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Miller G, Ankerst DP, Kattan MW, Hüser N, Stocker F, Vogelaar S, van Bruchem M, Assfalg V. Pancreas Transplantation Outcome Predictions-PTOP: A Risk Prediction Tool for Pancreas and Pancreas-Kidney Transplants Based on a European Cohort. Transplant Direct 2024; 10:e1632. [PMID: 38757051 PMCID: PMC11098189 DOI: 10.1097/txd.0000000000001632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/18/2024] Open
Abstract
Background For patients with complicated type 1 diabetes having, for example, hypoglycemia unawareness and end-stage renal disease because of diabetic nephropathy, combined pancreas and kidney transplantation (PKT) is the therapy of choice. However, the shortage of available grafts and complex impact of risk factors call for individualized, impartial predictions of PKT and pancreas transplantation (PT) outcomes to support physicians in graft acceptance decisions. Methods Based on a large European cohort with 3060 PKT and PT performed between 2006 and 2021, the 3 primary patient outcomes time to patient mortality, pancreas graft loss, and kidney graft loss were visualized using Kaplan-Meier survival curves. Multivariable Cox proportional hazards models were developed for 5- and 10-y prediction of outcomes based on 26 risk factors. Results Risk factors associated with increased mortality included previous kidney transplants, rescue allocations, longer waiting times, and simultaneous transplants of other organs. Increased pancreas graft loss was positively associated with higher recipient body mass index and donor age and negatively associated with simultaneous transplants of kidneys and other organs. Donor age was also associated with increased kidney graft losses. The multivariable Cox models reported median C-index values were 63% for patient mortality, 62% for pancreas loss, and 55% for kidney loss. Conclusions This study provides an online risk tool at https://riskcalc.org/ptop for individual 5- and 10-y post-PKT and PT patient outcomes based on parameters available at the time of graft offer to support critical organ acceptance decisions and encourage external validation in independent populations.
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Affiliation(s)
- Gregor Miller
- Department of Surgery, Technical University of Munich (TUM), TUM School of Medicine and Health, TUM – Munich Transplant Center, Klinikum rechts der Isar, Munich, Germany
- Technical University of Munich (TUM), TUM School of Computation, Information and Technology, Garching, Germany
- Core Facility Statistical Consulting, Helmholtz Munich, Neuherberg, Germany
| | - Donna P. Ankerst
- Technical University of Munich (TUM), TUM School of Computation, Information and Technology, Garching, Germany
| | - Michael W. Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Norbert Hüser
- Department of Surgery, Technical University of Munich (TUM), TUM School of Medicine and Health, TUM – Munich Transplant Center, Klinikum rechts der Isar, Munich, Germany
| | - Felix Stocker
- Department of Surgery, Technical University of Munich (TUM), TUM School of Medicine and Health, TUM – Munich Transplant Center, Klinikum rechts der Isar, Munich, Germany
| | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, The Netherlands
| | | | - Volker Assfalg
- Department of Surgery, Technical University of Munich (TUM), TUM School of Medicine and Health, TUM – Munich Transplant Center, Klinikum rechts der Isar, Munich, Germany
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Steffani M, Jäger C, Hüser N, Friess H, Hartmann D, Demir IE, Scheufele F. Postoperative prophylactic antibiotic therapy after pancreaticoduodenectomy in bile duct-stented patients reduces postoperative major complications. Surgery 2024:S0039-6060(24)00190-9. [PMID: 38769037 DOI: 10.1016/j.surg.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/30/2024] [Accepted: 03/17/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Pancreaticoduodenectomy can entail a high complication rate, especially in patients who underwent preoperative bile duct drainage through bile duct stenting. Pancreaticoduodenectomy bile duct stenting patients frequently receive prophylactic antibiotic therapy in the postoperative period. However, the exact value and the benefit of prophylactic antibiotic therapy in pancreaticoduodenectomy bile duct stenting patients remains under-investigated and thus unclear. METHOD We conducted a retrospective single-center study of pancreaticoduodenectomy bile duct stenting patients between January 2007 and December 2022. Demographic, clinical, laboratory, and pathology data of 370 patients were collected, and intraoperative swab cultures of the bile were obtained from all patients upon transection of the common bile duct. The groups to be investigated were formed on the basis of postoperative antibiotic prophylaxis. Postoperative complications and antibiotic resistance analysis were recorded. RESULTS Postoperative antibiotic prophylaxis in stented patients after pancreaticoduodenectomy significantly reduced major complications (odds ratio: 0.547 [95% confidence interval 0.327-0.915]; P = .02) such as reoperation (P = .041) and readmission to the intensive care unit (P = .037). Patients with Enterococcus faecalis (odds ratio: 1.699 [95% confidence interval 0.978-2.950];P = .048), Enterococcus faecium (odds ratio: 1.808 [95% confidence interval 1.001-3.264]; P = .050), or Citrobacter (odds ratio: 2.211 [95% confidence interval 1.087-4.497]; P = .029) in their bile had a higher probability of developing wound infections. Appropriate antibiotic prophylaxis, according to the bile duct microbiome, significantly reduced the risk of wound infection (odds ratio: 2.239 [95% confidence interval 1.167-4.298]; P = .015). CONCLUSION Postoperative antibiotic prophylaxis in pancreaticoduodenectomy bile duct stenting patients significantly reduced major complications such as intensive care stay and reoperation. Targeted antibiotic treatment according to the biliary microbiome reduced the incidence of wound infections.
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Affiliation(s)
- Marcella Steffani
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Carsten Jäger
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Florian Scheufele
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.
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Stoess C, Mirschinka B, Ollesky J, Steffani M, Seyfried N, Kaufmann B, Friess H, Hüser N, Nitsche U, Hartmann D. Liver Resection in Synchronous Bilobar versus Unilobar Colorectal Liver Metastases: A Retrospective Analysis of Oncological Outcomes and Patient Survival. Dig Surg 2024:1-8. [PMID: 38705145 DOI: 10.1159/000538359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/04/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Resection of colorectal liver metastasis has emerged as the standard treatment. Our study compares oncological outcomes of patients with resected synchronous bilobar versus unilobar colorectal liver metastasis. METHODS This retrospective study presents long-term follow-up data of 105 consecutive patients with primary colorectal cancer and synchronous liver metastasis. All patients underwent primary tumor and metastasis resections between 2007 and 2019. RESULTS Fifty-five patients with bilobar and 50 patients with unilobar colorectal liver metastases were included. No significant difference in overall, tumor-specific, or recurrence-free survival was observed between patients with bilobar and unilobar metastases. After case-control matching, the results were confirmed in patients with similar tumor burdens. In the multivariate analysis, chemotherapy following liver metastasis resection was a significant prognostic factor associated with improved overall survival (hazard ratio 0.518, 95% confidence interval: 0.302-0.888, p = 0.017). CONCLUSION Overall survival, as well as tumor-specific and recurrence-free survival, did not differ between patients with unilobar and bilobar liver metastasis. These findings contribute to the understanding that primary tumor and metastasis resection in eligible patients improve long-term outcomes.
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Affiliation(s)
- Christian Stoess
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany,
| | - Benjamin Mirschinka
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Johanna Ollesky
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Marcella Steffani
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Nick Seyfried
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Benedikt Kaufmann
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Helmut Friess
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Norbert Hüser
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Ulrich Nitsche
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Daniel Hartmann
- Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
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Assfalg V, Miller G, Stocker F, Hüser N, Hartmann D, Heemann U, Tieken I, Zanen W, Vogelaar S, Rosenkranz AR, Schneeberger S, Függer R, Berlakovich G, Ysebaert DR, Jacobs-Tulleneers-Thevissen D, Mikhalski D, van Laecke S, Kuypers D, Mühlfeld AS, Viebahn R, Pratschke J, Melchior S, Hauser IA, Jänigen B, Weimer R, Richter N, Foller S, Schulte K, Kurschat C, Harth A, Moench C, Rademacher S, Nitschke M, Krämer BK, Renders L, Koliogiannis D, Pascher A, Hoyer J, Weinmann-Menke J, Schiffer M, Banas B, Hakenberg O, Schwenger V, Nadalin S, Lopau K, Piros L, Nemes B, Szakaly P, Bouts A, Bemelman FJ, Sanders JS, de Vries APJ, Christiaans MHL, Hilbrands L, van Zuilen AD, Arnol M, Stippel D, Wahba R. Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis. Transplantation 2024; 108:1200-1211. [PMID: 38073036 DOI: 10.1097/tp.0000000000004878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Whenever the kidney standard allocation (SA) algorithms according to the Eurotransplant (ET) Kidney Allocation System or the Eurotransplant Senior Program fail, rescue allocation (RA) is initiated. There are 2 procedurally different modes of RA: recipient oriented extended allocation (REAL) and competitive rescue allocation (CRA). The objective of this study was to evaluate the association of patient survival and graft failure with RA mode and whether or not it varied across the different ET countries. METHODS The ET database was retrospectively analyzed for donor and recipient clinical and demographic characteristics in association with graft outcomes of deceased donor renal transplantation (DDRT) across all ET countries and centers from 2014 to 2021 using Cox proportional hazards methods. RESULTS Seventeen thousand six hundred seventy-nine renal transplantations were included (SA 15 658 [89%], REAL 860 [4.9%], and CRA 1161 [6.6%]). In CRA, donors were older, cold ischemia times were longer, and HLA matches were worse in comparison with REAL and especially SA. Multivariable analyses showed comparable graft and recipient survival between SA and REAL; however, CRA was associated with shorter graft survival. Germany performed 76% of all DDRTs after REAL and CRA and the latter mode reduced waiting times by up to 2.9 y. CONCLUSIONS REAL and CRA are used differently in the ET countries according to national donor rates. Both RA schemes optimize graft utilization, lead to acceptable outcomes, and help to stabilize national DDRT programs, especially in Germany.
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Affiliation(s)
- Volker Assfalg
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Felix Stocker
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Norbert Hüser
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Daniel Hartmann
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Uwe Heemann
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Wouter Zanen
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, the Netherlands
| | - Alexander R Rosenkranz
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Reinhold Függer
- Department of Surgery, Krankenhaus der Elisabethinen and Johannes Kepler University, Linz, Austria
| | | | - Dirk R Ysebaert
- Department of HPB and Transplantation Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | | | - Dimitri Mikhalski
- Department of Abdominal Surgery and Transplantation, Hôpital Erasme, ULB, Brussels, Belgium
| | | | - Dirk Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Anja S Mühlfeld
- Department of Nephrology, Uniklinik RWTH Aachen, Aachen, Germany
| | - Richard Viebahn
- Chirurgische Klinik, Universitätsklinikum Knappschaftskrankenhaus, Bochum, Germany
| | - Johann Pratschke
- Chirurgische Klinik CCM/CVK, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ingeborg A Hauser
- Department of Nephrology, University Clinic Frankfurt, Frankfurt am Main, Germany
| | - Bernd Jänigen
- Department of General and Digestive Surgery, Transplant Unit, Freiburg, Germany
| | - Rolf Weimer
- Department of Internal Medicine, Nephrology/Renal Transplantation, University of Giessen, Giessen, Germany
| | - Nicolas Richter
- Medizinische Hochschule Hannover, Allgemein-, Viszeral- und Transplantationschirurgie, Hannover, Germany
| | - Susan Foller
- Department of Urology, Jena University Hospital, Jena, Germany
| | - Kevin Schulte
- Department of Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christine Kurschat
- Department II of Internal Medicine and Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ana Harth
- Medizinische Klinik I Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany
| | - Christian Moench
- General-, Visceral- and Transplantation Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Martin Nitschke
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Bernhard K Krämer
- Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Lutz Renders
- TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Dionysios Koliogiannis
- Department of General, Visceral, and Transplant Surgery, LMU University of Munich, Munich, Germany
| | - Andreas Pascher
- Department of General, Visceral, and Transplant Surgery, UKM Muenster, Münster, Germany
| | - Joachim Hoyer
- Department of Internal Medicine and Nephrology, University Medical Center, Philipps University Marburg, Marburg, Germany
| | - Julia Weinmann-Menke
- I. Department of Medicine, Division of Nephrology, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mario Schiffer
- Nephrology and Hypertension, Friedrich-Alexander-University Erlangen, Erlangen, Germany
| | - Bernhard Banas
- Abteilung für Nephrologie, Universitäres Transplantationszentrum, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Oliver Hakenberg
- Department of Urology, Rostock University Medical Centre, Rostock, Germany
| | - Vedat Schwenger
- Department of Nephrology and Transplant Center, Klinikum Stuttgart, Stuttgart, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Kai Lopau
- Department of Internal Medicine, Division of Nephrology, University of Wuerzburg-Kidney Transplant Program, Wuerzburg, Germany
| | - Laszlo Piros
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Balazs Nemes
- Department of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Szakaly
- Department of Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Antonia Bouts
- Pediatric Nephrology Department, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Department of Nephrology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jan S Sanders
- Departement of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Aiko P J de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Center and Transplant Center, Leiden, the Netherlands
| | - Maarten H L Christiaans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arjan D van Zuilen
- Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, the Netherlands
| | - Miha Arnol
- Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Dirk Stippel
- Department of Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roger Wahba
- Department of Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Steffani M, Nitsche U, Ollesky J, Kaufmann B, Schulze S, Novotny A, Friess H, Hüser N, Stoess C, Hartmann D. Liver Fibrosis Is Associated with Poorer Overall Survival and Higher Recurrence Rate in Patients with Cholangiocarcinoma. Dig Surg 2024; 41:53-62. [PMID: 38325358 DOI: 10.1159/000535733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Cholangiocarcinoma is the second most common primary liver tumour worldwide with an increasing incidence in recent decades. While the effects of fibrosis on hepatocellular carcinoma have been widely demonstrated, the impact on cholangiocarcinoma remains unclear. The aim of this study was to evaluate the impact of liver fibrosis on overall survival (OS) and disease-free survival (DFS) in patients who have undergone liver resection for cholangiocarcinoma. METHODS Eighty patients with cholangiocarcinoma who underwent curatively intended liver surgery between January 2007 and December 2020 were included in this retrospective single-centre study. Clinical and histopathological features were analysed. The primary endpoint was cause-specific survival. Secondary endpoints were DFS and identification of prognostic factors. RESULTS The present study shows that the median OS is significantly reduced in patients with fibrosis (p < 0.001). The median OS in patients with fibrosis was three times shorter than in the group without fibrosis. In addition, a significantly shorter DFS was observed in patients with fibrosis (p < 0.002). Multivariate analysis showed that fibrosis is the strongest independent factor with a negative impact on OS and DFS. CONCLUSION Liver fibrosis has a significant impact on OS and DFS in patients with cholangiocarcinoma. Patients with known liver fibrosis require thorough perioperative care and postoperative follow-up.
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Affiliation(s)
- Marcella Steffani
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany,
| | - Ulrich Nitsche
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Johanna Ollesky
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Benedikt Kaufmann
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sarah Schulze
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Christian Stoess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
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Wang B, Kaufmann B, Mogler C, Zhong S, Yin Y, Cheng Z, Schmid RM, Friess H, Hüser N, von Figura G, Hartmann D. Hepatocellular Brg1 promotes CCl4-induced liver inflammation, ECM accumulation and fibrosis in mice. PLoS One 2023; 18:e0294257. [PMID: 38033027 PMCID: PMC10688683 DOI: 10.1371/journal.pone.0294257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Hepatic fibrosis is a progressive pathological process involving the exhaustion of hepatocellular regenerative capacity and ultimately leading to the development of cirrhosis and even hepatocellular carcinoma. Brg1, the core subunit of the SWI/SNF chromatin-remodeling complex, was recently identified as important for liver regeneration. This study investigates the role of Brg1 in hepatic fibrosis development. METHODS Hepatocyte-specific Brg1 knockout mice were generated and injected with carbon tetrachloride (CCl4) for 4, 6, 8, and 12 weeks to induce liver fibrosis. Afterwards, liver fibrosis and liver damage were assessed. RESULTS Brg1 expression was significantly increased in the fibrotic liver tissue of wild-type mice, as compared to that of untreated wild-type mice. The livers of the Brg1 knockout animals showed reduced liver inflammation, extracellular matrix accumulation, and liver fibrosis. TNF-α and NF-κB-mediated inflammatory response was reduced in Brg1 knockout animals. CONCLUSION Brg1 promotes the progression of liver fibrosis in mice and may therefore be used as a potential therapeutic target for treating patients with liver fibrosis due to chronic injury.
