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Huebner L, Warmbein A, Scharf C, Schroeder I, Manz K, Rathgeber I, Gutmann M, Biebl J, Mehler-Klamt A, Huber J, Eberl I, Kraft E, Fischer U, Zoller M. Effects of robotic-assisted early mobilization versus conventional mobilization in intensive care unit patients: prospective interventional cohort study with retrospective control group analysis. Crit Care 2024; 28:112. [PMID: 38582934 PMCID: PMC10999075 DOI: 10.1186/s13054-024-04896-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Approximately one in three survivors of critical illness suffers from intensive-care-unit-acquired weakness, which increases mortality and impairs quality of life. By counteracting immobilization, a known risk factor, active mobilization may mitigate its negative effects on patients. In this single-center trial, the effect of robotic-assisted early mobilization in the intensive care unit (ICU) on patients' outcomes was investigated. METHODS We enrolled 16 adults scheduled for lung transplantation to receive 20 min of robotic-assisted mobilization and verticalization twice daily during their first week in the ICU (intervention group: IG). A control group (CG) of 13 conventionally mobilized patients after lung transplantation was recruited retrospectively. Outcome measures included the duration of mechanical ventilation, length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months. RESULTS During the first week in the ICU, the intervention group received a median of 6 (interquartile range 3-8) robotic-assisted sessions of early mobilization and verticalization. There were no statistically significant differences in the duration of mechanical ventilation (IG: median 126 vs. CG: 78 h), length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months between the IG and CG. CONCLUSION In this study, robotic-assisted mobilization was successfully implemented in the ICU setting. No significant differences in patients' outcomes were observed between conventional and robotic-assisted mobilization. However, randomized and larger studies are necessary to validate the adequacy of robotic mobilization in other cohorts. TRIAL REGISTRATION This single-center interventional trial was registered in clinicaltrials.gov as NCT05071248 on 27/08/2021.
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Affiliation(s)
- Lucas Huebner
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Angelika Warmbein
- Clinical Nursing Research and Quality Management Unit, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christina Scharf
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ines Schroeder
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Kirsi Manz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Ivanka Rathgeber
- Clinical Nursing Research and Quality Management Unit, LMU University Hospital, LMU Munich, Munich, Germany
| | - Marcus Gutmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Johanna Biebl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Amrei Mehler-Klamt
- Professorship for Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Jana Huber
- Professorship for Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Inge Eberl
- Professorship for Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Uli Fischer
- Clinical Nursing Research and Quality Management Unit, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Zoller
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
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Warmbein A, Hübner L, Rathgeber I, Mehler-Klamt AC, Huber J, Schroeder I, Scharf C, Gutmann M, Biebl J, Manz K, Kraft E, Eberl I, Zoller M, Fischer U. Robot-assisted early mobilization for intensive care unit patients: Feasibility and first-time clinical use. Int J Nurs Stud 2024; 152:104702. [PMID: 38350342 DOI: 10.1016/j.ijnurstu.2024.104702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Early mobilization is only carried out to a limited extent in the intensive care unit. To address this issue, the robotic assistance system VEMOTION® was developed to facilitate (early) mobilization measures more easily. This paper describes the first integration of robotic assistance systems in acute clinical intensive care units. OBJECTIVE Feasibility test of robotic assistance in early mobilization of intensive care patients in routine clinical practice. SETTING Two intensive care units guided by anesthesiology at a German university hospital. PARTICIPANTS Patients who underwent elective surgery with postoperative treatment in the intensive care unit and had an estimated ventilation time over 48 h. METHODS Participants underwent robot-assisted mobilization, scheduled for twenty-minute sessions twice a day, ten times or one week, conducted by nursing staff under actual operational conditions on the units. No randomization or blinding took place. We assessed data regarding feasible cutoff points (in brackets): the possibility of enrollment (x ≥ 50 %), duration (pre- and post-setup (x ≤ 25 min), therapy duration (x = 20 min), and intervention-related parameters (number of mobilizing professionals (x ≤ 2), intensity of training, events that led to adverse events, errors or discontinuation). Mobilizing professionals rated each mobilization regarding their physical stress (x ≤ 3) and feasibility (x ≥ 4) on a 7 Point Likert Scale. An estimated sample size of at least twenty patients was calculated. We analyzed the data descriptively. RESULTS Within 6 months, we screened thirty-two patients for enrollment. 23 patients were included in the study and 16 underwent mobilization using robotic assistance, 7 dropped out (enrollment eligibility = 69 %). On average, 1.9 nurses were involved per therapy unit. Participants received 5.6 robot-assisted mobilizations in mean. Pre- and post-setup had a mean duration of 18 min, therapy a mean of 21 min. The robot-assisted mobilization was started after a median of 18 h after admission to the intensive care unit. We documented two adverse events (pain), twelve errors in handling, and seven unexpected events that led to interruptions or discontinuation. No serious adverse events occurred. The mobilizing nurses rated their physical stress as low (mean 2.0 ± 1.3) and the intervention as feasible (mean 5.3 ± 1.6). CONCLUSIONS Robot-assisted mobilization was feasible, but specific safety measures should be implemented to prevent errors. Robotic-assisted mobilization requires process adjustments and consideration of unit staffing levels, as the intervention does not save staff resources or time. REGISTRATION clinicaltrials.org TRN: NCT05071248; Date: 2021/10/08; URL https://clinicaltrials.gov/ct2/show/NCT05071248. TWEETABLE ABSTRACT Robot-assisted early mobilization in intensive care patients is feasible and no adverse event occurred.
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Affiliation(s)
- Angelika Warmbein
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany.
| | - Lucas Hübner
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Ivanka Rathgeber
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany
| | - Amrei Christin Mehler-Klamt
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Jana Huber
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Ines Schroeder
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Christina Scharf
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Marcus Gutmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Johanna Biebl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Kirsi Manz
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Inge Eberl
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Michael Zoller
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Uli Fischer
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany
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Gutmann M, Reinhardt D, Seidensticker C, Raschig M, Hahn L, Moscaroli A, Behe M, Meinel L, Lühmann T. Matrix Metalloproteinase-Responsive Delivery of PEGylated Fibroblast Growth Factor 2. ACS Biomater Sci Eng 2024; 10:156-165. [PMID: 37988287 DOI: 10.1021/acsbiomaterials.3c01511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Attachment of polyethylene glycol (PEG) chains is a common, well-studied, and Food and Drug Administration-approved method to address the pharmacokinetic challenges of therapeutic proteins. Occasionally, PEGylation impairs the activity of pharmacodynamics (PD). To overcome this problem, disease-relevant cleavable linkers between the polymer and the therapeutic protein can unleash full PD by de-PEGylating the protein at its target site. In this study, we engineered a matrix metalloproteinase (MMP)-responsive fibroblast growth factor 2 (FGF-2) mutant that was site-specifically extended with a PEG polymer chain. Using bioinspired strategies, the bioconjugate was designed to release the native protein at the desired structure/environment with preservation of the proliferative capacity in vitro on NIH3T3 cells. In vivo, hepatic exposure was diminished but not its renal distribution over time compared to unconjugated FGF-2. By releasing the growth factor from the PEG polymer in response to MMP cleavage, restored FGF-2 may enter hard-to-reach tissues and activate cell surface receptors or nuclear targets.
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Affiliation(s)
- Marcus Gutmann
- Institute of Pharmacy and Food Chemistry, University of Würzburg, DE-97074 Würzburg, Germany
| | - Debora Reinhardt
- Institute of Pharmacy and Food Chemistry, University of Würzburg, DE-97074 Würzburg, Germany
| | - Christian Seidensticker
- Medizinische Klinik und Poliklinik Für Innere Medizin II, Klinikum Rechts der Isar der TU München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Martina Raschig
- Institute of Pharmacy and Food Chemistry, University of Würzburg, DE-97074 Würzburg, Germany
| | - Lukas Hahn
- Institute of Pharmacy and Food Chemistry, University of Würzburg, DE-97074 Würzburg, Germany
| | - Alessandra Moscaroli
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, CH-5232 Villigen PSI, Switzerland
| | - Martin Behe
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, CH-5232 Villigen PSI, Switzerland
| | - Lorenz Meinel
- Institute of Pharmacy and Food Chemistry, University of Würzburg, DE-97074 Würzburg, Germany
- Helmholtz Institute for RNA-Based Infection Research (HIRI), Helmholtz Center for Infection Research (HZI), DE-97080 Würzburg, Germany
| | - Tessa Lühmann
- Institute of Pharmacy and Food Chemistry, University of Würzburg, DE-97074 Würzburg, Germany
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Wolkersdorfer AM, Jugovic I, Scheller L, Gutmann M, Hahn L, Diessner J, Lühmann T, Meinel L. PEGylation of Human Vascular Endothelial Growth Factor. ACS Biomater Sci Eng 2024; 10:149-155. [PMID: 37296497 DOI: 10.1021/acsbiomaterials.3c00253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Vascular endothelial growth factor A-165 (VEGF-A165) positively modulates neointimal hyperplasia, lumen stenosis, and neovascularization. One challenge for the use of VEGF-A165 for potential therapy is its short serum half-life. Therefore, we are designing VEGF-A165 bioconjugates carrying polyethylene glycol (PEG). The purity of the recombinantly expressed human VEGF-A165 exceeded 90%. The growth factor had a half-maximal effective concentration of 0.9 ng/mL (EC50) and induced tube formation of human umbilical vein endothelial cells. PEGylation was conducted by Schiff base reaction followed by reductive amination. After purification, two species were obtained, with one or two PEG attached per VEGF-A165 dimer. Both resulting bioconjugates had a purity exceeding 90%, wild-type bioactivity, and increased hydrodynamic radii as required for prolonging the half-life.
