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Lambers L, Waschinsky N, Schleicher J, König M, Tautenhahn HM, Albadry M, Dahmen U, Ricken T. Quantifying fat zonation in liver lobules: an integrated multiscale in silico model combining disturbed microperfusion and fat metabolism via a continuum biomechanical bi-scale, tri-phasic approach. Biomech Model Mechanobiol 2024; 23:631-653. [PMID: 38402347 DOI: 10.1007/s10237-023-01797-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/22/2023] [Indexed: 02/26/2024]
Abstract
Metabolic zonation refers to the spatial separation of metabolic functions along the sinusoidal axes of the liver. This phenomenon forms the foundation for adjusting hepatic metabolism to physiological requirements in health and disease (e.g., metabolic dysfunction-associated steatotic liver disease/MASLD). Zonated metabolic functions are influenced by zonal morphological abnormalities in the liver, such as periportal fibrosis and pericentral steatosis. We aim to analyze the interplay between microperfusion, oxygen gradient, fat metabolism and resulting zonated fat accumulation in a liver lobule. Therefore we developed a continuum biomechanical, tri-phasic, bi-scale, and multicomponent in silico model, which allows to numerically simulate coupled perfusion-function-growth interactions two-dimensionally in liver lobules. The developed homogenized model has the following specifications: (i) thermodynamically consistent, (ii) tri-phase model (tissue, fat, blood), (iii) penta-substances (glycogen, glucose, lactate, FFA, and oxygen), and (iv) bi-scale approach (lobule, cell). Our presented in silico model accounts for the mutual coupling between spatial and time-dependent liver perfusion, metabolic pathways and fat accumulation. The model thus allows the prediction of fat development in the liver lobule, depending on perfusion, oxygen and plasma concentration of free fatty acids (FFA), oxidative processes, the synthesis and the secretion of triglycerides (TGs). The use of a bi-scale approach allows in addition to focus on scale bridging processes. Thus, we will investigate how changes at the cellular scale affect perfusion at the lobular scale and vice versa. This allows to predict the zonation of fat distribution (periportal or pericentral) depending on initial conditions, as well as external and internal boundary value conditions.
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Affiliation(s)
- Lena Lambers
- Institute of Structural Mechanics and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, Stuttgart, 70191, Germany
| | - Navina Waschinsky
- Institute of Structural Mechanics and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, Stuttgart, 70191, Germany
| | - Jana Schleicher
- Friedrich-Schiller-Universität Jena, Fürstengraben 27, Jena, 07743, Germany
| | - Matthias König
- Systems Medicine of Liver, Institute for Theoretical Biology, Institute for Biology, Humboldt-University Berlin, Philippstraße 13, 10115 Berlin, Germany
| | - Hans-Michael Tautenhahn
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Liebigstraße 20, Leipzig, 04103, Germany
| | - Mohamed Albadry
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Drackendorfer Straße 1, Jena, 07747, Germany
- Department of Pathology, Faculty of Veterinary Medicine, Menoufia University, Shebin Elkom, Menoufia, Egypt
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Drackendorfer Straße 1, Jena, 07747, Germany
| | - Tim Ricken
- Institute of Structural Mechanics and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Pfaffenwaldring 27, Stuttgart, 70191, Germany.
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Xu F, Dirsch O, Dahmen U. Causal relationship between psychological factors and hepatocellular carcinoma as revealed by Mendelian randomization. J Cancer Res Clin Oncol 2024; 150:100. [PMID: 38383696 PMCID: PMC10881603 DOI: 10.1007/s00432-024-05617-5] [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: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE The impact of psychological factors on the incidence of hepatocellular carcinoma (HCC) in humans remains unclear. Mendelian randomization (MR) study is a novel approach aimed at unbiased detection of causal effects. Therefore, we conducted a two-sample MR to determine if there is a causal relationship between psychological distress (PD), participation in leisure/social activities of religious groups (LARG), and HCC. METHODS The genetic summary data of exposures and outcome were retrieved from genome-wide association studies (GWAS). We used PD and LARG as exposures and HCC as outcome. Five MR methods were used to investigate the causal relationship between PD, LARG, and HCC. The result of inverse variance weighted (IVW) method was deemed as principal result. Besides, we performed a comprehensive sensitivity analysis to verify the robustness of the results. RESULTS The IVW results showed that PD [odds ratio (OR) 1.006, 95% confidence interval (CI) 1.000-1.011, P = 0.033] and LARG (OR 0.994, 95% CI 0.988-1.000, P = 0.035) were causally associated with the incidence of HCC. Sensitivity analysis did not identify any bias in the results. CONCLUSION PD turned out to be a mild risk factor for HCC. In contrast, LARG is a protective factor for HCC. Therefore, it is highly recommended that people with PD are seeking positive leisure activities such as participation in formal religious social activities, which may help them reduce the risk of HCC.
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Affiliation(s)
- Fengming Xu
- Department of Infectious Diseases, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
- Else Kröner Graduate School for Medical Students "JSAM", Jena University Hospital, 07747, Jena, Germany
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747, Jena, Germany
| | - Olaf Dirsch
- Institute of Pathology, Klinikum Chemnitz gGmbH, 09111, Chemnitz, Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747, Jena, Germany.
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Xu F, Dirsch O, Dahmen U. Causal Relationship between Angina and Hepatic Failure as Revealed by Mendelian Randomization. J Clin Med 2024; 13:449. [PMID: 38256583 PMCID: PMC10816156 DOI: 10.3390/jcm13020449] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/07/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Patients with angina are often suffering from comorbidities such as varying degrees of hepatic dysfunction. However, the impact of angina on the incidence of hepatic failure (HF) remains unclear. METHODS The genetic data were retrieved from genome-wide association studies. Five Mendelian randomization methods were used to investigate the causal relationship between unstable angina (UA), stable angina (SA), and HF. The result of the Inverse variance weighted (IVW) method was deemed the principal result. In addition, we performed a comprehensive sensitivity analysis to verify the robustness of the results. RESULTS The IVW results showed that UA (Odds ratio (OR): 2.055, 95% confidence interval (CI): 1.171-3.606, p = 0.012) was causally associated with the incidence of HF. SA (OR: 1.122, 95% CI: 0.738-1.706, p = 0.591) was not causally associated with the incidence of HF. Sensitivity analysis did not identify any bias in the results. CONCLUSIONS UA turned out to be a risk factor for HF. SA does not have a significant causal effect on HF. Therefore, it is highly recommended that patients with chronic liver disease seek prompt medical attention and undergo regular monitoring of liver function when experiencing UA. This may help them to reduce the risk of HF.
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Affiliation(s)
- Fengming Xu
- Department of Infectious Diseases, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, China;
- Else Kröner Graduate School for Medical Students “JSAM”, Jena University Hospital, 07747 Jena, Germany
| | - Olaf Dirsch
- Institute of Pathology, Klinikum Chemnitz gGmbH, 09111 Chemnitz, Germany;
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany
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Tekbaş A, Bremer-Streck S, Wissenbach DK, Peters FT, von Lilienfeld-Toal M, Soonawalla Z, Rauchfuß F, Settmacher U, Dahmen U. Gas Chromatography-Mass Spectrometry Detection of Thymoquinone in Oil and Serum for Clinical Pharmacokinetic Studies. Int J Mol Sci 2023; 24:16431. [PMID: 38003621 PMCID: PMC10671713 DOI: 10.3390/ijms242216431] [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: 09/25/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Thymoquinone (TQ) is the primary component of Nigella sativa L. (NS) oil, which is renowned for its potent hepatoprotective effects attributed to its antioxidant, anti-fibrotic, anti-inflammatory, anti-carcinogenic, and both anti- and pro-apoptotic properties. The aim of this work was to establish a method of measuring TQ in serum in order to investigate the pharmacokinetics of TQ prior to a targeted therapeutic application. In the first step, a gas chromatography-mass spectrometry method for the detection and quantification of TQ in an oily matrix was established and validated according to European Medicines Agency (EMA) criteria. For the assessment of the clinical application, TQ concentrations in 19 oil preparations were determined. Second, two serum samples were spiked with TQ to determine the TQ concentration after deproteinization using toluene. Third, one healthy volunteer ingested 1 g and another one 3 g of a highly concentrated NS oil 30 and 60 min prior to blood sampling for the determination of serum TQ level. After the successful establishment and validation of the measurement method, the highest concentration of TQ (36.56 g/L) was found for a bottled NS oil product (No. 1). Since a capsule is more suitable for oral administration, the product with the third highest TQ concentration (No. 3: 24.39 g/L) was used for all further tests. In the serum samples spiked with TQ, the TQ concentration was reliably detectable in a range between 5 and 10 µg/mL. After oral intake of NS oil (No. 3), however, TQ and/or its derivatives were not detectable in human serum. This discrepancy in detecting TQ after spiking serum or following oral ingestion may be attributed to the instability of TQ in biomatrices as well as its strong protein binding properties. A pharmacokinetics study was therefore not viable. Studies on isotopically labeled TQ in an animal model are necessary to study the pharmacokinetics of TQ using alternative modalities.
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Affiliation(s)
- A. Tekbaş
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
- Research Programme “Clinician Scientist Programme”, Interdisciplinary Center of Clinical Research, Medical Faculty Jena, Jena University Hospital, Friedrich Schiller University Jena, Salvador-Allende-Platz 29, 07747 Jena, Germany
- Experimental Transplantation Surgery, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - S. Bremer-Streck
- Institute of Clinical Chemistry and Laboratory Diagnostics, Centralised Diagnostic Laboratory Services, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - D. K. Wissenbach
- Institute for Forensic Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - F. T. Peters
- Institute for Forensic Medicine, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - M. von Lilienfeld-Toal
- Institute for Diversity Medicine, Ruhr-University Bochum, Universitaetsstr. 105, 44789 Bochum, Germany
| | - Z. Soonawalla
- Hepato-Pancreato-Biliary Surgery, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - F. Rauchfuß
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - U. Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - U. Dahmen
- Experimental Transplantation Surgery, Jena University Hospital, Friedrich Schiller University Jena, Am Klinikum 1, 07747 Jena, Germany
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Chen H, Dirsch O, Albadry M, Ana PH, Dahmen U. Normothermic Ex Vivo Liver Machine Perfusion in Mouse. J Vis Exp 2023. [PMID: 37811934 DOI: 10.3791/65363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
This protocol presents an optimized erythrocytes-free NEVLP system using mouse livers. Ex vivo preservation of mouse livers was achieved by employing modified cannulas and techniques adapted from conventional commercial ex vivo perfusion equipment. The system was utilized to evaluate the preservation outcomes following 12 h of perfusion. C57BL/6J mice served as liver donors, and the livers were explanted by cannulating the portal vein (PV) and bile duct (BD), and subsequently flushing the organ with warm (37 °C) heparinized saline. Then, the explanted livers were transferred to the perfusion chamber and subjected to normothermic oxygenated machine perfusion (NEVLP). Inlet and outlet perfusate samples were collected at 3 h intervals for perfusate analysis. Upon completion of the perfusion, liver samples were obtained for histological analysis, with morphological integrity assessed using modified Suzuki-Score through Hematoxylin-Eosin (HE) staining. The optimization experiments yielded the following findings: (1) mice weighing over 30 g were deemed more suitable for the experiment due to the larger size of their bile duct (BD). (2) a 2 Fr (outer diameter = 0.66 mm) polyurethane cannula was better suited for cannulating the portal vein (PV) when compared to a polypropylene cannula. This was attributed to the polyurethane material's enhanced grip, resulting in reduced catheter slippage during the transfer from the body to the organ chamber. (3) for cannulation of the bile duct (BD), a 1 Fr (outer diameter = 0.33 mm) polyurethane cannula was found to be more effective compared to the polypropylene UT - 03 (outer diameter = 0.30 mm) cannula. With this optimized protocol, mouse livers were successfully preserved for a duration of 12 h without significant impact on the histological structure. Hematoxylin-Eosin (HE) staining revealed a well-preserved morphological architecture of the liver, characterized by predominantly viable hepatocytes with clearly visible nuclei and mild dilation of hepatic sinusoids.
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Affiliation(s)
- Haotian Chen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital
| | - Olaf Dirsch
- Institute of Pathology, Klinikum Chemnitz GmbH
| | - Mohamed Albadry
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital; Department of Pathology, Faculty of Veterinary Medicine, Menoufia University
| | - Paz Hernandez Ana
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital;
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Press AT, Ungelenk L, Medyukhina A, Pennington SA, Nietzsche S, Kan C, Lupp A, Dahmen U, Wang R, Settmacher U, Wetzker R, Figge MT, Clemens MG, Bauer M. Sodium thiosulfate refuels the hepatic antioxidant pool reducing ischemia-reperfusion-induced liver injury. Free Radic Biol Med 2023; 204:151-160. [PMID: 37105418 DOI: 10.1016/j.freeradbiomed.2023.04.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 04/29/2023]
Abstract
Ischemia-reperfusion injury is a critical liver condition during hepatic transplantation, trauma, or shock. An ischemic deprivation of antioxidants and energy characterizes liver injury in such cases. In the face of increased reactive oxygen production, hepatocytes are vulnerable to the reperfusion driving ROS generation and multiple cell-death mechanisms. In this study, we investigate the importance of hydrogen sulfide as part of the liver's antioxidant pool and the therapeutic potency of the hydrogen sulfide donors sodium sulfide (Na2S, fast releasing) and sodium thiosulfate (STS, Na2S2O3, slow releasing). The mitoprotection and toxicity of STS and Na2S were investigated on isolated mitochondria and a liver perfusion oxidative stress model by adding text-butyl hydroperoxide and hydrogen sulfide donors. The respiratory capacity of mitochondria, hepatocellular released LDH, glutathione, and lipid-peroxide levels were quantified. In addition, wild-type and cystathionine-γ-lyase knockout mice were subjected to warm selective ischemia-reperfusion injury by clamping the main inflow for 1 h followed by reperfusion of 1 or 24 h. A subset of animals was treated with STS shortly before reperfusion. Glutathione, plasma ALT, and lipid-peroxide levels were investigated alongside mitochondrial changes in structure (electron microscopy) and function (intravital microscopy). Liver tissue necrosis quantified 24 h after reperfusion indicates the net effects of the treatment on the organ. STS refuels and protects the endogenous antioxidant pool during liver ischemia-reperfusion injury. In addition, STS-mediated ROS scavenging significantly reduced lipid peroxidation and mitochondrial damage, resulting in better molecular and histopathological preservation of the liver tissue architecture. STS prevents tissue damage in liver ischemia-reperfusion injury by increasing the liver's antioxidant pool, thereby protecting mitochondrial integrity.
