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Seizer P, von Ungern-Sternberg SNI, Haug V, Dicenta V, Rosa A, Butt E, Nöthel M, Rohlfing AK, Sigle M, Nawroth PP, Nussbaum C, Sperandio M, Kusch C, Meub M, Sauer M, Münzer P, Bieber K, Stanger A, Mack AF, Huber R, Brand K, Lehners M, Feil R, Poso A, Krutzke K, Schäffer TE, Nieswandt B, Borst O, May AE, Zernecke A, Gawaz M, Heinzmann D. Cyclophilin A is a ligand for RAGE in thrombo-inflammation. Cardiovasc Res 2024; 120:385-402. [PMID: 38175781 DOI: 10.1093/cvr/cvad189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 10/08/2023] [Accepted: 10/20/2023] [Indexed: 01/06/2024] Open
Abstract
AIMS Cyclophilin A (CyPA) induces leucocyte recruitment and platelet activation upon release into the extracellular space. Extracellular CyPA therefore plays a critical role in immuno-inflammatory responses in tissue injury and thrombosis upon platelet activation. To date, CD147 (EMMPRIN) has been described as the primary receptor mediating extracellular effects of CyPA in platelets and leucocytes. The receptor for advanced glycation end products (RAGE) shares inflammatory and prothrombotic properties and has also been found to have similar ligands as CD147. In this study, we investigated the role of RAGE as a previously unknown interaction partner for CyPA. METHODS AND RESULTS Confocal imaging, proximity ligation, co-immunoprecipitation, and atomic force microscopy were performed and demonstrated an interaction of CyPA with RAGE on the cell surface. Static and dynamic cell adhesion and chemotaxis assays towards extracellular CyPA using human leucocytes and leucocytes from RAGE-deficient Ager-/- mice were conducted. Inhibition of RAGE abrogated CyPA-induced effects on leucocyte adhesion and chemotaxis in vitro. Accordingly, Ager-/- mice showed reduced leucocyte recruitment and endothelial adhesion towards CyPA in vivo. In wild-type mice, we observed a downregulation of RAGE on leucocytes when endogenous extracellular CyPA was reduced. We furthermore evaluated the role of RAGE for platelet activation and thrombus formation upon CyPA stimulation. CyPA-induced activation of platelets was found to be dependent on RAGE, as inhibition of RAGE, as well as platelets from Ager-/- mice showed a diminished activation and thrombus formation upon CyPA stimulation. CyPA-induced signalling through RAGE was found to involve central signalling pathways including the adaptor protein MyD88, intracellular Ca2+ signalling, and NF-κB activation. CONCLUSION We propose RAGE as a hitherto unknown receptor for CyPA mediating leucocyte as well as platelet activation. The CyPA-RAGE interaction thus represents a novel mechanism in thrombo-inflammation.
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Affiliation(s)
- Peter Seizer
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
- Department of Cardiology and Angiology, Ostalbklinikum Aalen, Aalen, Germany
| | - Saskia N I von Ungern-Sternberg
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Verena Haug
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Valerie Dicenta
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Annabelle Rosa
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Elke Butt
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Moritz Nöthel
- Department of Internal Medicine II, Cardiology, Pneumology, Angiology, University Hospital Bonn, Bonn, Germany
| | - Anne-Katrin Rohlfing
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Manuel Sigle
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - Peter P Nawroth
- Department of Internal Medicine 1 and Clinical Chemistry, University Hospital of Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
- Joint Heidelberg-ICD Translational Diabetes Program, Helmholtz-Zentrum, Munich, Germany
| | - Claudia Nussbaum
- Division of Neonatology, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Markus Sperandio
- Institute of Cardiovascular Physiology and Pathophysiology, Ludwig-Maximilians University Munich, Munich, Germany
- German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Munich Heart Alliance Partner Site, Munich, Germany
| | - Charly Kusch
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Mara Meub
- Department of Biotechnology und Biophysics, Julius-Maximilians University, Würzburg, Germany
| | - Markus Sauer
- Department of Biotechnology und Biophysics, Julius-Maximilians University, Würzburg, Germany
| | - Patrick Münzer
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
- DFG Heisenberg Group Cardiovascular Thromboinflammation and Translational Thrombocardiology, University of Tübingen, Tübingen, Germany
| | - Kristin Bieber
- Department of Hematology, Oncology, Immunology und Pulmonology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Anna Stanger
- Department of Hematology, Oncology, Immunology und Pulmonology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Andreas F Mack
- Institute of Clinical Anatomy and Cell Analytics, Eberhard Karls University Tübingen, Tübingen, Germany
| | - René Huber
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Korbinian Brand
- Institute of Clinical Chemistry, Hannover Medical School, Hannover, Germany
| | - Moritz Lehners
- Interfakultäres Institut für Biochemie, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Robert Feil
- Interfakultäres Institut für Biochemie, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Antti Poso
- Department of Internal Medicine VIII, University Hospital of Tübingen, Tübingen, Germany
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmaceutical Sciences, Eberhard Karls University Tübingen, Tübingen, Germany
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmaceutical Sciences, Eberhard Karls University, Tübingen, Germany
- Tübingen Center for Academic Drug Discovery & Development (TüCAD2), Tübingen, Germany
- Excellence Cluster 'Controlling Microbes to Fight Infections' (CMFI), Tübingen, Germany
| | - Konstantin Krutzke
- Institute of Applied Physics, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Tilman E Schäffer
- Institute of Applied Physics, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
- Rudolf Virchow Center, University of Würzburg, Würzburg, Germany
| | - Oliver Borst
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
- DFG Heisenberg Group Cardiovascular Thromboinflammation and Translational Thrombocardiology, University of Tübingen, Tübingen, Germany
| | - Andreas E May
- Department of Cardiology, Innere Medizin I, Klinikum Memmingen, Memmingen, Germany
| | - Alma Zernecke
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
| | - David Heinzmann
- Department of Cardiology and Angiology, Universitätsklinikum Tübingen, Eberhard Karls University Tübingen, Otfried-Müller-Str. 10, 72076 Tübingen, Germany
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Weyand S, Adam V, Biehler P, Hägele P, Hanger S, Heinzmann D, Löbig S, Pinchuk A, Waechter C, Seizer P. Focal Pulsed Field Ablation for Atrial Arrhythmias: Efficacy and Safety under Deep Sedation. J Clin Med 2024; 13:576. [PMID: 38276082 PMCID: PMC10817052 DOI: 10.3390/jcm13020576] [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: 12/14/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Focal pulsed field ablation (PFA) is a novel technique for treating cardiac arrhythmias. It has demonstrated positive results in initial studies and has a good safety profile. In recent studies, PFA was often utilized for first-time pulmonary vein isolation (PVI) and was performed under general anesthesia. In our study, we assessed the feasibility, safety, acute procedural efficacy, and efficiency of focal PFA under deep sedation in patients, 80% of whom had undergone at least one left atrial ablation previously. We treated 30 patients (71 ± 7, 46% male) using the CENTAURI system for various atrial arrhythmias, including atrial fibrillation, typical and atypical atrial flutter, and focal atrial tachycardia. The average procedure and fluoroscopy times were 122 ± 43 min and 9 ± 7 min, respectively. A total of 83.33% of patients received additional line ablations beyond PVI, specifically targeting the posterior box and anterior mitral line. All ablations were successfully performed in deep sedation with only one major and one minor complication observed. The major complication was a vasospasm of the right coronary artery during ablation of the cavotricuspid isthmus, which was treated successfully with intracoronary nitroglycerin. All patients could be discharged in sinus rhythm. Moreover, adenosine appears effective in identifying dormant conduction in some patients after focal PFA. In conclusion, focal PFA is an effective approach for complex left atrial ablations under deep sedation, offering both high efficacy and efficiency with a reliable safety profile. Studies on long-term outcomes are needed.
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Affiliation(s)
- Sebastian Weyand
- Department of Cardiology, Ostalb Clinic Aalen, Im Kaelblesrain 1, 73430 Aalen, Germany; (S.W.); (V.A.); (P.B.); (P.H.); (S.H.); (S.L.); (A.P.)
| | - Viola Adam
- Department of Cardiology, Ostalb Clinic Aalen, Im Kaelblesrain 1, 73430 Aalen, Germany; (S.W.); (V.A.); (P.B.); (P.H.); (S.H.); (S.L.); (A.P.)
| | - Paloma Biehler
- Department of Cardiology, Ostalb Clinic Aalen, Im Kaelblesrain 1, 73430 Aalen, Germany; (S.W.); (V.A.); (P.B.); (P.H.); (S.H.); (S.L.); (A.P.)
| | - Patricia Hägele
- Department of Cardiology, Ostalb Clinic Aalen, Im Kaelblesrain 1, 73430 Aalen, Germany; (S.W.); (V.A.); (P.B.); (P.H.); (S.H.); (S.L.); (A.P.)
| | - Simon Hanger
- Department of Cardiology, Ostalb Clinic Aalen, Im Kaelblesrain 1, 73430 Aalen, Germany; (S.W.); (V.A.); (P.B.); (P.H.); (S.H.); (S.L.); (A.P.)
| | - David Heinzmann
- Department of Cardiology, University Hospital Tuebingen, Otfried-Mueller-Straße 10, 72076 Tuebingen, Germany
| | - Stephanie Löbig
- Department of Cardiology, Ostalb Clinic Aalen, Im Kaelblesrain 1, 73430 Aalen, Germany; (S.W.); (V.A.); (P.B.); (P.H.); (S.H.); (S.L.); (A.P.)
| | - Andrei Pinchuk
- Department of Cardiology, Ostalb Clinic Aalen, Im Kaelblesrain 1, 73430 Aalen, Germany; (S.W.); (V.A.); (P.B.); (P.H.); (S.H.); (S.L.); (A.P.)
| | - Christian Waechter
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Baldingerstraße, 35043 Marburg, Germany;
| | - Peter Seizer
- Department of Cardiology, Ostalb Clinic Aalen, Im Kaelblesrain 1, 73430 Aalen, Germany; (S.W.); (V.A.); (P.B.); (P.H.); (S.H.); (S.L.); (A.P.)
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Sigle M, Rohlfing AK, Kenny M, Scheuermann S, Sun N, Graeßner U, Haug V, Sudmann J, Seitz CM, Heinzmann D, Schenke-Layland K, Maguire PB, Walch A, Marzi J, Gawaz MP. Translating genomic tools to Raman spectroscopy analysis enables high-dimensional tissue characterization on molecular resolution. Nat Commun 2023; 14:5799. [PMID: 37726278 PMCID: PMC10509269 DOI: 10.1038/s41467-023-41417-0] [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: 09/18/2022] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
Spatial transcriptomics of histological sections have revolutionized research in life sciences and enabled unprecedented insights into genetic processes involved in tissue reorganization. However, in contrast to genomic analysis, the actual biomolecular composition of the sample has fallen behind, leaving a gap of potentially highly valuable information. Raman microspectroscopy provides untargeted spatiomolecular information at high resolution, capable of filling this gap. In this study we demonstrate spatially resolved Raman "spectromics" to reveal homogeneity, heterogeneity and dynamics of cell matrix on molecular levels by repurposing state-of-the-art bioinformatic analysis tools commonly used for transcriptomic analyses. By exploring sections of murine myocardial infarction and cardiac hypertrophy, we identify myocardial subclusters when spatially approaching the pathology, and define the surrounding metabolic and cellular (immune-) landscape. Our innovative, label-free, non-invasive "spectromics" approach could therefore open perspectives for a profound characterization of histological samples, while additionally allowing the combination with consecutive downstream analyses of the very same specimen.
