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Sirtl S, Bretthauer K, Ahmad M, Hohmann E, Schmidt VF, Allawadhi P, Vornhülz M, Klauss S, Goni E, Vielhauer J, Orgler E, Saka D, Knoblauch M, Hofmann FO, Schirra J, Schulz C, Beyer G, Mahajan UM, Mayerle J, Zorniak M. Severity of gallstone, sludge or microlithiasis induced pancreatitis - all of the same? Pancreas 2024:00006676-990000000-00151. [PMID: 38696426 DOI: 10.1097/mpa.0000000000002349] [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] [Indexed: 05/04/2024]
Abstract
BACKGROUND/AIM Severity of microlithiasis and sludge-induced pancreatitis in comparison to gallstone-induced pancreatitis has never been studied for a lack of definition. In order to understand whether bile duct obstruction or other mechanisms contribute to biliary pancreatitis severity we performed a monocentric, retrospective cohort study. METHODS In this retrospective cohort study 263 patients with acute biliary pancreatitis treated at a tertiary care center from 2005 to 2021 were stratified according to the recent consensus definition for microlithiasis and sludge. The gallstone-pancreatitis cohort was compared to microlithiasis, sludge and suspected stone passage pancreatitis cohorts in terms of pancreatitis outcome, liver function and EUS/ERCP results using one-way ANOVA and Chi2 test. Multinomial logistic regression analysis was performed to correct for bias. RESULTS Microlithiasis and sludge-induced pancreatitis classified according to the revised Atlanta classification, did not present with a milder course than gallstone-induced pancreatitis (p = 0.62). Microlithiasis and sludge showed an increase in bilirubin on the day of admission to hospital, which was not significantly different from gallstone-induced pancreatitis (p = 0.36). The likelihood of detecting biliary disease on EUS resulting in bile duct clearance was highest on the day of admission and day 1, respectively. CONCLUSION Microlithiasis and sludge induce gallstone-equivalent impaired liver function tests and induce pancreatitis with similar severity compared with gallstone-induced acute biliary pancreatitis.
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Affiliation(s)
- Simon Sirtl
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | | | - Mahmood Ahmad
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Eric Hohmann
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | | | - Prince Allawadhi
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Marlies Vornhülz
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Sarah Klauss
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Elisabetta Goni
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Jakob Vielhauer
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Elisabeth Orgler
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Didem Saka
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Mathilda Knoblauch
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU Munich, Germany
| | - Felix O Hofmann
- Department of General, Visceral, and Transplantation Surgery, University Hospital, LMU Munich, Germany
| | - Jörg Schirra
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Christian Schulz
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Ujjwal M Mahajan
- Department of Medicine II, University Hospital, LMU Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Germany
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2
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Ye L, Ziesch A, Schneider JS, Ofner A, Nieß H, Denk G, Hohenester S, Mayr D, Mahajan UM, Munker S, Khaled NB, Wimmer R, Gerbes AL, Mayerle J, He Y, Geier A, Toni END, Zhang C, Reiter FP. The inhibition of YAP Signaling Prevents Chronic Biliary Fibrosis in the Abcb4 -/- Model by Modulation of Hepatic Stellate Cell and Bile Duct Epithelium Cell Pathophysiology. Aging Dis 2024; 15:338-356. [PMID: 37307826 PMCID: PMC10796084 DOI: 10.14336/ad.2023.0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] Open
Abstract
Primary sclerosing cholangitis (PSC) represents a chronic liver disease characterized by poor prognosis and lacking causal treatment options. Yes-associated protein (YAP) functions as a critical mediator of fibrogenesis; however, its therapeutic potential in chronic biliary diseases such as PSC remains unestablished. The objective of this study is to elucidate the possible significance of YAP inhibition in biliary fibrosis by examining the pathophysiology of hepatic stellate cells (HSC) and biliary epithelial cells (BEC). Human liver tissue samples from PSC patients were analyzed to assess the expression of YAP/connective tissue growth factor (CTGF) relative to non-fibrotic control samples. The pathophysiological relevance of YAP/CTGF in HSC and BEC was investigated in primary human HSC (phHSC), LX-2, H69, and TFK-1 cell lines through siRNA or pharmacological inhibition utilizing verteporfin (VP) and metformin (MF). The Abcb4-/- mouse model was employed to evaluate the protective effects of pharmacological YAP inhibition. Hanging droplet and 3D matrigel culture techniques were utilized to investigate YAP expression and activation status of phHSC under various physical conditions. YAP/CTGF upregulation was observed in PSC patients. Silencing YAP/CTGF led to inhibition of phHSC activation and reduced contractility of LX-2 cells, as well as suppression of epithelial-mesenchymal transition (EMT) in H69 cells and proliferation of TFK-1 cells. Pharmacological inhibition of YAP mitigated chronic liver fibrosis in vivo and diminished ductular reaction and EMT. YAP expression in phHSC was effectively modulated by altering extracellular stiffness, highlighting YAP's role as a mechanotransducer. In conclusion, YAP regulates the activation of HSC and EMT in BEC, thereby functioning as a checkpoint of fibrogenesis in chronic cholestasis. Both VP and MF demonstrate effectiveness as YAP inhibitors, capable of inhibiting biliary fibrosis. These findings suggest that VP and MF warrant further investigation as potential therapeutic options for the treatment of PSC.
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Affiliation(s)
- Liangtao Ye
- Digestive Diseases Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | - Andreas Ziesch
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | | | - Andrea Ofner
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | - Hanno Nieß
- Biobank of the Department of General, Visceral and Transplantion Surgery, University Hospital, LMU Munich, Germany.
| | - Gerald Denk
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | - Simon Hohenester
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | - Doris Mayr
- Institute of Pathology, Faculty of Medicine, LMU Munich, Germany.
| | - Ujjwal M. Mahajan
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | - Stefan Munker
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | - Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | - Ralf Wimmer
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | | | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | - Yulong He
- Digestive Diseases Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Andreas Geier
- Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany.
| | - Enrico N. De Toni
- Department of Medicine II, University Hospital, LMU Munich, Germany.
| | - Changhua Zhang
- Digestive Diseases Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Florian P. Reiter
- Department of Medicine II, University Hospital, LMU Munich, Germany.
- Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany.
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3
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Benitz S, Steep A, Nasser M, Preall J, Mahajan UM, McQuithey H, Loveless I, Davis ET, Wen HJ, Long DW, Metzler T, Zwernik S, Louw M, Rempinski D, Salas-Escabillas D, Brender S, Song L, Huang L, Zhang Z, Steele NG, Regel I, Bednar F, Crawford HC. ROR2 regulates cellular plasticity in pancreatic neoplasia and adenocarcinoma. bioRxiv 2024:2023.12.13.571566. [PMID: 38168289 PMCID: PMC10760092 DOI: 10.1101/2023.12.13.571566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Cellular plasticity is a hallmark of pancreatic ductal adenocarcinoma (PDAC) starting from the conversion of normal cells into precancerous lesions to the progression of carcinoma subtypes associated with aggressiveness and therapeutic response. We discovered that normal acinar cell differentiation, maintained by the transcription factor Pdx1, suppresses a broad gastric cell identity that is maintained in metaplasia, neoplasia, and the classical subtype of PDAC in mouse and human. We have identified the receptor tyrosine kinase Ror2 as marker of a gastric metaplasia (SPEM)-like identity in the pancreas. Ablation of Ror2 in a mouse model of pancreatic tumorigenesis promoted a switch to a gastric pit cell identity that largely persisted through progression to the classical subtype of PDAC. In both human and mouse pancreatic cancer, ROR2 activity continued to antagonize the gastric pit cell identity, strongly promoting an epithelial to mesenchymal transition, conferring resistance to KRAS inhibition, and vulnerability to AKT inhibition.
