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Zettersten M, Cox C, Bergmann C, Tsui ASM, Soderstrom M, Mayor J, Lundwall RA, Lewis M, Kosie JE, Kartushina N, Fusaroli R, Frank MC, Byers-Heinlein K, Black AK, Mathur MB. Evidence for Infant-directed Speech Preference Is Consistent Across Large-scale, Multi-site Replication and Meta-analysis. Open Mind (Camb) 2024; 8:439-461. [PMID: 38665547 PMCID: PMC11045035 DOI: 10.1162/opmi_a_00134] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/19/2024] [Indexed: 04/28/2024] Open
Abstract
There is substantial evidence that infants prefer infant-directed speech (IDS) to adult-directed speech (ADS). The strongest evidence for this claim has come from two large-scale investigations: i) a community-augmented meta-analysis of published behavioral studies and ii) a large-scale multi-lab replication study. In this paper, we aim to improve our understanding of the IDS preference and its boundary conditions by combining and comparing these two data sources across key population and design characteristics of the underlying studies. Our analyses reveal that both the meta-analysis and multi-lab replication show moderate effect sizes (d ≈ 0.35 for each estimate) and that both of these effects persist when relevant study-level moderators are added to the models (i.e., experimental methods, infant ages, and native languages). However, while the overall effect size estimates were similar, the two sources diverged in the effects of key moderators: both infant age and experimental method predicted IDS preference in the multi-lab replication study, but showed no effect in the meta-analysis. These results demonstrate that the IDS preference generalizes across a variety of experimental conditions and sampling characteristics, while simultaneously identifying key differences in the empirical picture offered by each source individually and pinpointing areas where substantial uncertainty remains about the influence of theoretically central moderators on IDS preference. Overall, our results show how meta-analyses and multi-lab replications can be used in tandem to understand the robustness and generalizability of developmental phenomena.
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Affiliation(s)
| | - Christopher Cox
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University; Interacting Minds Center, School of Culture and Society, Aarhus University
| | | | | | | | - Julien Mayor
- Department of Linguistics and Scandinavian Studies, University of Oslo
| | | | - Molly Lewis
- Department of Psychology/Social and Decision Sciences, Carnegie Mellon University
| | | | | | - Riccardo Fusaroli
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University; Interacting Minds Center, School of Culture and Society, Aarhus University
| | | | | | - Alexis K. Black
- School of Audiology and Speech Sciences, University of British Columbia
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Györfi AH, Filla T, Dickel N, Möller F, Li YN, Bergmann C, Matei AE, Harrer T, Kunz M, Schett G, Distler JHW. Performance of serum biomarkers reflective of different pathogenic processes in systemic sclerosis-associated interstitial lung disease. Rheumatology (Oxford) 2024; 63:962-969. [PMID: 37421394 DOI: 10.1093/rheumatology/kead332] [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: 02/22/2023] [Revised: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVE Interstitial lung disease (ILD) is the leading cause of mortality in SSc. Novel biomarkers are crucial to improve outcomes in SSc-ILD. We aimed to compare the performance of potential serum biomarkers of SSc-ILD that reflect different pathogenic processes: KL-6 and SP-D (epithelial injury), CCL18 (type 2 immune response), YKL-40 (endothelial injury and matrix remodelling) and MMP-7 (ECM remodelling). METHODS Baseline and follow-up serum samples from 225 SSc patients were analysed by ELISA. Progressive ILD was defined according to the 2022-ATS/ERS/JRS/ALAT guidelines. Linear mixed models and random forest models were used for statistical analyses. RESULTS Serum levels of KL-6 [MD 35.67 (95% CI 22.44-48.89, P < 0.01)], SP-D [81.13 (28.46-133.79, P < 0.01)], CCL18 [17.07 (6.36-27.77, P < 0.01)], YKL-40 [22.81 (7.19-38.44, P < 0.01)] and MMP-7 [2.84 (0.88-4.80, P < 0.01)] were independently associated with the presence of SSc-ILD. A machine-learning model including all candidates classified patients with or without ILD with an accuracy of 85%. The combination of KL-6 and SP-D was associated with the presence [0.77 (0.53-1.00, P' <0.01)] and previous progression of SSc-ILD [OR 1.28 (1.01-1.61, P' =0.047)]. Higher baseline levels of KL-6 [OR 3.70 (1.52-9.03, P < 0.01)] or SP-D [OR 2.00 (1.06-3.78, P = 0.03)] increased the odds of future SSc-ILD progression, independent of other conventional risk factors, and the combination of KL-6 and SP-D [1.109 (0.665-1.554, P < 0.01)] showed improved performance compared with KL-6 and SP-D alone. CONCLUSION All candidates performed well as diagnostic biomarkers for SSc-ILD. The combination of KL-6 and SP-D might serve as biomarker for the identification of SSc patients at risk of ILD progression.
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Affiliation(s)
- Andrea-Hermina Györfi
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
| | - Tim Filla
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
| | - Nicholas Dickel
- Chair of Medical Informatics, Friedrich-Alexander University (FAU) of Erlangen-Nürnberg, Erlangen, Germany
| | - Florian Möller
- Department of Internal Medicine 3, Rheumatology and Clinical Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Yi-Nan Li
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3, Rheumatology and Clinical Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Alexandru-Emil Matei
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
| | - Thomas Harrer
- Department of Internal Medicine 3, Rheumatology and Clinical Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Meik Kunz
- Chair of Medical Informatics, Friedrich-Alexander University (FAU) of Erlangen-Nürnberg, Erlangen, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hanover, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Clinical Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine University, Düsseldorf, Germany
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Müller F, Taubmann J, Bucci L, Wilhelm A, Bergmann C, Völkl S, Aigner M, Rothe T, Minopoulou I, Tur C, Knitza J, Kharboutli S, Kretschmann S, Vasova I, Spoerl S, Reimann H, Munoz L, Gerlach RG, Schäfer S, Grieshaber-Bouyer R, Korganow AS, Farge-Bancel D, Mougiakakos D, Bozec A, Winkler T, Krönke G, Mackensen A, Schett G. CD19 CAR T-Cell Therapy in Autoimmune Disease - A Case Series with Follow-up. N Engl J Med 2024; 390:687-700. [PMID: 38381673 DOI: 10.1056/nejmoa2308917] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Treatment for autoimmune diseases such as systemic lupus erythematosus (SLE), idiopathic inflammatory myositis, and systemic sclerosis often involves long-term immune suppression. Resetting aberrant autoimmunity in these diseases through deep depletion of B cells is a potential strategy for achieving sustained drug-free remission. METHODS We evaluated 15 patients with severe SLE (8 patients), idiopathic inflammatory myositis (3 patients), or systemic sclerosis (4 patients) who received a single infusion of CD19 chimeric antigen receptor (CAR) T cells after preconditioning with fludarabine and cyclophosphamide. Efficacy up to 2 years after CAR T-cell infusion was assessed by means of Definition of Remission in SLE (DORIS) remission criteria, American College of Rheumatology-European League against Rheumatism (ACR-EULAR) major clinical response, and the score on the European Scleroderma Trials and Research Group (EUSTAR) activity index (with higher scores indicating greater disease activity), among others. Safety variables, including cytokine release syndrome and infections, were recorded. RESULTS The median follow-up was 15 months (range, 4 to 29). The mean (±SD) duration of B-cell aplasia was 112±47 days. All the patients with SLE had DORIS remission, all the patients with idiopathic inflammatory myositis had an ACR-EULAR major clinical response, and all the patients with systemic sclerosis had a decrease in the score on the EUSTAR activity index. Immunosuppressive therapy was completely stopped in all the patients. Grade 1 cytokine release syndrome occurred in 10 patients. One patient each had grade 2 cytokine release syndrome, grade 1 immune effector cell-associated neurotoxicity syndrome, and pneumonia that resulted in hospitalization. CONCLUSIONS In this case series, CD19 CAR T-cell transfer appeared to be feasible, safe, and efficacious in three different autoimmune diseases, providing rationale for further controlled clinical trials. (Funded by Deutsche Forschungsgemeinschaft and others.).
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Affiliation(s)
- Fabian Müller
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Jule Taubmann
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Laura Bucci
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Artur Wilhelm
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Christina Bergmann
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Simon Völkl
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Michael Aigner
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Tobias Rothe
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Ioanna Minopoulou
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Carlo Tur
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Johannes Knitza
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Soraya Kharboutli
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Sascha Kretschmann
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Ingrid Vasova
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Silvia Spoerl
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Hannah Reimann
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Luis Munoz
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Roman G Gerlach
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Simon Schäfer
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Ricardo Grieshaber-Bouyer
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Anne-Sophie Korganow
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Dominique Farge-Bancel
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Dimitrios Mougiakakos
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Aline Bozec
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Thomas Winkler
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Gerhard Krönke
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Andreas Mackensen
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Georg Schett
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
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4
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Zhou X, Trinh-Minh T, Matei AE, Györfi AH, Hong X, Bergmann C, Schett G, Atkinson J, Bowcutt R, Patel J, Johnson TS, Distler JHW. Amelioration of Fibrotic Remodeling of Human 3-Dimensional Full-Thickness Skin by Transglutamase 2 Inhibition. Arthritis Rheumatol 2023; 75:1619-1627. [PMID: 37057394 DOI: 10.1002/art.42518] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/09/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE Fibrotic tissues are characterized by excessive crosslinking between extracellular matrix (ECM) proteins, rendering them more resistant to degradation. Although increased crosslinking of ECM is thought to play an important role for progression of tissue fibrosis, enhanced ECM crosslinking has not yet been targeted therapeutically in systemic sclerosis (SSc). Here, we investigated the role of transglutaminase 2 (TG2), a central crosslinking enzyme, in the activation of SSc fibroblasts. METHODS We assessed TG2 expression and activity using TG2 staining, Western blotting, and TG2 activity assays. We inhibited TG2 in fibroblasts cultured under standard 2-dimensional conditions and in a 3-dimensional full-thickness equivalent skin model using monoclonal inhibitory anti-TG2 antibodies. RESULTS TG2 expression was increased in the skin of patients with SSc compared with healthy controls, with levels particularly high in patients with SSc-associated interstitial lung disease. TG2 expression and TG2 activity were also increased in SSc dermal fibroblasts. Moreover, the levels of circulating TG2 in the plasma samples from SSc patients were increased versus samples from healthy controls. Anti-TG2 antibodies did not show consistent antifibrotic effects across different fibroblast cell lines under 2-dimensional culture conditions; however, anti-TG2 antibodies effectively reduced transforming growth factor β-induced dermal thickening, myofibroblast differentiation, and collagen accumulation in the 3-dimensional full-thickness model of human skin. CONCLUSION We provide the first evidence, to our knowledge, that inhibition of TG2 might be a potential antifibrotic approach in SSc. Our findings have translational potential as anti-TG2 antibodies are currently evaluated in a phase II clinical trial in chronic allograft injury and would thus be available for clinical studies in SSc (ClinicalTrials.gov identifier: NCT04335578).
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Affiliation(s)
- Xiang Zhou
- Clinic for Rheumatology University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, and Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Thuong Trinh-Minh
- Clinic for Rheumatology University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, and Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Alexandru-Emil Matei
- Clinic for Rheumatology University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, and Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Andrea-Hermina Györfi
- Clinic for Rheumatology University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, and Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Xuezhi Hong
- Clinic for Rheumatology University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, and Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, and Deutsches Zentrum Immuntherapie (DZI), FAU Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, and Deutsches Zentrum Immuntherapie (DZI), FAU Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | | | | | | | | | - Jörg H W Distler
- Clinic for Rheumatology University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, and Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
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5
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Bergmann C, Müller F, Distler JHW, Györfi AH, Völkl S, Aigner M, Kretschmann S, Reimann H, Harrer T, Bayerl N, Boeltz S, Wirsching A, Taubmann J, Rösler W, Spriewald B, Wacker J, Atzinger A, Uder M, Kuwert T, Mackensen A, Schett G. Treatment of a patient with severe systemic sclerosis (SSc) using CD19-targeted CAR T cells. Ann Rheum Dis 2023; 82:1117-1120. [PMID: 37147112 PMCID: PMC10359520 DOI: 10.1136/ard-2023-223952] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/06/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Christina Bergmann
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fabian Müller
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 5-Haematology and Clinical Oncology, FAU Erlangen-Nurnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Rheumatology, Universitatsklinikum Dusseldorf, Dusseldorf, Germany
- Hiller Research Unit, University of Düsseldorf, Duesseldorf, Germany
| | - Andrea-Hermina Györfi
- Department of Rheumatology, Universitatsklinikum Dusseldorf, Dusseldorf, Germany
- Hiller Research Unit, University of Düsseldorf, Duesseldorf, Germany
| | - Simon Völkl
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 5-Haematology and Clinical Oncology, FAU Erlangen-Nurnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michael Aigner
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 5-Haematology and Clinical Oncology, FAU Erlangen-Nurnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sascha Kretschmann
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 5-Haematology and Clinical Oncology, FAU Erlangen-Nurnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hannah Reimann
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 5-Haematology and Clinical Oncology, FAU Erlangen-Nurnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Thomas Harrer
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Nadine Bayerl
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sebastian Boeltz
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Wirsching
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jule Taubmann
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wolf Rösler
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 5-Haematology and Clinical Oncology, FAU Erlangen-Nurnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Bernd Spriewald
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 5-Haematology and Clinical Oncology, FAU Erlangen-Nurnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jochen Wacker
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Armin Atzinger
- Institute of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Torsten Kuwert
- Institute of Nuclear Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Mackensen
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 5-Haematology and Clinical Oncology, FAU Erlangen-Nurnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Klimek L, Hagemann J, Huppertz T, Bärhold F, Albrecht T, Klimek F, Casper I, Cuevas M, Bergmann C, Becker S. COVID-19 and chronic rhinosinusitis: management and comorbidity - what have we learned? Expert Rev Clin Immunol 2023; 19:1399-1406. [PMID: 37551742 DOI: 10.1080/1744666x.2023.2244673] [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: 02/22/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Approximately 5%-12% of the population worldwide suffer from chronic rhinosinusitis (CRS). CRS is defined as a chronic respiratory disease and is considered to be a risk factor for COVID-19 patients. AREAS COVERED A non-systematic literature research was conducted on COVID-19 and treatment options for CRSwNP. The latest international publications in medical databases, international guidelines, and the internet were reviewed. Since there were no publications on all aspects of this topic during the pandemic, we included our own experience in this report. Based on the conducted literature research in addition to our previously reported experience, we discuss the treatment of CRSwNP during the COVID-19 pandemic and what can be taken for future pandemics. EXPERT OPINION Intranasal corticosteroids remain the standard treatment for CRS in patients with SARS-CoV-2 infection. Indications for surgical treatment of CRS should be critically evaluated and reserved for patients with complications and those with no other treatment options. For this purpose, COVID-19 status should be known if possible and, in case of unclear status (emergency), using appropriate personal protective equipment. Systemic corticosteroids should be avoided were possible. Biological treatment should be continued under careful monitoring in uninfected patients and should be temporarily interrupted during COVID-19 infection.
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Affiliation(s)
- L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - J Hagemann
- Department of Otorhinolaryngology, Mainz University Medical Center, Mainz, Germany
| | - T Huppertz
- Department of Otorhinolaryngology, Mainz University Medical Center, Mainz, Germany
| | - F Bärhold
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of Eberhard-Karls University, Tübingen, Germany
| | - T Albrecht
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of Eberhard-Karls University, Tübingen, Germany
| | - F Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - I Casper
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - M Cuevas
- Clinic and Polyclinic for Otorhinolaryngology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - C Bergmann
- Practice for Ear, Nose and Throat Medicine, Clinic RKM 740, Düsseldorf, Germany
| | - S Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of Eberhard-Karls University, Tübingen, Germany
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7
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Perisse A, De Cacqueray F, Delarbre D, Marsaa H, Bergmann C, Da Silva V, Bronstein A, Paleiron N, Menoud N, Cobola J, Verret C, Mayet A, Bylicki O. Symptoms of Long-COVID 1-Year after a COVID-19 outbreak among sailors on a French aircraft carrier. Infect Dis Now 2023; 53:104673. [PMID: 36775065 PMCID: PMC9918313 DOI: 10.1016/j.idnow.2023.104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/02/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES While persistent symptoms have been reported after the coronavirus disease-2019 (COVID-19), long-term data on outpatients with mild COVID-19 are lacking. The objective was to describe symptoms persisting for 12 months. METHODS This prospective cohort study on 1767 sailors of an aircraft carrier in which a Covid-19 outbreak occurred during a mission in April 2020 described predefined self-reported symptoms of Long-COVID at 6, 9 and 12 months. Logistic-regression analyses were used to identify correlates for Long-COVID at months 6, 9 and 12. RESULTS Among the 641 participants, 619 (35%) completed at least one follow-up questionnaire (413 COVID-positive and 206 COVID-negative). Symptoms of Long-COVID were reported by 53.7%, 55.2% and 54.3% of COVID-positive participants vs 31.2%, 23.3% and 40.0% in COVID-negative patients, at 6 (p <.002), 9 (p <.002) and 12 months (p =.13), respectively. The most frequent symptoms reported were concentration and memory difficulties, asthenia and sleep disorders. CONCLUSION In this study more than half of COVID-positive outpatients reported persistent symptoms up to 12 months post-quarantine. These findings suggests that all patients, including those with mild disease, can be affected by Long-COVID. A lack of difference at 12 months with COVID-negative patienys prompts caution. The symptoms of Long-COVID are so non-specific that they may be viewed as the consequence of multiple intercurrent factors.