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Affiliation(s)
- Manuel Sigle
- Department of Cardiology and Angiology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Anne-Katrin Rohlfing
- Department of Cardiology and Angiology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Martin Kenny
- UCD Conway SPHERE Research Group, Conway Institute, University College Dublin, Dublin, Ireland
- School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Sophia Scheuermann
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tuebingen, 72076, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tuebingen, 72076, Tuebingen, Germany
| | - Na Sun
- Research Unit Analytical Pathology, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Ulla Graeßner
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tuebingen, 72076, Tuebingen, Germany
| | - Verena Haug
- Department of Cardiology and Angiology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Jessica Sudmann
- Department of Cardiology and Angiology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Christian M Seitz
- Department of Pediatric Hematology and Oncology, University Children's Hospital Tuebingen, 72076, Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tuebingen, 72076, Tuebingen, Germany
| | - David Heinzmann
- Department of Cardiology and Angiology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
| | - Katja Schenke-Layland
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tuebingen, 72076, Tuebingen, Germany
- Institute of Biomedical Engineering, Department for Medical Technologies and Regenerative Medicine, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770, Reutlingen, Germany
| | - Patricia B Maguire
- UCD Conway SPHERE Research Group, Conway Institute, University College Dublin, Dublin, Ireland
- School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
- Institute for Discovery, O'Brien Centre for Science, University College Dublin, Dublin, Ireland
| | - Axel Walch
- Research Unit Analytical Pathology, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Julia Marzi
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tuebingen, 72076, Tuebingen, Germany
- Institute of Biomedical Engineering, Department for Medical Technologies and Regenerative Medicine, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany
- NMI Natural and Medical Sciences Institute at the University of Tuebingen, 72770, Reutlingen, Germany
| | - Meinrad Paul Gawaz
- Department of Cardiology and Angiology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, 72076, Tuebingen, Germany.
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Weyand S, Beuter M, Heinzmann D, Seizer P. High-resolution mapping as an alternative for exit block testing in the presence of entrance block after high-power short-duration pulmonary vein isolation. Herzschrittmacherther Elektrophysiol 2022; 33:440-445. [PMID: 36083317 DOI: 10.1007/s00399-022-00895-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND After pulmonary vein isolation (PVI) for atrial fibrillation (AF), it is common as an endpoint to demonstrate an exit block from the pulmonary veins (PVs) in addition to an entrance block into them. By using high-resolution mapping catheters, even very small signals can be detected. OBJECTIVES We investigated whether additional exit block testing is still necessary when using high-resolution mapping catheters after ablation in high-power short-duration (HPSD) techniques. MATERIALS AND METHODS Overall, 114 patients with AF (average age, 65.14 ± 11.3 years; 65.8% male) undergoing radiofrequency PVI were included in the study. Ablation was performed with the HPSD technique using a fixed protocol for energy delivery of 50 W (contact force 3-20 g). Entrance and exit block were tested with a high-resolution mapping catheter. Isolation of the PVs was achieved in all patients. RESULTS Capture of local PV tissue was demonstrated in all patients after PVI and exit block was present in all patients after entrance block was detected using a high-resolution mapping catheter. CONCLUSION Exit block testing in addition to the demonstration of an entrance block as an endpoint of PVI seems to have no additional benefit and might no longer be necessary when a high-resolution mapping catheter is used in HPSD ablation for PVI of AF.
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Affiliation(s)
- Sebastian Weyand
- Medizinische Klinik II - Kardiologie und Angiologie, Ostalb-Klinikum Aalen, Im Kälblesrain 1, 73430, Aalen, Germany.
| | - Matthias Beuter
- Medizinische Klinik II - Kardiologie und Angiologie, Ostalb-Klinikum Aalen, Im Kälblesrain 1, 73430, Aalen, Germany
| | - David Heinzmann
- Innere Medizin III - Kardiologie und Angiologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Peter Seizer
- Medizinische Klinik II - Kardiologie und Angiologie, Ostalb-Klinikum Aalen, Im Kälblesrain 1, 73430, Aalen, Germany
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Schreieck J, Seizer P, Duckheim M, Scheckenbach C, Gawaz M, Heinzmann D. Contact force-controlled high power short duration radiofrequency ablation enables efficient creation of roof line and anterior mitral line in course of low voltage areas. Europace 2022. [DOI: 10.1093/europace/euac053.274] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Linear ablation lines in the left atrium are questionable for treatment of atrial fibrillation (AF). In particular they are challenging, performed with limited success rate and are arrhythmogenic due to recurrence of conduction. Contact force (CF)-controlled high power short duration (HPSD) radiofrequency ablation (RFA) in areas of fibrosis may overcome these limitations.
Purpose
We investigated the efficiency of contact force (CF)-controlled high power short duration (HPSD) radiofrequency ablation (RFA) for creation of linear lines in case of fibrotic areas in the anterior left atrium.
Methods
In 530 consecutive patients (pts), age 65±9 years, paroxysmal AF in 45%, persistent AF in 55%, AF-re-ablation in 32% of pts, undergoing HPSD CF-controlled RF ablation of AF. Besides from pulmonary vein isolation (PVI) additional left atrial linear ablation in the anterior left atrium was performed in 28% of patients exclusively in case of low voltage areas in the course of the line or in case of re-ablation of prior performed lines. Fibrosis was defined by areas of less than 0.5mV signals in high density 3D microelectrode mapping. More than 5% low voltage was present in 46% of pts and more than 20% low voltage in 27% of pts. HPSD RF ablation was performed using a power of 50 Watt, duration 5-15s, with CF-controlled catheters, seeking for CF of 10-30g, and an interlesion distance of 6mm.
Results
A anterior roof line between both upper pulmonary veins was performed in 25% of pts (n=133), and an anterior mitral line in 17% of pts (n=88). The anterior mitral line connected the superior mitral anulus with left upper, right upper PV or anywhere this the roof line depending on the distribution of low voltage areas. Overall success rate of bidirectional conduction block at the roof line was 92% and at the mitral line 94%. After remapping of gaps and re-ablation with conventional 35-40 Watt RF application of unlimited duration, success rate at the roof line improved to 98% and at the mitral line to 97%. No serious complications were associated with creation of these lines, especially, no pericardial tamponade occurred. Limited follow up will presented at the time of presentation.
Conclusions
CF-controlled creation of ablation lines in the anterior left atrium (roof line and anterior mitral line) by HPSD RF ablation is very efficient and safe in case of areas of low voltage in the course of the linear ablation. In rare cases additional conventional RF application of unlimited duration becomes necessary to complete the lines supported by identification of gaps by high density 3D microelectrode mapping. This approach has the potential to improve efficacy of AF ablation in patients with atrial fibrosis. The hypothesis have to be proven by a prospective controlled study in the near future.
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Affiliation(s)
- J Schreieck
- Medical University of Tuebingen, Tuebingen, Germany
| | - P Seizer
- Rehabilitation Medicine Ostalb, Ostalbklinikum Aalen, Aalen, Germany
| | - M Duckheim
- Medical University of Tuebingen, Tuebingen, Germany
| | - C Scheckenbach
- Department of Paediatric Cardiology, University Tuebingen, Tuebingen, Germany
| | - M Gawaz
- Medical University of Tuebingen, Tuebingen, Germany
| | - D Heinzmann
- Medical University of Tuebingen, Tuebingen, Germany
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Rosa A, Butt E, Hopper CP, Loroch S, Bender M, Schulze H, Sickmann A, Vorlova S, Seizer P, Heinzmann D, Zernecke A. Cyclophilin A Is Not Acetylated at Lysine-82 and Lysine-125 in Resting and Stimulated Platelets. Int J Mol Sci 2022; 23:ijms23031469. [PMID: 35163387 PMCID: PMC8836233 DOI: 10.3390/ijms23031469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 12/24/2022] Open
Abstract
Cyclophilin A (CyPA) is widely expressed by all prokaryotic and eukaryotic cells. Upon activation, CyPA can be released into the extracellular space to engage in a variety of functions, such as interaction with the CD147 receptor, that contribute to the pathogenesis of cardiovascular diseases. CyPA was recently found to undergo acetylation at K82 and K125, two lysine residues conserved in most species, and these modifications are required for secretion of CyPA in response to cell activation in vascular smooth muscle cells. Herein we addressed whether acetylation at these sites is also required for the release of CyPA from platelets based on the potential for local delivery of CyPA that may exacerbate cardiovascular disease events. Western blot analyses confirmed the presence of CyPA in human and mouse platelets. Thrombin stimulation resulted in CyPA release from platelets; however, no acetylation was observed-neither in cell lysates nor in supernatants of both untreated and activated platelets, nor after immunoprecipitation of CyPA from platelets. Shotgun proteomics detected two CyPA peptide precursors in the recombinant protein, acetylated at K28, but again, no acetylation was found in CyPA derived from resting or stimulated platelets. Our findings suggest that acetylation of CyPA is not a major protein modification in platelets and that CyPA acetylation is not required for its secretion from platelets.
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Affiliation(s)
- Annabelle Rosa
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany; (A.R.); (E.B.); (C.P.H.); (M.B.); (H.S.); (S.V.)
| | - Elke Butt
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany; (A.R.); (E.B.); (C.P.H.); (M.B.); (H.S.); (S.V.)
| | - Christopher P. Hopper
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany; (A.R.); (E.B.); (C.P.H.); (M.B.); (H.S.); (S.V.)
| | - Stefan Loroch
- Leibniz-Institut für Analytische Wissenschaften (ISAS), 44139 Dortmund, Germany; (S.L.); (A.S.)
| | - Markus Bender
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany; (A.R.); (E.B.); (C.P.H.); (M.B.); (H.S.); (S.V.)
| | - Harald Schulze
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany; (A.R.); (E.B.); (C.P.H.); (M.B.); (H.S.); (S.V.)
| | - Albert Sickmann
- Leibniz-Institut für Analytische Wissenschaften (ISAS), 44139 Dortmund, Germany; (S.L.); (A.S.)
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
- Department of Chemistry, College of Physical Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Sandra Vorlova
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany; (A.R.); (E.B.); (C.P.H.); (M.B.); (H.S.); (S.V.)
| | | | - David Heinzmann
- Department of Cardiology and Angiology, University of Tübingen, 72076 Tübingen, Germany;
| | - Alma Zernecke
- Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany; (A.R.); (E.B.); (C.P.H.); (M.B.); (H.S.); (S.V.)
- Correspondence: ; Tel.: +49-(0)-931-201-48331
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Mizera L, Rath D, Schoellmann A, Petersen-Uribe A, Avdiu A, Zdanyte M, Jaeger P, Heinzmann D, Müller K, Gawaz M, Eick C, Duckheim M. Deceleration capacity is associated with acute respiratory distress syndrome in COVID-19. Heart Lung 2021; 50:914-918. [PMID: 34428736 PMCID: PMC8326018 DOI: 10.1016/j.hrtlng.2021.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/25/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is considered the main cause of COVID-19 associated morbidity and mortality. Early and reliable risk stratification is of crucial clinical importance in order to identify persons at risk for developing a severe course of disease. Deceleration capacity (DC) of heart rate as a marker of cardiac autonomic function predicts outcome in persons with myocardial infarction and heart failure. We hypothesized that reduced modulation of heart rate may be helpful in identifying persons with COVID-19 at risk for developing ARDS. METHODS We prospectively enrolled 60 consecutive COVID-19 positive persons presenting at the University Hospital of Tuebingen. Arterial blood gas analysis and 24 h-Holter ECG recordings were performed and analyzed at admission. The primary end point was defined as development of ARDS with regards to the Berlin classification. RESULTS 61.7% (37 of 60 persons) developed an ARDS. In persons with ARDS DC was significantly reduced when compared to persons with milder course of infection (3.2 ms vs. 6.6 ms, p < 0.001). DC achieved a good discrimination performance (AUC = 0.76) for ARDS in COVID-19 persons. In a multivariate analysis, decreased DC was associated with the development of ARDS. CONCLUSION Our data suggest a promising role of DC to risk stratification in COVID-19.
