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Zierke L, John D, Gischke M, Tran QT, Sendler M, Weiss FU, Bornscheuer UT, Ritter C, Lerch MM, Aghdassi AA. Initiation of acute pancreatitis in mice is independent of fusion between lysosomes and zymogen granules. Cell Mol Life Sci 2024; 81:207. [PMID: 38709385 DOI: 10.1007/s00018-024-05247-7] [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: 01/25/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
The co-localization of the lysosomal protease cathepsin B (CTSB) and the digestive zymogen trypsinogen is a prerequisite for the initiation of acute pancreatitis. However, the exact molecular mechanisms of co-localization are not fully understood. In this study, we investigated the role of lysosomes in the onset of acute pancreatitis by using two different experimental approaches. Using an acinar cell-specific genetic deletion of the ras-related protein Rab7, important for intracellular vesicle trafficking and fusion, we analyzed the subcellular distribution of lysosomal enzymes and the severity of pancreatitis in vivo and ex vivo. Lysosomal permeabilization was performed by the lysosomotropic agent Glycyl-L-phenylalanine 2-naphthylamide (GPN). Acinar cell-specific deletion of Rab7 increased endogenous CTSB activity and despite the lack of re-distribution of CTSB from lysosomes to the secretory vesicles, the activation of CTSB localized in the zymogen compartment still took place leading to trypsinogen activation and pancreatic injury. Disease severity was comparable to controls during the early phase but more severe at later time points. Similarly, GPN did not prevent CTSB activation inside the secretory compartment upon caerulein stimulation, while lysosomal CTSB shifted to the cytosol. Intracellular trypsinogen activation was maintained leading to acute pancreatitis similar to controls. Our results indicate that initiation of acute pancreatitis seems to be independent of the presence of lysosomes and that fusion of lysosomes and zymogen granules is dispensable for the disease onset. Intact lysosomes rather appear to have protective effects at later disease stages.
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Affiliation(s)
- Lukas Zierke
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch Str, 17475, Greifswald, Germany
| | - Daniel John
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch Str, 17475, Greifswald, Germany
| | - Marcel Gischke
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch Str, 17475, Greifswald, Germany
| | - Quang Trung Tran
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch Str, 17475, Greifswald, Germany
- Department of Internal Medicine, Hue University, Hue, Vietnam
| | - Matthias Sendler
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch Str, 17475, Greifswald, Germany
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch Str, 17475, Greifswald, Germany
| | - Uwe T Bornscheuer
- Institute of Biochemistry, Department of Biotechnology & Enzyme Catalysis, University of Greifswald, Greifswald, Germany
| | - Christoph Ritter
- Department of Pharmacy, University of Greifswald, Greifswald, Germany
| | | | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch Str, 17475, Greifswald, Germany.
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Bruns N, Meyer F, Rischmüller K, Frost F, Tran QT, Ittermann T, Bahls M, Valentini L, Lamprecht G, Lerch MM, Aghdassi AA, Wiese ML. Nutritional status in patients with chronic pancreatitis and liver cirrhosis is related to disease conditions and not dietary habits. Sci Rep 2024; 14:4700. [PMID: 38409360 PMCID: PMC10897307 DOI: 10.1038/s41598-024-54998-7] [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: 10/23/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
Malnutrition is a common complication of chronic pancreatitis (CP) and liver cirrhosis (LC). Inadequate food intake is considered a relevant driver of malnutrition in both entities. However, the contribution of habitual diet to impaired nutritional status is unclear. In a prospective, multicenter cross-sectional study, we recruited patients with confirmed CP or LC and healthy volunteers as a control group. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition criteria. We comprehensively investigated habitual dietary intake on nutrient, food group, and dietary pattern level applying two validated food frequency questionnaires. We included 144 patients (CP: n = 66; LC: n = 78) and 94 control subjects. Malnutrition was prevalent in 64% and 62% of patients with CP or LC, respectively. In both CP and LC, despite slightly altered food group consumption in malnourished and non-malnourished patients there were no differences in energy or nutrient intake as well as dietary quality. Compared to controls patients showed distinct dietary food group habits. Patients consumed less alcohol but also lower quantities of fruits and vegetables as well as whole grain products (p < 0.001, respectively). Nevertheless, overall dietary quality was comparable between patients and healthy controls. Nutritional status in CP and LC patients is rather related to disease than habitual dietary intake supporting the relevance of other etiologic factors for malnutrition such as malassimilation or chronic inflammation. Despite distinct disease-related differences, overall dietary quality in patients with CP or LC was comparable to healthy subjects, which suggests susceptibility to dietary counselling and the benefits of nutrition therapy in these entities.
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Affiliation(s)
- Niklas Bruns
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Fatuma Meyer
- Institute of Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Karen Rischmüller
- Division of Gastroenterology, Department of Medicine II, Rostock University Medical Center, Rostock, Germany
| | - Fabian Frost
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Quang Trung Tran
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Luzia Valentini
- Institute of Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Georg Lamprecht
- Division of Gastroenterology, Department of Medicine II, Rostock University Medical Center, Rostock, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
- LMU University Hospital, Ludwig Maximilian Universität München, Munich, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Mats L Wiese
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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Lima IS, da Silva TM, Weiss S, Homuth G, Lerch MM, Figueiredo CA, Alcantara-Neves NM, Barreto ML, Marques CR. Genome-wide association study of Helicobacter pylori serological status in Latin American children. Helicobacter 2023; 28:e13008. [PMID: 37497783 DOI: 10.1111/hel.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/07/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Few genome-wide association studies (GWAS) on Helicobacter pylori infection susceptibility have been conducted for admixed populations from developing countries. Here, we performed a GWAS to identify genetic factors associated with H. pylori serostatus in a cohort of admixed children from a large Latin American urban center. METHODS A cross-sectional study involving 1161 children from 4 to 11 years old living in poor areas of Salvador, in northeastern Brazil. Logistic regression analysis was performed to detect associations between single-nucleotide variants (SNVs) and H. pylori seropositivity, assuming an additive genetic model. Enrichment analyses were conducted using the MAGMA v1.10 software. RESULTS We found 22 SNVs to be suggestively associated (p < 10-5 ) with H. pylori seropositivity. The most suggestive SNV was the rs77955022 (p = 4.83e-07) located in an intronic region of EXOC3 at 5p15.33. The second most suggestively associated SNV was rs10914996 (p = 8.97e-07), located in an intergenic region at 1p34.3. Furthermore, we were able to replicate three SNVs (p < 0.05) in the Study of Health in Pomerania (SHIP) cohort: the rs2339212 and rs4795970, both located at 17q12 near TMEM132E, as well as the rs6595814, an intronic variant of FBN2 at 5q23.3. The enrichment analysis indicated the participation of genes and metabolic pathways related to the regulation of the digestive system and gastric acid secretion in the risk of seropositivity for H. pylori. CONCLUSIONS Additional studies are required to validate these association findings in larger population samples and to get insight into the underlying physiological mechanisms.
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Affiliation(s)
- Iasmin Souza Lima
- Multidisciplinary Institute in Health, Federal University of Bahia, Vitória da Conquista, Brazil
| | | | - Stefan Weiss
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Georg Homuth
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | | | | | - Maurício Lima Barreto
- Center of Data and Knowledge Integration for Health, Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | - Cintia Rodrigues Marques
- Multidisciplinary Institute in Health, Federal University of Bahia, Vitória da Conquista, Brazil
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Żorniak M, Sirtl S, Beyer G, Mahajan UM, Bretthauer K, Schirra J, Schulz C, Kohlmann T, Lerch MM, Mayerle J. Consensus definition of sludge and microlithiasis as a possible cause of pancreatitis. Gut 2023; 72:1919-1926. [PMID: 37072178 PMCID: PMC10511955 DOI: 10.1136/gutjnl-2022-327955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 04/01/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE In up to 20% of patients, the aetiology of acute pancreatitis (AP) remains elusive and is thus called idiopathic. On more detailed review these cases can often be explained through biliary disease and are amenable to treatment. Findings range from biliary sludge to microlithiasis but their definitions remain fluid and controversial. DESIGN A systematic literature review (1682 reports, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) analysed definitions of biliary sludge and microlithiasis, followed by an online international expert survey (30 endoscopic ultrasound/hepatobiliary and pancreatic experts; 36 items) which led to definitions of both. These were consented by Delphi voting and clinically evaluated in a retrospective cohort of patients with presumed biliary pancreatitis. RESULTS In 13% of original articles and 19.2% of reviews, microlithiasis and biliary sludge were used synonymously. In the survey, 41.7% of experts described the term 'sludge' and 'microlithiasis' as identical findings. As a consequence, three definitions were proposed, agreed on and confirmed by voting to distinctly discriminate between biliary sludge (hyperechoic material without acoustic shadowing) and microlithiasis (echorich calculi of ≤5 mm with acoustic shadowing) as opposed to larger biliary stones, both for location in gallbladder and bile ducts. In an initial attempt to investigate the clinical relevance in a retrospective analysis in 177 confirmed cases in our hospital, there was no difference in severity of AP if caused by sludge, microlithiasis or stones. CONCLUSION We propose a consensus definition for the localisation, ultrasound morphology and diameter of biliary sludge and microlithiasis as distinct entities. Interestingly, severity of biliary AP was not dependent on the size of concrements warranting prospective randomised studies which treatment options are adequate to prevent recurrence.
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Affiliation(s)
- Michal Żorniak
- Department of Medicine II, LMU University Hospital, Munich, Germany
- Department of Gastroenterology, Hepatology, and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
- Department of Gastroenterological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Simon Sirtl
- Department of Medicine II, LMU University Hospital, Munich, Germany
| | - Georg Beyer
- Department of Medicine II, LMU University Hospital, Munich, Germany
| | | | | | - Jörg Schirra
- Department of Medicine II, LMU University Hospital, Munich, Germany
| | - Christian Schulz
- Department of Medicine II, LMU University Hospital, Munich, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, University Medicine of Greifswald, Greifswald, Germany
| | | | - Julia Mayerle
- Department of Medicine II, LMU University Hospital, Munich, Germany
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Beyer G, Kasprowicz F, Hannemann A, Aghdassi A, Thamm P, Volzke H, Lerch MM, Kühn JP, Mayerle J. Definition of age-dependent reference values for the diameter of the common bile duct and pancreatic duct on MRCP: a population-based, cross-sectional cohort study. Gut 2023; 72:1738-1744. [PMID: 36828626 PMCID: PMC10423481 DOI: 10.1136/gutjnl-2021-326106] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/13/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Changes of the pancreaticobiliary ducts herald disease. Magnetic resonance cholangiopancreatography (MRCP) allows accurate duct visualisation. Data on reliable upper reference ranges are missing. DESIGN Cross-sectional whole body MRI data from the population-based Study of Health in Pomerania were analysed. The width of the common bile duct (CBD) and the pancreatic duct (PD) was determined. We aimed to describe the distribution of physiological duct diameters on MRCP in a population of healthy subjects and to identify factors influencing duct size. RESULTS After excluding pre-existing pancreaticobiliary conditions, CBD and PD diameters from 938 and 774 healthy individuals, respectively, showed a significant increase with age (p<0.0001) and exceeded the conventional upper reference limit of normal in 10.9% and 18.2%, respectively. Age-dependent upper reference limits of duct diameters were delineated with non-parametric quantile regression, defined as 95th percentile: for CBD up to 8 mm in subjects <65 years and up to 11 mm in subjects ≥65 years. For the PD reference diameters were up to 3 mm in subjects <65 years and up to 4 mm in subjects ≥65 years. CONCLUSIONS This is the first population-based study delineating age-adjusted upper reference limits of CBD and PD on MRCP. We showed that up to 18.2% of healthy volunteers would have needed diagnostic workup, if the conventional reference values were used. The utilisation of the adapted reference levels may help to avoid unnecessary investigations and thus to reduce healthcare expenditure and test-related adverse events.
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Affiliation(s)
- Georg Beyer
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Kasprowicz
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Partner Site Greifswald, German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Ali Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Patrick Thamm
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Henry Volzke
- Partner Site Greifswald, German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
- Institute for Community Medicine, Clinical Epidemiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens-Peter Kühn
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, Carl-Gustav-Carus, Dresden, Sachsen, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
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Thiel FG, Asgarbeik S, Glaubitz J, Wilden A, Lerch MM, Weiss FU, Sendler M. IRAK3-mediated suppression of pro-inflammatory MyD88/IRAK signaling affects disease severity in acute pancreatitis. Sci Rep 2023; 13:10833. [PMID: 37402858 DOI: 10.1038/s41598-023-37930-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
Acute pancreatitis (AP), which is characterized by self-digestion of the pancreas by its own prematurely activated digestive proteases, is a major reason for hospitalization. The autodigestive process causes necrotic cell death of pancreatic acinar cells and the release of damage associated molecular pattern which activate macrophages and drive the secretion of pro-inflammatory cytokines. The MYD88/IRAK signaling pathway plays an important role for the induction of inflammatory responses. Interleukin-1 receptor associated kinase-3 (IRAK3) is a counter-regulator of this pathway. In this study, we investigated the role of MYD88/IRAK using Irak3-/- mice in two experimental animal models of mild and severe AP. IRAK3 is expressed in macrophages as well as pancreatic acinar cells where it restrains NFκB activation. Deletion of IRAK3 enhanced the migration of CCR2+ monocytes into the pancreas and triggered a pro-inflammatory type 1 immune response characterized by significantly increased serum levels of TNFα, IL-6, and IL-12p70. Unexpectedly, in a mild AP model this enhanced pro-inflammatory response resulted in decreased pancreatic damage, whereas in a severe AP model, induced by partial pancreatic duct ligation, the increased pro-inflammatory response drives a severe systemic inflammatory response syndrome (SIRS) and is associated with an increased local and systemic damage. Our results indicate that complex immune regulation mechanism control the course of AP, where moderate pro-inflammation not necessarily associates with increased disease severity but also drives tissue regenerative processes through a more effective clearance of necrotic acinar cells. Only when the pro-inflammation exceeds a certain systemic level, it fuels SIRS and increases disease severity.
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Affiliation(s)
- Franziska G Thiel
- Department of Medicine A, University Medicine, University of Greifswald, Fleischmannstr. 41, 17475, Greifswald, Germany
| | - Saeedeh Asgarbeik
- Department of Medicine A, University Medicine, University of Greifswald, Fleischmannstr. 41, 17475, Greifswald, Germany
| | - Juliane Glaubitz
- Department of Medicine A, University Medicine, University of Greifswald, Fleischmannstr. 41, 17475, Greifswald, Germany
| | - Anika Wilden
- Department of Medicine A, University Medicine, University of Greifswald, Fleischmannstr. 41, 17475, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine, University of Greifswald, Fleischmannstr. 41, 17475, Greifswald, Germany
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine, University of Greifswald, Fleischmannstr. 41, 17475, Greifswald, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine, University of Greifswald, Fleischmannstr. 41, 17475, Greifswald, Germany.
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Bannert K, Karbe C, Förster RH, Sautter LF, Meyer F, Valentini L, Wiese ML, Ehlers L, Berlin P, Jaster R, Aghdassi AA, Lerch MM, Lamprecht G. Orally compensated short bowel patients are thin, potentially malnourished but rarely sarcopenic. Clin Nutr 2023:S0261-5614(23)00160-7. [PMID: 37311685 DOI: 10.1016/j.clnu.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM In short bowel syndrome, insufficient absorptive capacity of the remnant bowel may lead to metabolic and nutritional consequences including electrolyte disturbances, severe diarrhea and malnutrition. While intestinal failure requires parenteral nutrition, short bowel patients with intestinal insufficiency (SB/II) have achieved oral autonomy. The aim of this exploratory study was to assess the nutritional, muscular and functional status of orally compensated SB/II patients. METHODS 28 orally compensated SB/II patients with a mean of 46 months after termination of parenteral nutrition and 56 age- and sex-matched healthy controls (HC) were compared regarding anthropometric parameters, body composition using bioelectrical impedance analysis, handgrip strength and gait speed, blood parameters as well as nutritional intake and physical activity using validated questionnaires. Malnutrition and sarcopenia were diagnosed according to the criteria of the GLIM or EWGSOP2. RESULTS SB/II patients had lower body mass index (BMI) and anthropometric parameters than HC but were within the normal weight range. The GLIM algorithm operationally diagnosed malnutrition in 39% (n = 11) of SB/II patients. Reduced skeletal muscle mass index and phase angle were rarely accompanied by a reduction of handgrip strength below cut-off values and the subsequent diagnosis of sarcopenia in SB/II patients (15%, n = 4). Compared to 11% of HC, 37% of SB/II patients had low physical activity level. Female SB/II patients had higher caloric and macronutrient intake. Caloric intake negatively correlated with body weight indicating compensatory hyperphagia in patients with lower body weight. Some of the SB/II patients showed signs of dehydration. CONCLUSIONS Orally compensated SB/II patients are thinner than HC but have mostly normal BMI. Malnutrition is frequently diagnosed but may be overestimated due to the underlying malabsorption and its interplay with hyperphagia. Muscle mass is often reduced but is rarely accompanied by functional impairment leading to sarcopenia diagnosis. Thus, SB/II patients long term after termination of parenteral support may be malnourished but usually do not develop sarcopenia.