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Affiliation(s)
- Alena Maria Wolkersdorfer
- Institute of Pharmacy and Food Chemistry, University of Würzburg, University, Am Hubland, Würzburg DE-97074, Germany
| | - Isabelle Jugovic
- Institute of Pharmacy and Food Chemistry, University of Würzburg, University, Am Hubland, Würzburg DE-97074, Germany
| | - Lena Scheller
- Institute of Pharmacy and Food Chemistry, University of Würzburg, University, Am Hubland, Würzburg DE-97074, Germany
| | - Marcus Gutmann
- Institute of Pharmacy and Food Chemistry, University of Würzburg, University, Am Hubland, Würzburg DE-97074, Germany
| | - Lukas Hahn
- Institute of Pharmacy and Food Chemistry, University of Würzburg, University, Am Hubland, Würzburg DE-97074, Germany
| | - Joachim Diessner
- University of Würzburg, Department of Obstetrics and Gynecology, Josef-Schneider-Straße 14, Würzburg DE-97080, Germany
| | - Tessa Lühmann
- Institute of Pharmacy and Food Chemistry, University of Würzburg, University, Am Hubland, Würzburg DE-97074, Germany
| | - Lorenz Meinel
- Institute of Pharmacy and Food Chemistry, University of Würzburg, University, Am Hubland, Würzburg DE-97074, Germany
- Helmholtz Centre for Infection Research, Helmholtz-Institute for RNA-based Infection Research (HIRI), Josef-Schneider-Strasse 2/D15, Würzburg 97080, Germany
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Meiners K, Hamm P, Gutmann M, Niedens J, Nowak-Król A, Pané S, Lühmann T. Site-specific PEGylation of recombinant tissue-type plasminogen activator. Eur J Pharm Biopharm 2023; 192:79-87. [PMID: 37783360 DOI: 10.1016/j.ejpb.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/13/2023] [Accepted: 09/29/2023] [Indexed: 10/04/2023]
Abstract
Tissue-type plasminogen activator (tPA) is the gold standard for emergency treatment of ischemic stroke, which is the third leading cause of death worldwide. Major challenges of tPA therapy are its rapid elimination by plasminogen activator inhibitor-1 (PAI-1) and hepatic clearance, leading to the use of high doses and consequent serious side effects, including internal bleeding, swelling and low blood pressure. In this regard, we developed three polyethylene glycol (PEG)ylated tPA bioconjugates based on the recombinant human tPA drug Alteplase using site-specific conjugation strategies. The first bioconjugate with PEGylation at the N-terminus of tPA performed by reductive alkylation showed a reduced proteolytic activity of 68 % compared to wild type tPA. PEGylation at the single-free cysteine of tPA with linear and branched PEG revealed similar proteolytic activities as the wild-type protein. Moreover, both bioconjugates with PEG-cysteine-modification showed 2-fold slower inhibition kinetics by PAI-1. All bioconjugates increased in hydrodynamic size as a critical requirement for half-life extension.
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Affiliation(s)
- Kirstin Meiners
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, DE-97074 Würzburg, Germany
| | - Prisca Hamm
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, DE-97074 Würzburg, Germany
| | - Marcus Gutmann
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, DE-97074 Würzburg, Germany
| | - Jan Niedens
- Institute of Inorganic Chemistry and Institute for Sustainable Chemistry & Catalysis with Boron, University of Würzburg, Am Hubland, DE-97074 Würzburg, Germany
| | - Agnieszka Nowak-Król
- Institute of Inorganic Chemistry and Institute for Sustainable Chemistry & Catalysis with Boron, University of Würzburg, Am Hubland, DE-97074 Würzburg, Germany
| | - Salvador Pané
- Multi-Scale Robotics Lab (MSRL), Institute of Robotics & Intelligent Systems (IRIS), ETH Zürich, CH-8092 Zürich, Switzerland
| | - Tessa Lühmann
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, DE-97074 Würzburg, Germany.
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Arcos-Holzinger M, Biebl JT, Storz C, Gutmann M, Azad SC, Holzapfel BM, Kraft E. Virtual reality in managing Complex Regional Pain Syndrome (CRPS): a scoping review. Front Neurol 2023; 14:1069381. [PMID: 37745669 PMCID: PMC10513177 DOI: 10.3389/fneur.2023.1069381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background Complex Regional Pain Syndrome (CRPS) is a severe pain disorder that does not yet have a specific treatment. Patients with CRPS not only suffer from a wide range of symptoms that affect their quality of life but also present psychological affections to the way they see their body and specifically their affected limb. Virtual Reality (VR) modalities have become a targeted treatment for chronic pain and in the case of CRPS, may be a valuable approach to the mechanisms that affect these patients. Objectives Using the PRISMA Scoping Review guidelines, we intend to uncover the key information from the studies available about VR modalities in the treatment of CRPS. We focus on the improvement of pain levels, body perception disturbances (BPD), and limb movement/daily function. Results Our search strategy resulted in 217 articles from PubMed. Twenty were assessed for eligibility and seven were included in the final qualitative synthesis. Of these seven articles, we included a clinical trial, three pilot studies, a blinded randomized controlled trial, a crossover double-blind trial, and a randomized controlled trial. These studies provide important subjective patient findings, along with some statistically significant results in the experiences of VR therapies modulating pain, BPD, and improving limb movement/daily function. However, not all the studies included statistical analysis, and there are contradicting data found from some patients that did not perceive any improvement from VR therapies. Conclusions We describe the results found in 7 articles that focus on the treatment of CRPS with VR modalities. Overall, the articles have various limitations, but the strategies related to immersive virtual reality, cardiac signaling, body switching and limb modulation have shown the most promising results for pain reduction and BPD improvement. These strategies reflect on pathophysiological mechanisms that are hypothesized to be affected in CRPS patients leading to the chronic pain and BPD that they experience. Not much evidence was found for improvement in limb movement and daily function. This review is a pathway for future studies on this topic and a more extensive data synthesis when more information is available.
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Affiliation(s)
- Mauricio Arcos-Holzinger
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- Facultad de Medicina, Universidad CES, Medellin, Colombia
| | - Johanna Theresia Biebl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Claudia Storz
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Marcus Gutmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Shahnaz Christina Azad
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
- Interdisciplinary Pain Unit, University Hospital, LMU Munich, Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- Interdisciplinary Pain Unit, University Hospital, LMU Munich, Munich, Germany
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7
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Cataldi E, Raschig M, Gutmann M, Geppert PT, Ruopp M, Schock M, Gerwe H, Bertermann R, Meinel L, Finze M, Nowak-Król A, Decker M, Lühmann T. Amber Light Control of Peptide Secondary Structure by a Perfluoroaromatic Azobenzene Photoswitch. Chembiochem 2023; 24:e202200570. [PMID: 36567253 DOI: 10.1002/cbic.202200570] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
The incorporation of photoswitches into the molecular structure of peptides and proteins enables their dynamic photocontrol in complex biological systems. Here, a perfluorinated azobenzene derivative triggered by amber light was site-specifically conjugated to cysteines in a helical peptide by perfluoroarylation chemistry. In response to the photoisomerization (trans→cis) of the conjugated azobenzene with amber light, the secondary structure of the peptide was modulated from a disorganized into an amphiphilic helical structure.
