1
|
Lange CM, Weismüller TJ, Strassburg CP. [Liver transplantation in viral and autoimmune liver diseases]. Inn Med (Heidelb) 2024; 65:357-364. [PMID: 38446182 DOI: 10.1007/s00108-024-01675-6] [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] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Despite substantial progress in the management of viral and autoimmune liver diseases, these entities remain relevant indications for liver transplantation. AIMS To provide an overview of the current knowledge regarding the management of viral and autoimmune liver diseases before and after liver transplantation. MATERIALS AND METHODS Selective literature search, including current guidelines and abstracts of key scientific meetings. RESULTS AND DISCUSSION Viral and autoimmune liver disease can be effectively treated in most cases, which has resulted in an overall decline in liver transplantations for this indication group. However, hepatitis D infection and primary sclerosing cholangitis remain difficult-to-treat liver diseases in some patients and may progress to end-stage liver disease despite best possible management. Viral or autoimmune hepatitis can lead to fulminant liver failure requiring emergency liver transplantation. In patients who are transplanted due to viral or autoimmune liver disease, specific measures to prevent recurrence of these diseases after transplantation are mandatory. In view of effective treatment modalities for chronic hepatitis B and C, even liver grafts from donors infected with these viruses can be considered for liver transplantation under certain circumstances.
Collapse
Affiliation(s)
- Christian M Lange
- Klinik und Poliklinik für Innere Medizin II, LMU Klinikum der Universität München, Marchioninistr. 15, 81337, München, Deutschland.
| | - Tobias J Weismüller
- Klinik für Innere Medizin - Gastroenterologie und Hepatologie, Vivantes Humboldt-Klinikum, Berlin, Deutschland
| | - Christian P Strassburg
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Venusberg-Campus 1, Gebäude 26, 53127, Bonn, Deutschland.
| |
Collapse
|
2
|
Ben Khaled N, Mörtl B, Beier D, Reiter FP, Pawlowska-Phelan D, Teufel A, Rössler D, Schwade DF, Philipp A, Kubisch I, Ehmer U, Geier A, Lange CM, Mayerle J, Berger K, De Toni EN, Munker S. Response to the letter re: Changing treatment landscape associated with improved survival in advanced hepatocellular carcinoma: A nationwide, population-based study. Eur J Cancer 2024; 198:113499. [PMID: 38160177 DOI: 10.1016/j.ejca.2023.113499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Institute of Molecular Oncology and Functional Genomics, School of Medicine, TU München, Munich, Germany.
| | - Bernhard Mörtl
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Dominik Beier
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Florian P Reiter
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | - Andreas Teufel
- Department of Medicine II, Division of Hepatology, Division of Bioinformatics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Rössler
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Daniel F Schwade
- Institute of Molecular Oncology and Functional Genomics, School of Medicine, TU München, Munich, Germany
| | - Alexander Philipp
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Ilja Kubisch
- Department of Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, Metabolic Disorders, Oncology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Ursula Ehmer
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Internal Medicine II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Andreas Geier
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Christian M Lange
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Karin Berger
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Stefan Munker
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; Department of Pharmaceutical Biology, LMU Munich, Munich, Germany
| |
Collapse
|
3
|
Manka P, Coombes JD, Sydor S, Swiderska-Syn MK, Best J, Gauthier K, van Grunsven LA, Oo YH, Wang C, Diehl AM, Hönes GS, Moeller LC, Figge A, Boosman RJ, Faber KN, Tannapfel A, Goetze O, Aspichueta P, Lange CM, Canbay A, Syn WK. Thyroid hormone receptor alpha modulates fibrogenesis in hepatic stellate cells. Liver Int 2024; 44:125-138. [PMID: 37872645 DOI: 10.1111/liv.15759] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE Progressive hepatic fibrosis can be considered the final stage of chronic liver disease. Hepatic stellate cells (HSC) play a central role in liver fibrogenesis. Thyroid hormones (TH, e.g. thyroxine; T4 and triiodothyronine; T3) significantly affect development, growth, cell differentiation and metabolism through activation of TH receptor α and/or β (TRα/β). Here, we evaluated the influence of TH in hepatic fibrogenesis. DESIGN Human liver tissue was obtained from explanted livers following transplantation. TRα-deficient (TRα-KO) and wild-type (WT) mice were fed a control or a profibrogenic methionine-choline deficient (MCD) diet. Liver tissue was assessed by qRT-PCR for fibrogenic gene expression. In vitro, HSC were treated with TGFβ in the presence or absence of T3. HSC with stable TRα knockdown and TRα deficient mouse embryonic fibroblasts (MEF) were used to determine receptor-specific function. Activation of HSC and MEF was assessed using the wound healing assay, Western blotting, and qRT-PCR. RESULTS TRα and TRβ expression is downregulated in the liver during hepatic fibrogenesis in humans and mice. TRα represents the dominant isoform in HSC. In vitro, T3 blunted TGFβ-induced expression of fibrogenic genes in HSC and abrogated wound healing by modulating TGFβ signalling, which depended on TRα presence. In vivo, TRα-KO enhanced MCD diet-induced liver fibrogenesis. CONCLUSION These observations indicate that TH action in non-parenchymal cells is highly relevant. The interaction of TRα with TH regulates the phenotype of HSC via the TGFβ signalling pathway. Thus, the TH-TR axis may be a valuable target for future therapy of liver fibrosis.
Collapse
Affiliation(s)
- Paul Manka
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason D Coombes
- Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Svenja Sydor
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Marzena K Swiderska-Syn
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jan Best
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Karine Gauthier
- Institut de Génomique Fonctionnelle de Lyon, Univ Lyon, CNRS UMR 5242, INRAE USC 1370 École Normale Supérieure de Lyon, Université Claude Barnard Lyon, Lyon, France
| | - Leo A van Grunsven
- Department of Basic (Bio-)medical Sciences, Liver Cell Biology Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ye H Oo
- Centre for Liver Research and NIHR BRC, Institute of Immunology and Immunotherapy, Birmingham Advanced Cell Therapy Facility, University of Birmingham, Birmingham, UK
| | - Cindy Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Anna M Diehl
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Georg S Hönes
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lars C Moeller
- Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anja Figge
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - René J Boosman
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas N Faber
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Oliver Goetze
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Patricia Aspichueta
- Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Vizcaya, Spain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd, Instituto de Salud Carlos III), Madrid, Spain
| | - Christian M Lange
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Ali Canbay
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Wing-Kin Syn
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
- Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Vizcaya, Spain
- Section of Gastroenterology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| |
Collapse
|
4
|
Hoang TPT, Schindler P, Börner N, Masthoff M, Gerwing M, von Beauvais P, De Toni EN, Lange CM, Trebicka J, Morgül H, Seidensticker M, Ricke J, Pascher A, Guba M, Ingrisch M, Wildgruber M, Öcal O. Imaging-Derived Biomarkers Integrated with Clinical and Laboratory Values Predict Recurrence of Hepatocellular Carcinoma After Liver Transplantation. J Hepatocell Carcinoma 2023; 10:2277-2289. [PMID: 38143909 PMCID: PMC10740736 DOI: 10.2147/jhc.s431503] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose To investigate the prognostic value of computed tomography (CT) derived imaging biomarkers in hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) and develop a predictive nomogram model. Patients and Methods This retrospective study included 178 patients with histopathologically confirmed HCC who underwent liver transplantation between 2007 and 2021 at the two academic liver centers. We evaluated dedicated imaging features from baseline multiphase contrast-enhanced CT supplemented by several clinical findings and laboratory parameters. Time-to-recurrence was estimated by Kaplan-Meier analysis. Univariable Cox proportional hazard regression and multivariable Least Absolute Shrinkage and Selection Operator (LASSO) regression were used to assess independent prognostic factors for recurrence. A nomogram model was then built based on the independent factors selected through LASSO regression, to predict the probabilities of HCC recurrence at one, three, and five years. Results The rate of HCC recurrence after LT was 17.4% (31 of 178). The LASSO analysis revealed six independent predictors associated with an elevated risk of tumor recurrence. These predictors included the presence of peritumoral enhancement, the presence of over three tumor lesions, the largest tumor diameter greater than 3 cm, serum alpha-fetoprotein (AFP) levels exceeding 400 ng/mL, and the presence of a tumor capsule. Conversely, a history of bridging therapies was found to be correlated with a reduced risk of HCC recurrence. In addition, Kaplan-Meier curves showed patients with irregular margin, satellite nodules, or small lesions displayed shorter time-to-recurrence. Our nomogram demonstrated good performance, yielding a C-index of 0.835 and AUC values of 0.86, 0.88, and 0.85 for the predictions of 1-year, 3-year, and 5-year TTR, respectively. Conclusion Imaging parameters derived from baseline contrast-enhanced CT showing malignant behavior and aggressive growth patterns, along with serum AFP and history of bridging therapies, show potential as biomarkers for predicting HCC recurrence after transplantation.
Collapse
Affiliation(s)
| | - Philipp Schindler
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Nikolaus Börner
- Department of General, Visceral and Transplantation Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Mirjam Gerwing
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | | | - Enrico N De Toni
- Department for Internal Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Christian M Lange
- Department for Internal Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Jonel Trebicka
- Department for Internal Medicine B, Universitätsklinikum Münster, Münster, Germany
| | - Haluk Morgül
- Department of General, Visceral and Transplant Surgery, Universitätsklinikum Münster, Münster, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, Universitätsklinikum Münster, Münster, Germany
| | - Markus Guba
- Department of General, Visceral and Transplantation Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Michael Ingrisch
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
5
|
Graf M, Lange CM, Langer MM, Schattenberg JM, Seessle J, Dietz J, Vermehren A, Michael FA, Mondorf A, Zeuzem S, Pathil A, Graf C. Primary Biliary Cholangitis (PBC)-Autoimmune Hepatitis (AIH) Variant Syndrome: Clinical Features, Response to Therapy and Long-Term Outcome. J Clin Med 2023; 12:7047. [PMID: 38002661 PMCID: PMC10672247 DOI: 10.3390/jcm12227047] [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: 08/06/2023] [Revised: 11/02/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Standardization of diagnostic criteria of autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) variant syndrome (AIH-PBC VS) has not been achieved so far and evidence-based recommendations for monitoring and treatment of the disease are still lacking. Our study aimed to assess the prevalence, biochemical, and serological features, as well as the clinical course, of VS. METHODS We performed a retrospective study including all patients with VS between 1999 and 2020 in four German centers. Data on demographic parameters, biochemical and serological tests, treatment, and outcome were collected. RESULTS Of 90 patients (3.1%) meeting Paris criteria for VS diagnosis, 65.6% showed AIH and PBC histological features, while biochemical Paris criteria were observed comparatively rarely. Further antibodies, which were not part of the diagnostic criteria of VS, were found in a subgroup of patients with available data (ACA: 30.0%; anti-CENP-A: 25.0%; anti-CENP-B: 33.3%; anti-SP100: 21.4%). Biochemical response was more frequently observed in patients treated with a combined therapy of ursodeoxycholic acid (UDCA) and immunosuppression (IS). Liver cirrhosis was detected in 31 patients (34.4%) and 25 patients (27.8%) developed clinical manifestations of portal hypertension. CONCLUSIONS Biochemical Paris criteria of VS were rarely detected, thus implying that these cut-off values should be redefined. Regarding pharmacological treatment, combined therapy of UDCA and IS appeared to be more effective than monotherapy with UDCA.
Collapse
Affiliation(s)
- Markus Graf
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Christian M. Lange
- Department of Internal Medicine II, University Hospital Munich, 81377 Munich, Germany; (C.M.L.); (M.M.L.)
| | - Mona M. Langer
- Department of Internal Medicine II, University Hospital Munich, 81377 Munich, Germany; (C.M.L.); (M.M.L.)
| | - Jörn M. Schattenberg
- Department of Internal Medicine I, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Jessica Seessle
- Department of Internal Medicine IV, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Julia Dietz
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Annika Vermehren
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Florian A. Michael
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Antonia Mondorf
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Anita Pathil
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| | - Christiana Graf
- Department of Internal Medicine I, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany; (M.G.); (J.D.); (A.V.); (F.A.M.); (A.M.); (S.Z.); (A.P.)
| |
Collapse
|
6
|
Lange CM, Trebicka J, Gerbes A, Canbay A, Geier A, Merle U, Peck-Radosavljevic M, Tacke F, Vogelmann T, Theis S, Heinze H, Zipprich A. Limited access to liver transplantation and TIPS despite high mortality, healthcare resource use and costs of cirrhosis in Germany. Liver Int 2023; 43:2503-2512. [PMID: 37602977 DOI: 10.1111/liv.15688] [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: 04/12/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND AND AIMS Data on number of patients with cirrhosis in Germany are limited. We therefore aimed to estimate prevalence, comorbidities, mortality, utilization of healthcare resources and costs of patients with cirrhosis and incidence of decompensation of cirrhosis in Germany. METHODS This longitudinal observational study was based on an anonymized representative claims database including 4.9 million persons insured by a statutory health insurance (SHI) between 2015-2020. Patients with decompensated and compensated cirrhosis were selected via diagnostic ICD codes and followed for 2 years. RESULTS Prevalence of cirrhosis in 2015 was 250/100 000, resulting in 201 747 (95% CI: 197 540-206 040) patients extrapolated to the German population. Out of all patients with compensated cirrhosis in 2015 who did not deceased, 16.0% developed a decompensation within 3 years. Overall, 978 patients (Ø-age: 68 years; 60% male) were included in the decompensated, and 5135 patients (Ø-age: 66 years; 59% male) in the compensated cirrhosis cohort. Patients with decompensated cirrhosis had a higher burden of comorbidities (Charlson Comorbidity Index 7.3 vs. 4.4) and 3 times higher costs per quarter (7172 € vs. 2213 €) than patients with compensated cirrhosis. 1-year mortality after decompensation was 51% compared to 8% in compensated cirrhosis. Of note, only few patients with decompensated cirrhosis received a liver transplantation or transjugular intrahepatic portosystemic shunts (TIPS) (1% and 5%). CONCLUSION Patients with cirrhosis have a high healthcare burden in especially decompensated stage. Accordingly, 1-year mortality of decompensated cirrhosis in Germany is high. Despite high health resource utilization, only few patients have access to liver transplantation or TIPS.
Collapse
Affiliation(s)
- Christian M Lange
- Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Jonel Trebicka
- Department of Internal Medicine B, University of Münster, Münster, Germany
| | - Alexander Gerbes
- Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Ali Canbay
- Department of Internal Medicine, University Hospital of the Knappschaftskrankenhauses Bochum, Bochum, Germany
| | - Andreas Geier
- Division of Hepatology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Uta Merle
- Internal Medicine IV Gastroenterology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK), Campus Charité Mitte (CCM), Berlin, Germany
| | | | | | | | - Alexander Zipprich
- Department of Internal Medicine IV (Gastroenterology, Hepatology, Infectiology), University Hospital Jena, Jena, Germany
| |
Collapse
|
7
|
Ben Khaled N, Mörtl B, Beier D, Reiter FP, Pawlowska-Phelan D, Teufel A, Rössler D, Schwade DF, Philipp A, Kubisch I, Ehmer U, Geier A, Lange CM, Mayerle J, Berger-Thürmel K, De Toni EN, Munker S. Changing treatment landscape associated with improved survival in advanced hepatocellular carcinoma: a nationwide, population-based study. Eur J Cancer 2023; 192:113248. [PMID: 37672814 DOI: 10.1016/j.ejca.2023.113248] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND AIMS The treatment of hepatocellular carcinoma (HCC) is undergoing a historic transformation with the approval of several new systemic therapies in the last few years. This study aimed to examine the impact of this changing landscape on survival and costs in a Western nationwide, real-world cohort. METHODS A nationwide representative claims database (InGef) was screened for HCC cases between 2015 and 2020. Survival in an era with only sorafenib (period A, January 2015 to July 2018) and after approval of lenvatinib and other systemic treatments (period B, August 2018 to December 2020) was analysed. Health care costs were assessed. RESULTS We identified 2876 individuals with HCC in the study period. The proportion of patients receiving systemic therapy increased significantly over time, from 11.8% in 2015 to 15.1% in 2020 (p < 0.0001). The median overall survival in period B was 6.5 months (95% confidence interval [CI]: 4.9-8.9) and in period A was 5.3 months (95% CI: 4.5-6.3; p = 0.046). In period B, the median overall survival with lenvatinib was 9.7 months (95% CI: 6.3-18.4) versus 4.8 months with sorafenib (95% CI: 4.0-7.1, p = 0.008). Costs for prescription drugs per patient increased from €6150 in 2015 to €9049 in 2020 (p < 0.0001), and costs for outpatient care per patient increased from €1646 to €2149 (p = 0.0240). CONCLUSION The approval of new systemic therapies resulted in a survival benefit in patients with HCC. The magnitude of the effect is modest and associated with a moderate increase in health costs.