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Affiliation(s)
- Adrian T Press
- Jena University Hospital, Department of Anesthesiology and Intensive Care Medicine, Jena, Germany; Jena University Hospital, Center for Sepsis Control and Care, Jena, Germany; Jena University Hospital, Medical Faculty, Jena, Germany.
| | - Luisa Ungelenk
- Jena University Hospital, Department of Anesthesiology and Intensive Care Medicine, Jena, Germany; Jena University Hospital, Medical Faculty, Jena, Germany
| | - Anna Medyukhina
- Applied Systems Biology, HKI-Center for Systems Biology of Infection, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute (HKI), Jena, Germany
| | - Samantha A Pennington
- Department of Biological Sciences, University of North Carolina, Charlotte, NC, USA; Pfeiffer University, Department of Natural and Health Sciences, Misenheimer, NC, USA
| | - Sandor Nietzsche
- Jena University Hospital, Electron Microscopy Center, Jena, Germany
| | - Chunyi Kan
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, Jena, Germany
| | - Amelie Lupp
- Institute of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany
| | - Uta Dahmen
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, Jena, Germany
| | - Rui Wang
- Department of Biology, York University, Toronto, Canada
| | - Utz Settmacher
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, Jena, Germany
| | - Reinhard Wetzker
- Jena University Hospital, Department of Anesthesiology and Intensive Care Medicine, Jena, Germany; Jena University Hospital, Center for Sepsis Control and Care, Jena, Germany
| | - Marc Thilo Figge
- Applied Systems Biology, HKI-Center for Systems Biology of Infection, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute (HKI), Jena, Germany; Institute of Microbiology, Faculty of Biological Sciences, Friedrich-Schiller-University, Jena, Germany
| | - Mark G Clemens
- Department of Biological Sciences, University of North Carolina, Charlotte, NC, USA
| | - Michael Bauer
- Jena University Hospital, Department of Anesthesiology and Intensive Care Medicine, Jena, Germany; Jena University Hospital, Center for Sepsis Control and Care, Jena, Germany
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Albadry M, Höpfl S, Ehteshamzad N, König M, Böttcher M, Neumann J, Lupp A, Dirsch O, Radde N, Christ B, Christ M, Schwen LO, Laue H, Klopfleisch R, Dahmen U. Periportal steatosis in mice affects distinct parameters of pericentral drug metabolism. Sci Rep 2022; 12:21825. [PMID: 36528753 PMCID: PMC9759570 DOI: 10.1038/s41598-022-26483-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Little is known about the impact of morphological disorders in distinct zones on metabolic zonation. It was described recently that periportal fibrosis did affect the expression of CYP proteins, a set of pericentrally located drug-metabolizing enzymes. Here, we investigated whether periportal steatosis might have a similar effect. Periportal steatosis was induced in C57BL6/J mice by feeding a high-fat diet with low methionine/choline content for either two or four weeks. Steatosis severity was quantified using image analysis. Triglycerides and CYP activity were quantified in photometric or fluorometric assay. The distribution of CYP3A4, CYP1A2, CYP2D6, and CYP2E1 was visualized by immunohistochemistry. Pharmacokinetic parameters of test drugs were determined after injecting a drug cocktail (caffeine, codeine, and midazolam). The dietary model resulted in moderate to severe mixed steatosis confined to periportal and midzonal areas. Periportal steatosis did not affect the zonal distribution of CYP expression but the activity of selected CYPs was associated with steatosis severity. Caffeine elimination was accelerated by microvesicular steatosis, whereas midazolam elimination was delayed in macrovesicular steatosis. In summary, periportal steatosis affected parameters of pericentrally located drug metabolism. This observation calls for further investigations of the highly complex interrelationship between steatosis and drug metabolism and underlying signaling mechanisms.
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Affiliation(s)
- Mohamed Albadry
- grid.275559.90000 0000 8517 6224Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany ,grid.411775.10000 0004 0621 4712Department of Pathology, Faculty of Veterinary Medicine, Menoufia University, Shebin Elkom, Menoufia, Egypt
| | - Sebastian Höpfl
- grid.5719.a0000 0004 1936 9713Institute for Systems Theory and Automatic Control, Faculty of Engineering Design, Production Engineering and Automotive Engineering, University of Stuttgart, Stuttgart, Germany
| | - Nadia Ehteshamzad
- grid.275559.90000 0000 8517 6224Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Matthias König
- grid.7468.d0000 0001 2248 7639Institute for Theoretical Biology, Institute of Biology, Humboldt-University, Berlin, Germany
| | - Michael Böttcher
- MVZ Medizinische Labore Dessau Kassel GmbH, Bauhüttenstraße 6, 06847 Dessau-Roßlau, Germany
| | - Jasna Neumann
- MVZ Medizinische Labore Dessau Kassel GmbH, Bauhüttenstraße 6, 06847 Dessau-Roßlau, Germany
| | - Amelie Lupp
- grid.275559.90000 0000 8517 6224Institute of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany
| | - Olaf Dirsch
- grid.459629.50000 0004 0389 4214Institute of Pathology, Klinikum Chemnitz, Chemnitz, Germany
| | - Nicole Radde
- grid.5719.a0000 0004 1936 9713Institute for Systems Theory and Automatic Control, Faculty of Engineering Design, Production Engineering and Automotive Engineering, University of Stuttgart, Stuttgart, Germany
| | - Bruno Christ
- grid.9647.c0000 0004 7669 9786Cell Transplantation/Molecular Hepatology Lab, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Madlen Christ
- grid.9647.c0000 0004 7669 9786Cell Transplantation/Molecular Hepatology Lab, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Lars Ole Schwen
- grid.428590.20000 0004 0496 8246Fraunhofer MEVIS, Max-Von-Laue-Str. 2, 28359 Bremen, Germany
| | - Hendrik Laue
- grid.428590.20000 0004 0496 8246Fraunhofer MEVIS, Max-Von-Laue-Str. 2, 28359 Bremen, Germany
| | - Robert Klopfleisch
- grid.14095.390000 0000 9116 4836Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Uta Dahmen
- grid.275559.90000 0000 8517 6224Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
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Arlt J, Vlaic S, Feuer R, Thomas M, Settmacher U, Dahmen U, Dirsch O. Selective gene expression profiling contributes to a better understanding of the molecular pathways underlying the histological changes observed after RHMVL. BMC Med Genomics 2022; 15:211. [PMID: 36207717 PMCID: PMC9547442 DOI: 10.1186/s12920-022-01364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background In previous studies, five vasoactive drugs were investigated for their effect on the recovery process after extended liver resection without observing relevant improvements. We hypothesized that an analysis of gene expression could help to identify potentially druggable pathways and could support the selection of promising drug candidates. Methods Liver samples obtained from rats after combined 70% partial hepatectomy and right median hepatic vein ligation (n = 6/group) sacrificed at 0 h, 24 h, 48 h, and 7days were selected for this study. Liver samples were collected from differentially perfused regions of the median lobe (obstruction-zone, border-zone, normal-zone). Gene expression profiling of marker genes regulating hepatic hemodynamics, vascular remodeling, and liver regeneration was performed with microfluidic chips. We used 3 technical replicates from each sample. Raw data were normalized using LEMming and differentially expressed genes were identified using LIMMA. Results The strongest differences were found in obstruction-zone at 24 h and 48 h postoperatively compared to all other groups. mRNA expression of marker genes from hepatic hemodynamics pathways (iNOS,Ptgs2,Edn1) was most upregulated. Conclusion These upregulated genes suggest a strong vasoconstrictive effect promoting arterial hypoperfusion in the obstruction-zone. Reducing iNOS expression using selective iNOS inhibitors seems to be a promising approach to promote vasodilation and liver regeneration. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01364-z.
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Affiliation(s)
- Janine Arlt
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Drackendorfer Str. 1, 07747, Jena, Germany
| | - Sebastian Vlaic
- Leibniz Institute for Natural Product Research and Infection Biology Hans Knöll Institute (HKI), Beutenbergstraße 11a, 07745, Jena, Germany
| | - Ronny Feuer
- Institute for System Dynamics, University of Stuttgart, Pfaffenwaldring 9, 70569, Stuttgart, Germany
| | - Maria Thomas
- Dr. Magarete Fischer-Bosch Institute for Clinical Pharmacology, Auerbachstr. 112, 70376, Stuttgart, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Drackendorfer Str. 1, 07747, Jena, Germany.
| | - Olaf Dirsch
- Institute of Pathology, Jena University Hospital, Ziegelmühlenweg 1, 07743, Jena, Germany
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Luo D, Chen X, Du J, Mei B, Wang A, Kuang F, Fang C, Gan Y, Peng F, Yang X, Dahmen U, Li B, Song S. Immunogenicity of COVID-19 vaccines in chronic liver disease patients and liver transplant recipients: A systematic review and meta-analysis. Liver Int 2022; 43:34-48. [PMID: 35986903 PMCID: PMC9537964 DOI: 10.1111/liv.15403] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 06/28/2022] [Revised: 07/27/2022] [Accepted: 08/18/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Chronic liver disease (CLD) patients and liver transplant (LT) recipients have an increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19). The immunogenicity of COVID-19 vaccines in CLD patients and LT recipients is poorly understood. The present study aimed to evaluate the immunogenicity of COVID-19 vaccines in CLD patients and LT recipients. METHODS We searched electronic databases for eligible studies. Two reviewers independently conducted the literature search, extracted the data and assessed the risk of bias of included studies. The rates of detectable immune response were pooled from single-arm studies. For comparative studies, we compared the rates of detectable immune response between patients and healthy controls. The meta-analysis was conducted using the Stata software with a random-effects model. RESULTS In total, 19 observational studies involving 4191 participants met the inclusion criteria. The pooled rates of detectable humoral immune response after two doses of COVID-19 vaccination in CLD patients and LT recipients were 95% (95% confidence interval [CI] = 88%-99%) and 66% (95% CI = 57%-74%) respectively. After two doses of vaccination, the humoral immune response rate was similar in CLD patients and healthy controls (risk ratio [RR] = 0.96; 95% CI = 0.90-1.02; p = .14). In contrast, LT recipients had a lower humoral immune response rate after two doses of vaccination than healthy controls (RR = 0.68; 95% CI = 0.59-0.77; p < .01). CONCLUSIONS Our meta-analysis demonstrated that COVID-19 vaccination induced strong humoral immune responses in CLD patients but poor humoral immune responses in LT recipients.
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Affiliation(s)
- De Luo
- Department of Hepatobiliary SurgeryThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina,Department of NephrologyUniversity Hospital Essen, University of Duisburg‐EssenEssenGermany
| | - Xinpei Chen
- Department of Hepatobiliary SurgeryPeople's Hospital of Deyang CityDeyangChina,Department of General, Visceral and Vascular SurgeryJena University HospitalJenaGermany
| | - Juan Du
- Department of Clinical MedicineSouthwest Medical UniversityLuzhouChina
| | - Bingjie Mei
- Sichuan Cancer HospitalSchool of Medicine, University of Electronic Science and Technology of ChinaChengduChina
| | - Ankang Wang
- Department of General SurgeryNanchong Central Hospital, The Second Clinical College of North Sichuan Medical CollegeNanchongChina
| | - Fei Kuang
- Institute of Immunology, Medical FacultyUniversity of Duisburg‐EssenEssenGermany
| | - Cheng Fang
- Department of Hepatobiliary SurgeryThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Yu Gan
- Department of Hepatobiliary SurgeryThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Fangyi Peng
- Department of Hepatobiliary SurgeryThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Xiaoli Yang
- Department of Hepatobiliary SurgeryThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Uta Dahmen
- Department of General, Visceral and Vascular SurgeryJena University HospitalJenaGermany
| | - Bo Li
- Department of Hepatobiliary SurgeryThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Su Song
- Department of Hepatobiliary SurgeryThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
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10
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Richter B, Sänger C, Mussbach F, Scheuerlein H, Settmacher U, Dahmen U. Selective biliary occlusion in rodents: description of a new technique. Innov Surg Sci 2022; 7:13-22. [PMID: 35974775 PMCID: PMC9352182 DOI: 10.1515/iss-2021-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/22/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Modern therapy concepts are of limited success in patients with cholestasis (e.g., biliary occluding malignancies). Therefore, we established a new animal model enabling simultaneous investigation of liver regeneration and hepato-biliary remodelling in biliary obstructed and biliary non-obstructed liver lobes.
Methods
Biliary occlusion of different extent was induced in 50 male rats: Ligation and transection of the common bile duct (100% of liver, tBDT, n=25); or of the left bile duct (70% of liver, sBDT, n=25). At postoperative days 1, 3, 7, 14 and 28 we assessed the hepatic histomorphological alterations, proliferative repair, progress of liver fibrosis (HE, BrdU, EvG) and signs of liver regeneration (liver lobe weight gain). In addition, we determined systemic markers of hepatocellular injury (ASAT, ALAT), cholestasis (Bilirubin) and synthetic liver function (INR). The animals were monitored daily (body weight gain, stress score, survival).
Results
All animals survived until the planned date of sacrifice. sBDT induced in the biliary occluded liver lobes similar histomorphological alterations, proliferative repair and progress of liver fibrosis like tBDT. In the biliary non-ligated liver lobes in sBDT animals we noticed a temporarily enhanced biliary proliferation and a persistent low grade liver fibrosis in the periportal area.
Conclusions
Our model of sBDT represents a safe and valid method to induce selective cholestasis. The model enables further comparative investigation of liver regeneration in different extents of occlusive cholestasis (e.g., mimicking biliary occluding malignancies).
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Affiliation(s)
- Beate Richter
- Department of General, Visceral and Vascular Surgery , Experimental Surgery Unit, University Hospital Jena , Jena , Germany
| | - Constanze Sänger
- Department of General, Visceral and Vascular Surgery , Experimental Surgery Unit, University Hospital Jena , Jena , Germany
| | - Franziska Mussbach
- Department of General, Visceral and Vascular Surgery , Experimental Surgery Unit, University Hospital Jena , Jena , Germany
| | - Hubert Scheuerlein
- Clinic for General, Visceral and Paediatric Surgery, St. Vincenz Hospital Paderborn, Teaching Hospital of the University of Göttingen , Paderborn , Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery , Experimental Surgery Unit, University Hospital Jena , Jena , Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery , Experimental Surgery Unit, University Hospital Jena , Jena , Germany
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11
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Richter B, Sänger C, Mussbach F, Scheuerlein H, Settmacher U, Dahmen U. Species specific morphological alterations in liver tissue after biliary occlusion in rat and mouse: Similar but different. PLoS One 2022; 17:e0271975. [PMID: 35881613 PMCID: PMC9321426 DOI: 10.1371/journal.pone.0271975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background The selection of the appropriate species is one of the key issues in experimental medicine. Bile duct ligation is the mostly used experimental model in rodents to explore special aspects of occlusive cholestasis. We aimed to clarify if rats or mice are suitable for the same or different aspects in cholestasis research. Methods We induced biliary occlusion by ligation and transection of the common bile duct (tBDT) in rats and mice (each n = 25). Recovery from surgical stress was assessed by daily scoring (stress score, body weight). At five different time points (days 1, 3, 7, 14, 28 after tBDT) we investigated hepatic morphometric and architectural alterations (Haematoxylin-Eosin staining, Elastica van Gieson staining) and the proliferative activities of parenchyma cells (Bromodeoxyuridine staining); as well as established systemic markers for liver synthesis, hepatocellular damage and renal dysfunction. Results We found substantial differences regarding survival (rats: 100%, 25/25 vs. mice 92%, 22/25, p = 0.07) and body weight gain (p<0.05 at postoperative days 14 and 28 (POD)). Rats showed a faster and progressive hepatobiliary remodelling than mice (p<0.05 at POD 7+14+28), resulting in: i) stronger relative loss of hepatocellular mass (rats by 31% vs. mice by 15% until POD 28; p<0.05 at POD 7+14+28); ii) rapidly progressing liver fibrosis (p<0.05 at POD 14); iii) a faster and stronger proliferative response of parenchyma cells (hepatocytes: p<0.05 at POD 1+14+18; cholangiocytes: p<0.05 at POD 1+3+7+28); and iv) only tiny bile infarcts compared to mice (p<0.05 at POD 1+3+7+14). Both species showed comparable elevated markers of hepatocellular damage and serum bilirubin. Conclusion The key difference between rats and mice are the severity and dynamics of histological alterations, possibly accounting for their different susceptibilities for (septic) complications with low survival (mice).