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Affiliation(s)
- Simone Benitz
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Alec Steep
- Center of Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Malak Nasser
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Jonathan Preall
- Cold Spring Harbor Laboratory Cancer Center, Cold Spring Harbor, New York, USA
| | - Ujjwal M Mahajan
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Holly McQuithey
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Ian Loveless
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA
| | - Erick T Davis
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Hui-Ju Wen
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Daniel W Long
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Thomas Metzler
- Comparative Experimental Pathology (CEP), Institute of Pathology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Samuel Zwernik
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Michaela Louw
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Donald Rempinski
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Sydney Brender
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Linghao Song
- Center of Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Ling Huang
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Zhenyu Zhang
- Center of Translational Data Science, University of Chicago, Chicago, Illinois, USA
| | - Nina G Steele
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
- Department of Pathology, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacology and Toxicology, Michigan State University, Lansing, Michigan, USA
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
| | - Ivonne Regel
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Filip Bednar
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Howard C Crawford
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
- Department of Pharmacology and Toxicology, Michigan State University, Lansing, Michigan, USA
- Department of Oncology, Wayne State University, Detroit, Michigan, USA
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4
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Mahajan UM, Oehrle B, Sirtl S, Alnatsha A, Goni E, Regel I, Beyer G, Vornhülz M, Vielhauer J, Chromik A, Bahra M, Klein F, Uhl W, Fahlbusch T, Distler M, Weitz J, Grützmann R, Pilarsky C, Weiss FU, Adam MG, Neoptolemos JP, Kalthoff H, Rad R, Christiansen N, Bethan B, Kamlage B, Lerch MM, Mayerle J. Independent Validation and Assay Standardization of Improved Metabolic Biomarker Signature to Differentiate Pancreatic Ductal Adenocarcinoma From Chronic Pancreatitis. Gastroenterology 2022; 163:1407-1422. [PMID: 35870514 DOI: 10.1053/j.gastro.2022.07.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Pancreatic ductal adenocarcinoma cancer (PDAC) is a highly lethal malignancy requiring efficient detection when the primary tumor is still resectable. We previously developed the MxPancreasScore comprising 9 analytes and serum carbohydrate antigen 19-9 (CA19-9), achieving an accuracy of 90.6%. The necessity for 5 different analytical platforms and multiple analytical runs, however, hindered clinical applicability. We therefore aimed to develop a simpler single-analytical run, single-platform diagnostic signature. METHODS We evaluated 941 patients (PDAC, 356; chronic pancreatitis [CP], 304; nonpancreatic disease, 281) in 3 multicenter independent tests, and identification (ID) and validation cohort 1 (VD1) and 2 (VD2) were evaluated. Targeted quantitative plasma metabolite analysis was performed on a liquid chromatography-tandem mass spectrometry platform. A machine learning-aided algorithm identified an improved (i-Metabolic) and minimalistic metabolic (m-Metabolic) signatures, and compared them for performance. RESULTS The i-Metabolic Signature, (12 analytes plus CA19-9) distinguished PDAC from CP with area under the curve (95% confidence interval) of 97.2% (97.1%-97.3%), 93.5% (93.4%-93.7%), and 92.2% (92.1%-92.3%) in the ID, VD1, and VD2 cohorts, respectively. In the VD2 cohort, the m-Metabolic signature (4 analytes plus CA19-9) discriminated PDAC from CP with a sensitivity of 77.3% and specificity of 89.6%, with an overall accuracy of 82.4%. For the subset of 45 patients with PDAC with resectable stages IA-IIB tumors, the sensitivity, specificity, and accuracy were 73.2%, 89.6%, and 82.7%, respectively; for those with detectable CA19-9 >2 U/mL, 81.6%, 88.7%, and 84.5%, respectively; and for those with CA19-9 <37 U/mL, 39.7%, 94.1%, and 76.3%, respectively. CONCLUSIONS The single-platform, single-run, m-Metabolic signature of just 4 metabolites used in combination with serum CA19-9 levels is an innovative accurate diagnostic tool for PDAC at the time of clinical presentation, warranting further large-scale evaluation.
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Affiliation(s)
- Ujjwal M Mahajan
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Bettina Oehrle
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Simon Sirtl
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Ahmed Alnatsha
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Elisabetta Goni
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Ivonne Regel
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Georg Beyer
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Marlies Vornhülz
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Jakob Vielhauer
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany
| | - Ansgar Chromik
- Department of General and Visceral Surgery, Asklepios Klinikum Hamburg, Hamburg, Germany
| | - Markus Bahra
- Zentrum für Onkologische Oberbauchchirurgie und Robotik, Krankenhaus Waldfriede, Berlin, Germany
| | - Fritz Klein
- Department of General, Visceral and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany
| | - Waldemar Uhl
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Tim Fahlbusch
- Department of General and Visceral Surgery, Katholisches Klinikum Bochum, Bochum, Germany
| | - Marius Distler
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department for Visceral, Thoracic and Vascular Surgery, University Hospital, Technical University Dresden, Dresden, Germany
| | - Robert Grützmann
- Department of Surgery, Erlangen University Hospital, Erlangen, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Erlangen, Germany
| | - Christian Pilarsky
- Department of Surgery, Erlangen University Hospital, Erlangen, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Erlangen, Germany
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - M Gordian Adam
- Metanomics Health GmbH, Berlin, Germany; biocrates life sciences ag, Innsbruck, Austria
| | - John P Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Holger Kalthoff
- Section for Molecular Oncology, Institut for Experimental Cancer Research (IET), Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Roland Rad
- Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany; Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine and Center for Translational Cancer Research (TranslaTUM), Technische Universität München, Munich, Germany
| | - Nicole Christiansen
- Metanomics Health GmbH, Berlin, Germany; TrinamiX GmbH, Ludwigshafen am Rhein, Rheinland-Pfalz, Germany
| | | | | | - Markus M Lerch
- Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany; Ludwig Maximilian University Klinikum, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany; Bavarian Centre for Cancer Research (Bayerisches Zentrum für Krebsforschung), Munich, Germany.
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5
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Orben F, Lankes K, Schneeweis C, Hassan Z, Jakubowsky H, Krauß L, Boniolo F, Schneider C, Schäfer A, Murr J, Schlag C, Kong B, Öllinger R, Wang C, Beyer G, Mahajan UM, Xue Y, Mayerle J, Schmid RM, Kuster B, Rad R, Braun CJ, Wirth M, Reichert M, Saur D, Schneider G. Epigenetic drug screening defines a PRMT5 inhibitor-sensitive pancreatic cancer subtype. JCI Insight 2022; 7:e151353. [PMID: 35439169 PMCID: PMC9220834 DOI: 10.1172/jci.insight.151353] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
Systemic therapies for pancreatic ductal adenocarcinoma (PDAC) remain unsatisfactory. Clinical prognosis is particularly poor for tumor subtypes with activating aberrations in the MYC pathway, creating an urgent need for novel therapeutic targets. To unbiasedly find MYC-associated epigenetic dependencies, we conducted a drug screen in pancreatic cancer cell lines. Here, we found that protein arginine N-methyltransferase 5 (PRMT5) inhibitors triggered an MYC-associated dependency. In human and murine PDACs, a robust connection of MYC and PRMT5 was detected. By the use of gain- and loss-of-function models, we confirmed the increased efficacy of PRMT5 inhibitors in MYC-deregulated PDACs. Although inhibition of PRMT5 was inducing DNA damage and arresting PDAC cells in the G2/M phase of the cell cycle, apoptotic cell death was executed predominantly in cells with high MYC expression. Experiments in primary patient-derived PDAC models demonstrated the existence of a highly PRMT5 inhibitor-sensitive subtype. Our work suggests developing PRMT5 inhibitor-based therapies for PDAC.
