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Hu F, Liu Y, Wang F, Fu X, Liu X, Zou Z, Zhou B. Prognostic and clinicopathological significance of TRIM21 in various cancers: A meta and bioinformatic analysis. Medicine (Baltimore) 2023; 102:e34012. [PMID: 37335642 DOI: 10.1097/md.0000000000034012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Tripartite motif-containing protein 21 (TRIM21), a member of the ubiquitin ligase family, makes a significant contribution to the ubiquitination of multiple tumor marker proteins associated with tumor cell proliferation, metastasis and selective apoptosis. As the research further develops, an increasing number of studies have manifested that the TRIM21 expression level can be considered an indicator of cancer prognosis. However, the interrelationship between TRIM21 and multiple forms of carcinogens has not been demonstrated in a meta-analysis. METHODS We performed a systematic literature retrieval in various electronic databases including PubMed, Embase, Web of Science, Wanfang and China National Knowledge Infrastructure. Besides, the hazard ratio (HR) and the pooled relative risk (RR) were integrated in the assessment of cancer incidence and cancer mortality by Stata SE15.1. Additionally, we used an online database based on The Cancer Genome Atlas (TCGA) to further validate our results. RESULTS A total of 17 studies were included, totaling 7239 participants. High expression of TRIM21 was significantly correlated with better OS (HR = 0.74; 95% CI: 0.57-0.91; P < .001) and progression-free survival (PFS) (HR = 0.66; 95% CI: 0.42-0.91; P < .001). We found that high TRIM21 expression predicted significant impact on clinical characteristics like decreased lymph node metastasis (RR = 1.12; 95% CI: 0.97-1.30; P < .001), tumor stage (RR = 1.06; 95% CI: 0.82-1.37; P < .001) and tumor grade (RR = 1.07; 95% CI: 0.56-2.05; P < .001). However, TRIM21 expression had no significant impact on other clinical characteristics such as age (RR = 1.06; 95% CI: 0.91-1.25; P = .068), sex (RR = 1.04; 95% CI: 0.95-1.12; P = .953), or tumor size (RR = 1.14; 95% CI: 0.97-1.33; P = .05). Based on the Gene Expression Profiling Interactive Analysis (GEPIA) online analysis tool, TRIM21 was significantly downregulated in 5 cancers while significantly upregulated in 2 cancers, and the descending expression of TRIM21 predicted shorter OS in 5 cancers, worse PFS in 2 malignancies, while the elevated expression of TRIM21 predicted shorter OS and worse PFS in 2 carcinomas. CONCLUSIONS TRIM21 could serve as a new biomarker for patients with solid malignancies and could be a potential therapeutic target for patients.
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Affiliation(s)
- Feng Hu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
- The First School of Clinical Medicine of Nanchang University, Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yan Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
- The Second School of Clinical Medicine of Nanchang University, Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Feiyang Wang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
- The First School of Clinical Medicine of Nanchang University, Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xinyi Fu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
- The First School of Clinical Medicine of Nanchang University, Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xiangjun Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zhenhong Zou
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Bin Zhou
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
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von Bernuth A, Ribbat-Idel J, Klapper L, Jagomast T, Rades D, Leichtle A, Pries R, Bruchhage KL, Perner S, Offermann A, Sailer V, Idel C. TRIM21 Expression as a Prognostic Biomarker for Progression-Free Survival in HNSCC. Int J Mol Sci 2023; 24:ijms24065140. [PMID: 36982215 PMCID: PMC10048917 DOI: 10.3390/ijms24065140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/30/2023] Open
Abstract
Patients with head and neck squamous cell carcinoma (HNSCC) continue to have a rather poor prognosis. Treatment-related comorbidities have negative impacts on their quality of life. TRIM21 is a cytosolic E3 ubiquitin ligase that was initially described as an autoantigen in autoimmune diseases and later associated with the intracellular antiviral response. Here, we investigated the role of TRIM21 as a biomarker candidate for HNSCC in predicting tumor progression and patient survival. We analyzed TRIM21 expression and its association with clinical-pathological parameters in our HNSCC cohort using immunohistochemistry. Our HNSCC cohort included samples from 419 patients consisting of primary tumors (n = 337), lymph node metastases (n = 156), recurrent tumors (n = 54) and distant metastases (n = 16). We found that cytoplasmic TRIM21 expression was associated with the infiltration of immune cells into primary tumors. In addition, TRIM21 expression was significantly higher in primary tumors than in lymph node metastases, and increased TRIM21 expression was correlated with shorter progression-free survival in HNSCC patients. These results suggest that TRIM21 could be a new biomarker for progression-free survival.