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Affiliation(s)
- Eleonora Cataldi
- Universität Würzburg, Institute for Pharmacy and Food Chemistry, Am Hubland, 97074, Würzburg, Germany
| | - Martina Raschig
- Universität Würzburg, Institute for Pharmacy and Food Chemistry, Am Hubland, 97074, Würzburg, Germany
| | - Marcus Gutmann
- Universität Würzburg, Institute for Pharmacy and Food Chemistry, Am Hubland, 97074, Würzburg, Germany
| | - Patrick T Geppert
- Universität Würzburg, Institute of Inorganic Chemistry and Institute for Sustainable Chemistry and Catalysis with Boron, Am Hubland, 97074, Würzburg, Germany
| | - Matthias Ruopp
- Universität Würzburg, Institute for Pharmacy and Food Chemistry, Am Hubland, 97074, Würzburg, Germany
| | - Marvin Schock
- Universität Würzburg, Institute for Pharmacy and Food Chemistry, Am Hubland, 97074, Würzburg, Germany
| | - Hubert Gerwe
- Universität Würzburg, Institute for Pharmacy and Food Chemistry, Am Hubland, 97074, Würzburg, Germany
| | - Rüdiger Bertermann
- Universität Würzburg, Institute of Inorganic Chemistry and Institute for Sustainable Chemistry and Catalysis with Boron, Am Hubland, 97074, Würzburg, Germany
| | - Lorenz Meinel
- Universität Würzburg, Institute for Pharmacy and Food Chemistry, Am Hubland, 97074, Würzburg, Germany.,Helmholtz Institute for RNA-Based Infection Research (HIRI), Helmholtz Center for Infection Research (HZI), 97080, Würzburg, Germany
| | - Maik Finze
- Universität Würzburg, Institute of Inorganic Chemistry and Institute for Sustainable Chemistry and Catalysis with Boron, Am Hubland, 97074, Würzburg, Germany
| | - Agnieszka Nowak-Król
- Universität Würzburg, Institute of Inorganic Chemistry and Institute for Sustainable Chemistry and Catalysis with Boron, Am Hubland, 97074, Würzburg, Germany
| | - Michael Decker
- Universität Würzburg, Institute for Pharmacy and Food Chemistry, Am Hubland, 97074, Würzburg, Germany
| | - Tessa Lühmann
- Universität Würzburg, Institute for Pharmacy and Food Chemistry, Am Hubland, 97074, Würzburg, Germany
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8
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Warmbein A, Rathgeber I, Seif J, Mehler-Klamt AC, Schmidbauer L, Scharf C, Hübner L, Schroeder I, Biebl J, Gutmann M, Eberl I, Zoller M, Fischer U. Barriers and facilitators in the implementation of mobilization robots in hospitals from the perspective of clinical experts and developers. BMC Nurs 2023; 22:45. [PMID: 36797701 PMCID: PMC9936640 DOI: 10.1186/s12912-023-01202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Early mobilization can help reduce severe side effects such as muscle atrophy that occur during hospitalization. However, due to time and staff shortages in intensive and critical care as well as safety risks for patients, it is often difficult to adhere to the recommended therapy time of twenty minutes twice a day. New robotic technologies might be one approach to achieve early mobilization effectively for patients and also relieve users from physical effort. Nevertheless, currently there is a lack of knowledge regarding the factors that are important for integrating of these technologies into complex treatment settings like intensive care units or rehabilitation units. METHODS European experts from science, technical development and end-users of robotic systems (n = 13) were interviewed using a semi-structured interview guideline to identify barriers and facilitating factors for the integration of robotic systems into daily clinical practice. They were asked about structural, personnel and environmental factors that had an impact on integration and how they had solved challenges. A latent content analysis was performed regarding the COREQ criteria. RESULTS We found relevant factors regarding the development, introduction, and routine of the robotic system. In this context, costs, process adjustments, a lack of exemptions, and a lack of support from the manufacturers/developers were identified as challenges. Easy handling, joint decision making between the end-users and the decision makers in the hospital, an accurate process design and the joint development of the robotic system of end-users and technical experts were found to be facilitating factors. CONCLUSION The integration and preparation for the integration of robotic assistance systems into the inpatient setting is a complex intervention that involves many parties. This study provides evidence for hospitals or manufacturers to simplify the planning of integrations for permanent use. TRIAL REGISTRATION DRKS-ID: DRKS00023848; registered 10/12/2020.
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Affiliation(s)
- Angelika Warmbein
- Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Ivanka Rathgeber
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Janesca Seif
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Amrei C. Mehler-Klamt
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Lena Schmidbauer
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Christina Scharf
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Lucas Hübner
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Ines Schroeder
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Johanna Biebl
- grid.5252.00000 0004 1936 973XDepartment of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Marcus Gutmann
- grid.5252.00000 0004 1936 973XDepartment of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Inge Eberl
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Michael Zoller
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Uli Fischer
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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9
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Riefer J, Zapf L, Sprenger JAP, Wirthensohn R, Endres S, Pöppler AC, Gutmann M, Meinel L, Ignat'ev NV, Finze M. Cyano(fluoro)borate and cyano(hydrido)borate ionic liquids: low-viscosity ionic media for electrochemical applications. Phys Chem Chem Phys 2023; 25:5037-5048. [PMID: 36722915 DOI: 10.1039/d2cp05725e] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The synthesis and detailed characterization of low-viscosity room-temperature ionic liquids (RTILs) and [BnPh3P]+ salts with the cyano(fluoro)borate anions [BF(CN)3]- (MFB), [BF2(CN)2]- (DFB), and [BF3(CN)]- as well as the new mixed-substituted anion [BFH(CN)2]- (FHB) is described. The RTILs with [EMIm]+ or [BMPL]+ as countercations were obtained in yields of up to 98% from readily available alkali metal salts and in high purities that allow application in electrochemical devices. Trends in thermal stability, melting and freezing behavior, density, electrochemical stability, dynamic viscosity, specific conductivity and ion diffusivity have been assessed and compared to those of the related tetracyanoborate- and cyano(hydrido)borate-RTILs. The crystal structure analysis of the [BnPh3P]+ salts of [BFn(CN)4-n]- (n = 0-4), [BHn(CN)4-n]- (n = 1-3) and [BFH(CN)2]- provided experimental access to anion volumina that together with ion molecular mass, electrostatic potential, shape and chemical stability have been correlated to physicochemical properties. In addition, the cytotoxicity of the [EMIm]+-ILs and potassium or sodium salts was studied.
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Affiliation(s)
- Jarno Riefer
- Julius-Maximilians-Universität Würzburg, Institut für Anorganische Chemie, Institut für nachhaltige Chemie & Katalyse mit Bor (ICB), Am Hubland, 97074 Würzburg, Germany.
| | - Ludwig Zapf
- Julius-Maximilians-Universität Würzburg, Institut für Anorganische Chemie, Institut für nachhaltige Chemie & Katalyse mit Bor (ICB), Am Hubland, 97074 Würzburg, Germany.
| | - Jan A P Sprenger
- Julius-Maximilians-Universität Würzburg, Institut für Anorganische Chemie, Institut für nachhaltige Chemie & Katalyse mit Bor (ICB), Am Hubland, 97074 Würzburg, Germany.
| | - Raphael Wirthensohn
- Julius-Maximilians-Universität Würzburg, Institut für Anorganische Chemie, Institut für nachhaltige Chemie & Katalyse mit Bor (ICB), Am Hubland, 97074 Würzburg, Germany.
| | - Sebastian Endres
- Julius-Maximilians-Universität Würzburg, Institut für Organische Chemie, Am Hubland, 97074 Würzburg, Germany
| | - Ann-Christin Pöppler
- Julius-Maximilians-Universität Würzburg, Institut für Organische Chemie, Am Hubland, 97074 Würzburg, Germany
| | - Marcus Gutmann
- Julius-Maximilians-Universität Würzburg, Institut für Pharmazie und Lebensmittelchemie, Am Hubland, 97074 Würzburg, Germany
| | - Lorenz Meinel
- Julius-Maximilians-Universität Würzburg, Institut für Pharmazie und Lebensmittelchemie, Am Hubland, 97074 Würzburg, Germany
| | - Nikolai V Ignat'ev
- Julius-Maximilians-Universität Würzburg, Institut für Anorganische Chemie, Institut für nachhaltige Chemie & Katalyse mit Bor (ICB), Am Hubland, 97074 Würzburg, Germany. .,Consultant, Merck KGaA, Frankfurter Straße 250, 64293 Darmstadt, Germany
| | - Maik Finze
- Julius-Maximilians-Universität Würzburg, Institut für Anorganische Chemie, Institut für nachhaltige Chemie & Katalyse mit Bor (ICB), Am Hubland, 97074 Würzburg, Germany.
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10
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Raschig M, Ramírez-Zavala B, Wiest J, Saedtler M, Gutmann M, Holzgrabe U, Morschhäuser J, Meinel L. Azobenzene derivatives with activity against drug-resistant Candida albicans and Candida auris. Arch Pharm (Weinheim) 2023; 356:e2200463. [PMID: 36403201 DOI: 10.1002/ardp.202200463] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 11/21/2022]
Abstract
Increasing resistance against antimycotic drugs challenges anti-infective therapies today and contributes to the mortality of infections by drug-resistant Candida species and strains. Therefore, novel antifungal agents are needed. A promising approach in developing new drugs is using naturally occurring molecules as lead structures. In this work, 4,4'-dihydroxyazobenzene, a compound structurally related to antifungal stilbene derivatives and present in Agaricus xanthodermus (yellow stainer), served as a starting point for the synthesis of five azobenzene derivatives. These compounds prevented the growth of both fluconazole-susceptible and fluconazole-resistant Candida albicans and Candida auris strains. Further in vivo studies are required to confirm the potential therapeutic value of these compounds.
