51
|
Riou C, du Bruyn E, Stek C, Daroowala R, Goliath RT, Abrahams F, Said-Hartley Q, Allwood BW, Hsiao NY, Wilkinson KA, Arlehamn CSL, Sette A, Wasserman S, Wilkinson RJ. Relationship of SARS-CoV-2-specific CD4 response to COVID-19 severity and impact of HIV-1 and tuberculosis coinfection. J Clin Invest 2021; 131:149125. [PMID: 33945513 PMCID: PMC8203446 DOI: 10.1172/jci149125] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/29/2021] [Indexed: 12/15/2022] Open
Abstract
T cells are involved in control of coronavirus disease 2019 (COVID-19), but limited knowledge is available on the relationship between antigen-specific T cell response and disease severity. Here, we used flow cytometry to assess the magnitude, function, and phenotype of SARS coronavirus 2-specific (SARS-CoV-2-specific) CD4+ T cells in 95 hospitalized COVID-19 patients, 38 of them being HIV-1 and/or tuberculosis (TB) coinfected, and 38 non-COVID-19 patients. We showed that SARS-CoV-2-specific CD4+ T cell attributes, rather than magnitude, were associated with disease severity, with severe disease being characterized by poor polyfunctional potential, reduced proliferation capacity, and enhanced HLA-DR expression. Moreover, HIV-1 and TB coinfection skewed the SARS-CoV-2 T cell response. HIV-1-mediated CD4+ T cell depletion associated with suboptimal T cell and humoral immune responses to SARS-CoV-2, and a decrease in the polyfunctional capacity of SARS-CoV-2-specific CD4+ T cells was observed in COVID-19 patients with active TB. Our results also revealed that COVID-19 patients displayed reduced frequency of Mycobacterium tuberculosis-specific CD4+ T cells, with possible implications for TB disease progression. These results corroborate the important role of SARS-CoV-2-specific T cells in COVID-19 pathogenesis and support the concept of altered T cell functions in patients with severe disease.
Collapse
Affiliation(s)
- Catherine Riou
- Wellcome Centre for Infectious Disease Research in Africa and Institute of Infectious Disease and Molecular Medicine
- Division of Medical Virology, Department of Pathology, and
| | - Elsa du Bruyn
- Wellcome Centre for Infectious Disease Research in Africa and Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Cari Stek
- Wellcome Centre for Infectious Disease Research in Africa and Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Remy Daroowala
- Wellcome Centre for Infectious Disease Research in Africa and Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Rene T. Goliath
- Wellcome Centre for Infectious Disease Research in Africa and Institute of Infectious Disease and Molecular Medicine
| | - Fatima Abrahams
- Wellcome Centre for Infectious Disease Research in Africa and Institute of Infectious Disease and Molecular Medicine
| | | | - Brian W. Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Nei-Yuan Hsiao
- Division of Medical Virology, Department of Pathology, and
- National Health Laboratory Service, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Katalin A. Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa and Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- The Francis Crick Institute, London, United Kingdom
| | | | - Alessandro Sette
- Center for Infectious Disease, La Jolla Institute for Immunology, La Jolla, California, USA
- Department of Medicine, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Sean Wasserman
- Wellcome Centre for Infectious Disease Research in Africa and Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Robert J. Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa and Institute of Infectious Disease and Molecular Medicine
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
| | | |
Collapse
|
52
|
González-Domenech CM, Pérez-Hernández I, Gómez-Ayerbe C, Viciana Ramos I, Palacios-Muñoz R, Santos J. A Pandemic within Other Pandemics. When a Multiple Infection of a Host Occurs: SARS-CoV-2, HIV and Mycobacterium tuberculosis. Viruses 2021; 13:931. [PMID: 34067925 PMCID: PMC8156167 DOI: 10.3390/v13050931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 02/07/2023] Open
Abstract
By the middle of 2021, we are still immersed in the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The concurrence of this new pandemic in regions where human immunodeficiency virus (HIV) and tuberculosis (TB) infections possess the same epidemiological consideration, has arisen concerns about the prognosis, clinical management, symptomatology, and treatment of patients with triple infection. At the same time, healthcare services previously devoted to diagnosis and treatment of TB and HIV are being jeopardized by the urgent need of resources and attention for COVID-19 patients. The aim of this review was to collect any article considering the three conditions (HIV, TB, and SARS-CoV-2), included in PubMed/Medline and published in the English language since the beginning of the COVID-19 pandemic. We focused on detailed descriptions of the unusual cases describing the three co-infections. Eighty-four out of 184 publications retrieved met our inclusion criteria, but only three of them reported cases (five in total) with the three concomitant infections. The clinical evolution, management, and therapy of all of them were not different from mild/severe cases with exclusive COVID-19; the outcome was not worse either, with recovery for the five patients. Cases of patients with COVID-19 besides HIV and TB infections are scarce in literature, but studies deliberately embracing the triple infection as a priori inclusion criterion should be carried out in order to provide a complete understanding of joint influence.