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Affiliation(s)
- A Perisse
- 9th Military Medical Center, Toulon, France
| | - F De Cacqueray
- 9th Military Medical Center, Toulon, France; Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - D Delarbre
- Division of Internal Medicine, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France
| | - H Marsaa
- 9th Military Medical Center, Toulon, France
| | | | - V Da Silva
- 16th Military Medical Center, Brest, France
| | - A Bronstein
- Respiratory Disease Unit, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France
| | - N Paleiron
- Respiratory Disease Unit, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France
| | - N Menoud
- Charles de Gaulle Nuclear Aircraft Carrier, Toulon, France
| | - J Cobola
- Charles de Gaulle Nuclear Aircraft Carrier, Toulon, France
| | - C Verret
- Department of Education, Research and Innovation, French Defense Health Service, Paris, France
| | - A Mayet
- French Military Center for Epidemiology and Public Health (CESPA), Marseille, France; UMR 1252 SESSTIM, INSERM-IRD-Université Aix-Marseille, Marseille, France
| | - O Bylicki
- Respiratory Disease Unit, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France.
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8
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Klimek L, Werminghaus P, Bergmann C, Hagemann J, Huppertz T, Bärhold F, Klimek F, Dziadziulia K, Casper I, Polk ML, Cuevas M, Gröger M, Becker S. [Neuroimmunology of allergic rhinitis part 2 : Interactions of neurons and immune cells and neuroimmunological units]. HNO 2023:10.1007/s00106-023-01304-y. [PMID: 37171595 DOI: 10.1007/s00106-023-01304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 05/13/2023]
Abstract
Allergic rhinitis is an IgE-mediated, type‑2 inflammatory disease. neuropeptides are released by neurons and interact with immune cells. Via colocalization, neuroimmune cell units such as nerve-mast cell units, nerve-type 2 innate lymphoid cell (ILC2) units, nerve-eosinophil units, and nerve-basophil units are formed. Markedly elevated tryptase levels were found in nasal lavage fluid and were strongly associated with neuropeptide levels. A close anatomical connection allows bidirectional communication between immune and neuronal cells. Transient receptor potential vanilloid 1 (TRPV1) and transient receptor potential ankyrin repeat 1 (TRPA1) are critically involved in immunological reactions in the setting of allergic rhinitis. Neuroimmunological communication plays an important role in the inflammatory process, so that allergic rhinitis can no longer be considered a purely immunological disease, but rather a combined neuroimmunological disease.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland.
| | - P Werminghaus
- Praxis für Hals‑, Nasen‑, Ohrenheilkunde und Allergologie, Düsseldorf, Deutschland
| | - C Bergmann
- Praxis für Hals‑, Nasen‑, Ohrenheilkunde, Klinik RKM 740, Düsseldorf, Deutschland
| | - J Hagemann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz, Mainz, Deutschland
| | - T Huppertz
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz, Mainz, Deutschland
| | - F Bärhold
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen, Tübingen, Deutschland
| | - F Klimek
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland
| | - K Dziadziulia
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland
| | - I Casper
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland
| | - M-L Polk
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - M Gröger
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik München, München, Deutschland
| | - S Becker
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen, Tübingen, Deutschland
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9
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Klimek L, Werminghaus P, Bergmann C, Hagemann J, Huppertz T, Bärhold F, Klimek F, Dziadziulia K, Casper I, Polk ML, Cuevas M, Gröger M, Becker S. [Neuroimmunology of allergic rhinitis : Part 1: Cellular and humoral basic principles]. HNO 2023; 71:337-346. [PMID: 37041304 DOI: 10.1007/s00106-023-01292-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 04/13/2023]
Abstract
Allergic rhinitis (AR) is a very common disease with a high prevalence worldwide. It is an IgE-mediated type 2 inflammatory disease following exposure to inhalant allergens. A multitude of different neuropeptides including substance P, vasoactive intestinal peptide (VIP), calcitonin gene-related peptide (CGRP), nerve growth factor (NGF), and neuromedin U (NMU) can be released via peripheral axon or central reflexes, interact with immune cells, and thus contribute to neurogenic inflammation which causes the nasal hyperreactivity (NHR) characteristic of AR. Independent production of neuroendocrine hormones and neuropeptides by immune cells has also been demonstrated. Neuro-immune cell units arise when immune and neuronal cells colocalize, for which typical anatomic regions are, e.g., the mast cell-nerve functional unit. The focus of this review is the elucidation of neuroimmune communication mechanisms in AR.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland.
| | - P Werminghaus
- Praxis für Hals‑, Nasen‑, Ohrenheilkunde und Allergologie, Düsseldorf, Deutschland
| | - C Bergmann
- Praxis für Hals‑, Nasen‑, Ohrenheilkunde, Klinik RKM 740, Düsseldorf, Deutschland
| | - J Hagemann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz, Mainz, Deutschland
| | - T Huppertz
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz, Mainz, Deutschland
| | - F Bärhold
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen, Tübingen, Deutschland
| | - F Klimek
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland
| | - K Dziadziulia
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland
| | - I Casper
- Zentrum für Rhinologie und Allergologie Wiesbaden, An den Quellen 10, 65183, Wiesbaden, Deutschland
| | - M-L Polk
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - M Gröger
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik München, München, Deutschland
| | - S Becker
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen, Tübingen, Deutschland
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10
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Becker S, Laudien M, Förster-Ruhrmann U, Olze H, Rudack C, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Bärhold F, Klimek F, Kianfar R, Zuberbier J, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Werminghaus P, Gröger M, Beutner C, Weber RK, Hildenbrand T, Hoffmann AS, Klimek L. Erratum: Positionspapier: ICD-Codierung der chronischen Rhinosinusitis mit Nasenpolypen (CRSwNP) im ICD-10-GM als Grundlage für eine Therapie mit Biologika. Laryngorhinootologie 2023; 102:e2. [PMID: 37023780 DOI: 10.1055/a-2069-1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- S Becker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - M Laudien
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Kiel
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
- Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St.-Elisabeth-Hospital
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - F Bärhold
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - R Kianfar
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg
| | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - P Werminghaus
- Praxis für Hals-Nasen-Ohrenheilkunde und Allergologie, Düsseldorf
| | - M Gröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum LMU München
| | - C Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Allergiezentrum Südniedersachsen, Universitätsmedizin Göttingen
| | - R K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe
| | - T Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
| | - A S Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
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11
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Becker S, Laudien M, Förster-Ruhrmann U, Olze H, Rudack C, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Bärhold F, Klimek F, Kianfar R, Zuberbier J, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Werminghaus P, Gröger OM, Beutner C, Weber RK, Hildenbrand T, Hoffmann AS, Klimek L. Positionspapier: ICD-Codierung der chronischen Rhinosinusitis mit Nasenpolypen (CRSwNP) im ICD-10-GM als Grundlage für eine Therapie mit Biologika – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA), der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC) und des Deutschen CRS-Registers. Laryngorhinootologie 2023; 102:349-356. [PMID: 36882095 DOI: 10.1055/a-2039-1831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Zusammenfassung
Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der Schleimhäute von Nase und Nasennebenhöhlen. In Deutschland sind 3 verschiedene monoklonale Antikörper für die Indikation „Zusatztherapie zu intranasalen Glukokortikosteroiden für die Behandlung Erwachsener mit schwerer chronischer Rhinosinusitis mit Nasenpolypen“ zugelassen. Um die Verordnung in der zugelassenen Indikation (In-Label) zu dokumentieren, ist neben einer Dokumentation zahlreicher medizinischer Parameter die korrekte Auswahl der ICD-10-GM-Codierung entscheidend. Hierfür existieren in Deutschland bislang keine konsentierten Empfehlungen.
Methoden Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium von AeDA, DGHNO-KHC und Deutschem CRS-Register Codierungsmöglichkeiten von CRS und CRSwNP analysiert und auf dieser Basis eine konsentierte Empfehlung für die ICD-10-GM-Codierung in Deutschland ausgesprochen.
Ergebnis Die Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme ICD-10-GM (International Classification of Diseases, 10. Revision, German Modification) ist die amtliche Klassifikation zur Verschlüsselung von Diagnosen in der ambulanten und stationären Versorgung in Deutschland. Der ICD-10-GM unterscheidet nicht adäquat zwischen heute anerkannten klinischen und immunologischen Differenzierungen der CRSsNP und der CRSwNP. Dennoch wird insbesondere bei indiziertem Einsatz von Biologika in der Therapie der schweren CRSwNP eine möglichst exakte Verschlüsselung mit den Codes J33.8 (im Einzelfall J33.1 oder J33.9) empfohlen.
Schlussfolgerungen Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue Behandlungsansätze mit monoklonalen Antikörpern für Patienten mit schwerer, unkontrollierter Erkrankung. Hier geben wir Empfehlungen für eine adäquate ICD-10-GM-Codierung in Deutschland.
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Affiliation(s)
- S Becker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - M Laudien
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Kiel
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St.-Elisabeth-Hospital
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - F Bärhold
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - R Kianfar
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg
| | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - P Werminghaus
- Praxis für Hals-Nasen-Ohrenheilkunde und Allergologie, Düsseldorf
| | - O M Gröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum LMU München
| | - C Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Allergiezentrum Südniedersachsen, Universitätsmedizin Göttingen
| | - R K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe
| | - T Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
| | - A S Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
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12
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Fuchs F, Morf H, Mohn J, Mühlensiepen F, Ignatyev Y, Bohr D, Araujo E, Bergmann C, Simon D, Kleyer A, Vorbrüggen W, Ramming A, Distler JHW, Bartz-Bazzanella P, Schett G, Welcker M, Hueber AJ, Knitza J. Diagnostic delay stages and pre-diagnostic treatment in patients with suspected rheumatic diseases before special care consultation: results of a multicenter-based study. Rheumatol Int 2023; 43:495-502. [PMID: 36214864 PMCID: PMC9968271 DOI: 10.1007/s00296-022-05223-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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022]
Abstract
Early and effective discrimination (triage) of patients with inflammatory rheumatic diseases (IRD) and other diseases (non-IRD) is essential for successful treatment and preventing damage. The aim of this study was to investigate diagnostic delays and pre-diagnosis treatment in patients newly presenting to rheumatology outpatient clinics. A total of 600 patients newly presenting to one university hospital and two non-academic centers were included. Time from onset of symptoms to rheumatology consultation "total delay" as well as medical treatment before consultation were recorded. Median time from symptom onset to rheumatologist appointment (total delay) was 30 weeks. Median time to online search, first physician appointment request and first physician appointment was 2, 4 and 5 weeks, respectively. Total delay was significantly shorter for IRD patients compared to non-IRD patients, 26 vs 35 weeks (p = 0.007). Only 17.7% of all patients and 22.9% of IRD patients had a delay of less than 12 weeks. Total delay was significantly lower in patients seen in non-academic centers compared to the university center, 20 vs 50 weeks (p < 0.0001). 32.2% of IRD patients received medical treatment that eased their symptoms prior to the rheumatology appointment. These findings highlight the persistent diagnostic delays in rheumatology; however, they also suggest that current triage strategies effectively lead to earlier appointments for IRD patients. Improvement of triage methods and pre-diagnosis treatment could decrease overall burden of disease in IRD patients.
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Affiliation(s)
- Franziska Fuchs
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Harriet Morf
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jacob Mohn
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Felix Mühlensiepen
- Faculty of Health Sciences, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Neuruppin, Germany
| | - Yuriy Ignatyev
- Faculty of Health Sciences, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Neuruppin, Germany
| | - Daniela Bohr
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Elizabeth Araujo
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wolfgang Vorbrüggen
- Verein Zur Förderung Der Rheumatologie E.V, Würselen, Germany.,RheumaDatenRhePort (rhadar), Planegg, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Peter Bartz-Bazzanella
- RheumaDatenRhePort (rhadar), Planegg, Germany.,Klinik Für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Welcker
- Klinik Für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany.,MVZ Für Rheumatologie Dr. Martin Welcker GmbH, Planegg, Germany
| | - Axel J Hueber
- Division of Rheumatology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany.,Section Rheumatology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. .,Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
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13
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Klimek L, Förster-Ruhrmann U, Olze H, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Bärhold F, Klimek F, Casper I, Zuberbier J, Rudack C, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Werminghaus P, Pfaar O, Gosepath J, Gröger M, Beutner C, Laudien M, Weber RK, Hildenbrand T, Hoffmann AS, Bachert C. Empfehlungen zur Überprüfung der Wirksamkeit und Verlaufsdokumentation von Mepolizumab bei chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC). Laryngorhinootologie 2023; 102:89-99. [PMID: 36750110 DOI: 10.1055/a-2003-4730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the mucous membranes of the nose and sinuses. Eosinophilic inflammation is described as a common endotype. The anti-IL5 antibody mepolizumab was approved in November 2021 as an add-on therapy to intranasal glucocorticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps when systemic glucocorticosteroids or surgery do not provide adequate disease control. While national and international recommendations exist for the use of mepolizumab in CRSwNP, it has not yet been adequately specified how this therapy is to be monitored, what follow-up documentation is necessary, and when it should be terminated if necessary. METHODS A literature search was performed to analyze previous data on the treatment of CRSwNP with mepolizumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 10/2022 were considered. RESULTS Based on the international literature and previous experience by an expert panel, recommendations for follow-up, adherence to therapy intervals and possible therapy breaks, as well as termination of therapy when using mepolizumab for the indication CRSwNP in the German health care system are given on the basis of a documentation sheet. CONCLUSIONS Understanding the immunological basis of CRSwNP opens up new non-surgical therapeutic approaches with biologics for patients with severe, uncontrolled courses. Here, we provide recommendations for follow-up, adherence to therapy intervals, possible therapy pauses, or discontinuation of therapy when mepolizumab is used as add-on therapy with intranasal glucocorticosteroids to treat adult patients with severe CRSwNP that cannot be adequately controlled with systemic glucocorticosteroids and/or surgical intervention.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster.,Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie der Universitätsmedizin Greifswald
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Ruhr-Universität Bochum, St.-Elisabeth-Hospital
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Bärhold
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg
| | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - P Werminghaus
- Praxis für Hals-Nasen-Ohrenheilkunde und Allergologie, Düsseldorf
| | - O Pfaar
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg
| | - J Gosepath
- Klinik für Hals-, Nasen- und Ohrenheilkunde, HSK Wiesbaden
| | - M Gröger
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum LMU München
| | - C Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Allergiezentrum Südniedersachsen, Universitätsmedizin Göttingen
| | - M Laudien
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Kiel
| | - R K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe
| | - T Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
| | - A S Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
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14
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Surci N, Bassi C, Salvia R, Marchegiani G, Casetti L, Deiro G, Bergmann C, Walenta K, Tamandl D, Schindl M, Sahora K, Mühlbacher J. Long-Term Follow-Up after Surgery for Chronic Pancreatitis: A Bicentric Retrospective Experience. Dig Surg 2023; 39:169-175. [PMID: 35917792 PMCID: PMC9909709 DOI: 10.1159/000526263] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The impact of surgery on nutritional status, pancreatic function, and symptoms of patients affected by chronic pancreatitis (CP) has not been unequivocally determined. This study aimed to evaluate clinical follow-up after surgery for CP in an Italian-Austrian population. MATERIALS AND METHODS Patients operated for CP at two high-volume centers between 2000 and 2018 were analyzed. The following parameters were compared between the pre- and postoperative period: nutritional status, endocrine and exocrine pancreatic functions, and chronic pain. RESULTS Overall, 186 patients underwent surgery for CP. Among these, 68 (40%) answered a specific follow-up questionnaire. The body mass index showed a significant increase between pre- and postoperative assessments (21.1 vs. 22.5 p = 0.003). Furthermore, a 60% decrease in the prevalence of chronic pain (81 vs. 21%, p < 0.001) was observed. On the contrary, both exocrine and endocrine pancreatic functions pointed toward a worsening after surgery, with consistent higher rates of patients presenting with diabetes mellitus, as well as patients requiring insulin therapy and oral intake of pancreatic enzymes. The analysis of body composition performed on 40 (24%) patients with a complete imaging pack revealed no significant change in the nutritional status after surgery. DISCUSSION/CONCLUSION Despite the good results observed in terms of pain relief, the surgical approach led to a consistent worsening of the global pancreatic function. No significant influence of surgery on the nutritional status of patients was detected.
