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Roll W, Bauer J, Dik A, Mueller C, Backhaus P, Räuber S, Zinnhardt B, Gallus M, Wimberley C, Körtvelyessy P, Schindler P, Stenzel W, Elger CE, Becker A, Lewerenz J, Wiendl H, Meuth SG, Schäfers M, Melzer N. [ 18F]DPA-714-PET-MRI reveals pronounced innate immunity in human anti-LGI1 and anti-CASPR2 limbic encephalitis. J Neurol 2024:10.1007/s00415-024-12302-7. [PMID: 38472399 DOI: 10.1007/s00415-024-12302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Wolfgang Roll
- Department of Nuclear Medicine, University of Münster, Münster, Germany
| | - Jan Bauer
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Andre Dik
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Christoph Mueller
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Philipp Backhaus
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Saskia Räuber
- Department of Neurology, Medical Faculty and University Hospital, Heinrich Heine University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Bastian Zinnhardt
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
- Biomarkers and Translational Technologies (BTT), Pharma Research & Early Development (pRED), F.Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Marco Gallus
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurological Surgery, University of California San Francisco, San Francisco, USA
| | | | - Peter Körtvelyessy
- Department of Neurology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp Schindler
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Werner Stenzel
- Department of Neuropathology, and Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Albert Becker
- Section for Translational Epilepsy Research, Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Jan Lewerenz
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty and University Hospital, Heinrich Heine University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Nico Melzer
- Department of Neurology, Medical Faculty and University Hospital, Heinrich Heine University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
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Perez B, Aljumaily R, Marron TU, Shafique MR, Burris H, Iams WT, Chmura SJ, Luke JJ, Edenfield W, Sohal D, Liao X, Boesler C, Machl A, Seebeck J, Becker A, Guenther B, Rodriguez-Gutierrez A, Antonia SJ. Phase I study of peposertib and avelumab with or without palliative radiotherapy in patients with advanced solid tumors. ESMO Open 2024; 9:102217. [PMID: 38320431 PMCID: PMC10937199 DOI: 10.1016/j.esmoop.2023.102217] [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: 09/12/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION We report results from a phase I, three-part, dose-escalation study of peposertib, a DNA-dependent protein kinase inhibitor, in combination with avelumab, an immune checkpoint inhibitor, with or without radiotherapy in patients with advanced solid tumors. MATERIALS AND METHODS Peposertib 100-400 mg twice daily (b.i.d.) or 100-250 mg once daily (q.d.) was administered in combination with avelumab 800 mg every 2 weeks in Part A or avelumab plus radiotherapy (3 Gy/fraction × 10 days) in Part B. Part FE assessed the effect of food on the pharmacokinetics of peposertib plus avelumab. The primary endpoint in Parts A and B was dose-limiting toxicity (DLT). Secondary endpoints were safety, best overall response per RECIST version 1.1, and pharmacokinetics. The recommended phase II dose (RP2D) and maximum tolerated dose (MTD) were determined in Parts A and B. RESULTS In Part A, peposertib doses administered were 100 mg (n = 4), 200 mg (n = 11), 250 mg (n = 4), 300 mg (n = 6), and 400 mg (n = 4) b.i.d. Of DLT-evaluable patients, one each had DLT at the 250-mg and 300-mg dose levels and three had DLT at the 400-mg b.i.d. dose level. In Part B, peposertib doses administered were 100 mg (n = 3), 150 mg (n = 3), 200 mg (n = 4), and 250 mg (n = 9) q.d.; no DLT was reported in evaluable patients. Peposertib 200 mg b.i.d. plus avelumab and peposertib 250 mg q.d. plus avelumab and radiotherapy were declared as the RP2D/MTD. No objective responses were observed in Part A or B; one patient had a partial response in Part FE. Peposertib exposure was generally dose proportional. CONCLUSIONS Peposertib doses up to 200 mg b.i.d. in combination with avelumab and up to 250 mg q.d. in combination with avelumab and radiotherapy were tolerable in patients with advanced solid tumors; however, antitumor activity was limited. CLINICALTRIALS GOV IDENTIFIER NCT03724890.
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Affiliation(s)
- B Perez
- Moffitt Cancer Center, Tampa
| | | | - T U Marron
- Icahn School of Medicine at Mount Sinai, New York
| | | | - H Burris
- Sarah Cannon Research Institute, Nashville
| | - W T Iams
- Vanderbilt University Medical Center, Nashville
| | | | - J J Luke
- UPMC Hillman Cancer Center, Pittsburgh
| | - W Edenfield
- Greenville Health System, Institute for Translational Oncology Research, Greenville
| | - D Sohal
- University of Cincinnati Medical Center, Cincinnati, USA
| | - X Liao
- Merck Serono Co., Ltd. (An Affiliate of Merck KGaA), Beijing, China
| | - C Boesler
- Merck Healthcare KGaA, Darmstadt, Germany
| | - A Machl
- EMD Serono Research & Development Institute, Inc. (An Affiliate of Merck KGaA), Billerica, USA
| | - J Seebeck
- Merck Healthcare KGaA, Darmstadt, Germany
| | - A Becker
- Merck Healthcare KGaA, Darmstadt, Germany
| | - B Guenther
- Merck Healthcare KGaA, Darmstadt, Germany
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Föhner K, Seipp H, Becker A, Maulbecker-Armstrong C, Schneider A, Seifart U, van der Wardt V. Factors associated with return-to-work outcomes in inpatient rehabilitation - a systematic scoping review. PSYCHOL HEALTH MED 2024; 29:191-215. [PMID: 37823613 DOI: 10.1080/13548506.2023.2269497] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
Inpatient rehabilitation is common in Germany to improve return-to-work outcomes. The objective of this systematic scoping review was to identify factors associated with return-to-work outcomes in musculoskeletal, psychological and oncological health conditions to improve tailoring of rehabilitation therapies. A search was completed in Embase, Medline, PsycInfo and AMED until May 2023 for articles investigating inpatient rehabilitation including working-age patients with oncological, musculoskeletal, or psychological diseases using a quantitative design and reporting factors associated with return-to-work outcomes. Screening of all titles and abstracts was completed by one reviewer, full texts were read by two reviewers. Quality appraisal and data extraction was completed by two reviewers. Data was analysed using a narrative synthesis. Eighteen studies of moderate quality were included. The review identified a wide range of return-to-work parameters including employment status, work ability, sickness absence, retirement status and duration of employment since rehabilitation. In addition, 48 psychological, health- and work-related factors associated with return-to-work parameters were identified. Only one RCT investigated the relationship between a depression prevention intervention and a return-to-work outcome (work ability), which showed a significant effect. In addition to the depression prevention intervention, only the factor 'health literacy' could be considered modifiable and be addressed as part of an inpatient rehabilitation programme. Furthermore, gradual work reintegration programs and/or workplace interventions in addition to inpatient rehabilitation should be further explored to improve return-to-work outcomes.
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Affiliation(s)
- K Föhner
- Department of General Practice, University of Marburg, Germany
| | - H Seipp
- Department of General Practice, University of Marburg, Germany
| | - A Becker
- Department of General Practice, University of Marburg, Germany
| | | | - A Schneider
- Faculty of Health Sciences, University of Applied Sciences Giessen, Germany
| | - U Seifart
- Rehabilitation Clinic Sonnenblick, German Pension Insurance, Marburg, Germany
| | - V van der Wardt
- Department of General Practice, University of Marburg, Germany
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Liu Y, Jun H, Becker A, Wallick C, Mattke S. Detection Rates of Mild Cognitive Impairment in Primary Care for the United States Medicare Population. J Prev Alzheimers Dis 2024; 11:7-12. [PMID: 38230712 PMCID: PMC10995024 DOI: 10.14283/jpad.2023.131] [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: 08/15/2023] [Accepted: 09/17/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Existing evidence points to substantial gaps in detecting mild cognitive impairment in primary care but is based on limited or self-reported data. The recent emergence of disease-modifying treatments for the Alzheimer's disease, the most common etiology of mild cognitive impairment, calls for a systematic assessment of detection rates in primary care. OBJECTIVES The current study aims to examine detection rates for mild cognitive impairment among primary care clinicians and practices in the United States using Medicare claims and encounter data. DESIGN Observational study. SETTING Medicare administrative data. PARTICIPANTS The study sample includes a total of 226,756 primary care clinicians and 54,597 practices that had at least 25 patients aged 65 or older, who were enrolled in Medicare fee-for-service or a Medicare Advantage plan between 2017 and 2019. MEASUREMENTS The detection rate for mild cognitive impairment is assessed as the ratio between the observed diagnosis rate of a clinician or practice as documented in the data, and the expected rate based on a predictive model. RESULTS The average detection rates for mild cognitive impairment is 0.08 (interquartile range=0.00-0.02) for both clinicians and practices, suggesting that only about 8% of expected cases were diagnosed on average. Only 0.1% of clinicians and practices had diagnosis rates within the expected range. CONCLUSIONS Mild cognitive impairment is vastly underdiagnosed, pointing to an urgent need to improve early detection in primary care.
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Affiliation(s)
- Y Liu
- Ying Liu, PhD, Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA 90089, USA,
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Singh K, Han C, Fleming JL, McElroy J, Becker A, Bell EH, Manring H, Haque J, Chakravarti A. Oncogenic Activities of Tribbles1 (TRIB1) Pseudokinase Overexpressed in GBM are Mediated by Protein-Protein Interactions. Int J Radiat Oncol Biol Phys 2023; 117:S86. [PMID: 37784591 DOI: 10.1016/j.ijrobp.2023.06.409] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Glioblastoma (GBM) is the most aggressive form of glioma with a low 5-year survival rate. The current treatments are inadequate and crippled by therapy resistance. Therefore, there is an unmet need to identify druggable therapeutic targets in GBM. In this study we identified TRIB1, a Ser/Thr pseudokinase that acts as a scaffold to initiate Ubiquitin Proteasome System-mediated degradation of its substrates. We and others have found that TRIB1 activates the canonical MAPK and Akt signaling cascades. Previous reports also suggest that TRIB1 contributes to chemotherapy resistance in various cancers. Therefore, we evaluated oncogenic roles of TRIB1 in GBM cells and its contribution to therapy resistance. MATERIALS/METHODS Patient-centered reverse translational approach was utilized to identify novel therapeutic targets. To this end, TRIB1 was identified by statistical association (Cox regression analysis) of the patient-derived gene expression profiling data publicly available from TCGA GBM cohort. TRIB1 was functionally validated in vitro by generating stable overexpression cell lines (patient-derived) by antibiotic selection. Conditional knockdown of TRIB1 was achieved by doxycycline induction. Protein-protein interactions were evaluated by co-immunoprecipitation. Protein levels were detected by western blotting. Changes in tumor volume and overall survival (OS) were calculated. RESULTS The mRNA profiling of TCGA GBM cohort revealed that increased TRIB1 gene expression was associated with worse OS of GBM patients [HR = 1.3 (1.0-1.5); P = 0.019]. The same analyses in our institutional cohort revealed a similar association. Mice bearing TRIB1 transgene overexpressing tumors had the increased tumor volume and shorter OS compared to empty vector control at the end of experiment. Overexpression of TRIB1 increased the phosphorylation/activation of ERK and Akt in patient-derived primary cell lines. Akt but not ERK activation was decreased after TRIB1 knockdown. TRIB1 bound directly to ERK and Akt in these cells. TRIB1 also formed a complex with p53, COP1 and HDAC1 in patient-derived primary cell lines. This protein-protein interaction was independent of TP53 mutation status. CONCLUSION Our data suggest that TRIB1 overexpressed in GBM executes various oncogenic functions through interaction with different proteins. Activating ERK signaling, can induce cell proliferation. Similarly, by activating Akt it can cause prosurvival effects. Finally, by associating with HDAC1 and COP1, TRIB1 can modulate p53 function. All these protein-protein interactions ultimately contribute to chemoradiotherapy resistance in GBM cells. We are currently developing small molecule inhibitors targeting the above-mentioned interactions of TRIB1 to overcome therapeutic resistance.
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Affiliation(s)
- K Singh
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - C Han
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J L Fleming
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J McElroy
- The Ohio State University, Center for Biostatistics, Department of Biomedical Informatics, Columbus, OH
| | - A Becker
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - E H Bell
- Administrative Director, Neuroscience Research Institute, Columbus, OH
| | - H Manring
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J Haque
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - A Chakravarti
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Kumar A, Rajasekera P, Becker V, Biehn S, Pérez-Soto B, Beyer S, McElroy J, Becker A, Johnson B, Cui T, Sebastian E, Grosu A, Lindert S, Bell EH, Manring H, Haque J, Chakravarti A. Hypoxia-Inducible Transgelin-2 Confers Treatment Resistance through Activation of PI3K/Akt/GSK3β Pathway in Glioblastoma. Int J Radiat Oncol Biol Phys 2023; 117:e121. [PMID: 37784671 DOI: 10.1016/j.ijrobp.2023.06.910] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Glioblastoma (GBM) patients with wild-type IDH experience worse survival response to the standard treatment of surgery followed by radiation therapy (RT) and temozolomide (TMZ) chemotherapy compared to their mutant IDH counterparts. This treatment has remained relatively ineffective partly due to the highly invasive phenotype of GBM leading to therapeutic resistance and tumor recurrence. Hypoxia is one of the key characteristic features of GBM which results in cancer metastasis and confers treatment resistance. Therefore, it is paramount to identify targets to help overcome hypoxia-induced treatment resistance in glioblastoma. Our lab has identified transgelin-2 (TAGLN2) to be significantly upregulated in IDH-wt GBM through multiple molecular profiling studies. This study aims to understand the mechanisms by which TAGLN2 confers treatment resistance for developing additional treatments for GBM. Additionally, active drug development efforts are also underway to target TAGLN2 for circumventing these therapeutic resistance mechanisms for effective GBM therapy. MATERIALS/METHODS RNAi-mediated TAGLN2 knockdown (KD) approach was employed to assess the functions of TAGLN2 in GBM patient-derived xenograft (PDX) cell lines. Series of in vitro functional assays were performed to assess the role of TAGLN2 in these cell lines. Cell proliferation, invasion ± RT and/or TMZ were assessed by MTS and Trans-well invasion assays. Subsequently, WB analysis of oncogenic signaling pathways was performed following Transgelin-2 KD. Co-IP assays and Biacore/SPR analyses were performed to study the binding affinity and kinetics for the interaction of PTEN with TAGLN2. Further, cells were intracranially implanted in nude mice to assess the role of TAGLN2 on tumor growth in vivo. RESULTS Conditional KD of TAGLN2 reduces cell proliferation, survival and invasive potential of GBM PDX cell lines. TAGLN2 KD also improved the sensitivity of these cells to both TMZ and radiation in vitro, as assessed by proliferation, survival, clonal expansion, and invasion. Histopathological studies of human GBM tumors and mouse xenograft tumors showed elevated expression of TAGLN2 in the peri-necrotic region of the tumors indicating that TAGLN2 protein level was upregulated by hypoxia. We also show that TAGLN2 is induced in hypoxic microenvironments with GBM PDX cell lines and its overexpression may enhance cellular resistance towards conventional therapy. Subsequently, we also show that hypoxia-induced TAGLN2 activates the PI3K/Akt oncogenic pathway through binding and inhibition of PTEN. Finally, in vivo data using an orthotopic xenograft mouse model shows reduction of tumor growth with knockdown of TAGLN2. CONCLUSION Our in vitro and in vivo xenograft studies suggest that TAGLN2 confers treatment resistance to GBM contributing to tumor recurrence. Altogether, TAGLN2 may serve as a potential therapeutically vulnerable target in GBM specifically through its role in cell survival and invasion.
