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Abu Jhaisha S, Hohlstein P, Yagmur E, Köller V, Pollmanns MR, Adams JK, Wirtz TH, Brozat JF, Bündgens L, Hamesch K, Weiskirchen R, Tacke F, Trautwein C, Koch A. Soluble Semaphorin 4D Serum Concentrations Are Elevated in Critically Ill Patients with Liver Cirrhosis and Correlate with Aminotransferases. Diagnostics (Basel) 2024; 14:370. [PMID: 38396409 PMCID: PMC10887520 DOI: 10.3390/diagnostics14040370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Semaphorin 4D (Sema4D), also known as CD100, is a multifunctional transmembrane protein with immunoregulatory functions. Upon the activation of immune cells, soluble Semaphorin 4D (sSema4D) is proteolytically cleaved from the membrane by metalloproteinases. sSema4D levels are elevated in various (auto-)inflammatory diseases. Our aim was to investigate sSema4D levels in association with sepsis and critical illnesses and to evaluate sSema4D's potential as a prognostic biomarker. We measured sSema4D levels in 192 patients upon admission to our medical intensive care unit. We found similar levels of sSema4D in 125 patients with sepsis compared to 67 non-septic patients. sSema4D levels correlated with leukocytes but not with other markers of systemic inflammation such as C-reactive protein or procalcitonin. Most interestingly, in a subgroup of patients suffering from pre-existing liver cirrhosis, we observed significantly higher levels of sSema4D. Consistently, sSema4D was also positively correlated with markers of hepatic and cholestatic injury. Our study suggests that sSema4D is not regulated in sepsis compared to other causes of critical illness. However, sSema4D seems to be associated with hepatic injury and inflammation.
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Affiliation(s)
- Samira Abu Jhaisha
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
| | - Philipp Hohlstein
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
| | - Eray Yagmur
- Institute of Laboratory Medicine, Western Palatinate Hospital, 67655 Kaiserslautern, Germany;
| | - Vera Köller
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
| | - Maike R. Pollmanns
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
| | - Jule K. Adams
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
| | - Theresa H. Wirtz
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
| | - Jonathan F. Brozat
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
- Department of Hepatology and Gastroenterology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Lukas Bündgens
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
| | - Karim Hamesch
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany;
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Christian Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
| | - Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany (K.H.)
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Hohlstein P, Abu Jhaisha S, Yagmur E, Wawer D, Pollmanns MR, Adams JK, Wirtz TH, Brozat JF, Bündgens L, Hamesch K, Weiskirchen R, Tacke F, Trautwein C, Koch A. Elevated Midkine Serum Levels Are Associated with Long-Term Survival in Critically Ill Patients. Int J Mol Sci 2023; 25:454. [PMID: 38203625 PMCID: PMC10779074 DOI: 10.3390/ijms25010454] [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: 11/13/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Midkine (Mdk) is a multifunctional protein involved in inflammatory processes. Hence, circulating Mdk is increased in sepsis and has been previously suggested as a potential biomarker in these patients. The aim of this study was to elucidate the role of Mdk serum concentrations in critical illness and sepsis and to verify its value as a prognostic biomarker. Thus, we analyzed the Mdk serum concentrations of 192 critically ill patients on admission to the medical intensive care unit (ICU). While the serum levels of Mdk at admission were similar in septic and nonseptic critical illness (362 vs. 337 ng/L, p = 0.727), we found several interesting correlations of Mdk to laboratory and clinical markers associated with ischemia or hypoxia, e.g., to renal failure and hepatic injury. Mdk serum concentrations at admission did not differ between various causes of sepsis or other critical illness. Most noticeable, we observed upregulated Mdk serum concentrations at admission in patients surviving in the long-term, which was only seen in nonseptic critical illness but not in sepsis. Our study suggests a relevant role of Mdk in critically ill patients in general and highlights the possible protective features of Mdk in critical illness.
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Affiliation(s)
- Philipp Hohlstein
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
| | - Samira Abu Jhaisha
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
| | - Eray Yagmur
- Institute of Laboratory Medicine, Western Palatinate Hospital, 67655 Kaiserslautern, Germany;
| | - Dennis Wawer
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
| | - Maike R. Pollmanns
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
| | - Jule K. Adams
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
| | - Theresa H. Wirtz
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
| | - Jonathan F. Brozat
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Lukas Bündgens
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
| | - Karim Hamesch
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry (IFMPEGKC), RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany;
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Christian Trautwein
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
| | - Alexander Koch
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine, RWTH-University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; (P.H.); (S.A.J.); (D.W.); (M.R.P.); (J.K.A.); (T.H.W.); (J.F.B.); (L.B.); (K.H.); (C.T.)
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Puengel T, Weber B, Wirtz TH, Buendgens L, Loosen SH, Geisler L, Özdirik B, Karim H, Jhaisha SA, Brozat JF, Hohlstein P, Eisert A, Yagmur E, Trautwein C, Tacke F, Koch A. Low Serum Levels of Soluble Receptor Activator of Nuclear Factor κ B Ligand (sRANKL) Are Associated with Metabolic Dysregulation and Predict Long-Term Mortality in Critically Ill Patients. Diagnostics (Basel) 2021; 12:diagnostics12010062. [PMID: 35054232 PMCID: PMC8774641 DOI: 10.3390/diagnostics12010062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 01/23/2023] Open
Abstract
Soluble receptor activator of nuclear factor κ B ligand (sRANKL) is a member of the tumor necrosis factor receptor superfamily, and therefore, involved in various inflammatory processes. The role of sRANKL in the course of bone remodeling via activation of osteoclasts as well as chronic disease progression has been described extensively. However, the potential functional importance of sRANKL in critically ill or septic patients remained unknown. Therefore, we measured sRANKL serum concentrations in 303 critically ill patients, including 203 patients with sepsis and 100 with non-sepsis critical illness. Results were compared to 99 healthy controls. Strikingly, in critically ill patients sRANKL serum levels were significantly decreased at intensive care unit (ICU) admission (p = 0.011) without differences between sepsis and non-sepsis patients. Inline, sRANKL was correlated with markers of metabolic dysregulation, such as pre-existing diabetes and various adipokines (e.g., adiponectin, leptin receptor). Importantly, overall mortality of critically ill patients in a three-year follow-up was significantly associated with decreased sRANKL serum concentrations at ICU admission (p = 0.038). Therefore, our study suggests sRANKL as a biomarker in critically ill patients which is associated with poor prognosis and overall survival beyond ICU stay.
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Affiliation(s)
- Tobias Puengel
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
- Correspondence:
| | - Beate Weber
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Theresa H. Wirtz
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Lukas Buendgens
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Sven H. Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany;
| | - Lukas Geisler
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
| | - Burcin Özdirik
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
| | - Hamesch Karim
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Samira Abu Jhaisha
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Jonathan F. Brozat
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Philipp Hohlstein
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Albrecht Eisert
- Hospital Pharmacy, RWTH-University Hospital Aachen, 52074 Aachen, Germany;
- Institute of Clinical Pharmacology, RWTH-University Hospital Aachen, 52074 Aachen, Germany
| | - Eray Yagmur
- Institute of Laboratory Medicine, Western Palatinate Hospital, 67655 Kaiserslautern, Germany;
| | - Christian Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum (CVK) and Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.G.); (B.Ö.); (F.T.)
| | - Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, 52074 Aachen, Germany; (B.W.); (T.H.W.); (L.B.); (H.K.); (S.A.J.); (J.F.B.); (P.H.); (C.T.); (A.K.)
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Yagmur E, Sckaer JH, Koek GH, Weiskirchen R, Trautwein C, Koch A, Tacke F. Elevated MR-proANP plasma concentrations are associated with sepsis and predict mortality in critically ill patients. J Transl Med 2019; 17:415. [PMID: 31830996 PMCID: PMC6909604 DOI: 10.1186/s12967-019-02165-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 05/31/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background and aims Mid-regional pro atrial natriuretic peptide (MR-proANP) is an established biomarker for heart failure, based on its key role in regulating homeostasis of water balance and blood pressure. The aim of the study was to determine the value of MR-proANP as a clinical biomarker in critical illness and/or sepsis. Upon admission to the medical intensive care unit (ICU), we investigated MR-proANP plasma concentrations in 217 critically ill patients (144 with sepsis, 73 without sepsis). Results were compared with 65 healthy controls. Results MR-proANP plasma levels were significantly elevated in critically ill patients, when compared to healthy controls. Notably, MR-proANP levels were significantly higher in ICU patients with sepsis. MR-proANP levels were not associated with metabolic comorbidities like diabetes or obesity. In critically ill patients, MR-proANP plasma concentrations correlated with inflammatory cytokines, markers of organ dysfunction and several adipocytokines, such as resistin, retinol-binding protein 4 (RBP4) and adiponectin. Importantly, high MR-proANP plasma levels were associated with mortality, as MR-proANP levels above 227.0 pmol/l indicated a particularly increased mortality risk in ICU patients. The association between MR-proANP and mortality was independent of single organ failure and inflammation markers. Conclusion Our study emphasizes the role of circulating MR-proANP as a biomarker in critically ill patients, in which high MR-proANP indicates organ dysfunction, sepsis and mortality risk. The association between high MR-proANP and inflammatory as well as adipose tissue-derived endocrine mediators warrants further pathophysiological investigations.
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Affiliation(s)
- Eray Yagmur
- Medical Care Center, Dr. Stein and Colleagues, Tomphecke 45, 41169, Mönchengladbach, Germany.
| | | | - Ger H Koek
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, RWTH-University Hospital Aachen, Aachen, Germany
| | - Christian Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Frank Tacke
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany.,Department of Hepatology and Gastroenterology, Charité University Medical Center, Berlin, Germany
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Hamesch K, Mandorfer M, Pereira VM, Moeller LS, Pons M, Dolman GE, Reichert MC, Schneider CV, Woditsch V, Voss J, Lindhauer C, Fromme M, Spivak I, Guldiken N, Zhou B, Arslanow A, Schaefer B, Zoller H, Aigner E, Reiberger T, Wetzel M, Siegmund B, Simões C, Gaspar R, Maia L, Costa D, Bento-Miranda M, van Helden J, Yagmur E, Bzdok D, Stolk J, Gleiber W, Knipel V, Windisch W, Mahadeva R, Bals R, Koczulla R, Barrecheguren M, Miravitlles M, Janciauskiene S, Stickel F, Lammert F, Liberal R, Genesca J, Griffiths WJ, Trauner M, Krag A, Trautwein C, Strnad P. Liver Fibrosis and Metabolic Alterations in Adults With alpha-1-antitrypsin Deficiency Caused by the Pi*ZZ Mutation. Gastroenterology 2019; 157:705-719.e18. [PMID: 31121167 DOI: 10.1053/j.gastro.2019.05.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [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: 05/19/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Alpha-1 antitrypsin deficiency (AATD) is among the most common genetic disorders. Severe AATD is caused by a homozygous mutation in the SERPINA1 gene that encodes the Glu342Lys substitution (called the Pi*Z mutation, Pi*ZZ genotype). Pi*ZZ carriers may develop lung and liver diseases. Mutation-associated lung disorders have been well studied, but less is known about the effects in liver. We assessed the liver disease burden and associated features in adults with this form of AATD. METHODS We collected data from 554 Pi*ZZ adults (403 in an exploratory cohort, 151 in a confirmatory cohort), in 9 European countries, with AATD who were homozygous for the Pi*Z mutation, and 234 adults without the Pi*Z mutation (controls), all without pre-existing liver disease. We collected data on demographic parameters, comorbidities, lung- and liver-related health, and blood samples for laboratory analysis. Liver fibrosis was assessed non-invasively via the serum tests Aspartate Aminotransferase to Platelet Ratio Index and HepaScore and via transient elastography. Liver steatosis was determined via transient elastography-based controlled attenuation parameter. We performed histologic analyses of livers from transgenic mice that overexpress the AATD-associated Pi*Z variant. RESULTS Serum levels of liver enzymes were significantly higher in Pi*ZZ carriers vs controls. Based on non-invasive tests for liver fibrosis, significant fibrosis was suspected in 20%-36% of Pi*ZZ carriers, whereas signs of advanced fibrosis were 9- to 20-fold more common in Pi*ZZ carriers compared to non-carriers. Male sex; age older than 50 years; increased levels of alanine aminotransferase, aspartate aminotransferase, or γ-glutamyl transferase; and low numbers of platelets were associated with higher liver fibrosis burden. We did not find evidence for a relationship between lung function and liver fibrosis. Controlled attenuation parameter ≥280 dB/m, suggesting severe steatosis, was detected in 39% of Pi*ZZ carriers vs 31% of controls. Carriers of Pi*ZZ had lower serum concentrations of triglyceride and low- and very-low-density lipoprotein cholesterol than controls, suggesting impaired hepatic secretion of lipid. Livers from Pi*Z-overexpressing mice had steatosis and down-regulation of genes involved in lipid secretion. CONCLUSIONS In studies of AATD adults with the Pi*ZZ mutation, and of Pi*Z-overexpressing mice, we found evidence of liver steatosis and impaired lipid secretion. We identified factors associated with significant liver fibrosis in patients, which could facilitate hepatologic assessment and counseling of individuals who carry the Pi*ZZ mutation. ClinicalTrials.gov Number NCT02929940.