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Affiliation(s)
- Lars Mizera
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Dominik Rath
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Anna Schoellmann
- Department of Gastroenterology, Hepatology, Infectiology and Geriatrics, University of Tuebingen, Germany
| | - Alvaro Petersen-Uribe
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Alban Avdiu
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Monika Zdanyte
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Philippa Jaeger
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - David Heinzmann
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Karin Müller
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Meinrad Gawaz
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
| | - Christian Eick
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany.
| | - Martin Duckheim
- Department of Cardiology, Angiology and Cardiovascular Medicine, University of Tuebingen, Otfried-Müller Str.10, Tuebingen 72076, Germany
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8
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Petersen-Uribe A, Avdiu A, Martus P, Witzel K, Jaeger P, Zdanyte M, Heinzmann D, Tavlaki E, Warm V, Geisler T, Müller K, Gawaz M, Rath D. Impaired Myocardial Function Is Prognostic for Severe Respiratory Failure in the Course of COVID-19 Infection. Front Cardiovasc Med 2021; 8:584108. [PMID: 34150860 PMCID: PMC8213370 DOI: 10.3389/fcvm.2021.584108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 04/30/2021] [Indexed: 12/11/2022] Open
Abstract
COVID-19 may lead to severe acute respiratory distress syndrome (ARDS) resulting in increased morbidity and mortality. Heart failure and/or pre-existing cardiovascular disease may correlate with poor outcomes and thus require special attention from treating physicians. The present study sought to investigate a possible impact of impaired myocardial function as well as myocardial distress markers on mortality or ARDS with need for mechanical ventilation in 157 consecutive patients with confirmed SARS-CoV-2 infection. All patients were admitted and treated at the University Hospital of Tübingen, Germany, during the first wave of the pandemic. Electrocardiography, echocardiography, and routine blood sampling were performed at hospital admission. Impaired left-ventricular and right-ventricular function, tricuspid regurgitation > grade 1, and elevated RV-pressure as well as thrombotic and myocardial distress markers (D-dimers, NT-pro-BNP, and troponin-I) were associated with mechanical ventilation and/or all-cause mortality. Impaired cardiac function is more frequent amidst ARDS, leading to subsequent need for mechanical ventilation, and thus denotes a poor outcome in COVID-19. Since a causal treatment for SARS-CoV-2 infection is still lacking, guideline-compliant cardiovascular evaluation and treatment remains the best approach to improve outcomes in COVID-19 patients with cardiovascular comorbidities.
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Affiliation(s)
- Alvaro Petersen-Uribe
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Alban Avdiu
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Katja Witzel
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Philippa Jaeger
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Monika Zdanyte
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - David Heinzmann
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Elli Tavlaki
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Verena Warm
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Karin Müller
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Dominik Rath
- Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
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9
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Schreieck J, Heinzmann D, Scheckenbach C, Gawaz M, Duckheim M. A novel local impedance algorithm and contact force sensing to guide high power short duration radiofrequency ablation is efficient and safe for circumferential pulmonary vein isolation. Europace 2021. [DOI: 10.1093/europace/euab116.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Local impedance (LI) drop can predict sufficient lesion formation during radiofrequency ablation (RF). Recently, a novel ablation catheter technology able to measure LI and contact force has been made available for clinical use. High power short duration (HPSD) RF ablation has been shown to be feasible for atrial fibrillation (AF) ablation with short procedure time. We used LI drop and plateau formation to guide duration of 50 Watt RF power applications for circumferential pulmonary vein isolation (PVI).
Methods
Consecutive patients with indication for de novo AF ablation (n = 32, age 65 ± 10 years) with paroxysmal (n = 16) or persistent (n = 16) AF underwent ultra high density 3D mapping of the left atrium and catheter ablation. Thereafter, ipsilateral PV encircling with 50 Watt RF-applications targeting an interlesion distance of ≤ 6mm and a contact force of 10-30g was performed. Duration of HPSD RF application between 7-15s was guided by impedance drop >20 Ohm and plateau formation of LI. Further ablation strategy was left to the investigator’s discretion. Esophageal temperature measurement was performed using a three thermistor catheter with temperature cut off 39.0°C. In case of temperature rise or very near esophageal contact to the circumferential line, RF application time was shortened to 7s. Patients underwent adenosine testing after PVI. Previously we performed all types of AF ablation using an LI guided HPSD ablation without contact force measurement capability in 80 patients.
Results
Complete PVI was achieved in all pts with only 13.5 ± 4.3 min cumulative RF application duration and an ablation procedure duration of 46.5 ± 10.4 min with the novel LI measuring catheter. First-pass isolation of ipsilateral veins was achieved in 75% of circles. Recurrence of PV conduction during waiting period (20min) and adenosine testing occured in 25% of circles, and was reablated in most patients with a single spot of HPSD application. Using 94 ± 36 RF application per patient, mean maximum LI drop was 23.6 ± 4.0 Ohm. Reconnected fibers were associated with low LI drop due to instability of contact in most cases due to breathing in case of difficult sedation of the patients. No serious complications occurred in all 32 pts using HPSD with the novel contact force catheter design.
Conclusion
Guiding of HPSD RF ablation by LI is highly efficient and safe. A novel local impedance algorithm in combination with contact force sensing enable short PVI times with low early recurrence of PV conduction. Prediction of permanent lesions seems possible and the only limitation seems to be unstable RF catheter contact due patients breathing. Follow up have to be waited.
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Affiliation(s)
- J Schreieck
- Medical University of Tuebingen, Tuebingen, Germany
| | - D Heinzmann
- Medical University of Tuebingen, Tuebingen, Germany
| | | | - M Gawaz
- Medical University of Tuebingen, Tuebingen, Germany
| | - M Duckheim
- Medical University of Tuebingen, Tuebingen, Germany
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10
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Heinzmann D, Noethel M, von Ungern-Sternberg S, Mitroulis I, Gawaz M, Chavakis T, May AE, Seizer P. CD147 is a Novel Interaction Partner of Integrin αMβ2 Mediating Leukocyte and Platelet Adhesion. Biomolecules 2020; 10:biom10040541. [PMID: 32252487 PMCID: PMC7226095 DOI: 10.3390/biom10040541] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 02/23/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 01/16/2023] Open
Abstract
Surface receptor-mediated adhesion is a fundamental step in the recruitment of leukocytes and platelets, as well as platelet-leukocyte interactions. The surface receptor CD147 is crucially involved in host defense against self-derived and invading targets, as well as in thrombosis. In the current study, we describe the previously unknown interaction of CD147 with integrin αMβ2 (Mac-1) in this context. Using binding assays, we were able to show a stable interaction of CD147 with Mac-1 in vitro. Leukocytes from Mac-1-/- and CD147+/- mice showed a markedly reduced static adhesion to CD147- and Mac-1-coated surfaces, respectively, compared to wild-type mice. Similarly, we observed reduced rolling and adhesion of monocytes under flow conditions when cells were pre-treated with antibodies against Mac-1 or CD147. Additionally, as assessed by antibody inhibition experiments, CD147 mediated the dynamic adhesion of platelets to Mac-1-coated surfaces. The interaction of CD147 with Mac-1 is a previously undescribed mechanism facilitating the adhesion of leukocytes and platelets.
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Affiliation(s)
- David Heinzmann
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls Universität Tübingen, 72076 Tübingen, Germany
- Correspondence:
| | - Moritz Noethel
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls Universität Tübingen, 72076 Tübingen, Germany
| | - Saskia von Ungern-Sternberg
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls Universität Tübingen, 72076 Tübingen, Germany
| | - Ioannis Mitroulis
- Institute for Clinical Chemistry and Laboratory Medicine, University Clinic and Faculty of Medicine Carl-Gustav-Carus, TU Dresden, 01397 Dresden, Germany
| | - Meinrad Gawaz
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls Universität Tübingen, 72076 Tübingen, Germany
| | - Triantafyllos Chavakis
- Institute for Clinical Chemistry and Laboratory Medicine, University Clinic and Faculty of Medicine Carl-Gustav-Carus, TU Dresden, 01397 Dresden, Germany
| | - Andreas E. May
- Department of Cardiology, Innere Medizin I, Klinikum Memmingen, 87700 Memmingen, Germany
| | - Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard-Karls Universität Tübingen, 72076 Tübingen, Germany
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11
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Pelzl L, Sahu I, Ma K, Heinzmann D, Bhuyan AAM, Al-Maghout T, Sukkar B, Sharma Y, Marini I, Rigoni F, Artunc F, Cao H, Gutti R, Voelkl J, Pieske B, Gawaz M, Bakchoul T, Lang F. Beta-Glycerophosphate-Induced ORAI1 Expression and Store Operated Ca 2+ Entry in Megakaryocytes. Sci Rep 2020; 10:1728. [PMID: 32015442 PMCID: PMC6997179 DOI: 10.1038/s41598-020-58384-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
Impairment of renal phosphate elimination in chronic kidney disease (CKD) leads to enhanced plasma and tissue phosphate concentration, which in turn up-regulates transcription factor NFAT5 and serum & glucocorticoid-inducible kinase SGK1. The kinase upregulates ORAI1, a Ca2+-channel accomplishing store-operated Ca2+-entry (SOCE). ORAI1 is stimulated following intracellular store depletion by Ca2+-sensors STIM1 and/or STIM2. In megakaryocytes and blood platelets SOCE and thus ORAI1 are powerful regulators of activity. The present study explored whether the phosphate-donor ß-glycerophosphate augments NFAT5, ORAI1,2,3 and/or STIM1,2 expressions and thus SOCE in megakaryocytes. Human megakaryocytic Meg01cells were exposed to 2 mM of phosphate-donor ß-glycerophosphate for 24 hours. Platelets were isolated from blood samples of patients with impaired kidney function or control volunteers. Transcript levels were estimated utilizing q-RT-PCR, cytosolic Ca2+-concentration ([Ca2+]i) by Fura-2-fluorescence, and SOCE from increase of [Ca2+]i following re-addition of extracellular Ca2+ after store depletion with thapsigargin (1 µM). NFAT5 and ORAI1 protein abundance was estimated with Western blots. As a result, ß-glycerophosphate increased NFAT5, ORAI1/2/3, STIM1/2 transcript levels, as well as SOCE. Transcript levels of NFAT5, SGK1, ORAI1/2/3, and STIM1/2 as well as NFAT5 and ORAI1 protein abundance were significantly higher in platelets isolated from patients with impaired kidney function than in platelets from control volunteers. In conclusion, phosphate-donor ß-glycerophosphate triggers a signaling cascade of NFAT5/SGK1/ORAI/STIM, thus up-regulating store-operated Ca2+-entry.