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Affiliation(s)
- Baocai Wang
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Department of General Surgery, The Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Benedikt Kaufmann
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carolin Mogler
- Institute of Pathology, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Suyang Zhong
- Department of Medicine II, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Yuhan Yin
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Zhangjun Cheng
- Department of General Surgery, The Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Roland M. Schmid
- Department of Medicine II, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Guido von Figura
- Department of Medicine II, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Lei Z, Ma W, Si A, Zhang Y, Yang F, Yu Q, Tang H, Xiao Q, Zhou J, Wang K, Tang Y, Han T, Yin G, Chen J, Liu X, Zhao H, Yu D, Luo T, Wang Q, Yan M, Mao X, Li J, Wang K, Li J, Zeng Y, Ding D, Chen T, Wu X, Xia Y, Wang K, Guo W, Zhu G, Gao S, Hüser N, Lau WY, Song T, Cheng S, Shen F, Cheng Z. Effect of different PD-1 inhibitor combination therapies for unresectable intrahepatic cholangiocarcinoma. Aliment Pharmacol Ther 2023; 58:611-622. [PMID: 37349908 DOI: 10.1111/apt.17623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Immune checkpoint inhibitor (ICI) combination therapy offers a new option for treatment of unresectable intrahepatic cholangiocarcinoma (uICC). AIM To compare the effect of different anti-PD-1 combination therapies as the first-line treatments for uICC. METHODS This study included 318 patients who received chemotherapy alone (Chemo), anti-PD-1 plus chemotherapy (ICI-chemo), anti-PD-1 plus targeted therapy (ICI-target) or anti-PD-1 plus targeted therapy and chemotherapy (ICI-target-chemo) as first line for uICC from 22 centres in China. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective response rate (ORR) and safety. RESULTS Patients with ICI-chemo (median PFS [mPFS], 6.3 months; HR: 0.61, 95% CI: 0.42-0.88; p = 0.008; median OS [mOS], 10.7 months; HR: 0.61, 95% CI: 0.39-0.94; p = 0.026), ICI-target (7.2 months; HR: 0.54, 95% CI: 0.36-0.80; p = 0.002; 15.8 months; HR: 0.54, 95% CI: 0.35-0.84; p = 0.006) or ICI-target-chemo (6.9 months; HR: 0.65, 95% CI: 0.47-0.90; p = 0.009; 14.4 months; HR: 0.47, 95% CI: 0.31-0.70; p < 0.001) achieved better clinical outcomes than those with Chemo (3.8 months; 9.3 months). ICI-target was not inferior to ICI-chemo in survival outcomes (HR for PFS: 0.88, 95% CI: 0.55-1.42; p = 0.614; HR for OS: 0.89, 95% CI: 0.51-1.55; p = 0.680). ICI-target-chemo yielded similar prognoses as ICI-chemo (HR for PFS: 1.07, 95% CI: 0.70-1.62; p = 0.764; HR for OS: 0.77, 95% CI: 0.45-1.31; p = 0.328) and ICI-target (HR for PFS: 1.20, 95% CI: 0.77-1.88; p = 0.413; HR for OS: 0.86, 95% CI: 0.51-1.47; p = 0.583) but resulted in more adverse events (p < 0.001; p = 0.010). Multivariable and propensity score analyses supported these findings. CONCLUSIONS Among patients with uICC, ICI-chemo or ICI-target provided more survival benefits than Chemo while achieving comparable prognoses and fewer adverse events than ICI-target-chemo.
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Affiliation(s)
- Zhengqing Lei
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Weihu Ma
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Anfeng Si
- Department of Surgical Oncology, Qin Huai Medical District of Jinling Hospital, Nanjing University, Nanjing, China
| | - Yuhua Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Facai Yang
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qiushi Yu
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Haolan Tang
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qianru Xiao
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jiahua Zhou
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kui Wang
- Department of Hepatic Surgery II, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Yufu Tang
- Department of Hepatobiliary Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Tao Han
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang, China
| | - Guowen Yin
- Interventional Radiology Department, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Jinhong Chen
- Department of General Surgery, Huashan Hospital & Cancer Metastasis Institute, Fudan University, Shanghai, China
| | - Xiufeng Liu
- Department of Medical Oncology of PLA Cancer Center, Jinling Hospital, Nanjing, China
| | - Hua Zhao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Decai Yu
- Department of Hepatobiliary Surgery, The Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tao Luo
- Key Laboratory of Tumor Immunopathology, Ministry of Education of China, Institute of Pathology and Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Qing Wang
- Department of General Surgery, Zibo Central Hospital, Zibo, China
| | - Maolin Yan
- Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Xianhai Mao
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jing Li
- Department of Hepatobiliary, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Kai Wang
- Department of General Surgery, Jiangxi Provincial Clinical Research Center for General Surgery Disease, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jingdong Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yongyi Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fuzhou, China
| | - Dequan Ding
- Department of Interventional Radiology, Maanshan People's Hospital, Maanshan, China
| | - Tingsong Chen
- Department of Oncology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaofeng Wu
- Hepatobiliary Center, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Liver Transplantation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongxiang Xia
- Hepatobiliary Center, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Liver Transplantation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kang Wang
- Department of Hepatic Surgery VI, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Weixing Guo
- Department of Hepatic Surgery VI, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Guangyu Zhu
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Shan Gao
- Zhongda Hospital, School of Life Sciences and Technology, Advanced Institute for Life and Health, Southeast University, Nanjing, China
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wan Y Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Tianqiang Song
- Liver Cancer Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Feng Shen
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Zhangjun Cheng
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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8
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Li L, Ling Y, Cheng Z, Hüser N, Cho WC. Editorial: Extracellular vesicles in gastrointestinal cancers. Front Oncol 2023; 13:1240002. [PMID: 37469416 PMCID: PMC10352940 DOI: 10.3389/fonc.2023.1240002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/21/2023] Open
Affiliation(s)
- Liang Li
- Laboratory of Tumor Immunity and Metabolism, National Center for Liver Cancer, Shanghai, China
| | - Yan Ling
- Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Zhangjun Cheng
- Hepato-Pancreato-biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Norbert Hüser
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - William C. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong SAR, China
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9
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Esser K, Cheng X, Wettengel JM, Lucifora J, Hansen-Palmus L, Austen K, Suarez AAR, Heintz S, Testoni B, Nebioglu F, Pham MT, Yang S, Zernecke A, Wohlleber D, Ringelhan M, Broxtermann M, Hartmann D, Hüser N, Mergner J, Pichlmair A, Thasler WE, Heikenwalder M, Gasteiger G, Blutke A, Walch A, Knolle PA, Bartenschlager R, Protzer U. Hepatitis B virus targets lipid transport pathways to infect hepatocytes. Cell Mol Gastroenterol Hepatol 2023:S2352-345X(23)00051-6. [PMID: 37054914 PMCID: PMC10394270 DOI: 10.1016/j.jcmgh.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND AND AIMS A single hepatitis B virus (HBV) particle is sufficient to establish chronic infection of the liver after intravenous injection, suggesting that the virus targets hepatocytes via a highly efficient transport pathway. We therefore investigated whether HBV utilizes a physiological liver-directed pathway that supports specific host-cell targeting in vivo. METHODS We established an ex vivo system of perfused human liver tissue that recapitulates the liver physiology to investigate HBV liver targeting. This model allowed us to investigate virus-host cell interactions in a cellular microenvironment mimicking the in vivo situation. RESULTS HBV was rapidly sequestered by liver macrophages within one hour after a virus pulse, but was detected in hepatocytes only after 16 hours. We found that HBV associates with lipoproteins. Electron- and immunofluorescence microscopy corroborated a co-localization in recycling endosomes within peripheral and liver macrophages. Importantly, recycling endosomes accumulated HBV and cholesterol, followed by transport of HBV back to the cell surface along the cholesterol efflux pathway. To reach hepatocytes as final target cells, HBV was able to utilise the hepatocyte-directed cholesterol transport machinery of macrophages. CONCLUSIONS Our results propose that HBV by binding to liver targeted lipoproteins and utilizing the reverse cholesterol transport pathway of macrophages hijacks the physiological lipid transport pathways to the liver to most efficiently reach its target organ. This may involve trans-infection of liver macrophages and result in deposition of HBV in the perisinusoidal space from where HBV can bind its receptor on hepatocytes.
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Affiliation(s)
- Knud Esser
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany.
| | - Xiaoming Cheng
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Jochen M Wettengel
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Julie Lucifora
- INSERM U1052, CNRS UMR-5286, Cancer Research Center of Lyon (CRCL), Lyon, France, University of Lyon, Université Claude-Bernard (UCBL), Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Univ Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon
| | - Lea Hansen-Palmus
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Katharina Austen
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Armando A R Suarez
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Univ Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon
| | - Sarah Heintz
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Univ Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon
| | - Barbara Testoni
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Univ Lyon, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS Lyon
| | - Firat Nebioglu
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Im Neuenheimer Feld 344, 69120 Heidelberg, Germany
| | - Minh Tu Pham
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Im Neuenheimer Feld 344, 69120 Heidelberg, Germany
| | - Shangqing Yang
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Im Neuenheimer Feld 344, 69120 Heidelberg, Germany
| | - Alma Zernecke
- Institute of Experimental Biomedicine, University Hospital Würzburg, Josef-Schneider-Str. 2, Würzburg 97080, Germany
| | - Dirk Wohlleber
- Institute of Molecular Immunology and Experimental Oncology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675 Munich, Germany; German Center for Infection Research (DZIF), Munich and Heidelberg partner sites
| | - Marc Ringelhan
- German Center for Infection Research (DZIF), Munich and Heidelberg partner sites; 2nd Medical Department, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675 Munich, Germany
| | - Mathias Broxtermann
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675 Munich Germany
| | - Norbert Hüser
- Department of Surgery, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675 Munich Germany
| | - Julia Mergner
- Bavarian Center for Biomolecular Mass Spectrometry at Klinikum rechts der Isar (BayBioMS@MRI), TUM, Munich, Germany
| | - Andreas Pichlmair
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany; German Center for Infection Research (DZIF), Munich and Heidelberg partner sites; Bavarian Center for Biomolecular Mass Spectrometry at Klinikum rechts der Isar (BayBioMS@MRI), TUM, Munich, Germany
| | - Wolfgang E Thasler
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Grosshadern Hospital, Ludwig Maximilians University, Nussbaumstr. 20, 80336 Munich, Germany
| | - Mathias Heikenwalder
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Georg Gasteiger
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany
| | - Andreas Blutke
- Institute of Pathology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Axel Walch
- Institute of Pathology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology and Experimental Oncology, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger Str. 22, 81675 Munich, Germany; German Center for Infection Research (DZIF), Munich and Heidelberg partner sites
| | - Ralf Bartenschlager
- Heidelberg University, Medical Faculty Heidelberg, Department of Infectious Diseases, Molecular Virology, Center for Integrative Infectious Diseases Research, Im Neuenheimer Feld 344, 69120 Heidelberg, Germany; German Center for Infection Research (DZIF), Munich and Heidelberg partner sites; Division Virus-Associated Carcinogenesis, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Ulrike Protzer
- Institute of Virology, Technical University of Munich, School of Medicine / Helmholtz Munich, Trogerstr. 30, 81675 Munich, Germany; German Center for Infection Research (DZIF), Munich and Heidelberg partner sites.
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10
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Yin Y, Sichler A, Ecker J, Laschinger M, Liebisch G, Höring M, Basic M, Bleich A, Zhang XJ, Kübelsbeck L, Plagge J, Scherer E, Wohlleber D, Wang J, Wang Y, Steffani M, Stupakov P, Gärtner Y, Lohöfer F, Mogler C, Friess H, Hartmann D, Holzmann B, Hüser N, Janssen KP. Gut microbiota promote liver regeneration through hepatic membrane phospholipid biosynthesis. J Hepatol 2023; 78:820-835. [PMID: 36681162 DOI: 10.1016/j.jhep.2022.12.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND & AIMS Hepatocyte growth and proliferation depends on membrane phospholipid biosynthesis. Short-chain fatty acids (SCFAs) generated by bacterial fermentation, delivered through the gut-liver axis, significantly contribute to lipid biosynthesis. We therefore hypothesized that dysbiotic insults like antibiotic treatment not only affect gut microbiota, but also impair hepatic lipid synthesis and liver regeneration. METHODS Stable isotope labeling and 70% partial hepatectomy (PHx) was carried out in C57Bl/6J wild-type mice, in mice treated with broad-spectrum antibiotics, in germ-free mice and mice colonized with minimal microbiota. The microbiome was analyzed by 16S rRNA gene sequencing and microbial culture. Gut content, liver, blood and primary hepatocyte organoids were tested by mass spectrometry-based lipidomics, quantitative reverse-transcription PCR (qRT-PCR), immunoblot and immunohistochemistry for expression of proliferative and lipogenic markers. Matched biopsies from hyperplastic and hypoplastic liver tissue of patients subjected to surgical intervention to induce hyperplasia were analyzed by qRT-PCR for lipogenic enzymes. RESULTS Three days of antibiotic treatment induced persistent dysbiosis with significantly decreased beta-diversity and richness, but a massive increase of Proteobacteria, accompanied by decreased colonic SCFAs. After PHx, antibiotic-treated mice showed delayed liver regeneration, increased mortality, impaired hepatocyte proliferation and decreased hepatic phospholipid synthesis. Expression of the lipogenic enzyme SCD1 was upregulated after PHx but delayed by antibiotic treatment. Germ-free mice essentially recapitulated the phenotype of antibiotic treatment. Phospholipid biosynthesis, hepatocyte proliferation, liver regeneration and survival were rescued in gnotobiotic mice colonized with a minimal SCFA-producing microbial community. SCFAs induced the growth of murine hepatocyte organoids and hepatic SCD1 expression in mice. Further, SCD1 was required for proliferation of human hepatoma cells and was associated with liver regeneration in human patients. CONCLUSION Gut microbiota are pivotal for hepatic membrane phospholipid biosynthesis and liver regeneration. IMPACT AND IMPLICATIONS Gut microbiota affect hepatic lipid metabolism through the gut-liver axis, but the underlying mechanisms are poorly understood. Perturbations of the gut microbiome, e.g. by antibiotics, impair the production of bacterial metabolites, which normally serve as building blocks for membrane lipids in liver cells. As a consequence, liver regeneration and survival after liver surgery is severely impaired. Even though this study is preclinical, its results might allow physicians in the future to improve patient outcomes after liver surgery, by modulation of gut microbiota or their metabolites.
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Affiliation(s)
- Yuhan Yin
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Anna Sichler
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Josef Ecker
- ZIEL - Inst. for Food & Health, TUM, Freising, Germany
| | - Melanie Laschinger
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Gerhard Liebisch
- Inst. of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Marcus Höring
- Inst. of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Marijana Basic
- Institute for Laboratory Animal Science, Hannover Medical School, Germany
| | - André Bleich
- Institute for Laboratory Animal Science, Hannover Medical School, Germany
| | - Xue-Jun Zhang
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Ludwig Kübelsbeck
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | | | - Emely Scherer
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dirk Wohlleber
- Institute of Molecular Immunology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jianye Wang
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Yang Wang
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Marcella Steffani
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Pavel Stupakov
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Yasmin Gärtner
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Fabian Lohöfer
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, TUM, Munich, Germany
| | - Carolin Mogler
- Institute of Pathology, School of Medicine, TUM, Munich, Germany
| | - Helmut Friess
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Daniel Hartmann
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Bernhard Holzmann
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
| | - Norbert Hüser
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
| | - Klaus-Peter Janssen
- Dept. of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
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11
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Miller G, Ankerst DP, Kattan MW, Hüser N, Vogelaar S, Tieken I, Heemann U, Assfalg V. Kidney Transplantation Outcome Predictions (KTOP): A Risk Prediction Tool for Kidney Transplants from Brain-dead Deceased Donors Based on a Large European Cohort. Eur Urol 2023; 83:173-179. [PMID: 35000822 DOI: 10.1016/j.eururo.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/24/2021] [Accepted: 12/02/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND European kidney donation shortages mandate efficient organ allocation by optimizing the prediction of success for individual recipients. OBJECTIVE To develop the first European online risk tool for kidney transplant outcomes on the basis of recipient-only and recipient plus donor characteristics. DESIGN, SETTING, AND PARTICIPANTS We used individual recipient and donor risk factors and three outcomes (death, death with functioning graft [DWFG], and graft loss) for 32 958 transplants within the Eurotransplant kidney allocation system and the Eurotransplant senior program between January 2006 and May 2018 in eight European countries to develop and validate a risk tool. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cox proportional-hazards models were used to analyze the association of risk factors with overall patient mortality, and proportional subdistribution hazard regression models for their association with graft loss and DWFG. Prediction models were developed with recipient-only and recipient-donor risk factors. Sensitivity analyses based on time-specific area under the receiver operating characteristic curve (AUC) with leave-one-country-out validation were performed and calibration plots were generated. RESULTS AND LIMITATIONS The 10-yr cumulative incidence rate was 37% for mortality, 12% for DWFG, and 41% for graft loss. In recipient-donor models the leading risk factors for mortality were recipient diabetes (hazard ratio [HR] 10.73), retransplantation (HR 3.08 per transplant), and recipient age (HR 1.08). Effects were similar for DWFG. For graft loss, diabetes (subdistributional HR [SHR] 1.32), increased donor age (SHR 1.02), and prolonged cold ischemia time (SHR 1.02) had increased SHRs. All p values were <0.001. CONCLUSIONS Previously identified risk factors for outcomes following kidney transplants allow for outcome prediction with 10-yr AUC values of up to 0.81. PATIENT SUMMARY Using European data, we estimated individual risks to predict the success of kidney transplants and support physicians in decision-making. An online tool is now available (https://riskcalc.org/ktop/) for predicting kidney transplant outcomes both before and after a donor has been identified.
