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Zeng Z, Vadivel CK, Gluud M, Namini MRJ, Yan L, Ahmad S, Hansen MB, Coquet J, Mustelin T, Koralov SB, Bonefeld CM, Woetmann A, Geisler C, Guenova E, Kamstrup MR, Litman T, Gjerdrum LMR, Buus TB, Ødum N. Keratinocytes present Staphylococcus aureus enterotoxins and promote malignant and non-malignant T cell proliferation in cutaneous T cell lymphoma. J Invest Dermatol 2024:S0022-202X(24)00377-4. [PMID: 38762064 DOI: 10.1016/j.jid.2024.04.018] [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: 02/05/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/20/2024]
Abstract
Cutaneous T-cell lymphoma (CTCL) is characterized by malignant T-cells proliferating in a unique tumor microenvironment (TME) dominated by keratinocytes. Skin colonization and infection by Staphylococcus aureus (S. aureus) is a common cause of morbidity and suspected of fueling disease activity. Here we show that expression of HLA-DR, high-affinity receptors for Staphylococcal enterotoxins (SE), by keratinocytes correlates with IFN-γ expression in the TME. Importantly, IFN-γ induces HLA-DR, SE-binding, and SE-presentation by keratinocytes to malignant T-cells from Sézary syndrome (SS) patients, and malignant and non-malignant T-cell lines derived from SS and Mycosis fungoides patients. Likewise, preincubation of keratinocytes with supernatant from patient-derived SE-producing S. aureus triggers proliferation in malignant T-cells and cytokine release (including IL-2), when cultured with non-malignant T-cells. This is inhibited by pre-treatment with engineered bacteriophage S. aureus-specific endolysins. Furthermore, mutations in the HLA-DR binding sites of SE type-A, and siRNA-mediated knockdown of Janus Kinase-3 (JAK3) and IL-2Rγ block induction of malignant T-cell proliferation. In conclusion, we show that, upon exposure to patient-derived S. aureus and SE, keratinocytes stimulate IL-2Rγ/JAK3-dependent proliferation of malignant and non-malignant T-cells in an environment with non-malignant T-cells. These findings suggest that keratinocytes in the TME play a key role in S. aureus mediated disease activity in CTCL.
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Affiliation(s)
- Ziao Zeng
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Chella Krishna Vadivel
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Maria Gluud
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Martin R J Namini
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Lang Yan
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Sana Ahmad
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Blood Bank, State University Hospital (Rigshospitalet), Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan Coquet
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Tomas Mustelin
- Department of Rheumatology, University of Washington, Seattle, USA
| | - Sergei B Koralov
- Department of Pathology, New York University School of Medicine, New York, USA
| | - Charlotte Menne Bonefeld
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Anders Woetmann
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Geisler
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Emmanuella Guenova
- University Hospital Lausanne (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Maria R Kamstrup
- Department of Dermatology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Thomas Litman
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Lise-Mette R Gjerdrum
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Pathology, Zealand University Hospital, Roskilde, Copenhagen, Denmark
| | - Terkild B Buus
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
| | - Niels Ødum
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.
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2
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Iversen AM, Hansen MB, Münster M, Kristensen B, Ellermann-Eriksen S. Hand hygiene compliance in nursing home wards: the effect of increased accessibility of alcohol-based hand rub. J Hosp Infect 2024; 147:206-212. [PMID: 38521416 DOI: 10.1016/j.jhin.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Elderly nursing home residents are vulnerable to infection from micro-organisms. Hand hygiene is considered one of the most important measures to prevent transmission. AIM To determine the effect of increased accessibility to alcohol-based hand rub (ABHR) in nursing home wards by monitoring hand hygiene compliance (HHC) among healthcare workers (HCWs). METHODS An 11-month intervention study was conducted in a Danish six-ward nursing home. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. Baseline HHC was compared with the HHC during an immediate intervention period and a long-term intervention period. FINDINGS A total of 159 HCWs were included. The AHHMS registered 341,078 hand hygiene opportunities. Overall baseline HHC was 31% (95% confidence interval: 30-32). A significant +18% absolute immediate effect (first five months) (95% CI: 17-19; P < 0.0001) and +13 percentage points (95% CI: 11-14; P < 0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean +27 percentage point difference (P < 0.0001). CONCLUSION Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, demonstrating a noteworthy effect. The study is the first to report the effect on nursing home dispenser accessibility as a single intervention and to show a significant unmet potential.
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Affiliation(s)
- A-M Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Denmark.
| | - M B Hansen
- Konduto ApS, Sani Nudge, Copenhagen, Denmark
| | | | - B Kristensen
- National Centre of Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - S Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Denmark
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3
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von Stemann JH, Pedersen OBV, Hjalgrim H, Erikstrup C, Ullum H, Dowsett J, Thørner LW, Larsen MAH, Sørensen E, Hansen MB, Ostrowski SR. IL-6 Autoantibodies Predict Lower Platelet Counts and Altered Plasma Cytokine Profiles in Healthy Blood Donors: Results From the Danish Blood Donor Study. Front Med (Lausanne) 2022; 9:914262. [PMID: 35814772 PMCID: PMC9263719 DOI: 10.3389/fmed.2022.914262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/02/2022] [Indexed: 12/03/2022] Open
Abstract
Cytokine-specific autoantibodies (c-aAb) represent a novel type of immune dysfunction. Though they have been detected in both patient cohorts and healthy individuals, and have immunomodulatory properties, the full extent of their influence remains unknown. Based on the critical role of several cytokines in thrombopoiesis, we investigated if there is an association between c-aAb and platelet variables in healthy individuals, with a specific focus on c-aAb against a known thrombopoietic cytokine, IL-6. Using platelet count and mean platelet volume in 3,569 healthy participants of the Danish Blood Donor Study as dependent variables, we performed a series of multivariate regression analyses using five cytokine autoantibodies, including IL-6 c-aAb, as independent variables. In men, high titers of IL-6 c-aAb were negatively associated with platelet counts (β = −24 *109/l (95% confidence interval −43 to −6), p = 0.008) and positively associated with mean platelet volume (β = 0.4 fL (95% confidence interval 0.0–0.7) p = 0.043). These associations were exacerbated when adjusting for undetectable C-reactive protein levels, which we used as a proxy for c-aAb mediated IL-6 inhibition in vivo. Furthermore, in a smaller subgroup, individuals with high vs. low titer IL-6 c-aAb had different profiles of plasma IL-6, IL-10, TNFα and TPO, further suggesting a functional inhibition of IL-6 by high titers of circulating IL-6 c-aAb. We therefore speculate that in addition to their immunomodulatory potential IL-6 c-aAb may interfere with thrombopoiesis – directly or indirectly – under normal physiological conditions. This study is the first to suggest an influence of c-aAb on platelets in healthy individuals, beyond their apparent effects on immune competence.
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Affiliation(s)
- Jakob Hjorth von Stemann
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- *Correspondence: Jakob Hjorth von Stemann
| | - Ole Birger Vesterager Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Centre for Cancer Research, Danish Cancer Society, Copenhagen, Denmark
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Joseph Dowsett
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lise Wegner Thørner
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Margit Anita Hørup Larsen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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4
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von Stemann JH, Gjærde LK, Haastrup EK, Minculescu L, Brooks PT, Sengeløv H, Hansen MB, Ostrowski SR. Cytokine autoantibodies are stable throughout the haematopoietic stem cell transplantation course and are associated with distinct biomarker and blood cell profiles. Sci Rep 2021; 11:23971. [PMID: 34907183 PMCID: PMC8671426 DOI: 10.1038/s41598-021-01952-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/19/2021] [Indexed: 01/15/2023] Open
Abstract
Cytokine-specific autoantibodies (c-aAbs) represent an emerging field in endogenous immunodeficiencies, and the immunomodulatory potential of c-aAbs is now well documented. Here, we investigated the hypothesis that c-aAbs affects inflammatory, immunoregulatory and injury-related processes and hence the clinical outcome of haematopoietic stem cell transplantation (HSCT). C-aAbs against IL-1α, IL-6, IL-10, IFNα, IFNγ and GM-CSF were measured in 131 HSCT recipients before and after (days + 7, + 14, + 28) HSCT and tested for associations with 33 different plasma biomarkers, leukocyte subsets, platelets and clinical outcomes, including engraftment, GvHD and infections. We found that c-aAb levels were stable over the course of HSCT, including at high titres, with few individuals seeming to acquire high-titre levels of c-aAbs. Both patients with stable and those with acquired high-titre c-aAb levels displayed significant differences in biomarker concentrations and blood cell counts pre-HSCT and at day 28, and the trajectories of these variables varied over the course of HSCT. No clinical outcomes were associated with high-titre c-aAbs. In this first study of c-aAbs in HSCT patients, we demonstrated that high-titre levels of c-aAb may both persist and emerge in patients over the course of HSCT and may be associated with altered immune biomarkers and cell profiles.
