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da Cunha CB, Andrade R, Veloso TR, Learmonth DA, Espregueira-Mendes J, Sousa RA. Enhanced microfracture using acellular scaffolds improves results after treatment of symptomatic focal grade III/IV knee cartilage lesions but current clinical evidence does not allow unequivocal recommendation. Knee Surg Sports Traumatol Arthrosc 2020; 28:3245-3257. [PMID: 31894366 DOI: 10.1007/s00167-019-05832-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/12/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE To systematically analyse post-operative outcomes following enhanced microfracture procedures in focal cartilage injuries of the knee. METHODS Database searches were conducted in PubMed, EMBASE and Cochrane Library databases up to 30 November 2018, for clinical studies in humans that assessed surgical outcomes of enhanced microfracture procedures in focal cartilage injuries of the knee. The clinical, functional and imaging outcomes were assessed and summarized. The MINORS scale was used to assess the methodological quality of the studies included. RESULTS Ten studies were included comprising a total of 331 patients (mean age of 37.0 ± 5.5 years, body mass 25.2 ± 1.7 kg m2, 56% male and 42% left knee), 278 femoral condyle chondral defects (147 medial, 35 lateral and 78 undefined) and 43 chondral defects distributed by the tibial plateau, patella and femoral trochlea. The chondral defects were mostly Outerbridge grade III or IV and the mean defect size was 3.2 ± 0.6 cm2. Studies consistently demonstrated significant improvement in the patient-reported outcome measures from baseline to final follow-up. Overall, imaging outcomes showed inconsistent results. Treatment-related adverse events were poorly reported. CONCLUSION Enhanced microfracture techniques significantly result in improved patient-reported outcome measures over the MCID, but provide inconsistent imaging results. Current clinical evidence does not allow for unequivocal recommendation of enhanced microfracture to treat symptomatic focal grade III/IV knee cartilage lesions. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cristiana Branco da Cunha
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Parque de Ciência e Tecnologia Avepark, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal.
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Faculty of Sports, University of Porto, Porto, Portugal
| | - Tiago Rafael Veloso
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Parque de Ciência e Tecnologia Avepark, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal
| | - David A Learmonth
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Parque de Ciência e Tecnologia Avepark, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Rui A Sousa
- Stemmatters, Biotecnologia e Medicina Regenerativa SA, Parque de Ciência e Tecnologia Avepark, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal
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Mancini S, Oechslin F, Menzi C, Que YA, Claes J, Heying R, Veloso TR, Vanassche T, Missiakas D, Schneewind O, Moreillon P, Entenza JM. Marginal role of von Willebrand factor-binding protein and coagulase in the initiation of endocarditis in rats with catheter-induced aortic vegetations. Virulence 2019; 9:1615-1624. [PMID: 30280967 PMCID: PMC7000203 DOI: 10.1080/21505594.2018.1528845] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Staphylococcus aureus is the leading cause of infective endocarditis (IE). While the role of S. aureus cell-wall associated protein clumping factor A (ClfA) in promoting IE has been already demonstrated, that of the secreted plasma-clotting factors staphylocoagulase (Coa) and von Willebrand factor-binding protein (vWbp) has not yet been elucidated. We investigated the role of Coa and vWbp in IE initiation in rats with catheter-induced aortic vegetations, using Lactococcus lactis expressing coa, vWbp, clfA or vWbp/clfA, and S. aureus Newman Δcoa, ΔvWbp, ΔclfA or Δcoa/ΔvWbp/ΔclfA mutants. vWbp-expression increased L. lactis valve infection compared to parent and coa-expressing strains (incidence: 62%, versus 0% and 13%, respectively; P < 0.01). Likewise, expression of clfA increased L. lactis infectivity (incidence: 80%), which was not further affected by co-expression of vWbp. In symmetry, deletion of the coa or vWbp genes in S. aureus did not decrease infectivity (incidence: 68 and 64%, respectively) whereas deletion of clfA did decrease valve infection (incidence: 45%; P = 0.03 versus parent), which was not further affected by the triple deletion Δcoa/ΔvWbp/ΔclfA (incidence: 36%; P > 0.05 versus ΔclfA mutant). Coa does not support the initial colonization of IE (in L. lactis) without other key virulence factors and vWbp contributes to initiation of IE (in L. lactis) but is marginal in the present of ClfA.