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Affiliation(s)
- Karen Bannert
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Cathleen Karbe
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Robert H Förster
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Lea F Sautter
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Fatuma Meyer
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Germany
| | - Luzia Valentini
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Germany
| | - Mats L Wiese
- University Medicine Greifswald, Department and Polyclinic of Internal Medicine A, Germany
| | - Luise Ehlers
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Peggy Berlin
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Robert Jaster
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Ali A Aghdassi
- University Medicine Greifswald, Department and Polyclinic of Internal Medicine A, Germany
| | - Markus M Lerch
- LMU University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Georg Lamprecht
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany.
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Lerch MM. [The limits of internal medicine]. Inn Med (Heidelb) 2023:10.1007/s00108-023-01501-5. [PMID: 37052623 PMCID: PMC10098989 DOI: 10.1007/s00108-023-01501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 04/14/2023]
Abstract
"The limits of internal medicine" was the congress motto of the 128th Congress of the German Society of Internal Medicine in Wiesbaden in 2022. In his presidential address Prof. Lerch focused on four aspects of this motto: physician-assisted suicide, lessons from the corona pandemic, deficits in the digitalization of the German healthcare system and the German Sonderweg in applying EU regulations for patient data protection. Using data from Canada, Switzerland and the Netherlands, where different forms of physician-assisted suicide are practiced, Prof. Lerch appealed to internists, specifically in family practices, to confront this issue in view of a German Supreme Court ruling. With respect to the development of the corona pandemic he discussed the root causes of the opposition to vaccination in parts of society as well as the question why non-clinically active and only few clinical disciplines have shaped the discussion about corona protection measures in Germany. Another focus of his speech was the insufficient digital maturity of the German healthcare system, which clearly lags behind other countries with respect to digital transformation. Physicians need to become more involved in the digital transformation in order to reorganize the healthcare system for the benefit of the patients. The German Sonderweg in the application of the General Data Protection Regulation (GDPR) requires a new legal framework to enable a pragmatic and progressive use of patient data for medical research and patient safety.
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Affiliation(s)
- Markus M Lerch
- Ärztliches Direktorat, LMU Klinikum München, Marchioninistraße 15, 81377, München, Deutschland.
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Rathmayer M, Heinlein W, Wagner T, Lerch MM, Lammert F, Dollhopf M, Haag C, Gölder SK, Kandulski A, Schad M, Schmidt A, Gundling F, Wilke M, Albert JG. [Costs of potentially outpatient endoscopic procedures in cases with a 1-day hospital stay versus a longer stay]. Z Gastroenterol 2023; 61:504-514. [PMID: 36893789 DOI: 10.1055/a-2016-9196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
INTRODUCTION The transfer of patient care and medical interventions that was previously provided on an inpatient basis to outpatient settings is a stated goal of health politics. It is unclear to what extent costs of an endoscopic procedure and the disease severity depend on the duration of inpatient treatment. We therefore examined whether endoscopic services for cases with a one-day length of stay (VWD) are comparably expensive to cases with a longer VWD. METHODS Outpatient services were selected from the DGVS service catalog. Day cases with exactly one such gastroenterological endoscopic (GAEN) service were compared with cases with VWD>1 day regarding their patient clinical complexity levels (PCCL) and mean costs. Data from the DGVS-DRG project with §21-KHEntgG cost data from a total of 57 hospitals from 2018 and 2019 served as the basis. Endoscopic costs were taken from cost center group 8 of the InEK cost matrix and plausibility checked. RESULTS A total of 122,514 cases with exactly one GAEN service were identified. Statistically equal costs were shown in 30 of 47 service groups. In 10 groups, the cost difference was not relevant (<10%). Cost differences >10% existed only for EGD with variceal therapy, insertion of a self-expanding prosthesis, dilatation/bougienage/exchange with PTC/PTCD in place, non-extensive ERCP, endoscopic ultrasound in the upper gastrointestinal tract, and colonoscopy with submucosal or full thickness resection, or foreign object removal. PCCL differed in all but one group. CONCLUSION Gastroenterology endoscopy services provided as part of inpatient care but potentially performable on an outpatient basis are predominantly equally expensive for day cases as for patients with a length of stay greater than one day. The disease severity is lower. Calculated §21-KHEntgG cost data thus form a reliable basis for the calculation of appropriate reimbursement for hospital services to be provided as outpatient services under the AOP in the future.
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Affiliation(s)
| | | | | | - Markus M Lerch
- Klinikum der Ludwigs-Maximilian-Universität München, Munich, Germany
| | | | - Markus Dollhopf
- Klinik für Gastroenterologie und Hepatologie, Munich Hospital Neuperlach, Munich, Germany
| | - Cornelie Haag
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany
| | | | - Arne Kandulski
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regensburg, Germany
| | | | - Alexandra Schmidt
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany
| | - Felix Gundling
- Medizinische Klinik II (Gastroenterologie, Gastroenterologische Onkologie, Hepatologie, Diabetologie, Stoffwechsel, Infektiologie), Klinikum Bamberg, Bamberg, Germany
| | | | - Jörg G Albert
- Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Robert-Bosch-Krankenhaus GmbH, Stuttgart, Germany.,Klinik für Gastroenterologie, gastroenterologische Onkologie, Hepatologie, Infektiologie und Pneumologie, Klinikum der Landeshauptstadt Stuttgart gemeinnützige Kommunalanstalt öffentlichen Rechts (gKAöR), Stuttgart, Germany
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10
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Wang M, Weiss FU, Guo X, Kolodecik T, Bewersdorf JP, Laine L, Lerch MM, Desir G, Gorelick FS. Plasma renalase levels are associated with the development of acute pancreatitis. Pancreatology 2023; 23:158-162. [PMID: 36697349 DOI: 10.1016/j.pan.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/04/2022] [Accepted: 01/02/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND/OBJECTIVES Severe acute pancreatitis is associated with significant morbidity and mortality. Identifying factors that affect the risk of developing severe disease could influence management. Plasma levels of renalase, an anti-inflammatory secretory protein, dramatically decrease in a murine acute pancreatitis model. We assessed this response in hospitalized acute pancreatitis patients to determine if reduced plasma renalase levels occur in humans. METHODS Plasma samples were prospectively and sequentially collected from patients hospitalized for acute pancreatitis. Two forms of plasma renalase, native (no acid) and acidified, were measured by ELISA and RNLS levels were compared between healthy controls and patients with mild and severe disease (defined as APACHE-II score ≥7) using nonparametric statistical analysis. RESULTS Control (33) and acute pancreatitis (mild, 230 (76.7%) and severe, 70 (23.3%) patients were studied. Acidified RNLS levels were lower in pancreatitis patients: Control: 10.1 μg/ml, Mild 5.1 μg/ml, Severe 6.0 μg/ml; p < 0.001. Native RNLS levels were increased in AP: Control: 0.4 μg/ml, Mild 0.9 μg g/ml, Severe 1.2 μg/ml p < 0.001; those with severe AP trended to have higher native RNLS levels than those with mild disease (p = 0.056). In patients with severe AP, higher APACHE-II scores at 24 h after admission correlated with lower acid-sensitive RNLS levels on admission (r = -0.31, p = 0.023). CONCLUSION Low plasma acidified RNLS levels, and increased native RNLS levels are associated with AP. Additional studies should assess the clinical correlation between plasma RNLS levels and AP severity and outcomes.
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Affiliation(s)
- Melinda Wang
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Xiaojia Guo
- Yale University School of Medicine, New Haven, CT, USA; VA CT Healthcare System, West Haven, USA
| | - Thomas Kolodecik
- Yale University School of Medicine, New Haven, CT, USA; VA CT Healthcare System, West Haven, USA
| | | | - Loren Laine
- Yale University School of Medicine, New Haven, CT, USA; VA CT Healthcare System, West Haven, USA
| | | | - Gary Desir
- Yale University School of Medicine, New Haven, CT, USA; VA CT Healthcare System, West Haven, USA
| | - Fred S Gorelick
- Yale University School of Medicine, New Haven, CT, USA; VA CT Healthcare System, West Haven, USA.
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11
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Bannert K, Sautter LF, Wiese ML, Meyer F, Ehlers L, Fromhold-Treu S, Karbe C, Gärtner S, Lerch MM, Aghdassi AA, Jaster R, Valentini L, Lamprecht G. Analysis of ESPEN and GLIM algorithms reveals specific drivers for the diagnosis of malnutrition in patients with chronic gastrointestinal diseases. Nutrition 2023; 106:111887. [PMID: 36473417 DOI: 10.1016/j.nut.2022.111887] [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: 04/03/2022] [Revised: 09/09/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Disease-related malnutrition (MN) is common in patients with liver cirrhosis (LC), short bowel syndrome (SBS), and chronic pancreatitis (CP). Different MN risk screening tools and diagnostic criteria of the European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM) algorithms were analyzed for their diagnostic accuracy and role as specific drivers to diagnose MN in patients with LC, SBS, and CP. METHODS A total of 187 patients with LC, SBS, and CP, as well as control patients were prospectively recruited in a multicenter cross-sectional study. MN risk was screened using Nutritional Risk Screening 2002 (NRS-2002), the Malnutrition Universal Screening Tool (MUST), and the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), and diagnosed using the ESPEN, GLIM, and GLIMCRP+ (GLIM incorporating C-reactive protein [CRP] >5 mg/L) algorithms. For each of the individual diagnostic criteria, relative frequency, sensitivity, specificity, as well as positive and negative predictive values were calculated. RESULTS NRS-2002 was only sensitive in conjunction with ESPEN, while MUST was sensitive additionally with the GLIM algorithm. RFH-NPT worked the best for LC. GLIM and GLIMCRP+ diagnosed MN more frequently than the ESPEN algorithm. Diagnostic criteria were detected at remarkably different relative frequencies starting with reduced food intake/malabsorption and chronic disease/inflammation, followed by weight loss, reduced fat-free mass index, low body mass index, and body mass index <18.5 kg/m². Relative frequencies differed between LC, SBS, and CP. Weight loss in LC and CP and reduced fat-free mass index and food intake in SBS had good diagnostic accuracy, suggesting that these criteria act as specific drivers for MN. CONCLUSIONS RFH-NPT and MUST performed better in conjunction with the GLIM algorithm than NRS-2002. MN was diagnosed more frequently by GLIM than the ESPEN algorithm in LC, SBS, and CP. Individual criteria acted as specific drivers in MN in chronic gastrointestinal diseases.
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Affiliation(s)
- Karen Bannert
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Lea Franziska Sautter
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Mats Lukas Wiese
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Fatuma Meyer
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Neubrandenburg, Germany
| | - Luise Ehlers
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Sophie Fromhold-Treu
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Cathleen Karbe
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Simone Gärtner
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Robert Jaster
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany
| | - Luzia Valentini
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Neubrandenburg, Germany
| | - Georg Lamprecht
- Department of Medicine II, Division of Gastroenterology and Endocrinology, Rostock University Medical Center, Rostock, Germany.
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12
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Glaubitz J, Wilden A, Frost F, Ameling S, Homuth G, Mazloum H, Rühlemann MC, Bang C, Aghdassi AA, Budde C, Pickartz T, Franke A, Bröker BM, Voelker U, Mayerle J, Lerch MM, Weiss FU, Sendler M. Activated regulatory T-cells promote duodenal bacterial translocation into necrotic areas in severe acute pancreatitis. Gut 2023:gutjnl-2022-327448. [PMID: 36631247 DOI: 10.1136/gutjnl-2022-327448] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE In acute pancreatitis (AP), bacterial translocation and subsequent infection of pancreatic necrosis are the main risk factors for severe disease and late death. Understanding how immunological host defence mechanisms fail to protect the intestinal barrier is of great importance in reducing the mortality risk of the disease. Here, we studied the role of the Treg/Th17 balance for maintaining the intestinal barrier function in a mouse model of severe AP. DESIGN AP was induced by partial duct ligation in C57Bl/6 or DEREG mice, in which regulatory T-cells (Treg) were depleted by intraperitoneal injection of diphtheria toxin. By flow cytometry, functional suppression assays and transcriptional profiling we analysed Treg activation and characterised T-cells of the lamina propria as well as intraepithelial lymphocytes (IELs) regarding their activation and differentiation. Microbiota composition was examined in intestinal samples as well as in murine and human pancreatic necrosis by 16S rRNA gene sequencing. RESULTS The prophylactic Treg-depletion enhanced the proinflammatory response in an experimental mouse model of AP but stabilised the intestinal immunological barrier function of Th17 cells and CD8+/γδTCR+ IELs. Treg depleted animals developed less bacterial translocation to the pancreas. Duodenal overgrowth of the facultative pathogenic taxa Escherichia/Shigella which associates with severe disease and infected necrosis was diminished in Treg depleted animals. CONCLUSION Tregs play a crucial role in the counterbalance against systemic inflammatory response syndrome. In AP, Treg-activation disturbs the duodenal barrier function and permits translocation of commensal bacteria into pancreatic necrosis. Targeting Tregs in AP may help to ameliorate the disease course.