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Affiliation(s)
- Felix Orben
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar and
| | | | - Christian Schneeweis
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar and
- Institute for Translational Cancer Research and Experimental Cancer Therapy, Technical University Munich (TUM), Munich, Germany
| | - Zonera Hassan
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar and
| | - Hannah Jakubowsky
- Institute for Translational Cancer Research and Experimental Cancer Therapy, Technical University Munich (TUM), Munich, Germany
| | - Lukas Krauß
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar and
- University Medical Center Göttingen, Department of General, Visceral and Pediatric Surgery, Göttingen, Germany
| | - Fabio Boniolo
- Institute for Translational Cancer Research and Experimental Cancer Therapy, Technical University Munich (TUM), Munich, Germany
| | - Carolin Schneider
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar and
- University Medical Center Göttingen, Department of General, Visceral and Pediatric Surgery, Göttingen, Germany
| | - Arlett Schäfer
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar and
| | - Janine Murr
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar and
| | | | - Bo Kong
- Department of Surgery, Klinikum rechts der Isar, TUM, Munich, Germany
- Department of General Surgery, University of Ulm, Ulm, Germany
| | - Rupert Öllinger
- Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine and
| | - Chengdong Wang
- Chair of Proteomics and Bioanalytics, TUM School of Life Sciences, TUM, Freising, Germany
- Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Department of Surgery, Children’s Hospital of Soochow University, Suzhou, China
| | - Georg Beyer
- Department of Medicine II, LMU University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Ujjwal M. Mahajan
- Department of Medicine II, LMU University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Yonggan Xue
- Department of Medicine II, LMU University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, LMU University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
- German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Roland M. Schmid
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar and
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Bernhard Kuster
- Chair of Proteomics and Bioanalytics, TUM School of Life Sciences, TUM, Freising, Germany
- German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
- Bavarian Center for Biomolecular Mass Spectrometry (BayBioMS), TUM, Freising, Germany
| | - Roland Rad
- Institute of Molecular Oncology and Functional Genomics, TUM School of Medicine and
- German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Christian J. Braun
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Wirth
- Department of Hematology, Oncology and Tumor Immunology, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Reichert
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar and
- Bavarian Cancer Research Center (BZKF), Munich, Germany
- German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
- Center for Protein Assemblies (CPA), TUM, Garching, Germany
- Translational Pancreatic Research Cancer Center, Medical Clinic and Polyclinic II, Klinikum rechts der Isar, TUM, Munich, Germany
| | - Dieter Saur
- Institute for Translational Cancer Research and Experimental Cancer Therapy, Technical University Munich (TUM), Munich, Germany
- German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Günter Schneider
- Medical Clinic and Polyclinic II, Klinikum rechts der Isar and
- University Medical Center Göttingen, Department of General, Visceral and Pediatric Surgery, Göttingen, Germany
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6
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Allawadhi P, Beyer G, Mahajan UM, Mayerle J. Novel Insights Into Macrophage Diversity During the Course of Pancreatitis. Gastroenterology 2021; 161:1802-1805. [PMID: 34587487 DOI: 10.1053/j.gastro.2021.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Prince Allawadhi
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Georg Beyer
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Bavarian Cancer Research Center, Munich, Germany
| | - Ujjwal M Mahajan
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Bavarian Cancer Research Center, Munich, Germany.
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7
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Adam MG, Beyer G, Christiansen N, Kamlage B, Pilarsky C, Distler M, Fahlbusch T, Chromik A, Klein F, Bahra M, Uhl W, Grützmann R, Mahajan UM, Weiss FU, Mayerle J, Lerch MM. Identification and validation of a multivariable prediction model based on blood plasma and serum metabolomics for the distinction of chronic pancreatitis subjects from non-pancreas disease control subjects. Gut 2021; 70:2150-2158. [PMID: 33541865 PMCID: PMC8515121 DOI: 10.1136/gutjnl-2020-320723] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Chronic pancreatitis (CP) is a fibroinflammatory syndrome leading to organ dysfunction, chronic pain, an increased risk for pancreatic cancer and considerable morbidity. Due to a lack of specific biomarkers, diagnosis is based on symptoms and specific but insensitive imaging features, preventing an early diagnosis and appropriate management. DESIGN We conducted a type 3 study for multivariable prediction for individual prognosis according to the TRIPOD guidelines. A signature to distinguish CP from controls (n=160) was identified using gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry on ethylenediaminetetraacetic acid (EDTA)-plasma and validated in independent cohorts. RESULTS A Naive Bayes algorithm identified eight metabolites of six ontology classes. After algorithm training and computation of optimal cut-offs, classification according to the metabolic signature detected CP with an area under the curve (AUC) of 0.85 ((95% CI 0.79 to 0.91). External validation in two independent cohorts (total n=502) resulted in similar accuracy for detection of CP compared with non-pancreatic controls in EDTA-plasma (AUC 0.85 (95% CI 0.81 to 0.89)) and serum (AUC 0.87 (95% CI 0.81 to 0.95)). CONCLUSIONS This is the first study that identifies and independently validates a metabolomic signature in plasma and serum for the diagnosis of CP in large, prospective cohorts. The results could provide the basis for the development of the first routine laboratory test for CP.
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Affiliation(s)
| | - Georg Beyer
- Department of Medicine II, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany
| | | | | | - Christian Pilarsky
- Department of Surgery, Erlangen University Hospital, Erlangen, Bayern, Germany
| | - Marius Distler
- Clinic and Outpatient Clinic for Visceral-, Thorax- and Vascular Surgery, Dresden University Hospital, Dresden, Sachsen, Germany
| | - Tim Fahlbusch
- St. Josef Hospital, Department of Surgery, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Ansgar Chromik
- Askleipios Clinic Harburg, Department for General and Visceral Surgery, Asklepios Hospital Group, Hamburg, Hamburg, Germany
| | - Fritz Klein
- Department of Surgery, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Berlin, Germany
| | - Marcus Bahra
- Department of Surgery, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Berlin, Germany
| | - Waldemar Uhl
- St. Josef Hospital, Department of Surgery, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Robert Grützmann
- Department of Surgery, Erlangen University Hospital, Erlangen, Bayern, Germany
| | - Ujjwal M Mahajan
- Department of Medicine II, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany
| | - Frank U Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Julia Mayerle
- Department of Medicine II, Ludwig-Maximilians-Universitat Munchen, Munchen, Bayern, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
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8
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Mahajan UM, Li Q, Alnatsha A, Maas J, Orth M, Maier SH, Peterhansl J, Regel I, Sendler M, Wagh PR, Mishra N, Xue Y, Allawadhi P, Beyer G, Kühn JP, Marshall T, Appel B, Lämmerhirt F, Belka C, Müller S, Weiss FU, Lauber K, Lerch MM, Mayerle J. Tumor-Specific Delivery of 5-Fluorouracil-Incorporated Epidermal Growth Factor Receptor-Targeted Aptamers as an Efficient Treatment in Pancreatic Ductal Adenocarcinoma Models. Gastroenterology 2021; 161:996-1010.e1. [PMID: 34097885 DOI: 10.1053/j.gastro.2021.05.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 09/21/2020] [Revised: 04/19/2021] [Accepted: 05/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUNDS & AIMS Fluoropyrimidine c (5-fluorouracil [5FU]) increasingly represents the chemotherapeutic backbone for neoadjuvant, adjuvant, and palliative treatment of pancreatic ductal adenocarcinoma (PDAC). Even in combination with other agents, 5FU efficacy remains transient and limited. One explanation for the inadequate response is insufficient and nonspecific delivery of 5FU to the tumor. METHODS We designed, generated, and characterized 5FU-incorporated systematic evolution of ligands by exponential enrichment (SELEX)-selected epidermal growth factor receptor (EGFR)-targeted aptamers for tumor-specific delivery of 5FU to PDAC cells and tested their therapeutic efficacy in vitro and in vivo. RESULTS 5FU-EGFR aptamers reduced proliferation in a concentration-dependent manner in mouse and human pancreatic cancer cell lines. Time-lapsed live imaging showed EGFR-specific uptake of aptamers via clathrin-dependent endocytosis. The 5FU-aptamer treatment was equally effective in 5FU-sensitive and 5FU-refractory PDAC cell lines. Biweekly treatment with 5FU-EGFR aptamers reduced tumor burden in a syngeneic orthotopic transplantation model of PDAC, in an autochthonously growing genetically engineered PDAC model (LSL-KrasG12D/+;LSL-Trp53flox/+;Ptf1a-Cre [KPC]), in an orthotopic cell line-derived xenograft model using human PDAC cells in athymic mice (CDX; Crl:NU-Foxn1nu), and in patient-derived organoids. Tumor growth was significantly attenuated during 5FU-EGFR aptamer treatment in the course of follow-up. CONCLUSIONS Tumor-specific targeted delivery of 5FU using EGFR aptamers as the carrier achieved high target specificity; overcame 5FU resistance; and proved to be effective in a syngeneic orthotopic transplantation model, in KPC mice, in a CDX model, and in patient-derived organoids and, therefore, represents a promising backbone for pancreatic cancer chemotherapy in patients. Furthermore, our approach has the potential to target virtually any cancer entity sensitive to 5FU treatment by incorporating 5FU into cancer cell-targeting aptamers as the delivery platform.
