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Janssen S, El Shafie RA, Grohmann M, Knippen S, Putora PM, Beck M, Baehr A, Clemens P, Stefanowicz S, Rades D, Becker JN, Fahlbusch FB. Survey in radiation oncology departments in Germany, Austria, and Switzerland: state of digitalization by 2023. Strahlenther Onkol 2023:10.1007/s00066-023-02182-7. [PMID: 38052968 DOI: 10.1007/s00066-023-02182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE The aim of this work was to assess the current state of digitalization in radiation oncology departments in Germany, Austria, and Switzerland. METHODS A comprehensive survey was conducted in a digital format, consisting of 53 questions that covered various aspects of digitalization including patient workflow, departmental organization, radiotherapy planning, and employee-related aspects. RESULTS Overall, 120 forms were eligible for evaluation. Participants were mainly physicians or medical physicists responsible for digitalization aspects in their departments. Nearly 70% of the institutions used electronic patient records, with 50% being completely paperless. However, the use of smartphone apps for electronic patient reported outcomes (ePROMs) and digital health applications (DIGA) was limited (9% and 4.9%, respectively). In total, 70.8% of the radio-oncology departments had interfaces with diagnostic departments, and 36% had digital interchanges with other clinics. Communication with external partners was realized mainly through fax (72%), e‑mails (55%), postal letters (63%), or other digital exchange formats (28%). Almost half of the institutions (49%) had dedicated IT staff for their operations. CONCLUSION To the best of our knowledge, this survey is the first of its kind conducted in German-speaking radiation oncology departments within the medical field. The findings suggest that there is a varied level of digitalization implementation within these departments, with certain areas exhibiting lower rates of digitalization that could benefit from targeted improvement initiatives.
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Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
- Private Practice of Radiation Oncology, Hannover, Germany.
| | - Rami A El Shafie
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Maximilian Grohmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Stefan Knippen
- Department of Radiation Oncology, Helios Hospitals Schwerin, 19053 Schwerin, Germany
- Department for Human Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
| | - Paul M Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Marcus Beck
- Department of Radiooncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andrea Baehr
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Sarah Stefanowicz
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Jan-Niklas Becker
- Department of Radiotherapy and Special Oncology, Medical School Hannover, 30625, Hannover, Germany
| | - Fabian B Fahlbusch
- Neonatology and Pediatric Intensive Care, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
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Morhart P, Gerlach RG, Kunz C, Held J, Valenza G, Wölfle J, Reutter H, Hanslik GJ, Fahlbusch FB. Application of Next-Generation Sequencing to Enterobacter Hormaechei Subspecies Analysis during a Neonatal Intensive Care Unit Outbreak. Children (Basel) 2023; 10:1696. [PMID: 37892359 PMCID: PMC10605273 DOI: 10.3390/children10101696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION The Enterobacter cloacae complex (ECC) species are potential neonatal pathogens, and ECC strains are among the most commonly encountered Enterobacter spp. associated with nosocomial bloodstream infections. Outbreaks caused by ECC can lead to significant morbidity and mortality in susceptible neonates. At the molecular level, ECC exhibits genomic heterogeneity, with six closely related species and subspecies. Genetic variability poses a challenge in accurately identifying outbreaks by determining the clonality of ECC isolates. This difficulty is further compounded by the limitations of the commonly used molecular typing methods, such as pulsed field gel electrophoresis, which do not provide reliable accuracy in distinguishing between ECC strains and can lead to incorrect conclusions. Next-generation sequencing (NGS) offers superior resolution in determining strain relatedness. Therefore, we investigated the clinical pertinence of incorporating NGS into existing bundle measures to enhance patient management during an outbreak of ECC in a level-3 neonatal intensive care unit (NICU) in Germany. METHODS As the standard of care, all neonates on the NICU received weekly microbiological swabs (nasopharyngeal and rectal) and analysis of endotracheal secretion, where feasible. During the 2.5-month outbreak, colonisation with ECC was detected in n = 10 neonates. The phylogenetic relationship and potential antimicrobial resistance genes as well as mobile genetic elements were identified via bacterial whole-genome sequencing (WGS) using Illumina MiSeq followed by in silico data analysis. RESULTS Although all ECC isolates exhibited almost identical antimicrobial susceptibility patterns, the WGS data revealed the involvement of four different ECC clones. The isolates could be characterised as Enterobacter hormaechei subspecies steigerwaltii (n = 6, clonal), subsp. hoffmannii (n = 3, two clones) and subsp. oharae (n = 1). Despite the collection of environmental samples, no source of this diffuse outbreak could be identified. A new standardised operating procedure was implemented to enhance the management of neonates colonised with MRGN. This collaborative approach involved both parents and medical professionals and successfully prevented further transmission of ECC. CONCLUSIONS Initially, it was believed that the NICU outbreak was caused by a single ECC clone due to the similarity in antibiotic resistance. However, our findings show that antibiotic susceptibility patterns can be misleading in investigating outbreaks of multi-drug-resistant ECC. In contrast, bacterial WGS accurately identified ECC at the clonal level, which significantly helped to delineate the nature of the observed outbreak.
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Affiliation(s)
- Patrick Morhart
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (P.M.); (H.R.); (G.J.H.)
| | - Roman G. Gerlach
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Caroline Kunz
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Jürgen Held
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Giuseppe Valenza
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Joachim Wölfle
- Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Heiko Reutter
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (P.M.); (H.R.); (G.J.H.)
| | - Gregor J. Hanslik
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (P.M.); (H.R.); (G.J.H.)
| | - Fabian B. Fahlbusch
- Neonatology and Pediatric Intensive Care, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
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Menendez-Castro C, Cordasic N, Fahlbusch FB, Woelfle J, Hilgers KF, Hartner A. Sex differences in long-term kidney fibrosis following neonatal nephron loss during ongoing nephrogenesis. Mol Cell Pediatr 2023; 10:8. [PMID: 37624430 PMCID: PMC10457250 DOI: 10.1186/s40348-023-00164-4] [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: 05/14/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Clinical studies suggest that female sex plays a protective role in the development and progression of kidney disease. Recent experimental studies indicate that in male rats early nephron loss under ongoing nephrogenesis is accompanied by severe long-term sequelae. In humans, nephron formation occurs mainly in the third trimester, ceasing with 36 weeks of gestation. Due to perinatal complications, preterm infants delivered during this vulnerable period may undergo acute nephron loss. In rats nephrogenesis persists until postnatal day 10, reflecting the situation of human preterms with persisting nephrogenesis. In our animal model of neonatal uninephrectomy, female and male rats were uninephrectomized at day 1 of life. Hypothesizing sex-dependent differences, long-term renal outcome was assessed after 1 year. RESULTS In both sexes, neonatal uninephrectomy was not followed by arterial hypertension at 1 year of age. Compensatory weight gain and glomerular hypertrophy of the remaining kidney occurred in uninephrectomized female and male animals. Selected markers of interstitial inflammation and fibrosis were regulated sex-dependently. The expression of monocyte chemoattractant protein-1 was increased in females, while tubulointerstitial infiltration by M1 macrophages was significantly higher in males after neonatal uninephrectomy. Neonatally uninephrectomized male rats had more glomerulosclerosis and podocyte damage compared to females, which was assessed by a semiquantitative score and desmin staining. RT-PCR revealed that after neonatal uninephrectomy in the remaining contralateral kidney of female rats the expression of candidate genes of renal development and function, i.e., wt-1, nephrin, synaptopodin, gdnf, and itga8 was higher than in males. CONCLUSIONS Based on these observations we conclude that female sex is protective in the long-term response of the kidney to acute nephron loss under active nephrogenesis.
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Affiliation(s)
- Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, Erlangen, Germany.
| | - Nada Cordasic
- Department of Nephrology and Hypertension, University Hospital of Erlangen, Erlangen, Germany
| | - Fabian B Fahlbusch
- Division of Neonatology and Pediatric Intensive Care Medicine, University Hospital of Erlangen, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, Erlangen, Germany
| | - Karl F Hilgers
- Department of Nephrology and Hypertension, University Hospital of Erlangen, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, Erlangen, Germany
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Gleichauf J, Hennemann L, Fahlbusch FB, Hofmann O, Niebler C, Koelpin A. Sensor Fusion for the Robust Detection of Facial Regions of Neonates Using Neural Networks. Sensors (Basel) 2023; 23:4910. [PMID: 37430829 PMCID: PMC10223875 DOI: 10.3390/s23104910] [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] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 07/12/2023]
Abstract
The monitoring of vital signs and increasing patient comfort are cornerstones of modern neonatal intensive care. Commonly used monitoring methods are based on skin contact which can cause irritations and discomfort in preterm neonates. Therefore, non-contact approaches are the subject of current research aiming to resolve this dichotomy. Robust neonatal face detection is essential for the reliable detection of heart rate, respiratory rate and body temperature. While solutions for adult face detection are established, the unique neonatal proportions require a tailored approach. Additionally, sufficient open-source data of neonates on the NICU is lacking. We set out to train neural networks with the thermal-RGB-fusion data of neonates. We propose a novel indirect fusion approach including the sensor fusion of a thermal and RGB camera based on a 3D time-of-flight (ToF) camera. Unlike other approaches, this method is tailored for close distances encountered in neonatal incubators. Two neural networks were used with the fusion data and compared to RGB and thermal networks. For the class "head" we reached average precision values of 0.9958 (RetinaNet) and 0.9455 (YOLOv3) for the fusion data. Compared with the literature, similar precision was achieved, but we are the first to train a neural network with fusion data of neonates. The advantage of this approach is in calculating the detection area directly from the fusion image for the RGB and thermal modality. This increases data efficiency by 66%. Our results will facilitate the future development of non-contact monitoring to further improve the standard of care for preterm neonates.
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Affiliation(s)
| | - Lukas Hennemann
- Nuremberg Institute of Technology, 90489 Nuremberg, Germany (C.N.)
| | - Fabian B. Fahlbusch
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany;
- University Children’s Hospital Augsburg, Neonatal and Pediatric Intensive Care Unit, 86156 Augsburg, Germany
| | - Oliver Hofmann
- Nuremberg Institute of Technology, 90489 Nuremberg, Germany (C.N.)
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Janssen S, El Shafie RA, Ruder AM, Buergy D, Scafa D, Giordano FA, Nicolay NH, Vogel MME, Combs SE, Fahlbusch FB, Rades D, Käsmann L. Mobile applications in radiation oncology-current choices and future potentials. Strahlenther Onkol 2023; 199:337-349. [PMID: 36810957 PMCID: PMC9943039 DOI: 10.1007/s00066-023-02048-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/15/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To review existing scientific literature on mobile applications (apps) in the field of radiation oncology and to evaluate characteristics of commercially available apps across different platforms. METHODS A systematic review of the literature for publications presenting apps in the field of radiation oncology was carried out using the PubMed database, Cochrane library, Google Scholar, and annual meetings of major radiation oncology societies. Additionally, the two major marketplaces for apps, App Store and Play Store, were searched for available radiation oncology apps for patients and health care professionals (HCP). RESULTS A total of 38 original publications which met the inclusion criteria were identified. Within those publications, 32 apps were developed for patients and 6 for HCP. The vast majority of patient apps focused on documenting electronic patient-reported outcomes (ePROs). In the two major marketplaces, 26 apps were found, mainly supporting HCP with dose calculations. CONCLUSION Apps used in (and for) scientific research in radiation oncology are rarely available for patients and HCP in common marketplaces.