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Affiliation(s)
- Beate Richter
- Department of General, Visceral and Vascular Surgery, University Jena, Jena, Germany
- * E-mail:
| | - Constanze Sänger
- Department of General, Visceral and Vascular Surgery, University Jena, Jena, Germany
| | - Franziska Mussbach
- Department of General, Visceral and Vascular Surgery, University Jena, Jena, Germany
| | - Hubert Scheuerlein
- Clinic for General, Visceral and Paediatric Surgery, St. Vincenz Hospital Paderborn, Teaching Hospital of the University Göttingen, Göttingen, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Jena, Jena, Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, University Jena, Jena, Germany
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12
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Xu F, Tautenhahn HM, Dirsch O, Dahmen U. Blocking autophagy with chloroquine aggravates lipid accumulation and reduces intracellular energy synthesis in hepatocellular carcinoma cells, both contributing to its anti-proliferative effect. J Cancer Res Clin Oncol 2022; 148:3243-3256. [PMID: 35695930 DOI: 10.1007/s00432-022-04074-2] [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] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/16/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The autophagy inhibitor chloroquine enhances the effect of targeted therapy using tyrosine kinase inhibitor in liver cancer. We would like to further understand the specific mechanism by which chloroquine inhibits the proliferation of tumor cells. METHODS We used a human hepatocarcinoma cell line (HepG2) as cell culture model. In contrast to the control groups (treated only with complete medium), cells in experimental groups were treated either with complete medium + 40 ng/ml Hepatocyte growth factor (HGF), or with complete medium + 60 μM chloroquine or with complete medium + 40 ng/ml HGF + 60 μM chloroquine for 24 h. Cell number and ATP content were investigated using spectrophotometric assays. Cell proliferation and apoptosis were detected by immunohistochemistry. Cell morphological alterations were examined by Giemsa and H&E staining. Cellular lipid content was determined by Oil Red O staining and Triglyceride quantification assay. Autophagy-related proteins (LC3B and p62) and hepatocyte proliferation-related protein (S6K1) were examined using western blot. The autophagic flux of cells was assessed by mRFP-EGFP-LC3 transfection assay. RESULTS We found that chloroquine inhibited the proliferation of HepG2 cells, as evidenced by a decrease in cellular ATP content, Ki-67 and S6K1 protein expression and a reduction in cell number. This finding was associated with an increase in lipid content. As expected, chloroquine inhibited autophagy of HepG2 cells, as evidenced by the accumulation of LC3B-II and the significant upregulation of p62. mRFP-EGFP-LC3 transfection assay showed that indeed chloroquine blocked the autophagic flux in HepG2 cells. CONCLUSION Chloroquine impaired proliferation of HepG2 cells might be due to intracellular accumulation of lipids and inhibition of energy synthesis.
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Affiliation(s)
- Fengming Xu
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747, Jena, Germany
- Else Kröner Graduate School for Medical Students "JSAM", Jena University Hospital, 07747, Jena, Germany
| | - Hans-Michael Tautenhahn
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747, Jena, Germany
- Else Kröner Research Schools for Physicians "AntiAge", Jena University Hospital, 07747, Jena, Germany
| | - Olaf Dirsch
- Institute of Pathology, Klinikum Chemnitz gGmbH, 09111, Chemnitz, Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747, Jena, Germany.
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13
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Massaro MS, Kochová P, Pálek R, Rosendorf J, Červenková L, Dahmen U, Liška V, Moulisová V. Decellularization of Porcine Carotid Arteries: From the Vessel to the High-Quality Scaffold in Five Hours. Front Bioeng Biotechnol 2022; 10:833244. [PMID: 35651544 PMCID: PMC9150822 DOI: 10.3389/fbioe.2022.833244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
The use of biologically derived vessels as small-diameter vascular grafts in vascular diseases is currently intensely studied. Vessel decellularization provides a biocompatible scaffold with very low immunogenicity that avoids immunosuppression after transplantation. Good scaffold preservation is important as it facilitates successful cell repopulation. In addition, mechanical characteristics have to be carefully evaluated when the graft is intended to be used as an artery due to the high pressures the vessel is subjected to. Here, we present a new and fast decellularization protocol for porcine carotid arteries, followed by investigation of the quality of obtained vessel scaffolds in terms of maintenance of important extracellular matrix components, mechanical resistance, and compatibility with human endothelial cells. Our results evidence that our decellularization protocol minimally alters both the presence of scaffold proteins and their mechanical behavior and human endothelial cells could adhere to the scaffold in vitro. We conclude that if a suitable protocol is used, a high-quality decellularized arterial scaffold of non-human origin can be promptly obtained, having a great potential to be recellularized and used as an arterial graft in transplantation medicine.
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Affiliation(s)
| | - Petra Kochová
- New Technologies for Information Society-NTIS, University of West Bohemia, Pilsen, Czechia
| | - Richard Pálek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Jáchym Rosendorf
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Lenka Červenková
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Václav Liška
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Vladimíra Moulisová
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
- *Correspondence: Vladimíra Moulisová,
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14
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Richter B, Zafarnia S, Gremse F, Kießling F, Scheuerlein H, Settmacher U, Dahmen U. Corrosion Cast and 3D Reconstruction of the Murine Biliary Tree After Biliary Obstruction: Quantitative Assessment and Comparison With 2D Histology. J Clin Exp Hepatol 2022; 12:755-766. [PMID: 35677523 PMCID: PMC9168744 DOI: 10.1016/j.jceh.2021.12.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022] Open
Abstract
Background Obstructive cholestasis can lead to significant alterations of the biliary tree depending on the extent and duration of the biliary occlusion. Current experimental studies reported about advanced techniques for corrosion cast and 3D reconstruction (3D-reco) visualizing delicate microvascular structures in animals. We compared these two different techniques for visualization and quantitative assessment of the obstructed murine biliary tree with classical 2D histology. Methods Male mice (n = 36) were allocated to 3 different experiments. In experiments 1 and 2, we injected two different media (Microfil© for 3D-reco, MV; Batson's No.17 for corrosion cast, CC) into the extrahepatic bile duct. In experiment 3 we sampled liver tissue for 2D histology (HE, BrdU). Time points of interest were days 1, 3, 5, 7, 14, and 28 after biliary occlusion. We used different types of software for quantification of the different samples: IMALYTICS Preclinical for 3D scans (MV); NDP.view2 for the digital photography of CC; HistoKat software for 2D histology. Results We achieved samples in 75% of the animals suitable for evaluation (MV and CC, each with 9/12). Contrasting of terminal bile ducts (4th order of branches) was achieved with either technique. MV permitted a fast 3D-reco of the hierarchy of the biliary tree, including the 3rd and 4th order of branches in almost all samples (8/9 and 6/9). CC enabled focused evaluation of the hierarchy of the biliary tree, including the 4th to 5th order of branches in almost all samples (9/9 and 8/9). In addition, we detected dense meshes of the smallest bile ducts in almost all CC samples (8/9). MV and CC allowed a quantitative assessment of anatomical details of the 3rd and 4th order branches of almost every sample. The 2D histology identified different kinetics and areas of proliferation of hepatocytes and cholangiocytes. Complementary usage of 3D-reco, corrosion casting and 2D histology matched dense meshes of small bile ducts with areas of intensive proliferative activity of cholangiocytes as periportal proliferative areas of 4th and 5th order branches (∼terminal bile ducts and bile ductules) matched with its morphological information the matching assessment of areas with increased proliferative activity (BrdU) and a partial quantification of the characteristics of the 4th order branches of the biliary tree. Conclusion The 3D-reco and corrosion casting of the murine biliary tree are feasible and provide a straightforward, robust, and reliable (and more economical) procedure for the visualization and quantitative assessment of architectural alterations, in comparative usage with the 2D histology.
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Key Words
- 2D IHC, two-dimensional immunohistochemistry
- 3D reconstruction
- 3D-reco, three-dimensional reconstruction
- BD, bile duct
- BT, extrahepatic and intrahepatic biliary tree
- BrdU, Bromodeoxyuridine
- CC, Corrosion Cast using Batson No.17
- CoH, Canals of Hering
- DHC, Ductus hepatocholedochus, main extrahepatic bile duct
- HE, Haematoxylin-Eosin
- MV, Microfil®-MV
- POD, postoperative day
- biliary occlusion
- biliary tree
- corrosion cast
- ehBD, extrahepatic bile duct
- ihBD, intrahepatic bile duct
- microfil
- periportal segments
- tBDT, bile duct ligation (using three sutures) with transection of the ligated extrahepatic bile duct between the middle and proximal sutures
- μCT, micro Computer Tomography (micro-CT)
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Affiliation(s)
- Beate Richter
- Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, University Hospital Jena, Drackendorfer Strasse 1, 07747, Jena, Germany
- Department of General, Visceral and Vascular Surgery, University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sarah Zafarnia
- Institute for Experimental Molecular Imaging, RWTH University Hospital Aachen, Templergraben 55, 52056, Aachen, Germany
| | - Felix Gremse
- Institute for Experimental Molecular Imaging, RWTH University Hospital Aachen, Templergraben 55, 52056, Aachen, Germany
| | - Fabian Kießling
- Institute for Experimental Molecular Imaging, RWTH University Hospital Aachen, Templergraben 55, 52056, Aachen, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Max-von-Laue-Str. 2, 28359 Bremen, Germany
| | - Hubert Scheuerlein
- Clinic for General, Visceral and Pediatric Surgery, St. Vincenz Hospital Paderborn, Teaching Hospital of the University of Göttingen, Am Busdorf 2, 33098 Paderborn, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, University Hospital Jena, Drackendorfer Strasse 1, 07747, Jena, Germany
- Department of General, Visceral and Vascular Surgery, University Jena, Am Klinikum 1, 07747 Jena, Germany
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15
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Richter B, Sänger C, Mussbach F, Scheuerlein H, Settmacher U, Dahmen U. The Interplay Between Biliary Occlusion and Liver Regeneration: Repeated Regeneration Stimuli Restore Biliary Drainage by Promoting Hepatobiliary Remodeling in a Rat Model. Front Surg 2022; 9:799669. [PMID: 35548189 PMCID: PMC9081651 DOI: 10.3389/fsurg.2022.799669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Aims Patients with malignant biliary obstruction do not seem to benefit from “two-stage hepatectomy” due to an impairment of liver regeneration. We designed a novel model of “repeated regeneration stimuli” in rats mimicking a “two-stage hepatectomy” with selective or complete biliary occlusion mimicking Klatskin tumors III° or IV°. Using this new model, we wanted to investigate (1) the impact of preexistent cholestasis of different extent on the time course of liver regeneration and (2) the dynamics of hepatobiliary remodeling under regeneration conditions. Materials and Methods Rats were subjected to a sequence of three operations: surgical induction of biliary occlusion, followed by “repeated regeneration stimuli” consisting of ligation of the left branch of the portal vein (supplying 70% of the liver volume, sPVL) as first stage and a 70%-hepatectomy (70%PHx) as second stage. Biliary occlusion (1st procedure) was induced by ligating and transection of either the common (100%, tBDT) or the left bile duct (70%, sBDT). A sham operation without ligating the bile duct was performed as control (0%, Sham). Two weeks later, on day 14 (POD14), the sPVL (2nd procedure) was performed. Another week later (POD 21), the 70%PHx (3rd procedure) took place and animals were observed for 1 week (POD 28). The first experiment (n = 45 rats) was dedicated to investigating liver regeneration (hypertrophy/atrophy), proliferative activity and hepatobiliary histomorphology (2D-histology: HE, BrdU) in the future liver remnant (FLR). The second experiment (n = 25 rats) was performed to study the dynamics of hepatobiliary remodeling in livers with different regenerative pressure (tBDT only POD21 vs. tBDT only POD 28 vs. tBDT + sPVL vs. tBDT + 70%PHx vs. tBDT + sPVL + 70%PHx) using μCT scans of explanted livers. Results Effect of biliary occlusion Total biliary occlusion (tBDT) led to a 2.4-fold increase in whole liver volume due to severe biliary proliferation within 14 days. In contrast, partial biliary occlusion (sBDT) caused only a volume gain of the obstructed liver lobes due to biliary proliferates, resulting in a minor increase of total liver volume (1.7-fold) without an increase in bilirubin levels. Liver regeneration and atrophy As expected, sPVL caused substantial volume gain (tBDT: 3-fold; sBDT: 2.8-fold; Sham 2.8-fold) of FLR and a substantial volume loss (tBDT: 0.9-fold; sBDT: 0.6-fold; Sham: 0.4-fold) of the portally deprived “future resected lobes” compared to the preoperative liver volume. The subsequent 70%PHx promoted a further volume gain of the FLR in all groups (tBDT: 4-fold; sBDT: 3-fold; Sham 3-fold compared to original volume) until POD 28. Hepatobiliary remodeling: After tBDT, we identified histologically three phases of hepatobiliary remodeling in the FLR. Following tBDT, biliary proliferates developed, replacing about 15% of the hepatocellular tissue. After sPVL we found incomplete restoration of the hepatocellular tissue with a visible reduction of the biliary proliferates. The 70%PHx led to an almost complete recovery of the hepatocellular tissue in the FLR with a nearly normal liver architecture. In contrast, after sBDT and Sham we observed a near normal liver morphology in the FLR at all time points. CT-scanning of the explanted livers and subsequent 3D reconstruction visualized the development of extrahepatic biliary collaterals. Collaterals were detected in 0/5 cases 1 week after sPVL (first regeneration stimulus), and in even more cases (3/5) 1 week after the 70%PHx (second regeneration stimulus). Histological workup identified the typical biliary cuboid epithelium as inner lining of the collaterals and peribiliary glands. Conclusion Liver volume of the FLR increased in cholestatic rats mainly due to biliary proliferates. Application of repeated regeneration stimuli in the style of a “two-stage hepatectomy” promoted almost full restoration of hepatocellular tissue and architecture in the FLR by reestablishing biliary drainage via formation of biliary collaterals. Further exploration of the dynamics in hepatobiliary modeling using this model might help to better understand the underlying mechanism.
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Affiliation(s)
- Beate Richter
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
- *Correspondence: Beate Richter
| | - Constanze Sänger
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Franziska Mussbach
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Hubert Scheuerlein
- Clinic for General, Visceral and Paediatric Surgery, St. Vincenz Hospital Paderborn, University of Göttingen, Paderborn, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
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16
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Budelmann D, Laue H, Weiss N, Dahmen U, D'Alessandro LA, Biermayer I, Klingmüller U, Ghallab A, Hassan R, Begher-Tibbe B, Hengstler JG, Schwen LO. Automated Detection of Portal Fields and Central Veins in Whole-Slide Images of Liver Tissue. J Pathol Inform 2022; 13:100001. [PMID: 35242441 PMCID: PMC8860737 DOI: 10.1016/j.jpi.2022.100001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
Many physiological processes and pathological phenomena in the liver tissue are spatially heterogeneous. At a local scale, biomarkers can be quantified along the axis of the blood flow, from portal fields (PFs) to central veins (CVs), i.e., in zonated form. This requires detecting PFs and CVs. However, manually annotating these structures in multiple whole-slide images is a tedious task. We describe and evaluate a fully automated method, based on a convolutional neural network, for simultaneously detecting PFs and CVs in a single stained section. Trained on scans of hematoxylin and eosin-stained liver tissue, the detector performed well with an F1 score of 0.81 compared to annotation by a human expert. It does, however, not generalize well to previously unseen scans of steatotic liver tissue with an F1 score of 0.59. Automated PF and CV detection eliminates the bottleneck of manual annotation for subsequent automated analyses, as illustrated by two proof-of-concept applications: We computed lobulus sizes based on the detected PF and CV positions, where results agreed with published lobulus sizes. Moreover, we demonstrate the feasibility of zonated quantification of biomarkers detected in different stainings based on lobuli and zones obtained from the detected PF and CV positions. A negative control (hematoxylin and eosin) showed the expected homogeneity, a positive control (glutamine synthetase) was quantified to be strictly pericentral, and a plausible zonation for a heterogeneous F4/80 staining was obtained. Automated detection of PFs and CVs is one building block for automatically quantifying physiologically relevant heterogeneity of liver tissue biomarkers. Perspectively, a more robust and automated assessment of zonation from whole-slide images will be valuable for parameterizing spatially resolved models of liver metabolism and to provide diagnostic information.
