J, Richardt G, Mehran R, Gershlick A, Mehilli J, Burgdorf C, Byrne RA, Cassese S, Fusaro M, Hausleiter J, Hengstenberg C, Joner M, Kasel M, Kastrati A, Massberg S, Ott I, Pache J, Schunkert H, Seyfarth M, Sibbing D, Tiroch K, Laugwitz KL, Ibrahim T, Hoppmann P, Schneider S, Bradaric C, Richardt G, Abdel-Wahab M, Geist V, Schwarz B, Sulimov D, Tolg R, Schulz S, Schomig G, von Merzljak B, Luckmann J, Ruf J, Morath T, Holle H, Paul H, Vogel J, Hoesl K, Rifatov N, Pastor I, Maimer-Rodrigues F, Schulz M, Neudecker J, Mayer K, Hofmann F, Mann J, Hauschke D, Schmitt C, Poci D, Barthel P, Ndrepepa G, Keta D, Byrne RA, Kufner S, Piniek S, Hurt S, Kastrati S, Anette Fiedler K. Prasugrel plus bivalirudin vs. clopidogrel plus heparin in patients with ST-segment elevation myocardial infarction. Eur Heart J 2014; 35:2285-94. [DOI: 10.1093/eurheartj/ehu182] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Kufner S, Byrne RA, De Waha A, Schulz S, Joner M, Kastrati A. Sirolimus-eluting vs. paclitaxel-eluting stents in diabetic and non-diabetic patients with in "LIMUS"-stent restennosis, results from the ISAR DESIRE 2 trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Dreyssig J, Kremser A, Liepert A, Grabrucker C, Freudenreich M, Schmid C, Kroell T, Scholl N, Tischer J, Kufner S, Salih H, Kolb HJ, Schmetzer HM. Various ‘dendritic cell antigens’ are already expressed on uncultured blasts in acute myeloid leukemia and myelodysplastic syndromes. Immunotherapy 2011; 3:1113-24. [DOI: 10.2217/imt.11.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim and methods: Leukemia-derived dendritic cells (DCleu) potentially present the whole leukemic antigen repertoire. We studied antigen-expression profiles of blasts/dendritic cells (DCs) generated from 137 acute myeloid leukemia (AML)/49 myelodysplastic syndromes (MDS) patients with six different DC-generating media by flow-cytometry combining expression of blast/maturation and DC antigens (DCA:CD1a,b,c, CD25, CD40, CD80, CD83, CD86, CD137-L and CD206). Results: First, DCA are regularly and variably expressed on uncultured blasts/mononuclear cells (MNCs). Individual patients’ DCA profiles must be evaluated before DC-culture to find suitable DCA to estimate quality/quantity of DC after culture. Second, after culture in every patient, at least one marker fulfilled these criteria. Third, different DC-generating methods showed varying efficiency to generate DC: not every method was always successful. Fourth, individual FACS-DCA profiles showed a successful DC/DCleu generation with at least one of three previously tested methods in every given AML/MDS case. Fifth, pooling results of all selected best methods in every given case, 28/30% DC were generated from AML/MDS samples: >60% viable DC, on average 49/56% mature DC and on average 36% of blasts were convertible to DCleu resulting in on average 49% DCleu of AML-DC. Conclusions: Individual DCA-expression profiles should be evaluated before culture to evaluate DC counts/subtypes (mature/viableDC, DCleu) in individual patients.
