1
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Pouyiourou M, Mokry T, Feszler M, Teifke A, Kreft A, Krämer A. Cancer of unknown primary derived from regressed breast cancer. J Cancer Res Clin Oncol 2024; 150:229. [PMID: 38703270 PMCID: PMC11069480 DOI: 10.1007/s00432-024-05768-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Maria Pouyiourou
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Maximilian Feszler
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andrea Teifke
- Department of Diagnostic and Interventional Radiology, University of Mainz, Mainz, Germany
| | - Andreas Kreft
- Institute of Pathology, University of Mainz, Mainz, Germany
| | - Alwin Krämer
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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2
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Frueh JT, Campe J, Sunaga-Franze DY, Verheyden NA, Ghimire S, Meedt E, Haslinger D, Harenkamp S, Staudenraus D, Sauer S, Kreft A, Schubert R, Lohoff M, Krueger A, Bonig H, Chiocchetti AG, Zeiser R, Holler E, Ullrich E. Interferon regulatory factor 4 plays a pivotal role in the development of aGVHD-associated colitis. Oncoimmunology 2023; 13:2296712. [PMID: 38170159 PMCID: PMC10761041 DOI: 10.1080/2162402x.2023.2296712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Interferon regulatory factor 4 (IRF4) is a master transcription factor that regulates T helper cell (Th) differentiation. It interacts with the Basic leucine zipper transcription factor, ATF-like (BATF), depletion of which in CD4+ T cells abrogates acute graft-versus-host disease (aGVHD)-induced colitis. Here, we investigated the immune-regulatory role of Irf4 in a mouse model of MHC-mismatched bone marrow transplantation. We found that recipients of allogenic Irf4-/- CD4+ T cells developed less GVHD-related symptoms. Transcriptome analysis of re-isolated donor Irf4-/- CD4+ T helper (Th) cells, revealed gene expression profiles consistent with loss of effector T helper cell signatures and enrichment of a regulatory T cell (Treg) gene expression signature. In line with these findings, we observed a high expression of the transcription factor BTB and CNC homolog 2; (BACH2) in Irf4-/- T cells, which is associated with the formation of Treg cells and suppression of Th subset differentiation. We also found an association between BACH2 expression and Treg differentiation in patients with intestinal GVHD. Finally, our results indicate that IRF4 and BACH2 act as counterparts in Th cell polarization and immune homeostasis during GVHD. In conclusion, targeting the BACH2/IRF4-axis could help to develop novel therapeutic approaches against GVHD.
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Affiliation(s)
- Jochen T. Frueh
- Department of Pediatrics, Experimental Immunology and Cell Therapy, Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of Pediatrics, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Julia Campe
- Department of Pediatrics, Experimental Immunology and Cell Therapy, Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of Pediatrics, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Daniele Yumi Sunaga-Franze
- Genomics Platform, Max Delbrueck Center for Molecular Medicine, Berlin Institute of Health, Berlin, Germany
| | - Nikita A. Verheyden
- Institute for Molecular Medicine, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- Molecular Immunology, Justus Liebig University Giessen, Giessen, Germany
| | - Sakhila Ghimire
- Hematology and Oncology Department, Medical Clinic 3, University Hospital Regensburg, Regensburg, Germany
| | - Elisabeth Meedt
- Hematology and Oncology Department, Medical Clinic 3, University Hospital Regensburg, Regensburg, Germany
| | - Denise Haslinger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Sabine Harenkamp
- German Red Cross Blood Service BaWüHe, Frankfurt am Main, Germany
| | | | - Sascha Sauer
- Genomics Platform, Max Delbrueck Center for Molecular Medicine, Berlin Institute of Health, Berlin, Germany
| | - Andreas Kreft
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Ralf Schubert
- Department of Pediatric Medicine, Division of Pneumology, Allergology, Infectious diseaes und Gastroenterology. Frankfurt am Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Michael Lohoff
- Institute for Microbiology, Philipps University, Marburg, Germany
| | - Andreas Krueger
- Institute for Molecular Medicine, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- Molecular Immunology, Justus Liebig University Giessen, Giessen, Germany
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany
| | - Halvard Bonig
- German Red Cross Blood Service BaWüHe, Frankfurt am Main, Germany
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt am Main, Germany
| | - Andreas G. Chiocchetti
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
| | - Robert Zeiser
- Department of Internal Medicine I, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ernst Holler
- Hematology and Oncology Department, Medical Clinic 3, University Hospital Regensburg, Regensburg, Germany
| | - Evelyn Ullrich
- Department of Pediatrics, Experimental Immunology and Cell Therapy, Goethe University Frankfurt, Frankfurt am Main, Germany
- Department of Pediatrics, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany
- Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), partner site Frankfurt/Mainz, a partnership between DKFZ, University Hospital Frankfurt, Frankfurt, Germany
- University Cancer Center (UCT), Frankfurt am Main, Germany
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3
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Kriege O, Kreft A, Hauptrock B, Wölfinger P, Theobald M, Wagner-Drouet EM. Diagnosis of sinusoidal obstruction syndrome: can biopsy be the key? Ann Hematol 2023; 102:3635-3637. [PMID: 37740063 PMCID: PMC10640494 DOI: 10.1007/s00277-023-05445-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Oliver Kriege
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz (UCT), Langenbeckstr 1, 55131, Mainz, Germany.
| | - Andreas Kreft
- Department of Pathology, University Medical Center Mainz, Langenbeckstr 1, 55131, Mainz, Germany
| | - Beate Hauptrock
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz (UCT), Langenbeckstr 1, 55131, Mainz, Germany
| | - Pascal Wölfinger
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz (UCT), Langenbeckstr 1, 55131, Mainz, Germany
| | - Matthias Theobald
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz (UCT), Langenbeckstr 1, 55131, Mainz, Germany
| | - Eva-Maria Wagner-Drouet
- Center for Cellular Immunotherapy and Stem Cell Transplantation, Third Medical Department, Hematology and Oncology, University Cancer Center Mainz (UCT), Langenbeckstr 1, 55131, Mainz, Germany
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4
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Hippe K, Kreft A, Reu-Hofer S, Rosenwald A, Ferrazzi F, Daniel C, Amann K, Kraus S, Holler E, Kandulski A, Hirsch D, Buttner A, Rösler W, Hildner K, Winkler J, Büttner-Herold M. Round-Robin test for the histological diagnosis of acute colonic Graft-versus-Host disease validating established histological criteria and grading systems. Virchows Arch 2023:10.1007/s00428-023-03544-3. [PMID: 37165134 DOI: 10.1007/s00428-023-03544-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023]
Abstract
Histomorpholgy is one of the mainstays of acute Graft-versus-host disease (GvHD) diagnosis. However, concerns about reproducibility and the most appropriate grading system question its usefulness. Our aim was to assess histomorphological parameters and previously reported grading systems for GvHD regarding reproducibility and validity. Moreover, we propose that sum scores, derived by combining separately scored morphological parameters into a total score, might provide a simplified but equally effective means to grade GvHD. A total of 123 colon biopsies were assessed across four pathologists for intestinal GvHD using a Round-Robin test and results were correlated with clinical findings. Interobserver reproducibility was high for histological parameters that were evaluated as indicators of acute GvHD. Published grading systems were moderately reproducible (ICC 0.679-0.769) while simplified sum scores, in comparison, showed better interrater reliability (ICC 0.818-0.896). All grading systems and sum scores were associated with clinical signs of GvHD and in part with therapy response and survival. However, they were not able to stratify patients according to the clinical severity of GvHD. In a hot-spot analysis 1 crypt apoptotic body (CAB) in 10 crypts was a reasonable cut-off value for minimal diagnostic criteria of GvHD. In conclusion, histology can contribute to the diagnosis of GvHD and is reproducible. Published grading systems are able to reflect clinical findings as are simplified sum scores, which showed improved reproducibility and might be easier to handle as they are based on adding up histological parameters rather than transferring histological findings into a separate grading system. Sum scores will have to be further tested in a prospective setting.
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Affiliation(s)
- Katrin Hippe
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Andreas Kreft
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Simone Reu-Hofer
- Institute of Pathology, Julius-Maximillians-University Würzburg, Würzburg, Germany
| | - Andreas Rosenwald
- Institute of Pathology, Julius-Maximillians-University Würzburg, Würzburg, Germany
| | - Fulvia Ferrazzi
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital, Krankenhausstr. 8-10, 91054, Erlangen, Germany
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital, Erlangen, Germany
| | - Christoph Daniel
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital, Krankenhausstr. 8-10, 91054, Erlangen, Germany
| | - Kerstin Amann
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital, Krankenhausstr. 8-10, 91054, Erlangen, Germany
| | - Sabrina Kraus
- Department of Internal Medicine II, University Hospital Wuerzburg, Würzburg, Germany
| | - Ernst Holler
- Department of Internal Medicine III, University Medical Centre, Regensburg, Germany
| | - Arne Kandulski
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Daniela Hirsch
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Anke Buttner
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Wolf Rösler
- Department of Medicine 5, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital, Erlangen, Germany
| | - Kai Hildner
- Department of Medicine 1, Kussmaul-Campus for Medical Research and Translational Research Center, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Julia Winkler
- Department of Medicine 5, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital, Erlangen, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital, Krankenhausstr. 8-10, 91054, Erlangen, Germany.