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MESH Headings
- Animals
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/metabolism
- Aptamers, Nucleotide/administration & dosage
- Aptamers, Nucleotide/metabolism
- Carcinoma, Pancreatic Ductal/drug therapy
- Carcinoma, Pancreatic Ductal/metabolism
- Carcinoma, Pancreatic Ductal/pathology
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Drug Delivery Systems
- Drug Resistance, Neoplasm
- Endocytosis
- ErbB Receptors/genetics
- ErbB Receptors/metabolism
- Female
- Fluorouracil/administration & dosage
- Fluorouracil/metabolism
- Humans
- Male
- Mice, Inbred C57BL
- Mice, Transgenic
- Organoids
- Pancreatic Neoplasms/drug therapy
- Pancreatic Neoplasms/genetics
- Pancreatic Neoplasms/metabolism
- Pancreatic Neoplasms/pathology
- SELEX Aptamer Technique
- Tumor Burden/drug effects
- Tumor Cells, Cultured
- Xenograft Model Antitumor Assays
- Mice
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Affiliation(s)
- Ujjwal M Mahajan
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Qi Li
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Ahmed Alnatsha
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Jessica Maas
- Department of Radiation Oncology, Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Michael Orth
- Department of Radiation Oncology, Hospital of Ludwig-Maximilians-University, Munich, Germany
| | | | - Julian Peterhansl
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Ivonne Regel
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Preshit R Wagh
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Neha Mishra
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Yonggan Xue
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Prince Allawadhi
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Jens-Peter Kühn
- Institute and Policlinic of Diagnostic and Interventional Radiology, Medical University, Carl-Gustav-Carus, Dresden, Germany
| | - Thomas Marshall
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Bettina Appel
- Institute of Biochemistry, University Greifswald, Germany
| | - Felix Lämmerhirt
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Claus Belka
- Department of Radiation Oncology, Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Sabine Müller
- Institute of Biochemistry, University Greifswald, Germany
| | - Frank-Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Kirsten Lauber
- Department of Radiation Oncology, Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany; LMU Klinikum, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.
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9
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Trapp S, Aghdassi AA, Glaubitz J, Sendler M, Weiss FU, Kühn JP, Kromrey ML, Mahajan UM, Pallagi P, Rakonczay Z, Venglovecz V, Lerch MM, Hegyi P, Mayerle J. Pancreatitis severity in mice with impaired CFTR function but pancreatic sufficiency is mediated via ductal and inflammatory cells-Not acinar cells. J Cell Mol Med 2021; 25:4658-4670. [PMID: 33682322 PMCID: PMC8107082 DOI: 10.1111/jcmm.16404] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
Mutations in the cystic fibrosis transmembrane conductance regulator gene (CFTR) are an established risk factor for cystic fibrosis (CF) and chronic pancreatitis. Whereas patients with CF usually develop complete exocrine pancreatic insufficiency, pancreatitis patients with CFTR mutations have mostly preserved exocrine pancreatic function. We therefore used a strain of transgenic mice with significant residual CFTR function (CFTRtm1HGU ) to induce pancreatitis experimentally by serial caerulein injections. Protease activation and necrosis were investigated in isolated acini, disease severity over 24h, pancreatic function by MRI, isolated duct stimulation and faecal chymotrypsin, and leucocyte function by ex vivo lipopolysaccharide (LPS) stimulation. Pancreatic and lung injury were more severe in CFTRtm1HGU but intrapancreatic trypsin and serum enzyme activities higher than in wild-type controls only at 8h, a time interval previously attributed to leucocyte infiltration. CCK-induced trypsin activation and necrosis in acini from CFTRtm1HGU did not differ from controls. Fluid and bicarbonate secretion were greatly impaired, whereas faecal chymotrypsin remained unchanged. LPS stimulation of splenocytes from CFTRtm1HGU resulted in increased INF-γ and IL-6, but decreased IL-10 secretion. CFTR mutations that preserve residual pancreatic function significantly increase the severity of experimental pancreatitis-mostly via impairing duct cell function and a shift towards a pro-inflammatory phenotype, not by rendering acinar cells more susceptible to pathological stimuli.
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Affiliation(s)
- Simon Trapp
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Juliane Glaubitz
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Frank Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Jens Peter Kühn
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Marie-Luise Kromrey
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Ujjwal M Mahajan
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.,Department of Medicine II, Ludwig-Maximilians University Munich, Munich, Germany
| | - Petra Pallagi
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Rakonczay
- Department of Pathophysiology, University of Szeged, Szeged, Hungary
| | - Viktória Venglovecz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Peter Hegyi
- Department of Translational Medicine/First Department of Medicine, Medical School, Institute for Translational Medicine, Pécs, Hungary
| | - Julia Mayerle
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany.,Department of Medicine II, Ludwig-Maximilians University Munich, Munich, Germany
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10
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Reiter FP, Obermeier W, Jung J, Denk G, Mahajan UM, De Toni EN, Schirra J, Mayerle J, Schulz C. Prevalence, Resistance Rates, and Risk Factors of Pathogens in Routine Bile Cultures Obtained during Endoscopic Retrograde Cholangiography. Dig Dis 2020; 39:42-51. [PMID: 32521535 DOI: 10.1159/000509289] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/09/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION AND OBJECTIVE Acute cholangitis is a life-threatening condition. The early initiation of antibiotic therapy significantly impacts the course of disease. Only few data are available on distribution and resistance profiles of bile pathogens. Here, we report on an analysis of routinely acquired bile specimens and provide an overview of the prevalence, resistance rates, and risk factors for the presence of pathogens in bile. METHODS Bile cultures obtained from 388 endoscopic retrograde cholangiographies (ERCs) with corresponding clinical data were analysed in 208 patients. RESULTS The majority (84.8%) of cultures yielded positive for at least 1 organism. Abundance was highest for Enterococcus faecalis, Enterococcus faecium, and Escherichia coli. Multiresistant organisms were present in 14.9%. The initial antibiotic regimen was changed in 44.1%, which increased the length of hospital stay significantly (***p < 0.001). Pre-existing papillotomy (EPT) or biliary drainage was associated with higher frequency of bile pathogens (**p < 0.01) in a univariate analysis. Multivariate analysis confirmed these results for EPT and revealed significantly more positive results for pathogens, gram-negative bacteria, and fungi in patients with biliary drainage. Significant differences in the prevalence of pathogens were observed between relevant subgroups of ERC indications. The highest susceptibility rates were observed for linezolid and tigecycline in gram-positive bacteria and for meropenem and gentamicin in gram-negative bacteria. CONCLUSIONS Our study provides a comprehensive analysis of the distribution, resistance profiles, and risk factors for the detection of bile pathogens. The frequent change in initial antibiotic treatment highlights the importance of routine bile culture and indicates that current schemas of empirical treatment might not cover the contemporary spectrum of pathogens in bile.