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Affiliation(s)
- Niccolò Surci
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria,Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Luca Casetti
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Giacomo Deiro
- Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, Verona, Italy
| | - Christina Bergmann
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Walenta
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Dietmar Tamandl
- Department of Radiology, Medical University of Vienna, General Hospital, Vienna, Austria
| | - Martin Schindl
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Sahora
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Mühlbacher
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria,*Jakob Mühlbacher, jakob.muehlbacherMühlbachermeduniwien.ac.at
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15
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Treutlein C, Distler JHW, Tascilar K, Fakhouri SC, Györfi AH, Atzinger A, Matei AE, Dees C, Büttner-Herold M, Kuwert T, Prante O, Bäuerle T, Uder M, Schett G, Schmidkonz C, Bergmann C. Assessment of myocardial fibrosis in patients with systemic sclerosis using [68Ga]Ga-FAPI-04-PET-CT. Eur J Nucl Med Mol Imaging 2022; 50:1629-1635. [PMID: 36522438 PMCID: PMC10119041 DOI: 10.1007/s00259-022-06081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Purpose
Myocardial fibrosis (MF) is a factor of poor prognosis in systemic sclerosis (SSc). Direct in-vivo visualization of fibroblast activation as early readout of MF has not been feasible to date. Here, we characterize 68Gallium-labeled-Fibroblast-Activation-Inhibitor-04 ([68Ga]Ga-FAPI-04)-PET-CT as a diagnostic tool in SSc-related MF.
Methods
In this proof-of-concept trial, six SSc patients with and eight without MF of the EUSTAR cohort Erlangen underwent [68Ga]Ga-FAPI-04-PET-CT and cardiac MRI (cMRI) and clinical and serologic investigations just before baseline and during follow-up between January 2020 and December 2020. Myocardial biopsy was performed as clinically indicated.
Results
[68Ga]Ga-FAPI-04 tracer uptake was increased in SSc-related MF with higher uptake in SSc patients with arrhythmias, elevated serum-NT-pro-BNP, and increased late gadolinium enhancement (LGE) in cMRI. Histologically, myocardial biopsies from cMRI- and [68Ga]Ga-FAPI-04-positive regions confirmed the accumulation of FAP+ fibroblasts surrounded by collagen deposits. We observed similar but not equal spatial distributions of [68Ga]Ga-FAPI-04 uptake and quantitative cMRI-based techniques. Using sequential [68Ga]Ga-FAPI-04-PET-CTs, we observed dynamic changes of [68Ga]Ga-FAPI-04 uptake associated with changes in the activity of SSc-related MF, while cMRI parameters remained stable after regression of molecular activity and rather indicated tissue damage.
Conclusions
We present first in-human evidence that [68Ga]Ga-FAPI-04 uptake visualizes fibroblast activation in SSc-related MF and may be a diagnostic option to monitor cardiac fibroblast activity in situ.
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16
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Matei AE, Kubánková M, Xu L, Györfi AH, Boxberger E, Soteriou D, Papava M, Prater J, Hong X, Bergmann C, Kräter M, Schett G, Guck J, Distler JHW. Identification of a Distinct Monocyte-Driven Signature in Systemic Sclerosis Using Biophysical Phenotyping of Circulating Immune Cells. Arthritis Rheumatol 2022; 75:768-781. [PMID: 36281753 DOI: 10.1002/art.42394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 09/08/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Pathologically activated circulating immune cells, including monocytes, play major roles in systemic sclerosis (SSc). Their functional characterization can provide crucial information with direct clinical relevance. However, tools for the evaluation of pathologic immune cell activation and, in general, of clinical outcomes in SSc are scarce. Biophysical phenotyping (including characterization of cell mechanics and morphology) provides access to a novel, mostly unexplored layer of information regarding pathophysiologic immune cell activation. We hypothesized that the biophysical phenotyping of circulating immune cells, reflecting their pathologic activation, can be used as a clinical tool for the evaluation and risk stratification of patients with SSc. METHODS We performed biophysical phenotyping of circulating immune cells by real-time fluorescence and deformability cytometry (RT-FDC) in 63 SSc patients, 59 rheumatoid arthritis (RA) patients, 28 antineutrophil cytoplasmic antibody-associated vasculitis (AAV) patients, and 22 age- and sex-matched healthy donors. RESULTS We identified a specific signature of biophysical properties of circulating immune cells in SSc patients that was mainly driven by monocytes. Since it is absent in RA and AAV, this signature reflects an SSc-specific monocyte activation rather than general inflammation. The biophysical properties of monocytes indicate current disease activity, the extent of skin or lung fibrosis, and the severity of manifestations of microvascular damage, as well as the risk of disease progression in SSc patients. CONCLUSION Changes in the biophysical properties of circulating immune cells reflect their pathologic activation in SSc patients and are associated with clinical outcomes. As a high-throughput approach that requires minimal preparations, RT-FDC-based biophysical phenotyping of monocytes can serve as a tool for the evaluation and risk stratification of patients with SSc.
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Affiliation(s)
- Alexandru-Emil Matei
- Department of Rheumatology and Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany, and Department of Internal Medicine 3-Rheumatology and Immunology and Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nürnberg (FAU), and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Markéta Kubánková
- Max Planck Institute for the Science of Light & Max-Planck-Center für Physik und Medizin, Erlangen, Germany, and Biotechnology Center, Center for Molecular and Cellular Bioengineering, Technische Universität Dresden, Dresden, Germany
| | - Liyan Xu
- Department of Rheumatology and Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany, and Department of Internal Medicine 3-Rheumatology and Immunology and Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nürnberg (FAU), and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andrea-Hermina Györfi
- Department of Rheumatology and Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany, and Department of Internal Medicine 3-Rheumatology and Immunology and Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nürnberg (FAU), and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Evgenia Boxberger
- Department of Internal Medicine 3-Rheumatology and Immunology and Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Despina Soteriou
- Max Planck Institute for the Science of Light & Max-Planck-Center für Physik und Medizin, Erlangen, Germany
| | - Maria Papava
- Department of Internal Medicine 3-Rheumatology and Immunology and Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Julia Prater
- Department of Internal Medicine 3-Rheumatology and Immunology and Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Xuezhi Hong
- Department of Rheumatology and Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany, and Department of Internal Medicine 3-Rheumatology and Immunology and Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nürnberg (FAU), and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3-Rheumatology and Immunology and Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Kräter
- Max Planck Institute for the Science of Light & Max-Planck-Center für Physik und Medizin, Erlangen, Germany, and Biotechnology Center, Center for Molecular and Cellular Bioengineering, Technische Universität Dresden, Dresden, Germany
| | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology and Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jochen Guck
- Max Planck Institute for the Science of Light & Max-Planck-Center für Physik und Medizin, Erlangen, Germany, and Biotechnology Center, Center for Molecular and Cellular Bioengineering, Technische Universität Dresden, Dresden, Germany
| | - Jörg H W Distler
- Department of Rheumatology and Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany, and Department of Internal Medicine 3-Rheumatology and Immunology and Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nürnberg (FAU), and Universitätsklinikum Erlangen, Erlangen, Germany
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17
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Klimek L, Förster-Ruhrmann U, Olze H, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Klimek F, Sperl A, Casper I, Zuberbier J, Rudack C, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Pfaar O, Gosepath J, Gröger M, Beutner C, Laudien M, Weber RK, Hildenbrand T, Hoffmann AS, Bachert C. Empfehlungen zur Überprüfung der Wirksamkeit und Verlaufsdokumentation von Dupilumab bei chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC). Laryngorhinootologie 2022; 101:855-865. [PMID: 36150698 DOI: 10.1055/a-1908-3074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the nasal and paranasal mucosa. A Type-2 inflammation is described as the most common endotype. Since October 2019 the anti-IL-4/-IL-13 antibody dupilumab has been approved in Germany as an add-on therapy to intranasal corticosteroids for the treatment of adults with severe chronic rhinosinusitis with nasal polyps, when systemic corticosteroids alone or surgery do not provide adequate disease control. While recommendations for the use of dupilumab in CRSwNP exist at both national and international levels, until now it has not been adequately established, how therapy should be monitored and when it should be discontinued in the German Health Care System. METHODS A literature search was performed analyzing previous data on the treatment of CRSwNP with dupilumab and to determine the available evidence by searching Medline, Pubmed, the national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to 05/2022 were included. RESULTS Based on international literature and previous experience, recommendations are given by an expert panel for follow-up and possible therapy breaks, therapy intervals or termination of therapy when using dupilumab for the indication CRSwNP in the German health care system based on a documentation form. CONCLUSIONS Understanding the immunological basis of CRSwNP opens new non-surgical therapy approaches with biologics for patients with severe courses. The authors give recommendations for follow-up, possible therapy breaks, therapy intervals and a termination for dupilumab treatment as add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP that cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster.,Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie der Universitätsmedizin Greifswald
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Ruhr-Universität Bochum, St. Elisabeth-Hospital
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik und Poliklinik für Hals-, Nasen-, Ohren-Heilkunde, Universitätsklinikum Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - A Sperl
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Regensburg
| | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Mainz
| | - C Bergmann
- Praxis für Hals-, Nasen-, Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - O Pfaar
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Marburg
| | - J Gosepath
- Klinik für Hals-, Nasen- und Ohrenheilkunde, HSK Wiesbaden
| | - M Gröger
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum LMU München
| | - C Beutner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - M Laudien
- Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie der Christian-Albrechts-Universität zu Kiel und des Universitätsklinikums Schleswig-Holstein, Campus Kiel
| | - R K Weber
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe
| | - T Hildenbrand
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg
| | - A S Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
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Cristia A, Tsuji S, Bergmann C. A meta-analytic approach to evaluating the explanatory adequacy of theories. MP 2022. [DOI: 10.15626/mp.2020.2741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
How can data be used to check theories' explanatory adequacy? The two traditional and most widespread approaches use single studies and non-systematic narrative reviews to evaluate theories' explanatory adequacy; more recently, large-scale replications entered the picture. We argue here that none of these approaches fits in with cumulative science tenets. We propose instead Community-Augmented Meta-Analyses (CAMAs), which, like meta-analyses and systematic reviews, are built using all available data; like meta-analyses but not systematic reviews, can rely on sound statistical practices to model methodological effects; and like no other approach, are broad-scoped, cumulative and open. We explain how CAMAs entail a conceptual shift from meta-analyses and systematic reviews, a shift that is useful when evaluating theories' explanatory adequacy. We then provide step-by-step recommendations for how to implement this approach - and what it means when one cannot. This leads us to conclude that CAMAs highlight areas of uncertainty better than alternative approaches that bring data to bear on theory evaluation, and can trigger a much needed shift towards a cumulative mindset with respect to both theory and data, leading us to do and view experiments and narrative reviews differently.
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19
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Zhou X, Trinh-Minh T, Tran Manh C, Giessl A, Bergmann C, Györfi AH, Schett G, Distler JHW. AB0130 DEREGULATION OF TFAM EXPRESSION PROMOTES MITOCHONDRIAL DAMAGE AND FIBROBLAST ACTIVATION IN SYSTEMIC SCLEROSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundTranscription factor A, mitochondrial (TFAM) is a transcription factor with essential function in the mitochondrial homeostasis, such as mitochondria biogenesis and mtDNA replication. Deregulation of TFAM expression has been linked to mitochondrial dysfunction. However, its role in the pathogenesis of rheumatic diseases has not been studied so far.ObjectivesWe aimed to study the role of TFAM in the pathological fibroblast activation in SSc.MethodsThe expression of TFAM in SSc skin fibroblast and skin biopsies was analyzed by immunofluorescence and Western blot. The role of TFAM in fibroblast activation was investigated by TFAM knockdown in cultured fibroblasts. The role of TFAM in skin and lung fibrosis was further studied in mice with fibroblast specific knockout of TFAM in three independent mouse models: Bleomycin-induced skin and lung fibrosis as well as TβRIact-induced skin fibrosis.ResultsDermal fibroblasts from SSc patients express lower level of TFAM in the skin and also after prolonged culture in vitro. The downregulation of TFAM impairs mitochondria homeostasis with decreased mitochondrial number, accumulation of damaged mitochondria with release of mtDNA, accumulation of deletions in mtDNA, metabolic reshaping with impaired OXPHOS and release of the mitokine GDF15. Long time, but not acute exposure of normal fibroblasts to TGFβ mimicked the finding in SSc fibroblasts with downregulation of TFAM and mitochondrial homeostasis disruption and damage. Knockdown TFAM of normal fibroblasts promotes fibroblast activation with increased myofibroblast differentiation and collagen release in a SMAD3 dependent manner. RNA sequencing demonstrated upregulation of pro-fibrotic genes and pathways. Mice with fibroblast-specific knockout of TFAM demonstrate are more sensitive to fibrotic stimuli such as bleomycin injection and TβRIact-overexpression and even demonstrate responses to NaCl instillation.ConclusionAlterations in the key mitochondrial transcription factor TFAM in response to prolonged activation of TGFβ and associated mitochondrial damage induce transcriptional programs that promote fibroblast activation and tissue fibrosis.Disclosure of InterestsXiang Zhou: None declared, Thuong Trinh-Minh: None declared, Cuong Tran Manh: None declared, Andreas Giessl: None declared, Christina Bergmann: None declared, Andrea-Hermina Györfi: None declared, Georg Schett: None declared, Jörg H.W. Distler Consultant of: Actelion, Active Biotech, Anamar, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB.,, Grant/research support from: Anamar, Active Biotech, Array Biopharma, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB.