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5
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Griemert T, Siegel E, Brandstetter M, Straub BK, Kreft A, Galle PR, Sprinzl MF. Entamoeba histolytica-associated proctitis and ileitis mimicking Crohn's disease-A case report. Clin Case Rep 2023; 11:e6833. [PMID: 37220511 PMCID: PMC10199808 DOI: 10.1002/ccr3.6833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/28/2022] [Accepted: 12/05/2022] [Indexed: 05/25/2023] Open
Abstract
We report about a proctitis and ileitis terminalis, leading to the misdiagnosis of Chron's disease, in a male patient who has sex with men. Molecular multiplex analysis identified Entamoeba histolytica as the underlying cause. We provide diagnostic images, clues and pitfalls for diagnosis of E. histolytica associated proctitis.
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Affiliation(s)
- Thomas Griemert
- Department of Internal Medicine IUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Ekkehard Siegel
- Institute of MicrobiologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Moritz Brandstetter
- Institute of MicrobiologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Beate K. Straub
- Institute of PathologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Andreas Kreft
- Institute of PathologyUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Peter R. Galle
- Department of Internal Medicine IUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
| | - Martin F. Sprinzl
- Department of Internal Medicine IUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
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6
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Kreft A, Schulze L, Ries I, Schindeldecker M, Neumann H. Histological diagnosis of acute graft-versus-host disease in different sites of the upper gastrointestinal tract with correlation to endoscopic findings. Leuk Lymphoma 2023; 64:433-439. [PMID: 36335433 DOI: 10.1080/10428194.2022.2142056] [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: 11/08/2022]
Abstract
Graft-versus-host disease (GvHD) involving the intestine is a threat to patients after allogeneic hematopoietic stem cell transplantation (alloHSCT). We evaluated biopsies from different sites of the upper gastrointestinal tract (GIT) of 97 patients after alloHSCT. Forty-six patients with clinical symptoms consistent with upper GI GvHD revealed histological features of GvHD in the esophagus, stomach, and/or duodenum. Biopsies of the duodenum and esophagus were significantly more sensitive for signs of GvHD than those of the gastric antrum or corpus. The histological features of GvHD were significantly correlated with the endoscopic findings of ulcers, erosion, atrophy, and white plaques; however, the sensitivity and specificity of the latter were low. In univariate analysis, overall mortality was significantly associated with histological GvHD signs in all four sites. Nonrelapse mortality was associated with histologic GvHD features in the antrum only. Regarding GvHD diagnosis, biopsies of the upper gastrointestinal tract should include the duodenum and/or esophagus.
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Affiliation(s)
- Andreas Kreft
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Lisa Schulze
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Isabelle Ries
- 3rd Medical Department, Hematology, Oncology and Pneumology, University Medical Center Mainz, Germany
| | | | - Helmut Neumann
- GastroZentrum Lippe, Bad Salzuflen, Germany.,Department of Medicine 1, University Medical Center Mainz, Mainz, Germany
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7
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Kreft A, Dennebaum MS. [Strongyloides stercoralis infection]. Pathologe 2022; 43:2. [PMID: 35015129 DOI: 10.1007/s00292-021-01046-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Andreas Kreft
- Institut für Pathologie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55101, Mainz, Deutschland.
| | - Martin S Dennebaum
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsmedizin Mainz, Langenbeckstraße 1, 55101, Mainz, Deutschland
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8
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Kreft A, Alverson C, Wagner-Drouet EM, Ries I, Sommer C, Dr.re.nat MS. Veno-occlusive Disease of the Lung After Allogeneic Haematopoietic Stem-cell Transplantation: An Autopsy Study. Pathol Res Pract 2022; 231:153799. [DOI: 10.1016/j.prp.2022.153799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022]
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9
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Kreft A, Hippe K, Wagner-Drouet EM, Ries I, Kandulski A, Büttner-Herold M, Neumann H, Weber D, Holler E, Schindeldecker M. An investigation of the diagnostic, predictive, and prognostic impacts of three colonic biopsy grading systems for acute graft versus host disease. PLoS One 2021; 16:e0256543. [PMID: 34437603 PMCID: PMC8389423 DOI: 10.1371/journal.pone.0256543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022] Open
Abstract
Acute graft versus host disease (aGvHD) is an important, life-threatening complication after allogeneic hematopoietic stem cell transplantation (alloHSCT). To investigate the value of multiple simultaneous colon biopsies in improving diagnostic accuracy in patients with aGvHD, we retrospectively analyzed 157 patients after alloHSCT. The biopsies were evaluated individually using three established histological grading systems (Lerner, Sale, and Melson). The maximum, minimum, median, and mean histological aGvHD grades were calculated for each patient, and the results were correlated with the Glucksberg grade of clinical manifestation of GvHD, steroid therapy status, and outcome. We found that multiple colon biopsies enhanced diagnostic sensitivity. Moreover, higher histological grades correlated with steroid therapy initiation and refractoriness; the latter particularly occurred when advanced damage was present in all samples and healthy colon mucosa was reduced or absent. On multivariate analysis, the minimal Lerner and Glucksberg grades for intestinal aGvHD were significantly associated with steroid treatment failure. Ninety-nine patients died. The median survival was 285 days after the biopsies were taken. Fifteen patients died from relapse of their underling disorder and 84 from other causes, mostly infection (53 patients) and GvHD (14 patients). Multivariate analysis revealed a significant association between none-relapse mortality and the mean Lerner grade, minimum Melson grade, Glucksberg organ stage, and platelet counts. Thus, we found the Lerner system to be superior to the other grading methods in most instances and histologic evaluation of multiple simultaneously obtained biopsies from the colon to result in a higher diagnostic yield, which helps plan systemic steroid treatment while predicting treatment response and outcome.
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Affiliation(s)
- Andreas Kreft
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
- * E-mail:
| | - Katrin Hippe
- Institute of Pathology, University Hospital Regensburg, Regensburg, Germany
| | - Eva Maria Wagner-Drouet
- 3 Medical Department, Hematology, Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Isabelle Ries
- 3 Medical Department, Hematology, Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Arne Kandulski
- Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Helmut Neumann
- 1 Medical Department, University Medical Center Mainz, Mainz, Germany
| | - Daniela Weber
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Holler
- Department of Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Mario Schindeldecker
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
- Tissue Biobank, University Medical Center Mainz, Mainz, Germany
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10
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Neumann H, Kreft A, Sivanathan V, Rahman F, Galle PR. Evaluation of novel LCI CAD EYE system for real time detection of colon polyps. PLoS One 2021; 16:e0255955. [PMID: 34437563 PMCID: PMC8389480 DOI: 10.1371/journal.pone.0255955] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/12/2021] [Accepted: 07/27/2021] [Indexed: 12/29/2022] Open
Abstract
Background Linked color imaging (LCI) has been shown to be effective in multiple randomized controlled trials for enhanced colorectal polyp detection. Recently, artificial intelligence (AI) with deep learning through convolutional neural networks has dramatically improved and is increasingly recognized as a promising new technique for enhancing colorectal polyp detection. Aim This study aims to evaluate a newly developed computer-aided detection (CAD) system in combination with LCI for colorectal polyp detection. Methods First, a convolutional neural network was trained for colorectal polyp detection in combination with the LCI technique using a dataset of anonymized endoscopy videos. For validation, 240 polyps within fully recorded endoscopy videos in LCI mode, covering the entire spectrum of adenomatous histology, were used. Sensitivity (true-positive rate per lesion) and false-positive frames in a full procedure were assessed. Results The new CAD system used in LCI mode could process at least 60 frames per second, allowing for real-time video analysis. Sensitivity (true-positive rate per lesion) was 100%, with no lesion being missed. The calculated false-positive frame rate was 0.001%. Among the 240 polyps, 34 were sessile serrated lesions. The detection rate for sessile serrated lesions with the CAD system used in LCI mode was 100%. Conclusions The new CAD system used in LCI mode achieved a 100% sensitivity per lesion and a negligible false-positive frame rate. Note that the new CAD system used in LCI mode also specifically allowed for detection of serrated lesions in all cases. Accordingly, the AI algorithm introduced here for the first time has the potential to dramatically improve the quality of colonoscopy.
