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Leuschner G, Semenova A, Mayr CH, Kapellos TS, Ansari M, Seeliger B, Frankenberger M, Kneidinger N, Hatz RA, Hilgendorff A, Prasse A, Behr J, Mann M, Schiller HB. Mass spectrometry-based autoimmune profiling reveals predictive autoantigens in idiopathic pulmonary fibrosis. iScience 2023; 26:108345. [PMID: 38026226 PMCID: PMC10661358 DOI: 10.1016/j.isci.2023.108345] [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: 07/05/2023] [Revised: 09/13/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Autoimmunity plays a role in certain types of lung fibrosis, notably connective tissue disease-associated interstitial lung disease (CTD-ILD). In idiopathic pulmonary fibrosis (IPF), an incurable and fatal lung disease, diagnosis typically requires clinical exclusion of autoimmunity. However, autoantibodies of unknown significance have been detected in IPF patients. We conducted computational analysis of B cell transcriptomes in published transcriptomics datasets and developed a proteomic Differential Antigen Capture (DAC) assay that captures plasma antibodies followed by affinity purification of lung proteins coupled to mass spectrometry. We analyzed antibody capture in two independent cohorts of IPF and CTL-ILD patients over two disease progression time points. Our findings revealed significant upregulation of specific immunoglobulins with V-segment bias in IPF across multiple cohorts. We identified a predictive autoimmune signature linked to reduced transplant-free survival in IPF, persisting over time. Notably, autoantibodies against thrombospondin-1 were associated with decreased survival, suggesting their potential as predictive biomarkers.
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Affiliation(s)
- Gabriela Leuschner
- Institute of Lung Health and Immunity, Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, CPC-M bioArchive, Munich, Asklepios Clinics, Gauting, Germany
| | - Anna Semenova
- Institute of Lung Health and Immunity, Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Christoph H. Mayr
- Institute of Lung Health and Immunity, Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Theodore S. Kapellos
- Institute of Lung Health and Immunity, Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Meshal Ansari
- Institute of Lung Health and Immunity, Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Benjamin Seeliger
- Department of Pneumology, Hannover Medical School, Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Marion Frankenberger
- Institute of Lung Health and Immunity, Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, CPC-M bioArchive, Munich, Asklepios Clinics, Gauting, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, CPC-M bioArchive, Munich, Asklepios Clinics, Gauting, Germany
| | - Rudolf A. Hatz
- Center for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU), Munich, and Asklepios Medical Center, Member of the German Center for Lung Research (DZL), Gauting, Germany
| | - Anne Hilgendorff
- Institute of Lung Health and Immunity, Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
- Center for Comprehensive Developmental Care (CDeCLMU), Hospital of the Ludwig-Maximilians University (LMU), Member of the German Center for Lung Research (DZL), CPC-M bioArchive, Munich, Germany
| | - Antje Prasse
- Department of Pneumology, Hannover Medical School, Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, CPC-M bioArchive, Munich, Asklepios Clinics, Gauting, Germany
| | - Matthias Mann
- Max Planck Institute of Biochemistry, Department of Proteomics and Signal Transduction, Martinsried, Germany
| | - Herbert B. Schiller
- Institute of Lung Health and Immunity, Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
- Institute of Experimental Pneumology, LMU University Hospital, Ludwig-Maximilians University, Munich, Germany
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Munker D, Arnold P, Leuschner G, Irlbeck M, Michel S, Kauke T, Meiser B, Behr J, Kneidinger N, Veit T. Impact of ILD-Specific Therapies on Perioperative Course in Patients with Progressive Interstitial Lung Disease Undergoing Lung Transplantation. J Clin Med 2023; 12:4996. [PMID: 37568398 PMCID: PMC10419359 DOI: 10.3390/jcm12154996] [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: 06/12/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Immunosuppressants and antifibrotics are currently used to treat patients with various interstitial lung diseases, which may undergo lung transplantation (LTx). The retrospective study aimed to evaluate the potential effects of therapeutic regimen on the perioperative course in patients with idiopathic pulmonary fibrosis (IPF) or progressive pulmonary fibrosis (PPF) undergoing LTx. All patients with IPF and PPF undergoing LTx between January 2014 and December 2021 were included. We retrospectively screened for previous use of immunosuppressants and antifibrotic therapy. We analyzed perioperative courses, short-term outcomes, and safety retrospectively. In total, 286 patients with diagnosis of IPF or PPF were analyzed. According to the treatment regimen before LTx, the study cohort was divided into four groups and compared. No differences between antifibrotic monotherapy, combined antifibrotic and immunosuppressive therapy with regard to postoperative complications were observed. Length of mechanical ventilation was shorter in patients with antifibrotics prior to LTx. Pretreatment with antifibrotic monotherapy and a combination of antifibrotic drugs with immunosuppressive therapy, lower body mass index (BMI) and lower blood loss, were independently associated with primary graft dysfunction grades 0-3 72 hours after LTx (p < 0.001). Finally, patients with antifibrotic monotherapy developed significantly less de novo donor-specific antibodies (DSA) (p = 0.009). Higher intraoperative blood loss, etiology of interstitial lung disease (ILD) and older age were independently associated with shorter survival after LTx. Use of antifibrotic monotherapy and a combination of antifibrotic drugs with immunosuppressive therapy in IPF/PPF patients undergoing LTx, proved to be safe and might lead to beneficial effects after LTx.
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Affiliation(s)
- Dieter Munker
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
| | - Paola Arnold
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
| | - Gabriela Leuschner
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
| | - Michael Irlbeck
- Department of Anaesthesiology, University of Munich (LMU), 81377 Munich, Germany;
| | - Sebastian Michel
- Clinic of Cardiac Surgery, University of Munich (LMU), 81377 Munich, Germany;
| | - Teresa Kauke
- Department of Thoracic Surgery, University of Munich (LMU), 81377 Munich, Germany;
| | - Bruno Meiser
- Transplant Center, University of Munich, 81377 Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
| | - Nikolaus Kneidinger
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
| | - Tobias Veit
- Department of Medicine V, University Hospital LMU Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), 81377 Munich, Germany; (D.M.); (P.A.); (J.B.); (N.K.)
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Veit T, Barnikel M, Kneidinger N, Munker D, Arnold P, Barton J, Crispin A, Milger K, Behr J, Neurohr C, Leuschner G. Clinical Impact of Physical Activity and Cough on Disease Progression in Fibrotic Interstitial Lung Disease. J Clin Med 2023; 12:jcm12113787. [PMID: 37297982 DOI: 10.3390/jcm12113787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Physical activity limitations and cough are common in patients with interstitial lung disease (ILD), potentially leading to reduced health-related quality of life. We aimed to compare physical activity and cough between patients with subjective, progressive idiopathic pulmonary fibrosis (IPF) and fibrotic non-IPF ILD. In this prospective observational study, wrist accelerometers were worn for seven consecutive days to track steps per day (SPD). Cough was evaluated using a visual analog scale (VAScough) at baseline and weekly for six months. We included 35 patients (IPF: n = 13; non-IPF: n = 22; mean ± SD age 61.8 ± 10.8 years; FVC 65.3 ± 21.7% predicted). Baseline mean ± SD SPD was 5008 ± 4234, with no differences between IPF and non-IPF ILD. At baseline, cough was reported by 94.3% patients (mean ± SD VAScough 3.3 ± 2.6). Compared to non-IPF ILD, patients with IPF had significantly higher burden of cough (p = 0.020), and experienced a greater increase in cough over six months (p = 0.009). Patients who died or underwent lung transplantation (n = 5), had significantly lower SPD (p = 0.007) and higher VAScough (p = 0.047). Long-term follow up identified VAScough (HR: 1.387; 95%-CI 1.081-1.781; p = 0.010) and SPD (per 1000 SPD: HR 0.606; 95%-CI: 0.412-0.892; p = 0.011) as significant predictors for transplant-free survival. In conclusion, although activity didn't differ between IPF and non-IPF ILD, cough burden was significantly greater in IPF. SPD and VAScough differed significantly in patients who subsequently experienced disease progression and were associated with long-term transplant-free survival, calling for better acknowledgement of both parameters in disease management.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Michaela Barnikel
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Paola Arnold
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Alexander Crispin
- IBE-Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University, 81377 Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Claus Neurohr
- Department of Pneumology and Respiratory Medicine, Hospital Schillerhoehe, Academic Teaching Hospital of the University of Tuebingen, 70376 Gerlingen, Germany
| | - Gabriela Leuschner
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
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Kreuter M, Behr J, Bonella F, Costabel U, Gerber A, Hamer OW, Heussel CP, Jonigk D, Krause A, Koschel D, Leuschner G, Markart P, Nowak D, Pfeifer M, Prasse A, Wälscher J, Winter H, Kabitz HJ. [Consensus guideline on the interdisciplinary diagnosis of interstitial lung diseases]. Pneumologie 2023; 77:269-302. [PMID: 36977470 DOI: 10.1055/a-2017-8971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
The evaluation of a patient with interstitial lung disease (ILD) includes assessment of clinical, radiological, and often histopathological data. As there were no specific recommendations to guide the evaluation of patients under the suspicion of an ILD within the German practice landscape, this position statement from an interdisciplinary panel of ILD experts provides guidance related to the diagnostic modalities which should be used in the evaluation of ILD. This includes clinical assessment rheumatological evaluation, radiological examinations, histopathologic sampling and the need for a final discussion in a multidisciplinary team.