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Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
- Private Practice of Radiation Oncology, Hannover, Germany.
| | - Rami A El Shafie
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Arne M Ruder
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniel Buergy
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Davide Scafa
- Department of Radiation Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
- Institute for Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
- Institute for Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Neuherberg, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Neonatology and Pediatric Intensive Care, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Lukas Käsmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Partner Site Munich, German Cancer Consortium (DKTK), Munich, Germany
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6
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Goebel CA, Brown E, Fahlbusch FB, Wagner AL, Buehler A, Raupach T, Hohmann M, Späth M, Burton N, Woelfle J, Schmidt M, Hartner A, Regensburger AP, Knieling F. High-resolution label-free mapping of murine kidney vasculature by raster-scanning optoacoustic mesoscopy: an ex vivo study. Mol Cell Pediatr 2022; 9:13. [PMID: 35788444 PMCID: PMC9253231 DOI: 10.1186/s40348-022-00144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global burden affecting both children and adults. Novel imaging modalities hold great promise to visualize and quantify structural, functional, and molecular organ damage. The aim of the study was to visualize and quantify murine renal vasculature using label-free raster scanning optoacoustic mesoscopy (RSOM) in explanted organs from mice with renal injury. MATERIAL AND METHODS For the experiments, freshly bisected kidneys of alpha 8 integrin knock-out (KO) and wildtype mice (WT) were used. A total of n=7 female (n=4 KO, n=3 WT) and n=6 male animals (n=2 KO, n=4 WT) aged 6 weeks were examined with RSOM optoacoustic imaging systems (RSOM Explorer P50 at SWL 532nm and/or ms-P50 imaging system at 532 nm, 555 nm, 579 nm, and 606 nm). Images were reconstructed using a dedicated software, analyzed for size and vascular area and compared to standard histologic sections. RESULTS RSOM enabled mapping of murine kidney size and vascular area, revealing differences between kidney sizes of male (m) and female (f) mice (merged frequencies (MF) f vs. m: 52.42±6.24 mm2 vs. 69.18±15.96 mm2, p=0.0156) and absolute vascular area (MF f vs. m: 35.67±4.22 mm2 vs. 49.07±13.48 mm2, p=0.0036). Without respect to sex, the absolute kidney area was found to be smaller in knock-out (KO) than in wildtype (WT) mice (WT vs. KO: MF: p=0.0255) and showed a similar trend for the relative vessel area (WT vs. KO: MF p=0.0031). Also the absolute vessel areas of KO compared to WT were found significantly different (MF p=0.0089). A significant decrease in absolute vessel area was found in KO compared to WT male mice (MF WT vs. KO: 54.37±9.35 mm2 vs. 34.93±13.82 mm2, p=0.0232). In addition, multispectral RSOM allowed visualization of oxygenated and deoxygenated parenchymal regions by spectral unmixing. CONCLUSION This study demonstrates the capability of RSOM for label-free visualization of differences in vascular morphology in ex vivo murine renal tissue at high resolution. Due to its scalability optoacoustic imaging provides an emerging modality with potential for further preclinical and clinical imaging applications.
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Affiliation(s)
- Colin A Goebel
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Emma Brown
- Department of Physics, University of Cambridge, Cambridge, UK.,Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK.,Washington University School of Medicine, St. Louis, USA
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Alexandra L Wagner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian Buehler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Raupach
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Martin Hohmann
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies, 91052, Erlangen, Germany
| | - Moritz Späth
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies, 91052, Erlangen, Germany
| | | | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Schmidt
- Institute of Photonic Technologies, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Erlangen Graduate School in Advanced Optical Technologies, 91052, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.
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Schüssler SC, Schmidt M, Deiters L, Candova A, Fahlbusch FB, Trollmann R. Long-term outcomes of very-low-birth-weight and low-birth-weight preterm newborns with neonatal seizures: A single-center perspective. Eur J Paediatr Neurol 2022; 36:137-142. [PMID: 34973622 DOI: 10.1016/j.ejpn.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 11/17/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Newborn seizures are frequent in preterm newborns and indicate brain lesions in many cases. The objective of this observational study was to investigate the long-term outcome of very-low-birth-weight (VLBW) and low-birth-weight (LBW) preterm infants with neonatal seizures. METHODS We examined 54 preterm infants (40 VLBW and 14 LBW cases) born between 2008 and 2011 with clinical seizures during the neonatal period confirmed by interictal or ictal electroencephalography recordings in a retrospective single-center study. Neurodevelopmental follow-up included an expert neurological examination and cognitive testing (Kaufman Assessment Battery for Children) at a mean age of six years. RESULTS The (mean ± standard deviation) gestational ages of the VLBW and LBW infants were 27.2 ± 1.9 weeks and 33.4 ± 1.7 weeks, respectively, and the postnatal age at seizure onset was 13 ± 11 days in VLBW infants and 9 ± 8 days in LBW infants, with a wide range of one to 62 days. LBW infants more frequently developed non-motor seizures (50.0%) than VLBW infants did (25.0%), and higher-grade intracranial hemorrhage was the predominant etiology in the VLBW group (18.0%), while the etiology in the LBW group was more heterogeneous and included central nervous system malformations and genetic syndromes. At the mean age of 6.2 ± 2.0, years, 25/54 patients were assessed and 44.4% of the VLBW group and 71.4% of the LBW group showed intellectual impairment. Infantile cerebral palsy was present in 22% of VLBW and 42.9% of LBW infants, respectively. SIGNIFICANCE The present analysis of long-term neurodevelopmental outcomes of preterm neonates who experienced seizures shows that the risk for intellectual impairment is not limited only to VLBW infants but may significantly affect LBW infants as well. The etiological spectrum differs in relation to gestational age.
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Affiliation(s)
- S C Schüssler
- Department of Pediatrics, Division of Pediatric Neurology, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Schmidt
- Department of Pediatrics, Division of Pediatric Neurology, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - L Deiters
- Department of Pediatrics, Division of Pediatric Neurology, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Candova
- Department of Pediatrics, Division of Pediatric Neurology, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - F B Fahlbusch
- Department of Pediatrics, Division of Neonatology, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - R Trollmann
- Department of Pediatrics, Division of Pediatric Neurology, Friedrich-Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Raming R, Cordasic N, Kirchner P, Ekici AB, Fahlbusch FB, Woelfle J, Hilgers KF, Hartner A, Menendez-Castro C. Neonatal nephron loss during active nephrogenesis results in altered expression of renal developmental genes and markers of kidney injury. Physiol Genomics 2021; 53:509-517. [PMID: 34704838 DOI: 10.1152/physiolgenomics.00059.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Preterm neonates are at a high risk for nephron loss under adverse clinical conditions. Renal damage potentially collides with postnatal nephrogenesis. Recent animal studies suggest that nephron loss within this vulnerable phase leads to renal damage later in life. Nephrogenic pathways are commonly reactivated after kidney injury supporting renal regeneration. We hypothesized that nephron loss during nephrogenesis affects renal development, which, in turn, impairs tissue repair after secondary injury. Neonates prior to 36 wk of gestation show an active nephrogenesis. In rats, nephrogenesis is ongoing until day 10 after birth. Mimicking the situation of severe nephron loss during nephrogenesis, male pups were uninephrectomized at day 1 of life (UNXd1). A second group of males was uninephrectomized at postnatal day 14 (UNXd14), after terminated nephrogenesis. Age-matched controls were sham operated. Three days after uninephrectomy transcriptional changes in the right kidney were analyzed by RNA-sequencing, followed by functional pathway analysis. In UNXd1, 1,182 genes were differentially regulated, but only 143 genes showed a regulation both in UNXd1 and UNXd14. The functional groups "renal development" and "kidney injury" were among the most differentially regulated groups and revealed distinctive alterations. Reduced expression of candidate genes concerning renal development (Bmp7, Gdnf, Pdgf-B, Wt1) and injury (nephrin, podocin, Tgf-β1) were detected. The downregulation of Bmp7 and Gdnf persisted until day 28. In UNXd14, Six2 was upregulated and Pax2 was downregulated. We conclude that nephron loss during nephrogenesis affects renal development and induces a specific regulation of genes that might hinder tissue repair after secondary kidney injury.
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Affiliation(s)
- Roman Raming
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, Erlangen, Germany
| | - Nada Cordasic
- Department of Nephrology and Hypertension, University Hospital of Erlangen, Erlangen, Germany
| | - Philipp Kirchner
- Institute of Human Genetics, University Hospital of Erlangen, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital of Erlangen, Erlangen, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, Erlangen, Germany
| | - Karl F Hilgers
- Department of Nephrology and Hypertension, University Hospital of Erlangen, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, Erlangen, Germany
| | - Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, Erlangen, Germany
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9
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Menendez-Castro C, Cordasic N, Fahlbusch FB, Ekici AB, Kirchner P, Daniel C, Amann K, Velkeen R, Wölfle J, Schiffer M, Hartner A, Hilgers KF. RNA sequencing reveals induction of specific renal inflammatory pathways in a rat model of malignant hypertension. J Mol Med (Berl) 2021; 99:1727-1740. [PMID: 34528115 PMCID: PMC8599225 DOI: 10.1007/s00109-021-02133-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/09/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022]
Abstract
In malignant hypertension, far more severe kidney injury occurs than in the "benign" form of the disease. The role of high blood pressure and the renin-angiotensin-aldosterone system is well recognized, but the pathogenesis of the renal injury of malignant hypertension (MH) remains incompletely understood. Using the rat model of two-kidney, one-clip renovascular hypertension in which some but not all animals develop MH, we performed a transcriptomic analysis of gene expression by RNA sequencing to identify transcriptional changes in the kidney cortex specific for MH. Differential gene expression was assessed in three groups: MH, non-malignant hypertension (NMH), and normotensive, sham-operated controls. To distinguish MH from NMH, we considered two factors: weight loss and typical renovascular lesions. Mean blood pressure measured intraarterially was elevated in MH (220 ± 6.5 mmHg) as well as in NMH (192 ± 6.4 mmHg), compared to controls (119 ± 1.7 mmHg, p < 0.05). Eight hundred eighty-six genes were exclusively regulated in MH only. Principal component analysis revealed a separated clustering of the three groups. The data pointed to an upregulation of many inflammatory mechanisms in MH including pathways which previously attracted relatively little attention in the setting of hypertensive kidney injury: Transcripts from all three complement activation pathways were upregulated in MH compared to NMH but not in NMH compared with controls; immunohistochemistry confirmed complement deposition in MH exclusively. The expression of chemokines attracting neutrophil granulocytes (CXCL6) and infiltration of myeloperoxidase-positive cells were increased only in MH rats. The data suggest that these pathways, especially complement deposition, may contribute to kidney injury under MH. KEY MESSAGES: The most severe hypertension-induced kidney injury occurs in malignant hypertension. In a rat model of malignant hypertension, we assessed transcriptional responses in the kidney exposed to high blood pressure. A broad stimulation of inflammatory mechanisms was observed, but a few specific pathways were activated only in the malignant form of the disease, notably activation of the complement cascades. Complement inhibitors may alleviate the thrombotic microangiopathy of malignant hypertension even in the absence of primary complement abnormalities.
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Affiliation(s)
- Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Nada Cordasic
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Kirchner
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Daniel
- Institute of Nephropathology, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Kerstin Amann
- Institute of Nephropathology, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Roland Velkeen
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Joachim Wölfle
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Karl F Hilgers
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University of Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
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10
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Denkl B, Cordasic N, Huebner H, Menendez-Castro C, Schmidt M, Mocker A, Woelfle J, Hartner A, Fahlbusch FB. No evidence of the unfolded protein response in the placenta of two rodent models of preeclampsia and intrauterine growth restriction. Biol Reprod 2021; 105:449-463. [PMID: 33955453 DOI: 10.1093/biolre/ioab087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/31/2021] [Accepted: 09/01/2020] [Indexed: 11/13/2022] Open
Abstract
In humans, intrauterine growth restriction (IUGR) and preeclampsia (PE) are associated with induction of the unfolded protein response (UPR) and increased placental endoplasmic reticulum (ER) stress. Especially in PE, oxidative stress occurs relative to the severity of maternal vascular underperfusion (MVU) of the placental bed. On the premise that understanding the mechanisms of placental dysfunction could lead to targeted therapeutic options for human IUGR and PE, we investigated the roles of the placental UPR and oxidative stress in two rodent models of these human gestational pathologies. We employed a rat IUGR model of gestational maternal protein restriction, as well as an endothelial nitric oxide synthase knockout mouse model (eNOS-/-) of PE/IUGR. Placental expression of UPR members was analyzed via qRT-PCR (Grp78, Calnexin, Perk, Chop, Atf6, and Ern1), immunohistochemistry, and Western blotting (Calnexin, ATF6, GRP78, CHOP, phospho-eIF2α, and phospho-IRE1). Oxidative stress was determined via Western blotting (3-nitrotyrosine and 4-hydroxy-2-nonenal). Both animal models showed a significant reduction of fetal and placental weight. These effects did not induce placental UPR. In contrast to human data, results from our rodent models suggest retention of placental plasticity in the setting of ER stress under an adverse gestational environment. Oxidative stress was significantly increased only in female IUGR rat placentas, suggesting a sexually dimorphic response to maternal malnutrition. Our study advances understanding of the involvement of the placental UPR in IUGR and PE. Moreover, it emphasizes the appropriate choice of animal models researching various aspects of these pregnancy complications.