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Affiliation(s)
- Helmut Neumann
- Department of Interdisciplinary Endoscopy, I. Medizinische Klinik und Poliklinik, University Hospital, Mainz, Germany
- GastroZentrum Lippe, Bad Salzuflen, Germany
- * E-mail:
| | - Andreas Kreft
- Institute of Pathology, University Hospital, Mainz, Germany
| | - Visvakanth Sivanathan
- Department of Interdisciplinary Endoscopy, I. Medizinische Klinik und Poliklinik, University Hospital, Mainz, Germany
| | - Fareed Rahman
- Department of Interdisciplinary Endoscopy, I. Medizinische Klinik und Poliklinik, University Hospital, Mainz, Germany
| | - Peter R. Galle
- Department of Interdisciplinary Endoscopy, I. Medizinische Klinik und Poliklinik, University Hospital, Mainz, Germany
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11
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Rosigkeit S, Kruchem M, Thies D, Kreft A, Eichler E, Boegel S, Jansky S, Siegl D, Kaps L, Pickert G, Haehnel P, Kindler T, Hartwig UF, Guerra C, Barbacid M, Schuppan D, Bockamp E. Definitive evidence for Club cells as progenitors for mutant Kras/Trp53-deficient lung cancer. Int J Cancer 2021; 149:1670-1682. [PMID: 34331774 DOI: 10.1002/ijc.33756] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 12/30/2022]
Abstract
Accumulating evidence suggests that both the nature of oncogenic lesions and the cell-of-origin can strongly influence cancer histopathology, tumor aggressiveness and response to therapy. Although oncogenic Kras expression and loss of Trp53 tumor suppressor gene function have been demonstrated to initiate murine lung adenocarcinomas (LUADs) in alveolar type II (AT2) cells, clear evidence that Club cells, representing the second major subset of lung epithelial cells, can also act as cells-of-origin for LUAD is lacking. Equally, the exact anatomic location of Club cells that are susceptible to Kras transformation and the resulting tumor histotype remains to be established. Here, we provide definitive evidence for Club cells as progenitors for LUAD. Using in vivo lineage tracing, we find that a subset of Kras12V -expressing and Trp53-deficient Club cells act as precursors for LUAD and we define the stepwise trajectory of Club cell-initiated tumors leading to lineage marker conversion and aggressive LUAD. Our results establish Club cells as cells-of-origin for LUAD and demonstrate that Club cell-initiated tumors have the potential to develop aggressive LUAD.
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Affiliation(s)
- Sebastian Rosigkeit
- Institute of Translational Immunology (TIM), University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Marie Kruchem
- Institute of Translational Immunology (TIM), University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Dorothe Thies
- Institute of Translational Immunology (TIM), University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Andreas Kreft
- Institute of Pathology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Emma Eichler
- Institute of Translational Immunology (TIM), University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Sebastian Boegel
- Department of Internal Medicine, University Center of Autoimmunity, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Sandrine Jansky
- Institute of Translational Immunology (TIM), University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Dominik Siegl
- Institute of Translational Immunology (TIM), University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Leonard Kaps
- Institute of Translational Immunology (TIM), University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Geethanjali Pickert
- Institute of Translational Immunology (TIM), University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Patricia Haehnel
- III. Department of Medicine Hematology, Internal Oncology and Pneumology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Thomas Kindler
- III. Department of Medicine Hematology, Internal Oncology and Pneumology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Udo F Hartwig
- Research Center for Immunotherapy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.,III. Department of Medicine Hematology, Internal Oncology and Pneumology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Carmen Guerra
- Experimental Oncology, Molecular Oncology Program, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Mariano Barbacid
- Experimental Oncology, Molecular Oncology Program, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Detlef Schuppan
- Institute of Translational Immunology (TIM), University Medical Center, Johannes Gutenberg-University, Mainz, Germany.,Research Center for Immunotherapy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.,Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ernesto Bockamp
- Institute of Translational Immunology (TIM), University Medical Center, Johannes Gutenberg-University, Mainz, Germany.,Research Center for Immunotherapy, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
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12
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Wegner J, Weidenthaler-Barth B, Engelbert J, Knothe M, Braun C, Helbig D, Sacher C, Kreft A, Wagner EM, Ziemer M, Meyer RG, von Stebut E. Immunohistochemical markers for histopathological diagnosis and differentiation of acute cutaneous graft-versus-host disease. Exp Dermatol 2021; 30:1814-1819. [PMID: 34223669 DOI: 10.1111/exd.14416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/30/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
Graft-versus-host disease (GvHD) is a major complication following stem-cell or solid-organ transplantation. Accurate diagnosis of cutaneous GvHD is challenging, given that drug eruptions and viral rashes may present with similar clinical/histological manifestations. Specific markers are not available. We performed the histological examination of biopsy samples from acute GvHD (aGvHD; n = 54), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN; n = 27), maculopapular drug eruption (MDE; n = 26) and healthy controls (n = 26). Samples of aGvHD showed a decrease in Langerhans cells (LC, p = 0.0001) and an increase in macrophages (MΦ, p = 0.0001) compared to healthy skin. Compared to SJS/TEN, MDE and healthy skin, aGvHD biopsies contained greater numbers of CD4+ and CD8+ T cells. The majority of CD4+ T-helper cells were localized in the upper dermis, whereas cytotoxic CD8+ T cells were found in the epidermis. Increased numbers of CD56+ natural killer (NK) cells in the upper dermis of aGvHD skin (p = 0.007) were not observed in controls or SJS/TEN and MDE. There were no differences in elafin staining between aGvHD and the latter two conditions. Acute GvHD appears to have a distinct inflammatory cell profile (T cells/NK cells) that may aid establishing in a more accurate diagnosis, especially when used to rule out differential diagnoses such as SJS/TEN or MDE.
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Affiliation(s)
- Joanna Wegner
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | - Julia Engelbert
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Max Knothe
- Department of Dermatology, University Hospital of Leipzig, Leipzig, Germany
| | - Claudia Braun
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Doris Helbig
- Department of Dermatology, University Hospital Cologne and Faculty of Medicine Cologne, University of Cologne, Cologne, Germany
| | - Christopher Sacher
- Department of Dermatology, University Hospital Cologne and Faculty of Medicine Cologne, University of Cologne, Cologne, Germany
| | - Andreas Kreft
- Department of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Eva M Wagner
- Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
| | - Mirjana Ziemer
- Department of Dermatology, University Hospital of Leipzig, Leipzig, Germany
| | - Ralf G Meyer
- Department of Internal Medicine III, University Medical Center Mainz, Mainz, Germany
| | - Esther von Stebut
- Department of Dermatology, University Hospital Cologne and Faculty of Medicine Cologne, University of Cologne, Cologne, Germany
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13
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Foersch S, Eckstein M, Wagner DC, Gach F, Woerl AC, Geiger J, Glasner C, Schelbert S, Schulz S, Porubsky S, Kreft A, Hartmann A, Agaimy A, Roth W. Deep learning for diagnosis and survival prediction in soft tissue sarcoma. Ann Oncol 2021; 32:1178-1187. [PMID: 34139273 DOI: 10.1016/j.annonc.2021.06.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/26/2021] [Accepted: 06/06/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Clinical management of soft tissue sarcoma (STS) is particularly challenging. Here, we used digital pathology and deep learning (DL) for diagnosis and prognosis prediction of STS. PATIENTS AND METHODS Our retrospective, multicenter study included a total of 506 histopathological slides from 291 patients with STS. The Cancer Genome Atlas cohort (240 patients) served as training and validation set. A second, multicenter cohort (51 patients) served as an additional test set. The use of the DL model (DLM) as a clinical decision support system was evaluated by nine pathologists with different levels of expertise. For prognosis prediction, 139 slides from 85 patients with leiomyosarcoma (LMS) were used. Area under the receiver operating characteristic (AUROC) and accuracy served as main outcome measures. RESULTS The DLM achieved a mean AUROC of 0.97 (±0.01) and an accuracy of 79.9% (±6.1%) in diagnosing the five most common STS subtypes. The DLM significantly improved the accuracy of the pathologists from 46.3% (±15.5%) to 87.1% (±11.1%). Furthermore, they were significantly faster and more certain in their diagnosis. In LMS, the mean AUROC in predicting the disease-specific survival status was 0.91 (±0.1) and the accuracy was 88.9% (±9.9%). Cox regression showed the DLM's prediction to be a significant independent prognostic factor (P = 0.008, hazard ratio 5.5, 95% confidence interval 1.56-19.7) in these patients, outperforming other risk factors. CONCLUSIONS DL can be used to accurately diagnose frequent subtypes of STS from conventional histopathological slides. It might be used for prognosis prediction in LMS, the most prevalent STS subtype in our cohort. It can also help pathologists to make faster and more accurate diagnoses. This could substantially improve the clinical management of STS patients.
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Affiliation(s)
- S Foersch
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany.
| | - M Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - D-C Wagner
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - F Gach
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - A-C Woerl
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany; Institute of Computer Science, Johannes Gutenberg University Mainz, Mainz, Germany
| | - J Geiger
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany; Institute of Computer Science, Johannes Gutenberg University Mainz, Mainz, Germany
| | - C Glasner
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany; Institute of Computer Science, Johannes Gutenberg University Mainz, Mainz, Germany
| | - S Schelbert
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - S Schulz
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - S Porubsky
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - A Kreft
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - A Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - A Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - W Roth
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
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14
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Herold S, Klodt T, Toelle D, Dennebaum M, Lippe E, Walz C, Kaes J, Kreft A, Siegel E, Munder M, Teschner D. Lethal systemic and brain infection caused by Prototheca zopfii algae in a patient with acute myeloid leukemia. Med Mycol Case Rep 2021; 32:17-20. [PMID: 33604236 PMCID: PMC7873573 DOI: 10.1016/j.mmcr.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/08/2022] Open
Abstract
Systemic protothecosis is an exceptionally rare cause of sepsis with few available therapeutic options. Here, we report on a female patient with newly diagnosed acute myeloid leukemia who died after start of chemotherapy due to a severe septic shock caused by a disseminated systemic infection with Prototheca zopfii including encephalitis.