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20
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Treutlein C, Schmidkonz C, Tascilar K, Chenguiti Fakhouri S, Dees C, Györfi AH, Matei AE, Baeuerle T, Kuwert T, Uder M, Schett G, Distler JHW, Bergmann C. POS0864 ASSESSMENT OF SYSTEMIC SCLEROSIS RELATED MYOCARDIAL FIBROSIS BY 68Ga-FAPI-04 PET/CT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundMyocardial fibrosis is a poor prognostic factor and a relevant cause of SSc-related mortality. Current non-invasive screening methods for myocardial fibrosis (MF) include echocardiography, electrocardiography and serum Nt-pro-BNP, which are not specific for MF and not sensitive for early changes. Cardiac MRI predominately visualizes extracellular space changes as consequence of long-standing fibroblast activation. Direct visualization of the remodeling fibrotic remodeling process has not been feasible so far.ObjectivesHere, we use a tracer labeled probe directed against Fibroblast-Activation-Protein (FAP) to visualize activated fibroblasts in the myocardium of SSc patients and healthy individuals to test the hypothesis that FAPI-based PET imaging might enable the assessment of disease activity in SSc-related MF.MethodsIn this exploratory trial, 7 patients with SSc-related myocardial fibrosis (MF) confirmed by cardic MRI and 8 SSc patients without myocardial involvement were enrolled. All participants underwent 68Ga-FAPI-04 PET/CT imaging and cardiac MRI as well as echocardiography, electrocardiogram, and serum NT-pro-BNP. Patients were followed for at least 6 months including a follow-up cardiac MRI. Regional mapping of 68Ga-FAPI-04-uptake, late gadolinium enhancement (LGE) and T1-relaxation times were performed according to the American Heart Association 17 regions model. Myocardial tissue was analysed by immunofluorescence- (aSMA and FAP) and Sirius-Red staining.ResultsMyocardial FAPI-04-accumulation was significantly increased in SSc patients with myocardial fibrosis as defined by LGE in MRI compared to SSc patients without LGE. Consistent with the previously reported widespread remodeling in SSc-associated myocardial disease, the distribution of FAPI uptake was observed across multiple areas and did not correspond to the supply areas of the coronary arteries. Histological analyses of myocardial tissue biopsied from a LGE and 68Ga-FAPI-04-positive region revealed the accumulation of FAP+; SMA+ myofibroblasts in regions of pronounced collagen deposition. Slightly increased 68Ga-FAPI-04 -uptake values were observed in SSc patients without LGE, but with cardiovascular risk factors.Comparing 68Ga-FAPI-04-uptake with cardiac MRI based mapping techniques, we observed a partial overlap for certain regions and differences in others. These observations suggest, that 68Ga-FAPI-PET/CT and cMRI could visualize different aspects of the disease process.To confirm that 68Ga-FAPI-04-uptake assesses current molecular fibroblast activity rather than accumulating disease damage, we analyzed associations of 68Ga-FAPI-04-uptake with changes of clinical parameters of SSc-MF on follow-up: Here we observed different dynamics of change of 68Ga-FAPI-04-uptake and cardiac MRI-based, e.g. in response to start of immunosuppressive therapy.ConclusionOur study presents first in human evidence on a limited number of patients that FAPI-04-uptake correlates with fibrotic activity in SSc-associated myocardial fibrosis and that 68Ga-FAPI-04-PET/CT may thus improve risk stratification in this population.Disclosure of InterestsNone declared
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21
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Knitza J, Muehlensiepen F, Ignatyev Y, Fuchs F, Mohn J, Simon D, Kleyer A, Fagni F, Boeltz S, Morf H, Bergmann C, Labinsky H, Vorbrüggen W, Ramming A, Distler JHW, Bartz-Bazzanella P, Vuillerme N, Schett G, Welcker M, Hueber AJ. Patient's Perception of Digital Symptom Assessment Technologies in Rheumatology: Results From a Multicentre Study. Front Public Health 2022; 10:844669. [PMID: 35273944 PMCID: PMC8902046 DOI: 10.3389/fpubh.2022.844669] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction An increasing number of digital tools, including dedicated diagnostic decision support systems (DDSS) exist to better assess new symptoms and understand when and where to seek medical care. The aim of this study was to evaluate patient's previous online assessment experiences and to compare the acceptability, usability, usefulness and potential impact of artificial intelligence (AI)-based symptom checker (Ada) and an online questionnaire-based self-referral tool (Rheport). Materials and Methods Patients newly presenting to three German secondary rheumatology outpatient clinics were randomly assigned in a 1:1 ratio to complete consecutively Ada or Rheport in a prospective non-blinded multicentre controlled crossover randomized trial. DDSS completion time was recorded by local study personnel and perceptions on DDSS and previous online assessment were collected through a self-completed study questionnaire, including usability measured with the validated System Usability Scale (SUS). Results 600 patients (median age 52 years, 418 women) were included. 277/600 (46.2%) of patients used an online search engine prior to the appointment. The median time patients spent assessing symptoms was 180, 7, and 8 min, respectively using online using search engines, Ada and Rheport. 111/275 (40.4%), 266/600 (44.3%) and 395/600 (65.8%) of patients rated the respective symptom assessment as very helpful or helpful, using online search engines, Ada and Rheport, respectively. Usability of both diagnostic decision support systems (DDSS) was “good” with a significantly higher mean SUS score (SD) of Rheport 77.1/100 (16.0) compared to Ada 74.4/100 (16.8), (p < 0.0001). In male patients, usability of Rheport was rated higher than Ada (p = 0.02) and the usability rating of older (52 years ≥) patients of both DDSS was lower than in younger participants (p = 0.005). Both effects were independent of each other. 440/600 (73.3%) and 475/600 (79.2%) of the patients would recommend Ada and Rheport to friends and other patients, respectively. Conclusion In summary, patients increasingly assess their symptoms independently online, however only a minority used dedicated symptom assessment websites or DDSS. DDSS, such as Ada an Rheport are easy to use, well accepted among patients with musculoskeletal complaints and could replace online search engines for patient symptom assessment, potentially saving time and increasing helpfulness.
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Affiliation(s)
- Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Université Grenoble Alpes, AGEIS, Grenoble, France
| | - Felix Muehlensiepen
- Université Grenoble Alpes, AGEIS, Grenoble, France.,Center for Health Services Research, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Yuriy Ignatyev
- Center for Health Services Research, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Franziska Fuchs
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jacob Mohn
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sebastian Boeltz
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Harriet Morf
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hannah Labinsky
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wolfgang Vorbrüggen
- Verein zur Förderung der Rheumatologie e.V., Würselen, Germany.,RheumaDatenRhePort (RHADAR), Planegg, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Peter Bartz-Bazzanella
- RheumaDatenRhePort (RHADAR), Planegg, Germany.,Klinik für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany
| | - Nicolas Vuillerme
- Université Grenoble Alpes, AGEIS, Grenoble, France.,Institut Universitaire de France, Paris, France.,LabCom Telecom4Health, Orange Labs & Univ. Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Welcker
- RheumaDatenRhePort (RHADAR), Planegg, Germany.,MVZ für Rheumatologie Dr. Martin Welcker GmbH, Planegg, Germany
| | - Axel J Hueber
- Section Rheumatology, Sozialstiftung Bamberg, Bamberg, Germany.,Division of Rheumatology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
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22
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Gasparini L, Tsuji S, Bergmann C. Ten easy steps to conducting transparent, reproducible meta-analyses for infant researchers. Infancy 2022; 27:736-764. [PMID: 35478257 DOI: 10.1111/infa.12470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/20/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Abstract
Meta-analyses provide researchers with an overview of the body of evidence in a topic, with quantified estimates of effect sizes and the role of moderators, and weighting studies according to their precision. We provide a guide for conducting a transparent and reproducible meta-analysis in the field of developmental psychology within the framework of the MetaLab platform, in 10 steps: (1) Choose a topic for your meta-analysis, (2) Formulate your research question and specify inclusion criteria, (3) Preregister and document all stages of your meta-analysis, (4) Conduct the literature search, (5) Collect and screen records, (6) Extract data from eligible studies, (7) Read the data into analysis software and compute effect sizes, (8) Visualize your data, (9) Create meta-analytic models to assess the strength of the effect and investigate possible moderators, (10) Write up and promote your meta-analysis. Meta-analyses can inform future studies, through power calculations, by identifying robust methods and exposing research gaps. By adding a new meta-analysis to MetaLab, datasets across multiple topics of developmental psychology can be synthesized, and the dataset can be maintained as a living, community-augmented meta-analysis to which researchers add new data, allowing for a cumulative approach to evidence synthesis.
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Affiliation(s)
- Loretta Gasparini
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sho Tsuji
- International Research Center for Neurointelligence, Institutes for Advanced Studies, The University of Tokyo, Tokyo, Japan
| | - Christina Bergmann
- Language Development Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
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23
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Klimek L, Olze H, Förster-Ruhrmann U, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Klimek F, Zuberbier J, Rudack C, Cuevas M, Hintschich CA, Guntinas-Lichius O, Stöver T, Bergmann C, Bachert C. Positionspapier: Empfehlungen zur Anwendung von Mepolizumab bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC). Laryngorhinootologie 2022; 101:284-294. [PMID: 35168284 DOI: 10.1055/a-1752-8462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease of the paranasal sinus mucosa with eosinophilic inflammation as the most common endotype. The anti-IL5 antibody mepolizumab was approved for the treatment of severe CRSwNP in the EU in November 2021. METHODS A literature search was performed to analyze the immunology of CRSwNP and determine the available evidence by searching Medline, Pubmed, and the German national and international trial and guideline registries and the Cochrane Library. Human studies published in the period up to and including 12/2021 that investigated the effect of mepolizumab in CRSwNP were considered. RESULTS Based on the international literature and previous experience, recommendations for the use of mepolizumab in CRSwNP in the German health care system are given by an expert panel on the basis of a documentation form. CONCLUSIONS Understanding about the immunological basis of CRSwNP opens new non-surgical therapeutic approaches with biologics for patients with severe courses. Mepolizumab is approved since November 2021 for add-on therapy with intranasal corticosteroids for the treatment of adult patients with severe CRSwNP who cannot be adequately controlled with systemic corticosteroids and/or surgical intervention.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - H Olze
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - U Förster-Ruhrmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Bochum
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - S Strieth
- Klinik u. Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Wiesbaden
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsklinik Tübingen
| | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - J Zuberbier
- Klinik für Hals-Nasen-Ohrenheilkunde, Charité-Universitätsmedizin Berlin, Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | | | | | - T Stöver
- Universitäts-Hals-Nasen-Ohrenklinik Frankfurt am Main
| | - C Bergmann
- Praxis für Hals-Nasen-Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
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24
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Bergmann C, Dimitrova N, Alaslani K, Almohammadi A, Alroqi H, Aussems S, Barokova M, Davies C, Gonzalez-Gomez N, Gibson SP, Havron N, Horowitz-Kraus T, Kanero J, Kartushina N, Keller C, Mayor J, Mundry R, Shinskey J, Mani N. Young children's screen time during the first COVID-19 lockdown in 12 countries. Sci Rep 2022; 12:2015. [PMID: 35132065 PMCID: PMC8821703 DOI: 10.1038/s41598-022-05840-5] [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: 06/08/2021] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Older children with online schooling requirements, unsurprisingly, were reported to have increased screen time during the first COVID-19 lockdown in many countries. Here, we ask whether younger children with no similar online schooling requirements also had increased screen time during lockdown. We examined children’s screen time during the first COVID-19 lockdown in a large cohort (n = 2209) of 8-to-36-month-olds sampled from 15 labs across 12 countries. Caregivers reported that toddlers with no online schooling requirements were exposed to more screen time during lockdown than before lockdown. While this was exacerbated for countries with longer lockdowns, there was no evidence that the increase in screen time during lockdown was associated with socio-demographic variables, such as child age and socio-economic status (SES). However, screen time during lockdown was negatively associated with SES and positively associated with child age, caregiver screen time, and attitudes towards children’s screen time. The results highlight the impact of the COVID-19 lockdown on young children’s screen time.
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Affiliation(s)
| | - Nevena Dimitrova
- Faculty of Social Work of Lausanne, University of Applied Sciences and Arts of Western Switzerland (HES-SO), Lausanne, Switzerland
| | | | | | | | | | | | | | | | - Shannon P Gibson
- Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | | | - Tzipi Horowitz-Kraus
- Educational Neuroimaging Center, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | - Christina Keller
- University of Göttingen, Goßlerstr. 14, 37073, Göttingen, Germany
| | | | - Roger Mundry
- Cognitive Ethology Laboratory, German Primate Center, Göttingen, Germany.,Department for Primate Cognition, Georg-August-University Goettingen, Göttingen, Germany.,Leibniz ScienceCampus Primate Cognition, Göttingen, Germany
| | | | - Nivedita Mani
- University of Göttingen, Goßlerstr. 14, 37073, Göttingen, Germany. .,Leibniz ScienceCampus Primate Cognition, Göttingen, Germany.
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25
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Affiliation(s)
| | - Christina Bergmann
- Language Development Department Max Planck Institute for Psycholinguistics Nijmegen the Netherlands
| | - Victoria Savalei
- Department of Psychology University of British Columbia Vancouver Canada
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26
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Klimek L, Hagemann J, Welkoborsky HJ, Cuevas M, Casper I, Förster-Rurmann U, Klimek F, Hintschich CA, Huppertz T, Bergmann KC, Tomazic PV, Bergmann C, Becker S. T2-Inflammation bei entzündlichen Atemwegserkrankungen: Grundlage neuer Behandlungsoptionen. Laryngorhinootologie 2021; 101:96-108. [PMID: 34937094 DOI: 10.1055/a-1709-7899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden.,Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz
| | - J Hagemann
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz
| | | | - M Cuevas
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Carl Gustav Carus, TU Dresden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | | | - F Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - C A Hintschich
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg
| | - T Huppertz
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Mainz
| | - K-Ch Bergmann
- Klinik für Dermatologie, Venerologie und Allergie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health
| | - P V Tomazic
- HNO-Universitätsklinik Graz, Medizinische Universität Graz
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27
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Chakraborty D, Šumová B, Mallano T, Chen CW, Distler A, Bergmann C, Ludolph I, Horch RE, Gelse K, Ramming A, Distler O, Schett G, Šenolt L, Distler JHW. Author Correction: Activation of STAT3 integrates common profibrotic pathways to promote fibroblast activation and tissue fibrosis. Nat Commun 2021; 12:7259. [PMID: 34880239 PMCID: PMC8655015 DOI: 10.1038/s41467-021-27450-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Debomita Chakraborty
- Department of Internal Medicine 3 -Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, 91054, Germany
| | - Barbora Šumová
- Department of Internal Medicine 3 -Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, 91054, Germany.,Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, 120 00, Czech Republic
| | - Tatjana Mallano
- Department of Internal Medicine 3 -Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, 91054, Germany
| | - Chih-Wei Chen
- Department of Internal Medicine 3 -Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, 91054, Germany
| | - Alfiya Distler
- Department of Internal Medicine 3 -Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, 91054, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3 -Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, 91054, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, 91054, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, 91054, Germany
| | - Kolja Gelse
- Department of Orthopaedic Trauma Surgery, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, 91054, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3 -Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, 91054, Germany
| | - Oliver Distler
- Center of Experimental Rheumatology and Zurich Center of Integrative Human Physiology, University Hospital Zurich, Zurich, 8091, Switzerland
| | - Georg Schett
- Department of Internal Medicine 3 -Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, 91054, Germany
| | - Ladislav Šenolt
- Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, 120 00, Czech Republic
| | - Jörg H W Distler
- Department of Internal Medicine 3 -Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, 91054, Germany.
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28
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Zhou X, Trinh-Minh T, Tran-Manh C, Gießl A, Bergmann C, Györfi AH, Schett G, Distler JHW. Impaired TFAM expression promotes mitochondrial damage to drive fibroblast activation and fibrosis in systemic sclerosis. Arthritis Rheumatol 2021; 74:871-881. [PMID: 34807516 DOI: 10.1002/art.42033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/12/2021] [Accepted: 11/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The transcription factor TFAM is controlling the transcription of core proteins required for mitochondrial homeostasis. The aim of the current study was to investigate changes in TFAM expression in systemic sclerosis (SSc), to analyze mitochondrial function and to evaluate the consequences for fibroblast activation. METHODS The expression of TFAM was analyzed by immunofluorescence and Western blot. The effects of TFAM knockout were investigated in cultured fibroblasts and in bleomycin-induced skin and lung fibrosis and in TβRIact -induced skin fibrosis. RESULTS The expression of TFAM was downregulated in fibroblasts in SSc skin and in cultured SSc fibroblasts. The downregulation of TFAM was associated with decreased mitochondrial number and accumulation of damaged mitochondria with release of mtDNA, accumulation of deletions in mtDNA, metabolic alterations with impaired OXPHOS and release of the mitokine GDF15. Chronic, but not acute, exposure of normal fibroblasts to TGFβ mimicked the finding in SSc fibroblasts with downregulation of TFAM and accumulation of mitochondrial damage. Downregulation of TFAM promotes fibroblast activation with upregulation of fibrosis-relevant GO-terms in RNASeq, partially in a ROS-dependent manner. Mice with fibroblast-specific knockout of TFAM are prone to fibrotic tissue remodeling with fibrotic responses even to NaCl instillation and enhanced sensitivity to bleomycin injection and TβRIact-overexpression. TFAM knockout fosters SMAD3 signaling to promote fibroblast activation. CONCLUSIONS Alterations in the key mitochondrial transcription factor TFAM in response to prolonged activation of TGFβ and associated mitochondrial damage induce transcriptional programs that promote fibroblast-to-myofibroblast transition and drive tissue fibrosis.