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Affiliation(s)
- Florian P Reiter
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany, .,Liver Center, University Hospital, LMU Munich, Munich, Germany,
| | - Wolfgang Obermeier
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Jette Jung
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikobiologie, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gerald Denk
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Ujjwal M Mahajan
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Jörg Schirra
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
| | - Christian Schulz
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.,Liver Center, University Hospital, LMU Munich, Munich, Germany
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11
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Malla SR, Krueger B, Wartmann T, Sendler M, Mahajan UM, Weiss FU, Thiel FG, De Boni C, Gorelick FS, Halangk W, Aghdassi AA, Reinheckel T, Gukovskaya AS, Lerch MM, Mayerle J. Early trypsin activation develops independently of autophagy in caerulein-induced pancreatitis in mice. Cell Mol Life Sci 2020; 77:1811-1825. [PMID: 31363815 PMCID: PMC8221268 DOI: 10.1007/s00018-019-03254-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 12/18/2022]
Abstract
Premature intrapancreatic trypsinogen activation is widely regarded as an initiating event for acute pancreatitis. Previous studies have alternatively implicated secretory vesicles, endosomes, lysosomes, or autophagosomes/autophagolysosomes as the primary site of trypsinogen activation, from which a cell-damaging proteolytic cascade originates. To identify the subcellular compartment of initial trypsinogen activation we performed a time-resolution analysis of the first 12 h of caerulein-induced pancreatitis in transgenic light chain 3 (LC3)-GFP autophagy reporter mice. Intrapancreatic trypsin activity increased within 60 min and serum amylase within 2 h, but fluorescent autophagosome formation only by 4 h of pancreatitis in parallel with a shift from cytosolic LC3-I to membranous LC3-II on Western blots. At 60 min, activated trypsin in heavier subcellular fractions was co-distributed with cathepsin B, but not with the autophagy markers LC3 or autophagy protein 16 (ATG16). Supramaximal caerulein stimulation of primary pancreatic acini derived from LC3-GFP mice revealed that trypsinogen activation is independent of autophagolysosome formation already during the first 15 min of exposure to caerulein. Co-localization studies (with GFP-LC3 autophagosomes versus Ile-Pro-Arg-AMC trypsin activity and immunogold-labelling of lysosomal-associated membrane protein 2 [LAMP-2] versus trypsinogen activation peptide [TAP]) indicated active trypsin in autophagolysosomes only at the later timepoints. In conclusion, during the initiating phase of caerulein-induced pancreatitis, premature protease activation develops independently of autophagolysosome formation and in vesicles arising from the secretory pathway. However, autophagy is likely to regulate overall intracellular trypsin activity during the later stages of this disease.
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Affiliation(s)
- Sudarshan R Malla
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruchstrasse, Greifswald, 17475, Germany
- Veterans Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine, Southern California Research Center for Alcoholic Liver and Pancreatic Disease and Cirrhosis, University of California at Los Angeles, Los Angeles, CA, 90073, USA
| | - Burkhard Krueger
- Division of Medical Biology, University of Rostock, Rostock, 18051, Germany
| | - Thomas Wartmann
- Division of Experimental Surgery, University of Magdeburg, Magdeburg, 39120, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruchstrasse, Greifswald, 17475, Germany
| | - Ujjwal M Mahajan
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruchstrasse, Greifswald, 17475, Germany
- Department of Medicine II, Ludwigs-Maximilians University Munich, 80539, Munich, Germany
| | - F Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruchstrasse, Greifswald, 17475, Germany
| | - Franziska G Thiel
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruchstrasse, Greifswald, 17475, Germany
| | - Carina De Boni
- Division of Experimental Surgery, University of Magdeburg, Magdeburg, 39120, Germany
| | | | - Walter Halangk
- Division of Experimental Surgery, University of Magdeburg, Magdeburg, 39120, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruchstrasse, Greifswald, 17475, Germany
| | - Thomas Reinheckel
- Institute of Molecular Medicine and Cell Research, University of Freiburg, Freiburg, 79104, Germany
| | - Anna S Gukovskaya
- Veterans Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine, Southern California Research Center for Alcoholic Liver and Pancreatic Disease and Cirrhosis, University of California at Los Angeles, Los Angeles, CA, 90073, USA
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruchstrasse, Greifswald, 17475, Germany.
| | - Julia Mayerle
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruchstrasse, Greifswald, 17475, Germany
- Department of Medicine II, Ludwigs-Maximilians University Munich, 80539, Munich, Germany
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12
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Mahajan UM, Goni E, Langhoff E, Li Q, Costello E, Greenhalf W, Kruger S, Ormanns S, Halloran C, Ganeh P, Marron M, Lämmerhirt F, Zhao Y, Beyer G, Weiss FU, Sendler M, Bruns CJ, Kohlmann T, Kirchner T, Werner J, D’Haese JG, von Bergwelt-Baildon M, Heinemann V, Neoptolemos JP, Büchler MW, Belka C, Boeck S, Lerch MM, Mayerle J. Cathepsin D Expression and Gemcitabine Resistance in Pancreatic Cancer. JNCI Cancer Spectr 2020; 4:pkz060. [PMID: 32296755 PMCID: PMC7050148 DOI: 10.1093/jncics/pkz060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/01/2019] [Accepted: 08/06/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cathepsin-D (CatD), owing to its dual role as a proteolytic enzyme and as a ligand, has been implicated in cancer progression. The role of CatD in pancreatic ductal adenocarcinoma is unknown. METHODS CatD expression quantified by immunohistochemistry of tumor-tissue microarrays of 403 resected pancreatic cancer patients from the ESPAC-Tplus trial, a translational study within the ESPAC (European Study Group for Pancreatic Cancer) trials, was dichotomously distributed to low and high H scores (cut off 22.35) for survival and multivariable analysis. The validation cohort (n = 69) was recruited based on the hazard ratio of CatD from ESPAC-Tplus. 5-fluorouracil-, and gemcitabine-resistant pancreatic cancer cell lines were employed for mechanistic experiments. All statistical tests were two-sided. RESULTS Median overall survival was 23.75 months and median overall survival for patients with high CatD expression was 21.09 (95% confidence interval [CI] = 17.31 to 24.80) months vs 27.20 (95% CI = 23.75 to 31.90) months for low CatD expression (χ2 LR, 1DF = 4.00; P = .04). Multivariable analysis revealed CatD expression as a predictive marker in gemcitabine-treated (z stat = 2.33; P = .02) but not in 5-fluorouracil-treated (z stat = 0.21; P = .82) patients. An independent validation cohort confirmed CatD as a negative predictive marker for survival (χ2 LR, 1DF = 6.80; P = .009) and as an independent predictive marker in gemcitabine-treated patients with a hazard ratio of 3.38 (95% CI = 1.36 to 8.38, P = .008). Overexpression of CatD was associated with a concomitant suppression of the acid sphingomyelinase, and silencing of CatD resulted in upregulation of acid sphingomyelinase with rescue of gemcitabine resistance. CONCLUSIONS Adjuvant gemcitabine is less effective in pancreatic ductal adenocarcinoma with high CatD expression, and thus CatD could serve as a marker for biomarker-driven therapy.