Collapse
Affiliation(s)
- Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Institute of Molecular Oncology and Functional Genomics, School of Medicine, TU München, Munich, Germany.
| | - Bernhard Mörtl
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Dominik Beier
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Florian P Reiter
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | - Andreas Teufel
- Department of Medicine II, Division of Hepatology, Division of Bioinformatics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Rössler
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Daniel F Schwade
- Institute of Molecular Oncology and Functional Genomics, School of Medicine, TU München, Munich, Germany
| | - Alexander Philipp
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Ilja Kubisch
- Department of Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, Metabolic Disorders, Oncology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Ursula Ehmer
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Internal Medicine II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Andreas Geier
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Christian M Lange
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Karin Berger-Thürmel
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Stefan Munker
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; Department of Pharmaceutical Biology, LMU Munich, Munich, Germany
| |
Collapse
|
8
|
Mücke MM, Bruns T, Canbay A, Matzdorff A, Tacke F, Tiede A, Trebicka J, Wedemeyer H, Zacharowski K, Zeuzem S, Lange CM. [Use of Thrombopoetin-Receptor-Agonists (TPO-RA) in patients with liver cirrhosis before invasive procedures]. Z Gastroenterol 2023; 61:1225-1234. [PMID: 36377140 DOI: 10.1055/a-1934-1867] [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: 11/17/2022]
Abstract
Advanced chronic liver disease is accompanied with relevant changes in the corpuscular and plasmatic coagulation system. Due to thrombocytopenia that is regularly observed in these patients, platelet transfusions are often performed prior invasive procedures to prevent possible bleeding complications. However, platelet transfusions are associated with clinically significant adverse events and economically relevant health care costs. Thus, avoiding unnecessary platelet transfusions remains pivotal in daily clinical practice. The first step is to carefully check if increasing platelet counts prior to a planned invasive procedure is really necessary. Nowadays, two well-tolerated thrombopoetin-receptor agonists (TPO-RAs), Avatrombopaq and Lusutrombopaq, to treat thrombocytopenia preemptively before an invasive procedure in patients with liver cirrhosis are available. This review provides a guide for clinician when to increase platelet counts prior an invasive procedure in patients with liver cirrhosis and helps to identify situations in which the use of TPO-RA may be reasonable.
Collapse
Affiliation(s)
- Marcus M Mücke
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe Universität, Frankfurt am Main, Germany
| | - Tony Bruns
- Medizinische Klinik III, Uniklinik RWTH Aachen, Rheinisch-Westfaelische Technische Hochschule, Aachen, Germany
| | - Ali Canbay
- Klinik für Innere Medizin, Universitätsklinikum des Knappschaftskrankenhauses Bochum, Bochum, Germany
| | - Axel Matzdorff
- Klinik für Innere Medizin II, Asklepios Klinikum Uckermark GmbH, Schwedt/Oder, Germany
| | - Frank Tacke
- Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Tiede
- Klinik für Hämatologie, Hämostaseologie, Onkologie und Stammzelltransplantation, Medizinische Hochschule, Hannover, Germany
| | - Jonel Trebicka
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe Universität, Frankfurt am Main, Germany
- Medizinische Klinik B, Universitätsklinikum Münster, Westfälische Wilhelms Universität Münster, Münster, Germany
| | - Heiner Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Kai Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe Universität, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Medizinische Klinik 1, Universitätsklinikum Frankfurt, Goethe Universität, Frankfurt am Main, Germany
| | - Christian M Lange
- Klinik und Poliklinik für Innere Medizin II, LMU Klinikum München, München, Germany
| |
Collapse
|
9
|
Deniz S, Schinner R, Monroe EJ, Horslen S, Srinivasa RN, Lv Y, Fan D, Han G, Sarma MS, Srivastava A, Poddar U, Yadav R, Hoang TPT, Lange CM, Öcal O, Ricke J, Seidensticker M, Lurz E, Di Giorgio A, D'Antiga L, Wildgruber M. Outcome of Children with Transjugular Intrahepatic Portosystemic Shunt: A Meta-Analysis of Individual Patient Data. Cardiovasc Intervent Radiol 2023; 46:1203-1213. [PMID: 37532945 PMCID: PMC10471675 DOI: 10.1007/s00270-023-03520-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE The purpose of the study was to investigate outcome after pediatric transjugular intrahepatic portosystemic shunt (TIPS) with respect to survival MATERIAL AND METHODS: After searching for studies on TIPS in children in Ovid, Medline, Embase, Scopus and Cochrane published between 2000 and 2022, individual patient data were retrieved from five retrospective cohorts. Overall survival (OS) and transplant-free survival (TFS) were calculated using Kaplan-Meier analysis and log-rank test and compared to the indication (ascites vs. variceal bleeding) as well as to the level of obstruction (pre-hepatic vs. hepatic vs. post-hepatic). Additionally, TIPS patency was analyzed. RESULTS n = 135 pediatric patients were included in the final analysis. Indication for pediatric TIPS creation was heterogeneous among the included studies. TIPS patency decreased from 6 to 24 months, subsequent pediatric liver transplantation was performed in 22/135 (16.3%) of cases. The presence of ascites was related with poorer TFS (HR 2.3, p = 0.023), while variceal bleeding was not associated with impaired survival. Analysis of the level of obstruction (pre-hepatic, hepatic and post-hepatic) failed to prove significantly reduced OS for post-hepatic obstruction (HR 3.2, p = 0.092) and TFS (HR 1.3, p = 0.057). There was no difference in OS and TFS according to age at time of TIPS placement. CONCLUSIONS The presence of ascites associates with impaired survival after TIPS in children, with no differences in survival according to the age of the child. Interventional shunt procedures can be considered feasible for all ages. LEVEL OF EVIDENCE Level 2a.
Collapse
Affiliation(s)
- Sinan Deniz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Eric J Monroe
- Department of Radiology, University of Wisconsin, Madison, WA, USA
| | - Simon Horslen
- Division of Gastroenterology and Hepatology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ravi N Srinivasa
- Division of Vascular and Interventional Radiology, Department of Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Yong Lv
- Military Medical Innovation Center, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, Digestive Diseases Hospital, Xi'an International Medical Center Hospital, Northwest University, Xi'an, China
| | - Moinak Sen Sarma
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Anshu Srivastava
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Ujjal Poddar
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Rajanikant Yadav
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Thi Phuong Thao Hoang
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian M Lange
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Eberhard Lurz
- Division for Pediatric Gastroenterology, Hepatology and Transplantation, Department for Pediatrics, Dr. Von Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany
| | - Angelo Di Giorgio
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII Bergamo, Bergamo, Italy
| | - Lorenzo D'Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII Bergamo, Bergamo, Italy
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| |
Collapse
|
10
|
Luo X, Zhang R, Schefczyk S, Liang Y, Lin SS, Liu S, Baba HA, Lange CM, Wedemeyer H, Lu M, Broering R. Nuclear translocation of YAP drives BMI-associated hepatocarcinogenesis in hepatitis B virus infection. Liver Int 2023; 43:2002-2016. [PMID: 37312627 DOI: 10.1111/liv.15628] [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: 07/04/2022] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS Hepatitis B virus (HBV) infection is a major cause of hepatocellular carcinoma (HCC) development and progression. The aim of this study was to mechanistically investigate the involvement of Hippo signalling in HBV surface antigen (HBsAg)-dependent neoplastic transformation. METHODS Liver tissue and hepatocytes from HBsAg-transgenic mice were examined for the Hippo cascade and proliferative events. Functional experiments in mouse hepatoma cells included knockdown, overexpression, luciferase reporter assays and chromatin immunoprecipitation. Results were validated in HBV-related HCC biopsies. RESULTS Hepatic expression signatures in HBsAg-transgenic mice correlated with YAP responses, cell cycle control, DNA damage and spindle events. Polyploidy and aneuploidy occurred in HBsAg-transgenic hepatocytes. Suppression and inactivation of MST1/2 led to the loss of YAP phosphorylation and the induction of BMI1 expression in vivo and in vitro. Increased BMI1 directly mediated cell proliferation associated with decreased level of p16INK4a , p19ARF , p53 and Caspase 3 as well as increased Cyclin D1 and γ-H2AX expression. Chromatin immunoprecipitation and the analysis of mutated binding sites in dual-luciferase reporter assays confirmed that the YAP/TEAD4 transcription factor complex bound and activated the Bmi1 promoter. In chronic hepatitis B patients, paired liver biopsies of non-tumour and tumour tissue indicated a correlation between YAP expression and the abundance of BMI1. In a proof-of-concept, treatment of HBsAg-transgenic mice with YAP inhibitor verteporfin directly suppressed the BMI1-related cell cycle. CONCLUSION HBV-associated proliferative HCC might be related to the HBsAg-YAP-BMI1 axis and offer a potential target for the development of new therapeutic approaches.
Collapse
Affiliation(s)
- Xufeng Luo
- Institute for Lymphoma Research, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Rui Zhang
- Department of Hepato-Pancreato-Biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Stefan Schefczyk
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Yaojie Liang
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Shu S Lin
- Department of Hepato-Pancreato-Biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shi Liu
- State Key Laboratory of Virology, Modern Virology Research Center, College of Life Sciences, Wuhan University, Wuhan, China
| | - Hideo A Baba
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian M Lange
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
- Department of Internal Medicine II, LMU University Hospital Munich, Munich, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Mengji Lu
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ruth Broering
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
11
|
Jeschke M, Ludwig JM, Leyh C, Pabst KM, Weber M, Theysohn JM, Lange CM, Herrmann K, Schmidt HHJ, Jochheim LS. Bilobar Radioembolization Carries the Risk of Radioembolization-Induced Liver Disease in the Treatment of Advanced Hepatocellular Carcinoma: Safety and Efficacy Comparison to Systemic Therapy with Atezolizumab/Bevacizumab. Cancers (Basel) 2023; 15:4274. [PMID: 37686549 PMCID: PMC10486761 DOI: 10.3390/cancers15174274] [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: 07/24/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Recommended treatment options for advanced-stage hepatocellular carcinoma (HCC) include systemic therapy (ST) and trans-arterial radioembolization (TARE) with Yttrium-90 (Y90). Before the approval of immune-checkpoint inhibitors, a similar safety profile was reported for TARE and ST with tyrosine kinase inhibitors (TKI). However, whole-liver treatment and underlying cirrhosis were identified as risk factors for potentially lethal radioembolization-induced liver disease (REILD). Therefore, the safety and efficacy of TARE and ST with atezolizumab/bevacizumab were compared in patients with advanced HCC involving at least both liver lobes in a retrospective real-world cohort. In total, 74 patients with new or recurrent advanced-stage HCC (BCLC stage B/C) were included if treated with either bilobar TARE (n = 33) or systemic combination therapy with atezolizumab plus bevacizumab (n = 41). Most patients had compensated liver function (90.5% were classified as Child-Pugh Score A, 73% as ALBI Grade 1) at baseline. Although not significant, patients treated with ST showed a more prolonged overall survival than those treated with Y90 TARE (7.1 months vs. 13.0 months, p = 0.07). While a similar disease control rate could be achieved with bilobar TARE and atezolizumab/bevacizumab, in the TARE group, overall survival was curtailed by the occurrence of REILD. In patients with underlying liver cirrhosis, the liver function at baseline was a predictor for REILD.
Collapse
Affiliation(s)
- Matthias Jeschke
- Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Johannes M. Ludwig
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Catherine Leyh
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty of Heinrich Heine University Düsseldorf, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Kim M. Pabst
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, 45147 Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, 45147 Essen, Germany
| | - Jens M. Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Christian M. Lange
- Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- German Cancer Consortium (DKTK), University Hospital Essen, 45147 Essen, Germany
| | - Hartmut H. -J. Schmidt
- Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Leonie S. Jochheim
- Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| |
Collapse
|
12
|
Payani E, Börner N, Kolliogiannis D, Brunner S, Klein I, Ehmer U, Denk G, Lange CM, Ograja K, Dietrich P, Werner J, Guba M. Regional transplant rates depend more on physician-dependent variables than on proximity to transplant center. Langenbecks Arch Surg 2023; 408:191. [PMID: 37171640 PMCID: PMC10181954 DOI: 10.1007/s00423-023-02874-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/30/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The objective of this work was to uncover inequalities in access to liver transplantation in Bavaria, Germany. METHODS For this purpose, the annual transplantation rate per 1 million inhabitants for the respective districts was determined from the aggregated postal codes of the place of residence of transplanted patients. The variables examined were proximity and travel time to the nearest transplant center, as well as the care category of the regional hospital. In addition, we assessed whether the head of gastroenterology at the regional hospital through which liver transplant candidates are referred was trained at a liver transplant center. RESULTS We could not demonstrate a direct relationship between proximity or travel time to the nearest transplant center and access to liver transplantation. Multivariate regression analysis shows that liver transplant training (p < 0.0001) of the chief physician (gastroenterologist) of the regional hospital was the most decisive independent factor for access to liver transplantation within a district. CONCLUSION We show that the transplant training experience of the head of gastroenterology at a regional hospital is an independent factor for the regional transplantation rate. Therefore, it appears important to maintain some liver transplant expertise outside the transplant centers in order to properly identify and assign potential transplant candidates for transplantation.
Collapse
Affiliation(s)
- Elnaz Payani
- Department of General, Visceral and Transplant Surgery, LMU Klinikum Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Nikolaus Börner
- Department of General, Visceral and Transplant Surgery, LMU Klinikum Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Dionysios Kolliogiannis
- Department of General, Visceral and Transplant Surgery, LMU Klinikum Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefan Brunner
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Ingo Klein
- Department of Surgery, University of Würzburg, Würzburg, Germany
| | - Ursula Ehmer
- Internal Medicine II, Klinikum Rechts Der Isar, Technical University Munich, Munich, Germany
| | | | | | | | - Peter Dietrich
- Transplant Center Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jens Werner
- Department of General, Visceral and Transplant Surgery, LMU Klinikum Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Markus Guba
- Department of General, Visceral and Transplant Surgery, LMU Klinikum Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany.
| |
Collapse
|
13
|
Dietz-Fricke C, Tacke F, Zöllner C, Demir M, Schmidt HH, Schramm C, Willuweit K, Lange CM, Weber S, Denk G, Berg CP, Grottenthaler JM, Merle U, Olkus A, Zeuzem S, Sprinzl K, Berg T, van Bömmel F, Wiegand J, Herta T, Seufferlein T, Zizer E, Dikopoulos N, Thimme R, Neumann-Haefelin C, Galle PR, Sprinzl M, Lohse AW, Schulze zur Wiesch J, Kempski J, Geier A, Reiter FP, Schlevogt B, Gödiker J, Hofmann WP, Buggisch P, Kahlhöfer J, Port K, Maasoumy B, Cornberg M, Wedemeyer H, Deterding K. Treating hepatitis D with bulevirtide - Real-world experience from 114 patients. JHEP Rep 2023; 5:100686. [PMID: 37025462 PMCID: PMC10071092 DOI: 10.1016/j.jhepr.2023.100686] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 04/08/2023] Open
Abstract
Background & Aims Bulevirtide is a first-in-class entry inhibitor of hepatitis B surface antigen. In July 2020, bulevirtide was conditionally approved for the treatment of hepatitis D, the most severe form of viral hepatitis, which frequently causes end-stage liver disease and hepatocellular carcinoma. Herein, we report the first data from a large multicenter real-world cohort of patients with hepatitis D treated with bulevirtide at a daily dose of 2 mg without additional interferon. Methods In a joint effort with 16 hepatological centers, we collected anonymized retrospective data from patients treated with bulevirtide for chronic hepatitis D. Results Our analysis is based on data from 114 patients, including 59 (52%) with cirrhosis, receiving a total of 4,289 weeks of bulevirtide treatment. A virologic response defined as an HDV RNA decline of at least 2 log or undetectable HDV RNA was observed in 87/114 (76%) cases with a mean time to virologic response of 23 weeks. In 11 cases, a virologic breakthrough (>1 log-increase in HDV RNA after virologic response) was observed. After 24 weeks of treatment, 19/33 patients (58%) had a virologic response, while three patients (9%) did not achieve a 1 log HDV RNA decline. No patient lost hepatitis B surface antigen. Alanine aminotransferase levels improved even in patients not achieving a virologic response, including five patients who had decompensated cirrhosis at the start of treatment. Treatment was well tolerated and there were no reports of drug-related serious adverse events. Conclusions In conclusion, we confirm the safety and efficacy of bulevirtide monotherapy in a large real-world cohort of patients with hepatitis D treated in Germany. Future studies need to explore the long-term benefits and optimal duration of bulevirtide treatment. Impact and implications Clinical trials proved the efficacy of bulevirtide for chronic hepatitis D and led to conditional approval by the European Medical Agency. Now it is of great interest to investigate the effects of bulevirtide treatment in a real-world setting. In this work, we included data from 114 patients with chronic hepatitis D who were treated with bulevirtide at 16 German centers. A virologic response was seen in 87/114 cases. After 24 weeks of treatment, only a small proportion of patients did not respond to treatment. At the same time, signs of liver inflammation improved. This observation was independent from changes in hepatitis D viral load. The treatment was generally well tolerated. In the future, it will be of interest to investigate the long-term effects of this new treatment.