Collapse
Affiliation(s)
- Carmen María González-Domenech
- Clinical Research in HIV Infection, Endovascular Infection and Bacteriemia, Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (C.G.-A.); (I.V.R.); (R.P.-M.); (J.S.)
- Department of Microbiology, Faculty of Sciences, University of Malaga, 29071 Malaga, Spain
| | | | - Cristina Gómez-Ayerbe
- Clinical Research in HIV Infection, Endovascular Infection and Bacteriemia, Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (C.G.-A.); (I.V.R.); (R.P.-M.); (J.S.)
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria Hospital, 29010 Malaga, Spain
| | - Isabel Viciana Ramos
- Clinical Research in HIV Infection, Endovascular Infection and Bacteriemia, Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (C.G.-A.); (I.V.R.); (R.P.-M.); (J.S.)
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria Hospital, 29010 Malaga, Spain
| | - Rosario Palacios-Muñoz
- Clinical Research in HIV Infection, Endovascular Infection and Bacteriemia, Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (C.G.-A.); (I.V.R.); (R.P.-M.); (J.S.)
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria Hospital, 29010 Malaga, Spain
| | - Jesús Santos
- Clinical Research in HIV Infection, Endovascular Infection and Bacteriemia, Biomedical Research Institute of Malaga (IBIMA), 29010 Malaga, Spain; (C.G.-A.); (I.V.R.); (R.P.-M.); (J.S.)
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria Hospital, 29010 Malaga, Spain
| |
Collapse
|
53
|
Rojas‐Bolivar D, Intimayta‐Escalante C, Cardenas‐Jara A, Jandarov R, Huaman MA. COVID-19 case fatality rate and tuberculosis in a metropolitan setting. J Med Virol 2021; 93:3273-3276. [PMID: 33570198 PMCID: PMC8013772 DOI: 10.1002/jmv.26868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/17/2020] [Accepted: 02/09/2021] [Indexed: 11/16/2022]
Abstract
In this study, we aimed to assess the relationship between tuberculosis case rate and COVID-19 case fatality rate (CFR) among districts within a tuberculosis-endemic metropolitan area. We analyzed data from 43 districts in Lima, Peru. We used districts as the units of observation. Linear regressions were used to investigate the relationship between COVID-19 CFRs and tuberculosis case rates. The mean COVID-19 CFR in each district for reporting Weeks 5-32 was used as the dependent variable. Independent variable was the mean rate of confirmed pulmonary tuberculosis cases for 2017-2019 period. Analyses were adjusted by population density, socioeconomic status, crowded housing, health facility density, and case rates of hypertension, diabetes mellitus, and HIV infection. The mean COVID-19 CFR in Lima was 4.0% ± 1.1%. The mean tuberculosis rate was 16.0 cases per 10,000 inhabitants. In multivariate analysis, tuberculosis case rate was associated with COVID-19 CFR (β = 1.26; 95% confidence interval: 0.24-2.28; p = .02), after adjusting for potential confounders. We found that Lima districts with a higher burden of tuberculosis exhibited higher COVID-19 CFRs, independent of socioeconomic, and morbidity variables.