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Affiliation(s)
- Ujjwal M Mahajan
- Department of Medicine II, University Hospital, LMU-Munich, Munich, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Elisabetta Goni
- Department of Medicine II, University Hospital, LMU-Munich, Munich, Germany
| | - Enno Langhoff
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Qi Li
- Department of Medicine II, University Hospital, LMU-Munich, Munich, Germany
| | - Eithne Costello
- National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK
| | - William Greenhalf
- National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK
| | - Stephan Kruger
- Department of Medicine III, University Hospital, LMU-Munich, Munich, Germany
| | - Steffen Ormanns
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Christopher Halloran
- National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK
| | - Paula Ganeh
- National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK
| | - Manuela Marron
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Felix Lämmerhirt
- Department of Medicine II, University Hospital, LMU-Munich, Munich, Germany
| | - Yue Zhao
- Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany
| | - Georg Beyer
- Department of Medicine II, University Hospital, LMU-Munich, Munich, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Frank-Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Christiane J Bruns
- Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany
| | - Thomas Kohlmann
- Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kirchner
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jan G D’Haese
- Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Volker Heinemann
- Department of Medicine III, University Hospital, LMU-Munich, Munich, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - John P Neoptolemos
- National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU-Munich, Munich, Germany
| | - Stefan Boeck
- Department of Medicine III, University Hospital, LMU-Munich, Munich, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU-Munich, Munich, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
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Simon O, Beyer G, Mahajan UM, Mayerle J. [Pancreatic Cancer in the Year 2018 - Room for Precision Medicine?]. Dtsch Med Wochenschr 2018; 143:1109-1112. [PMID: 30060283 DOI: 10.1055/a-0542-4310] [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] [Indexed: 10/28/2022]
Abstract
In Germany, an estimated 19 000 people will develop pancreatic carcinoma in 2018. The 5-year survival rate of all pancreatic carcinoma patients is very low at around 6 %, and the potentially curative operation is only possible in 15 - 20 % of patients. More frequent use and combination of systemic chemotherapeutic agents has led to improved life expectancy in recent years. In this article we will summarize recent therapeutic strategies depending on tumor status and current approaches to personalized medicine in pancreatic carcinoma.
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Affiliation(s)
- Ole Simon
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum München, Ludwig-Maximilians-Universität, München
| | - Georg Beyer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum München, Ludwig-Maximilians-Universität, München
| | - Ujjwal M Mahajan
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum München, Ludwig-Maximilians-Universität, München
| | - Julia Mayerle
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum München, Ludwig-Maximilians-Universität, München
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Beyer G, Mahajan UM, Lerch MM, Mayerle J. Reply. Gastroenterology 2018; 154:1853-1854. [PMID: 29621520 DOI: 10.1053/j.gastro.2018.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Georg Beyer
- Department of Medicine A, University Medicine Greifswald, Greifswald and Department of Medicine 2, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Ujjwal M Mahajan
- Department of Medicine A, University Medicine Greifswald, Greifswald and Department of Medicine 2, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, University Medicine Greifswald, Greifswald and Department of Medicine 2, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
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Sendler M, Weiss FU, Golchert J, Homuth G, van den Brandt C, Mahajan UM, Partecke LI, Döring P, Gukovsky I, Gukovskaya AS, Wagh PR, Lerch MM, Mayerle J. Cathepsin B-Mediated Activation of Trypsinogen in Endocytosing Macrophages Increases Severity of Pancreatitis in Mice. Gastroenterology 2018; 154:704-718.e10. [PMID: 29079517 PMCID: PMC6663074 DOI: 10.1053/j.gastro.2017.10.018] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Acute pancreatitis is characterized by premature intracellular activation of digestive proteases within pancreatic acini and a consecutive systemic inflammatory response. We investigated how these processes interact during severe pancreatitis in mice. METHODS Pancreatitis was induced in C57Bl/6 wild-type (control), cathepsin B (CTSB)-knockout, and cathepsin L-knockout mice by partial pancreatic duct ligation with supramaximal caerulein injection, or by repetitive supramaximal caerulein injections alone. Immune cells that infiltrated the pancreas were characterized by immunofluorescence detection of Ly6g, CD206, and CD68. Macrophages were isolated from bone marrow and incubated with bovine trypsinogen or isolated acinar cells; the macrophages were then transferred into pancreatitis control or cathepsin-knockout mice. Activities of proteases and nuclear factor (NF)-κB were determined using fluorogenic substrates and trypsin activity was blocked by nafamostat. Cytokine levels were measured using a cytometric bead array. We performed immunohistochemical analyses to detect trypsinogen, CD206, and CD68 in human chronic pancreatitis (n = 13) and acute necrotizing pancreatitis (n = 15) specimens. RESULTS Macrophages were the predominant immune cell population that migrated into the pancreas during induction of pancreatitis in control mice. CD68-positive macrophages were found to phagocytose acinar cell components, including zymogen-containing vesicles, in pancreata from mice with pancreatitis, as well as human necrotic pancreatic tissues. Trypsinogen became activated in macrophages cultured with purified trypsinogen or co-cultured with pancreatic acini and in pancreata of mice with pancreatitis; trypsinogen activation required macrophage endocytosis and expression and activity of CTSB, and was sensitive to pH. Activation of trypsinogen in macrophages resulted in translocation of NF-kB and production of inflammatory cytokines; mice without trypsinogen activation (CTSB-knockout mice) in macrophages developed less severe pancreatitis compared with control mice. Transfer of macrophage from control mice to CTSB-knockout mice increased the severity of pancreatitis. Inhibition of trypsin activity in macrophages prevented translocation of NF-κB and production of inflammatory cytokines. CONCLUSIONS Studying pancreatitis in mice, we found activation of digestive proteases to occur not only in acinar cells but also in macrophages that infiltrate pancreatic tissue. Activation of the proteases in macrophage occurs during endocytosis of zymogen-containing vesicles, and depends on pH and CTSB. This process involves macrophage activation via NF-κB-translocation, and contributes to systemic inflammation and severity of pancreatitis.
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MESH Headings
- Adoptive Transfer
- Animals
- Cathepsin B/deficiency
- Cathepsin B/genetics
- Cathepsin B/metabolism
- Cathepsin L/deficiency
- Cathepsin L/genetics
- Cells, Cultured
- Ceruletide
- Coculture Techniques
- Cytokines/metabolism
- Disease Models, Animal
- Endocytosis
- Enzyme Activation
- Genetic Predisposition to Disease
- Humans
- Hydrogen-Ion Concentration
- Inflammation Mediators/metabolism
- Macrophages/enzymology
- Macrophages/immunology
- Macrophages/pathology
- Macrophages/transplantation
- Mice, Inbred C57BL
- Mice, Knockout
- NF-kappa B/metabolism
- NLR Family, Pyrin Domain-Containing 3 Protein/deficiency
- NLR Family, Pyrin Domain-Containing 3 Protein/genetics
- Necrosis
- Pancreas/enzymology
- Pancreas/immunology
- Pancreas/pathology
- Pancreatectomy
- Pancreatitis, Acute Necrotizing/chemically induced
- Pancreatitis, Acute Necrotizing/enzymology
- Pancreatitis, Acute Necrotizing/immunology
- Pancreatitis, Acute Necrotizing/pathology
- Phagocytosis
- Phenotype
- Severity of Illness Index
- Time Factors
- Trypsinogen/metabolism
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Affiliation(s)
- Matthias Sendler
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Frank-Ulrich Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Janine Golchert
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | | | - Ujjwal M Mahajan
- Medizinische Klinik und Poliklinik II, Universitätsklinikum der Ludwig-Maximilians-Universität, Klinikum Grosshadern, Munich, Germany
| | - Lars-Ivo Partecke
- Department of Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Paula Döring
- Institute of Pathology, University Medicine Greifswald, Greifswald, Germany
| | - Ilya Gukovsky
- VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California at Los Angeles, California
| | - Anna S Gukovskaya
- VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California at Los Angeles, California
| | - Preshit R Wagh
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany; Medizinische Klinik und Poliklinik II, Universitätsklinikum der Ludwig-Maximilians-Universität, Klinikum Grosshadern, Munich, Germany.