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Affiliation(s)
- Karim Hamesch
- Coordinating Center for Alpha1-Antitrypsin Deficiency-Related Liver Disease of the European Reference Network "Rare Liver" and the European Association for the Study of the Liver Registry Group "Alpha1-Liver," University Hospital Aachen, Aachen, Germany; Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Vítor M Pereira
- Department of Gastroenterology, Centro Hospitalar do Funchal, Madeira, Portugal
| | - Linda S Moeller
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Monica Pons
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Grace E Dolman
- Department of Hepatology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Matthias C Reichert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Carolin V Schneider
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Vivien Woditsch
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Jessica Voss
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Cecilia Lindhauer
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Malin Fromme
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Igor Spivak
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Nurdan Guldiken
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Biaohuan Zhou
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Anita Arslanow
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany; Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Benedikt Schaefer
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria
| | - Heinz Zoller
- Department of Internal Medicine I, Medical University Innsbruck, Innsbruck, Austria
| | - Elmar Aigner
- Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Martin Wetzel
- Department of Medicine I, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Britta Siegmund
- Department of Medicine I, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Carolina Simões
- Gastroenterology Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar de São João, Faculty of Medicine of Porto University, Porto, Portugal
| | - Luís Maia
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Dalila Costa
- Gastroenterology Department, Hospital de Braga, Braga, Portugal
| | - Mário Bento-Miranda
- Gastroenterology Department, Hospital Universitário de Coimbra, Coimbra, Portugal
| | - Josef van Helden
- Medical Care Centre, Dr Stein and Colleagues, Moenchengladbach, Germany
| | - Eray Yagmur
- Medical Care Centre, Dr Stein and Colleagues, Moenchengladbach, Germany
| | - Danilo Bzdok
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany; Jülich Aachen Research Alliance-Brain, Aachen, Germany
| | - Jan Stolk
- Clinic for Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wolfgang Gleiber
- Clinic for Pulmonology, University Hospital Frankfurt, Frankfurt, Germany
| | - Verena Knipel
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Cologne, Germany
| | - Ravi Mahadeva
- Department of Respiratory Medicine, Cambridge National Institute for Health Research, Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Robert Bals
- Department of Medicine V, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Rembert Koczulla
- Clinic for Pneumology, Marburg University Hospital, Marburg, Germany; Institute for Pulmonary Rehabilitation Research, Schoen Clinic Berchtesgadener Land, Member of the Deutsches Zentrum für Lungenforschung, Schönau am Königssee, Germany
| | - Miriam Barrecheguren
- Department of Pneumology, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Spain
| | - Marc Miravitlles
- Department of Pneumology, Vall d'Hebron University Hospital, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Barcelona, Spain
| | - Sabina Janciauskiene
- Clinic for Pneumology, German Center for Lung Research, Medical University Hannover, Hannover, Germany
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Rodrigo Liberal
- Gastroenterology Department, Centro Hospitalar de São João, Faculty of Medicine of Porto University, Porto, Portugal
| | - Joan Genesca
- Liver Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - William J Griffiths
- Department of Hepatology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Christian Trautwein
- Coordinating Center for Alpha1-Antitrypsin Deficiency-Related Liver Disease of the European Reference Network "Rare Liver" and the European Association for the Study of the Liver Registry Group "Alpha1-Liver," University Hospital Aachen, Aachen, Germany; Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Pavel Strnad
- Coordinating Center for Alpha1-Antitrypsin Deficiency-Related Liver Disease of the European Reference Network "Rare Liver" and the European Association for the Study of the Liver Registry Group "Alpha1-Liver," University Hospital Aachen, Aachen, Germany; Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.
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Yagmur E, Buergerhausen D, Koek GH, Weiskirchen R, Trautwein C, Koch A, Tacke F. Elevated CTRP1 Plasma Concentration Is Associated with Sepsis and Pre-Existing Type 2 Diabetes Mellitus in Critically Ill Patients. J Clin Med 2019; 8:jcm8050661. [PMID: 31083558 PMCID: PMC6572622 DOI: 10.3390/jcm8050661] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/16/2022] Open
Abstract
The adipokine family of C1q/TNF-like proteins (CTRP) plays a critical role in regulating systemic energy homeostasis and insulin sensitivity. It is involved in pathophysiological processes including inflammation and insulin-resistant obesity. Sepsis is associated with metabolic alterations and dysregulated adipokines, but the role of CTRP1 in critical illness and sepsis is unclear. We investigated CTRP1 plasma concentrations in 145 septic and 73 non-septic critically ill patients at admission to the medical intensive care unit (ICU) in comparison to 66 healthy controls. We also assessed associations of CTRP1 with clinical characteristics, adipokine levels, metabolic and inflammatory parameters. CTRP1 plasma concentration was significantly elevated in critically ill patients compared to healthy subjects. CTRP1 levels were significantly higher in ICU patients with sepsis. CTRP1 correlated strongly with markers of inflammatory response, renal function, liver damage and cholestasis. Furthermore, CTRP1 levels were higher in ICU patients with type 2 diabetes mellitus, and correlated with HbA1c and body mass index. This study demonstrates significantly elevated levels of CTRP1 in critically ill patients, particularly with sepsis, and links circulating CTRP1 to inflammatory and metabolic disturbances.
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Affiliation(s)
- Eray Yagmur
- Medical Care Center, Dr. Stein and Colleagues, D-41169 Mönchengladbach, Germany.
| | - David Buergerhausen
- Department of Medicine III, RWTH-University Hospital Aachen, D-52074 Aachen, Germany.
| | - Ger H Koek
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Medical Centre (MUMC), 6202AZ Maastricht, The Netherlands.
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, RWTH-University Hospital Aachen, D-52074 Aachen, Germany.
| | - Christian Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, D-52074 Aachen, Germany.
| | - Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, D-52074 Aachen, Germany.
| | - Frank Tacke
- Department of Medicine III, RWTH-University Hospital Aachen, D-52074 Aachen, Germany.
- Department of Hepatology and Gastroenterology, Charité University Medical Center, D-10117 Berlin, Germany.
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Koch A, Yagmur E, Hoss A, Buendgens L, Herbers U, Weiskirchen R, Koek GH, Trautwein C, Tacke F. Clinical relevance of copeptin plasma levels as a biomarker of disease severity and mortality in critically ill patients. J Clin Lab Anal 2018; 32:e22614. [PMID: 29974524 DOI: 10.1002/jcla.22614] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/12/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Copeptin, also termed C-terminal pre-pro-vasopressin or CTproAVP, mirrors endogenous vasopressin (anti-diuretic hormone, ADH) activity and might thereby serve as a biomarker reflecting the biological stress level. We therefore hypothesized that copeptin plasma concentrations are associated with disease severity in critically ill patients and could predict mortality. METHODS We analyzed plasma copeptin levels in a prospective, single-center, observational study comprising 218 critically ill patients at admission to the medical intensive care unit (ICU). Mortality was assessed during a 2-year observational follow-up period. RESULTS Copeptin plasma levels were significantly elevated in critically ill patients (n = 218) at ICU admission, as compared with 66 healthy controls. Neither sepsis as the cause of critical illness nor pre-existing metabolic disorders (type 2 diabetes, obesity) were found to influence copeptin levels. On the contrary, plasma copeptin was closely associated with disease severity (eg APACHE-II score) and correlated with biomarkers of inflammation, renal failure, metabolism, vascular tone, and tissue perfusion. Elevated copeptin levels at ICU admission predicted short-term and long-term mortality. CONCLUSIONS Copeptin plasma concentrations are significantly elevated in critically ill patients, correlate with disease severity and predict ICU and long-term outcome. Thus, copeptin could be a promising tool for prognostication and management of critically ill patients.
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Affiliation(s)
- Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Eray Yagmur
- Medical Care Center, Dr. Stein and Colleagues, Mönchengladbach, Germany
| | - Alexander Hoss
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Lukas Buendgens
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Ulf Herbers
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, RWTH-University Hospital Aachen, Aachen, Germany
| | - Ger H Koek
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Christian Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Frank Tacke
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
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Yagmur E, Buendgens L, Herbers U, Beeretz A, Weiskirchen R, Koek GH, Trautwein C, Tacke F, Koch A. High mobility group box 1 as a biomarker in critically ill patients. J Clin Lab Anal 2018; 32:e22584. [PMID: 29862569 DOI: 10.1002/jcla.22584] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/15/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Extracellular release of high mobility group box 1 (HMGB1) acts as a danger-associated molecular pattern, thereby "alarming" the immune system and promoting systemic inflammation. We investigated plasma HMGB1 concentrations as a potential diagnostic and prognostic biomarker in critical illness. METHODS Our study included 218 critically ill patients (145 with sepsis, 73 without sepsis), of whom blood samples were obtained at the time-point of admission to the medical intensive care unit (ICU). RESULTS High mobility group box 1 levels were significantly elevated in critically ill patients (n = 218) compared with healthy controls (n = 66). Elevated HMGB1 plasma levels were independent from the presence of sepsis. Moreover, HMGB1 was not associated with disease severity, organ failure, or mortality in the ICU. We observed a trend toward lower HMGB1 levels in ICU patients with pre-existing obesity, type 2 diabetes and end-stage renal disease patients on chronic hemodialysis. CONCLUSION In conclusion, our study did not reveal significant associations between HMGB1 levels at ICU admission and clinical outcomes in critically ill patients. Due to the pathogenic role of HMGB1 in the late phases of experimental sepsis, future studies might assess the potential value of HMGB1 by measuring its plasma concentrations at later time points during the course of critical illness.
