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Altmann J, Kummer J, Herse F, Hellmeyer L, Schlembach D, Henrich W, Weichert A. Lifting the veil of secrecy: maternal and neonatal outcome of oocyte donation pregnancies in Germany. Arch Gynecol Obstet 2021; 306:59-69. [PMID: 34605992 PMCID: PMC9300520 DOI: 10.1007/s00404-021-06264-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/15/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND In Germany, performing fertility procedures involving oocyte donation is illegal, as stated by the Embryo Protection Law. Nonetheless, in our clinical routine we attend to a steadily rising number of pregnant women, who have sought oocyte donation abroad. Due to the legal circumstances many women opt to keep the origin of their pregnancy a secret. However, studies have shown, that oocyte donation is an independent risk factor for the development of pregnancy complications, such as preeclampsia. OBJECTIVE The aim of this study is to evaluate maternal and neonatal outcomes of oocyte donation pregnancies in three large obstetric care units in Berlin, Germany. METHODS We retrospectively analyzed all available medical data on oocyte donation pregnancies at Charité University hospital, Vivantes Hospital Friedrichshain, and Neukoelln in the German capital. RESULTS We included 115 oocyte donation (OD) pregnancies in the present study. Our data are based on 62 singleton, 44 twin, 7 triplet, and 2 quadruplet oocyte donation pregnancies. According to our data, oocyte donation pregnancies are associated with a high risk of adverse maternal and fetal outcome, i.e., hypertension in pregnancy, preterm delivery, Cesarean section as mode of delivery, and increased peripartum hemorrhage. CONCLUSION Although oocyte donation is prohibited by German law, many couples go abroad to seek reproductive measures using oocyte donation after former treatment options have failed. OD pregnancies are associated with a high risk of preeclampsia, C-section as mode of delivery, and peripartum hemorrhage. Detailed knowledge of the associated risks is of utmost importance to both the patient and the treating physician and midwife.
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Affiliation(s)
- J Altmann
- Department of Obstetrics, Charité-Universitätsmedizin, 10117, Berlin, Germany. .,Berlin Institute of Health, Berlin, Germany.
| | - J Kummer
- Department of Obstetrics and Gynecology, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - F Herse
- Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center-A Joint Cooperation Between the Max-Delbrück-Center for Molecular Medicine and the Charité-Universitätsmedizin, Berlin, Germany
| | - L Hellmeyer
- Department of Obstetrics and Gynecology, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - D Schlembach
- Clinic of Obstetric Medicine, Vivantes Hospital Neukoelln, Berlin, Germany
| | - W Henrich
- Department of Obstetrics, Charité-Universitätsmedizin, 10117, Berlin, Germany
| | - A Weichert
- Department of Obstetrics, Charité-Universitätsmedizin, 10117, Berlin, Germany.,Center for Prenatal Diagnosis, Bergmannstrasse 102, Berlin, Germany
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Altmann J, Henrich W, Weichert A. Maternale und neonatale Komplikationen bei Eizellspenden-Schwangerschaften. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717897] [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: 10/23/2022] Open
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3
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Koomen JV, Heerspink HJL, Schrieks IC, Schwartz GG, Lincoff AM, Nicholls SJ, Svensson A, Wedel H, Weichert A, Grobbee DE, Stevens J. Exposure and response analysis of aleglitazar on cardiovascular risk markers and safety outcomes: An analysis of the AleCardio trial. Diabetes Obes Metab 2020; 22:30-38. [PMID: 31468659 PMCID: PMC6916612 DOI: 10.1111/dom.13862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/02/2019] [Accepted: 08/25/2019] [Indexed: 01/30/2023]
Abstract
AIMS The AleCardio trial aimed to characterize the efficacy and safety of peroxisome proliferator-activated receptor-αγ agonist aleglitazar in patients with type 2 diabetes mellitus and acute coronary syndrome. The trial terminated early because of futility and safety signals. We evaluated whether the safety signals could be attributed to increased exposure to aleglitazar. MATERIALS AND METHODS The AleCardio trial enrolled 7226 patients to receive aleglitazar 150 μg or matching placebo on top of standard care. A population pharmacokinetic analysis was conducted in a pharmacokinetic substudy to identify covariates that explained interindividual variability in exposure. Subsequently, the effect of these covariates on surrogate and clinical outcomes was assessed in the full patient population. RESULTS Concomitant administration of clopidogrel was identified as a covariate that influenced the apparent clearance of aleglitazar. Patients using clopidogrel had a mean predicted area under the plasma-concentration-time curve (AUC0-24 ) of 174.7 ng h/mL (SD: ±112.9 ng h/mL) versus 142.2 ng h/mL (SD: ±92.6 ng h/mL) in patients without clopidogrel. The effect of aleglitazar compared with placebo on HbA1c, haemoglobin, serum creatinine and adiponectin was modified by concomitant clopidogrel use (P for interaction 0.007, 0.002, <0.001 and < 0.001, respectively). CONCLUSIONS Concomitant use of clopidogrel was identified as a covariate that explained interindividual variability in exposure to aleglitazar. Patients using clopidogrel showed an additional lowering of HbA1c, at the expense of an additional decrease in haemoglobin, and an increase in serum creatinine and adiponectin. Clopidogrel is a moderate inhibitor of CYP2C8. Because aleglitazar is metabolized by CYP2C8, a pharmacokinetic interaction could explain differences in exposure and response to aleglitazar.