Collapse
Affiliation(s)
- Christopher Dietz-Fricke
- Department of Gastroenterology, Hepatology and Endocrinology at Hannover Medical School, Hannover, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Berlin, Germany
| | - Caroline Zöllner
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Berlin, Germany
| | - Münevver Demir
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Berlin, Germany
| | - Hartmut H. Schmidt
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Christoph Schramm
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Katharina Willuweit
- Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Christian M. Lange
- Department of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Sabine Weber
- Department of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Gerald Denk
- Department of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Christoph P. Berg
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Julia M. Grottenthaler
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Infectiology, and Geriatrics, University Hospital Tuebingen, Tuebingen, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
| | - Alexander Olkus
- Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
| | - Stefan Zeuzem
- Internal Medicine Department, Goethe University Hospital, Frankfurt, Germany
| | - Kathrin Sprinzl
- Internal Medicine Department, Goethe University Hospital, Frankfurt, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Florian van Bömmel
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Johannes Wiegand
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Toni Herta
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | | | - Eugen Zizer
- Department of Internal Medicine I, University of Ulm, Ulm, Germany
| | | | - Robert Thimme
- Department of Medicine II, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter R. Galle
- Department of Medicine I, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | - Martin Sprinzl
- Department of Medicine I, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | - Ansgar W. Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Schulze zur Wiesch
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg - Lübeck - Borstel - Riems, Hamburg, Germany
| | - Jan Kempski
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Mildred Scheel Cancer Career Center HaTriCS, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Geier
- University Hospital Würzburg, Division of Hepatology, Dept. of Medicine II, Würzburg, Germany
| | - Florian P. Reiter
- University Hospital Würzburg, Division of Hepatology, Dept. of Medicine II, Würzburg, Germany
| | | | - Juliana Gödiker
- Department of Medicine B, University Hospital Münster, Münster, Germany
| | | | - Peter Buggisch
- Ifi-Institute for Interdisciplinary Medicine, Hamburg, Germany
| | - Julia Kahlhöfer
- Department of Gastroenterology, Hepatology and Endocrinology at Hannover Medical School, Hannover, Germany
| | - Kerstin Port
- Department of Gastroenterology, Hepatology and Endocrinology at Hannover Medical School, Hannover, Germany
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology at Hannover Medical School, Hannover, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology at Hannover Medical School, Hannover, Germany
- D-SOLVE consortium, a EU Horizon Europe funded project (No 101057917)
- Centre for Individualised Infection Medicine (CiiM), a Joint Venture Between the Helmholtz Centre for Infection Research (HZI) and Hannover Medical School (MHH), Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology at Hannover Medical School, Hannover, Germany
- Excellence Cluster Resist, Hannover Medical School, Germany
- German Centre for Infection Research (DZIF), Hannover-Braunschweig, Germany
- D-SOLVE consortium, a EU Horizon Europe funded project (No 101057917)
| | - Katja Deterding
- Department of Gastroenterology, Hepatology and Endocrinology at Hannover Medical School, Hannover, Germany
- Corresponding author. Address: Department of Gastroenterology, Hepatology and Endocrinology at Hannover Medical School, Hannover, Germany.
| |
Collapse
|
14
|
Langer MM, Sichelschmidt S, Bauschen A, Bornemann L, Guckenbiehl S, Gunzer M, Lange CM. Pathological neutrophil migration predicts adverse outcomes in hospitalized patients with liver cirrhosis. Liver Int 2023; 43:896-905. [PMID: 36440606 DOI: 10.1111/liv.15486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/04/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Given the early response of neutrophil granulocytes to infections, detection of pathological neutrophil migration might help in predicting adverse events in patients with liver cirrhosis. METHODS Migration of blood neutrophils in hospitalized patients with cirrhosis was characterized by a novel standardized migration assay. Pathological neutrophil migration patterns were associated with a composite endpoint of ACLF, sepsis or death within 7 or 30 days. RESULTS Overall, 125 patients were included, of whom 11 (8.8%) had compensated cirrhosis, 84 (67.2%) had acute decompensation (AD) and 30 (24%) had acute-on-chronic liver failure (ACLF). The migration response of neutrophils from patients with AD or ACLF to stimulation with the chemotactic formylpeptide f-Met-Leu-Phe (fMLP) was significantly impaired, while the response to chemokine (C-X-C motif)-ligand 8 (CXCL8) was affected less pronouncedly. In contrast, no relevant differences in response to CXCL1 were observed. Of note, neutrophils of a number of patients with AD and ACLF were largely immotile at resting and stimulated conditions. Patients with non-migrating neutrophils at unstimulated conditions were at high risk to develop the composite endpoint of ACLF, sepsis or death. Moreover, expression of chemokine receptors CXCR1 and CXCR2 was significantly decreased in patients with ACLF. Interestingly, the expression of chemokine receptors did not correlate with neutrophil migration patterns, but-based on the increased expression of the cell surface markers CD66b and CD177-neutrophils of patients with AD and ACLF were strongly pre-activated. CONCLUSION Pathological neutrophil migration in patients with cirrhosis indicates a high risk of developing adverse outcomes.
Collapse
Affiliation(s)
- Mona-May Langer
- Department for Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg-Essen, Germany
- Department of Internal Medicine II, LMU University Hospital Munich, Munich, Germany
| | - Stefanie Sichelschmidt
- Department for Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Alina Bauschen
- Department for Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Lea Bornemann
- Institute for Experimental Immunology and Imaging, University Hospital Essen, University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Sabrina Guckenbiehl
- Department for Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg-Essen, Germany
| | - Matthias Gunzer
- Institute for Experimental Immunology and Imaging, University Hospital Essen, University of Duisburg-Essen, Duisburg-Essen, Germany
- Leibniz-Institut für Analytische Wissenschaften - ISAS -e.V, Dortmund, Germany
| | - Christian M Lange
- Department for Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Duisburg-Essen, Germany
- Department of Internal Medicine II, LMU University Hospital Munich, Munich, Germany
| |
Collapse
|
15
|
Stahl K, Klein F, Voigtländer T, Großhennig A, Book T, Müller T, Wree A, Kuellmer A, Weigt J, Dechene A, Wedi E, Kandulski A, Lange CM, Holzwart D, von Witzendorff D, Ringe KI, Wedemeyer H, Heidrich B. BISCIT: Biliary interventions in critically ill patients with secondary sclerosing cholangitis-a study protocol for a multicenter, randomized, controlled parallel group trial. Trials 2023; 24:247. [PMID: 37004078 PMCID: PMC10067228 DOI: 10.1186/s13063-023-07260-w] [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: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Progress of cholangitis to cholangiosepsis is a frequent observation in patients with secondary sclerosing cholangitis in critically ill patients (SSC-CIP). Adequate biliary drainage may reduce episodes of cholangiosepsis and therefore stabilize liver function and improve survival. The primary objective of the BISCIT study is to demonstrate that scheduled biliary interventions will reduce incidence of cholangiosepsis, liver transplantation, or death in patients with SSC-CIP. METHODS A total of 104 patients will be randomized at ten study sites. Patients with SSC-CIP, confirmed by endoscopic retrograde cholangiography (ERC), will be randomized 1:1 either in the intervention group which will be treated with scheduled biliary interventions (i.e., therapeutic ERC) every 8 weeks for 6 months or in the control group which will receive standard of care. The randomization will be stratified by center. The composite primary efficacy endpoint is defined as (1) occurrence of death, (2) necessity of liver transplantation, or (3) occurrence of cholangiosepsis within 6 months following randomization. DISCUSSION Prospective evaluation of endoscopic treatment procedures is urgently needed to establish an evidence-based therapeutic treatment algorithm in SSC-CIP. A positive trial result could change the current standard of care for patients with SSC-CIP. The results of this study will be disseminated through presentations at international congresses, workshops, and peer-reviewed publications. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov (NCT05396755, date of registration: May 31, 2022, last update: May 31, 2022).
Collapse
Affiliation(s)
- Klaus Stahl
- Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Carl-Neuberg Strasse 1, 30625, Hannover, Germany.
| | - Friederike Klein
- Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Torsten Voigtländer
- Department of Gastroenterology, Clementinenkrankenhaus Hannover, Hannover, Germany
| | - Anika Großhennig
- Department of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Thorsten Book
- Department of Gastroenterology, Clementinenkrankenhaus Hannover, Hannover, Germany
| | - Tobias Müller
- Department of Hepatology and Gastroenterology, Charite University Medicine Berlin, Campus Charite Mitte/Campus Virchow Clinic, Berlin, Germany
| | - Alexander Wree
- Department of Hepatology and Gastroenterology, Charite University Medicine Berlin, Campus Charite Mitte/Campus Virchow Clinic, Berlin, Germany
| | - Armin Kuellmer
- Clinic for Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, University Hospital Freiburg, Freiburg, Germany
| | - Jochen Weigt
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexander Dechene
- Department of Gastroenterology and Endocrinology, Hospital Nurnberg, Nurnberg, Germany
| | - Edris Wedi
- Department of Gastroenterology, Gastro-Oncology and Interventional Endoscopy, Sana Hospital Offenbach, Offenbach, Germany
| | - Arne Kandulski
- Department of Gastroenterology, Endocrinology, Infectious Diseases and Rheumatology, University Hospital Regensburg, Regensburg, Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital Munich (LMU), Munich, Germany
| | - Dennis Holzwart
- Department of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Dorothee von Witzendorff
- Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Zentrum Klinische Studien (ZKS), Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Benjamin Heidrich
- Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| |
Collapse
|
16
|
Le-Trilling VTK, Ebel JF, Baier F, Wohlgemuth K, Pfeifer KR, Mookhoek A, Krebs P, Determann M, Katschinski B, Adamczyk A, Lange E, Klopfleisch R, Lange CM, Sokolova V, Trilling M, Westendorf AM. Acute cytomegalovirus infection modulates the intestinal microbiota and targets intestinal epithelial cells. Eur J Immunol 2023; 53:e2249940. [PMID: 36250419 DOI: 10.1002/eji.202249940] [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: 04/12/2022] [Revised: 08/29/2022] [Accepted: 10/14/2022] [Indexed: 02/04/2023]
Abstract
Primary and recurrent cytomegalovirus (CMV) infections frequently cause CMV colitis in immunocompromised as well as inflammatory bowel disease (IBD) patients. Additionally, colitis occasionally occurs upon primary CMV infection in patients who are apparently immunocompetent. In both cases, the underlying pathophysiologic mechanisms are largely elusive - in part due to the lack of adequate access to specimens. We employed the mouse cytomegalovirus (MCMV) model to assess the association between CMV and colitis. During acute primary MCMV infection of immunocompetent mice, the gut microbial composition was affected as manifested by an altered ratio of the Firmicutes to Bacteroidetes phyla. Interestingly, these microbial changes coincided with high-titer MCMV replication in the colon, crypt hyperplasia, increased colonic pro-inflammatory cytokine levels, and a transient increase in the expression of the antimicrobial protein Regenerating islet-derived protein 3 gamma (Reg3γ). Further analyses revealed that murine and human intestinal epithelial cell lines, as well as primary intestinal crypt cells and organoids represent direct targets of CMV infection causing increased cell death. Accordingly, in vivo MCMV infection disrupted the intestinal epithelial barrier and increased apoptosis of intestinal epithelial cells. In summary, our data show that CMV transiently induces colitis in immunocompetent hosts by altering the intestinal homeostasis.
Collapse
Affiliation(s)
| | - Jana-Fabienne Ebel
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Franziska Baier
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kerstin Wohlgemuth
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Kai Robin Pfeifer
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Aart Mookhoek
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Philippe Krebs
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Madita Determann
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Benjamin Katschinski
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexandra Adamczyk
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Erik Lange
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Free University of Berlin, Berlin, Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Viktoriya Sokolova
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Inorganic Chemistry and Centre for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, Essen, Germany
| | - Mirko Trilling
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Astrid M Westendorf
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
17
|
Doldi PM, Stolz L, Buech J, Saha S, Weckbach L, Gmeiner J, Orban M, Braun D, Stocker TJ, Nabauer M, Lange CM, Massberg S, Hagl C, Hausleiter J. Indocyanine green clearance predicts outcome in patients undergoing transcatheter valve intervention for severe atrio-ventricular valve regurgitation. Interdiscip Cardiovasc Thorac Surg 2023; 36:7008333. [PMID: 36847676 PMCID: PMC9901415 DOI: 10.1093/icvts/ivad024] [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] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Severe mitral regurgitation (MR) and tricuspid regurgitation (TR) aggravate haemodynamic stress leading to congestive heart failure with impaired hepatic function, also known as cardiohepatic syndrome (CHS). Current perioperative risk calculators do not sufficiently consider CHS and serum liver function parameters lack sensitivity to diagnose CHS. Indocyanine green and its elimination (measured by the LIMON® test) represent a dynamic and non-invasive test which correlates with the hepatic function. Nevertheless, its utility in the setting of transcatheter valve repair/replacement (TVR) to predict CHS and outcome remains unknown. METHODS We analysed liver function and outcomes of patients undergoing TVR for MR or TR between August 2020 and May 2021 at the Munich University Hospital. RESULTS Out of a total of 44 patients treated at the University Hospital of Munich, 21 (48%) were treated for severe MR, 20 (46%) for severe TR and 3 (7%) for both diseases. Procedural success defined as MR/TR ≤2+ was 94% among MR patients and 92% among TR patients. While classical serum liver function parameters did not change after TVR, there was a significant improvement in liver function as assessed by the LIMON® test (P ≤ 0.001). Patients with baseline indocyanine green plasma disappearance rate <12.95%/min showed significantly increased 1-year mortality (hazard ratio: 1.54, 95% confidence interval: 1.05-2.25, P = 0.027) and lower New York Hear Association class improvement (P = 0.05). CONCLUSIONS Especially in the context of the recently stressed importance of a careful patient selection prior to the interdisciplinary treatment of valvular heart disease, the LIMON® test may provide further real-time information on the patients' cardiohepatic injury and prognosis.
Collapse
Affiliation(s)
- Philipp Maximilian Doldi
- Corresponding author. Medizinische Klinik und Poliklinik I, Marchioninistr. 15, 81377 München, Germany. Tel: +49-89-4400-72361; fax: +49-89-4400-78870; e-mail: (P.M. Doldi)
| | - Lukas Stolz
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Joscha Buech
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Department of Cardiac Surgery, Ludwig Maximillian University of Munich, Munich, Germany
| | - Shekhar Saha
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Department of Cardiac Surgery, Ludwig Maximillian University of Munich, Munich, Germany
| | - Ludwig Weckbach
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jonas Gmeiner
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Martin Orban
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Nabauer
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian M Lange
- Department of Gastroenterology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Department of Cardiac Surgery, Ludwig Maximillian University of Munich, Munich, Germany
| | - Jörg Hausleiter
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| |
Collapse
|
18
|
Langer MM, Bauschen A, Guckenbiehl S, Klauss S, Lutz T, Denk G, Zwanziger D, Moeller LC, Lange CM. Evolution of non-thyroidal illness syndrome in acute decompensation of liver cirrhosis and acute-on-chronic liver failure. Front Endocrinol (Lausanne) 2023; 14:1104388. [PMID: 36755907 PMCID: PMC9899974 DOI: 10.3389/fendo.2023.1104388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND AIMS Non-thyroidal illness syndrome (NTIS) is frequent in critically ill patients and associated with adverse outcomes. We aimed to characterize the evolution of NTIS in patients with acute decompensation (AD) of cirrhosis and acute-on-chronic liver failure (ACLF), since NTIS is not well described in these newly defined syndromes. METHODS Thyroid hormones (TH) were quantified at baseline in consecutive patients with cirrhosis. In addition, 76 inflammatory mediators were quantified by proximity extension analysis assay in a subgroup of patients. Associations between TH, cirrhosis stage, mortality and inflammation were assessed. RESULTS Overall, 437 patients were included, of whom 165 (37.8%), 211 (48.3%), and 61 (14%) had compensated cirrhosis (CC), AD, and ACLF. FT3 concentrations were lower in AD versus CC, and further decreased in ACLF. Importantly, NTIS was present in 83 (39.3%) patients with AD and in 44 (72.1%) patients with ACLF (P<0.001). Yet, TSH and TSH-based indexes (TSH/FT3-ratio, thyroid index) showed an U-shaped evolution during progression of cirrhosis, suggesting a partially preserved responsiveness of the hypothalamus and pituitary in AD. Infections were associated with lower FT3 concentrations in AD, but not in ACLF. Low FT3 concentrations correlated significantly with 90-day mortality. Both, AD/ACLF and NTIS, were associated with signatures of inflammatory mediators, which were partially non-overlapping. CONCLUSION NTIS is frequent already in AD and therefore precedes critically illness in a subgroup of patients with decompensated cirrhosis. This might constitute a new paradigm of TH signaling in cirrhosis, offering opportunities to explore preventive effects of TH in AD.