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Affiliation(s)
- Eray Yagmur
- Medical Care Centre, Dr Stein and Colleagues, Mönchengladbach, Germany
| | - Lukas Buendgens
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Ulf Herbers
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Anne Beeretz
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Ralf Weiskirchen
- Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and Clinical Chemistry, RWTH-University Hospital Aachen, Aachen, Germany
| | - Ger H Koek
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Christian Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Frank Tacke
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
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Stellbrink K, de Taeye A, Müller R, Kiefer P, Yagmur E, Weber C, Kelm M, Hoffmann R, Blindt R. The significance of vasodilator-stimulated phosphoprotein for risk stratification of stent thrombosis. Thromb Haemost 2017. [DOI: 10.1160/th07-05-0324] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryLow-response to the P2Y12 adenosine diphosphate (ADP)-receptor antagonist clopidogrel was suggested to correspond to a higher incidence of stent thrombosis (ST). This prospective observational study assessed the capability of two platelet function assays, e.g. direct measurement of the phosphorylation status of vasodilator-stimulated phosphoprotein (VASP) and ADP-induced platelet aggregation for definition of the individual risk to develop ST. Ninety-nine patients with an elevated high risk to develop ST were enrolled. All patients received a dual antiplatelet therapy consisting of 100 mg aspirin and 75 mg clopidogrel during an observation period of six months. Flow cytometry of VASP phosphorylation and densitometrically-determined measurement of ADP-induced platelet aggregation was performed 72–96 hours after stent implantation. These data were related to angiographically confirmed ST. Nine patients suffered from angiographically confirmed ST (9.1%). The meanVASP-platelet reactivity indices (VASP-PRI) and values for ADP-induced platelet aggregation in the ST group were significantly higher (60.8 ± 13.0 and 60.9 ± 13.1, respectively) compared to patients without ST (41.3 ± 14.0 and 50.8 ± 14.4, P<0.001 vs. 0.048, respectively). There was a fair correlation between both methods using non-linear regression analysis (r=0.332). In a multivariate analysis, VASP was the only independent predictor of ST and was superior to previously identified angiographic parameters. Receiver- operator characteristic (ROC) curve analysis revealed a cut-off value for VASP-PRI of <48% to be associated with low risk of ST. In conclusion, determination ofVASP phosphorylation is superior to conventional platelet aggregometry and angiographic parameters for assessing the risk of ST. Patients with a VASP-PRI >48% seem to have a significantly increased risk.
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Yagmur E, Weiskirchen R, Schede A, Bugert P. PTGS1 compound heterozygosity impairs gene expression and platelet aggregation and is associated with severe bleeding complications. Thromb Haemost 2017; 110:1083-5. [DOI: 10.1160/th13-02-0110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 07/20/2013] [Indexed: 01/09/2023]
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Rausch V, Peccerella T, Lackner C, Yagmur E, Seitz HK, Longerich T, Mueller S. S01-1Primary liver injury and delayed resolution of liver stiffness after alcohol detoxification in heavy drinkers with the PNPLA3 variant I148M. Alcohol Alcohol 2017. [DOI: 10.1093/alcalc/agx075.01] [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: 11/13/2022] Open
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Shirvani-Dastgerdi E, Winer BY, Celià-Terrassa T, Kang Y, Tabernero D, Yagmur E, Rodríguez-Frías F, Gregori J, Luedde T, Trautwein C, Ploss A, Tacke F. Selection of the highly replicative and partially multidrug resistant rtS78T HBV polymerase mutation during TDF-ETV combination therapy. J Hepatol 2017; 67:246-254. [PMID: 28392234 PMCID: PMC6016549 DOI: 10.1016/j.jhep.2017.03.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 03/01/2017] [Accepted: 03/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients chronically infected with the hepatitis B virus (HBV) and receiving long-term treatment with nucleoside or nucleotide analogues are at risk of selecting HBV strains with complex mutational patterns. We herein report two cases of HBV-infected patients with insufficient viral suppression, despite dual antiviral therapy with entecavir (ETV) and tenofovir (TDF). One patient died from aggressive hepatocellular carcinoma (HCC). METHODS Serum samples from the two patients at different time points were analyzed using ultra-deep pyrosequencing analysis. HBV mutations were identified and transiently transfected into hepatoma cells in vitro using replication-competent HBV vectors, and functionally analyzed. We assessed replication efficacy, resistance to antivirals and potential impact on HBV secretion (viral particles, exosomes). RESULTS Sequencing analyses revealed the selection of the rtS78T HBV polymerase mutation in both cases that simultaneously creates a premature stop codon at sC69 and thereby deletes almost the entire small HBV surface protein. One of the patients had an additional 261bp deletion in the preS1/S2 region. Functional analyses of the mutations in vitro revealed that the rtS78T/sC69∗ mutation, but not the preS1/S2 deletion, significantly enhanced viral replication and conferred reduced susceptibility to ETV and TDF. The sC69∗ mutation caused truncation of HBs protein, leading to impaired detection by commercial HBsAg assay, without causing intracellular HBsAg retention or affecting HBV secretion. CONCLUSIONS The rtS78T/sC69∗ HBV mutation, associated with enhanced replication and insufficient response to antiviral treatment, may favor long-term persistence of these isolates. In addition to the increased production of HBV transcripts and the sustained secretion of viral particles in the absence of antigenic domains of S protein, this HBV mutation may predispose patients to carcinogenic effects. LAY SUMMARY Long-term treatment with antiviral drugs carries the risk of selecting mutations in the hepatitis B virus (HBV). We herein report two cases of patients with insufficient response to dual tenofovir and entecavir therapy. Molecular analyses identified a distinct mutation, rtS78T/sC69∗, that abolishes HBsAg detection, enhances replication, sustains exosome-mediated virion secretion and decreases susceptibility to antivirals, thereby representing a potentially high-risk mutation for HBV-infected individuals.
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Affiliation(s)
- Elham Shirvani-Dastgerdi
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany; Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Benjamin Y Winer
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | | | - Yibin Kang
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - David Tabernero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Eray Yagmur
- Medical Care Centre, Dr Stein and Colleagues, Mönchengladbach, Germany
| | - Francisco Rodríguez-Frías
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Tom Luedde
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Christian Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - Alexander Ploss
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - Frank Tacke
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany.
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Mueller S, Nahon P, Rausch V, Peccerella T, Silva I, Yagmur E, Straub BK, Lackner C, Seitz HK, Rufat P, Sutton A, Bantel H, Longerich T. Caspase-cleaved keratin-18 fragments increase during alcohol withdrawal and predict liver-related death in patients with alcoholic liver disease. Hepatology 2017; 66:96-107. [PMID: 28170108 DOI: 10.1002/hep.29099] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 01/30/2017] [Indexed: 12/24/2022]
Abstract
UNLABELLED Noninvasive assessment of disease activity in patients with nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) is still unsettled, but essential for the evaluation of disease progression. We here studied the association of total (M65) and caspase-cleaved (M30) serum keratin-18 fragments (n = 204) with histological parameters (n = 106) in heavy drinkers primarily admitted for alcohol withdrawal before and after alcohol detoxification. An age-, sex-, and fibrosis-stage matched NAFLD cohort (n = 30) was used for comparison. The prognostic value of M30 and M65 levels were assessed in an additional prospectively followed-up cohort of 230 patients with alcoholic cirrhosis (AC) using competing risk analyses. Among the histological parameters, both M30/65 correlated significantly and better than any other serum marker with apoptosis and liver damage, such as ballooning (r = 0.65; P < 0.001), followed by lobular inflammation (0.48; P < 0.001), steatosis (0.46; P < 0.001), but less with fibrosis (0.24; P < 0.001). Area under the receiver operating characteristics curves to detect ballooning, steatosis, or steatohepatitis (SH) were slightly better for M30 (P < 0.005). Optimal M30 cut-off values for mild and severe ballooning were 330 and 420 U/L, and 290 and 330 U/L for SH grades 1 and 2. No significant differences of M30/65 were found between the matched NAFLD and ALD cohort. In contrast to aspartate-amino-transferase and M65, M30 levels increased significantly from 391 to 518 U/L during alcohol detoxification. Moreover, levels of M30 and M65 predicted non-hepatocellular carcinoma liver-related mortality in patients with AC during a mean observation interval of 67.2 months. CONCLUSION Our data suggest M30 as highly specific marker of liver apoptosis both in ALD and NAFLD. In addition, hepatocellular apoptosis, as determined by M30 levels, occurs during alcohol withdrawal, and survival data point toward a novel underestimated role of apoptosis in patients with ALD. (Hepatology 2017;66:96-107).
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Affiliation(s)
- Sebastian Mueller
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France.,Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206, Saint-Denis, France.,Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris, France
| | - Vanessa Rausch
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Tessa Peccerella
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Ines Silva
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Eray Yagmur
- Laboratory Diagnostics Center, RWTH-University Hospital Aachen, Aachen and Medical Care Center, Dr. Stein and colleagues, Mönchengladbach, Germany
| | - Beate K Straub
- Institute for Pathology, Universities of Mainz and Heidelberg, Germany
| | - Carolin Lackner
- Institute for Pathology, Medical University Graz, Graz, Austria
| | - Helmut K Seitz
- Salem Medical Center and Center for Alcohol Research, University of Heidelberg, Heidelberg, Germany
| | - Pierre Rufat
- APHP, Biostatistics, Pitié-Salepêtrière Hospital, Paris, France
| | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027, Paris, France.,APHP, Biochemistry Unit, Jean Verdier Hospital, Bondy, France.,INSERM U1148, and Paris 13 University, Bobigny, France
| | - Heike Bantel
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Thomas Longerich
- Institute of Pathology, RWTH-University Hospital Aachen, Aachen, Germany
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Buendgens L, Yagmur E, Bruensing J, Herbers U, Baeck C, Trautwein C, Koch A, Tacke F. C-terminal proendothelin-1 (CT-proET-1) is associated with organ failure and predicts mortality in critically ill patients. J Intensive Care 2017; 5:25. [PMID: 28331622 PMCID: PMC5359904 DOI: 10.1186/s40560-017-0219-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 03/02/2017] [Indexed: 11/23/2022] Open
Abstract
Background Endothelin 1 (ET-1) is a strong vasoconstrictor, which is involved in inflammation and reduced tissue perfusion. C-terminal proendothelin-1 (CT-proET-1) is the stable circulating precursor protein of ET-1. We hypothesized that CT-proET-1, reflecting ET-1 activation, is involved in the pathogenesis of critical illness and associated with its prognosis. Methods Two hundred seventeen critically ill patients (144 with sepsis, 73 without sepsis) were included prospectively upon admission to the medical intensive care unit (ICU), in comparison to 65 healthy controls. CT-proET-1 serum concentrations were correlated with clinical data and extensive laboratory parameters. Overall survival was followed for up to 3 years. Results CT-proET-1 serum levels at admission were significantly increased in critically ill patients compared to controls. CT-proET-1 serum levels showed significant correlations to systemic inflammation as well as multiple markers of organ dysfunction (kidney, liver, heart). Patients with sepsis displayed higher circulating CT-proET-1 than ICU patients with non-septic diseases. CT-proET-1 levels >74 pmol/L at ICU admission independently predicted ICU death (adjusted hazard ratio (HR) 2.66, 95% confidence interval (CI) 1.30–5.47) and overall mortality during follow-up (adjusted HR 2.19, 95%-CI 1.21–3.98). Conclusions CT-proET-1 serum concentrations at admission are increased in critically ill patients and associated with sepsis, disease severity, organ failure, and mortality.