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Affiliation(s)
- Martina Raschig
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Wuerzburg, Germany
| | - Bernardo Ramírez-Zavala
- Institute for Molecular Infection Biology (IMIB), University of Wuerzburg, Wuerzburg, Germany
| | - Johannes Wiest
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Wuerzburg, Germany
| | - Marco Saedtler
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Wuerzburg, Germany
| | - Marcus Gutmann
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Wuerzburg, Germany
| | - Ulrike Holzgrabe
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Wuerzburg, Germany
| | - Joachim Morschhäuser
- Institute for Molecular Infection Biology (IMIB), University of Wuerzburg, Wuerzburg, Germany
| | - Lorenz Meinel
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Wuerzburg, Germany.,Helmholtz Institute for RNA-Based Infection Biology (HIRI), Wuerzburg, Germany
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11
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Reiländer S, Schmehl W, Popp K, Nuss K, Kronen P, Verdino D, Wiezorek C, Gutmann M, Hahn L, Däubler C, Meining A, Raschig M, Kaiser F, von Rechenberg B, Scherf-Clavel O, Meinel L. Oral Use of Therapeutic Carbon Monoxide for Anyone, Anywhere, and Anytime. ACS Biomater Sci Eng 2022. [DOI: 10.1021/acsbiomaterials.2c00464] [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: 11/30/2022]
Affiliation(s)
- Simon Reiländer
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074Wuerzburg, Germany
| | - Wolfgang Schmehl
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074Wuerzburg, Germany
| | - Kevin Popp
- German Plastics Center (SKZ), Friedrich-Bergius-Ring 22, Wuerzburg97076, Germany
| | - Katja Nuss
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty ZH, University of Zuerich, Winterthurerstrasse 260, Zuerich8057, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty ZH, University of Zuerich, Winterthurerstrasse 260, Zuerich8057, Switzerland
| | - Peter Kronen
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty ZH, University of Zuerich, Winterthurerstrasse 260, Zuerich8057, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty ZH, University of Zuerich, Winterthurerstrasse 260, Zuerich8057, Switzerland
| | - Dagmar Verdino
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty ZH, University of Zuerich, Winterthurerstrasse 260, Zuerich8057, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty ZH, University of Zuerich, Winterthurerstrasse 260, Zuerich8057, Switzerland
| | - Christina Wiezorek
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty ZH, University of Zuerich, Winterthurerstrasse 260, Zuerich8057, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty ZH, University of Zuerich, Winterthurerstrasse 260, Zuerich8057, Switzerland
| | - Marcus Gutmann
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074Wuerzburg, Germany
| | - Lukas Hahn
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074Wuerzburg, Germany
| | - Christof Däubler
- Department of Internal Medicine II, Gastroenterology, University Hospital Wuerzburg, Oberdürrbacherstr. 6, Wuerzburg97080, Germany
| | - Alexander Meining
- Department of Internal Medicine II, Gastroenterology, University Hospital Wuerzburg, Oberdürrbacherstr. 6, Wuerzburg97080, Germany
| | - Martina Raschig
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074Wuerzburg, Germany
| | - Friederike Kaiser
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, Würzburg97070, Germany
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit (MSRU), Vetsuisse Faculty ZH, University of Zuerich, Winterthurerstrasse 260, Zuerich8057, Switzerland
- Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), Vetsuisse Faculty ZH, University of Zuerich, Winterthurerstrasse 260, Zuerich8057, Switzerland
| | - Oliver Scherf-Clavel
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074Wuerzburg, Germany
| | - Lorenz Meinel
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074Wuerzburg, Germany
- Helmholtz Institute for RNA-based Infection Biology (HIRI), Würzburg97070, Germany
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12
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Warmbein A, Schroeder I, Mehler-Klamt A, Rathgeber I, Huber J, Scharf C, Hübner L, Gutmann M, Biebl J, Lorenz A, Kraft E, Zoller M, Eberl I, Fischer U. Robot-assisted early mobilization of intensive care patients: a feasibility study protocol. Pilot Feasibility Stud 2022; 8:236. [PMCID: PMC9636622 DOI: 10.1186/s40814-022-01191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Early mobilization positively influences the outcome of critically ill patients, yet in clinical practice, the implementation is sometimes challenging. In this study, an adaptive robotic assistance system will be used for early mobilization in intensive care units. The study aims to evaluate the experience of the mobilizing professionals and the general feasibility of implementing robotic assistance for mobilization in intensive care as well as the effects on patient outcomes as a secondary outcome.
Methods
The study is single-centric, prospective, and interventional and follows a longitudinal study design. To evaluate the feasibility of robotic-assisted early mobilization, the number of patients included, the number of performed VEM (very early mobilization) sessions, and the number and type of adverse events will be collected. The behavior and experience of mobilizing professionals will be evaluated using standardized observations (n > 90) and episodic interviews (n > 36) before implementation, shortly after, and in routine. Patient outcomes such as duration of mechanical ventilation, loss of muscle mass, and physical activity will be measured and compared with a historical patient population. Approximately 30 patients will be included.
Discussion
The study will provide information about patient outcomes, feasibility, and the experience of mobilizing professionals. It will show whether robotic systems can increase the early mobilization frequency of critically ill patients. Within ICU structures, early mobilization as therapy could become more of a focus. Effects on the mobilizing professionals such as increased motivation, physical relief, or stress will be evaluated. In addition, this study will focus on whether current structures allow following the recommendation of mobilizing patients twice a day for at least 20 min.
Trial registration
ClinicalTrials.gov, NCT05071248. Date: 2021/10/21
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13
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Huebner L, Schroeder I, Kraft E, Gutmann M, Biebl J, Klamt AC, Frey J, Warmbein A, Rathgeber I, Eberl I, Fischer U, Scharf C, Schaller SJ, Zoller M. [Early mobilization in the intensive care unit-Are robot-assisted systems the future?]. Anaesthesiologie 2022; 71:795-800. [PMID: 35925160 DOI: 10.1007/s00101-022-01130-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Intensive care unit (ICU) acquired weakness is associated with reduced physical function, increased mortality and reduced quality of life, and affects about 43% of survivors of critical illness. Lacking therapeutic options, the prevention of known risk factors and implementation of early mobilization is essential. Robotic assistance devices are increasingly being studied in mobilization. OBJECTIVE This qualitative review synthesizes the evidence of early mobilization in the ICU and focuses on the advantages of robotic assistance devices. RESULTS Active mobilization should begin early during critical care. Interventions commencing 72 h after admission to the ICU are considered early. Mobilization interventions during critical care have been shown to be safe and reduce the time on mechanical ventilation in the ICU and the length of delirious episodes. Protocolized early mobilization interventions led to more active mobilization and increased functional independence and mobility at hospital discharge. In rehabilitation after stroke, robot-assisted training increases the chance of regaining independent walking ability, especially in more severely impaired patients, seems to be safe and increases muscle strength and quality of life in small trials. CONCLUSION Early mobilization improves the outcome of the critically ill. Robotic devices support the gait training after stroke and are the subject of ongoing studies on early mobilization and verticalization in the intensive care setting.
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Affiliation(s)
- Lucas Huebner
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
| | - Ines Schroeder
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Eduard Kraft
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, München, Deutschland
| | - Marcus Gutmann
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, München, Deutschland
| | - Johanna Biebl
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, München, Deutschland
| | - Amrei Christin Klamt
- Professur für Pflegewissenschaften, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Jana Frey
- Professur für Pflegewissenschaften, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Angelika Warmbein
- Klinische Pflegeforschung & Qualitätsmanagement, LMU Klinikum, München, Deutschland
| | - Ivanka Rathgeber
- Klinische Pflegeforschung & Qualitätsmanagement, LMU Klinikum, München, Deutschland
| | - Inge Eberl
- Professur für Pflegewissenschaften, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Uli Fischer
- Klinische Pflegeforschung & Qualitätsmanagement, LMU Klinikum, München, Deutschland
| | - Christina Scharf
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Stefan J Schaller
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Michael Zoller
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
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14
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Gutmann M, Adroja D, Rainford B, Refson K, Von Zimmermann M. Thermal diffuse scattering and ab initio phonons in LaPdSb. Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322095298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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15
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Hofmann J, Spatz P, Walther R, Gutmann M, Maurice T, Decker M. Synthesis and Biological Evaluation of Flavonoid‐Cinnamic Acid Amide Hybrids with Distinct Activity against Neurodegeneration in Vitro and in Vivo. Chemistry 2022; 28:e202200786. [PMID: 35621167 PMCID: PMC9400986 DOI: 10.1002/chem.202200786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Indexed: 11/10/2022]
Abstract
Flavonoids are polyphenolic natural products and have shown significant potential as disease‐modifying agents against neurodegenerative disorders like Alzheimer's disease (AD), with activities even in vivo. Hybridization of the natural products taxifolin and silibinin with cinnamic acid led to an overadditive effect of these compounds in several phenotypic screening assays related to neurodegeneration and AD. Therefore, we have exchanged the flavonoid part of the hybrids with different flavonoids, which show higher efficacy than taxifolin or silibinin, to improve the activity of the respective hybrids. Chemical connection between the flavonoid and cinnamic acid was realized by an amide instead of a labile ester bond to improve stability towards hydrolysis. To investigate the influence of a double bond at the C‐ring of the flavonoid, the dehydro analogues of the respective hybrids were also synthesized. All compounds obtained show neuroprotection against oxytosis, ferroptosis and ATP‐depletion, respectively, in the murine hippocampal cell line HT22. Interestingly, the taxifolin and the quercetin derivatives are the most active compounds, whereby the quercetin derivate shows even more pronounced activity than the taxifolin one in all assays applied. As aimed for, no hydrolysis product was found in cellular uptake experiments after 4 h whereas different metabolites were detected. Furthermore, the quercetin‐cinnamic acid amide showed pronounced activity in an in vivo AD mouse model at a remarkably low dose of 0.3 mg/kg.