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Affiliation(s)
- Jeroen V. Koomen
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Hiddo J. L. Heerspink
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Ilse C. Schrieks
- Julius Clinical & Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Gregory G. Schwartz
- Cardiology SectionRocky Mountain Regional VA Medical Center and University of Colorado School of MedicineColoradoAurora
| | - A. Michael Lincoff
- C5Research, Department of Cardiovascular MedicineCleveland ClinicClevelandOhio
| | | | - Anders Svensson
- Clinical Development, Cardio Metabolism, F. Hoffmann‐La Roche Ltd.BaselSwitzerland
| | - Hans Wedel
- Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Arlette Weichert
- Product DevelopmentImmunology, Infectious Disease and Ophthalmology (I2O), F. Hoffmann‐La Roche Ltd.BaselSwitzerland
| | - Diederick E. Grobbee
- Julius Clinical & Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Jasper Stevens
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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Chanu P, Schaefer F, Warady BA, Schmitt CP, Reigner B, Schnetzler G, Meyer Reigner S, Eisner M, Weichert A, Frey N. Model-based approach for methoxy polyethylene glycol-epoetin beta drug development in paediatric patients with anaemia of chronic kidney disease. Br J Clin Pharmacol 2019; 86:801-811. [PMID: 31770451 DOI: 10.1111/bcp.14186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/03/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
AIMS Methoxy polyethylene glycol-epoetin beta (continuous erythropoietin receptor activator, C.E.R.A.) is used for the treatment of anaemia in adults with chronic kidney disease (CKD). Patients treated with shorter-acting erythropoiesis-stimulating agents up to three times weekly can be switched to once-monthly C.E.R.A.. Doses can be adjusted on a monthly basis based on haemoglobin (Hb) levels during the preceding period. A model-based approach was applied to optimise C.E.R.A. development, more specifically the confirmatory trial of the paediatric plan. METHODS Pharmacokinetic and pharmacodynamic data from a phase II paediatric study and phase II and III adult studies were analysed together using modelling and simulation to determine the pharmacokinetic/pharmacodynamic characteristics of C.E.R.A. in a broad population. Model-based simulations of C.E.R.A. treatment outcomes in paediatric patients were performed, notably when administered subcutaneously and compared to clinical and real-world data. RESULTS Age and body weight explained differences in pharmacokinetics, while the pharmacodynamic characteristics of C.E.R.A. were similar between adult and paediatric populations. Simulated Hb levels (mean and 95% prediction interval 10.9 [10.6, 11.2] g dL-1 ) and C.E.R.A. doses (median and 95% prediction interval 105 [72, 159] μg) 20 weeks after switching to subcutaneous C.E.R.A. were confirmed by observed real-world data from International Pediatric Dialysis Network registries (mean Hb was 10.8 g dL-1 and median C.E.R.A. dose was 100 μg). CONCLUSIONS These analyses have facilitated optimisation of the C.E.R.A. development programme in paediatric patients with anaemia of CKD to provide this patient population with faster access to the drug while avoiding unnecessary clinical trial exposure and related monitoring burden in children.
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Affiliation(s)
- Pascal Chanu
- Clinical Pharmacology, Genentech/Roche, Lyon, France
| | | | | | | | - Bruno Reigner
- Roche Pharma Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | | | | | | | | | - Nicolas Frey
- Roche Pharma Research and Early Development, Roche Innovation Center, Basel, Switzerland
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Dressler I, Henrich W, Weichert A, Weißhaupt K. Nabelschnurverknotung bei einer monoamnialen Geminigravidität – ein Fallbericht. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671533] [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: 10/28/2022] Open
Affiliation(s)
- I Dressler
- Charité Universitätsmedizin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - W Henrich
- Charité Universitätsmedizin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - A Weichert
- Charité Universitätsmedizin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - K Weißhaupt
- Charité Universitätsmedizin, Klinik für Geburtsmedizin, Berlin, Deutschland
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6
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Schubert M, Henrich W, Weichert A. Case-Report: Aspiration bei der Intubation im Rahmen der Notsectio. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671559] [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: 10/28/2022] Open
Affiliation(s)
- M Schubert
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Berlin, Deutschland
| | - W Henrich
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Berlin, Deutschland
| | - A Weichert
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Berlin, Deutschland
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7
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Pahlitzsch TMJ, Hanne L, Henrich W, Weichert A. Fetale Makrosomie – eine retrospektive Analyse von Risikofaktoren und maternalem und neonatalem Ausgang. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671429] [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: 10/28/2022] Open
Affiliation(s)
- TMJ Pahlitzsch
- Charité Universitätsmedizin Berlin, Geburtshilfe, Berlin, Deutschland
| | - L Hanne
- Charité Universitätsmedizin Berlin, Geburtshilfe, Berlin, Deutschland
| | - W Henrich
- Charité Universitätsmedizin Berlin, Geburtshilfe, Berlin, Deutschland
| | - A Weichert
- Charité Universitätsmedizin Berlin, Geburtshilfe, Berlin, Deutschland
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8
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Altmann J, Kiver V, Henrich W, Weichert A. Klinischer Verlauf von Kindern mit pränatal diagnostizierten Rhabdomyomen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671121] [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: 10/28/2022] Open
Affiliation(s)
- J Altmann
- Charité, Geburtshilfe, Berlin, Deutschland
| | - V Kiver
- Charité, Geburtshilfe, Berlin, Deutschland
| | - W Henrich
- Charité, Geburtshilfe, Berlin, Deutschland
| | - A Weichert
- Charité, Geburtshilfe, Berlin, Deutschland
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Neymeyer J, Weichert A, Weinberger S, Schlomm T. The „Pumping Probe Technique“ and complete sealing stent – a new simple method for the detection and treatment of ureteric fistulae. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671398] [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: 10/28/2022] Open
Affiliation(s)
- J Neymeyer
- Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - A Weichert
- Charité Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - S Weinberger