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Affiliation(s)
- Juliane Glaubitz
- Department of Medicine A, university medicine Greifswald, Greifswald, Germany
| | - Anika Wilden
- Department of Medicine A, university medicine Greifswald, Greifswald, Germany
| | - Fabian Frost
- Department of Medicine A, university medicine Greifswald, Greifswald, Germany
| | - Sabine Ameling
- Interfaculty Institute for Genetics and Functional Genomics, Department of Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, Department of Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Hala Mazloum
- Department of Medicine A, university medicine Greifswald, Greifswald, Germany
| | - Malte Christoph Rühlemann
- Institute of Clinical Molecular Biology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany.,Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Hannover, Germany
| | - Corinna Bang
- Institute of Clinical Molecular Biology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Ali A Aghdassi
- Department of Medicine A, university medicine Greifswald, Greifswald, Germany
| | - Christoph Budde
- Department of Medicine A, university medicine Greifswald, Greifswald, Germany
| | - Tilmann Pickartz
- Department of Medicine A, university medicine Greifswald, Greifswald, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Barbara M Bröker
- Department of Immunology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Uwe Voelker
- Interfaculty Institute for Genetics and Functional Genomics, Department of Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Julia Mayerle
- Medizinische Klinik und Poliklinik 2, Klinikum der Universitat Munchen, Munchen, Germany
| | - Markus M Lerch
- Department of Medicine A, university medicine Greifswald, Greifswald, Germany
| | - Frank-Ulrich Weiss
- Department of Medicine A, university medicine Greifswald, Greifswald, Germany
| | - Matthias Sendler
- Department of Medicine A, university medicine Greifswald, Greifswald, Germany
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13
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Völzke H, Schössow J, Schmidt CO, Jürgens C, Richter A, Werner A, Werner N, Radke D, Teumer A, Ittermann T, Schauer B, Henck V, Friedrich N, Hannemann A, Winter T, Nauck M, Dörr M, Bahls M, Felix SB, Stubbe B, Ewert R, Frost F, Lerch MM, Grabe HJ, Bülow R, Otto M, Hosten N, Rathmann W, Schminke U, Großjohann R, Tost F, Homuth G, Völker U, Weiss S, Holtfreter S, Bröker BM, Zimmermann K, Kaderali L, Winnefeld M, Kristof B, Berger K, Samietz S, Schwahn C, Holtfreter B, Biffar R, Kindler S, Wittfeld K, Hoffmann W, Kocher T. Cohort Profile Update: The Study of Health in Pomerania (SHIP). Int J Epidemiol 2022; 51:e372-e383. [PMID: 35348705 DOI: 10.1093/ije/dyac034] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Janka Schössow
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Clemens Jürgens
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Adrian Richter
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - André Werner
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Nicole Werner
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Dörte Radke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Birgit Schauer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Vivien Henck
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Anke Hannemann
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Theresa Winter
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Martin Bahls
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Beate Stubbe
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Fabian Frost
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Clinic of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.,German Centre for Neurodegenerative Diseases, Site Rostock/Greifswald, Greifswald, Greifswald, Germany
| | - Robin Bülow
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Markus Otto
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Norbert Hosten
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Greifswald, Germany
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Rico Großjohann
- Clinic of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
| | - Frank Tost
- Clinic of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
| | - Georg Homuth
- Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Uwe Völker
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Weiss
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Silva Holtfreter
- Department of Immunology, University Medicine Greifswald, Greifswald, Germany
| | - Barbara M Bröker
- Department of Immunology, University Medicine Greifswald, Greifswald, Germany
| | - Kathrin Zimmermann
- Friedrich Loeffler Institute for Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Lars Kaderali
- Institute for Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | | | | | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Munster, Munster, Germany
| | - Stefanie Samietz
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Christian Schwahn
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Birte Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Reiner Biffar
- Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Kindler
- Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Katharina Wittfeld
- Clinic of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.,German Centre for Neurodegenerative Diseases, Site Rostock/Greifswald, Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,German Centre for Neurodegenerative Diseases, Site Rostock/Greifswald, Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
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14
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Müller R, Aghdassi AA, Kruse J, Lerch MM, Rach C, Simon P, Salloch S. Lived Experience of Hereditary Chronic Pancreatitis - A Qualitative Interview Study. Chronic Illn 2022; 18:818-833. [PMID: 34559012 PMCID: PMC9643816 DOI: 10.1177/17423953211039774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Hereditary chronic pancreatitis is a rare condition characterized by intermittent acute episodes of pancreatitis and long-term impairment of pancreatic functions. However, the subjective perspective of individuals affected by hereditary chronic pancreatitis has been little studied. This qualitative study investigates the experience of hereditary chronic pancreatitis patients and their relatives because the awareness of the needs of those affected is an essential component of a patient-centered management of chronic conditions. METHODS Semi-structured qualitative interviews were conducted with hereditary chronic pancreatitis patients and their relatives. Data were analysed using qualitative content analysis. The concepts of 'biographical contingency,' 'biographical disruption' and the 'shifting perspectives model' served as theoretical frameworks. RESULTS A total of 24 participants (17 patients, 7 relatives) were interviewed individually. Four main themes were identified: (1) The unpredictable clinical course of hereditary chronic pancreatitis; (2) hereditary chronic pancreatitis as a devastating experience; (3) hereditary chronic pancreatitis as part of a normal life; and (4) being reduced to hereditary chronic pancreatitis. DISCUSSION The 'shifting perspectives model' of chronic illness covers the four dimensions adequately and can serve as a theoretical model to explain hereditary chronic pancreatitis patients' experience. A better understanding of the patients and their families' experience and the shifting character of hereditary chronic pancreatitis can help healthcare professionals to tailor the care to meet the needs of those affected.
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Affiliation(s)
- Regina Müller
- Institute of Ethics and History of Medicine, University of Tuebingen, Tübingen, Germany.,Institute of Ethics and History of Medicine, 60634University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, 221223University Medicine Greifswald, Greifswald, Germany
| | - Judith Kruse
- Institute of Ethics and History of Medicine, 60634University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, 221223University Medicine Greifswald, Greifswald, Germany
| | - Christoph Rach
- Department of Psychiatry, Psychotherapy and Psychosomatics, 84491Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Peter Simon
- Department of Medicine A, 221223University Medicine Greifswald, Greifswald, Germany
| | - Sabine Salloch
- Institute of Ethics, 88782History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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15
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Tran QT, Sendler M, Wiese ML, Doller J, Zierke L, Gischke M, Glaubitz J, Tran VH, Lalk M, Bornscheuer UT, Weiss FU, Lerch MM, Aghdassi AA. Systemic Bile Acids Affect the Severity of Acute Pancreatitis in Mice Depending on Their Hydrophobicity and the Disease Pathogenesis. Int J Mol Sci 2022; 23:13592. [PMID: 36362379 PMCID: PMC9655547 DOI: 10.3390/ijms232113592] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2023] Open
Abstract
Acute pancreatitis (AP) is a major, globally increasing gastrointestinal disease and a biliary origin is the most common cause. However, the effects of bile acids (BAs), given systemically, on the pancreas and on disease severity remains elusive. In this study, we have investigated the roles of different circulating BAs in animal models for AP to elucidate their impact on disease severity and the underlying pathomechanisms. BAs were incubated on isolated acini and AP was induced through repetitive injections of caerulein or L-arginine; pancreatic duct ligation (PDL); or combined biliopancreatic duct ligation (BPDL). Disease severity was assessed using biochemical and histological parameters. Serum cholecystokinin (CCK) concentrations were determined via enzyme immunoassay. The binding of the CCK1 receptor was measured using fluorescence-labeled CCK. In isolated acini, hydrophobic BAs mitigated the damaging effects of CCK. The same BAs further enhanced pancreatitis in L-arginine- and PDL-based pancreatitis, whereas they ameliorated pancreatic damage in the caerulein and BPDL models. Mechanistically, the binding affinity of the CCK1 receptor was significantly reduced by hydrophobic BAs. The hydrophobicity of BAs and the involvement of CCK seem to be relevant in the course of AP. Systemic BAs may affect the severity of AP by interfering with the CCK1 receptor.
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Affiliation(s)
- Quang Trung Tran
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue City 530000, Vietnam
| | - Matthias Sendler
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Mats L. Wiese
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Julia Doller
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Lukas Zierke
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Marcel Gischke
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Juliane Glaubitz
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Van Huy Tran
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue City 530000, Vietnam
| | - Michael Lalk
- Institute of Biochemistry, University Greifswald, 17489 Greifswald, Germany
| | - Uwe T. Bornscheuer
- Institute of Biochemistry, University Greifswald, 17489 Greifswald, Germany
| | - Frank Ulrich Weiss
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Markus M. Lerch
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
- Ludwig Maximilian University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany
| | - Ali A. Aghdassi
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
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16
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Mahajan UM, Oehrle B, Sirtl S, Alnatsha A, Goni E, Regel I, Beyer G, Vornhülz M, Vielhauer J, Chromik A, Bahra M, Klein F, Uhl W, Fahlbusch T, Distler M, Weitz J, Grützmann R, Pilarsky C, Weiss FU, Adam MG, Neoptolemos JP, Kalthoff H, Rad R, Christiansen N, Bethan B, Kamlage B, Lerch MM, Mayerle J. Independent Validation and Assay Standardization of Improved Metabolic Biomarker Signature to Differentiate Pancreatic Ductal Adenocarcinoma From Chronic Pancreatitis. Gastroenterology 2022; 163:1407-1422. [PMID: 35870514 DOI: 10.1053/j.gastro.2022.07.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Pancreatic ductal adenocarcinoma cancer (PDAC) is a highly lethal malignancy requiring efficient detection when the primary tumor is still resectable. We previously developed the MxPancreasScore comprising 9 analytes and serum carbohydrate antigen 19-9 (CA19-9), achieving an accuracy of 90.6%. The necessity for 5 different analytical platforms and multiple analytical runs, however, hindered clinical applicability. We therefore aimed to develop a simpler single-analytical run, single-platform diagnostic signature. METHODS We evaluated 941 patients (PDAC, 356; chronic pancreatitis [CP], 304; nonpancreatic disease, 281) in 3 multicenter independent tests, and identification (ID) and validation cohort 1 (VD1) and 2 (VD2) were evaluated. Targeted quantitative plasma metabolite analysis was performed on a liquid chromatography-tandem mass spectrometry platform. A machine learning-aided algorithm identified an improved (i-Metabolic) and minimalistic metabolic (m-Metabolic) signatures, and compared them for performance. RESULTS The i-Metabolic Signature, (12 analytes plus CA19-9) distinguished PDAC from CP with area under the curve (95% confidence interval) of 97.2% (97.1%-97.3%), 93.5% (93.4%-93.7%), and 92.2% (92.1%-92.3%) in the ID, VD1, and VD2 cohorts, respectively. In the VD2 cohort, the m-Metabolic signature (4 analytes plus CA19-9) discriminated PDAC from CP with a sensitivity of 77.3% and specificity of 89.6%, with an overall accuracy of 82.4%. For the subset of 45 patients with PDAC with resectable stages IA-IIB tumors, the sensitivity, specificity, and accuracy were 73.2%, 89.6%, and 82.7%, respectively; for those with detectable CA19-9 >2 U/mL, 81.6%, 88.7%, and 84.5%, respectively; and for those with CA19-9 <37 U/mL, 39.7%, 94.1%, and 76.3%, respectively. CONCLUSIONS The single-platform, single-run, m-Metabolic signature of just 4 metabolites used in combination with serum CA19-9 levels is an innovative accurate diagnostic tool for PDAC at the time of clinical presentation, warranting further large-scale evaluation.
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Affiliation(s)
- Ujjwal M Mahajan
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Bettina Oehrle
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Simon Sirtl
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Ahmed Alnatsha
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Elisabetta Goni
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Ivonne Regel
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Georg Beyer
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Marlies Vornhülz
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Jakob Vielhauer
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Ansgar Chromik
- Department of General and Visceral Surgery, Asklepios Klinikum Hamburg, Hamburg, Germany
| | - Markus Bahra
- Zentrum für Onkologische Oberbauchchirurgie und Robotik, Krankenhaus Waldfriede, Berlin, Germany
| | - Fritz Klein
- Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Tim Fahlbusch
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Marius Distler
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Robert Grützmann
- Department of Surgery, Erlangen University Hospital, Erlangen, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Erlangen, Germany
| | - Christian Pilarsky
- Department of Surgery, Erlangen University Hospital, Erlangen, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Erlangen, Germany
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - M Gordian Adam
- Metanomics Health GmbH, Berlin, Germany; biocrates life sciences ag, Innsbruck, Austria
| | - John P Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Holger Kalthoff
- Section for Molecular Oncology, Institut for Experimental Cancer Research (IET), Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Roland Rad
- Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany; Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine and Center for Translational Cancer Research (TranslaTUM), Technische Universität München, Munich, Germany
| | - Nicole Christiansen
- Metanomics Health GmbH, Berlin, Germany; TrinamiX GmbH, Ludwigshafen am Rhein, Rheinland-Pfalz, Germany
| | | | | | - Markus M Lerch
- Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany; Ludwig Maximilian University Klinikum, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany.
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Wilden A, Glaubitz J, Otto O, Biedenweg D, Nauck M, Mack M, Ribback S, Bröker BM, von Rheinbaben SF, Lerch MM, Aghdassi AA, Weiss FU, Sendler M. Mobilization of CD11b+/Ly6chi monocytes causes multi organ dysfunction syndrome in acute pancreatitis. Front Immunol 2022; 13:991295. [PMID: 36300116 PMCID: PMC9589437 DOI: 10.3389/fimmu.2022.991295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Acute pancreatitis (AP) is an inflammatory disorder, the severe form of which is burdened with multi-organ dysfunction and high mortality. The pathogenesis of life –threatening organ complications, such as respiratory and renal failure, is unknown. Design Organ dysfunction was investigated in a mouse model of AP. The influence of monocytes and neutrophils on multi organ dysfunction syndrome (MODS) was investigated in vivo by antibody depletion. Using real-time-fluorescence and deformability-cytometry (RT-DC) analysis we determined the mechanical properties of neutrophils and monocytes during AP. Furthermore, blood samples of pancreatitis patients were used to characterize severity-dependent chemokine profiles according to the revised Atlanta classification. Results Similar to AP in humans, severe disease in the mouse model associates with organ dysfunction mainly of lung and kidney, which is triggered by a mobilisation of Ly6g-/CD11b+/Ly6c hi monocytes, but not of Ly6g+/CD11b+ neutrophils. Monocyte depletion by anti-CCR2 antibody treatment ameliorated lung function (oxygen consumption) without interfering with the systemic immune response. RT-DC analysis of circulation monocytes showed a significant increase in cell size during SAP, but without a compensatory increase in elasticity. Patient chemokine profiles show a correlation of AP severity with monocyte attracting chemokines like MCP-1 or MIG and with leukocyte mobilisation. Conclusion In AP, the physical properties of mobilized monocytes, especially their large size, result in an obstruction of the fine capillary systems of the lung and of the kidney glomeruli. A selective depletion of monocytes may represent a treatment strategy for pancreatitis as well as for other inflammation-related disorders.
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Affiliation(s)
- Anika Wilden
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Juliane Glaubitz
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Oliver Otto
- Center for Innovation Competence: Humoral Immune Reactions in Cardiovascular Disorders, University of Greifswald, Greifswald, Germany
| | - Doreen Biedenweg
- Center for Innovation Competence: Humoral Immune Reactions in Cardiovascular Disorders, University of Greifswald, Greifswald, Germany
- Department of Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Diagnostics, University Medicine Greifswald, Greifswald, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Matthias Mack
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Silvia Ribback
- Institute of Pathology, Universitat Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Barbara M. Bröker
- Department of Immunology, University Medicine Greifswald, Greifswald, Germany
| | | | - Markus M. Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | | | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
- *Correspondence: Matthias Sendler,
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18
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Frost F, Schlesinger L, Wiese ML, Urban S, von Rheinbaben S, Tran QT, Budde C, Lerch MM, Pickartz T, Aghdassi AA. Infection of (Peri-)Pancreatic Necrosis Is Associated with Increased Rates of Adverse Events during Endoscopic Drainage: A Retrospective Study. J Clin Med 2022; 11:jcm11195851. [PMID: 36233718 PMCID: PMC9573742 DOI: 10.3390/jcm11195851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/16/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
Pancreatic necroses are a major challenge in the treatment of patients with pancreatitis, causing high morbidity. When indicated, these lesions are usually drained endoscopically using plastic or metal stents. However, data on factors associated with the occurrence of failure or adverse events during stent therapy are scarce. We retrospectively analyzed all adverse events and their associated features which occurred in patients who underwent a first-time endoscopic drainage of pancreatic necrosis from 2009 to 2019. During the observation period, a total of 89 eligible cases were identified. Adverse events occurred in 58.4% of the cases, of which 76.9% were minor (e.g., stent dislocation, residual lesions, or stent obstruction). However, these events triggered repeated interventions (63.5% vs. 0%, p < 0.001) and prolonged hospital stays (21.0 [11.8−63.0] vs. 14.0 [7.0−31.0], p = 0.003) compared to controls without any adverse event. Important factors associated with the occurrence of adverse events during endoscopic drainage therapy were positive necrosis cultures (6.1 [2.3−16.1], OR [95% CI], p < 0.001) and a larger diameter of the treated lesion (1.3 [1.1−1.5], p < 0.001). Superinfection of pancreatic necrosis is the most significant factor increasing the likelihood of adverse events during endoscopic drainage. Therefore, control of infection is crucial for successful drainage therapy, and future studies need to consider superinfection of pancreatic necrosis as a possible confounding factor when comparing different therapeutic modalities.
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Affiliation(s)
- Fabian Frost
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence: ; Tel.: +49-3834-86-7230
| | - Laura Schlesinger
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Mats L. Wiese
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Steffi Urban
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany
| | | | - Quang Trung Tran
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue 530000, Vietnam
| | - Christoph Budde
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Markus M. Lerch
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany
- Ludwig Maximilian University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany
| | - Tilman Pickartz
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Ali A. Aghdassi
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany
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19
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Neubauer C, Ewers M, Schulz HU, Weiß FU, Lämmerhirt F, Lerch MM, Bugert P, Landt O, Algül H, Rosendahl J, Witt H. Genetic Analysis of the ATG16L1 c.898A>G (p.T300A) Variant in Acute and Chronic Pancreatitis. Pancreas 2022; 51:1231-1234. [PMID: 37078950 DOI: 10.1097/mpa.0000000000002177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES Human and animal studies suggest an important role of autophagy in the pathogenesis of pancreatitis. ATG16L1 (autophagy-related 16 like 1) is part of a protein complex that is involved in the formation of autophagosomes. The c.898A > G (p.T300A) variant of ATG16L1 is associated with Crohn disease. In this study, we analyzed ATG16L1 c.898A > G (p.T300A) for an association with pancreatitis. METHODS We genotyped 777 patients and 551 control subjects of German origin by melting curve analysis using fluorescence resonance energy transfer probes. The patient group included 429 patients with nonalcoholic chronic pancreatitis (CP), 141 patients with alcoholic CP, and 207 patients with acute pancreatitis (AP). We classified AP by severity according to the Atlanta symposium 1992. RESULTS Allele and genotype frequencies of ATG16L1 c.898A > G (p.T300A) did not differ significantly between patients and controls (G allele frequencies: nonalcoholic CP, 49.9%; alcoholic CP, 48.2%; AP, 49.5%; controls, 52.7%). We found no significant association with the severity of AP either. CONCLUSIONS Our data do not support a role of ATG16L1 c.898A > G (p.T300A) in the pathogenesis of AP or CP or an influence on the severity of AP.
