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Müller-Redetzky H, Wienhold S, Berlinghoff R, Hellwig K, Gruber AD, Suttorp N, Witzenrath M. Untersuchung des immunmodulatorischen Potentials von Moxifloxacin in der Pneumokokkenpneumonie. Pneumologie 2013. [DOI: 10.1055/s-0033-1334521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schneider H, Weber CE, Hellwig K, Schroten H, Tenenbaum T. Natalizumab treatment during pregnancy - effects on the neonatal immune system. Acta Neurol Scand 2013; 127:e1-4. [PMID: 22950358 DOI: 10.1111/ane.12004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pregnancies in women with severe relapsing-remitting multiple sclerosis treated with natalizumab constitute a major challenge, because withdrawal of the drug may cause relapses but continuation might have unknown effects on the infantile immune system. AIMS OF THE STUDY To identify the impact of maternal natalizumab treatment during pregnancy on basic immune functions of the newborn. METHODS Basic immunological testing and assessment of the chemotaxis rate of freshly isolated T lymphocytes in the presence and absence of CXCL12 was performed in two neonates, whose mothers were treated with natalizumab until the 34th week of pregnancy (pw). RESULTS Both children had an uneventful birth. However, a reduction in the CXCL12-induced T-cell chemotaxis was found in both children. In contrast, the chemotaxis rate of unstimulated T lymphocytes was not altered. The distribution of the lymphocyte subpopulations was investigated only in case 1 and was normal. CONCLUSIONS Here, we present to our knowledge the first assessment of T lymphocytes chemotaxis rate in two natalizumab-exposed newborns. A significant reduction in the CXCL12-induced chemotaxis rate of T lymphocytes has been observed and may compromise host defence function in early life. More clinical and immunological data on natalizumab-exposed neonates are warranted.
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Hellwig K, Trampe N, Lukas C, Gold R. Progressive multifokale Leukenzephalopathie und moderne MS-Therapie - Diagnostik und Therapie. AKTUELLE NEUROLOGIE 2012. [DOI: 10.1055/s-0032-1305185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bayas A, Penzien J, Hellwig K. Accidental natalizumab administration in pregnancy in multiple sclerosis. Acta Neurol Scand 2012; 126:e5-6. [PMID: 22671932 DOI: 10.1111/j.1600-0404.2011.01636.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Trampe AK, Hemmelmann C, Stroet A, Haghikia A, Hellwig K, Wiendl H, Goelz S, Ziegler A, Gold R, Chan A. Anti-JC virus antibodies in a large German natalizumab-treated multiple sclerosis cohort. Neurology 2012; 78:1736-42. [PMID: 22592369 DOI: 10.1212/wnl.0b013e3182583022] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the rate of seropositivity of anti-JC virus (JCV) antibodies in a German multiple sclerosis (MS) cohort treated with natalizumab in the postmarketing setting and to assess anti-JCV serostatus in samples obtained before diagnosis of progressive multifocal leukoencephalopathy (PML). METHODS This was a blinded, retrospective cross-sectional and longitudinal analysis for anti-JCV antibodies using a confirmatory 2-step ELISA on 2,782 blood samples obtained from 2,253 patients nationwide for routine testing for anti-natalizumab antibodies during open-label treatment between 2007 and 2010. RESULTS Of the natalizumab-treated patients with MS, 58.8% tested positive for anti-JCV antibodies. The rate of seropositivity was higher in males and increased with age, with a plateau between age intervals 20-29 and 30-39 years. In longitudinal analyses, 19 of 194 (9.8%) patients converted from anti-JCV antibody-negative to seropositive status over 7.7 months; 4.7% reverted from antibody-positive to seronegative status over 7.9 months. Antibody levels, especially in the latter group, were low, indicating fluctuations around the lower cut point of the assay. Neither anti-JCV serostatus nor antibody levels were associated with immunosuppressive pretreatment, duration of natalizumab treatment, or anti-natalizumab antibodies. All samples obtained from 10 patients who developed PML were seropositive (13 samples before PML diagnosis [2.0-37.6 months]; 2 samples at diagnosis). Antibody levels in these samples were higher than those in samples from seropositive patients who did not develop PML. CONCLUSIONS These data argue for the potential clinical utility of JCV serology for PML risk stratification. However, further investigations of fluctuations in serostatus and of antibody levels for a more precise understanding of the predictive value are warranted.