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Affiliation(s)
- Lukas Buendgens
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Eray Yagmur
- Medical Care Center, Dr. Stein and Colleagues, 41061 Mönchengladbach, Germany
| | - Jan Bruensing
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Ulf Herbers
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Christer Baeck
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Christian Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Frank Tacke
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Bruns T, Nuraldeen R, Mai M, Stengel S, Zimmermann HW, Yagmur E, Trautwein C, Stallmach A, Strnad P. Low serum transferrin correlates with acute-on-chronic organ failure and indicates short-term mortality in decompensated cirrhosis. Liver Int 2017; 37:232-241. [PMID: 27473364 DOI: 10.1111/liv.13211] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 05/07/2016] [Accepted: 07/23/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Iron represents an essential, but potentially harmful micronutrient, whose regulation has been associated with poor outcome in liver disease. Its homeostasis is tightly linked to oxidative stress, bacterial infections and systemic inflammation. To study the prognostic short-term significance of iron parameters in a cohort study of patients with decompensation of cirrhosis at risk of acute-on-chronic liver failure (ACLF). METHODS Ferritin, transferrin, iron, transferrin saturation (TSAT) and hepcidin were determined in sera from 292 German patients hospitalized for decompensation of cirrhosis with ascites, of which 78 (27%) had ACLF. Short-term mortality was prospectively assessed 30 and 90 days after inclusion. RESULTS Transferrin concentrations were significantly lower, whereas ferritin and TSAT were higher in patients with ACLF compared to patients without ACLF (P≤.006). Transferrin, TSAT and ferritin differentially correlated with the severity of organ failure, active alcoholism and surrogates of systemic inflammation and macrophage activation. As compared with survivors, 30-day non-survivors displayed lower serum transferrin (P=.0003) and higher TSAT (P=.003), whereas 90-day non-survivors presented with higher ferritin (P=.03) and lower transferrin (P=.02). Lower transferrin (continuous or dichotomized at 87 mg/dL) and consecutively higher TSAT (continuous or dichotomized >41%) indicated increased mortality within 30 days and remained significant after adjustment for organ failure and inflammation in multivariate regression models and across subgroups of patients. CONCLUSION Among the investigated indicators of iron metabolism, serum transferrin concentration was the best indicator of organ failure and an independent predictor of short-term mortality at 30 days.
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Affiliation(s)
- Tony Bruns
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.,The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena, Germany
| | - Renwar Nuraldeen
- Department of Internal Medicine III, University Hospital Aachen, Aachen, Germany
| | - Martina Mai
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.,The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena, Germany
| | - Sven Stengel
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Henning W Zimmermann
- Department of Internal Medicine III, University Hospital Aachen, Aachen, Germany
| | - Eray Yagmur
- Laboratory Diagnostics Center, University Hospital Aachen, Aachen, Germany
| | - Christian Trautwein
- Department of Internal Medicine III, University Hospital Aachen, Aachen, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.,The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena, Germany
| | - Pavel Strnad
- Department of Internal Medicine III, University Hospital Aachen, Aachen, Germany.,Interdisciplinary Center for Clinical Research (IZKF), University Hospital Aachen, Aachen, Germany
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Rausch V, Peccerella T, Lackner C, Yagmur E, Seitz HK, Longerich T, Mueller S. Primary liver injury and delayed resolution of liver stiffness after alcohol detoxification in heavy drinkers with the PNPLA3 variant I148M. World J Hepatol 2016; 8:1547-1556. [PMID: 28050235 PMCID: PMC5165268 DOI: 10.4254/wjh.v8.i35.1547] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/15/2016] [Accepted: 09/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the influence of PNPLA3 genotype in heavy drinkers on serum markers and liver stiffness (LS) during alcohol withdrawal and its association with histology.
METHODS Caucasian heavy drinkers (n = 521) with a mean alcohol consumption of 192.1 g/d (median alcohol consumption: 169.0 g/d; 95%CI: 179.0-203.3) were enrolled at the Salem Medical Center, University of Heidelberg. LS was measured by transient elastography (Fibroscan, Echosens SA, Paris, France). LS and serum markers were prospectively studied in these patients with all stages of alcoholic liver disease (steatosis, steatohepatitis, fibrosis) prior and after alcohol detoxification with a mean observation interval of 6.2 ± 3.2 d. A liver biopsy with histological analysis including the Kleiner score was obtained in 80 patients.
RESULTS The PNPLA3 rs738409 genotype distribution for CC, CG and GG was 39.2%, 52.6% and 8.2%. GG genotype primarily correlated with histological steatohepatitis (r = 0.404, P < 0.005), ballooning (r = 0.319, P < 0.005) and less with steatosis (r = 0.264, P < 0.05). Mean LS was lowest in CC carriers (13.1 kPa) as compared to CG and GG carriers (17.6 and 17.2 kPa). Notably, LS primarily correlated with fibrosis stage (r = 0.828, P < 0.005), ballooning (r = 0.516, P < 0.005), steatohepatitis (r = 0.319, P < 0.005) but not with steatosis. After alcohol withdrawal, LS did not change in CC carriers, significantly decreased in CG-carriers from 17.6 to 12.7 kPa but to a lesser extent in GG carriers from 17.6 to 14.5 kPa. This was due to prolonged resolution of inflammation with significantly elevated aspartate transaminase levels after alcohol withdrawal in GG carriers. Non-invasive fibrosis assessment by LS in all patients showed a significantly higher F0 rate as compared to the biopsy cohort (47% vs 6%) with 3.8% more CC carriers while 3.7% less were seen in the F4 cirrhosis group. Thus, about 20% of patients with alcoholic liver cirrhosis would be attributable to PNPLA3 G variants. The OR to develop cirrhosis corrected for age, gender and body mass index was 1.295 (95%CI: 0.787-2.131) for CG + GG carriers.
CONCLUSION In heavy drinkers, PNPLA3 GG primarily correlates with ballooning/steatohepatitis but not steatosis resulting in a delayed inflammation-associated resolution of LS. Consequently, sustained ballooning-associated LS elevation seems to be a potential risk factor for fibrosis progression in PNPLA3 GG carriers.
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Sadeghi A, Shirvani-Dastgerdi E, Tacke F, Yagmur E, Poortahmasebi V, Poorebrahim M, Mohraz M, Hajabdolbaghi M, Rasoolinejad M, Abbasian L, Jafari R, Fakhari Z, Norouzi M, Ebrahimian A, Geravand B, Alavian SM, Jazayeri SM. HBsAg mutations related to occult hepatitis B virus infection in HIV-positive patients result in a reduced secretion and conformational changes of HBsAg. J Med Virol 2016; 89:246-256. [DOI: 10.1002/jmv.24623] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Ahmadreza Sadeghi
- Hepatitis B Molecular Laboratory, Department of Virology; School of Public Health, Tehran University of Medical Sciences; Tehran Iran
| | | | - Frank Tacke
- Department of Medicine III; RWTH-University Hospital Aachen; Aachen Germany
| | - Eray Yagmur
- Laboratory Diagnostics Center; RWTH-University Hospital Aachen and Medical Care Center, Dr. Stein and Colleagues; Moenchengladbach Germany
| | - Vahdat Poortahmasebi
- Hepatitis B Molecular Laboratory, Department of Virology; School of Public Health, Tehran University of Medical Sciences; Tehran Iran
| | - Mansour Poorebrahim
- Department of Medical Biotechnology; School of Advanced Technologies in Medicine, Tehran University of Medical Sciences; Tehran Iran
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS; Tehran Iran
| | | | | | | | - Rezvaneh Jafari
- Hepatitis B Molecular Laboratory, Department of Virology; School of Public Health, Tehran University of Medical Sciences; Tehran Iran
| | - Zahra Fakhari
- Hepatitis B Molecular Laboratory, Department of Virology; School of Public Health, Tehran University of Medical Sciences; Tehran Iran
| | - Mehdi Norouzi
- Hepatitis B Molecular Laboratory, Department of Virology; School of Public Health, Tehran University of Medical Sciences; Tehran Iran
| | - Arefeh Ebrahimian
- Hepatitis B Molecular Laboratory, Department of Virology; School of Public Health, Tehran University of Medical Sciences; Tehran Iran
| | - Babak Geravand
- Hepatitis B Molecular Laboratory, Department of Virology; School of Public Health, Tehran University of Medical Sciences; Tehran Iran
| | | | - Seyed Mohammad Jazayeri
- Hepatitis B Molecular Laboratory, Department of Virology; School of Public Health, Tehran University of Medical Sciences; Tehran Iran
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Bernuth S, Yagmur E, Schuppan D, Sprinzl MF, Zimmermann A, Schad A, Kittner JM, Weyer V, Knapstein J, Schattenberg JM, Wörns MA, Galle PR, Zimmermann T. Early changes in dynamic biomarkers of liver fibrosis in hepatitis C virus-infected patients treated with sofosbuvir. Dig Liver Dis 2016; 48:291-7. [PMID: 26514736 DOI: 10.1016/j.dld.2015.09.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/08/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis C is a major cause of liver-associated mortality caused by decompensated cirrhosis and hepatocellular carcinoma. With the approval of sofosbuvir, therapeutic efficacy has markedly increased. Early changes in non-invasive biomarkers of liver fibrosis under effective antiviral therapy are widely unknown. AIM To evaluate early changes of fibrosis markers determined by enhanced liver fibrosis (ELF) scores and liver stiffness measurement (FibroScan(®)) in patients treated with sofosbuvir. METHODS A total of 32 hepatitis C patients treated prospectively with sofosbuvir were included. The ELF-panel and FibroScan measurements were performed at baseline, week 4, end-of-treatment and 12 weeks thereafter. RESULTS Antiviral therapy resulted in a biochemical and virological response within 4 weeks. Sustained virological response rate at 12-week follow-up (SVR12) was 93.8%; there was a significantly decrease from baseline to 12-week post-treatment follow-up in ELF (10.00 vs. 9.37; p=0.007) and FibroScan (8.0 vs. 6.8 kPa; p=0.016) measurements, indicating improvement of the dynamics of liver fibrosis. CONCLUSION We observed a rapid decrease in non-invasive fibrosis markers measured by ELF-scores and FibroScan in hepatitis C-infected patients receiving sofosbuvir treatment. These initial results need to be histologically confirmed by liver biopsy in the future.
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Affiliation(s)
- Sebastian Bernuth
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Eray Yagmur
- Laboratory Diagnostics Center, RWTH-University Hospital Aachen, Aachen and Medical Care Center, Dr. Stein and Colleagues, Mönchengladbach, Germany
| | - Detlef Schuppan
- Institute of Translational Immunology, University Medical Center Mainz, Germany
| | - Martin F Sprinzl
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Anca Zimmermann
- Department of Endocrinology and Metabolic Diseases, University Medical Center Mainz, Germany
| | - Arno Schad
- Institute of Pathology, Johannes Gutenberg University Mainz, Germany
| | - Jens M Kittner
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Veronika Weyer
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Germany
| | - Johanna Knapstein
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Jörn M Schattenberg
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Marcus A Wörns
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Peter R Galle
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany
| | - Tim Zimmermann
- First Department of Medicine, Cirrhosis Center Mainz (CCM), Johannes Gutenberg University Mainz, Germany.
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Shirvani-Dastgerdi E, Pourkarim MR, Herbers U, Amini-Bavil-Olyaee S, Yagmur E, Alavian SM, Trautwein C, Tacke F. Hepatitis delta virus facilitates the selection of hepatitis B virus mutants in vivo and functionally impacts on their replicative capacity in vitro. Clin Microbiol Infect 2015; 22:98.e1-98.e6. [PMID: 26433026 DOI: 10.1016/j.cmi.2015.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/07/2015] [Accepted: 09/19/2015] [Indexed: 02/06/2023]
Abstract
To identify molecular interactions between hepatitis B virus (HBV) and hepatitis delta virus (HDV), HBV sequences were analysed in HBV/HDV-infected patients. Characteristic amino acid substitutions were found in cytosolic domains of hepatitis B surface antigen (HBsAg), in contrast to HBV-mono-infected controls. The functional impact of HDV on the replication of wild-type and mutant HBV was assessed in vitro. HDV co-transfection significantly reduced the replication of HBV strains containing precore or basal core promoter mutations, and HBV polymerase or surface antigen mutants affected HDV replication in vitro. Conclusively, our study revealed distinct HBsAg mutational patterns in HBV/HDV-infected patients and novel functional interactions between HBV and HDV.