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Affiliation(s)
- Gregor Miller
- Department of Mathematics, Technical University of Munich, Garching, Germany.
| | - Donna P Ankerst
- Department of Mathematics, Technical University of Munich, Garching, Germany; Department of Life Science Systems, Munich Data Science Institute, Technical University of Munich, Freising, Germany
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Norbert Hüser
- TransplanTUM - Munich Transplant Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Serge Vogelaar
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Uwe Heemann
- TransplanTUM - Munich Transplant Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Volker Assfalg
- TransplanTUM - Munich Transplant Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany; Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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12
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Nitsche U, Seitz M, Friess H, Feussner H, Hüser N, Jell A. Long-term outcome of patients with epiphrenic diverticula: A retrospective single-center analysis over 20 years. Surgery 2022; 172:1689-1696. [PMID: 36202656 DOI: 10.1016/j.surg.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/30/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epiphrenic diverticula are extremely rare. Evidence-based treatment recommendations are scarce. The primary study outcome was to examine whether surgical treatment in patients with epiphrenic diverticula leads to improved quality of life by outweighing the perioperative risks compared with conservative treatment. METHODS All patients with an epiphrenic diverticula at our institution between 2001 and 2021 were retrospectively reviewed and followed-up using a specific questionnaire, including the Eating Assessment Tool, and Gastrointestinal Quality of Life Index quality-of-life scores. RESULTS Of 51 patients with epiphrenic diverticula, 28 had surgery and 23 had conservative treatment. The most common symptom at presentation was dysphagia. Although 16 patients underwent open surgery, 12 had minimally invasive procedures. A prophylactic stent was applied intraoperatively in 6 patients. The morbidity rate in surgically treated patients was 50% (14/28), with a leakage in 43% (12/28; 33% for prophylactic stenting). Mortality was nil. At a median follow-up of 139 months, patients with surgery had better outcomes than those without (ie, less dysphagia [6/12 vs 11/12; P = .025]), a less likely pathologic Eating Assessment Tool score (4/12 vs 9/12; P = .041), and a nonsignificant better Gastrointestinal Quality of Life Index score (122 vs 112; P = .929). The rate of recurrence/progression of symptoms was significantly higher for conservatively treated patients (11/18 vs 6/27 for any surgery; P = .008), as well as for patients with minimally invasive procedure (5/12 vs 1/15 for open surgery; P = .030). CONCLUSION Despite the high perioperative morbidity, surgical treatment of epiphrenic diverticula leads to an improved long-term quality of life and lower recurrence rates than conservative treatment.
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Affiliation(s)
- Ulrich Nitsche
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Marie Seitz
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alissa Jell
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Steffani M, Stöss C, Laschinger M, Assfalg V, Schulze S, Mogler C, Lohöfer F, Paprottka P, Hüser N, Friess H, Hartmann D, Novotny A. softALPPS - A novel, individual procedure for patients with advanced liver tumors. HPB (Oxford) 2022; 24:1362-1364. [PMID: 35289281 DOI: 10.1016/j.hpb.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The first-line therapy for liver malignancies is a radical extended liver resection. This high-risk operation has a high incidence of post-hepatectomy liver failure (PHLF) due to a small future liver remnant (FLR). One of the procedures to increase the FLR is the associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) which is still associated with high morbidity and mortality. Here, we present a new, less invasive ALPPS variant that may be associated with lower morbidity. METHODS SoftALPPS is characterized by reduced trauma to the liver tissue and individual adaptation to the patient's health constitution. In softALPPS, portal vein embolization (PVE) is performed instead of portal vein ligation (PVL) after complete recovery of liver function. In addition, a non-absorbable foil was avoided in order to be able to extend the interval to step two or skip step two when required. RESULTS Four patients successfully underwent softALPPS. Two of these patients have been followed-up for over a year (one patient with Klatskin tumor, one patient with extensive HCC). Both patients show no evidence of recurrence after 12 months and are in good medical condition. The other two patients who recently had surgery are also doing well. CONCLUSION SoftALPPS offers the chance to curatively resect patients with high tumor burden of the liver even when the FLR is inadequate. This individual therapy method can give patients the possibility of complete tumor resection and can help to reduce perioperative morbidity.
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Affiliation(s)
- Marcella Steffani
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Christian Stöss
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Volker Assfalg
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Sarah Schulze
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Carolin Mogler
- Institute of General and Surgical Pathology, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Fabian Lohöfer
- Department of Radiology, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Philipp Paprottka
- Department of Interventional Radiology, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine, Ismaninger St. 22, 81675 Munich, Germany.
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14
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Assfalg V, Miller G, Stocker F, van Meel M, Groenevelt T, Tieken I, Ankerst D, Renders L, Novotny A, Hartmann D, Jell A, Rahmel A, Wahba R, Mühlfeld A, Bouts A, Ysebaert D, Globke B, Jacobs-Tulleneers-Thevissen D, Piros L, Stippel D, Heller K, Eisenberger U, van Laecke S, Weimer R, Rosenkranz AR, Berger S, Fischer L, Kliem V, Vondran F, Sester U, Schneeberger S, Harth A, Kuypers D, Függer R, Arnol M, Christiaans M, Weinmann-Menke J, Krüger B, Hilbrands L, Banas B, Hakenberg O, Minnee R, Schwenger V, Heyne N, van Zuilen A, Reindl-Schwaighofer R, Lopau K, Hüser N, Heemann U. Kidney Transplantation After Rescue Allocation-the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis. Transplantation 2022; 106:1215-1226. [PMID: 34608103 DOI: 10.1097/tp.0000000000003964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND At Eurotransplant (ET), kidneys are transferred to "rescue allocation" (RA), whenever the standard allocation (SA) algorithms Eurotransplant Kidney Allocation System (ETKAS) and Eurotransplant Senior Program (ESP) fail. We analyzed the outcome of RA. METHODS Retrospective patient clinical and demographic characteristics association analyses were performed with graft outcomes for 2422 recipients of a deceased donor renal transplantation (DDRT) after RA versus 25 481 after SA from 71 centers across all ET countries from 2006 to 2018. RESULTS Numbers of DDRTs after RA increased over the time, especially in Germany. RA played a minor role in ESP versus ETKAS (2.7% versus 10.4%). RA recipients and donors were older compared with SA recipients and donors, cold ischemia times were longer, waiting times were shorter, and the incidence of primary nonfunction was comparable. Among ETKAS recipients, HLA matching was more favorable in SA (mean 3.7 versus 2.5). In multivariate modeling, the incidence of graft loss in ETKAS recipients was reduced in RA compared with SA (subdistribution hazard ratio, 0.80; 95% confidence interval [0.70-0.91], P < 0.001), whereas other outcomes (mortality, death with functioning graft (DwFG)) were not significantly different. None of the 3 outcomes were significantly different when comparing RA with SA within the ESP program. CONCLUSIONS Facing increased waiting times and mortality on dialysis due to donor shortage, this study reveals encouragingly positive DDRT outcomes following RA. This supports the extension of RA to more patients and as an alternative tool to enable transplantation in patients in countries with prohibitively long waiting times or at risk of deterioration.
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Affiliation(s)
- Volker Assfalg
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Felix Stocker
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Marieke van Meel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Tiny Groenevelt
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Ineke Tieken
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Donna Ankerst
- Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Lutz Renders
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Alexander Novotny
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Daniel Hartmann
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Alissa Jell
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Axel Rahmel
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Roger Wahba
- Department of General Visceral Cancer and Transplant Surgery, Transplant Center Cologne, University of Cologne Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Anja Mühlfeld
- Department of Nephrology, Universitätsklinikum Aachen, Aachen, Germany
| | - Antonia Bouts
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Dirk Ysebaert
- Department of Surgery, Antwerp University Hospital & University of Antwerp, Edegem, Antwerpen, Belgium
| | - Brigitta Globke
- Department of Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - László Piros
- Department of Transplantation and Surgery, School of Medicine, Semmelweis University, Budapest, Hungary
| | - Dirk Stippel
- Department of General Visceral Cancer and Transplant Surgery, Transplant Center Cologne, University of Cologne Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Katharina Heller
- Medizinische Klinik 4, Universitätsklinikum Erlangen-Nürnberg, Transplantation szentrum Erlangen-Nürnberg, Erlangen, Germany
| | - Ute Eisenberger
- Department of Nephrology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Rolf Weimer
- Department of Internal Medicine, Nephrology and Renal Transplantation, University Clinic of Giessen and Marburg (UKGM), Giessen, Germany
| | - Alexander R Rosenkranz
- Universitätsklinik für Innere Medizin, Nephrologie, Medizinische Universität Graz, Graz, Austria
| | - Stefan Berger
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lutz Fischer
- Department of Visceral Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Kliem
- Division of Nephrology, Department of Internal Medicine, Transplantationszentrum Hannoversch Münden, Münden, Germany
| | - Florian Vondran
- Department for General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Urban Sester
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ana Harth
- Medizinische Klinik I, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Innere Medizin II, Nephrologie, Uniklinik Witten/Herdecke, Köln, Germany
| | - Dirk Kuypers
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Reinhold Függer
- Department of Surgery, Ordensklinikum Elisabethinen Linz, Linz, Austria
| | - Miha Arnol
- Department of Nephrology and Renal Transplantation, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maarten Christiaans
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Julia Weinmann-Menke
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Nephrologie und Nierentransplantation, Mainz, Germany
| | - Bernd Krüger
- Department of Nephrology, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bernhard Banas
- Department of Nephrology, Universitätsklinikum Regensburg, Universitäres Transplantationszentrum, Regensburg, Germany
| | - Oliver Hakenberg
- Department of Urology, University Hospital Rostock, Rostock, Germany
| | - Robert Minnee
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Vedat Schwenger
- Department of Nephrology, Klinikum der Landeshauptstadt Stuttgart, Katharinenhospital, Stuttgart, Germany
| | - Nils Heyne
- Department of Internal Medicine IV, Section of Nephrology and Hypertension, Tübingen University Hospital, Tübingen, Germany
| | - Arjan van Zuilen
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roman Reindl-Schwaighofer
- Division of Nephrology and Dialysis, Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Kai Lopau
- Division of Nephrology, Department of Internal Medicine 1, University hospital Wuerzburg, Würzburg, Germany
| | - Norbert Hüser
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
| | - Uwe Heemann
- TransplanTUM Munich Transplant Center, Interdisciplinary Transplant Center, Technical University of Munich, TUM School of Medicine, München, Germany
- Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany
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Brugger M, Laschinger M, Lampl S, Schneider A, Manske K, Esfandyari D, Hüser N, Hartmann D, Steiger K, Engelhardt S, Wohlleber D, Knolle PA. High precision-cut liver slice model to study cell-autonomous anti-viral defense of hepatocytes within their microenvironment. JHEP Rep 2022; 4:100465. [PMID: 35462860 PMCID: PMC9019249 DOI: 10.1016/j.jhepr.2022.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 10/25/2022] Open
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Wang J, Wang Y, Steffani M, Stöß C, Ankerst D, Friess H, Hüser N, Hartmann D. Novel Risk Classification Based on Pyroptosis-Related Genes Defines Immune Microenvironment and Pharmaceutical Landscape for Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:cancers14020447. [PMID: 35053610 PMCID: PMC8773536 DOI: 10.3390/cancers14020447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/24/2022] Open
Abstract
Growing evidence has indicated that pyroptosis functions in the development of cancer. Nonetheless, specific roles of pyroptosis-related genes in tumor progression, immune response, prognosis, and immunotherapy have not been thoroughly elucidated. After a comprehensive evaluation of pyroptosis genes, unsupervised clustering was performed to generate three distinct clusters from hepatocellular carcinoma (HCC) samples. Three distinct pyroptosis-related molecular subtypes comprising three gene clusters that had differential prognostic effects on patient survival were then identified. Immune characteristics analyses revealed diversified immune cell infiltration among the subtypes. Two clusters served as immune-hot phenotypes associated with significantly poorer survival compared to a remaining third immune-cold cluster. Among these, the immune-hot clusters were characterized by abundant adaptive immune cell infiltration, active CD4+ and CD8+ T cells, high total leukocyte counts and tumor growth status, and lower Th17 cell and M2 macrophage densities. Then, risk scores indicated that low-risk patients were more sensitive to anti-tumor therapy. Subsequently, we found a significant correlation between pyroptosis and prognosis in HCC and that pyroptosis genes drive the heterogeneity of the tumor microenvironment. The risk scoring system, based on pyroptosis-related differentially expressed genes, was established to evaluate the individual outcomes and contribute to new insights into the molecular characterization of pyroptosis-related subtypes.
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Affiliation(s)
- Jianye Wang
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
| | - Ying Wang
- Chair of Livestock Biotechnology, School of Life Sciences Weihenstephan, Technical University of Munich, Liesel Beckman Str. 1, 85354 Freising, Germany;
| | - Marcella Steffani
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
| | - Christian Stöß
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
| | - Donna Ankerst
- Departments of Mathematics and Life Science Systems, Technical University of Munich, Boltzmannstr. 3, 85748 Garching, Germany;
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany; (J.W.); (M.S.); (C.S.); (H.F.); (N.H.)
- Correspondence: ; Tel.: +49-89-4140-5886; Fax: +49-89-4140-4780
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Steffani M, Merz C, Stöß C, Landau L, Hüser N, Hartmann D, Friess H, Theisen J, Novotny A. [Effects of the first COVID-19 wave on visceral surgery : A retrospective comparison of case numbers from a university hospital and a primary care hospital]. Chirurg 2021; 92:559-566. [PMID: 34009441 PMCID: PMC8132278 DOI: 10.1007/s00104-021-01434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 11/07/2022]
Abstract
Hintergrund Während der ersten COVID-19-Pandemiewelle führte die Aussetzung aller elektiven Eingriffe im Zeitraum vom 15.03. bis 15.05.2020 in Deutschland zu einem Rückgang an Operationen. Die Auswirkungen auf die Zahl spezifischer Operationen in der Viszeralchirurgie sind bislang nicht bekannt. Methoden In diese retrospektive Studie wurden 301 Patienten eingeschlossen, die eine Cholezystektomie bzw. Appendektomie an einem Universitätsklinikum oder Krankenhaus der Grund- und Regelversorgung zwischen dem 15.03.2020 und 05.05.2020 (vs. 2018 und 2019) erhielten. Analysiert wurden die Fallzahlen und der klinische Verlauf. Ergebnisse Die Aussetzung des Elektivprogramms führte zu einer signifikanten Reduktion elektiver Cholezystektomien und notfallmäßiger Appendektomien. Am Universitätsklinikum reduzierte sich die Anzahl der Appendektomien von 24 im Jahr 2018 um 33 % auf 16 im Jahr 2020, die Zahl der Cholezystektomien sank von 30 um 57 % auf 13. Am Grundversorger reduzierte sich die Zahl der Appendektomiepatienten von 23 im Jahr 2018 um 48 % auf 12 im Jahr 2020, die Zahl der Cholezystektomien stieg im Jahr 2018 auf 2019 an und sank anschließend um 30 % im Jahr 2020. Die Operationsdauer, Krankenhausverweildauer und der klinische Verlauf der Patienten unterschied sich nicht signifikant zu den Vorjahreszeiträumen. Diskussion Der Lockdown während der ersten COVID-19-Pandemiewelle führte zu einer deutlichen Reduktion häufiger viszeralchirurgischer Eingriffe. Um die medizinische Versorgung der gesamten Bevölkerung während einer Pandemie möglichst auf hohem Niveau zu erhalten, müssen aktuelle Möglichkeiten der operativen und konservativen Therapie, unter anderem abhängig von lokalen Infektionszahlen und den individuellen Komorbiditäten der Patienten, gegeneinander abgewogen werden.
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Affiliation(s)
- Marcella Steffani
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Constanze Merz
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Christian Stöß
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Lars Landau
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Norbert Hüser
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Daniel Hartmann
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Helmut Friess
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Jörg Theisen
- Abteilung für Allgemein‑, Viszeral‑, Thorax- und Endokrine Chirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Alexander Novotny
- Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
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18
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Assfalg V, Misselwitz S, Renders L, Hüser N, Novotny A, Jäger C, Büttner-Herold M, Amann K, Schmaderer C, Heemann U, Wen M, Haberfellner F, Torrez C, Bachmann Q, Kemmner S. Kidney transplantation after rescue allocation-meticulous selection yields the chance for excellent outcome. Nephrol Dial Transplant 2021; 36:551-560. [PMID: 33367794 DOI: 10.1093/ndt/gfaa286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The small number of organ donors forces transplant centres to consider potentially suboptimal kidneys for transplantation. Eurotransplant established an algorithm for rescue allocation (RA) of kidneys repeatedly declined or not allocated within 5 h after procurement. Data on the outcomes and benefits of RA are scarce to date. METHODS We conducted a retrospective 8-year analysis of transplant outcomes of RA offers based on our in-house criteria catalogue for acceptance and decline of organs and potential recipients. RESULTS RA donors and recipients were both older compared with standard allocation (SA). RA donors more frequently had a history of hypertension, diabetes or fulfilled expanded criteria donor key parameters. RA recipients had poorer human leucocyte antigen (HLA) matches and longer cold ischaemia times (CITs). However, waiting time was shorter and delayed graft function, primary non-function and biopsy-proven rejections were comparable to SA. Five-year graft and patient survival after RA were similar to SA. In multivariate models accounting for confounding factors, graft survival and mortality after RA and SA were comparable as well. CONCLUSIONS Facing relevant comorbidities and rapid deterioration with the risk of being removed from the waiting list, kidney transplantation after RA was identified to allow for earlier transplantation with excellent outcome. Data from this survey propose not to reject categorically organs from multimorbid donors with older age and a history of hypertension or diabetes to aim for the best possible HLA matching and to carefully calculate overall expected CIT.