- Charité Universitätsmedizin Berlin, Klinik für Urologie, Berlin, Deutschland
| | - T Schlomm
- Charité Universitätsmedizin Berlin, Klinik für Urologie, Berlin, Deutschland
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10
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Weißhaupt K, Großbölting R, Weilnhammer VA, Weichert A, Henrich W, Dressler I. Psychiatrische Patientinnen in der Geburtsmedizin, Fallbeispiele vor dem juristischen Hintergrund. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671472] [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: 10/28/2022] Open
Affiliation(s)
- K Weißhaupt
- Charitè – Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - R Großbölting
- kwm Berlin – Kanzlei für Wirtschaft und Medizin, Berlin, Deutschland
| | - VA Weilnhammer
- Charitè – Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Berlin, Deutschland
| | - A Weichert
- Charitè – Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - W Henrich
- Charitè – Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - I Dressler
- Charitè – Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin, Deutschland
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11
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Schrieks IC, Nozza A, Stähli BE, Buse JB, Henry RR, Malmberg K, Neal B, Nicholls SJ, Rydén L, Mellbin L, Svensson A, Wedel H, Weichert A, Lincoff AM, Tardif JC, Grobbee DE, Schwartz GG. Adiponectin, Free Fatty Acids, and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Acute Coronary Syndrome. Diabetes Care 2018; 41:1792-1800. [PMID: 29903845 DOI: 10.2337/dc18-0158] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/25/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In observational cohorts, adiponectin is inversely associated and free fatty acids (FFAs) are directly associated with incident coronary heart disease (CHD). Adiponectin tends to be reduced and FFAs elevated in type 2 diabetes. We investigated relationships of adiponectin and FFA and major adverse cardiovascular events (MACEs) and death in patients with acute coronary syndrome (ACS) and type 2 diabetes using data from the AleCardio (Effect of Aleglitazar on Cardiovascular Outcomes After Acute Coronary Syndrome in Patients With Type 2 Diabetes Mellitus) trial, which compared the PPAR-α/γ agonist aleglitazar with placebo. RESEARCH DESIGN AND METHODS Using Cox regression adjusted for demographic, laboratory, and treatment variables, we determined associations of baseline adiponectin and FFAs, or the change in adiponectin and FFAs from baseline, with MACEs (cardiovascular death, myocardial infarction, or stroke) and death. RESULTS A twofold higher baseline adiponectin (n = 6,998) was directly associated with risk of MACEs (hazard ratio [HR] 1.17 [95% CI 1.08-1.27]) and death (HR 1.53 [95% CI 1.35-1.73]). A doubling of adiponectin from baseline to month 3 (n = 6,325) was also associated with risk of death (HR 1.20 [95% CI 1.03-1.41]). Baseline FFAs (n = 7,038), but not change in FFAs from baseline (n = 6,365), were directly associated with greater risk of MACEs and death. There were no interactions with study treatment. CONCLUSIONS In contrast to prior observational data for incident CHD, adiponectin is prospectively associated with MACEs and death in patients with type 2 diabetes and ACS, and an increase in adiponectin from baseline is directly related to death. These findings raise the possibility that adiponectin has different effects in patients with type 2 diabetes and ACS than in populations without prevalent cardiovascular disease. Consistent with prior data, FFAs are directly associated with adverse outcomes.
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Affiliation(s)
- Ilse C Schrieks
- Julius Clinical and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Canada
| | - Barbara E Stähli
- Department of Cardiology, Charité Berlin-University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Klas Malmberg
- Karolinska Institutet and Vicore Pharma, Stockholm, Sweden
| | - Bruce Neal
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, The University of Adelaide, Adelaide, Australia
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Linda Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Hans Wedel
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Cleveland, OH
| | | | - Diederick E Grobbee
- Julius Clinical and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gregory G Schwartz
- Division of Cardiology, VA Medical Center and University of Colorado School of Medicine, Denver, CO
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Stähli BE, Nozza A, Schrieks IC, Buse JB, Malmberg K, Mellbin L, Neal B, Nicholls SJ, Rydén L, Svensson A, Wedel H, Weichert A, Lincoff AM, Grobbee DE, Tardif JC, Schwartz GG. Homeostasis Model Assessment of Insulin Resistance and Survival in Patients With Diabetes and Acute Coronary Syndrome. J Clin Endocrinol Metab 2018; 103:2522-2533. [PMID: 29659887 DOI: 10.1210/jc.2017-02772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/02/2018] [Indexed: 02/13/2023]
Abstract
OBJECTIVE Insulin resistance has been linked to development and progression of atherosclerosis and is present in most patients with type 2 diabetes. Whether the degree of insulin resistance predicts adverse outcomes in patients with type 2 diabetes and acute coronary syndrome (ACS) is uncertain. DESIGN The Effect of Aleglitazar on Cardiovascular Outcomes after Acute Coronary Syndrome in Patients with Type 2 Diabetes Mellitus trial compared the peroxisome proliferator-activated receptor-α/γ agonist aleglitazar with placebo in patients with type 2 diabetes and recent ACS. In participants not treated with insulin, we determined whether baseline homeostasis model assessment of insulin resistance (HOMA-IR; n = 4303) or the change in HOMA-IR on assigned study treatment (n = 3568) was related to the risk of death or major adverse cardiovascular events (cardiovascular death, myocardial infarction, and stroke) in unadjusted and adjusted models. Because an inverse association of HOMA-IR with N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been described, we specifically examined effects of adjustment for the latter. RESULTS In unadjusted analysis, twofold higher baseline HOMA-IR was associated with lower risk of death [hazard ratio (HR): 0.79, 95% CI: 0.68 to 0.91, P = 0.002]. Adjustment for 24 standard demographic and clinical variables had minimal effect on this association. However, after further adjustment for NT-proBNP, the association of HOMA-IR with death was no longer present (adjusted HR: 0.99, 95% CI: 0.83 to 1.19, P = 0.94). Baseline HOMA-IR was not associated with major adverse cardiovascular events, nor was the change in HOMA-IR on study treatment associated with death or major adverse cardiovascular events. CONCLUSIONS After accounting for levels of NT-proBNP, insulin resistance assessed by HOMA-IR is not related to the risk of death or major adverse cardiovascular events in patients with type 2 diabetes and ACS.