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Affiliation(s)
| | | | | | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Lorenza A D'Alessandro
- Deutsches Krebsforschungszentrum, Systems Biology of Signal Transduction, Heidelberg, Germany
| | - Ina Biermayer
- Deutsches Krebsforschungszentrum, Systems Biology of Signal Transduction, Heidelberg, Germany
| | - Ursula Klingmüller
- Deutsches Krebsforschungszentrum, Systems Biology of Signal Transduction, Heidelberg, Germany
| | - Ahmed Ghallab
- Leibniz Research Centre for Working Environment and Human Factors at the Technical University Dortmund, Dortmund, Germany.,Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Reham Hassan
- Leibniz Research Centre for Working Environment and Human Factors at the Technical University Dortmund, Dortmund, Germany.,Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Brigitte Begher-Tibbe
- Leibniz Research Centre for Working Environment and Human Factors at the Technical University Dortmund, Dortmund, Germany
| | - Jan G Hengstler
- Leibniz Research Centre for Working Environment and Human Factors at the Technical University Dortmund, Dortmund, Germany
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Christ B, Dahmen U, Radde N, Ricken T. Editorial: Computational Modeling for Liver Surgery and Interventions. Front Physiol 2022; 13:859522. [PMID: 35242057 PMCID: PMC8886156 DOI: 10.3389/fphys.2022.859522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bruno Christ
- Cell Transplantation/Molecular Hepatology Lab, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Nicole Radde
- Institute for Systems Theory and Automatic Control, Faculty of Engineering Design, Production Engineering and Automotive Engineering, University of Stuttgart, Stuttgart, Germany
| | - Tim Ricken
- Institute of Mechanics, Structural Analysis and Dynamics, Faculty of Aerospace Engineering and Geodesy, University of Stuttgart, Stuttgart, Germany
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18
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Christ B, Collatz M, Dahmen U, Herrmann KH, Höpfl S, König M, Lambers L, Marz M, Meyer D, Radde N, Reichenbach JR, Ricken T, Tautenhahn HM. Hepatectomy-Induced Alterations in Hepatic Perfusion and Function - Toward Multi-Scale Computational Modeling for a Better Prediction of Post-hepatectomy Liver Function. Front Physiol 2021; 12:733868. [PMID: 34867441 PMCID: PMC8637208 DOI: 10.3389/fphys.2021.733868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/26/2021] [Indexed: 01/17/2023] Open
Abstract
Liver resection causes marked perfusion alterations in the liver remnant both on the organ scale (vascular anatomy) and on the microscale (sinusoidal blood flow on tissue level). These changes in perfusion affect hepatic functions via direct alterations in blood supply and drainage, followed by indirect changes of biomechanical tissue properties and cellular function. Changes in blood flow impose compression, tension and shear forces on the liver tissue. These forces are perceived by mechanosensors on parenchymal and non-parenchymal cells of the liver and regulate cell-cell and cell-matrix interactions as well as cellular signaling and metabolism. These interactions are key players in tissue growth and remodeling, a prerequisite to restore tissue function after PHx. Their dysregulation is associated with metabolic impairment of the liver eventually leading to liver failure, a serious post-hepatectomy complication with high morbidity and mortality. Though certain links are known, the overall functional change after liver surgery is not understood due to complex feedback loops, non-linearities, spatial heterogeneities and different time-scales of events. Computational modeling is a unique approach to gain a better understanding of complex biomedical systems. This approach allows (i) integration of heterogeneous data and knowledge on multiple scales into a consistent view of how perfusion is related to hepatic function; (ii) testing and generating hypotheses based on predictive models, which must be validated experimentally and clinically. In the long term, computational modeling will (iii) support surgical planning by predicting surgery-induced perfusion perturbations and their functional (metabolic) consequences; and thereby (iv) allow minimizing surgical risks for the individual patient. Here, we review the alterations of hepatic perfusion, biomechanical properties and function associated with hepatectomy. Specifically, we provide an overview over the clinical problem, preoperative diagnostics, functional imaging approaches, experimental approaches in animal models, mechanoperception in the liver and impact on cellular metabolism, omics approaches with a focus on transcriptomics, data integration and uncertainty analysis, and computational modeling on multiple scales. Finally, we provide a perspective on how multi-scale computational models, which couple perfusion changes to hepatic function, could become part of clinical workflows to predict and optimize patient outcome after complex liver surgery.
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Affiliation(s)
- Bruno Christ
- Cell Transplantation/Molecular Hepatology Lab, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Maximilian Collatz
- RNA Bioinformatics and High-Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany
- Optisch-Molekulare Diagnostik und Systemtechnologié, Leibniz Institute of Photonic Technology (IPHT), Jena, Germany
- InfectoGnostics Research Campus Jena, Jena, Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Karl-Heinz Herrmann
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Sebastian Höpfl
- Faculty of Engineering Design, Production Engineering and Automotive Engineering, Institute for Systems Theory and Automatic Control, University of Stuttgart, Stuttgart, Germany
| | - Matthias König
- Systems Medicine of the Liver Lab, Institute for Theoretical Biology, Humboldt-University Berlin, Berlin, Germany
| | - Lena Lambers
- Faculty of Aerospace Engineering and Geodesy, Institute of Mechanics, Structural Analysis and Dynamics, University of Stuttgart, Stuttgart, Germany
| | - Manja Marz
- RNA Bioinformatics and High-Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany
| | - Daria Meyer
- RNA Bioinformatics and High-Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany
| | - Nicole Radde
- Faculty of Engineering Design, Production Engineering and Automotive Engineering, Institute for Systems Theory and Automatic Control, University of Stuttgart, Stuttgart, Germany
| | - Jürgen R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Tim Ricken
- Faculty of Aerospace Engineering and Geodesy, Institute of Mechanics, Structural Analysis and Dynamics, University of Stuttgart, Stuttgart, Germany
| | - Hans-Michael Tautenhahn
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
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19
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Daum AK, Dittmann J, Jansen L, Peters S, Dahmen U, Heger JI, Hoppe-Seyler F, Gille A, Clement JH, Runnebaum IB, Dürst M, Backsch C. ITIH5 shows tumor suppressive properties in cervical cancer cells grown as multicellular tumor spheroids. Am J Transl Res 2021; 13:10298-10314. [PMID: 34650698 PMCID: PMC8507072] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Abstract
Cervical cancer (CC) arises from premalignant cervical intraepithelial neoplasia (CIN) induced by a persistent infection with human papillomaviruses. The multi-stepwise disease progression is driven by genetic and epigenetic alterations. Our previous studies demonstrated a clear downregulation of inter-α-trypsin-inhibitor-heavy chain 5 (ITIH5) at mRNA and protein levels in CC compared to CIN2/3 and normal cervical tissue. Initial in vitro functional analyses revealed a suppressive effect of ITIH5 on relevant mechanisms for cancer progression in conventional two dimensional (2D) cell culture model systems. Based on these studies, we aimed to investigate the functional relevance of ITIH5 in multicellular tumor spheroid (MCTS) models, which resemble in vivo tumors more closely. We successfully established CC cell line-derived MCTS using the hanging-drop technique. ITIH5 was ectopically overexpressed in HeLa and SiHa cells and its functional relevance was investigated under three dimensional (3D) culture conditions. We found that ITIH5 re-expression significantly suppressed tumor spheroid growth and spheroid invasiveness of both HeLa and SiHa spheroids. Immunohistochemical (IHC) analyses revealed a significant reduction in Ki-67 cell proliferation index and CAIX-positive areas indicative for hypoxia and acidification. Furthermore, we observed an increase in cPARP-positive cells suggesting a higher rate of apoptosis upon ITIH5 overexpression. An effect of ITIH5 expression on the susceptibility of cervical MCTS towards cytostatic drug treatment was not observed. Collectively, these data uncover pronounced anti-proliferative effects of ITIH5 under 3D cell culture conditions and provide further functional evidence that the downregulation of ITIH5 expression during cervical carcinogenesis could support cancer development.
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Affiliation(s)
- Ann-Kathrin Daum
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
- Current address: German Cancer Research Center (DKFZ), Division of Cancer Genome ResearchHeidelberg, Germany
| | - Jessica Dittmann
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
| | - Lars Jansen
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
| | - Sven Peters
- Department of Ophthalmology, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
| | - Julia I Heger
- Placenta-Lab, Department of Obstetrics, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
| | - Felix Hoppe-Seyler
- Molecular Therapy of Virus-Associated Cancers, German Cancer Research Center (DKFZ)Heidelberg, Germany
| | - Alexandra Gille
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
| | - Joachim H Clement
- Department of Hematology and Medical Oncology, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
| | - Ingo B Runnebaum
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
| | - Matthias Dürst
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
| | - Claudia Backsch
- Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-UniversityJena, Germany
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20
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Meng L, Song Z, Liu A, Dahmen U, Yang X, Fang H. Effects of Lipopolysaccharide-Binding Protein (LBP) Single Nucleotide Polymorphism (SNP) in Infections, Inflammatory Diseases, Metabolic Disorders and Cancers. Front Immunol 2021; 12:681810. [PMID: 34295331 PMCID: PMC8290185 DOI: 10.3389/fimmu.2021.681810] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/08/2021] [Indexed: 01/11/2023] Open
Abstract
Inflammation, which is induced by the immune response, is recognized as the driving factor in many diseases, including infections and inflammatory diseases, metabolic disorders and cancers. Genetic variations in pivotal genes associated with the immune response, particularly single nucleotide polymorphisms (SNPs), may account for predisposition and clinical outcome of diseases. Lipopolysaccharide (LPS)-binding protein (LBP) functions as an enhancer of the host response to LPS, the main component of the outer membrane of gram-native bacteria. Given the crucial role of LBP in inflammation, we will review the impact of SNPs in the LBP gene on infections and inflammatory diseases, metabolic disorders and cancers.
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Affiliation(s)
- Leilei Meng
- Department of Pathophysiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Zichen Song
- Department of Pathophysiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Anding Liu
- Experimental Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - Xiao Yang
- Experimental Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoshu Fang
- Department of Pathophysiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
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21
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Xu F, Tautenhahn HM, Dirsch O, Dahmen U. Modulation of Autophagy: A Novel "Rejuvenation" Strategy for the Aging Liver. Oxid Med Cell Longev 2021; 2021:6611126. [PMID: 33628363 PMCID: PMC7889356 DOI: 10.1155/2021/6611126] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/08/2020] [Accepted: 01/23/2021] [Indexed: 12/11/2022]
Abstract
Aging is a natural life process which leads to a gradual decline of essential physiological processes. For the liver, it leads to alterations in histomorphology (steatosis and fibrosis) and function (protein synthesis and energy generation) and affects central hepatocellular processes (autophagy, mitochondrial respiration, and hepatocyte proliferation). These alterations do not only impair the metabolic capacity of the liver but also represent important factors in the pathogenesis of malignant liver disease. Autophagy is a recycling process for eukaryotic cells to degrade dysfunctional intracellular components and to reuse the basic substances. It plays a crucial role in maintaining cell homeostasis and in resisting environmental stress. Emerging evidence shows that modulating autophagy seems to be effective in improving the age-related alterations of the liver. However, autophagy is a double-edged sword for the aged liver. Upregulating autophagy alleviates hepatic steatosis and ROS-induced cellular stress and promotes hepatocyte proliferation but may aggravate hepatic fibrosis. Therefore, a well-balanced autophagy modulation strategy might be suitable to alleviate age-related liver dysfunction. Conclusion. Modulation of autophagy is a promising strategy for "rejuvenation" of the aged liver. Detailed knowledge regarding the most devastating processes in the individual patient is needed to effectively counteract aging of the liver without causing obvious harm.
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Affiliation(s)
- Fengming Xu
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany
| | - Hans-Michael Tautenhahn
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany
| | - Olaf Dirsch
- Institute of Pathology, Klinikum Chemnitz gGmbH, Chemnitz 09111, Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena 07747, Germany
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22
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Felgendreff P, Schindler C, Mussbach F, Xie C, Gremse F, Settmacher U, Dahmen U. Identification of tissue sections from decellularized liver scaffolds for repopulation experiments. Heliyon 2021; 7:e06129. [PMID: 33644446 PMCID: PMC7895725 DOI: 10.1016/j.heliyon.2021.e06129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/07/2021] [Accepted: 01/26/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Biological organ engineering is a novel experimental approach to generate functional liver grafts by decellularization and repopulation. Currently, healthy organs of small or large animals and human organs with preexisting liver diseases are used to optimize decellularization and repopulation.However, the effects of morphological changes on allo- and xenogeneic cell-scaffold interactions during repopulation procedure, e.g., using scaffold-sections, are unknown. We present a sequential morphological workflow to identify murine liver scaffold-sections with well-preserved microarchitecture. METHODS Native livers (CONT, n = 9) and livers with experimentally induced pathologies (hepatics steatosis: STEA, n = 7; hepatic fibrosis induced by bile duct ligation: BDL, n = 9; nodular regenerative hyperplasia induced by 90% partial hepatectomy: PH, n = 8) were decellularized using SDS and Triton X-100 to generate cell-free scaffolds. Scaffold-sections were assessed using a sequential morphological workflow consisting of macroscopic, microscopic and morphological evaluation: (1) The scaffold was evaluated by a macroscopic decellularization score. (2) Regions without visible tissue remnants were localized for sampling and histological processing. Subsequent microscopical examination served to identify tissue samples without cell remnants. (3) Only cell-free tissue sections were subjected to detailed liver-specific morphological assessment using a histological and immunohistochemical decellularization score. RESULTS Decellularization was feasible in 33 livers, which were subjected to the sequential morphological workflow. In 11 of 33 scaffolds we achieved a good macroscopic decellularization result (CONT: 3 scaffolds; STEA: 3 scaffolds; BDL: 3 scaffolds; PH: 2 scaffolds). The microscopic assessment resulted in the selection of 88 cell-free tissue sections (CONT: 15 sections; STEA: 38 sections; BDL: 30 sections; PH: 5 sections). In 27 of those sections we obtained a good histological decellularization result (CONT: 3 sections; STEA: 6 sections; BDL: 17 sections; PH: 1 section). All experimental groups contained sections with a good immunohistochemical decellularization result (CONT: 6 sections; STEA: 5 sections; BDL: 4 sections; PH: 1 section). DISCUSSION Decellularization was possible in all experimental groups, irrespectively of the underlying morphological alteration. Furthermore, our proposed sequential morphological workflow was suitable to detect tissue sections with well-preserved hepatic microarchitecture, as needed for further repopulation experiments.