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Müller-Redetzky HC, Kummer W, Pfeil U, Hellwig K, Will D, Paddenberg R, Tabeling C, Hippenstiel S, Suttorp N, Witzenrath M. Intermedin stabilized endothelial barrier function and attenuated ventilator-induced lung injury in mice. PLoS One 2012; 7:e35832. [PMID: 22563471 PMCID: PMC3341380 DOI: 10.1371/journal.pone.0035832] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 03/22/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Even protective ventilation may aggravate or induce lung failure, particularly in preinjured lungs. Thus, new adjuvant pharmacologic strategies are needed to minimize ventilator-induced lung injury (VILI). Intermedin/Adrenomedullin-2 (IMD) stabilized pulmonary endothelial barrier function in vitro. We hypothesized that IMD may attenuate VILI-associated lung permeability in vivo. METHODOLOGY/PRINCIPAL FINDINGS Human pulmonary microvascular endothelial cell (HPMVEC) monolayers were incubated with IMD, and transcellular electrical resistance was measured to quantify endothelial barrier function. Expression and localization of endogenous pulmonary IMD, and its receptor complexes composed of calcitonin receptor-like receptor (CRLR) and receptor activity-modifying proteins (RAMPs) 1-3 were analyzed by qRT-PCR and immunofluorescence in non ventilated mouse lungs and in lungs ventilated for 6 h. In untreated and IMD treated mice, lung permeability, pulmonary leukocyte recruitment and cytokine levels were assessed after mechanical ventilation. Further, the impact of IMD on pulmonary vasoconstriction was investigated in precision cut lung slices (PCLS) and in isolated perfused and ventilated mouse lungs. IMD stabilized endothelial barrier function in HPMVECs. Mechanical ventilation reduced the expression of RAMP3, but not of IMD, CRLR, and RAMP1 and 2. Mechanical ventilation induced lung hyperpermeability, which was ameliorated by IMD treatment. Oxygenation was not improved by IMD, which may be attributed to impaired hypoxic vasoconstriction due to IMD treatment. IMD had minor impact on pulmonary leukocyte recruitment and did not reduce cytokine levels in VILI. CONCLUSIONS/SIGNIFICANCE IMD may possibly provide a new approach to attenuate VILI.
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Rockhoff M, Hellwig K. Kinderwunsch und Interferon β-1b - Fallbericht einer erfolgreichen Hormonstimulation, Schwangerschaft und Stillzeit unter Interferon β-1b. AKTUELLE NEUROLOGIE 2012. [DOI: 10.1055/s-0032-1304879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Geissbuhler Y, Butzkueven H, Hernandez-Diaz S, Koren G, MacDonald T, Tilson H, Starzyk K, Plana E, Cremer M, von Rosenstiel P, Hellwig K. Multinational Gilenya (Fingolimod) Pregnancy Exposure Registry in Multiple Sclerosis: Study Design (P06.189). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hellwig K, Haghikia A, Gold R. Natalizumab and Pregnancy - Results from the German MS and Pregnancy Registry (P06.187). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Chan A, Trampe AK, Hemmelmann C, Stroet A, Haghikia A, Hellwig K, Wiendl H, Goelz S, Ziegler A, Gold R. Anti-JC Virus Antibodies in a Large German Natalizumab-Treated Multiple Sclerosis Cohort (P02.137). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p02.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hellwig K, Rockhoff M, Gold R, Langer-Gould A. When Supplemental Infant Feedings Begin, Postpartum Multiple Sclerosis Relapses Return (P06.186). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Müller-Redetzky HC, Will D, Hellwig K, Kummer W, Tschernig T, Pfeil U, Paddenberg R, Hippenstiel S, Suttorp N, Witzenrath M. Ventilator-induced lung injury in severe pneumococcal pneumonia: protection by Adrenomedullin. Pneumologie 2012. [DOI: 10.1055/s-0032-1302605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ayzenberg I, Lukas C, Trampe N, Gold R, Hellwig K. Value of MRI as a surrogate marker for PML in natalizumab long-term therapy. J Neurol 2012; 259:1732-3. [DOI: 10.1007/s00415-012-6426-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 01/09/2012] [Accepted: 01/11/2012] [Indexed: 10/14/2022]