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Affiliation(s)
- Julia Dreyssig
- Medical Department III, University Hospital Großhadern, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Kremser
- Medical Department III, University Hospital Großhadern, Ludwig-Maximilians-University, Munich, Germany
| | - Anja Liepert
- Medical Department III, University Hospital Großhadern, Ludwig-Maximilians-University, Munich, Germany
| | - Christine Grabrucker
- Medical Department III, University Hospital Großhadern, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Freudenreich
- Medical Department III, University Hospital Großhadern, Ludwig-Maximilians-University, Munich, Germany
| | | | - Tanja Kroell
- Medical Department III, University Hospital Großhadern, Ludwig-Maximilians-University, Munich, Germany
| | - Nina Scholl
- Medical Department III, University Hospital Großhadern, Ludwig-Maximilians-University, Munich, Germany
| | - Johanna Tischer
- Medical Department III, University Hospital Großhadern, Ludwig-Maximilians-University, Munich, Germany
| | - Stephany Kufner
- Medical Department III, University Hospital Großhadern, Ludwig-Maximilians-University, Munich, Germany
| | - Helmut Salih
- Department of Internal Medicine II, University Hospital of the Eberhard Karls University, Tuebingen, Germany
| | - Hans-Jochem Kolb
- Medical Department III, University Hospital Großhadern, Ludwig-Maximilians-University, Munich, Germany
- Helmholtz Center Munich, German Research Center for Environmental Health/Clinical Cooperative Group Haematopoetic Cell Transplantation (CCG-HCT), Marchioninistr. 15, 81377 Munich, Germany
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Byrne RA, Kufner S, Tiroch K, Massberg S, Laugwitz KL, Birkmeier A, Schulz S, Mehilli J. Randomised trial of three rapamycin-eluting stents with different coating strategies for the reduction of coronary restenosis: 2-year follow-up results. Heart 2009; 95:1489-94. [DOI: 10.1136/hrt.2009.172379] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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19
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Kufner S, Fleischer RP, Kroell T, Schmid C, Zitzelsberger H, Salih H, Valle FD, Treder W, Schmetzer HM. Serum-free generation and quantification of functionally active Leukemia-derived DC is possible from malignant blasts in acute myeloid leukemia and myelodysplastic syndromes. Cancer Immunol Immunother 2005; 54:953-70. [PMID: 15789235 PMCID: PMC11032985 DOI: 10.1007/s00262-004-0657-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Accepted: 12/06/2004] [Indexed: 11/30/2022]
Abstract
Functional dendritic cells (DC) are professional antigen presenting cells (APC) and can be generated in vitro from leukemic cells from acute myeloid leukemia AML patients, giving rise to APC of leukemic origin presenting leukemic antigens (DC(leu)). We have already shown that DC can be successfully generated from AML and myeloplastic syndromes (MDS) cells in serum-free 'standard' medium (X-vivo + GM-CSF + IL-4 +TNFalpha + FL) in 10-14 days. In this study, we present that DC counts generated from mononuclear cells (MNC) varied between 20% (from 55 MDS samples), 34% (from 100 AML samples) and 25% (from 38 healthy MNC samples) medium. Between 53% and 58% of DC are mature CD83+ DC. DC harvests were highest in monocytoid FAB types (AML-M4/M5, MDS-CMML) and independent from cytogenetic risk groups, demonstrating that DC-based strategies can be applied for patients with all cytogenetic risk groups. Proof of the clonal derivation of DC generated was obtained in five AML and four MDS cases with a combined FISH/immunophenotype analysis (FISH-IPA): The clonal numerical chromosome aberrations of the diseases were regularly codetectable with DC markers; however, not with all clonal cells being convertible to leukemia-derived DC(leu) (on average, 53% of blasts in AML or MDS). To the contrary, not all DC generated carried the clonal aberration (on average, 51% of DC). In 41 AML and 13 MDS cases with a suitable antigen expression, we could confirm FISH-IPA data by Flow cytometry: although DC(leu) are regularly detectable, on average only 57% of blasts in AML and 64% of blasts in MDS were converted to DC(leu). After coculture with DC in mixed lymphocyte reactions (MLR), autologous T cells from AML and MDS patients proliferate and upregulate costimulatory receptors. The specific lysis of leukemic cells by autologous T cells could be demonstrated in three cases with AML in a Fluorolysis assay. In six cases with only few DC(leu) or few vital T cells available after the DC/MLR procedure, no lysis of allogeneic or autologous leukemic cells was seen, pointing to the crucial role of both partners in the lysis process. We conclude: (1) the generation of DC is regularly possible in AML and also in MDS under serum-free conditions. (2) Clonal/leukemia-derived DC(leu) can be regularly generated from MDS and AML-MNC; however, not with all blasts being converted to DC(leu) and not all DC generated carrying leukemic markers. We recommend to select DC(leu) for vaccinations or ex vivo T-cell activations to avoid contaminations with non-converted blasts and non-leukemia-derived DC and to improve the harvest of specific, anti-leukemic T cells. DC and DC-primed T cells could provide a practical strategy for the immunotherapy of AML and MDS.