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Affiliation(s)
| | - M R Pourkarim
- Department of Microbiology and Immunology, Laboratory of Clinical and Epidemiological Virology, Rega Institute for Medical Research, KU Leuven, Belgium; Blood Transfusion Research Centre, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - U Herbers
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - S Amini-Bavil-Olyaee
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Harlyne J. Norris Cancer Research Tower, Los Angeles, CA, USA
| | - E Yagmur
- Medical Care Centre, Dr Stein and Colleagues, Mönchengladbach, Germany
| | - S M Alavian
- Baqiyatallah Research Centre for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - C Trautwein
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
| | - F Tacke
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany.
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20
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Rausch V, Straub BK, Peccerella T, Pawella LM, Lackner C, Yagmur E, Stickel F, Herzig S, Seitz HK, Longerich, T, Mueller S. FOC5-2PRIMARY HEPATOCELLULAR DAMAGE AND SUPPRESSED FAT MOBILIZATION IN HEAVY DRINKERS WITH PNPLA3 G GENOTYPE. Alcohol Alcohol 2015. [DOI: 10.1093/alcalc/agv079.16] [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: 11/12/2022] Open
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21
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Rausch V, Katharina Straub B, Peccerella T, Pawella LM, Lackner, C, Yagmur E, Stickel F, Herzig S, Seitz H, Longerich T, Mueller S. SY14-4PRIMARY HEPATOCELLULAR DAMAGE AND SUPPRESSED FAT MOBILIZATION IN HEAVY DRINKERS WITH PNPLA3 G GENOTYPE. Alcohol Alcohol 2015. [DOI: 10.1093/alcalc/agv076.59] [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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22
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Asimakopoulou A, Borkham-Kamphorst E, Henning M, Yagmur E, Gassler N, Liedtke C, Berger T, Mak TW, Weiskirchen R. Lipocalin-2 (LCN2) regulates PLIN5 expression and intracellular lipid droplet formation in the liver. Biochim Biophys Acta Mol Cell Biol Lipids 2014; 1842:1513-24. [PMID: 25086218 DOI: 10.1016/j.bbalip.2014.07.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/17/2014] [Accepted: 07/22/2014] [Indexed: 01/14/2023]
Abstract
Lipocalin-2 (LCN2) belongs to the superfamily of lipocalins and plays critical roles in the control of cellular homeostasis during inflammation and in responses to cellular stress or injury. In the liver, LCN2 triggers protective effects following acute or chronic injury, and its expression is a reliable indicator of liver damage. However, little is known about LCN2's functions in the homeostasis and metabolism of hepatic lipids or in the development of steatosis. In this study, we fed wild type (WT) and LCN2-deficient (Lcn2(-/-)) mice a methionine- and choline-deficient (MCD) diet as a nutritional model of non-alcoholic steatohepatitis, and compared intrahepatic lipid accumulation, lipid droplet formation, mitochondrial content, and expression of the Perilipin proteins that regulate cellular lipid metabolism. We found that Lcn2(-/-) mice fed an MCD diet accumulated more lipids in the liver than WT controls, and that the basal expression of the lipid droplet coat protein Perilipin 5 (PLIN5, also known as OXPAT) was significantly reduced in these animals. Similarly, the overexpression of LCN2 and PLIN5 were also found in animals that were fed with a high fat diet. Furthermore, the loss of LCN2 and/or PLIN5 in hepatocytes prevented normal intracellular lipid droplet formation both in vitro and in vivo. Restoration of LCN2 in Lcn2(-/-) primary hepatocytes by either transfection or adenoviral vector infection induced PLIN5 expression and restored proper lipid droplet formation. Our data indicate that LCN2 is a key modulator of hepatic lipid homeostasis that controls the formation of intracellular lipid droplets by regulating PLIN5 expression. LCN2 may therefore represent a novel therapeutic drug target for the treatment of liver diseases associated with elevated fat accumulation and steatosis.
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Affiliation(s)
- Anastasia Asimakopoulou
- Institute of Clinical Chemistry and Pathobiochemistry, RWTH University Hospital Aachen, Aachen, Germany
| | - Erawan Borkham-Kamphorst
- Institute of Clinical Chemistry and Pathobiochemistry, RWTH University Hospital Aachen, Aachen, Germany
| | - Marc Henning
- Institute of Clinical Chemistry and Pathobiochemistry, RWTH University Hospital Aachen, Aachen, Germany
| | - Eray Yagmur
- MVZ Medical Laboratory Center, Dr. Stein and Partner, Mönchengladbach, Germany
| | - Nikolaus Gassler
- Institute of Pathology, RWTH University Hospital Aachen, Aachen, Germany
| | - Christian Liedtke
- Department of Internal Medicine III, RWTH University Hospital Aachen, Aachen, Germany
| | - Thorsten Berger
- The Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, ON, Canada
| | - Tak W Mak
- The Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, ON, Canada; Ontario Cancer Institute, University Health Network, Toronto, ON, Canada
| | - Ralf Weiskirchen
- Institute of Clinical Chemistry and Pathobiochemistry, RWTH University Hospital Aachen, Aachen, Germany.
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Tacke F, Galm O, Kanig N, Yagmur E, Brandt S, Lindquist JA, Eberhardt CS, Raffetseder U, Mertens PR. High prevalence of Y-box protein-1/p18 fragment in plasma of patients with malignancies of different origin. BMC Cancer 2014; 14:33. [PMID: 24443788 PMCID: PMC3909385 DOI: 10.1186/1471-2407-14-33] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 10/31/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Expression of the cold shock protein Y-box protein 1 (YB-1) is associated with deleterious outcome in various malignant diseases. Our group recently showed that the detection of an 18 kDa YB-1 fragment (YB-1/p18) in human plasma identifies patients with malignant diseases. We now tested the prevalence, clinical, and diagnostic value of YB-1/p18 detection in common tumors. METHODS A newly established monoclonal YB-1 antibody was used to detect YB-1/p18 by immunoblotting in plasma samples from 151 unselected tumor patients, alongside established tumor markers and various diagnostic measures, during evaluation for a cancerous disease and in follow-up studies after therapeutic interventions. RESULTS Circulating YB-1/p18 was detected in 78% of patients having a tumor disease. YB-1/p18 positivity was highly prevalent in all examined malignancies, including lung cancer (32/37; 87%), breast cancer (7/10; 70%), cancer of unknown primary (CUP; 5/5, 100%) or hematological malignancies (42/62; 68%). Positivity for YB-1/p18 was independent of other routine laboratory parameters, tumor stage, or histology. In comparison to 13 established tumor markers (cancer antigens 15-3, 19-9, 72-4, and 125; carcinoembryonic antigen; cytokeratin fragments 21-1; neuron-specific enolase; alpha-fetoprotein; beta-2-microglobulin; squamous cell carcinoma antigen; thymidine kinase; tissue polypeptide antigen; pro-gastrin-releasing peptide), YB-1/p18 detection within serum samples was the most sensitive general parameter identifying malignant disorders. YB-1/p18 concentrations altered during therapeutic interventions, but did not predict prognosis. CONCLUSIONS Plasma YB-1/p18 detection has a high specific prevalence in malignancies, thereby providing a novel tool for cancer screening independent of the tumor origin.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Peter R Mertens
- Department of Nephrology and Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Leipziger Str, 44, 39120 Magdeburg, Germany.
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Wawrzynowicz-Syczewska M, Laurans L, Jurczyk K, Lachtara M, Kornak D, Dooley S, Hofmann S, Rakoczy P, Breitkopf-Heinlein K, Meyer C, Stickel F, Patsenker E, Buch S, Hampe J, Datz C, Seitz H, Trabut JB, Gagni C, Patel V, Mueller S, Rausch V, Peccerella T, Seitz H, Stickel F, Yagmur E, Herzig S, Longerich T, Mueller S, Yagmur E, Seitz H, Stickel F, Longerich T, Bantel H, Houchi H, Nguyen-Khac E, Dreher ML, Naassila M, Borodinsky A, Razvodovsky Y. ALCOHOL LIVER DISEASE. Alcohol Alcohol 2013. [DOI: 10.1093/alcalc/agt116] [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: 11/12/2022] Open
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Mueller S, Yagmur E, Stickel F, Seitz HK, Longerich T, Bantel H. M65 is a highly sensitive marker of alcoholic steatohepatitis. Z Gastroenterol 2013. [DOI: 10.1055/s-0033-1352767] [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] [Indexed: 02/07/2023]
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Rausch V, Peccerella T, Seitz HK, Stickel F, Yagmur E, Herzig S, Mueller S. Histological hepatocyte damage precedes steatosis in ALD patients with genetic variant l148 M in PNPLA3. Z Gastroenterol 2013. [DOI: 10.1055/s-0033-1352758] [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] [Indexed: 12/24/2022]
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Lynch C, Tee N, Rouse H, Gordon A, Sati L, Zeiss C, Soygur B, Bassorgun I, Goksu E, Demir R, McGrath J, Groendahl ML, Thuesen L, Andersen AN, Loft A, Smitz J, Adriaenssens T, Vikesa J, Borup R, Mersy E, Kisters N, Macville MVE, Engelen JJM, Consortium SENN, Menheere PPCA, Geraedts JP, Coumans ABC, Frints SGM, Aledani T, Assou S, Traver S, Ait-ahmed O, Dechaud H, Hamamah S, Mizutani E, Suzumori N, Sugiyama C, Hattori Y, Sato T, Ando H, Ozaki Y, Sugiura-Ogasawara M, Wissing M, Kristensen SG, Andersen CY, Mikkelsen AL, Hoest T, Borup R, Groendahl ML, Velthut-Meikas A, Simm J, Metsis M, Salumets A, Palini S, Galluzzi L, De Stefani S, Primiterra M, Wells D, Magnani M, Bulletti C, Vogt PH, Frank-Herrmann P, Bender U, Strowitzki T, Besikoglu B, Heidemann P, Wunsch L, Bettendorf M, Jelinkova L, Vilimova S, Kosarova M, Sebek P, Volemanova E, Kruzelova M, Civisova J, Svobodova L, Sobotka V, Mardesic T, van de Werken C, Santos MA, Eleveld C, Laven JSE, Baart EB, Pylyp LY, Spinenko LA, Zukin VD, Perez-Sanz J, Matorras R, Arluzea J, Bilbao J, Gonzalez-Santiago N, Yeh N, Koff A, Barlas A, Romin Y, Manova-Todorova K, Hoz CDL, Mauri AL, Nascimento AM, Vagnini LD, Petersen CG, Ricci J, Massaro FC, Cavagna M, Pontes A, Oliveira JBA, Baruffi RLR, Franco JG, Wu EX, Ma S, Parriego M, Sole M, Boada M, Coroleu B, Veiga A, Kakourou G, Poulou M, Vrettou C, Destouni A, Traeger-Synodinos J, Kanavakis E, Yatsenko AN, Georgiadis AP, McGuire MM, Zorrilla M, Bunce KD, Peters D, Rajkovic A, Olszewska M, Kurpisz M, Gilbertson AZA, Ottolini CS, Summers MC, Sage K, Handyside AH, Thornhill AR, Griffin DK, Chung MK, Kim JW, Lee JH, Jeong HJ, Kim MH, Ryu MJ, Park SJ, Kang HY, Lee HS, Zimmermann B, Banjevic M, Hill M, Lacroute P, Dodd M, Sigurjonsson S, Lau P, Prosen D, Chopra N, Ryan A, Hall M, McAdoo S, Demko Z, Levy B, Rabinowitz M, Vereczeky A, Kosa ZS, Savay S, Csenki M, Nanassy L, Dudas B, Domotor ZS, Debreceni D, Rossi A, Alegretti JR, Cuzzi J, Bonavita M, Tanada M, Matunaga P, Fettback P, Rosa MB, Maia V, Hassun P, Motta ELA, Piccolomini M, Gomes C, Barros B, Nicoliello M, Matunaga P, Criscuolo T, Bonavita M, Alegretti JR, Miyadahira E, Cuzzi J, Hassun P, Motta ELA, Montjean D, Benkhalifa M, Berthaut I, Griveau JF, Morcel K, Bashamboo A, McElreavey K, Ravel C, Rubio C, Rodrigo L, Mateu E, Mercader A, Peinado V, Buendia P, Milan M, Delgado A, Al-Asmar N, Escrich L, Campos-Galindo I, Garcia-Herrero S, Poo ME, Mir P, Simon C, Reyes-Engel A, Cortes-Rodriguez M, Lendinez A, Perez-Nevot B, Palomares AR, Galdon MR, Ruberti A, Minasi MG, Biricik A, Colasante A, Zavaglia D, Iammarrone E, Fiorentino F, Greco E, Demir N, Ozturk S, Sozen B, Morales R, Lledo