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Mayerle J, Kalthoff H, Reszka R, Kamlage B, Peter E, Schniewind B, González Maldonado S, Pilarsky C, Heidecke CD, Schatz P, Distler M, Scheiber JA, Mahajan UM, Weiss FU, Grützmann R, Lerch MM. Metabolic biomarker signature to differentiate pancreatic ductal adenocarcinoma from chronic pancreatitis. Gut 2018; 67:128-137. [PMID: 28108468 PMCID: PMC5754849 DOI: 10.1136/gutjnl-2016-312432] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/22/2016] [Accepted: 12/26/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Current non-invasive diagnostic tests can distinguish between pancreatic cancer (pancreatic ductal adenocarcinoma (PDAC)) and chronic pancreatitis (CP) in only about two thirds of patients. We have searched for blood-derived metabolite biomarkers for this diagnostic purpose. DESIGN For a case-control study in three tertiary referral centres, 914 subjects were prospectively recruited with PDAC (n=271), CP (n=282), liver cirrhosis (n=100) or healthy as well as non-pancreatic disease controls (n=261) in three consecutive studies. Metabolomic profiles of plasma and serum samples were generated from 477 metabolites identified by gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry. RESULTS A biomarker signature (nine metabolites and additionally CA19-9) was identified for the differential diagnosis between PDAC and CP. The biomarker signature distinguished PDAC from CP in the training set with an area under the curve (AUC) of 0.96 (95% CI 0.93-0.98). The biomarker signature cut-off of 0.384 at 85% fixed specificity showed a sensitivity of 94.9% (95% CI 87.0%-97.0%). In the test set, an AUC of 0.94 (95% CI 0.91-0.97) and, using the same cut-off, a sensitivity of 89.9% (95% CI 81.0%-95.5%) and a specificity of 91.3% (95% CI 82.8%-96.4%) were achieved, successfully validating the biomarker signature. CONCLUSIONS In patients with CP with an increased risk for pancreatic cancer (cumulative incidence 1.95%), the performance of this biomarker signature results in a negative predictive value of 99.9% (95% CI 99.7%-99.9%) (training set) and 99.8% (95% CI 99.6%-99.9%) (test set). In one third of our patients, the clinical use of this biomarker signature would have improved diagnosis and treatment stratification in comparison to CA19-9.
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Affiliation(s)
- Julia Mayerle
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany,Medizinische Klinik und Poliklinik II, Klinikum der LMU München-Grosshadern, München, Germany
| | - Holger Kalthoff
- Section for Molecular Oncology, Institut for Experimental Cancer Research (IET), UKSH, Kiel, Germany
| | | | | | | | - Bodo Schniewind
- Section for Molecular Oncology, Institut for Experimental Cancer Research (IET), UKSH, Kiel, Germany
| | | | | | - Claus-Dieter Heidecke
- Department of General, Visceral, Thoracic and Vascular Surgery University Medicine Greifswald, Ernst-Moritz-Arndt University, Greifswald, Germany
| | | | - Marius Distler
- Clinic and Outpatient Clinic for Visceral-, Thorax- and Vascular Surgery, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Jonas A Scheiber
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
| | - Ujjwal M Mahajan
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany,Medizinische Klinik und Poliklinik II, Klinikum der LMU München-Grosshadern, München, Germany
| | - F Ulrich Weiss
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
| | | | - Markus M Lerch
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
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Beyer G, Mahajan UM, Budde C, Bulla TJ, Kohlmann T, Kuhlmann L, Schütte K, Aghdassi AA, Weber E, Weiss FU, Drewes AM, Olesen SS, Lerch MM, Mayerle J. Development and Validation of a Chronic Pancreatitis Prognosis Score in 2 Independent Cohorts. Gastroenterology 2017; 153:1544-1554.e2. [PMID: 28918191 DOI: 10.1053/j.gastro.2017.08.073] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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] [Received: 01/26/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS The clinical course of chronic pancreatitis is unpredictable. There is no model to assess disease severity or progression or predict patient outcomes. METHODS We performed a prospective study of 91 patients with chronic pancreatitis; data were collected from patients seen at academic centers in Europe from January 2011 through April 2014. We analyzed correlations between clinical, laboratory, and imaging data with number of hospital readmissions and in-hospital days over the next 12 months; the parameters with the highest degree of correlation were used to develop a 3-stage chronic pancreatitis prognosis score (COPPS). The predictive strength was validated in 129 independent subjects identified from 2 prospective databases. RESULTS The mean number of hospital admissions was 1.9 (95% confidence interval [CI], 1.39-2.44) and 15.2 for hospital days (95% CI, 10.76-19.71) for the development cohort and 10.9 for the validation cohort (95% CI, 7.54-14.30) (P = .08). Based on bivariate correlations, pain (numeric rating scale), level of glycated hemoglobin A1c, level of C-reactive protein, body mass index, and platelet count were used to develop the COPPS system. The patients' median COPPS was 8.9 points (range, 5-14). The system accurately discriminated stages of disease severity (low to high): A (5-6 points), B (7-9), and C (10-15). In Pearson correlation analysis of the development cohort, the COPPS correlated with hospital admissions (0.39; P < .01) and number of hospital days (0.33; P < .01). The correlation was validated in the validation set (Pearson correlation values of 0.36 and 0.44; P < .01). COPPS did not correlate with results from the Cambridge classification system. CONCLUSIONS We developed and validated an easy to use dynamic multivariate scoring system, similar to the Child-Pugh-Score for liver cirrhosis. The COPPS allows objective monitoring of patients with chronic pancreatitis, determining risk for readmission to hospital and potential length of hospital stay.
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Affiliation(s)
- Georg Beyer
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Ujjwal M Mahajan
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Christoph Budde
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - Thomas J Bulla
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - Thomas Kohlmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-Universität Greifswald, Germany
| | - Louise Kuhlmann
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kerstin Schütte
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Ali A Aghdassi
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - Eckhard Weber
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - F Ulrich Weiss
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - Asbjørn M Drewes
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren S Olesen
- Centre for Pancreatic Diseases and Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Markus M Lerch
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-University Greifswald, Germany; Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.
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Mahajan UM, Teller S, Sendler M, Palankar R, van den Brandt C, Schwaiger T, Kühn JP, Ribback S, Glöckl G, Evert M, Weitschies W, Hosten N, Dombrowski F, Delcea M, Weiss FU, Lerch MM, Mayerle J. Tumour-specific delivery of siRNA-coupled superparamagnetic iron oxide nanoparticles, targeted against PLK1, stops progression of pancreatic cancer. Gut 2016; 65:1838-1849. [PMID: 27196585 PMCID: PMC5099195 DOI: 10.1136/gutjnl-2016-311393] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/01/2016] [Accepted: 04/18/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies and is projected to be the second leading cause of cancer-related death by 2030. Despite extensive knowledge and insights into biological properties and genetic aberrations of PDAC, therapeutic options remain temporary and ineffective. One plausible explanation for the futile response to therapy is an insufficient and non-specific delivery of anticancer drugs to the tumour site. DESIGN Superparamagnetic iron oxide nanoparticles (SPIONs) coupled with siRNA directed against the cell cycle-specific serine-threonine-kinase, Polo-like kinase-1 (siPLK1-StAv-SPIONs), could serve a dual purpose for delivery of siPLK1 to the tumour and for non-invasive assessment of efficiency of delivery in vivo by imaging the tumour response. siPLK1-StAv-SPIONs were designed and synthesised as theranostics to function via a membrane translocation peptide with added advantage of driving endosomal escape for mediating transportation to the cytoplasm (myristoylated polyarginine peptides) as well as a tumour-selective peptide (EPPT1) to increase intracellular delivery and tumour specificity, respectively. RESULTS A syngeneic orthotopic as well as an endogenous cancer model was treated biweekly with siPLK1-StAv-SPIONs and tumour growth was monitored by small animal MRI. In vitro and in vivo experiments using a syngeneic orthotopic PDAC model as well as the endogenous LSL-KrasG12D, LSL-Trp53R172H, Pdx-1-Cre model revealed significant accumulation of siPLK1-StAv-SPIONs in PDAC, resulting in efficient PLK1 silencing. Tumour-specific silencing of PLK1 halted tumour growth, marked by a decrease in tumour cell proliferation and an increase in apoptosis. CONCLUSIONS Our data suggest siPLK1-StAv-SPIONs with dual specificity residues for tumour targeting and membrane translocation to represent an exciting opportunity for targeted therapy in patients with PDAC.