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Affiliation(s)
- S. Kufner
- Medical Department III, Klinikum Grosshadern, University of Munich, Marchioninistr 15, 81377 Munich, Germany
| | - R. Pelka Fleischer
- Medical Department III, Klinikum Grosshadern, University of Munich, Marchioninistr 15, 81377 Munich, Germany
| | - T. Kroell
- Medical Department III, Klinikum Grosshadern, University of Munich, Marchioninistr 15, 81377 Munich, Germany
| | - C. Schmid
- Medical Department III, Klinikum Grosshadern, University of Munich, Marchioninistr 15, 81377 Munich, Germany
| | | | - H. Salih
- Medical Department, University of Tuebingen, Germany
| | | | - W. Treder
- Municipial Hospital Oldenburg, Germany
| | - H. M. Schmetzer
- Medical Department III, Klinikum Grosshadern, University of Munich, Marchioninistr 15, 81377 Munich, Germany
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20
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Kufner S, Zitzelsberger H, Kroell T, Pelka-Fleischer R, Salem A, de Valle F, Schweiger C, Nuessler V, Schmid C, Kolb HJ, Schmetzer HM. Leukemia-Derived Dendritic Cells can be Generated from Blood or Bone Marrow Cells from Patients with Acute Myeloid Leukaemia: A Methodological Approach under Serum-Free Culture Conditions. Scand J Immunol 2005; 62:86-98. [PMID: 16091128 DOI: 10.1111/j.1365-3083.2005.01630.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Functional dendritic cells (DC) are professional antigen-presenting cells (APC) and can be generated in vitro from healthy as well as from leukaemic cells from acute myeloid leukemia (AML) patients giving rise to APC of leukaemic origin-presenting leukaemic antigens. We describe the generation and characterization of DC from different mononuclear cell (MNC) fractions from 50 AML patients under different serum-free culture conditions, determine the optimal culture conditions and compare the results with that from 23 healthy donors. In parallel cultures, we compared DC harvests after 7- or 14-day culture, with total or adherent MNC or T-cell depleted MNC or peripheral blood (PB) or bone marrow-MNC (BM-MNC), thawn or fresh MNC, in Xvivo or CellGro serum-free media, +/-10% autologous plasma or +/-FL. In detail, we could show that AML-DC harvests were higher after 10-14 days culture (healthy DC: 7 days); total or adherent PB or BM-MNC fractions yield comparable DC counts, however, from magnetic cell sorting (MACS)-depleted MNC fractions or thawn MNC lower DC counts can be generated. Whereas the addition of FL increases the DC harvest, the addition of autologous plasma in many cases has inhibitory influence on DC maturation. CellGro and Xvivo media yield comparable DC counts. Optimal harvest of vital and mature DC from AML samples was obtained with a granulocyte/macrophage-colony stimulating factor, interleukin-4, FL and tumour necrosis factor-alpha-containing serum-free Xvivo medium after 10-14 days of culture (36/26% DC; 38/64% vital DC; 46/51% mature DC were generated from AML/healthy MNC samples). Surface marker profiles (e.g. costimulatory antigen expressing) of DC obtained from AML samples were comparable with that of healthy DC. The leukaemic derivation of AML-DC was demonstrated by the persistence of the clonal cytogenetic aberration in the DC or by coexpression of leukaemic antigens on DC. Autologous T-cell activation of leukaemia-derived DC was demonstrated in cases with AML. Autologous T cells proliferate and upregulate DC-contact-relevant antigens. We demonstrate that the generation of leukaemia-derived DC is feasable in AML under serum-free culture conditions giving rise to DC with comparable characteristics as healthy DC and offering an anti-leukaemia-directed immunotherapeutical vaccination strategy in AML.
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Affiliation(s)
- S Kufner
- Medical Department III, Klinikum Grosshadern, University of Munich, Munich, Germany
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21
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Kufner S, Zitzelsberger H, Kroell T, Pelka-Fleischer R, Salem A, de Valle F, Schmid C, Schweiger C, Kolb HJ, Schmetzer HM. Leukaemia-Derived Dendritic Cells Can Be Generated From Blood or Bone Marrow Cells From Patients With Myelodysplasia: A Methodological Approach Under Serum-Free Culture Conditions. Scand J Immunol 2005; 62:75-85. [PMID: 16091127 DOI: 10.1111/j.1365-3083.2005.01631.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Functional dendritic cells (DC) are professional antigen-presenting cells (APC) and can be generated in vitro from healthy as well as from leukaemic cells from AML patients giving rise to APC of leukaemic origin presenting leukaemic antigens. In a comparative methodological analysis of 50 AML samples, we could already show that leukaemia-derived DC can regularly be generated under serum-free culture conditions. In this study, we describe the generation and characterization of DC from different mononuclear cell (MNC) fractions from 24 myelodysplastic syndrome (MDS) patients under those different serum-free culture conditions, determine the optimal culture conditions and compare the results with that from 23 healthy donors. In parallel cultures, we compared DC harvests after 7- or 14-day culture, with total or adherent MNC or T-cell-depleted MNC or PB or BM-MNC, thawn or fresh MNC, in Xvivo or CellGro serum-free media, +/-10% autologous plasma or +/-FL. In detail, we could show that MDS-DC harvests compared to healthy DC were higher after 10- to 14-day culture; total or adherent PB or BM-MNC fractions yield comparable DC counts; however, from MACS-depleted MNC fractions or thawn MNC lower DC counts can be generated. Whereas the addition of FL increases the DC harvest, the addition of autologous plasma in many cases has inhibitory influence on DC maturation, CellGro and Xvivo media yield comparable DC counts. Optimal harvest of vital and mature DC from MDS samples was obtained with a GM-CSF, IL-4, FL and TNF-alpha containing serum-free Xvivo medium after 10-14 days of culture (18/26% DC; 54/64% vital DC; 59/51% mature DC were generated from MDS/healthy MNC samples). Surface marker profiles (e.g. costimulatory antigen expression) of DC obtained from MDS samples were comparable with that of healthy DC. The leukaemic derivation of MDS-DC was demonstrated by the persistence of the clonal cytogenetic aberration in the DC or by coexpression of leukaemic antigens on DC. Autologous T-cell activation of leukaemia-derived DC was demonstrated in cases with MDS. Autologous T cells proliferate and upregulate DC-contact-relevant antigens. We are the first who demonstrate that the generation of leukaemia-derived DC is feasible not only in AML but also in MDS under serum-free culture conditions giving rise to DC with comparable characteristics as healthy DC and offering an antileukaemia-directed immunotherapeutical vaccination strategy in AML and MDS.