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Affiliation(s)
- Claudia Neubauer
- From the Pediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising
| | - Maren Ewers
- From the Pediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising
| | - Hans-Ulrich Schulz
- Klinik für Allgemein- und Viszeralchirurgie, AMEOS Klinikum Haldensleben, Haldensleben
| | - Frank Ulrich Weiß
- Department of Medicine A, Greifswald University Medicine, Greifswald
| | - Felix Lämmerhirt
- Department of Medicine A, Greifswald University Medicine, Greifswald
| | | | | | | | - Hana Algül
- Comprehensive Cancer Center Munich TUM (CCCM), Klinikum rechts der Isar, Technical University Munich (TUM), Munich
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University, Halle, Germany
| | - Heiko Witt
- From the Pediatric Nutritional Medicine & Else Kröner-Fresenius-Centre for Nutritional Medicine (EKFZ), Technical University Munich (TUM), Freising
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20
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Ma Y, Schulz B, Trakooljul N, Al Ammar M, Sekora A, Sender S, Hadlich F, Zechner D, Weiss FU, Lerch MM, Jaster R, Junghanss C, Murua Escobar H. Inhibition of KRAS, MEK and PI3K Demonstrate Synergistic Anti-Tumor Effects in Pancreatic Ductal Adenocarcinoma Cell Lines. Cancers (Basel) 2022; 14:cancers14184467. [PMID: 36139627 PMCID: PMC9497071 DOI: 10.3390/cancers14184467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Kirsten rat sarcoma virus (KRAS) mutations are widespread in pancreatic ductal adenocarcinoma (PDAC) and contribute significantly to tumor initiation, progression, tumor relapse/resistance, and prognosis of patients. Although inhibitors against KRAS mutations have been developed, this therapeutic approach is not routinely used in PDAC patients. We investigated the anti-tumor efficacy of two KRAS inhibitors BI-3406 (KRAS::SOS1 inhibitor) and sotorasib (KRAS G12C inhibitor) alone or in combination with MEK1/2 inhibitor trametinib and/or PI3K inhibitor buparlisib in seven PDAC cell lines. Whole transcriptomic analysis of combined inhibition and control groups were comparatively analyzed to explore the corresponding mechanisms of inhibitor combination. Both KRAS inhibitors and corresponding combinations exhibited cytotoxicity against specific PDAC cell lines. BI-3406 enhance the efficacy of trametinib and buparlisib in BXPC-3, ASPC-1 and MIA PACA-2, but not in CAPAN-1, while sotorasib enhances the efficacy of trametinib and buparlisib only in MIA PACA-2. The whole transcriptomic analysis demonstrates that the two triple-inhibitor combinations exert antitumor effects by affecting related cell functions, such as affecting the immune system, cell adhesion, cell migration, and cytokine binding. As well as directly involved in RAF/MEK/ERK pathway and PI3K/AKT pathway affect cell survival. Our current study confirmed inhibition of KRAS and its downstream pathways as a potential novel therapy for PDAC and provides fundamental data for in vivo evaluations.
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Affiliation(s)
- Yixuan Ma
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (M.A.A.); (A.S.); (S.S.); (C.J.)
| | - Benjamin Schulz
- Institute for Experimental Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (B.S.); (D.Z.)
| | - Nares Trakooljul
- Institute of Genome Biology, Research Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany; (N.T.); (F.H.)
| | - Moosheer Al Ammar
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (M.A.A.); (A.S.); (S.S.); (C.J.)
| | - Anett Sekora
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (M.A.A.); (A.S.); (S.S.); (C.J.)
| | - Sina Sender
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (M.A.A.); (A.S.); (S.S.); (C.J.)
| | - Frieder Hadlich
- Institute of Genome Biology, Research Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany; (N.T.); (F.H.)
| | - Dietmar Zechner
- Institute for Experimental Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (B.S.); (D.Z.)
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (F.U.W.); (M.M.L.)
| | - Markus M. Lerch
- Department of Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (F.U.W.); (M.M.L.)
- Ludwig Maximilian University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany
| | - Robert Jaster
- Department of Medicine II, Division of Gastroenterology, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Christian Junghanss
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (M.A.A.); (A.S.); (S.S.); (C.J.)
| | - Hugo Murua Escobar
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (M.A.A.); (A.S.); (S.S.); (C.J.)
- Correspondence: ; Tel.: +49-381494-7519 or +49-381494-7639; Fax: +49-381494-45803
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21
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Wiese ML, Urban S, von Rheinbaben S, Frost F, Sendler M, Weiss FU, Bülow R, Kromrey ML, Tran QT, Lerch MM, Schauer B, Aghdassi AA. Identification of early predictors for infected necrosis in acute pancreatitis. BMC Gastroenterol 2022; 22:405. [PMID: 36057565 PMCID: PMC9440524 DOI: 10.1186/s12876-022-02490-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background In acute pancreatitis, secondary infection of pancreatic necrosis is a complication that mostly necessitates interventional therapy. A reliable prediction of infected necrotizing pancreatitis would enable an early identification of patients at risk, which however, is not possible yet. Methods This study aims to identify parameters that are useful for the prediction of infected necrosis and to develop a prediction model for early detection. We conducted a retrospective analysis from the hospital information and reimbursement data system and screened 705 patients hospitalized with diagnosis of acute pancreatitis who underwent contrast-enhanced computed tomography and additional diagnostic puncture or drainage of necrotic collections. Both clinical and laboratory parameters were analyzed for an association with a microbiologically confirmed infected pancreatic necrosis. A prediction model was developed using a logistic regression analysis with stepwise inclusion of significant variables. The model quality was tested by receiver operating characteristics analysis and compared to single parameters and APACHE II score. Results We identified a total of 89 patients with necrotizing pancreatitis, diagnosed by computed tomography, who additionally received biopsy or drainage. Out of these, 59 individuals had an infected necrosis. Eleven parameters showed a significant association with an infection including C-reactive protein, albumin, creatinine, and alcoholic etiology, which were independent variables in a predictive model. This model showed an area under the curve of 0.819, a sensitivity of 0.692 (95%-CI [0.547–0.809]), and a specificity of 0.840 (95%-CI [0.631–0.947]), outperforming single laboratory markers and APACHE II score. Even in cases of missing values predictability was reliable. Conclusion A model consisting of a few single blood parameters and etiology of pancreatitis might help for differentiation between infected and non-infected pancreatic necrosis and assist medical therapy in acute necrotizing pancreatitis. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02490-9.
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Affiliation(s)
- Mats L Wiese
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Steffi Urban
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Sabrina von Rheinbaben
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Fabian Frost
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Marie-Luise Kromrey
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Quang Trung Tran
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,Ludwigs-Maximilians University Munich, Munich, Germany
| | - Birgit Schauer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
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22
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von Hirschhausen E, Lerch MM. [Conversation on the impact of climate change on medicine and mankind]. Radiologie (Heidelb) 2022; 62:786-788. [PMID: 36001122 DOI: 10.1007/s00117-022-01061-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - Markus M Lerch
- Ärztliches Direktorat, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
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23
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Tran VH, Tran QT, Nguyen THT, Dang CT, Lerch MM, Aghdassi AA, Miayahara R. Erratum: Non-cardia early gastric cancer in Central Vietnam: noticeable uncommon background mucosa and results of endoscopic submucosal dissection. Endosc Int Open 2022; 10:C7. [PMID: 36003304 PMCID: PMC9395238 DOI: 10.1055/a-1925-4922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
[This corrects the article DOI: 10.1055/a-1854-4587.].
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Affiliation(s)
- Van Huy Tran
- Gastrointestinal Endoscopy Center, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Quang Trung Tran
- Gastrointestinal Endoscopy Center, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam,Department of Internal Medicine A, University Medicine Greifswald, Germany
| | - Thi Huyen Thuong Nguyen
- Gastrointestinal Endoscopy Center, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Cong Thuan Dang
- Pathology Department, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Markus M. Lerch
- Department of Internal Medicine A, University Medicine Greifswald, Germany
| | - Ali A. Aghdassi
- Department of Internal Medicine A, University Medicine Greifswald, Germany
| | - Ryoji Miayahara
- Gastroenterology & Hepatology Department, Fujita Health University, Toyoake, Japan
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24
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Tran VH, Tran QT, Nguyen THT, Dang CT, Lerch MM, Aghdassi AA, Miayahara R. Non-cardia early gastric cancer in Central Vietnam: noticeable uncommon background mucosa and results of endoscopic submucosa dissection. Endosc Int Open 2022; 10:E1029-E1036. [PMID: 35979032 PMCID: PMC9377828 DOI: 10.1055/a-1854-4587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022] Open
Abstract
Background and study aims Gastric cancer (GC) is one of the leading causes of malignancy-related death in Vietnam, with increasing incidence of non-cardia early gastric cancer (N-EGC). Data on accurate diagnosis of EGC and treatment by endoscopic submucosal dissection (ESD) in Vietnam are very sparse. The aim of this study was to describe the characteristics of N-EGC and evaluate the effectiveness and the safety of ESD in Central Vietnam. Patients and methods We prospectively enrolled patients with N-EGC detected by magnified chromoendoscopy from December 2013 to August, 2018 in Central Vietnam. Selected cases of N-EGC received standardized ESD technique and have been following up carefully as in protocol. Results Among 606 GC patients, 46 had N-GEC and underwent ESD. The depth of invasion was pT1a in 33 (71.7 %), pT1b1 in 10 (21.7 %), and pT1b2 in three cases (6.6 %). Mild chronic atrophic gastritis, most being C2 (63 %), and gastritis-like EGC that did not appear malignant was the predominant type. ESD achieved a 97.8 % en bloc resection rate; the mean procedure time was 76 ± 22 minutes (range 24-155), and mean endoscopic tumor size was 23 ± 5 mm (range 13-52) and ESD sample size was 28 ± 7 mm (range 16.5-60). Complications consisted of two patients with bleeding and one with a minor perforation, all of which were successfully managed by endoscopy. The longest and the mean follow-up times were 84 and 64 months, respectively, with no recurrence. Conclusions A significant proportion patients with N-EGC have a background mucosa of mild chronic atrophic gastritis. Our results 7 years after starting ESD demonstrate early promising outcomes with the procedure.
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Affiliation(s)
- Van Huy Tran
- Gastrointestinal Endoscopy Center, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Quang Trung Tran
- Gastrointestinal Endoscopy Center, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam,Department of Internal Medicine A, University Medicine Greifswald, Germany
| | - Thi Huyen Thuong Nguyen
- Gastrointestinal Endoscopy Center, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Cong Thuan Dang
- Pathology Department, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Markus M. Lerch
- Department of Internal Medicine A, University Medicine Greifswald, Germany
| | - Ali A. Aghdassi
- Department of Internal Medicine A, University Medicine Greifswald, Germany
| | - Ryoji Miayahara
- Gastroenterology & Hepatology Department, Fujita Health University, Toyoake, Japan
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25
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Glaubitz J, Wilden A, Golchert J, Homuth G, Völker U, Bröker BM, Thiele T, Lerch MM, Mayerle J, Aghdassi AA, Weiss FU, Sendler M. In mouse chronic pancreatitis CD25 +FOXP3 + regulatory T cells control pancreatic fibrosis by suppression of the type 2 immune response. Nat Commun 2022; 13:4502. [PMID: 35922425 PMCID: PMC9349313 DOI: 10.1038/s41467-022-32195-2] [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: 06/28/2021] [Accepted: 07/20/2022] [Indexed: 12/19/2022] Open
Abstract
Chronic pancreatitis (CP) is characterized by chronic inflammation and the progressive fibrotic replacement of exocrine and endocrine pancreatic tissue. We identify Treg cells as central regulators of the fibroinflammatory reaction by a selective depletion of FOXP3-positive cells in a transgenic mouse model (DEREG-mice) of experimental CP. In Treg-depleted DEREG-mice, the induction of CP results in a significantly increased stroma deposition, the development of exocrine insufficiency and significant weight loss starting from day 14 after disease onset. In CP, FOXP3+CD25+ Treg cells suppress the type-2 immune response by a repression of GATA3+ T helper cells (Th2), GATA3+ innate lymphoid cells type 2 (ILC2) and CD206+ M2-macrophages. A suspected pathomechanism behind the fibrotic tissue replacement may involve an observed dysbalance of Activin A expression in macrophages and of its counter regulator follistatin. Our study identified Treg cells as key regulators of the type-2 immune response and of organ remodeling during CP. The Treg/Th2 axis could be a therapeutic target to prevent fibrosis and preserve functional pancreatic tissue. The function of T regulatory cells in the tissue fibrosis in chronic pancreatitis is not fully understood. Here the authors use a mouse model of chronic pancreatitis to show that Treg cells reduce IL-4 mediated chronic inflammation in the pancreas associated with M2-like macrophages in vivo.
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Affiliation(s)
- Juliane Glaubitz
- Department of Medicine A, University Medicine, University of Greifswald, Greifswald, Germany
| | - Anika Wilden
- Department of Medicine A, University Medicine, University of Greifswald, Greifswald, Germany
| | - Janine Golchert
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Uwe Völker
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Barbara M Bröker
- Department of Immunology, Institute of Immunology and Transfusion Medicine, University Medicine, Greifswald, Germany
| | - Thomas Thiele
- Department of Transfusion Medicine, Institute of Immunology and Transfusion Medicine, University Medicine, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine, University of Greifswald, Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, University Medicine, University of Greifswald, Greifswald, Germany.,Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine, University of Greifswald, Greifswald, Germany
| | - Frank U Weiss
- Department of Medicine A, University Medicine, University of Greifswald, Greifswald, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine, University of Greifswald, Greifswald, Germany.
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26
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Ponce-de-Leon M, Hannemann A, Linseisen J, Nauck M, Lerch MM, Bülow R, Völzke H, Friedrich N, Kassubek J, Müller HP, Baumeister SE, Meisinger C. Links between ectopic and abdominal fat and systemic inflammation: New insights from the SHIP-Trend study. Dig Liver Dis 2022; 54:1030-1037. [PMID: 35232676 DOI: 10.1016/j.dld.2022.02.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Excessive fat accumulation in adipose tissue depots and organs such as the pancreas and the liver is associated with systemic low-grade chronic inflammation. AIMS To investigate the association between abdominal, hepatic, and pancreatic fat and the circulating level of inflammatory biomarkers. METHODS We used data from a subsample of the Study of Health in Pomerania (SHIP-Trend, n = 469). The plasma concentration of 37 inflammatory biomarkers was measured using the Bio-Plex-Pro™-Human-Inflammation-Panel-1. Subcutaneous and visceral adipose tissue (SAT and VAT), as well as hepatic and pancreatic fat, were determined by magnetic resonance imaging. We assessed the associations between fat content and inflammatory biomarkers using multiple linear regression. RESULTS Hepatic fat was associated with MMP-2 (β -0.11), PTX3 (β -0.14), and TNFSF12 (β -0.06). Pancreatic fat was associated with sTNFR1 (β 0.15), sTNFR2 (β 0.11), and sCD163 (β 0.13). VAT and SAT were associated with sCD163 (βVAT 0.20, βSAT 0.16), MMP-2 (βVAT -0.12, βSAT -0.10), OSTCN (βVAT -0.16, βSAT -0.10), sTNFR1 (βVAT 0.13, βSAT 0.13), sTNFR2 (βVAT 0.13, βSA 0.12), TNFSF12 (βVAT -0.11, βSAT -0.08), and TNFSF14 (βVAT 0.21, βSAT 0.20). VAT was additionally associated with TNFSF13B (β 0.08) and CHI3L1 (β 0.07). CONCLUSIONS Our findings provide new insights into the involvement of hepatic and pancreatic fat on systemic inflammation.