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Affiliation(s)
- Stefano Mancini
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
| | - Frank Oechslin
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
| | - Carmen Menzi
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
| | - Yok Ai Que
- b Department of Intensive Care Medicine , Bern University Hospital , Bern , Switzerland
| | - Jorien Claes
- c Cardiovascular Developmental Biology, Department of Cardiovascular Sciences , KU Leuven , Leuven , Belgium.,d Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences , KU Leuven , Leuven , Belgium
| | - Ruth Heying
- c Cardiovascular Developmental Biology, Department of Cardiovascular Sciences , KU Leuven , Leuven , Belgium
| | - Tiago Rafael Veloso
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
| | - Thomas Vanassche
- d Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences , KU Leuven , Leuven , Belgium
| | | | - Olaf Schneewind
- e Department of Microbiology , University of Chicago , Chicago , IL , USA
| | - Philippe Moreillon
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
| | - José Manuel Entenza
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
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Veloso TR, Ditkowski B, Mela P, Hoylaerts MF, Heying R. Are plasma proteins key players in the pathogenesis of infective endocarditis? J Thorac Cardiovasc Surg 2018; 156:738-739. [PMID: 30011766 DOI: 10.1016/j.jtcvs.2018.04.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Tiago Rafael Veloso
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Bartosz Ditkowski
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Petra Mela
- Department of Tissue Engineering & Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, Aachen, Germany
| | - Marc F Hoylaerts
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Claes J, Ditkowski B, Liesenborghs L, Veloso TR, Entenza JM, Moreillon P, Vanassche T, Verhamme P, Hoylaerts MF, Heying R. Assessment of the Dual Role of Clumping Factor A in S. Aureus Adhesion to Endothelium in Absence and Presence of Plasma. Thromb Haemost 2018; 118:1230-1241. [PMID: 29909601 DOI: 10.1055/s-0038-1660435] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Adhesion of Staphylococcus aureus to endothelial cells (ECs) is paramount in infective endocarditis. Bacterial proteins such as clumping factor A (ClfA) and fibronectin binding protein A (FnbpA) mediate adhesion to EC surface molecules and (sub)endothelial matrix proteins including fibrinogen (Fg), fibrin, fibronectin (Fn) and von Willebrand factor (vWF). We studied the influence of shear flow and plasma on the binding of ClfA and FnbpA (including its sub-domains A, A16+, ABC, CD) to coverslip-coated vWF, Fg/fibrin, Fn or confluent ECs, making use of Lactococcus lactis, expressing these adhesins heterologously. Global adherence profiles were similar in static and flow conditions. In the absence of plasma, L. lactis-clfA binding to Fg increased with shear forces, whereas binding to fibrin did not. The degree of adhesion of L. lactis-fnbpA to EC-bound Fn and of L. lactis-clfA to EC-bound Fg, furthermore, was similar to that of L. lactis-clfA to coated vWF domain A1, in the presence of vWF-binding protein (vWbp). Yet, in plasma, L. lactis-clfA adherence to activated EC-vWF/vWbp dropped over 10 minutes by 80% due to vWF-hydrolysis by a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 and that of L. lactis-fnbpA likewise by > 70% compared to the adhesion in absence of plasma. In contrast, plasma Fg supported high L. lactis-clfA binding to resting and activated ECs. Or, in plasma S. aureus adhesion to active endothelium occurs mainly via two complementary pathways: a rapid but short-lived vWF/vWbp pathway and a stable integrin-coupled Fg-pathway. Hence, the pharmacological inhibition of ClfA-Fg interactions may constitute a valuable additive treatment in infective endocarditis.