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Affiliation(s)
- Barbara Denkl
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Nada Cordasic
- Department of Nephrology and Hypertension, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Hanna Huebner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Marius Schmidt
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Mocker
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center EMN, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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11
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Gebauer J, Mehta P, Fahlbusch FB, Schmid SM, Rades D, Janssen S. Hypothalamic-Pituitary Axis Dysfunction after Whole Brain Radiotherapy - A Cohort Study. Anticancer Res 2020; 40:5787-5792. [PMID: 32988906 DOI: 10.21873/anticanres.14595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/06/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Hypothalamic-pituitary (HT-P) dysfunction is one of the most common endocrine late effects following cranial radiotherapy. However, there are currently no specific data describing this complication in adult-onset cancer patients after whole brain radiotherapy (WBRT). The present cohort study aims to establish the prevalence of HT-P axis dysfunction in this group of patients. PATIENTS AND METHODS Twenty-six cancer patients previously treated with WBRT (median follow-up=20.5 months) received standardized endocrine check-up focusing on HT-P function. RESULTS In 50% of the patients, impaired hypothalamic-pituitary function was detected during follow-up. While functional loss of a single hormonal axis was evident in 34.6% of patients, 7.7% showed an impairment of multiple endocrine axes, and one patient developed adrenocorticotropic hormone deficiency. Hypothalamic-pituitary dysfunction did not directly correlate with the applied WBRT total doses. CONCLUSION In our cohort, hypothalamic-pituitary dysfunction appeared to be common after WBRT and was diagnosed as early as 6 months following radiation. This finding highlights the need for routine endocrine follow-up even in patients with limited life expectancy.
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Affiliation(s)
- Judith Gebauer
- Institute for Endocrinology and Diabetes, University of Luebeck, Luebeck, Germany
| | - Preena Mehta
- Department of Radiation Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, Erlangen, Germany
| | - Sebastian M Schmid
- Institute for Endocrinology and Diabetes, University of Luebeck, Luebeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany .,Private Practice of Radiation Oncology, Hannover, Germany
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12
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Mehta P, Janssen S, Fahlbusch FB, Schmid SM, Gebauer J, Cremers F, Ziemann C, Tartz M, Rades D. Sparing the hippocampus and the hypothalamic- pituitary region during whole brain radiotherapy: a volumetric modulated arc therapy planning study. BMC Cancer 2020; 20:610. [PMID: 32605648 PMCID: PMC7325372 DOI: 10.1186/s12885-020-07091-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/23/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Feasibility testing of a simultaneous sparing approach of hippocampus, hypothalamus and pituitary gland in patients undergoing whole-brain radiotherapy (WBRT) with and without a concomitant boost to metastatic sites. INTRODUCTION Cognitive impairment and hormonal dysfunction are common side effects of cranial radiotherapy. A reduced dose application to the patho-physiologically involved functional brain areas, i.e. hippocampus, hypothalamus and pituitary gland, could reduce these common side effects. While hippocampal sparing is already a common practice to improve cognitive outcome, technical experience of additional combined sparing of the hypothalamus/pituitary gland (HT-P) is insufficient. METHODS Twenty patients were included in the planning study. In 11 patients, a total dose of 36 Gy of WBRT (2 Gy per fraction) plus a simultaneous integrated boost (SIB) of 9 Gy (0.5 Gy per fraction, total dose: 45 Gy) to the brain metastases was applied. In 9 patients, prophylactic cranial irradiation (PCI) was simulated with a total dose of 30 Gy (2 Gy per fraction). In both patient cohorts, a sparing approach of the hippocampus and the HT-P area was simulated during WBRT. For all treatment plans, volumetric modulated arc therapy (VMAT) was used. Quality assurance included assessment of homogeneity, conformality and target coverage. RESULTS The mean dose to the hippocampus and HT-P region was limited to less than 50% of the prescribed dose to the planning target volume (PTV) in all treatment plans. Dose homogeneity (HI) of the target volume was satisfying (median HI = 0.16 for WBRT+SIB and 0.1 for PCI) and target coverage (conformation number, CN) was not compromised (median CN = 0.82 for SIB and 0.86 for PCI). CONCLUSION Simultaneous dose reduction to the hippocampus and the HT-P area did not compromise the PTV coverage in patients undergoing WBRT+SIB or PCI using VMAT. While the feasibility of the presented approach is promising, prospective neurologic, endocrine outcome and safety studies are required.
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Affiliation(s)
- P Mehta
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - S Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. .,Private Practice of Radiation Oncology, Hannover, Germany.
| | - F B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - S M Schmid
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - J Gebauer
- Institute for Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
| | - F Cremers
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - C Ziemann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - M Tartz
- Private Practice of Radiation Oncology, Hannover, Germany
| | - D Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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13
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Regensburger AP, Wagner AL, Hanslik G, Schüssler SC, Fahlbusch FB, Woelfle J, Jüngert J, Trollmann R, Knieling F. Ultra-high-frequency ultrasound in patients with spinal muscular atrophy: A retrospective feasibility study. Muscle Nerve 2020; 61:E18-E21. [PMID: 31884704 DOI: 10.1002/mus.26796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Adrian P Regensburger
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexandra L Wagner
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Gregor Hanslik
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie C Schüssler
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jörg Jüngert
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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14
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Mocker A, Schmidt M, Huebner H, Wachtveitl R, Cordasic N, Menendez-Castro C, Hartner A, Fahlbusch FB. Expression of Retinoid Acid Receptor-Responsive Genes in Rodent Models of Placental Pathology. Int J Mol Sci 2019; 21:ijms21010242. [PMID: 31905805 PMCID: PMC6981780 DOI: 10.3390/ijms21010242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 01/13/2023] Open
Abstract
In humans, retinoic acid receptor responders (RARRES) have been shown to be altered in third trimester placentas complicated by the pathologies preeclampsia (PE) and PE with intrauterine growth restriction (IUGR). Currently, little is known about the role of placental Rarres in rodents. Therefore, we examined the localization and expression of Rarres1 and 2 in placentas obtained from a Wistar rat model of isocaloric maternal protein restriction (E18.5, IUGR-like features) and from an eNOS-knockout mouse model (E15 and E18.5, PE-like features). In both rodent models, Rarres1 and 2 were mainly localized in the placental spongiotrophoblast and giant cells. Their placental expression, as well as the expression of the Rarres2 receptor chemokine-like receptor 1 (CmklR1), was largely unaltered at the examined gestational ages in both animal models. Our results have shown that RARRES1 and 2 may have different expression and roles in human and rodent placentas, thereby underlining immanent limitations of comparative interspecies placentology. Further functional studies are required to elucidate the potential involvement of these proteins in early placentogenesis.
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Affiliation(s)
- Alexander Mocker
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.M.); (M.S.); (C.M.-C.); (A.H.)
| | - Marius Schmidt
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.M.); (M.S.); (C.M.-C.); (A.H.)
| | - Hanna Huebner
- Department of Gynaecology and Obstetrics/Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Rainer Wachtveitl
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (R.W.); (N.C.)
| | - Nada Cordasic
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (R.W.); (N.C.)
| | - Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.M.); (M.S.); (C.M.-C.); (A.H.)
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.M.); (M.S.); (C.M.-C.); (A.H.)
| | - Fabian B. Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (A.M.); (M.S.); (C.M.-C.); (A.H.)
- Correspondence: ; Tel.: +49-9131-853-3118; Fax: +49-9131-853-3714
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15
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Mehta P, Fahlbusch FB, Rades D, Schmid SM, Gebauer J, Janssen S. Are hypothalamic- pituitary (HP) axis deficiencies after whole brain radiotherapy (WBRT) of relevance for adult cancer patients? - a systematic review of the literature. BMC Cancer 2019; 19:1213. [PMID: 31830931 PMCID: PMC6909600 DOI: 10.1186/s12885-019-6431-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 12/03/2019] [Indexed: 12/16/2022] Open
Abstract
Background Cranial radiotherapy (cRT) can induce hormonal deficiencies as a consequence of significant doses to the hypothalamic-pituitary (HP) axis. In contrast to profound endocrinological follow-up data from survivors of childhood cancer treated with cRT, little knowledge exists for adult cancer patients. Methods A systematic search of the literature was conducted using the PubMed database and the Cochrane library offering the basis for our debate of the relevance of HP axis impairment after cRT in adult cancer patients. Against the background of potential relevance for patients receiving whole brain radiotherapy (WBRT), a particular focus was set on the temporal onset of hypopituitarism and the radiation dose to the HP axis. Results Twenty-eight original papers with a total of 1728 patients met the inclusion criteria. Radiation doses to the HP area ranged from 4 to 97 Gray (Gy). Hypopituitarism incidences ranged from 20 to 93% for adult patients with nasopharyngeal cancer or non-pituitary brain tumors. No study focused particularly on hypopituitarism after WBRT. The onset of hypopituitarism occurred as early as within the first year following cRT (range: 3 months to 25.6 years). However, since most studies started follow-up evaluation only several years after cRT, early onset of hypopituitarism might have gone unnoticed. Conclusion Hypopituitarism occurs frequently after cRT in adult cancer patients. Despite the general conception that it develops only after several years, onset of endocrine sequelae can occur within the first year after cRT without a clear threshold. This finding is worth debating particularly in respect of treatment options for patients with brain metastases and favorable survival prognoses.
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Affiliation(s)
- P Mehta
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - F B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - D Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - S M Schmid
- Department of Endocrinology, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - J Gebauer
- Department of Endocrinology, University of Lübeck, Lübeck, Germany
| | - S Janssen
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. .,Private Practice of Radiation Oncology, Hannover, Germany.
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16
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Mocker A, Hilgers KF, Cordasic N, Wachtveitl R, Menendez-Castro C, Woelfle J, Hartner A, Fahlbusch FB. Renal Chemerin Expression is Induced in Models of Hypertensive Nephropathy and Glomerulonephritis and Correlates with Markers of Inflammation and Fibrosis. Int J Mol Sci 2019; 20:ijms20246240. [PMID: 31835675 PMCID: PMC6941130 DOI: 10.3390/ijms20246240] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022] Open
Abstract
Chemerin and its receptor, chemokine-like receptor 1 (CmklR1), are associated with chemotaxis, inflammation, and endothelial function, especially in metabolic syndrome, coronary heart disease, and hypertension. In humans, circulating chemerin levels and renal function show an inverse relation. So far, little is known about the potential role of chemerin in hypertensive nephropathy and renal inflammation. Therefore, we determined systemic and renal chemerin levels in 2-kidney-1-clip (2k1c) hypertensive and Thy1.1 nephritic rats, respectively, to explore the correlation between chemerin and markers of renal inflammation and fibrosis. Immunohistochemistry revealed a model-specific induction of chemerin expression at the corresponding site of renal damage (tubular vs. glomerular). In both models, renal expression of chemerin (RT-PCR, Western blot) was increased and correlated positively with markers of inflammation and fibrosis. In contrast, circulating chemerin levels remained unchanged. Taken together, these findings demonstrate that renal chemerin expression is associated with processes of inflammation and fibrosis-related to renal damage. However, its use as circulating biomarker of renal inflammation seems to be limited in our rat models.