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Affiliation(s)
- Julian Hofmann
- Pharmaceutical and Medicinal Chemistry Institute of Pharmacy and Food Chemistry University of Würzburg Am Hubland 97074 Würzburg Germany
| | - Philipp Spatz
- Pharmaceutical and Medicinal Chemistry Institute of Pharmacy and Food Chemistry University of Würzburg Am Hubland 97074 Würzburg Germany
| | - Rasmus Walther
- Pharmaceutical and Medicinal Chemistry Institute of Pharmacy and Food Chemistry University of Würzburg Am Hubland 97074 Würzburg Germany
| | - Marcus Gutmann
- Drug Formulation and Delivery Institute of Pharmacy and Food Chemistry University of Würzburg Am Hubland 97074 Würzburg Germany
| | - Tangui Maurice
- MMDN University of Montpellier, EPHE, INSERM 34095 Montpellier France
| | - Michael Decker
- Pharmaceutical and Medicinal Chemistry Institute of Pharmacy and Food Chemistry University of Würzburg Am Hubland 97074 Würzburg Germany
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16
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Abstract
Intraoperative bleeding and postoperative bleeding are major surgical complications. Tissue sealants, hemostats, and adhesives provide the armamentarium for establishing hemostatic balance, including the tissue sealant fibrin. Fibrin sealants combine advantages including instantaneous effect, biocompatibility, and biodegradability. However, several challenges remain. This review summarizes current fibrin product generations and highlights new trends and potential strategies for future improvement.
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Affiliation(s)
- Matthias Beudert
- Institute of Pharmacy and Food Chemistry, Julius-Maximilians-University Würzburg, Am Hubland, 97074 Würzburg, Germany
| | - Marcus Gutmann
- Institute of Pharmacy and Food Chemistry, Julius-Maximilians-University Würzburg, Am Hubland, 97074 Würzburg, Germany
| | - Tessa Lühmann
- Institute of Pharmacy and Food Chemistry, Julius-Maximilians-University Würzburg, Am Hubland, 97074 Würzburg, Germany
| | - Lorenz Meinel
- Institute of Pharmacy and Food Chemistry, Julius-Maximilians-University Würzburg, Am Hubland, 97074 Würzburg, Germany.,Helmholtz Institute for RNA-based Infection Research, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
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17
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Beudert M, Hahn L, Horn AHC, Hauptstein N, Sticht H, Meinel L, Luxenhofer R, Gutmann M, Lühmann T. Merging bioresponsive release of insulin-like growth factor I with 3D printable thermogelling hydrogels. J Control Release 2022; 347:115-126. [PMID: 35489547 DOI: 10.1016/j.jconrel.2022.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/31/2022] [Accepted: 04/16/2022] [Indexed: 11/15/2022]
Abstract
3D printing of biomaterials enables spatial control of drug incorporation during automated manufacturing. This study links bioresponsive release of the anabolic biologic, insulin-like growth factor-I (IGF-I) in response to matrix metalloproteinases (MMP) to 3D printing using the block copolymer of poly(2-methyl-2-oxazoline) and thermoresponsive poly(2-n-propyl-2-oxazine) (POx-b-POzi). For that, a chemo-enzymatic synthesis was deployed, ligating IGF-I enzymatically to a protease sensitive linker (PSL), which was conjugated to a POx-b-POzi copolymer. The product was blended with the plain thermogelling POx-b-POzi hydrogel. MMP exposure of the resulting hydrogel triggered bioactive IGF-I release. The bioresponsive IGF-I containing POx-b-POzi hydrogel system was further detailed for shape control and localized incorporation of IGF-I via extrusion 3D printing for future applications in biomedicine and biofabrication.
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Affiliation(s)
- Matthias Beudert
- University of Würzburg, Institute for Pharmacy and Food Chemistry, 97074 Würzburg, Germany
| | - Lukas Hahn
- University of Würzburg, Institute for Pharmacy and Food Chemistry, 97074 Würzburg, Germany; Functional Polymer Materials, Chair for Advanced Materials Synthesis, Institute for Functional Materials and Biofabrication, Department of Chemistry and Pharmacy, Julius-Maximilians-University Würzburg, Röntgenring 11, 97070 Würzburg, Germany
| | - Anselm H C Horn
- Bioinformatics, Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Fahrstraße 17, 91054 Erlangen, Germany; Erlangen National High Performance Computing Center (NHR@FAU), Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstraße 1, 91058 Erlangen, Germany
| | - Niklas Hauptstein
- University of Würzburg, Institute for Pharmacy and Food Chemistry, 97074 Würzburg, Germany
| | - Heinrich Sticht
- Bioinformatics, Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Fahrstraße 17, 91054 Erlangen, Germany; Erlangen National High Performance Computing Center (NHR@FAU), Friedrich-Alexander-Universität Erlangen-Nürnberg, Martensstraße 1, 91058 Erlangen, Germany
| | - Lorenz Meinel
- University of Würzburg, Institute for Pharmacy and Food Chemistry, 97074 Würzburg, Germany; Helmholtz Institute for RNA-based Infection Research, Josef-Schneider-Straße 2, DE-97080 Würzburg, Germany
| | - Robert Luxenhofer
- Functional Polymer Materials, Chair for Advanced Materials Synthesis, Institute for Functional Materials and Biofabrication, Department of Chemistry and Pharmacy, Julius-Maximilians-University Würzburg, Röntgenring 11, 97070 Würzburg, Germany; Soft Matter Chemistry, Department of Chemistry and Helsinki Institute of Sustainability Science, Faculty of Science, University of Helsinki, P.O. Box 55, 00014 Helsinki, Finland
| | - Marcus Gutmann
- University of Würzburg, Institute for Pharmacy and Food Chemistry, 97074 Würzburg, Germany.
| | - Tessa Lühmann
- University of Würzburg, Institute for Pharmacy and Food Chemistry, 97074 Würzburg, Germany.
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18
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Hahn L, Beudert M, Gutmann M, Keßler L, Stahlhut P, Fischer L, Karakaya E, Lorson T, Thievessen I, Detsch R, Lühmann T, Luxenhofer R. From Thermogelling Hydrogels toward Functional Bioinks: Controlled Modification and Cytocompatible Crosslinking. Macromol Biosci 2021; 21:e2100122. [PMID: 34292657 DOI: 10.1002/mabi.202100122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/20/2021] [Indexed: 12/14/2022]
Abstract
Hydrogels are key components in bioink formulations to ensure printability and stability in biofabrication. In this study, a well-known Diels-Alder two-step post-polymerization modification approach is introduced into thermogelling diblock copolymers, comprising poly(2-methyl-2-oxazoline) and thermoresponsive poly(2-n-propyl-2-oxazine). The diblock copolymers are partially hydrolyzed and subsequently modified by acid/amine coupling with furan and maleimide moieties. While the thermogelling and shear-thinning properties allow excellent printability, trigger-less cell-friendly Diels-Alder click-chemistry yields long-term shape-fidelity. The introduced platform enables easy incorporation of cell-binding moieties (RGD-peptide) for cellular interaction. The hydrogel is functionalized with RGD-peptides using thiol-maleimide chemistry and cell proliferation as well as morphology of fibroblasts seeded on top of the hydrogels confirm the cell adhesion facilitated by the peptides. Finally, bioink formulations are tested for biocompatibility by incorporating fibroblasts homogenously inside the polymer solution pre-printing. After the printing and crosslinking process good cytocompatibility is confirmed. The established bioink system combines a two-step approach by physical precursor gelation followed by an additional chemical stabilization, offering a broad versatility for further biomechanical adaptation or bioresponsive peptide modification.