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Affiliation(s)
- Lisann Pelzl
- Transfusion Medicine, Medical Faculty, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Itishri Sahu
- Department of Internal Medicine III, Eberhard Karl University Tuebingen, Tuebingen, Germany.,Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, 500046, India
| | - Ke Ma
- Department of Internal Medicine III, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - David Heinzmann
- Department of Internal Medicine III, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | | | - Tamer Al-Maghout
- Department of Internal Medicine III, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Basma Sukkar
- Department of Internal Medicine III, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Yamini Sharma
- Department of Internal Medicine III, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Irene Marini
- Transfusion Medicine, Medical Faculty, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Flaviana Rigoni
- Transfusion Medicine, Medical Faculty, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Ferruh Artunc
- Department of Internal Medicine IV, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Hang Cao
- Department of Internal Medicine III, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Ravi Gutti
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, 500046, India
| | - Jakob Voelkl
- Institute for Physiology, Johannes Kepler University, Linz, Austria.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Nephrology and Medical Intensive Care, Charité University Medicine, Berlin, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine, Berlin, Germany
| | - Burkert Pieske
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, and Department of Internal Medicine and Cardiology, German Heart Center Berlin (DHZB), Berlin, Germany.,Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité University Medicine, Berlin, Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Eberhard Karl University Tuebingen, Tuebingen, Germany
| | - Tamam Bakchoul
- Transfusion Medicine, Medical Faculty, Eberhard Karl University Tuebingen, Tuebingen, Germany.,Centre for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Florian Lang
- Department of Vegetative and Clinical Physiology, Eberhard Karl University Tuebingen, Tuebingen, Germany.
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12
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Rath D, von Ungern-Sternberg S, Heinzmann D, Sigle M, Monzien M, Horstmann K, Schaeffeler E, Winter S, Müller K, Groga-Bada P, Zdanyte M, Borst O, Zernecke A, Gawaz M, Martus P, Schwab M, Geisler T, Seizer P. Platelet surface expression of cyclophilin A is associated with increased mortality in patients with symptomatic coronary artery disease. J Thromb Haemost 2020; 18:234-242. [PMID: 31519036 DOI: 10.1111/jth.14635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/06/2019] [Accepted: 09/03/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cyclophilin A (CyPA) is an important intracellular molecule mediating essential cellular functions such as signaling and protein folding. Enhanced CyPA platelet surface expression is associated with hypertension and hypercholesterolemia in patients with stable coronary artery disease (CAD). In patients with acute myocardial infarction CyPA platelet surface expression is significantly decreased. The aim of this study was to investigate possible associations of CyPA platelet surface expression and a clinically relevant CyPA single-nucleotide polymorphism (CyPA PPIA rs6850) with prognosis in patients with symptomatic cardiovascular disease. MATERIALS AND METHODS Blood was obtained from 335 consecutive patients with symptomatic CAD. All patients were followed up for 1080 days for endpoints all-cause death, myocardial infarction (MI), ischemic stroke, and bleeding. The primary combined endpoint was defined as a composite of all-cause death and/or MI and/or ischemic stroke. Cyclophilin A platelet surface expression levels less than or equal to the median were significantly associated with a worse prognosis (combined endpoint and all-cause death) when compared to CyPA greater than the median. Genotyping for CyPA PPIA rs6850 was performed in 752 patients with symptomatic CAD. Homozygous carriers of the minor allele showed a significantly worse cumulative event-free survival for both combined endpoint and MI when compared to carriers of the major allele. CONCLUSION The CyPA platelet surface expression is associated with mortality whereas CyPA PPIA rs6850 is associated with recurrent MI in patients with symptomatic CAD. Cyclophilin A might offer a new biomarker for risk stratification and tailoring therapies in patients with cardiovascular disease.
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Affiliation(s)
- Dominik Rath
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | | | - David Heinzmann
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Manuel Sigle
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Mona Monzien
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Katja Horstmann
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Elke Schaeffeler
- Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - Stefan Winter
- Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
| | - Karin Müller
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Patrick Groga-Bada
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Monika Zdanyte
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Oliver Borst
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Alma Zernecke
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Meinrad Gawaz
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Matthias Schwab
- Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
- University of Tübingen, Tübingen, Germany
- Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany
- Department of Pharmacy and Biochemistry, University of Tübingen, Tübingen, Germany
| | - Tobias Geisler
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Seizer
- Department of Cardiology, University Hospital Tübingen, Tübingen, Germany
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13
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Schreieck J, Duckheim M, Yurtbil U, Flassak J, Scheckenbach C, Stimpfle F, Heinzmann D, Gawaz M, Seizer P. P4763High power radiofrequency ablation with fixed short duration is rapid, efficient and safe for circumferential pulmonary vein isolation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1139] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Short duration 50 Watt radiofrequency (RF) ablation has been shown to be feasible for atrial fibrillation (AF) ablation with short procedure times.
Purpose
We evaluated 50 Watt RF power with a different fixed short application duration at the anterior and posterior left atrial wall using contact force (CF) sensing catheters for circumferential pulmonary vein isolation (PVI).
Methods
Consecutive patients (pts) with indication for de novo AF ablation (n=40, age 64±12 years) with paroxysmal (n=23) or persistent (n=17) AF underwent high density 3D mapping of the left atrium. Low voltage areas of more than 5% of the left atrium were only found in 20% of pts. Thereafter, circumferential PVI using CF sensing catheters was performed. For each RF application (50 Watt, RF duration 11–13s at the anterior wall, 9–11s at the posterior wall) a stable catheter tip position with minimal mean CF of 3g was required and application was stopped in case of CF more than 30g. Esophageal temperature measurement was performed with temperature cut off 39.0°C. In case of temperature rise, ablation protocol was switched to conventional 20 Watt RF applications for ablation adjacent to the esophagus.
Results
Complete PVI was achieved in all pts with 81±29 short RF applications resulting in cumulative RF applications duration of 13.1±4.2min and an ablation duration of 59±17min for complete PVI. Even RF application with low CF (3–5g) were effective. Due to esophageal temperature rise, switch to conventional RF application with 20 Watt was performed in 43% of pts at least at one posterior PV entrance. After a waiting period of 20 min only in 33% of pts any PV conduction recurs, in 28% of pts only at a single spot and reconnected fibers were not associated with low CF application at that spot, but clearly associated with low energy application at the posterior wall. All PV were successfully re-isolated in most of pts with a single spot high energy RF application. No serious complications occurred in association with PVI. Follow up will be available at presentation time.
Conclusion
RF ablation with 50 Watt fixed short duration is efficient and safe for circumferential PVI. Ablation procedure durations are shorter and early recurrence rates are lower compared to reported conventional ablation procedures. The importance of CF titration seems to be diminished by 50 Watt RF applications in the left atrium. Further follow up have to be waited.
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Affiliation(s)
- J Schreieck
- Department of Cardiology, Medical University Tuebingen, Tuebingen, Germany
| | - M Duckheim
- Department of Cardiology, Medical University Tuebingen, Tuebingen, Germany
| | - U Yurtbil
- Abbott Medical GmbH, Eschborn, Germany
| | - J Flassak
- Department of Cardiology, Medical University Tuebingen, Tuebingen, Germany
| | - C Scheckenbach
- Department of Paediatric Cardiology, University Tuebingen, Tuebingen, Germany
| | - F Stimpfle
- Department of Cardiology, Medical University Tuebingen, Tuebingen, Germany
| | - D Heinzmann
- Department of Cardiology, Medical University Tuebingen, Tuebingen, Germany
| | - M Gawaz
- Department of Cardiology, Medical University Tuebingen, Tuebingen, Germany
| | - P Seizer
- Department of Cardiology, Medical University Tuebingen, Tuebingen, Germany
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14
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Bo H, Heinzmann D, Grasshoff C, Rosenberger P, Schlensak C, Gawaz M, Schreieck J, Langer HF, Patzelt J, Seizer P. ECG changes after percutaneous edge-to-edge mitral valve repair. Clin Cardiol 2019; 42:1094-1099. [PMID: 31497886 PMCID: PMC6837028 DOI: 10.1002/clc.23258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/17/2019] [Accepted: 08/27/2019] [Indexed: 01/22/2023] Open
Abstract
Background Mitral regurgitation (MR) has a severe impact on hemodynamics and induces severe structural changes in the left atrium. Atrial remodeling is known to alter excitability and conduction in the atrium facilitating atrial fibrillation and atrial flutter. PMVR is a feasible and highly effective procedure to reduce MR in high‐risk patients, which are likely to suffer from atrial rhythm disturbances. So far, electroanatomical changes after PMVR have not been studied. Hypothesis In the current study, we investigated changes in surface electrocardiograms (ECGs) of patients undergoing PMVR for reduction of MR. Methods We evaluated 104 surface ECGs from patients in sinus rhythm undergoing PMVR. P wave duration, P wave amplitude, PR interval, QRS duration, QRS axis, and QT interval were evaluated before and after PMVR and at follow‐up. Results We found no changes in QRS duration, QRS axis, and QT interval after successful PMVR. However, P wave duration, amplitude, and PR interval were significantly decreased after reduction of MR through PMVR (P < .05, respectively). Conclusion The data we provide offers insight into changes in atrial conduction after reduction of MR using PMVR in patients with sinus rhythm.
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Affiliation(s)
- Hou Bo
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany.,Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - David Heinzmann
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christian Grasshoff
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anaesthesiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Cardiovascular Surgery, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Jürgen Schreieck
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Harald F Langer
- Medical Clinic II, Universitäres Herzzentrum Lübeck, University Hospital Schleswig-Holstein, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Johannes Patzelt
- Medical Clinic II, Universitäres Herzzentrum Lübeck, University Hospital Schleswig-Holstein, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Peter Seizer
- Department of Cardiology and Angiology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
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Zhou Q, Maleck C, von Ungern-Sternberg SNI, Neupane B, Heinzmann D, Marquardt J, Duckheim M, Scheckenbach C, Stimpfle F, Gawaz M, Schreieck J, Seizer P, Gramlich M. Circulating MicroRNA-21 Correlates With Left Atrial Low-Voltage Areas and Is Associated With Procedure Outcome in Patients Undergoing Atrial Fibrillation Ablation. Circ Arrhythm Electrophysiol 2019; 11:e006242. [PMID: 29848477 PMCID: PMC7661044 DOI: 10.1161/circep.118.006242] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/12/2018] [Indexed: 01/14/2023]
Abstract
Background: Atrial fibrosis is a hallmark of arrhythmogenic structural remodeling in patients with persistent atrial fibrillation (AF) and is negatively correlated with procedure outcome in patients undergoing ablation. However, noninvasive methods to determine the extent of atrial fibrosis are limited. Here, we used microRNA (miRNA) expression analysis to detect markers of left atrial low-voltage areas (LVAs) in patients with persistent AF undergoing catheter ablation. Methods: We performed 3-dimensional voltage mapping in 102 patients (average age 62.1±13.1 years, CHA2DS2-VASc score of 2.3±1.6, LA size 41.5±5.7 mm) undergoing ablation for persistent AF and determined the extent of left atrial low-voltage. LVAs were defined if bipolar electrogram amplitudes were <0.5 mV during sinus rhythm. Before ablation, we obtained a blood sample, isolated miRNAs, and profiled them on a miRCURY LNA Universal RT microRNA PCR Human panel. Results: Sixty-nine miRNAs were identified in all samples, with an average of 123 miRNAs detectable per sample. We found that the serum concentration of miR-21, a miRNA that has been previously linked to cardiac fibrosis development, was strongly associated with the extent of LVAs determined by voltage mapping. We could confirm that LVAs were negatively correlated with ablation success in a 1-year follow-up. In addition, miR-21 serum levels were associated with AF-free survival after catheter ablation. Conclusions: Circulating miR-21 correlates with left atrial LVAs and is associated with procedure outcome in patients with persistent AF undergoing ablation.
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Affiliation(s)
- Qifeng Zhou
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Carole Maleck
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | | | - Balram Neupane
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - David Heinzmann
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Jonathan Marquardt
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Martin Duckheim
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Christian Scheckenbach
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Fabian Stimpfle
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Jürgen Schreieck
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Peter Seizer
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Michael Gramlich
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany.