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Affiliation(s)
- Barbara E Stähli
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany
- Montreal Heart Institute and Université de Montréal, Montreal, Canada
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Montreal QC, Canada
| | - Ilse C Schrieks
- Julius Clinical and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, CD Zeist, Netherlands
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Klas Malmberg
- Karolinska Institutet, Stockholm, Sweden
- Vicore Pharma, Mölndal, Sweden
| | - Linda Mellbin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bruce Neal
- George Institute for Global Health and University of Sydney, Newtown, New South Wales, Australia
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Hans Wedel
- Health Metrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio
| | - Diederick E Grobbee
- Julius Clinical and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, CD Zeist, Netherlands
| | - Jean-Claude Tardif
- Montreal Heart Institute and Université de Montréal, Montreal, Canada
- Montreal Health Innovations Coordinating Center, Montreal QC, Canada
| | - Gregory G Schwartz
- VA Medical Center and University of Colorado School of Medicine, Denver, Colorado
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13
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Neymeyer J, Weichert B, Weinberger S, Weintraub A, Weichert A. Laparoskopische Sakropexie mit Retroperitonealsierung des Mesh-Interponats: Ergebnisse an 298 Patientinnen. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593110] [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] Open
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14
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Kiver V, Thomas A, Henrich W, Bartens A, Weichert A. Exazerbation eines Malabsorptionssyndroms auf Basis eines Magenbypasses in der Schwangerschaft. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592889] [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] Open
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15
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Bigler M, Koutsantonis D, Odriozola A, Halm S, Tschanz SA, Zakrzewicz A, Weichert A, Baum O. Morphometry of skeletal muscle capillaries: the relationship between capillary ultrastructure and ageing in humans. Acta Physiol (Oxf) 2016; 218:98-111. [PMID: 27174490 DOI: 10.1111/apha.12709] [Citation(s) in RCA: 20] [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: 02/23/2016] [Revised: 04/25/2016] [Accepted: 05/11/2016] [Indexed: 12/31/2022]
Abstract
AIM To determine whether the ultrastructure of the capillary system in human skeletal muscle changes during advancing senescence, we evaluated the compartmental and subcompartmental organization of capillaries from vastus lateralis muscle (VL) biopsies of 41 non-diseased persons aged 23-75 years. METHODS From each VL biopsy, 38-40 randomly selected capillaries were assessed by transmission electron microscopy and subsequent morphometry with a newly established tablet-based image analysis technique. RESULTS Quantification of the compartmental organization revealed most indicators of the capillary ultrastructure to be only non-significantly altered (P > 0.05) over age. However, the peri-capillary basement membrane (BM) was thicker in the older participants than in the younger ones (P ≤ 0.05). Regression analysis revealed a bipartite relationship between the two parameters: a homogenous slight increase in BM thickness up to the age of approximately 50 years was followed by a second phase with more scattered BM thickness values. In 44.5% of the capillary profiles, projections/filopodia of the pericytes (PCs) traversed the BM and invaded endothelial cells (ECs) visible as PC pegs in pale cytoplasm holes (EC sockets). Strikingly, PC pegs were often in proximity to the EC nucleus. In PC profiles, sockets were likewise detected in 14.2% of the capillaries. Within these PC sockets, cellular profiles were frequently seen, which could be assigned to EC filopodia, internal PC curling or PC-PC interactions. Quantification of the occurrence of peg-socket junctions revealed the proportions of empty EC sockets and empty PC sockets to increase (P ≤ 0.05) during ageing. CONCLUSION Our investigation demonstrates advancing senescence to be associated with increase in BM thickness and loss of EC and PC filopodia length in skeletal muscle capillaries.
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Affiliation(s)
- M. Bigler
- Institute of Anatomy; University of Bern; Bern Switzerland
| | | | - A. Odriozola
- Institute of Anatomy; University of Bern; Bern Switzerland
| | - S. Halm
- Institute of Anatomy; University of Bern; Bern Switzerland
| | - S. A. Tschanz
- Institute of Anatomy; University of Bern; Bern Switzerland
| | - A. Zakrzewicz
- Institute of Physiology; CharitéCrossOver (CCO); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Weichert
- Institute of Physiology; CharitéCrossOver (CCO); Charité - Universitätsmedizin Berlin; Berlin Germany
- Department of Obstetrics; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - O. Baum
- Institute of Physiology; CharitéCrossOver (CCO); Charité - Universitätsmedizin Berlin; Berlin Germany
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Weichert A, von Schöning D, Fischer T, Thomas A. Cervical Sonoelastography and Cervical Length Measurement but not Cervicovaginal Interleukin-6 Are Predictors for Preterm Birth. Ultrasound Int Open 2016; 2:E83-9. [PMID: 27689180 DOI: 10.1055/s-0042-110317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 02/21/2016] [Accepted: 05/17/2016] [Indexed: 01/08/2023] Open
Affiliation(s)
- A Weichert
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - D von Schöning
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T Fischer
- Department of Radiology and Ultrasound Research Laboratory, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Thomas
- Department of Obstetrics and Ultrasound Research Laboratory, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Weichert J, Gembicki M, Weichert A, Hartge D. Standardisierte frühe fetale Echokardiografie mittels automatisierter 5D HeartTM-Technologie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583835] [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] Open
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Kölle A, Kiver V, Weichert A, Henrich W. Persistierender nicht immunologischer Hydrops fetalis nach intrauteriner Parvovirus B19 Infektion. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566567] [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: 10/22/2022]
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Schneider-Schulze C, Hänel M, Schöning DV, Weichert A, Henrich W, Tucher EV. Fetales Fibronektin und Zervixlänge zur Prädiktion einer Frühgeburt bei symptomatischen Schwangeren. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566647] [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: 10/22/2022]
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Weichert A, Neymeyer J, Hinkson L, Weichert TM, Schmiedel D, Kalache KD. Semi-Automatic Identification of the Fetal Profile and Nasal Bone Measurement at the Time of the Routine Mid-Trimester Ultrasound Scan. Ultraschall Med 2015; 36:473-479. [PMID: 25072245 DOI: 10.1055/s-0034-1366880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE This study was designed to compare nasal bone length (NBL) measurements using a manual multiplanar mode with those made using a newer semi-automatic technique (Volume NT™) acquired by an experienced operator as well as measurements done by two independent observers with different levels of ultrasound experience (conventional 2 D vs. Volume NT™). MATERIALS AND METHODS Ultrasound examination was performed prospectively on 81 pregnant women with a singleton pregnancy at the time of their routine mid-trimester ultrasound scan. RESULTS The correct mid-sagittal plane of the fetal profile was successfully obtained using the semi-automatic technique in 53 of 81 cases. CONCLUSION NBL measurements using conventional two-dimensional techniques showed significantly higher inter-observer variability than the semi-automatic program. Our study shows the feasibility of using a semi-automatic technique, especially for less experienced operators. Measurements obtained with the semi-automatic technique produced much less variable results around a mean than those obtained with conventional two-dimensional ultrasound.