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Affiliation(s)
- Lukas Hahn
- Functional Polymer Materials, Chair for Advanced Materials Synthesis, Institute for Functional Materials and Biofabrication, Department of Chemistry and Pharmacy and Bavarian Polymer Institute, Julius-Maximilians-University Würzburg, Röntgenring 11, Würzburg, 97070, Germany
| | - Matthias Beudert
- Institute of Pharmacy and Food Chemistry, Julius-Maximilians-University Würzburg, Am Hubland, Würzburg, 97074, Germany
| | - Marcus Gutmann
- Institute of Pharmacy and Food Chemistry, Julius-Maximilians-University Würzburg, Am Hubland, Würzburg, 97074, Germany
| | - Larissa Keßler
- Functional Polymer Materials, Chair for Advanced Materials Synthesis, Institute for Functional Materials and Biofabrication, Department of Chemistry and Pharmacy and Bavarian Polymer Institute, Julius-Maximilians-University Würzburg, Röntgenring 11, Würzburg, 97070, Germany
| | - Philipp Stahlhut
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, Würzburg, 97070, Germany
| | - Lena Fischer
- Center for Medical Physics and Technology, Biophysics Group, Friedrich-Alexander-University of Erlangen-Nuremberg, Henkestrasse 91, Erlangen, 91052, Germany
| | - Emine Karakaya
- Institute of Biomaterials, University of Erlangen-Nürnberg, Cauerstr. 6, Erlangen, 91058, Germany
| | - Thomas Lorson
- Institute of Pharmacy and Food Chemistry, Julius-Maximilians-University Würzburg, Am Hubland, Würzburg, 97074, Germany
| | - Ingo Thievessen
- Center for Medical Physics and Technology, Biophysics Group, Friedrich-Alexander-University of Erlangen-Nuremberg, Henkestrasse 91, Erlangen, 91052, Germany
| | - Rainer Detsch
- Institute of Biomaterials, University of Erlangen-Nürnberg, Cauerstr. 6, Erlangen, 91058, Germany
| | - Tessa Lühmann
- Institute of Pharmacy and Food Chemistry, Julius-Maximilians-University Würzburg, Am Hubland, Würzburg, 97074, Germany
| | - Robert Luxenhofer
- Functional Polymer Materials, Chair for Advanced Materials Synthesis, Institute for Functional Materials and Biofabrication, Department of Chemistry and Pharmacy and Bavarian Polymer Institute, Julius-Maximilians-University Würzburg, Röntgenring 11, Würzburg, 97070, Germany.,Soft Matter Chemistry, Department of Chemistry and Helsinki Institute of Sustainability Science, Faculty of Science, University of Helsinki, P.O. Box 55, Helsinki, FIN-00014, Finland
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19
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Abstract
Fibroblast growth factor 2 (FGF-2) is a small 18 kDa protein with clinical potential for ischemic heart disease, wound healing, and spinal cord injury. However, the therapeutic potential of systemic FGF-2 administration is challenged by its fast elimination. Therefore, we deployed genetic codon expansion to integrate an azide functionality to the FGF-2 N-terminus, which was site-directly decorated with poly(ethylene glycol) (PEG) through bioorthogonal strain-promoted azide-alkyne cycloaddition (SPAAC). PEGylated FGF-2 was as bioactive as wild-type FGF-2 as demonstrated by cell proliferation and Erk phosphorylation of fibroblasts. The PEGylated FGF-2 conjugate was radiolabeled with [111In] Indium cation ([111In]In3+) to study its biodistribution through noninvasive imaging by single-photon emission computed tomography (SPECT) and by quantitative activity analysis of the respective organs in healthy mice. This study details the biodistribution pattern of site-specific PEGylated FGF-2 in tissues after intravenous (iv) administration compared to the unconjugated protein. Low accumulation of the PEGylated FGF-2 variant in the kidney and the liver was demonstrated, whereas specific uptake of PEGylated FGF-2 into the retina was significantly diminished. In conclusion, site-specific PEGylation of FGF-2 by SPAAC resulted in a superior outcome for the synthesis yield and in conjugates with excellent biological performances with a gain of half-life but reduced tissue access in vivo.
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Affiliation(s)
- Tessa Lühmann
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074 Würzburg, Germany
| | - Marcus Gutmann
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074 Würzburg, Germany
| | - Alessandra Moscaroli
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Martina Raschig
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074 Würzburg, Germany
| | - Martin Béhé
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Lorenz Meinel
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074 Würzburg, Germany
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20
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Barnett S, Allan D, Gutmann M, Cockcroft J, Mai V, Aliev A, Saßmannshausen J. Combined high resolution X-ray and DFT Bader analysis to reveal a proposed Ru–H⋯Si interaction in Cp(IPr)Ru(H)2SiH(Ph)Cl. Inorganica Chim Acta 2019. [DOI: 10.1016/j.ica.2019.01.034] [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] [Indexed: 10/27/2022]
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21
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Gutmann M, Bechold J, Seibel J, Meinel L, Lühmann T. Metabolic Glycoengineering of Cell-Derived Matrices and Cell Surfaces: A Combination of Key Principles and Step-by-Step Procedures. ACS Biomater Sci Eng 2018; 5:215-233. [DOI: 10.1021/acsbiomaterials.8b00865] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Marcus Gutmann
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Julian Bechold
- Institute of Organic Chemistry, University of Würzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Jürgen Seibel
- Institute of Organic Chemistry, University of Würzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Lorenz Meinel
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Tessa Lühmann
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
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22
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Reggane M, Wiest J, Saedtler M, Harlacher C, Gutmann M, Zottnick SH, Piechon P, Dix I, Müller-Buschbaum K, Holzgrabe U, Meinel L, Galli B. Bioinspired co-crystals of Imatinib providing enhanced kinetic solubility. Eur J Pharm Biopharm 2018; 128:290-299. [DOI: 10.1016/j.ejpb.2018.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/03/2018] [Indexed: 11/28/2022]
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23
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Affiliation(s)
- Marcus Gutmann
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, Würzburg 97074, Germany
| | - Alexandra Braun
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, Würzburg 97074, Germany
| | - Jürgen Seibel
- Institute of Organic Chemistry, University of Würzburg, Am Hubland, Würzburg 97074, Germany
| | - Tessa Lühmann
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, Würzburg 97074, Germany
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24
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Braun AC, Gutmann M, Lühmann T, Meinel L. Bioorthogonal strategies for site-directed decoration of biomaterials with therapeutic proteins. J Control Release 2018; 273:68-85. [PMID: 29360478 DOI: 10.1016/j.jconrel.2018.01.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 01/04/2023]
Abstract
Emerging strategies targeting site-specific protein modifications allow for unprecedented selectivity, fast kinetics and mild reaction conditions with high yield. These advances open exciting novel possibilities for the effective bioorthogonal decoration of biomaterials with therapeutic proteins. Site-specificity is particularly important to the therapeutics' end and translated by targeting specific functional groups or introducing new functional groups into the therapeutic at predefined positions. Biomimetic strategies are designed for modification of therapeutics emulating enzymatic strategies found in Nature. These strategies are suitable for a diverse range of applications - not only for protein-polymer conjugation, particle decoration and surface immobilization, but also for the decoration of complex biomaterials and the synthesis of bioresponsive drug delivery systems. This article reviews latest chemical and enzymatic strategies for the biorthogonal decoration of biomaterials with therapeutic proteins and inter-positioned linker structures. Finally, the numerous reports at the interface of biomaterials, linkers, and therapeutic protein decoration are integrated into practical advice for design considerations intended to support the selection of productive ligation strategies.
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Affiliation(s)
- Alexandra C Braun
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, DE-97074 Würzburg, Germany
| | - Marcus Gutmann
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, DE-97074 Würzburg, Germany
| | - Tessa Lühmann
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, DE-97074 Würzburg, Germany
| | - Lorenz Meinel
- Institute for Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, DE-97074 Würzburg, Germany.