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Affiliation(s)
- Stephanie Herold
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Tristan Klodt
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Daniela Toelle
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Martin Dennebaum
- Institute of Clinical Microbiology and Hygiene, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Elena Lippe
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Cleo Walz
- Institute of Forensic Medicine, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Joachim Kaes
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Andreas Kreft
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Ekkehard Siegel
- Institute of Clinical Microbiology and Hygiene, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Markus Munder
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Daniel Teschner
- Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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15
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Ahmed S, Kreft A, Chowdhury EH, Hossain SM, Galle PR, Neumann H. Molecular endoscopic imaging for the detection of Barrett's metaplasia using biodegradable inorganic nanoparticles: An ex-vivo pilot study on human tissue. PLoS One 2020; 15:e0239814. [PMID: 33002048 PMCID: PMC7529275 DOI: 10.1371/journal.pone.0239814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Despite major technical advancements, endoscopic surveillance for detecting premalignant lesions in Barrett's esophagus is challenging because of their flat appearance with only subtle morphological changes. Molecular endoscopic imaging (MEI) using nanoparticles (NPs), coupled with fluorescently labeled antibody permits visualization of disease-specific molecular alterations. The aim of this ex vivo study was to assess the diagnostic applicability of MEI with NPs to detect Barrett's metaplasia. PATIENTS AND METHODS Seven patients undergoing endoscopic surveillance of known Barrett's esophagus were recruited. Freshly resected biopsy specimens were incubated with NPs coupled with FITC labeled Muc-2 antibodies and examined with MEI. Fluorescence intensity from Barrett's mucosa and control specimens were compared, followed by histological confirmation. RESULTS Fluorescence signals, indicating the presence of goblet cells, were noted for traditional MEI using Muc-2 antibodies in Barrett's intestinal metaplasia. Significantly stronger fluorescence signals were achieved with NPs coupled with FITC-conjugated Muc-2 antibodies. The results of MEI with NPs for the prediction of Barrett's metaplasia correlated with the final histopathological examination in all the cases. CONCLUSIONS Highly-specific NPs detected Barrett's metaplasia more efficiently than conventional MEI in this first feasibility study. MEI was as effective as standard histopathology for identifying Muc-2 containing goblet cells for diagnosis of Barrett's metaplasia. (DRKS-ID: DRKS00017747).
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Affiliation(s)
- Shakil Ahmed
- Inner Medicine, University Medical Centre, Mainz, Germany
| | - Andreas Kreft
- Institute of Pathology, University Medical Centre, Mainz, Germany
| | - Ezharul Hoque Chowdhury
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Sultana Mehbuba Hossain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Peter R. Galle
- Inner Medicine, University Medical Centre, Mainz, Germany
| | - Helmut Neumann
- Inner Medicine, University Medical Centre, Mainz, Germany
- * E-mail:
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16
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Kreft A, Wagner DC, Neumann H. Intestinal Graft Versus Host Disease Involving Brunner's Glands. Int J Surg Pathol 2020; 28:772-773. [PMID: 31918610 DOI: 10.1177/1066896919899159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andreas Kreft
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | | | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
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17
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Kreft A, Neumann H, Schindeldecker M, Wagner-Drouet EM. Diagnosis and grading of acute graft-versus-host disease in endoscopic biopsy series throughout the upper and lower intestine in patients after allogenic hematopoietic stem cell transplantation: a systematic approach. Leuk Lymphoma 2019; 60:1512-1521. [DOI: 10.1080/10428194.2018.1535118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Andreas Kreft
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Helmut Neumann
- 1st Medical Department, University Medical Center Mainz, Mainz, Germany
| | - Mario Schindeldecker
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
- Tissue Bank, University Medical Center Mainz, Mainz, Germany
| | - Eva Maria Wagner-Drouet
- 3rd Medical Department, Hematology, Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
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18
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Kreft A, Neumann H, von Bach DS, Wagner-Drouet EM. Histologic diagnosis and grading of esophageal acute graft-versus-host disease. Virchows Arch 2019; 474:325-332. [DOI: 10.1007/s00428-018-2507-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/10/2018] [Accepted: 12/04/2018] [Indexed: 12/14/2022]
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19
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Wagner DC, Balzer JO, Gohrbandt B, Kreft A. Two Growth Patterns in One Melanoma Lung Metastasis. Int J Surg Pathol 2018; 27:529-530. [PMID: 30449216 DOI: 10.1177/1066896918813452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Rosigkeit S, Meng M, Grunwitz C, Gomes P, Kreft A, Hayduk N, Heck R, Pickert G, Ziegler K, Abassi Y, Röder J, Kaps L, Vascotto F, Beissert T, Witzel S, Kuhn A, Diken M, Schuppan D, Sahin U, Haas H, Bockamp E. Monitoring Translation Activity of mRNA-Loaded Nanoparticles in Mice. Mol Pharm 2018; 15:3909-3919. [DOI: 10.1021/acs.molpharmaceut.8b00370] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | - Martin Meng
- BioNTech RNA Pharmaceuticals GmbH, 55131 Mainz, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Andreas Kuhn
- BioNTech RNA Pharmaceuticals GmbH, 55131 Mainz, Germany
| | - Mustafa Diken
- BioNTech RNA Pharmaceuticals GmbH, 55131 Mainz, Germany
- TRON gGmbH, 55131 Mainz, Germany
| | - Detlef Schuppan
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, United States
| | - Ugur Sahin
- BioNTech RNA Pharmaceuticals GmbH, 55131 Mainz, Germany
- TRON gGmbH, 55131 Mainz, Germany
| | - Heinrich Haas
- BioNTech RNA Pharmaceuticals GmbH, 55131 Mainz, Germany
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21
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Kreft A, Krümpelmann K, Rosenwald A, Hollemann D, Wagner-Drouet EM. Dermatopathic lymphadenopathy with Langerhans cell chimerism in graft-versus-host disease of the skin. Eur J Haematol 2017; 99:582-585. [PMID: 28888027 DOI: 10.1111/ejh.12968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2017] [Indexed: 11/28/2022]
Abstract
Dermatopathic lymphadenopathy (DL) is well-known in inflammatory skin disease; however, it has not been reported in graft-versus-host disease (GvHD) after allogeneic stem cell transplantation. Here, we report 2 cases of DL in patients with acute GvHD of the skin and demonstrate complete donor chimerism of Langerhans cells within the lymph nodes.
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Affiliation(s)
- Andreas Kreft
- Institute of Pathology, University Medical Centre Mainz, Mainz, Germany
| | | | - Andreas Rosenwald
- Institute of Pathology, University of Würzburg and Comprehensive Cancer Centre, Würzburg, Germany
| | - David Hollemann
- Institute of Pathology, University Medical Centre Regensburg, Regensburg, Germany
| | - Eva Maria Wagner-Drouet
- Department of Internal Medicine III, University Cancer Center, University Medical Centre Mainz, Mainz, Germany
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22
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Vahl C, Ister D, Buschmann K, Tütün E, Ghazy A, Brendel L, Kreft A. Stabilization of the Aortocoronary Junction as a Prognostic Factor after Aorta Ascendens Replacement? Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C.F. Vahl
- Universitätsmedizin Mainz, Herz-, Thorax-, Gefäßchirurgie, Mainz, Germany
| | - D. Ister
- Universitätsmedizin Mainz, Herz-, Thorax-, Gefäßchirurgie, Mainz, Germany
| | - K. Buschmann
- Universitätsmedizin Mainz, Herz-, Thorax-, Gefäßchirurgie, Mainz, Germany
| | - E. Tütün
- Universitätsmedizin Mainz, Herz-, Thorax-, Gefäßchirurgie, Mainz, Germany
| | - A. Ghazy
- Universitätsmedizin Mainz, Herz-, Thorax-, Gefäßchirurgie, Mainz, Germany
| | - L. Brendel
- Universitätsmedizin Mainz, Herz-, Thorax-, Gefäßchirurgie, Mainz, Germany
| | - A. Kreft
- Universitätsmedizin Mainz, Institut für Pathologie, Mainz, Germany
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23
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Kreft A, Russo A, Lux S, Waiz L, Seidmann L, Faber J, Kirkpatrick CJ. Apoptosis of ileal crypt epithelia after allogeneic bone marrow transplantation without graft-versus-host disease. Clin Case Rep 2015; 3:298-300. [PMID: 25984309 PMCID: PMC4427372 DOI: 10.1002/ccr3.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 11/30/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022] Open
Abstract
Intestinal crypt cell apoptosis may occur after allogeneic bone marrow transplantation without clinically overt graft-versus-host disease. We describe this phenomenon in a case of a 12-year-old girl who had segments of the ileum resected because of a relapse of acute lymphoblastic leukemia. The diagnostic difficulties are discussed.