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Affiliation(s)
- Volker Assfalg
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Svea Misselwitz
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lutz Renders
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Novotny
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Surgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carsten Jäger
- Department of Surgery, Study Site for Clinical Research, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maike Büttner-Herold
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Kerstin Amann
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Schmaderer
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Uwe Heemann
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ming Wen
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Flora Haberfellner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carlos Torrez
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Quirin Bachmann
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- TransplanTUM, Munich Transplant Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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19
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Dudek M, Pfister D, Donakonda S, Filpe P, Schneider A, Laschinger M, Hartmann D, Hüser N, Meiser P, Bayerl F, Inverso D, Wigger J, Sebode M, Öllinger R, Rad R, Hegenbarth S, Anton M, Guillot A, Bowman A, Heide D, Müller F, Ramadori P, Leone V, Garcia-Caceres C, Gruber T, Seifert G, Kabat AM, Mallm JP, Reider S, Effenberger M, Roth S, Billeter AT, Müller-Stich B, Pearce EJ, Koch-Nolte F, Käser R, Tilg H, Thimme R, Boettler T, Tacke F, Dufour JF, Haller D, Murray PJ, Heeren R, Zehn D, Böttcher JP, Heikenwälder M, Knolle PA. Author Correction: Auto-aggressive CXCR6 + CD8 T cells cause liver immune pathology in NASH. Nature 2021; 593:E14. [PMID: 33972788 DOI: 10.1038/s41586-021-03568-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Michael Dudek
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Dominik Pfister
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Sainitin Donakonda
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,German Center for Infection Research, Munich, Germany
| | - Pamela Filpe
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Schneider
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Philippa Meiser
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Felix Bayerl
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Donato Inverso
- Division of Vascular Oncology and Metastasis, German Cancer ResearchCenter Heidelberg (DKFZ-ZMBH Alliance), Heidelberg, Germany.,European Center of Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jennifer Wigger
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marcial Sebode
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Rupert Öllinger
- Institute of Molecular Oncology and Functional Genomics, TUM, Munich, Germany
| | - Roland Rad
- Institute of Molecular Oncology and Functional Genomics, TUM, Munich, Germany
| | - Silke Hegenbarth
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Martina Anton
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Adrien Guillot
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, Berlin, Germany
| | - Andrew Bowman
- Maastricht MultiModal Molecular Imaging (M4I) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, the Netherlands
| | - Danijela Heide
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Florian Müller
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Pierluigi Ramadori
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Valentina Leone
- Institute of Virology, Technical University Munich and Helmholtz Zentrum Munich, Munich, Germany.,Research Unit of Radiation Cytogenetics, Helmholtz Zentrum Munich, Neuherberg, Germany
| | - Cristina Garcia-Caceres
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Tim Gruber
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gabriel Seifert
- Department of General and Visceral Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Agnieszka M Kabat
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Jan-Philipp Mallm
- Division of Chromatin Networks, Single-cell Open Lab, German Cancer Research Center, Heidelberg, Germany
| | - Simon Reider
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria.,Christian Doppler Labor for Mucosal Immunology, Innsbruck, Austria
| | - Maria Effenberger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Susanne Roth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Adrian T Billeter
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Beat Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Edward J Pearce
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Friedrich Koch-Nolte
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rafael Käser
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Robert Thimme
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Boettler
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, Berlin, Germany
| | - Jean-Francois Dufour
- University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Dirk Haller
- Chair of Nutrition and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany
| | - Peter J Murray
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,Max Planck Institute for Biochemistry, Martinsried, Germany
| | - Ron Heeren
- Maastricht MultiModal Molecular Imaging (M4I) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, the Netherlands
| | - Dietmar Zehn
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany
| | - Jan P Böttcher
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Mathias Heikenwälder
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany. .,German Center for Infection Research, Munich, Germany. .,Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany.
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20
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Dudek M, Pfister D, Donakonda S, Filpe P, Schneider A, Laschinger M, Hartmann D, Hüser N, Meiser P, Bayerl F, Inverso D, Wigger J, Sebode M, Öllinger R, Rad R, Hegenbarth S, Anton M, Guillot A, Bowman A, Heide D, Müller F, Ramadori P, Leone V, Garcia-Caceres C, Gruber T, Seifert G, Kabat AM, Mallm JP, Reider S, Effenberger M, Roth S, Billeter AT, Müller-Stich B, Pearce EJ, Koch-Nolte F, Käser R, Tilg H, Thimme R, Boettler T, Tacke F, Dufour JF, Haller D, Murray PJ, Heeren R, Zehn D, Böttcher JP, Heikenwälder M, Knolle PA. Auto-aggressive CXCR6 + CD8 T cells cause liver immune pathology in NASH. Nature 2021; 592:444-449. [PMID: 33762736 DOI: 10.1038/s41586-021-03233-8] [Citation(s) in RCA: 216] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
Nonalcoholic steatohepatitis (NASH) is a manifestation of systemic metabolic disease related to obesity, and causes liver disease and cancer1,2. The accumulation of metabolites leads to cell stress and inflammation in the liver3, but mechanistic understandings of liver damage in NASH are incomplete. Here, using a preclinical mouse model that displays key features of human NASH (hereafter, NASH mice), we found an indispensable role for T cells in liver immunopathology. We detected the hepatic accumulation of CD8 T cells with phenotypes that combined tissue residency (CXCR6) with effector (granzyme) and exhaustion (PD1) characteristics. Liver CXCR6+ CD8 T cells were characterized by low activity of the FOXO1 transcription factor, and were abundant in NASH mice and in patients with NASH. Mechanistically, IL-15 induced FOXO1 downregulation and CXCR6 upregulation, which together rendered liver-resident CXCR6+ CD8 T cells susceptible to metabolic stimuli (including acetate and extracellular ATP) and collectively triggered auto-aggression. CXCR6+ CD8 T cells from the livers of NASH mice or of patients with NASH had similar transcriptional signatures, and showed auto-aggressive killing of cells in an MHC-class-I-independent fashion after signalling through P2X7 purinergic receptors. This killing by auto-aggressive CD8 T cells fundamentally differed from that by antigen-specific cells, which mechanistically distinguishes auto-aggressive and protective T cell immunity.
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Affiliation(s)
- Michael Dudek
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Dominik Pfister
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Sainitin Donakonda
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,German Center for Infection Research, Munich, Germany
| | - Pamela Filpe
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Schneider
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, University Hospital München rechts der Isar, TUM, Munich, Germany
| | - Philippa Meiser
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Felix Bayerl
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Donato Inverso
- Division of Vascular Oncology and Metastasis, German Cancer ResearchCenter Heidelberg (DKFZ-ZMBH Alliance), Heidelberg, Germany.,European Center of Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jennifer Wigger
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marcial Sebode
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Rupert Öllinger
- Institute of Molecular Oncology and Functional Genomics, TUM, Munich, Germany
| | - Roland Rad
- Institute of Molecular Oncology and Functional Genomics, TUM, Munich, Germany
| | - Silke Hegenbarth
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Martina Anton
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Adrien Guillot
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, Berlin, Germany
| | - Andrew Bowman
- Maastricht MultiModal Molecular Imaging (M4I) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, the Netherlands
| | - Danijela Heide
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Florian Müller
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Pierluigi Ramadori
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Valentina Leone
- Institute of Virology, Technical University Munich and Helmholtz Zentrum Munich, Munich, Germany.,Research Unit of Radiation Cytogenetics, Helmholtz Zentrum Munich, Neuherberg, Germany
| | - Cristina Garcia-Caceres
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Tim Gruber
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Gabriel Seifert
- Department of General and Visceral Surgery, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Agnieszka M Kabat
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Jan-Philipp Mallm
- Division of Chromatin Networks, Single-cell Open Lab, German Cancer Research Center, Heidelberg, Germany
| | - Simon Reider
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria.,Christian Doppler Labor for Mucosal Immunology, Innsbruck, Austria
| | - Maria Effenberger
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Susanne Roth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Adrian T Billeter
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Beat Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Edward J Pearce
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Friedrich Koch-Nolte
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rafael Käser
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
| | - Robert Thimme
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Boettler
- Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, Berlin, Germany
| | - Jean-Francois Dufour
- University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Dirk Haller
- Chair of Nutrition and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany
| | - Peter J Murray
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,Max Planck Institute for Biochemistry, Martinsried, Germany
| | - Ron Heeren
- Maastricht MultiModal Molecular Imaging (M4I) Institute, Division of Imaging Mass Spectrometry, Maastricht University, Maastricht, the Netherlands
| | - Dietmar Zehn
- Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany
| | - Jan P Böttcher
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Mathias Heikenwälder
- Institute of Chronic Inflammation and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology and Experimental Oncology, School of Medicine, Technical University of Munich (TUM), Munich, Germany. .,German Center for Infection Research, Munich, Germany. .,Division of Animal Physiology and Immunology, School of Life Sciences Weihenstephan, TUM, Freising, Germany.
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21
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Cheng Z, Lei Z, Jin X, Zhang Q, Si A, Yang P, Zhou J, Hartmann D, Hüser N, Shen F. Postoperative adjuvant transarterial chemoembolization for intrahepatic cholangiocarcinoma patients with microvascular invasion: a propensity score analysis. J Gastrointest Oncol 2021; 12:819-830. [PMID: 34012669 DOI: 10.21037/jgo-20-443] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Microvascular invasion (MVI) is an independent risk factor associated with tumor recurrence and poor survival in patients with intrahepatic cholangiocarcinoma (ICC) after partial hepatectomy (PH). The potential impact of adjuvant TACE on the prognosis of patients with ICC involving MVI (ICC-MVI) remains uncertain. Our aim was to investigate the effectiveness of postoperative adjuvant transarterial chemoembolization (TACE) on ICC involving MVI. Methods Multicentric data consisted of 223 patients who underwent curative-intent PH for ICC-MVI from 2002-2015 were retrospectively analyzed. The impact of adjuvant TACE was evaluated using inverse probability of treatment weighting (IPTW) and propensity-score matched (PSM) analyses. Results No association between the TACE and the overall survival (OS) and recurrence rates was observed among the overall ICC-MVI patients. However, subgroup analyses revealed that adjuvant TACE favored OS (HR, 0.62; 95% CI, 0.39-0.99; P=0.047) and time to recurrence (TTR) (HR, 0.59; 95% CI, 0.36-0.97; P=0.037) among patients with elevated CA19-9 and those without lymphadenectomy (HR, 0.53; 95% CI, 0.30-0.93; P=0.027 for OS, and HR, 0.49; 95% CI, 0.28-0.87; P=0.015 for TTR, respectively). In the CA19-9 ≥39 U/L subgroup and Nx subgroup, adjuvant TACE was associated with higher 1-, 3-, and 5-year OS rates (P=0.033 and P=0.034, respectively) and lower corresponding recurrence rates (P=0.024 and P=0.023, respectively). Conclusions Among the ICC-MVI patients undergoing curative-intent PH, only those have elevated CA19-9 or who did not undergo lymphadenectomy might be suitable for adjuvant TACE.
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Affiliation(s)
- Zhangjun Cheng
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Zhengqing Lei
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xiaoling Jin
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qi Zhang
- Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Anfeng Si
- Department of Surgical Oncology, Qin Huai Medical District of Eastern Theater General Hospital, Nanjing, China
| | - Pinghua Yang
- Department of Minimally Invasive Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jiahua Zhou
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Feng Shen
- Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
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22
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Hidalgo-Sastre A, Kuebelsbeck LA, Jochheim LS, Staufer LM, Altmayr F, Johannes W, Steiger K, Ronderos M, Hartmann D, Hüser N, Schmid RM, Holzmann B, von Figura G. Toll-like receptor 3 expression in myeloid cells is essential for efficient regeneration after acute pancreatitis in mice. Eur J Immunol 2021; 51:1182-1194. [PMID: 33521935 DOI: 10.1002/eji.202048771] [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: 05/28/2020] [Revised: 11/12/2020] [Accepted: 01/29/2021] [Indexed: 11/09/2022]
Abstract
Stringent regulation of the inflammatory response is crucial for normal tissue regeneration. Here, we analyzed the role of Toll-like receptor 3 (TLR3) in pancreatic regeneration after acute pancreatitis (AP). AP was induced by caerulein treatment in mice with global TLR3 deficiency (TLR3OFF ) or in mice re-expressing TLR3 exclusively in the myeloid cell lineage (TLR3Mye ). Compared to WT mice, TLR3OFF mice had a markedly increased formation of acinar-to-ductal metaplasia (ADM) that persisted until day 7 after initiation of AP. Pancreatic tissue of WT mice was completely regenerated after 5 days with no detectable ADM structures. The enhancing effect of TLR3-deficiency on ADM formation was closely linked with an increased and prolonged accumulation of macrophages in pancreata of TLR3OFF mice. Importantly, the phenotype of TLR3OFF mice was rescued in TLR3Mye mice, demonstrating the causative role of myeloid cell selective TLR3 signaling. Moreover, in vitro stimulation of macrophages through TLR3 initiated cell death by a caspase-8-associated mechanism. Therefore, these findings provide evidence that TLR3 signaling in myeloid cells is sufficient to limit inflammation and ADM formation and to promote regeneration after AP. Notably, resolution of inflammation after AP was associated with macrophage sensitivity to TLR3-mediated cell death.
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Affiliation(s)
- Ana Hidalgo-Sastre
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ludwig A Kuebelsbeck
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Leonie S Jochheim
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lina M Staufer
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Felicitas Altmayr
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Widya Johannes
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Katja Steiger
- Technical University of Munich, School of Medicine, Department of Pathology, Munich, Germany
| | - Monica Ronderos
- Technical University of Munich, School of Medicine, Department of Pathology, Munich, Germany
| | - Daniel Hartmann
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Norbert Hüser
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Roland M Schmid
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Holzmann
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Surgery, Munich, Germany
| | - Guido von Figura
- School of Medicine, Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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23
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Hamesch K, Guldiken N, Aly M, Hüser N, Hartmann D, Rufat P, Ziol M, Remih K, Lurje G, Scheiner B, Trautwein C, Mandorfer M, Reiberger T, Mueller S, Bruns T, Nahon P, Strnad P. Serum keratin 19 (CYFRA21-1) links ductular reaction with portal hypertension and outcome of various advanced liver diseases. BMC Med 2020; 18:336. [PMID: 33176798 PMCID: PMC7661160 DOI: 10.1186/s12916-020-01784-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/16/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Keratins (Ks) represent tissue-specific proteins. K18 is produced in hepatocytes while K19, the most widely used ductular reaction (DR) marker, is found in cholangiocytes and hepatic progenitor cells. K18-based serum fragments are commonly used liver disease predictors, while K19-based serum fragments detected through CYFRA21-1 are established tumor but not liver disease markers yet. Since DR reflects the severity of the underlying liver disease, we systematically evaluated the usefulness of CYFRA21-1 in different liver disease severities and etiologies. METHODS Hepatic expression of ductular keratins (K7/K19/K23) was analyzed in 57 patients with chronic liver disease (cohort i). Serum CYFRA21-1 levels were measured in 333 Austrians with advanced chronic liver disease (ACLD) of various etiologies undergoing hepatic venous pressure gradient (HVPG) measurement (cohort ii), 231 French patients with alcoholic cirrhosis (cohort iii), and 280 hospitalized Germans with decompensated cirrhosis of various etiologies (cohort iv). RESULTS (i) Hepatic K19 levels were comparable among F0-F3 fibrosis stages, but increased in cirrhosis. Hepatic K19 mRNA strongly correlated with the levels of other DR-specific keratins. (ii) In ACLD, increased serum CYFRA21-1 associated with the presence of clinically significant portal hypertension (CSPH; HVPG ≥ 10 mmHg) (OR = 5.87 [2.95-11.68]) and mortality (HR = 3.02 [1.78-5.13]; median follow-up 22 months). (iii) In alcoholic cirrhosis, elevated serum CYFRA21-1 indicated increased risk of death/liver transplantation (HR = 2.59 [1.64-4.09]) and of HCC (HR = 1.74 [1.02-2.96]) over the long term (median follow-up 73 months). (iv) In decompensated cirrhosis, higher serum CYFRA21-1 predicted 90-day mortality (HR = 2.97 [1.92-4.60]) with a moderate accuracy (AUROC 0.64), independently from established prognostic scores. CONCLUSIONS Hepatic K19 mRNA and serum CYFRA21-1 levels rise in cirrhosis. Increased CYFRA21-1 levels associate with the presence of CSPH and reliably indicate mortality in the short and long term independently of conventional liver biochemistry markers or scoring systems. Hence, the widely available serum CYFRA21-1 constitutes a novel, DR-related marker with prognostic implications in patients with different settings of advanced liver disease.