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Affiliation(s)
- Philipp Felgendreff
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
- Research Program “Else Kröner-Forschungskolleg AntiAge”, Jena University Hospital, Jena, Germany
| | - Claudia Schindler
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Franziska Mussbach
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Chichi Xie
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Felix Gremse
- Institute for Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
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23
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Jirik M, Gruber I, Moulisova V, Schindler C, Cervenkova L, Palek R, Rosendorf J, Arlt J, Bolek L, Dejmek J, Dahmen U, Zelezny M, Liska V. Semantic Segmentation of Intralobular and Extralobular Tissue from Liver Scaffold H&E Images. Sensors (Basel) 2020; 20:s20247063. [PMID: 33321713 PMCID: PMC7764590 DOI: 10.3390/s20247063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
Decellularized tissue is an important source for biological tissue engineering. Evaluation of the quality of decellularized tissue is performed using scanned images of hematoxylin-eosin stained (H&E) tissue sections and is usually dependent on the observer. The first step in creating a tool for the assessment of the quality of the liver scaffold without observer bias is the automatic segmentation of the whole slide image into three classes: the background, intralobular area, and extralobular area. Such segmentation enables to perform the texture analysis in the intralobular area of the liver scaffold, which is crucial part in the recellularization procedure. Existing semi-automatic methods for general segmentation (i.e., thresholding, watershed, etc.) do not meet the quality requirements. Moreover, there are no methods available to solve this task automatically. Given the low amount of training data, we proposed a two-stage method. The first stage is based on classification of simple hand-crafted descriptors of the pixels and their neighborhoods. This method is trained on partially annotated data. Its outputs are used for training of the second-stage approach, which is based on a convolutional neural network (CNN). Our architecture inspired by U-Net reaches very promising results, despite a very low amount of the training data. We provide qualitative and quantitative data for both stages. With the best training setup, we reach 90.70% recognition accuracy.
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Affiliation(s)
- Miroslav Jirik
- NTIS—New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, 301 00 Pilsen, Czech Republic; (I.G.); (M.Z.)
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.M.); (L.C.); (R.P.); (J.R.); (L.B.); (J.D.); (V.L.)
- Correspondence:
| | - Ivan Gruber
- NTIS—New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, 301 00 Pilsen, Czech Republic; (I.G.); (M.Z.)
| | - Vladimira Moulisova
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.M.); (L.C.); (R.P.); (J.R.); (L.B.); (J.D.); (V.L.)
| | - Claudia Schindler
- Experimental Transplantation Surgery Department, Universitätsklinikum Jena, 07743 Jena, Germany; (C.S.); (J.A.); (U.D.)
| | - Lenka Cervenkova
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.M.); (L.C.); (R.P.); (J.R.); (L.B.); (J.D.); (V.L.)
| | - Richard Palek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.M.); (L.C.); (R.P.); (J.R.); (L.B.); (J.D.); (V.L.)
- Department of Surgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Jachym Rosendorf
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.M.); (L.C.); (R.P.); (J.R.); (L.B.); (J.D.); (V.L.)
- Department of Surgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Janine Arlt
- Experimental Transplantation Surgery Department, Universitätsklinikum Jena, 07743 Jena, Germany; (C.S.); (J.A.); (U.D.)
| | - Lukas Bolek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.M.); (L.C.); (R.P.); (J.R.); (L.B.); (J.D.); (V.L.)
| | - Jiri Dejmek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.M.); (L.C.); (R.P.); (J.R.); (L.B.); (J.D.); (V.L.)
| | - Uta Dahmen
- Experimental Transplantation Surgery Department, Universitätsklinikum Jena, 07743 Jena, Germany; (C.S.); (J.A.); (U.D.)
| | - Milos Zelezny
- NTIS—New Technologies for the Information Society, Faculty of Applied Sciences, University of West Bohemia, 301 00 Pilsen, Czech Republic; (I.G.); (M.Z.)
| | - Vaclav Liska
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; (V.M.); (L.C.); (R.P.); (J.R.); (L.B.); (J.D.); (V.L.)
- Department of Surgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
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24
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Bachmann C, Paz Hernandez AL, Müller S, Khalatbarizamanpoor S, Tschiesche T, Reißmann F, Kiesow L, Ebbert D, Smirnow W, Wilken A, Dahmen U. Digital teaching and learning of surgical skills (not only) during the pandemic: a report on a blended learning project. GMS J Med Educ 2020; 37:Doc68. [PMID: 33364347 PMCID: PMC7740016 DOI: 10.3205/zma001361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/09/2020] [Accepted: 10/29/2020] [Indexed: 06/12/2023]
Abstract
Due to the COVID-19 pandemic, digital teaching approaches should be used wherever possible. In this article we report on our project for digital teaching and learning of surgical skills. The compulsory elective "Intensivkurs Chirurgische Techniken" for medical students starting with semester 5 was designed as a blended learning course. One week before the face-to-face class, the students receive the learning and teaching material online in a Moodle course. In the face-to-face class, live demos of procedures (e.g. performing skin and intestinal sutures) are presented by the teachers. The learners then perform the practical procedures and record themselves with the camera of an iPad. They publish their videos in the Moodle course via an Opencast plugin. The implementation of an annotation tool enables everyone in the Moodle course to add free-text comments to selected parts of the videos (video-assisted feedback and coaching). As a result of the pandemic, the face-to-face class is being moved to a digital learning environment. For this purpose, we are extending the existing system with a web conference tool (BigBlueButton).
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Affiliation(s)
- Carina Bachmann
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, Jena, Germany
| | - Ana Lucia Paz Hernandez
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, Jena, Germany
| | - Stefan Müller
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, Jena, Germany
| | - Sadaf Khalatbarizamanpoor
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, Jena, Germany
| | - Tino Tschiesche
- University of Jena, University Computer Centre, Multimedia Centre, Jena, Germany
| | - Frank Reißmann
- University of Jena, University Computer Centre, Multimedia Centre, Jena, Germany
| | | | | | | | | | - Uta Dahmen
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, Jena, Germany
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25
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Moulisová V, Jiřík M, Schindler C, Červenková L, Pálek R, Rosendorf J, Arlt J, Bolek L, Šůsová S, Nietzsche S, Liška V, Dahmen U. Novel morphological multi-scale evaluation system for quality assessment of decellularized liver scaffolds. J Tissue Eng 2020; 11:2041731420921121. [PMID: 32523667 PMCID: PMC7257850 DOI: 10.1177/2041731420921121] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/02/2020] [Indexed: 12/19/2022] Open
Abstract
Decellularized scaffolds can serve as an excellent three-dimensional environment for cell repopulation. They maintain tissue-specific microarchitecture of extracellular matrix proteins with important spatial cues for cell adhesion, migration, growth, and differentiation. However, criteria for quality assessment of the three-dimensional structure of decellularized scaffolds are rather fragmented, usually study-specific, and mostly semi-quantitative. Thus, we aimed to develop a robust structural assessment system for decellularized porcine liver scaffolds. Five scaffolds of different quality were used to establish the new evaluation system. We combined conventional semi-quantitative scoring criteria with a quantitative scaffold evaluation based on automated image analysis. For the quantitation, we developed a specific open source software tool (ScaffAn) applying algorithms designed for texture analysis, segmentation, and skeletonization. ScaffAn calculates selected parameters characterizing structural features of porcine liver scaffolds such as the sinusoidal network. After evaluating individual scaffolds, the total scores predicted scaffold interaction with cells in terms of cell adhesion. Higher scores corresponded to higher numbers of cells attached to the scaffolds. Moreover, our analysis revealed that the conventional system could not identify fine differences between good quality scaffolds while the additional use of ScaffAn allowed discrimination. This led us to the conclusion that only using the combined score resulted in the best discrimination between different quality scaffolds. Overall, our newly defined evaluation system has the potential to select the liver scaffolds most suitable for recellularization, and can represent a step toward better success in liver tissue engineering.
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Affiliation(s)
- Vladimíra Moulisová
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Miroslav Jiřík
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Department of Cybernetics, University of West Bohemia, Pilsen, Czech Republic
| | - Claudia Schindler
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Lenka Červenková
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Department of Pathology, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Richard Pálek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Department of Surgery, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Jáchym Rosendorf
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Department of Surgery, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Janine Arlt
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Lukáš Bolek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Department of Biophysics, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Simona Šůsová
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Department of Toxicogenomics, National Institute of Public Health, Prague, Czech Republic
| | - Sandor Nietzsche
- Centre for Electron Microscopy, University Hospital Jena, Jena, Germany
| | - Václav Liška
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Department of Surgery, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
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26
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Werner C, Dirsch O, Dahmen U, Grimm MO, Schulz S, Lupp A. Evaluation of Somatostatin and CXCR4 Receptor Expression in a Large Set of Prostate Cancer Samples Using Tissue Microarrays and Well-Characterized Monoclonal Antibodies. Transl Oncol 2020; 13:100801. [PMID: 32460182 PMCID: PMC7249232 DOI: 10.1016/j.tranon.2020.100801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND: Prostate cancer (PCa) is the most common type of cancer among men in Western countries. Despite numerous therapeutic options, few treatments are available for patients with end-stage disease. In the present study, different somatostatin receptors (SSTs) and the chemokine receptor CXCR4 were evaluated for their suitability as novel therapeutic targets in PCa. MATERIALS AND METHODS: The expression of SST subtypes 1, 2A, 3, and 5 and of CXCR4 was evaluated in 276 PCa tumor samples on a tissue microarray (TMA) in 23 whole-block tumor samples and in 3 PCa cell lines by immunohistochemistry using well-characterized monoclonal antibodies. RESULTS: Overall, the frequency and intensity of expression of SSTs and CXCR4 were very low among the PCa samples investigated. Specifically, SST5, SST2A, and SST3 were expressed, albeit at low intensity, in 10.5%, 9.1%, and 0.7% of the TMA samples, respectively. None of the TMA samples showed SST1 or CXCR4 expression. Only a single small-cell-type neuroendocrine carcinoma that was coincidentally included among the whole-block samples exhibited strong SST2A, SST5, and CXCR4 and moderate SST3 expression. Independent of the tumor cells, the tumor capillaries in many of the PCa samples were strongly positive for SST2A, SST3, SST5, or CXCR4 expression. SST expression in the tumor cells was associated with advanced tumor grade and stage. CONCLUSION: Overall, SST and CXCR4 expression levels are clearly of no therapeutic relevance in PCa. SST- or CXCR4-based therapy might be feasible, however, in rare cases of small-cell-type neuroendocrine carcinoma of the prostate.
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Affiliation(s)
- Christoph Werner
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany; Institute of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany
| | - Olaf Dirsch
- Institute of Pathology, Jena University Hospital, Jena, Germany; Institute of Pathology, Klinikum Chemnitz, Chemnitz, Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | | | - Stefan Schulz
- Institute of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany
| | - Amelie Lupp
- Institute of Pharmacology and Toxicology, Jena University Hospital, Jena, Germany.
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27
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Xu F, Hua C, Tautenhahn HM, Dirsch O, Dahmen U. The Role of Autophagy for the Regeneration of the Aging Liver. Int J Mol Sci 2020; 21:ijms21103606. [PMID: 32443776 PMCID: PMC7279469 DOI: 10.3390/ijms21103606] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
Age is one of the key risk factors to develop malignant diseases leading to a high incidence of hepatic tumors in the elderly population. The only curative treatment for hepatic tumors is surgical removal, which initiates liver regeneration. However, liver regeneration is impaired with aging, leading to an increased surgical risk for the elderly patient. Due to the increased risk, those patients are potentially excluded from curative surgery. Aging impairs autophagy via lipofuscin accumulation and inhibition of autophagosome formation. Autophagy is a recycling mechanism for eukaryotic cells to maintain homeostasis. Its principal function is to degrade endogenous bio-macromolecules for recycling cellular substances. A number of recent studies have shown that the reduced regenerative capacity of the aged remnant liver can be restored by promoting autophagy. Autophagy can be activated via multiple mTOR-dependent and mTOR-independent pathways. However, inducing autophagy through the mTOR-dependent pathway alone severely impairs liver regeneration. In contrast, recent observations suggest that inducing autophagy via mTOR-independent pathways might be promising in promoting liver regeneration. Conclusion: Activation of autophagy via an mTOR-independent autophagy inducer is a potential therapy for promoting liver regeneration, especially in the elderly patients at risk.
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Affiliation(s)
- Fengming Xu
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany; (F.X.); (C.H.); (H.-M.T.)
| | - Chuanfeng Hua
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany; (F.X.); (C.H.); (H.-M.T.)
| | - Hans-Michael Tautenhahn
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany; (F.X.); (C.H.); (H.-M.T.)
| | - Olaf Dirsch
- Institute of Pathology, Klinikum Chemnitz gGmbH, 09111 Chemnitz, Germany;
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany; (F.X.); (C.H.); (H.-M.T.)
- Correspondence: ; Tel.: +49-03641-9325350
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28
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Ho H, Dahmen U, Hunter P. An in silico rat liver atlas. Comput Methods Biomech Biomed Engin 2020; 23:597-600. [PMID: 32310673 DOI: 10.1080/10255842.2020.1754404] [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] [Indexed: 10/24/2022]
Abstract
Numerous hepatic function, disease and pharmacological experiments are performed on rat livers. Many of these experiments rely on an accurate understanding of the rat liver anatomy. In this short paper, we present an in silico rat liver atlas which is constructed from the micro-CT images of explanted rat livers. The atlas consists of the parametric mesh for four liver lobes and a paracaval portion. 1D and 3D cubic Hermite mesh are used to represent the rat liver vessels and lobes, respectively. We discuss potential applications that can be performed from the in silico atlas.
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Affiliation(s)
- Harvey Ho
- Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, Jena University, Germany
| | - Peter Hunter
- Auckland Bioengineering Institute, The University of Auckland, New Zealand
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29
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Meyer K, Morales‐Navarrete H, Seifert S, Wilsch‐Braeuninger M, Dahmen U, Tanaka EM, Brusch L, Kalaidzidis Y, Zerial M. Bile canaliculi remodeling activates YAP via the actin cytoskeleton during liver regeneration. Mol Syst Biol 2020; 16:e8985. [PMID: 32090478 PMCID: PMC7036714 DOI: 10.15252/msb.20198985] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 01/19/2020] [Accepted: 01/23/2020] [Indexed: 12/13/2022] Open
Abstract
The mechanisms of organ size control remain poorly understood. A key question is how cells collectively sense the overall status of a tissue. We addressed this problem focusing on mouse liver regeneration. Using digital tissue reconstruction and quantitative image analysis, we found that the apical surface of hepatocytes forming the bile canalicular network expands concomitant with an increase in F-actin and phospho-myosin, to compensate an overload of bile acids. These changes are sensed by the Hippo transcriptional co-activator YAP, which localizes to apical F-actin-rich regions and translocates to the nucleus in dependence of the integrity of the actin cytoskeleton. This mechanism tolerates moderate bile acid fluctuations under tissue homeostasis, but activates YAP in response to sustained bile acid overload. Using an integrated biophysical-biochemical model of bile pressure and Hippo signaling, we explained this behavior by the existence of a mechano-sensory mechanism that activates YAP in a switch-like manner. We propose that the apical surface of hepatocytes acts as a self-regulatory mechano-sensory system that responds to critical levels of bile acids as readout of tissue status.