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16
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Gramlich M, Maleck C, Marquardt J, Duckheim M, Stimpfle F, Heinzmann D, Scheckenbach C, Gawaz M, Schreieck J, Seizer P. Cryoballoon ablation for persistent atrial fibrillation in patients without left atrial fibrosis. J Cardiovasc Electrophysiol 2019; 30:999-1004. [PMID: 30938897 DOI: 10.1111/jce.13936] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The role of cryoballoon (CB) pulmonary vein isolation (PVI) for patients with persistent atrial fibrillation (AF) is controversial, since long-term success can be poor. We performed left atrial voltage mapping before CB PVI and determined AF-free survival depending on the extent of low-voltage areas (LVAs). METHODS AND RESULTS We consecutively enrolled 60 patients with persistent AF (average age, 60.6 ± 12.9 years; CHA2 DS 2 VASc score, 2.3 ± 1.6; and left atrial size 46.0 ± 5.2 mm) who were planned for CB PVI. Before ablation, we performed left atrial voltage mapping (Abbott EnSite Precision or Velocity). LVAs were defined if local bipolar signal amplitudes were less than 0.5 mV during sinus rhythm. Thirty-seven patients did not show significant LVAs (<10%), while 12 patients had LVAs between 10% and 30% and 11 patients showed substantial LVAs greater than 30% of the left atrial area. CB PVI could be successfully performed in all patients. A 7-day holter monitoring was obtained 3, 6, and 12 months after ablation. After a 12-month follow-up time, 83.8% of patients without LVAs (<10%) were free of atrial fibrillation, while 50.0% of patients with 10% to 30% LVAs and 9.1% of patients with LVAs more than 30% had stable sinus rhythm. The degree of atrial fibrosis correlated with the risk of AF recurrence. CONCLUSION In patients with persistent AF undergoing CB PVI, the extent of left atrial LVAs predicts an AF-free survival. CB PVI seems to be a highly effective treatment for patients with persistent AF without atrial fibrosis.
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Affiliation(s)
- Michael Gramlich
- Department of Invasive Electrophysiology, RWTH Aachen, Aachen, Germany.,Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Carole Maleck
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | | | - Martin Duckheim
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Fabian Stimpfle
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - David Heinzmann
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Christian Scheckenbach
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Jürgen Schreieck
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
| | - Peter Seizer
- Department of Cardiology and Cardiovascular Diseases, Eberhard Karls University, Tübingen, Germany
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Yu H, Vowinckel J, Escher C, Heinzmann D, Dupuis N. Simultaneous unbiased and absolute quantification of a 500 protein panel in pancreatic cancer plasma using HRM mass spectrometry. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz030.003] [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: 11/14/2022] Open
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18
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Kümmel S, Tondini C, Abraham J, Nowecki Z, Itrych B, Hitre E, Karaszewska B, Juarez A, Morales-Vásquez F, Pérez García J, Cardona-Huerta S, Heinzmann D, He J, Duc A, Crepelle-Fléchais A, Martín M. Subcutaneous trastuzumab (H SC) with intravenous pertuzumab (P IV) and docetaxel (D IV) in HER2-positive advanced breast cancer (BC): MetaPHER second interim analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Heinzmann D, Fuß S, Ungern-Sternberg S, Schreieck J, Gawaz M, Gramlich M, Seizer P. TGFβ Is Specifically Upregulated on Circulating CD14++ CD16+ and CD14+ CD16++ Monocytes in Patients with Atrial Fibrillation and Severe Atrial Fibrosis. Cell Physiol Biochem 2018; 49:226-234. [DOI: 10.1159/000492873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 08/14/2018] [Indexed: 11/19/2022] Open
Abstract
Background/Aims: Fibrotic remodeling of the atria plays a key role in the pathogenesis of atrial fibrillation (AF). As little is known about the contribution of circulating monocytes in atrial remodeling and the pathophysiology of AF, we investigated profibrotic factors in different subsets of circulating monocytes obtained from patients with atrial fibrillation undergoing catheter ablation. Methods: A 3D high density voltage mapping was performed in sinus rhythm to evaluate the extent of low-voltage areas (LVAs) in the atria of 71 patients with persistent AF. Low-voltage was defined as signals of < 0.5mV during sinus rhythm. Prior to ablation, blood was drawn and monocytes were analyzed by FACS. Based on the expression of CD14 and CD16, three subgroups including CD14++ CD16- (‘classical’), CD14++ CD16+ (‘intermediate’), and CD14+ CD16++ (‘non-classical’) were analyzed for the expression of TGFb, CD147, and MMP-9, representing pivotal profibrotic pathways in myocardial remodeling. Results: Expression of TGFb was increased in CD14+ monocytes of patients with extensive LVAs compared to patients with a low extend of LVAs. While CD14++ CD16- monocytes showed no difference, CD14++ CD16+ and CD14+ CD16++ monocytes showed a strong increase of TGFb abundance. Although CD147 and MMP-9 are strongly associated with myocardial fibrosis, we found no difference in expression between the two groups in any monocyte subsets. Conclusion: TGFb is specifically upregulated on CD14++ CD16+ and CD14+ CD16++ monocytes in patients with extensive LVAs undergoing catheter ablation.
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20
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Heinzmann D, Mueller K, Klingel K, Kumbrink J, Kirchner T, Gawaz M, Seizer P. 5925Regulation of NADPH oxidases in tachycardia-induced heart failure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Heinzmann
- Eberhard-Karls University of Tubingen, Department of Cardiology and Circulatory Disorders, Tubingen, Germany
| | - K Mueller
- Eberhard-Karls University of Tubingen, Department of Cardiology and Circulatory Disorders, Tubingen, Germany
| | - K Klingel
- Eberhard-Karls University of Tubingen, Cardiopathology, Institute for Pathology and Neuropathology, Tubingen, Germany
| | - J Kumbrink
- Ludwig-Maximilians University, Institute of Pathology, Munich, Germany
| | - T Kirchner
- Ludwig-Maximilians University, Institute of Pathology, Munich, Germany
| | - M Gawaz
- Eberhard-Karls University of Tubingen, Department of Cardiology and Circulatory Disorders, Tubingen, Germany
| | - P Seizer
- Eberhard-Karls University of Tubingen, Department of Cardiology and Circulatory Disorders, Tubingen, Germany
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21
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Heinzmann D, Seizer P. Mitochondria in heart failure: EMID-sign. Eur Heart J 2018; 39:898. [PMID: 29304230 DOI: 10.1093/eurheartj/ehx787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- David Heinzmann
- Medizinische Klinik, Innere Medizin III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum Tuebingen, Otfried-Mueller-Str. 10, Tuebingen, 72076, Germany
| | - Peter Seizer
- Medizinische Klinik, Innere Medizin III, Kardiologie und Kreislauferkrankungen, Universitaetsklinikum Tuebingen, Otfried-Mueller-Str. 10, Tuebingen, 72076, Germany
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22
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Jackisch C, Stroyakovskiy D, Pivot X, Ahn JS, Melichar B, Chen SC, Meyenberg C, Al-Sakaff N, Heinzmann D, Hegg R. Abstract PD3-11: Efficacy and safety of subcutaneous or intravenous trastuzumab in patients with HER2-positive early breast cancer after 5 years' treatment-free follow-up: Final analysis from the phase III, open-label, randomized HannaH study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd3-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background HannaH (NCT00950300) compared subcutaneous and intravenous trastuzumab (H SC and H IV) as neoadjuvant–adjuvant therapy for HER2-positive breast cancer. The co-primary endpoints of pathological complete response (pCR) and serum trough concentration at predose cycle 8 demonstrated noninferiority between H SC and H IV. Efficacy analyses of event-free survival (EFS) and overall survival (OS) at a median follow-up of 40 months supported this noninferiority. Safety analyses also confirmed the consistency of the safety profile across both arms. In this final follow-up analysis, we report the long-term efficacy and safety outcomes at 5 years of treatment-free follow-up (TFFU; 6 years in total). The correlation between total pCR (tpCR; absence of invasive neoplastic cells in ipsilateral nodes and the breast) and EFS was also explored.
Methods Enrolled patients (n=596; pts) were randomized to receive 4 cycles of docetaxel, then 4 cycles of 5-fluorouracil/epirubicin/cyclophosphamide concurrently with 3-weekly fixed-dose 600mg H SC or H IV (loading: 8mg/kg; maintenance: 6mg/kg) in the neoadjuvant setting. Post-surgery, pts received an additional 10 cycles of H SC or H IV in the adjuvant setting to complete 1 year of anti-HER2 therapy. EFS (time from randomization to local, regional, or distant recurrence, contralateral breast cancer, or death) and OS were calculated using the Kaplan-Meier method. Adverse events (AEs) and serious AEs were recorded and graded per standard criteria.
Results In total, 297 pts were randomized to the H SC arm and 299 to the H IV arm; 294 and 297 pts were included in the respective efficacy analysis populations. Median duration of follow-up (including TFFU) was 70.8 and 71.4 months in the H SC and H IV arms, respectively. EFS and OS were similar across both study arms (Table 1). Pts who achieved tpCR had longer EFS and OS vs. those who did not (Table 1).
Table 1 H SCH IVHazard Ratio (95% CI)6-year EFS, % (95% CI)n=294n=297 Overall65 (59;70)65 (60;71)0.98 (0.74;1.29)tpCR status*tpCRn=102n=90 80 (73;88)83 (75;91) no tpCRn=158n=173 57 (49;65)61 (54;69) 6-year OS, % (95% CI)n=294n=297 Overall84 (79;88)84 (79;88)0.94 (0.61;1.45)* Efficacy per protocol population
Cardiac AE incidence was low and consistent across study arms (Table 2).
Table 2Pts, n (%)H SC (n=297)H IV (n=298)Any AE290 (98)282 (95)≥ Grade 3 AE158 (53)160 (54)Serious AE65 (22)45 (15)Cardiac AE44 (15)42 (14)LVEF decline (≥10%-points from baseline to <50%)11 (3.8)12 (4.2)LVEF, left ventricular ejection fraction
Conclusion Long-term efficacy EFS and OS results confirmed the noninferiority of H SC compared with H IV, as demonstrated by pCR and pharmacokinetic endpoints. tpCR was associated with longer EFS and OS. The overall safety profile of H SC was consistent with that of H IV.
Citation Format: Jackisch C, Stroyakovskiy D, Pivot X, Ahn J-S, Melichar B, Chen S-C, Meyenberg C, Al-Sakaff N, Heinzmann D, Hegg R. Efficacy and safety of subcutaneous or intravenous trastuzumab in patients with HER2-positive early breast cancer after 5 years' treatment-free follow-up: Final analysis from the phase III, open-label, randomized HannaH study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD3-11.