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25
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Gutmann M, Schober I, Haberland D. Thermokinetische Untersuchung der Reaktion von Pentacyanokobaltat(II) mit organischen Halogenverbindungen. Z PHYS CHEM 2017. [DOI: 10.1515/zpch-1978-25904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Griesbeck S, Zhang Z, Gutmann M, Lühmann T, Edkins RM, Clermont G, Lazar AN, Haehnel M, Edkins K, Eichhorn A, Blanchard-Desce M, Meinel L, Marder TB. Water-Soluble Triarylborane Chromophores for One- and Two-Photon Excited Fluorescence Imaging of Mitochondria in Cells. Chemistry 2016; 22:14701-6. [DOI: 10.1002/chem.201602639] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Stefanie Griesbeck
- Institut für Anorganische Chemie; Julius-Maximilians-Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Zuolun Zhang
- Institut für Anorganische Chemie; Julius-Maximilians-Universität Würzburg; Am Hubland 97074 Würzburg Germany
- State Key Laboratory of Supramolecular Structure and Materials; College of Chemistry; Jilin University; Changchun 130012 P.R. China
| | - Marcus Gutmann
- Institut für Pharmazie und Lebensmittelchemie; Julius-Maximilians-Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Tessa Lühmann
- Institut für Pharmazie und Lebensmittelchemie; Julius-Maximilians-Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Robert M. Edkins
- Institut für Anorganische Chemie; Julius-Maximilians-Universität Würzburg; Am Hubland 97074 Würzburg Germany
- Chemistry Research Laboratory; University of Oxford; 12 Mansfield Road Oxford OX1 3TA UK
| | - Guillaume Clermont
- Institut des Sciences Moléculaires; Univ. Bordeaux, ISM (CNRS UMR5255), Bâtiment A12, 351 cours de la libération; 33405 TALENCE cedex France
| | - Adina N. Lazar
- Institut des Sciences Moléculaires; Univ. Bordeaux, ISM (CNRS UMR5255), Bâtiment A12, 351 cours de la libération; 33405 TALENCE cedex France
| | - Martin Haehnel
- Institut für Anorganische Chemie; Julius-Maximilians-Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Katharina Edkins
- Institut für Anorganische Chemie; Julius-Maximilians-Universität Würzburg; Am Hubland 97074 Würzburg Germany
- School of Medicine, Pharmacy and Health; Durham University, University Boulevard; Stockton-on-Tees TS17 6BH UK
| | - Antonius Eichhorn
- Institut für Anorganische Chemie; Julius-Maximilians-Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Mireille Blanchard-Desce
- Institut des Sciences Moléculaires; Univ. Bordeaux, ISM (CNRS UMR5255), Bâtiment A12, 351 cours de la libération; 33405 TALENCE cedex France
| | - Lorenz Meinel
- Institut für Pharmazie und Lebensmittelchemie; Julius-Maximilians-Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Todd B. Marder
- Institut für Anorganische Chemie; Julius-Maximilians-Universität Würzburg; Am Hubland 97074 Würzburg Germany
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27
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Steiger C, Uchiyama K, Takagi T, Mizushima K, Higashimura Y, Gutmann M, Hermann C, Botov S, Schmalz HG, Naito Y, Meinel L. Prevention of colitis by controlled oral drug delivery of carbon monoxide. J Control Release 2016; 239:128-36. [PMID: 27578097 DOI: 10.1016/j.jconrel.2016.08.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/22/2016] [Accepted: 08/24/2016] [Indexed: 01/03/2023]
Abstract
Carbon monoxide (CO) is an endogenous signal transmitter involved in numerous physiological processes including the gastrointestinal (GI) homeostasis. CO has been recognized as potential new therapeutic agent for motility related and inflammatory disorders of the GI tract. A therapeutic use, however, is challenged by inappropriate drug delivery modes. Here we describe a micro scale Oral Carbon Monoxide Release System (M-OCORS) designed for localized and controlled exposure of the GI tract with in situ generated CO. M-OCORS allowed for controlled release profiles lasting for several minutes or up to almost one day. These in vitro release profiles translated into a large pharmacokinetic design space following oral administration in mice and measured as CO-hemoglobin (CO-Hb) formation. M-OCORS with a release profile featuring exposure of the intestine was profiled in two independently performed studies demonstrating preventive effects in chemically induced colitis. M-OCORS significantly reduced damage scores and prevented upregulation of colitis biomarkers.
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Affiliation(s)
- Christoph Steiger
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Kazuhiko Uchiyama
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tomohisa Takagi
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Katsura Mizushima
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yasuki Higashimura
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Marcus Gutmann
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Cornelius Hermann
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Svetlana Botov
- Department of Chemistry, University of Cologne, Greinstrasse 4, 50939 Koeln, Germany
| | - Hans-Günther Schmalz
- Department of Chemistry, University of Cologne, Greinstrasse 4, 50939 Koeln, Germany
| | - Yuji Naito
- Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Lorenz Meinel
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany.
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28
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Dechnik J, Mühlbach F, Dietrich D, Wehner T, Gutmann M, Lühmann T, Meinel L, Janiak C, Müller-Buschbaum K. Luminescent Metal-Organic Framework Mixed-Matrix Membranes from Lanthanide Metal-Organic Frameworks in Polysulfone and Matrimid. Eur J Inorg Chem 2016. [DOI: 10.1002/ejic.201600235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Janina Dechnik
- Institut für Anorganische Chemie und Strukturchemie; Universität Düsseldorf; Universitätsstraße 1 40225 Düsseldorf Germany
| | - Friedrich Mühlbach
- Institut für Anorganische Chemie; Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Dennis Dietrich
- Institut für Anorganische Chemie und Strukturchemie; Universität Düsseldorf; Universitätsstraße 1 40225 Düsseldorf Germany
| | - Tobias Wehner
- Institut für Anorganische Chemie; Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Marcus Gutmann
- Institut für Pharmazie und Lebensmittelchemie; Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Tessa Lühmann
- Institut für Pharmazie und Lebensmittelchemie; Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Lorenz Meinel
- Institut für Pharmazie und Lebensmittelchemie; Universität Würzburg; Am Hubland 97074 Würzburg Germany
| | - Christoph Janiak
- Institut für Anorganische Chemie und Strukturchemie; Universität Düsseldorf; Universitätsstraße 1 40225 Düsseldorf Germany
| | - Klaus Müller-Buschbaum
- Institut für Anorganische Chemie; Universität Würzburg; Am Hubland 97074 Würzburg Germany
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29
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Gutmann M, Memmel E, Braun AC, Seibel J, Meinel L, Lühmann T. Biocompatible Azide-Alkyne "Click" Reactions for Surface Decoration of Glyco-Engineered Cells. Chembiochem 2016; 17:866-75. [PMID: 26818821 DOI: 10.1002/cbic.201500582] [Citation(s) in RCA: 30] [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: 11/02/2015] [Indexed: 11/09/2022]
Abstract
Bio-orthogonal copper (I)-catalyzed azide-alkyne cycloaddition (CuAAC) has been widely used to modify azide- or alkyne-bearing monosaccharides on metabolic glyco-engineered mammalian cells. Here, we present a systematic study to elucidate the design space for the cytotoxic effects of the copper catalyst on NIH 3T3 fibroblasts and on HEK 293-F cells. Monitoring membrane integrity by flow cytometry and RT-PCR analysis with apoptotic and anti-apoptotic markers elucidated the general feasibility of CuAAC, with exposure time of the CuAAC reaction mixture having the major influence on biocompatibility. A high labeling efficiency of HEK 293-F cells with a fluorescent alkyne dye was rapidly achieved by CuAAC in comparison to copper free strain-promoted azide-alkyne cycloaddition (SPAAC). The study details effective and biocompatible conditions for CuAAC-based modification of glyco-engineered cells in comparison to its copper free alternative.
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Affiliation(s)
- Marcus Gutmann
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Elisabeth Memmel
- Institute of Organic Chemistry, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Alexandra C Braun
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Jürgen Seibel
- Institute of Organic Chemistry, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Lorenz Meinel
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Tessa Lühmann
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074, Würzburg, Germany.
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30
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Steiger C, Wollborn J, Gutmann M, Zehe M, Wunder C, Meinel L. Controlled therapeutic gas delivery systems for quality-improved transplants. Eur J Pharm Biopharm 2015; 97:96-106. [PMID: 26527426 DOI: 10.1016/j.ejpb.2015.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/16/2015] [Accepted: 10/18/2015] [Indexed: 12/15/2022]
Abstract
Therapeutic gases enriched into perfusion solutions have been effectively used for the improvement of organ transplant quality. At present, the enrichment of perfusion solutions with gases requires complex machinery/containers and handling precautions. Alternatively, the gas is generated within the perfusion solution by supplemented carbonylated transition metal complexes with associated toxicological concerns when these metals contact the transplant. Therefore, we developed therapeutic gas releasing systems (TGRSs) allowing for the controlled generation and release of therapeutic gases (carbon monoxide and hydrogen sulfide) from otherwise hermetically sealed containers, such that the perfusion solution for the transplant is saturated with the gas but no other components from the TGRS are liberated in the solution. The release from the TGRS into the perfusion solution can be tailored as a function of the number and thickness of gas permeable membranes leading to release patterns having been linked to therapeutic success in previous trials. Furthermore, the surrogate biomarker HMGB1 was significantly downregulated in ischemic rat liver transplants perfused with enriched CO solution as compared to control. In conclusion, the TGRS allows for easy, reliable, and controlled generation and release of therapeutic gases while removing safety concerns of current approaches, thereby positively impacting the risk benefit profile of using therapeutic gases for transplant quality improvement in the future.
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Affiliation(s)
- Christoph Steiger
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, DE-97074 Wuerzburg, Germany
| | - Jakob Wollborn
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Oberduerrbacherstraße 6, DE-97080 Wurzburg, Germany; Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Str. 55, DE-79106 Freiburg, Germany
| | - Marcus Gutmann
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, DE-97074 Wuerzburg, Germany
| | - Markus Zehe
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, DE-97074 Wuerzburg, Germany
| | - Christian Wunder
- Department of Anaesthesia and Critical Care, University of Wuerzburg, Oberduerrbacherstraße 6, DE-97080 Wurzburg, Germany
| | - Lorenz Meinel
- Institute for Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, DE-97074 Wuerzburg, Germany.