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Affiliation(s)
- Michael Kreuter
- Universitäres Lungenzentrum Mainz, Abteilungen für Pneumologie, ZfT, Universitätsmedizin Mainz und Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg und Klinik für Pneumologie, Klinikum Ludwigsburg
- Deutsches Zentrum für Lungenforschung
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München
- Deutsches Zentrum für Lungenforschung
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Alexander Gerber
- Rheumazentrum Halensee, Berlin und Institut für Arbeits- Sozial- und Umweltmedizin, Goetheuniversität Frankfurt am Main
| | - Okka W Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg und Abteilung für Radiologie, Klinik Donaustauf, Donaustauf
| | - Claus Peter Heussel
- Diagnostische und interventionelle Radiologie, Thoraxklinik Heidelberg, Universitätsklinikum Heidelberg
- Deutsches Zentrum für Lungenforschung
| | - Danny Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover und Institut für Pathologie, RWTH Universitätsklinikum Aachen
- Deutsches Zentrum für Lungenforschung
| | - Andreas Krause
- Abteilung für Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin
| | - Dirk Koschel
- Abteilung für Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig und Bereich Pneumologie der Medizinischen Klinik, Carl Gustav Carus Universitätsklinik, Dresden
| | - Gabriela Leuschner
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München
- Deutsches Zentrum für Lungenforschung
| | - Philipp Markart
- Medizinische Klinik V, Campus Fulda, Universitätsmedizin Marburg und Medizinische Klinik und Poliklinik, Universitätsklinikum Gießen
- Deutsches Zentrum für Lungenforschung
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München
| | - Michael Pfeifer
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg
| | - Antje Prasse
- Klinik für Pneumologie und Infektionsmedizin, Medizinische Hochschule Hannover und Abteilung für Fibroseforschung, Fraunhofer ITEM
- Deutsches Zentrum für Lungenforschung
| | - Julia Wälscher
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Hauke Winter
- Abteilung für Thoraxchirurgie, Thoraxklinik, Universität Heidelberg, Heidelberg
- Deutsches Zentrum für Lungenforschung
| | - Hans-Joachim Kabitz
- II. Medizinische Klinik, Pneumologie und Internistische Intensivmedizin, Klinikum Konstanz, GLKN, Konstanz
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Behr J, Bonella F, Frye BC, Günther A, Hagmeyer L, Henes J, Klemm P, Koschel D, Kreuter M, Leuschner G, Nowak D, Prasse A, Quadder B, Sitter H, Costabel U. [Pharmacological treatment of idiopathic pulmonary fibrosis (update) and progressive pulmonary fibrosis - S2k Guideline of the German Respiratory Society]. Pneumologie 2023; 77:e1. [PMID: 36858353 DOI: 10.1055/a-2043-4482] [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: 03/03/2023]
Affiliation(s)
- Jürgen Behr
- Medizinische Klinik und Polklinik V, LMU Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung; Delegierte/r der DGP
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen; Delegierter der DGP
| | - Björn C Frye
- Klinik für Pneumologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland; Delegierter der DGP
| | - Andreas Günther
- Center for Interstitial and Rare Lung Diseases, University Hospital Giessen Marburg, Giessen, Agaplesion Evangelisches Krankenhaus Mittelhessen, Giessen, Germany; Delegierter der DGP
| | - Lars Hagmeyer
- Krankenhaus Bethanien Solingen, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Institut für Pneumologie an der Universität zu Köln; Delegierter der DGP
| | - Jörg Henes
- Zentrum für interdisziplinäre Rheumatologie, Immunologie und Autoimmunerkrankungen (INDIRA) und Innere Medizin II; Delegierter DGRh
| | - Philipp Klemm
- Abt. Rheumatologie und klinische Immunologie, Kerckhoff Klinik und Campus Kerckhoff der Justus-Liebig-Universität Gießen, Bad Nauheim; Delegierter der DGRh
| | - Dirk Koschel
- Fachkrankenhaus Coswig, Lungenzentrum und Medizinische Klinik 1, Universitätsklinik Carl Gustav Carus der TU Dresden; Delegierter der DGP
| | - Michael Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen & interdisziplinäres Sarkoidosezentrum, Thoraxklinik, Universitätsklinikum Heidelberg, Deutsches Zentrum für Lungenforschung Heidelberg und Klinik für Pneumologie, Interdisziplinäres Lungenzentrum Ludwigsburg, RKH Klinik Ludwigsburg; Delegierter der DGIM
| | - Gabriela Leuschner
- Medizinische Klinik und Polklinik V, LMU Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung; Delegierte/r der DGP
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum der Universität München, Comprehensive Pneumology Center (CPC) München, Mitglied des Deutsches Zentrums für Lungenforschung; Delegierter der DGAUM
| | - Antje Prasse
- Klinik für Pneumologie und Infektiologie, Medizinische Hochschule Hannover, DZL BREATH und Abteilung für Fibroseforschung, Fraunhofer ITEM, Hannover, Delegierte der DGP
| | | | - Helmut Sitter
- Institut für Theoretische Chirurgie, Philipps-Universität Marburg, Moderator
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen; Delegierter der DGP
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Behr J, Bonella F, Frye BC, Günther A, Hagmeyer L, Henes J, Klemm P, Koschel D, Kreuter M, Leuschner G, Nowak D, Prasse A, Quadder B, Sitter H, Costabel U. [Pharmacological treatment of idiopathic pulmonary fibrosis (update) and progressive pulmonary fibrosis - S2k Guideline of the German Respiratory Society]. Pneumologie 2023; 77:94-119. [PMID: 36791790 DOI: 10.1055/a-1983-6796] [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: 02/17/2023]
Affiliation(s)
- Jürgen Behr
- Medizinische Klinik und Polklinik V, LMU Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung; Delegierte/r der DGP
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen; Delegierter der DGP
| | - Björn C Frye
- Klinik für Pneumologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland; Delegierter der DGP
| | - Andreas Günther
- Center for Interstitial and Rare Lung Diseases, University Hospital Giessen Marburg, Giessen, Agaplesion Evangelisches Krankenhaus Mittelhessen, Giessen, Germany; Delegierter der DGP
| | - Lars Hagmeyer
- Krankenhaus Bethanien Solingen, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Institut für Pneumologie an der Universität zu Köln; Delegierter der DGP
| | - Jörg Henes
- Zentrum für interdisziplinäre Rheumatologie, Immunologie und Autoimmunerkrankungen (INDIRA) und Innere Medizin II; Delegierter DGRh
| | - Philipp Klemm
- Abt. Rheumatologie und klinische Immunologie, Kerckhoff Klinik und Campus Kerckhoff der Justus-Liebig-Universität Gießen, Bad Nauheim; Delegierter der DGRh
| | - Dirk Koschel
- Fachkrankenhaus Coswig, Lungenzentrum und Medizinische Klinik 1, Universitätsklinik Carl Gustav Carus der TU Dresden; Delegierter der DGP
| | - Michael Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen & interdisziplinäres Sarkoidosezentrum, Thoraxklinik, Universitätsklinikum Heidelberg, Deutsches Zentrum für Lungenforschung Heidelberg und Klinik für Pneumologie, Interdisziplinäres Lungenzentrum Ludwigsburg, RKH Klinik Ludwigsburg; Delegierter der DGIM
| | - Gabriela Leuschner
- Medizinische Klinik und Polklinik V, LMU Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung; Delegierte/r der DGP
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum der Universität München, Comprehensive Pneumology Center (CPC) München, Mitglied des Deutsches Zentrums für Lungenforschung; Delegierter der DGAUM
| | - Antje Prasse
- Klinik für Pneumologie und Infektiologie, Medizinische Hochschule Hannover, DZL BREATH und Abteilung für Fibroseforschung, Fraunhofer ITEM, Hannover, Delegierte der DGP
| | | | - Helmut Sitter
- Institut für Theoretische Chirurgie, Philipps-Universität Marburg, Moderator
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen; Delegierter der DGP
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Munker D, Veit T, Schönermarck U, Arnold P, Leuschner G, Barton J, Mümmler C, Briegel I, Mumm JN, Zoller M, Kauke T, Sisic A, Ghiani A, Walter J, Milger K, Mueller S, Michel S, Munker S, Keppler O, Fischereder M, Meiser B, Behr J, Kneidinger N, Neurohr C. Polyomavirus exerts detrimental effects on renal function in patients after lung transplantation. J Clin Virol 2021; 145:105029. [PMID: 34798365 DOI: 10.1016/j.jcv.2021.105029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/03/2021] [Accepted: 11/10/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with significant morbidity and mortality after lung transplantation (LTX). Calcineurin inhibitor (CNI) nephrotoxicity is the leading cause of CKD. After kidney transplantation, polyomavirus-associated nephropathy (PyVAN) is a well-recognized problem. This study aims to evaluate the role of polyomavirus in patients after LTX. METHODS From January 2017 to January 2020, all lung transplant recipients who performed follow-up visits in our center were included in the study and retrospectively assessed. We measured renal function (creatinine levels before and after transplantation), JCPyV, and BKPyV load by polymerase chain reaction (PCR) in serum and urine samples after transplantation. RESULTS In total, 104 consecutive patients (59 males, 56.7%) with a mean age of 49.6 ± 11.1 years were identified. JCPyV was found in urine of 36 patients (34.6%) and serum of 3 patients (2.9%). BKPyV was found in urine of 40 patients (38.5%) and serum of 4 patients (3.8%), respectively. Urine evidence for JCPyV (p < 0.001, coefficient: +21.44) and BKPyV (p < 0.001, coefficient: +29.65) correlated highly with further kidney function decline. CONCLUSION Kidney function deterioration is associated with JCPyV and BKPyV viruria in patients after LTX. This might indicate a role of PyVAN in lung transplant recipients.
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Affiliation(s)
- Dieter Munker
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - Tobias Veit
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Ulf Schönermarck
- Department of Medicine IV, University hospital, LMU Munich, Germany
| | - Paola Arnold
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Gabriela Leuschner
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Barton
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Carlo Mümmler
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Ignaz Briegel
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jan-Niclas Mumm
- Department of Urology, University hospital, LMU Munich, Germany
| | - Michael Zoller
- Department of Anesthesiology, University hospital, LMU Munich, Germany
| | - Teresa Kauke
- Department of Thoracic Surgery, University hospital, LMU Munich, Germany
| | - Alma Sisic
- Transplant Center, University hospital, LMU Munich, Germany
| | - Alessandro Ghiani
- Department of Pneumology and Respiratory Medicine, Schillerhoehe Clinic (affiliated to Rober-Bosch-Hospital GmbG, Stuttgart), Solitudestr. 18, 70839, Gerlingen, Germany
| | - Julia Walter
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Susanna Mueller
- Department of Pathology, University hospital, LMU Munich, Germany
| | - Sebastian Michel
- Department of Thoracic Surgery, University hospital, LMU Munich, Germany; Transplant Center, University hospital, LMU Munich, Germany
| | - Stefan Munker
- Department of Internal Medicine II, University hospital, LMU Munich, Germany
| | - Oliver Keppler
- Department of Internal Medicine II, University hospital, LMU Munich, Germany
| | | | - Bruno Meiser
- Transplant Center, University hospital, LMU Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, University hospital, LMU Munich; Comprehensive Pneumology Center (CPC-M); Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Claus Neurohr
- Department of Virology, University hospital, LMU Munich, Germany; Department of Pneumology and Respiratory Medicine, Schillerhoehe Clinic (affiliated to Rober-Bosch-Hospital GmbG, Stuttgart), Solitudestr. 18, 70839, Gerlingen, Germany
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8
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Fischer DS, Ansari M, Wagner KI, Jarosch S, Huang Y, Mayr CH, Strunz M, Lang NJ, D’Ippolito E, Hammel M, Mateyka L, Weber S, Wolff LS, Witter K, Fernandez IE, Leuschner G, Milger K, Frankenberger M, Nowak L, Heinig-Menhard K, Koch I, Stoleriu MG, Hilgendorff A, Behr J, Pichlmair A, Schubert B, Theis FJ, Busch DH, Schiller HB, Schober K. Single-cell RNA sequencing reveals ex vivo signatures of SARS-CoV-2-reactive T cells through 'reverse phenotyping'. Nat Commun 2021; 12:4515. [PMID: 34312385 PMCID: PMC8313584 DOI: 10.1038/s41467-021-24730-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/16/2021] [Indexed: 02/07/2023] Open
Abstract
The in vivo phenotypic profile of T cells reactive to severe acute respiratory syndrome (SARS)-CoV-2 antigens remains poorly understood. Conventional methods to detect antigen-reactive T cells require in vitro antigenic re-stimulation or highly individualized peptide-human leukocyte antigen (pHLA) multimers. Here, we use single-cell RNA sequencing to identify and profile SARS-CoV-2-reactive T cells from Coronavirus Disease 2019 (COVID-19) patients. To do so, we induce transcriptional shifts by antigenic stimulation in vitro and take advantage of natural T cell receptor (TCR) sequences of clonally expanded T cells as barcodes for 'reverse phenotyping'. This allows identification of SARS-CoV-2-reactive TCRs and reveals phenotypic effects introduced by antigen-specific stimulation. We characterize transcriptional signatures of currently and previously activated SARS-CoV-2-reactive T cells, and show correspondence with phenotypes of T cells from the respiratory tract of patients with severe disease in the presence or absence of virus in independent cohorts. Reverse phenotyping is a powerful tool to provide an integrated insight into cellular states of SARS-CoV-2-reactive T cells across tissues and activation states.