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Affiliation(s)
- A Kumar
- Department of Radiation Oncology, Arthur G. James Hospital Ohio State Comprehensive Cancer Center, Columbus, OH
| | - P Rajasekera
- Department of Radiation Oncology, Arthur G. James Hospital/The Ohio State University Wexner Medical Center/Comprehensive Cancer Center, Columbus, OH
| | - V Becker
- 1Department of Radiation Oncology, Arthur G. James Hospital/Ohio State Comprehensive Cancer Center, Columbus, OH
| | - S Biehn
- Department of Chemistry & Biochemistry, The Ohio State University, Columbus, OH
| | - B Pérez-Soto
- Department of Chemistry & Biochemistry, The Ohio State University, Columbus, OH
| | - S Beyer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J McElroy
- The Ohio State University, Center for Biostatistics, Department of Biomedical Informatics, Columbus, OH
| | - A Becker
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - B Johnson
- The Ohio State University, Columbus, OH
| | - T Cui
- The Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - E Sebastian
- Department of Radiation Oncology, Arthur G. James Hospital/The Ohio State University Wexner Medical Center/Comprehensive Cancer Center, Columbus, OH
| | - A Grosu
- German Cancer Consortium (DKTK), Partner Site Freiburg, Heidelberg, Germany
| | - S Lindert
- Department of Chemistry & Biochemistry, The Ohio State University, Columbus, OH
| | - E H Bell
- Administrative Director, Neuroscience Research Institute, Columbus, OH
| | - H Manring
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - J Haque
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - A Chakravarti
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Ghomashi B, Walker S, Becker A. Enabling elliptically polarized high harmonic generation with short cross polarized laser pulses. Sci Rep 2023; 13:12843. [PMID: 37553388 PMCID: PMC10409740 DOI: 10.1038/s41598-023-39814-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023] Open
Abstract
Enabling elliptically polarized high-order harmonics overcomes a historical limitation in the generation of this highly nonlinear process in atomic, molecular and optical physics with applications in other branches. Here, we shed new light on a controversy between experimental observations and theoretical predictions on the possibility to generate harmonics with large ellipticity using two bichromatic laser pulses which are linearly polarized in orthogonal directions. Results of numerical calculations confirm the previous experimental data that in short laser pulses even harmonics with large ellipticity can be obtained for the interaction of such cross-polarized laser pulses with atoms initially in a s- or p-state, while odd harmonics have low ellipticity. The amount of the ellipticity can be controlled via the relative carrier-envelope phase of the pulses, their intensity ratio and the duration of the pulses.
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Affiliation(s)
- B Ghomashi
- JILA and Department of Physics, University of Colorado, Boulder, CO, 80309-0440, USA.
| | - S Walker
- JILA and Department of Physics, University of Colorado, Boulder, CO, 80309-0440, USA
| | - A Becker
- JILA and Department of Physics, University of Colorado, Boulder, CO, 80309-0440, USA
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Schuch F, Walger L, Schmitz M, David B, Bauer T, Harms A, Fischbach L, Schulte F, Schidlowski M, Reiter J, Bitzer F, von Wrede R, Rácz A, Baumgartner T, Borger V, Schneider M, Flender A, Becker A, Vatter H, Weber B, Specht-Riemenschneider L, Radbruch A, Surges R, Rüber T. An open presurgery MRI dataset of people with epilepsy and focal cortical dysplasia type II. Sci Data 2023; 10:475. [PMID: 37474522 PMCID: PMC10359264 DOI: 10.1038/s41597-023-02386-7] [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: 11/14/2022] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
Automated detection of lesions using artificial intelligence creates new standards in medical imaging. For people with epilepsy, automated detection of focal cortical dysplasias (FCDs) is widely used because subtle FCDs often escape conventional neuroradiological diagnosis. Accurate recognition of FCDs, however, is of outstanding importance for affected people, as surgical resection of the dysplastic cortex is associated with a high chance of postsurgical seizure freedom. Here, we make publicly available a dataset of 85 people affected by epilepsy due to FCD type II and 85 healthy control persons. We publish 3D-T1 and 3D-FLAIR, manually labeled regions of interest, and carefully selected clinical features. The open presurgery MRI dataset may be used to validate existing automated algorithms of FCD detection as well as to create new approaches. Most importantly, it will enable comparability of already existing approaches and support a more widespread use of automated lesion detection tools.
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Affiliation(s)
- Fabiane Schuch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Lennart Walger
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmitz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Bastian David
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Antonia Harms
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Laura Fischbach
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Freya Schulte
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Johannes Reiter
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Felix Bitzer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Atilla Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Achim Flender
- Medical Faculty, University Hospital Bonn, Bonn, Germany
| | - Albert Becker
- Section of Translational Epilepsy Research, Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | | | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.
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Tröscher AR, Mair KM, Verdú de Juan L, Köck U, Steinmaurer A, Baier H, Becker A, Blümcke I, Finzel M, Geis C, Höftberger R, Mawrin C, von Oertzen TJ, Pitsch J, Surges R, Voges B, Weis S, Winklehner M, Woermann F, Bauer J, Bien CG. Temporal lobe epilepsy with GAD antibodies: neurons killed by T cells not by complement membrane attack complex. Brain 2023; 146:1436-1452. [PMID: 36314080 PMCID: PMC10115353 DOI: 10.1093/brain/awac404] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 05/18/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 11/14/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is one of the syndromes linked to antibodies against glutamic acid decarboxylase (GAD). It has been questioned whether 'limbic encephalitis with GAD antibodies' is a meaningful diagnostic entity. The immunopathogenesis of GAD-TLE has remained enigmatic. Improvement of immunological treatability is an urgent clinical concern. We retrospectively assessed the clinical, MRI and CSF course as well as brain tissue of 15 adult patients with GAD-TLE who underwent temporal lobe surgery. Brain tissue was studied by means of immunohistochemistry, multiplex fluorescent microscopy and transcriptomic analysis for inflammatory mediators and neuronal degeneration. In 10 patients, there was a period of mediotemporal swelling and T2 signal increase; in nine cases this occurred within the first 6 years after symptom onset. This resulted in unilateral or bilateral hippocampal sclerosis; three cases developed hippocampal sclerosis within the first 2 years. All CSF studies done within the first year (n = 6) revealed intrathecal synthesis of immunoglobulin G. Temporal lobe surgeries were done after a median disease duration of 9 years (range 3 weeks to 60 years). Only two patients became seizure-free. Brain parenchyma collected during surgery in the first 6 years revealed high numbers of plasma cells but no signs of antibody-mediated tissue damage. Even more dense was the infiltration by CD8+ cytotoxic T lymphocytes (CTLs) that were seen to locally proliferate. Further, a portion of these cells revealed an antigen-specific resident memory T cell phenotype. Finally, CTLs with cytotoxic granzyme B+ granules were also seen in microglial nodules and attached to neurons, suggesting a CTL-mediated destruction of these cells. With longer disease duration, the density of all lymphocytes decreased. Whole transcriptome analysis in early/active cases (but not in late/inactive stages) revealed 'T cell immunity' and 'Regulation of immune processes' as the largest overrepresented clusters. To a lesser extent, pathways associated with B cells and neuronal degeneration also showed increased representation. Surgically treated patients with GAD-TLE go through an early active inflammatory, 'encephalitic' stage (≤6 years) with CTL-mediated, antigen-driven neuronal loss and antibody-producing plasma cells but without signs of complement-mediated cell death. Subsequently, patients enter an apparently immunologically inactive or low-active stage with ongoing seizures, probably caused by the structural damage to the temporal lobe. 'Limbic encephalitis' with GAD antibodies should be subsumed under GAD-TLE. The early tissue damage explains why immunotherapy does not usually lead to freedom from seizures.
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Affiliation(s)
- Anna R Tröscher
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
- Department of Neurology I, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Katharina M Mair
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Laia Verdú de Juan
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Ulrike Köck
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Anja Steinmaurer
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | | | - Albert Becker
- Section for Translational Epilepsy Research Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Ingmar Blümcke
- Department of Neuropathology, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Christian Geis
- Section Translational Neuroimmunology, Department of Neurology, University Hospital Jena, Jena, Germany
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Christian Mawrin
- Department of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Tim J von Oertzen
- Department of Neurology I, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Julika Pitsch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Berthold Voges
- Hamburg Epilepsy Centre, Protestant Hospital Alsterdorf, Department of Neurology and Epileptology, Hamburg, Germany
| | - Serge Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Neuromed Campus, Kepler University Hospital Linz, Linz, Austria
| | - Michael Winklehner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Friedrich Woermann
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
- Epilepsy Centre Bodensee, Ravensburg, Germany
| | - Jan Bauer
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Campus Bielefeld-Bethel, Bielefeld University, Bielefeld, Germany
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10
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Hoeh B, Wenzel M, Koll F, Fleisgarten F, Rührup J, Marieke K, Köllermann J, Roos FC, Kluth L, Mandel P, Chun F, Becker A. Comparison of perioperative outcomes of open vs. robotic-assisted partial nephrectomy for renal cell carcinoma: A propensity matched analysis relying on 20 years of tertiary care experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01052-7] [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: 02/12/2023]
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11
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Walger L, Adler S, Wagstyl K, Henschel L, David B, Borger V, Hattingen E, Vatter H, Elger CE, Baldeweg T, Rosenow F, Urbach H, Becker A, Radbruch A, Surges R, Reuter M, Cendes F, Wang ZI, Huppertz HJ, Rüber T. Artificial intelligence for the detection of focal cortical dysplasia: Challenges in translating algorithms into clinical practice. Epilepsia 2023; 64:1093-1112. [PMID: 36721976 DOI: 10.1111/epi.17522] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/02/2023]
Abstract
Focal cortical dysplasias (FCDs) are malformations of cortical development and one of the most common pathologies causing pharmacoresistant focal epilepsy. Resective neurosurgery yields high success rates, especially if the full extent of the lesion is correctly identified and completely removed. The visual assessment of magnetic resonance imaging does not pinpoint the FCD in 30%-50% of cases, and half of all patients with FCD are not amenable to epilepsy surgery, partly because the FCD could not be sufficiently localized. Computational approaches to FCD detection are an active area of research, benefitting from advancements in computer vision. Automatic FCD detection is a significant challenge and one of the first clinical grounds where the application of artificial intelligence may translate into an advance for patients' health. The emergence of new methods from the combination of health and computer sciences creates novel challenges. Imaging data need to be organized into structured, well-annotated datasets and combined with other clinical information, such as histopathological subtypes or neuroimaging characteristics. Algorithmic output, that is, model prediction, requires a technically correct evaluation with adequate metrics that are understandable and usable for clinicians. Publication of code and data is necessary to make research accessible and reproducible. This critical review introduces the field of automatic FCD detection, explaining underlying medical and technical concepts, highlighting its challenges and current limitations, and providing a perspective for a novel research environment.
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Affiliation(s)
- Lennart Walger
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Sophie Adler
- University College London Great Ormond Street Institute for Child Health, London, UK
| | | | | | - Bastian David
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital and Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Torsten Baldeweg
- University College London Great Ormond Street Institute for Child Health, London, UK
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University and University Hospital Frankfurt, Frankfurt am Main, Germany.,LOEWE Center for Personalized Translational Epilepsy Research, Goethe University, Frankfurt am Main, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | | | - Rainer Surges
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Martin Reuter
- German Center for Neurodegenerative Diseases, Bonn, Germany.,A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Zhong Irene Wang
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Theodor Rüber
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
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12
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Royero P, Quatraccioni A, Früngel R, Silva MH, Bast A, Ulas T, Beyer M, Opitz T, Schultze JL, Graham ME, Oberlaender M, Becker A, Schoch S, Beck H. Circuit-selective cell-autonomous regulation of inhibition in pyramidal neurons by Ste20-like kinase. Cell Rep 2022; 41:111757. [PMID: 36476865 PMCID: PMC9756112 DOI: 10.1016/j.celrep.2022.111757] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/18/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Maintaining an appropriate balance between excitation and inhibition is critical for neuronal information processing. Cortical neurons can cell-autonomously adjust the inhibition they receive to individual levels of excitatory input, but the underlying mechanisms are unclear. We describe that Ste20-like kinase (SLK) mediates cell-autonomous regulation of excitation-inhibition balance in the thalamocortical feedforward circuit, but not in the feedback circuit. This effect is due to regulation of inhibition originating from parvalbumin-expressing interneurons, while inhibition via somatostatin-expressing interneurons is unaffected. Computational modeling shows that this mechanism promotes stable excitatory-inhibitory ratios across pyramidal cells and ensures robust and sparse coding. Patch-clamp RNA sequencing yields genes differentially regulated by SLK knockdown, as well as genes associated with excitation-inhibition balance participating in transsynaptic communication and cytoskeletal dynamics. These data identify a mechanism for cell-autonomous regulation of a specific inhibitory circuit that is critical to ensure that a majority of cortical pyramidal cells participate in information coding.