B, Ortiz JA, Ten J, Llacer J, Bernabeu R, Nagayoshi M, Tanaka A, Tanaka I, Kusunoki H, Watanabe S, Temel SG, Beyazyurek C, Ekmekci GC, Aybar F, Cinar C, Kahraman S, Nordqvist S, Karehed K, Akerud H, Ottolini CS, Griffin DK, Thornhill AR, Handyside AH, Gultomruk M, Tulay P, Findikli N, Yagmur E, Karlikaya G, Ulug U, Bahceci M, Bargallo MF, Arevalo MR, Salat MM, Barbat IV, Lopez JT, Algam ME, Boluda AB, de Oya GC, Tolmacheva EN, Kashevarova AA, Skryabin NA, Lebedev IN, Semaco E, Belo A, Riboldi M, Cuzzi J, Barros B, Luz L, Criscuolo T, Nobrega N, Matunaga P, Mazetto R, Alegretti JA, Bibancos M, Hassun P, Motta ELA, Serafini P, Neupane J, Vandewoestyne M, Heindryckx B, Deroo T, Lu Y, Ghimire S, Lierman S, Qian C, Deforce D, De Sutter P, Rodrigo L, Rubio C, Mateu E, Peinado V, Milan M, Viloria T, Al-Asmar N, Mercader A, Buendia P, Delgado A, Escrich L, Martinez-Jabaloyas JM, Simon C, Gil-Salom M, Capalbo A, Treff N, Cimadomo D, Tao X, Ferry K, Ubaldi FM, Rienzi L, Scott RT, Katzorke N, Strowitzki T, Vogt HP, Hehr A, Gassner C, Paulmann B, Kowalzyk Z, Klatt M, Krauss S, Seifert D, Seifert B, Hehr U, Minasi MG, Ruberti A, Biricik A, Lobascio M, Zavaglia D, Varricchio MT, Fiorentino F, Greco E, Rubino P, Bono S, Cotarelo RP, Spizzichino L, Biricik A, Colicchia A, Giannini P, Fiorentino F, Suhorutshenko M, Rosenstein-Tamm K, Simm J, Salumets A, Metsis M. Reproductive (epi)genetics. Hum Reprod 2013. [DOI: 10.1093/humrep/det220] [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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Yagmur E, Frank RD, Neulen J, Floege J, Mühlfeld AS. Platelet Hyperaggregability is Highly Prevalent in Patients With Chronic Kidney Disease. Clin Appl Thromb Hemost 2013; 21:132-8. [DOI: 10.1177/1076029613490828] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Platelet hyperaggregation is known to be associated with arterial and venous thromboembolic events. The prevalence of platelet hyperaggregation in patients with chronic kidney disease (CKD) has not been described to date. Methods: Platelet hyperaggregation in patients with renal disease was defined by comparison of platelet aggregation patterns to non-CKD patients without thromboembolic disorders and healthy controls. Results: Among the 30 hemodialysis patients and 34 renal transplant recipients, 20 (67%) and 28 (82%) showed significantly decreased median Δ-epinephrine aggregation and increased 0.5 mol/L epinephrine response (65% and 54%) compared to healthy controls and non-CKD patients. In concordance to the laboratory finding of platelet hyperaggregability, renal transplant recipients showed a high rate of thromboembolic events (normal platelet aggregation: 0 events and platelet hyperaggregation: 30 events in 13 of 28 patients). Conclusions: Patients with CKD exhibit a hitherto unappreciated high prevalence of platelet hyperaggregability indicating sticky platelet syndrome. Laboratory testing of platelet hyperaggregability may supplement the assessment of thromboembolic complications in patients with CKD.
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Affiliation(s)
- Eray Yagmur
- Laboratory Diagnostics Center, RWTH-University Hospital Aachen, Aachen and Medical Care Center, Dr Stein and colleagues, Mönchengladbach, Germany
| | - Rolf Dario Frank
- Clinic for Internal Medicine and Clinical Intensive Care Medicine, Sankt Antonius Hospital Eschweiler, Eschweiler, Germany
| | - Joseph Neulen
- Department of Gynecological Endocrinology and Reproductive Medicine, RWTH-University Hospital Aachen, Aachen, Germany
| | - Jürgen Floege
- Division of Nephrology and Clinical Immunology, RWTH-University Hospital Aachen, Aachen, Germany
| | - Anja Susanne Mühlfeld
- Division of Nephrology and Clinical Immunology, RWTH-University Hospital Aachen, Aachen, Germany
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Yagmur E, Koch A, Jadem J, Tacke F. Effektive Glykolyse-Inhibierung in venösem Vollblut durch Azidifikation des Fluorid Additivs. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Koch A, Zimmermann HW, Baeck C, Schneider C, Yagmur E, Trautwein C, Tacke F. Serum NT-proCNP concentrations are elevated in patients with chronic liver diseases and associated with complications and unfavorable prognosis of cirrhosis. Clin Biochem 2012; 45:429-35. [PMID: 22285383 DOI: 10.1016/j.clinbiochem.2012.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/23/2011] [Accepted: 01/08/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVES C-type natriuretic peptide (CNP) might be an important regulator of vasodilatation, fluid and sodium balance in liver cirrhosis. We aimed at assessing its regulation and prognostic relevance in liver disease patients. DESIGN AND METHODS We analyzed NT-proCNP serum levels in 193 patients with chronic liver diseases and 43 healthy controls. RESULTS Serum NT-proCNP concentrations were significantly elevated in liver disease patients compared to healthy controls, with highest levels in established hepatic cirrhosis, independent of disease etiology. NT-proCNP was associated with complications of liver diseases and portal hypertension, namely ascites, esophageal varices and hepatic encephalopathy. Circulating NT-proCNP correlated inversely with renal function. Importantly, elevated NT-proCNP levels were identified as a predictor of mortality or necessity for transplantation. NT-proCNP levels >2 pmol/L indicated adverse prognosis (sensitivity 66.7%, specificity 72.8%, RR 5.4 [95%-CI 2.6-11.2]). CONCLUSIONS Serum NT-proCNP is elevated in advanced liver diseases and has prognostic value in cirrhotic patients.
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Affiliation(s)
- Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Yagmur E, Koch A, Haumann M, Kramann R, Trautwein C, Tacke F. Hyaluronan serum concentrations are elevated in critically ill patients and associated with disease severity. Clin Biochem 2012; 45:82-7. [DOI: 10.1016/j.clinbiochem.2011.10.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 12/18/2022]
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Koch A, Horn A, Dückers H, Yagmur E, Sanson E, Bruensing J, Buendgens L, Voigt S, Trautwein C, Tacke F. Increased liver stiffness denotes hepatic dysfunction and mortality risk in critically ill non-cirrhotic patients at a medical ICU. Crit Care 2011; 15:R266. [PMID: 22082207 PMCID: PMC3388655 DOI: 10.1186/cc10543] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/04/2011] [Accepted: 11/14/2011] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hepatic dysfunction is a common finding in critically ill patients on the ICU and directly influences survival. Liver stiffness can be measured by the novel method of transient elastography (fibroscan) and is closely associated with hepatic fibrosis in patients with chronic liver disease, but also is increased in patients with acute hepatitis, acute liver failure and cholestasis. We investigated liver stiffness as a potentially useful tool for early detection of patients with hepatic deterioration and risk stratification with respect to short- and long-term mortality. METHODS We prospectively evaluated 108 consecutive critically ill patients at our medical intensive care unit (ICU) with subsequent longitudinal liver stiffness measurements (admission, Day 3, Day 7 and weekly thereafter) during the course of ICU treatment. Outcome was followed after discharge (median observation time 237 days). RESULTS Liver stiffness could be reliably measured in 71% of ICU patients at admission (65% at Day 3, 63% at Day 7). Critically ill patients (n = 108) had significantly increased liver stiffness compared to sex- and age-matched standard care patients (n = 25). ICU patients with decompensated cirrhosis showed highest liver stiffness, whereas other critical diseases (for example, sepsis) and comorbidities (for example, diabetes, obesity) did not impact stiffness values. At admission to the ICU, liver stiffness is closely related to hepatic damage (liver synthesis, cholestasis, fibrosis markers). During the course of ICU treatment, fluid overload (renal failure, volume therapy) and increased central venous pressure (mechanical ventilation, heart failure) were major factors determining liver stiffness. Liver stiffness values > 18 kilopascal (kPa) at ICU admission were associated with increased ICU and long-term mortality, even in non-cirrhotic patients. CONCLUSIONS Considering that liver stiffness cannot be validly measured in about 30% of ICU patients, transient elastography performed at ICU admission might be a useful tool to early identify liver dysfunction and predict mortality in critically ill patients at a medical ICU.
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Affiliation(s)
- Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Koch A, Voigt S, Kruschinski C, Sanson E, Dückers H, Horn A, Yagmur E, Zimmermann H, Trautwein C, Tacke F. Circulating soluble urokinase plasminogen activator receptor is stably elevated during the first week of treatment in the intensive care unit and predicts mortality in critically ill patients. Crit Care 2011; 15:R63. [PMID: 21324198 PMCID: PMC3221996 DOI: 10.1186/cc10037] [Citation(s) in RCA: 228] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 12/18/2010] [Accepted: 02/16/2011] [Indexed: 12/12/2022]
Abstract
INTRODUCTION suPAR is the soluble form of the urokinase plasminogen activator receptor (uPAR), which is expressed in various immunologically active cells. High suPAR serum concentrations are suggested to reflect the activation of the immune system in circumstances of inflammation and infection, and have been associated with increased mortality in different populations of non-intensive care patients. In this study we sequentially analyzed suPAR serum concentrations within the first week of intensive care in a large cohort of well characterized intensive care unit (ICU) patients, in order to investigate potential regulatory mechanisms and evaluate the prognostic significance in critically ill patients. METHODS A total of 273 patients (197 with sepsis, 76 without sepsis) were studied prospectively upon admission to the medical intensive care unit (ICU), on Day 3 and Day 7, and compared to 43 healthy controls. Clinical data, various laboratory parameters as well as investigational inflammatory cytokine profiles were assessed. Patients were followed for approximately one year. RESULTS Upon admission to the ICU suPAR serum concentrations were elevated in critically ill patients as compared with healthy controls. In sepsis patients suPAR levels were higher than in non-sepsis patients (with or without systemic inflammatory response syndrome (SIRS)). During the first week after admission to the ICU serum suPAR concentrations remained stably elevated. suPAR serum concentrations measured upon admission were closely and independently correlated to various laboratory parameters, specifically biomarkers of inflammation (tumor necrosis factor (TNF), C-reactive protein (CRP)), hepatic and renal dysfunction. High suPAR levels at admission and at Day 3 were a strong independent predictor for both ICU and long-term mortality in critically ill patients. CONCLUSIONS In sepsis and non-sepsis patients suPAR serum concentrations are increased upon admission to the ICU, likely reflecting the activation state of the immune system, and remain stably elevated in the initial course of treatment. Low suPAR levels are a positive predictor of ICU- and overall survival in critically ill patients, including sepsis and non-sepsis patients. Aside from its value as a promising new prognostic biomarker, both experimental and clinical studies are required in order to understand the specific effects and regulatory mechanisms of suPAR in SIRS and sepsis, and may reveal new therapeutic options.