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Affiliation(s)
- David S. Fischer
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, München, Germany ,grid.6936.a0000000123222966TUM School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Meshal Ansari
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, München, Germany ,grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Karolin I. Wagner
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Sebastian Jarosch
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Yiqi Huang
- grid.6936.a0000000123222966Institute of Virology, Technische Universität München (TUM), Munich, Germany
| | - Christoph H. Mayr
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Maximilian Strunz
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Niklas J. Lang
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Elvira D’Ippolito
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Monika Hammel
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Laura Mateyka
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Simone Weber
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany
| | - Lisa S. Wolff
- grid.6936.a0000000123222966Institute of Virology, Technische Universität München (TUM), Munich, Germany
| | - Klaus Witter
- grid.5252.00000 0004 1936 973XLaboratory of Immunogenetics and Molecular Diagnostics, Department of Transfusion Medicine, Cell Therapeutic Agents and Hemostaseology, LMU Munich, Munich, Germany ,grid.5252.00000 0004 1936 973XDepartment of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for lung research (DZL), Munich, Germany
| | - Isis E. Fernandez
- grid.5252.00000 0004 1936 973XDepartment of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for lung research (DZL), Munich, Germany
| | - Gabriela Leuschner
- grid.5252.00000 0004 1936 973XDepartment of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for lung research (DZL), Munich, Germany
| | - Katrin Milger
- grid.5252.00000 0004 1936 973XDepartment of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for lung research (DZL), Munich, Germany
| | - Marion Frankenberger
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany ,grid.5252.00000 0004 1936 973XCenter for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Munich, Germany
| | - Lorenz Nowak
- grid.5252.00000 0004 1936 973XCenter for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Munich, Germany
| | - Katharina Heinig-Menhard
- grid.5252.00000 0004 1936 973XCenter for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Munich, Germany
| | - Ina Koch
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany ,Asklepios Biobank for pulmonary diseases, Gauting, Germany ,grid.452624.3Member of the German Center for Lung Research (DZL), Center for Comprehensive Developmental Care (CDeCLMU), Department of Neonatology, Perinatal Center, Munich, Germany
| | - Mircea G. Stoleriu
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany ,Asklepios Biobank for pulmonary diseases, Gauting, Germany ,grid.452624.3Member of the German Center for Lung Research (DZL), Center for Comprehensive Developmental Care (CDeCLMU), Department of Neonatology, Perinatal Center, Munich, Germany
| | - Anne Hilgendorff
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany ,grid.452463.2German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Jürgen Behr
- grid.5252.00000 0004 1936 973XDepartment of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for lung research (DZL), Munich, Germany ,grid.5252.00000 0004 1936 973XCenter for Thoracic Surgery Munich, Ludwig-Maximilians-University of Munich (LMU) and Asklepios Lung Clinic Munich-Gauting, Munich and Gauting, Munich, Germany
| | - Andreas Pichlmair
- grid.6936.a0000000123222966Institute of Virology, Technische Universität München (TUM), Munich, Germany ,grid.6936.a0000000123222966Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Benjamin Schubert
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, München, Germany ,grid.6936.a0000000123222966Focus Group ‘Clinical Cell Processing and Purification”, Institute for Advanced Study, TUM, Munich, Germany
| | - Fabian J. Theis
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, München, Germany ,grid.6936.a0000000123222966Focus Group ‘Clinical Cell Processing and Purification”, Institute for Advanced Study, TUM, Munich, Germany
| | - Dirk H. Busch
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany ,grid.6936.a0000000123222966Department of Mathematics, Technical University of Munich, Garching, Germany ,grid.5252.00000 0004 1936 973XGrosshadern, Hospital of the Ludwig-Maximilians University (LMU), Munich, Germany
| | - Herbert B. Schiller
- grid.4567.00000 0004 0483 2525Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC-M bioArchive, Helmholtz Zentrum Muenchen, Member of the German Center for Lung Research (DZL), Munich, Germany ,grid.4567.00000 0004 0483 2525Present Address: Institute of Lung Biology and Disease, Comprehensive Pneumology Center, Helmholtz Zentrum München, Neuherberg, München, Germany
| | - Kilian Schober
- grid.6936.a0000000123222966Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Munich, Germany ,grid.411668.c0000 0000 9935 6525Present Address: Microbiological Institute—Institute of Clinical Microbiology, Immunology and Hygiene, University Hospital of Erlangen, Erlangen, Germany
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9
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Mayr CH, Simon LM, Leuschner G, Ansari M, Schniering J, Geyer PE, Angelidis I, Strunz M, Singh P, Kneidinger N, Reichenberger F, Silbernagel E, Böhm S, Adler H, Lindner M, Maurer B, Hilgendorff A, Prasse A, Behr J, Mann M, Eickelberg O, Theis FJ, Schiller HB. Integrative analysis of cell state changes in lung fibrosis with peripheral protein biomarkers. EMBO Mol Med 2021; 13:e12871. [PMID: 33650774 PMCID: PMC8033531 DOI: 10.15252/emmm.202012871] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 06/03/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
The correspondence of cell state changes in diseased organs to peripheral protein signatures is currently unknown. Here, we generated and integrated single-cell transcriptomic and proteomic data from multiple large pulmonary fibrosis patient cohorts. Integration of 233,638 single-cell transcriptomes (n = 61) across three independent cohorts enabled us to derive shifts in cell type proportions and a robust core set of genes altered in lung fibrosis for 45 cell types. Mass spectrometry analysis of lung lavage fluid (n = 124) and plasma (n = 141) proteomes identified distinct protein signatures correlated with diagnosis, lung function, and injury status. A novel SSTR2+ pericyte state correlated with disease severity and was reflected in lavage fluid by increased levels of the complement regulatory factor CFHR1. We further discovered CRTAC1 as a biomarker of alveolar type-2 epithelial cell health status in lavage fluid and plasma. Using cross-modal analysis and machine learning, we identified the cellular source of biomarkers and demonstrated that information transfer between modalities correctly predicts disease status, suggesting feasibility of clinical cell state monitoring through longitudinal sampling of body fluid proteomes.
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Affiliation(s)
- Christoph H Mayr
- Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC–M bioArchiveHelmholtz Zentrum München, Member of the German Center for Lung Research (DZL)MunichGermany
| | - Lukas M Simon
- Institute of Computational BiologyHelmholtz Zentrum MünchenMunichGermany
| | - Gabriela Leuschner
- Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC–M bioArchiveHelmholtz Zentrum München, Member of the German Center for Lung Research (DZL)MunichGermany
- Department of Internal Medicine VLudwig‐Maximilians University (LMU) MunichMember of the German Center for Lung Research (DZL), CPC‐M bioArchiveMunichGermany
| | - Meshal Ansari
- Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC–M bioArchiveHelmholtz Zentrum München, Member of the German Center for Lung Research (DZL)MunichGermany
- Institute of Computational BiologyHelmholtz Zentrum MünchenMunichGermany
| | - Janine Schniering
- Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC–M bioArchiveHelmholtz Zentrum München, Member of the German Center for Lung Research (DZL)MunichGermany
- Department of RheumatologyCenter of Experimental RheumatologyUniversity & University Hospital ZurichZurichSwitzerland
| | - Philipp E Geyer
- Department of Proteomics and Signal TransductionMax Planck Institute of BiochemistryMartinsriedGermany
| | - Ilias Angelidis
- Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC–M bioArchiveHelmholtz Zentrum München, Member of the German Center for Lung Research (DZL)MunichGermany
| | - Maximilian Strunz
- Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC–M bioArchiveHelmholtz Zentrum München, Member of the German Center for Lung Research (DZL)MunichGermany
| | - Pawandeep Singh
- Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC–M bioArchiveHelmholtz Zentrum München, Member of the German Center for Lung Research (DZL)MunichGermany
| | - Nikolaus Kneidinger
- Department of Internal Medicine VLudwig‐Maximilians University (LMU) MunichMember of the German Center for Lung Research (DZL), CPC‐M bioArchiveMunichGermany
| | - Frank Reichenberger
- Asklepios Fachkliniken Munich‐GautingCPC‐M bioArchive, Member of the German Center for Lung Research (DZL)MunichGermany
| | - Edith Silbernagel
- Asklepios Fachkliniken Munich‐GautingCPC‐M bioArchive, Member of the German Center for Lung Research (DZL)MunichGermany
| | - Stephan Böhm
- Faculty of MedicineMax von Pettenkofer‐Institute, VirologyNational Reference Center for RetrovirusesLMU MünchenMunichGermany
| | - Heiko Adler
- Helmholtz Zentrum MünchenResearch Unit Lung Repair and Regeneration, Member of the German Center for Lung Research (DZL)MunichGermany
| | - Michael Lindner
- Asklepios Fachkliniken Munich‐GautingCPC‐M bioArchive, Member of the German Center for Lung Research (DZL)MunichGermany
- University Department of Visceral and Thoracic Surgery SalzburgParacelsus Medical UniversitySalzburgAustria
| | - Britta Maurer
- Department of RheumatologyCenter of Experimental RheumatologyUniversity & University Hospital ZurichZurichSwitzerland
| | - Anne Hilgendorff
- Center for Comprehensive Developmental Care (CDeCLMU)Member of the German Center for Lung Research (DZL)Hospital of the Ludwig‐Maximilians University (LMU)CPC‐M bioArchiveMunichGermany
| | - Antje Prasse
- Department of PneumologyHannover Medical School, Member of the German Center for Lung Research (DZL)HannoverGermany
| | - Jürgen Behr
- Department of Internal Medicine VLudwig‐Maximilians University (LMU) MunichMember of the German Center for Lung Research (DZL), CPC‐M bioArchiveMunichGermany
- Asklepios Fachkliniken Munich‐GautingCPC‐M bioArchive, Member of the German Center for Lung Research (DZL)MunichGermany
| | - Matthias Mann
- Department of Proteomics and Signal TransductionMax Planck Institute of BiochemistryMartinsriedGermany
| | - Oliver Eickelberg
- Division of Pulmonary, Allergy, and Critical Care MedicineDepartment of MedicineUniversity of PittsburghPittsburghPAUSA
| | - Fabian J Theis
- Institute of Computational BiologyHelmholtz Zentrum MünchenMunichGermany
| | - Herbert B Schiller
- Institute of Lung Biology and Disease and Comprehensive Pneumology Center with the CPC–M bioArchiveHelmholtz Zentrum München, Member of the German Center for Lung Research (DZL)MunichGermany
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10
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Behr J, Günther A, Bonella F, Dinkel J, Fink L, Geiser T, Geissler K, Gläser S, Handzhiev S, Jonigk D, Koschel D, Kreuter M, Leuschner G, Markart P, Prasse A, Schönfeld N, Schupp JC, Sitter H, Müller-Quernheim J, Costabel U. S2K Guideline for Diagnosis of Idiopathic Pulmonary Fibrosis. Respiration 2021; 100:238-271. [PMID: 33486500 DOI: 10.1159/000512315] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe and often fatal disease. Diagnosis of IPF requires considerable expertise and experience. Since the publication of the international IPF guideline in the year 2011 and the update 2018 several studies and technical advances have occurred, which made a new assessment of the diagnostic process mandatory. The goal of this guideline is to foster early, confident, and effective diagnosis of IPF. The guideline focusses on the typical clinical context of an IPF patient and provides tools to exclude known causes of interstitial lung disease including standardized questionnaires, serologic testing, and cellular analysis of bronchoalveolar lavage. High-resolution computed tomography remains crucial in the diagnostic workup. If it is necessary to obtain specimens for histology, transbronchial lung cryobiopsy is the primary approach, while surgical lung biopsy is reserved for patients who are fit for it and in whom a bronchoscopic diagnosis did not provide the information needed. After all, IPF is a diagnosis of exclusion and multidisciplinary discussion remains the golden standard of diagnosis.