Collapse
Affiliation(s)
- Daniel Rojas‐Bolivar
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales (CITBM)CallaoPeru
| | | | | | - Roman Jandarov
- Department of Biostatistics and BioinformaticsUniversity of CincinnatiCincinnatiOhio
| | - Moises A. Huaman
- Division of Infectious Diseases, Department of Internal MedicineUniversity of CincinnatiCincinnatiOhioUSA
| |
Collapse
|
54
|
Furtado I, Aguiar A, Duarte R. Getting back on the road towards tuberculosis elimination: lessons learnt from the COVID-19 pandemic. J Bras Pneumol 2021; 47:e20210123. [PMID: 33950099 PMCID: PMC8332847 DOI: 10.36416/1806-3756/e20210123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Isabel Furtado
- . Serviço de Infeciologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Ana Aguiar
- . EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | - Raquel Duarte
- . EPIUnit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal.,. Unidade de Investigação Clínica da Administração Regional de Saúde Norte, Porto, Portugal.,. Departamento de Ciências de Saúde Pública, Ciências Forenses e Educação Médica, Universidade do Porto, Porto, Portugal.,. Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
55
|
Silva DR, Mello FCDQ, D’Ambrosio L, Centis R, Dalcolmo MP, Migliori GB. Tuberculosis and COVID-19, the new cursed duet: what differs between Brazil and Europe? J Bras Pneumol 2021; 47:e20210044. [PMID: 33950095 PMCID: PMC8332832 DOI: 10.36416/1806-3756/e20210044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
On April 1st, 2020, COVID-19 surpassed tuberculosis regarding the number of deaths per day worldwide. The combination of tuberculosis and COVID-19 has great potential for morbidity and mortality. In addition, the COVID-19 pandemic has had a significant impact on the diagnosis and treatment of tuberculosis. In this review article, we address concurrent tuberculosis and COVID-19, with particular regard to the differences between Brazil and Europe. In addition, we discuss priorities in clinical care, public health, and research.
Collapse
Affiliation(s)
- Denise Rossato Silva
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | | | - Lia D’Ambrosio
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italia
| | - Rosella Centis
- . Blizard Institute, Queen Mary University of London, London, United Kingdom
| | | | - Giovanni Battista Migliori
- . Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italia
- . Blizard Institute, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
56
|
Nachega JB, Kapata N, Sam-Agudu NA, Decloedt EH, Katoto PDMC, Nagu T, Mwaba P, Yeboah-Manu D, Chanda-Kapata P, Ntoumi F, Geng EH, Zumla A. Minimizing the impact of the triple burden of COVID-19, tuberculosis and HIV on health services in sub-Saharan Africa. Int J Infect Dis 2021; 113 Suppl 1:S16-S21. [PMID: 33757874 PMCID: PMC7980520 DOI: 10.1016/j.ijid.2021.03.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 02/08/2023] Open
Abstract
In this perspective, we discuss the impact of COVID-19 on tuberculosis (TB)/HIV health services and approaches to mitigating the growing burden of these three colliding epidemics in sub-Saharan Africa (SSA). SSA countries bear significantly high proportions of TB and HIV cases reported worldwide, compared to countries in the West. Whilst COVID-19 epidemiology appears to vary across Africa, most countries in this region have reported relatively lower-case counts compared to the West. Nevertheless, the COVID-19 pandemic has added an additional burden to already overstretched health systems in SSA, which, among other things, have been focused on the longstanding dual epidemics of TB and HIV. As with these dual epidemics, inadequate resources and poor case identification and reporting may be contributing to underestimations of the COVID-19 case burden in SSA. Modelling studies predict that the pandemic-related disruptions in TB and HIV services will result in significant increases in associated morbidity and mortality over the next five years. Furthermore, limited empirical evidence suggests that SARS-CoV-2 coinfections with TB and HIV are associated with increased mortality risk in SSA. However, predictive models require a better evidence-base to accurately define the impact of COVID-19, not only on communicable diseases such as TB and HIV, but on non-communicable disease comorbidities. Further research is needed to assess morbidity and mortality data among both adults and children across the African continent, paying attention to geographic disparities, as well as the clinical and socio-economic determinants of COVID-19 in the setting of TB and/or HIV.
Collapse
Affiliation(s)
- Jean B Nachega
- Department of Medicine and Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa; Department of Epidemiology, Infectious Diseases and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nathan Kapata
- Zambia National Public Health Institute, University of Zambia-University College London Medical School Research and Training Project, University Teaching Hospital, Ministry of Health, Lusaka, Zambia.
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria; Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Pediatrics and Child Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Eric H Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - Patrick D M C Katoto
- Department of Medicine and Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
| | - Tumaini Nagu
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
| | - Peter Mwaba
- Lusaka Apex Medical University, Lusaka, Zambia.
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
| | | | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), Brazzaville, Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.
| | - Elvin H Geng
- Division of Infectious Diseases, Department of Medicine, and Center for Dissemination and Implementation, Institute for Public Health, Washington University, St Louis, Missouri, USA.