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Affiliation(s)
- Pedro Royero
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, University of Bonn Medical Center, Venusberg-Campus 1, 53105 Bonn, Germany,International Max Planck Research School for Brain and Behavior, Bonn, Germany
| | - Anne Quatraccioni
- Department of Neuropathology, University Hospital Bonn, Section for Translational Epilepsy Research, 53127 Bonn, Germany,International Max Planck Research School for Brain and Behavior, Bonn, Germany
| | - Rieke Früngel
- In Silico Brain Sciences Group, Max-Planck Institute for Neurobiology of Behavior – Caesar, Bonn, Germany,International Max Planck Research School for Brain and Behavior, Bonn, Germany
| | - Mariella Hurtado Silva
- Synapse Proteomics, Children’s Medical Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Arco Bast
- In Silico Brain Sciences Group, Max-Planck Institute for Neurobiology of Behavior – Caesar, Bonn, Germany,International Max Planck Research School for Brain and Behavior, Bonn, Germany
| | - Thomas Ulas
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Bonn, Germany,PRECISE Platform for Single Cell Genomics and Epigenomics, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V. and University of Bonn, Bonn, Germany,Genomics & Immunoregulation, LIMES Institute, University of Bonn, Bonn, Germany
| | - Marc Beyer
- PRECISE Platform for Single Cell Genomics and Epigenomics, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V. and University of Bonn, Bonn, Germany,Immunogenomics & Neurodegeneration, Deutsches Zentrum für Neurodegenerative Erkrankungen e.V., Bonn, Germany
| | - Thoralf Opitz
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, University of Bonn Medical Center, Venusberg-Campus 1, 53105 Bonn, Germany
| | - Joachim L. Schultze
- Systems Medicine, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V., Bonn, Germany,PRECISE Platform for Single Cell Genomics and Epigenomics, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) e.V. and University of Bonn, Bonn, Germany,Genomics & Immunoregulation, LIMES Institute, University of Bonn, Bonn, Germany
| | - Mark E. Graham
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, University of Bonn Medical Center, Venusberg-Campus 1, 53105 Bonn, Germany
| | - Marcel Oberlaender
- In Silico Brain Sciences Group, Max-Planck Institute for Neurobiology of Behavior – Caesar, Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, Section for Translational Epilepsy Research, 53127 Bonn, Germany
| | - Susanne Schoch
- Department of Neuropathology, University Hospital Bonn, Section for Translational Epilepsy Research, 53127 Bonn, Germany
| | - Heinz Beck
- Institute of Experimental Epileptology and Cognition Research, University of Bonn, University of Bonn Medical Center, Venusberg-Campus 1, 53105 Bonn, Germany,Deutsches Zentrum für Neurodegenerative Erkrankungen e.V., Bonn, Germany,Corresponding author
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13
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Mabry R, Becker A, Wesselhoeft A, Horhata A. 44P In situ CAR therapy using oRNA™ lipid nanoparticles regresses tumors in mice. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Maiseyeu I, Güresir Á, Vatter H, Herrlinger U, Becker A, Wach J, Güresir E. Preoperative Risk Stratification of Increased MIB-1 Labeling Index in Pituitary Adenoma: A Newly Proposed Prognostic Scoring System. J Clin Med 2022; 11:jcm11237151. [PMID: 36498723 PMCID: PMC9738462 DOI: 10.3390/jcm11237151] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
The MIB-1 index is an important risk factor for progression-free survival (PFS) in pituitary adenoma (PA). Preoperatively, the MIB-1 index is not available in the decision-making process. A preoperative method regarding MIB-1 index estimation in PA has not been evaluated so far. Between 2011 and 2021, 109 patients with tumor morphology data, MIB-1 index data, and inflammatory and pituitary hormone laboratory values underwent surgery for PA. An MIB-1 index cutoff point (≥4/<4%) determines the probability of PFS in completely resected PA. An elevated MIB-1 index (≥4%) was present in 32 cases (29.4%) and was significantly associated with increased IGF-1, age ≤ 60, increased ACTH, and increased fibrinogen levels in the multivariable analysis. A scoring system (“FATE”) using preoperative IGF-1, age, ACTH, and plasma fibrinogen level enables the estimation of the MIB-1 index (sensitivity 72%, specificity 68%). The FATE score is also significantly associated with the time to PA progression after the complete resection of the PA. We propose the FATE score to preoperatively estimate the risk of an elevated MIB-1 index (≥4%), which might enable tailoring to medical decision-making, and follow-up interval scheduling, as well as inform future studies analyzing proliferative activities.
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Affiliation(s)
- Ivan Maiseyeu
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
- Correspondence: ; Tel.: +49-228-287-16521
| | - Ági Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, 53127 Bonn, Germany
| | - Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
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15
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Tong Z, Fleming J, Grozdic I, McElroy J, Beyer S, Fabian D, Becker A, Bell E, Mahler K, Popp I, Staszewski O, Manring H, Haque J, Grosu A, Chakravarti A. Therapeutic Potential of Small Molecule Inhibitors of TBK1 in Glioma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.848] [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: 11/28/2022]
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16
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Wach J, Güresir Á, Vatter H, Herrlinger U, Becker A, Toma M, Hölzel M, Güresir E. Low-Dose Acetylsalicylic Acid Treatment in Non-Skull-Base Meningiomas: Impact on Tumor Proliferation and Seizure Burden. Cancers (Basel) 2022; 14:cancers14174285. [PMID: 36077817 PMCID: PMC9454729 DOI: 10.3390/cancers14174285] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
MIB-1 index is an important predictor of meningioma progression and was found to be correlated with COX-2 expression. However, the impact of low-dose acetylsalicylic acid (ASA) on MIB-1 index and clinical symptoms is unclear. Between 2009 and 2022, 710 patients with clinical data, tumor-imaging data, inflammatory laboratory (plasma fibrinogen, serum C-reactive protein) data, and neuropathological reports underwent surgery for primary cranial WHO grade 1 and 2 meningioma. ASA intake was found to be significantly associated with a low MIB-1 labeling index in female patients ≥ 60 years. Multivariable analysis demonstrated that female patients ≥ 60 years with a non-skull-base meningioma taking ASA had a significantly lower MIB-1 index (OR: 2.6, 95%: 1.0–6.6, p = 0.04). Furthermore, the intake of ASA was independently associated with a reduced burden of symptomatic epilepsy at presentation in non-skull-base meningiomas in both genders (OR: 3.8, 95%CI: 1.3–10.6, p = 0.03). ASA intake might have an anti-proliferative effect in the subgroup of elderly female patients with non-skull-base meningiomas. Furthermore, anti-inflammatory therapy seems to reduce the burden of symptomatic epilepsy in non-skull-base meningiomas. Further research is needed to investigate the role of anti-inflammatory therapy in non-skull-base meningiomas.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
- Correspondence: ; Tel.: +49-228-287-16521
| | - Ági Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, 53127 Bonn, Germany
| | - Marieta Toma
- Institute of Pathology, University Hospital Bonn, 53127 Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
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17
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Billingy N, Tromp V, Becker A, Hoek R, Aaronson N, Bogaard HJ, Hugtenburg J, Onwuteaka-Philipsen B, Van De Poll-Franse L, Belderbos J, Van den Hurk C, Walraven I. CN1 Patient-reported symptom monitoring improves health-related quality of life in lung cancer patients: The SYMPRO-Lung trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.311] [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: 11/01/2022] Open
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18
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Reinhardt A, Pfister K, Schrimpf D, Stichel D, Sahm F, Reuss DE, Capper D, Wefers AK, Ebrahimi A, Sill M, Felsberg J, Reifenberger G, Becker A, Prinz M, Staszewski O, Hartmann C, Schittenhelm J, Gramatzki D, Weller M, Olar A, Rushing EJ, Bergmann M, Farrell MA, Blümcke I, Coras R, Beckervordersandforth J, Kim SH, Rogerio F, Dimova PS, Niehusmann P, Unterberg A, Platten M, Pfister SM, Wick W, Herold-Mende C, von Deimling A. Anaplastic ganglioglioma - a diagnosis comprising several distinct tumour types. Neuropathol Appl Neurobiol 2022; 48:e12847. [PMID: 35977725 DOI: 10.1111/nan.12847] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/20/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022]
Abstract
Anaplastic ganglioglioma is a rare tumour and diagnosis has been based on histological criteria. The 5th edition of the World Health Organization Classification of Tumours of the Central Nervous System (CNS WHO) does not list anaplastic ganglioglioma as a distinct diagnosis due to lack of molecular data in previous publications AIM: We retrospectively compiled a cohort of 54 histologically diagnosed anaplastic gangliogliomas to explore whether the molecular profiles of these tumours represent a separate type or resolve into other entities METHODS: Samples were subjected to histological review, DNA methylation profiling and next generation sequencing. Morphologic and molecular data were summarised to an integrated diagnosis RESULTS: The majority of histologically diagnosed anaplastic gangliogliomas resolved into CNS WHO diagnoses of glial tumours, most commonly pleomorphic xanthoastrocytoma (16/54), glioblastoma, IDH wildtype and diffuse paediatric-type high-grade glioma, H3 wildtype and IDH wildtype (11 and 2/54) followed by low-grade glial or glioneuronal tumours including pilocytic astrocytoma, dysembryoplastic neuroepithelial tumour and diffuse leptomeningeal glioneuronal tumour (5/54), IDH mutant astrocytoma (4/54) and others (6/54). A subset of tumours (10/54) was not assignable to a CNS WHO diagnosis and common molecular profiles pointing to a separate entity were not evident CONCLUSION: In summary, we show that tumours histologically diagnosed as anaplastic ganglioglioma comprise a wide spectrum of CNS WHO tumour types with different prognostic and therapeutic implications. We therefore suggest assigning this designation with caution and recommend comprehensive molecular workup.
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Affiliation(s)
- Annekathrin Reinhardt
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Current address: Centre for Human Genetics Tübingen, Tübingen, Germany
| | - Kristin Pfister
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Pathology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Daniel Schrimpf
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Damian Stichel
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David E Reuss
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Capper
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Neuropathology, Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Azadeh Ebrahimi
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Martin Sill
- German Cancer Consortium (DKTK), Core Center Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Joerg Felsberg
- Institute of Neuropathology, Heinrich Heine University, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany.,German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Albert Becker
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Marco Prinz
- Institute of Neuropathology, Medical Faculty, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Ori Staszewski
- Institute of Neuropathology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School, Hannover, Germany
| | - Jens Schittenhelm
- Institute of Pathology and Neuropathology, University Tübingen, Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Dorothee Gramatzki
- Department of Neurology, University Hospital and University Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital and University Zurich, Zurich, Switzerland
| | | | | | - Markus Bergmann
- Institute of Neuropathology, Center for Pathology, Klinikum Bremen Mitte, Bremen, Germany
| | | | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Jan Beckervordersandforth
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Se Hoon Kim
- Department of Pathology, Yonsei University, College of Medicine, Seoul, South Korea
| | - Fabio Rogerio
- Department of Pathology, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Petia S Dimova
- Epilepsy Surgery Center, Department of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Pitt Niehusmann
- Section of Neuropathology, Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Andreas Unterberg
- Clinic for Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Clinical Cooperation Unit Neuroimmunology and Brain Tumour Immunology, German Cancer Research Center (DKFZ), Heidelberg
| | - Stefan M Pfister
- German Cancer Consortium (DKTK), Core Center Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Paediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Paediatric Oncology and Hematology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- German Cancer Consortium (DKTK), Core Center Heidelberg, Germany.,Neurology Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Core Center Heidelberg, Germany
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19
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Borger V, Hamed M, Bahna M, Rácz Á, Ilic I, Potthoff AL, Baumgartner T, Rüber T, Becker A, Radbruch A, Mormann F, Surges R, Vatter H, Schneider M. Temporal lobe epilepsy surgery: Piriform cortex resection impacts seizure control in the long-term. Ann Clin Transl Neurol 2022; 9:1206-1211. [PMID: 35776784 PMCID: PMC9380176 DOI: 10.1002/acn3.51620] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022] Open
Abstract
Objective Recently, we showed that resection of at least 27% of the temporal part of piriform cortex (PiC) strongly correlated with seizure freedom 1 year following selective amygdalo‐hippocampectomy (tsSAHE) in patients with mesial temporal lobe epilepsy (mTLE). However, the impact of PiC resection on long‐term seizure outcome following tsSAHE is currently unknown. The aim of this study was to evaluate the impact of PiC resection on long‐term seizure outcome in patients with mTLE treated with tsSAHE. Methods Between 2012 and 2017, 64 patients were included in the retrospective analysis. Long‐term follow‐up (FU) was defined as at least 2 years postoperatively. Seizure outcome was assessed according to the International League against Epilepsy (ILAE). The resected proportions of hippocampus, amygdala, and PiC were volumetrically assessed. Results The mean FU duration was 3.75 ± 1.61 years. Patients with ILAE class 1 revealed a significantly larger median proportion of resected PiC compared to patients with ILAE class 2–6 [46% (IQR 31–57) vs. 16% (IQR 6–38), p = 0.001]. Resected proportions of hippocampus and amygdala did not significantly differ for these groups. Among those patients with at least 27% resected proportion of PiC, there were significantly more patients with seizure freedom compared to the patients with <27% resected proportion of PiC (83% vs. 39%, p = 0.0007). Conclusions Our results show a strong impact of the extent of PiC resection on long‐term seizure outcome following tsSAHE in mTLE. The authors suggest the PiC to constitute a key target volume in tsSAHE to achieve seizure freedom in the long term.