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Affiliation(s)
- Xiang Zhou
- Department of Internal Medicine 3 - Rheumatology and Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Thuong Trinh-Minh
- Department of Internal Medicine 3 - Rheumatology and Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Cuong Tran-Manh
- Department of Internal Medicine 3 - Rheumatology and Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Andreas Gießl
- Department of Ophthalmology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3 - Rheumatology and Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Andrea-Hermina Györfi
- Department of Internal Medicine 3 - Rheumatology and Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3 - Rheumatology and Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany.,Deutsches Zentrum für Immuntherapie (DZI), FAU Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
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29
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Klimek L, Förster-Ruhrmann U, Beule AG, Chaker AM, Hagemann J, Huppertz T, Hoffmann TK, Dazert S, Deitmer T, Olze H, Strieth S, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Becker S, Rudack C, Wagenmann M, Bergmann C, Bachert C. Positionspapier: Empfehlungen zur Anwendung von Omalizumab bei chronischer Rhinosinusitis mit Polyposis nasi (CRSwNP) im deutschen Gesundheitssystem – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der AGs Klinische Immunologie, Allergologie und Umweltmedizin und Rhinologie und Rhinochirurgie der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC). Laryngorhinootologie 2021; 100:952-963. [PMID: 34592767 DOI: 10.1055/a-1644-4066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Zusammenfassung
Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der paranasalen Schleimhäute, der als Endotyp meistens eine TH2-Inflammation zugrunde liegt. IgE-Antikörper spielen dabei eine wichtige Rolle. Der anti-IgE-Antikörper Omalizumab wurde im August 2020 für die Therapie der schweren CRSwNP zugelassen.
Methoden In einer Literatursuche wurde die Immunologie der CRSwNP analysiert und die Evidenz zur Wirkung von Omalizumab bei dieser Erkrankung ermittelt durch Recherchen in Medline, Pubmed sowie den nationalen und internationalen Studien- und Leitlinien-Registern und der Cochrane Library.
Ergebnisse Basierend auf diesen Angaben aus der internationalen Literatur werden von einem Expertengremium Empfehlungen für die Anwendung von Omalizumab bei CRSwNP im deutschen Gesundheitssystem gegeben.
Schlussfolgerung Omalizumab ist zugelassen für Patienten ab 18 Jahren mit schwerer chronischer Rhinosinusitis mit Nasenpolypen als Zusatztherapie zu intranasalen Kortikosteroiden (INCS), wenn durch eine Therapie mit INCS keine ausreichende Krankheitskontrolle erzielt werden kann.
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Affiliation(s)
- L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | | | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München.,Zentrum für Allergie und Umwelt (ZAUM), TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum, St. Elisabeth-Hospital, Bochum
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - H Olze
- Charité - Universitätsmedizin Berlin
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn (UKB)
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Dreieich
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, TUM School of Medicine, Klinikum rechts der Isar, Technische Universität München
| | - S Becker
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Universitätsklinik Tübingen
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster
| | - M Wagenmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Düsseldorf
| | - C Bergmann
- Praxis für Hals-, Nasen-, Ohrenheilkunde, Klinik RKM 740, Düsseldorf
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
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30
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Förster-Ruhrmann U, Beule AG, Becker S, Chaker AM, Huppertz T, Hagemann J, Hoffmann TK, Dazert S, Deitmer T, Wrede H, Schlenter W, Welkoborsky HJ, Wollenberg B, Olze H, Rudack C, Sperl A, Casper I, Dietz A, Wagenmann M, Zuberbier T, Bergmann KC, Bedbrook A, Bousquet J, Bachert C, Bergmann C, Klimek L. Positionspapier: Hinweise zur Patienteninformation und -aufklärung vor Anwendung von Biologika bei chronischer Rhinosinusitis mit Nasenpolypen (CRSwNP) – Teil 2: Omalizumab – Empfehlungen des Ärzteverbandes Deutscher Allergologen (AeDA) und der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie (DGHNOKHC). Laryngorhinootologie 2021; 100:864-872. [PMID: 34521148 DOI: 10.1055/a-1592-0316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Zusammenfassung
Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung, oftmals auf der Grundlage einer Typ-2-Inflammation. Für die Behandlung von Patienten mit einer schweren Ausprägung ohne ausreichendes Ansprechen auf die Standardtherapie mit topischen nasalen Steroiden und/oder Zustand nach endonasaler Operation sind als Biologika aktuell Dupilumab und Omalizumab für die Therapie zugelassen. Nachdem wir in einer früheren Publikation für Dupilumab bereits entsprechende Hinweise gegeben haben, ist das Ziel der vorliegenden Arbeit die Standardisierung von Patienteninformation und -aufklärung vor einer Therapie mit Omalizumab.
Methoden Auf Grundlage des aktuellen Wissensstandes zur Immunologie der CRSwNP und zu den erwünschten und möglichen unerwünschten Wirkungen von Omalizumab werden Empfehlungen für die Patienteninformation entwickelt.
Ergebnisse Basierend auf der internationalen Literatur, der aktuellen Fachinformation und Erfahrungen aus der praktischen Anwendung und den derzeitigen Pharmakovigilanz-Daten hat ein Expertengremium Empfehlungen für die Patienteninformation und -aufklärung zur Anwendung von Omalizumab bei CRSwNP entwickelt und auf dieser Grundlage einen Patienteninformations- und Aufklärungsbogen erstellt.
Schlussfolgerung Die Information und Einwilligung des Patienten wird vor der Verordnung bzw. Verabreichung von allen Biologika, damit auch Omalizumab, empfohlen. Das vorliegende Positionspapier enthält wichtige Informationen zur praktischen Umsetzung und einen Vorschlag für eine Patienteninformation.
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Affiliation(s)
- U Förster-Ruhrmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin, Berlin
| | - A G Beule
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätskliniken Münster
| | - S Becker
- Hals-Nasen-Ohrenklinik und Poliklinik, Universitätsklinik Tübingen
| | - A M Chaker
- Klinik für Hals-, Nasen- und Ohrenheilkunde und Zentrum für Allergie und Umwelt (ZAUM), Klinikum rechts der Isar, Technische Universität München
| | - T Huppertz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - J Hagemann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsmedizin Mainz
| | - T K Hoffmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Ulm
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Bochum
| | - T Deitmer
- Deutsche Gesellschaft für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Bonn
| | - H Wrede
- Hals-, Nasen- und Ohrenarzt, Herford
| | - W Schlenter
- Ärzteverband Deutscher Allergologen, Dreieich
| | - H J Welkoborsky
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum Nordstadt Hannover
| | - B Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde und Zentrum für Allergie und Umwelt (ZAUM), Klinikum rechts der Isar, Technische Universität München
| | - H Olze
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Charité-Universitätsmedizin, Berlin
| | - C Rudack
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätskliniken Münster
| | - A Sperl
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - I Casper
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - A Dietz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig
| | - M Wagenmann
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Düsseldorf
| | - T Zuberbier
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin
| | - K C Bergmann
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin
| | - A Bedbrook
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, Frankreich
| | - J Bousquet
- MACVIA-France, Fondation partenariale FMC VIA-LR, Montpellier, Frankreich.,INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif.,Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, Frankreich.,Berlin Institute of Health, Comprehensive Allergy Center, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin
| | - C Bachert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Gent, Belgien
| | - C Bergmann
- RKM 740, HNO, Interdisziplinäre Facharztklinik, Düsseldorf
| | - L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
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31
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Zaadnoordijk L, Buckler H, Cusack R, Tsuji S, Bergmann C. A Global Perspective on Testing Infants Online: Introducing ManyBabies-AtHome. Front Psychol 2021; 12:703234. [PMID: 34566781 PMCID: PMC8458619 DOI: 10.3389/fpsyg.2021.703234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022] Open
Abstract
Online testing holds great promise for infant scientists. It could increase participant diversity, improve reproducibility and collaborative possibilities, and reduce costs for researchers and participants. However, despite the rise of platforms and participant databases, little work has been done to overcome the challenges of making this approach available to researchers across the world. In this paper, we elaborate on the benefits of online infant testing from a global perspective and identify challenges for the international community that have been outside of the scope of previous literature. Furthermore, we introduce ManyBabies-AtHome, an international, multi-lab collaboration that is actively working to facilitate practical and technical aspects of online testing and address ethical concerns regarding data storage and protection, and cross-cultural variation. The ultimate goal of this collaboration is to improve the method of testing infants online and make it globally available.
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Affiliation(s)
- Lorijn Zaadnoordijk
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Helen Buckler
- School of English, University of Nottingham, Nottingham, United Kingdom
| | - Rhodri Cusack
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Sho Tsuji
- International Research Center for Neurointelligence, The University of Tokyo, Tokyo, Japan
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32
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Györfi AH, Matei AE, Fuchs M, Liang C, Rigau AR, Hong X, Zhu H, Luber M, Bergmann C, Dees C, Ludolph I, Horch RE, Distler O, Wang J, Bengsch B, Schett G, Kunz M, Distler JH. Engrailed 1 coordinates cytoskeletal reorganization to induce myofibroblast differentiation. J Exp Med 2021; 218:e20201916. [PMID: 34259830 PMCID: PMC8288503 DOI: 10.1084/jem.20201916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 04/05/2021] [Accepted: 05/24/2021] [Indexed: 12/18/2022] Open
Abstract
Transforming growth factor-β (TGFβ) is a key mediator of fibroblast activation in fibrotic diseases, including systemic sclerosis. Here we show that Engrailed 1 (EN1) is reexpressed in multiple fibroblast subpopulations in the skin of SSc patients. We characterize EN1 as a molecular amplifier of TGFβ signaling in myofibroblast differentiation: TGFβ induces EN1 expression in a SMAD3-dependent manner, and in turn, EN1 mediates the profibrotic effects of TGFβ. RNA sequencing demonstrates that EN1 induces a profibrotic gene expression profile functionally related to cytoskeleton organization and ROCK activation. EN1 regulates gene expression by modulating the activity of SP1 and other SP transcription factors, as confirmed by ChIP-seq experiments for EN1 and SP1. Functional experiments confirm the coordinating role of EN1 on ROCK activity and the reorganization of cytoskeleton during myofibroblast differentiation, in both standard fibroblast culture systems and in vitro skin models. Consistently, mice with fibroblast-specific knockout of En1 demonstrate impaired fibroblast-to-myofibroblast transition and are partially protected from experimental skin fibrosis.
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Affiliation(s)
- Andrea-Hermina Györfi
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Alexandru-Emil Matei
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Maximilian Fuchs
- Medical Informatics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Chunguang Liang
- Medical Informatics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Aleix Rius Rigau
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Xuezhi Hong
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Honglin Zhu
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Department of Rheumatology, Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Markus Luber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Clara Dees
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Raymund E. Horch
- Department of Plastic and Hand Surgery, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Oliver Distler
- Department of Rheumatology, Center of Experimental Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Jiucun Wang
- State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, P.R. China
- Human Phenome Institute, Fudan University, Shanghai, P.R. China
- Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, P.R. China
| | - Bertram Bengsch
- Department of Medicine II: Gastroenterology, Hepatology, Endocrinology, and Infectious Disease, University Medical Center Freiburg, Freiburg, Germany
- BIOSS Centre for Biological Signaling Studies, Freiburg, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Meik Kunz
- Medical Informatics, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg H.W. Distler
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
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Zehender A, Li YN, Lin NY, Stefanica A, Nüchel J, Chen CW, Hsu HH, Zhu H, Ding X, Huang J, Shen L, Györfi AH, Soare A, Rauber S, Bergmann C, Ramming A, Plomann M, Eckes B, Schett G, Distler JHW. TGFβ promotes fibrosis by MYST1-dependent epigenetic regulation of autophagy. Nat Commun 2021; 12:4404. [PMID: 34285225 PMCID: PMC8292318 DOI: 10.1038/s41467-021-24601-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/29/2021] [Indexed: 12/13/2022] Open
Abstract
Activation of fibroblasts is essential for physiological tissue repair. Uncontrolled activation of fibroblasts, however, may lead to tissue fibrosis with organ dysfunction. Although several pathways capable of promoting fibroblast activation and tissue repair have been identified, their interplay in the context of chronic fibrotic diseases remains incompletely understood. Here, we provide evidence that transforming growth factor-β (TGFβ) activates autophagy by an epigenetic mechanism to amplify its profibrotic effects. TGFβ induces autophagy in fibrotic diseases by SMAD3-dependent downregulation of the H4K16 histone acetyltransferase MYST1, which regulates the expression of core components of the autophagy machinery such as ATG7 and BECLIN1. Activation of autophagy in fibroblasts promotes collagen release and is both, sufficient and required, to induce tissue fibrosis. Forced expression of MYST1 abrogates the stimulatory effects of TGFβ on autophagy and re-establishes the epigenetic control of autophagy in fibrotic conditions. Interference with the aberrant activation of autophagy inhibits TGFβ-induced fibroblast activation and ameliorates experimental dermal and pulmonary fibrosis. These findings link uncontrolled TGFβ signaling to aberrant autophagy and deregulated epigenetics in fibrotic diseases and may contribute to the development of therapeutic interventions in fibrotic diseases.
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Affiliation(s)
- Ariella Zehender
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Yi-Nan Li
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Neng-Yu Lin
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
- Graduate Institute of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Adrian Stefanica
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Julian Nüchel
- Center for Biochemistry, University of Cologne, Faculty of Medicine, Cologne, Germany
| | - Chih-Wei Chen
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Hsiao-Han Hsu
- Graduate Institute of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Honglin Zhu
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
- Department of Rheumatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiao Ding
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Jingang Huang
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Lichong Shen
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Andrea-Hermina Györfi
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Alina Soare
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Simon Rauber
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Markus Plomann
- Center for Biochemistry, University of Cologne, Faculty of Medicine, Cologne, Germany
| | - Beate Eckes
- Translational Matrix Biology, University of Cologne, Faculty of Medicine, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany.
- Deutsches Zentrum für Immuntherapie, Friedrich Alexander University Erlangen-Nuremberg and Universitaetsklinikum Erlangen, Erlangen, Germany.
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Distler JH, Bergmann C, Kuwert T, Schmidkonz C. Quantification of 68Ga-FAPI-04 in systemic sclerosis-associated interstitial lung disease - Authors' reply. Lancet Rheumatol 2021; 3:e475-e477. [PMID: 38279400 DOI: 10.1016/s2665-9913(21)00147-8] [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] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/20/2021] [Indexed: 01/28/2024]
Affiliation(s)
- Jörg Hw Distler
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen 91054, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen 91054, Germany.
| | - Torsten Kuwert
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen 91054, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen 91054, Germany
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35
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Chakraborty D, Zhu H, Jüngel A, Summa L, Li YN, Matei AE, Zhou X, Huang J, Trinh-Minh T, Chen CW, Lafyatis R, Dees C, Bergmann C, Soare A, Luo H, Ramming A, Schett G, Distler O, Distler JHW. Fibroblast growth factor receptor 3 activates a network of profibrotic signaling pathways to promote fibrosis in systemic sclerosis. Sci Transl Med 2021; 12:12/563/eaaz5506. [PMID: 32998972 DOI: 10.1126/scitranslmed.aaz5506] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Abstract
Aberrant activation of fibroblasts with progressive deposition of extracellular matrix is a key feature of systemic sclerosis (SSc), a prototypical idiopathic fibrotic disease. Here, we demonstrate that the profibrotic cytokine transforming growth factor β selectively up-regulates fibroblast growth factor receptor 3 (FGFR3) and its ligand FGF9 to promote fibroblast activation and tissue fibrosis, leading to a prominent FGFR3 signature in the SSc skin. Transcriptome profiling, in silico analysis and functional experiments revealed that FGFR3 induces multiple profibrotic pathways including endothelin, interleukin-4, and connective tissue growth factor signaling mediated by transcription factor CREB (cAMP response element-binding protein). Inhibition of FGFR3 signaling by fibroblast-specific knockout of FGFR3 or FGF9 or pharmacological inhibition of FGFR3 blocked fibroblast activation and attenuated experimental skin fibrosis in mice. These findings characterize FGFR3 as an upstream regulator of a network of profibrotic mediators in SSc and as a potential target for the treatment of fibrosis.
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Affiliation(s)
- Debomita Chakraborty
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Honglin Zhu
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany.,Department of Rheumatology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Astrid Jüngel
- Center of Experimental Rheumatology and Zurich Center of Integrative Human Physiology, University Hospital Zurich, 8091 Zürich, Switzerland
| | - Lena Summa
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Yi-Nan Li
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Alexandru-Emil Matei
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Xiang Zhou
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Jingang Huang
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Thuong Trinh-Minh
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Chih-Wei Chen
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Robert Lafyatis
- Department of Medicine, University of Pittsburgh, PA 15261, USA
| | - Clara Dees
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Alina Soare
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Hui Luo
- Department of Rheumatology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Andreas Ramming
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Oliver Distler
- Center of Experimental Rheumatology and Zurich Center of Integrative Human Physiology, University Hospital Zurich, 8091 Zürich, Switzerland
| | - Jörg H W Distler
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany.