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Affiliation(s)
- Karim Hamesch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Nurdan Guldiken
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Mahmoud Aly
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,Department of Medicine and Infectious Diseases, Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
| | - Norbert Hüser
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, 81675, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, 81675, Munich, Germany
| | - Pierre Rufat
- AP-HP, Service d'Biostatistic Hopital Jean Verdier, Bondy, France
| | - Marianne Ziol
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Université Paris Diderot, F-75006, Paris, France.,Centre de ressources biologiques du groupe hospitalier Paris-Seine-Saint-Denis, BB0033-00027, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance Publique Hôpitaux de Paris, Bondy, France
| | - Katharina Remih
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital Aachen, Aachen, Germany.,Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum-Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernhard Scheiner
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology und Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Christian Trautwein
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Mattias Mandorfer
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology und Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Thomas Reiberger
- Vienna Hepatic Hemodynamic Lab, Division of Gastroenterology und Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Sebastian Mueller
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Tony Bruns
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.,Department of Internal Medicine IV, Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Jena, Germany.,Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Pierre Nahon
- AP-HP, Service d'Hépatologie, Hopital Jean Verdier, Bondy, France.,Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206, Saint-Denis, France.,Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", F-75000, Paris, France
| | - Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Jell A, Kuttler C, Ostler D, Hüser N. How to Cope with Big Data in Functional Analysis of the Esophagus. Visc Med 2020; 36:439-442. [PMID: 33447599 DOI: 10.1159/000511931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/30/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Esophageal motility disorders have a severe impact on patients' quality of life. While high-resolution manometry (HRM) is the gold standard in the diagnosis of esophageal motility disorders, intermittently occurring muscular deficiencies often remain undiscovered if they do not lead to an intense level of discomfort or cause suffering in patients. Ambulatory long-term HRM allows us to study the circadian (dys)function of the esophagus in a unique way. With the prolonged examination period of 24 h, however, there is an immense increase in data which requires personnel and time for evaluation not available in clinical routine. Artificial intelligence (AI) might contribute here by performing an autonomous analysis. Methods On the basis of 40 previously performed and manually tagged long-term HRM in patients with suspected temporary esophageal motility disorders, we implemented a supervised machine learning algorithm for automated swallow detection and classification. Results For a set of 24 h of long-term HRM by means of this algorithm, the evaluation time could be reduced from 3 days to a core evaluation time of 11 min for automated swallow detection and clustering plus an additional 10-20 min of evaluation time, depending on the complexity and diversity of motility disorders in the examined patient. In 12.5% of patients with suggested esophageal motility disorders, AI-enabled long-term HRM was able to reveal new and relevant findings for subsequent therapy. Conclusion This new approach paves the way to the clinical use of long-term HRM in patients with temporary esophageal motility disorders and might serve as an ideal and clinically relevant application of AI.
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Affiliation(s)
- Alissa Jell
- Department of Surgery, Medical Faculty, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christina Kuttler
- M6 - Mathematical Modelling, Mathematical Faculty, Technical University of Munich, Munich, Germany
| | - Daniel Ostler
- Minimally Invasive Interdisciplinary Therapeutical Intervention (MITI) Research Group, Medical Faculty, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Medical Faculty, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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25
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Nitsche U, Weber C, Kaufmann B, von Figura G, Assfalg V, Miller G, Friess H, Hüser N, Hartmann D. Survival data on timing of resection of liver metastases in colorectal cancer patients. Data Brief 2020; 31:105973. [PMID: 32671166 PMCID: PMC7341369 DOI: 10.1016/j.dib.2020.105973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022] Open
Abstract
Between 2007 and 2016, 140 consecutive patients who underwent resection of colorectal cancer with simultaneous liver metastases at a single university hospital were retrospectively analysed. In order to gather information regarding potential survival differences for n = 68 simultaneous versus n = 72 staged resections of the colorectal primary tumor and the liver metastases, Clinical, histopathological, serological, and survival data were compared for those two patient groups. The rate of simultaneous tumor resections increased from approximately 25% in 2007 to >75% in 2016. There was no difference in tumor specific survival for patients with simultaneous vs. staged resection (p = 0.631). This effect continued after excluding patients with extrahepatic metastases (p = 0.440). Further, neoadjuvant treatment did not lead to differences in the tumor-specific survival (p = 0.123). Factors associated with an increased tumor-specific survival were low ASA score (p < 0.001), low number of tumor-affected lymph nodes (p < 0.001), histological grading G1/2 (p = 0.001), and a low number of liver metastases (p = 0.044). There was no significant survival difference for the primary tumor stage (pT), the Clavien-Dindo complication rate, the resection status (R0), and minor versus major hepatectomies.
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Affiliation(s)
- Ulrich Nitsche
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Constance Weber
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Benedikt Kaufmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Guido von Figura
- Department of Medicine II, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Volker Assfalg
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Germany
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26
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Nitsche U, Weber C, Kaufmann B, von Figura G, Assfalg V, Miller G, Friess H, Hüser N, Hartmann D. Simultaneous Versus Staged Resection of Colorectal Cancer Liver Metastasis: A Retrospective Single-Center Study. J Surg Res 2020; 255:346-354. [PMID: 32599454 DOI: 10.1016/j.jss.2020.05.076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/01/2020] [Revised: 05/08/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND For patients with colorectal cancer and synchronous liver metastasis, either a simultaneous, or a two-staged resection of the primary tumor and the liver metastases is possible. There are currently no guidelines preferring one approach to the other. MATERIAL AND METHODS Consecutive patients who underwent hepatic resection at our university hospital from 2007-2016 were included. Clinical, histopathologic, serologic, and survival data were analyzed. The primary end point was tumor-specific survival for patients with simultaneous versus staged resections. RESULTS Of all 140 patients, 68 underwent simultaneous resection and 72 underwent staged resection. The characteristics of both groups were comparable. Patients with simultaneous resections had a shorter duration of cumulative operation time (299 versus 460 min; P = 0.003) and a shorter cumulative length of hospital stay (23 versus 43 d; P = 0.002). Perioperative mortality (P = 0.257) did not differ significantly; however, patients with simultaneous resections had higher rates of grade 2 complications according to Clavien-Dindo (P < 0.001). Tumor-specific 1-y survival was 85 ± 5% for simultaneous and 83 ± 5% for staged resection (P = 0.631). On multivariable analysis, pT4 (P = 0.038), pN3 (P = 0.003), and G3/4 (P = 0.041) of the primary tumor and postoperative complications (Clavien-Dindo 3/4/5, P = 0.003) were poor prognostic factors regarding tumor-specific survival. CONCLUSIONS This is one of the largest and most thoroughly documented retrospective single-center studies of consecutive patients with synchronous hepatic metastases. Simultaneous resection of colorectal cancer together with hepatic metastases is a safe procedure in selected patients and does not have a significant influence on long-term survival.
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Affiliation(s)
- Ulrich Nitsche
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Constance Weber
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Kaufmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Guido von Figura
- Department of Medicine II, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Volker Assfalg
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gregor Miller
- Department of Mathematics, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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27
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Stöß C, Laschinger M, Wang B, Lu M, Altmayr F, Hartmann D, Hüser N, Holzmann B. TLR3 promotes hepatocyte proliferation after partial hepatectomy by stimulating uPA expression and the release of tissue-bound HGF. FASEB J 2020; 34:10387-10397. [PMID: 32539223 DOI: 10.1096/fj.202000904r] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 12/18/2022]
Abstract
TLR3 is implicated in anti-viral immune responses, but may also act as a sensor of tissue damage in the absence of infection. Here, we provide evidence for an essential role of TLR3 in liver regeneration after an acute loss of tissue due to partial hepatectomy. Mice lacking TLR3 had a severe and sustained defect in the restoration of liver tissue with reduced liver-to-body weight ratios even after an extended recovery period of 2 weeks. Hepatocyte cell cycle progression into S phase was impaired in TLR3-deficient mice. Mechanistic analyses revealed that TLR3-deficient mice had markedly reduced systemic levels of active HGF, but had increased amounts of inactive tissue-bound HGF. Importantly, expression of uPA, which orchestrates the processing and release of HGF from the hepatic extracellular matrix, was reduced in regenerating livers of TLR3-deficient mice. In addition, expression of the HGF maturation factor HGFAC was transiently diminished in TLR3-deficient mice. In vitro, engagement of TLR3 directly stimulated expression of uPA by hepatic stellate cells. Thus, TLR3 supports liver regeneration through upregulation of uPA, which promotes the release of preformed HGF from extracellular matrix stores.
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Affiliation(s)
- Christian Stöß
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Baocai Wang
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Miao Lu
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Felicitas Altmayr
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Holzmann
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
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28
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Laschinger M, Wang Y, Holzmann G, Wang B, Stöß C, Lu M, Brugger M, Schneider A, Knolle P, Wohlleber D, Schulze S, Steiger K, Tsujikawa K, Altmayr F, Friess H, Hartmann D, Hüser N, Holzmann B. The CGRP receptor component RAMP1 links sensory innervation with YAP activity in the regenerating liver. FASEB J 2020; 34:8125-8138. [PMID: 32329113 DOI: 10.1096/fj.201903200r] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 12/13/2022]
Abstract
The effectiveness of liver regeneration limits surgical therapies of hepatic disorders and determines patient outcome. Here, we investigated the role of the neuropeptide calcitonin gene-related peptide (CGRP) for liver regeneration after acute or chronic injury. Mice deficient for the CGRP receptor component receptor activity-modifying protein 1 (RAMP1) were subjected to a 70% partial hepatectomy or repeated intraperitoneal injections of carbon tetrachloride. RAMP1 deficiency severely impaired recovery of organ mass and hepatocyte proliferation after both acute and chronic liver injury. Mechanistically, protein expression of the transcriptional coactivators Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ) was decreased in regenerating livers of RAMP1-deficient mice. Lack of RAMP1 was associated with hyperphosphorylation of YAP on Ser127 and Ser397, which regulates YAP functional activity and protein levels. Consequently, expression of various YAP-controlled cell cycle regulators and hepatocyte proliferation were severely reduced in the absence of RAMP1. In vitro, CGRP treatment caused increased YAP protein expression and a concomitant decline of YAP phosphorylation in liver tissue slice cultures of mouse and human origin and in primary human hepatocytes. Thus, our results indicate that sensory nerves represent a crucial control element of liver regeneration after acute and chronic injury acting through the CGRP-RAMP1 pathway, which stimulates YAP/TAZ expression and activity.
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Affiliation(s)
- Melanie Laschinger
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yang Wang
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Gabriela Holzmann
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Baocai Wang
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christian Stöß
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Miao Lu
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus Brugger
- School of Medicine, Institute of Molecular Immunology & Experimental Oncology, Technical University of Munich, Munich, Germany
| | - Annika Schneider
- School of Medicine, Institute of Molecular Immunology & Experimental Oncology, Technical University of Munich, Munich, Germany
| | - Percy Knolle
- School of Medicine, Institute of Molecular Immunology & Experimental Oncology, Technical University of Munich, Munich, Germany
| | - Dirk Wohlleber
- School of Medicine, Institute of Molecular Immunology & Experimental Oncology, Technical University of Munich, Munich, Germany
| | - Sarah Schulze
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Katja Steiger
- School of Medicine, Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Kazutake Tsujikawa
- Laboratory of Molecular and Cellular Physiology, Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan
| | - Felicitas Altmayr
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Holzmann
- Department of Surgery, School of Medicine, Technical University of Munich, Munich, Germany
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Assfalg V, Selig K, Tolksdorf J, Meel M, Vries E, Ramsoebhag A, Rahmel A, Renders L, Novotny A, Matevossian E, Schneeberger S, Rosenkranz AR, Berlakovich G, Ysebaert D, Knops N, Kuypers D, Weekers L, Muehlfeld A, Rump L, Hauser I, Pisarski P, Weimer R, Fornara P, Fischer L, Kliem V, Sester U, Stippel D, Arns W, Hau H, Nitschke M, Hoyer J, Thorban S, Weinmann‐Menke J, Heller K, Banas B, Schwenger V, Nadalin S, Lopau K, Hüser N, Heemann U. Repeated kidney re‐transplantation—the Eurotransplant experience: a retrospective multicenter outcome analysis. Transpl Int 2020; 33:617-631. [DOI: 10.1111/tri.13569] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/09/2019] [Accepted: 12/27/2019] [Indexed: 12/18/2022]
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Cheng Z, Lei Z, Si A, Yang P, Luo T, Guo G, Zhou J, Wang X, Li Z, Xia Y, Li J, Wang K, Yan Z, Wei W, Hartmann D, Hüser N, Lau WY, Shen F. Modifications of the AJCC 8th edition staging system for intrahepatic cholangiocarcinoma and proposal for a new staging system by incorporating serum tumor markers. HPB (Oxford) 2019; 21:1656-1666. [PMID: 31307889 DOI: 10.1016/j.hpb.2019.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/01/2019] [Accepted: 05/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several studies have noted that the discriminatory ability and stratification performance of the AJCC 8th edition staging system is not entirely satisfactory. We aimed to improve the American Joint Committee on Cancer (AJCC) 8th edition staging system for intrahepatic cholangiocarcinoma (ICC). METHODS A multicentric database from three Chinese mainland centers (n = 1601 patients) was used to modify the 8th edition staging system. This modified TNM (mTNM) staging system was then validated using the SEER database (n = 761 patients). A new TNM staging system, by incorporating serum tumor markers (TNMIS) into the mTNM staging system was then proposed. RESULTS The 8th edition staging system did not provide an adequate stratification of prognosis in the Chinese multicentric cohort. The mTNM staging system offered a better discriminatory capacity in the multicentric cohort than the original 8th edition. External validation in the SEER cohort showed that the mTNM staging system also had a good stratification performance. After further incorporating a serum marker stage into the mTNM staging, the TNMIS staging system was able to stratify prognosis even better. CONCLUSION The proposed mTNM staging system resulted in better stratification performance and the TNMIS staging system provided even more accurate prognostic classification than the conventional TNM system.
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Affiliation(s)
- Zhangjun Cheng
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhengqing Lei
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Anfeng Si
- Department of Surgical Oncology, The Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Pinghua Yang
- Department of Minimally Invasive Surgery, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Tao Luo
- Institute of Pathology and Southwest Hospital, Third Military Medical University (Army Medical University), Key Laboratory of Tumor Immunopathology, Ministry of Education of China, Chongqing, China
| | - Guangmeng Guo
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jiahua Zhou
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xuan Wang
- Department of Surgical Oncology, The Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zheng Li
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yong Xia
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Jun Li
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Kui Wang
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Zhenlin Yan
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wenxin Wei
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wan Y Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Feng Shen
- Department of Hepatic Surgery IV, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
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31
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Zhang XJ, Olsavszky V, Yin Y, Wang B, Engleitner T, Öllinger R, Schledzewski K, Koch PS, Rad R, Schmid RM, Friess H, Goerdt S, Hüser N, Géraud C, von Figura G, Hartmann D. Angiocrine Hepatocyte Growth Factor Signaling Controls Physiological Organ and Body Size and Dynamic Hepatocyte Proliferation to Prevent Liver Damage during Regeneration. Am J Pathol 2019; 190:358-371. [PMID: 31783007 DOI: 10.1016/j.ajpath.2019.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/11/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023]
Abstract
Liver sinusoidal endothelial cells (LSECs) control organ functions, metabolism, and development through the secretion of angiokines. LSECs express hepatocyte growth factor (Hgf), which is involved in prenatal development, metabolic homeostasis, and liver regeneration. This study aimed to elucidate the precise contribution of LSEC-derived Hgf in physiological homeostasis and liver regeneration. Stab2-iCretg/wt;Hgffl/fl (HgfΔLSEC) mice were generated to abrogate Hgf expression selectively in LSECs from early fetal development onwards, to study global development, metabolic and endothelial zonation, and organ functions as well as liver regeneration in response to 70% partial hepatectomy (PH). Although zonation and liver/body weight ratios were not altered, total body weight and total liver weight were reduced in HgfΔLSEC. Necrotic organ damage was more marked in HgfΔLSEC mice, and regeneration was delayed 72 hours after PH. This was associated with decreased hepatocyte proliferation at 48 hours after PH. Molecularly, HgfΔLSEC mice showed down-regulation of Hgf/c-Met signaling and decreased expression of Deptor in hepatocytes. In vitro knockdown of Deptor was associated with decreased proliferation. Therefore, angiocrine Hgf controls hepatocyte proliferation and susceptibility to necrosis after partial hepatectomy via the Hgf/c-Met axis involving Deptor to prevent excessive organ damage.
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Affiliation(s)
- Xue-Jun Zhang
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany; Department of Orthopedic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Victor Olsavszky
- Department of Dermatology, Venereology, and Allergology, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Center of Excellence in Dermatology, Mannheim, Germany
| | - Yuhan Yin
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Baocai Wang
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Thomas Engleitner
- Translatum Cancer Center, and Department of Medicine II, Institute of Molecular Oncology and Functional Genomics, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Rupert Öllinger
- Translatum Cancer Center, and Department of Medicine II, Institute of Molecular Oncology and Functional Genomics, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Kai Schledzewski
- Department of Dermatology, Venereology, and Allergology, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Center of Excellence in Dermatology, Mannheim, Germany
| | - Philipp-Sebastian Koch
- Department of Dermatology, Venereology, and Allergology, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Center of Excellence in Dermatology, Mannheim, Germany
| | - Roland Rad
- Translatum Cancer Center, and Department of Medicine II, Institute of Molecular Oncology and Functional Genomics, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Roland M Schmid
- II: Medical Clinic and Policlinic, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Sergij Goerdt
- Department of Dermatology, Venereology, and Allergology, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Center of Excellence in Dermatology, Mannheim, Germany
| | - Norbert Hüser
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Cyrill Géraud
- Department of Dermatology, Venereology, and Allergology, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Center of Excellence in Dermatology, Mannheim, Germany; Section of Clinical and Molecular Dermatology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Guido von Figura
- II: Medical Clinic and Policlinic, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.