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Affiliation(s)
- Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Majd Bahna
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Áttila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Inja Ilic
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | | | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Albert Becker
- Section for Translational Epilepsy Research, Institute of Neuropathology, Medical Faculty, University of Bonn, Bonn, Germany
| | | | - Florian Mormann
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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Baumgartner T, Pitsch J, Olaciregui-Dague K, Hoppe C, Racz A, Rüber T, Becker A, von Wrede R, Surges R. Seizure underreporting in LGI1 and CASPR2 antibody encephalitis. Epilepsia 2022; 63:e100-e105. [PMID: 35735209 DOI: 10.1111/epi.17338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
Patients with anti-leucine-rich glioma-inactivated 1 protein (LGI1) or anti-contactin-associated protein 2 (CASPR2) antibody encephalitis typically present with frequent epileptic seizures. The seizures generally respond well to immunosuppressive therapy and the long-term seizure outcome seems to be favorable. Consequentially, diagnosing acute symptomatic seizures secondary to autoimmune encephalitis instead of autoimmune epilepsy was proposed. However, published data on long-term seizure outcomes in CASPR2 and LGI1 antibody encephalitis are mostly based on patient reports and seizure underreporting is a recognized issue. Clinical records from our tertiary epilepsy center were screened retrospectively for patients with LGI1 and CASPR2 antibody encephalitis who reported seizure freedom for at least three months and received video-EEG for >24 hours at follow-up visits. Twenty (LGI1: n=15; CASPR2: n=5) out of thirty-two patients with LGI1 (n=24) and CASPR2 (n=8) antibody encephalitis fulfilled these criteria. We recorded focal aware and impaired awareness seizures in four of these patients (20%) with reported seizure-free intervals ranging from 3 to 27 months. Our results question the favorable seizure outcome in patients with CASPR2 and LGI1 antibody encephalitis and suggest that the proportion of patients who have persistent seizures may be greater. Our findings underline the importance of prolonged video-EEG telemetry in this population.
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Affiliation(s)
| | - Julika Pitsch
- Dept. of Epileptology, University Hospital Bonn, Germany
| | | | | | - Attila Racz
- Dept. of Epileptology, University Hospital Bonn, Germany
| | - Theodor Rüber
- Dept. of Epileptology, University Hospital Bonn, Germany
| | - Albert Becker
- Section for Translational Epilepsy Research, Dept. of Neuropathology, University Hospital Bonn, Germany
| | | | - Rainer Surges
- Dept. of Epileptology, University Hospital Bonn, Germany
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21
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Jacquot R, Gerfaud-Valentin M, Lega JC, Becker A, Jamilloux Y, Seve P. Murine typhus complicated by sHLH mimicking adult-onset Still's disease. Rev Med Interne 2022; 43:617-621. [PMID: 35697578 DOI: 10.1016/j.revmed.2022.05.011] [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: 02/16/2022] [Revised: 05/21/2022] [Accepted: 05/29/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Adult-onset Still's disease (AOSD) is a rare multisystemic disorder and a diagnostic challenge for physicians because of the wide range of differential diagnoses. Common features of AOSD and secondary hemophagocytic lymphohistiocytosis (sHLH) could favour diagnostic uncertainty, in particular in case of infection-related sHLH. OBSERVATION A 61-year-old man was admitted to our internal medicine department for suspected AOSD. He reported a 2-week history of sudden onset fever, headaches, myalgia, sore throat, diarrhoea, and an erythematous macular rash of the trunk as well as petechial purpuric lesions on both legs on return from Reunion Island. Laboratory tests found cytopenia, hepatic cytolysis, hypertriglyceridaemia, and hyperferritinaemia. Hemophagocytosis was diagnosed on bone marrow aspiration in favour of the diagnosis of secondary hemophagocytic lymphohistiocytosis (sHLH). Subcutaneous anakinra (100mg) was initiated to treat sHLH with favourable course. Oral doxycycline was added 3days later because of atypical features for AOSD diagnosis such as diarrhoea, hypergammaglobulinaemia, and doubtful serologies for Rickettsia and Coxiella. Three weeks later, Rickettsia typhi serology was checked again and revealed an increase in IgG titer>4 times that confirmed the diagnosis of murine typhus. A diagnosis of murine typhus complicated by sHLH was retained, successfully treated by anakinra and doxycycline. CONCLUSION Our observation shows that AOSD diagnosis has to be stringent due to the many differential diagnoses, particularly infection complicated by sHLH, which may be rare. It is important to consider murine typhus in patients returning from endemic areas, such as La Reunion or other tropical areas, when they present fever of unknown origin with non-specific clinical features. Moreover, this case illustrates the effectiveness of IL-1 blockers as a treatment for symptomatic sHLH without severity criteria, regardless of the aetiology.
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Affiliation(s)
- R Jacquot
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude-Bernard University - Lyon 1, Lyon, France.
| | - M Gerfaud-Valentin
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude-Bernard University - Lyon 1, Lyon, France
| | - J-C Lega
- Department of Internal Medicine, University Hospital Lyon Sud, Claude-Bernard University - Lyon 1, Lyon, France
| | - A Becker
- Department of Infectious Disease, University Hospital Lyon Croix-Rousse, Claude-Bernard University - Lyon 1, Lyon, France
| | - Y Jamilloux
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude-Bernard University - Lyon 1, Lyon, France
| | - P Seve
- Department of Internal Medicine, University Hospital Lyon Croix-Rousse, Claude-Bernard University - Lyon 1, Lyon, France; University Claude-Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
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22
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Gopalakrishnan S, Krebs-Brown A, Nogueira Filho M, Kuroki Y, Bachmann A, Becker A, Schippers F, Fluck M, Yalkinoglu Ö, Klopp-Schulze L. POS0755 SAFETY, TOLERABILITY, PHARMACOKINETICS, AND PHARMACODYNAMICS OF A SINGLE ORALLY ADMINISTERED DOSE OF ENPATORAN IN A PHASE I STUDY OF HEALTHY JAPANESE AND CAUCASIAN PARTICIPANTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundEnpatoran, a novel, highly selective and potent dual toll-like receptor (TLR) 7 and TLR8 inhibitor, is in development for the treatment of autoimmune disorders including systemic and cutaneous lupus erythematosus. A first-in-human study in healthy participants has shown that enpatoran is well-tolerated and has a linear pharmacokinetic (PK) profile.ObjectivesTo compare the PK parameters, safety, and tolerability of single ascending oral doses of enpatoran in a Phase I study in Japanese and Caucasian participants, and to explore a potential PK/pharmacodynamic (PD) relationship.MethodsA single-centre, open-label, sequential dose group study enrolled healthy Japanese and Caucasian participants into three dose cohorts. Each Caucasian participant was matched by body weight (± 20%), height (± 15%) and sex to a Japanese participant. Participants received a single orally administered enpatoran dose of 100 mg, 200 mg, or 300 mg as a film-coated tablet under fasting conditions. PK parameters, (maximum plasma concentration [Cmax]; area under the plasma concentration–time curve (AUC) from time 0 to infinity [AUC0-inf]; AUC from time 0 to the last sampling time [AUC0-tlast]) determined using noncompartmental analysis, were estimated post-dose from Day 1–3. Safety was assessed from Day -1 to 8. PK (exposure) between the two ethnic groups was compared using an analysis of covariance (ANCOVA) model including ethnic group, natural log-transformed dose, and ethnic group by natural log dose interaction. Ex vivo secretion of cytokines (PD) under stimulated (using the TLR7/8 agonist, R848) and unstimulated conditions, was assessed pre- and post-dose. A panel of cytokines was analysed by multiplex immunoassay; IL-6 was considered the primary PD biomarker.ResultsThe study included 36 male participants (18 Japanese and 18 Caucasian) with a mean (± SD) age of 35.1 (± 10.8) years and mean (± SD) body mass index of 23.1 (± 2.1) kg/m2. Each dose group included six Japanese and six Caucasian participants. The geometric mean enpatoran plasma exposure parameters (Cmax, AUC0-inf, and AUC0-tlast) were consistent between the two ethnic groups for each dose level (Table 1) and indicated dose proportionality. ANCOVA modeling demonstrated comparable exposure between the two groups (geometric least square mean ratio [Japanese/Caucasian;90% CI] of Cmax: 0.9409 [0.7855–1.1270]; AUC0-inf: 0.8959 [0.7497–1.0704] and AUC0-tlast: 0.8963 [0.7511–1.0695]). Treatment-emergent adverse events (TEAEs) were observed in six Japanese (n = 0, 100 mg; n = 3, 200 mg; n = 3, 300 mg) and four Caucasian (n = 1, 100 mg; n = 0, 200 mg; n = 3, 300 mg) participants. There we no serious TEAEs; most were mild and not dose dependent. Treatment-related TEAEs were mild diarrhoea, mild flatulence, and moderate headache. There were no deaths, withdrawals, or early terminations due to TEAEs. Administering enpatoran effectively reduced ex vivo stimulated cytokine release, with maximal inhibition observed at 2 hours post-dose (IL-6: mean ≥99%). High inhibition levels were sustained through 24 hours in a dose-dependent manner (IL-6: mean ~76–97%). The pattern of cytokine release inhibition was consistent across doses and ethnic groups.Table 1.PK parameters in Japanese and Caucasian participants at the three enpatoran dose levelsParameter100 mg200 mg300 mgJapaneseCaucasianJapaneseCaucasianJapaneseCaucasianN = 6N = 6N = 6N = 6N = 6N = 6Cmax139175260245486490(ng/mL)AUC0-inf7749481910185028403330(h*ng/mL)AUC0-tlast7589311880183028103270(h*ng/mL)All values are Geometric mean.Cmax, maximum plasma concentration AUC0-inf, area under the plasma concentration–time curve (AUC) from time 0 to infinity; AUC0-tlast, AUC from time 0 to the last sampling time.ConclusionThere were no relevant ethnic differences in PK, PD, and safety between healthy Japanese and Caucasian participants across a range of single oral enpatoran doses, thus supporting the inclusion of Asian participants in future global Phase II studies.AcknowledgementsWe would like to thank those who took part in the study. This study was sponsored by the healthcare business of Merck KGaA, Darmstadt, Germany (CrossRef Funder ID: 10.13039/100009945), who funded medical writing support by Bioscript Stirling Ltd.Disclosure of InterestsSathej Gopalakrishnan Shareholder of: Merck Healthcare KGaA, Employee of: Merck Healthcare KGaA, Axel Krebs-Brown Employee of: Merck Healthcare KGaA, Marco Nogueira Filho Employee of: Merck Healthcare KGaA, Yoshihiro Kuroki Employee of: Merck Biopharma Co., Ltd., Angelika Bachmann Employee of: Merck Healthcare KGaA, Andreas Becker Shareholder of: Merck Healthcare KGaA, Employee of: Merck Healthcare KGaA, Frank Schippers Employee of: Merck Healthcare KGaA, Markus Fluck Shareholder of: Merck Healthcare KGaA, Employee of: Merck Healthcare KGaA, Özkan Yalkinoglu Employee of: Merck Healthcare KGaA, Lena Klopp-Schulze Employee of: Merck Healthcare KGaA
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Rácz A, Hummel CA, Becker A, Helmstaedter C, Schuch F, Baumgartner T, von Wrede R, Borger V, Solymosi L, Surges R, Elger CE. Histopathologic Characterization and Neurodegenerative Markers in Patients With Limbic Encephalitis Undergoing Epilepsy Surgery. Front Neurol 2022; 13:859868. [PMID: 35493848 PMCID: PMC9051082 DOI: 10.3389/fneur.2022.859868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Limbic encephalitis is an increasingly recognized cause of medial temporal lobe epilepsy (mTLE) and associated cognitive deficits, potentially resulting in hippocampal sclerosis (HS). For several reasons, these patients usually do not undergo epilepsy surgery. Thus, histopathologic examinations in surgical specimens of clearly diagnosed limbic encephalitis are scarce. The purpose of this study was a detailed histopathologic analysis of surgical tissue alterations, including neurodegenerative markers, in patients with limbic encephalitis undergoing epilepsy surgery. Methods We investigated the surgical specimens of six patients operated on with mTLE related to limbic encephalitis (among them four patients were with GAD65 and one with Ma1/2 antibodies), and compared the findings to a control group with six patients matched according to age at the time of surgery without limbic encephalitis and without early inciting events. Results Histopathologic analysis in the group with limbic encephalitis revealed HS in four patients, while three of them also displayed signs of an active inflammatory reaction with lymphocytes. In one of the patients with GAD65-encephalitis who was suffering from a late-onset mTLE and a long disease course, neurodegenerative protein markers (β-amyloid and hyperphosphorylated tau) were found coexisting with inflammatory reactions and HS. Investigations in the control group did not reveal any inflammatory reaction or neurodegenerative marker. Conclusion Our findings suggest a possible link between long-lasting immune reactions in the medial temporal lobe, HS, and further toward the development of neurodegenerative diseases. Presently, however, a causal relationship between these entities cannot yet be established. Furthermore, our results suggest that an immunological etiology should always be considered in late onset (> 18 years) mTLE, also in cases of long disease duration and the presence of HS.