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Affiliation(s)
- Jakob Hjorth von Stemann
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Lars Klingen Gjærde
- Department of Haematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eva Kannik Haastrup
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lia Minculescu
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Patrick Terrence Brooks
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Sengeløv
- Department of Haematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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5
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Hansen MB, Stangerup M, Hansen R, Sode LP, Hesselbo B, Kostadinov K, Calum H, Olesen BS. Changing hand hygiene behaviour might not be that easy. J Hosp Infect 2021; 123:137-138. [PMID: 34774973 DOI: 10.1016/j.jhin.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | - M Stangerup
- Infection Control Unit, Bispebjerg and Frederiksberg Hospitals, Denmark
| | - R Hansen
- Department of Orthopedic, Bispebjerg University Hospital, Denmark
| | - L P Sode
- Department of Orthopedic, Bispebjerg University Hospital, Denmark
| | - B Hesselbo
- Infection Control Unit, Bispebjerg and Frederiksberg Hospitals, Denmark
| | - K Kostadinov
- Department of Orthopedic, Bispebjerg University Hospital, Denmark
| | - H Calum
- Infection Control Unit, Bispebjerg and Frederiksberg Hospitals, Denmark; Department of Clinical Microbiology, Amager and Hvidovre Hospitals, Denmark
| | - B S Olesen
- Department of Clinical Microbiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
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6
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Chandrasekar A, Paulus U, Bokhorst A, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, van Kraaij M, Merz EM, van den Hurk K, Hansen MB, Slot E, Ullum H. How donor selection criteria can be evaluated with limited scientific evidence: lessons learned from the TRANSPOSE project. Vox Sang 2020; 116:342-350. [PMID: 33191514 DOI: 10.1111/vox.13028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Donor selection criteria (DSC) are a vital link in the chain of supply of Substances of Human Origin (SoHO) but are also subject to controversy and differences of opinion. Traditionally, DSC have been based on application of the precautionary principle. MATERIALS AND METHODS From 2017 to 2020, TRANSPOSE (TRANSfusion and transplantation PrOtection and SElection of donors), a European research project, aimed to identify discrepancies between current DSC by proposing a standardized risk assessment method for all SoHO (solid organs excluded) and all levels of evidence. RESULTS The current DSC were assessed using a modified risk assessment method based on the Alliance of Blood Operators' Risk-based decision-making framework for blood safety. It was found that with limited or diverging scientific evidence, it was difficult to reach consensus and an international standardized method for decision-making was lacking. Furthermore, participants found it hard to disregard their local guidelines when providing expert opinion, which resulted in substantial influence on the consensus-based decision-making process. CONCLUSIONS While the field of donation-safety research is expanding rapidly, there is an urgent need to formalize the decision-making process regarding DSC. This includes the need for standardized methods to increase transparency in the international decision-making process and to ensure that this is performed consistently. Our framework provides an easy-to-implement approach for standardizing risk assessments, especially in the context of limited scientific evidence.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | - Livia Cannata
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Solna, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | | | | | | | - Arlinke Bokhorst
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | | | - Eva-Maria Merz
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands.,Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Katja van den Hurk
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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Barnkob MB, Pottegård A, Støvring H, Haunstrup TM, Homburg K, Larsen R, Hansen MB, Titlestad K, Aagaard B, Møller BK, Barington T. Reduced prevalence of SARS-CoV-2 infection in ABO blood group O. Blood Adv 2020; 4:4990-4993. [PMID: 33057631 PMCID: PMC7594382 DOI: 10.1182/bloodadvances.2020002657] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/21/2020] [Indexed: 12/30/2022] Open
Abstract
Identification of risk factors for contracting and developing serious illness following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is of paramount interest. Here, we performed a retrospective cohort analysis of all Danish individuals tested for SARS-CoV-2 between 27 February 2020 and 30 July 2020, with a known ABO and RhD blood group, to determine the influence of common blood groups on virus susceptibility. Distribution of blood groups was compared with data from nontested individuals. Participants (29% of whom were male) included 473 654 individuals tested for SARS-CoV-2 using real-time polymerase chain reaction (7422 positive and 466 232 negative) and 2 204 742 nontested individuals, accounting for ∼38% of the total Danish population. Hospitalization and death from COVID-19, age, cardiovascular comorbidities, and job status were also collected for confirmed infected cases. ABO blood groups varied significantly between patients and the reference group, with only 38.41% (95% confidence interval [CI], 37.30-39.50) of the patients belonging to blood group O compared with 41.70% (95% CI, 41.60-41.80) in the controls, corresponding to a relative risk of 0.87 (95% CI, 0.83-0.91) for acquiring COVID-19. This study identifies ABO blood group as a risk factor for SARS-CoV-2 infection but not for hospitalization or death from COVID-19.
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Affiliation(s)
- Mike Bogetofte Barnkob
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
- Clinical Department, Faculty of Health Sciences, and
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henrik Støvring
- Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Thure Mors Haunstrup
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Keld Homburg
- Department of Clinical Immunology, Zealand University Hospital, Næstved, Denmark
| | - Rune Larsen
- Department of Clinical Immunology, Zealand University Hospital, Næstved, Denmark
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Bjarne Kuno Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Barington
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
- Clinical Department, Faculty of Health Sciences, and
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, Pozenel P, van Kraaij M, Hansen MB, Slot E, Ullum H. Putting the spotlight on donation-related risks and donor safety - are we succeeding in protecting donors? Vox Sang 2020; 116:313-323. [PMID: 33103801 DOI: 10.1111/vox.13014] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The European consortium project TRANSPOSE (TRANSfusion and transplantation: PrOtection and SElection of donors) aimed to assess and evaluate the risks to donors of Substances of Human Origin (SoHO), and to identify gaps between current donor vigilance systems and perceived risks. MATERIALS AND METHODS National and local data from participating organizations on serious and non-serious adverse reactions in donors were collected from 2014 to 2017. Following this, a survey was performed among participants to identify risks not included in the data sets. Finally, participants rated the risks according to severity, level of evidence and prevalence. RESULTS Significant discrepancies between anticipated donor risks and the collected data were found. Furthermore, many participants reported that national data on adverse reactions in donors of stem cells, gametes, embryos and tissues were not routinely collected and/or available. CONCLUSIONS These findings indicate that there is a need to further develop and standardize donor vigilance in Europe and to include long-term risks to donors, which are currently underreported, ensuring donor health and securing the future supply of SoHO.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, Berne and University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue and Istituto Superiore di Sanità, Italy
| | - Livia Cannata
- Centro Nazionale Sangue and Istituto Superiore di Sanità, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | | | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Primoz Pozenel
- Blood transfusion Center of Slovenia, Ljubljana, Slovenia
| | | | - Morten Bagge Hansen
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Henrik Ullum
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
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Georgsen M, Krog MC, Korsholm AS, Hvidman HW, Kolte AM, Rigas AS, Ullum H, Ziebe S, Andersen AN, Nielsen HS, Hansen MB. Serum ferritin level is inversely related to number of previous pregnancy losses in women with recurrent pregnancy loss. Fertil Steril 2020; 115:389-396. [PMID: 32988613 DOI: 10.1016/j.fertnstert.2020.08.1410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/31/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study whether low serum ferritin (s-ferritin) levels are associated with recurrent pregnancy loss (RPL), and whether low s-ferritin predicts the risk of another pregnancy loss or the ability to conceive. DESIGN Cohort study. SETTING Fertility clinic at a university hospital. PATIENT(S) Eighty-four women referred to the RPL Unit and 153 women of reproductive age with no known fertility problem. s-Ferritin levels were measured in serum samples taken before pregnancy attempt. INTERVENTION None. MAIN OUTCOME MEASURE(S) s-Ferritin levels were correlated to pregnancy history, ability to conceive, and time to conception during the first 2 years after sampling. Furthermore, s-ferritin levels were correlated to outcome of the first pregnancy after referral for RPL. RESULT(S) Women with RPL had lower s-ferritin than the comparison group, 39.9 μg/L versus 62.2 μg/L, and had a higher prevalence of low iron stores (s-ferritin <30 μg/L), 35.7% versus 13.7%. We found an inverse relationship between s-ferritin level and number of pregnancy losses before referral. We did not find s-ferritin level to be associated with ability to conceive or time to pregnancy in either group. Nor did s-ferritin level predict the risk of losing the first pregnancy after referral for RPL. CONCLUSION(S) The inverse relationship between s-ferritin levels and previous pregnancy losses suggests that low s-ferritin is associated with a more severe reproductive disturbance in women with RPL. Whether low s-ferritin is causally related to RPL and if such women could benefit from iron supplementation to achieve a live birth warrants further investigation.
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Affiliation(s)
- Maja Georgsen
- Recurrent Pregnancy Loss Unit, Capital Region, Rigshospitalet and Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Maria Christine Krog
- Recurrent Pregnancy Loss Unit, Capital Region, Rigshospitalet and Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne-Sofie Korsholm
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Astrid Marie Kolte
- Recurrent Pregnancy Loss Unit, Capital Region, Rigshospitalet and Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Stribolt Rigas
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Ziebe
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anders Nyboe Andersen
- Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Recurrent Pregnancy Loss Unit, Capital Region, Rigshospitalet and Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark; Department of Gynecology and Obstetrics, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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10
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Stryhn A, Kongsgaard M, Rasmussen M, Harndahl MN, Østerbye T, Bassi MR, Thybo S, Gabriel M, Hansen MB, Nielsen M, Christensen JP, Randrup Thomsen A, Buus S. A Systematic, Unbiased Mapping of CD8 + and CD4 + T Cell Epitopes in Yellow Fever Vaccinees. Front Immunol 2020; 11:1836. [PMID: 32983097 PMCID: PMC7489334 DOI: 10.3389/fimmu.2020.01836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/29/2020] [Accepted: 07/08/2020] [Indexed: 12/30/2022] Open
Abstract
Examining CD8+ and CD4+ T cell responses after primary Yellow Fever vaccination in a cohort of 210 volunteers, we have identified and tetramer-validated 92 CD8+ and 50 CD4+ T cell epitopes, many inducing strong and prevalent (i.e., immunodominant) T cell responses. Restricted by 40 and 14 HLA-class I and II allotypes, respectively, these responses have wide population coverage and might be of considerable academic, diagnostic and therapeutic interest. The broad coverage of epitopes and HLA overcame the otherwise confounding effects of HLA diversity and non-HLA background providing the first evidence of T cell immunodomination in humans. Also, double-staining of CD4+ T cells with tetramers representing the same HLA-binding core, albeit with different flanking regions, demonstrated an extensive diversification of the specificities of many CD4+ T cell responses. We suggest that this could reduce the risk of pathogen escape, and that multi-tetramer staining is required to reveal the true magnitude and diversity of CD4+ T cell responses. Our T cell epitope discovery approach uses a combination of (1) overlapping peptides representing the entire Yellow Fever virus proteome to search for peptides containing CD4+ and/or CD8+ T cell epitopes, (2) predictors of peptide-HLA binding to suggest epitopes and their restricting HLA allotypes, (3) generation of peptide-HLA tetramers to identify T cell epitopes, and (4) analysis of ex vivo T cell responses to validate the same. This approach is systematic, exhaustive, and can be done in any individual of any HLA haplotype. It is all-inclusive in the sense that it includes all protein antigens and peptide epitopes, and encompasses both CD4+ and CD8+ T cell epitopes. It is efficient and, importantly, reduces the false discovery rate. The unbiased nature of the T cell epitope discovery approach presented here should support the refinement of future peptide-HLA class I and II predictors and tetramer technologies, which eventually should cover all HLA class I and II isotypes. We believe that future investigations of emerging pathogens (e.g., SARS-CoV-2) should include population-wide T cell epitope discovery using blood samples from patients, convalescents and/or long-term survivors, who might all hold important information on T cell epitopes and responses.