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Affiliation(s)
- Alexander Mocker
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, 91054 Erlangen, Germany; (A.M.); (C.M.-C.); (J.W.); (A.H.)
| | - Karl F. Hilgers
- Department of Nephrology and Hypertension, University Hospital of Erlangen, 91054 Erlangen, Germany; (K.F.H.); (N.C.); (R.W.)
| | - Nada Cordasic
- Department of Nephrology and Hypertension, University Hospital of Erlangen, 91054 Erlangen, Germany; (K.F.H.); (N.C.); (R.W.)
| | - Rainer Wachtveitl
- Department of Nephrology and Hypertension, University Hospital of Erlangen, 91054 Erlangen, Germany; (K.F.H.); (N.C.); (R.W.)
| | - Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, 91054 Erlangen, Germany; (A.M.); (C.M.-C.); (J.W.); (A.H.)
| | - Joachim Woelfle
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, 91054 Erlangen, Germany; (A.M.); (C.M.-C.); (J.W.); (A.H.)
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, 91054 Erlangen, Germany; (A.M.); (C.M.-C.); (J.W.); (A.H.)
| | - Fabian B. Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen, 91054 Erlangen, Germany; (A.M.); (C.M.-C.); (J.W.); (A.H.)
- Correspondence: ; Tel.: +49-9131-8533-118; Fax: +49-9131-8533-714
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17
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Schüssler SC, Kußmann F, Fahlbusch FB, Münster T, Hirsch K, Carbon R, Albrecht S, Dötsch J, Rascher W. Postoperative pain in small-for-gestational age infants after hernia repair, orchidopexy and urethral reconstruction surgery: A pilot study. Early Hum Dev 2019; 136:39-44. [PMID: 31302387 DOI: 10.1016/j.earlhumdev.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Small-for-gestational-age (SGA) birth bears an enhanced risk of developing hypertension, obesity, insulin resistance and mental health disorders in later life as a consequence of adaptive processes in utero. Only a small number of studies on pain perception in SGA infants exist. These are indicative of a blunted stress response to pain in SGA newborns. AIM We initiated a pilot study investigating differences in postoperative pain perception between SGA and appropriate-for-gestational-age (AGA) infants. METHODS Pain and alertness levels of 10 formerly SGA and 14 AGA infants at the age 0.5-2 years were evaluated by the FLACC scale, Steward and Aldrete Scores following hernia repair, reconstructive surgery of hypospadia and orchidopexy. In addition, the postoperative consumption of non-steroidal anti-inflammatory drugs was compared between SGA and AGA. RESULTS Postoperative pain and alertness levels were not significantly different in SGA and AGA children. We did not observe significant group differences regarding the consumption of non-steroidal anti-inflammatory drugs. CONCLUSION While previous studies were suggestive of a suppressed stress response to pain in SGA newborns, these findings did not fully translate into an altered response to pain beyond the newborn age. Further studies in a larger cohort seem necessary to verify this finding.
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Affiliation(s)
- Stephanie C Schüssler
- Department of Pediatrics and Adolescent Medicine, University Hospital, Erlangen, Germany.
| | - Franziska Kußmann
- Department of Pediatrics and Adolescent Medicine, University Hospital, Erlangen, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University Hospital, Erlangen, Germany
| | - Tino Münster
- Department of Anaesthesiology, University Hospital, Erlangen, Germany
| | - Karin Hirsch
- Department of Urology, University Hospital, Erlangen, Germany
| | - Roman Carbon
- Department of Pediatric Surgery, University Hospital, Erlangen, Germany
| | - Sven Albrecht
- Department of Anaesthesiology, University Hospital, Erlangen, Germany
| | - Jörg Dötsch
- Department of Pediatrics, University Hospital, Köln, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, University Hospital, Erlangen, Germany
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Janssen S, Mehta P, Bartscht T, Schmid SM, Fahlbusch FB, Rades D. Prevalence of metastases within the hypothalamic-pituitary area in patients with brain metastases. Radiat Oncol 2019; 14:152. [PMID: 31455428 PMCID: PMC6712746 DOI: 10.1186/s13014-019-1337-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022] Open
Abstract
Aim To quantify the prevalence of brain metastases involving the hypothalamic-pituitary (HT-P) area. Introduction Cognitive impairment and fatigue are common side effects of whole brain irradiation (WBI) comprising the quality of life (QoL) for survivors. While the former is related to radiation-induced hippocampal injury, the latter could be secondary to hormonal disbalance as a consequence of radiation of the HT-P area. Thus, sparing both regions from higher irradiation doses could reduce these sequelae. Methods T1 contrast medium enhanced magnetic resonance imaging (MRI) scans of 865 patients with brain metastases (4,280 metastases) were reviewed. HT-P area was individually contoured with a margin of 5 mm in order to evaluate the prevalence of brain metastases in this region. Results Involvement of the hypothalamic region was found in 26 patients (involvement rate of 3% for patients and 1% for metastases), involvement of the pituitary gland in 9 patients (1% for patients and < 1% for metastases). Binary logistical regression analysis revealed the presence of > 10 brain metastases as the only factor associated with hypothalamic involvement while no distinct factor was associated with an involvement of the pituitary gland. Conclusion The low prevalence of metastases within the HT-P area in patients with brain metastases calls for further studies examining whether sparing of this region might improve patients QoL.
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Affiliation(s)
- Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. .,Private Practice of Radiation Oncology, Hannover, Germany. .,Klinik für Strahlentherapie, Universität zu Lübeck, Ratzeburger Allee 160, Haus 40, 23562, Lübeck, Germany.
| | - Preena Mehta
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Tobias Bartscht
- Department of Haematology and Oncology, University of Lübeck, Lübeck, Germany
| | - Sebastian M Schmid
- Department of Endocrinology, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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Topf HG, Strasser ER, Breuer G, Rascher W, Rauh M, Fahlbusch FB. Closing the gap - detection of clinically relevant von Willebrand disease in emergency settings through an improved algorithm based on rotational Thromboelastometry. BMC Anesthesiol 2019; 19:10. [PMID: 30630422 PMCID: PMC6329185 DOI: 10.1186/s12871-018-0672-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 12/26/2018] [Indexed: 01/25/2023] Open
Abstract
Background Hemorrhage and blood loss are still among the main causes of preventable death. Global hemostatic assays are useful point-of-care test (POCT) devices to rapidly detect cumulative effects of plasma factors and platelets on coagulation. Thromboelastography (TEG) and Thromboelastometry (ROTEM) are established methods in many anesthesiological departments for guided hemostatic treatment. However, von Willebrand disease remains undetected by standard ROTEM, especially during emergency care, despite being the most prevalent congenital hemostatic disorder. Methods In our monocentric cohort pilot study we focused on hemostatic challenges associated with von Willebrand disease. Twenty-seven patients with suspected von Willebrand disease were included. We modified the routine ROTEM assay by adding a preincubation with ristocetin and commercially available plasma-derived von Willebrand factor to identify clinically relevant von Willebrand disease (VWD). Results Addition of von Willebrand factor to the ristocetin assay of a VWD type 3 patient restored the reaction of the whole blood probe to match the response of a healthy person. Our modified ROTEM assay with ristocetin (Ricotem) showed that all high responders (n = 7) had VWD. In the low responder group (n = 16) – 10 of 16 had VWD and in the normal responder group (n = 5), 2 of 5 had mild type 1 VWD. Conclusions This new modification of the standard ROTEM assay enables the detection of otherwise unnoticed critical von Willebrand disease based on alterations in clot formation and might serve as a novel approach to reliably assess severe VWD patients by platelet-mediated blood clotting in an emergency setting. We recommend incorporating this new VWD-focused screening tool into the current ROTEM-based management algorithm of acute microvascular bleeding. Electronic supplementary material The online version of this article (10.1186/s12871-018-0672-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H-G Topf
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nurnberg, Loschgestr. 15, 91054, Erlangen, Germany.
| | - E R Strasser
- Department of Transfusion Medicine and Hemostasis, University of Erlangen-Nurnberg, Erlangen, Germany
| | - G Breuer
- Department of Anesthesiology, University of Erlangen-Nurnberg, Erlangen, Germany
| | - W Rascher
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nurnberg, Loschgestr. 15, 91054, Erlangen, Germany
| | - M Rauh
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nurnberg, Loschgestr. 15, 91054, Erlangen, Germany
| | - F B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nurnberg, Loschgestr. 15, 91054, Erlangen, Germany
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20
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Schmidt M, Rauh M, Schmid MC, Huebner H, Ruebner M, Wachtveitl R, Cordasic N, Rascher W, Menendez-Castro C, Hartner A, Fahlbusch FB. Influence of Low Protein Diet-Induced Fetal Growth Restriction on the Neuroplacental Corticosterone Axis in the Rat. Front Endocrinol (Lausanne) 2019; 10:124. [PMID: 30915031 PMCID: PMC6421269 DOI: 10.3389/fendo.2019.00124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 02/11/2019] [Indexed: 01/21/2023] Open
Abstract
Objectives: Placental steroid metabolism is linked to the fetal hypothalamus-pituitary-adrenal axis. Intrauterine growth restriction (IUGR) might alter this cross-talk and lead to maternal stress, in turn contributing to the pathogenesis of anxiety-related disorders of the offspring, which might be mediated by fetal overexposure to, or a reduced local enzymatic protection against maternal glucocorticoids. So far, direct evidence of altered levels of circulating/local glucocorticoids is scarce. Liquid chromatography tandem-mass spectrometry (LC-MS/MS) allows quantitative endocrine assessment of blood and tissue. Using a rat model of maternal protein restriction (low protein [LP] vs. normal protein [NP]) to induce IUGR, we analyzed fetal and maternal steroid levels via LC-MS/MS along with the local expression of 11beta-hydroxysteroid-dehydrogenase (Hsd11b). Methods: Pregnant Wistar dams were fed a low protein (8%, LP; IUGR) or an isocaloric normal protein diet (17%, NP; controls). At E18.5, the expression of Hsd11b1 and 2 was determined by RT-PCR in fetal placenta and brain. Steroid profiling of maternal and fetal whole blood, fetal brain, and placenta was performed via LC-MS/MS. Results: In animals with LP-induced reduced body (p < 0.001) and placental weights (p < 0.05) we did not observe any difference in the expressional Hsd11b1/2-ratio in brain or placenta. Moreover, LP diet did not alter corticosterone (Cort) or 11-dehydrocorticosterone (DH-Cort) levels in dams, while fetal whole blood levels of Cort were significantly lower in the LP group (p < 0.001) and concomitantly in LP brain (p = 0.003) and LP placenta (p = 0.002). Maternal and fetal progesterone levels (whole blood and tissue) were not influenced by LP diet. Conclusion: Various rat models of intrauterine stress show profound alterations in placental Hsd11b2 gatekeeper function and fetal overexposure to corticosterone. In contrast, LP diet in our model induced IUGR without altering maternal steroid levels or placental enzymatic glucocorticoid barrier function. In fact, IUGR offspring showed significantly reduced levels of circulating and local corticosterone. Thus, our LP model might not represent a genuine model of intrauterine stress. Hypothetically, the observed changes might reflect a fetal attempt to maintain anabolic conditions in the light of protein restriction to sustain regular brain development. This may contribute to fetal origins of later neurodevelopmental sequelae.