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Lu M, Hartmann D, Braren R, Gupta A, Wang B, Wang Y, Mogler C, Cheng Z, Wirth T, Friess H, Kleeff J, Hüser N, Sunami Y. Oncogenic Akt-FOXO3 loop favors tumor-promoting modes and enhances oxidative damage-associated hepatocellular carcinogenesis. BMC Cancer 2019; 19:887. [PMID: 31488102 PMCID: PMC6728971 DOI: 10.1186/s12885-019-6110-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 08/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer, accounting for 80-90% of cases. Mutations are commonly found in the signaling regulating the PI3K/Akt pathway, leading to oncogenic cell proliferation and survival. Key transcription factors that are negatively regulated downstream of PI3K/Akt are members of the forkhead box O family (FOXO). FOXOs were initially considered as tumor suppressors by inducing cell cycle arrest and apoptosis. However, there is increasing evidence showing that FOXOs, especially FOXO3, can support tumorigenesis. METHODS To understand the roles of FOXO3 in liver tumorigenesis and hepatocarcinogenesis, we analyzed HCC patient specimens and also established a doxycycline-regulated transgenic mouse model with hepatocyte-specific FOXO3 expression in a constitutively active form. RESULTS We found that FOXO3 protein is significantly overexpressed and activated in livers of HCC patients. Hepatic activation of FOXO3 induced extensive hepatic damage and elevated gene expression of several HCC-associated factors. Furthermore, FOXO3 expression enhanced hepatotoxicin-induced tumorigenesis. Mechanistically, FOXO3 activation caused oxidative stress and DNA damage and triggered positive feedback-loop for Akt activation as well as mTORC2 activation. Interestingly, FOXO3 activated not only reactive oxygen species (ROS)-promoting pathways, but also ROS-eliminating systems, which can be associated with the activation of the pentose phosphate pathway. CONCLUSIONS FOXO3 is a master regulator of ROS in a 'carrot and stick' manner; on one side avoiding cellular crisis while also supporting hepatocellular carcinogenesis. Clinically, we suggest analyzing FOXO3 activation status in patients with liver diseases, in addition to PI3K/Akt signaling. Personalized therapy of FOXO3 inhibition may be a reasonable, depending on the activation status of FOXO3.
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Affiliation(s)
- Miao Lu
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany.,Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Daniel Hartmann
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany
| | - Rickmer Braren
- School of Medicine, Klinikum rechts der Isar, Institute for diagnostic and interventional Radiology, Technical University of Munich, Munich, Germany
| | - Aayush Gupta
- School of Medicine, Klinikum rechts der Isar, Institute for diagnostic and interventional Radiology, Technical University of Munich, Munich, Germany
| | - Baocai Wang
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany
| | - Yang Wang
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany
| | - Carolin Mogler
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Zhangjun Cheng
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Thomas Wirth
- Institute of Physiological Chemistry, University of Ulm, Ulm, Germany
| | - Helmut Friess
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany
| | - Jörg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, University Medical Center Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Norbert Hüser
- School of Medicine, Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Munich, Germany.
| | - Yoshiaki Sunami
- Department of Visceral, Vascular and Endocrine Surgery, University Medical Center Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
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Cheng Z, Lei Z, Yang P, Si A, Xiang D, Tang X, Guo G, Zhou J, Hüser N. Exosome-transmitted p120-catenin suppresses hepatocellular carcinoma progression via STAT3 pathways. Mol Carcinog 2019; 58:1389-1399. [PMID: 30997702 DOI: 10.1002/mc.23022] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/22/2019] [Accepted: 04/07/2019] [Indexed: 12/14/2022]
Abstract
Hepatocellular carcinoma (HCC) is a fatal disease with increasing morbidity and poor prognosis due to surgical recurrence and metastasis. Moreover, the molecular mechanism of HCC progression remains unclear. Although the role of p120-catenin (p120ctn) in liver cancer is well studied, the effects of secreted p120ctn transported by exosomes are less understood. Here, we show that p120ctn in exosomes secreted from liver cancer cells suppresses HCC cell proliferation and metastasis and expansion of liver cancer stem cells (CSCs). Mechanically, exosome p120ctn inhibits HCC cell progression via the STAT3 pathway, and the STAT3 inhibitor S3I-201 abolishes the observed effects on growth, metastasis, and self-renewal ability between exosome p120ctn-treated HCC cells and control cells. Taken together, we propose that p120ctn-containing exosomes derived from cancer cells inhibit the progression of liver cancer and may offer a new therapeutic strategy.
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Affiliation(s)
- Zhangjun Cheng
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhengqing Lei
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Pinghua Yang
- Department of Hepatic Surgery, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Anfeng Si
- Department of Minimally Invasive Surgery, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Daimin Xiang
- National Liver Cancer Science Center, Second Military Medical University, Shanghai, China
| | - Xuewu Tang
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Guangmeng Guo
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jiahua Zhou
- Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, The Technical University of Munich, Munich, Germany
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Jochheim LS, Odysseos G, Hidalgo-Sastre A, Zhong S, Staufer LM, Kroiss M, Kabacaoglu D, Lange S, Engleitner T, Hartmann D, Hüser N, Steiger K, Schmid RM, Holzmann B, von Figura G. The neuropeptide receptor subunit RAMP1 constrains the innate immune response during acute pancreatitis in mice. Pancreatology 2019; 19:541-547. [PMID: 31109903 DOI: 10.1016/j.pan.2019.05.455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/02/2019] [Accepted: 05/10/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The importance of the Calcitonin-gene-related-peptide-pathway (CGRP) as neuronal modulator of innate immune responses in mice has been previously demonstrated. The CGRP-receptor is composed of two subunits: the receptor-activity-modifying-protein-1 (RAMP1) and the calcitonin-receptor-like-receptor (CLR). CGRP can influence immune cells and their capacity of producing inflammatory cytokines. Using a RAMP1 knockout-mouse (RAMP1-/-) we examined the role of the CGRP-receptor in the acute-phase of cerulein-induced pancreatitis. METHODS Hourly cerulein-injections for a period of 8 h in RAMP1-/- and wild-type mice were performed. To compare severity and extent of inflammation in RAMP1-/- and wild-type mice, histological analyses were done and cytokine levels were assessed using qRT-PCR 8 h, 24 h, 2 days, and 7 days post-cerulein-treatment. Furthermore, serum activities of LDH and lipase were determined. RESULTS After 8 h RAMP1-/- mice showed a higher pancreas-to-body-weight-ratio, increased tissue edema and immune cell infiltration with higher amount of F4/80-positive cells as compared to wild-type mice. Overall infiltration of immune cells at 24 h was increased in RAMP1-/- mice and composed predominantly of MPO-positive neutrophils. In addition, after 24 h RAMP1-/- mice presented a higher pancreas-to-body-weight-ratio, higher expression of Ccl3, Il6, and Il1b and increased number of cleaved caspase 3 positive cells. Serum lipase correlated with the extent of tissue damage in RAMP1-/- compared to wild-type mice 24 h post-cerulein treatment. CONCLUSION Mice lacking RAMP1 showed increased inflammation, tissue edema, and pancreas injury particularly in the early phase of acute pancreatitis. This study highlights the essential role of CGRP for dampening the innate immune response in acute pancreatitis.
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Affiliation(s)
- Leonie S Jochheim
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Georgios Odysseos
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Ana Hidalgo-Sastre
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Suyang Zhong
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Lina M Staufer
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Markus Kroiss
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Derya Kabacaoglu
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Sebastian Lange
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany; Technical University of Munich, School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Thomas Engleitner
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany; Technical University of Munich, School of Medicine, Institute of Molecular Oncology and Functional Genomics, Munich, Germany
| | - Daniel Hartmann
- Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Surgery, Munich, Germany
| | - Norbert Hüser
- Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Surgery, Munich, Germany
| | - Katja Steiger
- Technical University Munich, School of Medicine, Department of Pathology, Munich, Germany
| | - Roland M Schmid
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Bernhard Holzmann
- Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Surgery, Munich, Germany
| | - Guido von Figura
- Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Department of Internal Medicine II, Munich, Germany.
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Prokopchuk O, Neumann PA, Hüser N, Friess H, Wilhelm D. Multiple intestinal intussusceptions caused by highly impaired gastrointestinal motility in a patient with chronic cannabis consumption. J Surg Case Rep 2019; 2019:rjz160. [PMID: 31139341 PMCID: PMC6532137 DOI: 10.1093/jscr/rjz160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/21/2019] [Accepted: 05/07/2019] [Indexed: 11/13/2022] Open
Abstract
Since the therapeutic use of cannabis and its derivatives is currently rising, the adverse effects of cannabis and cannabinoids are of special interest. However little is known about the possible effects of long-term use of cannabis on the gastrointestinal motility. Herewith we describe the case of a patient with a rare severe form of intestinal intussusception following long-term cannabis consumption. The case shall raise awareness of possible life threatening complications of the use of cannabis and its derivates.
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Affiliation(s)
- Olga Prokopchuk
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.,Institut für Molekulare Immunologie und Experimentelle Onkologie, Technische, Universität München, Munich, Germany
| | | | - Norbert Hüser
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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36
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He S, Jell A, Hüser N, Kohn N, Feussner H. 24-hour monitoring of transient lower esophageal sphincter relaxation events by long-term high-resolution impedance manometry in normal volunteers: The "mirror phenomenon". Neurogastroenterol Motil 2019; 31:e13530. [PMID: 30676686 DOI: 10.1111/nmo.13530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/30/2018] [Accepted: 11/27/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the frequency and circadian changes in transient lower esophageal sphincter relaxations (TLESRs) in normal volunteers using 24-hour high-resolution impedance manometry (HRIM). METHODS Fifteen volunteers underwent HRIM. TLESRs were recorded during the mealtime, 2-hour postprandial, daytime, and supine periods. The catheter was firmly secured to the nose, and subjects went home, ate normal meals, and continued routine daily activities. KEY RESULTS Successful recordings were obtained in 11 volunteers. Overall, 1083 TLESRs were documented; the average occurrence was 4.2/h, and the duration was 21.0 ± 5.2 seconds. The majority of the TLESRs occurred during the 2-hour postprandial (42.7%) and daytime (31.5%) periods, while 10.2% and 15.6% occurred during the mealtime and supine periods, respectively. Eight hundred and eighty-six (81.8%) TLESRs were associated with reflux. Overall, 25.5% of TLESRs were preceded by partial secondary peristalsis (PSP), while 74.5% were preceded by nothing. Terminating events included primary peristalsis (PP; 40.3%), PSP (42.8%), full secondary peristalsis (FSP; 8.2%), or nothing (8.7%). Both preceding and terminating events periodically changed throughout the four periods. One hundred and twelve (10.3%) TLESRs with both preceding and terminating events of PSP, presenting as a "mirror phenomenon," were documented. The majority of these TLESRs occurred during the supine (70.5%). CONCLUSIONS & INFERENCES Transient lower esophageal sphincter relaxations are common physiological motor events in normal volunteers; these events have certain circadian rhythms, as do the events that precede and terminate TLESR events. A special "mirror phenomenon" is observed when both the preceding and terminating events are PSP.
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Affiliation(s)
- Suyu He
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, China
| | - Alissa Jell
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nils Kohn
- Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hubertus Feussner
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Working Group for Minimally Invasive Interdisciplinary Therapeutical Intervention, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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37
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Wang B, Kaufmann B, Engleitner T, Lu M, Mogler C, Olsavszky V, Öllinger R, Zhong S, Geraud C, Cheng Z, Rad RR, Schmid RM, Friess H, Hüser N, Hartmann D, von Figura G. Brg1 promotes liver regeneration after partial hepatectomy via regulation of cell cycle. Sci Rep 2019; 9:2320. [PMID: 30787318 PMCID: PMC6382836 DOI: 10.1038/s41598-019-38568-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 07/05/2018] [Accepted: 12/21/2018] [Indexed: 12/29/2022] Open
Abstract
Brahma-related gene 1 (Brg1), a catalytic subunit of the SWItch/Sucrose Non-Fermentable (SWI/SNF) complex, is known to be involved in proliferative cell processes. Liver regeneration is initiated spontaneously after injury and leads to a strong proliferative response. In this study, a hepatocyte-specific Brg1 gene knockout mouse model was used to analyse the role of Brg1 in liver regeneration by performing a 70% partial hepatectomy (PH). After PH, Brg1 was significantly upregulated in wildtype mice. Mice with hepatocyte-specific Brg1 gene knockout showed a significantly lower liver to body weight ratio 48 h post-PH concomitant with a lower hepatocellular proliferation rate compared to wildtype mice. RNA sequencing demonstrated that Brg1 controlled hepatocyte proliferation through the regulation of the p53 pathway and several cell cycle genes. The data of this study reveal a crucial role of Brg1 for liver regeneration by promoting hepatocellular proliferation through modulation of cell cycle genes and, thus, identify Brg1 as potential target for therapeutic approaches.
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Affiliation(s)
- Baocai Wang
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.,Department of General Surgery, the Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210000, China
| | - Benedikt Kaufmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Thomas Engleitner
- Institute of Molecular Oncology and Functional Genomics, Department of Medicine II and TranslaTUM Cancer Center, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Miao Lu
- Department of General Surgery, the Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210000, China
| | - Carolin Mogler
- Institute of Pathology, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Victor Olsavszky
- Department of Dermatology, Venereology, and Allergology, University Medical Center and Medical Faculty Mannheim, Heidelberg University and Center of Excellence in Dermatology, Mannheim, 68135, Germany
| | - Rupert Öllinger
- Institute of Molecular Oncology and Functional Genomics, Department of Medicine II and TranslaTUM Cancer Center, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Suyang Zhong
- Department of Medicine II, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Cyrill Geraud
- Department of Dermatology, Venereology, and Allergology, University Medical Center and Medical Faculty Mannheim, Heidelberg University and Center of Excellence in Dermatology, Mannheim, 68135, Germany
| | - Zhangjun Cheng
- Department of General Surgery, the Affiliated Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210000, China
| | - Roland R Rad
- Institute of Molecular Oncology and Functional Genomics, Department of Medicine II and TranslaTUM Cancer Center, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Roland M Schmid
- Department of Medicine II, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Norbert Hüser
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany
| | - Daniel Hartmann
- Department of Surgery, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.
| | - Guido von Figura
- Department of Medicine II, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, 81675, Germany.
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Cheng Z, Lei Z, Yang P, Si A, Xiang D, Zhou J, Hüser N. Long non-coding RNA THOR promotes liver cancer stem cells expansion via β-catenin pathway. Gene 2018; 684:95-103. [PMID: 30359743 DOI: 10.1016/j.gene.2018.10.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/14/2018] [Accepted: 10/19/2018] [Indexed: 12/19/2022]
Abstract
Hepatocellular carcinoma (HCC) is a highly aggressive liver tumor containing cancer stem cells (CSCs), which participate in tumor invasion, therapeutic resistance, and tumor relapse leading to poor outcome and limited therapeutic options. Recently, a novel lncRNA, THOR (testis-associated highly conserved oncogenic long non-coding RNA), was characterized in human cancers and shown to exhibit an oncogenic role. However, the role of THOR in liver cancer stem cells (CSCs) remains obscure. Herein, we observed high expression of THOR in chemoresistant hepatocellular carcinomas (HCCs). A remarkable increase of THOR expression in OV6 or EpCAM-positive liver CSCs as well as in CSC-enriched hepatoma spheres. Interference THOR suppressed liver CSC expansion by inhibiting the dedifferentiation of hepatoma cells and decreasing the self-renewal ability of liver CSCs. Mechanistically, we found β-catenin as the downstream of THOR in HCC cells. The special β-catenin inhibitor FH535 abolished the discrepancy in liver CSC proportion and the self-renewal capacity between THOR knockdown HCC cells and control cells, which further confirmed that β-catenin was required in THOR promoted liver CSCs expansion. Moreover, interference THOR hepatoma cells were more sensitive to sorafenib treatment, indicates that HCC patients with low THOR expression may benefit from sorafenib treatment. Collectively, THOR was upregulated in liver CSCs and could promote HCC cells dedifferentiation and liver CSCs expansion by targeting β-catenin signaling.
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Affiliation(s)
- Zhangjun Cheng
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
| | - Zhengqing Lei
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Pinghua Yang
- Department of Laparoscope, The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Anfeng Si
- Department of Surgical Oncology, The Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Daimin Xiang
- National Liver Cancer Science Center, Second Military Medical University, Shanghai, China
| | - Jiahua Zhou
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich 81675, Germany
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Schulze S, Stöß C, Lu M, Wang B, Laschinger M, Steiger K, Altmayr F, Friess H, Hartmann D, Holzmann B, Hüser N. Cytosolic nucleic acid sensors of the innate immune system promote liver regeneration after partial hepatectomy. Sci Rep 2018; 8:12271. [PMID: 30115978 PMCID: PMC6095902 DOI: 10.1038/s41598-018-29924-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 07/20/2018] [Indexed: 12/19/2022] Open
Abstract
Stimulation of cytosolic nucleic acid sensors of innate immunity by pathogen-derived nucleic acids is important for antimicrobial defence, but stimulation through self-derived nucleic acids may contribute to autoinflammation and cancer. DNA sensing in the cytosol requires the stimulator of interferon genes (STING), while cytosolic RNA sensors use mitochondrial antiviral-signalling protein (MAVS). In a murine model of two-thirds hepatectomy, combined deficiency of MAVS and STING resulted in strongly impaired hepatocyte proliferation and delayed recovery of liver mass. Whereas lack of MAVS and STING did not influence upregulation of the G1-phase cyclins D1 and E1, it substantially reduced the hyperphosphorylation of retinoblastoma protein, attenuated the activation of cyclin-dependent kinase (CDK)-2, delayed upregulation of CDK1 and cyclins A2 and B1, and impaired S-phase entry of hepatocytes. Mechanistically, lack of cytosolic nucleic acid sensors strongly upregulated the anti-proliferative mediators TGF-β2 and activin A, which was associated with an increased expression of the cell cycle inhibitors p15 and p21. Partial hepatectomy was followed by the release of exosomes with abundant nucleic acid cargo, which may provide ligands for the MAVS and STING pathways. Together, these findings identify a previously unrecognised function of cytosolic nucleic acid sensors of innate immunity for promoting liver regeneration.