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Affiliation(s)
- C Jackisch
- Sana Klinikum Offenbach GmbH, Breast Cancer and Gynecology Cancer Center, Offenbach, Germany; City Clinical Oncology Hospital 62, Moscow, Russian Federation; CHU Jean Minjoz, Chemotherapy – Oncology, Besançon, France; Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Korea; Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic; Chang Gung Memorial Hospital, Taoyuan, Taiwan; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Product Development – Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland; Hospital Pérola Byington, São Paulo, Brazil
| | - D Stroyakovskiy
- Sana Klinikum Offenbach GmbH, Breast Cancer and Gynecology Cancer Center, Offenbach, Germany; City Clinical Oncology Hospital 62, Moscow, Russian Federation; CHU Jean Minjoz, Chemotherapy – Oncology, Besançon, France; Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Korea; Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic; Chang Gung Memorial Hospital, Taoyuan, Taiwan; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Product Development – Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland; Hospital Pérola Byington, São Paulo, Brazil
| | - X Pivot
- Sana Klinikum Offenbach GmbH, Breast Cancer and Gynecology Cancer Center, Offenbach, Germany; City Clinical Oncology Hospital 62, Moscow, Russian Federation; CHU Jean Minjoz, Chemotherapy – Oncology, Besançon, France; Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Korea; Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic; Chang Gung Memorial Hospital, Taoyuan, Taiwan; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Product Development – Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland; Hospital Pérola Byington, São Paulo, Brazil
| | - J-S Ahn
- Sana Klinikum Offenbach GmbH, Breast Cancer and Gynecology Cancer Center, Offenbach, Germany; City Clinical Oncology Hospital 62, Moscow, Russian Federation; CHU Jean Minjoz, Chemotherapy – Oncology, Besançon, France; Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Korea; Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic; Chang Gung Memorial Hospital, Taoyuan, Taiwan; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Product Development – Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland; Hospital Pérola Byington, São Paulo, Brazil
| | - B Melichar
- Sana Klinikum Offenbach GmbH, Breast Cancer and Gynecology Cancer Center, Offenbach, Germany; City Clinical Oncology Hospital 62, Moscow, Russian Federation; CHU Jean Minjoz, Chemotherapy – Oncology, Besançon, France; Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Korea; Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic; Chang Gung Memorial Hospital, Taoyuan, Taiwan; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Product Development – Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland; Hospital Pérola Byington, São Paulo, Brazil
| | - S-C Chen
- Sana Klinikum Offenbach GmbH, Breast Cancer and Gynecology Cancer Center, Offenbach, Germany; City Clinical Oncology Hospital 62, Moscow, Russian Federation; CHU Jean Minjoz, Chemotherapy – Oncology, Besançon, France; Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Korea; Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic; Chang Gung Memorial Hospital, Taoyuan, Taiwan; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Product Development – Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland; Hospital Pérola Byington, São Paulo, Brazil
| | - C Meyenberg
- Sana Klinikum Offenbach GmbH, Breast Cancer and Gynecology Cancer Center, Offenbach, Germany; City Clinical Oncology Hospital 62, Moscow, Russian Federation; CHU Jean Minjoz, Chemotherapy – Oncology, Besançon, France; Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Korea; Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic; Chang Gung Memorial Hospital, Taoyuan, Taiwan; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Product Development – Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland; Hospital Pérola Byington, São Paulo, Brazil
| | - N Al-Sakaff
- Sana Klinikum Offenbach GmbH, Breast Cancer and Gynecology Cancer Center, Offenbach, Germany; City Clinical Oncology Hospital 62, Moscow, Russian Federation; CHU Jean Minjoz, Chemotherapy – Oncology, Besançon, France; Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Korea; Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic; Chang Gung Memorial Hospital, Taoyuan, Taiwan; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Product Development – Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland; Hospital Pérola Byington, São Paulo, Brazil
| | - D Heinzmann
- Sana Klinikum Offenbach GmbH, Breast Cancer and Gynecology Cancer Center, Offenbach, Germany; City Clinical Oncology Hospital 62, Moscow, Russian Federation; CHU Jean Minjoz, Chemotherapy – Oncology, Besançon, France; Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Korea; Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic; Chang Gung Memorial Hospital, Taoyuan, Taiwan; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Product Development – Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland; Hospital Pérola Byington, São Paulo, Brazil
| | - R Hegg
- Sana Klinikum Offenbach GmbH, Breast Cancer and Gynecology Cancer Center, Offenbach, Germany; City Clinical Oncology Hospital 62, Moscow, Russian Federation; CHU Jean Minjoz, Chemotherapy – Oncology, Besançon, France; Samsung Medical Center and Sungkyunkwan University School of Medicine, Seoul, Korea; Palacký University Medical School & Teaching Hospital, Olomouc, Czech Republic; Chang Gung Memorial Hospital, Taoyuan, Taiwan; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Product Development – Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland; Hospital Pérola Byington, São Paulo, Brazil
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von Ungern-Sternberg SNI, Vogel S, Walker-Allgaier B, Geue S, Maurer A, Wild AM, Münzer P, Chatterjee M, Heinzmann D, Kremmer E, Borst O, Loughran P, Zernecke A, Neal MD, Billiar TR, Gawaz M, Seizer P. Extracellular Cyclophilin A Augments Platelet-Dependent Thrombosis and Thromboinflammation. Thromb Haemost 2017; 117:2063-2078. [PMID: 28981554 DOI: 10.1160/th17-01-0067] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cyclophilin A (CyPA) is involved in the pathophysiology of several inflammatory and cardiovascular diseases. To our knowledge, there is no specific inhibitor targeting extracellular CyPA without affecting other extracellular cyclophilins or intracellular CyPA functions. In this study, we developed an antibody-based inhibitor of extracellular CyPA and analysed its effects in vitro and in vivo. To generate a specific antibody, mice and rats were immunized with a peptide containing the extracellular matrix metalloproteinase inducer binding site and various antibody clones were selected and purified. At first, antibodies were tested for their binding capacity to recombinant CyPA and their functional activity. The clone 8H7-mAb was chosen for further experiments. 8H7-mAb reduced the CyPA-induced migration of inflammatory cells in vitro and in vivo. Furthermore, 8H7-mAb revealed strong antithrombotic effects by inhibiting CyPA-dependent activation of platelets and thrombus formation in vitro and in vivo. Surprisingly, 8H7-mAb did not influence in vivo tail bleeding time or in vitro whole blood coagulation parameters. Our study provides first evidence that antibody-based inhibition of extracellular CyPA inhibits thrombosis and thromboinflammation without affecting blood homeostasis. Thus, 8H7-mAb may be a promising compound for thrombi modulation in inflammatory diseases to prevent organ dysfunction.
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Affiliation(s)
| | - Sebastian Vogel
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Tübingen, Germany
| | - Britta Walker-Allgaier
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Tübingen, Germany
| | - Sascha Geue
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Tübingen, Germany
| | - Andreas Maurer
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls-Universität Tübingen, Tübingen, Germany
| | - Anna-Maria Wild
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls-Universität Tübingen, Tübingen, Germany
| | - Patrick Münzer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Tübingen, Germany
| | - Madhumita Chatterjee
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Tübingen, Germany
| | - David Heinzmann
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Tübingen, Germany
| | - Elisabeth Kremmer
- Helmholtz Zentrum München, Institut für Molekulare Immunologie, München, Germany
| | - Oliver Borst
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Tübingen, Germany
| | - Patricia Loughran
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.,Center for Biological Imaging, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Alma Zernecke
- Institut für Experimentelle Biomedizin, Universitätsklinikum Würzburg, Germany
| | - Matthew D Neal
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Timothy R Billiar
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Meinrad Gawaz
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Tübingen, Germany
| | - Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen, Tübingen, Germany
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Mueller K, Heck C, Heinzmann D, Schwille J, Klingel K, Kandolf R, Kramer U, Gramlich M, Geisler T, Gawaz M, Schreieck J, Seizer P. P770Comparison of ventricular inducibility with late gadolinium enhancement and myocardial inflammation in endomyocardial biopsy in patients with dilated cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p770] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Von Ungern-Sternberg S, Vogel S, Walker-Allgaier B, Geue S, Heinzmann D, Chatterjee M, Kremmer E, Borst O, Loughran P, Zernecke A, Neal M, Billiar T, May A, Gawaz M, Seizer P. P6040Extracellular cyclophilin a augments platelet-dependent thrombosis and thrombo-inflammation without affecting physiological hemostasis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6040] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Heinzmann D, Gawaz M, Seizer P. Risk Stratification in Dilated Cardiomyopathy. JACC: Heart Failure 2017; 5:394. [DOI: 10.1016/j.jchf.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 11/26/2022]
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Liu G, Cao H, Liu G, Heinzmann D, Chen H, Umbach AT, Gawaz M, Lang F. Effect of Lysosomotropic Polyamineoxidase Inhibitor MDL-72527 on Platelet Activation. Cell Physiol Biochem 2016; 38:1695-702. [PMID: 27160671 DOI: 10.1159/000443108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The polyamine oxidase inhibitor MDL-72527 (N1,N4-bis(2,3-butadienyl)-1,4-butanediamine) were expected to increase the abundance of spermine, a powerful inhibitor of platelet activation. Nothing is known, however, on the sensitivity of platelet function and survival to MDL-72527 exposure. The present study thus explored whether MDL-72527 modifies function and survival of platelets without and with platelet activation by collagen related peptide (CRP). METHODS Platelets isolated from wild-type mice were exposed for 30 minutes to MDL-72527 (100 µM) with or without subsequent activation with CRP (2-5 µg/ml). Flow cytometry was employed to estimate cytosolic Ca2+-activity ([Ca2+]i) from Fluo-3 fluorescence, platelet degranulation from P-selectin abundance, integrin activation from αIIbβ3 integrin abundance, generation of reactive oxygen species (ROS) from DCFDA fluorescence, phospholipid scrambling of the cell membrane from annexin-V-binding, platelet volume from forward scatter and aggregation utilizing staining with CD9-APC and CD9-PE. RESULTS In the absence of CRP, exposure of platelets to MDL-72527 did not significantly modify [Ca2+]i, P-selectin abundance, αIIbβ3 integrin abundance, ROS, annexin-V-binding, and forward scatter. The addition of 2-5 µg/ml CRP was followed by significant increase of [Ca2+]i, P-selectin abundance, αIIbβ3 integrin activation, ROS abundance, annexin-V-binding, and aggregation as well as a significant decrease of forward scatter, all effects significantly blunted or virtually abolished in the presence of MDL-72527. CONCLUSIONS MDL-72527 is a powerful inhibitor of platelet activation, apoptosis and aggregation.
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Feng X, Szulzewsky F, Yerevanian A, Chen Z, Heinzmann D, Rasmussen RD, Alvarez-Garcia V, Kim Y, Wang B, Tamagno I, Zhou H, Li X, Kettenmann H, Ransohoff RM, Hambardzumyan D. Loss of CX3CR1 increases accumulation of inflammatory monocytes and promotes gliomagenesis. Oncotarget 2016; 6:15077-94. [PMID: 25987130 PMCID: PMC4558137 DOI: 10.18632/oncotarget.3730] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [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: 01/19/2015] [Accepted: 03/10/2015] [Indexed: 11/25/2022] Open
Abstract
The most abundant populations of non-neoplastic cells in the glioblastoma (GBM) microenvironment are resident microglia, macrophages and infiltrating monocytes from the blood circulation. The mechanisms by which monocytes infiltrate into GBM, their fate following infiltration, and their role in GBM growth are not known. Here we tested the hypothesis that loss of the fractalkine receptor CX3CR1 in microglia and monocytes would affect gliomagenesis. Deletion of Cx3cr1 from the microenvironment resulted in increased tumor incidence and shorter survival times in glioma-bearing mice. Loss of Cx3cr1 did not affect accumulation of microglia/macrophages in peri-tumoral areas, but instead indirectly promoted the trafficking of CD11b+CD45hiCX3CR1lowLy-6ChiLy-6G−F4/80−/low circulating inflammatory monocytes into the CNS, resulting in their increased accumulation in the perivascular area. Cx3cr1-deficient microglia/macrophages and monocytes demonstrated upregulation of IL1β expression that was inversely proportional to Cx3cr1 gene dosage. The Proneural subgroup of the TCGA GBM patient dataset with high IL1β expression showed shorter survival compared to patients with low IL1β. IL1β promoted tumor growth and increased the cancer stem cell phenotype in murine and human Proneural glioma stem cells (GSCs). IL1β activated the p38 MAPK signaling pathway and expression of monocyte chemoattractant protein (MCP-1/CCL2) by tumor cells. Loss of Cx3cr1 in microglia in a monocyte-free environment had no impact on tumor growth and did not alter microglial migration. These data suggest that enhancing signaling to CX3CR1 or inhibiting IL1β signaling in intra-tumoral macrophages can be considered as potential strategies to decrease the tumor-promoting effects of monocytes in Proneural GBM.