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Affiliation(s)
- Marius Schmidt
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias C. Schmid
- Institute of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Hanna Huebner
- Department of Gynaecology and Obstetrics/Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynaecology and Obstetrics/Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Rainer Wachtveitl
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Nada Cordasic
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Fabian B. Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- *Correspondence: Fabian B. Fahlbusch
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Huebner H, Knörr B, Betzler A, Hartner A, Kehl S, Baier F, Wachter DL, Strick R, Beckmann MW, Fahlbusch FB, Rübner M. Reduzierte Detyrosinierung von alpha-Tubulin in fetoplazentaren Gefäßen der Präeklampsie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- H Huebner
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - B Knörr
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Betzler
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Hartner
- Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - S Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - F Baier
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - DL Wachter
- Pathologisches Institut, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - R Strick
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - MW Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - FB Fahlbusch
- Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - M Rübner
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
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22
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Wahlbuhl M, Schuepbach-Mallepell S, Kowalczyk-Quintas C, Dick A, Fahlbusch FB, Schneider P, Schneider H. Attenuation of Mammary Gland Dysplasia and Feeding Difficulties in Tabby Mice by Fetal Therapy. J Mammary Gland Biol Neoplasia 2018; 23:125-138. [PMID: 29855766 DOI: 10.1007/s10911-018-9399-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/22/2018] [Indexed: 12/11/2022] Open
Abstract
Hypohidrotic ectodermal dysplasias (HED) are hereditary differentiation disorders of multiple ectodermal structures including the mammary gland. The X-linked form of HED (XLHED) is caused by a lack of the secreted signaling molecule ectodysplasin A1 (EDA1) which is encoded by the gene EDA and belongs to the tumor necrosis factor (TNF) superfamily. Although male patients (hemizygous) are usually more severely affected by XLHED, heterozygous female carriers of an EDA mutation may also suffer from a variety of symptoms, in particular from abnormal development of their breasts. In Tabby mice, a well-studied animal model of XLHED, EDA1 is absent. We investigated the effects of prenatal administration of Fc-EDA, a recombinant EDA1 replacement protein, on mammary gland development in female Tabby mice. Intra-amniotic delivery of Fc-EDA to fetal animals resulted later in improved breastfeeding and thus promoted the growth of their offspring. In detail, such treatment led to a normalization of the nipple shape (protrusion, tapering) that facilitated sucking. Mammary glands of treated female Tabby mice also showed internal changes, including enhanced branching morphogenesis and ductal elongation. Our findings indicate that EDA receptor stimulation during development has a stable impact on later stages of mammary gland differentiation, including lactation, but also show that intra-amniotic administration of an EDA1 replacement protein to fetal Tabby mice partially corrects the mammary gland phenotype in female adult animals.
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Affiliation(s)
- Mandy Wahlbuhl
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Loschgestr. 15, 91054, Erlangen, Germany.
| | | | | | - Angela Dick
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Loschgestr. 15, 91054, Erlangen, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Loschgestr. 15, 91054, Erlangen, Germany
| | - Pascal Schneider
- Department of Biochemistry, University of Lausanne, Epalinges, Switzerland
| | - Holm Schneider
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Loschgestr. 15, 91054, Erlangen, Germany
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Fahlbusch FB, Heinlein T, Rauh M, Dittrich S, Cesnjevar R, Moosmann J, Nadal J, Schmid M, Muench F, Schroth M, Rascher W, Topf HG. Influence of factor XIII activity on post-operative transfusion in congenital cardiac surgery-A retrospective analysis. PLoS One 2018; 13:e0199240. [PMID: 29990321 PMCID: PMC6038983 DOI: 10.1371/journal.pone.0199240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/25/2018] [Indexed: 12/16/2022] Open
Abstract
Objectives Coagulation factor XIII (FXIII) plays a key role in fibrin clot stabilization—an essential process for wound healing following cardiothoracic surgery. However, FXIII deficiency as a risk for post-operative bleeding in pediatric cardiac surgery involving cardiopulmonary bypass (CPB) for congenital heart disease (CHD) is controversially discussed. Thus, as primary outcome measures, we analyzed the association of pre-operative FXIII activity and post-operative chest tube drainage (CTD) loss with transfusion requirements post-operatively. Secondary outcomes included the influence of cyanosis and sex on transfusion. Methods Our retrospective analysis (2009–2010) encompassed a single center series of 76 cardio-surgical cases with CPB (0–17 years, mean age 5.61 years) that were post-operatively admitted to our pediatric intensive care unit (PICU). The observational period was 48 hours after cardiac surgery. Blood cell counts and coagulation status, including FXIII activity were routinely performed pre- and post-operatively. The administered amount of blood products and volume expanders was recorded electronically, along with the amount of CTD loss. Uni- and multivariate logistic regression analysis was performed to calculate the associations (odds ratios) of variables with post-operative transfusion needs. Results FXIII activities remained stable following CPB surgery. There was no association of pre- and post-operative FXIII activities and transfusion of blood products or volume expanders in the first 48 hours after surgery. Similarly, FXIII showed no association with CTD loss. Cyanosis and female sex were associated with transfusion rates. Conclusions Although essentially involved in wound healing and clotting after surgery, FXIII activity does not serve as a valid predictor of post-operative transfusion need.
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Affiliation(s)
- Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Heinlein
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Robert Cesnjevar
- Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Julia Moosmann
- Department of Pediatric Cardiology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jennifer Nadal
- Institute of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital, Bonn, Germany
| | - Matthias Schmid
- Institute of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital, Bonn, Germany
| | - Frank Muench
- Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Schroth
- Cnopf'sche Kinderklinik, Diakonie Neuendettelsau, Nürnberg, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Hans-Georg Topf
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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Marek I, Becker R, Fahlbusch FB, Menendez-Castro C, Rascher W, Daniel C, Volkert G, Hartner A. Expression of the Alpha8 Integrin Chain Facilitates Phagocytosis by Renal Mesangial Cells. Cell Physiol Biochem 2018; 45:2161-2173. [PMID: 29544224 DOI: 10.1159/000488160] [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: 06/03/2017] [Accepted: 02/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Healing of mesangioproliferative glomerulonephritis involves degradation of excess extracellular matrix, resolution of hypercellularity by apoptosis and phagocytosis of apoptotic cells. Integrin receptors participate in the regulation of phagocytosis. In mice deficient for alpha8 integrin (Itga8-/-) healing of glomerulonephritis is delayed. As Itga8 is abundant in mesangial cells (MC) which are non-professional phagocytes, we hypothesized that Itga8 facilitates phagocytosis of apoptotic cells and matrix components by MC. METHODS MC were isolated from wild type (WT) and Itga8-/- mice. Latex beads were coated with matrix components. Apoptosis was induced by cisplatin in macrophages and in DiI-stained MC. After coincubation of latex beads or apoptotic cells with MC, the phagocytosis rate was detected in WT and Itga8-/- MC via fluorescence microscopy and FACS analysis. RESULTS Itga8-/- MC showed reduced phagocytosis of matrix-coated beads and apoptotic cells compared to WT MC. Reduction of stress fibers was observed in Itga8-/- compared to WT MC. Inhibition of cytoskeletal reorganization by inhibition of Rac1 or ROCK during phagocytosis significantly decreased the rate of phagocytosis by WT MC but not by Itga8-/- MC. CONCLUSION The expression of Itga8 facilitates phagocytosis in MC, likely mediated by Itga8-cytoskeleton interactions. An impairment of MC phagocytosis might thus contribute to a delayed glomerular regeneration in Itga8-/- mice.
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Affiliation(s)
- Ines Marek
- Department of Pediatrics and Adolescent Medicine, Erlangen, Germany
| | - Robert Becker
- Institute of Nephropathology, University Hospital of Erlangen, Erlangen, Germany
| | | | | | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, Erlangen, Germany
| | - Christoph Daniel
- Institute of Nephropathology, University Hospital of Erlangen, Erlangen, Germany
| | - Gudrun Volkert
- Department of Pediatrics and Adolescent Medicine, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, Erlangen, Germany
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Knieling F, Gonzales Menezes J, Claussen J, Schwarz M, Neufert C, Fahlbusch FB, Rath T, Thoma OM, Kramer V, Menchicchi B, Kersten C, Scheibe K, Schürmann S, Carlé B, Rascher W, Neurath MF, Ntziachristos V, Waldner MJ. Raster-Scanning Optoacoustic Mesoscopy for Gastrointestinal Imaging at High Resolution. Gastroenterology 2018; 154:807-809.e3. [PMID: 29309775 DOI: 10.1053/j.gastro.2017.11.285] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Jean Gonzales Menezes
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | | | | | - Clemens Neufert
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Timo Rath
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Ludwig Demling Center of Excellence, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Oana-Maria Thoma
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Viktoria Kramer
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Bianca Menchicchi
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Christina Kersten
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Kristina Scheibe
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Sebastian Schürmann
- Institute of Medical Biotechnology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Birgitta Carlé
- Institute of Medical Biotechnology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Markus F Neurath
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Ludwig Demling Center of Excellence, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Vasilis Ntziachristos
- Institute for Biological and Medical Imaging, Helmholtz Zentrum München, München, Germany; Chair for Biological Imaging, TranslaTUM, Technische Universität München, München, Germany
| | - Maximilian J Waldner
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.
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Huebner H, Hartner A, Rascher W, Strick RR, Kehl S, Heindl F, Wachter DL, Beckmann Md MW, Fahlbusch FB, Ruebner M. Expression and Regulation of Retinoic Acid Receptor Responders in the Human Placenta. Reprod Sci 2017; 25:1357-1370. [PMID: 29246089 DOI: 10.1177/1933719117746761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Retinoic acid (RA) signaling through its receptors (RARA, RARB, RARG, and the retinoic X receptor RXRA) is essential for healthy placental and fetal development. An important group of genes regulated by RA are the RA receptor responders (RARRES1, 2, and 3). We set out to analyze their expression and regulation in healthy and pathologically altered placentas of preeclampsia (PE) and intrauterine growth restriction (IUGR) as well as in trophoblast cell lines. METHODS We performed immunohistochemical staining on placental sections and analyzed gene expression by real-time polymerase chain reaction. Additionally, we performed cell culture experiments and stimulated Swan71 and Jeg-3 cells with different RA derivates and 2'-deoxy-5-azacytidine (AZA) to induce DNA demethylation. RESULTS RARRES1, 2, and 3 and RARA, RARB, RARG, and RXRA are expressed in the extravillous part of the placenta. RARRES1, RARA, RARG, and RXRA were additionally detected in villous cytotrophoblasts. RARRES gene expression was induced via activation of RARA, RARB, and RARG in trophoblast cells. RARRES1 was overexpressed in villous trophoblasts and the syncytiotrophoblast from PE placentas, but not in IUGR without PE. Promoter methylation was detectable for RARRES1 and RARB based on their sensitivity toward AZA treatment of trophoblast cell lines. DISCUSSION RARRES1, 2 and 3 are expressed in the functional compartments of the human placenta and can be regulated by RA. We hypothesize that the epigenetic suppression of trophoblast RARRES1 and RARB expression and the upregulation of RARRES1 in PE trophoblast cells suggest an involvement of environmental factors (eg, maternal vitamin A intake) in the pathogenesis of this pregnancy complication.