Collapse
Affiliation(s)
- Mona-May Langer
- Department for Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Department of Internal Medicine II, Ludwig-Maximilians University (LMU) University Hospital Munich, Munich, Germany
| | - Alina Bauschen
- Department for Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sabrina Guckenbiehl
- Department for Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sarah Klauss
- Department of Internal Medicine II, Ludwig-Maximilians University (LMU) University Hospital Munich, Munich, Germany
| | - Teresa Lutz
- Department of Internal Medicine II, Ludwig-Maximilians University (LMU) University Hospital Munich, Munich, Germany
| | - Gerald Denk
- Department of Internal Medicine II, Ludwig-Maximilians University (LMU) University Hospital Munich, Munich, Germany
| | - Denise Zwanziger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lars C. Moeller
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christian M. Lange
- Department for Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Department of Internal Medicine II, Ludwig-Maximilians University (LMU) University Hospital Munich, Munich, Germany
- *Correspondence: Christian M. Lange,
| |
Collapse
|
19
|
A. Aulinger B, H. Saner F, Stark K, Mayerle J, M. Lange C. Platelet Aggregation Inhibitors and Anticoagulants in Gastroenterological and Visceral Surgical Procedures. Dtsch Arztebl Int 2022; 119:851-860. [PMID: 36345703 PMCID: PMC9981979 DOI: 10.3238/arztebl.m2022.0342] [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] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/22/2022] [Accepted: 09/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The proper management of patients being treated with platelet aggregation inhibitors or anticoagulant drugs is a common clinical problem for both elective and emergency procedures in gastroenterology and visceral surgery. The essential matters that must be kept in mind in this situation are the hemorrhagic risk of the procedure, the indication for anticoagulation, and the pharmacology of anticoagulant drugs and platelet aggregation inhibitors. METHODS This review is based on publications retrieved by a selective search in PubMed and on the guidelines of the relevant specialist societies. RESULTS Nearly all procedures in gastroenterology and visceral surgery can be performed under monotherapy with acetyl - salicylic acid. Other platelet aggregation inhibitors, such as clopidogrel or prasugrel, or anticoagulant drugs generally do not need to paused before diagnostic endoscopic procedures with a low risk of bleeding (<1.5%), but they must be paused before procedures in gastroenterology and visceral surgery where the risk of bleeding is high (≥ 1.5%). Bridging with heparin is reserved for patients with a very high risk of thromboembolism ( ≥ 5%). CONCLUSION Knowledge of the current recommendations on the management of anticoagulants before gastroenterological and visceral surgical procedures gives the clinician a well-founded means of dealing with this complex and common clinical situation.
Collapse
Affiliation(s)
| | - Fuat H. Saner
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Germany
| | - Konstantin Stark
- Medizinische Klinik und Poliklinik I, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Julia Mayerle
- Department of Internal Medicine II, LMU University Hospital Munich, Germany
| | - Christian M. Lange
- Department of Internal Medicine II, LMU University Hospital Munich, Germany,*Medizinische Klinik und Poliklinik II, Klinikum der Universität München, Marchioninistrasse 15,D- 81337 Munich, Germany
| |
Collapse
|
20
|
Le‐Trilling VTK, Ebel J, Baier F, Wohlgemuth K, Pfeifer KR, Mookhoek A, Krebs P, Determann M, Katschinski B, Adamczyk A, Lange E, Klopfleisch R, Lange CM, Sokolova V, Trilling M, Westendorf AM. Acute cytomegalovirus infection modulates the intestinal microbiota and targets intestinal epithelial cells. Eur J Immunol 2022. [DOI: 10.1002/eji.202249940 10.1002/eji.202249940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Jana‐Fabienne Ebel
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Franziska Baier
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Kerstin Wohlgemuth
- Institute for Virology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Kai Robin Pfeifer
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Aart Mookhoek
- Institute of Pathology University of Bern Bern Switzerland
| | - Philippe Krebs
- Institute of Pathology University of Bern Bern Switzerland
| | - Madita Determann
- Institute for Virology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Benjamin Katschinski
- Institute for Virology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Alexandra Adamczyk
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Erik Lange
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Robert Klopfleisch
- Institute of Veterinary Pathology Free University of Berlin Berlin Germany
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Viktoriya Sokolova
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
- Inorganic Chemistry and Centre for Nanointegration Duisburg‐Essen (CeNIDE) University of Duisburg‐Essen Essen Germany
| | - Mirko Trilling
- Institute for Virology University Hospital Essen University of Duisburg‐Essen Essen Germany
| | - Astrid M. Westendorf
- Institute of Medical Microbiology University Hospital Essen University of Duisburg‐Essen Essen Germany
| |
Collapse
|
21
|
Langer MM, Eickelmann C, Kleinbongard P, Lange CM. Impaired mitochondrial complex IV respiration in peripheral blood mononuclear cells discriminates acute-on-chronic liver failure from acute decompensation. J Hepatol 2022; 77:874-876. [PMID: 35562066 DOI: 10.1016/j.jhep.2022.04.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Mona-May Langer
- Department for Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Germany; Department of Internal Medicine II, LMU University Hospital Munich, Germany
| | - Chantal Eickelmann
- Institute for Pathophysiology, West German Heart and Vascular Centre, University of Essen Medical School, University Duisburg-Essen, Germany
| | - Petra Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular Centre, University of Essen Medical School, University Duisburg-Essen, Germany
| | - Christian M Lange
- Department for Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Germany; Department of Internal Medicine II, LMU University Hospital Munich, Germany.
| |
Collapse
|
22
|
Ben Khaled N, Allgeier J, Lutz T, Weber S, Lange CM. Medikamentöse Therapie bei Patienten mit Leberzirrhose. Gastroenterologie 2022. [PMCID: PMC9247913 DOI: 10.1007/s11377-022-00635-6] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Die Leberzirrhose ist das Endstadium chronischer Lebererkrankungen und insbesondere im fortgeschrittenen Stadium mit einer hohen Morbidität und Mortalität verbunden. Patienten mit Leberfunktionseinschränkung sind permanent von einer Vielzahl schwerwiegender Komplikationen bedroht. Ein optimales pharmakologisches Management bei Patienten mit Leberinsuffizienz kann die Progression der Grunderkrankung verlangsamen, Hospitalisationen verhindern sowie Lebensqualität und Überleben verbessern. Dieser Artikel gibt einen Überblick über den aktuellen Stand und neue Entwicklungen der Pharmakotherapie bei Patienten mit Leberzirrhose.
Collapse
Affiliation(s)
- Najib Ben Khaled
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Marchioninistr. 15, 81377 München, Bayern Deutschland
| | - Julian Allgeier
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Marchioninistr. 15, 81377 München, Bayern Deutschland
| | - Teresa Lutz
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Marchioninistr. 15, 81377 München, Bayern Deutschland
| | - Sabine Weber
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Marchioninistr. 15, 81377 München, Bayern Deutschland
| | - Christian M. Lange
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Marchioninistr. 15, 81377 München, Bayern Deutschland
| |
Collapse
|
23
|
Sokolova V, Ebel JF, Kollenda S, Klein K, Kruse B, Veltkamp C, Lange CM, Westendorf AM, Epple M. Uptake of Functional Ultrasmall Gold Nanoparticles in 3D Gut Cell Models. Small 2022; 18:e2201167. [PMID: 35712760 DOI: 10.1002/smll.202201167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/14/2022] [Indexed: 06/15/2023]
Abstract
Ultrasmall gold nanoparticles (2 nm) easily penetrate the membranes of intestinal murine epithelial cells (MODE-K) and colorectal cancer cells (CT-26). They are also taken up by 3D spheroids (400 µm) of these cell types and primary gut organoids (500 µm). In contrast, dissolved dyes are not taken up by any of these cells or 3D structures. The distribution of fluorescent ultrasmall gold nanoparticles inside cells, spheroids, and gut organoids is examined by confocal laser scanning microscopy. Nanoparticles conjugated with the cytostatic drug doxorubicin and a fluorescent dye exhibit significantly greater cytotoxicity toward CT-26 tumor spheroids than equally concentrated dissolved doxorubicin, probably because they enter the interior of a spheroid much more easily than dissolved doxorubicin. Comprehensive analyses show that the cellular uptake of ultrasmall gold nanoparticles occurs by different endocytosis pathways.
Collapse
Affiliation(s)
- Viktoriya Sokolova
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitaetsstrasse 5-7, 45117, Essen, Germany
| | - Jana-Fabienne Ebel
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, Germany
| | - Sebastian Kollenda
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitaetsstrasse 5-7, 45117, Essen, Germany
| | - Kai Klein
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitaetsstrasse 5-7, 45117, Essen, Germany
| | - Benedikt Kruse
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitaetsstrasse 5-7, 45117, Essen, Germany
| | - Claudia Veltkamp
- Department of Gastroenterology, Hepatology and Transplantation Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, Germany
| | - Christian M Lange
- Department of Gastroenterology, Hepatology and Transplantation Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, Germany
| | - Astrid M Westendorf
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen, Germany
| | - Matthias Epple
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitaetsstrasse 5-7, 45117, Essen, Germany
| |
Collapse
|
24
|
Roessler D, Öcal O, Philipp AB, Markwardt D, Munker S, Mayerle J, Jochheim LS, Hammer K, Lange CM, Geier A, Seidensticker M, Reiter FP, De Toni EN, Ben Khaled N. Ipilimumab and nivolumab in advanced hepatocellular carcinoma after failure of prior immune checkpoint inhibitor-based combination therapies: a multicenter retrospective study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04206-8. [PMID: 35864269 DOI: 10.1007/s00432-022-04206-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Immune checkpoint inhibitor (ICI)-based regimens are transforming the landscape of hepatocellular carcinoma (HCC) treatment. We describe the effect of combined ipilimumab and nivolumab in patients with advanced HCC after the failure of prior ICI-based combination treatments. METHODS The clinical course of patients with advanced HCC who received combined ipilimumab and nivolumab after prior ICI-based combination therapies was assessed. Progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) per RECIST v1.1 and mRECIST, overall survival (OS), and safety were analyzed. RESULTS Of 109 patients treated with atezolizumab and bevacizumab or other ICI-based combination treatments, ten patients received subsequent therapy with ipilimumab and nivolumab. The majority of patients had Barcelona Clinic Liver Cancer (BCLC) Stage C (80%) HCC and a preserved liver function as defined by Child-Pugh A (80%). At a median follow-up of 15.3 months, ORR for ipilimumab and nivolumab was 30% with a DCR of 40%. Median PFS was 2.9 months and the median OS was 7.4 months. CONCLUSION This retrospective study demonstrates that combined ipilimumab and nivolumab can be effective and tolerable after prior ICI-based combination therapies and provides a rationale for the prospective clinical evaluation of this treatment sequencing.
Collapse
Affiliation(s)
- Daniel Roessler
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Bavaria, Germany. .,Bavarian Cancer Research Center (BZKF), Partner site Munich, Munich, Germany.
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Alexander B Philipp
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Bavaria, Germany
| | - Daniel Markwardt
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Bavaria, Germany
| | - Stefan Munker
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Bavaria, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Bavaria, Germany.,Bavarian Cancer Research Center (BZKF), Partner site Munich, Munich, Germany
| | - Leonie S Jochheim
- Department for Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Katharina Hammer
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Bavaria, Germany
| | - Christian M Lange
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Bavaria, Germany.,Department for Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
| | - Andreas Geier
- Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Florian P Reiter
- Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Bavaria, Germany
| | - Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Bavaria, Germany.,German Cancer Consortium (DKTK), Partner site Munich, Munich, Germany
| |
Collapse
|
25
|
Ben Khaled N, Rössler D, Reiter FP, Mayerle J, Lange CM, Seidensticker M, Guba M, De Toni EN. Reply. Liver Transpl 2022; 28:897-898. [PMID: 35090084 DOI: 10.1002/lt.26410] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/14/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Najib Ben Khaled
- Department of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Daniel Rössler
- Department of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Florian P Reiter
- Department of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Christian M Lange
- Department of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Markus Guba
- Department of General-, Visceral- and Transplantation-Surgery, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| |
Collapse
|
26
|
Ben Khaled N, Seidensticker M, Ricke J, Mayerle J, Oehrle B, Rössler D, Teupser D, Ehmer U, Bitzer M, Waldschmidt D, Fuchs M, Reuken PA, Lange CM, Wege H, Kandulski A, Dechêne A, Venerito M, Berres ML, Luedde T, Kubisch I, Reiter FP, De Toni EN. Atezolizumab and bevacizumab with transarterial chemoembolization in hepatocellular carcinoma: the DEMAND trial protocol. Future Oncol 2022; 18:1423-1435. [PMID: 35081747 DOI: 10.2217/fon-2021-1261] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Indexed: 02/08/2023] Open
Abstract
The combination of the anti-PD-L1 antibody atezolizumab and the anti-VEGF bevacizumab is the first approved immunotherapeutic regimen for first-line therapy in patients with unresectable hepatocellular carcinoma (HCC), currently approved in more than 80 countries. The efficacy and tolerability of this regimen suggest that the use of atezolizumab + bevacizumab could be extended to the treatment of patients with intermediate-stage HCC in combination with transarterial chemoembolization (TACE). The authors describe the rationale and design of the DEMAND study. This investigator-initiated, multicenter, randomized phase II study is the first trial to evaluate the safety and efficacy of atezolizumab + bevacizumab prior to or in combination with TACE in patients with intermediate-stage HCC. The primary end point is the 24-month survival rate; secondary end points include objective response rate, progression-free survival, safety and quality of life. Clinical Trial Registration: NCT04224636 (ClinicalTrials.gov).