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Affiliation(s)
- Mariana Ponce-de-Leon
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich 81377, Germany; Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstr. 2, Augsburg 86156, Germany; Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg D-85764, Germany.
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald 17489, Germany; DZHK (German Center for Cardiovascular Research), Partner site Greifswald, Greifswald 17475, Germany
| | - Jakob Linseisen
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich 81377, Germany; Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstr. 2, Augsburg 86156, Germany; Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg D-85764, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald 17489, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Ferdinand Sauerbruch-Straße, Greifswald 17475, Germany
| | - Robin Bülow
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald 17475, Germany
| | - Henry Völzke
- DZHK (German Center for Cardiovascular Research), Partner site Greifswald, Greifswald 17475, Germany; Institute for Community Medicine, University Medicine Greifswald, Greifswald 17475, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald 17489, Germany; DZHK (German Center for Cardiovascular Research), Partner site Greifswald, Greifswald 17475, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm 89081, Germany
| | | | | | - Christa Meisinger
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstr. 2, Augsburg 86156, Germany; Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg D-85764, Germany
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27
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Beyer G, Hoffmeister A, Lorenz P, Lynen P, M. Lerch M, Mayerle J. Clinical Practice Guideline—Acute and Chronic Pancreatitis. Dtsch Arztebl Int 2022; 119:495-501. [PMID: 35945698 PMCID: PMC9669327 DOI: 10.3238/arztebl.m2022.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 03/20/2022] [Accepted: 05/09/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acute pancreatitis (AP) is among the commonest non-malignant admission diagnoses in gastroenterology. Its incidence in Germany lies between 13 and 43 per 100 000 inhabitants and is increasing. In 2017, 24 per 100 000 inhabitants were hospitalized for chronic pancreatitis. METHODS From October 2018 to January 2019, we systematically searched the literature for original articles, meta-analyses, and evidence-based guidelines that were published in German or English between 1960 and 2018. RESULTS 30-50% of cases of acute pancreatitis are caused by gallstone disease, and another 30-50% are due to alcohol abuse. The diagnosis is made when at least two of the following three criteria are met: typical abdominal pain, elevation of serum lipase, and characteristic imaging findings. If those criteria are ambiguous, transabdominal sonography is indicated. The early initiation of food intake lowers the rate of infected pancreatic necrosis, organ failure, or death (odds ratio 0.44; 95% confidence interval [0.2; 0.96]). In AP, Ringer's lactate solution should be preferred for fluid resuscitation, at 200-250 mL/hr for 24 hours. Severe pain should be treated with opiates. CONCLUSION The current German clinical practice guideline reflects the developments in the diagnosis and treatment of pancreatitis that have taken place over the past few years. The long-term care and monitoring of patients with complication-free pancreatitis is the responsibility of primary care physicians and gastroenterologists.
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Affiliation(s)
- Georg Beyer
- *1 The two authors are co-first authors.,Department of Internal Medicine II, LMU Hospital, Munich, Germany
| | - Albrecht Hoffmeister
- *1 The two authors are co-first authors.,Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leibzig, Germany
| | - Pia Lorenz
- German Society of Gastroenterology, Digestive and Metabolic Disease (DGVS), Berlin, Germany
| | - Petra Lynen
- German Society of Gastroenterology, Digestive and Metabolic Disease (DGVS), Berlin, Germany
| | - Markus M. Lerch
- *2 The two authors are co-last authors. The members of the Guideline Development Group are listed in the eBox.,Department of Medicine A, University Medicine Greifswald, Greifswald, Germany,LMU Hospital, Munich, Germany: Markus M. Lerch
| | - Julia Mayerle
- *2 The two authors are co-last authors. The members of the Guideline Development Group are listed in the eBox.,Department of Internal Medicine II, LMU Hospital, Munich, Germany,*Klinik und Poliklinik für Innere Medizin II Campus Innenstadt/Großhadern Marchioninistr. 15, 81337 München, Germany
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28
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van den Berg FF, Issa Y, Vreijling JP, Lerch MM, Weiss FU, Besselink MG, Baas F, Boermeester MA, van Santvoort HC. Whole-exome Sequencing Identifies SLC52A1 and ZNF106 Variants as Novel Genetic Risk Factors for (Early) Multiple-organ Failure in Acute Pancreatitis. Ann Surg 2022; 275:e781-e788. [PMID: 33427755 DOI: 10.1097/sla.0000000000004312] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to identify genetic variants associated with early multiple organ failure (MOF) in acute pancreatitis. SUMMARY BACKGROUND DATA MOF is a life-threatening complication of acute pancreatitis, and risk factors are largely unknown, especially in early persistent MOF. Genetic risk factors are thought to enhance severity in complex diseases such as acute pancreatitis. METHODS A 2-phase study design was conducted. First, we exome sequenced 9 acute pancreatitis patients with early persistent MOF and 9 case-matched patients with mild edematous pancreatitis (phenotypic extremes) from our initial Dutch cohort of 387 patients. Secondly, 48 candidate variants that were overrepresented in MOF patients and 10 additional variants known from literature were genotyped in a replication cohort of 286 Dutch and German patients. RESULTS Exome sequencing resulted in 161,696 genetic variants, of which the 38,333 non-synonymous variants were selected for downstream analyses. Of these, 153 variants were overrepresented in patients with multiple-organ failure, as compared with patients with mild acute pancreatitis. In total, 58 candidate variants were genotyped in the joined Dutch and German replication cohort. We found the rs12440118 variant of ZNF106 to be overrepresented in patients with MOF (minor allele frequency 20.4% vs 11.6%, Padj=0.026). Additionally, SLC52A1 rs346821 was found to be overrepresented (minor allele frequency 48.0% vs 42.4%, Padj= 0.003) in early MOF. None of the variants known from literature were associated.Conclusions: This study indicates that SLC52A1, a riboflavin plasma membrane transporter, and ZNF106, a zinc finger protein, may be involved in disease progression toward (early) MOF in acute pancreatitis.
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Affiliation(s)
- Fons F van den Berg
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Yama Issa
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen P Vreijling
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Departments of Clinical Chemistry, Genetics and Pediatrics, Amsterdam Gastroenterology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Ulrich Weiss
- Departments of Clinical Chemistry, Genetics and Pediatrics, Amsterdam Gastroenterology & Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank Baas
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Marja A Boermeester
- Department of Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, University Medical Center, Utrecht, The Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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Naeem M, Schipf S, Bülow R, Werner N, Dörr M, Lerch MM, Kühn JP, Rathmann W, Nauck M, Paulista Markus MR, Targher G, Ittermann T, Völzke H. Association between hepatic iron overload assessed by magnetic resonance imaging and glucose intolerance states in the general population. Nutr Metab Cardiovasc Dis 2022; 32:1470-1476. [PMID: 35282980 DOI: 10.1016/j.numecd.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 02/03/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM While there is evidence that iron overload disorders are associated with type 2 diabetes, the relationship between hepatic iron overload and prediabetes remains unclear. We aimed to investigate the association between hepatic iron overload, as assessed by magnetic resonance imaging (MRI), and different glucose intolerance states in the population-based Study. METHODS AND RESULTS We included data from 1622 individuals with MRI data, who did not have known type 2 diabetes (T2DM). Using an oral glucose tolerance testing, participants were classified as having isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), combined IFG and IGT (IFG + IGT) or previously unknown T2DM. Hepatic iron and fat contents were assessed through quantitative MRI. We undertook linear and multinomial logistic regression models adjusted for potential confounders and MRI-assessed hepatic fat content to examine the association of hepatic iron overload with different glucose intolerance states or continuous markers of glucose metabolism. MRI-assessed hepatic iron overload was positively associated only with both 2-h plasma glucose (β = 0.32; 95%CI 0.04-0.60) and the combined IFG + IGT category (relative risk ratio = 1.87; 95%CI 1.15-3.06). No significant associations were found between hepatic iron overload and other glucose intolerance states or biomarkers of glucose metabolism, independently of potential confounders. CONCLUSIONS MRI-assessed hepatic iron overload was associated with higher 2-h glucose concentrations and the combined IFG + IGT category, but not with other glucose intolerance states. Our findings suggest a weak adverse impact of hepatic iron overload on glucose metabolism, but further studies are needed to confirm these findings.
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Affiliation(s)
- Muhammad Naeem
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; Department of Zoology, University of Malakand, 18800, Pakistan.
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Diabetes Research (DZD), Partner Site Greifswald, Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Germany
| | - Nicole Werner
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Germany
| | - Markus M Lerch
- Department of Gastroenterology, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl Gustav Carus University, TU Dresden, Dresden, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research (DZD), Partner Site Greifswald, Germany; Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Matthias Nauck
- Institute for Laboratory Medicine and Clinical Chemistry, University Medicine Greifswald, Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- Department of Internal Medicine B - Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Germany; German Center for Diabetes Research (DZD), Partner Site Greifswald, Germany
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Germany; German Center for Diabetes Research (DZD), Partner Site Greifswald, Germany
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Wiese ML, Gärtner S, von Essen N, Doller J, Frost F, Tran QT, Weiss FU, Meyer F, Valentini L, Garbe LA, Metges CC, Bannert K, Sautter LF, Ehlers L, Jaster R, Lamprecht G, Steveling A, Lerch MM, Aghdassi AA. Malnutrition Is Highly Prevalent in Patients With Chronic Pancreatitis and Characterized by Loss of Skeletal Muscle Mass but Absence of Impaired Physical Function. Front Nutr 2022; 9:889489. [PMID: 35719155 PMCID: PMC9202591 DOI: 10.3389/fnut.2022.889489] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/09/2022] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Patients with chronic pancreatitis (CP) have an increased risk of malnutrition, a condition linked to reduced muscle mass and physical performance. We have investigated the risk factors, phenotypic presentation, and health implications associated with malnutrition in CP. Materials and Methods In a multicenter cross-sectional study we recruited patients with confirmed CP and healthy volunteers as a control group. Malnutrition was diagnosed according to the criteria proposed by the Global Leadership Initiative on Malnutrition. We performed detailed examinations of body composition and physical function as well as testing of routine blood parameters and markers of inflammation. Results We included 66 patients [mean (±SD) age: 56.0 (±14.5) years; 51 males] and an equal number of age- and sex-matched controls. Moderate malnutrition was diagnosed in 21% (n = 14) and severe malnutrition in 42% (n = 28) of patients. Besides weight loss malnourished patients showed lower fat and skeletal muscle mass compared to both non-malnourished subjects and healthy controls. Only in severe malnutrition, blood parameters reflected elevated inflammation and reduced muscle reserves. Handgrip strength in patients did not differ by nutritional status but there was a significant correlation (rho = 0.705, p < 0.001) with skeletal muscle mass. Although 20 patients (30%) had pathologically reduced skeletal muscle mass, only two individuals (3%) had sarcopenia with concomitantly reduced handgrip strength. Conclusion Malnutrition is a frequent complication of CP characterized by loss of skeletal muscle mass. As this condition becomes evident only at an advanced stage, regular testing for altered body composition is recommended. Suitable biomarkers and the link between loss of muscle mass and physical function require further investigation. Clinical Trial Registration [https://clinicaltrials.gov/ct2/show/NCT04474743], identifier [NCT04474743].
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Affiliation(s)
- Mats L. Wiese
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Simone Gärtner
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Nele von Essen
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Julia Doller
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Fabian Frost
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Quang Trung Tran
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Fatuma Meyer
- Institute of Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Luzia Valentini
- Institute of Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Leif-A. Garbe
- Department of Agriculture and Food Sciences, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Cornelia C. Metges
- Institute of Nutritional Physiology “Oskar Kellner”, Research Institute for Farm Animal Biology (FBN), Dummerstorf, Germany
| | - Karen Bannert
- Department of Medicine II, Division of Gastroenterology, Rostock University Medical Center, Rostock, Germany
| | - Lea Franziska Sautter
- Department of Medicine II, Division of Gastroenterology, Rostock University Medical Center, Rostock, Germany
| | - Luise Ehlers
- Department of Medicine II, Division of Gastroenterology, Rostock University Medical Center, Rostock, Germany
| | - Robert Jaster
- Department of Medicine II, Division of Gastroenterology, Rostock University Medical Center, Rostock, Germany
| | - Georg Lamprecht
- Department of Medicine II, Division of Gastroenterology, Rostock University Medical Center, Rostock, Germany
| | - Antje Steveling
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M. Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
- Ludwig Maximilian University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ali A. Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
- *Correspondence: Ali A. Aghdassi,
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Lam SY, Mommersteeg MC, Yu B, Broer L, Spaander MCW, Frost F, Weiss S, Völzke H, Lerch MM, Schöttker B, Zhang Y, Stocker H, Brenner H, Levy D, Hwang SJ, Wood AC, Rich SS, Rotter JI, Taylor KD, Tracy RP, Kabagambe EK, Leja M, Klovins J, Peculis R, Rudzite D, Nikitina-Zake L, Skenders G, Rovite V, Uitterlinden A, Kuipers EJ, Fuhler GM, Homuth G, Peppelenbosch MP. Toll-Like Receptor 1 Locus Re-examined in a Genome-Wide Association Study Update on Anti-Helicobacter pylori IgG Titers. Gastroenterology 2022; 162:1705-1715. [PMID: 35031300 DOI: 10.1053/j.gastro.2022.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/03/2021] [Accepted: 01/07/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS A genome-wide significant association between anti-Helicobacter pylori (H pylori) IgG titers and Toll-like receptor (TLR1/6/10) locus on 4p14 was demonstrated for individuals of European ancestry, but not uniformly replicated. We re-investigated this association in an updated genome-wide association study (GWAS) meta-analysis for populations with low gastric cancer incidence, address potential causes of cohort heterogeneity, and explore functional implications of genetic variation at the TLR1/6/10 locus. METHODS The dichotomous GWAS (25% individuals exhibiting highest anti-H pylori IgG titers vs remaining 75%) included discovery and replication sampls of, respectively, n = 15,685 and n = 9676, all of European ancestry. Longitudinal analysis of serologic data was performed on H pylori-eradicated subjects (n = 132) and patients under surveillance for premalignant gastric lesions (n = 107). TLR1/6/10 surface expression, TLR1 mRNA, and cytokine levels were measured in leukocyte subsets of healthy subjects (n = 26) genotyped for TLR1/6/10 variants. RESULTS The association of the TLR1/6/10 locus with anti-H pylori IgG titers (rs12233670; β = -0.267 ± SE 0.034; P = 4.42 × 10-15) presented with high heterogeneity and failed replication. Anti-H pylori IgG titers declined within 2-4 years after eradication treatment (P = 0.004), and decreased over time in patients with premalignant gastric lesions (P < 0.001). Variation at the TLR1/6/10 locus affected TLR1-mediated cytokine production and TLR1 surface expression on monocytes (P = 0.016) and neutrophils (P = 0.030), but not mRNA levels. CONCLUSIONS The association between anti-H pylori IgG titers and TLR1/6/10 locus was not replicated across cohorts, possibly owing to dependency of anti-H pylori IgG titers on therapy, clearance, and antibody decay. H pylori-mediated immune cell activation is partly mediated via TLR1 signaling, which in turn is affected by genetic variation.