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Affiliation(s)
- Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Munich, Germany,
| | - Andreas Günther
- Section of Fibrotic Lung Diseases, University Hospital Giessen and Marburg, Giessen Campus, Justus Liebig University Giessen, Agaplesion Pneumological Clinic Waldhof-Elgershausen, University of Giessen Marburg Lung Center, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Giessen, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik - University Hospital, University Duisburg-Essen, Essen, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU, and Asklepios Specialty Hospitals Munich Gauting, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Munich, Germany
| | - Ludger Fink
- Institute of Pathology and Cytology, Supraregional Joint Practice for Pathology (Überregionale Gemeinschaftspraxis für Pathologie, ÜGP), Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Wetzlar, Germany
| | - Thomas Geiser
- Clinic of Pneumology of the University Hospital of Bern, Bern, Switzerland
| | - Klaus Geissler
- Pulmonary Fibrosis (IPF) Patient Advocacy Group, Essen, Germany
| | - Sven Gläser
- Vivantes Neukölln and Spandau Hospitals Berlin, Department of Internal Medicine - Pneumology and Infectiology as well as Greifswald Medical School, University of Greifswald, Greifswald, Germany
| | - Sabin Handzhiev
- Clinical Department of Pneumology, University Hospital Krems, Krems, Austria
| | - Danny Jonigk
- Institute of Pathology, Hanover Medical School, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hanover, Germany
| | - Dirk Koschel
- Department of Internal Medicine/Pneumology, Coswig Specialist Hospital, Center for Pneumology, Allergology, Respiratory Medicine, Thoracic Surgery and Medical Clinic 1, Pneumology Department, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Medicine, Thorax Clinic, University Hospital Heidelberg, Member of German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Heidelberg, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Ludwig-Maximilians-University (LMU) of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Munich, Germany
| | - Philipp Markart
- Section of Fibrotic Lung Diseases, University Hospital Giessen and Marburg, Giessen Campus, Justus Liebig University Giessen, University of Giessen Marburg Lung Center, as well as the Fulda Campus of the Medical University of Marburg, Med. Clinic V, Member of German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Giessen, Germany
| | - Antje Prasse
- Department of Pneumology, Hanover Medical School and Clinical Research Center Fraunhofer Institute ITEM, Member of the German Center for Lung Research (Deutsches Zentrum für Lungenforschung, DZL), Hanover, Germany
| | - Nicolas Schönfeld
- Pneumology Clinic, Part of the Heckeshorn Lung Clinic, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Jonas Christian Schupp
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Helmut Sitter
- Institute for Surgical Research, Philipps-University Marburg, Marburg, Germany
| | - Joachim Müller-Quernheim
- Department of Pneumology, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik - University Hospital, University Duisburg-Essen, Essen, Germany
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11
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Leuschner G, Klotsche J, Kreuter M, Prasse A, Wirtz H, Pittrow D, Frankenberger M, Behr J, Kneidinger N. Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study. Front Med (Lausanne) 2020; 7:601279. [PMID: 33313046 PMCID: PMC7703706 DOI: 10.3389/fmed.2020.601279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/31/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background: An association between idiopathic pulmonary fibrosis (IPF) and advancing age is suspected since IPF occurs primarily in patients over 60 years of age. Though, little is known about the disease in the elderly. The aim of this study was to characterize elderly IPF patients using data from the longitudinal, German-wide INSIGHTS-IPF registry. Methods: Patients were grouped into elderly (≥75 years) and nonelderly IPF (<75 years) at the time of enrollment into the study. Baseline clinical characteristics, comorbidities, health related quality of life (HRQoL), medical therapy and survival were compared between age groups. Effects of antifibrotic therapy on forced vital capacity (FVC) were analyzed over 24 months. Results: Of 1,009 patients, 350 (34.7%) were ≥75 years old. Elderly IPF patients compared to younger patients had a higher number of comorbidities (3.6 ± 2.5 vs. 2.8 ± 2.3; p < 0.001). The mean ± SD EQ-5D score (0.64 ± 0.21 vs. 0.69 ± 0.21; p = 0.005), and the overall WHO-5 score (13.1 ± 5.9 vs. 14.3 ± 6.0; p = 0.015) were significantly lower while the UCSD-SOBQ (52.6 ± 31.2 vs. 45.5 ± 31.2; p = 0.030) was significantly higher in elderly patients, indicating a more impaired HRQoL and more breathlessness. At baseline, 55.4% of elderly and 56.8% of nonelderly patients with IPF were treated with antifibrotic therapy (p = 0.687). For FVC decline after initiation of antifibrotic therapy, there was neither a significant difference between age groups at the different time points over 24 months (beta: 0.41; 95%-CI: -0.98 to 1.81; p = 0.563) nor over the whole course of time (beta: -0.05; 95%-CI: -0.20 to 0.09; p = 0.478). All-cause mortality was higher in elderly patients (49.1 vs. 37.9%; HR 1.65; 95%-CI 1.36-2.00; p < 0.001). Antifibrotic therapy was associated with improved survival in IPF patients, independent from age (<75 years: beta 0.76; 95%-CI: 0.59-0.99; p = 0.049; ≥75 years: beta 0.71; 95%-CI: 0.51-0.98; p = 0.043). Conclusion: In real life, a significant proportion of IPF patients are ≥75 years old, characterized by higher number of comorbidities and global reduced HRQoL. However, the effect of an antifibrotic therapy was similar between age groups and associated with a survival benefit emphasizing the importance for an early antifibrotic therapy in IPF, independent from age.
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Affiliation(s)
- Gabriela Leuschner
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,Department of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, Germany.,German Center for Lung Research, München, Germany
| | - Jens Klotsche
- Epidemiology, German Rheumatism Research Center, A Leibniz Institute, Berlin, Germany
| | - Michael Kreuter
- German Center for Lung Research, München, Germany.,Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Antje Prasse
- German Center for Lung Research, München, Germany.,Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany.,Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Hubert Wirtz
- Abteilung für Pneumologie, Department Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - David Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,German Center for Lung Research, München, Germany
| | - Jürgen Behr
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,Department of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, Germany.,German Center for Lung Research, München, Germany
| | - Nikolaus Kneidinger
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,Department of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, Germany.,German Center for Lung Research, München, Germany
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12
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Veit T, Barnikel M, Crispin A, Kneidinger N, Ceelen F, Arnold P, Munker D, Schmitzer M, Barton J, Schiopu S, Schiller HB, Frankenberger M, Milger K, Behr J, Neurohr C, Leuschner G. Variability of forced vital capacity in progressive interstitial lung disease: a prospective observational study. Respir Res 2020; 21:270. [PMID: 33076914 PMCID: PMC7574190 DOI: 10.1186/s12931-020-01524-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background Fibrotic interstitial lung disease (ILD) is often associated with poor outcomes, but has few predictors of progression. Daily home spirometry has been proposed to provide important information about the clinical course of idiopathic pulmonary disease (IPF). However, experience is limited, and home spirometry is not a routine component of patient care in ILD. Using home spirometry, we aimed to investigate the predictive potential of daily measurements of forced vital capacity (FVC) in fibrotic ILD. Methods In this prospective observational study, patients with fibrotic ILD and clinical progression were provided with home spirometers for daily measurements over 6 months. Hospital based spirometry was performed after three and 6 months. Disease progression, defined as death, lung transplantation, acute exacerbation or FVC decline > 10% relative was assessed in the cohort. Results From May 2017 until August 2018, we included 47 patients (IPF n = 20; non-IPF n = 27). Sufficient daily measurements were performed by 85.1% of the study cohort. Among these 40 patients (IPF n = 17; non-IPF n = 23), who had a mean ± SD age of 60.7 ± 11.3 years and FVC 64.7 ± 21.7% predicted (2.4 ± 0.8 L), 12 patients experienced disease progression (death: n = 2; lung transplantation: n = 3; acute exacerbation: n = 1; FVC decline > 10%: n = 6). Within the first 28 days, a group of patients had high daily variability in FVC, with 60.0% having a variation ≥5%. Patients with disease progression had significantly higher FVC variability than those in the stable group (median variability 8.6% vs. 4.8%; p = 0.002). Cox regression identified FVC variability as independently associated with disease progression when controlling for multiple confounding variables (hazard ratio: 1.203; 95% CI:1.050–1.378; p = 0.0076). Conclusions Daily home spirometry is feasible in IPF and non-IPF ILD and facilitates the identification of FVC variability, which was associated with disease progression.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michaela Barnikel
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Alexander Crispin
- IBE - Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Felix Ceelen
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Paola Arnold
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Magdalena Schmitzer
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sanziana Schiopu
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Herbert B Schiller
- Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.,Department of Pneumology, Asklepios Fachkliniken Muenchen-Gauting, Academic Teaching Hospital of the University of Munich, Gauting, Germany
| | - Claus Neurohr
- Department of Pneumology and Respiratory Medicine, Hospital Schillerhoehe, Academic Teaching Hospital of the University of Tuebingen, Gerlingen, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany. .,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
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13
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Leuschner G, Lauseker M, Howanietz AS, Milger K, Veit T, Munker D, Schneider C, Weig T, Michel S, Barton J, Meiser B, Dinkel J, Neurohr C, Behr J, Kneidinger N. Longitudinal lung function measurements in single lung transplant recipients with chronic lung allograft dysfunction. J Heart Lung Transplant 2020; 39:1270-1278. [PMID: 32917480 DOI: 10.1016/j.healun.2020.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Phenotyping chronic lung allograft dysfunction (CLAD) in single lung transplant (SLTX) recipients is challenging. The aim of this study was to assess the diagnostic and prognostic value of longitudinal lung function tests in SLTX recipients with CLAD. METHODS A total of 295 SLTX recipients were analyzed and stratified according to native lung physiology. In addition to spirometry, measurements of static lung volumes and lung capacities were used to phenotype patients and to assess their prognostic value. Outcome was survival after CLAD onset. Patients with insufficient clinical information were excluded (n = 71). RESULTS Of 224 lung transplant recipients, 105 (46.9%) developed CLAD. Time to CLAD onset (hazard ratio [HR]: 0.82, 95% CI: 0.74-0.90; p < 0.001), severity of CLAD at onset (HR: 0.97, 95% CI: 0.94-0.99; p = 0.009), and progression after onset of CLAD (HR: 1.03, 95% CI: 1.00-1.05; p = 0.023) were associated with outcome. Phenotypes at onset were bronchiolitis obliterans syndrome (BOS) (59.1%), restrictive allograft syndrome (RAS) (12.4%), mixed phenotype (6.7%), and undefined phenotype (21.9%). Survival estimates differed significantly between phenotypes (p = 0.004), with RAS and mixed phenotype being associated with the worst survival, followed by BOS and undefined phenotype. Finally, a higher hazard for mortality was noticed for RAS (HR: 2.34, 95% CI: 0.99-5.52; p = 0.054) and mixed phenotype (HR: 3.30, 95% CI: 1.20-9.11; p = 0.021) while controlling for time to CLAD onset and severity of CLAD at onset. CONCLUSIONS Phenotyping CLAD in SLTX remains challenging with a high number of patients with an undefined phenotype despite comprehensive lung function testing. However, phenotyping is of prognostic value. Furthermore, early, severe, and progressive CLADs are associated with worse survival.