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Hellwig K, Kleiter I, Gold R, Clifford DB, Major EO. Immune Reconstitution Inflammatory Syndrome in Natalizumab-Associated PML. Neurology 2012; 78:371; author reply 371. [DOI: 10.1212/01.wnl.0000411451.56205.c3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Müller-Redetzky HC, Will D, Hellwig K, Kummer W, Tschernig T, Pfeil U, Paddenberg R, Hippenstiel S, Suttorp N, Witzenrath M. Ventilator-induced lung injury in severe pneumococcal pneumonia: protection by Adrenomedullin. Pneumologie 2011. [DOI: 10.1055/s-0031-1296129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Bayas A, Penzien J, Hellwig K. Accidental natalizumab administration to the third trimester of pregnancy in an adolescent patient with multiple sclerosis. Acta Neurol Scand 2011; 124:290-2. [PMID: 21943035 DOI: 10.1111/j.1600-0404.2010.01480.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Natalizumab is neither licensed for the use in adolescents nor during pregnancy. There are no reports of accidental natalizumab exposure during pregnancy continued as long as to the third trimester of pregnancy. AIMS We report the outcome of pregnancy in a 17-year-old adolescent patient with multiple sclerosis (MS) treated with natalizumab from the age of 16, who was diagnosed to be pregnant in the 31st gestational week (gw) of pregnancy. To our knowledge, this report describes the first patient receiving natalizumab to the third trimester of pregnancy. CASE REPORT Because of high relapse activity, natalizumab treatment was administered in an adolescent patient with MS. Pregnancy was diagnosed in the 31st gw after 17 natalizumab infusions, seven of them accidentally during pregnancy. RESULTS Pre- and postnatal development of the child was normal. CONCLUSIONS The case reported indicates that accidentally continued natalizumab treatment until few weeks before delivery may have no negative impact on the developing foetus.
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Lippmann J, Müller HC, Naujoks J, Tabeling C, Shin S, Witzenrath M, Hellwig K, Kirschning CJ, Taylor GA, Barchet W, Bauer S, Suttorp N, Roy CR, Opitz B. Dissection of a type I interferon pathway in controlling bacterial intracellular infection in mice. Cell Microbiol 2011; 13:1668-82. [PMID: 21790939 DOI: 10.1111/j.1462-5822.2011.01646.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Defence mechanisms against intracellular bacterial pathogens are incompletely understood. Our study characterizes a type I IFN-dependent cell-autonomous defence pathway directed against Legionella pneumophila, an intracellular model organism and frequent cause of pneumonia. We show that macrophages infected with L. pneumophila produced IFNβ in a STING- and IRF3- dependent manner. Paracrine type I IFNs stimulated upregulation of IFN-stimulated genes and a cell-autonomous defence pathway acting on replicating and non-replicating Legionella within their specialized vacuole. Our infection experiments in mice lacking receptors for type I and/or II IFNs show that type I IFNs contribute to expression of IFN-stimulated genes and to bacterial clearance as well as resistance in L. pneumophila pneumonia in addition to type II IFN. Overall, our study shows that paracrine type I IFNs mediate defence against L. pneumophila, and demonstrates a protective role of type I IFNs in in vivo infections with intracellular bacteria.