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Affiliation(s)
- Jorien Claes
- Division of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Bartosz Ditkowski
- Division of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Laurens Liesenborghs
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Tiago Rafael Veloso
- Division of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jose M Entenza
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - Philippe Moreillon
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Marc F Hoylaerts
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Ruth Heying
- Division of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Veloso TR, Claes J, Van Kerckhoven S, Ditkowski B, Hurtado-Aguilar LG, Jockenhoevel S, Mela P, Jashari R, Gewillig M, Hoylaerts MF, Meyns B, Heying R. Bacterial adherence to graft tissues in static and flow conditions. J Thorac Cardiovasc Surg 2018; 155:325-332.e4. [DOI: 10.1016/j.jtcvs.2017.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 12/29/2022]
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Claes J, Liesenborghs L, Peetermans M, Veloso TR, Missiakas D, Schneewind O, Mancini S, Entenza JM, Hoylaerts MF, Heying R, Verhamme P, Vanassche T. Clumping factor A, von Willebrand factor-binding protein and von Willebrand factor anchor Staphylococcus aureus to the vessel wall. J Thromb Haemost 2017; 15:1009-1019. [PMID: 28182324 PMCID: PMC6232194 DOI: 10.1111/jth.13653] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 01/10/2023]
Abstract
Essentials Staphylococcus aureus (S. aureus) binds to endothelium via von Willebrand factor (VWF). Secreted VWF-binding protein (vWbp) mediates S. aureus adhesion to VWF under shear stress. vWbp interacts with VWF and the Sortase A-dependent surface protein Clumping factor A (ClfA). VWF-vWbp-ClfA anchor S. aureus to vascular endothelium under shear stress. SUMMARY Objective When establishing endovascular infections, Staphylococcus aureus (S. aureus) overcomes shear forces of flowing blood by binding to von Willebrand factor (VWF). Staphylococcal VWF-binding protein (vWbp) interacts with VWF, but it is unknown how this secreted protein binds to the bacterial cell wall. We hypothesized that vWbp interacts with a staphylococcal surface protein, mediating the adhesion of S. aureus to VWF and vascular endothelium under shear stress. Methods We studied the binding of S. aureus to vWbp, VWF and endothelial cells in a micro-parallel flow chamber using various mutants deficient in Sortase A (SrtA) and SrtA-dependent surface proteins, and Lactococcus lactis expressing single staphylococcal surface proteins. In vivo adhesion of bacteria was evaluated in the murine mesenteric circulation using real-time intravital vascular microscopy. Results vWbp bridges the bacterial cell wall and VWF, allowing shear-resistant binding of S. aureus to inflamed or damaged endothelium. Absence of SrtA and Clumping factor A (ClfA) reduced adhesion of S. aureus to vWbp, VWF and activated endothelial cells. ADAMTS-13 and an anti-VWF A1 domain antibody, when combined, reduced S. aureus adhesion to activated endothelial cells by 90%. Selective overexpression of ClfA in the membrane of Lactococcus lactis enabled these bacteria to bind to VWF and activated endothelial cells but only in the presence of vWbp. Absence of ClfA abolished bacterial adhesion to the activated murine vessel wall. Conclusions vWbp interacts with VWF and with the SrtA-dependent staphylococcal surface protein ClfA. The complex formed by VWF, secreted vWbp and bacterial ClfA anchors S. aureus to vascular endothelium under shear stress.
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Affiliation(s)
- J Claes
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - L Liesenborghs
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - M Peetermans
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - T R Veloso
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - D Missiakas
- Department of Microbiology, University of Chicago, Chicago, IL, USA
| | - O Schneewind
- Department of Microbiology, University of Chicago, Chicago, IL, USA
| | - S Mancini
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - J M Entenza
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - M F Hoylaerts
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - R Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - P Verhamme
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - T Vanassche
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Liesenborghs L, Peetermans M, Claes J, Veloso TR, Vandenbriele C, Criel M, Lox M, Peetermans WE, Heilbronner S, de Groot PG, Vanassche T, Hoylaerts MF, Verhamme P. Shear-Resistant Binding to von Willebrand Factor Allows Staphylococcus lugdunensis to Adhere to the Cardiac Valves and Initiate Endocarditis. J Infect Dis 2016; 213:1148-56. [PMID: 26743845 DOI: 10.1093/infdis/jiv773] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 07/20/2015] [Accepted: 12/19/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Staphylococcus lugdunensis is an emerging cause of endocarditis. To cause endovascular infections, S. lugdunensis requires mechanisms to overcome shear stress. We investigated whether platelets and von Willebrand factor (VWF) mediate bacterial adhesion to the vessel wall and the cardiac valves under flow. METHODS S. lugdunensis binding to VWF, collagen, and endothelial cells was studied in a parallel flow chamber in the absence and presence of platelets. In vivo adhesion of S. lugdunensis was evaluated in a mouse microvasculature perfusion model and a new mouse model of endocarditis. RESULTS Contrary to other coagulase-negative staphylococci, S. lugdunensis bound to VWF under flow, thus enabling its adhesion to endothelial cells and to the subendothelial matrix. In inflamed vessels of the mesenteric circulation, VWF recruited S. lugdunensis to the vessel wall. In a novel endocarditis mouse model, local inflammation and the resulting release of VWF enabled S. lugdunensis to bind and colonize the heart valves. CONCLUSIONS S. lugdunensis binds directly to VWF, which proved to be vital for withstanding shear forces and for its adhesion to the vessel wall and cardiac valves. This mechanism explains why S. lugdunensis causes more-aggressive infections, including endocarditis, compared with other coagulase-negative staphylococci.