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Affiliation(s)
- Suk Yee Lam
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michiel C Mommersteeg
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bingting Yu
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fabian Frost
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany; Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Yan Zhang
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hannah Stocker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Daniel Levy
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA; Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Shih-Jen Hwang
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA; Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Alexis C Wood
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Russell P Tracy
- Laboratory for Clinical Biochemistry Research, University of Vermont College of Medicine, Colchester, Vermont, USA
| | | | - Marcis Leja
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Janis Klovins
- Latvian Biomedical Research and Study Center, Riga, Latvia
| | - Raitis Peculis
- Latvian Biomedical Research and Study Center, Riga, Latvia
| | - Dace Rudzite
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga, Latvia
| | | | - Girts Skenders
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Vita Rovite
- Latvian Biomedical Research and Study Center, Riga, Latvia
| | - André Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gwenny M Fuhler
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Georg Homuth
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Maikel P Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Goni E, Regel I, Mahajan UM, Amodio A, De Marchi G, Beyer G, Zuppardo RA, Di Leo M, Lanzillotta M, Bonatti F, Kauke T, Dick A, Weiss FU, Schönermarck U, Lerch MM, Frulloni L, Cavestro GM, Mayerle J. HLA-DRB1∗16 and -DQB1∗05 alleles are strongly associated with autoimmune pancreatitis in a cohort of hundred patients. Pancreatology 2022; 22:466-471. [PMID: 35379557 DOI: 10.1016/j.pan.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Autoimmune diseases are often associated with human leukocyte antigen (HLA) haplotypes, indicating that changes in major histocompatibility complex (MHC)-dependent self-peptide or antigen presentation contribute to autoimmunity. In our study, we aimed to investigate HLA alleles in a large European cohort of autoimmune pancreatitis (AIP) patients. METHODS Hundred patients with AIP, diagnosed and classified according to the International Consensus Diagnostic Criteria (ICDC), were prospectively enrolled in the study. Forty-four patients with chronic pancreatitis (CP) and 254 healthy subjects served as control groups. DNA was isolated from blood samples and two-digit HLA typing was performed with sequence-specific primer (SSP-) PCR. HLA allele association strength to AIP was calculated as odds ratio. RESULTS We uncovered a strong enrichment of HLA-DQB1 homozygosity in type 1 and type 2 AIP patients. Moreover, a significantly increased incidence of the HLA-DRB1∗16 and HLA-DQB1∗05 alleles and a concomitant lack of the HLA-DRB1∗13 allele was detected in AIP type 1 and type 2 patients. In contrast, the HLA-DQB1∗02 allele was underrepresented in the 'not otherwise specified' (NOS) AIP subtype. We detected no significant difference in the HLA-DRB3, HLA-DRB4 and HLA-DRB5 allele frequency in our cohort. CONCLUSIONS Although AIP type 1 and type 2 are characterized by distinct histopathological characteristics, both subtypes are associated with the same HLA alleles, indicating that the disease might rely on similar immunogenic mechanisms. However, AIP NOS represented another subclass of AIP.
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Affiliation(s)
- Elisabetta Goni
- Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Ivonne Regel
- Department of Medicine II, University Hospital, LMU, Munich, Germany.
| | | | - Antonio Amodio
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Giulia De Marchi
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Raffaella Alessia Zuppardo
- Gastroenterology and Gastrointestinal Endoscopy, Division of Experimental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Milena Di Leo
- Gastroenterology and Gastrointestinal Endoscopy, Division of Experimental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Lanzillotta
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, uniRAR, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bonatti
- Department of Medicine and Surgery, Medical Genetics Unit, University of Parma, Italy
| | - Teresa Kauke
- Division of Transfusion Medicine, Cellular Therapeutics and Hemostaseology, University Clinic LMU, Munich, Germany
| | - Andrea Dick
- Division of Transfusion Medicine, Cellular Therapeutics and Hemostaseology, University Clinic LMU, Munich, Germany
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ulf Schönermarck
- Department of Medicine IV, University Hospital, LMU, Munich, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Luca Frulloni
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy, Division of Experimental Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU, Munich, Germany
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Ma Y, Sender S, Sekora A, Kong W, Bauer P, Ameziane N, Krake S, Radefeldt M, Al-Ali R, Weiss FU, Lerch MM, Parveen A, Zechner D, Junghanss C, Murua Escobar H. Inhibitory Response to CK II Inhibitor Silmitasertib and CDKs Inhibitor Dinaciclib Is Related to Genetic Differences in Pancreatic Ductal Adenocarcinoma Cell Lines. Int J Mol Sci 2022; 23:4409. [PMID: 35457227 PMCID: PMC9031017 DOI: 10.3390/ijms23084409] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 01/15/2023] Open
Abstract
Casein kinase II (CK2) and cyclin-dependent kinases (CDKs) frequently interact within multiple pathways in pancreatic ductal adenocarcinoma (PDAC). Application of CK2- and CDK-inhibitors have been considered as a therapeutic option, but are currently not part of routine chemotherapy regimens. We investigated ten PDAC cell lines exposed to increasing concentrations of silmitasertib and dinaciclib. Cell proliferation, metabolic activity, biomass, and apoptosis/necrosis were evaluated, and bioinformatic clustering was used to classify cell lines into sensitive groups based on their response to inhibitors. Furthermore, whole exome sequencing (WES) and RNA sequencing (RNA-Seq) was conducted to assess recurrent mutations and the expression profile of inhibitor targets and genes frequently mutated in PDAC, respectively. Dinaciclib and silmitasertib demonstrated pronounced and limited cell line specific effects in cell death induction, respectively. WES revealed no genomic variants causing changes in the primary structure of the corresponding inhibitor target proteins. RNA-Seq demonstrated that the expression of all inhibitor target genes was higher in the PDAC cell lines compared to non-neoplastic pancreatic tissue. The observed differences in PDAC cell line sensitivity to silmitasertib or dinaciclib did not depend on target gene expression or the identified gene variants. For the PDAC hotspot genes kirsten rat sarcoma virus (KRAS) and tumor protein p53 (TP53), three and eight variants were identified, respectively. In conclusion, both inhibitors demonstrated in vitro efficacy on the PDAC cell lines. However, aberrations and expression of inhibitor target genes did not appear to affect the efficacy of the corresponding inhibitors. In addition, specific aberrations in TP53 and KRAS affected the efficacy of both inhibitors.
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Affiliation(s)
- Yixuan Ma
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
| | - Sina Sender
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
| | - Anett Sekora
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
| | - Weibo Kong
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
- Institute of Muscle Biology and Growth, Research Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany
| | - Peter Bauer
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
- CENTOGENE GmbH, 18057 Rostock, Germany; (N.A.); (S.K.); (M.R.); (R.A.-A.)
| | - Najim Ameziane
- CENTOGENE GmbH, 18057 Rostock, Germany; (N.A.); (S.K.); (M.R.); (R.A.-A.)
- Arcensus GmbH, 18055 Rostock, Germany
| | - Susann Krake
- CENTOGENE GmbH, 18057 Rostock, Germany; (N.A.); (S.K.); (M.R.); (R.A.-A.)
| | - Mandy Radefeldt
- CENTOGENE GmbH, 18057 Rostock, Germany; (N.A.); (S.K.); (M.R.); (R.A.-A.)
| | - Ruslan Al-Ali
- CENTOGENE GmbH, 18057 Rostock, Germany; (N.A.); (S.K.); (M.R.); (R.A.-A.)
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine, University of Greifswald, 17475 Greifswald, Germany; (F.U.W.); (M.M.L.)
| | - Markus M. Lerch
- Department of Medicine A, University Medicine, University of Greifswald, 17475 Greifswald, Germany; (F.U.W.); (M.M.L.)
- LMU Munich University Hospital, 81377 Munich, Germany
| | - Alisha Parveen
- Institute for Experimental Surgery, University of Rostock, 18057 Rostock, Germany; (A.P.); (D.Z.)
| | - Dietmar Zechner
- Institute for Experimental Surgery, University of Rostock, 18057 Rostock, Germany; (A.P.); (D.Z.)
| | - Christian Junghanss
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
| | - Hugo Murua Escobar
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
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Buchmann N, Ittermann T, Demuth I, Markus MRP, Völzke H, Dörr M, Friedrich N, Lerch MM, Santos RD, Schipf S, Steinhagen-Thiessen E. Lipoprotein(a) and Metabolic Syndrome. Dtsch Arztebl Int 2022; 119:270-276. [PMID: 35331368 PMCID: PMC9400195 DOI: 10.3238/arztebl.m2022.0153] [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] [Received: 08/25/2021] [Revised: 08/25/2021] [Accepted: 02/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND An inverse association between lipoprotein(a) (Lp[a]) and type 2 diabetes mellitus is well documented. However, data on the association of the metabolic syndrome (MetS) with Lp(a) are sparse. METHODS Cross-sectional data for MetS and Lp(a) were available for 5743 BASE-II and SHIP-0 participants (48.7% men; age 58 [20-85] years) (BASE, Berlin Aging Study; SHIP, Study of Health in Pomerania). The association of MetS and its components with Lp(a) was analyzed by means of median regression adjusted for age, sex, and study. Associations were evaluated for the total population as well as stratified by sex and menopausal status. RESULTS Overall, 27.6% (n = 1573) of the participants in the two studies had MetS and 22.5% (n = 1291) were premenopausal women. There was an inverse association between MetS and Lp(a) in the whole study sample (β = -11.9, 95% confidence interval [-21.3; -2.6]) as well as in men (β = -16.5 [-28.6; -4.3]). Participants with MetS (whole study sample) had 11.9 mmol/L lower Lp(a). Analogous results were found in postmenopausal women (β = -25.4 [-46.0; -4.8]). In premenopausal women with MetS, Lp(a) levels were higher by 39.1 mg/L on average [12.3; 65.9]) than in premenopausal women without MetS. CONCLUSION Hormonal aspects and menopausal alterations seem to affect the association between MetS and Lp(a), as the expected inverse association was not present in premenopausal women.
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Affiliation(s)
- Nikolaus Buchmann
- Department of Cardiology, Benjamin Franklin Campus, Charité – University Medical Center Berlin: Dr. med. Nikolaus Buchmann
| | - Till Ittermann
- Institute for Community Medicine, University Medical Center Greifswald: Dr. rer. med. Till Ittermann, Prof. Dr. med. Henry Völzke, Dr. rer. med. Sabine Schipf
| | - Ilja Demuth
- Biology of Aging Group, Department of Endocrinology and Metabolic Medicine (including Lipid Metabolism), Charité – University Medical Center Berlin, corporate member of Free University Berlin and Humboldt University of Berlin: Prof. Dr. rer. nat. Ilja Demuth, Prof. Dr. med. Elisabeth Steinhagen-Thiessen
- Berlin Institute for Health Research at Charité – University Medical Center Berlin, BCRT – Berlin Center for Regenerative Therapy: Prof. Dr. rer. nat. Ilja Demuth
| | - Marcello R. P. Markus
- Department of Internal Medicine B, University Medical Center Greifswald: Dr. med. Marcello R. P. Markus, Prof. Dr. med. Marcus Dörr
- German Center for Diabetes Research (DZD), Greifswald Site, Greifswald: Dr. med. Marcello R. P. Markus, Prof. Dr. med. Henry Völzke, Prof. Dr. med. Marcus Dörr, Dr. rer. med. Sabine Schipf
- German Center for Cardiovascular Research (DZHK), Greifswald Site, Greifswald: Dr. med. Marcello R. P. Markus, Prof. Dr. med. Henry Völzke, Prof. Dr. med. Marcus Dörr
| | - Henry Völzke
- Institute for Community Medicine, University Medical Center Greifswald: Dr. rer. med. Till Ittermann, Prof. Dr. med. Henry Völzke, Dr. rer. med. Sabine Schipf
- German Center for Diabetes Research (DZD), Greifswald Site, Greifswald: Dr. med. Marcello R. P. Markus, Prof. Dr. med. Henry Völzke, Prof. Dr. med. Marcus Dörr, Dr. rer. med. Sabine Schipf
- German Center for Cardiovascular Research (DZHK), Greifswald Site, Greifswald: Dr. med. Marcello R. P. Markus, Prof. Dr. med. Henry Völzke, Prof. Dr. med. Marcus Dörr
| | - Marcus Dörr
- Department of Internal Medicine B, University Medical Center Greifswald: Dr. med. Marcello R. P. Markus, Prof. Dr. med. Marcus Dörr
- German Center for Diabetes Research (DZD), Greifswald Site, Greifswald: Dr. med. Marcello R. P. Markus, Prof. Dr. med. Henry Völzke, Prof. Dr. med. Marcus Dörr, Dr. rer. med. Sabine Schipf
- German Center for Cardiovascular Research (DZHK), Greifswald Site, Greifswald: Dr. med. Marcello R. P. Markus, Prof. Dr. med. Henry Völzke, Prof. Dr. med. Marcus Dörr
| | - Nele Friedrich
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Greifswald: Dr. rer. med. Nele Friedrich
| | - Markus M. Lerch
- Department of Internal Medicine A, University Medical Center Greifswald: Prof. Dr. med. Markus M. Lerch
| | - Raul D. Santos
- Lipid Clinic, Heart Institute (InCor), Medical Teaching Hospital, University of São Paulo, Brazil: Prof. Raul D. Santos, MD, PhD
| | - Sabine Schipf
- Institute for Community Medicine, University Medical Center Greifswald: Dr. rer. med. Till Ittermann, Prof. Dr. med. Henry Völzke, Dr. rer. med. Sabine Schipf
- German Center for Diabetes Research (DZD), Greifswald Site, Greifswald: Dr. med. Marcello R. P. Markus, Prof. Dr. med. Henry Völzke, Prof. Dr. med. Marcus Dörr, Dr. rer. med. Sabine Schipf
| | - Elisabeth Steinhagen-Thiessen
- Biology of Aging Group, Department of Endocrinology and Metabolic Medicine (including Lipid Metabolism), Charité – University Medical Center Berlin, corporate member of Free University Berlin and Humboldt University of Berlin: Prof. Dr. rer. nat. Ilja Demuth, Prof. Dr. med. Elisabeth Steinhagen-Thiessen
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Ma Y, Sender S, Sekora A, Kong W, Bauer P, Ameziane N, Al-Ali R, Krake S, Radefeldt M, Weiss FU, Lerch MM, Parveen A, Zechner D, Junghanss C, Murua Escobar H. The Inhibitory Response to PI3K/AKT Pathway Inhibitors MK-2206 and Buparlisib Is Related to Genetic Differences in Pancreatic Ductal Adenocarcinoma Cell Lines. Int J Mol Sci 2022; 23:4295. [PMID: 35457111 PMCID: PMC9029322 DOI: 10.3390/ijms23084295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 01/23/2023] Open
Abstract
The aberrant activation of the phosphoinositide 3-kinase (PI3K)/ protein kinase B (AKT) pathway is common in pancreatic ductal adenocarcinomas (PDAC). The application of inhibitors against PI3K and AKT has been considered as a therapeutic option. We investigated PDAC cell lines exposed to increasing concentrations of MK-2206 (an AKT1/2/3 inhibitor) and Buparlisib (a pan-PI3K inhibitor). Cell proliferation, metabolic activity, biomass, and apoptosis/necrosis were evaluated. Further, whole-exome sequencing (WES) and RNA sequencing (RNA-seq) were performed to analyze the recurrent aberrations and expression profiles of the inhibitor target genes and the genes frequently mutated in PDAC (Kirsten rat sarcoma virus (KRAS), Tumor protein p53 (TP53)). MK-2206 and Buparlisib demonstrated pronounced cytotoxic effects and limited cell-line-specific effects in cell death induction. WES revealed two sequence variants within the direct target genes (PIK3CA c.1143C > G in Colo357 and PIK3CD c.2480C > G in Capan-1), but a direct link to the Buparlisib response was not observed. RNA-seq demonstrated that the expression level of the inhibitor target genes did not affect the efficacy of the corresponding inhibitors. Moreover, increased resistance to MK-2206 was observed in the analyzed cell lines carrying a KRAS variant. Further, increased resistance to both inhibitors was observed in SU.86.86 carrying two TP53 missense variants. Additionally, the presence of the PIK3CA c.1143C > G in KRAS-variant-carrying cell lines was observed to correlate with increased sensitivity to Buparlisib. In conclusion, the present study reveals the distinct antitumor effects of PI3K/AKT pathway inhibitors against PDAC cell lines. Aberrations in specific target genes, as well as KRAS and TP53, individually or together, affect the efficacy of the two PI3K/AKT pathway inhibitors.
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Affiliation(s)
- Yixuan Ma
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
| | - Sina Sender
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
| | - Anett Sekora
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
| | - Weibo Kong
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
- Institute of Muscle Biology and Growth, Research Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany
| | - Peter Bauer
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
- CENTOGENE GmbH, 18057 Rostock, Germany; (N.A.); (R.A.-A.); (S.K.); (M.R.)
| | - Najim Ameziane
- CENTOGENE GmbH, 18057 Rostock, Germany; (N.A.); (R.A.-A.); (S.K.); (M.R.)
- Arcensus GmbH, 18055 Rostock, Germany
| | - Ruslan Al-Ali
- CENTOGENE GmbH, 18057 Rostock, Germany; (N.A.); (R.A.-A.); (S.K.); (M.R.)
| | - Susann Krake
- CENTOGENE GmbH, 18057 Rostock, Germany; (N.A.); (R.A.-A.); (S.K.); (M.R.)
| | - Mandy Radefeldt
- CENTOGENE GmbH, 18057 Rostock, Germany; (N.A.); (R.A.-A.); (S.K.); (M.R.)