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Affiliation(s)
- Hanna Huebner
- 1 Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Andrea Hartner
- 2 Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Rascher
- 2 Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Reiner R Strick
- 1 Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sven Kehl
- 1 Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Heindl
- 1 Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - David L Wachter
- 3 Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany * The authors are contributed equally
| | - Matthias W Beckmann Md
- 1 Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Fabian B Fahlbusch
- 2 Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Ruebner
- 1 Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Huebner H, Strick R, Wachter DL, Kehl S, Strissel PL, Schneider-Stock R, Hartner A, Rascher W, Horn LC, Beckmann MW, Ruebner M, Fahlbusch FB. Hypermethylation and loss of retinoic acid receptor responder 1 expression in human choriocarcinoma. J Exp Clin Cancer Res 2017; 36:165. [PMID: 29169400 PMCID: PMC5701501 DOI: 10.1186/s13046-017-0634-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/13/2017] [Indexed: 01/06/2023]
Abstract
Background Human placental development resembles tumorigenesis, due to the invasive and fusogenic potential of trophoblasts. However, these features are tightly controlled in trophoblasts. Disturbance of this spatial and temporal regulation is thought to contribute to the rare formation of choriocarcinomas. Promoter hypermethylation and loss of the tumor suppressor Retinoic acid receptor responder 1 (RARRES1) were shown to contribute to cancer progression. Our study investigated the epigenetic and transcriptional regulation of RARRES1 in healthy human placenta in comparison to choriocarcinoma cell lines and cases. Methods Three choriocarcinoma cell lines (Jeg-3, JAR and BeWo) were treated with three different retinoic acid derivates (Am580, Tazarotene and all-trans retinoic acid) and 5-aza-2′-deoxycytidine. We analyzed RARRES1 promoter methylation by pyrosequencing and performed realtime-PCR quantification to determine RARRES1 expression in placental tissue and trophoblastic cell lines. Additionally, RARRES1 was stained in healthy placentas and in biopsies of choriocarcinoma cases (n = 10) as well as the first trimester trophoblast cell line Swan71 by immunofluorescence and immunohistochemistry. Results In the choriocarcinoma cell lines, RARRES1 expression could not be induced by sole retinoic acid treatment. Stimulation with 5-aza-2′-deoxycytidine significantly induced RARRES1 expression, which then could be further increased with Am580, Tazarotene and all-trans retinoic acid. In comparison to healthy placenta, choriocarcinoma cell lines showed a hypermethylation of the RARRES1 promoter, which correlated with a reduced RARRES1 expression. In concordance, RARRES1 protein expression was lost in choriocarcinoma tissue. Additionally, in the trophoblastic cell line Swan71, we found a significant induction of RARRES1 expression with increased cell density, during mitosis and in syncytial knots. Conclusions Our findings showed that RARRES1 expression is absent in choriocarcinoma due to promoter methylation. Based on our analysis, we hypothesize that RARRES1 might exert tumor suppressive functions in multiple cellular processes (e.g. cell cycle regulation, adhesion, invasion and apoptosis). Electronic supplementary material The online version of this article (10.1186/s13046-017-0634-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H Huebner
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - R Strick
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - D L Wachter
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - S Kehl
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - P L Strissel
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - R Schneider-Stock
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - A Hartner
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Loschgestraße 15, 91054 Erlangen, Erlangen, Germany
| | - W Rascher
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Loschgestraße 15, 91054 Erlangen, Erlangen, Germany
| | - L C Horn
- Division Molecular Pathology, Institute of Pathology, University of Leipzig, Leipzig, Germany
| | - M W Beckmann
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - M Ruebner
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - F B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Loschgestraße 15, 91054 Erlangen, Erlangen, Germany.
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Meliso FM, Micali D, Silva CT, Sabedot TS, Coetzee SG, Koch A, Fahlbusch FB, Noushmehr H, Schneider-Stock R, Jasiulionis MG. Abstract 2413: SIRT1 regulates Mxd1 throughout melanoma progression. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
In a murine melanoma model of malignant transformation promoted by sustained stress, increased levels of reactive oxygen species were found to result in DNA damage and were related to massive epigenetic alterations. Since the chromatin modifier Sirtuin-1 (SIRT1) is a protein attracted to double-stranded DNA break (DSB) sites and can recruit other components of the epigenetic machinery, we aimed to define the role of SIRT1 in melanomagenesis through our melanoma model. The DNA damage marker, γH2AX was found increased in melanocytes after 24 hours of deadhesion, accompanied by increased SIRT1 expression and decreased levels of its target, H4K16ac. Moreover, SIRT1 started to be associated to DNMT3B during the stress condition, and this complex was maintained along malignant progression. Mxd1 was identified by ChIP-seq among the DNA sequences differentially associated with SIRT1 during deadhesion and was shown to be a common target of both, SIRT1 and DNMT3B. In addition, Mxd1 was found down-regulated from pre-malignant melanocytes to metastatic melanoma cells. Treatment with DNMT inhibitor 5AzaCdR reversed the Mxd1 expression. Sirt1 stable silencing increased Mxd1 mRNA expression and led to up-regulation of MYC targets, such as Cdkn1a, Bcl2 and Psen2, the upregulation of which is associated with human melanoma aggressiveness and poor prognosis. We demonstrated a novel role of the stress responsive protein SIRT1 in malignant transformation of melanocytes associated with deadhesion. Mxd1 was identified as a new SIRT1 target gene. SIRT1 promoted Mxd1 silencing, which led to increased activity of MYC oncogene contributing to melanoma progression.
Citation Format: Fabiana M. Meliso, Danilo Micali, Camila T. Silva, Thais S. Sabedot, Simon G. Coetzee, Adrian Koch, Fabian B. Fahlbusch, Houtan Noushmehr, Regine Schneider-Stock, Miriam G. Jasiulionis. SIRT1 regulates Mxd1 throughout melanoma progression [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2413. doi:10.1158/1538-7445.AM2017-2413
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Affiliation(s)
| | - Danilo Micali
- 1Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Adrian Koch
- 3Friedrich-Alexander University, Erlangen, Germany
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Marek I, Canu M, Cordasic N, Rauh M, Volkert G, Fahlbusch FB, Rascher W, Hilgers KF, Hartner A, Menendez-Castro C. Sex differences in the development of vascular and renal lesions in mice with a simultaneous deficiency of Apoe and the integrin chain Itga8. Biol Sex Differ 2017; 8:19. [PMID: 28572914 PMCID: PMC5450388 DOI: 10.1186/s13293-017-0141-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/23/2017] [Indexed: 01/21/2023] Open
Abstract
Background Apoe-deficient (Apoe−/−) mice develop progressive atherosclerotic lesions with age but no severe renal pathology in the absence of additional challenges. We recently described accelerated atherosclerosis as well as marked renal injury in Apoe−/− mice deficient in the mesenchymal integrin chain Itga8 (Itga8−/−). Here, we used this Apoe−/−, Itga8−/− mouse model to investigate the sex differences in the development of atherosclerosis and concomitant renal injury. We hypothesized that aging female mice are protected from vascular and renal damage in this mouse model. Methods Apoe−/− mice were backcrossed with Itga8−/− mice. Mice were kept on a normal diet. At the age of 12 months, the aortae and kidneys of male and female Apoe−/−Itga8+/+ mice or Apoe−/−Itga8−/− mice were studied. En face preparations of the aorta were stained with Sudan IV (lipid deposition) or von Kossa (calcification). In kidney tissue, immunostaining for collagen IV, CD3, F4/80, and PCNA and real-time PCR analyses for Il6, Vegfa, Col1a1 (collagen I), and Ssp1 (secreted phosphoprotein 1, synonym osteopontin) as well as ER stress markers were performed. Results When compared to male mice, Apoe−/−Itga8+/+ female mice had a lower body weight, equal serum cholesterol levels, and lower triglyceride levels. However, female mice had increased aortic lipid deposition and more aortic calcifications than males. Male Apoe−/− mice with the additional deficiency of Itga8 developed increased serum urea, glomerulosclerosis, renal immune cell infiltration, and reduced glomerular cell proliferation. In females of the same genotype, these renal changes were less pronounced and were accompanied by lower expression of interleukin-6 and collagen I, while osteopontin expression was higher and markers of ER stress were not different. Conclusions In this model of atherosclerosis, the female sex is a risk factor to develop more severe atherosclerotic lesions, even though serum fat levels are higher in males. In contrast, female mice are protected from renal damage, which is accompanied by attenuated inflammation and matrix deposition. Thus, sex affects vascular and renal injury in a differential manner. Electronic supplementary material The online version of this article (doi:10.1186/s13293-017-0141-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ines Marek
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuernberg, Loschgestrasse 15, 91054 Erlangen, Germany
| | - Maurizio Canu
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuernberg, Loschgestrasse 15, 91054 Erlangen, Germany
| | - Nada Cordasic
- Department of Nephrology and Hypertension, University Hospital of Erlangen-Nuernberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuernberg, Loschgestrasse 15, 91054 Erlangen, Germany
| | - Gudrun Volkert
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuernberg, Loschgestrasse 15, 91054 Erlangen, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuernberg, Loschgestrasse 15, 91054 Erlangen, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuernberg, Loschgestrasse 15, 91054 Erlangen, Germany
| | - Karl F Hilgers
- Department of Nephrology and Hypertension, University Hospital of Erlangen-Nuernberg, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuernberg, Loschgestrasse 15, 91054 Erlangen, Germany
| | - Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, University Hospital of Erlangen-Nuernberg, Loschgestrasse 15, 91054 Erlangen, Germany
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Heussner K, Rauh M, Cordasic N, Menendez-Castro C, Huebner H, Ruebner M, Schmidt M, Hartner A, Rascher W, Fahlbusch FB. Adhesive blood microsampling systems for steroid measurement via LC-MS/MS in the rat. Steroids 2017; 120:1-6. [PMID: 28189541 DOI: 10.1016/j.steroids.2017.01.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) allows for the direct analysis of multiple hormones in a single probe with minimal sample volume. Rodent-based animal studies strongly rely on microsampling, such as the dry blood spot (DBS) method. However, DBS suffers the drawback of hematocrit-dependence (non-volumetric). Hence, novel volumetric microsampling techniques were introduced recently, allowing sampling of fixed accurate volumes. We compared these methods for steroid analysis in the rat to improve inter-system comparability. EXPERIMENTAL We analyzed steroid levels in blood using the absorptive microsampling devices Whatman® 903 Protein Saver Cards, Noviplex™ Plasma Prep Cards and the Mitra™ Microsampling device and compared the obtained results to the respective EDTA plasma levels. Quantitative steroid analysis was performed via LC-MS/MS. For the determination of the plasma volume factor for each steroid, their levels in pooled blood samples from each human adults and rats (18weeks) were compared and the transferability of these factors was evaluated in a new set of juvenile (21days) and adult (18weeks) rats. Hematocrit was determined concomitantly. RESULTS Using these approaches, we were unable to apply one single volume factor for each steroid. Instead, plasma volume factors had to be adjusted for the recovery rate of each steroid and device individually. The tested microsampling systems did not allow the use of one single volume factor for adult and juvenile rats based on an unexpectedly strong hematocrit-dependency and other steroid specific (pre-analytic) factors. DISCUSSION Our study provides correction factors for LC-MS/MS steroid analysis of volumetric and non-volumetric microsampling systems in comparison to plasma. It argues for thorough analysis of chromatographic effects before the use of novel volumetric systems for steroid analysis.
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Key Words
- 11-Dehydrocorticosterone (21-Hydroxypregn-4-ene-3,11,20-trione, PubChem CID: 5311364)
- Corticosterone (11β,21-Dihydroxy-4-pregnene-3,20-dione, PubChem CID: 5753)
- Cortisol (Cortisol-9,11,12,12-d4, PubChem CID: 53442221)
- Cortisone (17α,21-Dihydroxy-4-pregnene-3,11,20-trione, PubChem CID: 222786)
- DBS
- LC–MS/MS
- Microsampling devices
- Mitra
- Noviplex
- Progesterone (4-Pregnene-3,20-dione, PubChem CID: 5994).
- Rat
- Steroids
- Testosterone (17β-Hydroxy-3-oxo-4-androstene, PubChem CID: 6013)
- Whatman
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Affiliation(s)
- Kirsten Heussner
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Nada Cordasic
- Department of Nephrology and Hypertension, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Hanna Huebner
- Department of Gynecology and Obstetrics, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Marius Schmidt
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany.