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Dees C, Poetter S, Fuchs M, Bergmann C, Matei AE, Györfi AH, Soare A, Ramming A, Ceppi P, Schett G, Kunz M, Distler JHW. POS0423 NCOA3 AMPLIFIES PROFIBROTIC TRANSCRIPTIONAL PROGRAMS IN SYSTEMIC SCLEROSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Excessive activation of fibroblasts with a TGFβ-biased gene signature and deposition of extracellular matrix are key features of fibrotic diseases. The mechanisms underlying these transcriptional changes remain poorly understood. Deregulation, mutations and malfunctions of transcriptional co-regulators, which can interact with multiple transcription factors and enable a broad-spectrum regulation of transcriptional networks, have been implicated as driving factors in a large number of diseases and pathologies.Objectives:In the present study, we aimed to analyze the role of the co-regulator Nuclear Receptor Co-Activator 3 (NCOA3) in fibroblast activation and tissue fibrosis, and to evaluate a potential interaction of NCOA3 with fibrosis-relevant transcription factors.Methods:NCOA3 was inhibited genetically by siRNA transfection and pharmacologically by the SRC3 inhibitor-2 (SI-2). We performed bulk RNASeq of human dermal fibroblasts and in silico transcription factor binding site screening of differentially expressed genes (DEGs). The interaction of NCOA3 and TGFβ-SMAD signaling was analyzed by reporter and CoIP assays.Results:The expression of NCOA3 in skin biopsies of SSc patients compared to normal controls demonstrated that SSc fibroblasts express modestly, but significantly reduced levels of NCOA3, which persisted in cultured SSc fibroblasts. Stimulation of normal fibroblasts with chronically high levels of TGFβ as they also occur in fibrotic tissue remodeling strongly decreased NCOA3 expression to a similar extent as in SSc fibroblasts. Furthermore, NCOA3 expression is also deregulated in different murine models of skin fibrosis. To investigate the functional effects of decreased NCOA3 levels, we targeted the expression of NCOA3 in normal fibroblasts. SiRNA-mediated knockdown of NCOA3 ameliorated TGFβ-induced gene expression, collagen release, myofibroblast differentiation and cell proliferation. In contrast, knockdown of NCOA3 had no effects on collagen release, expression of contractile proteins or gene expression in unstimulated fibroblasts, suggesting that NCOA3 is not required for cellular homeostasis. To characterize the molecular mechanisms, we performed RNASeq upon NCOA3 knockdown. We identified 343 significant differentially expressed genes (220 downregulated and 123 upregulated with a Benjamini-Hochberg false discovery rate FDR < 0.25 and fold change > 1.5) between TGFβ-stimulated fibroblasts with and without NCOA3 knockdown (NCOA3-DEGs) including the fibrosis-relevant genes EDNRB, COL5A3, HES1, IL11 or IL33. Functional analysis of the NCOA3-DEGs showed enrichment of pathway terms such as collagen binding and extracellular matrix organization. In silico screening of the promoters of the NCOA3-DEGs for potential transcription factor binding motifs revealed binding motifs of core transcription factors of fibroblast activation and tissue fibrosis such as SMAD2/3/4, RBPJ, ZEB1, TCF4, REL, and SNAIL2 amongst the downregulated NCOA3-DEGs. Experimental validation of our biostatistical results using SMAD3 as example demonstrated a higher percentage of NCOA3-pSMAD3 double-positive fibroblasts in skin sections of SSc patients compared to healthy controls. In addition, knockdown of NCOA3 reduced TGFβ-induced SMAD-reporter activity. Furthermore, stimulation with TGFβ increased the interaction of NCOA3 with SMAD3 as analyzed by co-immunoprecipitation. Simultaneous knockdown of NCOA3 and SMAD3 showed no additional reductions compared to the single knockdowns, suggesting that NCOA3 controls SMAD3-dependent gene transcription under fibrotic conditions. Finally, inhibition of NCOA3 showed anti-fibrotic effects in different murine models of experimental skin and lung fibrosis.Conclusion:Our findings characterize NCOA3 as regulator of multiple pro-fibrotic transcription programs. Pharmaceutical inhibition of NCOA3 might be a strategy to interfere simultaneously with several core pro-fibrotic mediators in fibrotic diseases such as SSc.Acknowledgements:We thank Lena Summa, Vladyslav Fedorchenko, Wolfgang Espach and Regina Kleinlein for excellent technical assistance.The study was funded by grants DI 1537/7-1, DI 1537/8-1, DI 1537/9-1 and -2, DI 1537/11-1, DI 1537/12-1, DI 1537/13-1, DI 1537/14-1, DI 1537/17-1, DE 2414/2-1, DE 2414/4-1, and RA 2506/3-1 of the German Research Foundation, SFB CRC1181 (project C01) and SFB TR221/ project number 324392634 (B04) of the German Research Foundation, grants J39, J40 and A64 of the IZKF in Erlangen, grant 2013.056.1 of the Wilhelm-Sander-Foundation, grants 2014_A47, 2014_A248 and 2014_A184 of the Else-Kröner-Fresenius-Foundation, grant 14-12-17-1-Bergmann of the ELAN-Foundation Erlangen, BMBF (Era-Net grant 01KT1801), MASCARA program, TP 2 and a Career Support Award of Medicine of the Ernst Jung Foundation.Disclosure of Interests:Clara Dees: None declared, Sebastian Poetter: None declared, Maximilian Fuchs: None declared, Christina Bergmann: None declared, Alexandru-Emil Matei: None declared, Andrea-Hermina Györfi: None declared, Alina Soare: None declared, Andreas Ramming: None declared, Paolo Ceppi: None declared, Georg Schett: None declared, Meik Kunz: None declared, Jörg H.W. Distler Consultant of: Actelion, Active Biotech, Anamar, ARXX, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB, Grant/research support from: Anamar, Active Biotech, Array Biopharma, ARXX, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB
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Györfi AH, Matei AE, Fuchs M, Rius Rigau A, Hong X, Honglin Z, Luber M, Bergmann C, Dees C, Ludolph I, Horch R, Distler O, Schett G, Kunz M, Distler JHW. POS0328 ENGRAILED 1 COORDINATES CYTOSKELETAL ORGANIZATION TO PROMOTE MYOFIBROBLAST DIFFERENTIATION AND FIBROTIC TISSUE REMODELING. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Engrailed 1 (EN1) is a homeodomain-containing transcription factor with essential roles in embryonic development. In most cell types, the expression of EN1 is restricted to embryonic development. However, under pathological conditions, EN1 can be re-expressed to promote phenotypical adaptation. En1 is transiently expressed in the developing dermis of murine embryos in a distinct fibroblast lineage and silenced before birth (1). Former EN1-expressing cells give rise to a subpopulation of fibroblasts that has a high capacity for extracellular matrix production in adult murine skin. The role of EN1 in systemic sclerosis (SSc) was previously not explored.Objectives:To study the role of EN1 in the pathological activation of fibroblasts in tissue fibrosis.Methods:Bulk RNA-Seq and EN1 or SP1 ChIP-Seq were performed from cultured human dermal fibroblasts. The expression of EN1 was inhibited by siRNA. Cytoskeletal drugs paclitaxel, vinblastin and ROCK inhibitor (Y27632) were used to modulate the cytoskeleton in EN1 knockdown or overexpressing dermal fibroblasts. The role of EN1 in fibroblast activation was evaluated by functional experiments with EN1 knockdown or overexpression in standard 2D culture systems as well as in 3D skin equivalent models. The role of EN1 in skin fibrosis was further studied in En1fl/fl X Col6Cre mice, with fibroblast-specific knockout of En1 in three complementary mouse models: overexpression of a constitutively active TGFß-receptor I (TBRICA), bleomycin-induced skin fibrosis and TSK1 mice.Results:Pathologically activated dermal fibroblasts from SSc patients express higher levels of EN1 compared with age and sex matched healthy individuals in the skin and in vitro. TGFβ induces EN1 expression in fibroblasts in a SMAD3-dependent manner both in cultured fibroblasts and in murine skin. Knockdown of EN1 prevents TGFβ-induced fibroblast activation, whereas overexpression of EN1 fosters the pro-fibrotic effects of TGFβ with increased expression of αSMA, stress fibers and collagen. RNA sequencing demonstrates that EN1 induces a pro-fibrotic gene expression profile functionally related to cytoskeleton organization and ROCK activation. In silico analyses of the promoters of En1 target genes coupled with siRNA-mediated knockdown demonstrated that EN1 regulates these pro-fibrotic target genes by modulating the activity of regulatory modules that contain transcription factors of the specificity protein (SP) family. Functional experiments with selective modulators of ROCK and of microtubule polymerization confirm the coordinating role of EN1 on ROCK activity and the re-organization of cytoskeleton during myofibroblast differentiation in both conventional culture systems and 3D skin equivalents. Consistently, mice with fibroblast-specific knockout of En1 demonstrate impaired fibroblast-to-myofibroblast transition, reduced dermal thickening and impaired collagen deposition in the TBRICA, bleomycin-induced and TSK1 models.Conclusion:We characterize the homeodomain transcription factor EN1 as a molecular amplifier of TGFβ signaling in myofibroblast differentiation that coordinates cytoskeletal organization in a SP-dependent manner. EN1 might thus be a novel candidate for molecular targeted therapies to interfere with myofibroblast differentiation in fibrotic diseases.References:[1]Rinkevich Y, Walmsley GG, Hu MS, Maan ZN, Newman AM, Drukker M, et al. Skin fibrosis. Identification and isolation of a dermal lineage with intrinsic fibrogenic potential. Science. 2015;348(6232):aaa2151.Disclosure of Interests:Andrea-Hermina Györfi: None declared, Alexandru-Emil Matei: None declared, Maximilian Fuchs: None declared, Aleix Rius Rigau: None declared, Xuezhi Hong: None declared, ZHU Honglin: None declared, Markus Luber: None declared, Christina Bergmann: None declared, Clara Dees: None declared, Ingo Ludolph: None declared, Raymund Horch: None declared, Oliver Distler Consultant of: Actellion, AbbVie, Acceleron Pharma, Anamar, Amgen, Blade Therapeutics, CSL Behring, ChemomAb, Ergonex, Glenmark Pharma, GSK, Inventiva, Italfarmaco, iQvia, Medac, Medscape, Lilly, Sanofi, Target BioScience, UCB, Bayer, Boehringer Ingelheim, Catenion, iQone, Menarini, Mepha, Novartis, Mitsubishi, MSD, Roche, Pfizer, Georg Schett: None declared, Meik Kunz: None declared, Jörg H.W. Distler Consultant of: Actelion, Active Biotech, Anamar, ARXX, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB., Grant/research support from: Anamar, Active Biotech, Array Biopharma, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB
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Bergmann C, Distler JHW, Treutlein C, Tascilar K, Mueller AT, Atzinger A, Matei AE, Knitza J, Györfi AH, Lueck A, Dees C, Soare A, Ramming A, Schönau V, Distler O, Prante O, Ritt P, Goetz TI, Koehner M, Cordes M, Baeuerle T, Kuwert T, Schett G, Schmidkonz C. OP0272 68GA-FAPI-04 PET/CT STUDY EXTENSION FOR THE ASSESSMENT OF FIBROBLAST ACTIVATION AND RISK EVALUATION IN SYSTEMIC SCLEROSIS-RELATED INTERSTITIAL LUNG DISEASE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Interstitial lung disease (ILD) is the most common cause of death in systemic sclerosis (SSc). To date, the progression of SSc-ILD is judged by the accrual of lung damage on computed tomography (CT) and functional decline (forced vital capacity). However, this approach does not directly assess the activity of tissue remodeling. Moreover, prediction of the course of ILD in individual SSc patients remains challenging. Fibroblast Activation Protein (FAP) is a specific, ex vivo validated marker for activated fibroblasts.Objectives:The aims of this study were: 1. To assess differences in the uptake of 68GA-FAPI 04 in SSc-ILD patients compared to controls, to analyze 2. whether 68GA-FAPI 04 uptake at baseline correlates with other risk factors of disease progression and 3. Whether 68GA-FAPI 04 uptake is associated with the course of SSc-ILD.Methods:Between September 2018 and April 2020, 21 patients with SSc-ILD confirmed by HRCT and onset of SSc-ILD within ≤ 5 years or signs of progressive ILD and 21 controls without ILD were consecutively enrolled. All participants underwent 68Ga-FAPI-04 PET/CT imaging and standard-of-care procedures including HRCT and lung function testing (PFT) at baseline. Patients with SSc-ILD patients were followed-up for 6 months with HRCT and PFT. Follow-up 68Ga-FAPI-04 PET/CT scans were obtained in a subset of patients treated with nintedanib. We compared baseline 68Ga-FAPI-04 PET/CT uptake to standard diagnostic tools and currently used predictors of ILD progression. The association of 68Ga-FAPI-04 uptake with changes in FVC was analyzed using mixed-effects models.Results:68Ga-FAPI-04 accumulated in fibrotic areas of the lungs in SSc-ILD compared to controls with a median (q1-q3 interval) wlSUVmean of 0.8 (0.6 to 2.1) in the SSc-ILD group and 0.5 (0.4 to 0.5) in the control group (p<0.0001 with Mann-Whitney test) and a median whole lung maximal standardized uptake value (wlSUVmax) of 4.4 (3.05 to 5.2) in the SSc-ILD group compared to 0.7 (0.65 to 0.7) in the control group (p<0.0001). wlFAPI-MAV and wlTL-FAPI were not measurable in control subjects, as no 68Ga-FAPI-04 uptake above background level was observed. In the SSc-ILD group the median wlFAPI-MAV was 254cm3 (163.4 to 442.3) and the median wlTL-FAPI was 183.6 cm3 (98.04 to 960.7). 68Ga-FAPI-04 uptake was higher in patients with extensive disease, with previous ILD progression or high EUSTAR activity scores. Increased 68Ga-FAPI-04 uptake at baseline was associated with progression of ILD independently of extent of involvement on HRCT scan and the forced vital capacity at baseline. In consecutive 68Ga-FAPI-04-PET/CTs, changes in 68Ga-FAPI-04 uptake was concordant with the observed response to the fibroblast-targeting antifibrotic agent nintedanib.Conclusion:Our study presents first in human evidence that 68Ga-FAPI-04-fibroblast uptake correlates with fibrotic activity and disease progression in the lungs of SSc-ILD patients and that 68Ga-FAPI-04-PET/CT may be of potential to improve risk assessment of SSc-ILD.Figure 1.A and B:68Ga-FAPI-04 PET/CT scan from a patient with SSc-ILD with selective 68Ga-FAPI-04 uptake in fibrotic areas of the left- and right lower lung lobes (red arrows), but not in non-fibrotic areas such as the middle lobe (green arrow). B Corresponding CT component.Acknowledgements:We gratefully acknowledge Prof. Uwe Haberkorn (University Hospital Heidelberg and DKFZ, Heidelberg, Germany) and iTheranostics Inc. (Dulles, VA, USA) for providing the precursor FAPI-04.Disclosure of Interests:Christina Bergmann: None declared, Jörg H.W. Distler Speakers bureau: Actelion, Anamar, ARXX, Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, and UCB, Grant/research support from: Anamar, Active Biotech, Array Biopharma, ARXX, aTyr, BMS, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB, Christoph Treutlein: None declared, Koray Tascilar Speakers bureau: Gilead sciences GmbH, Pfizer Turkey, UCB Turkey, Anna-Theresa Mueller: None declared, Armin Atzinger: None declared, Alexandru-Emil Matei: None declared, Johannes Knitza: None declared, Andrea-Hermina Györfi: None declared, Anja Lueck: None declared, Clara Dees: None declared, Alina Soare: None declared, Andreas Ramming: None declared, Verena Schönau: None declared, Oliver Distler Speakers bureau: Arxx Therapeutics, Baecon Discovery, Blade Therapeutics,Bayer, Böhringer Ingelheim, Catenion,Competitive Drug Development International Ltd, Corbuspharma, CSL Behring, ChemomAb, Horizon Pharmaceuticals, Ergonex, Galaapagos NV, Glenmark Pharmaceuticals,GSK, Inventiva, Italfarmaco, IQvia, Kymera, Lilly, Medac, Medscape, MSD, Novartis, Pfizer, Roche, Sanofi, Taget Bio Sciencec, UCB, Grant/research support from: Bayer,Böhringer Ingelheim, Mitsubishi Tanabe Pharma, Olaf Prante: None declared, Philipp Ritt: None declared, Theresa Ida Goetz: None declared, Markus Koehner: None declared, Michael Cordes: None declared, Tobias Baeuerle: None declared, Torsten Kuwert Speakers bureau: Honoraria for occasional lectures by Siemens Healthineers, Grant/research support from: Research grant to the Clinic of Nuclear Medicine by this entity covering projects in the field of SPECT/CT, Georg Schett: None declared, Christian Schmidkonz: None declared