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Affiliation(s)
- Andreas Kreft
- Institut für Pathologie, University Medical Center Mainz Langenbeckstr. 1, D 55101, Mainz, Germany
| | - Alexandra Russo
- Zentrum für Kinder- und Jugendmedizin, University Medical Center Mainz Langenbeckstr. 1, D 55101 Mainz, Germany
| | - Steffi Lux
- Institut für Pathologie, University Medical Center Mainz Langenbeckstr. 1, D 55101, Mainz, Germany
| | - Lioudmila Waiz
- Institut für Pathologie, University Medical Center Mainz Langenbeckstr. 1, D 55101, Mainz, Germany
| | - Larissa Seidmann
- Institut für Pathologie, University Medical Center Mainz Langenbeckstr. 1, D 55101, Mainz, Germany
| | - Jörg Faber
- Zentrum für Kinder- und Jugendmedizin, University Medical Center Mainz Langenbeckstr. 1, D 55101 Mainz, Germany
| | - Charles J Kirkpatrick
- Institut für Pathologie, University Medical Center Mainz Langenbeckstr. 1, D 55101, Mainz, Germany
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24
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Shulman HM, Cardona DM, Greenson JK, Hingorani S, Horn T, Huber E, Kreft A, Longerich T, Morton T, Myerson D, Prieto VG, Rosenberg A, Treister N, Washington K, Ziemer M, Pavletic SZ, Lee SJ, Flowers MED, Schultz KR, Jagasia M, Martin PJ, Vogelsang GB, Kleiner DE. NIH Consensus development project on criteria for clinical trials in chronic graft-versus-host disease: II. The 2014 Pathology Working Group Report. Biol Blood Marrow Transplant 2015; 21:589-603. [PMID: 25639770 DOI: 10.1016/j.bbmt.2014.12.031] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 12/24/2014] [Indexed: 12/17/2022]
Abstract
The 2005 National Institute of Health (NIH) Consensus Conference outlined histopathological diagnostic criteria for the major organ systems affected by both acute and chronic graft-versus-host disease (GVHD). The 2014 Consensus Conference led to this updated document with new information from histopathological studies of GVHD in the gut, liver, skin, and oral mucosa and an expanded discussion of GVHD in the lungs and kidneys. The recommendations for final histological diagnostic categories have been simplified from 4 categories to 3: no GVHD, possible GVHD, and likely GVHD, based on better reproducibility achieved by combining the previous categories of "consistent with GVHD" and "definite GVHD" into the single category of "likely GVHD." Issues remain in the histopathological characterization of GVHD, particularly with respect to the threshold of histological changes required for diagnostic certainty. Guidance is provided for the incorporation of biopsy information into prospective clinical studies of GVHD, particularly with respect to biomarker validation.
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Affiliation(s)
- Howard M Shulman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Diana M Cardona
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Joel K Greenson
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Sangeeta Hingorani
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Departments of Pediatrics, Gastroenterology and Pathology, University of Washington, Seattle, Washington; Seattle Children's Hospital, Seattle, Washington
| | - Thomas Horn
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elisabeth Huber
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Andreas Kreft
- Institute of Pathology, University Medical Center Mainz, Mainz, Germany
| | - Thomas Longerich
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Thomas Morton
- Departments of Pediatrics, Gastroenterology and Pathology, University of Washington, Seattle, Washington
| | - David Myerson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pathology, University of Washington, Seattle, Washington
| | - Victor G Prieto
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Avi Rosenberg
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Kay Washington
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, Tennessee
| | - Mirjana Ziemer
- Department of Dermatology, University Hospital of Leipzig, Leipzig, Germany
| | - Steven Z Pavletic
- Experimental Transplantation and Immunology Branch, National Cancer Institute, Bethesda, Maryland
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kirk R Schultz
- Department of Pediatrics, BC Children's Hospital/University of British Columbia, Vancouver, British Columbia
| | - Madan Jagasia
- Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul J Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Georgia B Vogelsang
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David E Kleiner
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
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25
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Kreft A, Springer E, Geissinger E, Wagner EM, Bender K, Kolbe K, Hainz M, Rosenwald A, Herr W, Kirkpatrick CJ, Meyer RG. Transmission of angioimmunoblastic T-cell lymphoma by bone marrow transplant. Leuk Lymphoma 2014; 56:1164-7. [PMID: 25120051 DOI: 10.3109/10428194.2014.949702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andreas Kreft
- Institute of Pathology, University Medical Center Mainz , Mainz , Germany
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Weber M, Stein P, Prüfer S, Rudolph B, Kreft A, Schmitt E, Bopp T, Roers A, Schild H, Fillatreau S, Radsak MP. Donor and host B cell-derived IL-10 contributes to suppression of graft-versus-host disease. Eur J Immunol 2014; 44:1857-65. [PMID: 24643745 DOI: 10.1002/eji.201344081] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 09/13/2013] [Revised: 01/20/2014] [Accepted: 02/18/2014] [Indexed: 11/11/2022]
Abstract
Graft-versus-host disease (GvHD) is a frequent life-threatening complication following allogeneic HSC transplantation (HSCT). IL-10 is a regulatory cytokine with important roles during GvHD, yet its relevant sources, and mode of action, remain incompletely defined in this disease. Using IL-10-deficient donor or host mice (BALB/c or C57BL/6, respectively) in a MHC-mismatched model for acute GvHD, we found a strongly aggravated course of the disease with increased mortality when either donor or host cells could not produce this cytokine. A lack of IL-10 resulted in increased allogeneic T-cell responses and enhanced activation of host DCs in spleen and MLNs. Remarkably, IL-10 was prominently produced by host- and donor-derived CD5(int) CD1d(int) TIM-1(int) B cells in this disease, and consistent with this, allogeneic HSCT resulted in exacerbated GvHD when mice lacking IL-10 expression in B cells were used as donor or host, compared with controls. Taken together, this study demonstrates that host and donor B cell-derived IL-10 provides a unique mechanism of suppression of acute GvHD, and suggests that DCs are the targets of this B cell-mediated suppressive effect. These findings open novel therapeutic possibilities based on the use of B cells to increase the feasibility of allogeneic HSCT.
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Affiliation(s)
- Michael Weber
- Institute of Immunology, Johannes Gutenberg-University Medical Center, Mainz, Germany
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Prüfer S, Weber M, Stein P, Bosmann M, Stassen M, Kreft A, Schild H, Radsak MP. Oxidative burst and neutrophil elastase contribute to clearance of Aspergillus fumigatus pneumonia in mice. Immunobiology 2014; 219:87-96. [DOI: 10.1016/j.imbio.2013.08.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/13/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
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Cabezas-Wallscheid N, Eichwald V, de Graaf J, Löwer M, Lehr HA, Kreft A, Eshkind L, Hildebrandt A, Abassi Y, Heck R, Dehof AK, Ohngemach S, Sprengel R, Wörtge S, Schmitt S, Lotz J, Meyer C, Kindler T, Zhang DE, Kaina B, Castle JC, Trumpp A, Sahin U, Bockamp E. Instruction of haematopoietic lineage choices, evolution of transcriptional landscapes and cancer stem cell hierarchies derived from an AML1-ETO mouse model. EMBO Mol Med 2013; 5:1804-20. [PMID: 24124051 PMCID: PMC3914523 DOI: 10.1002/emmm.201302661] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 11/11/2022] Open
Abstract
The t(8;21) chromosomal translocation activates aberrant expression of the AML1-ETO (AE) fusion protein and is commonly associated with core binding factor acute myeloid leukaemia (CBF AML). Combining a conditional mouse model that closely resembles the slow evolution and the mosaic AE expression pattern of human t(8;21) CBF AML with global transcriptome sequencing, we find that disease progression was characterized by two principal pathogenic mechanisms. Initially, AE expression modified the lineage potential of haematopoietic stem cells (HSCs), resulting in the selective expansion of the myeloid compartment at the expense of normal erythro- and lymphopoiesis. This lineage skewing was followed by a second substantial rewiring of transcriptional networks occurring in the trajectory to manifest leukaemia. We also find that both HSC and lineage-restricted granulocyte macrophage progenitors (GMPs) acquired leukaemic stem cell (LSC) potential being capable of initiating and maintaining the disease. Finally, our data demonstrate that long-term expression of AE induces an indolent myeloproliferative disease (MPD)-like myeloid leukaemia phenotype with complete penetrance and that acute inactivation of AE function is a potential novel therapeutic option.