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Affiliation(s)
- A Weichert
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Germany
| | - J Neymeyer
- Department of Urology, Charité - Universitätsmedizin Berlin, Germany
| | - L Hinkson
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Germany
| | - T M Weichert
- Department of Pediatrics, Sana Klinikum Lichtenberg, Berlin, Germany
| | - D Schmiedel
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Germany
| | - K D Kalache
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Germany
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Weichert A, Weichert TM, Bergmann RL, Henrich W, Kalache KD, Richter R, Neymeyer J, Bergmann KE. Factors for Preterm Births in Germany - An Analysis of Representative German Data (KiGGS). Geburtshilfe Frauenheilkd 2015; 75:819-826. [PMID: 26366001 DOI: 10.1055/s-0035-1557817] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 03/29/2015] [Revised: 06/03/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022] Open
Abstract
Introduction: Preterm birth is a global scourge, the leading cause of perinatal mortality and morbidity. This study set out to identify the principal risk factors for preterm birth, based on the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A range of possible factors influencing preterm birth were selected for inclusion in the questionnaire, covering factors such as gender, national origin, immigrant background, demography, living standard, family structure, parental education and vocational training. Methods: All data were taken from the aforementioned KiGGS survey conducted between 2003 and 2006. A total of 17 641 children and adolescents (8656 girls and 8985 boys) drawn from 167 German towns and municipalities deemed to be representative of the Federal Republic of Germany were included in the study. Gestational age at birth was available for 14 234 datasets. The questionnaire included questions from the following areas as possible factors influencing preterm birth: gender, national origins, immigrant background, demography, living standard, family structure, parental education and vocational training. Results: The preterm birth rate was 11.6 %, higher than that of other national statistical evaluations. Around 57.4 % of multiple pregnancies and 10 % of singleton pregnancies resulted in preterm delivery. Multiple pregnancy was found to be the most important risk factor (OR 13.116). With regard to national origins and immigration background, mothers from Turkey, the Middle East, and North Africa had a higher incidence of preterm birth. Preterm birth was more prevalent in cities and large towns than in small towns and villages. Conclusion: Risk factors associated with preterm birth were identified. These should help with the early identification of pregnant women at risk. The preterm birth rate in our survey was higher than that found in other national statistical evaluations based on process data. More than half of all multiple pregnancies ended in preterm birth.
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Affiliation(s)
- A Weichert
- Charité - Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin
| | - T M Weichert
- Bezirksamt Mitte von Berlin, Gesundheitsamt - Kinder- und Jugendgesundheitsdienst, Berlin
| | - R L Bergmann
- Charité - Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin
| | - W Henrich
- Charité - Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin
| | - K D Kalache
- Sidra Medical and Research Center, Obstetrics & Gynecology Department, Doha, Qatar
| | - R Richter
- Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Berlin
| | - J Neymeyer
- Charité - Universitätsmedizin Berlin, Klinik für Urologie, Berlin
| | - K E Bergmann
- Charité - Universitätsmedizin Berlin, Klinik für Geburtsmedizin, Berlin
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Bergmann K, Bergmann R, Richter R, Henrich W, Weichert A. Vitamin-D-Mangel bei Kindern- und Jugendlichen in Deutschland (Teil 1). Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3389-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Lincoff AM, Tardif JC, Schwartz GG, Nicholls SJ, Rydén L, Neal B, Malmberg K, Wedel H, Buse JB, Henry RR, Weichert A, Cannata R, Svensson A, Volz D, Grobbee DE. Effect of aleglitazar on cardiovascular outcomes after acute coronary syndrome in patients with type 2 diabetes mellitus: the AleCardio randomized clinical trial. JAMA 2014; 311:1515-25. [PMID: 24682069 DOI: 10.1001/jama.2014.3321] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE No therapy directed against diabetes has been shown to unequivocally reduce the excess risk of cardiovascular complications. Aleglitazar is a dual agonist of peroxisome proliferator-activated receptors with insulin-sensitizing and glucose-lowering actions and favorable effects on lipid profiles. OBJECTIVE To determine whether the addition of aleglitazar to standard medical therapy reduces cardiovascular morbidity and mortality among patients with type 2 diabetes mellitus and a recent acute coronary syndrome (ACS). DESIGN, SETTING, AND PARTICIPANTS AleCardio was a phase 3, multicenter, randomized, double-blind, placebo-controlled trial conducted in 720 hospitals in 26 countries throughout North America, Latin America, Europe, and Asia-Pacific regions. The enrollment of 7226 patients hospitalized for ACS (myocardial infarction or unstable angina) with type 2 diabetes occurred between February 2010 and May 2012; treatment was planned to continue until patients were followed-up for at least 2.5 years and 950 primary end point events were positively adjudicated. INTERVENTIONS Randomized in a 1:1 ratio to receive aleglitazar 150 µg or placebo daily. MAIN OUTCOMES AND MEASURES The primary efficacy end point was time to cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Principal safety end points were hospitalization due to heart failure and changes in renal function. RESULTS The trial was terminated on July 2, 2013, after a median follow-up of 104 weeks, upon recommendation of the data and safety monitoring board due to futility for efficacy at an unplanned interim analysis and increased rates of safety end points. A total of 3.1% of patients were lost to follow-up and 3.2% of patients withdrew consent. The primary end point occurred in 344 patients (9.5%) in the aleglitazar group and 360 patients (10.0%) in the placebo group (hazard ratio, 0.96 [95% CI, 0.83-1.11]; P = .57). Rates of serious adverse events, including heart failure (3.4% for aleglitazar vs 2.8% for placebo, P = .14), gastrointestinal hemorrhages (2.4% for aleglitazar vs 1.7% for placebo, P = .03), and renal dysfunction (7.4% for aleglitazar vs 2.7% for placebo, P < .001) were increased. CONCLUSIONS AND RELEVANCE Among patients with type 2 diabetes and recent ACS, use of aleglitazar did not reduce the risk of cardiovascular outcomes. These findings do not support the use of aleglitazar in this setting with a goal of reducing cardiovascular risk. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01042769.