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Affiliation(s)
- Kirstin Meyer
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
| | | | - Sarah Seifert
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
| | | | - Uta Dahmen
- Experimental Transplantation SurgeryDepartment of General, Visceral and Vascular SurgeryJena University HospitalJenaGermany
| | - Elly M Tanaka
- Research Institute of Molecular PathologyVienna BioCenterViennaAustria
| | - Lutz Brusch
- Center for Information Services and High Performance ComputingTechnische Universität DresdenDresdenGermany
| | - Yannis Kalaidzidis
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
- Faculty of Bioengineering and BioinformaticsMoscow State UniversityMoscowRussia
| | - Marino Zerial
- Max Planck Institute of Molecular Cell Biology and GeneticsDresdenGermany
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30
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Wang A, Kuriata O, Xu F, Nietzsche S, Gremse F, Dirsch O, Settmacher U, Dahmen U. A Survival Model of In Vivo Partial Liver Lobe Decellularization Towards In Vivo Liver Engineering. Tissue Eng Part C Methods 2019; 26:402-417. [PMID: 31668131 DOI: 10.1089/ten.tec.2019.0194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In vivo liver decellularization has become a promising strategy to study in vivo liver engineering. However, long-term survival after in vivo liver decellularization has not yet been achieved due to anatomical and technical challenges. This study aimed at establishing a survival model of in vivo partial liver lobe perfusion-decellularization in rats. We compared three decellularization protocols (1% Triton X100 followed by 1% sodium dodecyl sulfate [SDS], 1% SDS vs. 1% Triton X100, n = 6/group). Using the optimal one as judged by macroscopy, histology and DNA content, we characterized the structural integrity and matrix proteins by using histology, scanning electron microscopy, computed tomography scanning, and immunohistochemistry (IHC). We prevented contamination of the abdominal cavity with the corrosive detergents by using polyvinylidene chloride (PVDC) film + dry gauze in comparison to PVDC film + dry gauze + aspiration tube (n = 6/group). Physiological reperfusion was assessed by histology. Survival rate was determined after a 7-day observation period. Only perfusion with 1% SDS resulted in an acellular scaffold (fully translucent without histologically detectable tissue remnants, DNA concentration is <2% of that in native lobe) with remarkable structural and ultrastructural integrity as well as preservation of main matrix proteins (IHC positive for collagen IV, laminin, and elastin). Contamination of abdominal organs with the potentially toxic SDS solution was achieved by placing a suction tube in addition to the PVDC film + dry gauze and allowed a 7-day survival of all animals without severe postoperative complications. On reperfusion, the liver turned red within seconds without any leakage from the surface of the liver. About 12 h after reperfusion, not only blood cells but also some clots were visible in the portal vein, sinusoidal matrix network, and central vein, suggesting physiological perfusion. In conclusion, our results of this study show the first available data on generation of a survival model of in vivo parenchymal organ decellularization, creating a critical step toward in vivo organ engineering. Impact Statement Recently, in vivo liver decellularization has been considered a promising approach to study in vivo liver repopulation of a scaffold compared with ex vivo liver repopulation. However, long-term survival of in vivo liver decellularization has not yet been achieved. Here, despite anatomical and technical challenges, we successfully created a survival model of in vivo selected liver lobe decellularization in rats, providing a major step toward in vivo organ engineering.
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Affiliation(s)
- An Wang
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Olha Kuriata
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Fengming Xu
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Sandor Nietzsche
- Center for Electron Microscopy, Jena University Hospital, Jena, Germany
| | - Felix Gremse
- Experimental Molecular Imaging, RWTH Aachen University, Aachen, Germany
| | - Olaf Dirsch
- Institute of Pathology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
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31
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Sterz J, Adili F, Bender M, Dahmen U, Heinemann MK, Hofmann HS, König S, Obertacke U, Rüsseler M, Stefanescu C, Voß SH, Walcher F, Kadmon M. [National Learning Objectives Catalogue in Surgery - General Part Defining Competences of Medical School Graduates in Surgery]. Zentralbl Chir 2019; 144:573-579. [PMID: 31842239 DOI: 10.1055/a-1033-7769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Competency-based medical education is needed in order to meet the requirements of medical care currently and in the future. The basis of this are activity-based learning objectives that are merged in competency-based catalogues. A basis for a core curriculum of undergraduate medical training is the National Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM). Already in 2013, for surgery, the competencies which medical students should have achieved after completing the practical year (PJ) in relation to surgical diseases were defined in the special part of the National Catalogue of Learning Objectives in Surgery (NKLC). In the now amended general part of the NKLC, interdisciplinary competencies were defined and consented from all surgical disciplines, that are relevant for all surgical disciplines and that all representatives from the different surgical disciplines should incorporate in their surgical training. The complete NKLC is now available for faculties, teachers and students for trial (available online: https://www.dgch.de/index.php?id=190&L=528). The guiding principle for the entire development process was to make sure that students gain all competencies they need when starting to work as a medical doctor and therefor to increase patient safety.
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Affiliation(s)
- Jasmina Sterz
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Deutschland
| | - Farzin Adili
- Klinik für Gefäßmedizin-Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
| | - Michael Bender
- Klinik für Innere Medizin 1, Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Deutschland
| | - Uta Dahmen
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Experimentelle Transplantationschirurgie, Universitätsklinikum Jena, Deutschland
| | - Markus K Heinemann
- Klinik und Poliklinik für Herz-, Thorax und Gefäß-Chirurgie, Universitätsmedizin Mainz, Deutschland
| | | | - Sarah König
- Institut für Medizinische Lehre und Ausbildungsforschung, Universitätsklinikum Würzburg, Deutschland
| | - Udo Obertacke
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Deutschland
| | - Miriam Rüsseler
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Deutschland
| | - Christina Stefanescu
- Klinik für Kinderchirurgie und Kinderurologie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Deutschland
| | | | - Felix Walcher
- Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Deutschland
| | - Martina Kadmon
- Gründungsdekanat, Medizinische Fakultät der Universität Augsburg, Deutschland
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32
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Schindler C, Felgendreff P, Settmacher U, Dahmen U. [Video-based Analysis of Practical Skills - a Suitable Tool to Develop Surgical Training?]. Zentralbl Chir 2019; 144:606-613. [PMID: 31826295 DOI: 10.1055/a-1030-4676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Video-based analysis concepts are being is increasingly applied in medical education. These tools are mainly used to obtain information about the individual performance of a candidate and to provide feedback. The present study explores whether video-based analysis of practical skills can also be used for the development of surgical training. METHODS First, the performance of students in semester 10 (n = 38) in a surgical suture exercise (duration: 3 min) was video-documented. The video material was then analysed using 10 specific criteria. The analysis then served as a basis for the development of error prevention exercises. In the following, the effects of the additional teaching units on the performance in the suture exercise were examined in a pilot study using a two-group comparison. RESULTS The video sequences were reviewed independently by 2 experts. Typical errors could be observed in the handling of the surgical instruments, the handling of the suture material as well as in the motion sequence. Then, additional teaching units dealing with the identified error areas (handling of the instruments and the suture material) were developed. The results of the two-group comparison (before and after implementation of the new exercises) showed that completing the additional teaching units had a medium effect on the result quality of the suture exercise (Cohen's d = 0.73). CONCLUSION Video analysis of practical skills seems to be a suitable basis for the development of surgical training. Typical errors can be identified in terms of type and frequency, and preventive exercises can be developed, which have a positive effect on the quality of the results of a practical task.
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Affiliation(s)
- Claudia Schindler
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Experimentelle Transplantationschirurgie, Universitätsklinikum Jena, Deutschland
| | - Philipp Felgendreff
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Experimentelle Transplantationschirurgie, Universitätsklinikum Jena, Deutschland.,Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland
| | - Utz Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland
| | - Uta Dahmen
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Experimentelle Transplantationschirurgie, Universitätsklinikum Jena, Deutschland
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33
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Tautenhahn HM, Dahmen U, Diamantis I, Settmacher U, Zanow J. [Benign liver tumors : Diagnostics and treatment]. Chirurg 2019; 90:1033-1046. [PMID: 31784769 DOI: 10.1007/s00104-019-01068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Benign liver tumors are often detected during routine ultrasound examinations or as an incidental finding in radiological imaging. Only very few benign liver tumors are at risk of becoming malignant. In the majority of cases the differentiation from malignant tumors is currently carried out using imaging procedures. In a few cases of diagnostic uncertainty, a transcutaneous liver biopsy can lead to clarification. If the suspicion of malignancy is substantiated or this cannot be excluded with absolute certainty, the tumor should be removed by partial liver resection.
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Affiliation(s)
- H-M Tautenhahn
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, Jena, 07747, Deutschland. .,Research Programme "Else Kröner-Forschungskolleg AntiAge", Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland. .,Experimentelle Chirurgie, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, Jena, 07747, Deutschland.
| | - U Dahmen
- Experimentelle Chirurgie, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, Jena, 07747, Deutschland
| | - I Diamantis
- Institut für diagnostische und interventionelle Radiologie, Universitätsklinikum Jena, Am Klinikum 1, Jena, 07747, Deutschland
| | - U Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, Jena, 07747, Deutschland
| | - J Zanow
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, Jena, 07747, Deutschland
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34
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Terbonssen T, Settmacher U, Dirsch O, Dahmen U. [Knowledge, trust, and the decision to donate organs : A comparison of medical students and students of other disciplines in Germany]. Chirurg 2019; 89:131-137. [PMID: 28894905 DOI: 10.1007/s00104-017-0508-y] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Following the organ transplant scandal in Germany in 2011, the willingness to donate organs postmortem decreased dramatically. This was explained by a loss of confidence in the German organ donation system. OBJECTIVES The aim of this study was to evaluate the relationship between knowledge, trust, and fear in respect to organ donation and the explicit willingness to potentially act as an organ donor by comparing medical students to students of other disciplines. MATERIAL AND METHODS We conducted a Facebook-based online survey (June-July 2013). The participating students were divided into two groups according to their discipline: medical students and other students. Based on questions covering different aspects of organ donation, a knowledge, trust, and fear score was established and calculated. The answers were related to an explicitly expressed decision to donate organs as expressed in a signed organ donor card. RESULTS In total, 2484 participants took part in our survey. Of these, 1637 were students, 83.7% (N = 1370) of which were medical students and 16.3% (N = 267) other students. As expected, medical students reached a higher knowledge score regarding organ donation compared with other students (knowledge score 4.13 vs. 3.38; p < 0.001). They also demonstrated more confidence in organ donation, resulting in a higher confidence score (3.94 vs. 3.33; p < 0.001) and expressed less fear towards organ donation as indicated by the lower fear score (1.76 vs. 2.04; p < 0.01). Medical students declared their written willingness to donate organs more often than did other students (78.2% vs. 55.2%; p < 0.001). Entries on organ donation cards did not differ significantly between medical students and other students. Medical students possessing an organ donor card showed a higher knowledge and a higher trust score than did medical students without an organ donor card. In contrast, other students possessing an organ donor card showed a higher trust score but did not show a higher knowledge score. CONCLUSIONS The higher level of knowledge and trust demonstrated by the medical students was associated with a higher rate of written decisions to donate organs. In contrast, the lower level of knowledge and trust observed in the non-medical students was associated with a lower rate of organ donor cards. Interestingly, in the group of non-medical students, the decision regarding organ donation was associated with a higher level of trust, but not with a higher level of knowledge. It would appear that knowledge, trust, and the decision to donate organs are closely related. In cases of a low level of knowledge, confidence is even more important. Therefore, organ donation campaigns should focus on increasing knowledge and fostering trust.
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Affiliation(s)
- T Terbonssen
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - U Settmacher
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - O Dirsch
- Institut für Pathologie, Klinikum Chemnitz gGmbH, Flemmingstraße 2, 09116, Chemnitz, Deutschland
| | - U Dahmen
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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35
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Müller S, Koch I, Settmacher U, Dahmen U. How the introduction of OSCEs has affected the time students spend studying: results of a nationwide study. BMC Med Educ 2019; 19:146. [PMID: 31092236 PMCID: PMC6521539 DOI: 10.1186/s12909-019-1570-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 04/23/2019] [Indexed: 06/01/2023]
Abstract
BACKGROUND Medical schools globally now use objective structured clinical examinations (OSCEs) for assessing a student's clinical performance. In Germany, almost all of the 36 medical schools have incorporated at least one summative OSCE into their clinical curriculum. This nationwide study aimed to examine whether the introduction of OSCEs shifted studying time. The authors explored what resources were important for studying in preparation for OSCEs, how much time students spent studying, and how they performed; each compared to traditionally used multiple choice question (MCQ) tests. METHODS The authors constructed a questionnaire comprising two identical sections, one for each assessment method. Either section contained a list of 12 study resources requesting preferences on a 5-point scale, and two open-ended questions about average studying time and average grades achieved. During springtime of 2015, medical schools in Germany were asked to administer the web-based questionnaire to their students in years 3-6. Statistical analysis compared the responses on the open-ended questions between the OSCE and MCQs using a paired t-test. RESULTS The sample included 1131 students from 32 German medical schools. Physical examination courses were most important in preparation for OSCEs, followed by class notes/logs and the skills lab. Other activities in clinical settings (e.g. medical clerkships) and collaborative strategies ranked next. Conversely, resources for gathering knowledge (e.g. lectures or textbooks) were of minor importance when studying for OSCEs. Reported studying time was lower for OSCEs compared to MCQ tests. The reported average grade, however, was better on OSCEs. CONCLUSIONS The study findings suggest that the introduction of OSCEs shifted studying time. When preparing for OSCEs students focus on the acquisition of clinical skills and need less studying time to achieve the expected level of competence/performance, as compared to the MCQ tests.
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Affiliation(s)
- Stefan Müller
- Department of General, Visceral and Vascular Surgery, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Ines Koch
- Department of Gynaecology and Reproductive Medicine, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, Universitätsklinikum Jena, Drackendorfer Str. 1, 07747 Jena, Germany
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Adili F, Dahmen U, Heinemann MK, Kadmon M, Kauffels-Sprenger A, König S, Meder A, Obertacke U, Schwanitz von Keitz P, Stefanescu C, Sterz J, Rüsseler M. [Position Paper of the Surgical Working Group for Teaching of the German Society of Surgery Regarding the "Master Plan 2020"]. Zentralbl Chir 2019; 144:532-535. [PMID: 31067573 DOI: 10.1055/a-0869-8081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The "Masterplan Medizinstudium 2020" from the German Federal Government should not be underestimated as only one among many announcement. Thus, the Surgical Working Group on Medical Education (CAL) of the German Association of Surgeons (DGCH) comments on the intended measures of the "Masterplan Medizinstudium 2020" and discusses the challenges, consequences and duties arising from the "Masterplan Medizinstudium 2020" for the representatives of the surgical societies and those engaged in surgical undergraduate training.
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Affiliation(s)
- Farzin Adili
- Klinik für Gefäßmedizin - Gefäß- und Endovascularchirurgie, Klinikum Darmstadt, Deutschland
| | - Uta Dahmen
- Experimentelle Transplantationschirurgie, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Deutschland
| | - Markus K Heinemann
- Klinik und Poliklinik für Herz-, Thorax und Gefäß-Chirurgie, Universitätsmedizin Mainz, Deutschland
| | - Martina Kadmon
- Dekanat der Medizinischen Fakultät der Universität Augsburg, Deutschland
| | - Anne Kauffels-Sprenger
- Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Deutschland
| | - Sarah König
- Institut für Medizinische Lehre und Ausbildungsforschung, Universitätsklinikum Würzburg, Deutschland
| | - Adrian Meder
- Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Deutschland
| | - Udo Obertacke
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsmedizin Mannheim, Deutschland
| | | | - Christina Stefanescu
- Klinik für Kinderchirurgie und Kinderurologie, Universitätsklinikum Frankfurt, Deutschland
| | - Jasmina Sterz
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Deutschland
| | - Miriam Rüsseler
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt, Deutschland
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Rauchfuß F, Helble J, Bruns J, Dirsch O, Dahmen U, Ardelt M, Settmacher U, Scheuerlein H. Biocellulose for Incisional Hernia Repair-An Experimental Pilot Study. Nanomaterials (Basel) 2019; 9:nano9020236. [PMID: 30744160 PMCID: PMC6410132 DOI: 10.3390/nano9020236] [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] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 01/23/2023]
Abstract
Ventral or incisional hernia are a common disease pattern in general surgery. Most commonly, a mesh repair is used for reconstruction, whereby the mesh itself might cause complications, like infections or adhesions. Biological materials, like biocellulose, might reduce these clinical problems substantially. In this prospective rodent study, a biocellulose mesh (produced by Gluconacetobacter xylinus) was implanted either by a sublay technique or as supplementation of the abdominal wall. After an observation period of 90 days, animals were sacrificed. The adhesions after the reconstruction of the abdominal wall were moderate. The histologic investigations revealed that the biocellulose itself was inert, with a minimal regenerative response surrounding the mesh. The explanted mesh showed a minimal shrinkage (around 15%) as well as a minimal loss of tear-out force, which might be without clinical relevance. This is the first in vivo study describing biocellulose as a suitable mesh for the repair of ventral hernia in two different hernia models. The material seems to be a promising option for solving actual problems in modern hernia surgery.