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Affiliation(s)
- Alexander Koch
- Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Berres ML, Schnyder B, Yagmur E, Inglis B, Stanzel S, Tischendorf JJW, Koch A, Winograd R, Trautwein C, Wasmuth HE. Longitudinal monocyte human leukocyte antigen-DR expression is a prognostic marker in critically ill patients with decompensated liver cirrhosis. Liver Int 2009; 29:536-43. [PMID: 18795898 DOI: 10.1111/j.1478-3231.2008.01870.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [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: 12/20/2022]
Abstract
BACKGROUND Critical illness in cirrhotic patients is associated with a poor prognosis and increased susceptibility to infections. Monocyte HLA-DR expression is decreased in cirrhotic patients, but its prognostic value has not been investigated prospectively. METHODS Thirty-eight critically ill patients with decompensated liver cirrhosis were included in this prospective study. On admission to the intensive care unit (ICU), inflammatory parameters (C-reactive protein, procalcitonin and lipopolysaccharide-binding protein), interleukin (IL)-10, interferon (IFN)-gamma serum levels, tumour necrosis factor (TNF)-alpha ex vivo stimulation (whole blood assay) and HLA-DR expression on monocytes (FACS analysis) were determined. Immune parameters were furthermore measured every third day until discharge from the ICU or death of the patients. RESULTS Intensive care unit mortality of the cirrhotic patients was 34.2%. During admission, TNF ex vivo, IFN-gamma and HLA-DR expression were lower in non-survivors (all P<0.05), while IL-10 levels were increased in non-survivors compared with survivors (P=0.001). However, individual values clearly overlapped between groups. Prospective analysis revealed that monocyte HLA-DR expression remained stable or increased in survivors, but decreased in non-survivors (P=0.002). A decrease in HLA-DR expression between admission and day 3 was strongly associated with decreased IFN-gamma levels and increased ICU mortality (hazard ratio 3.36, P=0.008), mostly owing to late sepsis. This association was independent of the sequential organ failure assessment and model for end-stage liver disease score. CONCLUSIONS Here we establish the relative HLA-DR expression (admission/day 3) as a prognostic marker for ICU mortality in critically ill cirrhotic patients. These results may guide the evaluation of immune-modulating therapies in these patients.
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Affiliation(s)
- Marie-Luise Berres
- Medical Department III, University Hospital Aachen, Aachen University, Aachen, Germany
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Hütten M, Kohne E, Yagmur E, Schaible T, Wenzl T, Wagner N, Heimann K. Persistent Cyanosis in a 4 Month Old Infant with Severe Pneumonia and Haemoglobin M. Klin Padiatr 2009; 221:305-7. [DOI: 10.1055/s-0028-1104597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schlieper G, Hristov M, Brandenburg V, Kruger T, Westenfeld R, Mahnken AH, Yagmur E, Boecker G, Heussen N, Gladziwa U, Ketteler M, Weber C, Floege J. Predictors of low circulating endothelial progenitor cell numbers in haemodialysis patients. Nephrol Dial Transplant 2008; 23:2611-8. [DOI: 10.1093/ndt/gfn103] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Kreitschmann-Andermahr I, Poll E, Reineke A, Langejürgen Y, Yagmur E, Gilsbach J, Saller B. Diagnosing Neuroendocrine Dysfunction in Patients after Aneurysmal Subarachnoid Hemorrhage in Clinical Practice - Does Basal Hormone Screening Make Sense? Exp Clin Endocrinol Diabetes 2008; 116:276-81. [DOI: 10.1055/s-2007-1004552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pecks U, Bartz C, Schwamborn K, Yagmur E, Stepan H, Schmidt M, Schlembach D, Rath W. MALDI TOF Massenspektrometrie zur Diagnostik der Präeklampsie und der Vergleich mit den Serummarkern PlGF, sFlt1 und Endoglin. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1075777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tischendorf JJW, Yagmur E, Scholten D, Vidacek D, Koch A, Winograd R, Gressner AM, Trautwein C, Wasmuth HE, Lammert F. The interleukin-6 (IL6)-174 G/C promoter genotype is associated with the presence of septic shock and the ex vivo secretion of IL6. Int J Immunogenet 2008; 34:413-8. [PMID: 18001296 DOI: 10.1111/j.1744-313x.2007.00712.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Septic shock is associated with a high mortality and an excessive activation of immune cascades. Interleukin (IL)-6 has been found to be a key cytokine in the pathogenesis of severe sepsis, but the importance of a regulatory polymorphism within the IL6 promoter has been controversial in these patients. The aim of the study was therefore to systematically investigate the IL6-174 G/C promoter genotype with regard to the presence of shock in patients with sepsis, the IL6 serum levels, and the ex vivo secretion of IL6, respectively. Overall, 112 consecutive subjects with severe sepsis and septic shock according to consensus criteria were enrolled. The ex vivo secretion of IL6 after stimulation with lipopolysaccharide (LPS) in a whole blood assay and the IL6 serum concentrations were determined after admission of the patients. Among the 112 subjects with severe sepsis, 85 patients fulfilled the criteria of septic shock. In these patients, the frequency of the mutated C-allele of the IL6 promoter polymorphism was significantly (P = 0.04) higher compared to that in individuals without shock. IL6 serum concentrations were highest in patients with the GG genotype (mean 2209 pg mL(-1)), followed by CG genotype (mean 1113 pg mL(-1)), and lowest in individuals with the CC genotype (mean 256 pg mL(-1)). Interestingly, a significantly (P = 0.005) higher ex vivo secretion of IL6 is detected in heterozygote individuals (535 pg mL(-1)) and patients with the IL6 CC genotype (555 pg mL(-1)) compared to patients with the -174 GG genotype (276 pg mL(-1)). In conclusion, the IL6-174 G/C promoter genotype is associated with shock in patients with sepsis. Functionally, the mutated C-allele is correlated with low IL6 serum concentrations, but a high ex vivo secretion after LPS stimulation. These results further indicate a complex regulation of the expression of IL6 during infection and have implications for the design of immune intervention trials.
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Affiliation(s)
- J J W Tischendorf
- Department of Medicine III, University Hospital Aachen, Aachen University (RWTH), Aachen, Germany
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Blindt R, Stellbrink K, de Taeye A, Müller R, Kiefer P, Yagmur E, Weber C, Kelm M, Hoffmann R. The significance of vasodilator-stimulated phosphoprotein for risk stratification of stent thrombosis. Thromb Haemost 2007; 98:1329-1334. [PMID: 18064332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Low-response to the P2Y12 adenosine diphosphate (ADP)-receptor antagonist clopidogrel was suggested to correspond to a higher incidence of stent thrombosis (ST). This prospective observational study assessed the capability of two platelet function assays, e.g. direct measurement of the phosphorylation status of vasodilator-stimulated phosphoprotein (VASP) and ADP-induced platelet aggregation for definition of the individual risk to develop ST. Ninety-nine patients with an elevated high risk to develop ST were enrolled. All patients received a dual antiplatelet therapy consisting of 100 mg aspirin and 75 mg clopidogrel during an observation period of six months. Flow cytometry of VASP phosphorylation and densitometrically-determined measurement of ADP-induced platelet aggregation was performed 72-96 hours after stent implantation. These data were related to angiographically confirmed ST. Nine patients suffered from angiographically confirmed ST (9.1%). The meanVASP-platelet reactivity indices (VASP-PRI) and values for ADP-induced platelet aggregation in the ST group were significantly higher (60.8 +/- 13.0 and 60.9 +/- 13.1, respectively) compared to patients without ST (41.3 +/- 14.0 and 50.8 +/- 14.4, P < 0.001 vs. 0.048, respectively). There was a fair correlation between both methods using non-linear regression analysis (r = 0.332). In a multivariate analysis, VASP was the only independent predictor of ST and was superior to previously identified angiographic parameters. Receiver- operator characteristic (ROC) curve analysis revealed a cut-off value for VASP-PRI of <48% to be associated with low risk of ST. In conclusion, determination of VASP phosphorylation is superior to conventional platelet aggregometry and angiographic parameters for assessing the risk of ST. Patients with a VASP-PRI >48% seem to have a significantly increased risk.
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Affiliation(s)
- Rüdiger Blindt
- Department of Cardiology, University Hospital Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
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Miehe U, Krieg RC, Bartz C, Yagmur E, Gressner AM, Stepan H, Rath W. Potential diagnostic value of serum proteome profiling with MALDI-TOF-MS and the suggested serum markers sFlt-1, PlGF and Endoglin in patients with preeclampsia. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1032345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yagmur E, Rizk M, Stanzel S, Hellerbrand C, Lammert F, Trautwein C, Wasmuth HE, Gressner AM. Elevation of endoglin (CD105) concentrations in serum of patients with liver cirrhosis and carcinoma. Eur J Gastroenterol Hepatol 2007; 19:755-61. [PMID: 17700260 DOI: 10.1097/meg.0b013e3282202bea] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Liver cirrhosis is considered as a premalignant state, as about 80% of hepatocellular carcinoma (HCC) is associated with liver cirrhosis. Although alpha-fetoprotein (AFP) has a high negative predictive value, its sensitivity for detecting HCC is poor. The aim of this study was to evaluate circulating endoglin (CD105) in the serum of patients with liver cirrhosis and at high risk for HCC. METHODS CD105 and AFP serum concentrations were measured in 70 healthy and 94 nonliver-diseased controls and 130 patients with chronic liver diseases and HCC, respectively. RESULTS Fifty-seven liver cirrhotic patients, 45 patients with liver cirrhosis plus HCC, 19 liver fibrosis patients and nine patients with HCC only were studied. Serum CD105 is significantly elevated in liver cirrhotic patients compared with healthy (P<0.0001) and nonliver-diseased controls (P<0.0001). Patients with liver cirrhosis and HCC show the highest CD105 concentrations being significantly elevated in comparison to liver cirrhosis (P=0.0006) and HCC only (P=0.0134). A stronger positive correlation exists between CD105 and AFP in the patient group suffering from liver cirrhosis and HCC (r=0.479, P=0.0015) than the obtained correlation between both markers in the group of patients diagnosed with liver cirrhosis alone (r=0.358, P=0.0073). The logistic regression model identified CD105 as an independent marker (P=0.0077, odds ratio 1.3). CONCLUSION CD105 has the potential to be a novel complementary biomarker that has some important bearing on the risk assessment for development of HCC in cirrhotic patients.
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Affiliation(s)
- Eray Yagmur
- Institute of Clinical Chemistry and Pathobiochemistry, RWTH-University Hospital Aachen, Germany.