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Affiliation(s)
- Nina Cabezas-Wallscheid
- Medical Center of the Johannes Gutenberg-University Mainz, Department of Internal Medicine III, Division of Translational and Experimental Oncology, Mainz, Germany; German Cancer Research Center, Department of Stem Cells and Cancer, Heidelberg, Germany; Medical Center of the Johannes Gutenberg-University Mainz, Institute for Toxicology, Mainz, Germany
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Polak-Berecka M, Waśko A, Skrzypek H, Kreft A. Production of exopolysaccharides by a probiotic strain ofLactobacillus rhamnosus: Biosynthesis and purification methods. Acta Alimentaria 2013. [DOI: 10.1556/aalim.42.2013.2.9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hellwig S, Kreft A, Amtage F, Tüscher O, Winz OH, Weiller C, Weber WA, Vach W, Meyer PT. Die IBZM-SPECT ist kein erkrankungsunabhängiger Prädiktor des dopaminergen Ansprechens beim neurodegenerativen Parkinson-Syndrom. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hellwig S, Frings L, Bormann T, Kreft A, Amtage F, Weiller C, Weber WA, Tüscher O, Meyer PT. Neuronale Korrelate der kognitiven Dysfunktion bei Tauopathien und Erkrankungen des Lewykörperspektrums: Kombiniertes Assessment mittels [18F]FDG-PET und CERAD-Testbatterie. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Weber M, Lupp C, Stein P, Kreft A, Bopp T, Wehler TC, Schmitt E, Schild H, Radsak MP. Mechanisms of cyclic nucleotide phosphodiesterases in modulating T cell responses in murine graft-versus-host disease. PLoS One 2013; 8:e58110. [PMID: 23483980 PMCID: PMC3590136 DOI: 10.1371/journal.pone.0058110] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 09/03/2012] [Accepted: 01/30/2013] [Indexed: 01/07/2023] Open
Abstract
Graft-versus-host disease (GvHD) is a key contributor to the morbidity and mortality after allogeneic hematopoetic stem cell transplantation (HSCT). Regulatory Foxp3+ CD4+ T cells (Treg) suppress conventional T cell activation and can control GvHD. In our previous work, we demonstrate that a basic mechanism of Treg mediated suppression occurs by the transfer of cyclic adenosine monophosphate (cAMP) to responder cells. Whether this mechanism is relevant for Treg mediated suppression of GvHD is currently unknown. To address this question, bone marrow and T cells from C57BL/6 mice were transferred into lethally irradiated BALB/c recipients, and the course of GvHD and survival were monitored. Transplanted recipients developed severe GvHD that was strongly ameliorated by the transfer of donor Treg cells. Towards the underlying mechanisms, in vitro studies revealed that Treg communicated with DCs via gap junctions, resulting in functional inactivation of DC by a metabolic pathway involving cAMP that is modulated by the phosphodiesterase (PDE) 4 inhibitor rolipram. PDE2 or PDE3 inhibitors as well as rolipram suppressed allogeneic T cell activation, indirectly by enhancing Treg mediated suppression of DC activation and directly by inhibiting responder T cell proliferation. In line with this, we observed a cooperative suppression of GvHD upon Treg transfer and additional rolipram treatment. In conclusion, we propose that an important pathway of Treg mediated control of GvHD is based on a cAMP dependent mechanism. These data provide the basis for future concepts to manipulate allogeneic T cell responses to prevent GvHD.
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Affiliation(s)
- Michael Weber
- Institute for Immunology, Johannes Gutenberg-University Medical Center, Mainz, Germany
| | - Corinna Lupp
- Institute for Immunology, Johannes Gutenberg-University Medical Center, Mainz, Germany
| | - Pamela Stein
- Institute for Immunology, Johannes Gutenberg-University Medical Center, Mainz, Germany
| | - Andreas Kreft
- Institute of Pathology, Johannes Gutenberg-University Medical Center, Mainz, Germany
| | - Tobias Bopp
- Institute for Immunology, Johannes Gutenberg-University Medical Center, Mainz, Germany
| | - Thomas C. Wehler
- Institute of Pathology, Johannes Gutenberg-University Medical Center, Mainz, Germany
| | - Edgar Schmitt
- Institute for Immunology, Johannes Gutenberg-University Medical Center, Mainz, Germany
| | - Hansjörg Schild
- Institute for Immunology, Johannes Gutenberg-University Medical Center, Mainz, Germany
| | - Markus P. Radsak
- Department Internal of Medicine III, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
- * E-mail:
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Verder H, Ebbesen F, Fenger-Grøn J, Henriksen TB, Andreasson B, Bender L, Bertelsen A, Björklund LJ, Dahl M, Esberg G, Eschen C, Høvring M, Kreft A, Kroner J, Lundberg F, Pedersen P, Reinholdt J, Stanchev H. Early surfactant guided by lamellar body counts on gastric aspirate in very preterm infants. Neonatology 2013; 104:116-22. [PMID: 23942627 DOI: 10.1159/000351638] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/18/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND We have developed a rapid method, based on lamellar body counts (LBC) on gastric aspirate, for identifying newborns who will develop respiratory distress syndrome with a need for surfactant supplementation. OBJECTIVE We set out to test whether it was possible to improve the outcome when used in a clinical trial. METHODS We randomly assigned 380 infants born at 24-29 weeks' gestation and supported with nasal continuous positive airway pressure (nCPAP) to receive surfactant guided either by LBC (intervention group) or increasing need for oxygen (control group). The primary outcome was mechanical ventilation or death within 5 days. Secondary outcomes included need for oxygen expressed by arterial to alveolar oxygen tension ratio (a/APO2) at the age of 6 h and need for oxygen at day 28. RESULTS The primary outcomes were equal (25%) in the two groups. The intervention group had higher a/APO2 than the control group at 6 h, median 0.64 versus 0.52 (p < 0.01), and the subgroup with gestational age 26-29 weeks needed fewer days of oxygen supplementation than the controls, median 2 vs. 9 days (p = 0.01), and fewer infants needed oxygen at day 28 (p = 0.04). Furthermore, there was a tendency in the intervention group towards a shorter duration of nCPAP. Too little or viscose aspirate in 23% of the cases was a limitation of the method. CONCLUSION Using LBC test as indicator of lung maturity and early surfactant therapy in very preterm newborns, it is possible to reduce the need for oxygen supplementation.
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Affiliation(s)
- Henrik Verder
- Department of Pediatrics, Holbæk Hospital, Holbæk, Denmark.
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Oberholzer K, Menig M, Pohlmann A, Junginger T, Heintz A, Kreft A, Hansen T, Schneider A, Lollert A, Schmidberger H, Christoph D. Rectal cancer: assessment of response to neoadjuvant chemoradiation by dynamic contrast-enhanced MRI. J Magn Reson Imaging 2012. [PMID: 23188618 DOI: 10.1002/jmri.23952] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess pretreatment functional and morphological tumor characteristics with magnetic resonance imaging (MRI) in advanced rectal carcinoma and to identify factors predicting response to neoadjuvant chemoradiation. MATERIALS AND METHODS In a prospective study, 95 patients with rectal carcinoma underwent dynamic contrast-enhanced MRI before and after chemoradiation. Quantitative parameters were derived from a pharmacokinetic two-compartment model. Tumors were also characterized with regard to mucinous status at pretreatment high-resolution MRI as nonmucinous or mucinous. Response to treatment was defined as a downshift in the local tumor stage. RESULTS The parameter k21 (contrast medium exchange rate) was higher at pretreatment MRI in nonmucinous compared with mucinous carcinomas (P < 0.001). The effect of chemoradiation on dynamic MR parameters was higher in nonmucinous carcinomas than in the mucinous subtype (P < 0.001). A higher rate of response to treatment was linked with nonmucinous morphology (P < 0.001). Multivariate analysis revealed an association between mucinous tumor morphology and poor response (odds ratio [95% confidence interval]: 0.113 [0.032-0.395], P < 0.001) as well as an association between a high 75th percentile of k21 and a higher response rate (odds ratio: 1.043 [1.001-1.086], P = 0.019). CONCLUSION Functional and morphological parameters of pretreatment MRI can assess tumor characteristics associated with the effectiveness of chemoradiation before treatment initiation.
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Affiliation(s)
- Katja Oberholzer
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University, Mainz, Germany.
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Tam WF, Hähnel PS, Schüler A, Lee BH, Okabe R, Zhu N, Pante SV, Raffel G, Mercher T, Wernig G, Bockamp E, Sasca D, Kreft A, Robinson GW, Hennighausen L, Gilliland DG, Kindler T. STAT5 is crucial to maintain leukemic stem cells in acute myelogenous leukemias induced by MOZ-TIF2. Cancer Res 2012; 73:373-84. [PMID: 23149921 DOI: 10.1158/0008-5472.can-12-0255] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
MOZ-TIF2 is a leukemogenic fusion oncoprotein that confers self-renewal capability to hematopoietic progenitor cells and induces acute myelogenous leukemia (AML) with long latency in bone marrow transplantation assays. Here, we report that FLT3-ITD transforms hematopoietic cells in cooperation with MOZ-TIF2 in vitro and in vivo. Coexpression of FLT3-ITD confers growth factor independent survival/proliferation, shortens disease latency, and results in an increase in the number of leukemic stem cells (LSC). We show that STAT5, a major effector of aberrant FLT3-ITD signal transduction, is both necessary and sufficient for this cooperative effect. In addition, STAT5 signaling is essential for MOZ-TIF2-induced leukemic transformation itself. Lack of STAT5 in fetal liver cells caused rapid differentiation and loss of replating capacity of MOZ-TIF2-transduced cells enriched for LSCs. Furthermore, mice serially transplanted with Stat5(-/-) MOZ-TIF2 leukemic cells develop AML with longer disease latency and finally incomplete penetrance when compared with mice transplanted with Stat5(+/+) MOZ-TIF2 leukemic cells. These data suggest that STAT5AB is required for the self-renewal of LSCs and represents a combined signaling node of FLT3-ITD and MOZ-TIF2 driven leukemogenesis. Therefore, targeting aberrantly activated STAT5 or rewired downstream signaling pathways may be a promising therapeutic option.