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Affiliation(s)
- A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio
| | - Jean-Claude Tardif
- Montreal Heart Institute Coordinating Center, Université de Montréal, Montreal, Canada
| | - Gregory G Schwartz
- Veterans Affairs Medical Center and University of Colorado School of Medicine, Denver
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide
| | - Lars Rydén
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bruce Neal
- George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Klas Malmberg
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden7F. Hoffman-La Roche Ltd, Basel, Switzerland
| | - Hans Wedel
- Nordic School of Public Health, Frolunda, Sweden
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill
| | | | | | - Ruth Cannata
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio
| | | | | | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care and Julius Clinical, University Medical Center Utrecht, Utrecht, the Netherlands
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Tucher EV, Schneider C, Thomas A, Weichert A, Ramsauer B, Henrich W. Sonografische Zervixlängenmessung und qualitatives fetales Fibronektin (fFN) bei symptomatischen Patientinnen zur Prädiktion einer drohenden Frühgeburt. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361195] [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: 10/26/2022]
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Tucher EV, Siedentopf N, Siedentopf JP, Weichert A, Bamberg C, Dückelmann A, Henrich W. Inkarzerationen und Sacculationen bei Retroflexio uteri. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361307] [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: 10/26/2022]
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Weichert A, Schmiedel D, Kalache KD, Tucher EV, Thomas A. Wertigkeit der Interleukin-6-Konzentration (IL-6) im Scheidensekret bei der Einschätzung des Frühgeburtsrisikos bei symptomatischen Patientinnen mit vorzeitigen Wehen oder vorzeitiger Zervixreifung. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361412] [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: 10/26/2022]
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Weichert A, Kalache KD, Armbrust R, Thomas A, Henrich W, Hinkson L. Einsatz des Fetal Pillow unter der Geburt vor einer Sectio casearea in der Austreibungsperiode. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361268] [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: 10/26/2022]
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Lincoff AM, Tardif JC, Neal B, Nicholls SJ, Rydén L, Schwartz GG, Malmberg K, Buse JB, Henry RR, Wedel H, Weichert A, Cannata R, Grobbee DE. Evaluation of the dual peroxisome proliferator-activated receptor α/γ agonist aleglitazar to reduce cardiovascular events in patients with acute coronary syndrome and type 2 diabetes mellitus: rationale and design of the AleCardio trial. Am Heart J 2013; 166:429-34. [PMID: 24016490 DOI: 10.1016/j.ahj.2013.05.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/21/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Peroxisome proliferator-activated receptors (PPARs) regulate transcription of genes involved in glucose uptake, lipid metabolism, and inflammation. Aleglitazar is a potent dual PPAR agonist with insulin-sensitizing and glucose-lowering actions and favorable effects on lipid profiles and biomarkers of cardiovascular risk. The AleCardio trial examines whether the addition of aleglitazar to standard medical therapy reduces the risk of cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus and recent acute coronary syndrome. STUDY DESIGN AleCardio is a phase 3, multicenter, randomized, double-blind, placebo-controlled trial. A total of 7,228 patients were randomized to aleglitazar 150 μg or placebo daily in addition to standard medical therapy. The primary efficacy end point is time to the first event of cardiovascular death, myocardial infarction, or stroke. Principal safety end points are hospitalization due to heart failure and changes in renal function. Treatment will continue until 7,000 patients are followed up for at least 2.5 years and 950 primary end point events are adjudicated. CONCLUSIONS AleCardio will establish whether the PPAR-α/γ agonist aleglitazar improves cardiovascular outcomes in patients with diabetes and high-risk coronary disease.
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Affiliation(s)
- A Michael Lincoff
- Cleveland Clinic Coordinating Center for Clinical Research (C5Research), Cleveland, OH.
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Weichert A, von Weizsäcker K, Oligmüller AK, El-Hussein K, Beinder E, Henrich W. Fetalblutanalyse mit dem Rocket® Fetal Blood Sampling Kit. Anwenderstudie. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293457] [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: 10/15/2022]
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Weichert A, David M, Gottschalk EM, Dudenhausen JW, Henrich W. Management einer akuten postpartalen Inversio uteri mit schwerer Atonie nach Spontangeburt. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089086] [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: 10/19/2022] Open
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Weichert A, Stupin JH, Dudenhausen JW, Henrich W. Schwangerschaft bei maternalem Caroli-Syndrom – Ein seltener Fall. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002993] [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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Busch S, Rosskopf D, Lang HJ, Weichert A, Siffert W. Expression, functional characterization and tissue distribution of a Na+/H+ exchanger cloned from Xenopus laevis oocytes (XL-NHE). Pflugers Arch 1998; 436:828-33. [PMID: 9799395 DOI: 10.1007/s004240050711] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We examined the functional properties of a Na+/H+ exchanger cloned from Xenopus laevis oocytes (XL-NHE) upon stable transfection into PS120 fibroblasts which lack endogenous Na+/H+ exchange. In contrast to untransfected cells, XL-NHE-transfected cells displayed Na+-dependent alkalinization upon acidification with nigericin. XL-NHE activity was inhibited by amiloride, ethylisopropylamiloride, HOE694 [(3-methylsulphonyl-4-piperidinobenzoyl)-guanidine methanesulphonate] and HOE642 [4-isopropyl-3-methylsulphonylbenzoyl)-guanidine methanesulphonate], Ki values being calculated at 5 micromol/l, 25 nmol/l, 300 nmol/l and 180 nmol/l, respectively. The Na+ dependence of pHi recovery was compatible with simple Michaelis-Menten kinetics, the Km for Na+ being 22.0+/-3.2 mmol/l and the Hill coefficient for Na+ being approximately 1. XL-NHE was activated by phorbol ester, whereas forskolin exerted no effect, suggesting the involvement of phospholipase C/protein kinase C signalling pathways rather than protein kinase A signalling pathways in XL-NHE stimulation. Using reverse transcription polymerase chain reaction, XL-NHE message could be detected in various Xenopus tissues including heart, brain, skeletal muscle, reticulocytes, A6-kidney cells and oocytes.