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Affiliation(s)
- Amelie von Bernuth
- Institute of Pathology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Julika Ribbat-Idel
- Institute of Pathology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Luise Klapper
- Institute of Pathology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Tobias Jagomast
- Institute of Pathology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Anke Leichtle
- Department of Otorhinolaryngology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Ralph Pries
- Department of Otorhinolaryngology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Karl-Ludwig Bruchhage
- Department of Otorhinolaryngology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Sven Perner
- Institute of Pathology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
- Pathology, Research Center Borstel, Leibniz Lung Center, Parkallee 1-40, 23845 Borstel, Germany
- Institute of Hematopathology & Medical Care Center Hanse Histologikum, Fangdieckstr. 75a, 22547 Hamburg, Germany
| | - Anne Offermann
- Institute of Pathology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Verena Sailer
- Institute of Pathology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Christian Idel
- Department of Otorhinolaryngology, University of Luebeck, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
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Rajabi-Moghaddam M, Abbaszadeh H. Gene polymorphisms and risk of head and neck squamous cell carcinoma: a systematic review. Rep Pract Oncol Radiother 2022; 27:1058-1076. [PMID: 36632298 PMCID: PMC9826653 DOI: 10.5603/rpor.a2022.0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022] Open
Abstract
Background Exposure to the same environmental factors in different people have resulted in different susceptibility to head and neck squamous cell carcinoma (HNSCC), which suggests genetic variation may be a risk factor for the development of HNSCC. So, the aim was to review literatures on the association between gene polymorphisms and risk of HNSCCs. Materials and methods This systematic review included all articles on the impact of gene polymorphisms on risk and susceptibility to HNSCC published till September 2021 using PubMed, Web of science, SCOPUS, Google Scholar and Cochrane library databases. Results Of 1163 initial searched articles, 77 articles were eligible to include in this review. Studies were categorized based on gene functions. In each category, studied gene polymorphisms related to growth control genes, cell cycle control, apoptosis, DNA repair genes, carcinogen-metabolizing enzymes, alcohol-metabolizing genes, antioxidant gene, inflammatory cytokine, transcription factor, tumor immunity, folate metabolism, and tumor suppressor gene were discussed separately. Among the polymorphisms that are often significantly associated with HNSCC risk are: GSTM1 null, GSTT1 null, CYP2D6 *4, XRCC1 Arg194Trp and Arg399Gln, ERCC1 C8092A, XPD Lys751Gln, XRCC3 Thr241Met, P53 codon 72 and MTHFR C677T polymorphisms. Conclusion Varied and contradictory results have been reported in different studies regarding the association of gene polymorphisms with HNSCC risk. To conclude about this association and to overcome these contradictions, it is necessary to use the results of existing meta-analyses or to perform new or updated meta-analyses.
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Affiliation(s)
- Mahdieh Rajabi-Moghaddam
- Department of Pathology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Hamid Abbaszadeh
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
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Wu Z, Wang Y, Yu Z, Meng Z, Duan W, Zhang W, Fang J. TRIM21‑a potential biomarker for the prognosis of thyroid cancer. Exp Ther Med 2022; 24:761. [PMID: 36561971 PMCID: PMC9748667 DOI: 10.3892/etm.2022.11697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022] Open
Abstract
Thyroid cancer (THCA) is one of the commonest malignancies associated with increased recurrence. Therefore, identifying the putative molecular markers and therapeutic targets to improve the treatment of THCA is essential. The present study analyzed the potential role of tripartite motif-containing 21 (TRIM21), a member of the TRIM family belonging to the subfamily of E3 ubiquitin ligases, in the progression of THCA. Using bioinformatics analysis and immunohistochemistry of THCA tissues, it was observed that TRIM21 is overexpressed in THCA tissues. The present study also found that TRIM21 is associated with lymph node metastasis and high-risk recurrence of THCA. Furthermore, it identified a promotional role of TRIM21 in THCA cell migration and invasion. In addition, the present study analyzed TRIM21-enriched pathways and co-expressed genes in THCA. The present study suggested that TRIM21 may serve as a potential biomarker for THCA prognosis.