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Zehender A, Li YN, Lin NY, Györfi AH, Soare A, Bergmann C, Ramming A, Schett G, Distler JHW. AB0091 INHIBITION OF AUTOPHAGY PREVENTS PROGRESSION OF FIBROSIS IN MURINE MODELS OF SYSTEMIC SCLEROSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Autophagy is catabolic process allowing cells to degrade unnecessary or dysfunctional cellular organelles. Failure of appropriate regulation of autophagy, however, can severely perturb tissue homeostasis. Recent studies demonstrate that autophagy is activated in several fibrotic diseases such as liver fibrosis, renal interstitial fibrosis, cardiac fibrosis.Objectives:The objective of this work was to characterize the activation of autophagy in systemic sclerosis (SSc) and to decipher its role in the pathogenesis of SSc.Methods:Activation of autophagy in skin samples of patients and murine models of SSc was assessed by co-staining of LC3B and P62 with the lysosomal marker LAMP2. The role of the autophagy was investigated in the model of bleomycin-induced dermal fibrosis. Beclin1 was overexpressed using adenovirus encoding for Beclin1. To knockdown Atg7 in vivo was achieved by subcutaneous injections of Atg7 siRNA or non-targeting siRNA. In vivo, 3-methyladenine (3-MA) was administered i.p. in a concentration of 15 mg/kg ones daily. Protein expression was measured by Western blot. Target genes were analyzed by qPCR. To monitor the autophagic flux, we generated adenoviral vectors encoding for tandem fluorescent-tagged LC3 (mRFP-EGFP-LC3).Results:In the present study, we demonstrate that autophagy is activated in fibroblasts in SSc skin and also in experimental fibrosis models as compared to respective non-fibrotic control tissue with enhanced activity in in vivo and in vitro autophagy reporter studies. The aberrant activation of autophagy had profound stimulatory effects on fibroblasts. Activation of autophagy by forced expression of BECLIN1 promoted fibroblast-to-myofibroblast transition and stimulated the collagen release by cultured human fibroblasts and induced fibrosis in murine model. Nevertheless, inhibition of autophagy can deactivate myofibroblasts and induce regression of tissue fibrosis. Knockdown of ATG7 or BECLIN1 in human fibroblasts reduced the expression of αSMA and the number of stress fibers in myofibroblasts, indicating re-differentiation of myofibroblasts into resting fibroblasts upon inhibition of autophagy. Similar results were obtained with the autophagy inhibitors CQ and 3-MA. In vivo, siRNA mediated knockdown of Atg7 effectively prevented progression of fibrosis in a model of established bleomycin-induced skin fibrosis. Inactivation of autophagy decreased dermal thickness, myofibroblast counts and hydroxyproline content to below pretreatment levels, indicating regression of bleomycin-induced skin fibrosis. In addition, treatment of mice with the autophagy inhibitor 3-MA ameliorated bleomycin-induced skin fibrosis.Conclusion:We demonstrate that autophagy activity is enhanced in fibroblasts of SSc patients and in murine models of SSc. The increased activation of autophagy induces fibroblast-to-myofibroblast transition and promotes fibrotic tissue remodeling. However, inhibition of autophagy can deactivate myofibroblasts and induce regression of tissue fibrosis.References:[1]Wynn, T. Cellular and molecular mechanisms of fibrosis. J Pathol 214, 199-210 (2008).[2]Klionsky DJ, Abeliovich H, Agostinis P, et al. Guidelines for the use and interpretation of assays for monitoring autophagy in higher eukaryotes. Autophagy 4, 151-175 (2008).[3]Wang, CW & Klionsky, DJ. The molecular mechanism of autophagy. Mol Med 9, 65-76 (2003).[4]Hernández-Gea V, Ghiassi-Nejad Z, Rozenfeld R, et al. Autophagy releases lipid that promotes fibrogenesis by activated hepatic stellate cells in mice and in human tissues. Gastroenterology 142, 938-946 (2012).Disclosure of Interests:Ariella Zehender: None declared, Yi-Nan Li: None declared, Neng-Yu Lin: None declared, Andrea-Hermina Györfi: None declared, Alina Soare: None declared, Christina Bergmann: None declared, Andreas Ramming: None declared, Georg Schett: None declared, Jörg H.W. Distler Consultant of: Actelion, Active Biotech, Anamar, ARXX, Bayer Pharma, Boehringer Ingelheim, Celgene, Galapagos, GSK, Inventiva, JB Therapeutics, Medac, Pfizer, RuiYi and UCB., Grant/research support from: Anamar, Active Biotech, Array Biopharma, aTyr, BMS, Bayer Pharma, Boehringer Ingel-heim, Celgene, Galapagos, GSK, Inventiva, Novartis, Sanofi-Aventis, RedX, UCB., Employee of: stock owner of 4D Science and Scientific head of FibroCure
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Bergmann C, Stögmann E, Lehrner J. Depressive symptoms and olfactory function in patients with subjective cognitive decline, mild cognitive impairment and Alzheimer's disease. Brain Disorders 2021. [DOI: 10.1016/j.dscb.2021.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bergmann C, Hallenberger L, Chenguiti Fakhouri S, Merlevede B, Brandt A, Dees C, Zhu H, Zehender A, Zhou X, Schwab A, Chen CW, Györfi AH, Matei AE, Chakraborty D, Trinh-Minh T, Rauber S, Coras R, Bozec A, Kreuter A, Ziemer M, Schett G, Distler JHW. X-linked inhibitor of apoptosis protein (XIAP) inhibition in systemic sclerosis (SSc). Ann Rheum Dis 2021; 80:1048-1056. [PMID: 33903093 DOI: 10.1136/annrheumdis-2020-219822] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE X-linked inhibitor of apoptosis protein (XIAP) is a multifunctional protein with important functions in apoptosis, cellular differentiation and cytoskeletal organisation and is emerging as potential target for the treatment of various cancers. The aim of the current study was to investigate the role of XIAP in the pathogenesis of systemic sclerosis (SSc). METHODS The expression of XIAP in human skin samples of patients with SSc and chronic graft versus host disease (cGvHD) and healthy individuals was analysed by quantitative PCR, immunofluorescence (IF) and western blot. XIAP was inactivated by siRNA-mediated knockdown and pharmacological inhibition. The effects of XIAP inactivation were analysed in cultured fibroblasts and in the fibrosis models bleomycin-induced and topoisomerase-I-(topoI)-induced fibrosis and in Wnt10b-transgenic mice. RESULTS The expression of XIAP, but not of other inhibitor of apoptosis protein family members, was increased in fibroblasts in SSc and sclerodermatous cGvHD. Transforming growth factor beta (TGF-β) induced the expression of XIAP in a SMAD3-dependent manner. Inactivation of XIAP reduced WNT-induced fibroblast activation and collagen release. Inhibition of XIAP also ameliorated fibrosis induced by bleomycin, topoI and overexpression of Wnt10b in well-tolerated doses. The profibrotic effects of XIAP were mediated via WNT/β-catenin signalling. Inactivation of XIAP reduces binding of β-catenin to TCF to in a TLE-dependent manner to block WNT/β-catenin-dependent transcription. CONCLUSIONS Our data characterise XIAP as a novel link between two core pathways of fibrosis. XIAP is overexpressed in SSc and cGvHD in a TGF-β/SMAD3-dependent manner and in turn amplifies the profibrotic effects of WNT/β-catenin signalling on fibroblasts via transducin-like enhancer of split 3. Targeted inactivation of XIAP inhibits the aberrant activation of fibroblasts in murine models of SSc.
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Affiliation(s)
- Christina Bergmann
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Ludwig Hallenberger
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Sara Chenguiti Fakhouri
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Benita Merlevede
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Amelie Brandt
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Clara Dees
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Honglin Zhu
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany.,Department of Rheumatology and Immunology, Xiangya Hospital Central South University, Changsha, China
| | - Ariella Zehender
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Xiang Zhou
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Annemarie Schwab
- Interdisciplinary Centre for Clinical Research, University Hospital Erlangen, FAU-Erlangen-Nuremberg, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Chih-Wei Chen
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Andrea Hermina Györfi
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Alexandru Emil Matei
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Debomita Chakraborty
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Thuong Trinh-Minh
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Simon Rauber
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Roland Coras
- Department of Neuropathology, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Aline Bozec
- Institute for Clinical Immunology University of Erlangen-Nuremberg, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Alexander Kreuter
- Department of Dermatology and Allergology, HELIOS Sankt Elisabeth Klinik Oberhausen, Oberhausen, Nordrhein-Westfalen, Germany
| | - Mirjana Ziemer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Leipzig, Sachsen, Germany
| | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
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Knitza J, Mohn J, Bergmann C, Kampylafka E, Hagen M, Bohr D, Morf H, Araujo E, Englbrecht M, Simon D, Kleyer A, Meinderink T, Vorbrüggen W, von der Decken CB, Kleinert S, Ramming A, Distler JHW, Vuillerme N, Fricker A, Bartz-Bazzanella P, Schett G, Hueber AJ, Welcker M. Accuracy, patient-perceived usability, and acceptance of two symptom checkers (Ada and Rheport) in rheumatology: interim results from a randomized controlled crossover trial. Arthritis Res Ther 2021; 23:112. [PMID: 33849654 PMCID: PMC8042673 DOI: 10.1186/s13075-021-02498-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/31/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Timely diagnosis and treatment are essential in the effective management of inflammatory rheumatic diseases (IRDs). Symptom checkers (SCs) promise to accelerate diagnosis, reduce misdiagnoses, and guide patients more effectively through the health care system. Although SCs are increasingly used, there exists little supporting evidence. OBJECTIVE To assess the diagnostic accuracy, patient-perceived usability, and acceptance of two SCs: (1) Ada and (2) Rheport. METHODS Patients newly presenting to a German secondary rheumatology outpatient clinic were randomly assigned in a 1:1 ratio to complete Ada or Rheport and consecutively the respective other SCs in a prospective non-blinded controlled randomized crossover trial. The primary outcome was the accuracy of the SCs regarding the diagnosis of an IRD compared to the physicians' diagnosis as the gold standard. The secondary outcomes were patient-perceived usability, acceptance, and time to complete the SC. RESULTS In this interim analysis, the first 164 patients who completed the study were analyzed. 32.9% (54/164) of the study subjects were diagnosed with an IRD. Rheport showed a sensitivity of 53.7% and a specificity of 51.8% for IRDs. Ada's top 1 (D1) and top 5 disease suggestions (D5) showed a sensitivity of 42.6% and 53.7% and a specificity of 63.6% and 54.5% concerning IRDs, respectively. The correct diagnosis of the IRD patients was within the Ada D1 and D5 suggestions in 16.7% (9/54) and 25.9% (14/54), respectively. The median System Usability Scale (SUS) score of Ada and Rheport was 75.0/100 and 77.5/100, respectively. The median completion time for both Ada and Rheport was 7.0 and 8.5 min, respectively. Sixty-four percent and 67.1% would recommend using Ada and Rheport to friends and other patients, respectively. CONCLUSIONS While SCs are well accepted among patients, their diagnostic accuracy is limited to date. TRIAL REGISTRATION DRKS.de, DRKS00017642 . Registered on 23 July 2019.
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Affiliation(s)
- Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
- Université Grenoble Alpes, AGEIS, Grenoble, France.
| | - Jacob Mohn
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Eleni Kampylafka
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Melanie Hagen
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Daniela Bohr
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Harriet Morf
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Elizabeth Araujo
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Timo Meinderink
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wolfgang Vorbrüggen
- Verein zur Förderung der Rheumatologie e.V., Würselen, Germany
- RheumaDatenRhePort (rhadar), Planegg, Germany
| | - Cay Benedikt von der Decken
- RheumaDatenRhePort (rhadar), Planegg, Germany
- Medizinisches Versorgungszentrum Stolberg, Stolberg, Germany
- Klinik für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany
| | - Stefan Kleinert
- RheumaDatenRhePort (rhadar), Planegg, Germany
- Rheumatologische Schwerpunktpraxis, Drs. Kleinert, Rapp, Ronneberger, Schuch U. Wendler, Rheumatology, Erlangen, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Nicolas Vuillerme
- Université Grenoble Alpes, AGEIS, Grenoble, France
- Institut Universitaire de France, Paris, France
- LabCom Telecom4Health, University of Grenoble Alpes & Orange Labs, Grenoble, France
| | | | - Peter Bartz-Bazzanella
- RheumaDatenRhePort (rhadar), Planegg, Germany
- Klinik für Internistische Rheumatologie, Rhein-Maas Klinikum, Würselen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Section Rheumatology, Sozialstiftung Bamberg, Bamberg, Germany
| | - Martin Welcker
- RheumaDatenRhePort (rhadar), Planegg, Germany
- MVZ für Rheumatologie Dr. Martin Welcker GmbH, Planegg, Germany
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Keidel L, Elhardt C, Hohenfellner K, Priglinger S, Schworm B, Wertheimer C, Priglinger C, Luft N, Bechtold Dalla Pozza S, Bergmann C, Buss M, Dosch R, Erler J, Getzinger T, Herzig N, Hohenfellner K, Holla H, Knerr C, Koeppl C, Ockert C, Passow M, Rohayem J, Steidle G, Thiele A, Treikauskas U, Vill K, Weber R, Weitzel D. Establishing an objective biomarker for corneal cystinosis using a threshold-based Spectral domain optical coherence tomography imaging algorithm. Acta Ophthalmol 2021; 99:e189-e195. [PMID: 32833325 DOI: 10.1111/aos.14569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of the present study was to establish a semi-automated threshold-based image segmentation algorithm to detect and objectively quantify corneal cystine crystal deposition in ocular cystinosis with anterior segment optical coherence tomography (AS-OCT). METHODS This prospective, observational, comparative study included 88 eyes of 45 patients from the German Cystinosis Registry Study as well as 68 eyes of 35 healthy control subjects. All eyes were imaged with AS-OCT (Cirrus HD-OCT 5000, Carl Zeiss Meditec AG, Jena, Germany). As an initial step, B-scan images were subjectively analysed for typical changes in morphology in comparison to healthy controls. Based on the experience gained, an objective semi-automated B-scan image segmentation algorithm was developed using a grey scale value-based threshold method to automatically quantify corneal crystals. RESULTS On AS-OCT B-scans, corneal crystals appeared as hyperreflective deposits within the corneal stroma. The crystals were distributed either in all stromal layers (43 eyes, 49%) or confined to the anterior (23 eyes, 26%) or posterior stroma (22 eyes, 25%), respectively. The novel automatic B-scan image segmentation algorithm was most efficient in delineating corneal crystals at higher grey scale thresholds (e.g. 226 of a maximum of 255). Significant differences in suprathreshold grey scale pixels were observable between cystinosis patients and healthy controls (p < 0.001). In addition, the algorithm was able to detect an age-dependent depth distribution profile of crystal deposition. CONCLUSION Objective quantification of corneal cystine crystal deposition is feasible with AS-OCT and can serve as a novel biomarker for ocular disease control and topical treatment monitoring.