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Affiliation(s)
- S Busch
- Institut für Pharmakologie, Universitätsklinikum Essen, Hufelandstr. 55, D-45122 Essen, Germany.
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Bachmann O, Sonnentag T, Siegel WK, Lamprecht G, Weichert A, Gregor M, Seidler U. Different acid secretagogues activate different Na+/H+ exchanger isoforms in rabbit parietal cells. Am J Physiol 1998; 275:G1085-93. [PMID: 9815039 DOI: 10.1152/ajpgi.1998.275.5.g1085] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Rabbit parietal cells express three Na+/H+ exchanger isoforms (NHE1, NHE2, and NHE4). We investigated the effects of carbachol, histamine, and forskolin on Na+/H+ exchange activity and acid formation in cultured rabbit parietal cells and tested the effect of NHE isoform-specific inhibition on agonist-induced Na+/H+ exchange. Carbachol (10(-4) M) was the weakest acid secretagogue but caused the strongest Na+/H+ exchange activation, which was completely blocked by 1 microM HOE-642 (selective for NHE1); histamine (10(-4) M) and forskolin (10(-5) M) were stronger stimulants of [14C]aminopyrine accumulation but weaker stimulants of Na+/H+ exchange activity. HOE-642 (1 microM) reduced forskolin-stimulated Na+/H+ exchange activity by 35%, and 25 microM HOE-642 (inhibits NHE1 and -2) inhibited an additional 13%, but 500 microM dimethyl amiloride (inhibits NHE1, -2, and -4) caused complete inhibition. The presence of 5% CO2-HCO-3 markedly reduced agonist-stimulated H+ efflux rates, suggesting that the anion exchanger is also activated. Hyperosmolarity also activated Na+/H+ exchange. Our data suggest that, in rabbit parietal cells, Ca2+-dependent stimulation causes a selective activation of NHE1, whereas cAMP-dependent stimulation activates NHE1, NHE2, and more strongly NHE4. Because intracellular pH (pHi) did not change in the presence of CO2-HCO-3 and concomitant activation of Na+/H+ and anion exchange is one of the volume regulatory mechanisms, we speculate that the physiological significance of secretagogue-induced Na+/H+ exchange activation may not be related to pHi but to volume regulation during acid secretion.
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Affiliation(s)
- O Bachmann
- Department of Internal Medicine I, University Hospital Schnarrenberg, Eberhard-Karls University Tübingen, D-72076 Tübingen, Germany
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Linz W, Albus U, Crause P, Jung W, Weichert A, Schölkens BA, Scholz W. Dose-dependent reduction of myocardial infarct mass in rabbits by the NHE-1 inhibitor cariporide (HOE 642). Clin Exp Hypertens 1998; 20:733-49. [PMID: 9764718 DOI: 10.3109/10641969809052116] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to investigate the dose-dependent effect of pretreatment with the selective sodium-hydrogen exchange NHE-subtype 1 inhibitor cariporide on myocardial infarct mass in a rabbit model of coronary ligation and reperfusion. Furthermore, in a second part of the study, we tested the effect of cariporide in the rabbits when given prior to reperfusion. Rabbits (n=49) were randomized in 7 groups: saline vehicle, cariporide: 0.01, 0.03, 0.1 and 0.3 mg/kg, and subjected to a 30 min occlusion of a branch of the left coronary artery followed by 2 h reperfusion. Cariporide was given as a bolus intravenously 10 min before occlusion or 5 min before reperfusion. After reperfusion, myocardial infarct mass was determined by triphenyl tetrazolium chloride staining and expressed as a percent of area at risk. Cariporide given intravenously 10 min before occlusion in doses of 0.01, 0.03, 0.1, 0.3 mg/kg, led to a dose-dependent reduction in infarct mass from 58+/-6% in controls to 48+/-4% (-17%, NS), 36+/-5% (-38%, p<0.05), 26+/-6% (-55%, p<0.05), 11+/-4% (-81%, p<0.05) respectively, whereas area at risk did not differ in between the groups. The effect of the lowest dose of 0.01 mg/kg did not reach significance. Plasma levels at different doses of cariporide were correlated to the respective infarct mass. After coronary occlusion left ventricular end-diastolic pressure (LVEDP) significantly increased throughout occlusion and reperfusion. Cariporide in the doses of 0.3, 0.1 and 0.03 mg/kg normalized LVEDP when measured after 2 h reperfusion. In controls hemodynamic parameters such as mean arterial blood pressure (MAP), heart rate (HR), left ventricular pressure (LVP) and LV dP/dt(max) were not significantly changed by ischemia/reperfusion with the exception of MAP, LVP and LV dP/dt(max) which were significantly decreased after 120 min reperfusion. Cariporide at doses of 0.1, 0.03 and 0.01 mg/kg did not significantly influence these parameters, whereas the highest dose of 0.3 mg/kg prevented the decrease of MAP and LVP. Cariporide (0.3 mg/kg i.v.) administered 5 min before reperfusion significantly reduced infarct mass by 31%. Under these conditions the increase of LVEDP after coronary occlusion was not influenced by cariporide. As in the pretreatment experiments, the decrease of MAP and LVP was prevented when measured 2 h after reperfusion. The results show that pretreatment with the NHE-subtype 1 inhibitor cariporide is cardioprotective by reducing infarct mass in rabbits in a dose-dependent manner. While the cardioprotective effect of pretreatment could be demonstrated over a broad range of doses, the efficacy of the compound when given only on reperfusion was significant but more limited.
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Affiliation(s)
- W Linz
- Hoechst Marion Roussel, DG Cardiovascular Research, Frankfurt/Main, Germany.
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Weichert A, Faber S, Jansen HW, Scholz W, Lang HJ. Synthesis of the highly selective Na+/H+ exchange inhibitors cariporide mesilate and (3-methanesulfonyl-4-piperidino-benzoyl) guanidine methanesulfonate. Arzneimittelforschung 1997; 47:1204-7. [PMID: 9428974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The syntheses of cariporide mesilate ((4-isopropyl-3-methanesulfonyl-benzoyl) guanidine methanesulfonate, HOE 642, CAS 159138-81-5), currently being clinically investigated as a protective drug in cardiac ischemia and reperfusion states, and of HOE 694 ((3-methanesulfonyl-4-piperidino-benzoyl)guanidine methanesulfonate, CAS 149725-40-6), widely used as a physiological and pharmacological research tool in studies comprising Na+/H+ exchange (NHE) inhibition, are described. Additionally, their selectivity on the different subtypes is disclosed.