Collapse
Affiliation(s)
- Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Munich, 81377, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, 81377, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, 81377, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, 81377, Germany
| | - Bettina Oehrle
- Department of Medicine II, University Hospital, LMU Munich, Munich, 81377, Germany
| | - Daniel Rössler
- Department of Medicine II, University Hospital, LMU Munich, Munich, 81377, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, 81377, Germany
| | - Ursula Ehmer
- Internal Medicine II, Klinikum rechts der Isar, TU München, Munich, 81675, Germany
| | - Michael Bitzer
- Department for Internal Medicine I & Center for Personalized Medicine, Eberhard-Karls University, Tübingen, 72016, Germany
| | - Dirk Waldschmidt
- Department of Gastroenterology, University Hospital of Cologne, Cologne, 50937, Germany
| | - Martin Fuchs
- Department of Gastroenterology, Hepatology & GI-Oncology, Munich Hospital Bogenhausen, Munich, 81925, Germany
| | - Philipp A Reuken
- Department of Internal Medicine IV, Jena University Hospital, Jena, 07743, Germany
| | - Christian M Lange
- Department of Medicine II, University Hospital, LMU Munich, Munich, 81377, Germany
- Department of Gastroenterology & Hepatology, University Hospital Essen, Essen, 45147, Germany
| | - Henning Wege
- Cancer Center Esslingen, Medical Center Esslingen, Esslingen, 73730, Germany
| | - Arne Kandulski
- Department of Gastroenterology, University Hospital Regensburg, Regensburg, 93053, Germany
| | - Alexander Dechêne
- Department of Gastroenterology, Hepatology & Endocrinology, General Hospital Nuremberg, Nuremberg, 90419, Germany
| | - Marino Venerito
- Department of Gastroenterology, Hepatology & Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, 39120, Germany
| | - Marie-Luise Berres
- Medical Department III, University Hospital of Aachen, Aachen, 52074, Germany
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology & Infectious Diseases, University Hospital of Düsseldorf, Düsseldorf, 40225, Germany
| | - Ilja Kubisch
- Department of Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, Metabolic Disorders, Oncology, Klinikum Chemnitz gGmbH, Chemnitz, 09116, Germany
| | - Florian P Reiter
- Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, 97080, Germany
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, 81377, Germany
| |
Collapse
|
27
|
Rashidi-Alavijeh J, Frey A, Hörster A, Nguyen BP, Iannaccone A, Saner F, Lange CM, Willuweit K. Safe for Mother, Baby, and Graft? Pregnancy After Liver Transplant: A Single-Center Experience. Transplant Proc 2022; 54:744-748. [DOI: 10.1016/j.transproceed.2022.01.023] [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] [Received: 08/30/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
|
28
|
de Castro T, Jochheim LS, Bathon M, Welland S, Scheiner B, Shmanko K, Roessler D, Khaled NB, Jeschke M, Ludwig JM, Marquardt JU, Weinmann A, Pinter M, Lange CM, Vogel A, Saborowski A. Atezolizumab and bevacizumab in patients with advanced hepatocellular carcinoma with impaired liver function and prior systemic therapy: a real-world experience. Ther Adv Med Oncol 2022; 14:17588359221080298. [PMID: 35251317 PMCID: PMC8891886 DOI: 10.1177/17588359221080298] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [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: 10/04/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
Objective: Evaluation of the efficacy and safety of atezolizumab/bevacizumab in a
real-world HCC cohort, including patients with impaired liver function and
prior systemic therapy. Methods: Retrospective analysis of 147 HCC patients treated with
atezolizumab/bevacizumab at six sites in Germany and Austria. Results: The overall response rate and disease control rate were 20.4% and 51.7%,
respectively. Seventy-three patients (49.7%) met at least one major
exclusion criterion of the IMbrave150 trial (IMbrave-OUT), whereas 74
patients (50.3%) were eligible (IMbrave-IN). Median overall survival (mOS)
as well as median progression-free survival (mPFS) was significantly longer
in IMbrave-IN versus IMbrave-OUT patients [mOS: 15.0 months
(95% confidence interval (CI): 10.7–19.3] versus 6.0 months
(95% CI: 3.2–8.9; p < 0.001) and mPFS: 8.7 months (95%
CI: 5.9–11.5) versus 3.7 months (95% CI: 2.7–4.7;
p < 0.001)]. Prior systemic treatment did not
significantly affect mOS [hazard ratio (HR): 1.32 (95% CI: 0.78–2.23;
p = 0.305)]. mOS according to ALBI grades 1/2/3 were
15.0 months (95% CI: not estimable), 8.6 months (95% CI: 5.4–11.7), and
3.2 months (95% CI: 0.3–6.1), respectively. ALBI grade and ECOG score were
identified as independent prognostic factors [ALBI grade 2
versus 1; HR: 2.40 (95% CI: 1.34 – 4.30;
p = 0.003), ALBI grade 3 versus 1; HR:
7.28 (95% CI: 3.30–16.08; p < 0.001), and ECOG ⩾2
versus 0; HR: 2.09 (95% CI: 1.03 – 4.23;
p = 0.042)], respectively. Sixty-seven patients (45.6%)
experienced an adverse event classified as CTCAE grade ⩾3. Patients in the
IMbrave-OUT group were at increased risk of hepatic decompensation with
encephalopathy (13.7% versus 1.4%,
p = 0.004) and/or ascites (39.7% versus
9.5%; p < 0.001). Conclusion: In this real-world cohort, efficacy was comparable to the results of the
IMbrave150 study and not affected by prior systemic treatment. ALBI grade
and ECOG score were independently associated with survival. IMbrave-OUT
patients were more likely to experience hepatic decompensation.
Collapse
Affiliation(s)
- Tiago de Castro
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Leonie S. Jochheim
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany
| | - Melanie Bathon
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Sabrina Welland
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Bernhard Scheiner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Kateryna Shmanko
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Daniel Roessler
- Department of Medicine II, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Najib Ben Khaled
- Department of Medicine II, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matthias Jeschke
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany
| | - Johannes M. Ludwig
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Faculty of Medicine, Essen University Hospital, Essen, Germany
| | - Jens U. Marquardt
- Department of Medicine I, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Anna Saborowski
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
29
|
Welland S, Leyh C, Finkelmeier F, Jefremow A, Shmanko K, Gonzalez-Carmona MA, Kandulski A, Jeliazkova P, Best J, Fründt TW, Djanani A, Pangerl M, Maieron A, Greil R, Fricke C, Sookthai D, Günther R, Schmiderer A, Wege H, Venerito M, Ehmer U, Müller M, Strassburg CP, Weinmann A, Siebler J, Waidmann O, Lange CM, Saborowski A, Vogel A. Real-World Data for Lenvatinib in Hepatocellular Carcinoma (ELEVATOR): A Retrospective Multicenter Study. Liver Cancer 2022; 11:219-232. [PMID: 35949288 PMCID: PMC9218621 DOI: 10.1159/000521746] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Lenvatinib is approved as first-line treatment for patients with advanced hepatocellular carcinoma (HCC). The efficacy of lenvatinib in Caucasian real-world patients is insufficiently defined. The purpose of this study was to evaluate the efficacy of lenvatinib in a multi-center cohort (ELEVATOR) from Germany and Austria. METHODS A retrospective data analysis of 205 patients treated with first-line systemic lenvatinib at 14 different sites was conducted. Overall survival, progression free survival, overall response rate and adverse event rates were assessed and analyzed. RESULTS Patients receiving lenvatinib in the real-world setting reached a median overall survival of 12.8 months, which was comparable to the results reported from the REFLECT study. Median overall survival (mOS) and progression free survival (mPFS) was superior in those patients who met the inclusion criteria of the REFLECT study compared to patients who failed to meet the inclusion criteria (mOS 15.6 vs 10.2 months, HR 0.55, 95% CI 0.38-0.81, p=0.002; mPFS 8.1 vs 4.8 months HR 0.65, 95% CI 0.46-0.91, p=0.0015). For patients with an impaired liver function according to the Albumin-Bilirubin (ALBI) grade, or reduced ECOG performance status ≥2, survival was significantly shorter compared to patients with sustained liver function (ALBI grade 1) and good performance status (ECOG performance status 0), respectively (HR 1.69, 95% CI 1.07-2.66, p=0.023; HR 2.25, 95% CI 1.19-4.23, p=0.012). Additionally, macrovascular invasion (HR 1.55, 95% CI 1.02-2.37, p=0.041) and an AFP ≥200 ng/mL (HR 1.56, 95% CI 1.03-2.34, p=0.034) were confirmed as independent negative prognostic factors in our cohort of patients with advanced HCC. CONCLUSION Overall, our data confirm the efficacy of lenvatinib as first-line treatment and did not reveal new or unexpected side effects in a large retrospective Caucasian real-world cohort, supporting the use of lenvatinib as meaningful alternative for patients that cannot be treated with IO-based combinations in first-line HCC.
Collapse
Affiliation(s)
- Sabrina Welland
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Catherine Leyh
- Department of Gastroenterology and Hepatology, University Hospital and University of Duisburg-Essen, Essen, Germany
| | - Fabian Finkelmeier
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - André Jefremow
- Department of Internal Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany,CCC-Erlangen EMN, Erlangen, Germany
| | - Kateryna Shmanko
- Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | | | - Arne Kandulski
- Department of Internal Medicine I, Regensburg University Hospital, Regensburg, Germany
| | - Petia Jeliazkova
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Best
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Thorben W. Fründt
- Department of Gastroenterology and Hepatology, University Medical Center, Hamburg, Germany
| | - Angela Djanani
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital of Innsbruck, Innsbruck, Austria
| | - Maria Pangerl
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Andreas Maieron
- Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, St. Pölten, Austria
| | - Richard Greil
- Salzburg Cancer Research Institute, Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectiology and Rheumatology, Oncologic Center, Erlangen, Germany
| | - Christina Fricke
- Internal Medicine 2, Gastroenterology and Hepatology and Rheumatology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, St. Pölten, Austria
| | - Disorn Sookthai
- Institut für Klinische Krebsforschung IKF GmbH, Frankfurt, Germany
| | - Rainer Günther
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Andreas Schmiderer
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital of Innsbruck, Innsbruck, Austria
| | - Henning Wege
- Department of Gastroenterology and Hepatology, University Medical Center, Hamburg, Germany
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke-University Hospital Magdeburg, Magdeburg, Germany
| | - Ursula Ehmer
- Internal Medicine II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martina Müller
- Department of Internal Medicine I, Regensburg University Hospital, Regensburg, Germany
| | | | - Arndt Weinmann
- Department of Medicine I, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - Jürgen Siebler
- CCC-Erlangen EMN, Erlangen, Germany,Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany
| | - Oliver Waidmann
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology, University Hospital and University of Duisburg-Essen, Essen, Germany
| | - Anna Saborowski
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany,*Arndt Vogel,
| |
Collapse
|
30
|
Graf C, Arncken J, Lange CM, Willuweit K, Schattenberg JM, Seessle J, Lang-Meli J, Böttler T, Dietz J, Wetzstein N, Mondorf A, Vermehren J, Rohde G, Zeuzem S, Pathil A. Hepatic sarcoidosis: Clinical characteristics and outcome. JHEP Rep 2021; 3:100360. [PMID: 34765958 PMCID: PMC8571721 DOI: 10.1016/j.jhepr.2021.100360] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/13/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND & AIMS Clinical manifestation of hepatic involvement in sarcoidosis can vary from asymptomatic disease to severe complications such as cirrhosis and portal hypertension. However, data on hepatic sarcoidosis are limited, and evidence-based recommendations are lacking. Our study aimed to assess the features and clinical course of hepatic sarcoidosis in a predominantly Caucasian cohort. METHODS We performed a retrospective study including all patients with hepatic sarcoidosis between 2004 and 2020 in 5 German centres. The median follow-up time was 36 months (range 0.0-195). Data on demographic parameters, clinical manifestations, diagnostic test results, treatment, and outcome were collected. RESULTS A total of 1,476 patients with sarcoidosis and 62 patients with hepatic involvement (4.2%) were identified. Of the patients, 51.6% were female, and 80.6% were Caucasian. Most patients were asymptomatic and were observed to have a cholestatic pattern of liver enzyme elevations. Cirrhosis was detected in 9 patients (14.5%), of whom 6 developed clinical manifestations of portal hypertension. Fifty-four patients were medically treated, most commonly with glucocorticoids (69.4%) or ursodeoxycholic acid (UDCA) (40.3%). Levels of alkaline phosphatase (ALP) decreased by 60.8% on average from baseline in patients treated with glucocorticoids and by 59.9% in patients treated with UDCA. Seventeen patients received treatment augmentation with a second line agent, of whom 8 patients normalised ALP levels during follow-up. None of the patients underwent liver transplantation or developed hepatocellular carcinoma (HCC). Three of the patients died during follow-up owing to liver-related complications. CONCLUSIONS Hepatic involvement in sarcoidosis was found in 4.2% of patients with sarcoidosis and was clinically significant in 14.5% of those. These findings highlight the importance of early identifying, monitoring, and treating hepatic sarcoidosis, given its increased mortality when associated with end-stage liver disease. LAY SUMMARY Clinical diagnostic and surveillance of hepatic involvement in sarcoidosis has not been standardised, and management of hepatic involvement is a clinical challenge, since it remains poorly characterised in many ways. Our results show that one-third of patients with hepatic sarcoidosis presented with clinically significant portal hypertension, 14.5% suffered from cirrhosis, and 3 patients died owing to liver-related complications. Regarding pharmacological treatment options, corticosteroids and UDCA were the medical agents most frequently used, and both of them have been shown to induce biochemical response in the majority of patients. These findings highlight the importance of correctly and early identifying hepatic involvement in sarcoidosis, because of the potentially progressive course of disease.
Collapse
Key Words
- ACE, angiotensin-converting enzyme
- ACLF, acute-on-chronic liver failure
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- AST, aspartate transaminase
- ATS, American Thoracic Society
- AZA, azathioprine
- GGT, gamma glutamyl transferase
- HCC, hepatocellular carcinoma
- HE, hepatic encephalopathy
- HRS, hepatorenal syndrome
- Hepatic granuloma
- Hepatic sarcoidosis
- ICD-10, International Classification of Diseases, Tenth Revision
- IL-2R, IL-2 receptor
- Liver involvement
- MMF, mycophenolatmofetil
- MTX, methotrexate
- Outcome
- SBP, spontaneous bacterial peritonitis
- Treatment
- UDCA, ursodeoxycholic acid
- ULN, upper limit of normal
Collapse
Affiliation(s)
- Christiana Graf
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jeannette Arncken
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Katharina Willuweit
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Jörn M. Schattenberg
- Department of Internal Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Jessica Seessle
- Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
| | - Julia Lang-Meli
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | - Tobias Böttler
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | - Julia Dietz
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Nils Wetzstein
- Department of Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Antonia Mondorf
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johannes Vermehren
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Gernot Rohde
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Anita Pathil
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
31
|
Engelmann C, Herber A, Franke A, Bruns T, Reuken P, Schiefke I, Zipprich A, Zeuzem S, Goeser T, Canbay A, Berg C, Trebicka J, Uschner FE, Chang J, Mueller T, Aehling N, Schmelzle M, Splith K, Lammert F, Lange CM, Sarrazin C, Trautwein C, Manns M, Häussinger D, Pfeiffenberger J, Galle PR, Schmiedeknecht A, Berg T. Granulocyte-colony stimulating factor (G-CSF) to treat acute-on-chronic liver failure: A multicenter randomized trial (GRAFT study). J Hepatol 2021; 75:1346-1354. [PMID: 34364917 DOI: 10.1016/j.jhep.2021.07.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Based on positive results from small single center studies, granulocyte-colony stimulating factor (G-CSF) is being widely used for the treatment of patients with acute-on-chronic liver failure (ACLF). Herein, we aimed to evaluate the safety and efficacy of G-CSF in patients with ACLF. METHODS In this multicenter, prospective, controlled, open-label phase II study, 176 patients with ACLF (EASL-CLIF criteria) were randomized to receive G-CSF (5 μg/kg daily for the first 5 days and every third day thereafter until day 26) plus standard medical therapy (SMT) (n = 88) or SMT alone. The primary efficacy endpoint was 90-day transplant-free survival analyzed by Cox regression modeling. The key secondary endpoints were overall and transplant-free survival after 360 days, the development of ACLF-related complications, and the course of liver function scores during the entire observation period. RESULTS Patients treated with G-CSF had a 90-day transplant-free survival rate of 34.1% compared to 37.5% in the SMT group (hazard ratio [HR] 1.05; 95% CI 0.711-1.551; p = 0.805). Transplant-free and overall survival at 360 days did not differ between the 2 arms (HR 0.998; 95% CI 0.697-1.430; p = 0.992 and HR 1.058; 95% CI 0.727-1.548; p = 0.768, respectively). G-CSF did not improve liver function scores, the occurrence of infections, or survival in subgroups of patients without infections, with alcohol-related ACLF, or with ACLF defined by the APASL criteria. Sixty-one serious adverse events were reported in the G-CSF+SMT group and 57 were reported in the SMT group. In total, 7 drug-related serious adverse reactions occurred in the G-CSF group. The study was prematurely terminated due to futility after conditional power calculation. CONCLUSIONS In contrast to previous findings, G-CSF had no significant beneficial effect on patients with ACLF in this multicenter controlled trial, which suggests that it should not be used as a standard treatment for ACLF. CLINICALTRIALS. GOV NUMBER NCT02669680 LAY SUMMARY: Granulocyte-colony stimulating factor was considered as a novel treatment for acute-on-chronic liver failure (ACLF). We performed the first randomized, multicenter, controlled phase II trial, which showed that G-CSF did not improve survival or other clinical endpoints in patients with ACLF. Therefore, G-CSF should not be used to treat liver disease outside clinical studies.