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Affiliation(s)
- Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
- *Correspondence: Attila Rácz
| | - Chiara A. Hummel
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | | | - Fabiane Schuch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - László Solymosi
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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Nitsch L, Petzinna S, Zimmermann J, Getts DR, Becker A, Müller M. MOG-Specific T Cells Lead to Spontaneous EAE with Multilocular B Cell Infiltration in the GF-IL23 Model. Neuromolecular Med 2022; 24:415-423. [PMID: 35239103 DOI: 10.1007/s12017-022-08705-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
Although IL-23 and downstream signal transduction play essential roles in neuroinflammation, the local impact of IL-23 in multiple sclerosis is still not fully understood. Our previous study revealed that the central nervous system (CNS)-restricted expression of IL-23 in a mouse model with astrocyte-specific expression of IL-23, called GF-IL23 mice, leads to spontaneous formation of infiltrates in the brain, especially in the cerebellum. To further investigate the impact of CNS-specific IL-23-expression on neuroinflammation, we studied the GF-IL23 model in mice expressing a myelin oligodendrocyte glycoprotein (MOG)-specific T cell receptor (GF23-2D2 mice). The GF23-2D2 mice developed a chronic progressive experimental autoimmune encephalomyelitis with myelitis and ataxia without requiring additional immunization. CNS-production of IL-23 alone induced pronounced neuroinflammation in the transgenic MOG-specific T cell receptor model. The GF23-2D2 mice spontaneously developed multilocular infiltrates with a high number of B cells, demyelination and a proinflammatory cytokine milieu indicating that the interaction of encephalitogenic T cells and B cells via co-stimulatory factors seemed to be crucial.
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Affiliation(s)
- Louisa Nitsch
- Department of Neurology, University Hospital Bonn, Campus Venusberg 1, 53127, Bonn, Germany.
| | - Simon Petzinna
- Department of Neurology, University Hospital Bonn, Campus Venusberg 1, 53127, Bonn, Germany
| | - Julian Zimmermann
- Department of Neurology, University Hospital Bonn, Campus Venusberg 1, 53127, Bonn, Germany
| | - Daniel R Getts
- Department of Microbiology-Immunology and Interdepartmental Immunobiology Center, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, Campus Venusberg 1, 53127, Bonn, Germany
| | - Marcus Müller
- Department of Neurology, University Hospital Bonn, Campus Venusberg 1, 53127, Bonn, Germany.,School of Molecular Bioscience, University of Sydney, Sydney, Australia
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25
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Westhofen T, Buchner A, Schlenker B, Becker A, Stief C, Kretschmer A. Preoperative health-related quality of life accurately predicts metastasis-free survival for high-risk prostate cancer patients following radical prostatectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00895-8] [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: 11/28/2022]
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26
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Hoeh B, Wenzel M, Humke C, Wittler C, Hohenhorst J, Volckmann-Wilde M, Köllermann J, Steuber T, Graefen M, Derya T, Karakiewicz P, Becker A, Kluth L, Chun F, Mandel P. Correlation of urine loss after catheter removal and early continence in men undergoing radical prostatectomy. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01215-5] [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: 11/04/2022]
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Zeyen T, Potthoff AL, Nemeth R, Heiland DH, Burger MC, Steinbach JP, Hau P, Tabatabai G, Glas M, Schlegel U, Grauer O, Krex D, Schnell O, Goldbrunner R, Sabel M, Thon N, Delev D, Clusmann H, Seidel C, Güresir E, Schmid M, Schuss P, Giordano FA, Radbruch A, Becker A, Weller J, Schaub C, Vatter H, Schilling J, Winkler F, Herrlinger U, Schneider M. Phase I/II trial of meclofenamate in progressive MGMT-methylated glioblastoma under temozolomide second-line therapy-the MecMeth/NOA-24 trial. Trials 2022; 23:57. [PMID: 35045869 PMCID: PMC8767701 DOI: 10.1186/s13063-021-05977-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background Glioblastoma is the most frequent and malignant primary brain tumor. Even in the subgroup with O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation and favorable response to first-line therapy, survival after relapse is short (12 months). Standard therapy for recurrent MGMT-methylated glioblastoma is not standardized and may consist of re-resection, re-irradiation, and chemotherapy with temozolomide (TMZ), lomustine (CCNU), or a combination thereof. Preclinical results show that meclofenamate (MFA), originally developed as a nonsteroidal anti-inflammatory drug (NSAID) and registered in the USA, sensitizes glioblastoma cells to temozolomide-induced toxicity via inhibition of gap junction-mediated intercellular cytosolic traffic and demolishment of tumor microtube (TM)-based network morphology. Methods In this study, combined MFA/TMZ therapy will be administered (orally) in patients with first relapse of MGMT-methylated glioblastoma. A phase I component (6–12 patients, 2 dose levels of MFA + standard dose TMZ) evaluates safety and feasibility and determines the dose for the randomized phase II component (2 × 30 patients) with progression-free survival as the primary endpoint. Discussion This study is set up to assess toxicity and first indications of efficacy of MFA repurposed in the setting of a very difficult-to-treat recurrent tumor. The trial is a logical next step after the identification of the role of resistance-providing TMs in glioblastoma, and results will be crucial for further trials targeting TMs. In case of favorable results, MFA may constitute the first clinically feasible TM-targeted drug and therefore might bridge the idea of a TM-targeted therapeutic approach from basic insights into clinical reality. Trial registration EudraCT 2021-000708-39. Registered on 08 February 2021
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Affiliation(s)
- Thomas Zeyen
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Anna-Laura Potthoff
- Department of Neurosurgery and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Robert Nemeth
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Dieter H Heiland
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael C Burger
- Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital, Frankfurt am Main, Germany
| | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology, Goethe-University Hospital, Frankfurt am Main, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neurooncology, University of Tübingen, Tübingen, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | - Dietmar Krex
- Department of Neurosurgery, University of Dresden, Dresden, Germany
| | - Oliver Schnell
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Michael Sabel
- Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig Maximillian University of Munich and German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Daniel Delev
- Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Clemens Seidel
- Department of Radiotherapy and Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Erdem Güresir
- Department of Neurosurgery and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Judith Schilling
- Clinical Study Core Unit Bonn, Institute of Clinical Chemistry and Clinical Pharmacology, University Bonn, Bonn, Germany
| | - Frank Winkler
- Department of Neurology, University Hospital Heidelberg, Neurooncology Program at the National Center for Tumor Disease, German Cancer Consortium (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schneider
- Department of Neurosurgery and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany.
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Kosiba M, Hoeh B, Welte MN, Krimphove MJ, Vitucci K, Lindemann N, Schröder J, Jost L, Schmidt FE, von Hollen A, Kluth LA, Mandel P, Roos FC, Chun FKH, Becker A. Learning curve and functional outcomes after laser enucleation of the prostate for benign prostate hyperplasia according to surgeon's caseload. World J Urol 2022; 40:3007-3013. [PMID: 36289106 PMCID: PMC9712403 DOI: 10.1007/s00345-022-04177-y] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the impact of surgical caseload on safety, efficacy, and functional outcomes of laser enucleation of the prostate (LEP) applying a structured mentoring program. METHODS Patient characteristics, perioperative data, and functional outcomes were analyzed descriptively. Linear and logistic regression models analyzed the effect of caseload on complications, functional outcomes and operative speed. Within the structured mentoring program a senior surgeon was present for the first 24 procedures completely, for partial steps in procedures 25-49, and as needed thereafter. RESULTS A total of 677 patients from our prospective institutional database (2017-2022) were included for analysis. Of these, 84 (12%), 75 (11%), 82 (12%), 106 (16%), and 330 patients (49%) were operated by surgeons at (A) < 25, (B) 25-49, (C) 50-99, (D) 100-199, and (E) ≥ 200 procedures. Preoperative characteristics were balanced (all p > 0.05) except for prostate volume, which increased with caseload. There was no significant difference in change of IPSS, Quality of life, ICIQ, pad usage, peak urine flow, residual urine, and major complications (Group A: 8.3 to E: 7.6%, p = 0.2) depending on the caseload. Caseload was not associated (Odds ratio: 0.7-1.4, p > 0.2) with major complications in the multivariable logistic regression model. Only operating time was significantly shorter with increasing caseload in the multivariable analysis (111-55 min, beta 23.9-62.9, p < 0.001). CONCLUSION With a structured mentoring program, the safety and efficacy of LEP can be ensured even during the learning curve with very good outcome quality. Only the operating time decreases significantly with increasing experience of the surgeon.
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Affiliation(s)
- M. Kosiba
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - B. Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany ,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC Canada
| | - M. N. Welte
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - M. J. Krimphove
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - K. Vitucci
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - N. Lindemann
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - J. Schröder
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - L. Jost
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - F. E. Schmidt
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - A. von Hollen
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - L. A. Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - P. Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - F. C. Roos
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - F. K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - A. Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Wach J, Güresir Á, Borger V, Schuss P, Becker A, Coch C, Schmitz MT, Hölzel M, Toma M, Herrlinger U, Vatter H, Güresir E. Elevated baseline C-reactive protein levels predict poor progression-free survival in sporadic vestibular schwannoma. J Neurooncol 2021; 156:365-375. [PMID: 34882287 PMCID: PMC8816751 DOI: 10.1007/s11060-021-03918-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 01/01/2023]
Abstract
Background Recent investigations showed emerging evidence of the role of inflammation in the growth of sporadic vestibular schwannoma (VS). The present retrospective study investigated the impact of systemic inflammation on tumor progression using serum C-reactive protein (CRP) levels in a series of 87 surgically treated sporadic VS patients. Methods The optimal cut-off value for CRP was defined as 3.14 mg/dl according to the receiver operating characteristic curve (AUC: 0.70, 95% CI 0.47–0.92). Patient cohort was dichotomized into normal (n = 66; < 3.14 mg/dl) and high baseline (n = 21; ≥ 3.14 mg/dl) CRP groups. Results No significant differences in age, sex, comorbidities influencing the systemic inflammatory state, Karnofsky performance status (KPS), tumor size, extent of resection, or MIB-1 index were identified between the two groups defined by the baseline CRP levels. Univariable analysis demonstrated that a high CRP level (≥ 3.14 mg/dl) is significantly associated with a shortened progression-free survival (PFS) (hazard ratio (HR): 6.05, 95% CI 1.15–31.95, p = 0.03). Multivariable Cox regression analysis considering age, extent of resection, KPS, tumor size, and baseline CRP confirmed that an elevated CRP level (≥ 3.14 mg/dl) is an independent predictor of shortened PFS (HR: 7.20, 95% CI 1.08–48.14, p = 0.04). Conclusions The baseline CRP level thus serves as an independent predictor of PFS. Further investigations of the role of inflammation and tumor inflammatory microenvironment in the prediction of prognosis in sporadic VS are needed. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03918-0.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany.
| | - Ági Güresir
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Marieta Toma
- Institute of Pathology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Venusberg-Campus 1, Bonn, Germany
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30
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Ghomashi B, Reiff R, Becker A. Coherence in macroscopic high harmonic generation for spatial focal phase distributions of monochromatic and broadband Gaussian laser pulses. Opt Express 2021; 29:40146-40160. [PMID: 34809362 DOI: 10.1364/oe.444317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
Efficient application of ultrafast laser sources from high harmonic generation requires an understanding of how the spectrum can be controlled - the extent of the highest harmonics and the strength and cleanness of the harmonic lines. We study one important aspect in the coherent build-up of macroscopic high-order harmonic generation, namely the impact of different phase distributions in the focal area on the features of the generated radiation. Specifically, we compare the high harmonic signals for the commonly-used Gouy distribution of a monochromatic beam with those for the phase distribution of a short broadband Gaussian pulse. To this end, we apply a theoretical model in which the microscopic yields are obtained via interpolation of results of the time-dependent Schrödinger equation, which are then used in an individual-emitter approach to determine the macroscopic signals. Regions of poor and good coherent build-up as a function of the position of the gas jet are identified using measures for the strength of the harmonic lines and for the impact of off-harmonic radiation. While the largest extent of the spectra as well as the strongest contribution of off-harmonic radiation is found for positioning the gas jet after the focus for both distributions, the relative strength of the harmonics is overall weaker for the short Gaussian pulse distribution and the spectra differ for a gas jet positioned at the focus. These differences are mainly caused by the additional dependence of the focal phase in the transverse direction for the short Gaussian pulse distribution.
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31
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Kumar A, Rajasekera P, Biehn S, Beyer S, McElroy J, Becker A, Johnson B, Cui T, Sebastian E, Grosu A, Lindert S, Bell E, Haque S, Chakravarti A. In-Silico Discovery of Novel Small-Molecule Inhibitors Targeting Transgelin-2-Actin Interaction Inhibits Proliferation, Invasion and Improves Chemo-Radiation Response in Human Glioblastoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1587] [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: 10/20/2022]
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32
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Olaciregui Dague K, Pukropski J, Hummel C, Becker A, Surges R, Baumgartner T. [Dysphasic seizures due to chronic leptomeningitis : A challenge in differential diagnosis]. Nervenarzt 2021; 93:405-409. [PMID: 34586432 PMCID: PMC9010335 DOI: 10.1007/s00115-021-01190-1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/01/2022]
Affiliation(s)
- K Olaciregui Dague
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - J Pukropski
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - C Hummel
- Institut für Neuropathologie, Sektion für Translationale Epilepsieforschung, Universitätsklinikum Bonn, Bonn, Deutschland
| | - A Becker
- Institut für Neuropathologie, Sektion für Translationale Epilepsieforschung, Universitätsklinikum Bonn, Bonn, Deutschland
| | - R Surges
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - T Baumgartner
- Klinik und Poliklinik für Epileptologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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33
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Peters S, Pujol JL, Dafni U, Dómine M, Popat S, Reck M, Andrade J, Becker A, Moro-Sibilot D, Curioni-Fontecedro A, Molinier O, Nackaerts K, Insa Mollá A, Gervais R, López Vivanco G, Madelaine J, Mazieres J, Faehling M, Griesinger F, Majem M, González Larriba JL, Provencio Pulla M, Vervita K, Roschitzki-Voser H, Ruepp B, Mitchell P, Stahel RA, Le Pechoux C, De Ruysscher D. Consolidation nivolumab and ipilimumab versus observation in limited-disease small-cell lung cancer after chemo-radiotherapy - results from the randomised phase II ETOP/IFCT 4-12 STIMULI trial. Ann Oncol 2021; 33:67-79. [PMID: 34562610 DOI: 10.1016/j.annonc.2021.09.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/13/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Concurrent chemotherapy and thoracic radiotherapy followed by prophylactic cranial irradiation (PCI) is the standard treatment in limited-disease small-cell lung cancer (LD-SCLC), with 5-year overall survival (OS) of only 25% to 33%. PATIENTS AND METHODS STIMULI is a 1:1 randomised phase II trial aiming to demonstrate superiority of consolidation combination immunotherapy versus observation after chemo-radiotherapy plus PCI (protocol amendment-1). Consolidation immunotherapy consisted of four cycles of nivolumab [1 mg/kg, every three weeks (Q3W)] plus ipilimumab (3 mg/kg, Q3W), followed by nivolumab monotherapy (240 mg, Q2W) for up to 12 months. Patient recruitment closed prematurely due to slow accrual and the statistical analyses plan was updated to address progression-free survival (PFS) as the only primary endpoint. RESULTS Of the 222 patients enrolled, 153 were randomised (78: experimental; 75: observation). Among the randomised patients, median age was 62 years, 60% males, 34%/65% current/former smokers, 31%/66% performance status (PS) 0/1. Up to 25 May 2020 (median follow-up 22.4 months), 40 PFS events were observed in the experimental arm, with median PFS 10.7 months [95% confidence interval (CI) 7.0-not estimable (NE)] versus 42 events and median 14.5 months (8.2-NE) in the observation, hazard ratio (HR) = 1.02 (0.66-1.58), two-sided P = 0.93. With updated follow-up (03 June 2021; median: 35 months), median OS was not reached in the experimental arm, while it was 32.1 months (26.1-NE) in observation, with HR = 0.95 (0.59-1.52), P = 0.82. In the experimental arm, median time-to-treatment-discontinuation was only 1.7 months. CTCAE v4 grade ≥3 adverse events were experienced by 62% of patients in the experimental and 25% in the observation arm, with 4 and 1 fatal, respectively. CONCLUSIONS The STIMULI trial did not meet its primary endpoint of improving PFS with nivolumab-ipilimumab consolidation after chemo-radiotherapy in LD-SCLC. A short period on active treatment related to toxicity and treatment discontinuation likely affected the efficacy results.