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Affiliation(s)
- A Weichert
- Hoechst Marion Roussel TA Research, Cardiovascular Agents, Hoechst Aktiengesellschaft, Frankfurt/Main, Germany
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Russ U, Balser C, Scholz W, Albus U, Lang HJ, Weichert A, Schölkens BA, Gögelein H. Effects of the Na+/H+-exchange inhibitor Hoe 642 on intracellular pH, calcium and sodium in isolated rat ventricular myocytes. Pflugers Arch 1996; 433:26-34. [PMID: 9019727 DOI: 10.1007/s004240050244] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The inhibitors of the Na+/H+-exchange (NHE1) system Hoe 694 and Hoe 642 possess cardioprotective effects in ischaemia/reperfusion. It is assumed that these effects are due to the prevention of intracellular sodium (Nai) and calcium (Cai) overload. The purpose of the present study was to investigate the effects of Hoe 642 on intracellular pH, Na+ and Ca2+ (pHi, Nai and Cai) in isolated rat ventricular myocytes under anoxic conditions or in cells in which oxidative phosphorylation had been inhibited by 1.5 mmol/l cyanide. In cells which were dually loaded with the fluorescent dyes 2, 7-biscarboxyethyl-5,6-carboxyfluorescein (BCECF) and Fura-2, anoxia caused acidification of the cells (from pHi 7.2 to pHi 6.8) and an increase in Cai from about 50 nmol/l to about 1 micromol/l. The decrease in pHi began before the cells underwent hypoxic (rigor) contracture, whereas Cai only began to rise after rigor shortening had taken place. After reoxygenation, pHi returned to its control value and Cai oscillated and then declined to resting levels. It was during this phase that the cells rounded up (hypercontracture). When 10 micromol/l Hoe 642 was present from the beginning of the experiment, pHi and Cai were not significantly different from control experiments. At reoxygenation, pHi did not recover, but Cai oscillated and returned to its resting level. To monitor Nai, the cells were loaded with the dye SBFI. After adding 1.5 mmol/l cyanide or 100 micromol/l ouabain, Nai increased from the initial 8 mmol/l to approximately 16 mmol/l. Hoe 642 or Hoe 694 (10 micromol/l) did not prevent the increase in Nai. In contrast, the blocker of the persistent Na+ current R56865 (10 micromol/l) attenuated the CN--induced rise in Nai. The substance ethylisopropylamiloride was not used because it augmented considerably the intensity of the 380 nm wavelength of the cell's autofluorescence. In conclusion, the specific NHE1 inhibitor Hoe 642 did not attenuate anoxia-induced Cai overload, nor CN--induced Nai and Cai overload. Hoe 642 prevented the recovery of pHi from anoxic acidification. This low pHi maintained after reoxygenation may be cardioprotective. Other possible mechanisms of NHE1 inhibitors, such as prevention of Ca2+ overload in mitochondria, cannot be ruled out. The increase in Nai during anoxia is possibly due to an influx of Na+ via persistent Na+ channels.
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Affiliation(s)
- U Russ
- Hoechst AG, Cardiovascular Agents, H 821, P.O. Box 800320, D-65926 Frankfurt/Main, Germany
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Scholz W, Albus U, Counillon L, Gögelein H, Lang HJ, Linz W, Weichert A, Schölkens BA. Protective effects of HOE642, a selective sodium-hydrogen exchange subtype 1 inhibitor, on cardiac ischaemia and reperfusion. Cardiovasc Res 1995; 29:260-8. [PMID: 7736504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The aim was to characterise the new compound HOE642 as a selective and cardioprotective Na+/H+ exchange inhibitor in various models. METHODS The effect of HOE642 was tested in the osmotically activated Na+/H+ exchange of rabbit erythrocytes and in propionate induced swelling of human thrombocytes. Recovery of pH after an NH4Cl prepulse and effects on other ion transport systems by patch clamp technique were investigated in rat cardiomyocytes. NHE subtype specifity of the compound was determined by 22Na+ uptake inhibition in a fibroblast cell line separately expressing subtype isoforms 1-3. Protective effects of HOE642 in cardiac ischaemia and reperfusion by ligation of coronary artery were investigated in isolated working rat hearts and in anaesthetised rats. RESULTS HOE642 concentration dependently inhibited the amiloride sensitive sodium influx in rabbit erythrocytes, reduced the swelling of human platelets induced by intracellular acidification, and delayed pH recovery in rat cardiomyocytes. In the isolated working rat heart subjected to ischaemia and reperfusion HOE642 dose dependently reduced the incidence and the duration of reperfusion arrhythmias. It also reduced the the release of lactate dehydrogenase and creatine kinase, and preserved the tissue content of glycogen, ATP, and creatine phosphate. In anaesthetised rats undergoing coronary artery ligation intravenous and oral pretreatment with HOE642 caused a dose dependent reduction or a complete prevention of ventricular premature beats, ventricular tachycardia, and ventricular fibrillation. The compound was well tolerated and neutral to circulatory variables. Other cardiovascular agents tested in this model were not, or were only partly, effective at doses showing marked cardiodepressive effects. CONCLUSIONS HOE642 is a very selective NHE subtype 1 inhibitor showing cardioprotective and antiarrhythmic effects in ischaemic and reperfused hearts. Further development of well tolerated compounds like HOE642 could lead to a new therapeutic approach in clinical indications related to cardiac ischaemia and reperfusion.
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Affiliation(s)
- W Scholz
- Hoechst AG, Cardiovascular Research H 821, Frankfurt/Main, Germany
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Mincu I, Mihalache N, Georgescu S, Weichert A. [Studies on the diabetogenic action of thiazides]. Med Interna (Bucur) 1965; 17:1425-33. [PMID: 5863216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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