Collapse
Affiliation(s)
- Cornelius Engelmann
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany; Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Adam Herber
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Annegret Franke
- Clinical Trial Centre (ZKS) Leipzig, Faculty of Medicine, University Leipzig, Leipzig, Germany
| | - Tony Bruns
- Department of Medicine III, Aachen University Hospital, Aachen, Germany; Clinic for Internal Medicine IV, University Hospital Jena, Jena, Germany
| | - Philipp Reuken
- Clinic for Internal Medicine IV, University Hospital Jena, Jena, Germany
| | - Ingolf Schiefke
- Clinic for Gastroenterology, Hepatology and Endocrinology, St. Georg Hospital, Leipzig, Germany
| | - Alexander Zipprich
- University Hospital for Internal Medicine 1, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany
| | - Tobias Goeser
- Clinic for Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Ali Canbay
- Medical Department, University Hospital Ruhr-University Bochum, Bochum, Germany
| | - Christoph Berg
- Department of Internal Medicine I, University Hospital Tuebingen, Tuebingen, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Frank E Uschner
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany; Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Tobias Mueller
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Niklas Aehling
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinik, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katrin Splith
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinik, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Christian M Lange
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany; Clinic for Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany; Medical Clinic 2, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | | | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Dieter Häussinger
- Clinic and Policlinic of Gastroenterology, Hepatology and Infectious Disease, Heinrich Heine University Duesseldorf, Düsseldorf, Germany
| | - Jan Pfeiffenberger
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter R Galle
- Department of Internal Medicine, University Medical Center Mainz, Mainz, Germany
| | - Anett Schmiedeknecht
- Clinical Trial Centre (ZKS) Leipzig, Faculty of Medicine, University Leipzig, Leipzig, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.
| |
Collapse
|
32
|
Hirmas N, Leyh C, Sraieb M, Barbato F, Schaarschmidt BM, Umutlu L, Nader M, Wedemeyer H, Ferdinandus J, Rischpler C, Herrmann K, Costa PF, Lange CM, Weber M, Fendler WP. 68Ga-PSMA-11 PET/CT Improves Tumor Detection and Impacts Management in Patients with Hepatocellular Carcinoma. J Nucl Med 2021; 62:1235-1241. [PMID: 33509970 DOI: 10.2967/jnumed.120.257915] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 10/02/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer and the third most frequent cause of cancer-related death. A growing number of local and systemic therapies are available, and accurate staging is critical for management decisions. We assessed the impact of neovasculature imaging by 68Ga-PSMA-11 PET/CT on disease staging, prognostic groups, and management of patients with HCC compared with staging with CT. Methods: Forty patients who received imaging with 68Ga-PSMA-11 PET/CT for HCC staging between September 2018 and September 2019 were retrospectively included. Management before and after PET scanning was assessed by standardized surveys. The presence of HCC was evaluated by 3 masked readers on a per-patient and per-region basis for PET/CT (PET criteria) and multiphase contrast-enhanced CT (CT criteria) in separate sessions. Lesions were validated by follow-up imaging or histopathology, and progression-free survival was recorded. Endpoints were detection rate and positive predictive value for 68Ga-PSMA-11 PET versus CT, interreader reproducibility, and changes in stage, prognostic groups, and management plans. Results: Median age was 65 y (range, 37-81 y), and median Child-Pugh score was 5 (range, 5-9). Most patients were treatment-naïve (27/40, 67.5%). The sensitivity of PET versus CT to identify liver lesions for patients with lesion validation was 31 of 32 (97%) for both modalities, whereas it was 6 of 6 (100%) versus 4 of 6 (67%), respectively, for extrahepatic lesions. PET and CT each had a positive predictive value of 100% at the liver level. PET versus CT stage was congruent in 30 of 40 (75%) patients; upstaging was seen in 8 of 40 patients (20%), whereas 2 of 40 (5%) had downstaging by PET. Intended management changed in 19 of 40 patients (47.5%); 9 of 19 of these patients were found to have detectable distant metastases (47.4%) and assigned stage 4 disease, most of whom were shifted to systemic therapy (8/9, 89%). Two patients underwent 177Lu-PSMA-617 radioligand therapy. Median progression-free survival was 5.2 mo for the entire cohort; 5.3 mo for PET M0, and 4.7 mo for PET M1 patients, respectively. Conclusion: 68Ga-PSMA-11 PET demonstrated higher accuracy than CT in the detection of HCC metastases and was associated with a management change in about half the patient cohort.
Collapse
Affiliation(s)
- Nader Hirmas
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Catherine Leyh
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and
| | - Miriam Sraieb
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Francesco Barbato
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology; University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology; University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Nader
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and
| | - Justin Ferdinandus
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Pedro Fragoso Costa
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and
| | - Manuel Weber
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium-University Hospital Essen, Essen, Germany;
| |
Collapse
|
33
|
Finkelmeier F, Scheiner B, Leyh C, Best J, Fründt TW, Czauderna C, Beutel A, Bettinger D, Weiß J, Meischl T, Kütting F, Waldschmidt DT, Radu P, Schultheiß M, Peiffer KH, Ettrich TJ, Weinmann A, Wege H, Venerito M, Dufour JF, Lange CM, Pinter M, Waidmann O. Cabozantinib in Advanced Hepatocellular Carcinoma: Efficacy and Safety Data from an International Multicenter Real-Life Cohort. Liver Cancer 2021; 10:360-369. [PMID: 34414123 PMCID: PMC8339523 DOI: 10.1159/000515490] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/20/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS The multikinase inhibitor cabozantinib has been approved for hepatocellular carcinoma (HCC) previously treated with sorafenib. We report safety and efficacy data of an international, multicenter, real-life cohort of patients with advanced HCC treated with cabozantinib. METHODS Patients with HCC who were treated with cabozantinib were retrospectively identified across 11 centers in Austria, Switzerland, and Germany. Patients' characteristics, adverse events, duration of treatment and overall survival (OS) data were analyzed until April 1, 2020. RESULTS Eighty-eight patients from 11 centers were included. The predominant underlying liver diseases were NAFLD/NASH in 26 (30%) and hepatitis C infection in 21 (24%) patients. Seventy-eight patients (89%) were classified as Barcelona clinic liver cancer (BCLC) stage C. Sixty patients (68%) were Child-Pugh A, whereas 22 (25%) were Child-Pugh B, respectively. Cabozantinib was used as systemic second- and third-line or later treatment in 41 (47%) and 46 (52%) patients, respectively. The following best responses under cabozantinib were documented: partial response in 6 (7%), stable disease in 28 (32%), and progressive disease in 28 (32%) patients, respectively. Fifty-two patients (59%) died during follow-up. The median OS from start of cabozantinib treatment was 7.0 months in the entire cohort and 9.7 months in Child-Pugh A patients, while Child-Pugh B patients had a median OS of 3.4 months, respectively. Thirty-seven (42%) patients fulfilled the CELESTIAL inclusion and exclusion criteria, showing a median OS of 11.1 months. Most common adverse events were fatigue (15.6%) and diarrhea (15.6%). CONCLUSION Cabozantinib treatment was effective, safe, and feasible in patients with advanced HCC in patients with compensated cirrhosis. Patients in the real-life setting had more advanced liver disease - in which 25% of patients were Child-Pugh B. However, OS in patients with Child-Pugh A cirrhosis was similar to that reported in the phase 3 trial (CELESTIAL).
Collapse
Affiliation(s)
- Fabian Finkelmeier
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt, Germany
- University Cancer Center Frankfurt, University Hospital Frankfurt, Frankfurt, Germany
- Frankfurt Cancer Institute, Goethe University Frankfurt/Main, Frankfurt, Germany
| | - Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Catherine Leyh
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Jan Best
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-Von Guericke University Hospital, Magdeburg, Germany
| | - Thorben Wilhelm Fründt
- Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Czauderna
- Department of Internal Medicine 1, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Clinical Registry Unit (CRU), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Medicine I, University Medical Center Schleswig Holstein-Campus Lübeck, Lübeck, Germany
| | - Alica Beutel
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany
| | - Dominik Bettinger
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta Ottenstein Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Weiß
- Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Tobias Meischl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Fabian Kütting
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dirk-Thomas Waldschmidt
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Pompilia Radu
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Michael Schultheiß
- Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kai-Henrik Peiffer
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas J. Ettrich
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany
| | - Arndt Weinmann
- Department of Internal Medicine 1, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Clinical Registry Unit (CRU), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Henning Wege
- Department of Medicine, Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marino Venerito
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-Von Guericke University Hospital, Magdeburg, Germany
| | - Jean-Francois Dufour
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Oliver Waidmann
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt, Germany
- University Cancer Center Frankfurt, University Hospital Frankfurt, Frankfurt, Germany
| |
Collapse
|
34
|
Adamczyk A, Pastille E, Kehrmann J, Vu VP, Geffers R, Wasmer MH, Kasper S, Schuler M, Lange CM, Muggli B, Rau TT, Klein D, Hansen W, Krebs P, Buer J, Westendorf AM. GPR15 Facilitates Recruitment of Regulatory T Cells to Promote Colorectal Cancer. Cancer Res 2021; 81:2970-2982. [PMID: 33727229 DOI: 10.1158/0008-5472.can-20-2133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022]
Abstract
Colorectal cancer is one of the most frequent malignancies worldwide. Despite considerable progress in early detection and treatment, there is still an unmet need for novel antitumor therapies, particularly in advanced colorectal cancer. Regulatory T cells (Treg) are increased in the peripheral blood and tumor tissue of patients with colorectal cancer. Recently, transient ablation of tumor-associated Tregs was shown to foster CD8+ T-cell-mediated antitumoral immunity in murine colorectal cancer models. However, before considering therapies on targeting Tregs in patients with cancer, detailed knowledge of the phenotype and features of tumor-associated Tregs is indispensable. Here, we demonstrate in a murine model of inflammation-induced colorectal cancer that tumor-associated Tregs are mainly of thymic origin and equipped with a specific set of molecules strongly associated with enhanced migratory properties. Particularly, a dense infiltration of Tregs in mouse and human colorectal cancer lesions correlated with increased expression of the orphan chemoattractant receptor GPR15 on these cells. Comprehensive gene expression analysis revealed that tumor-associated GPR15+ Tregs have a Th17-like phenotype, thereby producing IL17 and TNFα. Gpr15 deficiency repressed Treg infiltration in colorectal cancer, which paved the way for enhanced antitumoral CD8+ T-cell immunity and reduced tumorigenesis. In conclusion, GPR15 represents a promising novel target for modifying T-cell-mediated antitumoral immunity in colorectal cancer. SIGNIFICANCE: The G protein-coupled receptor 15, an unconventional chemokine receptor, directs Tregs into the colon, thereby modifying the tumor microenvironment and promoting intestinal tumorigenesis.See related commentary by Chakraborty and Zappasodi, p. 2817.
Collapse
Affiliation(s)
- Alexandra Adamczyk
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Eva Pastille
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Kehrmann
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vivian P Vu
- Institute of Pathology, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Robert Geffers
- Genome Analytics, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Marie-Hélène Wasmer
- Institute of Pathology, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Beat Muggli
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tilman T Rau
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Diana Klein
- Institute for Cell Biology (Cancer Research), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Wiebke Hansen
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philippe Krebs
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Jan Buer
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Astrid M Westendorf
- Infection Immunology, Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| |
Collapse
|
35
|
Rueschenbaum S, Ciesek S, Queck A, Widera M, Schwarzkopf K, Brüne B, Welsch C, Wedemeyer H, Zeuzem S, Weigert A, Lange CM. Dysregulated Adaptive Immunity Is an Early Event in Liver Cirrhosis Preceding Acute-on-Chronic Liver Failure. Front Immunol 2021; 11:534731. [PMID: 33574809 PMCID: PMC7870861 DOI: 10.3389/fimmu.2020.534731] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/13/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Acute-on-chronic liver failure (ACLF) is characterized by high levels of systemic inflammation and parallel suppression of innate immunity, whereas little is known about adaptive immune immunity in ACLF. We therefore aimed to characterize the development of the adaptive immune system during the progression of liver cirrhosis to ACLF. Patients with compensated/stable decompensated liver cirrhosis, acute decompensation of liver cirrhosis, or ACLF were recruited from a prospective cohort study. Comprehensive immunophenotyping was performed using high dimensional flow cytometry. Replication of Torque teno (TT) virus was quantified as a marker of immunosuppression. High frequencies of detectable TT virus were observed already in patients with compensated/stable decompensated liver cirrhosis compared to healthy controls (>50% vs. 19%), suggesting relatively early occurrence of immunosuppression in cirrhosis. In line, profoundly reduced numbers of distinct innate and adaptive immune cell populations were observed before ACLF development. These changes were accompanied by parallel upregulation of co-stimulatory (e.g. CD40L, OX40, CD69, GITR, TIM-1) and inhibitory immune checkpoints (e.g. PDPN, PROCR, 2B4, TIGIT) on CD4+ and CD8+ T cells, which again preceded the development of ACLF. On a functional basis, the capacity of CD4+ and CD8+ T cells to produce pro-inflammatory cytokines upon stimulation was strongly diminished in patients with acute decompensation of liver cirrhosis and ACLF. Conclusion Impaired innate and—in particular—adaptive cellular immunity occurs relatively early in the pathogenesis of liver cirrhosis and precedes ACLF. This may contribute to the development of ACLF by increasing the risk of infections in patients with liver cirrhosis.
Collapse
Affiliation(s)
- Sabrina Rueschenbaum
- Department of Gastroenterology and Hepatology, University Hospital and University of Duisburg-Essen, Essen, Germany.,Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Sandra Ciesek
- Institute of Virology, University Hospital Essen, Essen, Germany
| | - Alexander Queck
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Marek Widera
- Institute of Virology, University Hospital Essen, Essen, Germany
| | - Katharina Schwarzkopf
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Bernhard Brüne
- Faculty of Medicine, Institute of Biochemistry 1, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christoph Welsch
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology and Hepatology, University Hospital and University of Duisburg-Essen, Essen, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas Weigert
- Faculty of Medicine, Institute of Biochemistry 1, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital and University of Duisburg-Essen, Essen, Germany.,Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| |
Collapse
|
36
|
Rueschenbaum S, Cai C, Schmidt M, Schwarzkopf K, Dittmer U, Zeuzem S, Welsch C, Lange CM. Translation of IRF-1 Restricts Hepatic Interleukin-7 Production to Types I and II Interferons: Implications for Hepatic Immunity. Front Immunol 2021; 11:581352. [PMID: 33584648 PMCID: PMC7874116 DOI: 10.3389/fimmu.2020.581352] [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: 08/14/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022] Open
Abstract
Interleukin-7 (IL-7) is an important cytokine with pivotal pro-survival functions in the adaptive immune system. However, the role of IL-7 in innate immunity is not fully understood. In the present study, the impact of hepatic IL-7 on innate immune cells was assessed by functional experiments as well as in patients with different stages of liver cirrhosis or acute-on-chronic liver failure (ACLF). Human hepatocytes and liver sinusoidal endothelial cells secreted IL-7 in response to stimulation with interferons (IFNs) of type I and II, yet not type III. De novo translation of interferon-response factor-1 (IRF-1) restricted IL-7 production to stimulation with type I and II IFNs. LPS-primed human macrophages were identified as innate immune target cells responding to IL-7 signaling by inactivation of Glycogen synthase kinase-3 (GSK3). IL-7-mediated GSK3 inactivation augmented LPS-induced secretion of pro-inflammatory cytokines and blunted LPS tolerance of macrophages. The IFN-IRF-1-IL-7 axis was present in liver cirrhosis patients. However, liver cirrhosis patients with or without ACLF had significantly lower concentrations of IL-7 in serum compared to healthy controls, which might contribute to LPS-tolerance in these patients. In conclusion, we propose the presence of an inflammatory cascade where IFNs of type I/II induce hepatocellular IL-7 in an IRF-1-restriced way. Beyond its role in adaptive immune responses, IL-7 appears to augment the response of macrophages to LPS and to ameliorate LPS tolerance, which may improve innate immune responses against invading pathogens.
Collapse
Affiliation(s)
- Sabrina Rueschenbaum
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Chengcong Cai
- Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Matthias Schmidt
- Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | | | - Ulf Dittmer
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Zeuzem
- Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Christoph Welsch
- Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Medicine 1, J.W. Goethe University Hospital, Frankfurt, Germany
| |
Collapse
|
37
|
Dauth N, Mücke VT, Mücke MM, Lange CM, Welker M, Zeuzem S, Badenhoop K. Hypopituitarism in Wilson's disease resolved after copper-chelating therapy. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM200086. [PMID: 33431708 PMCID: PMC7849456 DOI: 10.1530/edm-20-0086] [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: 09/14/2020] [Accepted: 10/08/2020] [Indexed: 11/26/2022] Open
Abstract
SUMMARY Wilson's disease (WD) is a rare disorder of copper metabolism usually presenting with variable liver damage and neuropsychiatric symptoms. Here we report a 39-year-old Taiwanese female with late manifestation of WD presenting with gonadotroph, thyreotroph and corticotroph hypopituitarism. Molecular genetic testing revealed compound heterozygosity for two mutations in exons 12 and 14 (c.2828G>A and c.3140A>T). Copper-chelating therapy with D-penicillamine and zinc was initiated along with supplementation of hydrocortisone and L-thyroxine. Hypopituitarism resolved when urinary copper excretion returned to normal levels under copper chelation. This case should raise awareness of pituitary function in WD patients. LEARNING POINTS Hypopituitarism can complicate Wilson's disease (WD) and endocrinologists should be aware of it when caring for hypopituitary patients. Hepatologists should consider endocrinologic testing for hypopituitarism when WD patients present with symptoms of adrenal insufficiency, thyroid or gonadal dysfunction. Copper-chelating treatment is mandatory and may lead to the recovery of pituitary function in such patients.