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Affiliation(s)
- Ujjwal M Mahajan
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Steffen Teller
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Raghavendra Palankar
- ZIK HIKE-Center for Innovation Competence Humoral Immune Reactions in Cardiovascular Diseases, Greifswald, Germany
| | - Cindy van den Brandt
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Theresa Schwaiger
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Jens-Peter Kühn
- Department of Radiology and Neuroradiology, University Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
| | - Silvia Ribback
- Institute of Pathology, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Gunnar Glöckl
- Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Matthias Evert
- Institute of Pathology, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Werner Weitschies
- Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Norbert Hosten
- Department of Radiology and Neuroradiology, University Medicine, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
| | - Frank Dombrowski
- Institute of Pharmacy, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Mihaela Delcea
- ZIK HIKE-Center for Innovation Competence Humoral Immune Reactions in Cardiovascular Diseases, Greifswald, Germany
| | - Frank-Ulrich Weiss
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany
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Mahajan UM, Lerch MM, Mayerle J. Tumor specific theranostic streptavidin-coupled superparamagnetic iron oxide nanoparticles for targeting therapeutic moieties in pancreatic cancer. Transl Cancer Res 2016. [DOI: 10.21037/tcr.2016.10.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Malla SR, Kärrman Mårdh C, Günther A, Mahajan UM, Sendler M, D'Haese J, Weiss FU, Lerch MM, Hansen MB, Mayerle J. Effect of oral administration of AZD8309, a CXCR2 antagonist, on the severity of experimental pancreatitis. Pancreatology 2016; 16:761-9. [PMID: 27450968 DOI: 10.1016/j.pan.2016.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/18/2016] [Accepted: 07/06/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Acute pancreatitis is a common gastrointestinal disorder burdened with a high mortality. Two pathophysiological events during experimental pancreatitis are thought to determine the clinical course: premature digestive protease activation and tissue infiltration by inflammatory cells. We have investigated the effect of AZD8309, a potent and orally bioavailable antagonist of the chemokine receptor CXCR2, which has been proposed to regulate the transmigration of neutrophils. METHODS Male C57BL6 mice (25-30 g) received gavage feeding of AZD8309 (50 mg/kg/BW) or mannitol (controls) twice daily starting 3 h prior to pancreatitis induction. Mild pancreatitis was induced by i.p. caerulein administration (50 μg/kg BW), severe pancreatitis by intraductal taurocholate (2%). Pancreas, lung, and serum was harvested up to 48 h after pancreatitis induction and used for histopathology, amylase, lipase, cathepsin B, trypsin, and elastase activity measurements, myeloperoxidase (MPO) content and cytokine concentrations. RESULTS Oral administration of AZD8309 significantly reduced MPO in the pancreas and lungs (8 h & 24 h) and reduced intrapancreatic trypsin and elastase activity (8 h) in caerulein-pancreatitis. In taurocholate-pancreatitis AZD8309 reduced cathepsin B activity and MPO. Serum cytokine levels were reduced by AZD8309 as well as histopathological damage. CONCLUSION The CXCR2 antagonist AZD8309 reduced the transmigration of neutrophils as well as intrapancreatic protease activation in experimental pancreatitis. This effect was sufficient to reduce the overall severity of the disease. CXCR2 may therefore be a viable therapeutic target and AZD8309 a suitable agent for the treatment of acute pancreatitis.
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Affiliation(s)
| | | | - Annett Günther
- Department of Medicine A, University Medicine, Greifswald, Germany
| | - Ujjwal M Mahajan
- Department of Medicine A, University Medicine, Greifswald, Germany
| | - Matthias Sendler
- Department of Medicine A, University Medicine, Greifswald, Germany
| | - Jan D'Haese
- Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of Munich, Germany
| | | | - Markus M Lerch
- Department of Medicine A, University Medicine, Greifswald, Germany
| | - Mark Berner Hansen
- AstraZeneca R&D Mölndal, Innovative and Global Medicines, Mölndal, Sweden
| | - Julia Mayerle
- Department of Medicine A, University Medicine, Greifswald, Germany.
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Sendler M, Beyer G, Mahajan UM, Kauschke V, Maertin S, Schurmann C, Homuth G, Völker U, Völzke H, Halangk W, Wartmann T, Weiss FU, Hegyi P, Lerch MM, Mayerle J. Complement Component 5 Mediates Development of Fibrosis, via Activation of Stellate Cells, in 2 Mouse Models of Chronic Pancreatitis. Gastroenterology 2015; 149:765-76.e10. [PMID: 26001927 PMCID: PMC4560830 DOI: 10.1053/j.gastro.2015.05.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/09/2015] [Accepted: 05/12/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS Little is known about the pathogenic mechanisms of chronic pancreatitis. We investigated the roles of complement component 5 (C5) in pancreatic fibrogenesis in mice and patients. METHODS Chronic pancreatitis was induced by ligation of the midpancreatic duct, followed by a single supramaximal intraperitoneal injection of cerulein, in C57Bl6 (control) and C5-deficient mice. Some mice were given injections of 2 different antagonists of the receptor for C5a over 21 days. In a separate model, mice were given injections of cerulein for 10 weeks to induce chronic pancreatitis. Direct effects of C5 were studied in cultured primary cells. We performed genotype analysis for the single-nucleotide polymorphisms rs 17611 and rs 2300929 in C5 in patients with pancreatitis and healthy individuals (controls). Blood cells from 976 subjects were analyzed by transcriptional profiling. RESULTS During the initial phase of pancreatitis, levels of pancreatic damage were similar between C5-deficient and control mice. During later stages of pancreatitis, C5-deficient mice and mice given injections of C5a-receptor antagonists developed significantly less pancreatic fibrosis than control mice. Primary pancreatic stellate cells were activated in vitro by C5a. There were no differences in the rs 2300929 SNP between subjects with or without pancreatitis, but the minor allele rs17611 was associated with a significant increase in levels of C5 in whole blood. CONCLUSIONS In mice, loss of C5 or injection of a C5a-receptor antagonist significantly reduced the level of fibrosis of chronic pancreatitis, but this was not a consequence of milder disease in early stages of pancreatitis. C5 might be a therapeutic target for chronic pancreatitis.
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Affiliation(s)
- Matthias Sendler
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Georg Beyer
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Ujjwal M. Mahajan
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Vivien Kauschke
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Sandrina Maertin
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Claudia Schurmann
- Interfaculty Institutes for Genetics and Functional Genomics, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Georg Homuth
- Interfaculty Institutes for Genetics and Functional Genomics, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Uwe Völker
- Interfaculty Institutes for Genetics and Functional Genomics, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Walter Halangk
- Department of Surgery, Division of Experimental Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Thomas Wartmann
- Department of Surgery, Division of Experimental Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank-Ulrich Weiss
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Peter Hegyi
- First Department of Medicine, University of Szeged, Szeged, Hungary,MTA-SZTE Lendulet Translational Gastroenterology Research Group, Szeged, Hungary
| | - Markus M. Lerch
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, University Medicine, Ernst-Moritz-Arndt University, Greifswald, Germany.
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