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Affiliation(s)
- Winnie F Tam
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Oberholzer K, Junginger T, Heintz A, Kreft A, Hansen T, Lollert A, Ebert M, Düber C. Rectal Cancer: MR imaging of the mesorectal fascia and effect of chemoradiation on assessment of tumor involvement. J Magn Reson Imaging 2012; 36:658-63. [PMID: 22592948 DOI: 10.1002/jmri.23687] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 03/27/2012] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate the impact of chemoradiation on the reliability of MRI in assessing tumor involvement of the mesorectal fascia in patients with rectal cancer. MATERIALS AND METHODS Presurgical MRI was performed in 150 patients; among them 85 had received neoadjuvant long-course chemoradiation. A standardized imaging protocol (1.5 Tesla [T] system, image voxel size 0.6 × 0.4 × 3 mm(3) ), standardized surgery, and histopathological examination were applied for the entire patient population. Images were analyzed to identify potential tumor involvement of the mesorectal fascia (minimum tumor distance to fascia ≤1 mm) and compared with histopathology as the reference standard. Results of nonirradiated and irradiated patients were compared to define the impact of chemoradiation on imaging reliability. RESULTS In nonirradiated patients, MRI was reliable in predicting or excluding tumor involvement of the mesorectal fascia, positive predictive value 80%, negative predictive value 89%. The frequency of overestimating tumor involvement was significantly higher in irradiated patients (P = 0.005, positive predictive value 42%). CONCLUSION Discussions about MRI assessment of tumor involvement of the mesorectal fascia as a basis for recommending neoadjuvant chemoradiation should focus on investigations that excluded irradiated patients, because MRI is less reliable after chemoradiation and tends to overestimate mesorectal tumor involvement.
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Affiliation(s)
- Katja Oberholzer
- Department of Radiology, Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, Mainz, Germany.
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Amtage F, Hellwig S, Kreft A, Rijntjes M, Winkler C, Weiller C, Weber WA, Tüscher O, Meyer PT. Funktionelle Korrelate der vertikalen Blickparese und anderer okulomotorischer Störungen der PSP: eine FDG-PET Studie. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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38
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Hellwig S, Amtage F, Kreft A, Buchert R, Winz OH, Spehl T, Weiller C, Winkler C, Tüscher O, Meyer PT. Prospektiver Vergleich von FDG-PET und IBZM-SPECT zur Differentialdiagnostik des Parkinson-Syndroms. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Amtage F, Hellwig S, Kreft A, Glauche V, Winkler C, Rijntjes M, Weiller C, Weber WA, Tüscher O, Meyer PT. Funktionelle Korrelate der asymmetrischen progressiven supranukleären Blickparese: eine FDG-PET-Studie. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Oberholzer K, Menig M, Kreft A, Schneider A, Junginger T, Heintz A, Kreitner KF, Hötker AM, Hansen T, Düber C, Schmidberger H. Rectal Cancer: Mucinous Carcinoma on Magnetic Resonance Imaging Indicates Poor Response to Neoadjuvant Chemoradiation. Int J Radiat Oncol Biol Phys 2012; 82:842-8. [DOI: 10.1016/j.ijrobp.2010.08.057] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/01/2010] [Accepted: 08/12/2010] [Indexed: 01/21/2023]
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Schattenberg JM, Zimmermann T, Wörns M, Sprinzl MF, Kreft A, Kohl T, Nagel M, Siebler J, Schulze Bergkamen H, He YW, Galle PR, Schuchmann M. Ablation of c-FLIP in hepatocytes enhances death-receptor mediated apoptosis and toxic liver injury in vivo. J Hepatol 2011; 55:1272-80. [PMID: 21703207 DOI: 10.1016/j.jhep.2011.03.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 03/07/2011] [Accepted: 03/08/2011] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS Apoptosis is crucially involved in acute and chronic liver injury, including viral, cholestatic, toxic, and metabolic liver disease. Additionally, dysregulation of apoptosis signaling pathways has been implicated in hepatocarcinogenesis. The most prominent members of the apoptosis-mediating tumor necrosis factor receptor superfamily are the TNF-R1 (CD120a) and the CD95 (Apo-1/Fas) receptor. Although extensively studied, the intracellular signaling events in hepatocytes are only incompletely understood. METHODS To examine the role of the caspase-8 homolog cellular FLICE-inhibitory protein (c-FLIP) in liver injury, we generated mice with hepatocyte specific deletion of c-FLIP. Three models of acute liver injury were employed: the agonistic anti-CD95 antibody Jo2, d-galactosamine and LPS (GalN/LPS), and concanavalin A. RESULTS Conditional ablation of c-FLIP in hepatocytes augmented liver injury and cell death in all three models of liver injury. CD95- and GalN/LPS-induced liver injury was ameliorated by a pancaspase inhibitor, while ConA-induced injury was unaffected by caspase inhibition. Augmented activation of the MAPK JNK was observed in parallel to liver injury in c-FLIP knockout mice in all injury models; however, inhibition of JNK only affected TNF- and ConA-mediated injury. CONCLUSIONS In summary, c-FLIP is a central regulator of cell death in hepatocytes, involving increased activation of caspases and the MAPK JNK.
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Affiliation(s)
- Jörn M Schattenberg
- Department of Medicine, University Medical Center, Johannes Gutenberg University, 55101 Mainz, Germany.
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Kreft A, Kindler T, Springer E, Kirkpatrick CJ. JAK2-V617F-mutated myeloproliferative neoplasms reveal different allele burden within hematopoietic cell lineages: a microdissection study of bone marrow trephine biopsies. Virchows Arch 2011; 459:521-7. [DOI: 10.1007/s00428-011-1154-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/26/2011] [Accepted: 10/03/2011] [Indexed: 01/31/2023]
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Karch HW, Gockel I, Goetz M, Kreft A, Lang H. [Granular-cell tumor (Abrikossoff's tumor): precise preoperative diagnosis is crucial when for minimally-invasive resection]. Dtsch Med Wochenschr 2011; 136:1609-12. [PMID: 21809253 DOI: 10.1055/s-0031-1281564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 38-year-old man was referred to a gastroenterologist because of thoracic pain and dysphagia of uncertain cause. INVESTIGATIONS Endoscopy revealed a centrally depressed, coarse submucosal tumor, 1.0 cm in diameter, in the anterior wall of the esophagus at about 35 cm from the teeth. Button-hole biopsy revealed histologically and immunohistochemically a granular cell tumor (Abrikossoff's tumor), positive for S-100 protein. CT-staging was unremarkable, except for a thickening of the distal esophageal wall. TREATMENT AND COURSE Minimally invasive submucosal resection was undertaken using the videoscopic/endoscopic rendezvous technique. Histological examination confirmed complete resection of the tumor. The clinical course was uneventful and endoscopy 6 and 12 weeks after the operation showed complete resection of the tumor. CONCLUSION An exact preoperative diagnosis beyond a mere description of site and morphology, but also providing the histopathological data creates favorable conditions for planning and performing a minimally invasive resection. Submucosal resection with the videoscopic/endoscopic in rendezvous technique offers the possibility of complete resection, which can often not be achieved in a submucosal tumor by only endoscopic resection.
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Tawfik AM, Kreft A, Wagner W, Vogl TJ. MRI of a microcystic adnexal carcinoma of the skin mimicking a fibrous tumour: case report and literature review. Br J Radiol 2011; 84:e114-7. [PMID: 21606063 DOI: 10.1259/bjr/44068180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Microcystic adnexal carcinoma of the skin is a very rare malignant tumour arising from the sweat glands. As far as we know, the MRI features of this tumour have not been described in the literature before. In this report we present the MRI features and pathological description of a case of a microcystic adnexal carcinoma in the cheek that was incidentally imaged during brain MRI examination. A review of the relevant literature as well as a discussion of MRI of skin tumours is also presented.
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Affiliation(s)
- A M Tawfik
- Department of Diagnostic and Interventional Radiology, Johan Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt am Main, Hessen, Germany.