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Heiss RU, Fahlbusch FB, Jacobi J, Daniel C, Ekici AB, Cordasic N, Amann K, Hartner A, Hilgers KF. Blunted transcriptional response to skeletal muscle ischemia in rats with chronic kidney disease: potential role for impaired ischemia-induced angiogenesis. Physiol Genomics 2017; 49:230-237. [PMID: 28213570 DOI: 10.1152/physiolgenomics.00124.2016] [Citation(s) in RCA: 5] [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: 11/14/2016] [Accepted: 02/15/2017] [Indexed: 11/22/2022] Open
Abstract
Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. Previous studies indicated an impairment of ischemia-induced angiogenesis in skeletal muscle of rats with CKD. We performed a systematic comparison of early gene expression in response to ischemia in rats with or without CKD to identify potential molecular mechanisms underlying impaired angiogenesis in CKD. CKD was induced in male rats by 5/6 nephrectomy (SNX); control rats were sham operated (sham). Eight weeks later, ischemia of the right limb was induced by ligation and resection of the femoral artery. Rats were killed 24 h after the onset of ischemia, and RNA was extracted from the musculus soleus of the ischemic and the nonischemic hindlimb. To identify differentially expressed transcripts, we analyzed RNA with Affymetrix GeneChip Rat Genome 230 2.0 Arrays. RT-PCR analysis of selected genes was performed to validate observed changes. Hindlimb ischemia upregulated 239 genes in CKD and 299 genes in control rats (66% overlap), whereas only a few genes were downregulated (14 in CKD and 34 in controls) compared with the nonischemic limb of the same animals. Comparison between the ischemic limbs of CKD and controls revealed downregulation of 65 genes in CKD; 37 of these genes were also among the ischemia-induced genes in controls. Analysis of functional groups (other than angiogenesis) pointed to genes involved in leukocyte recruitment and fatty acid metabolism. Transcript expression profiling points to a relatively small number of differentially expressed genes that may underlie the impaired postischemic angiogenesis in CKD.
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Affiliation(s)
- Rafael U Heiss
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany.,Department of Radiology, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany
| | - Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany
| | - Johannes Jacobi
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany
| | - Christoph Daniel
- Institute for Nephropathology, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany; and
| | - Arif B Ekici
- Institute of Human Genetics, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany
| | - Nada Cordasic
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany
| | - Kerstin Amann
- Institute for Nephropathology, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany; and
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany
| | - Karl F Hilgers
- Department of Nephrology and Hypertension, Friedrich-Alexander University, Erlangen-Nuremberg (FAU), Germany;
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Herdl S, Huebner H, Volkert G, Marek I, Menendez-Castro C, Noegel SC, Ruebner M, Rascher W, Hartner A, Fahlbusch FB. Integrin α8 Is Abundant in Human, Rat, and Mouse Trophoblasts. Reprod Sci 2017; 24:1426-1437. [PMID: 28136130 DOI: 10.1177/1933719116689597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Integrins exert regulatory functions in placentogenesis. Null mutation of certain integrin α subunits leads to placental defects with subsequent fetal growth restriction or embryonic lethality in mice. So far, the placental role of α8 integrin remains to be determined. METHODS Localization of α8 integrin and its ligands, fibronectin (FN) and osteopontin (OPN), was studied by immunohistochemistry in human, rat, and mouse placenta. The vascularization of the placental labyrinth layer of α8 integrin-deficient mice was determined by CD31 staining. In humans, α8 integrin expression was assessed via real-time polymerase chain reaction in healthy placentas, in the placental pathologies such as intrauterine growth restriction (IUGR), preeclampsia, and HELLP-syndrome (hemolysis, elevated liver enzymes, low platelet count), as well as in primary extravillous trophoblasts (EVT) and villous trophoblasts. RESULTS In humans, α8 integrin was detected in first and third trimester syncytiotrophoblast and EVT. Although OPN showed the same localization, FN was observed in EVT only. No expressional changes in α8 integrin were detected in the placental pathologies studied. Rodent placenta showed α8 integrin expression in giant cells and in the labyrinth layer. The localization of OPN and FN, however, showed species-specific differences. Knockout of α8 integrin in mice did not cause IUGR, despite some reduction in labyrinth layer vascularization. CONCLUSION α8 Integrin is expressed in functional placental compartments among its ligands, OPN and/or FN, across species. Although this may point to a regulatory role in trophoblast function, our data from α8 integrin-deficient mice indicated only mild placental pathology. Thus, the lack of placental α8 integrin seems to be largely compensated for.
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Affiliation(s)
- Sebastian Herdl
- 1 Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Hanna Huebner
- 2 Department of Gynaecology and Obstetrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Gudrun Volkert
- 1 Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ines Marek
- 1 Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Carlos Menendez-Castro
- 1 Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie C Noegel
- 1 Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Ruebner
- 2 Department of Gynaecology and Obstetrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Rascher
- 1 Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Hartner
- 1 Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Fabian B Fahlbusch
- 1 Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
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Huebner H, Fahlbusch FB, Strissel PL, Beckmann MW, Strick R, Ruebner M. CRISPR-Cas9 induzierter Knock-out des endogenen Retrovirus Erv3 in der humanen Chorionkarzinomzelllinie Jeg-3. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Huebner H, Engelbrecht J, Fahlbusch FB, Strick R, Beckmann MW, Ruebner M. Epigenetische Dysregulation des Tumorsuppressors RARRES1 und Störung der Zell-Zell-Konnektivität im Chorionkarzinom und in Präeklampsie-assoziierten Trophoblastem. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Huebner H, Fahlbusch FB, Ekici AB, Vasileiou G, Beckmann MW, Strick R, Ruebner M. Knock-out of the human endogenous retrovirus ERV3 using CRISPR/Cas9 technology. Placenta 2016. [DOI: 10.1016/j.placenta.2016.06.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Heussner K, Ruebner M, Huebner H, Rascher W, Menendez-Castro C, Hartner A, Fahlbusch FB, Rauh M. Species differences of 11beta-hydroxysteroid dehydrogenase type 2 function in human and rat term placenta determined via LC-MS/MS. Placenta 2016; 37:79-84. [DOI: 10.1016/j.placenta.2015.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/16/2015] [Accepted: 11/20/2015] [Indexed: 12/22/2022]
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Fahlbusch FB, Heussner K, Schmid M, Schild R, Ruebner M, Huebner H, Rascher W, Doerr HG, Rauh M. Measurement of amniotic fluid steroids of midgestation via LC-MS/MS. J Steroid Biochem Mol Biol 2015; 152:155-60. [PMID: 26047555 DOI: 10.1016/j.jsbmb.2015.05.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 05/02/2015] [Accepted: 05/31/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Analysis of steroids by mass spectrometry (MS) has evolved into a reliable tool for the simultaneous detection of multiple steroids. As amniotic fluid (AF) and fetal serum composition of early pregnancy are closely related, the analysis of AF can yield information on the physiological status of the developing fetus. We evaluated the use of liquid-chromatography tandem mass spectrometry (LC-MS/MS) for AF steroid analysis, including the analysis of its sensitivity and accuracy for gender verification in healthy subjects. MATERIALS AND METHODS AF of 78 male and 94 female healthy newborns was analyzed by LC-MS/MS at 16 weeks of gestation. The levels of androstenedione, corticosterone, cortisol, cortisone, deoxycorticosterone, 11-deoxycortisol, dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEA-S), 17-hydroxyprogesterone, progesterone (17-OHP) and testosterone were measured. Steroid levels were compared to RIA and GC-MS levels of midgestation from the literature. Cross-validated logistic regression was used to obtain statistical predictions of gender at birth from testosterone and the above steroids. RESULTS LC-MS/MS analysis of AF steroids yielded comparable results with published GC-MS data. Gender specific differences were found for androstenedione and testosterone concentrations with higher levels in the male fetus. In contrast to published RIA data no gender specific differences were observed for 17-hydroxyprogesterone and dehydroepiandrosterone AF concentrations. Testosterone concentrations yielded highly accurate predictions for male gender at birth. Additional analysis of further steroids did neither increase the accuracy, sensitivity nor specificity of this prediction. The estimated optimal cut-off value for amniotic testosterone level was 0.074 μg/L for healthy male newborns. CONCLUSIONS LC-MS/MS is a reliable method for the determination of steroids in amniotic fluid. The determination of testosterone in amniotic fluid by LC-MS/MS in early pregnancy of healthy subjects can be used to offer a reliable prediction of fetal gender at birth.
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Affiliation(s)
- Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany.
| | - Kirsten Heussner
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Schmid
- Institute of Medical Biometry, Informatics and Epidemiology (IMBIE), Rheinische Friedrich-Wilhelms-University, Bonn, Germany
| | - Ralf Schild
- Department of Obstetrics and Perinatal Medicine, Diakoniekrankenhaus Friederikenstift, Hannover, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Hanna Huebner
- Department of Gynecology and Obstetrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Helmuth-Guenther Doerr
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
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Huebner H, Fahlbusch FB, Wirth AK, Wuerfel FM, Strissel PL, Strick R, Beckmann MW, Ruebner M. Zell-Zell-Fusion in gynäkologischen Tumoren – Syncytin-1 als Markerprotein. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1555066] [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: 10/23/2022] Open
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Fahlbusch FB, Ruebner M, Huebner H, Volkert G, Bartunik H, Winterfeld I, Hartner A, Menendez-Castro C, Noegel SC, Marek I, Wachter D, Schneider-Stock R, Beckmann MW, Kehl S, Rascher W. Trophoblast expression dynamics of the tumor suppressor gene gastrokine 2. Histochem Cell Biol 2015; 144:281-91. [PMID: 26070363 DOI: 10.1007/s00418-015-1336-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 01/14/2023]
Abstract
Gastrokines (GKNs) were originally described as stomach-specific tumor suppressor genes. Recently, we identified GKN1 in extravillous trophoblasts (EVT) of human placenta. GKN1 treatment reduced the migration of the trophoblast cell line JEG-3. GKN2 is known to inhibit the proliferation, migration and invasion of gastric cancer cells and may interact with GKN1. Recently, GKN2 was detected in the placental yolk sac of mice. We therefore aimed to further characterize placental GKN2 expression. By immunohistochemistry, healthy first-trimester placenta showed ubiquitous staining for GKN2 at its early gestational stage. At later gestational stages, a more differentiated expression pattern in EVT and villous cytotrophoblasts became evident. In healthy third-trimester placenta, only EVT retained strong GKN2 immunoreactivity. In contrast, HELLP placentas showed a tendency of increased levels of GKN2 expression with a more prominent GKN2 staining in their syncytiotrophoblast. Choriocarcinoma cell lines did not express GKN2. Besides its trophoblastic expression, we found human GKN2 in fibrotic villi, in amniotic membrane and umbilical cord. GKN2 co-localized with smooth muscle actin in villous myofibroblasts and with HLA-G and GKN1 in EVT. In the rodent placenta, GKN2 was specifically located in the spongiotrophoblast layer. Thus, the gestational age-dependent and compartment-specific expression pattern of GKN2 points to a role for placental development. The syncytial expression of GKN2 in HELLP placentas might represent a reduced state of functional differentiation of the syncytiotrophoblast. Moreover, the specific GKN2 expression in the rodent spongiotrophoblast layer (equivalent to human EVT) might suggest an important role in EVT physiology.