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Affiliation(s)
- Anette Stryhn
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kongsgaard
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Rasmussen
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Nors Harndahl
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Østerbye
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria Rosaria Bassi
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Thybo
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Morten Bagge Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Nielsen
- Department of Health Technology, The Technical University of Denmark, Lyngby, Denmark
- Instituto de Investigaciones Biotecnológicas, Universidad Nacional de San Martín, Buenos Aires, Argentina
| | - Jan Pravsgaard Christensen
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Allan Randrup Thomsen
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Soren Buus
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Svalgaard JD, Talkhoncheh MS, Haastrup EK, Munthe-Fog L, Clausen C, Hansen MB, Andersen P, Gørløv JS, Larsson J, Fischer-Nielsen A. Pentaisomaltose, an Alternative to DMSO. Engraftment of Cryopreserved Human CD34 + Cells in Immunodeficient NSG Mice. Cell Transplant 2018; 27:1407-1412. [PMID: 30056762 PMCID: PMC6168988 DOI: 10.1177/0963689718786226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Hematopoietic stem cell transplantation often involves the cryopreservation of stem cell products. Currently, the standard cryoprotective agent (CPA) is dimethyl sulfoxide (DMSO), which is known to cause concentration-related toxicity and side effects when administered to patients. Based on promising in vitro data from our previous study using pentaisomaltose (a 1 kDa subfraction of Dextran 1) as an alternative to DMSO for cryopreservation of hematopoietic progenitor cells (HPCs) from apheresis products, we proceeded to a preclinical model and compared the two CPAs with respect to engraftment of human hematopoietic stem and progenitor cells (HSPCs) in the immunodeficient NSG mouse model. Human HPCs from apheresis products were cryopreserved with either pentaisomaltose or DMSO, and the following outcomes were measured: (1) the post-thaw recovery of cryopreserved cells and clonogenic potential of CD34+ cells and (2) hematopoietic engraftment in NSG mice. We found that recovery and colony-forming cells data were comparable between pentaisomaltose and DMSO. The engraftment data revealed comparable human CD45+ levels in peripheral blood at 8 weeks and bone marrow at 16 weeks post transplantation. Additionally, the frequencies of CD34+CD38low/negative and myeloid/lymphoid cells in the bone marrow were comparable. We here demonstrated that long-term engrafting HSPCs were well preserved in pentaisomaltose and comparable to cells cryopreserved with DMSO. Although a clinical trial is necessary to translate these results into human use, the present data represent an important step toward the replacement of DMSO with a non-toxic alternative.
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Affiliation(s)
- Jesper Dyrendom Svalgaard
- 1 Department of Clinical Immunology, Cell Therapy Facility, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Eva Kannik Haastrup
- 1 Department of Clinical Immunology, Cell Therapy Facility, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Lea Munthe-Fog
- 1 Department of Clinical Immunology, Cell Therapy Facility, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Morten Bagge Hansen
- 1 Department of Clinical Immunology, Cell Therapy Facility, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Pernille Andersen
- 4 Department of Clinical Immunology, Stem Cell Facility, Herlev Hospital, Herlev, Denmark
| | - Jette Sønderskov Gørløv
- 5 Department of Hematology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jonas Larsson
- 2 Molecular Medicine and Gene Therapy, Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Anne Fischer-Nielsen
- 1 Department of Clinical Immunology, Cell Therapy Facility, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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12
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Larsen R, Sandhu N, Heegaard NHH, Ullum H, von Stemann JH, Sørensen E, Nellemann DS, Hansen MB. Changes in circulating inflammatory markers following febrile non-haemolytic transfusion reactions to leucoreduced red cells. Vox Sang 2017; 113:76-79. [PMID: 29023768 DOI: 10.1111/vox.12607] [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: 04/07/2017] [Revised: 09/15/2017] [Accepted: 09/24/2017] [Indexed: 12/01/2022]
Abstract
It would be desirable to be able to distinguish fever as a result of febrile non-haemolytic transfusion reactions (FNHTR) from other febrile conditions. To further characterize the inflammatory feature of FNHTR, we measured a large panel of inflammatory markers in pre- and posttransfusion plasma samples from patients with and without FNHTR following the transfusion of leucoreduced red blood cells. As FNHTR patients only displayed a significant increase in IL-6, we conclude that changes in plasma cytokine levels during FNHTR are unlikely to be used diagnostically. An incidental finding of a distinct cytokine pattern in pretransfusion samples from FNHTR patients warrants further investigations, as it might be used to characterize the nature of FNHTR and to predict the risk of these adverse events.
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Affiliation(s)
- R Larsen
- Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - N Sandhu
- Department of Congenital Diseases, Statens Serum Institut, Copenhagen, Denmark
| | - N H H Heegaard
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - H Ullum
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J H von Stemann
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - E Sørensen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - D S Nellemann
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M B Hansen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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13
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Theut Riis P, von Stemann JH, Kjærsgaard Andersen R, Hansen MB, Jemec GBE. Serum Anticytokine Autoantibody Levels Are Not Increased in Hidradenitis Suppurativa: A Case-Control Pilot Study. Dermatology 2017; 233:126-128. [PMID: 28675899 DOI: 10.1159/000475925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/19/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa is a skin disease of recurrent episodes of inflammatory nodules, abscesses, and scarring of the intertriginous regions, e.g. the axillae and groin. A dysregulated immune response to one or more unknown antigens in hidradenitis suppurativa has been suggested. One hypothetical element of this dysregulation may be the functionality of the cytokines. This study examines the serum level of anticytokine autoantibodies for interleukin (IL)-1α, IL-6, IL-10, IL-17A, IL-17E, IL-17F, and interferon-α. METHOD Recombinant, carrier-free cytokines were coupled to microspheres. The coupled beads were incubated for 1 h in the dark with assay buffer-diluted sera, and subsequently for 30 min with polyclonal goat F(ab')2 anti-human IgG phycoerythrin-conjugated antibody. Data are presented as the median fluorescence intensity of samples. RESULTS No difference in levels of anticytokine autoantibodies was demonstrated for any of the autoantibodies studied. DISCUSSION The data suggest that endogenously produced autoantibodies only play a minor role, if any, in hidradenitis suppurativa.
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Affiliation(s)
- Peter Theut Riis
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
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14
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von Stemann JH, Rigas AS, Thørner LW, Rasmussen DGK, Pedersen OB, Rostgaard K, Erikstrup C, Ullum H, Hansen MB. Prevalence and correlation of cytokine-specific autoantibodies with epidemiological factors and C-reactive protein in 8,972 healthy individuals: Results from the Danish Blood Donor Study. PLoS One 2017; 12:e0179981. [PMID: 28665954 PMCID: PMC5493339 DOI: 10.1371/journal.pone.0179981] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/07/2017] [Indexed: 12/12/2022] Open
Abstract
Natural cytokine-specific autoantibodies (c-aAb) have been measured in healthy and diseased individuals, and have been considered as both endogenous immune-regulators and pathogenic factors. Overall, the etiology and potential pathology of c-aAb are still undefined. To further characterize the sero-prevalence, predictors and consequences of high c-aAb levels, we performed the largest population-based study of c-aAb to date, using participants and epidemiological data from the Danish Blood Donor Study. Using a validated bead-based multiplex assay we assessed plasma levels of IL-1α, IL-6, IL-10, IFNα and GM-CSF-specific c-aAb in 8,972 healthy blood donors. Trace levels of at least one of the investigated c-aAb could be measured in 86% of the participants. The presence of high levels of potentially inhibitory c-aAb was generally associated with increasing age and male or female sex, depending on the c-aAb in question. A negative correlation between high levels of IL-6-specific c-aAb and plasma levels of C-reactive protein was observed, indicating cytokine-neutralizing levels of c-aAb in healthy blood donors. There was no substantial correlation between high levels of the five individual c-aAb investigated in this study. These data suggest that autoimmunity against endogenous cytokines is a relatively common phenomenon in healthy individuals, and that predictive factors for high, potentially neutralizing c-aAb levels vary depending on the cytokine in question, and may differ from predictors of general c-aAb presence.
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Affiliation(s)
- Jakob Hjorth von Stemann
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- * E-mail:
| | - Andreas Stribolt Rigas
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lise Wegner Thørner
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Klaus Rostgaard
- Epidemiology research, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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15
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Norgaard A, Stensballe J, de Lichtenberg TH, White JO, Perner A, Wanscher M, Hillingsø J, Holm ML, Mau-Sørensen M, Sillesen H, Kjeldsen L, Bäck C, Nielsen J, Seeberg J, Hansen MB, Johansson PI. Three-year follow-up of implementation of evidence-based transfusion practice in a tertiary hospital. Vox Sang 2017; 112:229-239. [PMID: 28220499 DOI: 10.1111/vox.12485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/17/2016] [Accepted: 12/10/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Traditionally, Denmark has had a high rate of allogeneic red blood cell transfusion caused by a liberal transfusion practice despite the existence of restrictive guidelines. We established a Patient Blood Management programme in a tertiary hospital and report the results of the implementation of evidence-based transfusion practice. MATERIALS AND METHODS Red blood cell transfusion quality indicators were compared with the evidence-based guideline at hospital and department level. Based on this evaluation, wards were selected for interventions targeting doctors and nurses. The implementation process was monitored by transfusion quality and utilization data over a 3-year period with totally 166 341 admissions in 98 960 mixed, adult medical and surgical patients. RESULTS At the hospital level, transfusion above the upper guideline limit decreased from 23 to 10% (P < 0·001), and transfusion at or below the restrictive haemoglobin trigger of 7·3 g/dl increased from 7 to 19% (P < 0·001). The percentage of single-unit transfusions increased from 72 to 78% (P < 0·001), and the majority of transfusion rates and volumes decreased significantly. Red cell use decreased with 41% in surgical procedures and 28% in admissions (P < 0·001). CONCLUSION The intervention was associated with a significant and sustained overall increase in compliance with national guidelines for red blood cell transfusion for non-bleeding patients, and led to significantly fewer patients being exposed to transfusion.
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Affiliation(s)
- A Norgaard
- Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Stensballe
- Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - T H de Lichtenberg
- Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J O White
- Department of intensive care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A Perner
- Department of intensive care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Wanscher
- Department of thoracic anaesthesiology and intensive care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Hillingsø
- Department of abdominal surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M L Holm
- Department of urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Mau-Sørensen
- Department of oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Sillesen
- Department of vascular surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Kjeldsen
- Department of haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Bäck
- Department of thoracic surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Nielsen
- Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Seeberg
- Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - M B Hansen
- Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - P I Johansson
- Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Solberg Ø, Birkeland MS, Blix I, Hansen MB, Heir T. Towards an exposure-dependent model of post-traumatic stress: longitudinal course of post-traumatic stress symptomatology and functional impairment after the 2011 Oslo bombing. Psychol Med 2016; 46:3241-3254. [PMID: 27609412 DOI: 10.1017/s0033291716001860] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Our understanding of the dynamics of post-traumatic stress symptomatology and its link to functional impairment over time is limited. METHOD Post-traumatic stress symptomatology (Post-traumatic Checklist, PCL) was assessed three times in 1-year increments (T1, T2, T3) following the Oslo bombing of 22 July, 2011, in directly (n = 257) and indirectly exposed (n = 2223) government employees, together with demographics, measures of exposure and work and social adjustment. The dynamics of post-traumatic stress disorder symptom cluster interplay were examined within a structural equation modelling framework using a cross-lagged autoregressive panel model. RESULTS Intrusions at T1 played a prominent role in predicting all symptom clusters at T2 for the directly exposed group, exhibiting especially strong cross-lagged relationships with avoidance and anxious arousal. For the indirectly exposed group, dysphoric arousal at T1 played the most prominent role in predicting all symptom clusters at T2, exhibiting a strong relationship with emotional numbing. Emotional numbing seemed to be the main driver behind prolonged stress at T3 for both groups. Functional impairment was predominately associated with dysphoric arousal and emotional numbing in both groups. CONCLUSIONS For directly exposed individuals, memories of the traumatic incident and the following intrusions seem to drive their post-traumatic stress symptomatology. However, as these memories lose their potency over time, a sequela of dysphoric arousal and emotional numbing similar to the one reported by the indirectly exposed individuals seems to be the main driver for prolonged post-traumatic stress and functional impairment. Findings are discussed using contemporary models within an exposure-dependent perspective of post-traumatic stress.