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Affiliation(s)
- Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Michael Lauseker
- Institute for Medical Information Processing, Biometry, and Epidemiology
| | - Anne-Sophie Howanietz
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | | | | | | | - Jürgen Barton
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | | | - Julien Dinkel
- Institute for Clinical Radiology, University of Munich (LMU), Munich, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL)
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL).
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14
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Veit T, Munker D, Leuschner G, Mümmler C, Sisic A, Kauke T, Schneider C, Irlbeck M, Michel S, Eser-Valerie D, Huber M, Barton J, Milger K, Meiser B, Behr J, Kneidinger N. High prevalence of falsely declaring nicotine abstinence in lung transplant candidates. PLoS One 2020; 15:e0234808. [PMID: 32555678 PMCID: PMC7302701 DOI: 10.1371/journal.pone.0234808] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
Tobacco use after lung transplantation is associated with adverse outcome. Therefore, active smoking is regarded as a contraindication for lung transplantation and should be excluded prior to placement on the waiting list. The aim of the study was to compare self-reporting with a systematic cotinine based screening approach to identify patients with active nicotine abuse. Nicotine use was systematically assessed by interviews and cotinine test in all lung transplant candidates at every visit in our center. Patients were classified according to the stage prior to transplantation and cotinine test results were compared to self-reports and retrospectively analyzed until June 2019. Of 620 lung transplant candidates, 92 patients (14.8%) had at least one positive cotinine test. COPD as underlying disease (OR 2.102, CI 1.110–3.981; p = 0.023), number of pack years (OR 1.014, CI 1.000–1.028; p = 0.047) and a time of cessation less than one year (OR 2.413, CI 1.410–4.128; p = 0.001) were associated with a positive cotinine test in multivariable regression analysis. The majority of non-COPD patients (n = 13, 72.2%) with a positive test had a cessation time of less than one year. 78 patients (84.7%) falsely declared not consuming any nicotine-based products prior to the test. Finally, all never smokers were test negative. In conclusion, our data demonstrate that active nicotine use is prevalent in transplant candidates with a high prevalence of falsely declaring nicotine abstinence. COPD was the main diagnosis in affected patients. Short cessation time and a high number of pack years are risk factors for continued nicotine abuse.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Carlo Mümmler
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Alma Sisic
- Transplant Center, University of Munich, Munich, Germany
| | - Teresa Kauke
- Department of Thoracic Surgery, University of Munich, Munich, Germany
| | | | - Michael Irlbeck
- Department of Anaesthesiology, University of Munich, LMU, Munich, Germany
| | - Sebastian Michel
- Clinic of Cardiac Surgery, University of Munich, LMU, Munich, Germany
| | - Daniela Eser-Valerie
- Department of Psychiatry and Psychotherapy, University of Munich, LMU, Munich, Germany
| | - Maximilian Huber
- Department of Psychiatry and Psychotherapy, University of Munich, LMU, Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Bruno Meiser
- Transplant Center, University of Munich, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
- * E-mail:
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15
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Schiopu SRI, Zacherl M, Todica A, Bartenstein P, Milger K, Leuschner G, Munker D, Bauer M, Massberg S, Behr J, Neurohr C, Huber BC, Kneidinger N. Feasibility and accuracy of SPECT myocardial perfusion imaging in end-stage lung disease. J Nucl Cardiol 2020; 27:903-911. [PMID: 31428982 DOI: 10.1007/s12350-019-01851-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 07/25/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) is associated with increased mortality in patients with chronic lung disease. However, non-invasive diagnostic of CAD is difficult, especially in patients with more advanced disease. Therefore, we aimed to assess the feasibility and accuracy of SPECT-myocardial perfusion imaging (MPI) stress testing with regadenoson in patients with end-stage lung disease (ELD) undergoing assessment of stable CAD. METHODS Between January 2012 and May 2018, 102 patients with ELD, who were referred to our institution for lung transplant evaluation, were assessed retrospectively. All patients underwent both stress SPECT-MPI as well as coronary angiography. RESULTS The mean age in our population was 57±6 years. All patients had severe pulmonary function impairment. During stress SPECT-MPI 14 patients (14%) reported regadenoson-related symptoms, but only 2 patients (2%) required medical treatment. Coronary angiography revealed obstructive CAD in 20 patients (20%). Among those, 5 patients had abnormal SPECT-MPI and PCI was performed in 3 patients accordingly. In 14 patients with obstructive CAD, revascularization was deferred based on normal SPECT-MPI findings. CONCLUSIONS SPECT-MPI using regadenoson is well tolerated in patients with ELD and can help to make decisions about coronary revascularization before lung transplant.
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Affiliation(s)
- Sanziana R I Schiopu
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Mathias Zacherl
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Andrei Todica
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians-University Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Matthäus Bauer
- Medical Controlling Unit, Department for Patient Management, Munich University Hospital (TM), 81366, Munich, Germany
| | - Steffen Massberg
- Medical Department I, Campus Grosshadern and Campus Innenstadt, Ludwig-Maximilians-University, Munich, Marchioninistrasse 15, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Asklepios Clinic München, Gauting, Germany
| | - Claus Neurohr
- Department for Pneumology and Respiratory Medicine, Robert-Bosch-Hospital, Schillerhöhe Clinic, Solitudestr. 18, 70839, Gerlingen, Germany
| | - Bruno C Huber
- Medical Department I, Campus Grosshadern and Campus Innenstadt, Ludwig-Maximilians-University, Munich, Marchioninistrasse 15, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
- Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
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16
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Behr J, Günther A, Bonella F, Dinkel J, Fink L, Geiser T, Geißler K, Gläser S, Handzhhiev S, Jonigk D, Koschel D, Kreuter M, Leuschner G, Markart P, Prasse A, Schönfeld N, Schupp JC, Sitter H, Müller-Quernheim J, Costabel U. [German Guideline for Idiopathic Pulmonary Fibrosis]. Pneumologie 2020; 74:e1-e2. [PMID: 32422671 DOI: 10.1055/a-1179-2905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung, München
| | - A Günther
- Schwerpunkt Fibrosierende Lungenerkrankungen, Universitätsklinikum Gießen - Marburg, Standort Gießen, Justus-Liebig-Universität Gießen, sowie Agaplesion Pneumologische Klinik Waldhof-Elgershausen, Greifenstein, University of Giessen Marburg Lung Center, Mitglied des Deutschen Zentrums für Lungenforschung
| | - F Bonella
- Zentrum für interstitielle und seltene Lungenkrankheiten, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, Essen
| | - J Dinkel
- Klinik für Radiologie, Klinikum der Universität München, LMU, und Asklepios Fachkliniken München Gauting, Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - L Fink
- Institut für Pathologie und Zytologie, ÜGP Wetzlar, Mitglied des Deutschen Zentrums für Lungenforschung, Wetzlar
| | - T Geiser
- Universitätsklinik für Pneumologie, Universitätsspital, Universität Bern, Bern
| | - K Geißler
- Patientenvertretung Lungenfibrose e. V., Essen
| | - S Gläser
- Vivantes Klinikum Neukölln und Spandau Berlin, Klinik für Innere Medizin - Pneumologie und Infektiologie sowie und Universitätsmedizin Greifswald, Greifswald
| | - S Handzhhiev
- Klinische Abteilung für Pneumologie, Universitätsklinikum Krems, Krems an der Donau, Österreich
| | - D Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover, Mitglied des Deutschen Zentrums für Lungenforschung, Hannover
| | - D Koschel
- Abteilung Innere Medizin/Pneumologie, Fachkrankenhaus Coswig, Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thoraxchirurgie und Medizinische Klinik 1, Bereich Pneumologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Mitglied des Deutschen Zentrums für Lungenforschung, Heidelberg
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung, München
| | - P Markart
- Schwerpunkt Fibrosierende Lungenerkrankungen, Universitätsklinikum Gießen - Marburg, Standort Gießen, Justus-Liebig-Universität Gießen, University of Giessen Marburg Lung Center, sowie Campus Fulda Universitätsmedizin Marburg, Med. Klinik V; Mitglied des Deutschen Zentrums für Lungenforschung, Fulda
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover und Clinical Research Center Fraunhofer Institut ITEM, Mitglied des Deutschen Zentrums für Lungenforschung, Hannover
| | - N Schönfeld
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - J C Schupp
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - H Sitter
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin
| | - J Müller-Quernheim
- Klinik für Pneumologie, Department Innere Medizin, Medizinische Fakultät, Albert Ludwigs Universität, Freiburg
| | - U Costabel
- Zentrum für interstitielle und seltene Lungenkrankheiten, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, Essen
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17
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Behr J, Günther A, Bonella F, Dinkel J, Fink L, Geiser T, Geißler K, Gläser S, Handzhhiev S, Jonigk D, Koschel D, Kreuter M, Leuschner G, Markart P, Prasse A, Schönfeld N, Schupp JC, Sitter H, Müller-Quernheim J, Costabel U. [German Guideline for Idiopathic Pulmonary Fibrosis]. Pneumologie 2020; 74:263-293. [PMID: 32227328 DOI: 10.1055/a-1120-3531] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe and often fatal disease. Diagnosis of IPF requires considerable expertise and experience. Since publication of the international IPF guideline in the year 2011 and Update 2018 several studies and technical advances occurred, which made a new assessment of the diagnostic process mandatory. In view of the antifibrotic drugs which have been approved for the treatment of IPF patients, the goal of this guideline is to foster early, confident and effective diagnosis of IPF. The guideline focusses on the typical clinical setting of an IPF patient and provides tools to exclude known causes of interstitial lung disease including standardised questionnaires, serologic testing and cellular analysis of bronchoalveolar lavage. High resolution computed tomography remains crucial in the diagnostic work-up. If it is necessary to obtain specimen for histology transbronchial lung cryobiopsy is the primary approach, while surgical lung biopsy is reserved for patients who are fit for it and in whom bronchoscopic diagnosis did not provide the information needed. Despite considerable progress, IPF remains a diagnosis of exclusion and multidisciplinary discussion remains the golden standard of diagnosis.