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Affiliation(s)
- Falk Rauchfuß
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany.
| | - Julian Helble
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany.
| | - Johanna Bruns
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany.
| | - Olaf Dirsch
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, JenaUniversity Hospital, 07747 Jena, Germany.
- Institute of Pathology Hospital of Chemnitz, 09116 Chemnitz, Germany.
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, JenaUniversity Hospital, 07747 Jena, Germany.
| | - Michael Ardelt
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany.
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany.
| | - Hubert Scheuerlein
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, Germany.
- Department of General and Visceral Surgery, St. Vinzenz Hospital, 33098 Paderborn, Germany.
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Fang H, Liu A, Chen X, Cheng W, Dirsch O, Dahmen U. The severity of LPS induced inflammatory injury is negatively associated with the functional liver mass after LPS injection in rat model. J Inflamm (Lond) 2018; 15:21. [PMID: 30473633 PMCID: PMC6238277 DOI: 10.1186/s12950-018-0197-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/25/2018] [Indexed: 11/12/2022]
Abstract
Background High levels of serum lipopolysaccharide (LPS) were observed in sepsis patients with liver injury and high mortality. However, the role of liver in modulation LPS induced inflammatory injury was ill investigated. In the present study, the severity of LPS induced inflammatory response was observed after liver resection or portal branch occlusion to decreasing functional liver mass. The local and systemic damage was observed to investigate the role of liver in modulation inflammatory injury. Methods First, 30%, 70%, and 90% partial hepatectomy (PH) were performed, and serum TNF-α, survival rate, and hepatic LPS uptake was observed. Second, LPS-exposure of the functional liver mass was decreased by selectively blocking the RL prior to LPS-injection, which was given 30 min before a 70% PH, and the inflammatory response was compared in the occluded and the non-occluded liver. The control group was subjected to LPS injection 30 min prior to liver resection without blocking the RL transiently. The serum TNF-α, ALT, AST, creatinine levels, and urea levels, survival rate, hepatic LPS uptake, and hepatic inflammatory cytokines was observed. Results The decreasing of functional liver mass after 90%, 70%, and 30% PH was associated with decreased serum TNF-α, survival rate, and increased hepatic LPS uptake after LPS injection. Occluding the right lobes (RL) prior to LPS administration reversed the liver injury caused by 70% PH, indicated by 100% survival rate and decreased liver and kidney injury, and systemic inflammatory response. The induction of inflammatory response in occluding liver lobes were lower than un-occluding liver lobes. Conclusions The severity of the LPS-induced systemic inflammatory injury is determined by functional liver volume. This observation suggests that the liver is the central organ for the initiation of the inflammatory response, and is involved in causing a severe SIRS with systemic damage and death. Electronic supplementary material The online version of this article (10.1186/s12950-018-0197-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haoshu Fang
- 1Department of Pathophysiology, Anhui Medical University, Hefei, 230032 China.,2Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Friedrich-Schiller-University Jena, Drackendorferstraße1, 07747 Jena, Germany.,3Laboratory Animal Research Center, College of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Anding Liu
- 2Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Friedrich-Schiller-University Jena, Drackendorferstraße1, 07747 Jena, Germany.,4Experimental Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Xulin Chen
- 5Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022 China
| | - Wenhui Cheng
- 3Laboratory Animal Research Center, College of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Olaf Dirsch
- 6Institute of Pathology Hospital of Chemnitz, Chemnitz, Germany
| | - Uta Dahmen
- 2Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Friedrich-Schiller-University Jena, Drackendorferstraße1, 07747 Jena, Germany
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Müller S, Settmacher U, Koch I, Dahmen U. A pilot survey of student perceptions on the benefit of the OSCE and MCQ modalities. GMS J Med Educ 2018; 35:Doc51. [PMID: 30539076 PMCID: PMC6278234 DOI: 10.3205/zma001197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 05/24/2018] [Accepted: 06/24/2018] [Indexed: 06/02/2023]
Abstract
Objective: The objective structured clinical examination (OSCE) has become widely accepted as a form of assessment in medical education. At the same time, the more traditional multiple choice question (MCQ) examinations remain a central modality of student assessment. This pilot survey aimed to investigate students' perceptions about the benefits of the OSCE and MCQs to yield data supporting the implementation of this assessment strategy into the national medical licensing examination in Germany. Methods: A questionnaire was delivered electronically to 34 German medical schools. Students in years 3-6 were invited to rate 11 items about objectives of good medical assessment. All items were presented for both the OSCE and MCQs using a 5-point Likert Scale (1=strongly disagree to 5=strongly agree). Factor analysis was used to identify underlying components in the ratings. Average scores of items that belonged to a component were computed. Results: Data analysis included 1,082 students from 32 medical schools. For the OSCE, factor analysis revealed two components, which were labelled "educational impact" and "development of clinical competence". The average scores of items were 3.37 and 3.55, respectively. For the MCQ modality, also two components emerged. These were labelled "perceived weaknesses of MCQs" and "perceived strengths of MCQs" (consisting of items such as "promotes my theoretical knowledge"). The average scores for these components were 1.85 and 3.62. Conclusion: The results of this pilot survey indicate that students consider both OSCE and MCQs as useful assessments for the purposes for which they were designed. The assessment strategy thus appears appropriate and it should be used in the national licensing examination.
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Affiliation(s)
- Stefan Müller
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Jena, Germany
| | - Utz Settmacher
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Jena, Germany
| | - Ines Koch
- Jena University Hospital, Department of Gynaecology and Reproductive Medicine, Jena, Germany
| | - Uta Dahmen
- Jena University Hospital, Department of General, Visceral and Vascular Surgery, Experimental Transplantation Surgery, Jena, Germany
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Liu A, Yang J, Hu Q, Dirsch O, Dahmen U, Zhang C, Gewirtz DA, Fang H, Sun J. Young plasma attenuates age-dependent liver ischemia reperfusion injury. FASEB J 2018; 33:3063-3073. [PMID: 30383439 DOI: 10.1096/fj.201801234r] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aging is often associated with a decreased autophagic activity that contributes to the high sensitivity of aged livers to ischemia reperfusion injury (IRI). Blood from young animals can positively affect aged animals. This study was designed to evaluate the effect of young plasma in a model of liver IRI in aged rats. Aged rats were treated with pooled plasma collected from young rats before ischemia. Administration of young plasma restored aging-induced suppression in hepatic autophagic activity and reduced liver IRI. Inhibition of the young-plasma-restored autophagic activity abrogated the beneficial effect of young plasma against liver IRI. Similarly, young serum restored autophagic activity and reduced cellular injury after hypoxia/reoxygenation (H/R) in primary old rat hepatocytes. Mechanistic studies showed thatadministration of young plasma increased AMPK phosphorylation and led to unc-51-like autophagy activating kinase (ULK)1 activation. Furthermore, AMPK-inhibition abrogated the young serum-induced ULK1 activation and autophagic activity and diminished the protective action of young serum against H/R injury in primary old rat hepatocytes, whereas AMPK-activation potentiated the effects of young serum. Young plasma could restore age-impaired autophagy, at least in part, via AMPK/ULK1 signaling. Restoration of age-impaired autophagic activity may be a critical contributing mechanism to young-plasma-afforded protection against liver IRI in aged rats.-Liu, A., Yang, J., Hu, Q., Dirsch, O., Dahmen, U., Zhang, C., Gewirtz, D. A., Fang, H., Sun, J. Young plasma attenuates age-dependent liver ischemia reperfusion injury.
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Affiliation(s)
- Anding Liu
- Experimental Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiankun Yang
- Experimental Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Hu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Olaf Dirsch
- Institute of Pathology, Klinikum Chemnitz, Chemnitz, Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral, and Vascular Surgery, Friedrich-Schiller-University Jena, Jena, Germany
| | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - David A Gewirtz
- Department of Pharmacology and Toxicology, Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Haoshu Fang
- Department of Pathophysiology, Anhui Medical University, Hefei, China
| | - Jian Sun
- Department of Biliopancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Schleicher J, Dahmen U. Computational Modeling of Oxidative Stress in Fatty Livers Elucidates the Underlying Mechanism of the Increased Susceptibility to Ischemia/Reperfusion Injury. Comput Struct Biotechnol J 2018; 16:511-522. [PMID: 30505404 PMCID: PMC6247397 DOI: 10.1016/j.csbj.2018.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023] Open
Abstract
QUESTION Donor liver organs with moderate to high fat content (i.e. steatosis) suffer from an enhanced susceptibility to ischemia/reperfusion injury (IRI) during liver transplantation. Responsible for the cellular injury is an increased level of oxidative stress, however the underlying mechanistic network is still not fully understood. METHOD We developed a phenomenological mathematical model of key processes of hepatic lipid metabolism linked to pathways of oxidative stress. The model allows the simulation of hypoxia (i.e. ischemia-like conditions) and reoxygenation (i.e. reperfusion-like conditions) for various degrees of steatosis and predicts the level of hepatic lipid peroxidation (LPO) as a marker of cell damage caused by oxidative stress. RESULTS & CONCLUSIONS Our modeling results show that the underlying feedback loop between the formation of reactive oxygen species (ROS) and LPO leads to bistable systems behavior. Here, the first stable state corresponds to a low basal level of ROS production. The system is directed to this state for healthy, non-steatotic livers. The second stable state corresponds to a high level of oxidative stress with an enhanced formation of ROS and LPO. This state is reached, if steatotic livers with a high fat content undergo a hypoxic phase. Theoretically, our proposed mechanistic network would support the prediction of the maximal tolerable ischemia time for steatotic livers: Exceeding this limit during the transplantation process would lead to severe IRI and a considerable increased risk for liver failure.
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Key Words
- 4HNE, 4-Hydroxynonenal
- 8-OHdG, 8-Hydroxydeoxyguanosine
- ALOX12, Arachidonate 12-lipoxygenase
- AOD, Antioxidative defense
- CAT, Catalase
- DNL, de novo lipogenesis
- FA, Fatty acid
- GPx, Glutathione peroxidase
- GSH, Reduced glutathione
- GSSG, Oxidized glutathione
- H2O2, Hydrogen peroxide
- HFD, High-fat diet
- HIF, Hypoxia-inducible factor
- Hepatic fatty acid metabolism
- IL, Interleukin
- IR, Ischemia/reperfusion
- IRI, Ischemia/reperfusion injury
- LPO, Lipid peroxidation
- Lipid peroxidation
- MDA, Malondialdehyde
- NFκB, Nuclear factor kappa B
- O2, Oxygen
- O2–, Superoxide anion
- OH⁎, Hydroxyl radical
- Oxidative stress
- ROS, Reactive oxygen species
- Reactive oxygen species
- Steatosis
- TBARS, Thiobarbituric acid reactive substances
- TG, Triglyceride
- TNF, Tumor necrosis factor
- UCP2, Uncoupling protein-2
- cAMP, Cyclic adenosine monophosphate
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Affiliation(s)
- Jana Schleicher
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
- Department of Bioinformatics, Friedrich Schiller University Jena, Jena, Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
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Wang A, Jank I, Wei W, Schindler C, Dahmen U. A Novel Surgical Technique As a Foundation for In Vivo Partial Liver Engineering in Rat. J Vis Exp 2018. [PMID: 30346385 DOI: 10.3791/57991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Organ engineering is a novel strategy to generate liver organ substitutes that can potentially be used in transplantation. Recently, in vivo liver engineering, including in vivo organ decellularization followed by repopulation, has emerged as a promising approach over ex vivo liver engineering. However, postoperative survival was not achieved. The aim of this study is to develop a novel surgical technique of in vivo selective liver lobe perfusion in rats as a prerequisite for in vivo liver engineering. We generate a circuit bypass only through the left lateral lobe. Then, the left lateral lobe is perfused with heparinized saline. The experiment is performed with 4 groups (n = 3 rats per group) based on different perfusion times of 20 min, 2 h, 3 h, and 4 h. Survival, as well as the macroscopically visible change of color and the histologically determined absence of blood cells in the portal triad and the sinusoids, is taken as an indicator for a successful model establishment. After selective perfusion of the left lateral lobe, we observe that the left lateral lobe, indeed, turned from red to faint yellow. In a histological assessment, no blood cells are visible in the branch of the portal vein, the central vein, and the sinusoids. The left lateral lobe turns red after reopening the blocked vessels. 12/12 rats survived the procedure for more than one week. We are the first to report a surgical model for in vivo single liver lobe perfusion with a long survival period of more than one week. In contrast to the previously published report, the most important advantage of the technique presented here is that perfusion of 70% of the liver is maintained throughout the whole procedure. The establishment of this technique provides a foundation for in vivo partial liver engineering in rats, including decellularization and recellularization.
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Affiliation(s)
- An Wang
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena
| | - Isabel Jank
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena
| | - Weiwei Wei
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena
| | - Claudia Schindler
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena;
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Homeyer A, Hammad S, Schwen LO, Dahmen U, Höfener H, Gao Y, Dooley S, Schenk A. Focused scores enable reliable discrimination of small differences in steatosis. Diagn Pathol 2018; 13:76. [PMID: 30231920 PMCID: PMC6146776 DOI: 10.1186/s13000-018-0753-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/12/2018] [Indexed: 01/01/2023] Open
Abstract
Background Automated image analysis enables quantitative measurement of steatosis in histological images. However, spatial heterogeneity of steatosis can make quantitative steatosis scores unreliable. To improve the reliability, we have developed novel scores that are “focused” on steatotic tissue areas. Methods Focused scores use concepts of tile-based hotspot analysis in order to compute statistics about steatotic tissue areas in an objective way. We evaluated focused scores on three data sets of images of rodent liver sections exhibiting different amounts of dietary-induced steatosis. The same evaluation was conducted with the standard steatosis score computed by most image analysis methods. Results The standard score reliably discriminated large differences in steatosis (intraclass correlation coefficient ICC = 0.86), but failed to discriminate small (ICC = 0.54) and very small (ICC = 0.14) differences. With an appropriate tile size, mean-based focused scores reliably discriminated large (ICC = 0.92), small (ICC = 0.86) and very small (ICC = 0.83) differences. Focused scores based on high percentiles showed promise in further improving the discrimination of very small differences (ICC = 0.93). Conclusions Focused scores enable reliable discrimination of small differences in steatosis in histological images. They are conceptually simple and straightforward to use in research studies.