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Affiliation(s)
- Ø Solberg
- Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway
| | - M S Birkeland
- Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway
| | - I Blix
- Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway
| | - M B Hansen
- Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway
| | - T Heir
- Norwegian Centre for Violence and Traumatic Stress Studies,Oslo,Norway
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17
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Svalgaard JD, Haastrup EK, Reckzeh K, Holst B, Glovinski PV, Gørløv JS, Hansen MB, Moench KT, Clausen C, Fischer-Nielsen A. Low-molecular-weight carbohydrate Pentaisomaltose may replace dimethyl sulfoxide as a safer cryoprotectant for cryopreservation of peripheral blood stem cells. Transfusion 2016; 56:1088-95. [PMID: 26991781 DOI: 10.1111/trf.13543] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cryopreserved hematopoietic stem cell products are widely used for certain hematologic malignancies. Dimethyl sulfoxide (DMSO) is the most widely used cryoprotective agent (CPA) today, but due to indications of cellular toxicity, changes of the cellular epigenetic state, and patient-related side effects, there is an increasing demand for DMSO-free alternatives. We therefore investigated whether Pentaisomaltose (PIM), a low-molecular-weight carbohydrate (1 kDa), can be used for cryopreservation of peripheral blood stem cells, more specifically hematopoietic progenitor cell apheresis (HPC(A)) product. STUDY DESIGN AND METHODS We cryopreserved patient or donor HPC(A) products using 10% DMSO or 16% PIM and quantified the recovery of CD34+ cells and CD34+ subpopulations by multicolor flow cytometry. In addition, we compared the frequency of HPCs after DMSO and PIM cryopreservation using the colony-forming cells (CFCs) assay. RESULTS The mean CD34+ cell recovery was 56.3 ± 23.7% (11.4%-97.3%) and 58.2 ± 10.0% (45.7%-76.9%) for 10% DMSO and 16% PIM, respectively. The distribution of CD34+ cell subpopulations was similar when comparing DMSO or PIM as CPA. CFC assay showed mean colony numbers of 70.7 ± 25.4 (range, 37.8-115.5) and 67.7 ± 15.7 (range, 48-86) for 10% DMSO and 16% PIM, respectively. CONCLUSION Our findings demonstrate that PIM cryopreservation of HPC(A) products provides recovery of CD34+ cells, CD34+ subpopulations, and CFCs similar to that of DMSO cryopreservation and therefore may have the potential to be used for cryopreservation of peripheral blood stem cells.
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Affiliation(s)
- Jesper Dyrendom Svalgaard
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Eva Kannik Haastrup
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kristian Reckzeh
- The Finsen Laboratory, Biotech Research and Innovation Centre and Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Viktor Glovinski
- Department of Plastic Surgery and Burns, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Morten Bagge Hansen
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Kim Theilgaard Moench
- The Finsen Laboratory, Biotech Research and Innovation Centre and Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Hematology, Skånes University Hospital, Lund, Sweden
| | | | - Anne Fischer-Nielsen
- Department of Clinical Immunology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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18
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Guldager DKR, von Stemann JH, Larsen R, Bay JT, Galle PS, Svenson M, Ullum H, Hansen MB. A rapid, accurate and robust particle-based assay for the simultaneous screening of plasma samples for the presence of five different anti-cytokine autoantibodies. J Immunol Methods 2015; 425:62-68. [DOI: 10.1016/j.jim.2015.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/15/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
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Tietze A, Hansen MB, Østergaard L, Jespersen SN, Sangill R, Lund TE, Geneser M, Hjelm M, Hansen B. Mean Diffusional Kurtosis in Patients with Glioma: Initial Results with a Fast Imaging Method in a Clinical Setting. AJNR Am J Neuroradiol 2015; 36:1472-8. [PMID: 25977481 DOI: 10.3174/ajnr.a4311] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/24/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Diffusional kurtosis imaging is an MR imaging technique that provides microstructural information in biologic systems. Its application in clinical studies, however, is hampered by long acquisition and postprocessing times. We evaluated a new and fast (2 minutes 46 seconds) diffusional kurtosis imaging method with regard to glioma grading, compared it with conventional diffusional kurtosis imaging, and compared the diagnostic accuracy of fast mean kurtosis (MK') to that of the widely used mean diffusivity. MATERIALS AND METHODS MK' and mean diffusivity were measured in the contrast-enhancing tumor core, the perifocal hyperintensity (indicated on T2 FLAIR images), and the contralateral normal-appearing white and gray matter of 34 patients (22 with high-grade and 12 with low-grade gliomas). MK' and mean diffusivity in the different tumor grades were compared by using a Wilcoxon rank sum test. Receiver operating characteristic curves and the areas under the curve were calculated to determine the diagnostic accuracy of MK' and mean diffusivity. RESULTS MK' in the tumor core, but not mean diffusivity, differentiated high-grade from low-grade gliomas, and MK' differentiated glioblastomas from the remaining gliomas with high accuracy (area under the curveMK' = 0.842; PMK' < .001). MK' and mean diffusivity identified glioblastomas in the group of high-grade gliomas with similar significance and accuracy (area under the curveMK' = 0.886; area under the curvemean diffusivity = 0.876; PMK' = .003; Pmean diffusivity = .004). The mean MK' in all tissue types was comparable to that obtained by conventional diffusional kurtosis imaging. CONCLUSIONS The diffusional kurtosis imaging approach used here is considerably faster than conventional diffusional kurtosis imaging methods but yields comparable results. It can be accommodated in clinical protocols and enables exploration of the role of MK' as a biomarker in determining glioma subtypes or response evaluation.
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Affiliation(s)
- A Tietze
- From the Department of Neuroradiology (A.T., L.Ø., M.G., M.H.), Aarhus University Hospital, Aarhus, Denmark Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
| | - M B Hansen
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
| | - L Østergaard
- From the Department of Neuroradiology (A.T., L.Ø., M.G., M.H.), Aarhus University Hospital, Aarhus, Denmark Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
| | - S N Jespersen
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.) Department of Physics and Astronomy (S.N.J.), Aarhus University, Aarhus, Denmark
| | - R Sangill
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
| | - T E Lund
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
| | - M Geneser
- From the Department of Neuroradiology (A.T., L.Ø., M.G., M.H.), Aarhus University Hospital, Aarhus, Denmark Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
| | - M Hjelm
- From the Department of Neuroradiology (A.T., L.Ø., M.G., M.H.), Aarhus University Hospital, Aarhus, Denmark
| | - B Hansen
- Center of Functionally Integrative Neuroscience and MINDLab, Institute of Clinical Medicine (A.T., M.B.H., L.Ø., S.N.J., R.S., T.E.L., M.G., B.H.)
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Harritshøj LH, Nielsen C, Ullum H, Hansen MB, Julian HO. Ready-made allogeneic ABO-specific serum eye drops: production from regular male blood donors, clinical routine, safety and efficacy. Acta Ophthalmol 2014; 92:783-6. [PMID: 24629028 DOI: 10.1111/aos.12386] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/08/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To overcome problems and delays of the preparation of autologous serum eye drops, a production line of ABO-specific allogeneic serum eye drops from male blood donors was set up in a blood bank. Feasibility, clinical routine, safety and efficacy were evaluated in a cohort of patients with severe ocular surface disorders. METHODS Serum was derived from 450 ml whole-blood donations from regular male blood donors, produced and tested according to good manufacturing practice and legislation regulating blood products in Denmark. Serum was diluted to 20% (v/v) with NaCl 0.9%, filtered, bottled, registered and stored at -30°C in the blood bank. Upon request, frozen ABO-identical serum drops in lots of 14 bottles could be provided immediately. Safety and efficacy were evaluated in 34 patients with severe ocular surface disease refractory to conventional medical therapy. Patients were treated six times daily for minimum 2-4 weeks. Objective findings and subjective symptoms were compared between day 0 and after 4 weeks of treatment using the Wilcoxon signed-rank test. RESULTS Clinically, no side-effects were observed. In total, 59% of the patients with ocular surface changes improved objectively (slit-lamp examination). Partial or full healing of corneal changes, as well as subjective relief of symptoms, was observed in 16 of 20 patients with keratoconjunctivitis sicca (p < 0.001). The 14 patients with persistent epithelial defect experienced neither objective nor subjective improvements during serum treatment. CONCLUSION Ready-made ABO-identical allogeneic serum eye drops were straightforwardly produced, quality-assured and registered as a safe standard blood product for the treatment of certain cases of severe dry eye disease. Therapeutic efficacy was comparable to previous reports on autologous serum drops.