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Affiliation(s)
- Xi Feng
- Department of Neurosciences at Cleveland Clinic, Cleveland, Ohio, USA
| | - Frank Szulzewsky
- Cellular Neurosciences, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Alexan Yerevanian
- Department of Neurosciences at Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Zhihong Chen
- Department of Neurosciences at Cleveland Clinic, Cleveland, Ohio, USA
| | - David Heinzmann
- Department of Neurosciences at Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiology at Tübingen University School of Medicine, Tübingen, Germany
| | | | | | - Yeonghwan Kim
- Department of Stem Cell Biology and Regenerative Medicine, Cleveland, Ohio, USA
| | - Bingcheng Wang
- Rammelkamp Center for Research, MetroHealth Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ilaria Tamagno
- Department of Neurosciences at Cleveland Clinic, Cleveland, Ohio, USA
| | - Hao Zhou
- Department of Immunology at Cleveland Clinic, Cleveland, Ohio, USA
| | - Xiaoxia Li
- Department of Immunology at Cleveland Clinic, Cleveland, Ohio, USA
| | - Helmut Kettenmann
- Cellular Neurosciences, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Richard M Ransohoff
- Department of Neurosciences at Cleveland Clinic, Cleveland, Ohio, USA.,Neuroinflammation Research Center, Cleveland Clinic, Cleveland, Ohio, USA
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Kümmel S, Crepelle-Fléchais A, Schlegel M, Hillenbach C, Swat A, Franz M, Girase P, Schneider A, Heinzmann D, Shing M. Abstract OT3-01-13: MetaPHER: A phase IIIb multicenter, open-label, single-arm safety study of subcutaneous trastuzumab, in combination with pertuzumab and docetaxel in patients with HER2-positive advanced breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-01-13] [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: 11/16/2022]
Abstract
Abstract
Background: In patients (pts) with HER2-positive metastatic breast cancer (BC), the phase III CLEOPATRA study (NCT00567190) demonstrated significant improvement in progression-free (PFS) and overall survival (OS) from first-line treatment with intravenous (IV) pertuzumab (PERJETA® [P IV]) plus trastuzumab (Herceptin® [H IV]) plus docetaxel (D IV). HannaH (NCT00950300), a phase III trial in pts with HER2-positive early BC demonstrated that fixed-dose trastuzumab subcutaneous (Herceptin® [H SC]) is non-inferior to weight-based H IV infusion in the co-primary endpoints of serum trough concentration and pathologic complete response, which was supported by the long-term efficacy endpoints of event-free survival (EFS) and OS. The safety profile of H SC was consistent with the known safety profile of H IV. H SC is comprised of 600 mg trastuzumab and recombinant human hyaluronidase (rHuPH20) as an excipient, allowing a significantly reduced administration time compared with H IV (5 mins versus 30–90 mins, respectively). The MetaPHER study is designed to investigate the safety and efficacy of H SC in combination with P IV and D IV in pts with HER2-positive advanced BC.
Trial design: MetaPHER is a phase IIIb multicenter, open-label, single-arm study, with eligible pts receiving H SC 600 mg/5 mL q3w, P IV (840 mg loading dose, then 420 mg at each subsequent cycle q3w), and D IV (at least 6 cycles at 75 mg/m2 q3w with possible escalation to 100 mg/m2 q3w; after Cycle 6, continuation of docetaxel is at the investigator's discretion). Study treatment is administered until disease progression, unacceptable toxicity, withdrawal of consent, death, or predefined study end, whichever occurs first. Pts will receive post-treatment follow-up for safety and survival.
Eligibility: Women aged ≥18 years with metastatic or locally recurrent HER2-positive BC, ECOG performance status 0 or 1, and a left ventricular ejection fraction ≥50% are eligible. Exclusion criteria include disease-free interval of <6 months from completion of adjuvant or neoadjuvant non-hormonal treatment to disease recurrence; previous systemic non-hormonal therapy for metastatic or locally recurrent BC; history of persistent grade ≥2 hematological toxicity; current grade ≥3 peripheral neuropathy; or clinically significant cardiovascular disease.
Aims: The primary objective is to evaluate the safety and tolerability of H SC in combination with P IV and D IV in pts with HER2-positive advanced BC. Secondary endpoints include PFS, OS, objective response rate and incidence of anti-trastuzumab and anti-rHuPH20 antibody formation.
Statistical methods: Safety and efficacy results will be summarized descriptively to include all enrolled pts who received at least one dose of any study drug; the study is not designed for formal hypothesis testing. A sample size of 400 pts provides reasonable precision for the estimation of grade ≥3 AEs and cardiac AEs.
Accrual: MetaPHER is enrolling, FPI was May 2015, and target enrollment is 400 pts; clinicaltrials.gov ID: NCT02402712.
Contact information: For more information or to refer a patient, email global.rochegenentechtrials@roche.com or call 1-888-662-6728 (USA only).
Citation Format: Kümmel S, Crepelle-Fléchais A, Schlegel M, Hillenbach C, Swat A, Franz M, Girase P, Schneider A, Heinzmann D, Shing M. MetaPHER: A phase IIIb multicenter, open-label, single-arm safety study of subcutaneous trastuzumab, in combination with pertuzumab and docetaxel in patients with HER2-positive advanced breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-01-13.
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Affiliation(s)
- S Kümmel
- Kliniken Essen-Mitte, Essen, Germany; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Genentech, Inc., South San Francisco, CA
| | - A Crepelle-Fléchais
- Kliniken Essen-Mitte, Essen, Germany; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Genentech, Inc., South San Francisco, CA
| | - M Schlegel
- Kliniken Essen-Mitte, Essen, Germany; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Genentech, Inc., South San Francisco, CA
| | - C Hillenbach
- Kliniken Essen-Mitte, Essen, Germany; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Genentech, Inc., South San Francisco, CA
| | - A Swat
- Kliniken Essen-Mitte, Essen, Germany; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Genentech, Inc., South San Francisco, CA
| | - M Franz
- Kliniken Essen-Mitte, Essen, Germany; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Genentech, Inc., South San Francisco, CA
| | - P Girase
- Kliniken Essen-Mitte, Essen, Germany; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Genentech, Inc., South San Francisco, CA
| | - A Schneider
- Kliniken Essen-Mitte, Essen, Germany; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Genentech, Inc., South San Francisco, CA
| | - D Heinzmann
- Kliniken Essen-Mitte, Essen, Germany; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Genentech, Inc., South San Francisco, CA
| | - M Shing
- Kliniken Essen-Mitte, Essen, Germany; F. Hoffmann-La Roche Ltd, Basel, Switzerland; Genentech, Inc., South San Francisco, CA
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Seizer P, Fuchs C, Ungern-Sternberg SNIV, Heinzmann D, Langer H, Gawaz M, May AE, Geisler T. Platelet-bound cyclophilin A in patients with stable coronary artery disease and acute myocardial infarction. Platelets 2015; 27:155-8. [PMID: 26084004 DOI: 10.3109/09537104.2015.1051466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Recently, we reported that extracellular cyclophilin A (CyPA) is an important agonist for platelets. Whereas soluble CyPA-levels have been associated with cardiovascular risk factors, cell-bound CyPA has not been investigated yet. In this study, we analyzed for the first time platelet-bound CyPA in patients with symptomatic coronary artery disease (CAD). METHODS AND RESULTS blood was obtained from 388 consecutive patients: 204 with stable CAD and 184 with acute coronary syndrome (76 with unstable angina, 78 with non ST-elevation myocardial infarction (NSTEMI), and 30 with STEMI). In vitro stimulation of platelets with classical agonists revealed an enhanced expression of CyPA on the platelet surface. In patients with stable CAD, platelet-bound CyPA correlated excellently with platelet activity measured by P-selectin exposure in flow cytometry. The analysis of classical risk factors for atherosclerosis revealed that patients with hypertension and hypercholesterolemia had significantly enhanced platelet-bound CyPA, whereas diabetes and smoking were not associated with enhanced CyPA-binding to the platelet surface. In multivariate analysis, hypercholesterolemia was the only significant predictor of enhanced platelet-bound CyPA. Interestingly, in patients with acute myocardial infarction (AMI) platelet-bound CyPA was significantly decreased compared with patients with stable CAD. CONCLUSIONS Enhanced platelet-bound CyPA is associated with hypertension and hypercholesterolemia in stable CAD patients. In patients with AMI platelet-bound CyPA is significantly decreased.
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Affiliation(s)
- Peter Seizer
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | - Christian Fuchs
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | | | - David Heinzmann
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | - Harald Langer
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | - Meinrad Gawaz
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | - Andreas E May
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
| | - Tobias Geisler
- a Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls-Universität Tübingen , Germany
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Heinzmann D, Bangert A, Müller AM, von Ungern-Sternberg SNI, Emschermann F, Schönberger T, Chatterjee M, Mack AF, Klingel K, Kandolf R, Malesevic M, Borst O, Gawaz M, Langer HF, Katus H, Fischer G, May AE, Kaya Z, Seizer P. The Novel Extracellular Cyclophilin A (CyPA) - Inhibitor MM284 Reduces Myocardial Inflammation and Remodeling in a Mouse Model of Troponin I -Induced Myocarditis. PLoS One 2015; 10:e0124606. [PMID: 25894208 PMCID: PMC4404136 DOI: 10.1371/journal.pone.0124606] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/05/2015] [Indexed: 01/16/2023] Open
Abstract
Cyclophilins are a group of highly conserved cytosolic enzymes that have a peptidylprolyl cis/trans isomerase activity. Cyclophilin A (CyPA) can be secreted in the extracellular space by inflammatory cells and upon cell death. The presence of CyPA in patients with non-ischemic cardiomyopathy is associated with poor clinical prognosis. Here, we investigated the inhibition of extracellular CyPA in a mouse model of troponin I-induced autoimmune myocarditis using the strictly extracellular CyPA-inhibitor MM284. Since A/J mice develop severe inflammation and fibrosis after immunization with murine cardiac troponin I (mcTn I), we used this model to analyze the effects of an extracellular CyPA inhibition. As extracellular CyPA-inhibitor we used the recently described CsA-derivate MM284. In vitro studies confirmed that MM284 inhibits CyPA-induced monocytic migration and adhesion. A/J mice immunized with mcTnI were treated with MM284 or vehicle every second day. After 28 days, we found a considerable reduction of myocardial injury and fibrosis. Further analysis revealed a reduced myocardial presence of T-cells and macrophages compared to control treated animals. Whereas MMP-9 expression was reduced significantly by MM284, we observed no significant reduction of inflammatory cytokines such as IL-6 or TNFα. Extracellular CyPA plays an important role in autoimmune myocarditis for myocardial damage and fibrosis. Our data suggest a new pharmacological approach for the treatment of myocardial inflammation and reduction of cardiac fibrosis by inhibition of extracellular CyPA.