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Affiliation(s)
- S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Lausanne University, Lausanne, Switzerland
| | - J-L Pujol
- Thoracic Oncology Unit, Hopital Arnaud de Villeneuve, Montpellier, France
| | - U Dafni
- National and Kapodistrian University of Athens, Athens, Greece; Frontier Science Foundation-Hellas, Athens, Greece
| | - M Dómine
- Hospital Universitario Fundacion Jimenez Díaz (IIS-FJD), Madrid, Spain
| | - S Popat
- Medicine, Royal Marsden Hospital, London, UK
| | - M Reck
- Thoracic Oncology, Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - J Andrade
- Medical Oncology, Hospital Virgen De La Salud, Toledo, Spain
| | - A Becker
- Department of Pulmonology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - D Moro-Sibilot
- Thoracic Oncology Unit, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - A Curioni-Fontecedro
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - O Molinier
- Department of Respiratory Disease, Centre Hospitalier - Le Mans, Le Mans, France
| | - K Nackaerts
- Department of Pulmonology, Respiratory Oncology Unit, KU Leuven, Leuven, Belgium
| | - A Insa Mollá
- Medical Oncology, Hospital Clínico Universitario De Valencia, Valencia, Spain
| | - R Gervais
- Medical Oncology, Centre François Baclesse, Caen, France
| | - G López Vivanco
- Medical Oncology, Hospital Universitario Cruces, Barakaldo, Spain
| | - J Madelaine
- Thoracic Oncology Unit, Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - J Mazieres
- Thoracic Oncology, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | | | | | - M Majem
- Hospital De La Santa Creu I Sant Pau, Barcelona, Spain
| | | | | | - K Vervita
- Frontier Science Foundation-Hellas, Athens, Greece
| | - H Roschitzki-Voser
- Coordinating Office, European Thoracic Oncology Platform, Bern, Switzerland
| | - B Ruepp
- Coordinating Office, European Thoracic Oncology Platform, Bern, Switzerland
| | - P Mitchell
- Olivia Newton-John Cancer Centre, Austin Hospital (VIC), Melbourne, Australia
| | - R A Stahel
- Coordinating Office, European Thoracic Oncology Platform, Bern, Switzerland.
| | - C Le Pechoux
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - D De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht, Netherlands
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Marbury T, Yalkinoglu Ö, Becker A, Krebs-Brown A, Bytyqi A, Port A, Strotmann R. 1257P Effect of hepatic impairment on tepotinib pharmacokinetics. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1860] [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: 11/25/2022] Open
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35
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Borger V, Hamed M, Taube J, Aydin G, Ilic I, Schneider M, Schuss P, Güresir E, Becker A, Helmstaedter C, Elger CE, Vatter H. Resective temporal lobe surgery in refractory temporal lobe epilepsy: prognostic factors of postoperative seizure outcome. J Neurosurg 2021. [DOI: 10.3171/2020.7.jns20284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Temporal lobe epilepsy (TLE) is one of the most common forms of epilepsy. In approximately 30% of patients, seizures are refractory to drug treatment. Despite the achievements of modern presurgical evaluation in recent years, the presurgical prediction of seizure outcome remains difficult. The aim of this study was to evaluate the seizure outcome in patients with drug-refractory TLE who underwent resective temporal lobe surgery (rTLS) and to determine features associated with unfavorable postsurgical seizure outcome.
METHODS
Patients with medically refractory TLE who underwent rTLS between 2012 and 2017 were reviewed from the prospectively collected epilepsy surgery database. A retrospective analysis of clinical, radiological, neuropsychological, histopathological, and perioperative findings of 161 patients was performed. The patients were divided into two groups according to seizure outcome (group I, International League Against Epilepsy [ILAE] class 1; group II, ILAE class ≥ 2). For identification of independent risk factors for unfavorable postoperative seizure outcome (ILAE class ≥ 2), a multivariate logistic regression analysis was performed.
RESULTS
Seizure freedom (ILAE class 1) was achieved in 121 patients (75.2%). The neuropsychological evaluation demonstrated that losses in cognitive performance were more pronounced in verbal memory after resections in the left temporal lobe and in nonverbal memory after right-sided resections, whereas attention improved after surgery. Overall, postoperative visual field deficits (VFDs) were common and occurred in 51% of patients. There was no statistically significant difference in the incidence of VFD in patients with selective surgical procedures compared to the patients with nonselective procedures. The lack of MRI lesions and placement of depth electrodes were preoperatively identified as predictors for unfavorable seizure outcome.
CONCLUSIONS
rTLS is an effective treatment method in patients with refractory TLE. However, patients with a lack of MRI lesions and placement of depth electrodes prior to rTLS are at higher risk for an unfavorable postsurgical seizure outcome.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Albert Becker
- Institute of Neuropathology, University Hospital Bonn, Germany
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36
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Walker S, Reiff R, Jaron-Becker A, Becker A. Characterization of vacuum and deep ultraviolet pulses via two-photon autocorrelation signals. Opt Lett 2021; 46:3083-3086. [PMID: 34197386 DOI: 10.1364/ol.427200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
Characterization of ultrashort vacuum and deep ultraviolet pulses is important in view of applications of those pulses for spectroscopic and dynamical imaging of atoms, molecules, and materials. We present an extension of the autocorrelation technique, applied for measurement of the pulse duration via a single Gaussian function. Analytic solutions for two-photon ionization of atoms by Gaussian pulses are used along with an expansion of the pulse to be characterized using multiple Gaussians at multi-color central frequencies. This approach allows one to use two-photon autocorrelation signals to characterize isolated ultrashort pulses and pulse trains, i.e., the time-dependent amplitude and phase variation of the electric field. The potential of the method is demonstrated using vacuum and deep ultraviolet pulses and pulse trains obtained from numerical simulations of macroscopic high harmonic spectra.
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Triffault-Fillit C, Mabrut E, Corbin K, Braun E, Becker A, Goutelle S, Chaudier P, Fessy MH, Dupieux C, Laurent F, Gunst S, Lustig S, Chidiac C, Ferry T, Valour F. Tolerance and microbiological efficacy of cefepime or piperacillin/tazobactam in combination with vancomycin as empirical antimicrobial therapy of prosthetic joint infection: a propensity-matched cohort study. J Antimicrob Chemother 2021; 75:2299-2306. [PMID: 32407512 DOI: 10.1093/jac/dkaa166] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The use of piperacillin/tazobactam with vancomycin as empirical antimicrobial therapy (EAT) for prosthetic joint infection (PJI) has been associated with an increased risk of acute kidney injury (AKI), leading us to propose cefepime as an alternative since 2017 in our reference centre. OBJECTIVES To compare microbiological efficacy and tolerance of these two EAT strategies. METHODS All adult patients with PJI empirically treated with vancomycin+cefepime (n = 89) were enrolled in a prospective observational study and matched with vancomycin+piperacillin/tazobactam-treated historical controls (n = 89) according to a propensity score including age, baseline renal function and concomitant use of other nephrotoxic agents. The two groups were compared using Kaplan-Meier curve analysis, and non-parametric tests regarding the proportion of efficacious empirical regimen and the incidence of empirical therapy-related adverse events (AE). RESULTS Among 146 (82.0%) documented infections, the EAT was considered efficacious in 77 (98.7%) and 65 (98.5%) of the piperacillin/tazobactam- and cefepime-treated patients, respectively (P = 1.000). The rate of AE, particularly AKI, was significantly higher in the vancomycin+piperacillin/tazobactam group [n = 27 (30.3%) for all AE and 23 (25.8%) for AKI] compared with the vancomycin+cefepime [n = 13 (14.6%) and 6 (6.7%)] group (P = 0.019 and <0.001, respectively), leading to premature EAT discontinuation in 20 (22.5%) and 5 (5.6%) patients (P = 0.002). The two groups were not significantly different regarding their comorbidities, and AKI incidence was not related to vancomycin plasma overexposure. CONCLUSIONS Based on the susceptibility profile of bacterial isolates from included patients, microbiological efficacy of both strategies was expected to be similar, but vancomycin + cefepime was associated with a significantly lower incidence of AKI.
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Affiliation(s)
- C Triffault-Fillit
- Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - E Mabrut
- Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - K Corbin
- Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - E Braun
- Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - A Becker
- Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - S Goutelle
- Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service pharmaceutique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, ISPB Faculté de Pharmacie de Lyon, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Lyon, France
| | - P Chaudier
- Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de chirurgie orthopédique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - M H Fessy
- Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de chirurgie orthopédique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - C Dupieux
- Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France.,Institut des agents infectieux, Laboratoire de bactériologie, Centre National de référence des staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - F Laurent
- Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France.,Institut des agents infectieux, Laboratoire de bactériologie, Centre National de référence des staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - S Gunst
- Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de chirurgie orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - S Lustig
- Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Service de chirurgie orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - C Chidiac
- Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - T Ferry
- Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France
| | - F Valour
- Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Centre interrégional de référence pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France
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Demmer I, Selgert L, Altiner A, Baum E, Becker A, Schmittdiel L, Streitlein-Böhme I, Michiels-Corsten M, Zutz S, Hummers E, Jünger J. Implementation of a uniform nationwide medical licensing examination in general practice. A feasibility study. GMS J Med Educ 2021; 38:Doc96. [PMID: 34286076 PMCID: PMC8256129 DOI: 10.3205/zma001492] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/09/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
Objective: A competency-based training of medical students that is adapted to the realities of care is required internationally and is being intended in Germany with the Master Plan for Medical Studies 2020. In order to test these competencies, the German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP) has developed a concept for the redesign of the final part of the medical licensing examination in Germany. It focuses on general and interprofessional healthcare in the examination with outpatients. The aim of this work is to assess the feasibility of the new final examination on the basis of pilot examinations in family practices and to derive further steps for the national implementation. Methods: Fourteen medical students in their internship year completed a full examination with patients aged 42 to 84 years. Examiners evaluated the examination performance using standardised evaluation forms. Feasibility was qualitatively assessed in terms of compliance with content and time limits, examination results, patient reflections, and implementation in the practice. Results: Students were able to complete all tasks within the given time frame. Based on the evaluation forms, the examiners assessed the performance of the students. Patients appreciated the structured course of the examination in the familiar location of their family practice. For the nationwide implementation of the examination, 2,500 examination practices are required for about 10,000 examinees per year. Four students can then be examined on two days per year in each practice. Conclusions: Oral-practical examinations with outpatients in general medical practices can be carried out successfully throughout the nation. An implementation of the examinations throughout Germany requires that medical studies are restructured and that this new curriculum is implemented as intended by the Master Plan for Medical Studies 2020. Furthermore, training and remuneration of examiners together with a legal framework for the new examination must be established.