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Affiliation(s)
- J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung, München
| | - A Günther
- Schwerpunkt Fibrosierende Lungenerkrankungen, Universitätsklinikum Gießen - Marburg, Standort Gießen, Justus-Liebig-Universität Gießen, sowie Agaplesion Pneumologische Klinik Waldhof-Elgershausen, Greifenstein, University of Giessen Marburg Lung Center, Mitglied des Deutschen Zentrums für Lungenforschung
| | - F Bonella
- Zentrum für interstitielle und seltene Lungenkrankheiten, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, Essen
| | - J Dinkel
- Klinik für Radiologie, Klinikum der Universität München, LMU, und Asklepios Fachkliniken München Gauting, Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - L Fink
- Institut für Pathologie und Zytologie, ÜGP Wetzlar, Mitglied des Deutschen Zentrums für Lungenforschung, Wetzlar
| | - T Geiser
- Universitätsklinik für Pneumologie, Universitätsspital, Universität Bern, Bern
| | - K Geißler
- Patientenvertretung Lungenfibrose e. V., Essen
| | - S Gläser
- Vivantes Klinikum Neukölln und Spandau Berlin, Klinik für Innere Medizin - Pneumologie und Infektiologie sowie und Universitätsmedizin Greifswald, Greifswald
| | - S Handzhhiev
- Klinische Abteilung für Pneumologie, Universitätsklinikum Krems, Krems an der Donau, Österreich
| | - D Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover, Mitglied des Deutschen Zentrums für Lungenforschung, Hannover
| | - D Koschel
- Abteilung Innere Medizin/Pneumologie, Fachkrankenhaus Coswig, Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thoraxchirurgie und Medizinische Klinik 1, Bereich Pneumologie, Universitätsklinikum Carl Gustav Carus, Dresden
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Mitglied des Deutschen Zentrums für Lungenforschung, Heidelberg
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung, München
| | - P Markart
- Schwerpunkt Fibrosierende Lungenerkrankungen, Universitätsklinikum Gießen - Marburg, Standort Gießen, Justus-Liebig-Universität Gießen, University of Giessen Marburg Lung Center, sowie Campus Fulda Universitätsmedizin Marburg, Med. Klinik V; Mitglied des Deutschen Zentrums für Lungenforschung, Fulda
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover und Clinical Research Center Fraunhofer Institut ITEM, Mitglied des Deutschen Zentrums für Lungenforschung, Hannover
| | - N Schönfeld
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - J C Schupp
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States
| | - H Sitter
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Berlin
| | - J Müller-Quernheim
- Klinik für Pneumologie, Department Innere Medizin, Medizinische Fakultät, Albert Ludwigs Universität, Freiburg
| | - U Costabel
- Zentrum für interstitielle und seltene Lungenkrankheiten, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, Essen
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Abstract
BACKGROUND Pulmonary involvement in patients with underlying autoimmune diseases poses a major diagnostic and therapeutic challenge to the treating physician. Due to the associated increased mortality risk, early diagnosis is crucial. OBJECTIVE The incidence and mortality rate of connective tissue disease-related interstitial lung diseases (CTD-ILD) and pulmonary hypertension (PH) were evaluated in patients with rheumatic disease including clinical aspects, diagnostic procedure, prognosis and treatment recommendations. MATERIAL AND METHODS An analysis of remarkable publications was carried out and guidelines are presented. RESULTS The CTD-ILD and PH are frequent comorbidities with significantly increased mortality risk, especially in patients with systemic sclerosis (SSc). In primary fibrotic and non-inflammatory CTD-ILD, as occurs especially in patients with rheumatoid arthritis, immunosuppressive therapy is only partially effective. Currently, in some eligible patients only lung transplantation remains as a definitive therapy. CONCLUSION The diagnostics and treatment of CTD-ILD and PH in patients with an underlying autoimmune disease requires an interdisciplinary approach. The effectiveness of antifibrotic treatment needs to be evaluated in the future.
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Affiliation(s)
- G Leuschner
- Medizinische Klinik und Poliklinik V, Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - C Neurohr
- Abteilung für Pneumologie und Beatmungsmedizin, Robert-Bosch-Krankenhaus, Klinik Schillerhöhe, Solitudestr. 18, 70839, Gerlingen, Deutschland
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19
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Veit T, Leuschner G, Sisic A, Ceelen F, Munker D, Schmitzer M, Weig T, Michel S, Schneider C, Meiser B, Crispin A, Neurohr C, Behr J, Milger K, Kneidinger N. Pirfenidone exerts beneficial effects in patients with IPF undergoing single lung transplantation. Am J Transplant 2019; 19:2358-2365. [PMID: 30942945 DOI: 10.1111/ajt.15378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/17/2019] [Accepted: 03/24/2019] [Indexed: 01/25/2023]
Abstract
Pirfenidone demonstrated pleiotropic antiinflammatory effects in various experimental and clinical settings. The aim of this study was to assess the impact of previous treatment with pirfenidone on short-term outcomes after single lung transplantation (SLTx). Therefore, patients with idiopathic pulmonary fibrosis (IPF) who were undergoing SLTx were screened retrospectively for previous use of pirfenidone and compared to respective controls. Baseline parameters and short-term outcomes were recorded and analyzed. In total, 17 patients with pirfenidone were compared with 26 patients without antifibrotic treatment. Baseline characteristics and severity of disease did not differ between groups. Use of pirfenidone did not increase blood loss, wound-healing, or anastomotic complications. Severity of primary graft dysfunction at 72 hours was less (0.3 ± 0.6 vs 1.4 ± 1.3, P = .002), and length of mechanical ventilation (37.5 ± 34.8 vs 118.5 ± 151.0 hours, P = .016) and intensive care unit (ICU) stay (6.6 ± 7.1 vs 15.6 ± 20.3, P = .089) were shorter in patients with pirfenidone treatment. An independent beneficial effect of pirfenidone was confirmed by regression analysis while controlling for confounding variables (P = .016). Finally, incidence of acute cellular rejections within the first 30 days after SLTx was lower in patients with previous pirfenidone treatment (0.0% vs 19.2%; P = .040). Our data suggest a beneficial role of previous use of pirfenidone in patients with IPF who were undergoing SLTx.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Alma Sisic
- Transplant Center, University of Munich, Munich, Germany
| | - Felix Ceelen
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Magdalena Schmitzer
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Thomas Weig
- Department of Anaesthesiology, University of Munich, LMU, Munich, Germany
| | - Sebastian Michel
- Clinic of Cardiac Surgery, University of Munich, LMU, Munich, Germany
| | | | - Bruno Meiser
- Transplant Center, University of Munich, Munich, Germany
| | - Alexander Crispin
- IBE - Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, LMU, Munich, Germany
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20
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Matthes S, Stadler J, Barton J, Leuschner G, Munker D, Arnold P, Villena-Hermoza H, Frankenberger M, Probst P, Koch A, Kneidinger N, Milger K, Behr J, Neurohr C. Asthma features in severe COPD: Identifying treatable traits. Respir Med 2018; 145:89-94. [PMID: 30509722 DOI: 10.1016/j.rmed.2018.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 01/13/2023]
Abstract
AIM Biological therapies developed for severe asthma may have a role in COPD patients with asthma features. METHOD We carried out a prospective, consecutive, cross-sectional analysis of 80 patients with severe COPD GOLD IV/D. RESULTS We studied 80 patients (48.8% female), aged 57.6 ± 5.1 years, ex-smokers with 35.7 ± 21.2 pack years, BMI 22.3 ± 3.5 kg/m2, FEV1 of 0.61 ± 0.2 L (21.1 ± 5.6% pred), pO2 52.4 ± 8.4 mmHg, and BODE 6.9 ± 1.7. 68% had >2 moderate or severe exacerbations annually. 16.1% (5/31) patients showed FEV1 reversibility of >12% and >200 ml despite maximal therapy, 33% (15/45) had FENO ≥22.5 ppb, 33% (24/73) had serum IgE ≥100 I.E./ml and there was positive allergen sensitization in 51.5% (35/68). Blood eosinophilia of ≥150 cells/μl was seen in 47% (35/74). Induced sputum showed eosinophilia of ≥2% in 56% (14/24) with respiratory pathogens in 63.8% (30/47). We identified 12 (15%) patients with asthma-COPD overlap. Of these, 10 (83.3%) had frequent exacerbations and these patients had significantly more severe exacerbations requiring NIV or ICU than those without asthma features (p < 0.005). CONCLUSION We detected asthma features in a substantial subset of stable patients with severe COPD. Asthma features were associated with more severe exacerbation despite optimal COPD therapy, representing potential candidates for targeted therapy with anti- IgE or anti-IL5.
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Affiliation(s)
- Sandhya Matthes
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany.
| | - Jakob Stadler
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Jürgen Barton
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Dieter Munker
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Paola Arnold
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Heidrun Villena-Hermoza
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center, Helmholtz Center Munich, Ludwig-Maximilians University Munich and Asklepios Klinik Gauting, Germany
| | - Philipp Probst
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University Munich, Germany
| | - Andrea Koch
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Katrin Milger
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center (CPC-M), Member of the German Centre for Lung Research (DZL), Germany
| | - Claus Neurohr
- Department of Respiratory and Ventilatory Medicine, Klinik Schillerhöhe, Robert-Koch Hospital, Academic Hospital of the University of Tübingen, Germany
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21
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Leuschner G, Reiter F, Stocker F, Crispin A, Kneidinger N, Veit T, Klenner F, Ceelen F, Zimmermann G, Leuchte H, Reu S, Dinkel J, Behr J, Neurohr C. Idiopathic Pulmonary Fibrosis Among Young Patients: Challenges in Diagnosis and Management. Lung 2018; 196:401-408. [PMID: 29761229 DOI: 10.1007/s00408-018-0123-9] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/04/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is considered a disease of older patients, being rare in patients ≤ 50 years. Still, IPF can occur in younger patients, but this particular patient group is not well characterised so far. The aim of this study was to compare the diagnostic certainty, clinical features, comorbidities and survival in young versus older IPF patients. METHODS We reviewed our medical records from February 2011 until February 2015, to identify IPF patients, who were then classified as young (≤ 50 years) or older IPF (> 50 years). Radiographic and histological findings, lung function parameters, comorbidities, disease progression and survival were analysed and compared between the two groups. RESULTS Of 440 patients with interstitial lung disease, 129 patients with IPF were identified, including 30 (23.3%) ≤50 years and 99 (76.7%) > 50 years. There were no differences between age groups in baseline demographics; younger patients were less likely to have a confirmed diagnosis by high-resolution computed tomography (p = 0.014), more likely to require a biopsy (p = 0.08) and less likely to have received antifibrotic therapy (p = 0.006). Despite an overall limited prognosis, younger patients had a significantly better median survival after diagnosis (p = 0.0375), with a significantly higher proportion of older patients dying due to respiratory failure (p = 0.0383). CONCLUSION IPF patients under the age of 50 years have similar features and clinical course compared to older IPF patients. These patients should be diagnosed by adopting a multidisciplinary team approach, potentially benefitting from earlier intervention with effective antifibrotic therapy.