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Fottner C, Helisch A, Anlauf M, Rossmann H, Musholt TJ, Kreft A, Schadmand-Fischer S, Bartenstein P, Lackner KJ, Klöppel G, Schreckenberger M, Weber MM. 6-18F-fluoro-L-dihydroxyphenylalanine positron emission tomography is superior to 123I-metaiodobenzyl-guanidine scintigraphy in the detection of extraadrenal and hereditary pheochromocytomas and paragangliomas: correlation with vesicular monoamine transporter expression. J Clin Endocrinol Metab 2010; 95:2800-10. [PMID: 20371665 DOI: 10.1210/jc.2009-2352] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Pheochromocytomas (PHEOs) and paragangliomas (PGLs) may be better detected by (18)F-fluorodihydroxyphenylalanine-positron emission tomography (FDOPA-PET) than (123)I-metaiodobenzyl-guanidine (123-I-MIBG) scintigraphy. OBJECTIVE The objective of the study was to correlate functional imaging results with immunohistochemical, molecular-genetic, and biochemical findings. DESIGN AND SETTING Thirty consecutive patients with suspected PHEO/PGL presenting at a tertiary referral centre were investigated in a prospective study. PATIENTS Twenty-five patients had confirmed PHEO/PGL. Thirteen of 25 patients had a hereditary PHEO/PGL syndrome (two multiple endocrine neoplasia II, six succinate dehydrogenase complex, subunit D, two succinate dehydrogenase complex, subunit B, one von Hippel Lindau tumor suppressor protein, two Neurofibromatosis-1), and 12 of 25 were classified as sporadic. Five patients had hormonally inactive adrenal incidentalomas. MAIN OUTCOME MEASURES In all patients computed tomography scan and/or magnetic resonance imaging as well as both 123-I-MIBG scintigraphy and FDOPA-PET were performed. Resected tumors were examined by immunohistochemistry for expression of the vesicular monoamine transporter (VMAT)-1 and -2 and other markers. RESULTS A total of 64 lesions were found with both functional imaging modalities. FDOPA-PET detected 62 lesions, whereas only 34 lesions were detected by 123-I-MIBG scintigraphy. This resulted in an overall sensitivity and specificity for FDOPA-PET of 98 and 100% and for MIBG of 53 and 91%, respectively. Comparable sensitivities were found for adrenal and extraadrenal abdominal lesions (94 vs. 97%), whereas in thoracic/cervical lesions, the sensitivity for 123-I-MIBG scintigraphy (15%) was inferior to that of FDOPA-PET imaging (100%). Immunohistochemistry demonstrated a lack of VMAT-1 expression in all MIBG-negative tumors. Clinical predictors for MIBG negativity were a predominant norepinephrine/normetanephrine secretion, an age less than 45 yr, and a hereditary cause. CONCLUSION FDOPA-PET is superior to 123-I-MIBG scintigraphy in patients with extraadrenal, predominantly noradrenaline-secreting, and hereditary types of PHEO/PGL. The lack of VMAT-1 expression predicts negativity for MIBG-scintigraphy.
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Affiliation(s)
- C Fottner
- I. Medical Clinic, Department of Endocrinology and Metabolism, University of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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Kreft A, Holtmann H, Schad A, Kirkpatrick CJ. Detection of residual leukemic blasts in adult patients with acute T-lymphoblastic leukemia using bone marrow trephine biopsies: comparison of fluorescent immunohistochemistry with conventional cytologic and flow-cytometric analysis. Pathol Res Pract 2010; 206:560-4. [PMID: 20413226 DOI: 10.1016/j.prp.2010.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 01/24/2010] [Accepted: 03/05/2010] [Indexed: 11/25/2022]
Abstract
Evaluation of remission in adult acute lymphoblastic leukemia (ALL) normally relies on cytologic evaluation and flow-cytometric analysis. The diagnostic impact of bone marrow trephine biopsies has not been studied so far. We investigated 26 biopsies of 16 patients with T-ALL. Double fluorescent immunostaining with TdT and CD3 was performed. Corresponding cytologic evaluation and flow-cytometric data were available. In 17 of 26 investigations, the results were concordant (either positive or negative). In one examination, residual blasts were not recognized by trephine biopsy, but by other methods. By contrast, in eight investigations, the leukemic blasts were found only in the bone marrow trephine biopsies. Regarding the evaluation of remission of T-ALL, in our retrospective study, bone marrow trephine biopsies with double immunostaining were found to be sensitive and specific for the detection of residual blasts. This method may add to the conventional cytology and flow-cytometric analysis.
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Affiliation(s)
- Andreas Kreft
- Institut für Pathologie, Klinikum der Johannes Gutenberg Universität, Langenbeckstr. 1, 55101 Mainz, Germany
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Sotiropoulos GC, Tagkalos E, Kreft A, Moskalenko V, Gönner U, Molmenti EP, Timm S, Junginger T, Lang H. Liver resection for concomitant colorectal liver metastases and intrahepatic cholangiocarcinoma: a rare combination. Int J Colorectal Dis 2009; 24:1349. [PMID: 19396452 DOI: 10.1007/s00384-009-0713-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2009] [Indexed: 02/04/2023]
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Kreft A, Springer E, Lipka DB, Kirkpatrick CJ. Wild-type JAK2 secondary acute erythroleukemia developing after JAK2-V617F-mutated primary myelofibrosis. Acta Haematol 2009; 122:36-8. [PMID: 19713696 DOI: 10.1159/000235773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 06/29/2009] [Indexed: 11/19/2022]
Abstract
A 54-year-old female patient developed acute erythroleukemia after an 8-year course of primary myelofibrosis. The latter harbors the JAK2-V617F mutation and was treated with hydroxyurea and anagrelide. A bone marrow trephine biopsy disclosed 2 morphologically distinct areas of chronic primary myelofibrosis and acute erythroleukemia. Microdissection and a separate molecular pathological analysis was performed. Although the activating JAK2-V617F mutation was not maintained in blasts of acute erythroleukemia, it was detectable in the chronic phase of primary myelofibrosis, indicating that this mutation did not play a role in the leukemic transformation of erythroid cells.
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Affiliation(s)
- Andreas Kreft
- Institut für Pathologie, Universitätsmedizin der Johannes Gutenberg Universität, Mainz, Deutschland.
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Kreft A, Wiese B, Weiss M, Choritz H, Buhr T, Büsche G, Georgii A. Analysis of Risk Factors of the Evolution of Myelofibrosis in Pre-Fibrotic Chronic Idiopathic Myelofibrosis: A retrospective study based on follow up biopsies of 70 patients by using the RECPAM method. Leuk Lymphoma 2009; 45:553-9. [PMID: 15160918 DOI: 10.1080/10428190310001598026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The advanced, fibrotic phase of chronic idiopathic myelofibrosis (CIMF) is preceded by a pre-fibrotic stage. However, the factors which may influence or predict the development of myelofibrosis are not well established. Thus we investigated follow up biopsies of 70 patients with CIMF, diagnosed in stages of no or only scant fiber increase, for the development of myelofibrosis. The influence of histopathological (megakaryocytes, initial fiber content), clinical (age, gender, splenomegaly, chemotherapy) and hematological (Hb, leukocyte- and platelet count) parameters on the development of myelofibrosis was evaluated by using the univariate Log Rank method and the multivariate recursive partition and amalgamation (RECPAM) analysis. Surveying a mean observation period of 47 months we found a development of significant myelofibrosis in 30 of the 70 patients. In the univariate analysis, the development of myelofibrosis was associated with increased megakaryocytes, initial fiber content and age of the patient. In the RECPAM analysis, the patients with a high megakaryocytic count and older age showed the highest risk of developing myelofibrosis (mean 58.3 and 60.1 months). The group with the best prognosis comprised the patients under 60 years which have a low content of megakaryocytes (mean 137 months). We found that the development of myelofibrosis in CIMF was best predicted by an increase of megakaryocytes within the bone marrow, possibly reflecting the release of growth factors by these cells. The next important risk factor was the age of the patients.
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Affiliation(s)
- Andreas Kreft
- Institut für Pathologie, Medizinische Hochschule, Hannover, Germany.
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Kämmerer PW, Kreft A, Toyoshima T, Al-Nawas B, Klein MO. Misleading initial histological diagnosis of a polymorphous low-grade adenocarcinoma in situ ex pleomorphic adenoma-a case report. Oral Maxillofac Surg 2009; 13:99-103. [PMID: 19189140 DOI: 10.1007/s10006-009-0150-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Polymorphous low-grade adenocarcinoma (PLGA) are frequent tumours of palatinal minor salivary glands. They appear clinically as solid mass located beneath intact surface epithelium, thus quite similar with benign neoplasm. PLGA displays a low tendency of aggressive behaviour. The correct aetiology of this disorder is still unknown. CASE REPORT In this contribution, a PLGA is reported which was located in a pleomorphic adenoma (PA). Out of an initially incisional biopsy, only the benign part of the lesion was diagnosed. Definitive histological examination of the whole tumour revealed a small malignant fraction of the specimen besides a major part of benign tissue formations (PA). CONCLUSION This case shows the uncertain confidence of incisional biopsy, the variably biologic behaviour of PA, providing hints for consideration of the PLGA aetiology and highlights both the necessity to remove whole PA-like lesions as well as to perform systematically histological examination of whole specimens.
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Affiliation(s)
- P W Kämmerer
- Department of Oral and Maxillofacial Surgery, Johannes Gutenberg-University, Augustusplatz 2, 55131, Mainz, Germany.
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