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Affiliation(s)
| | | | - Jorien Claes
- Center for Molecular and Vascular Biology, KU Leuven, Belgium
| | | | | | - Maarten Criel
- Center for Molecular and Vascular Biology, KU Leuven, Belgium
| | - Marleen Lox
- Center for Molecular and Vascular Biology, KU Leuven, Belgium
| | | | - Simon Heilbronner
- Interfaculty Institute of Microbiology and Infection Medicine, University of Tübingen, Germany
| | - Philip G de Groot
- Laboratory of Clinical Chemistry and Haematology, University Medical Center, Utrecht, The Netherlands
| | | | | | - Peter Verhamme
- Center for Molecular and Vascular Biology, KU Leuven, Belgium
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Veloso TR, Oechslin F, Que YA, Moreillon P, Entenza JM, Mancini S. Aspirin plus ticlopidine prevented experimental endocarditis due to Enterococcus faecalis and Streptococcus gallolyticus. Pathog Dis 2015; 73:ftv060. [PMID: 26310867 DOI: 10.1093/femspd/ftv060] [Citation(s) in RCA: 18] [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] [Accepted: 08/06/2015] [Indexed: 01/01/2023] Open
Abstract
Enterococcus faecalis and Streptococcus gallolyticus cause infective endocarditis (IE), which can originate from the continuous release or translocation of low bacterial numbers into the bloodstream. In this context, IE cannot be prevented with antibiotics. We previously demonstrated that aspirin plus ticlopidine protected rats from IE due to S. gordonii and Staphylococcus aureus. Here we showed that aspirin plus ticlopidine significantly reduced vegetation weight and protected 73 and 64% rats (P < 0.005) from IE due to E. faecalis and S. gallolyticus, respectively. These results further support the potential use of aspirin plus ticlopidine for a global prevention of IE in high-risk patients.
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Affiliation(s)
- Tiago Rafael Veloso
- Department of Fundamental Microbiology, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Frank Oechslin
- Department of Fundamental Microbiology, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Lausanne University Hospital Center (CHUV), CH-1011 Lausanne, Switzerland
| | - Philippe Moreillon
- Department of Fundamental Microbiology, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - José Manuel Entenza
- Department of Fundamental Microbiology, University of Lausanne, CH-1015 Lausanne, Switzerland
| | - Stefano Mancini
- Department of Fundamental Microbiology, University of Lausanne, CH-1015 Lausanne, Switzerland
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Veloso TR, Mancini S, Giddey M, Vouillamoz J, Que YA, Moreillon P, Entenza JM. Vaccination against Staphylococcus aureus experimental endocarditis using recombinant Lactococcus lactis expressing ClfA or FnbpA. Vaccine 2015; 33:3512-7. [DOI: 10.1016/j.vaccine.2015.05.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/06/2015] [Accepted: 05/22/2015] [Indexed: 11/26/2022]
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Veloso TR, Que YA, Chaouch A, Giddey M, Vouillamoz J, Rousson V, Moreillon P, Entenza JM. Prophylaxis of Experimental Endocarditis With Antiplatelet and Antithrombin Agents: A Role for Long-term Prevention of Infective Endocarditis in Humans? J Infect Dis 2014; 211:72-9. [DOI: 10.1093/infdis/jiu426] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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