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Affiliation(s)
- Lene Holm Harritshøj
- Department of Clinical Immunology; Blood Bank; Rigshospitalet; Copenhagen Denmark
| | - Connie Nielsen
- Department of Clinical Immunology; Blood Bank; Rigshospitalet; Copenhagen Denmark
| | - Henrik Ullum
- Department of Clinical Immunology; Blood Bank; Rigshospitalet; Copenhagen Denmark
| | - Morten Bagge Hansen
- Department of Clinical Immunology; Blood Bank; Rigshospitalet; Copenhagen Denmark
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21
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Paglia G, Sigurjónsson ÓE, Rolfsson Ó, Hansen MB, Brynjólfsson S, Gudmundsson S, Palsson BO. Metabolomic analysis of platelets during storage: a comparison between apheresis- and buffy coat-derived platelet concentrates. Transfusion 2014; 55:301-13. [PMID: 25156572 DOI: 10.1111/trf.12834] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Platelet concentrates (PCs) can be prepared using three methods: platelet (PLT)-rich plasma, apheresis, and buffy coat. The aim of this study was to obtain a comprehensive data set that describes metabolism of buffy coat-derived PLTs during storage and to compare it with a previously published parallel data set obtained for apheresis-derived PLTs. STUDY DESIGN AND METHODS During storage we measured more than 150 variables in 8 PLT units, prepared by the buffy coat method. Samples were collected at seven different time points resulting in a data set containing more than 8000 measurements. This data set was obtained by combining a series of standard quality control assays to monitor the quality of stored PLTs and a deep coverage metabolomics study using liquid chromatography coupled with mass spectrometry. RESULTS Stored PLTs showed a distinct metabolic transition occurring 4 days after their collection. The transition was evident in PLT produced by both production methods. Apheresis-derived PLTs showed a clearer phenotype of PLT activation during early days of storage. The activated phenotype of apheresis PLTs was accompanied by a higher metabolic activity, especially related to glycolysis and the tricarboxylic acid cycle. Moreover, the extent of the activation differed between bags resulting in interbag variability in the storage lesion of apheresis-prepared PLTs. This may be related to donor-related polymorphism. CONCLUSION This study demonstrated two discrete metabolic phenotypes in stored PLTs prepared with both apheresis and buffy coat methods. PLT activation occurs during the first metabolic phenotype and might lead to a low reproducibility of the apheresis PCs.
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Affiliation(s)
- Giuseppe Paglia
- Center for Systems Biology, University of Iceland, Reykjavik, Iceland
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22
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Paglia G, Sigurjónsson ÓE, Rolfsson Ó, Valgeirsdottir S, Hansen MB, Brynjólfsson S, Gudmundsson S, Palsson BO. Comprehensive metabolomic study of platelets reveals the expression of discrete metabolic phenotypes during storage. Transfusion 2014; 54:2911-23. [PMID: 24840017 DOI: 10.1111/trf.12710] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/22/2014] [Accepted: 02/25/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Platelet (PLT) concentrates are routinely stored for 5 to 7 days. During storage they exhibit what has been termed PLT storage lesion (PSL), which is evident by a loss of hemostatic function when transfused into patients. The overall goal of this study was to obtain a comprehensive data set describing PLT metabolism during storage. STUDY DESIGN AND METHODS The experimental approach adopted to achieve this goal combined a series of standard assays to monitor the quality of stored PLTs and a deep-coverage metabolomics study using liquid chromatography coupled with mass spectrometry performed on both the extracellular and the intracellular environments. During storage we measured 174 different variables in 6 PLT units, collected by apheresis. Samples were collected at eight different time points resulting in a data set containing more than 8000 measurements. RESULTS Stored PLTs did not undergo a monotonic decay, but experienced systematic changes in metabolism reflected in three discrete metabolic phenotypes: The first (Days 0-3) was associated with active glycolysis, pentose phosphate pathway, and glutathione metabolism and down regulation of tricarboxylic acid (TCA) cycle. The second (Days 4-6) was associated with a more active TCA cycle as well as increased purine metabolism. A third metabolic phenotype of less clinical relevance (Days 7-10) was associated with a faster decay of cellular metabolism. CONCLUSION PSL is not associated with a linear decay of metabolism, but rather with successive metabolic shifts. These findings may give new insight into the mechanisms underlying PSL and encourage the deployment of systems biology methods to PSL.
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Affiliation(s)
- Giuseppe Paglia
- Center for Systems Biology, University of Iceland, Reykjavik, Iceland
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23
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Braendstrup P, Mortensen BK, Justesen S, Østerby T, Rasmussen M, Hansen AM, Christiansen CB, Hansen MB, Nielsen M, Vindeløv L, Buus S, Stryhn A. Identification and HLA-tetramer-validation of human CD4+ and CD8+ T cell responses against HCMV proteins IE1 and IE2. PLoS One 2014; 9:e94892. [PMID: 24760079 PMCID: PMC3997423 DOI: 10.1371/journal.pone.0094892] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/20/2014] [Indexed: 01/26/2023] Open
Abstract
Human cytomegalovirus (HCMV) is an important human pathogen. It is a leading cause of congenital infection and a leading infectious threat to recipients of solid organ transplants as well as of allogeneic hematopoietic cell transplants. Moreover, it has recently been suggested that HCMV may promote tumor development. Both CD4+ and CD8+ T cell responses are important for long-term control of the virus, and adoptive transfer of HCMV-specific T cells has led to protection from reactivation and HCMV disease. Identification of HCMV-specific T cell epitopes has primarily focused on CD8+ T cell responses against the pp65 phosphoprotein. In this study, we have focused on CD4+ and CD8+ T cell responses against the immediate early 1 and 2 proteins (IE1 and IE2). Using overlapping peptides spanning the entire IE1 and IE2 sequences, peripheral blood mononuclear cells from 16 healthy, HLA-typed, donors were screened by ex vivo IFN-γ ELISpot and in vitro intracellular cytokine secretion assays. The specificities of CD4+ and CD8+ T cell responses were identified and validated by HLA class II and I tetramers, respectively. Eighty-one CD4+ and 44 CD8+ T cell responses were identified representing at least seven different CD4 epitopes and 14 CD8 epitopes restricted by seven and 11 different HLA class II and I molecules, respectively, in total covering 91 and 98% of the Caucasian population, respectively. Presented in the context of several different HLA class II molecules, two epitope areas in IE1 and IE2 were recognized in about half of the analyzed donors. These data may be used to design a versatile anti-HCMV vaccine and/or immunotherapy strategy.
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Affiliation(s)
- Peter Braendstrup
- Laboratory of Experimental Immunology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- The Allogeneic Hematopoietic Cell Transplantation Laboratory, Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bo Kok Mortensen
- Laboratory of Experimental Immunology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- The Allogeneic Hematopoietic Cell Transplantation Laboratory, Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sune Justesen
- Laboratory of Experimental Immunology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Østerby
- Laboratory of Experimental Immunology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Rasmussen
- Laboratory of Experimental Immunology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Martin Hansen
- Laboratory of Experimental Immunology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Bohn Christiansen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Nielsen
- Center for Biological Sequence Analysis, Department of Systems Biology, Technical University of Denmark, Lyngby, Denmark and Instituto de Investigaciones Biotecnológicas, Universidad de San Martín, San Martín, Buenos Aires, Argentina
| | - Lars Vindeløv
- The Allogeneic Hematopoietic Cell Transplantation Laboratory, Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren Buus
- Laboratory of Experimental Immunology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anette Stryhn
- Laboratory of Experimental Immunology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
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Koch J, Hau J, Pravsgaard Christensen J, Elvang Jensen H, Bagge Hansen M, Rieneck K. Immune cells from SR/CR mice induce the regression of established tumors in BALB/c and C57BL/6 mice. PLoS One 2013; 8:e59995. [PMID: 23555858 PMCID: PMC3605416 DOI: 10.1371/journal.pone.0059995] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 02/23/2013] [Indexed: 11/18/2022] Open
Abstract
Few experimental models are available for the study of natural resistance to cancer. One of them is the SR/CR (spontaneous regression/complete resistance) mouse model in which natural resistance to a variety of cancer types appeared to be inherited in SR/CR strains of BALB/c and C57BL/6 mice. The genetic, cellular, and molecular effector mechanisms in this model are largely unknown, but cells from the innate immune system may play a significant role. In contrast to previous observations, the cancer resistance was limited to S180 sarcoma cancer cells. We were unable to confirm previous observations of resistance to EL-4 lymphoma cells and J774A.1 monocyte-macrophage cancer cells. The cancer resistance against S180 sarcoma cells could be transferred to susceptible non-resistant BALB/c mice as well as C57BL/6 mice after depletion of both CD4+/CD8+ leukocytes and B-cells from SR/CR mice. In the responding recipient mice, the cancer disappeared gradually following infiltration of a large number of polymorphonuclear granulocytes and remarkably few lymphocytes in the remaining tumor tissues. This study confirmed that the in vivo growth and spread of cancer cells depend on a complex interplay between the cancer cells and the host organism. Here, hereditary components of the immune system, most likely the innate part, played a crucial role in this interplay and lead to resistance to a single experimental cancer type. The fact that leukocytes depleted of both CD4+/CD8+ and B cells from the cancer resistant donor mice could be transferred to inhibit S180 cancer cell growth in susceptible recipient mice support the vision of an efficient and adverse event free immunotherapy in future selected cancer types.
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Affiliation(s)
- Janne Koch
- Department of Experimental Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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25
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Rohof WO, Lei A, Hirsch DP, Ny L, Astrand M, Hansen MB, Boeckxstaens GE. The effects of a novel metabotropic glutamate receptor 5 antagonist (AZD2066) on transient lower oesophageal sphincter relaxations and reflux episodes in healthy volunteers. Aliment Pharmacol Ther 2012; 35:1231-42. [PMID: 22469098 DOI: 10.1111/j.1365-2036.2012.05081.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 08/03/2011] [Accepted: 03/10/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND Selective metabotropic glutamate receptor 5 (mGluR5) antagonists inhibit transient lower oesophageal sphincter relaxations (TLESRs) in animals and acid reflux in humans. AIM To assess the effect of single doses of the mGluR5 antagonist AZD2066 on TLESRs and reflux in humans. METHODS Healthy male volunteers received AZD2066 13 mg and placebo (part A), or AZD2066 2 mg and AZD2066 6 mg and placebo (part B), in a randomised crossover study. Postprandial manometry/pH-impedance measurements were taken after each dose. RESULTS A total of 13 individuals completed part A of the study and 19 individuals completed part B. There was a significant reduction in the geometric mean number of TLESRs (27%; P = 0.02) and the geometric mean number of reflux episodes (51%; P = 0.01) in subjects receiving AZD2066 13 mg compared with placebo. Adverse events in participants receiving AZD2066 13 mg were mostly related to the nervous system [dizziness (3/13); disturbance in attention (3/13)]. Adverse events were reversible and of mild intensity. There were no serious adverse events. The effects of AZD2066 appeared dose-dependent, with smaller reductions in TLESRs and reflux episodes (relative to placebo) and fewer adverse events observed for AZD2066 2 mg and AZD2066 6 mg compared with AZD2066 13 mg. CONCLUSION The mGluR5-mediated inhibition of TLESRs may be a useful approach for inhibiting gastro-oesophageal reflux.