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals, London, UK.
| |
Collapse
|
57
|
Essien EJ, Mgbere O, Iloanusi S, Abughosh SM. COVID-19 Infection among People with HIV/AIDS in Africa: Knowledge Gaps, Public Health Preparedness and Research Priorities. Int J MCH AIDS 2021; 10:113-118. [PMID: 33842057 PMCID: PMC8020823 DOI: 10.21106/ijma.461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The emergence of novel virus SARS-CoV-2 that causes COVID-19 has complicated Africa's public health challenges, especially with the pre-existing epidemics such as HIV/AIDS. We highlight the known evidence related to COVID-19 infections among people with HIV (PWH) with specific reference to Africa. The knowledge gaps, level of public health preparedness and the potential research priorities are also outlined. Although the epidemiology and clinical course of COVID-19 in HIV patients are evolving, existing evidence indicate that the disease outcomes are comparable to that of the general population. However, PWH with low CD4 cell counts may have worse outcomes than individuals with restored immunity, whereas old age and co-morbidities such as obesity, hypertension and diabetes can further increase their overall risk. While there may be slight disruption of HIV service delivery in selected African countries, the resilience and resourcefulness of others have helped to sustain HIV service delivery and enhanced the level of public health preparedness and fight against the pandemic. The paucity of data and research studies on HIV-COVID-19 coinfection in Africa, call for concerted efforts to address these limitations.
Collapse
Affiliation(s)
- Ekere James Essien
- Institute of Community Health, University of Houston College of Pharmacy, Houston, Texas, USA.,Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA.,Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, Texas, USA
| | - Osaro Mgbere
- Institute of Community Health, University of Houston College of Pharmacy, Houston, Texas, USA.,Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA.,Disease Prevention and Control Division, Houston Health Department, Houston, Texas, USA
| | - Sorochi Iloanusi
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Susan M Abughosh
- Institute of Community Health, University of Houston College of Pharmacy, Houston, Texas, USA.,Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas, USA
| |
Collapse
|
58
|
Lommatzsch M, Rabe KF, Taube C, Joest M, Kreuter M, Wirtz H, Blum TG, Kolditz M, Geerdes-Fenge H, Otto-Knapp R, Häcker B, Schaberg T, Ringshausen FC, Vogelmeier CF, Reinmuth N, Reck M, Gottlieb J, Konstantinides S, Meyer FJ, Worth H, Windisch W, Welte T, Bauer T. [Risk Assessment for Patients with Chronic Respiratory and Pulmonary Conditions in the Context of the SARS-CoV-2 Pandemic - Statement of the German Respiratory Society (DGP) with the Support of the German Association of Respiratory Physicians (BdP)]. Pneumologie 2020; 75:19-30. [PMID: 33242887 DOI: 10.1055/a-1321-3400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- M Lommatzsch
- Zentrum für Innere Medizin, Abteilung Pneumologie, Universitätsmedizin Rostock, Rostock
| | - K F Rabe
- LungenClinic Großhansdorf, Großhansdorf.,Deutsches Zentrum für Lungenforschung
| | - C Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik, Westdeutsches Lungenzentrum, Essen
| | - M Joest
- Lungen- und Allergiezentrum Bonn, Bonn
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg.,Deutsches Zentrum für Lungenforschung
| | - H Wirtz
- Abt. Pneumologie, Universitätsklinikum Leipzig AöR, Leipzig
| | - T G Blum
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - M Kolditz
- Medizinische Klinik 1, Bereich Pneumologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - H Geerdes-Fenge
- Universitätsmedizin Rostock, Zentrum für Innere Medizin, Abteilung für Infektionskrankheiten und Tropenmedizin, Rostock
| | - R Otto-Knapp
- Dtsch. Zentralkomitee zur Bekämpfung der Tuberkulose, DZK, Berlin
| | - B Häcker
- Dtsch. Zentralkomitee zur Bekämpfung der Tuberkulose, DZK, Berlin
| | | | - F C Ringshausen
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover.,Deutsches Zentrum für Lungenforschung
| | - C F Vogelmeier
- Klinik für Pneumologie, Universitätsklinikum Marburg, Marburg.,Deutsches Zentrum für Lungenforschung
| | - N Reinmuth
- Asklepios Fachkliniken München-Gauting, Thorakale Onkologie, Gauting.,Deutsches Zentrum für Lungenforschung
| | - M Reck
- LungenClinic Großhansdorf, Großhansdorf.,Deutsches Zentrum für Lungenforschung
| | - J Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover.,Deutsches Zentrum für Lungenforschung
| | - S Konstantinides
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz
| | - F J Meyer
- Lungenzentrum München (Bogenhausen-Harlaching), München Klinik, München
| | | | - W Windisch
- Lungenklinik, Kliniken der Stadt Köln GmbH, Lehrstuhl für Pneumologie der Universität Witten-Herdecke
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover.,Deutsches Zentrum für Lungenforschung
| | - T Bauer
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| |
Collapse
|