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Affiliation(s)
- S Kufner
- Medical Department III, Klinikum Grosshadern, University of Munich, Munich, Germany
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Kufner S, Kufner M, Frank M, Muller A, Brenner KH. 3D integration of refractive microoptical components by deep proton irradiation. ACTA ACUST UNITED AC 1999. [DOI: 10.1088/0963-9659/2/2/004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lazare S, Lopez J, Turlet JM, Kufner M, Kufner S, Chavel P. Microlenses fabricated by ultraviolet excimer laser irradiation of poly(methyl methacrylate) followed by styrene diffusion. Appl Opt 1996; 35:4471-4475. [PMID: 21102861 DOI: 10.1364/ao.35.004471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A new technique of microlens array fabrication based on the use of excimer laser radiation is described. Poly(methyl methacrylate) (PMMA) substrates are treated with many low-energy KrF laser pulses and exposed to styrene vapor. The irradiated material swells, producing spherical microlenses that are stabilized by UV polymerization. The chemistry of this process and the optical quality of the lenses are discussed.
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Kufner M, Kufner S, Chavel P, Frank M. Monolithic integration of microlens arrays and fiber holder arrays in poly(methyl methacrylate) with fiber self-centering. Opt Lett 1995; 20:276-278. [PMID: 19859159 DOI: 10.1364/ol.20.000276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
For many fiber applications the precise spacing from one fiber to another and the collimation of the outgoing light are important subjects. In the case of three-dimensional arrangements, such as fiber arrays, the complexity increases. The method of proton irradiation of poly(methyl methacrylate) permits the fabrication of slightly fan-shaped fiber holder arrays that can correct inhomogeneities of the fiber diameters in the micrometer range. Even a three-dimensional monolithic integration of fiber holders and corresponding microlenses can be achieved.
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Brenner KH, Kufner M, Kufner S, Moisel J, Müller A, Sinzinger S, Testorf M, Göttert J, Mohr J. Application of three-dimensional micro-optical components formed by lithography, electroforming, and plastic molding. Appl Opt 1993; 32:6464-6469. [PMID: 20856485 DOI: 10.1364/ao.32.006464] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Micro-optics is usually associated with planar waveguides or integrated optical circuits. In this case the propagation of light is restricted to one or two dimensions, and the three-dimensional nature of light propagation is disregarded. We present a method of fabricating three-dimensional micro-optical components by the so-called LIGA process, a lithography, electroforming, and plastic molding process in which poly(methyl methacrylate) is structured by high-energy synchrotron radiation. We demonstrate an experimental system of image formation that uses microprisms and microlenses for a threedimensional microintegration of optical components.
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Frank M, Kufner M, Kufner S, Testorf M. Microlenses in polymethyl methacrylate with high relative aperture. Appl Opt 1991; 30:2666-2667. [PMID: 20700257 DOI: 10.1364/ao.30.002666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Lens arrays with relative apertures as high as 1 can be fabricated in polymethyl methacrylate with a high-energy H+b eam and diffusion of styrene in the irradiatedd omains.
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Abstract
Optical structures in polymethylmethacrylate can be generated with a high energy H(+) beam. The depth of the structures is up to 1 mm. We describe this new technique and demonstrate first results.
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Brenner KH, Kufner M, Kufner S. Highly parallel arithmetic algorithms for a digital optical processor using symbolic substitution logic. Appl Opt 1990; 29:1610-1618. [PMID: 20563051 DOI: 10.1364/ao.29.001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Symbolic substitution logic is a powerful tool for realizing optical arithmetic in a digital optical processor, because it is matched to the parallelism of optics and to the properties of optical switching devices. Working with such processor enables the use of very efficient parallel algorithms. We have investigated the implemention of the basic arithmetic operations: addition, subtraction, multiplication, and division.
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