Collapse
Affiliation(s)
- Nina Dauth
- MVZ Diamedicum Würzburg GmbH, Würzburg, Germany
| | - Victoria T Mücke
- Medical Department 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Marcus M Mücke
- Medical Department 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Christian M Lange
- Clinic for Gastroenterology and Hepatology, University Hospital Essen and University Duisburg-Essen, Essen, Germany
| | - Martin Welker
- Medical Department 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Medical Department 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Klaus Badenhoop
- Medical Department 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
38
|
Mücke MM, Mayer A, Kessel J, Mücke VT, Bon D, Schwarzkopf K, Rüschenbaum S, Queck A, Göttig S, Vermehren A, Weiler N, Welker MW, Reinheimer C, Hogardt M, Vermehren J, Herrmann E, Kempf VAJ, Zeuzem S, Lange CM. Quinolone and Multidrug Resistance Predicts Failure of Antibiotic Prophylaxis of Spontaneous Bacterial Peritonitis. Clin Infect Dis 2021; 70:1916-1924. [PMID: 31228250 DOI: 10.1093/cid/ciz540] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 04/02/2019] [Accepted: 06/19/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The efficacy of antibiotic prophylaxis to prevent spontaneous bacterial peritonitis (SBP) in patients colonized with multidrug-resistant organisms (MDROs) is unknown. We evaluated the effectiveness of fluoroquinolone-based SBP prophylaxis in an era and area of frequent antibiotic resistance. METHODS This is a prospective observational study in patients with liver cirrhosis and an indication for fluoroquinolone-based prophylaxis of SBP. Patients were recruited and followed in a large German tertiary reference center with comprehensive microbiological and clinical monitoring performed at baseline and after 30, 60, 90, and 180 days of prophylaxis. RESULTS Overall, 77 patients received antibiotic prophylaxis for an average of 93 days. Baseline prevalence of colonization with MDROs was high (N = 39, 50.6%). At least one de novo MDRO was detected in 27 patients (35.1%) during antibiotic prophylaxis; 33 patients (42.9%) developed secondary infections, including 14 cases (17.9%) of infections with MDROs, and 13 cases (16.9%) of de novo/recurrent SBP. Thirty patients (39.0%) died during follow-up. Significantly higher risks of SBP development during antibiotic prophylaxis were observed for patients with versus without any apparent MDROs (P = .009), vancomycin-resistant enterococci (P = .008), multidrug-resistant gram-negative bacteria (P = .016), or quinolone-resistant gram-negative bacteria (QR-GNB) (P = .015). In competing risk analysis, QR-GNB were independently associated with prophylaxis failure (hazard ratio, 3.39; P = .045) and infections with QR-GNB were independently associated with death before SBP (subdistribution hazard risk, 6.47; P = .034). CONCLUSIONS Antibiotic prophylaxis of SBP appears to be less efficient in patients with known MDROs. Regular MDRO screening seems to be useful to tailor treatment of secondary infections and re-evaluate antibiotic prophylaxis in case of selection of quinolone resistance.
Collapse
Affiliation(s)
- Marcus M Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Amelie Mayer
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johanna Kessel
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Internal Medicine 2, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Victoria T Mücke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Dimitra Bon
- Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Katharina Schwarzkopf
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sabrina Rüschenbaum
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alexander Queck
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stephan Göttig
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Annika Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Nina Weiler
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Martin-Walter Welker
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claudia Reinheimer
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michael Hogardt
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian M Lange
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
39
|
Mücke MM, Rüschenbaum S, Mayer A, Mücke VT, Schwarzkopf KM, Zeuzem S, Kehrmann J, Scholtysik R, Lange CM. Stool and sputum microbiome during quinolone prophylaxis of spontaneous bacterial peritonitis: an exploratory study. Gut Pathog 2020; 12:51. [PMID: 33133240 PMCID: PMC7596951 DOI: 10.1186/s13099-020-00389-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/18/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Quinolone prophylaxis is recommended for patients with advanced cirrhosis at high risk of spontaneous bacterial peritonitis (SBP) or with prior SBP. Yet, the impact of long-term antibiotic prophylaxis on the microbiome of these patients is poorly characterized. Methods Patients with liver cirrhosis receiving long-term quinolone prophylaxis to prevent SBP were prospectively included and sputum and stool samples were obtained at baseline, 1, 4 and 12 weeks thereafter. Both bacterial DNA and RNA were assessed with 16S rRNA sequencing. Relative abundance, alpha and beta diversity were calculated and correlated with clinical outcome. Results Overall, 35 stool and 19 sputum samples were obtained from 11 patients. Two patients died (day 9 and 12) all others were followed for 180 days. Reduction of Shannon diversity and bacterial richness was insignificant after initiation of quinolone prophylaxis (p > 0.05). Gut microbiota were significantly different between patients (p < 0.001) but non-significantly altered between the different time points before and after initiation of antibiotic prophylaxis (p > 0.05). A high relative abundance of Enterobacteriaceae > 20% during quinolone prophylaxis was found in three patients. Specific clinical scenarios (development of secondary infections during antibiotic prophylaxis or the detection of multidrug-resistant Enterobacteriaceae) characterized these patients. Sputum microbiota were not significantly altered in individuals during prophylaxis. Conclusion The present exploratory study with small sample size showed that inter-individual differences in diversity of gut microbiota were high at baseline, yet quinolone prophylaxis had only a moderate impact. High relative abundances of Enterobacteriaceae during follow-up might indicate failure of or non-adherence to quinolone prophylaxis. However, our results may not be clinically significant given the limitations of the study and therefore future studies are needed to further investigate this phenomenon.
Collapse
Affiliation(s)
- Marcus M Mücke
- Present Address: Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Sabrina Rüschenbaum
- Present Address: Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Present Address: Department for Gastroenterology and Hepatology, University Hospital Essen and University of Duisburg-Essen, Essen, Germany
| | - Amelie Mayer
- Present Address: Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Victoria T Mücke
- Present Address: Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Katharina M Schwarzkopf
- Present Address: Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Present Address: Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Jan Kehrmann
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - René Scholtysik
- Institute of Cell Biology, University Hospital Essen and University of Duisburg-Essen, Essen, Germany
| | - Christian M Lange
- Present Address: Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Present Address: Department for Gastroenterology and Hepatology, University Hospital Essen and University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
40
|
Anastasiou OE, Lange CM. Response to the Letter: Impact of SARS-CoV-2 Infection on Patients Suffering from Liver Injury. Dig Dis 2020; 39:68-69. [PMID: 33040069 PMCID: PMC7801960 DOI: 10.1159/000512151] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Olympia E. Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany,*Olympia E. Anastasiou, Institute for Virology, University of Duisburg-Essen, Hufelandstraße 55, DE–45147 Essen (Germany),
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| |
Collapse
|
41
|
Mücke VT, Maria Schwarzkopf K, Thomas D, Mücke MM, Rüschenbaum S, Trebicka J, Pfeilschifter J, Zeuzem S, Lange CM, Grammatikos G. Serum Sphingosine-1-Phosphate Is Decreased in Patients With Acute-on-Chronic Liver Failure and Predicts Early Mortality. Hepatol Commun 2020; 4:1477-1486. [PMID: 33024917 PMCID: PMC7527696 DOI: 10.1002/hep4.1561] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/17/2020] [Accepted: 06/10/2020] [Indexed: 12/30/2022] Open
Abstract
Sphingosine‐1‐phosphate (S1P) regulates pathophysiological processes, including liver regeneration, vascular tone control, and immune response. In patients with liver cirrhosis, acute deterioration of liver function is associated with high mortality rates. The present study investigated whether serum S1P concentrations are associated with disease severity in patients with chronic liver disease from compensated cirrhosis (CC), acute decompensation (AD), or acute‐on‐chronic liver failure (ACLF). From August 2013 to October 2017, patients who were admitted to the University Hospital Frankfurt with CC, AD, or ACLF were enrolled in our cirrhosis cohort study. Tandem mass spectrometry was performed on serum samples of 127 patients to assess S1P concentration. Our study comprised 19 patients with CC, 55 with AD, and 51 with ACLF, aged 29 to 76 years. We observed a significant decrease of S1P according to advanced liver injury from CC and AD up to ACLF (P < 0.001). S1P levels further decreased with progression to ACLF grade 3 (P < 0.05), and S1P highly inversely correlated with the Model for End‐Stage Liver Disease score (r = −0.508; P < 0.001). In multivariate analysis, S1P remained an independent predictor of 7‐day mortality with high diagnostic accuracy (area under the curve, 0.874; P < 0.001). Conclusion: In patients with chronic liver disease, serum S1P levels dramatically decreased with advanced stages of liver disease and were predictive of early mortality. Because S1P is a potent regulator of endothelial integrity and immune response, low S1P levels may significantly influence progressive multiorgan failure. Our data justify further elucidation of the diagnostic and therapeutic role of S1P in ACLF.
Collapse
Affiliation(s)
- Victoria T Mücke
- Departement of Internal Medicine 1 University Hospital Frankfurt Goethe University Frankfurt am Main Germany
| | - Katharina Maria Schwarzkopf
- Departement of Internal Medicine 1 University Hospital Frankfurt Goethe University Frankfurt am Main Germany
| | - Dominique Thomas
- Pharmazentrum Frankfurt Institute of Clinical Pharmacology Goethe University Frankfurt am Main Germany
| | - Marcus M Mücke
- Departement of Internal Medicine 1 University Hospital Frankfurt Goethe University Frankfurt am Main Germany
| | - Sabrina Rüschenbaum
- Department of Gastroenterology and Hepatology University Hospital Essen University of Duisburg-Essen Essen Germany
| | - Jonel Trebicka
- Departement of Internal Medicine 1 University Hospital Frankfurt Goethe University Frankfurt am Main Germany
| | - Josef Pfeilschifter
- Pharmazentrum Frankfurt Institute of General Pharmacology and Toxicology Goethe University Frankfurt am Main Germany
| | - Stefan Zeuzem
- Departement of Internal Medicine 1 University Hospital Frankfurt Goethe University Frankfurt am Main Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology University Hospital Essen University of Duisburg-Essen Essen Germany
| | - Georgios Grammatikos
- Departement of Internal Medicine 1 University Hospital Frankfurt Goethe University Frankfurt am Main Germany.,St. Luke's Hospital Thessaloniki Panorama Greece
| |
Collapse
|
42
|
Dultz G, Shimakami T, Schneider M, Murai K, Yamane D, Marion A, Zeitler TM, Stross C, Grimm C, Richter RM, Bäumer K, Yi M, Biondi RM, Zeuzem S, Tampé R, Antes I, Lange CM, Welsch C. Extended interaction networks with HCV protease NS3-4A substrates explain the lack of adaptive capability against protease inhibitors. J Biol Chem 2020; 295:13862-13874. [PMID: 32747444 PMCID: PMC7535904 DOI: 10.1074/jbc.ra120.013898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/16/2020] [Revised: 07/26/2020] [Indexed: 12/20/2022] Open
Abstract
Inhibitors against the NS3-4A protease of hepatitis C virus (HCV) have proven to be useful drugs in the treatment of HCV infection. Although variants have been identified with mutations that confer resistance to these inhibitors, the mutations do not restore replicative fitness and no secondary mutations that rescue fitness have been found. To gain insight into the molecular mechanisms underlying the lack of fitness compensation, we screened known resistance mutations in infectious HCV cell culture with different genomic backgrounds. We observed that the Q41R mutation of NS3-4A efficiently rescues the replicative fitness in cell culture for virus variants containing mutations at NS3-Asp168 To understand how the Q41R mutation rescues activity, we performed protease activity assays complemented by molecular dynamics simulations, which showed that protease-peptide interactions far outside the targeted peptide cleavage sites mediate substrate recognition by NS3-4A and support protease cleavage kinetics. These interactions shed new light on the mechanisms by which NS3-4A cleaves its substrates, viral polyproteins and a prime cellular antiviral adaptor protein, the mitochondrial antiviral signaling protein MAVS. Peptide binding is mediated by an extended hydrogen-bond network in NS3-4A that was effectively optimized for protease-MAVS binding in Asp168 variants with rescued replicative fitness from NS3-Q41R. In the protease harboring NS3-Q41R, the N-terminal cleavage products of MAVS retained high affinity to the active site, rendering the protease susceptible for potential product inhibition. Our findings reveal delicately balanced protease-peptide interactions in viral replication and immune escape that likely restrict the protease adaptive capability and narrow the virus evolutionary space.
Collapse
Affiliation(s)
- Georg Dultz
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Tetsuro Shimakami
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Markus Schneider
- Center for Integrated Protein Science Munich (CIPSM) at the Department of Life Sciences, Technical University Munich, Freising-Weihenstephan, Germany
| | - Kazuhisa Murai
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Daisuke Yamane
- Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Antoine Marion
- Center for Integrated Protein Science Munich (CIPSM) at the Department of Life Sciences, Technical University Munich, Freising-Weihenstephan, Germany
| | - Tobias M Zeitler
- Center for Integrated Protein Science Munich (CIPSM) at the Department of Life Sciences, Technical University Munich, Freising-Weihenstephan, Germany
| | - Claudia Stross
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Grimm
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Rebecca M Richter
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Katrin Bäumer
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - MinKyung Yi
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Ricardo M Biondi
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt, Germany; Biomedicine Research Institute of Buenos Aires - CONICET - Partner Institute of the Max Planck Society, Buenos Aires, Argentina
| | - Stefan Zeuzem
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt, Germany; University Center for Infectious Diseases, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Robert Tampé
- Institute of Biochemistry, Biocenter and Cluster of Excellence-Macromolecular Complexes, Goethe University Frankfurt, Frankfurt, Germany
| | - Iris Antes
- Center for Integrated Protein Science Munich (CIPSM) at the Department of Life Sciences, Technical University Munich, Freising-Weihenstephan, Germany
| | - Christian M Lange
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | - Christoph Welsch
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt, Germany; University Center for Infectious Diseases, Goethe University Hospital Frankfurt, Frankfurt, Germany.
| |
Collapse
|
43
|
Abstract
BACKGROUND Abnormal liver function has been reported in patients with COVID-19 infection. The aim of our study was to report on the prevalence of liver injury in our cohort, to evaluate the association of mild versus severe liver injury with mortality in COVID-19 patients and to scrutinize the temporal pattern of viral detection and liver injury. METHODS We present data from a German cohort of 147 SARS-CoV-2 infected patients. The patients were divided into 3 groups according to their liver status during treatment. The first group included patients without elevated alanine aminotransferase or bilirubin, the third group patients meeting the biochemical criteria of acute liver failure (ALF), and the second group all other patients. RESULTS Liver injury was detected in 75 (50.7%) and 93 (63%) patients by admission and during treatment, respectively. ALF was associated with the male sex, younger age, and higher BMI. Mortality was associated with the presence of ALF (OR = 9.423, 95% CI: 2.410-36.858) in contrast to milder liver injury (OR 1.101, 95% CI: 0.435-2.791). In 30% of patients with mild liver injury and in 50% of ALF patients, peak liver injury was observed at a time point when the virus was no longer detectable in the respiratory tract. CONCLUSION Mild liver injury was not associated with worse outcome in our cohort, and the pattern of liver injury did not fit well to the theory of SARS-CoV-2 directly causing liver impairment. Instead, severe liver injury in our cohort was associated multiple-organ failure and acute vascular events.