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Affiliation(s)
- Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Loschgestr. 15, 91054, Erlangen, Germany,
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Ruebner M, Henke C, Strissel PL, Fahlbusch FB, Faschingbauer F, Kehl S, Beckmann MW. Laser micro-dissection microscopy of single Cell-compartments from human placental tissue: A new approach to study trophoblast differentiation. Placenta 2014. [DOI: 10.1016/j.placenta.2014.06.354] [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: 10/24/2022]
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Huebner H, Ruebner M, Strissel PL, Schneider-Stock R, Kehl S, Rascher W, Strick R, Hartner A, Beckmann MW, Fahlbusch FB. Epigenetic and genetic alterations of the placental tumor-suppressor gene rarres1 during human placentogenesis. Placenta 2014. [DOI: 10.1016/j.placenta.2014.06.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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El-Baba C, Mahadevan V, Fahlbusch FB, Mohan S S, Rau TT, Gali-Muhtasib H, Schneider-Stock R. Thymoquinone-induced conformational changes of PAK1 interrupt prosurvival MEK-ERK signaling in colorectal cancer. Mol Cancer 2014; 13:201. [PMID: 25174975 PMCID: PMC4158125 DOI: 10.1186/1476-4598-13-201] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 08/25/2014] [Indexed: 12/13/2022] Open
Abstract
Background Thymoquinone (TQ) was shown to reduce tumor growth in several cancer models both in vitro and in vivo. So far only a few targets of TQ, including protein kinases have been identified. Considering that kinases are promising candidates for targeted anticancer therapy, we studied the complex kinase network regulated by TQ. Methods Novel kinase targets influenced by TQ were revealed by in silico analysis of peptide array data obtained from TQ-treated HCT116wt cells. Western blotting and kinase activity assays were used to determine changes in kinase expression patterns in colorectal cancer cells (HCT116wt, DLD-1, HT29). To study the viability/apoptotic effects of combining the PAK1 inhibitor IPA-3 and TQ, crystal violet assay and AnnexinV/PI staining were employed. Interactions between PAK1 and ERK1/2 were investigated by co-immunoprecipitation and modeled by docking studies. Transfection with different PAK1 mutants unraveled the role of TQ-induced changes in PAK1 phosphorylation and TQ´s effects on PAK1 scaffold function. Results Of the 104 proteins identified, 50 were upregulated ≥2 fold by TQ and included molecules in the AKT-MEK-ERK1/2 pathway. Oncogenic PAK1 emerged as an interesting TQ target. Time-dependent changes in two PAK1 phosphorylation sites generated a specific kinase profile with early increase in pPAKThr212 followed by late increase in pPAKThr423. TQ induced an increase of pERK1/2 and triggered the early formation of an ERK1/2-PAK1 complex. Modeling confirmed that TQ binds in the vicinity of Thr212 accompanied by conformational changes in ERK2-PAK1 binding. Transfecting the cells with the non-phosphorylatable mutant T212A revealed an increase of pPAKThr423 and enhanced apoptosis. Likewise, an increase in apoptosis was observed in cells transfected with both the kinase-dead K299R mutant and PAK1 siRNA. Using structural modeling we suggest that TQ interferes also with the kinase domain consequently disturbing its interaction with pPAKThr423, finally inhibiting MEK-ERK1/2 signaling and disrupting its prosurvival function. pERK1/2 loss was also validated in vivo. Conclusions Our study shows for the first time that the small molecule TQ directly binds to PAK1 changing its conformation and scaffold function. Because TQ affects the central RAF/MEK/ERK1/2 pathway, the combination of TQ with targeted therapies is worth considering for future anticancer treatments. Electronic supplementary material The online version of this article (doi:10.1186/1476-4598-13-201) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | - Regine Schneider-Stock
- Experimental Tumorpathology, Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Beinder L, Faehrmann N, Wachtveitl R, Winterfeld I, Hartner A, Menendez-Castro C, Rauh M, Ruebner M, Huebner H, Noegel SC, Doerr HG, Rascher W, Fahlbusch FB. Detection of expressional changes induced by intrauterine growth restriction in the developing rat mammary gland via exploratory pathways analysis. PLoS One 2014; 9:e100504. [PMID: 24955840 PMCID: PMC4067350 DOI: 10.1371/journal.pone.0100504] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 05/26/2014] [Indexed: 12/29/2022] Open
Abstract
Background Intrauterine growth restriction (IUGR) is thought to lead to fetal programming that in turn contributes to developmental changes of many organs postnatally. There is evidence that IUGR is a risk factor for the development of metabolic and cardiovascular disease later in life. A higher incidence of breast cancer was also observed after IUGR. This could be due to changes in mammary gland developmental pathways. We sought to characterise IUGR-induced alterations of the complex pathways of mammary development at the level of the transcriptome in a rat model of IUGR, using pathways analysis bioinformatics. Methodology/Principal Findings We analysed the mammary glands of Wistar rats with IUGR induced by maternal low protein (LP) diet at the beginning (d21) and the end (d28) of pubertal ductal morphogenesis. Mammary glands of the LP group were smaller in size at d28, however did not show morphologic changes. We identified multiple differentially expressed genes in the mammary gland using Agilent SurePrint arrays at d21 and d28. In silico analysis was carried out using Ingenuity Pathways Analysis. In mammary gland tissue of LP rats at d21 of life a prominent upregulation of WT1 and CDKN1A (p21) expression was observed. Differentially regulated genes were associated with the extracellular regulated kinase (ERK)-1/-2 pathway. Western Blot analysis showed reduced levels of phosphorylated ERK-1/-2 in the mammary glands of the LP group at d21. To identify possible changes in circulating steroid levels, serum LC-Tandem mass-spectrometry was performed. LP rats showed higher serum progesterone levels and an increased corticosterone/dehydrocorticosterone-ratio at d28. Conclusions/Significance Our data obtained from gene array analysis support the hypothesis that IUGR influences pubertal development of the rat mammary gland. We identified prominent differential regulation of genes and pathways for factors regulating cell cycle and growth. Moreover, we detected new pathways which appear to be programmed by IUGR.
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Affiliation(s)
- Lea Beinder
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Nina Faehrmann
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Rainer Wachtveitl
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ilona Winterfeld
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Hanna Huebner
- Department of Gynecology and Obstetrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie C. Noegel
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Helmuth G. Doerr
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Fabian B. Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
- * E-mail:
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Fahlbusch FB, Ruebner M, Rascher W, Rauh M. Combined quantification of corticotropin-releasing hormone, cortisol-to-cortisone ratio and progesterone by liquid chromatography-Tandem mass spectrometry in placental tissue. Steroids 2013; 78:888-95. [PMID: 23665406 DOI: 10.1016/j.steroids.2013.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 04/16/2013] [Accepted: 04/25/2013] [Indexed: 11/25/2022]
Abstract
With mid-gestation the production of placental corticotropin-releasing hormone (CRH) starts to steadily increase. The fetal peptide CRH excerts direct functions at the feto-maternal interface (vasodilatation, timing of birth) via its interaction with progesterone and indirectly ensures maturation and growth of fetal organ systems for delivery by driving fetal cortisol production via its induction of adrenocorticotropic hormone release. This feedback loop is tightly controlled by the amount of enzymatic cortisol/cortisone turnover in the placental syncytiotrophoblast by 11β-hydroxy-steroid dehydrogenase type 2 (11β-HSD2). Traditionally, placental tissue hormones have been quantified by immunological methods (e.g. RIA or ELISA), which have the drawback of possible cross-reactivity and tissue perturbations. Most importantly, it is not possible to quantify CRH and steroid hormones, such as cortisol, cortisone and progesterone together in the same sample with these methods. Hence, we aimed to develop and validate a quantitative mass spectrometry (MS) method for multi-modal quantification of these placental hormones: While CRH was readily detectable throughout the placenta, the placental levels of progesterone and especially cortisol and cortisone were higher at the placental base facing the maternal side. The HPLC-MS/MS procedure showed excellent selectivity and sufficient limit of quantification in placental tissue homogenates to allow for simultaneous detection of CRH, cortisol and cortisone, and progesterone.
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Affiliation(s)
- Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany.
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Fahlbusch FB, Ruebner M, Huebner H, Volkert G, Zuern C, Thiel F, Koch M, Menendez-Castro C, Wachter DL, Hartner A, Rascher W. The tumor suppressor gastrokine-1 is expressed in placenta and contributes to the regulation of trophoblast migration. Placenta 2013; 34:1027-35. [PMID: 23993393 DOI: 10.1016/j.placenta.2013.08.005] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 08/01/2013] [Accepted: 08/05/2013] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Gastrokine-1 (GKN1) is a secreted auto-/paracrine protein, described to be expressed in the gastric mucosa. In gastric cancers GKN1 expression is commonly down-regulated. While current research focusses on the exploration of tumor-suppressive properties of GKN1 with regard to its potential clinical use in the treatment of gastroenterologic tumor disease, nothing is known about GKN1 expression and function in other organ systems. We investigated GKN1 expression in placental tissue and cells. MATERIALS AND METHODS GKN1 was localized using immunohistochemistry in first and third trimester placental tissue, hydatidiform moles and various gestational trophoblastic neoplasias. We determined the expression of GKN1 in immunomagnetic bead-separated term placental cells and in choriocarcinoma cell lines. The role of GKN1 for JEG-3 migration was studied using live cell imaging. E-cadherin, MMP-2 and -9, TIMP-1 and -2, as well as urokinase (uPA) expression levels were determined. RESULTS GKN1 is expressed in healthy third trimester placentas. Its expression is specifically limited to the extravillous trophoblast (EVT). GKN1 expression is significantly reduced in choriocarcinoma cell lines and gestational trophoblastic neoplasias. GKN1 attenuates the migration of JEG-3 choriocarcinoma cells in vitro, possibly via AKT-mediated induction of E-cadherin. GKN1 treatment reduced MMP-9 expression in JEG-3. DISCUSSION Besides its role in gastric physiology our results clearly indicate regulatory functions of GKN1 in the EVT at the feto-maternal interface during pregnancy. Based on our findings in the JEG-3 choriocarcinoma cell line, an auto-/paracrine role of GKN1 for EVT motility and villous anchorage at the basal plate is conceivable. Thus, the tumor suppressor GKN1 is expressed in placental EVT and might contribute to the regulation of EVT migration/invasion.
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Affiliation(s)
- F B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany.
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Fahlbusch FB, Ruebner M, Volkert G, Offergeld R, Hartner A, Menendez-Castro C, Strick R, Rauh M, Rascher W, Dötsch J. Corticotropin-releasing hormone stimulates expression of leptin, 11beta-HSD2 and syncytin-1 in primary human trophoblasts. Reprod Biol Endocrinol 2012; 10:80. [PMID: 22971074 PMCID: PMC3492048 DOI: 10.1186/1477-7827-10-80] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 09/04/2012] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The placental syncytiotrophoblast is the major source of maternal plasma corticotropin-releasing hormone (CRH) in the second half of pregnancy. Placental CRH exerts multiple functions in the maternal organism: It induces the adrenal secretion of cortisol via the stimulation of adrenocorticotropic hormone, regulates the timing of birth via its actions in the myometrium and inhibits the invasion of extravillous trophoblast cells in vitro. However, the auto- and paracrine actions of CRH on the syncytiotrophoblast itself are unknown. Intrauterine growth restriction (IUGR) is accompanied by an increase in placental CRH, which could be of pathophysiological relevance for the dysregulation in syncytialisation seen in IUGR placentas. METHODS We aimed to determine the effect of CRH on isolated primary trophoblastic cells in vitro. After CRH stimulation the trophoblast syncytialisation rate was monitored via syncytin-1 gene expression and beta-hCG (beta-human chorionic gonadotropine) ELISA in culture supernatant. The expression of the IUGR marker genes leptin and 11beta-hydroxysteroid dehydrogenase 2 (11beta-HSD2) was measured continuously over a period of 72 h. We hypothesized that CRH might attenuate syncytialisation, induce leptin, and reduce 11beta-HSD2 expression in primary villous trophoblasts, which are known features of IUGR. RESULTS CRH did not influence the differentiation of isolated trophoblasts into functional syncytium as determined by beta-hCG secretion, albeit inducing syncytin-1 expression. Following syncytialisation, CRH treatment significantly increased leptin and 11beta-HSD2 expression, as well as leptin secretion into culture supernatant after 48 h. CONCLUSION The relevance of CRH for placental physiology is underlined by the present in vitro study. The induction of leptin and 11beta-HSD2 in the syncytiotrophoblast by CRH might promote fetal nutrient supply and placental corticosteroid metabolism in the phase before labour induction.
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Affiliation(s)
- Fabian B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Gudrun Volkert
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ramona Offergeld
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Hartner
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Carlos Menendez-Castro
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Reiner Strick
- Department of Gynecology and Obstetrics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Rascher
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jörg Dötsch
- Childrens’ and Adolescents’ Hospital, University of Cologne, Cologne, Germany
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Fahlbusch FB, Dawood Y, Hartner A, Menendez-Castro C, Nögel SC, Tzschoppe A, Schneider H, Strissel P, Beckmann MW, Schleussner E, Ruebner M, Dörr HG, Schild RL, Rascher W, Dötsch J. Cullin 7 and Fbxw 8 expression in trophoblastic cells is regulated via oxygen tension: implications for intrauterine growth restriction? J Matern Fetal Neonatal Med 2012; 25:2209-15. [DOI: 10.3109/14767058.2012.684166] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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