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Affiliation(s)
- Leonie Keidel
- Department of Ophthalmology Ludwig‐Maximilians‐University Munich Germany
| | - Carolin Elhardt
- Department of Ophthalmology Ludwig‐Maximilians‐University Munich Germany
| | | | | | - Benedikt Schworm
- Department of Ophthalmology Ludwig‐Maximilians‐University Munich Germany
| | | | - Claudia Priglinger
- Department of Ophthalmology Ludwig‐Maximilians‐University Munich Germany
| | - Nikolaus Luft
- Department of Ophthalmology Ludwig‐Maximilians‐University Munich Germany
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Bergmann C, Distler JHW, Treutlein C, Tascilar K, Müller AT, Atzinger A, Matei AE, Knitza J, Györfi AH, Lück A, Dees C, Soare A, Ramming A, Schönau V, Distler O, Prante O, Ritt P, Götz TI, Köhner M, Cordes M, Bäuerle T, Kuwert T, Schett G, Schmidkonz C. 68Ga-FAPI-04 PET-CT for molecular assessment of fibroblast activation and risk evaluation in systemic sclerosis-associated interstitial lung disease: a single-centre, pilot study. Lancet Rheumatol 2021; 3:e185-e194. [PMID: 38279381 DOI: 10.1016/s2665-9913(20)30421-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Interstitial lung disease (ILD) is the most common cause of death in systemic sclerosis. To date, the progression of systemic sclerosis-associated ILD is judged by the accrual of lung damage on CT and pulmonary function tests. However, diagnostic tools to assess disease activity are not available. Here, we tested the hypothesis that quantification of fibroblast activation by PET-CT using a 68Ga-labelled selective inhibitor of prolyl endopeptidase FAP (68Ga-FAPI-04) would correlate with ILD activity and disease progression in patients with systemic sclerosis-associated ILD. METHODS Between Sept 10, 2018, and April 8, 2020, 21 patients with systemic sclerosis-associated ILD confirmed by high-resolution CT (HRCT) within 12 months of inclusion and with onset of systemic sclerosis-associated ILD within 5 years or signs of progressive ILD and 21 controls without ILD were consecutively enrolled. All participants underwent 68Ga-FAPI-04 PET-CT imaging and standard-of-care procedures, including HRCT and pulmonary function tests at baseline. Patients with systemic sclerosis-associated ILD were followed for 6 months with HRCT and pulmonary function tests. We compared baseline 68Ga-FAPI-04 PET-CT uptake with standard diagnostic tools and predictors of ILD progression. The association of 68Ga-FAPI-04 uptake with changes in forced vital capacity was analysed using mixed-effects models. Follow-up 68Ga-FAPI-04 PET-CT scans were obtained in a subset of patients treated with nintedanib (follow-up between 6-10 months) to assess change over time. FINDINGS 68Ga-FAPI-04 accumulated in fibrotic areas of the lungs in patients with systemic sclerosis-associated ILD compared with controls, with a median standardised uptake value (SUV) mean over the whole lung of 0·80 (IQR 0·60-2·10) in the systemic sclerosis-ILD group and 0·50 (0·40-0·50) in the control group (p<0·0001) and a mean whole lung maximal SUV of 4·40 (range 3·05-5·20) in the systemic sclerosis-ILD group compared with 0·70 (0·65-0·70) in the control group (p<0·0001). Whole-lung FAPI metabolic active volume (wlFAPI-MAV) and whole-lung total lesion FAPI (wlTL-FAPI) were not measurable in control participants, because no 68Ga-FAPI-04 uptake above background level was observed. In the systemic sclerosis-ILD group the median wlFAPI-MAV was 254·00 cm3 (IQR 163·40-442·30), and the median wlTL-FAPI was 183·60 cm3 (98·04-960·70). 68Ga-FAPI-04 uptake was higher in patients with extensive disease, with previous ILD progression, or high EUSTAR activity scores than in those with with limited disease, previously stable ILD, or low EUSTAR activity scores. Increased 68Ga-FAPI-04 uptake at baseline was associated with progression of ILD independently of extent of involvement on HRCT scan and the forced vital capacity at baseline. In consecutive 68Ga-FAPI-04 PET-CTs, changes in 68Ga-FAPI-04 uptake was concordant with the observed response to the fibroblast-targeting antifibrotic drug nintedanib. INTERPRETATION Our study presents the first in-human evidence that fibroblast activation correlates with fibrotic activity and disease progression in the lungs of patients with systemic sclerosis-associated ILD and that 68Ga-FAPI-04 PET-CT might improve risk assessment of systemic sclerosis-associated ILD. FUNDING German Research Foundation, Erlangen Anschubs-und Nachwuchsfinanzierung, Interdisziplinäres Zentrum für Klinische Forschung Erlangen, Bundesministerium für Bildung und Forschung, Deutsche Stiftung Systemische Sklerose, Wilhelm-Sander-Foundation, Else-Kröner-Fresenius-Foundation, European Research Council, Ernst-Jung-Foundation, and Clinician Scientist Program Erlangen.
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Affiliation(s)
- Christina Bergmann
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
| | - Christoph Treutlein
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anna-Theresa Müller
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Armin Atzinger
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Alexandru-Emil Matei
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andrea-Hermina Györfi
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anja Lück
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Clara Dees
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Alina Soare
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Verena Schönau
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Oliver Distler
- Rheumaklinik, University Hospital Zurich, Zurich, Switzerland
| | - Olaf Prante
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Philipp Ritt
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Theresa Ida Götz
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Markus Köhner
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michael Cordes
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tobias Bäuerle
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Torsten Kuwert
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Dees C, Pötter S, Zhang Y, Bergmann C, Zhou X, Luber M, Wohlfahrt T, Karouzakis E, Ramming A, Gelse K, Yoshimura A, Jaenisch R, Distler O, Schett G, Distler JH. TGF-β-induced epigenetic deregulation of SOCS3 facilitates STAT3 signaling to promote fibrosis. J Clin Invest 2021; 130:2347-2363. [PMID: 31990678 DOI: 10.1172/jci122462] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [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: 05/25/2018] [Accepted: 01/17/2020] [Indexed: 12/28/2022] Open
Abstract
Fibroblasts are key effector cells in tissue remodeling. They remain persistently activated in fibrotic diseases, resulting in progressive deposition of extracellular matrix. Although fibroblast activation may be initiated by external factors, prolonged activation can induce an "autonomous," self-maintaining profibrotic phenotype in fibroblasts. Accumulating evidence suggests that epigenetic alterations play a central role in establishing this persistently activated pathologic phenotype of fibroblasts. We demonstrated that in fibrotic skin of patients with systemic sclerosis (SSc), a prototypical idiopathic fibrotic disease, TGF-β induced the expression of DNA methyltransferase 3A (DNMT3A) and DNMT1 in fibroblasts in a SMAD-dependent manner to silence the expression of suppressor of cytokine signaling 3 (SOCS3) by promoter hypermethylation. Downregulation of SOCS3 facilitated activation of STAT3 to promote fibroblast-to-myofibroblast transition, collagen release, and fibrosis in vitro and in vivo. Reestablishment of the epigenetic control of STAT3 signaling by genetic or pharmacological inactivation of DNMT3A reversed the activated phenotype of SSc fibroblasts in tissue culture, inhibited TGF-β-dependent fibroblast activation, and ameliorated experimental fibrosis in murine models. These findings identify a pathway of epigenetic imprinting of fibroblasts in fibrotic disease with translational implications for the development of targeted therapies in fibrotic diseases.
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Affiliation(s)
- Clara Dees
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sebastian Pötter
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Yun Zhang
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christina Bergmann
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Xiang Zhou
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Markus Luber
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Thomas Wohlfahrt
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Emmanuel Karouzakis
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Andreas Ramming
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Kolja Gelse
- Department of Trauma Surgery - Orthopedic Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Akihiko Yoshimura
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Rudolf Jaenisch
- Whitehead Institute for Biomedical Research, Cambridge, Massachusetts, USA
| | - Oliver Distler
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jörg Hw Distler
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Raina R, DeCoy M, Chakraborty R, Mahajan S, Moran R, Gibson K, Kumar D, Bergmann C. Renal cystic diseases during the perinatal and neonatal period. J Neonatal Perinatal Med 2021; 14:163-176. [PMID: 32986687 DOI: 10.3233/npm-200520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Renal cystic diseases are a clinically and genetically diverse group of renal diseases that can manifest in utero, infancy, or throughout childhood and adulthood. These diseases may be unilateral or bilateral with a single cyst or multiple cysts, or with increased echogenicity of the renal cortex without macroscopic cysts. Certain cystic renal diseases are life-threatening, with many developing chronic kidney and hepatic disease if not recognized early enough. Therefore, due to the prevalence and life-altering complications of this specific group of diseases in vulnerable populations, it is crucial for clinicians and healthcare providers to have an overall understanding of cystic diseases and how to pre-emptively detect and manage these conditions. In this review, we discuss in detail the epidemiology, genetics and pathophysiology, diagnosis, presentation, and management of numerous genetic and sporadic renal cystic diseases, such as polycystic kidney disease, multicystic dysplastic kidney, and calyceal diverticula, with an emphasis on prenatal care and pregnancy counseling.
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Affiliation(s)
- R Raina
- Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA
| | - M DeCoy
- Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA
| | - R Chakraborty
- Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA
| | - S Mahajan
- Revere High School, Richfield, OH, USA
| | - R Moran
- Department of Genetics, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - K Gibson
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - D Kumar
- Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - C Bergmann
- Department of Medicine, Nephrology, University Hospital Freiburg, Freiburg, Germany
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Byers-Heinlein K, Tsui ASM, Bergmann C, Black AK, Brown A, Carbajal MJ, Durrant S, Fennell CT, Fiévet AC, Frank MC, Gampe A, Gervain J, Gonzalez-Gomez N, Hamlin JK, Havron N, Hernik M, Kerr S, Killam H, Klassen K, Kosie JE, Kovács ÁM, Lew-Williams C, Liu L, Mani N, Marino C, Mastroberardino M, Mateu V, Noble C, Orena AJ, Polka L, Potter CE, Schreiner M, Singh L, Soderstrom M, Sundara M, Waddell C, Werker JF, Wermelinger S. A multi-lab study of bilingual infants: Exploring the preference for infant-directed speech. Adv Methods Pract Psychol Sci 2021; 4:10.1177/2515245920974622. [PMID: 35821764 PMCID: PMC9273003 DOI: 10.1177/2515245920974622] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
From the earliest months of life, infants prefer listening to and learn better from infant-directed speech (IDS) than adult-directed speech (ADS). Yet, IDS differs within communities, across languages, and across cultures, both in form and in prevalence. This large-scale, multi-site study used the diversity of bilingual infant experiences to explore the impact of different types of linguistic experience on infants' IDS preference. As part of the multi-lab ManyBabies 1 project, we compared lab-matched samples of 333 bilingual and 385 monolingual infants' preference for North-American English IDS (cf. ManyBabies Consortium, 2020: ManyBabies 1), tested in 17 labs in 7 countries. Those infants were tested in two age groups: 6-9 months (the younger sample) and 12-15 months (the older sample). We found that bilingual and monolingual infants both preferred IDS to ADS, and did not differ in terms of the overall magnitude of this preference. However, amongst bilingual infants who were acquiring North-American English (NAE) as a native language, greater exposure to NAE was associated with a stronger IDS preference, extending the previous finding from ManyBabies 1 that monolinguals learning NAE as a native language showed a stronger preference than infants unexposed to NAE. Together, our findings indicate that IDS preference likely makes a similar contribution to monolingual and bilingual development, and that infants are exquisitely sensitive to the nature and frequency of different types of language input in their early environments.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Judit Gervain
- Integrative Neuroscience and Cognition Center (INCC), CNRS & Université Paris Descartes
| | | | | | | | | | - Shila Kerr
- McGill University, School of Communication Sciences and Disorders
| | | | | | | | | | | | | | | | - Caterina Marino
- Integrative Neuroscience and Cognition Center (INCC), CNRS & Université Paris Descartes
| | | | | | | | | | - Linda Polka
- McGill University, School of Communication Sciences and Disorders
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Abstract
As they develop into mature speakers of their native language, infants must not only learn words but also the sounds that make up those words. To do so, they must strike a balance between accepting speaker-dependent variation (e.g., mood, voice, accent) but appropriately rejecting variation when it (potentially) changes a word's meaning (e.g., cat vs. hat). This meta-analysis focuses on studies investigating infants' ability to detect mispronunciations in familiar words, or mispronunciation sensitivity. Our goal was to evaluate the development of infants' phonological representations for familiar words as well as explore the role of experimental manipulations related to theoretical questions and of analysis choices. The results show that although infants are sensitive to mispronunciations, they still accept these altered forms as labels for target objects. Interestingly, this ability is not modulated by age or vocabulary size, suggesting that a mature understanding of native language phonology may be present in infants from an early age, possibly before the vocabulary explosion. These results support several theoretical assumptions made in the literature, such as sensitivity to mispronunciation size and position of the mispronunciation. We also shed light on the impact of data analysis choices that may lead to different conclusions regarding the development of infants' mispronunciation sensitivity. Our article concludes with recommendations for improved practice in testing infants' word and sentence processing online. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Katie Von Holzen
- Lehrstuhl Linguistik des Deutschen, Schwerpunkt Deutsch als Fremdsprache/Deutsch als Zweitsprache, Technische Universität Dortmund, Germany
- Department of Hearing and Speech Sciences, University of Maryland, USA
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christina Bergmann
- CNRS (Integrative Neuroscience and Cognition Center, UMR 8002), Paris, France
- Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands
- Laboratoire de Sciences Cognitives et de Psycholinguistique, Département d’études cognitives, ENS, EHESS, CNRS, PSL University
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49
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Byers-Heinlein K, Bergmann C, Davies C, Frank MC, Hamlin JK, Kline M, Kominsky JF, Kosie JE, Lew-Williams C, Liu L, Mastroberardino M, Singh L, Waddell CPG, Zettersten M, Soderstrom M. Building a collaborative Psychological Science: Lessons learned from ManyBabies 1. Can Psychol 2020; 61:349-363. [PMID: 34219905 PMCID: PMC8244655 DOI: 10.1037/cap0000216] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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] [Indexed: 11/08/2022]
Abstract
The field of infancy research faces a difficult challenge: some questions require samples that are simply too large for any one lab to recruit and test. ManyBabies aims to address this problem by forming large-scale collaborations on key theoretical questions in developmental science, while promoting the uptake of Open Science practices. Here, we look back on the first project completed under the ManyBabies umbrella - ManyBabies 1 - which tested the development of infant-directed speech preference. Our goal is to share the lessons learned over the course of the project and to articulate our vision for the role of large-scale collaborations in the field. First, we consider the decisions made in scaling up experimental research for a collaboration involving 100+ researchers and 70+ labs. Next, we discuss successes and challenges over the course of the project, including: protocol design and implementation, data analysis, organizational structures and collaborative workflows, securing funding, and encouraging broad participation in the project. Finally, we discuss the benefits we see both in ongoing ManyBabies projects and in future large-scale collaborations in general, with a particular eye towards developing best practices and increasing growth and diversity in infancy research and psychological science in general. Throughout the paper, we include first-hand narrative experiences, in order to illustrate the perspectives of researchers playing different roles within the project. While this project focused on the unique challenges of infant research, many of the insights we gained can be applied to large-scale collaborations across the broader field of psychology.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Liquan Liu
- University of Oslo; Western Sydney University
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Abstract
Visual reaction times to target pictures after naming events are an informative measurement in language acquisition research, because gaze shifts measured in looking-while-listening paradigms are an indicator of infants' lexical speed of processing. This measure is very useful, as it can be applied from a young age onwards and has been linked to later language development. However, to obtain valid reaction times, the infant is required to switch the fixation of their eyes from a distractor to a target object. This means that usually at least half the trials have to be discarded-those where the participant is already fixating the target at the onset of the target word-so that no reaction time can be measured. With few trials, reliability suffers, which is especially problematic when studying individual differences. In order to solve this problem, we developed a gaze-triggered looking-while-listening paradigm. The trials do not differ from the original paradigm apart from the fact that the target object is chosen depending on the infant's eye fixation before naming. The object the infant is looking at becomes the distractor and the other object is used as the target, requiring a fixation switch, and thus providing a reaction time. We tested our paradigm with forty-three 18-month-old infants, comparing the results to those from the original paradigm. The Gaze-triggered paradigm yielded more valid reaction time trials, as anticipated. The results of a ranked correlation between the conditions confirmed that the manipulated paradigm measures the same concept as the original paradigm.
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Affiliation(s)
- Julia Egger
- Max Planck Institute for Psycholinguistics, Wundtlaan 1, 6525XD, Nijmegen, The Netherlands.
| | - Caroline F Rowland
- Max Planck Institute for Psycholinguistics, Wundtlaan 1, 6525XD, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Christina Bergmann
- Max Planck Institute for Psycholinguistics, Wundtlaan 1, 6525XD, Nijmegen, The Netherlands
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