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Affiliation(s)
- Zhen Wu
- Department of Otorhinolaryngology Head and Neck Surgery and Department of Thyroid Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China,Department of Thyroid and Breast Surgery, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Yongkun Wang
- Department of Thyroid and Breast Surgery, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Zhengya Yu
- Department of Otorhinolaryngology Head and Neck Surgery and Department of Thyroid Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Zhen Meng
- Department of Stomatology, Medical School of Liaocheng University, Liaocheng, Shandong 252000, P.R. China
| | - Wenchao Duan
- Department of Otorhinolaryngology, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Wei Zhang
- Department of Thyroid and Breast Surgery, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China,Correspondence to: Dr Jugao Fang, Department of Otorhinolaryngology Head and Neck Surgery and Department of Thyroid Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomin Street, Beijing 100730, P.R. China
| | - Jugao Fang
- Department of Otorhinolaryngology Head and Neck Surgery and Department of Thyroid Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China,Correspondence to: Dr Jugao Fang, Department of Otorhinolaryngology Head and Neck Surgery and Department of Thyroid Surgery, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomin Street, Beijing 100730, P.R. China
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Liu LC, Chien YC, Wu GW, Hua CH, Tsai IC, Hung CC, Wu TK, Pan YR, Yang SF, Yu YL. Analysis of EZH2 Genetic Variants on Triple-Negative Breast Cancer Susceptibility and Pathology. Int J Med Sci 2022; 19:1023-1028. [PMID: 35813302 PMCID: PMC9254368 DOI: 10.7150/ijms.71931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is the third most common female cancer in Taiwan. EZH2 plays an important role in cancer development through transcriptional repression by chromatin remodeling. However, the expression of EZH2 in breast cancer is highly correlated with tumorigenesis, and patient survival is not matched to TNBC. Furthermore, it has not been determined if specific EZH2 genetic variants are associated with breast cancer risk. In this paper, we evaluated the survival of different types of breast cancer. The results indicated that a lower expression of EZH2 led to poor survival of TNBC patients. Therefore, we aimed at studying the relationship between genetic polymorphisms of EZH2 and susceptibility to TNBC in Taiwan. Four single-nucleotide polymorphisms (SNPs) of EZH2 (rs6950683, rs2302427, rs3757441, and rs41277434) were analyzed by real-time PCR genotyping in 176 patients with TNBC and 1000 cancer-free controls. The results showed that TNBC patients under 60 years old who carried a TC or CC genotype at EZH2 rs6950683 and re3757441 had a tumor size of 20 mm or smaller (T1). Thus, this study is the first to examine the age and mutant genes associated with EZH2 SNPs in TNBC progression and development in Taiwan.