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Affiliation(s)
- Sarah Schulze
- Technical University of Munich, School of Medicine, Department of Surgery, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Stöß
- Technical University of Munich, School of Medicine, Department of Surgery, Ismaninger Str. 22, 81675, Munich, Germany
| | - Miao Lu
- Technical University of Munich, School of Medicine, Department of Surgery, Ismaninger Str. 22, 81675, Munich, Germany
| | - Baocai Wang
- Technical University of Munich, School of Medicine, Department of Surgery, Ismaninger Str. 22, 81675, Munich, Germany
| | - Melanie Laschinger
- Technical University of Munich, School of Medicine, Department of Surgery, Ismaninger Str. 22, 81675, Munich, Germany
| | - Katja Steiger
- Technical University of Munich, School of Medicine, Comparative Experimental Pathology, Institute of Pathology, Trogerstr. 18, 81675, Munich, Germany
| | - Felicitas Altmayr
- Technical University of Munich, School of Medicine, Department of Surgery, Ismaninger Str. 22, 81675, Munich, Germany
| | - Helmut Friess
- Technical University of Munich, School of Medicine, Department of Surgery, Ismaninger Str. 22, 81675, Munich, Germany
| | - Daniel Hartmann
- Technical University of Munich, School of Medicine, Department of Surgery, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Holzmann
- Technical University of Munich, School of Medicine, Department of Surgery, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Norbert Hüser
- Technical University of Munich, School of Medicine, Department of Surgery, Ismaninger Str. 22, 81675, Munich, Germany
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Cheng Z, Lei Z, Yang P, Si A, Xiang D, Zhou J, Hüser N. Long non-coding RNA THOR promotes cell proliferation and metastasis in hepatocellular carcinoma. Gene 2018; 678:129-136. [PMID: 30098425 DOI: 10.1016/j.gene.2018.08.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/04/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
Long non-coding RNAs (lncRNAs) have been demonstrated to be involved in the development and progression of multiple cancers by previous studies. Recently, a novel lncRNA, THOR (testis-associated highly conserved oncogenic long non-coding RNA), was characterized in human cancers and shown to exhibit an oncogenic role. However, the role of THOR in hepatocellular carcinoma (HCC) is still unclear. In this study, we found that THOR was relatively highly expressed in human HCC tissues and cell lines. Notably, high THOR expression was associated with worse prognosis. THOR depletion resulted in significant inhibition of the growth and metastasis of HCC cells. Mechanistically, THOR drives HCC cell progression via the PTEN/AKT pathway. Moreover, the specific PI3-K inhibitor LY294002 abolished the discrepancy in the growth and metastatic capacity between THOR-silenced HCC cells and control cells, which further confirmed that AKT was required in THOR-driven HCC cell growth and metastasis. Taken together, our results suggest that THOR could promote HCC cell growth and metastasis by amplifying PTEN/AKT signaling and may be a new therapeutic target and predictive factor for HCC.
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Affiliation(s)
- Zhangjun Cheng
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
| | - Zhengqing Lei
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Pinghua Yang
- Department of Hepatic Surgery, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Anfeng Si
- Department of Surgical Oncology, the Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Daimin Xiang
- National Liver Cancer Science Center, Second Military Medical University, Shanghai, China
| | - Jiahua Zhou
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich 81675, Germany
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Levada K, Guldiken N, Zhang X, Vella G, Mo FR, James LP, Haybaeck J, Kessler SM, Kiemer AK, Ott T, Hartmann D, Hüser N, Ziol M, Trautwein C, Strnad P. Hsp72 protects against liver injury via attenuation of hepatocellular death, oxidative stress, and JNK signaling. J Hepatol 2018; 68:996-1005. [PMID: 29331340 PMCID: PMC9252261 DOI: 10.1016/j.jhep.2018.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 12/27/2017] [Accepted: 01/03/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND & AIMS Heat shock protein (Hsp) 72 is a molecular chaperone that has broad cytoprotective functions and is upregulated in response to stress. To determine its hepatic functions, we studied its expression in human liver disorders and its biological significance in newly generated transgenic animals. METHODS Double transgenic mice overexpressing Hsp72 (gene Hspa1a) under the control of a tissue-specific tetracycline-inducible system (Hsp72-LAP mice) were produced. Acute liver injury was induced by a single injection of acetaminophen (APAP). Feeding with either a methionine choline-deficient (MCD; 8 weeks) or a 3,5-diethoxycarbonyl-1,4-dihydrocollidine-supplemented diet (DDC; 12 weeks) was used to induce lipotoxic injury and Mallory-Denk body (MDB) formation, respectively. Primary hepatocytes were treated with palmitic acid. RESULTS Patients with non-alcoholic steatohepatitis and chronic hepatitis C infection displayed elevated HSP72 levels. These levels increased with the extent of hepatic inflammation and HSP72 expression was induced after treatment with either interleukin (IL)-1β or IL-6. Hsp72-LAP mice exhibited robust, hepatocyte-specific Hsp72 overexpression. Primary hepatocytes from these animals were more resistant to isolation-induced stress and Hsp72-LAP mice displayed lower levels of hepatic injury in vivo. Mice overexpressing Hsp72 had fewer APAP protein adducts and were protected from oxidative stress and APAP-/MCD-induced cell death. Hsp72-LAP mice and/or hepatocytes displayed significantly attenuated Jnk activation. Overexpression of Hsp72 did not affect steatosis or the extent of MDB formation. CONCLUSIONS Our results demonstrate that HSP72 induction occurs in human liver disease, thus, HSP72 represents an attractive therapeutic target owing to its broad hepatoprotective functions. LAY SUMMARY HSP72 constitutes a stress-inducible, protective protein. Our data demonstrate that it is upregulated in patients with chronic hepatitis C and non-alcoholic steatohepatitis. Moreover, Hsp72-overexpressing mice are protected from various forms of liver stress.
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Affiliation(s)
- Kateryna Levada
- Department of Internal Medicine III, RWTH University Hospital Aachen, Germany; Interdisciplinary Center for Clinical Research (IZKF), RWTH University Hospital Aachen, Germany; Center for Functionalized Magnetic Materials (FunMagMa), Immanuel Kant Baltic Federal University, Kaliningrad, Russian Federation
| | - Nurdan Guldiken
- Department of Internal Medicine III, RWTH University Hospital Aachen, Germany; Interdisciplinary Center for Clinical Research (IZKF), RWTH University Hospital Aachen, Germany
| | - Xiaoji Zhang
- Department of Internal Medicine III, RWTH University Hospital Aachen, Germany; Interdisciplinary Center for Clinical Research (IZKF), RWTH University Hospital Aachen, Germany
| | - Giovanna Vella
- Department of Internal Medicine III, RWTH University Hospital Aachen, Germany
| | - Fa-Rong Mo
- Department of Internal Medicine III, RWTH University Hospital Aachen, Germany
| | - Laura P James
- Arkansas Children's Hospital Research Institute and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AK, USA
| | - Johannes Haybaeck
- Department of Pathology, Medical Faculty, Otto-von-Guericke University Magdeburg, Germany; Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Sonja M Kessler
- Department of Pharmacy, Pharmaceutical Biology, Saarland University, Saarbrücken, Germany
| | - Alexandra K Kiemer
- Department of Pharmacy, Pharmaceutical Biology, Saarland University, Saarbrücken, Germany
| | - Thomas Ott
- Core Facility Transgenic Animals, University of Tübingen, Tübingen, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marianne Ziol
- Pathology Department, GH Paris-Seine-Saint-Denis, APHP, Bondy, France; University Paris 13, Bobigny, France; Centre de Ressources Biologiques - Hôpital Jean Verdier, GH Paris-Seine-Saint-Denis, APHP, Bondy, France
| | - Christian Trautwein
- Department of Internal Medicine III, RWTH University Hospital Aachen, Germany
| | - Pavel Strnad
- Department of Internal Medicine III, RWTH University Hospital Aachen, Germany; Interdisciplinary Center for Clinical Research (IZKF), RWTH University Hospital Aachen, Germany.
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42
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Boege Y, Malehmir M, Healy ME, Bettermann K, Lorentzen A, Vucur M, Ahuja AK, Böhm F, Mertens JC, Shimizu Y, Frick L, Remouchamps C, Mutreja K, Kähne T, Sundaravinayagam D, Wolf MJ, Rehrauer H, Koppe C, Speicher T, Padrissa-Altés S, Maire R, Schattenberg JM, Jeong JS, Liu L, Zwirner S, Boger R, Hüser N, Davis RJ, Müllhaupt B, Moch H, Schulze-Bergkamen H, Clavien PA, Werner S, Borsig L, Luther SA, Jost PJ, Weinlich R, Unger K, Behrens A, Hillert L, Dillon C, Di Virgilio M, Wallach D, Dejardin E, Zender L, Naumann M, Walczak H, Green DR, Lopes M, Lavrik I, Luedde T, Heikenwalder M, Weber A. A Dual Role of Caspase-8 in Triggering and Sensing Proliferation-Associated DNA Damage, a Key Determinant of Liver Cancer Development. Cancer Cell 2017; 32:342-359.e10. [PMID: 28898696 PMCID: PMC5598544 DOI: 10.1016/j.ccell.2017.08.010] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 06/30/2017] [Accepted: 08/16/2017] [Indexed: 12/11/2022]
Abstract
Concomitant hepatocyte apoptosis and regeneration is a hallmark of chronic liver diseases (CLDs) predisposing to hepatocellular carcinoma (HCC). Here, we mechanistically link caspase-8-dependent apoptosis to HCC development via proliferation- and replication-associated DNA damage. Proliferation-associated replication stress, DNA damage, and genetic instability are detectable in CLDs before any neoplastic changes occur. Accumulated levels of hepatocyte apoptosis determine and predict subsequent hepatocarcinogenesis. Proliferation-associated DNA damage is sensed by a complex comprising caspase-8, FADD, c-FLIP, and a kinase-dependent function of RIPK1. This platform requires a non-apoptotic function of caspase-8, but no caspase-3 or caspase-8 cleavage. It may represent a DNA damage-sensing mechanism in hepatocytes that can act via JNK and subsequent phosphorylation of the histone variant H2AX.
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Affiliation(s)
- Yannick Boege
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Mohsen Malehmir
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Marc E Healy
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Kira Bettermann
- Department of Translational Inflammation Research, Institute of Experimental Internal Medicine, Otto von Guericke University, 39120 Magdeburg, Germany
| | - Anna Lorentzen
- Institute of Virology, Technische Universität München, Helmholtz Zentrum München, 85764 Munich, Germany
| | - Mihael Vucur
- Department of Medicine III, Division of GI and Hepatobiliary Oncology, University Hospital RWTH Aachen, 52056 Aachen, Germany
| | - Akshay K Ahuja
- Institute of Molecular Cancer Research, University of Zurich, 8057 Zurich, Switzerland
| | - Friederike Böhm
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Joachim C Mertens
- Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Yutaka Shimizu
- Centre for Cell Death, Cancer, and Inflammation, Department of Cancer Biology, UCL Cancer Institute, University College London, London WC1E 6DD, UK
| | - Lukas Frick
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Caroline Remouchamps
- Laboratory of Molecular Immunology and Signal Transduction, GIGA-R, University of Liège, 4000 Liège, Belgium
| | - Karun Mutreja
- Institute of Molecular Cancer Research, University of Zurich, 8057 Zurich, Switzerland
| | - Thilo Kähne
- Institute of Experimental Internal Medicine, Otto von Guericke University, 39120 Magdeburg, Germany
| | - Devakumar Sundaravinayagam
- DNA Repair and Maintenance of Genome Stability, Max-Delbruck Center for Molecular Medicine (MDC) Berlin, 13125 Berlin, Germany
| | - Monika J Wolf
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Hubert Rehrauer
- Functional Genomics Center Zurich, ETH and University Zurich, 8057 Zurich, Switzerland
| | - Christiane Koppe
- Department of Medicine III, Division of GI and Hepatobiliary Oncology, University Hospital RWTH Aachen, 52056 Aachen, Germany
| | - Tobias Speicher
- Department of Biology, Institute of Molecular Health Sciences, ETH, Zurich, Switzerland
| | | | - Renaud Maire
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Jörn M Schattenberg
- I. Department of Medicine, University Medical Center, Johannes Gutenberg-University, 55122 Mainz, Germany
| | - Ju-Seong Jeong
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Lei Liu
- Department of Surgery, Technische Universität München, 80333 Munich, Germany
| | - Stefan Zwirner
- Department of Internal Medicine VIII, University Hospital Tübingen, 72076 Tübingen, Germany; Department of Physiology I, Institute of Physiology, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; Translational Gastrointestinal Oncology Group, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Regina Boger
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Norbert Hüser
- Department of Surgery, Technische Universität München, 80333 Munich, Germany
| | - Roger J Davis
- Howard Hughes Medical Institute, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Beat Müllhaupt
- Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Pierre-Alain Clavien
- Clinic of Visceral and Transplantation Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Sabine Werner
- Department of Biology, Institute of Molecular Health Sciences, ETH, Zurich, Switzerland
| | - Lubor Borsig
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland
| | - Sanjiv A Luther
- Department of Biochemistry, University of Lausanne, 1066 Epalinges, Switzerland
| | - Philipp J Jost
- III. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Ricardo Weinlich
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kristian Unger
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Axel Behrens
- Adult Stem Cell Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Laura Hillert
- Department of Translational Inflammation Research, Institute of Experimental Internal Medicine, Otto von Guericke University, 39120 Magdeburg, Germany
| | - Christopher Dillon
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Michela Di Virgilio
- DNA Repair and Maintenance of Genome Stability, Max-Delbruck Center for Molecular Medicine (MDC) Berlin, 13125 Berlin, Germany
| | - David Wallach
- Department of Biomolecular Sciences, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Emmanuel Dejardin
- Laboratory of Molecular Immunology and Signal Transduction, GIGA-R, University of Liège, 4000 Liège, Belgium
| | - Lars Zender
- Department of Internal Medicine VIII, University Hospital Tübingen, 72076 Tübingen, Germany; Department of Physiology I, Institute of Physiology, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; Translational Gastrointestinal Oncology Group, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Michael Naumann
- Institute of Experimental Internal Medicine, Otto von Guericke University, 39120 Magdeburg, Germany
| | - Henning Walczak
- Centre for Cell Death, Cancer, and Inflammation, Department of Cancer Biology, UCL Cancer Institute, University College London, London WC1E 6DD, UK
| | - Douglas R Green
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Massimo Lopes
- Institute of Molecular Cancer Research, University of Zurich, 8057 Zurich, Switzerland
| | - Inna Lavrik
- Department of Translational Inflammation Research, Institute of Experimental Internal Medicine, Otto von Guericke University, 39120 Magdeburg, Germany
| | - Tom Luedde
- Department of Medicine III, Division of GI and Hepatobiliary Oncology, University Hospital RWTH Aachen, 52056 Aachen, Germany
| | - Mathias Heikenwalder
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, 8091 Zurich, Switzerland; Institute of Virology, Technische Universität München, Helmholtz Zentrum München, 85764 Munich, Germany; Institute of Chronic Inflammation and Cancer, Deutsches Krebs-Forschungszentrum (DKFZ), 69120 Heidelberg, Germany.
| | - Achim Weber
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, 8091 Zurich, Switzerland.
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He S, Feussner H, Nennstiel S, Bajbouj M, Hüser N, Wilhelm D. Endoluminal Sphincter Augmentation with the MUSE System and GERDX System in the Treatment of Gastroesophageal Reflux Disease: A New Impact? Surg Technol Int 2017; 30:131-140. [PMID: 28537351] [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: 06/07/2023]
Abstract
To bridge the gap between the long-term intake of proton pump inhibitors (PPIs) and the potential risks of laparoscopic fundoplication, a number of endoscopic procedures for the treatment of gastro-esophageal reflux disease (GERD) have been developed over the past 30 years. Because of the minimally invasive approach, short operative time, and efficacy in selected patients, endoluminal sphincter augmentation appears to be highly attractive. However, most early devices have proven to be unsafe or failed to provide long-term symptom relief. Accordingly, products for endoluminal sphincter augmentation have undergone several modifications to achieve an increased lower esophageal sphincter (LES) baseline pressure to re-establish the LES as an efficacious anti-reflux barrier. This paper reviews and discusses the two latest products for endoluminal sphincter augmentation, the MUSE device (Medigus, Ltd., Omer, Israel) and the GERDX system (G-SURG GmbH, Seeon-Seebruck, Germany). While the currently available literature has proven their effectiveness in principle, long-term results are lacking. Further studies and developments are necessary to determine whether these two new devices will truly impact GERD therapy.