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Affiliation(s)
- W O Rohof
- Academic Medical Center, Amsterdam, The Netherlands
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26
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Sørensen E, Grau K, Berg T, Simonsen AC, Magnussen K, Erikstrup C, Hansen MB, Ullum H. A genetic risk factor for low serum ferritin levels in Danish blood donors. Transfusion 2012; 52:2585-9. [PMID: 22486183 DOI: 10.1111/j.1537-2995.2012.03629.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Iron deficiency is a frequent side effect of blood donation. In recent years, several studies have described genetic variants associated with iron concentrations. However, the impact of these variants on iron levels is unknown in blood donors. Knowledge of genetic variants that predispose donors to iron deficiency would allow bleeding frequency and iron supplementation to be tailored to the individual donor. STUDY DESIGN AND METHODS The genotypes of five specific single-nucleotide polymorphisms (SNPs) in three genes that have been previously associated with iron status and/or restless leg syndrome (RLS) were investigated in two groups of female blood donors. The first group had low iron stores (serum ferritin ≤ 12 µg/L, n = 657), and the second group had normal to high iron stores (serum ferritin > 30 µg/L, n = 645). Genotype distribution for each of the SNPs was compared between the two groups. RESULTS Homozygosity for the T-allele of BTBD9 rs9296249 was associated with lower serum ferritin. The odds ratio for low serum ferritin was 1.35 (95% confidence interval, 1.02-1.77; p = 0.03) when comparing donors with the TT genotype with donors with the CT genotype. CONCLUSION A frequent polymorphism in BTBD9 was significantly associated with serum ferritin. This polymorphism has previously been associated with RLS, but not low iron stores in blood donors.
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Affiliation(s)
- Erik Sørensen
- Department of Clinical Immunology, Capital Region, Copenhagen University Hospital, Denmark.
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Abstract
AIMS/HYPOTHESIS To study the distribution of causes of death in the Danish population, and its variation by diabetes status, sex, age and calendar year as well as the years of life lost from the specific causes of death. METHODS Persons aged 30-98 years were followed from 1995 to 2008 by linkage of Danish registers. Poisson regression was used to model cause-specific mortality rates by age and calendar time for each specific cause of death, according to sex and diabetes status. The mortality rates were also modelled as a function of age and birth cohort. We computed the distribution of causes of death and years of life lost from specific causes of death due to diabetes. RESULTS During the 14-year study period, patients with diabetes contributed 2.3 million person-years of follow-up and 124,210 deaths, whereas persons without diabetes contributed 45.1 million person-years and 648,020 deaths. The mortality was higher among individuals with diabetes, and the mortality ratio (diabetes vs no diabetes) decreased with age and for all causes and cardiovascular diseases also by calendar time. The effect of sex on the association between diabetes and mortality varied with age and cause of death. About 9 years of life were lost to diabetes at age 30 years, and 3 years at age 70 years. CONCLUSIONS/INTERPRETATION Age-specific mortality is higher among people with diabetes, and rate ratios vary with age, sex, calendar period and cause of death. The distribution of causes of death was similar for persons with and without diabetes.
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Affiliation(s)
- M B Hansen
- Steno Diabetes Center A/S, Niels Steensens Vej 2, DK-2820 Gentofte, Denmark
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Lundin P, Karpefors M, Carlsson K, Hansen MB, Ruth M. Bioimpedance spectroscopy: a new tool to assess early esophageal changes linked to gastroesophageal reflux disease? Dis Esophagus 2011; 24:462-9. [PMID: 21385284 DOI: 10.1111/j.1442-2050.2011.01181.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bioimpedance spectroscopy can identify pathological changes related to precancerous lesions of the cervix uteri and esophagus. It therefore has the potential to detect early reflux-related changes in the esophageal mucosa, such as dilated intercellular spaces. The reliable detection of dilated intercellular spaces at the time of endoscopy would yield a significant diagnostic advantage for separating patients with functional heartburn from the large proportion of patients with gastroesophageal reflux symptoms but no macroscopic esophagitis or pathological acid exposure. The bioimpedance of the esophageal mucosa, measured with a small caliber probe, was evaluated in a series of preclinical experiments. First, sections of rabbit esophageal epithelium were mounted in Ussing chambers and exposed to solutions at pH 7.4 or pH 1.5 for 45 minutes. Impedance measurements were taken at varying probe pressures. Second, rabbit esophageal epithelia were perfused for 45 minutes in situ with pH 1.1 or control solutions and impedance measurements taken. Samples from both in vitro and in situ experiments were taken for morphological examination by light microscopy. Finally, esophageal bioimpedance was measured in awake dogs with permanent esophagocutaneous stoma. The in situ experiments demonstrated that morphological changes in the esophageal mucosa could be discerned by the use of bioimpedance spectroscopy. The variability in resistivity was species-independent but was affected by the pressure applied to the probe. The results suggest that evaluation of bioimpedance spectroscopy for use in a clinical setting is warranted. Small morphological differences in the esophageal mucosa may be detected by the use of bioimpedance spectroscopy.
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Affiliation(s)
- P Lundin
- AstraZeneca Research & Development, Early Clinical Development, Mölndal, Sweden.
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Krarup AL, Ny L, Astrand M, Bajor A, Hvid-Jensen F, Hansen MB, Simrén M, Funch-Jensen P, Drewes AM. Randomised clinical trial: the efficacy of a transient receptor potential vanilloid 1 antagonist AZD1386 in human oesophageal pain. Aliment Pharmacol Ther 2011; 33:1113-22. [PMID: 21410733 DOI: 10.1111/j.1365-2036.2011.04629.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many patients with gastro-oesophageal reflux disease (GERD) are hypersensitive to heat and acid and may respond insufficiently to standard treatment. Antagonists of the heat and acid receptor 'transient receptor potential vanilloid 1'(TRPV1) are a potential drug class for GERD treatment. AIM To investigate the effect of a TRPV1 antagonist (AZD1386) on experimentally induced oesophageal pain. METHODS Twenty-two healthy men (20-31 years) participated in this randomised, placebo-controlled, double-blinded, crossover study examining the effects of a single-dose oral AZD1386 (30 and 95 mg). Subjects were block-randomised. On treatment days, participants were stimulated with painful heat, distension, electrical current and acid in the oesophagus. Heat and pressure pain on the forearm were somatic control stimuli. DATA ANALYSIS intention-to-treat. RESULTS A total of 21 participants completed the protocol and 1 voluntarily discontinued. In the oesophagus, both 30 and 95 mg of AZD1386 increased pain thresholds to heat stimuli 23% [95% confidence interval (CI): 10-38%] and 28%, respectively (CI: 14-43%). The skin heat tolerance was increased 2.1 °C (CI: 1.1-3.2 °C) after 30 mg AZD1386 and 4.0 °C (CI: 3.0-5.0 °C) after 95 mg. Heat analgesia persisted for 2.5 h. Pain thresholds to the other stimuli were unaffected by AZD1386. 50% reported 'feeling cold' and body temperature increased in all subjects exposed to 30 and 95 mg AZD1386 (mean increase 0.4±0.3 °C and 0.7±0.3 °C, respectively, P<0.05). CONCLUSIONS AZD1386 increased oesophageal and skin heat pain thresholds and had a safe adverse-event profile. This drug class may have a potential for treatment of GERD.
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Affiliation(s)
- A L Krarup
- Mech-Sense, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
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de Lemos Rieper C, Galle P, Pedersen BK, Hansen MB. Characterization of specific antibodies against cytomegalovirus (CMV)-encoded interleukin 10 produced by 28% of CMV-seropositive blood donors. J Gen Virol 2011; 92:1508-1518. [PMID: 21402594 DOI: 10.1099/vir.0.028738-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Cytomegalovirus (CMV) has evolved multiple immunological evasion strategies, including the encoding of viral interleukin (IL)-10 homologues (cmvIL-10). In this study, cmvIL-10 bound avidly to the same receptors on blood mononuclear cells and was as bio-potent as native human IL-10. Seventeen percent of plasma samples from 3200 Danish blood donors (corresponding to 28 % of the anti-CMV IgG-positive donors) contained substantial levels of anti-cmvIL-10 IgG antibodies, as measured by a radioimmunoassay for human anti-cmvIL-10 antibodies. The antibodies neither cross-reacted with native human IL-10 nor with Epstein-Barr virus-encoded IL-10. Anti-cmvIL-10 antibodies potently inhibited the binding of cmvIL-10 to cellular receptors, and they specifically inhibited cmvIL-10-induced JAK-STAT signalling. Ultimately, anti-cmvIL-10 antibodies blocked the inhibitory effect of cmvIL-10 on lipopolysaccharide-induced tumour necrosis factor alpha and IL-1β from blood mononuclear cells. Taken together, our data signify that cmvIL-10 has been produced during CMV infection, and that anti-cmvIL-10 IgG antibodies represent an effective immunological counter reaction against cmvIL-10.
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Affiliation(s)
- Carina de Lemos Rieper
- The Centre of Inflammation and Metabolism, Department of Infectious Diseases and CMRC, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Immunology, Rigshospitalet, National University Hospital, Copenhagen, Denmark
| | - Pia Galle
- The Centre of Inflammation and Metabolism, Department of Infectious Diseases and CMRC, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- The Centre of Inflammation and Metabolism, Department of Infectious Diseases and CMRC, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Rigshospitalet, National University Hospital, Copenhagen, Denmark
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Abstract
AIM Retrospectively, to investigate the relationship between body mass index (BMI) and basal electrogenic transport as measured by short-circuit current (SCC) in human duodenal and colonic mucosal biopsies. METHODS The study included biopsies from mucosa of normal appearance in the sigmoid colon and/or distal duodenum. Patients were referred for routine endoscopy (predominantly for monosymptomatic abdominal pain) and had normal endoscopic findings. Biopsies were mounted in miniaturized Ussing chambers and basal SCC was recorded. Patients were divided into two groups on the basis of BMI (≤25 and >25 kg m⁻²). Statistical significance was assessed by the unpaired t-test or Wilcoxon rank-sum test. Correlation coefficients were calculated by Pearson product moment correlation. RESULTS In colonic biopsies, basal SCC (mean ± standard deviation) was significantly higher in 59 biopsies from 30 patients with low BMI than in 32 biopsies from 23 patients with high BMI (45 ± 29 μA cm⁻² vs. 27 ± 21 μA cm⁻², P = 0.016). In duodenal biopsies, mean basal SCC was numerically lower in 38 biopsies from 15 patients with low BMI than in 46 biopsies from 19 patients with high BMI (54 ± 26 μA cm⁻² vs. 74 ± 39 μA cm⁻², P = 0.069). The correlation coefficient between BMI and SCC was -0.26 (P = 0.06) in colonic biopsies and +0.44 (P = 0.001) in duodenal biopsies. CONCLUSION Basal intestinal active electrogenic transport is related to BMI and this relationship may differ in different segments of the intestinal tract.
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Affiliation(s)
- P S Osbak
- Department of Surgery K, Bispebjerg Hospital, University of Copenhagen, Denmark.