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Affiliation(s)
- Liang-Chih Liu
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan.,Department of Surgery, China Medical University Hospital, Taichung 40402, Taiwan
| | - Yi-Chung Chien
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan.,Ph.D. Program for Translational Medicine, China Medical University, Taichung 40402, Taiwan.,Institute of New Drug Development, China Medical University, Taichung 40402, Taiwan.,Drug Development Center, Research Center for Cancer Biology, China Medical University, Taichung 40402, Taiwan.,Center for Molecular Medicine, China Medical University Hospital, Taichung 40402, Taiwan
| | - Guo-Wei Wu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan.,Center for Molecular Medicine, China Medical University Hospital, Taichung 40402, Taiwan
| | - Chun-Hung Hua
- Department of Otorhinolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung 40402, Taiwan
| | - I-Chen Tsai
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan.,Division of Breast Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chih-Chiang Hung
- Division of Breast Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan.,Department of Applied Cosmetology, College of Human Science and Social Innovation, Hungkuang University, Taichung 43302, Taiwan
| | - Tsai-Kun Wu
- Division of Renal Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung 43503, Taiwan.,College of Medicine, National Chung Hsing University, Taichung 402204, Taiwan
| | - Ying-Ru Pan
- Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Yung-Luen Yu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan.,Ph.D. Program for Translational Medicine, China Medical University, Taichung 40402, Taiwan.,Institute of New Drug Development, China Medical University, Taichung 40402, Taiwan.,Drug Development Center, Research Center for Cancer Biology, China Medical University, Taichung 40402, Taiwan.,Center for Molecular Medicine, China Medical University Hospital, Taichung 40402, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 41354, Taiwan
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6
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Offermann A, Kang D, Watermann C, Weingart A, Hupe MC, Saraji A, Stegmann-Frehse J, Kruper R, Schüle R, Pantel K, Taubert H, Duensing S, Culig Z, Aigner A, Klapper W, Jonigk D, Philipp Kühnel M, Merseburger AS, Kirfel J, Sailer V, Perner S. Manuscript Title: Analysis of tripartite motif (TRIM) family gene expression in prostate cancer bone metastases. Carcinogenesis 2021; 42:1475-1484. [PMID: 34487169 DOI: 10.1093/carcin/bgab083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/29/2021] [Accepted: 09/04/2021] [Indexed: 12/27/2022] Open
Abstract
Tripartite motif (TRIM) family proteins are post-translational protein modifiers with E3-ubiquitin ligase activity, thereby involved in various biological processes. The molecular mechanisms driving prostate cancer (PCa) bone metastasis (BM) are incompletely understood, and targetable genetic alterations are lacking in the majority of cases. Therefore, we aimed to explore the expression and potential functional relevance of 71 TRIM members in bone metastatic PCa. We performed transcriptome analysis of all human TRIM family members and 770 cancer-related genes in 29 localized PCa and 30 PCa BM using Nanostring. KEGG, STRING and Ubibrowser were used for further bioinformatic gene correlation and pathway enrichment analyses. Compared to localized tumors, six TRIMs are under-expressed while nine TRIMs are over-expressed in BM. The differentially expressed TRIM proteins are linked to TNF-, TGFβ-, PI3K/AKT- and HIF-1-signaling, and to features such as proteoglycans, platelet activation, adhesion and ECM-interaction based on correlation to cancer-related genes. The identification of TRIM-specific E3-ligase-substrates revealed insight into functional connections to oncogenes, tumor suppressors and cancer-related pathways including androgen receptor- and TGFβ signaling, cell cycle regulation and splicing. In summary, this is the first study that comprehensively and systematically characterizes the expression of all TRIM members in PCa BM. Our results describe post-translational protein modification as an important regulatory mechanism of oncogenes, tumor suppressors, and pathway molecules in PCa progression. Therefore, this study may provide evidence for novel therapeutic targets, in particular for the treatment or prevention of BM.
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Affiliation(s)
- Anne Offermann
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Duan Kang
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christian Watermann
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Anika Weingart
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Marie C Hupe
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Alireza Saraji
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Janine Stegmann-Frehse
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Roland Schüle
- Klinik für Urologie und Zentrale Klinische Forschung, Klinikum der Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Klaus Pantel
- Institute for Tumor Biology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Taubert
- Department of Urology and Paediatric Urology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Duensing
- Molecular Urooncology, Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Zoran Culig
- Experimental Urology, Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Achim Aigner
- Rudolf-Boehm-Institute for Pharmacology and Toxicology, Clinical Pharmacology, Faculty of Medicine, University of Leipzig, Germany
| | - Wolfram Klapper
- Institute of Pathology, Hematopathology Section and Lymph Node Registry, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Mark Philipp Kühnel
- Institute of Pathology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Jutta Kirfel
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Verena Sailer
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Sven Perner
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.,Research Center Borstel, Leibniz Lung Center, Borstel, Germany
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