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Affiliation(s)
- Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Fredrik Reiter
- Department of Internal Medicine V, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Florian Stocker
- Department of Internal Medicine V, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Crispin
- IBE - Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Friederike Klenner
- Department of Internal Medicine V, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Felix Ceelen
- Department of Internal Medicine V, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Gregor Zimmermann
- Department of Internal Medicine V, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Hanno Leuchte
- Department of Internal Medicine II, Neuwittelsbach Academic Hospital, Ludwig-Maximilian University Munich, Munich, Germany
| | - Simone Reu
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilian University Munich, Munich, Germany
| | - Julien Dinkel
- Department of Radiology, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Centre (CPC-M), Member of the German Centre for Lung Research (DZL), Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany
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22
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Polke M, Behr J, Kabitz H, Neurohr C, Leuschner G, Prasse A, Bonella F, Koschel D, Günther A, Wälscher J, Herth FJF, Kreuter M. Status zur Diagnostik und Therapie der akuten Exazerbation der idiopathischen Lungenfibrose in Deutschland – ein weites Feld! Pneumologie 2018. [DOI: 10.1055/s-0037-1619401] [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]
Affiliation(s)
- M Polke
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - J Behr
- Klinik für Pneumologie, Asklepios Fachklinik München-Gauting; Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Großhadern; Schwerpunkt Pneumologie, Klinikum Großhadern der LMU; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - H Kabitz
- II. Medizinische Klinik, Pneumologie, Kardiologie, Internistische Intensivmedizin, Klinikum Konstanz
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Großhadern; Schwerpunkt Pneumologie, Klinikum Großhadern der LMU; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Großhadern; Schwerpunkt Pneumologie, Klinikum Großhadern der LMU; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - F Bonella
- Schwerpunkt Interstitielle und Seltene Lungenkrankheiten, Ruhrlandklinik, Universitätsmedizin Essen
| | - D Koschel
- Zentrum für Pneumologie, Thorax- und Gefäßchirurgie, Fachkrankenhaus Coswig GmbH
| | - A Günther
- Med. Klinik II, Klinische Forschergruppe 'Lungenfibrose', Universitätsklinikum Gießen und Marburg; Lungenfachklinik Waldhof-Elgershausen, Greifenstein; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - J Wälscher
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - FJF Herth
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - M Kreuter
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
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23
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Leuschner G, Veit T, Barnikel M, Crispin A, Brust J, Ceelen F, Kneidinger N, Behr J, Neurohr C. Intensiviertes Monitoring mit täglicher Heimspirometrie und Aktivitätsmessung bei interstitiellen Lungenerkrankungen. Pneumologie 2018. [DOI: 10.1055/s-0037-1619183] [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]
Affiliation(s)
- G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZLl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZLl)
| | - M Barnikel
- Medizinische Klinik und Poliklinik V, Klinikum Großhadern
| | - A Crispin
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University Munich
| | - J Brust
- Medizinische Klinik und Poliklinik V, Klinikum Großhadern
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZLl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZLl)
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der LMU München; Comprehensive Pneumology Center
| | - C Neurohr
- Schwerpunkt Pneumologie, Medizinische Klinik und Poliklinik V, Klinikum der LMU München, Großhadern
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Leuschner G, Reiter F, Stocker F, Crispin A, Kneidinger N, Veit T, Klenner F, Ceelen F, Zimmermann G, Leuchte H, Reu S, Dinkel J, Behr J, Neurohr C. Idiopathische Lungenfibrose bei jungen Patienten – ernstzunehmend und nicht so selten. Pneumologie 2018. [DOI: 10.1055/s-0037-1619240] [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]
Affiliation(s)
- G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - F Reiter
- Medizinische Klinik und Polikinik V, Klinikum Großhadern
| | - F Stocker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - A Crispin
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University Munich
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - F Klenner
- Medizinische Klinik und Polikinik V, Klinikum Großhadern
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München; Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - G Zimmermann
- Pneumologie, Medizinische Klinik und Poliklinik I; Klinikum Großhadern der Ludwig-Maximilians-Universität München
| | | | - S Reu
- Institute of Pathology, Ludwig Maximilian University of Munich
| | - J Dinkel
- Institut für Klinische Radiologie; Klinikum der Universität München
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der LMU München; Comprehensive Pneumology Center
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Schwerpunkt Pneumologie, Klinikum der Universität München, Großhadern
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Schiller HB, Mayr CH, Leuschner G, Strunz M, Staab-Weijnitz C, Preisendörfer S, Eckes B, Moinzadeh P, Krieg T, Schwartz DA, Hatz RA, Behr J, Mann M, Eickelberg O. Deep Proteome Profiling Reveals Common Prevalence of MZB1-Positive Plasma B Cells in Human Lung and Skin Fibrosis. Am J Respir Crit Care Med 2017; 196:1298-1310. [PMID: 28654764 DOI: 10.1164/rccm.201611-2263oc] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [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: 12/24/2022] Open
Abstract
RATIONALE Analyzing the molecular heterogeneity of different forms of organ fibrosis may reveal common and specific factors and thus identify potential future therapeutic targets. OBJECTIVES We sought to use proteome-wide profiling of human tissue fibrosis to (1) identify common and specific signatures across end-stage interstitial lung disease (ILD) cases, (2) characterize ILD subgroups in an unbiased fashion, and (3) identify common and specific features of lung and skin fibrosis. METHODS We collected samples of ILD tissue (n = 45) and healthy donor control samples (n = 10), as well as fibrotic skin lesions from localized scleroderma and uninvolved skin (n = 6). Samples were profiled by quantitative label-free mass spectrometry, Western blotting, or confocal imaging. MEASUREMENTS AND MAIN RESULTS We determined the abundance of more than 7,900 proteins and stratified these proteins according to their detergent solubility profiles. Common protein regulations across all ILD cases, as well as distinct ILD subsets, were observed. Proteomic comparison of lung and skin fibrosis identified a common upregulation of marginal zone B- and B1-cell-specific protein (MZB1), the expression of which identified MZB1+/CD38+/CD138+/CD27+/CD45-/CD20- plasma B cells in fibrotic lung and skin tissue. MZB1 levels correlated positively with tissue IgG and negatively with diffusing capacity of the lung for carbon monoxide. CONCLUSIONS Despite the presumably high molecular and cellular heterogeneity of ILD, common protein regulations are observed, even across organ boundaries. The surprisingly high prevalence of MZB1-positive plasma B cells in tissue fibrosis warrants future investigations regarding the causative role of antibody-mediated autoimmunity in idiopathic cases of organ fibrosis, such as idiopathic pulmonary fibrosis.
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Affiliation(s)
- Herbert B Schiller
- 1 Comprehensive Pneumology Center, German Research Center for Environmental Health, Munich, Germany.,2 German Center for Lung Research (DZL), Germany
| | - Christoph H Mayr
- 1 Comprehensive Pneumology Center, German Research Center for Environmental Health, Munich, Germany
| | - Gabriela Leuschner
- 1 Comprehensive Pneumology Center, German Research Center for Environmental Health, Munich, Germany.,3 Department of Internal Medicine V and
| | - Maximilian Strunz
- 1 Comprehensive Pneumology Center, German Research Center for Environmental Health, Munich, Germany
| | - Claudia Staab-Weijnitz
- 1 Comprehensive Pneumology Center, German Research Center for Environmental Health, Munich, Germany.,2 German Center for Lung Research (DZL), Germany
| | - Stefan Preisendörfer
- 1 Comprehensive Pneumology Center, German Research Center for Environmental Health, Munich, Germany
| | - Beate Eckes
- 4 Department of Dermatology, University of Cologne, Cologne, Germany
| | - Pia Moinzadeh
- 4 Department of Dermatology, University of Cologne, Cologne, Germany
| | - Thomas Krieg
- 4 Department of Dermatology, University of Cologne, Cologne, Germany
| | - David A Schwartz
- 5 Division of Respiratory Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Rudolf A Hatz
- 6 Center for Thoracic Surgery, Munich Lung Transplant Group, University Hospital Grosshadern, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Jürgen Behr
- 2 German Center for Lung Research (DZL), Germany.,3 Department of Internal Medicine V and.,7 Asklepios Clinics Munich-Gauting, Comprehensive Pneumology Center, Munich, Germany; and
| | - Matthias Mann
- 8 Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Oliver Eickelberg
- 1 Comprehensive Pneumology Center, German Research Center for Environmental Health, Munich, Germany.,2 German Center for Lung Research (DZL), Germany.,7 Asklepios Clinics Munich-Gauting, Comprehensive Pneumology Center, Munich, Germany; and
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Abstract
Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has been defined as an acute, clinically significant deterioration that develops within less than 1 month without obvious clinical cause like fluid overload, left heart failure, or pulmonary embolism. Pathophysiologically, damage of the alveoli is the predominant feature of AE-IPF which manifests histopathologically as diffuse alveolar damage and radiologically as diffuse, bilateral ground-glass opacification on high-resolution computed tomography. A growing body of literature now focuses on acute exacerbations of interstitial lung disease (AE-ILD) other than idiopathic pulmonary fibrosis. Based on a shared pathophysiology it is generally accepted that AE-ILD can affect all patients with interstitial lung disease (ILD) but apparently occurs more frequently in patients with an underlying usual interstitial pneumonia pattern. The etiology of AE-ILD is not fully understood, but there are distinct risk factors and triggers like infection, mechanical stress, and microaspiration. In general, AE-ILD has a poor prognosis and is associated with a high mortality within 6–12 months. Although there is a lack of evidence based data, in clinical practice, AE-ILD is often treated with a high dose corticosteroid therapy and antibiotics. This article aims to provide a summary of the clinical features, diagnosis, management, and prognosis of AE-ILD as well as an update on the current developments in the field.
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Affiliation(s)
- Gabriela Leuschner
- Department of Internal Medicine V, Ludwig Maximilians University, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig Maximilians University, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), Munich, Germany.,Asklepios Fachkliniken München-Gauting, Gauting, Germany
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27
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Leuschner G, Stocker F, Veit T, Kneidinger N, Winter H, Schramm R, Weig T, Matthes S, Ceelen F, Arnold P, Munker D, Klenner F, Hatz R, Frankenberger M, Behr J, Neurohr C. Outcome of lung transplantation in idiopathic pulmonary fibrosis with previous anti-fibrotic therapy. J Heart Lung Transplant 2017; 37:S1053-2498(17)31886-7. [PMID: 28734935 DOI: 10.1016/j.healun.2017.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/06/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anti-fibrotic drugs may interfere with wound-healing after major surgery, theoretically preventing sufficient bronchial anastomosis formation after lung transplantation (LTx). The aim of this study was to assess the impact of previous treatment with pirfenidone and nintedanib on outcomes after LTx in patients with idiopathic pulmonary fibrosis (IPF). METHODS All patients with IPF undergoing LTx at the University of Munich between January 2012 and November 2016 were retrospectively screened for previous use of anti-fibrotics. Post-transplant outcome and survival of patients with and without anti-fibrotic treatment were analyzed. RESULTS A total of 62 patients with IPF were transplanted (lung allocation score [mean ± SD] 53.1 ± 16.1). Of these, 23 (37.1%) received pirfenidone and 7 (11.3%) received nintedanib before LTx; the remaining 32 (51.6%) did not receive any anti-fibrotic drug (control group). Patients receiving anti-fibrotics were significantly older (p = 0.004) and their carbon monoxide diffusion capacity was significantly higher (p = 0.008) than in controls. Previous anti-fibrotic treatment did not increase blood product utilization, wound-healing or anastomotic complications after LTx. Post-transplant surgical revisions due to bleeding and/or impaired wound-healing were necessary in 18 (29.0%) patients (pirfenidone 30.4%, nintedanib 14.3%, control 31.3%; p = 0.66). Anastomosis insufficiency occurred in 2 (3.2%) patients, both in the control group. No patient died within the first 30 days post-LTx, and no significant differences regarding survival were seen during the follow-up (12-month survival: pirfenidone 77.0%, nintedanib 100%, control 90.6%; p = 0.29). CONCLUSION Our data show that previous use of anti-fibrotic therapy does not increase surgical complications or post-operative mortality after LTx.