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Hansen MB. [Stem cells--belief, hope and knowledge]. Ugeskr Laeger 2010; 172:2593. [PMID: 20920400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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de Lemos Rieper C, Galle P, Svenson M, Pedersen BK, Hansen MB. Preparation and validation of radio iodinated recombinant human IL-10 for the measurement of natural human antibodies against IL-10. J Immunol Methods 2009; 350:46-53. [DOI: 10.1016/j.jim.2009.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/30/2009] [Accepted: 07/15/2009] [Indexed: 10/20/2022]
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de Lemos Rieper C, Galle P, Hansen MB. Characterization and potential clinical applications of autoantibodies against cytokines. Cytokine Growth Factor Rev 2009; 20:61-75. [DOI: 10.1016/j.cytogfr.2009.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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35
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Abstract
OBJECTIVE Serotonin is a vasoactive neuroendocrine substance and serotonergic drugs are promising agents for the treatment of functional gastrointestinal disorders. The effect of serotonin on superior mesenteric blood flow in humans is unknown. The aim of this study was to examine the effect of exogenous serotonin on superior mesenteric artery blood flow, as estimated by the resistance index with Doppler ultrasound, in healthy human volunteers. MATERIAL AND METHODS Six fasting healthy adult volunteers of both genders were studied. Transabdominal Doppler ultrasound was used to evaluate the effects of either a standard meal or intravenous infusion of serotonin (2.5-20 nmol kg-1 min-1) on the superior mesenteric artery resistance index, platelet-depleted plasma levels of serotonin, blood pressure, heart rate and electrocardiogram. RESULTS All subjects had the same patterns of response to meal and serotonin stimulation. Meal stimulation decreased the mean resistance index from 0.84+/-0.04 to 0.72+/-0.02 (p = 0.0004) and increased platelet-depleted-plasma levels of serotonin from 50+/-36 to 61+/-46 nmol L-1 (p = 0.04). Serotonin stimulation increased the mean resistance index from 0.82+/-0.04 to 0.88+/-0.03 (p = 0.006) and mean platelet-depleted-plasma levels of serotonin from 44+/-24 to 83+/-37 nmol L-1 (p = 0.03). Most subjects reported minor short-lived adverse effects. Electrocardiogram results were unchanged during all examinations. CONCLUSIONS We conclude that intravenous infusion of serotonin increases the resistance index of the superior mesenteric artery (increases downstream resistance) in healthy adult volunteers.
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Affiliation(s)
- M B Hansen
- Department of Gastrointestinal Surgery, Glostrup University Hospital of Copenhagen, DK-2600 Glostrup, Denmark.
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36
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Abstract
The physiological significance of serotonin released into the intestinal lumen for the regulation of motility is unknown in humans. The aim of this study was to evaluate the effect of serotonin infused into the lumen of the gastric antrum, duodenum or the jejunum, on antro-duodeno-jejunal contractility in healthy human volunteers. Manometric recordings were obtained and the effects of either a standard meal, continuous intravenous infusion of serotonin (20 nmol/kg/min) or intraluminal bolus infusions of graded doses of serotonin (2.5, 25 or 250 nmol) were compared. In addition, platelet-depleted plasma levels of serotonin, blood pressure, heart rate and electrocardiogram were evaluated. All subjects showed similar results. Intravenous serotonin increased migrating motor complex phase III frequency 3-fold and migrating velocity 2-fold. Intraluminal infusion of serotonin did not change contractile activity. Platelet-depleted-plasma levels of serotonin increased 2-fold following both intravenous and high doses of intraluminal infusions of serotonin. All subjects reported minor short-lived adverse effects following intravenous serotonin stimulation, while only half of the subjects reported minor short-lived adverse effects following intraluminal serotonin stimulations. We conclude that exogenous serotonin in the lumen of the upper part of the small intestine does not seem to change antro-duodeno-jejunal contractility significantly in healthy adult volunteers.
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Affiliation(s)
- M B Hansen
- Department of Gastrointestinal Surgery D, Glostrup University Hospital of Copenhagen, Glostrup, Denmark.
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Hansen MB, Galle P, Salomo M, Svenson M, Dickmeiss E, Gimsing P. Transfusion-related inhibition of cytokines (TRICK). Experimental transfer of neutralizing autoantibodies to interleukin-6 by plasma transfusions. Vox Sang 2007; 92:213-23. [PMID: 17348870 DOI: 10.1111/j.1423-0410.2006.00881.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND For some unknown reason humans may 'spontaneously' produce high amounts of neutralizing autoantibodies to a number of growth factors and cytokines. Reaching a certain high level the antibodies render the person cytokine deficient, mostly without overt clinical manifestations. The autoantibodies in question are detectable in normal immunoglobulin preparations and correspondingly in normal human plasma for transfusion. High affinity neutralizing autoantibodies to interleukin-6 (aAb-IL-6) are present in high titres in 0.1% of plasma from blood donors. Using aAb-IL-6 as a model we here report the first study addressing transfer of cytokine autoantibodies with blood components. MATERIALS AND METHODS We transferred high amounts of aAb-IL-6 to two patients suffering from end-stage disease of multiple myeloma. This was done by serial transfusions with normal human plasma highly positive for aAb-IL-6. We assessed recovery and kinetics of the transferred aAb-IL-6 and exposed how the recipients' plasma IL-6 bound to aAb-IL-6. RESULTS Free IL-6 was detectable in plasma of the recipients before transfusion. After the first transfusion IL-6 became immune complexed to aAb-IL-6 the molar plasma concentrations of which exceeded total IL-6 at least 500 times. CONCLUSION The observations signify that high amounts of neutralizing autoantibodies to cytokines (in this context aAb-IL-6) are occasionally transferred by transfusion. Although neither beneficial nor obvious detrimental effects of the plasmas were observed in this study our measurements evidently uncover a hitherto unknown form of transfusion-related immune modulation: transfusion-related inhibition of cytokines (TRICK). Depending on the cytokine autoantibody in question, the phenomenon might affect immune responses to infection and recovery after stem cell transplantation.
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Affiliation(s)
- M B Hansen
- Department of Clinical Immunology, Righospitalet, National University Hospital, Blegdamsvej 9, DK-2100 Ø Copenhagen, Denmark.
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Affiliation(s)
- J Lykke
- Department of Gastrointestinal Surgery K, Bispebjerg University Hospital, Copenhagen, Denmark.
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Abstract
AIM Assessment of functional EP receptor subtypes involved in PGE2-induced secretion in human duodenum. The spectrum of activities by PGE2 in mammals, including cytoprotective bicarbonate secretion in duodenum, is mediated through four G protein-coupled receptor subtypes (EP1-EP4). METHODS Biopsies from the second part of duodenum from patients undergoing endoscopy were mounted in modified Ussing chambers. Basal and stimulated short circuit current (SCC) and slope conductance (SG) were measured. Dose-response relations for PGE2 and subtype receptors EP1/EP3 (sulprostone), EP2 (butaprost), and EP4 (1-OH PGE1) were assessed by cumulated doses of single agonists. RESULTS PGE2 caused a dose-dependent increase in SCC, maximum 101 +/- 20 microA cm(-2) with an EC50 of 35.6 +/- 5.8 nm (n = 3). Likewise 1-OH PGE1 caused a dose-dependent SCC increase, maximum 63.3 +/- 28.6 microA cm(-2) with an EC50 of 56.7 +/- 7.2 nm (n = 3). 1-OH PGE1 at 500 nm increased SCC by 18.0 +/- 3.0 microA cm(-2) (n = 10) and SG by 2.9 +/- 0.4 mS cm(-2) (n = 6). Sulprostone (n = 6) and butaprost (n = 6) had no effects on SCC or SG. SCC was inhibited 31.4 +/- 13.2% (n = 10) by bumetanide (25 microM serosa) and 18.6 +/- 5.8% (n = 10) by acetazolamide (250 microM lumen). Diphenylamine-2-carboxylate (DPC) (250 microM mucosa) and SITS (10 microM mucosa) had almost no effect. CONCLUSIONS Effects of PGE2 on secretion in the second part of human duodenum is mediated through the EP4 receptor and not through EP1, EP2, or EP3.
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Affiliation(s)
- R Larsen
- Department of Medicine M, Division of Gastroenterology, Glostrup University Hospital of Copenhagen, Copenhagen, Denmark.
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40
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Abstract
BACKGROUND AND OBJECTIVES We identified some fatal cases where massively bleeding patients received inadequate transfusion therapy. The aim of this study was to review and evaluate the transfusion practice in acutely multitransfused patients. MATERIALS AND METHODS Patients receiving > 10 units of red blood cells (RBC) within 24 h of admission and 30 blood components within 7 days of admission were reviewed. RESULTS Thirty-nine patients were identified, 13 of whom were inadequately transfused (IT) and had a higher mortality (12/13) than adequately transfused (AT) patients 13/26 (P = 0.013). Ten of 13 IT patients developed a microvascular bleed compared to four of 26 in the AT group (P = 0.001) and had a lower platelet count upon arrival at the intensive care unit (40 x 10(9)/l vs. 80 x 10(9)/l, P = 0.024). CONCLUSIONS An early balanced transfusion therapy is vital in massively bleeding patients, and a pro-active approach from the blood bank is warranted. We have introduced an acute transfusion package (ATP) consisting of 5 RBC, 5 FFP and 2 PC units, indicated in massively bleeding patients, securing a balanced transfusion therapy.
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Affiliation(s)
- P I Johansson
- Department of Clinical Immunology, University Hospital of Copenhagen, Copenhagen, Denmark.
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Abstract
AIM Acetylcholine (ACh) stimulates ion secretion in the small intestine and colon. The purpose of the present study was to characterize the ACh-induced electrogenic ion transport in human duodenum and determine the muscarinic receptor subtypes functionally involved. METHODS Biopsies from the second part of duodenum were obtained from 28 patients during endoscopy. Biopsies were mounted in modified Ussing chambers with air-suction for measurements of short-circuit current by a previously validated technique. Short-circuit current was measured after application of chloride/bicarbonate transport inhibitors bumetanide, 4-acetamido-4'-isothiocyanostilbene-2,2'-disulfonic acid (SITS), diphenylamine-2-carboxylate (DPC), and acetazolamide. 4-diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP) and two mamba toxins MT3 and MT7 were used to characterize the mAChR receptor subtypes involved. The effects of transport inhibitors and receptor antagonists were measured by comparing two consecutive responses of ACh on short-circuit current in the same biopsy specimen. RESULTS Bumetanide and 4-DAMP significantly inhibited ACh-induced short-circuit current, whereas SITS, DPC, acetazolamide, mamba toxin MT3, and mamba toxin MT7 all failed to show any significant effect. CONCLUSION In conclusion, our results indicate that muscarinic receptor subtype M3 acts as the main mediator of bumetanide-sensitive ACh-induced secretion in human duodenum.