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31
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Lühmann T, Jones G, Gutmann M, Rybak JC, Nickel J, Rubini M, Meinel L. Bio-orthogonal Immobilization of Fibroblast Growth Factor 2 for Spatial Controlled Cell Proliferation. ACS Biomater Sci Eng 2015; 1:740-746. [DOI: 10.1021/acsbiomaterials.5b00236] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tessa Lühmann
- Institute
of Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Gabriel Jones
- Institute
of Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Marcus Gutmann
- Institute
of Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Jens-Christoph Rybak
- Institute
of Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
| | - Joachim Nickel
- Chair
of Tissue Engineering and Regenerative Medicine, University Hospital of Wuerzburg, Roentgenring 11, 97070 Wuerzburg Germany
- Translational
Center “Regenerative Therapies in Oncology and Musculoskeletal
Diseases” Wuerzburg, Branch of the Fraunhofer Institute Interfacial Engineering and Biotechnology (IGB), Wuerzburg, Germany
| | - Marina Rubini
- Institute
of Organic Chemistry, University of Konstanz, Konstanz, Germany
| | - Lorenz Meinel
- Institute
of Pharmacy and Food Chemistry, University of Wuerzburg, Am Hubland, 97074 Wuerzburg, Germany
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Zurek M, Brunner-La Rocca HP, Rickli H, Muzzarelli S, Gutmann M, Abbuehl H, Handschin R, Jeker U, Pfisterer M, Maeder MT. Differential prognostic impact of heart rate in younger and older patients with chronic heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Bull CL, Loveday JS, Nelmes RJ, Hamidov H, Guthrie M, Komatsu K, Gutmann M, Fernandez-Diaz MT. Single-crystal neutron diffraction 10 GPa and beyond. Acta Crystallogr A 2012. [DOI: 10.1107/s0108767312098996] [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: 11/10/2022] Open
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34
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Pazio A, Gutmann M, Dominiak P, Woźniak K. Multipolar refinement of amino acids with anisotropic H-atom treatment. Acta Crystallogr A 2012. [DOI: 10.1107/s0108767312095153] [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: 11/10/2022] Open
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35
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Heintz D, Burkhardt A, Raghunandan R, Gutmann M, Wagner A, Weckert E, Meents A. The role of hydrogen abstraction in X-ray radiation damage. Acta Crystallogr A 2012. [DOI: 10.1107/s010876731209753x] [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: 11/11/2022] Open
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36
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Pazio A, Malińska M, Gutmann M, Woźniak K. Experimental charge density of selected amino acids. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311080810] [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: 11/10/2022] Open
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37
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Meents A, Wagner A, Gutmann M, Heintz D, Burkhardt A. The role of hydrogen in radiation damage. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311096103] [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: 11/11/2022] Open
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Hudspeth J, Goossens D, Gutmann M, Welberry R. Short range order in ferroelectric triglycine sulphate. Acta Crystallogr A 2011. [DOI: 10.1107/s0108767311089574] [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: 11/10/2022] Open
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Gutmann M, Rothenheim C. Die Rolle der Leber und Leberpräparate in der Behandlung allergischer Krankheiten. Dtsch Med Wochenschr 2009. [DOI: 10.1055/s-0028-1130279] [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: 10/20/2022]
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Hüppe D, Zehnter E, Mauss S, Böker K, Lutz T, Racky S, Schmidt W, Ullrich J, Sbrijer I, Heyne R, Schober A, John C, Hey KH, Bokemeyer B, Kallinowski B, Möller B, Pape S, Gutmann M, Alshuth U, Niederau C. [Epidemiology of chronic hepatitis C in Germany--an analysis of 10,326 patients in hepatitis centres and outpatient units]. Z Gastroenterol 2008; 46:34-44. [PMID: 18188814 DOI: 10.1055/s-2007-963691] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Little is known about the epidemiology of chronic hepatitis C (CHC) in Germany and especially about the importance of transmission, duration of infection, genotypes, symptoms and quality of life of the patients. The current study prospectively evaluates epidemiological and clinical data of patients infected with the hepatitis C virus (HCV). Using online data entry, various characteristics of 10,326 untreated patients with CHC were documented from March 2003 until May 2006 in 352 centres all over Germany. Mean age of patients was 43.4 years. Patients infected by i.v. drug abuse were considerably younger (36.5 years) than the remaining patients (49.2 years). As indicated by their native language, 64.4% of the patients came from Germany and 19.2% from Russia. 61.7% were infected with genotype 1 and 34.9% with genotype 2 or 3. 45.5% of the patients had been infected by i.v. drug abuse. In at least 5.4% of the patients liver cirrhosis had been proved by biopsy. 63.5% of the patients felt an impairment of quality of life caused by CHC. In many patients infected with hepatitis C socio-economic issues are existent. This is reflected, i.e., in very high rates of unemployment in special subpopulations. Coinfections with hepatitis B and HIV occurred in 1.5% and 4.7%, respectively. Nearly 80% of patients were managed near their homes. The data of the 10 326 patients represent about 2% of all German patients with CHC. This database is up to now the largest of its kind and gives a representative insight into the epidemiological situation of CHC in Germany.
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Affiliation(s)
- D Hüppe
- Gastroenterologische Gemeinschaftspraxis Herne, Herne.
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Affiliation(s)
- C Hermosilla
- Institute of Parasitology, Justus Liebig University Giessen, Rudolf-Buchheim-Strasse 2, 35392 Giessen, Germany
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Gafurov MR, Ivanshin VA, Kurkin IN, Rodionova MP, Keller H, Gutmann M, Staub U. EPR study of some rare-earth ions (Dy3+, Tb3+, and Nd3+) in YBa2Cu3O6-compound. J Magn Reson 2003; 161:210-214. [PMID: 12713972 DOI: 10.1016/s1090-7807(03)00002-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We investigate the low temperature X-band electron paramagnetic resonance (EPR) of YBa(2)Cu(3)O(x) compounds with x congruent with 6.0 doped with Dy(3+), Tb(3+), and Nd(3). The EPR spectra of Dy(3+) and Tb(3+) have been identified. The EPR of Tb(3+) is used also to study the effect of suppression of high T(c) superconductivity by doping with Tb(3+). The EPR of Nd(3+) is probably masked by the intense resonance of Cu(2+). All experimental EPR results compare well with theoretical estimations.
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Affiliation(s)
- M R Gafurov
- MRS Laboratory, Kazan State University, 420008, Kremlevskaya 18, Kazan, Russia.
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Blake GR, Radaelli PG, Gutmann M, Argyriou DN, Mitchell JF. Imaging the competition between charge-ordered and charge-delocalised states in Pr 0.65(Ca ySr 1−y) 0.35MnO 3. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302090803] [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: 11/10/2022] Open
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Willberg DM, Breen JJ, Gutmann M, Zewail AH. Rotational constants of vibrationally excited iodine from purely rotational coherence observed in pump-probe experiments. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100172a010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zellweger MJ, Gutmann M, Müller-Brand J, Pfisterer ME. [Noninvasive cardiac diagnosis for quantifying scarring, ischemia and pump function within the scope of a study. 20 useful facets in routine cardiology nuclear medicine practice]. Praxis (Bern 1994) 2002; 91:644-649. [PMID: 12014064 DOI: 10.1024/0369-8394.91.15.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Myocardial perfusion SPECT (MPS) commonly is interpreted qualitatively and not quantitatively. Most of the prognostic literature is based on a semi-quantitative visual analysis (SQA) of MPS. However, data about the comparison between the SQA and coronary angiography (cath) is lacking. We therefore evaluated 167 patients who underwent MPS and subsequent cath. SQA using a 20 segment model was used for MPS interpretation. Patients with a small to moderate amount of ischemia (SDS < or = 4; mean 1.2 +/- 1.5) and with extensive ischemia (SDS > 4; mean 9.6 +/- 4.7) were then compared with respect to clinical and cath variables. Patients with extensive ischemia had more advanced CAD as demonstrated by several cath variables (more often triple vessel and LAD-disease). SQA therefore is a useful tool for MPS interpretation and decision making in patients with (suspected) CAD.
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Affiliation(s)
- M J Zellweger
- Abteilung für Kardiologie und Institut für Nuklearmedizin, Universitätskliniken, Kantonsspital Basel
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Hasegawa TK, Matthews M, Gutmann M. Ethical issues of domestic violence. Response to ethical dilemma #37. Tex Dent J 2001; 118:988-92. [PMID: 11764630] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- T K Hasegawa
- Caruth School of Dental Hygeine at Baylor College of Dentistry, USA
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Bingisser RM, Gutmann M, Dalquen P. [Rapidly progressing respiratory insufficiency of uncertain etiology]. Schweiz Med Wochenschr 2000; 130:2001-8. [PMID: 11688068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
In a 59-year-old male patient, chronic dry cough and dyspnoea on exertion preexisting for several years became rapidly progressive within a few weeks prior to hospitalisation. He died one month after admission from respiratory failure. Three months before admission, history, pulmonary function tests, and computed tomography (CT) of the chest revealed no evidence of asthma, COPD, or any other lung disease. Clinical examination showed no clubbing, but end-inspiratory velcro-rales were audible over both lungs. Inhaled steroids and diuretics did not bring clinical amelioration. On admission there were basal consolidations, bronchiectases, and predominant fibrotic changes with honeycombing and subpleural thickening over both lungs, in the absence of any ground-glass pattern in the CT. At the same time lymphocytosis predominated in bronchoalveolar lavage (BAL). The search for pneumonia, viral infection, tumour, vasculitis, or a drug-related disorder remained negative. Pathological examination at autopsy showed nonuniform fibrosing alveolitis.
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