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine, University of Greifswald, 17475 Greifswald, Germany; (F.U.W.); (M.M.L.)
| | - Markus M. Lerch
- Department of Medicine A, University Medicine, University of Greifswald, 17475 Greifswald, Germany; (F.U.W.); (M.M.L.)
- LMU Munich University Hospital, 81377 Munich, Germany
| | - Alisha Parveen
- Institute for Experimental Surgery, University of Rostock, 18057 Rostock, Germany; (A.P.); (D.Z.)
| | - Dietmar Zechner
- Institute for Experimental Surgery, University of Rostock, 18057 Rostock, Germany; (A.P.); (D.Z.)
| | - Christian Junghanss
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
| | - Hugo Murua Escobar
- Department of Medicine Clinic III, Hematology, Oncology and Palliative Medicine, Rostock University Medical Center, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany; (Y.M.); (S.S.); (A.S.); (W.K.); (P.B.); (C.J.)
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Hertel J, Fässler D, Heinken A, Weiß FU, Rühlemann M, Bang C, Franke A, Budde K, Henning AK, Petersmann A, Völker U, Völzke H, Thiele I, Grabe HJ, Lerch MM, Nauck M, Friedrich N, Frost F. NMR Metabolomics Reveal Urine Markers of Microbiome Diversity and Identify Benzoate Metabolism as a Mediator between High Microbial Alpha Diversity and Metabolic Health. Metabolites 2022; 12:metabo12040308. [PMID: 35448495 PMCID: PMC9025190 DOI: 10.3390/metabo12040308] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 12/12/2022] Open
Abstract
Microbial metabolites measured using NMR may serve as markers for physiological or pathological host–microbe interactions and possibly mediate the beneficial effects of microbiome diversity. Yet, comprehensive analyses of gut microbiome data and the urine NMR metabolome from large general population cohorts are missing. Here, we report the associations between gut microbiota abundances or metrics of alpha diversity, quantified from stool samples using 16S rRNA gene sequencing, with targeted urine NMR metabolites measures from 951 participants of the Study of Health in Pomerania (SHIP). We detected significant genus–metabolite associations for hippurate, succinate, indoxyl sulfate, and formate. Moreover, while replicating the previously reported association between hippurate and measures of alpha diversity, we identified formate and 4-hydroxyphenylacetate as novel markers of gut microbiome alpha diversity. Next, we predicted the urinary concentrations of each metabolite using genus abundances via an elastic net regression methodology. We found profound associations of the microbiome-based hippurate prediction score with markers of liver injury, inflammation, and metabolic health. Moreover, the microbiome-based prediction score for hippurate completely mediated the clinical association pattern of microbial diversity, hinting at a role of benzoate metabolism underlying the positive associations between high alpha diversity and healthy states. In conclusion, large-scale NMR urine metabolomics delivered novel insights into metabolic host–microbiome interactions, identifying pathways of benzoate metabolism as relevant candidates mediating the beneficial health effects of high microbial alpha diversity.
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Affiliation(s)
- Johannes Hertel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, D-17475 Greifswald, Germany; (D.F.); (H.-J.G.)
- Correspondence:
| | - Daniel Fässler
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, D-17475 Greifswald, Germany; (D.F.); (H.-J.G.)
| | - Almut Heinken
- School of Medicine, National University of Ireland, H91 CF50 Galway, Ireland; (A.H.); (I.T.)
| | - Frank U. Weiß
- Department of Internal Medicine A, University Medicine Greifswald, D-17475 Greifswald, Germany; (F.U.W.); (M.M.L.); (F.F.)
| | - Malte Rühlemann
- Institute of Clinical Molecular Biology, Kiel University, D-24105 Kiel, Germany; (M.R.); (C.B.); (A.F.)
| | - Corinna Bang
- Institute of Clinical Molecular Biology, Kiel University, D-24105 Kiel, Germany; (M.R.); (C.B.); (A.F.)
| | - Andre Franke
- Institute of Clinical Molecular Biology, Kiel University, D-24105 Kiel, Germany; (M.R.); (C.B.); (A.F.)
| | - Kathrin Budde
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17475 Greifswald, Germany; (K.B.); (A.-K.H.); (A.P.); (M.N.); (N.F.)
| | - Ann-Kristin Henning
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17475 Greifswald, Germany; (K.B.); (A.-K.H.); (A.P.); (M.N.); (N.F.)
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17475 Greifswald, Germany; (K.B.); (A.-K.H.); (A.P.); (M.N.); (N.F.)
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, D-26129 Oldenburg, Germany
| | - Uwe Völker
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, D-17475 Greifswald, Germany;
| | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, D-17475 Greifswald, Germany;
| | - Ines Thiele
- School of Medicine, National University of Ireland, H91 CF50 Galway, Ireland; (A.H.); (I.T.)
- Discipline of Microbiology, National University of Galway, H91 CF50 Galway, Ireland
- APC Microbiome Ireland, University College Cork, T12 CY82 Cork, Ireland
- Ryan Institute, National University of Galway, H91 CF50 Galway, Ireland
| | - Hans-Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, D-17475 Greifswald, Germany; (D.F.); (H.-J.G.)
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Rostock/Greifswald, D-17475 Greifswald, Germany
| | - Markus M. Lerch
- Department of Internal Medicine A, University Medicine Greifswald, D-17475 Greifswald, Germany; (F.U.W.); (M.M.L.); (F.F.)
- Faculty of Medicine, Ludwig-Maximilian University Munich, D-80539 Munich, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17475 Greifswald, Germany; (K.B.); (A.-K.H.); (A.P.); (M.N.); (N.F.)
- German Centre for Cardiovascular Research (DZHK), Partner Site, D-17475 Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, D-17475 Greifswald, Germany; (K.B.); (A.-K.H.); (A.P.); (M.N.); (N.F.)
- German Centre for Cardiovascular Research (DZHK), Partner Site, D-17475 Greifswald, Germany
| | - Fabian Frost
- Department of Internal Medicine A, University Medicine Greifswald, D-17475 Greifswald, Germany; (F.U.W.); (M.M.L.); (F.F.)
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37
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Nagel F, Palm GJ, Geist N, McDonnell TCR, Susemihl A, Girbardt B, Mayerle J, Lerch MM, Lammers M, Delcea M. Structural and Biophysical Insights into SPINK1 Bound to Human Cationic Trypsin. Int J Mol Sci 2022; 23:ijms23073468. [PMID: 35408828 PMCID: PMC8998336 DOI: 10.3390/ijms23073468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023] Open
Abstract
(1) The serine protease inhibitor Kazal type 1 (SPINK1) inhibits trypsin activity in zymogen granules of pancreatic acinar cells. Several mutations in the SPINK1 gene are associated with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). The most common variant is SPINK1 p.N34S. Although this mutation was identified two decades ago, the mechanism of action has remained elusive. (2) SPINK1 and human cationic trypsin (TRY1) were expressed in E. coli, and inhibitory activities were determined. Crystals of SPINK1-TRY1 complexes were grown by using the hanging-drop method, and phases were solved by molecular replacement. (3) Both SPINK1 variants show similar inhibitory behavior toward TRY1. The crystal structures are almost identical, with minor differences in the mutated loop. Both complexes show an unexpected rotamer conformation of the His63 residue in TRY1, which is a member of the catalytic triad. (4) The SPINK1 p.N34S mutation does not affect the inhibitory behavior or the overall structure of the protein. Therefore, the pathophysiological mechanism of action of the p.N34S variant cannot be explained mechanistically or structurally at the protein level. The observed histidine conformation is part of a mechanism for SPINK1 that can explain the exceptional proteolytic stability of this inhibitor.
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Affiliation(s)
- Felix Nagel
- Biophysical Chemistry, Institute of Biochemistry, University of Greifswald, 17489 Greifswald, Germany; (F.N.); (N.G.); (A.S.)
| | - Gottfried J. Palm
- Synthetic and Structural Biochemistry, Institute of Biochemistry, University of Greifswald, 17489 Greifswald, Germany; (G.J.P.); (B.G.); (M.L.)
| | - Norman Geist
- Biophysical Chemistry, Institute of Biochemistry, University of Greifswald, 17489 Greifswald, Germany; (F.N.); (N.G.); (A.S.)
| | - Thomas C. R. McDonnell
- Biochemical Engineering Department, University College London, Bernard Katz, London WC1E 6BT, UK;
| | - Anne Susemihl
- Biophysical Chemistry, Institute of Biochemistry, University of Greifswald, 17489 Greifswald, Germany; (F.N.); (N.G.); (A.S.)
- Department of Hematology and Oncology, Internal Medicine C, University of Greifswald, 17489 Greifswald, Germany
| | - Britta Girbardt
- Synthetic and Structural Biochemistry, Institute of Biochemistry, University of Greifswald, 17489 Greifswald, Germany; (G.J.P.); (B.G.); (M.L.)
| | - Julia Mayerle
- Department of Medicine II, University Hospital Munich, Ludwig-Maximillian University Munich, 81377 Munich, Germany;
| | - Markus M. Lerch
- Department of Medicine A, University Medicine Greifswald, 17489 Greifswald, Germany;
| | - Michael Lammers
- Synthetic and Structural Biochemistry, Institute of Biochemistry, University of Greifswald, 17489 Greifswald, Germany; (G.J.P.); (B.G.); (M.L.)
| | - Mihaela Delcea
- Biophysical Chemistry, Institute of Biochemistry, University of Greifswald, 17489 Greifswald, Germany; (F.N.); (N.G.); (A.S.)
- Correspondence:
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38
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von Hirschhausen E, Lerch MM. [Conversation on the impact of climate change on medicine and mankind]. Internist (Berl) 2022; 63:397-400. [PMID: 35294570 DOI: 10.1007/s00108-022-01299-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Markus M Lerch
- Ärztliches Direktorat, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
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39
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Lorenz P, Lynen Jansen P, Beyer G, Hoffmeister A, Lerch MM, Mayerle J. S3-Leitlinie Pankreatitis – Leitlinienreport der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – September 2021 – AWMF Registernummer 021-003. Z Gastroenterol 2022; 60:e236-e247. [PMID: 35263780 DOI: 10.1055/a-1713-4244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pia Lorenz
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Georg Beyer
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, Deutschland
| | - Albrecht Hoffmeister
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Deutschland
| | - Markus M Lerch
- Klinik für Innere Medizin A, Universitätsmedizin Greifswald, Deutschland.,Klinikum der Ludwig-Maximilians-Universität (LMU) München, Deutschland
| | - Julia Mayerle
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, Deutschland
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40
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Mayerle J, Jansen PL, Lorenz P, Beyer G, Hoffmeister A, Lerch MM. S3-Leitlinie Pankreatitis – Editorial der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (September 2021 – AWMF Registernummer 021-003) – Neue Leitlinie zur akuten und chronischen Pankreatitis (New guideline for acute and chronic pancreatitis). Z Gastroenterol 2022; 60:297-298. [PMID: 35263782 DOI: 10.1055/a-1713-4332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Julia Mayerle
- LMU Klinikum, Medizinische Klinik und Poliklinik II, Campus Großhadern, Universitätsklinikum München, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Pia Lorenz
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Georg Beyer
- LMU Klinikum, Medizinische Klinik und Poliklinik II, Campus Großhadern, Universitätsklinikum München, Deutschland
| | - Albrecht Hoffmeister
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Deutschland
| | - Markus M Lerch
- Klinik für Innere Medizin A, Universitätsmedizin Greifswald, Deutschland.,Klinikum der Ludwig-Maximilians-Universität (LMU) München, Deutschland
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41
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Beyer G, Hoffmeister A, Michl P, Gress TM, Huber W, Algül H, Neesse A, Meining A, Seufferlein TW, Rosendahl J, Kahl S, Keller J, Werner J, Friess H, Bufler P, Löhr MJ, Schneider A, Lynen Jansen P, Esposito I, Grenacher L, Mössner J, Lerch MM, Mayerle J. S3-Leitlinie Pankreatitis – Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – September 2021 – AWMF Registernummer 021-003. Z Gastroenterol 2022; 60:419-521. [PMID: 35263785 DOI: 10.1055/a-1735-3864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Georg Beyer
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, Deutschland
| | - Albrecht Hoffmeister
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Deutschland
| | - Patrick Michl
- Universitätsklinik u. Poliklinik Innere Medizin I mit Schwerpunkt Gastroenterologie, Universitätsklinikum Halle, Deutschland
| | - Thomas Mathias Gress
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg, Deutschland
| | - Wolfgang Huber
- Comprehensive Cancer Center München TUM, II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Hana Algül
- Comprehensive Cancer Center München TUM, II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Albrecht Neesse
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Deutschland
| | - Alexander Meining
- Medizinische Klinik und Poliklinik II Gastroenterologie und Hepatologie, Universitätsklinikum Würzburg, Deutschland
| | | | - Jonas Rosendahl
- Universitätsklinik u. Poliklinik Innere Medizin I mit Schwerpunkt Gastroenterologie, Universitätsklinikum Halle, Deutschland
| | - Stefan Kahl
- Klinik für Innere Medizin m. Schwerpkt. Gastro./Hämat./Onko./Nephro., DRK Kliniken Berlin Köpenick, Deutschland
| | - Jutta Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - Jens Werner
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, Deutschland
| | - Helmut Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - Philip Bufler
- Klinik für Pädiatrie m. S. Gastroenterologie, Nephrologie und Stoffwechselmedizin, Charité Campus Virchow-Klinikum - Universitätsmedizin Berlin, Deutschland
| | - Matthias J Löhr
- Department of Gastroenterology, Karolinska, Universitetssjukhuset, Stockholm, Schweden
| | - Alexander Schneider
- Klinik für Gastroenterologie und Hepatologie, Klinikum Bad Hersfeld, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Irene Esposito
- Pathologisches Institut, Heinrich-Heine-Universität und Universitätsklinikum Duesseldorf, Duesseldorf, Deutschland
| | - Lars Grenacher
- Conradia Radiologie München Schwabing, München, Deutschland
| | - Joachim Mössner
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Deutschland
| | - Markus M Lerch
- Klinik für Innere Medizin A, Universitätsmedizin Greifswald, Deutschland.,Klinikum der Ludwig-Maximilians-Universität (LMU) München, Deutschland
| | - Julia Mayerle
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, Deutschland
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Schwille-Kiuntke J, Ittermann T, Schmidt CO, Grabe HJ, Lerch MM, Völzke H, Rieger MA, Enck P, Schauer B. Quality of life and sleep in individuals with irritable bowel syndrome according to different diagnostic criteria and inflammatory bowel diseases: A comparison using data from a population-based survey. Z Gastroenterol 2022; 60:299-309. [PMID: 35263783 DOI: 10.1055/a-1708-0277] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND A proportion of irritable bowel syndrome (IBS) affected patients does not fulfil Rome criteria despite considerable impairment similarly to that in patients with organic gastrointestinal diseases.This investigation aims to examine differences regarding Mental (MQoL), Physical Quality of Life (PQoL), and sleep between IBS according to Rome III (IBS Rome), clinically defined IBS, inflammatory bowel diseases (IBD), and non-IBS/non-IBD individuals. METHODS Data from SHIP-Trend (Study of Health in Pomerania, 2008-2012), a population-based cohort study in Germany, were used. RESULTS Response was 50.1% (N = 4420). Prevalence was 3.5% for IBS Rome (95% confidence interval (CI): 3.0 - 4.1%, n = 148), 0.6% for clinically defined IBS (CI: 0.4 - 0.9%, n = 27), and 0.8% for IBD (CI: 0.6 - 1.1%, n = 34). Individuals with IBS Rome (4.54 (CI: -5.92; -3.17)) and clinically defined IBS (4.69 (CI: -7.82; -1.56)) had lower scores for MQoL compared to the non-IBS/non-IBD group. PQoL scores were lowered in IBS Rome (6.39 (CI: -7.89; -4.88)) and IBD (5.37 (CI: -8.51; -2.22)), but not in clinically defined IBS compared to the non-IBS/non-IBD group. IBS Rome was the only gastroenterological condition with higher odds of sleeping problems (odds ratio (OR) "falling asleep": 1.74; CI: 1.29; 2.36; OR "remaining asleep": 1.73; CI: 1.26; 2.38). CONCLUSIONS IBS Rome is associated with reduced MQoL, PQoL, and sleep problems. Clinically defined IBS is associated only with reduced MQoL. Heterogeneity within IBS affected patients should be considered in clinical routine and screening for daily life impairment should be performed.