Collapse
Affiliation(s)
- Olympia E Anastasiou
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany,
| | - Johannes Korth
- Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frank Herbstreit
- Department of Anesthesiology and Intensive Care, Essen University Hospital, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, Universitätsmedizin Essen, University Duisburg-Essen, Essen, Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| |
Collapse
|
44
|
Rashidi-Alavijeh J, Ceylan AS, Wedemeyer H, Kleefisch M, Willuweit K, Lange CM. Standard coagulation tests are superior to thromboelastometry in predicting outcome of patients with liver cirrhosis. PLoS One 2020; 15:e0236528. [PMID: 32722691 PMCID: PMC7386616 DOI: 10.1371/journal.pone.0236528] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background and aims Thromboelastometry (TEM) is superior to standard coagulation tests in the management of bleedings / invasive procedures in patients with liver cirrhosis. In contrast, the role of TEM as a prognostic parameter in liver cirrhosis is not well established. We therefore aimed to assess the role of TEM in predicting survival of outpatients with liver cirrhosis. Methods TEM was performed in consecutive outpatients with liver cirrhosis admitted in 2018 and 2019 to the University Hospital Essen. Associations with transplant-free survival were assessed in regression models. Results A number of 145 outpatients with liver cirrhosis were included, of whom 27 received a liver transplant (N = 7) or died (N = 20) within 6 months of follow-up. None of the TEM values was associated with transplant-free survival in this cohort. However, as expected, the classical coagulation tests INR (OR = 8.69 (95% CI 1.63–46.48), P = 0.01), PTT (OR = 1.15 (95% CI 1.04–1.27), P<0.01), as well as antithrombin (OR = 0.96 (95% CI 0.94–0.99), P<0.01), and protein C (OR = 0.96 (95% CI 0.92–0.99), P<0.01) were significantly associated with transplant-free survival. Conclusion In contrast to the superiority of TEM over classical coagulation tests to guide transfusion of blood products in patients with liver cirrhosis, TEM has no relevance in predicting mortality in outpatients with liver cirrhosis.
Collapse
Affiliation(s)
- Jassin Rashidi-Alavijeh
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ayse S. Ceylan
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Martin Kleefisch
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Katharina Willuweit
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian M. Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- * E-mail:
| |
Collapse
|
45
|
Queck A, Fink AF, Sirait-Fischer E, Rüschenbaum S, Thomas D, Snodgrass RG, Geisslinger G, Baba HA, Trebicka J, Zeuzem S, Weigert A, Lange CM, Brüne B. Alox12/15 Deficiency Exacerbates, While Lipoxin A 4 Ameliorates Hepatic Inflammation in Murine Alcoholic Hepatitis. Front Immunol 2020; 11:1447. [PMID: 32760397 PMCID: PMC7371948 DOI: 10.3389/fimmu.2020.01447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/02/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022] Open
Abstract
Alcoholism is one of the leading and increasingly prevalent reasons of liver associated morbidity and mortality worldwide. Alcoholic hepatitis (AH) constitutes a severe disease with currently no satisfying treatment options. Lipoxin A4 (LXA4), a 15-lipoxygenase (ALOX15)-dependent lipid mediator involved in resolution of inflammation, showed promising pre-clinical results in the therapy of several inflammatory diseases. Since inflammation is a main driver of disease progression in alcoholic hepatitis, we investigated the impact of endogenous ALOX15-dependent lipid mediators and exogenously applied LXA4 on AH development. A mouse model for alcoholic steatohepatitis (NIAAA model) was tested in Alox12/15+/+ and Alox12/15-/- mice, with or without supplementation of LXA4. Absence of Alox12/15 aggravated parameters of liver disease, increased hepatic immune cell infiltration in AH, and elevated systemic neutrophils as a marker for systemic inflammation. Interestingly, i.p. injections of LXA4 significantly lowered transaminase levels only in Alox12/15-/- mice and reduced hepatic immune cell infiltration as well as systemic inflammatory cytokine expression in both genotypes, even though steatosis progressed. Thus, while LXA4 injection attenuated selected parameters of disease progression in Alox12/15-/- mice, its beneficial impact on immunity was also apparent in Alox12/15+/+ mice. In conclusion, pro-resolving lipid mediators may be beneficial to reduce inflammation in alcoholic hepatitis.
Collapse
Affiliation(s)
- Alexander Queck
- Department of Internal Medicine 1, University Hospital, Goethe-University Frankfurt, Frankfurt, Germany
| | - Annika F Fink
- Faculty of Medicine, Institute of Biochemistry I, Goethe-University Frankfurt, Frankfurt, Germany
| | - Evelyn Sirait-Fischer
- Faculty of Medicine, Institute of Biochemistry I, Goethe-University Frankfurt, Frankfurt, Germany
| | - Sabrina Rüschenbaum
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dominique Thomas
- Institute of Clinical Pharmacology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Ryan G Snodgrass
- Faculty of Medicine, Institute of Biochemistry I, Goethe-University Frankfurt, Frankfurt, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology, Goethe-University Frankfurt, Frankfurt, Germany.,Branch Translational Medicine, Fraunhofer Institute for Molecular Biology and Applied Ecology, Frankfurt, Germany
| | - Hideo A Baba
- Department of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jonel Trebicka
- Department of Internal Medicine 1, University Hospital, Goethe-University Frankfurt, Frankfurt, Germany.,European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain.,Institute of Clinical Research, Odense University Hospital, University of Southern Denmark, Odense, Denmark.,Institute for Bioengineering of Catalonia, Barcelona, Spain
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital, Goethe-University Frankfurt, Frankfurt, Germany
| | - Andreas Weigert
- Faculty of Medicine, Institute of Biochemistry I, Goethe-University Frankfurt, Frankfurt, Germany
| | - Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernhard Brüne
- Faculty of Medicine, Institute of Biochemistry I, Goethe-University Frankfurt, Frankfurt, Germany.,Branch Translational Medicine, Fraunhofer Institute for Molecular Biology and Applied Ecology, Frankfurt, Germany
| |
Collapse
|
46
|
Lange CM. Systemic inflammation in hepatorenal syndrome - A target for novel treatment strategies? Liver Int 2019; 39:1199-1201. [PMID: 31290276 DOI: 10.1111/liv.14057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 02/13/2023]
Affiliation(s)
- Christian M Lange
- Department of Gastroenterology and Hepatology, University Hospital Essen and University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
47
|
Doncheva NT, Domingues FS, McGivern DR, Shimakami T, Zeuzem S, Lengauer T, Lange CM, Albrecht M, Welsch C. Near-Neighbor Interactions in the NS3-4A Protease of HCV Impact Replicative Fitness of Drug-Resistant Viral Variants. J Mol Biol 2019; 431:2354-2368. [PMID: 31051172 DOI: 10.1016/j.jmb.2019.04.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/19/2018] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/24/2022]
Abstract
A variety of amino acid substitutions in the NS3-4A protease of the hepatitis C virus lead to protease inhibitor (PI) resistance. Many of these significantly impair the replication fitness of the resistant variants in a genotype- and subtype-dependent manner, a critical factor in determining the probability with which resistant variants will persist. However, the underlying molecular mechanisms are unknown. Here, we present a novel residue-interaction network approach to determine how near-neighbor interactions of PI resistance mutations in NS3-4A can impact protease functional sites dependent on their genomic background. We constructed subtype-specific consensus residue networks for subtypes 1a and 1b from protease structure ensembles combined with biological properties of protein residues and evolutionary amino acid conservation. By applying local and global network topology analysis and visual exploration, we characterize PI resistance-associated sites and outline differences in near-neighbor interactions. We find local residue-interaction patterns and features at protease functional sites that are subtype specific. The noncovalent bonding patterns indicate higher fitness costs conferred by PI resistance mutations in a subtype 1b genomic background and explain the prevalence of Q80K and R155K in subtype 1a. Based on local residue interactions, we predict a subtype-specific role for the protease residue NS3-Q80 in molecular mechanisms related to the assembly of infectious virus particles that is supported by experimental data on the capacity of Q80K variants to replicate and produce infectious virus in subtype 1a and 1b cell culture.
Collapse
Affiliation(s)
- Nadezhda T Doncheva
- Department of Computational Biology and Applied Algorithmics, Max Planck Institute for Informatics, Saarbrücken, Germany; Graduate School of Computer Science, Saarland University, Saarbrücken, Germany
| | | | - David R McGivern
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Tetsuro Shimakami
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Stefan Zeuzem
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt a.M., Germany
| | - Thomas Lengauer
- Department of Computational Biology and Applied Algorithmics, Max Planck Institute for Informatics, Saarbrücken, Germany
| | - Christian M Lange
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt a.M., Germany
| | - Mario Albrecht
- Institute for Knowledge Discovery, Graz University of Technology, Graz, Austria
| | - Christoph Welsch
- Department of Computational Biology and Applied Algorithmics, Max Planck Institute for Informatics, Saarbrücken, Germany; Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Frankfurt a.M., Germany.
| |
Collapse
|
48
|
Schwarzkopf K, Rüschenbaum S, Barat S, Cai C, Mücke MM, Fitting D, Weigert A, Brüne B, Zeuzem S, Welsch C, Lange CM. IL-22 and IL-22-Binding Protein Are Associated With Development of and Mortality From Acute-on-Chronic Liver Failure. Hepatol Commun 2019; 3:392-405. [PMID: 30859151 PMCID: PMC6396350 DOI: 10.1002/hep4.1303] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022] Open
Abstract
Interleukin-22 (IL-22) has context-dependent hepatoprotective or adverse properties in vitro and in animal models. IL-22 binding protein (IL-22BP) is a soluble inhibitor of IL-22 signaling. The role of IL-22 and IL-22BP in patients with acute-on-chronic liver failure (ACLF) is unclear. Beginning in August 2013, patients with liver cirrhosis with and without ACLF were prospectively enrolled and followed at predefined time points. IL-22 and IL-22BP concentrations were quantified and associated with clinical endpoints. The impact of IL-22BP on hepatocellular IL-22 signaling was assessed by functional experiments. A total of 139 patients were analyzed, including 45 (32%), 52 (37%), and 42 (30%) patients with compensated/stable decompensated liver cirrhosis, acute decompensation of liver cirrhosis, and ACLF at baseline, respectively. Serum levels of IL-22 and IL-22BP were strongly associated with the presence of, or progression to, ACLF (P < 0.001), and with mortality (P < 0.01). Importantly, the mean IL-22BP levels exceeded IL-22 levels more than 300-fold. Furthermore, IL-22BP/IL-22 ratios were lowest in patients with adverse outcomes (i.e., ACLF and death). In vitro experiments showed that IL-22BP at these concentrations inhibits hepatocellular IL-22 signaling, including the induction of acute-phase proteins. The capacity of patient serum to induce signal transducer and activator of transcription 3 phosphorylation was substantially higher in the presence of low versus high IL-22BP/IL-22 ratios. Conclusion: Our study reveals that high IL-22 levels and low ratios of IL-22BP/IL-22 are associated with ACLF and mortality of patients with cirrhosis. Excessive secretion of IL-22BP can neutralize IL-22 in vitro and may prevent-likely in a context-specific manner-hepatoprotective, but also adverse effects, of IL-22 in patients with cirrhosis.
Collapse
Affiliation(s)
- Katharina Schwarzkopf
- Department of Internal Medicine 1 Goethe-University Hospital Frankfurt Frankfurt Germany
| | - Sabrina Rüschenbaum
- Department of Internal Medicine 1 Goethe-University Hospital Frankfurt Frankfurt Germany
| | - Samarpita Barat
- Department of Internal Medicine 1 Goethe-University Hospital Frankfurt Frankfurt Germany
| | - Chengcong Cai
- Department of Internal Medicine 1 Goethe-University Hospital Frankfurt Frankfurt Germany
| | - Marcus M Mücke
- Department of Internal Medicine 1 Goethe-University Hospital Frankfurt Frankfurt Germany
| | - Daniel Fitting
- Department of Internal Medicine 1 Goethe-University Hospital Frankfurt Frankfurt Germany
| | - Andreas Weigert
- Institute of Biochemistry 1 Goethe-University Frankfurt Frankfurt Germany
| | - Bernhard Brüne
- Institute of Biochemistry 1 Goethe-University Frankfurt Frankfurt Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1 Goethe-University Hospital Frankfurt Frankfurt Germany
| | - Christoph Welsch
- Department of Internal Medicine 1 Goethe-University Hospital Frankfurt Frankfurt Germany
| | - Christian M Lange
- Department of Internal Medicine 1 Goethe-University Hospital Frankfurt Frankfurt Germany
| |
Collapse
|
49
|
Saleh M, Rüschenbaum S, Welsch C, Zeuzem S, Moradpour D, Gouttenoire J, Lange CM. Glycogen Synthase Kinase 3β Enhances Hepatitis C Virus Replication by Supporting miR-122. Front Microbiol 2018; 9:2949. [PMID: 30542341 PMCID: PMC6278592 DOI: 10.3389/fmicb.2018.02949] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/15/2018] [Accepted: 11/16/2018] [Indexed: 12/13/2022] Open
Abstract
Hepatitis C virus (HCV) infection is associated with alterations in host lipid and insulin signaling cascades, which are partially explained by a dependence of the HCV life cycle on key molecules in these metabolic pathways. Yet, little is known on the role in the HCV life cycle of glycogen synthase kinase 3 (GSK3), one of the most important kinases in cellular metabolism. Therefore, the impact of GSK3 on the HCV life cycle was assessed in human hepatoma cell lines harboring subgenomic genotype 1b and 2a replicons or producing cell culture-derived HCV genotype 2a by exposure to synthetic GSK3 inhibitors, GSK3 gene silencing, overexpression of GSK3 constructs and immunofluorescence analyses. In addition, the role of GSK3 in hepatitis E virus (HEV) replication was investigated to assess virus specificity of the observed findings. We found that both inhibition of GSK3 function by synthetic inhibitors as well as silencing of GSK3β gene expression resulted in a decrease of HCV replication and infectious particle production, whereas silencing of the GSK3α isoform had no relevant effect on the HCV life cycle. Conversely, overexpression of GSK3β resulted in enhanced HCV replication. In contrast, GSK3β had no effect on replication of subgenomic HEV replicon. The pro-viral effect of GSK3β on HCV replication was mediated by supporting expression of microRNA-122 (miR-122), a micro-RNA which is mandatory for wild-type HCV replication, as GSK3 inhibitors suppressed miR-122 levels and as inhibitors of GSK3 had no antiviral effect on a miR-122-independent HCV mutant. In conclusion, we have identified GSK3β is a novel host factor supporting HCV replication by maintaining high levels of hepatic miR-122 expression.
Collapse
Affiliation(s)
- Maged Saleh
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Sabrina Rüschenbaum
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Christoph Welsch
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Darius Moradpour
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Jérôme Gouttenoire
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Christian M Lange
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| |
Collapse
|
50
|
Kubesch A, Quenstedt L, Saleh M, Rüschenbaum S, Schwarzkopf K, Martinez Y, Welsch C, Zeuzem S, Welzel TM, Lange CM. Vitamin D deficiency is associated with hepatic decompensation and inflammation in patients with liver cirrhosis: A prospective cohort study. PLoS One 2018; 13:e0207162. [PMID: 30408125 PMCID: PMC6224127 DOI: 10.1371/journal.pone.0207162] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/25/2018] [Indexed: 12/14/2022] Open
Abstract
Background Vitamin D is required to maintain the integrity of the intestinal barrier and inhibits inflammatory signaling pathways. Objective Vitamin D deficiency might be involved in cirrhosis-associated systemic inflammation and risk of hepatic decompensation in patients with liver cirrhosis. Methods Outpatients of the Hepatology Unit of the University Hospital Frankfurt with advanced liver fibrosis and cirrhosis were prospectively enrolled. 25-hydroxyvitamin D (25(OH)D3) serum concentrations were quantified and associated with markers of systemic inflammation / intestinal bacterial translocation and hepatic decompensation. Results A total of 338 patients with advanced liver fibrosis or cirrhosis were included. Of those, 51 patients (15%) were hospitalized due to hepatic decompensation during follow-up. Overall, 72 patients (21%) had severe vitamin D deficiency. However, patients receiving vitamin D supplements had significantly higher 25(OH)D3 serum levels compared to patients without supplements (37 ng/mL vs. 16 ng/ml, P<0.0001). Uni- and multivariate analyses revealed an independent association of severe vitamin D deficiency with the risk of hepatic decompensation during follow-up (multivariate P = 0.012; OR = 3.25, 95% CI = 1.30–8.2), together with MELD score, low hemoglobin concentration, low coffee consumption, and presence of diabetes. Of note, serum levels of C-reactive protein, IL-6 and soluble CD14 were significantly higher in patients with versus without severe vitamin D deficiency, and serum levels of soluble CD14 levels declined in patients with de novo supplementation of vitamin D (median 2.15 vs. 1.87 ng/mL, P = 0.002). Conclusions In this prospective cohort study, baseline vitamin D levels were inversely associated with liver-cirrhosis related systemic inflammation and the risk of hepatic decompensation.
Collapse
Affiliation(s)
- Alica Kubesch
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
- * E-mail:
| | - Leonie Quenstedt
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Maged Saleh
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Sabrina Rüschenbaum
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Katharina Schwarzkopf
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Yolanda Martinez
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Christoph Welsch
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Tania M. Welzel
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | - Christian M. Lange
- Department of Internal Medicine 1, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| |
Collapse
|