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Affiliation(s)
- André Homeyer
- Fraunhofer MEVIS, Am Fallturm 1, 28359, Bremen, Germany.
| | - Seddik Hammad
- Section Molecular Hepatology, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, 68167, Mannheim, Germany.,Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena, 83523, Egypt
| | | | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Drackendorfer Str. 1, 07747, Jena, Germany
| | | | - Yan Gao
- Section Molecular Hepatology, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Steven Dooley
- Section Molecular Hepatology, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, 68167, Mannheim, Germany
| | - Andrea Schenk
- Fraunhofer MEVIS, Am Fallturm 1, 28359, Bremen, Germany
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Grasreiner D, Dahmen U, Settmacher U. Specialty preferences and influencing factors: a repeated cross-sectional survey of first- to sixth-year medical students in Jena, Germany. BMC Med Educ 2018; 18:103. [PMID: 29743057 PMCID: PMC5944057 DOI: 10.1186/s12909-018-1200-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 04/20/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Given the expected increase in those entering retirement, the number of practising physicians is predicted to decrease. Conversely, the number of physicians needed is set to increase, due to higher demands resulting from the increasing average age of the German population. This may cause a deficit in the availability and accessibility of medical care for the population in Germany, as well as in other countries. As such, there needs to be a specific focus on the next generation of physicians. Will they fill the gap in those medical specialties where it is most needed? This study aims to investigate (a) preferences for medical specialties over time and (b) the reasoning behind these preferences among students. METHODS Over three subsequent years, all medical students from the Jena Faculty of Medicine were repeatedly invited to participate in an online survey. The questionnaire consisted of three parts to explore the students' (1) preferred postgraduate specialty, (2) the reasons for their decision and (3) socio-demographic data. Data analysis was performed using Fisher's exact tests and logistic regression analysis. RESULTS The number of students completing the questionnaire in a given year ranged from 180 to 320, resulting in a total number of 720 completed questionnaires. Between 40 and 50% of the students preferred internal medicine as postgraduate specialty. About 25% of the students were interested in a surgical specialty. Diagnostics and psychiatric medical fields were preferred by about 10% of all students for each field in each year of the survey. A large percentage (about 18%) of the students remained undecided. The factors influencing the students' specialty preferences were most frequently reconciliation of work and family life, career goals as well as predicted workload. The factors depended on the preferred medical specialty. CONCLUSION The influencing factors should be taken into account for recruiting prospective residents. Doing so could increase the chance to attract the number of physicians needed to ensure adequate medical care in the field of interest, according to the growing health needs of the population.
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Affiliation(s)
- Diana Grasreiner
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Experimentelle Transplantationschirurgie, Universitätsklinikum Jena, Drackendorfer Str. 1, 07747 Jena, Germany
| | - Uta Dahmen
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Experimentelle Transplantationschirurgie, Universitätsklinikum Jena, Drackendorfer Str. 1, 07747 Jena, Germany
| | - Utz Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
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Schleicher J, Dahmen U, Guthke R, Schuster S. Zonation of hepatic fat accumulation: insights from mathematical modelling of nutrient gradients and fatty acid uptake. J R Soc Interface 2018; 14:rsif.2017.0443. [PMID: 28835543 DOI: 10.1098/rsif.2017.0443] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/28/2017] [Indexed: 02/07/2023] Open
Abstract
Intrinsic of non-alcoholic fatty liver diseases is an aberrant accumulation of triglycerides (steatosis), which occurs inhomogeneously within lobules. To improve our understanding of the mechanisms involved in this zonation patterning, we developed a mathematical multicompartment model of hepatic fatty acid metabolism accompanied by blood flow simulations. A model analysis determines the influence of the uptake process of fatty acids, the porto-central gradient of plasma fatty acid concentration, and the oxygen supply via blood on the zonation of triglyceride accumulation. From this theoretical perspective, the plasma oxygen gradient, but not the fatty acid gradient, leads the way to a zonated triglyceride accumulation by its decisive role in oxidative processes. In addition, the uptake mechanism of fatty acids seems to be fundamental for a pericentral dominance of steatosis. However, the mechanism of cellular fatty acid uptake from the blood is still under debate. Our theoretical approach supports the transporter-mediated uptake mechanism and reveals that the maximal velocity of fatty acid uptake affects the switching between a periportal and a pericentral triglyceride accumulation. Further research on hepatic fatty acid uptake is needed to push forward our understanding of aberrant triglyceride accumulation in diet-induced steatosis.
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Affiliation(s)
- Jana Schleicher
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany .,Department of Bioinformatics, Friedrich-Schiller-University Jena, Jena, Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany
| | - Reinhard Guthke
- Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, Jena, Germany
| | - Stefan Schuster
- Department of Bioinformatics, Friedrich-Schiller-University Jena, Jena, Germany
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Liu A, Dong W, Peng J, Dirsch O, Dahmen U, Fang H, Zhang C, Sun J. Growth differentiation factor 11 worsens hepatocellular injury and liver regeneration after liver ischemia reperfusion injury. FASEB J 2018; 32:5186-5198. [DOI: 10.1096/fj.201800195r] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Anding Liu
- Experimental Medicine CenterTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Wei Dong
- Hepatic Surgery CenterTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jing Peng
- Department of Clinical LaboratoryTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Olaf Dirsch
- Institute of PathologyKlinikum ChemnitzChemnitzGermany
| | - Uta Dahmen
- Experimental Transplantation SurgeryDepartment of Generalm, Visceral, and Vascular SurgeryFriedrich-Schiller-University JenaJenaGermany
| | - Haoshu Fang
- Department of PathophysiologyAnhui Medical UniversityHefeiChina
| | - Cuntai Zhang
- Department of GeriatricsTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Jian Sun
- Department of Biliopancreatic Surgery Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene RegulationSun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouChina
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Tekbas A, Huebner J, Settmacher U, Dahmen U. Plants and Surgery: The Protective Effects of Thymoquinone on Hepatic Injury-A Systematic Review of In Vivo Studies. Int J Mol Sci 2018; 19:ijms19041085. [PMID: 29621129 PMCID: PMC5979411 DOI: 10.3390/ijms19041085] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/25/2018] [Accepted: 03/28/2018] [Indexed: 12/11/2022] Open
Abstract
Multimodal treatment concepts including liver transplantation for hepatocellular carcinoma (HCC), extended resection methods and neoadjuvant chemotherapy for colorectal liver metastasis significantly improve patients’ outcome. However, surgery-induced hepatic ischemia-reperfusion injury (IRI) and chemotherapy-associated hepatotoxicity result in hepatocellular damage and compromised liver function. Activation of common key pathways in ischemic liver and hepatotoxic injury results in oxidative stress, inflammatory responses and apoptosis causing organ damage. Controlling liver damage before and during surgery is essential for the postoperative outcome. Nigella sativa has a long tradition as a natural remedy. In the essential oil, Thymoquinone (TQ) was identified as the main component and responsible for most of the therapeutic effects. Therefore, this systematic review aimed to summarize the hepatoprotective effects of TQ and its potential suitability to improve surgical outcome by reducing surgical ischemic injury and hepatotoxicity of neoadjuvant chemotherapy. The key findings can be summarized as TQ having strong antioxidant, anti-inflammatory, antifibrotic, anti-/proapoptotic and anticarcinogenic effects. Almost no side effects were reported irrespective of a large dose range, suggesting a wide therapeutic window. These results give rise to the expectation that TQ could evolve to a novel powerful drug to reduce hepatic injury.
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Affiliation(s)
- Aysun Tekbas
- Department of General, Visceral and Vascular Surgery, University of Jena, 07743 Jena, Germany.
| | - Jutta Huebner
- Clinic for Internal Medicine II, Department of Hematology and Internal Oncology, University of Jena, 07743 Jena, Germany.
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University of Jena, 07743 Jena, Germany.
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, University of Jena, 07743 Jena, Germany.
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Abstract
BACKGROUND Organ engineering is a new strategy to cope with the shortage of donor organs. A functional scaffold from explanted organs is prepared by removing all cellular components (decellularization) and the reseeding (repopulation) of the organ scaffold to generate a functional organ in vitro for transplantation. This technique was also applied to the liver (liver engineering). OBJECTIVES Outline of the current state of the art and resulting approaches for future research strategies. MATERIAL AND METHODS Systematic review according to the PRISMA guidelines: a PubMed-based literature search (search terms liver, decellularization), selection of relevant articles based on predetermined criteria for relevance (e.g. decellularization, repopulation and transplantation), extraction and critical appraisal of data and results concerning the conditions for decellularization, repopulation and transplantation. RESULTS Decellularization was successfully performed in small and large animal models. Hepatocytes as well as stem cells and hepatic cell lines were applied for repopulation and 7 publications could show the successful transplantation of acellular and repopulated organ scaffolds. The current scientific need for further studies concerning the source of donor organs, optimization of the decellularization process, the cell type for the reseeding process and the establishment of the optimal conditions for the repopulation of the scaffold is still tremendous. For successful recellularization of the liver three goals need to be achieved: (1) reseeding of the organ scaffold with a sufficient amount of parenchymal cells, (2) endothelialization of the vascular tree to ensure the supply of oxygen and nutrients to parenchymal cells and (3) an appropriate epithelialization of the biliary tree. In order to progress to clinical trials a suitable transplantation model to verify the function of the organ constructs must be established. CONCLUSION Liver engineering using biological cell-free organ scaffolds represents a scientific and ethical challenge. The existing results emphasize the potential of this new and promising strategy to create organs for transplantation in the future.
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Affiliation(s)
- F Mußbach
- Experimentelle Transplantationschirurgie, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Drackendorfer Straße 1, 07747, Jena, Deutschland
| | - U Dahmen
- Experimentelle Transplantationschirurgie, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Drackendorfer Straße 1, 07747, Jena, Deutschland.
| | - O Dirsch
- Institut für Pathologie, Dr. Panofsky-Haus, Klinikum Chemnitz gGmbH, Chemnitz, Deutschland
| | - U Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Deutschland
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Liu A, Guo E, Yang J, Yang Y, Liu S, Jiang X, Hu Q, Dirsch O, Dahmen U, Zhang C, Gewirtz DA, Fang H. Young plasma reverses age-dependent alterations in hepatic function through the restoration of autophagy. Aging Cell 2018; 17. [PMID: 29210183 PMCID: PMC5770779 DOI: 10.1111/acel.12708] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 12/13/2022] Open
Abstract
Recent studies showing the therapeutic effect of young blood on aging‐associated deterioration of organs point to young blood as the solution for clinical problems related to old age. Given that defective autophagy has been implicated in aging and aging‐associated organ injuries, this study was designed to determine the effect of young blood on aging‐induced alterations in hepatic function and underlying mechanisms, with a focus on autophagy. Aged rats (22 months) were treated with pooled plasma (1 ml, intravenously) collected from young (3 months) or aged rats three times per week for 4 weeks, and 3‐methyladenine or wortmannin was used to inhibit young blood‐induced autophagy. Aging was associated with elevated levels of alanine transaminase and aspartate aminotransferase, lipofuscin accumulation, steatosis, fibrosis, and defective liver regeneration after partial hepatectomy, which were significantly attenuated by young plasma injections. Young plasma could also restore aging‐impaired autophagy activity. Inhibition of the young plasma‐restored autophagic activity abrogated the beneficial effect of young plasma against hepatic injury with aging. In vitro, young serum could protect old hepatocytes from senescence, and the antisenescence effect of young serum was abrogated by 3‐methyladenine, wortmannin, or small interfering RNA to autophagy‐related protein 7. Collectively, our data indicate that young plasma could ameliorate age‐dependent alterations in hepatic function partially via the restoration of autophagy.
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Affiliation(s)
- Anding Liu
- Experimental Medicine Center; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Enshuang Guo
- Department of Infectious Diseases; Wuhan General Hospital; Wuhan China
| | - Jiankun Yang
- Experimental Medicine Center; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Yan Yang
- Experimental Medicine Center; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Shenpei Liu
- Experimental Medicine Center; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Xiaojing Jiang
- Department of Infectious Diseases; Wuhan General Hospital; Wuhan China
| | - Qi Hu
- Department of Geriatrics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Olaf Dirsch
- Experimental Transplantation Surgery; Department of General, Visceral and Vascular Surgery; Friedrich-Schiller-University Jena; Jena Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery; Department of General, Visceral and Vascular Surgery; Friedrich-Schiller-University Jena; Jena Germany
| | - Cuntai Zhang
- Department of Geriatrics; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - David A Gewirtz
- Department of Pharmacology and Toxicology; Massey Cancer Center; Virginia Commonwealth University; Richmond VA USA
| | - Haoshu Fang
- Department of Pathophysiology; Anhui Medical University; Hefei China
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Vlaic S, Conrad T, Tokarski-Schnelle C, Gustafsson M, Dahmen U, Guthke R, Schuster S. ModuleDiscoverer: Identification of regulatory modules in protein-protein interaction networks. Sci Rep 2018; 8:433. [PMID: 29323246 PMCID: PMC5764996 DOI: 10.1038/s41598-017-18370-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 08/25/2017] [Accepted: 12/06/2017] [Indexed: 02/08/2023] Open
Abstract
The identification of disease-associated modules based on protein-protein interaction networks (PPINs) and gene expression data has provided new insights into the mechanistic nature of diverse diseases. However, their identification is hampered by the detection of protein communities within large-scale, whole-genome PPINs. A presented successful strategy detects a PPIN's community structure based on the maximal clique enumeration problem (MCE), which is a non-deterministic polynomial time-hard problem. This renders the approach computationally challenging for large PPINs implying the need for new strategies. We present ModuleDiscoverer, a novel approach for the identification of regulatory modules from PPINs and gene expression data. Following the MCE-based approach, ModuleDiscoverer uses a randomization heuristic-based approximation of the community structure. Given a PPIN of Rattus norvegicus and public gene expression data, we identify the regulatory module underlying a rodent model of non-alcoholic steatohepatitis (NASH), a severe form of non-alcoholic fatty liver disease (NAFLD). The module is validated using single-nucleotide polymorphism (SNP) data from independent genome-wide association studies and gene enrichment tests. Based on gene enrichment tests, we find that ModuleDiscoverer performs comparably to three existing module-detecting algorithms. However, only our NASH-module is significantly enriched with genes linked to NAFLD-associated SNPs. ModuleDiscoverer is available at http://www.hki-jena.de/index.php/0/2/490 (Others/ModuleDiscoverer).
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Affiliation(s)
- Sebastian Vlaic
- Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knöll-Institute, Systems Biology and Bioinformatics, Jena, 07745, Germany.
- Friedrich-Schiller-University, Department of Bioinformatics, Jena, 07743, Germany.
| | - Theresia Conrad
- Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knöll-Institute, Systems Biology and Bioinformatics, Jena, 07745, Germany
| | - Christian Tokarski-Schnelle
- Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knöll-Institute, Systems Biology and Bioinformatics, Jena, 07745, Germany
- University Hospital Jena, Friedrich-Schiller-University, General, Visceral and Vascular Surgery, Jena, 07749, Germany
| | - Mika Gustafsson
- Linköping University, Bioinformatics, Department of Physics, Chemistry and Biology, Linköping, 581 83, Sweden
| | - Uta Dahmen
- University Hospital Jena, Friedrich-Schiller-University, General, Visceral and Vascular Surgery, Jena, 07749, Germany
| | - Reinhard Guthke
- Leibniz Institute for Natural Product Research and Infection Biology - Hans-Knöll-Institute, Systems Biology and Bioinformatics, Jena, 07745, Germany
| | - Stefan Schuster
- Friedrich-Schiller-University, Department of Bioinformatics, Jena, 07743, Germany
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