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Affiliation(s)
- David Heinzmann
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Anna Bangert
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Anna-Maria Müller
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | | | - Frederic Emschermann
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Tanja Schönberger
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Madhumita Chatterjee
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Andreas F. Mack
- Institute of Anatomy, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, Department of Molecular Pathology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Reinhard Kandolf
- Institute for Pathology and Neuropathology, Department of Molecular Pathology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Miroslav Malesevic
- Martin-Luther-Universität Halle-Wittenberg, Institut für Biochemie, Abteilung Enzymologie, Projektgruppe gFP5, Halle (Saale), Germany
| | - Oliver Borst
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Harald F. Langer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Hugo Katus
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Gunter Fischer
- Max-Planck-Institut für Biophysikalische Chemie Göttingen, BO Halle (Saale), Göttingen, Germany
| | - Andreas E. May
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Ziya Kaya
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Peter Seizer
- Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Eberhard Karls Universität Tübingen, Tübingen, Germany
- * E-mail:
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Jackisch C, Hegg R, Stroyakovskiy D, Ahn J, Melichar B, Chen S, Crepelle-Flechais A, Heinzmann D, Shing M, Pivot X. P201 Subcutaneous versus intravenous trastuzumab in early breast cancer: 2-year follow-up of HannaH. Breast 2015. [DOI: 10.1016/s0960-9776(15)70235-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Seizer P, Ungern-Sternberg SNIV, Schönberger T, Borst O, Münzer P, Schmidt EM, Mack AF, Heinzmann D, Chatterjee M, Langer H, Malešević M, Lang F, Gawaz M, Fischer G, May AE. Extracellular cyclophilin A activates platelets via EMMPRIN (CD147) and PI3K/Akt signaling, which promotes platelet adhesion and thrombus formation in vitro and in vivo. Arterioscler Thromb Vasc Biol 2014; 35:655-63. [PMID: 25550208 DOI: 10.1161/atvbaha.114.305112] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Cyclophilin A (CyPA) is secreted under inflammatory conditions by various cell types. Whereas the important role of intracellular CyPA for platelet function has been reported, the effect of extracellular CyPA on platelet function has not been investigated yet. APPROACH AND RESULTS Inhibition of extracellular CyPA through a novel specific inhibitor MM284 reduced thrombus after ferric chloride-induced injury in vivo. In vitro extracellular CyPA enhanced thrombus formation even in CyPA(-/-) platelets. Treatment of isolated platelets with recombinant CyPA resulted in platelet degranulation in a time- and dose-dependent manner. Inhibition of the platelet surface receptor extracellular matrix metalloproteinase inducer (cluster of differentiation 147) by an anticluster of differentiation 147 monoclonal antibody significantly reduced CyPA-dependent platelet degranulation. Pretreatment of platelets with CyPA enhanced their recruitment to mouse carotid arteries after arterial injury, which could be inhibited by an anticluster of differentiation 147 monoclonal antibody (intravital microscopy). The role of extracellular CyPA in adhesion could be confirmed by infusing CyPA(-/-) platelets in CyPA(+/+) mice and by infusing CyPA(+/+) platelets in CyPA(-/-) mice. Stimulation of platelets with CyPA induced phosphorylation of Akt, which could in turn be inhibited in the presence of phosphoinositid-3-kinase inhibitors. Akt-1(-/-) platelets revealed a markedly decreased degranulation on CyPA stimulation. Finally, ADP-induced platelet aggregation was attenuated by MM284, as well as by inhibiting paracrine-secreted CyPA without directly affecting Ca(2+)-signaling. CONCLUSIONS Extracellular CyPA activates platelets via cluster of differentiation 147-mediated phosphoinositid-3-kinase/Akt-signaling, leading to enhanced adhesion and thrombus formation independently of intracellular CyPA. Targeting extracellular CyPA via a specific inhibitor may be a promising strategy for platelet inhibition without affecting critical functions of intracellular CyPA.
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Affiliation(s)
- Peter Seizer
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.).
| | - Saskia N I V Ungern-Sternberg
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Tanja Schönberger
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Oliver Borst
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Patrick Münzer
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Eva-Maria Schmidt
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Andreas F Mack
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - David Heinzmann
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Madhumita Chatterjee
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Harald Langer
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Miroslav Malešević
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Florian Lang
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Meinrad Gawaz
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Gunter Fischer
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
| | - Andreas E May
- From the Medizinische Klinik III, Kardiologie und Kreislauferkrankungen (P.S., S.N.I.v.U.-S., T.S., O.B., D.H., M.C., H.L., M.G., A.E.M.), Institute of Physiology (P.M., E.-M.S., F.L.), and Institute of Anatomy (A.F.M.), Eberhard Karls-University Tübingen, Tübingen, Germany; Institute of Biochemistry, Abteilung Enzymology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (M.M.); and Max-Planck-Institute für Biophysikalische Chemie Göttingen, BO Halle (Saale), Germany (G.F.)
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Láng I, Bell R, Feng F, Lopez R, Jassem J, Semiglazov V, Al-Sakaff N, Heinzmann D, Chang J. Trastuzumab Retreatment after Relapse on Adjuvant Trastuzumab Therapy for Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: Final Results of the Retreatment after Herceptin Adjuvant Trial. Clin Oncol (R Coll Radiol) 2014; 26:81-9. [DOI: 10.1016/j.clon.2013.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/15/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
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Grippo JF, Zhang W, Heinzmann D, Yang KH, Wong J, Joe AK, Munster P, Sarapa N, Daud A. A phase I, randomized, open-label study of the multiple-dose pharmacokinetics of vemurafenib in patients with BRAF V600E mutation-positive metastatic melanoma. Cancer Chemother Pharmacol 2013; 73:103-11. [DOI: 10.1007/s00280-013-2324-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
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Regan MM, Dafni U, Karlis D, Goldhirsch A, Untch M, Smith I, Gianni L, Jackisch C, de Azambuja E, Heinzmann D, Cameron D, Bell R, Dowsett M, Baselga J, Leyland-Jones B, Piccart-Gebhart MJ, Gelber RD. Abstract P5-18-02: Selective Crossover in Randomized Trials of Adjuvant Trastuzumab for Breast Cancer: Coping with Success. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-18-02] [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: 11/16/2022]
Abstract
Abstract
BACKGROUND: Disease-free survival (DFS) is often a primary endpoint of randomized trials of adjuvant therapies for breast cancer, but long-term follow-up of DFS and especially overall survival (OS) remain important. When the primary DFS results favor the experimental arm, patients (pts) assigned to the control group may select the option to crossover to receive the experimental treatment via protocol amendment. Such “selective crossover” disturbs the integrity of the randomized comparison for any efficacy endpoints that rely on further follow-up. Selective crossover, which is motivated by positive results having been observed in the current trial, is distinct from so-called “unplanned crossover,” which refers to non-adherence to protocol. In this abstract, we discuss the consequences of selective crossover for trials evaluating adjuvant trastuzumab, using the HERA (HERceptin Adjuvant) trial as an example, and present a variety of alternative analysis approaches.
METHODS: HERA enrolled 5102 women with HER2-positive early breast cancer who had completed all surgery and (neo)adjuvant chemotherapy to compare 1 or 2 years of trastuzumab treatment vs observation. After a positive first interim analysis at 1y median follow-up (MFU) showed that 1 year of trastuzumab significantly improved DFS vs observation [MJ Piccart-Gebhart et al; NEJM 2005], event-free patients in the observation group were offered crossover to receive trastuzumab. 885 (52%) of the 1698 pts in the observation group selectively crossed over to trastuzumab.
RESULTS: Previously reported intention-to-treat (ITT) analysis of HERA at 4y MFU showed a decreasing effectiveness of trastuzumab with respect to DFS compared with those at 2y MFU [L Gianni et al, Lancet Oncol 2011; I Smith et al, Lancet 2007]. In addition, the ITT analysis of OS at 4y MFU showed little effect of trastuzumab, while the analysis artificially censoring follow-up in the observation group at the time of selective crossover showed a substantial OS advantage for trastuzumab.
The dependent censored analysis of OS is clearly biased in favor of trastuzumab because data for pts who remain event-free can be censored at the time of crossover, while data for the sicker pts in the observation group (those who relapsed) cannot be censored due to crossover.
The issues related to the ITT and dependent censored analyses will be reviewed and discussed. Alternative analytic approaches designed to estimate the treatment effect that would have been observed had there been no selective crossover will be presented. The methods include the inverse probability of censoring weighted (IPCW) approach, and randomization-based estimators under the accelerated failure time model.
HERA data to about 8y MFU (available fall 2012) will be used to illustrate approaches.
CONCLUSION: Alternative methods addressing selective crossover are required to estimate the trastuzumab effect for updated analyses of DFS and OS for HERA, and for any other large randomized trial with positive interim results.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-18-02.
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Affiliation(s)
- MM Regan
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - U Dafni
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - D Karlis
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - A Goldhirsch
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - M Untch
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - I Smith
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - L Gianni
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - C Jackisch
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - E de Azambuja
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - D Heinzmann
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - D Cameron
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - R Bell
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - M Dowsett
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - J Baselga
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - B Leyland-Jones
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - MJ Piccart-Gebhart
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
| | - RD Gelber
- Dana-Farber Cancer Institute, Boston, MA; University of Athens and Frontier Science Foundation-Hellas, Athens, Greece; Institut Jules Bordet, Universite Libre de Bruxelles, Brussels, Belgium; Helios Klinikum Berlun Buch, Berlin, Germany; Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom; San Raffaele Institute, Milan, Italy; Western General Hospital and University of Edinburgh, United Kingdom; The Royal Marsden NHS Trust, London, United Kingdom; European Institute of Oncology, Milan, Italy; Athens University of Economics, Athens, Greece; Massachusetts General Hospital, Boston, MA; F. Hoffmann-La Roche, Basel, Switzerland; Sanford Research, Sioux Falls, SD; The Andrew Love Cancer Centre, The Geelong Hospital, Geelong, Australia; Klinikum Offenbach, Offenbach, Germany
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Jackisch C, Dank M, Frasci G, Park K, Lopez R, Johnston M, Heinzmann D, Weber H, Ismael G. Additional Safety Results of Hannah: A Phase III Randomised, Open-Label, International Study of the Subcutaneous Formulation of Trastuzumab (H) in HER2-Positive Early Breast Cancer Patients. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32833-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Jackisch C, Stroyakovskiy D, Muehlbauer S, Heinzmann D, Kopp M, Ahn J, Staroslawska E, Falcon S, Pivot X, Ismael G. 1BA Subcutaneous Administration of Trastuzumab in Patients with HER2-positive Early Breast Cancer: Results From the Phase III Randomised, Open-label, Multi-centre Neoadjuvant-adjuvant HannaH Study. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70068-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Heinzmann D. Diary of a strike, Part II. N J Nurse 1984; 14:4. [PMID: 6591122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Heinzmann D. Diary of a strike. N J Nurse 1984; 14:1, 10. [PMID: 6587317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Heinzmann D, Nadrowitz R, Besch W, Schmidt W, Hahn HJ. Decrease of glucose-induced insulin secretion of pancreatic rat islets after irradiation in vitro. Exp Clin Endocrinol 1983; 81:94-7. [PMID: 6343100 DOI: 10.1055/s-0029-1210213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Irradiation of pancreatic rat islets up to a dose of 2.5 Gy did neither alter glucose-nor IBMX-induced insulin secretion studied in vitro. The insulin as well as glucagon content of irradiated islets were similar as in the control tissue. This was also true in islets irradiated with 25 Gy which were characterized by a decreased insulin secretion in the presence of glucose and IBMX, respectively. Since we did not find indications of an enhanced hormone output in the radiation medium, we want to suggest that higher irradiation doses affect insulin release of pancreatic islets in vitro. This observation has to be taken into account for application of radioimmunosuppression for transplantation.
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