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Affiliation(s)
- Juliane Schwille-Kiuntke
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany
| | - Paul Enck
- Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Birgit Schauer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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43
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Henker R, Beyer G, Lerch MM, Mayerle J, Hoffmeister A. [Overview of relevant clinical recommendations from the new S3 guidelines on acute and chronic pancreatitis]. Chirurg 2022; 93:369-372. [PMID: 35254456 DOI: 10.1007/s00104-022-01598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 12/07/2022]
Abstract
Acute pancreatitis is a primary sterile inflammation of the pancreas, which is characterized by an unphysiological enzyme activation. This leads to an inflammatory reaction with edema, vascular damage and cell decay. The first German interdisciplinary S3 guidelines on chronic pancreatitis were published in 2012. Under the auspices of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and with the participation of various societies and patient representatives, the guidelines were recently revised and extended, Comprehensive S3 guidelines on acute and chronic pancreatitis were compiled and agreed by consensus. This article presents the important clinical aspects on acute pancreatitis from these guidelines in a compact form and the recommendations are justified.
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Affiliation(s)
- R Henker
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - G Beyer
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M M Lerch
- Klinik für Innere Medizin A, Universitätsmedizin Greifswald, Greifswald, Deutschland
- LMU Klinikum, Ludwig-Maximilians-Universität München, München, Deutschland
| | - J Mayerle
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, München, Deutschland
| | - A Hoffmeister
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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44
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Zinterl I, Ittermann T, Schipf S, Gross S, Anspieler H, Kim S, Ewert R, Bülow R, Kühn JP, Lerch MM, Völzke H, Felix SB, Bahls M, Targher G, Dörr M, Markus MRP. Low cardiopulmonary fitness is associated with higher liver fat content and higher gamma-glutamyltransferase concentrations in the general population - "The Sedentary's Liver". Liver Int 2022; 42:585-594. [PMID: 35020966 DOI: 10.1111/liv.15162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 02/13/2023]
Abstract
BACKGROUND We investigated the association between low cardiorespiratory fitness and liver fat content (LFC) in the general population. MATERIALS AND METHODS We evaluated data from 2151 adults (51.1% women) from two population-based cohorts of the Study of Health in Pomerania (SHIP-2 and SHIP-TREND-0). We analysed the cross-sectional associations of peak oxygen uptake (VO2peak ) with LFC, assessed by magnetic resonance imaging proton density fat fraction, as well as serum gamma-glutamyltransferase (GGT) and aminotransferase concentrations by multivariable regression models. RESULTS We observed significant inverse associations of VO2peak with LFC and serum GGT, but not with serum aminotransferase levels. Specifically, a 1 L/min lower VO2peak was associated with a 1.09% (95% confidence interval [CI]: 0.45-1.73; P = .002) higher LFC and a 0.18 μkatal/L (95% CI: 0.09-0.26; P < .001) higher GGT levels. The adjusted odds ratio (OR) for the risk of prevalent hepatic steatosis (HS) by a 1 L/min decrease in VO2peak was 1.61 (95% CI: 1.22-2.13; P = .001). Compared to subjects with high VO2peak , obese and overweight individuals with low VO2peak had 1.78% (95% CI: 0.32-3.25; P = .017) and 0.94% (95% CI: 0.15-1.74; P = .021) higher mean LFC, respectively. Compared to those with high VO2peak , low VO2peak was independently associated with a higher risk of prevalent HS in the obese (adjusted-OR 2.29, 95% CI=1.48-3.56; P < .001) and overweight (adjusted OR 1.57, 95% CI=1.16-2.14; P = .04) groups. CONCLUSIONS Lower VO2peak was significantly associated with greater LFC and higher serum GGT levels in a population-based cohort of adult individuals. Our results suggest that low VO2peak might be a risk factor for HS.
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Affiliation(s)
- Ines Zinterl
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Till Ittermann
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sabine Schipf
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Center for Diabetes Research (DZD), partner site Greifswald, Greifswald, Germany
| | - Stefan Gross
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Henryke Anspieler
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Simon Kim
- Department of Trauma and Reconstructive Surgery and Rehabilitative Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Jens-Peter Kühn
- Institute and Policlinic for Diagnostic and Interventional Radiology, University Hospital, Carl Gustav Carus University, TU Dresden, Dresden, Germany
| | - Markus M Lerch
- Department of Internal Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stephan Burkhard Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.,German Center for Diabetes Research (DZD), partner site Greifswald, Greifswald, Germany
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45
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Kruse J, Mueller R, Aghdassi AA, Lerch MM, Salloch S. Genetic Testing for Rare Diseases: A Systematic Review of Ethical Aspects. Front Genet 2022; 12:701988. [PMID: 35154238 PMCID: PMC8826556 DOI: 10.3389/fgene.2021.701988] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Genetic testing is associated with many ethical challenges on the individual, organizational and macro level of health care systems. The provision of genetic testing for rare diseases in particular requires a full understanding of the complexity and multiplicity of related ethical aspects. This systematic review presents a detailed overview of ethical aspects relevant to genetic testing for rare diseases as discussed in the literature. The electronic databases Pubmed, Science Direct and Web of Science were searched, resulting in 55 relevant publications. From the latter, a total of 93 different ethical aspects were identified. These ethical aspects were structured into three main categories (process of testing, consequences of the test outcome and contextual challenges) and 20 subcategories highlighting the diversity and complexity of ethical aspects relevant to genetic testing for rare diseases. This review can serve as a starting point for the further in-depth investigation of particular ethical issues, the education of healthcare professionals regarding this matter and for informing international policy development on genetic testing for rare diseases.
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Affiliation(s)
- Judith Kruse
- Institute of Ethics and History of Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Regina Mueller
- Institute of Ethics and History of Medicine, Medical Faculty, University Tübingen, Tübingen, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | | | - Sabine Salloch
- Institute of Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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46
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Liu L, Erickson NT, Ricard I, von Weikersthal LF, Lerch MM, Decker T, Kiani A, Kaiser F, Heintges T, Kahl C, Kullmann F, Scheithauer W, Link H, Höffkes HG, Moehler M, Gesenhues AB, Theurich S, Michl M, Modest DP, Algül H, Stintzing S, Heinemann V, Holch JW. Early weight loss is an independent risk factor for shorter survival and increased side effects in patients with metastatic colorectal cancer undergoing first-line treatment within the randomized Phase III trial FIRE-3 (AIO KRK-0306). Int J Cancer 2022; 150:112-123. [PMID: 34431518 DOI: 10.1002/ijc.33775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022]
Abstract
Body weight loss is frequently regarded as negatively related to outcomes in patients with malignancies. This retrospective analysis of the FIRE-3 study evaluated the evolution of body weight in patients with metastatic colorectal cancer (mCRC). FIRE-3 evaluated first-line FOLFIRI (folinic acid, fluorouracil and irinotecan) plus cetuximab or bevacizumab in mCRC patients with RAS-WT tumors (ie, wild-type in KRAS and NRAS exons 2-4). The prognostic and predictive relevance of early weight loss (EWL) regarding patient outcomes and treatment side effects were evaluated. Retrospective data on body weight during first 6 months of treatment were evaluated (N = 326). To correlate with efficacy endpoints and treatment side effects, patients were grouped according to clinically significant EWL ≥5% and <5% at Month 3. Age constituted the only significant predictor of EWL following a linear relationship with the corresponding log odds ratio (P = .016). EWL was significantly associated with the incident frequencies of diarrhea, edema, fatigue, nausea and vomiting. Further, a multivariate analysis revealed EWL to be an independent negative prognostic factor for overall survival (32.4 vs 21.1 months; hazard ratio [HR]: 1.64; 95% confidence interval [CI] = 1.13-2.38; P = .0098) and progression-free survival (11.8 vs 9.0 months; HR: 1.72; 95% CI = 1.18-2.5; P = .0048). In conclusion, EWL during systemic treatment against mCRC is significantly associated with patient age. Patients exhibiting EWL had worse survival and higher frequencies of adverse events. Early preventative measures targeted at weight maintenance should be evaluated, especially in elderly patients being at highest risk of EWL.
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Affiliation(s)
- Lian Liu
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany
| | | | - Ingrid Ricard
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany
| | | | - Markus M Lerch
- Klinik und Poliklinik für Innere Medizin A, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Thomas Decker
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | | | - Florian Kaiser
- Praxis Hämatologie/Onkologie/Palliativmedizin-Tagesklinik, Landshut, Germany.,VK&K Studien GbR, Landshut, Germany
| | | | - Christoph Kahl
- Städtisches Klinikum Magdeburg, Hämatologie/ Onkologie, Magdeburg, Germany
| | | | - Werner Scheithauer
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hartmut Link
- Department of Medicine I, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany
| | | | - Markus Moehler
- Medical Department 1, Johannes-Gutenberg Universität Mainz, Mainz, Germany
| | | | - Sebastian Theurich
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Cancer- and Immunometabolism Research Group, Gene Center LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Marlies Michl
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Dominik P Modest
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Department of Hematology, Oncology, and Tumorimmunology, Charité - Universitaetsmedizin, Berlin, Germany
| | - Hana Algül
- Comprehensive Cancer Center Munich TUM, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sebastian Stintzing
- German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany.,Department of Hematology, Oncology, and Tumorimmunology, Charité - Universitaetsmedizin, Berlin, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Julian W Holch
- Comprehensive Cancer Center, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich and German Cancer Research Centre (DKFZ), Heidelberg, Germany
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Aughton K, Elander NO, Evans A, Jackson R, Campbell F, Costello E, Halloran CM, Mackey JR, Scarfe AG, Valle JW, Carter R, Cunningham D, Tebbutt NC, Goldstein D, Shannon J, Glimelius B, Hackert T, Charnley RM, Anthoney A, Lerch MM, Mayerle J, Palmer DH, Büchler MW, Ghaneh P, Neoptolemos JP, Greenhalf W. hENT1 Predicts Benefit from Gemcitabine in Pancreatic Cancer but Only with Low CDA mRNA. Cancers (Basel) 2021; 13:5758. [PMID: 34830914 PMCID: PMC8616255 DOI: 10.3390/cancers13225758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
Gemcitabine or 5-fluorouracil (5-FU) based treatments can be selected for pancreatic cancer. Equilibrative nucleoside transporter 1 (hENT1) predicts adjuvant gemcitabine treatment benefit over 5-FU. Cytidine deaminase (CDA), inside or outside of the cancer cell, will deaminate gemcitabine, altering transporter affinity. ESPAC-3(v2) was a pancreatic cancer trial comparing adjuvant gemcitabine and 5-FU. Tissue microarray sections underwent in situ hybridization and immunohistochemistry. Analysis of both CDA and hENT1 was possible with 277 patients. The transcript did not correlate with protein levels for either marker. High hENT1 protein was prognostic with gemcitabine; median overall survival was 26.0 v 16.8 months (p = 0.006). Low CDA transcript was prognostic regardless of arm; 24.8 v 21.2 months with gemcitabine (p = 0.02) and 26.4 v 14.6 months with 5-FU (p = 0.02). Patients with low hENT1 protein did better with 5-FU, but only if the CDA transcript was low (median survival of 5-FU v gemcitabine; 29.3 v 18.3 months, compared with 14.2 v 14.6 with high CDA). CDA mRNA is an independent prognostic biomarker. When added to hENT1 protein status, it may also provide treatment-specific predictive information and, within the frame of a personalized treatment strategy, guide to either gemcitabine or 5FU for the individual patient.
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Affiliation(s)
- Karen Aughton
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Nils O Elander
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
- Department of Oncology, Linköping University, SE-581 83 Linköping, Sweden
| | - Anthony Evans
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Richard Jackson
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Fiona Campbell
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Eithne Costello
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Christopher M Halloran
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - John R Mackey
- Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Andrew G Scarfe
- Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Juan W Valle
- The Christie NHS Foundation Trust, University of Manchester, Manchester M20 4BX, UK
| | | | - David Cunningham
- Royal Marsden National Health Service (NHS) Foundation Trust, London SW3 6JJ, UK
| | | | - David Goldstein
- Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jennifer Shannon
- Nepean Cancer Centre, University of Sydney, Sydney, NSW 2747, Australia
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-751 05 Uppsala, Sweden
| | - Thilo Hackert
- Department of Surgery, University of Heidelberg, 69047 Heidelberg, Germany
| | | | | | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, University Medicine Greifswald, 17489 Greifswald, Germany
- Medizinische Klinik und Poliklinik II, Klinikum der LMU München-Grosshadern, 81377 München, Germany
| | - Daniel H Palmer
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Markus W Büchler
- Department of Surgery, University of Heidelberg, 69047 Heidelberg, Germany
| | - Paula Ghaneh
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - John P Neoptolemos
- Department of Surgery, University of Heidelberg, 69047 Heidelberg, Germany
| | - William Greenhalf
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
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Aghdassi A, Tran QT, Bulla T, Bülow R, Ribback S, Lerch MM, Pickartz T. Focal pancreatic lesions in autoimmune pancreatitis and weight loss. Gut 2021; 70:2065-2195. [PMID: 32699099 DOI: 10.1136/gutjnl-2020-321987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Ali Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Quang Trung Tran
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Thomas Bulla
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Silvia Ribback
- Institute of Pathology, Ernst-Moritz-Arndt Universitat Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Tilman Pickartz
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
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Adam MG, Beyer G, Christiansen N, Kamlage B, Pilarsky C, Distler M, Fahlbusch T, Chromik A, Klein F, Bahra M, Uhl W, Grützmann R, Mahajan UM, Weiss FU, Mayerle J, Lerch MM. Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects. Gut 2021; 70:2150-2158. [PMID: 33541865 PMCID: PMC8515121 DOI: 10.1136/gutjnl-2020-320723] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Chronic pancreatitis (CP) is a fibroinflammatory syndrome leading to organ dysfunction, chronic pain, an increased risk for pancreatic cancer and considerable morbidity. Due to a lack of specific biomarkers, diagnosis is based on symptoms and specific but insensitive imaging features, preventing an early diagnosis and appropriate management. DESIGN We conducted a type 3 study for multivariable prediction for individual prognosis according to the TRIPOD guidelines. A signature to distinguish CP from controls (n=160) was identified using gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry on ethylenediaminetetraacetic acid (EDTA)-plasma and validated in independent cohorts. RESULTS A Naive Bayes algorithm identified eight metabolites of six ontology classes. After algorithm training and computation of optimal cut-offs, classification according to the metabolic signature detected CP with an area under the curve (AUC) of 0.85 ((95% CI 0.79 to 0.91). External validation in two independent cohorts (total n=502) resulted in similar accuracy for detection of CP compared with non-pancreatic controls in EDTA-plasma (AUC 0.85 (95% CI 0.81 to 0.89)) and serum (AUC 0.87 (95% CI 0.81 to 0.95)). CONCLUSIONS This is the first study that identifies and independently validates a metabolomic signature in plasma and serum for the diagnosis of CP in large, prospective cohorts. The results could provide the basis for the development of the first routine laboratory test for CP.
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Affiliation(s)
| | - Georg Beyer
- Department of Medicine II, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany
| | | | | | - Christian Pilarsky
- Department of Surgery, Erlangen University Hospital, Erlangen, Bayern, Germany
| | - Marius Distler
- Clinic and Outpatient Clinic for Visceral-, Thorax- and Vascular Surgery, Dresden University Hospital, Dresden, Sachsen, Germany
| | - Tim Fahlbusch
- St. Josef Hospital, Department of Surgery, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Ansgar Chromik
- Askleipios Clinic Harburg, Department for General and Visceral Surgery, Asklepios Hospital Group, Hamburg, Hamburg, Germany
| | - Fritz Klein
- Department of Surgery, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Berlin, Germany
| | - Marcus Bahra
- Department of Surgery, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Berlin, Germany
| | - Waldemar Uhl
- St. Josef Hospital, Department of Surgery, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Robert Grützmann
- Department of Surgery, Erlangen University Hospital, Erlangen, Bayern, Germany
| | - Ujjwal M Mahajan
- Department of Medicine II, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany
| | - Frank U Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Julia Mayerle
- Department of Medicine II, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
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50
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Lerch MM. [Gender-conscious language in medicine-An appeal]. Internist (Berl) 2021; 62:1215-1219. [PMID: 34677654 DOI: 10.1007/s00108-021-01205-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 12/01/2022]
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