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Affiliation(s)
- Iris Demmer
- University Medical Center Göttingen, Department of General Practice, Göttingen, Germany
| | - L. Selgert
- German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP), Mainz, Germany
| | - A. Altiner
- University Medical Center Rostock, Department of General Practice, Rostock, Germany
| | - E. Baum
- University of Marburg, Department of General Practice/Family Medicine, Marburg, Germany
| | - A. Becker
- University of Marburg, Department of General Practice/Family Medicine, Marburg, Germany
| | | | - I. Streitlein-Böhme
- Ruhr-University Bochum, Department of General Practice/Family Medicine, Bochum, Germany
| | - M. Michiels-Corsten
- University of Marburg, Department of General Practice/Family Medicine, Marburg, Germany
| | - S. Zutz
- Practice for general and family medicine, Neubukow, Germany
| | - E. Hummers
- University Medical Center Göttingen, Department of General Practice, Göttingen, Germany
| | - J. Jünger
- German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy (IMPP), Mainz, Germany
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Westhofen T, Buchner A, Schlenker B, Becker A, Stief C, Kretschmer A. Finding ideal timing of radiotherapy after radical prostatectomy – the impact on health-related quality of life. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01551-7] [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: 10/20/2022]
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40
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Welte MN, Deuker M, Banek S, Kluth L, Roos F, Mandel P, Wenzel M, Chun F, Becker A. Evaluation of Retrograde Ejaculation (RE) and overall satisfaction with sexual function before and after Holmium Laser Enucleation of the Prostate (HoLEP). Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00467-x] [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: 11/24/2022]
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41
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Deuker M, Welte M, Kluth L, Mandel P, Roos F, Chun F, Becker A. Impact of early release of apical adenoma during Holmium Laser Enucleation of the Prostate (HoLEP) on early postoperative functional outcome. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00465-6] [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: 11/26/2022]
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42
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Gild P, Vetterlein M, Ludwig T, Marks P, Soave A, Dahlem R, Fisch M, Rink M, Meyer C, Becker A. Preoperative drivers of persistent/recurring Lower Urinary Tract Syndroms (LUTS) after Holmium Laser Enucleation of the Prostate (HoLEP) - report from a single center cohort of 902 patients with long-term follow-up. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00464-4] [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: 10/20/2022]
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Blümcke I, Coras R, Busch RM, Morita-Sherman M, Lal D, Prayson R, Cendes F, Lopes-Cendes I, Rogerio F, Almeida VS, Rocha CS, Sim NS, Lee JH, Kim SH, Baulac S, Baldassari S, Adle-Biassette H, Walsh CA, Bizzotto S, Doan RN, Morillo KS, Aronica E, Mühlebner A, Becker A, Cienfuegos J, Garbelli R, Giannini C, Honavar M, Jacques TS, Thom M, Mahadevan A, Miyata H, Niehusmann P, Sarnat HB, Söylemezoglu F, Najm I. Toward a better definition of focal cortical dysplasia: An iterative histopathological and genetic agreement trial. Epilepsia 2021; 62:1416-1428. [PMID: 33949696 DOI: 10.1111/epi.16899] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is a major cause of difficult-to-treat epilepsy in children and young adults, and the diagnosis is currently based on microscopic review of surgical brain tissue using the International League Against Epilepsy classification scheme of 2011. We developed an iterative histopathological agreement trial with genetic testing to identify areas of diagnostic challenges in this widely used classification scheme. METHODS Four web-based digital pathology trials were completed by 20 neuropathologists from 15 countries using a consecutive series of 196 surgical tissue blocks obtained from 22 epilepsy patients at a single center. Five independent genetic laboratories performed screening or validation sequencing of FCD-relevant genes in paired brain and blood samples from the same 22 epilepsy patients. RESULTS Histopathology agreement based solely on hematoxylin and eosin stainings was low in Round 1, and gradually increased by adding a panel of immunostainings in Round 2 and the Delphi consensus method in Round 3. Interobserver agreement was good in Round 4 (kappa = .65), when the results of genetic tests were disclosed, namely, MTOR, AKT3, and SLC35A2 brain somatic mutations in five cases and germline mutations in DEPDC5 and NPRL3 in two cases. SIGNIFICANCE The diagnoses of FCD 1 and 3 subtypes remained most challenging and were often difficult to differentiate from a normal homotypic or heterotypic cortical architecture. Immunohistochemistry was helpful, however, to confirm the diagnosis of FCD or no lesion. We observed a genotype-phenotype association for brain somatic mutations in SLC35A2 in two cases with mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy. Our results suggest that the current FCD classification should recognize a panel of immunohistochemical stainings for a better histopathological workup and definition of FCD subtypes. We also propose adding the level of genetic findings to obtain a comprehensive, reliable, and integrative genotype-phenotype diagnosis in the near future.
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Affiliation(s)
- Ingmar Blümcke
- Department of Neuropathology, University Hospital, Erlangen, Germany.,Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Roland Coras
- Department of Neuropathology, University Hospital, Erlangen, Germany
| | - Robyn M Busch
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Dennis Lal
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Prayson
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Sao Paulo, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, Sao Paulo, Brazil
| | - Iscia Lopes-Cendes
- Brazilian Institute of Neuroscience and Neurotechnology, Sao Paulo, Brazil.,Department of Medical Genetics and Genomic Medicine, University of Campinas, Sao Paulo, Brazil
| | - Fabio Rogerio
- Brazilian Institute of Neuroscience and Neurotechnology, Sao Paulo, Brazil.,Department of Pathology, University of Campinas, Sao Paulo, Brazil
| | - Vanessa S Almeida
- Brazilian Institute of Neuroscience and Neurotechnology, Sao Paulo, Brazil.,Department of Medical Genetics and Genomic Medicine, University of Campinas, Sao Paulo, Brazil
| | - Cristiane S Rocha
- Brazilian Institute of Neuroscience and Neurotechnology, Sao Paulo, Brazil.,Department of Medical Genetics and Genomic Medicine, University of Campinas, Sao Paulo, Brazil
| | - Nam Suk Sim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jeong Ho Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.,SoVarGen, Inc., Daejeon, Korea
| | - Se Hoon Kim
- Department of Pathology, College of Medicine, Yonsei University, Seoul, South Korea
| | - Stephanie Baulac
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Sara Baldassari
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Homa Adle-Biassette
- Pathological Anatomy Service, Public Hospital Network of Paris, Paris, France.,NeuroDiderot, Inserm U1141, University of Paris, Paris, France
| | - Christopher A Walsh
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Department of Pediatrics, and Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | - Sara Bizzotto
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Department of Pediatrics, and Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | - Ryan N Doan
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Department of Pediatrics, and Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | - Katherine S Morillo
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Department of Pediatrics, and Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands.,Epilepsy Institutes of the Netherlands Foundation, Heemstede, the Netherlands
| | - Angelika Mühlebner
- Department of (Neuro)Pathology, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands.,Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Albert Becker
- Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Jesus Cienfuegos
- Department of Anatomic Pathology, International Center for Epilepsy Surgery, Humanitas Medical Group Hospital, Mexico City, Mexico.,Department of Anatomic Pathology, Angels Mexico Hospital, Mexico City, Mexico
| | - Rita Garbelli
- Epilepsy Unit, Carlo Besta Neurological Institute, Scientific Institute for Research and Health Care Foundation, Milan, Italy
| | - Caterina Giannini
- Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical and Neuromotor Science,, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mrinalini Honavar
- Department of Anatomic Pathology, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Thomas S Jacques
- Developmental Biology and Cancer Research and Teaching Programme, University College London Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, UK
| | - Maria Thom
- Department of Neuropathology, Institute of Neurology, University College London, London, UK
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Hajime Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Pitt Niehusmann
- Department of Neuro-/Pathology, Translational Neurodegeneration Research and Neuropathology Lab, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Harvey B Sarnat
- Department of Paediatrics, University of Calgary Faculty of Medicine, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Pathology (Neuropathology),, University of Calgary Faculty of Medicine, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary Faculty of Medicine, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Figen Söylemezoglu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
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Nitsch L, Petzinna S, Zimmermann J, Schneider L, Krauthausen M, Heneka MT, Getts DR, Becker A, Müller M. Astrocyte-specific expression of interleukin 23 leads to an aggravated phenotype and enhanced inflammatory response with B cell accumulation in the EAE model. J Neuroinflammation 2021; 18:101. [PMID: 33906683 PMCID: PMC8080359 DOI: 10.1186/s12974-021-02140-z] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Interleukin 23 is a critical cytokine in the pathogenesis of multiple sclerosis. But the local impact of interleukin 23 on the course of neuroinflammation is still not well defined. To further characterize the effect of interleukin 23 on CNS inflammation, we recently described a transgenic mouse model with astrocyte-specific expression of interleukin 23 (GF-IL23 mice). The GF-IL23 mice spontaneously develop a progressive ataxic phenotype with cerebellar tissue destruction and inflammatory infiltrates with high amounts of B cells most prominent in the subarachnoid and perivascular space. METHODS To further elucidate the local impact of the CNS-specific interleukin 23 synthesis in autoimmune neuroinflammation, we induced a MOG35-55 experimental autoimmune encephalomyelitis (EAE) in GF-IL23 mice and WT mice and analyzed the mice by histology, flow cytometry, and transcriptome analysis. RESULTS We were able to demonstrate that local interleukin 23 production in the CNS leads to aggravation and chronification of the EAE course with a severe paraparesis and an ataxic phenotype. Moreover, enhanced multilocular neuroinflammation was present not only in the spinal cord, but also in the forebrain, brainstem, and predominantly in the cerebellum accompanied by persisting demyelination. Thereby, interleukin 23 creates a pronounced proinflammatory response with accumulation of leukocytes, in particular B cells, CD4+ cells, but also γδ T cells and activated microglia/macrophages. Furthermore, transcriptome analysis revealed an enhanced proinflammatory cytokine milieu with upregulation of lymphocyte activation markers, co-stimulatory markers, chemokines, and components of the complement system. CONCLUSION Taken together, the GF-IL23 model allowed a further breakdown of the different mechanisms how IL-23 drives neuroinflammation in the EAE model and proved to be a useful tool to further dissect the impact of interleukin 23 on neuroinflammatory models.
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Affiliation(s)
- Louisa Nitsch
- Department of Neurology, University Clinic Bonn, Campus Venusberg 1, D-53127, Bonn, Germany.
| | - Simon Petzinna
- Department of Neurology, University Clinic Bonn, Campus Venusberg 1, D-53127, Bonn, Germany
| | - Julian Zimmermann
- Department of Neurology, University Clinic Bonn, Campus Venusberg 1, D-53127, Bonn, Germany
| | - Linda Schneider
- Department of Neurology, University Clinic Bonn, Campus Venusberg 1, D-53127, Bonn, Germany.,Department of Surgery, University Clinic Bonn, Campus Venusberg 1, D-53127, Bonn, Germany
| | - Marius Krauthausen
- Department of Neurology, University Clinic Bonn, Campus Venusberg 1, D-53127, Bonn, Germany
| | - Michael T Heneka
- Department of Neurodegenerative Disease and Geriatric Psychiatry, University Clinic Bonn, Campus Venusberg 1, D-53127, Bonn, Germany
| | - Daniel R Getts
- Department of Microbiology-Immunology and Interdepartmental Immunobiology Center, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Albert Becker
- Department of Neuropathology, University Clinic Bonn, Campus Venusberg 1, D-53127, Bonn, Germany
| | - Marcus Müller
- Department of Neurology, University Clinic Bonn, Campus Venusberg 1, D-53127, Bonn, Germany.,School of Molecular Bioscience, University of Sydney, Sydney, Australia
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Ronden M, Bahce I, Hashemi S, Paul M, De Haan P, Becker A, Spoelstra F, Dahele M, Dickhoff C, Tiemessen M, Van Diepen D, Tarasevych S, Looysen E, Van Den Brink KM, Haasbeek N, Daniels J, Van Laren M, Roeleveld R, Alberts B, De Fraiture D, Veltman J, Verbakel W, Senan S. P18.02 Factors Influencing Multi-Disciplinary Tumor Board Recommendations in Stage III Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.558] [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: 10/21/2022]
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David B, Kröll-Seger J, Schuch F, Wagner J, Wellmer J, Woermann F, Oehl B, Van Paesschen W, Breyer T, Becker A, Vatter H, Hattingen E, Urbach H, Weber B, Surges R, Elger CE, Huppertz HJ, Rüber T. External validation of automated focal cortical dysplasia detection using morphometric analysis. Epilepsia 2021; 62:1005-1021. [PMID: 33638457 DOI: 10.1111/epi.16853] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Focal cortical dysplasias (FCDs) are a common cause of drug-resistant focal epilepsy but frequently remain undetected by conventional magnetic resonance imaging (MRI) assessment. The visual detection can be facilitated by morphometric analysis of T1-weighted images, for example, using the Morphometric Analysis Program (v2018; MAP18), which was introduced in 2005, independently validated for its clinical benefits, and successfully integrated in standard presurgical workflows of numerous epilepsy centers worldwide. Here we aimed to develop an artificial neural network (ANN) classifier for robust automated detection of FCDs based on these morphometric maps and probe its generalization performance in a large, independent data set. METHODS In this retrospective study, we created a feed-forward ANN for FCD detection based on the morphometric output maps of MAP18. The ANN was trained and cross-validated on 113 patients (62 female, mean age ± SD =29.5 ± 13.6 years) with manually segmented FCDs and 362 healthy controls (161 female, mean age ± SD =30.2 ± 9.6 years) acquired on 13 different scanners. In addition, we validated the performance of the trained ANN on an independent, unseen data set of 60 FCD patients (28 female, mean age ± SD =30 ± 15.26 years) and 70 healthy controls (42 females, mean age ± SD = 40.0 ± 12.54 years). RESULTS In the cross-validation, the ANN achieved a sensitivity of 87.4% at a specificity of 85.4% on the training data set. On the independent validation data set, our method still reached a sensitivity of 81.0% at a comparably high specificity of 84.3%. SIGNIFICANCE Our method shows a robust automated detection of FCDs and performance generalizability, largely independent of scanning site or MR-sequence parameters. Taken together with the minimal input requirements of a standard T1 image, our approach constitutes a clinically viable and useful tool in the presurgical diagnostic routine for drug-resistant focal epilepsy.