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Affiliation(s)
- Suyu He
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, China
| | - Hubertus Feussner
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany, Munich, Germany
| | - Simon Nennstiel
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Monther Bajbouj
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Norbert Hüser
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany, Munich, Germany
| | - Dirk Wilhelm
- Chirurgische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany, Munich, Germany
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Kaufmann B, Wang B, Zhong S, Laschinger M, Patil P, Lu M, Assfalg V, Cheng Z, Friess H, Hüser N, von Figura G, Hartmann D. BRG1 promotes hepatocarcinogenesis by regulating proliferation and invasiveness. PLoS One 2017; 12:e0180225. [PMID: 28700662 PMCID: PMC5507512 DOI: 10.1371/journal.pone.0180225] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/12/2017] [Indexed: 02/03/2023] Open
Abstract
The chromatin remodeler complex SWI/SNF plays an important role in physiological and pathological processes. Brahma related gene 1(BRG1), a catalytic subunit of the SWI/SNF complex, is known to be mutated in hepatocellular carcinoma (HCC). However, its role in HCC remains unclear. Here, we investigate the role of BRG1 on cell growth and invasiveness as well as its effect on the expression of putative target genes. Expression of BRG1 was examined in human liver tissue samples and in HCC cell lines. In addition, BRG1 was silenced in human HCC cell lines to analyse cell growth and invasiveness by growth curves, colony formation assay, invasion assay and the expression of putative target genes. BRG1 was found to be significantly increased in HCC samples compared to non-HCC samples. In addition, a declined proliferation rate of BRG1-silenced human HCC cell lines was associated with a decrease of expression of cyclin family members. In line with a decreased invasiveness of BRG1-siRNA-treated human HCC cell lines, down-regulation of MMP7 was detected. These results support the hypothesis that overexpression of BRG1 increases cell growth and invasiveness in HCC. Furthermore, the data highlight cyclin B, E and MMP7 to be associated with BRG1 during hepatocarcinogenesis.
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Affiliation(s)
- Benedikt Kaufmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Baocai Wang
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Suyang Zhong
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Melanie Laschinger
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Pranali Patil
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Miao Lu
- Department of General Surgery, the Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| | - Volker Assfalg
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Zhangjun Cheng
- Department of General Surgery, the Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Guido von Figura
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Yuan D, Huang S, Berger E, Liu L, Gross N, Heinzmann F, Ringelhan M, Connor TO, Stadler M, Meister M, Weber J, Öllinger R, Simonavicius N, Reisinger F, Hartmann D, Meyer R, Reich M, Seehawer M, Leone V, Höchst B, Wohlleber D, Jörs S, Prinz M, Spalding D, Protzer U, Luedde T, Terracciano L, Matter M, Longerich T, Knolle P, Ried T, Keitel V, Geisler F, Unger K, Cinnamon E, Pikarsky E, Hüser N, Davis RJ, Tschaharganeh DF, Rad R, Weber A, Zender L, Haller D, Heikenwalder M. Kupffer Cell-Derived Tnf Triggers Cholangiocellular Tumorigenesis through JNK due to Chronic Mitochondrial Dysfunction and ROS. Cancer Cell 2017; 31:771-789.e6. [PMID: 28609656 PMCID: PMC7909318 DOI: 10.1016/j.ccell.2017.05.006] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/31/2017] [Accepted: 05/11/2017] [Indexed: 12/15/2022]
Abstract
Intrahepatic cholangiocarcinoma (ICC) is a highly malignant, heterogeneous cancer with poor treatment options. We found that mitochondrial dysfunction and oxidative stress trigger a niche favoring cholangiocellular overgrowth and tumorigenesis. Liver damage, reactive oxygen species (ROS) and paracrine tumor necrosis factor (Tnf) from Kupffer cells caused JNK-mediated cholangiocellular proliferation and oncogenic transformation. Anti-oxidant treatment, Kupffer cell depletion, Tnfr1 deletion, or JNK inhibition reduced cholangiocellular pre-neoplastic lesions. Liver-specific JNK1/2 deletion led to tumor reduction and enhanced survival in Akt/Notch- or p53/Kras-induced ICC models. In human ICC, high Tnf expression near ICC lesions, cholangiocellular JNK-phosphorylation, and ROS accumulation in surrounding hepatocytes are present. Thus, Kupffer cell-derived Tnf favors cholangiocellular proliferation/differentiation and carcinogenesis. Targeting the ROS/Tnf/JNK axis may provide opportunities for ICC therapy.
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Affiliation(s)
- Detian Yuan
- Institute of Virology, Technische Universität München and Helmholtz Zentrum München, 81675 Munich, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Shan Huang
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Emanuel Berger
- Chair of Nutrition and Immunology, Technische Universität München, Gregor-Mendel-Straße 2, 85350 Freising-Weihenstephan, Germany
| | - Lei Liu
- Department of Surgery, Technische Universität München, 81675 Munich, Germany
| | - Nina Gross
- 2nd Department of Internal Medicine, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Florian Heinzmann
- Department of Internal Medicine VIII, University Hospital Tübingen, 72076 Tübingen, Germany; Department of Physiology I, Institute of Physiology, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Marc Ringelhan
- Institute of Virology, Technische Universität München and Helmholtz Zentrum München, 81675 Munich, Germany; 2nd Department of Internal Medicine, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Tracy O Connor
- Institute of Virology, Technische Universität München and Helmholtz Zentrum München, 81675 Munich, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Mira Stadler
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Michael Meister
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Julia Weber
- 2nd Department of Internal Medicine, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Rupert Öllinger
- 2nd Department of Internal Medicine, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Nicole Simonavicius
- Institute of Virology, Technische Universität München and Helmholtz Zentrum München, 81675 Munich, Germany
| | - Florian Reisinger
- Institute of Virology, Technische Universität München and Helmholtz Zentrum München, 81675 Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Technische Universität München, 81675 Munich, Germany
| | - Rüdiger Meyer
- Genome Technology Branch, National Human Genome Research Institute, U.S. National Institutes of Health, Bethesda, MD 20892, USA
| | - Maria Reich
- Clinic for Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine University, 40204 Düsseldorf, Germany
| | - Marco Seehawer
- Department of Internal Medicine VIII, University Hospital Tübingen, 72076 Tübingen, Germany; Department of Physiology I, Institute of Physiology, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Valentina Leone
- Institute of Virology, Technische Universität München and Helmholtz Zentrum München, 81675 Munich, Germany
| | - Bastian Höchst
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Dirk Wohlleber
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Simone Jörs
- 2nd Department of Internal Medicine, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Marco Prinz
- Institute of Neuropathology, University of Freiburg, 79106 Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, University of Freiburg, 79106 Freiburg, Germany
| | - Duncan Spalding
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Ulrike Protzer
- Institute of Virology, Technische Universität München and Helmholtz Zentrum München, 81675 Munich, Germany
| | - Tom Luedde
- Division of Gastroenterology, Hepatology and Hepatobiliary Oncology, RWTH Aachen University, 52074 Aachen, Germany
| | - Luigi Terracciano
- Institute of Pathology, University Hospital of Basel, 4003 Basel, Switzerland
| | - Matthias Matter
- Institute of Pathology, University Hospital of Basel, 4003 Basel, Switzerland
| | - Thomas Longerich
- Institute of Pathology, University Hospital RWTH, 52074 Aachen, Germany
| | - Percy Knolle
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Thomas Ried
- Genome Technology Branch, National Human Genome Research Institute, U.S. National Institutes of Health, Bethesda, MD 20892, USA
| | - Verena Keitel
- Clinic for Gastroenterology, Hepatology, and Infectious Diseases, Heinrich-Heine University, 40204 Düsseldorf, Germany
| | - Fabian Geisler
- 2nd Department of Internal Medicine, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Kristian Unger
- Research Unit of Radiation Cytogenetics, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Einat Cinnamon
- The Lautenberg Center for Immunology and Cancer Research, IMRIC, Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Eli Pikarsky
- The Lautenberg Center for Immunology and Cancer Research, IMRIC, Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel; Department of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Norbert Hüser
- Department of Surgery, Technische Universität München, 81675 Munich, Germany
| | - Roger J Davis
- Howard Hughes Medical Institute and Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Darjus F Tschaharganeh
- Helmholtz-University Group "Cell Plasticity and Epigenetic Remodeling", German Cancer Research Center (DKFZ) & Institute of Pathology University Hospital, 69120 Heidelberg, Germany
| | - Roland Rad
- 2nd Department of Internal Medicine, Klinikum Rechts der Isar, Technische Universität München, 81675 Munich, Germany
| | - Achim Weber
- Department of Pathology and Molecular Pathology, University Zurich and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lars Zender
- Department of Internal Medicine VIII, University Hospital Tübingen, 72076 Tübingen, Germany; Department of Physiology I, Institute of Physiology, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; Translational Gastrointestinal Oncology Group within the German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Dirk Haller
- Chair of Nutrition and Immunology, Technische Universität München, Gregor-Mendel-Straße 2, 85350 Freising-Weihenstephan, Germany; ZIEL - Institute for Food & Health, Technische Universität München, 85350 Freising-Weihenstephan, Germany.
| | - Mathias Heikenwalder
- Institute of Virology, Technische Universität München and Helmholtz Zentrum München, 81675 Munich, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
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Zheng K, Dai X, Lu M, Hüser N, Taccardi N, Boccaccini AR. Synthesis of copper-containing bioactive glass nanoparticles using a modified Stöber method for biomedical applications. Colloids Surf B Biointerfaces 2017; 150:159-167. [DOI: 10.1016/j.colsurfb.2016.11.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/07/2016] [Accepted: 11/14/2016] [Indexed: 02/05/2023]
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Feußner H, Hüser N, Wilhelm D, Fingerle A, Jell A, Friess H, Bajbouj M. [Surgical treatment of esophageal diverticula : Endoscopic or open approach?]. Chirurg 2017; 88:196-203. [PMID: 28054111 DOI: 10.1007/s00104-016-0344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Esophageal diverticula are comparatively rare. The majority are Zenker's diverticula but parabronchial and epiphrenic diverticula can also occur. Parabronchial diverticula are of low clinical relevance, whereas Zenker's and epiphrenic diverticula both belong to the group of pulsion diverticula and can become clinically apparent by dysphagia and regurgitation. Approximately 100 years after the first surgical treatment, peroral approaches (e.g. stapler dissection and flexible endoscopic diverticulotomy) have now achieved a certain level of importance. Both approaches are less invasive than the open approach but are evidently more prone to recurrences. Accordingly, traditional open diverticulectomy with cervical myotomy should be recommended to patients with a reasonable life expectancy and an acceptable operative risk. This holds particularly true for Brombart stages I-III of the disease, as complete myotomy cannot be achieved via the peroral access. The classical surgical treatment of epiphrenic diverticula is open or laparoscopic/thoracoscopic diverticulectomy with distal myotomy, mostly combined with an anterior partial fundoplication; however, the leakage rate is high and several alternative options are currently being evaluated.
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Affiliation(s)
- H Feußner
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - N Hüser
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - D Wilhelm
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - A Fingerle
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - A Jell
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - H Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - M Bajbouj
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
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von Figura G, Fahrenkrog-Petersen L, Hidalgo-Sastre A, Hartmann D, Hüser N, Schmid RM, Hebrok M, Roy N, Esposito I. Atypical flat lesions derive from pancreatic acinar cells. Pancreatology 2017; 17:350-353. [PMID: 28473229 PMCID: PMC5770228 DOI: 10.1016/j.pan.2017.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Pancreatic ductal adenocarcinoma (PDAC) is thought to derive from different precursor lesions including the recently identified atypical flat lesions (AFL). While all precursor lesions and PDAC share ductal characteristics, there is an ongoing debate about the cellular origin of the different PDAC precursor lesions. In particular, pancreatic acinar cells have previously been shown to display a remarkable plasticity being able to undergo ductal dedifferentiation in the context of oncogenic stimuli. METHODS Histological analyses were performed in a murine PDAC model that specifically expresses oncogenic Kras in adult pancreatic acinar cells. Occurrence, characterization, and lineage tracing of AFLs were investigated. RESULTS Upon expression of oncogenic Kras in adult pancreatic acinar cells, AFLs with typical morphology and expression profile arise. Lineage tracing confirmed that the AFLs were of acinar origin. CONCLUSIONS Using a murine PDAC model, this study identifies pancreatic acinar cells as a cellular source for AFLs.
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Affiliation(s)
- Guido von Figura
- II Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany,Corresponding author. II Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany. (G. von Figura)
| | - Leonie Fahrenkrog-Petersen
- II Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ana Hidalgo-Sastre
- II Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Hartmann
- Chirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Norbert Hüser
- Chirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roland M. Schmid
- II Medizinische Klinik und Poliklinik, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Hebrok
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Nilotpal Roy
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Irene Esposito
- Institute of Pathology, University Clinic Duesseldorf, Heinrich-Heine University, Duesseldorf, Germany
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Jörger AK, Liu L, Fehlner K, Weisser T, Cheng Z, Lu M, Höchst B, Bolzer A, Wang B, Hartmann D, Assfalg V, Sunami Y, Schlitter AM, Friess H, Hüser N, Laschinger M. Impact of NKT Cells and LFA-1 on Liver Regeneration under Subseptic Conditions. PLoS One 2016; 11:e0168001. [PMID: 27977747 PMCID: PMC5158001 DOI: 10.1371/journal.pone.0168001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/23/2016] [Indexed: 01/13/2023] Open
Abstract
Background Activation of the immune system in terms of subseptic conditions during liver regeneration is of paramount clinical importance. However, little is known about molecular mechanisms and their mediators that control hepatocyte proliferation. We sought to determine the functional role of immune cells, especially NKT cells, in response to partial hepatectomy (PH), and to uncover the impact of the integrin lymphocyte function-associated antigen-1 (LFA-1) on liver regeneration in a subseptic setting. Methods Wild-type (WT) and LFA-1-/- mice underwent a 2/3 PH and low-dose lipopolysaccharid (LPS) application. Hepatocyte proliferation, immune cell infiltration, and cytokine profile in the liver parenchyma were determined. Results Low-dose LPS application after PH results in a significant delay of liver regeneration between 48h and 72h, which is associated with a reduced number of CD3+ cells within the regenerating liver. In absence of LFA-1, an impaired regenerative capacity was observed under low-dose LPS application. Analysis of different leukocyte subpopulations showed less CD3+NK1.1+ NKT cells in the liver parenchyma of LFA-1-/- mice after PH and LPS application compared to WT controls, while CD3-NK1.1+ NK cells markedly increased. Concordantly with this observation, lower levels of NKT cell related cytokines IL-12 and IL-23 were expressed in the regenerating liver of LFA-1-/- mice, while the expression of NK cell-associated CCL5 and IL-10 was increased compared to WT mice. Conclusion A subseptic situation negatively alters hepatocyte proliferation. Within this scenario, we suggest an important impact of NKT cells and postulate a critical function for LFA-1 during processes of liver regeneration.
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Affiliation(s)
- Ann-Kathrin Jörger
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Lei Liu
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karin Fehlner
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tanja Weisser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Zhangjun Cheng
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Miao Lu
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bastian Höchst
- Institute of Molecular Immunology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Baocai Wang
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Daniel Hartmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Volker Assfalg
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Yoshiaki Sunami
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Helmut Friess
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Norbert Hüser
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- * E-mail:
| | - Melanie Laschinger
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Zheng K, Lu M, Rutkowski B, Dai X, Yang Y, Taccardi N, Stachewicz U, Czyrska-Filemonowicz A, Hüser N, Boccaccini AR. ZnO quantum dots modified bioactive glass nanoparticles with pH-sensitive release of Zn ions, fluorescence, antibacterial and osteogenic properties. J Mater Chem B 2016; 4:7936-7949. [PMID: 32263784 DOI: 10.1039/c6tb02053d] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Zinc (Zn)-containing materials have osteogenic and antibacterial activities while bioactive glass nanoparticles (BGN) show bone-bonding ability, as well as osteoconductive and osteoinductive properties. Zn-containing BGN are therefore considered to be promising materials for various biomedical applications, particularly in bone regeneration. In this study, we report a convenient method to prepare Zn-containing BGN by coating ZnO quantum dots (QDs) on BGN via electrostatic interactions. The synthesized ZnO-BGN nanocomposite particles are spherical and highly dispersed, and exhibit a unique fluorescence behavior under UV excitation, emitting three wavelengths in the violet, blue and green range. ZnO-BGN showed apatite-forming ability upon immersion in simulated body fluid, but their apatite formation was delayed compared to BGN. Interestingly, ZnO-BGN showed a rapid release of Zn ions at pH 4 but a far slower release at pH 7.4. ZnO-BGN also exhibited antibacterial effects on both Gram-positive and Gram-negative bacteria at the concentrations of 1, 0.1, and 0.01 mg mL-1. Higher concentrations could lead to stronger antibacterial effects. The LDH and live/dead assays indicated that ZnO-BGN had no significant cytotoxicity towards human mesenchymal stem cells (hMSC) at concentration of 0.1 and 0.01 mg mL-1, but ZnO-BGN inhibited the relative proliferation of hMSC compared to BGN and the control according to the MTT assay. Notably ZnO-BGN improved the osteogenic differentiation of hMSC as indicated by the determination of the alkaline phosphatase activity. In conclusion, coating quantum dots on BGN is a promising strategy to produce Zn-containing BGN. The synthesized ZnO-BGN are potential materials for bone regeneration, considering their apatite-forming ability, unique ion-release behavior, effective antibacterial activity, non-cytotoxicity, and osteogenic potential.
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Affiliation(s)
- Kai Zheng
- Institute of Biomaterials, Department of Materials Science and Engineering, University of Erlangen-Nuremberg, Cauerstrasse 6, 91058 Erlangen, Germany.
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