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Müller H, Kommer W, Pfeil U, Hellwig K, Will D, Hocke A, Hippenstiel S, Suttorp N, Witzenrath M. Ventilator-induced lung injury: Intermedin reduziert pulmonalvaskuläre Permeabilität im Mausmodell. Pneumologie 2011. [DOI: 10.1055/s-0031-1272318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Müller HC, Kummer W, Pfeil U, Hellwig K, Will D, Hocke AC, Hippenstiel S, Suttorp N, Witzenrath M. Ventilator-induced lung injury: Intermedin reduziert pulmonalvaskuläre Permeabilität im Mausmodell. Pneumologie 2011. [DOI: 10.1055/s-0030-1270375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Müller HC, Hellwig K, Rosseau S, Tschernig T, Schmiedl A, Gutbier B, Schmeck B, Hippenstiel S, Peters H, Morawietz L, Suttorp N, Witzenrath M. Simvastatin attenuates ventilator-induced lung injury in mice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R143. [PMID: 20673352 PMCID: PMC2945124 DOI: 10.1186/cc9209] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 05/13/2010] [Accepted: 07/30/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Mechanical ventilation (MV) is a life saving intervention in acute respiratory failure without alternative. However, particularly in pre-injured lungs, even protective ventilation strategies may evoke ventilator-induced lung injury (VILI), which is characterized by pulmonary inflammation and vascular leakage. Adjuvant pharmacologic strategies in addition to lung protective ventilation to attenuate VILI are lacking. Simvastatin exhibited anti-inflammatory and endothelial barrier stabilizing properties in vitro and in vivo. METHODS Mice were ventilated (12 ml/kg; six hours) and subjected to simvastatin (20 mg/kg) or sham treatment. Pulmonary microvascular leakage, oxygenation, pulmonary and systemic neutrophil and monocyte counts and cytokine release in lung and blood plasma were assessed. Further, lung tissue was analyzed by electron microscopy. RESULTS Mechanical ventilation induced VILI, displayed by increased pulmonary microvascular leakage and endothelial injury, pulmonary recruitment of neutrophils and Gr-1high monocytes, and by liberation of inflammatory cytokines in the lungs. Further, VILI associated systemic inflammation characterized by blood leukocytosis and elevated plasma cytokines was observed. Simvastatin treatment limited pulmonary endothelial injury, attenuated pulmonary hyperpermeability, prevented the recruitment of leukocytes to the lung, reduced pulmonary cytokine levels and improved oxygenation in mechanically ventilated mice. CONCLUSIONS High-dose simvastatin attenuated VILI in mice by reducing MV-induced pulmonary inflammation and hyperpermeability.
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Müller H, Witzenrath M, Hellwig K, Tschernig T, Schmiedl A, Gutbier B, Schmeck B, Hippenstiel S, Peters H, Suttorp N, Rosseau S. Simvastatin limitiert Beatmungsassoziierte Lungenschädigung im Mausmodell. Pneumologie 2010. [DOI: 10.1055/s-0030-1251437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Müller H, Witzenrath M, Hellwig K, Tschernig T, Schmiedl A, Gutbier B, Schmeck B, Hippenstiel S, Peters H, Suttorp N, Rosseau S. Simvastatin limitiert Beatmungsassoziierte Lungenschädigung im Mausmodell. Pneumologie 2010. [DOI: 10.1055/s-0030-1251086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Müller HC, Witzenrath M, Hellwig K, Tschernig T, Schmiedel A, Gutbier B, Schmeck B, Hippenstiel S, Peters H, Suttorp N, Rosseau S. Simvastatin attenuates ventilator-induced lung injury in mice. Pneumologie 2010. [DOI: 10.1055/s-0029-1247937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hellwig K, Haghikia A, Gold R. Vaterschaft und Immunodulation bei Patienten mit Multipler Sklerose. AKTUELLE NEUROLOGIE 2009. [DOI: 10.1055/s-0029-1238582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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