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Affiliation(s)
- R Larsen
- Department of Medicine M, Division of Gastroenterology, University Hospital of Glostrup, Glostrup, Denmark
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Gudbrandsdottir S, Larsen R, Sørensen LK, Nielsen S, Hansen MB, Svenson M, Bendtzen K, Müller K. TNF and LT binding capacities in the plasma of arthritis patients: effect of etanercept treatment in juvenile idiopathic arthritis. Clin Exp Rheumatol 2004; 22:118-24. [PMID: 15005015] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Etanercept (Enbrel) induces a rapid and sustained decline in disease activity in the majority of patients with refractory juvenile idiopathic arthritis (JIA). For unknown reasons, however, a number of JIA patients fail to respond to this therapy. During this treatment neutralisation of tumour necrosis factor (TNF, previously termed TNF alpha) and lymphotoxin (LT, previously termed TNF beta) may be mediated by etanercept itself as well as by naturally occurring soluble TNF receptors. In light of this, it was of interest to study the total TNF neutralizing capacity in plasma before and during treatment with etanercept. RESULTS In initial experiments plasma samples from healthy individuals were incubated with etanercept, and spiked with TNF or LT to a final concentration of 1000 pg/mL. Detection of TNF and LT by ELISA was found to be reduced by approximately 50% and 80% respectively, at a concentration of etanercept of 5-500 ng/mL, which is close to the pharmacological plasma concentrations. Plasma samples (n = 80) were then collected from 12 JIA patients (5 with pauciarticular, 5 with polyarticular and 2 with the systemic onset type) during treatment with etanercept (0.4 mg/kg twice weekly) for a period of 20.8 (15.6-23.9) months (median, range). The plasma samples were spiked with LT, and the inhibition of LT detection in ELISA was measured. In samples obtained 3 months after the start of etanercept, the inhibition of LT detection was augmented [72% (60-85)] compared with pre-treatment samples [16% (0.32)] (p = 0.0039). These findings were confirmed in binding assays using radiolabelled TNF. Among patients who responded insufficiently to therapy, reduced LT binding capacity, coinciding with flares of disease activity, was observed. CONCLUSION We have developed an assay by which LT binding capacity, reflecting the level of free, pharmacologically active etanercept, may be monitored in the blood of patients treated with etanercept. This assay may prove to be useful in guiding dose adjustments in patients with an incomplete response to etanercept.
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Affiliation(s)
- S Gudbrandsdottir
- Paediatric Department, Institute of Inflammation Research, Rigshospitalet, Copenhagen, Denmark
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Hansen MB. Neurohumoral control of gastrointestinal motility. Physiol Res 2003; 52:1-30. [PMID: 12625803] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Neurohumoral substances and their receptors play a major part in the complex regulation of gastrointestinal motility and have therefore been the predominant targets for drug development. The numerous receptors involved in motility are located mainly on smooth muscle cells and neuronal structures in the extrinsic and intrinsic parts of the enteric nervous system. Within this system, receptor agonists and antagonists interacts directly to modify excitatory or inhibitory signals. In view of this complexity it is not surprising that our knowledge about the mechanisms of actions of the various neurohormones and drugs affecting gut motility has been rather fragmented and incomplete. However, recently substantial progress has been achieved, and drug therapy for gut dysmotility is emerging, based primarily on neurohumoral receptors. This paper presents a selective review of the neurohumoral regulatory mechanisms of gastrointestinal motility. In this context, the physiology and pharmacology of the smooth muscle cells, gastrointestinal motility and dysmotility, the enteric nervous system, gastrointestinal reflexes, and serotonin is presented. Further investigation and understanding of the transmitters and receptors involved in especially the reflex activation of peristalsis is crucial for the development of novel therapies for motility disorders.
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Affiliation(s)
- M B Hansen
- Department of Surgical Gastroenterology K, Bispebjerg University Hospital of Copenhagen, NV, Denmark.
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Abstract
Most studies investigating chromium allergy have been performed with Cr(VI). However, real exposure to chromium from leather products includes both Cr(III) and Cr(VI). We have determined and compared the minimum elicitation threshold (MET) concentration for Cr(III) and Cr(VI) in Cr(VI)-sensitive patients. In addition, reactions to combinations of Cr(III) and Cr(VI) were compared to reactions elicited by Cr(III) and Cr(VI) alone. Dilution series of Cr(III) and Cr(VI) were applied in Finn Chambers on the back of 18 patients. The patches were left for 2 days and readings were done on days 2, 3 and 7. The MET10% for Cr(III) and Cr(VI) was calculated from the dose-response curves to be 0.18 microg/cm2/48 h (6 p.p.m.) and 0.03 microg/cm2/48 h (1 p.p.m.), respectively. No significant differences in the response to combined Cr(III) and Cr(VI) solutions versus single solutions were found. Cr(III) was concluded to play an important role in chromium allergy, because Cr(III) and Cr(VI) were both capable of eliciting eczema at low concentrations. Rather than regarding chromium dermatitis as a result of Cr(VI) allergy alone, it may be more correct to consider it as a result of a combined Cr(III) and Cr(VI) allergy.
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Affiliation(s)
- M B Hansen
- The National Allergy Research Centre for Consumer Products, University of Copenhagen, Gentofte Hospital, Ledreborg Allé 40, 2820 Gentofte, Denmark
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Hansen MB. Small intestinal manometry. Physiol Res 2003; 51:541-56. [PMID: 12613464] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Gastrointestinal motility is an integrated process including myoelectrical and contractile activity, tone, compliance and transit. The techniques for the assessment of gastrointestinal motility are multiple and all have their advantages and disadvantages. In the case of suspected abnormal upper gut transit, gastric and small bowel transit scintigraphy followed by small intestinal (antroduodenojejunalileal) manometry is recommended. Small bowel manometry can identify patterns suggestive of myopathy, neuropathy or obstruction. Information on procedures, indications, significance, pitfalls and guidelines for small bowel manometry is provided in this paper. In this context the potentials of small intestinal manometry for scientific experimental study of neurohumoral agents, such as serotonin receptor agonists and antagonists, on small intestinal motility is presented.
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Affiliation(s)
- M B Hansen
- Department of Surgical Gastroenterology D, Glostrup University Hospital of Copenhagen, Copenhagen, Denmark.
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46
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Affiliation(s)
- F K Knop
- Dept. of Gastrointestinal Surgery K, H:S Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
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47
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Hansen MB, Lillevang ST, Møller BK, Varming K, Svejgaard A. [Clinical immunology 2002. The Danish Society of Clinical Immunology]. Ugeskr Laeger 2003; 165:1241. [PMID: 12701291] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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48
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Pignatti P, Ciapponi L, Galle P, Hansen MB, Massa M, Meazza C, Paonessa G, Novick D, Ciliberto G, Martini A, De Benedetti F. High circulating levels of biologically inactive IL-6/SIL-6 receptor complexes in systemic juvenile idiopathic arthritis: evidence for serum factors interfering with the binding to gp130. Clin Exp Immunol 2003; 131:355-63. [PMID: 12562400 PMCID: PMC1808632 DOI: 10.1046/j.1365-2249.2003.02052.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We previously demonstrated that high levels of IL-6/sIL-6R complexes are present in sera of patients with systemic juvenile idiopathic arthritis (s-JIA) and that the amount of IL-6 estimated in the IL-6/sIL-6R complexes is markedly higher than that measured by the B9 assay. Here, we show that two additional bioassays, employing human myeloma XG-1 cells and human hepatoma Hep3B cells, detected serum IL-6 levels similar to those measured by the B9 assay and approximately 10-fold lower than the IL-6 levels estimated to be present in the IL-6/sIL-6R complex. Using an assay for the measurement of the amount of circulating IL-6 complexed with the sIL-6R and available for binding to gp130 (gp130 binding activity), we show that the IL-6/gp130 binding activity is similar to that detected by the bioassays and again significantly lower than that estimated to be present in the IL-6/sIL-6R complex. Addition of recombinant human IL-6 (rhIL-6) to sera of patients or controls results in a markedly lower increase in the gp130 binding activity in patients than in controls. Moreover, sera from s-JIA patients inhibited in a dose dependent manner the gp130 binding activity assay. These results show that sera from patients with s-JIA contain a factor, or factors, that inhibit(s) the binding of the IL-6/sIL-6R complex to gp130. This inhibitory activity does not appear to be due to soluble gp130, C-reactive protein or autoantibodies to IL-6.
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Affiliation(s)
- P Pignatti
- Paediatria Generale e Reumatologia, IRCCS Policlinico San Matteo, Pavia, Italy
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Gisselø CG, Roer O, Hoffmann MH, Hansen MB, Taaning E, Johnsen HE. Assessing agreement between CD34 enumeration by flow cytometry and volumetric analysis. Bone Marrow Transplant 2002; 29:699-703. [PMID: 12180116 DOI: 10.1038/sj.bmt.1703514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prior to replacement of an established method for CD34 enumeration by an alternative approach, evaluation of the agreement between the methods is essential. In this study, the comparison of two assays was evaluated according to the recommendation of Bland and Altman describing the agreement between two methods where the true value is not known. CD34 enumeration was performed on blood or leukapheresis product from 105 patients by flow cytometry (dual platform assay) and volumetric analysis (single platform assay). Both the flow cytometric and the volumetric analysis showed poor reproducibility for measures lower than approximately 9 CD34+ cells/mm3. For values higher than 29 CD34+ cells/mm3, evaluation of the agreement demonstrated a difference between the single and dual platform assay, where CD34 enumeration by the volumetric analysis demonstrated values 73-80% of the flow cytometric value. The difference between the two assays could be due to several technical pitfalls which are discussed.
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Affiliation(s)
- C G Gisselø
- Stem Cell Laboratory, Department of Haematology, Herlev Hospital, University of Copenhagen, DK-2730 Herlev, Denmark
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Abstract
Sotos syndrome, also known as cerebral gigantism, is a rare growth disorder first described by Sotos and colleagues in 1964. Since then, a majority of the literature pertaining to Sotos syndrome has focussed on the medical aspects of the syndrome, while neuropsychiatric issues have been given little attention. The present article presents a review of the current knowledge concerning neuropsychiatric aspects of Sotos syndrome. Information is provided relating to physical appearance, intellectual impairment, learning disabilities, language impairments, behavioural disorders and outcome. It is emphasised that careful delineation of neuropsychiatric aspects within a diagnostic syndrome may turn out to be the first step towards molecular characterisation of behaviour.
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Affiliation(s)
- S E Mouridsen
- Department of Child and Adolescent Psychiatry, Bispebjerg Hospital, Copenhagen, Denmark
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