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Affiliation(s)
- Bastian David
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Fabiane Schuch
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.,Department of Neurology, St. Johannes Hospital Troisdorf, Germany
| | - Jan Wagner
- Department of Neurology, University Clinic Ulm, Ulm, Germany
| | - Jörg Wellmer
- Department of Neurology, Ruhr-Epileptology, University Hospital Knappschaftskrankenhaus, Ruhr-University, Bochum, Germany
| | - Friedrich Woermann
- Epilepsy Center Bethel, Mara Hospital & Society for Epilepsy Research, Bielefeld, Germany
| | | | - Wim Van Paesschen
- Laboratory for Epilepsy Research, Department of Neurology, University Hospitals and KU Leuven, Leuven, Belgium
| | - Tobias Breyer
- Department of Radiology and Neuroradiology, Klinikum Dortmund, Dortmund, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Horst Urbach
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | | | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.,Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Goethe-University Frankfurt, Frankfurt am Main, Germany.,Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
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Helmstaedter C, Hansen N, Leelaarporn P, Schwing K, Oender D, Widman G, Racz A, Surges R, Becker A, Witt JA. Specific B- and T-cell populations are associated with cognition in patients with epilepsy and antibody positive and negative suspected limbic encephalitis. J Neurol 2021; 268:455-466. [PMID: 32816110 PMCID: PMC7880943 DOI: 10.1007/s00415-020-10158-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/30/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Neuropsychological impairments are major symptoms of autoimmune limbic encephalitis (LE) epilepsy patients. In LE epilepsy patients with an autoimmune response against intracellular antigens as well as in antibody-negative patients, the antibody findings and magnetic resonance imaging pathology correspond poorly to the clinical features. Here, we evaluated whether T- and B-cells are linked to cognitive impairment in these groups. METHODS In this cross-sectional, observational, case-controlled study, we evaluated 106 patients with adult-onset epilepsies with a suspected autoimmune etiology. We assessed verbal and visual memory, executive function, and mood in relation to the presence or absence of known auto-antibodies, and regarding T- and B-cell activity as indicated by flow cytometry (fluorescence-activated cell sorting = FACS, peripheral blood = PB and cerebrospinal fluid = CSF). RESULTS 56% of the patients were antibody-negative. In the other patients, auto-antibodies were directed against intracellular antigens (GAD65, paraneoplastic: 38%), or cellular surface antigens (LGI1/CASPR2/NMDA-R: 6%). Excluding LGI1/CASPR2/NMDA-R, the groups with and without antibodies did not differ in disease features, cognition, or mood. CD4+ T-cells and CD8+ T-cells in blood and CD4+ T-cells in CSF were prominent in the auto-antibody positive group. Regression analyses indicated the role education, drug load, amygdala and/or hippocampal pathology, and CD4+ T-cells play in verbal memory and executive function. Depressed mood revealed no relation to flow cytometry results. CONCLUSION Our results indicate a link between T- and B-cell activity and cognition in epilepsy patients with suspected limbic encephalitis, thus suggesting that flow cytometry results can provide an understanding of cognitive impairment in LE patients with autoantibodies against intracellular antigens.
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Affiliation(s)
- Christoph Helmstaedter
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Niels Hansen
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Pitshaporn Leelaarporn
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
| | - Kerstin Schwing
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
| | - Demet Oender
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
| | - Guido Widman
- SEIN Epilepsy Center, Hemsteede, The Netherlands
| | - Attila Racz
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
| | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital, Bonn, Germany
| | - Juri-Alexander Witt
- Department of Epileptology, University Hospital Bonn, Building 83 Venusberg-Campus 1, 53127, Bonn, Germany
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Cotte L, Hocqueloux L, Lefebvre M, Pradat P, Bani-Sadr F, Huleux T, Poizot-Martin I, Pugliese P, Rey D, Cabié A, Chirouze C, Drobacheff-Thiébaut C, Foltzer A, Bouiller K, Hustache-Mathieu L, Lepiller Q, Bozon F, Babre O, Brunel AS, Muret P, Chevalier E, Jacomet C, Laurichesse H, Lesens O, Vidal M, Mrozek N, Aumeran C, Baud O, Corbin V, Goncalvez E, Mirand A, brebion A, Henquell C, Lamaury I, Fabre I, Curlier E, Ouissa R, Herrmann-Storck C, Tressieres B, Receveur MC, Boulard F, Daniel C, Clavel C, Roger PM, Markowicz S, Chellum Rungen N, Merrien D, Perré P, Guimard T, Bollangier O, Leautez S, Morrier M, Laine L, Boucher D, Point P, Cotte L, Ader F, Becker A, Boibieux A, Brochier C, Brunel-Dalmas F, Cannesson O, Chiarello P, Chidiac C, Degroodt S, Ferry T, Godinot M, Livrozet JM, Makhloufi D, Miailhes P, Perpoint T, Perry M, Pouderoux C, Roux S, Triffault-Fillit C, Valour F, Charre C, Icard V, Tardy JC, Trabaud MA, Ravaux I, Ménard A, Belkhir AY, Colson P, Dhiver C, Madrid A, Martin-Degioanni M, Meddeb L, Mokhtari M, Motte A, Raoux A, Toméi C, Tissot-Dupont H, Poizot-Martin I, Brégigeon S, Zaegel-Faucher O, Obry-Roguet V, Laroche H, Orticoni M, Soavi MJ, Ressiot E, Ducassou MJ, Jaquet I, Galie S, Colson H, Ritleng AS, Ivanova A, Debreux C, Lions C, Rojas-Rojas T, Cabié A, Abel S, Bavay J, Bigeard B, Cabras O, Cuzin L, Dupin de Majoubert R, Fagour L, Guitteaud K, Marquise A, Najioullah F, Pierre-François S, Pasquier J, Richard P, Rome K, Turmel JM, Varache C, Atoui N, Bistoquet M, Delaporte E, Le Moing V, Makinson A, Meftah N, Merle de Boever C, Montes B, Montoya Ferrer A, Tuaillon E, Reynes J, Lefèvre B, Jeanmaire E, Hénard S, Frentiu E, Charmillon A, Legoff A, Tissot N, André M, Boyer L, Bouillon MP, Delestan M, Goehringer F, Bevilacqua S, Rabaud C, May T, Raffi F, Allavena C, Aubry O, Billaud E, Biron C, Bonnet B, Bouchez S, Boutoille D, Brunet-Cartier C, Deschanvres C, Gaborit BJ, Grégoire A, Grégoire M, Grossi O, Guéry R, Jovelin T, Lefebvre M, Le Turnier P, Lecomte R, Morineau P, Reliquet V, Sécher S, Cavellec M, Paredes E, Soria A, Ferré V, André-Garnier E, Rodallec A, Pugliese P, Breaud S, Ceppi C, Chirio D, Cua E, Dellamonica P, Demonchy E, De Monte A, Durant J, Etienne C, Ferrando S, Garraffo R, Michelangeli C, Mondain V, Naqvi A, Oran N, Perbost I, Carles M, Klotz C, Maka A, Pradier C, Prouvost-Keller B, Risso K, Rio V, Rosenthal E, Touitou I, Wehrlen-Pugliese S, Zouzou G, Hocqueloux L, Prazuck T, Gubavu C, Sève A, Giaché S, Rzepecki V, Colin M, Boulard C, Thomas G, Cheret A, Goujard C, Quertainmont Y, Teicher E, Lerolle N, Jaureguiberry S, Colarino R, Deradji O, Castro A, Barrail-Tran A, Yazdanpanah Y, Landman R, Joly V, Ghosn J, Rioux C, Lariven S, Gervais A, Lescure FX, Matheron S, Louni F, Julia Z, Le GAC S, Charpentier C, Descamps D, Peytavin G, Duvivier C, Aguilar C, Alby-Laurent F, Amazzough K, Benabdelmoumen G, Bossi P, Cessot G, Charlier C, Consigny PH, Jidar K, Lafont E, Lanternier F, Leporrier J, Lortholary O, Louisin C, Lourenco J, Parize P, Pilmis B, Rouzaud C, Touam F, Valantin MA, Tubiana R, Agher R, Seang S, Schneider L, PaLich R, Blanc C, Katlama C, Bani-Sadr F, Berger JL, N’Guyen Y, Lambert D, Kmiec I, Hentzien M, Brunet A, Romaru J, Marty H, Brodard V, Arvieux C, Tattevin P, Revest M, Souala F, Baldeyrou M, Patrat-Delon S, Chapplain JM, Benezit F, Dupont M, Poinot M, Maillard A, Pronier C, Lemaitre F, Morlat C, Poisson-Vannier M, Jovelin T, Sinteff JP, Gagneux-Brunon A, Botelho-Nevers E, Frésard A, Ronat V, Lucht F, Rey D, Fischer P, Partisani M, Cheneau C, Priester M, Mélounou C, Bernard-Henry C, de Mautort E, Fafi-Kremer S, Delobel P, Alvarez M, Biezunski N, Debard A, Delpierre C, Gaube G, Lansalot P, Lelièvre L, Marcel M, Martin-Blondel G, Piffaut M, Porte L, Saune K, Robineau O, Ajana F, Aïssi E, Alcaraz I, Alidjinou E, Baclet V, Bocket L, Boucher A, Digumber M, Huleux T, Lafon-Desmurs B, Meybeck A, Pradier M, Tetart M, Thill P, Viget N, Valette M. Microelimination or Not? The Changing Epidemiology of Human Immunodeficiency Virus-Hepatitis C Virus Coinfection in France 2012–2018. Clin Infect Dis 2021; 73:e3266-e3274. [DOI: 10.1093/cid/ciaa1940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/01/2021] [Indexed: 01/15/2023] Open
Abstract
Abstract
Background
The arrival of highly effective, well-tolerated, direct-acting antiviral agents (DAA) led to a dramatic decrease in hepatitis C virus (HCV) prevalence. Human immunodeficiency virus (HIV)-HCV–coinfected patients are deemed a priority population for HCV elimination, while a rise in recently acquired HCV infections in men who have sex with men (MSM) has been described. We describe the variations in HIV-HCV epidemiology in the French Dat’AIDS cohort.
Methods
This was a retrospective analysis of a prospective cohort of persons living with HIV (PLWH) from 2012 to 2018. We determined HCV prevalence, HCV incidence, proportion of viremic patients, treatment uptake, and mortality rate in the full cohort and by HIV risk factors.
Results
From 2012 to 2018, 50 861 PLWH with a known HCV status were followed up. During the period, HCV prevalence decreased from 15.4% to 13.5%. HCV prevalence among new HIV cases increased from 1.9% to 3.5% in MSM but remained stable in other groups. Recently acquired HCV incidence increased from 0.36/100 person-years to 1.25/100 person-years in MSM. The proportion of viremic patients decreased from 67.0% to 8.9%. MSM became the first group of viremic patients in 2018 (37.9%). Recently acquired hepatitis represented 59.2% of viremic MSM in 2018. DAA treatment uptake increased from 11.4% to 61.5%. More treatments were initiated in MSM in 2018 (41.2%) than in intravenous drug users (35.6%). In MSM, treatment at the acute phase represented 30.0% of treatments in 2018.
Conclusions
A major shift in HCV epidemiology was observed in PLWH in France from 2012 to 2018, leading to a unique situation in which the major group of HCV transmission in 2018 was MSM.
Clinical Trials Registration. NCT02898987.
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Affiliation(s)
- Laurent Cotte
- Department of Infectious Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM) U1052, Lyon, France
| | - Laurent Hocqueloux
- Department of Infectious Diseases, Centre Hospitalier Régional d’Orléans – La Source, Orléans, France
| | - Maeva Lefebvre
- Department of Infectious Diseases, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes; Centre d’Investigation Clinique (CIC) 1413, INSERM, Nantes, France
| | - Pierre Pradat
- Center for Clinical Research, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Firouze Bani-Sadr
- Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Robert Debré Hospital, University Hospital, Reims, France
| | - Thomas Huleux
- Department of Infectious Diseases and Travel Diseases, Centre Hospitalier Gustave-Dron, Tourcoing, France
| | - Isabelle Poizot-Martin
- Immuno-Hematology Clinic, Assistance Publique–Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Marseille, Aix-MarseilleUniversity–Inserm–Institut de Recherche pour le Développement (IRD), Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
| | - Pascal Pugliese
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, Hôpital l’Archet, Nice, France
| | - David Rey
- HIV Infection Care Centre, Hôpitaux Universitaires, Strasbourg
| | - André Cabié
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Martinique, Fort de France, Université des Antilles EA4537, Fort de France, INSERM CIC1424, Fort-de-France, France
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Schumacher A, Becker A. Teamführung – mit wenigen Bausteinen zu mehr Effizienz. Urologe A 2021; 60:102-103. [PMID: 33394053 DOI: 10.1007/s00120-020-01425-0] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Schumacher
- Dr. Schuhmacher Consulting & Training GmbH, Schützstr. 30, 50996, Köln, Deutschland.
| | - A Becker
- Frielingsdorf Consult GmbH, Köln, Deutschland
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50
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Kreitlow A, Becker A, Schotte U, Malorny B, Plötz M, Abdulmawjood A. Evaluation of different target genes for the detection of Salmonella sp. by loop-mediated isothermal amplification. Lett Appl Microbiol 2020; 72:420-426. [PMID: 33030743 DOI: 10.1111/lam.13409] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 12/14/2022]
Abstract
The loop-mediated isothermal amplification (LAMP) technique was used to investigate six salmonella-specific sequences for their suitability to serve as targets for the pathogen identification. Sequences selected for designing LAMP primers were genes invA, bcfD, phoP, siiA, gene62181533 and a region within the ttrRSBCA locus. Primers including single nucleotide polymorphisms were configured as degenerate primers. Specificity of the designed primer sets was determined by means of 46 salmonella and 32 other food- and waterborne bacterial reference species and strains. Primers targeting the ttrRSBCA locus showed 100 % inclusivity of target and exclusivity of other test species and strains. Other primer sets revealed deficiencies, especially regarding Salmonella enterica subsp. II-IV and Salmonella bongori. Additionally, primers targeting the siiA gene failed to detect S. enterica subsp. enterica serotypes Newport and Stanley, whereas bcfD primers did not amplify DNA of S. enterica subsp. enterica serotype Schleissheim. TtrRSBCA primers, providing short detection times and constant melting temperatures of amplification products, achieved best overall performance.
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Affiliation(s)
- A Kreitlow
- Institute for Food Quality and Food Safety, University of Veterinary Medicine Hannover, Hannover, Germany
| | - A Becker
- Institute for Food Quality and Food Safety, University of Veterinary Medicine Hannover, Hannover, Germany
| | - U Schotte
- Department A - Veterinary Medicine, Central Institute of the Bundeswehr Medical Service Kiel, Kronshagen, Germany
| | - B Malorny
- Department Biological Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - M Plötz
- Institute for Food Quality and Food Safety, University of Veterinary Medicine Hannover, Hannover, Germany
| | - A Abdulmawjood
- Institute for Food Quality and Food Safety, University of Veterinary Medicine Hannover, Hannover, Germany
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