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Tacke F, Trautwein C, Yagmur E, Hellerbrand C, Wiest R, Brenner DA, Schnabl B. Up-regulated eotaxin plasma levels in chronic liver disease patients indicate hepatic inflammation, advanced fibrosis and adverse clinical course. J Gastroenterol Hepatol 2007; 22:1256-64. [PMID: 17688666 DOI: 10.1111/j.1440-1746.2006.04621.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Recent studies highlight the role of chemokines for the attraction of inflammatory cells in liver injury and fibrogenesis. The CC chemokine ligand 11, eotaxin (CCL11), is up-regulated in senescent human hepatic stellate cells and crucial in animal models of T-cell mediated hepatitis. The aim of this study was to analyze the role of eotaxin in chronic liver disease. METHODS Plasma eotaxin levels of 111 patients with chronic liver disease were correlated with clinical presentation, laboratory parameters, liver histology and clinical course in a 6-year follow-up. RESULTS Eotaxin concentrations were significantly up-regulated in patients with liver cirrhosis and increased according to Child-Pugh and model of end-stage liver disease (MELD) score. Eotaxin correlated with the hepatic biosynthetic capacity and other inflammatory cytokines. High eotaxin was associated with hepatic necroinflammation and fibrosis in liver histology. In patients with typical clinical complications of cirrhosis, eotaxin was found to be increased. High eotaxin indicated an unfavorable prognosis in 6-year follow-up. CONCLUSIONS High eotaxin expression may be involved in the pathogenesis of chronic liver diseases. Plasma eotaxin levels correlate with the degree of liver cirrhosis and could serve as an additional biomarker indicating histological hepatic necroinflammation and fibrosis as well as an adverse clinical course.
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Affiliation(s)
- Frank Tacke
- Medical Clinic III, University Hospital Aachen, Aachen, Germany.
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Yagmur E, Weiskirchen R, Gressner AM, Trautwein C, Tacke F. Insulin resistance in liver cirrhosis is not associated with circulating retinol-binding protein 4. Diabetes Care 2007; 30:1168-72. [PMID: 17337499 DOI: 10.2337/dc06-2323] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Retinol-binding protein 4 (RBP4) has been identified as a novel adipokine mediating systemic insulin resistance, and elevated serum RBP4 indicates overt or impending insulin resistance in lean, obese, and type 2 diabetic subjects. As insulin resistance is present in nearly all patients with liver cirrhosis, we evaluated RBP4 in patients with chronic liver disease (CLD). RESEARCH DESIGN AND METHODS Serum RBP4 was measured in 111 CLD patients. Ninety-nine age- and sex-matched healthy blood donors served as control subjects. RBP4 gene expression was also quantified in normal and cirrhotic rat liver. RESULTS In CLD patients, serum RBP4 was significantly reduced compared with healthy control subjects and closely correlated with the stage of liver cirrhosis. CLD patients without cirrhosis showed normal RBP4 concentrations, which correlated with serum glucose and insulin secretion and inversely correlated with insulin sensitivity. In patients with Child A-C liver cirrhosis, however, RBP4 was not correlated with glucose metabolism or other adipokines, such as adiponectin or resistin, but closely linked to the hepatic biosynthetic capacity, fibrotic changes in liver histology, or clinical complications such as portal hypertension. In an animal model of experimental cirrhosis, hepatic RBP4 gene expression decreased in cirrhotic liver. CONCLUSIONS RBP4 appears, unlike in obesity or type 2 diabetes, not to be a relevant systemic factor in the pathogenesis of insulin resistance in liver cirrhosis. Liver function has a tremendous impact on RBP4 levels, and future studies will need to take liver function into account when examining serum RBP4 levels.
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Affiliation(s)
- Eray Yagmur
- Institute of Clinical Chemistry and Pathobiochemistry, RWTH-University Hospital Aachen, 52074 Aachen, Germany
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Delanghe JR, Helander A, Wielders JPM, Pekelharing JM, Roth HJ, Schellenberg F, Born C, Yagmur E, Gentzer W, Althaus H. Development and multicenter evaluation of the N latex CDT direct immunonephelometric assay for serum carbohydrate-deficient transferrin. Clin Chem 2007; 53:1115-21. [PMID: 17412797 DOI: 10.1373/clinchem.2006.084459] [Citation(s) in RCA: 61] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Carbohydrate-deficient transferrin (CDT) is a promising biomarker of alcohol abuse. We describe the development and multicenter evaluation of N Latex CDT (Dade Behring), an automated, particle-enhanced, homogeneous immunonephelometric assay for directly determining CDT. METHODS N Latex CDT uses a monoclonal antibody that recognizes the structure of transferrin glycoforms lacking 1 or 2 complete N-glycans [i.e., disialo-, monosialo-, and asialotransferrins (CDT glycoforms)] in combination with a simultaneous assay for total transferrin. The Dade Behring BN II and BN ProSpec systems automatically calculate the CDT value as a percentage of total transferrin (%CDT). No preanalytical sample treatment is used. RESULTS Total imprecision values for serum pools containing 1.8%-8.7% CDT were 3.4%-10.4% (mean, 6.8%). The mean (SD) %CDT for 561 serum samples from healthy control individuals was 1.76% (0.27%; range, 1.01%-2.85%). No marked sex or age differences were noted. The 97.5th percentile was at 2.35%. Transferrin genetic variants did not interfere with measurements. High transferrin concentrations did not falsely increase %CDT values, but increased %CDT values were noted for some samples with transferrin concentrations <1.1 g/L. N Latex CDT results correlated with those of a commercial CDT immunoassay involving column separation (r(2) = 0.862) and an HPLC candidate reference method (r(2) = 0.978). CONCLUSION N Latex CDT is the first direct immunoassay for quantifying %CDT in serum. The specificity of N Latex CDT for identifying alcohol abuse may be higher than for immunoassays that use column separation, because transferrin genetic variants do not interfere with measurements.
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Affiliation(s)
- Joris R Delanghe
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium.
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Poll EM, Kreitschmann-Andermahr I, Langejuergen Y, Stanzel S, Gilsbach JM, Gressner A, Yagmur E. Saliva collection method affects predictability of serum cortisol. Clin Chim Acta 2007; 382:15-9. [PMID: 17449021 DOI: 10.1016/j.cca.2007.03.009] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 03/08/2007] [Accepted: 03/08/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Measurement of cortisol is of particular importance for early diagnosis of adrenocorticotropic dysfunction and therapeutic monitoring. Saliva samples clearly present an easily manageable, non-invasive and anytime practicable assessment method of glucocorticoid production. The aims of the present study were to compare salivary cortisol collection method "Salivette" versus "passive drool", salivary cortisol concentrations with calculated free serum cortisol (FSC) and total serum cortisol (TSC) and the prediction of serum cortisol by salivary cortisol. METHODS Saliva samples were collected by Sarstedt-Salivette(R) and by passive drooling into plastic tubes. Salivary cortisol, TSC measurements and calculation of FSC concentrations as well were carried out simultaneously in 10 healthy volunteers on two consecutive days at six definite points of time (08.00-23.00). RESULTS Significant differences of salivary cortisol concentrations dependent on the saliva collection method (F-test 6.45; p=0.0317) and points of times were found (F-test 41.19; p<0.0001). Stronger overall correlation was observed in Salivette-salivary cortisol vs. TSC (r=0.813) and FSC (r=0.836) as compared to passive drooling. Specifically, more significant correlations were established in Salivettes vs. TSC (8/12 points of time, 66.7%) and FSC (8/12 points of time, 66.7%) than in passive drooling (TSC: 1/12 points of time, 8.3% and FSC: 2/12 points of time, 16.7%). Importantly, cortisol in Salivettes was a better predictor for FSC and TSC than passive drooling. CONCLUSIONS Our data indicate that salivary cortisol measurement with Salivettes is a reliable prediction method of total and calculated free serum cortisol levels. Moreover, it is a convenient method for saliva collection, handling and laboratory processing.
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Affiliation(s)
- Eva-Maria Poll
- Department of Neurosurgery, RWTH-University Hospital Aachen, Germany.
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Yagmur E, Trautwein C, Leers MPG, Gressner AM, Tacke F. Elevated apoptosis-associated cytokeratin 18 fragments (CK18Asp386) in serum of patients with chronic liver diseases indicate hepatic and biliary inflammation. Clin Biochem 2007; 40:651-5. [PMID: 17306787 DOI: 10.1016/j.clinbiochem.2006.12.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 12/15/2006] [Indexed: 12/25/2022]
Abstract
OBJECTIVES During apoptosis, intermediate filament protein cytokeratin 18 (CK18) is cleaved by caspases at Asp396 which can be specifically detected by the monoclonal antibody M30 (M30-antigen). DESIGN AND METHODS M30-antigen serum levels were analyzed in 76 chronic liver diseases (CLD) patients and 62 healthy controls. RESULTS M30-antigen levels were significantly elevated in CLD patients (median 296.3 U/L) compared with healthy controls (median 153.5 U/L, P<0.001) and increased with disease severity (Child-Pugh or MELD score). M30-antigen correlated with aminotransferase activities and parameters indicating cholestasis such as bile acids. Highest serum M30-antigen was associated with histologically confirmed severe intrahepatic cholestasis (median 599.1 U/L) or biliary duct inflammation (median 648.0 U/L). Furthermore, in contrast to patients with liver cirrhosis, presence of hepatocellular carcinoma was associated with elevated M30-antigen in patients without cirrhosis. CONCLUSION Serum M30-antigen levels are elevated in CLD and correlate with hepatic inflammation as well as cholangitis and cholestasis.
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Affiliation(s)
- E Yagmur
- Institute of Clinical Chemistry and Pathobiochemistry, Germany
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Yagmur E, Schnyder B, Scholten D, Schirin-Sokhan R, Koch A, Winograd R, Gressner AM, Trautwein C, Wasmuth HE. [Elevated concentrations of fecal calprotectin in patients with liver cirrhosis]. Dtsch Med Wochenschr 2006; 131:1930-4. [PMID: 16967390 DOI: 10.1055/s-2006-949189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED BACKGROUND AND OBJECTION: Bacterial translocation from the gut lumen is considered to play an important role in the development of infectious complications in patients with liver cirrhosis. This translocation might be increased by inflammation of the gut mucosa. Calprotectin is a cytoplasmatic protein of neutrophilic granulocytes and is an established marker for the assessment of localized intestinal inflammation. It was the aim of the current study to systematically evaluate a localized intestinal inflammation in patients with liver cirrhosis by means of fecal calprotectin concentrations. PATIENTS AND METHODS Fecal calprotectin concentrations were determined in 53 consecutive patients with liver cirrhosis and in 18 subjects without intestinal or liver diseases, who were comparable with respect to age and gender. Patients with diarrhoea, inflammatory bowel disease and a positive stool test for occult blood were excluded from the study. Fecal calprotectin concentrations were measured by a sandwich ELISA. The systemic inflammatory reaction of the patients was assessed by C-reactive protein, white blood cells counts and the serum concentrations of the cytokines IL-6, IL-8 and IL-10. RESULTS Fecal calprotectin concentrations were significantly increased in patients with liver cirrhosis (median 37.0 mg/kg) compared to controls patients (median 2.2, P < 0.0001). There were no significant correlations of calprotectin concentrations with systemic inflammatory parameters, like CRP, white blood cell count or serum cytokines. However, fecal calprotectin concentrations were significantly associated with the stage of liver cirrhosis as expressed by the Child-Pugh score ( P < 0.001). A trend towards higher concentrations of calprotectin was found in patients with alcoholic liver cirrhosis ( P = 0.1). CONCLUSIONS Patients with liver cirrhosis display elevated fecal calprotectin concentrations as a potential sign of intestinal inflammation. Further studies are warranted to establish a role of calprotectin for the risk assessment of infectious complications secondary to bacterial translocation in patients with liver cirrhosis.
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Affiliation(s)
- E Yagmur
- Institut für Klinische Chemie und Pathobiochemie, Universitätsklinikum Aachen
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Poll E, Yagmur E, Langejuergen Y, Gilsbach JM, Kreitschmann-Andermahr I. Comparison of salivary cortisol concentrations using two different saliva collection methods. Exp Clin Endocrinol Diabetes 2006. [DOI: 10.1055/s-2006-954730] [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: 10/19/2022]
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