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Affiliation(s)
- Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany.
| | - Florian Stocker
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany
| | - Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Hauke Winter
- Munich Lung Transplant Group, Munich, Germany; Department of Thoracic Surgery, University of Munich, Munich, Germany
| | - René Schramm
- Munich Lung Transplant Group, Munich, Germany; Clinic of Cardiac Surgery, University of Munich, Munich, Germany
| | - Thomas Weig
- Munich Lung Transplant Group, Munich, Germany; Department of Anesthesiology, University of Munich, Munich, Germany
| | - Sandhya Matthes
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Felix Ceelen
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Paola Arnold
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Friederike Klenner
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Rudolf Hatz
- Munich Lung Transplant Group, Munich, Germany; Department of Thoracic Surgery, University of Munich, Munich, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center, Institute of Lung Biology and Disease, Helmholtz Zentrum München, Member of the German Center for Lung Research, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center, University of Munich, Klinikum Grosshadern, Member of the German Center for Lung Research, Munich, Germany; Munich Lung Transplant Group, Munich, Germany
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28
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Sabel BO, Plum JL, Kneidinger N, Leuschner G, Koletzko L, Raziorrouh B, Schinner R, Kunz WG, Schoeppe F, Thierfelder KM, Sommer WH, Meinel FG. Structured reporting of CT examinations in acute pulmonary embolism. J Cardiovasc Comput Tomogr 2017; 11:188-195. [DOI: 10.1016/j.jcct.2017.02.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/14/2017] [Accepted: 02/19/2017] [Indexed: 02/04/2023]
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Kneidinger N, Milger K, Janitza S, Ceelen F, Leuschner G, Dinkel J, Königshoff M, Weig T, Schramm R, Winter H, Behr J, Neurohr C. Lung volumes predict survival in patients with chronic lung allograft dysfunction. Eur Respir J 2017; 49:49/4/1601315. [DOI: 10.1183/13993003.01315-2016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/15/2016] [Indexed: 01/09/2023]
Abstract
Identification of disease phenotypes might improve the understanding of patients with chronic lung allograft dysfunction (CLAD). The aim of the study was to assess the impact of pulmonary restriction and air trapping by lung volume measurements at the onset of CLAD.A total of 396 bilateral lung transplant recipients were analysed. At onset, CLAD was further categorised based on plethysmography. A restrictive CLAD (R-CLAD) was defined as a loss of total lung capacity from baseline. CLAD with air trapping (AT-CLAD) was defined as an increased ratio of residual volume to total lung capacity. Outcome was survival after CLAD onset. Patients with insufficient clinical information were excluded (n=95).Of 301 lung transplant recipients, 94 (31.2%) developed CLAD. Patients with R-CLAD (n=20) and AT-CLAD (n=21), respectively, had a significantly worse survival (p<0.001) than patients with non-R/AT-CLAD. Both R-CLAD and AT-CLAD were associated with increased mortality when controlling for multiple confounding variables (hazard ratio (HR) 3.57, 95% CI 1.39–9.18; p=0.008; and HR 2.65, 95% CI 1.05–6.68; p=0.039). Furthermore, measurement of lung volumes was useful to identify patients with combined phenotypes.Measurement of lung volumes in the long-term follow-up of lung transplant recipients allows the identification of patients who are at risk for worse outcome and warrant special consideration.
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30
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Munker D, Arnold P, Ceelen F, Kneidinger N, Leuschner G, Prechtl C, Matthes S, Veit T, Behr J, Neurohr C. Kortisonstoßtherapie bei Verschlechterung der Lungenfunktion nach Lungentransplantation und Ausschluss einer akuten zellulären Abstoßungsreaktion. Pneumologie 2017. [DOI: 10.1055/s-0037-1598292] [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: 10/20/2022]
Affiliation(s)
- D Munker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Arnold
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Prechtl
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - S Matthes
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
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31
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Leuschner G, Stocker F, Veit T, Kneidinger N, Ceelen F, Arnold P, Munker D, Matthes S, Behr J, Neurohr C. Lungentransplantation bei Patienten mit bestehender Pirfenidontherapie: eine Fallstudie. Pneumologie 2017. [DOI: 10.1055/s-0037-1598291] [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: 10/20/2022]
Affiliation(s)
- G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - F Stocker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Arnold
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - D Munker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - S Matthes
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
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32
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Ceelen F, Burger C, Kneidinger N, Matthes S, Leuschner G, Arnold P, Munker D, Veit T, Dinkel J, Behr J, Neurohr C. Stellenwert der Surveillance-Computertomografie nach Lungentransplantation. Pneumologie 2017. [DOI: 10.1055/s-0037-1598562] [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: 10/20/2022]
Affiliation(s)
- F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Burger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - S Matthes
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Arnold
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - D Munker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Dinkel
- Institut für Klinische Radiologie, Klinikum der Universität München
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
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Kneidinger N, Milger K, Janitza S, Ceelen F, Leuschner G, Königshoff M, Weig T, Schramm R, Winter H, Behr J, Neurohr C. Lung volumes predict survival in patients with chronic lung allograft dysfunction. Pneumologie 2017. [DOI: 10.1055/s-0037-1598295] [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: 10/20/2022]
Affiliation(s)
- N Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
| | - K Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
| | - S Janitza
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
| | - F Ceelen
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
| | - G Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
| | - M Königshoff
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
| | - T Weig
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
| | - R Schramm
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
| | - H Winter
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
| | - J Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
| | - C Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL) & Munich Lung Transplant Group (MLTG), University of Munich, Germany
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34
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Matthes S, Barton J, Stadler J, Kneidinger N, Ceelen F, Leuschner G, Arnold P, Munker D, Veit T, Villena-Hermoza H, Frankenberger M, Behr J, Neurohr C. Phänotypische Charakterisierung von Patienten mit schwerer chronisch obstruktiver Lungenerkrankung (COPD). Pneumologie 2017. [DOI: 10.1055/s-0037-1598546] [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: 10/20/2022]
Affiliation(s)
- S Matthes
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Barton
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Stadler
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Arnold
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - D Munker
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - H Villena-Hermoza
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - M Frankenberger
- Cpc Comprehensive Pneumology Center, Forschungsambulanz Helmholtz Zentrum München; Ludwig-Maximilians Universität und Asklepios Klinik Gauting
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Ludwig-Maximilians-Universität München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
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Arnold P, Munker D, Kneidinger N, Ceelen F, Leuschner G, Matthes S, Veit T, Prechtl C, Behr J, Neurohr C. Volumenbelastung bei Patienten mit fortgeschrittener Lungenerkrankung. Pneumologie 2017. [DOI: 10.1055/s-0037-1598569] [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: 10/20/2022]
Affiliation(s)
- P Arnold
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - D Munker
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - N Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - F Ceelen
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - G Leuschner
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - S Matthes
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - T Veit
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Prechtl
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
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Leuschner G, Wenter V, Milger K, Zimmermann GS, Matthes S, Meinel FG, Lehner S, Neurohr C, Behr J, Kneidinger N. Suspected pulmonary embolism in patients with pulmonary fibrosis: Discordance between ventilation/perfusion SPECT and CT pulmonary angiography. Respirology 2016; 21:1081-7. [PMID: 27061739 DOI: 10.1111/resp.12797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/30/2015] [Accepted: 02/01/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Pulmonary embolism (PE) is a common differential diagnosis in patients with pulmonary fibrosis presenting with a clinical deterioration. Both ventilation/perfusion (V/Q)-single photon emission computed tomography (SPECT) and computed tomographic pulmonary angiography (CTPA) are routinely used to detect PE. However, the value of V/Q-SPECT and CTPA in this scenario has not been studied so far. We aimed to investigate the concordance of V/Q-SPECT and CTPA in patients with pulmonary fibrosis and suspicion of pulmonary embolism. METHODS A total of 22 consecutive patients with pulmonary fibrosis and clinical deterioration who underwent both V/Q-SPECT and CTPA were included in the study and analyzed for the presence of pulmonary embolism. RESULTS Nine of 22 patients (41%) had evidence for pulmonary embolism in V/Q-SPECT, and two of these patients had matching evidence for pulmonary embolism in CTPA. In the other seven patients with positive findings in V/Q-SPECT, no evidence of pulmonary embolism was found in CTPA. None of the 13 patients with a negative V/Q-SPECT had evidence for pulmonary embolism in CTPA. CONCLUSION In patients with pulmonary fibrosis and suspected pulmonary embolism, pulmonary embolism is detected more frequently by V/Q-SPECT than by CTPA. Thromboembolic disease is identified on CTPA only in a minority of patients with positive findings on V/Q-SPECT. When making treatment decisions, clinicians should be aware of the high rate of discordant findings in V/Q-SPECT and CTPA in this specific patient population.
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Affiliation(s)
- Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Vera Wenter
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Gregor S Zimmermann
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sandhya Matthes
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Felix G Meinel
- Institute for Clinical Radiology, University of Munich, Munich, Germany
| | - Sebastian Lehner
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Claus Neurohr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Sabel B, Plum J, Kneidinger N, Leuschner G, Raziorrouh B, Koletzko L, Schinner R, Reiser M, Meinel F. Structured Reporting von CT-Untersuchungen bei akuter Lungenembolie. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581237] [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: 10/22/2022]
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Leuschner G, Geidel H. [Psycho-rheumatic problems in patients with soft tissue rheumatism]. Z Gesamte Inn Med 1991; 46:237-9. [PMID: 1897280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patients with non-articular rheumatism syndrome demand a multidimensional judgment and an interdisciplinary care in a biopsychosocial understanding of the disease. In the psychosomatic consideration factors from the person-environment interaction of the patient gains increasedly importance. Thereby the communication of pain in the doctor-patient relationship and the valuation of pain in the family play a particular role. These regions of psychorheumatological problems are shown and discussed.
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Affiliation(s)
- G Leuschner
- I. Medizinische Klinik, Bezirkskrankenhauses Dresden-Friedrichstadt
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Leuschner G, Geidel H. [Significance of occupational, health and life satisfaction in coping with rheumatic complaints]. Z Gesamte Hyg 1990; 36:440-2. [PMID: 2267848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In a pilot study with a prospective study design we analyzed the interaction between disease modifying drugs and coping styles. We examined 45 inpatients with definite or classical rheumatoid arthritis at the beginning of disease modifying drug treatment and eight months later. In this paper we evaluate the role of health satisfaction in relation to an effective therapy. The results of the discriminant analyses between sufficient and non-sufficient persons show that a differential discrimination can be achieved with psychosocial variables, for example diseasecompetency and self-mobility. Finally, our results show that a disease modifying drug treatment in rheumatic diseases must be completed with psychosocial treatments.
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Affiliation(s)
- G Leuschner
- Bezirkskrankenhaus Dresden-Friedrichstadt, I. Medizinische Klinik
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Schirmer F, Leuschner G. [Aspects of health psychology in vocational rehabilitation of teachers]. Z Gesamte Hyg 1990; 36:435-7. [PMID: 2267845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- F Schirmer
- Medizinische Akademie Dresden, Institut für Arbeitsmedizin
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Lorig K, Seydel E, Taal E, Rasker H, Basler HD, Geidel H, Leuschner G, Verreusel RLP, Lubberts EW, Theunisse HAM, Falkenbach A, Wigand R, Kaltwasser P, Clayson M, Phillips P, Graafsma EAM, Riemsma R, Brus H, Rasker JJ, Cziske R, Jaeckel WH, Jacobi E, Manshanden MAC, Schenk FC, Dijkmans BAC, Nordenskiöld U, Harmer R, Wright V, Hill J, Bird H, Elst P, Eshof IVD, Fits IVD, Laar MVD, Willigen JV, Boomgaardt IK, Tulleken JE, de Vries EGE, van Rijswijk MH, Lankveld WV, Daamen K, Bosch PV'P, Richardson MUS, Huiskes CJAE, Kraaimaat FW, Bijlsma JWJ, de Witte LP, Winants BAC, Tilli DJP, van der Linden S, van der Horst FG, Groen JJ, Sargautyté R, Kočiùnas R, Ammer K, Karetta M, Samuelsson A, Bjelle A, Sullivan M, Pincus T, Callahan LF, Persson LO, Berglund K, Kuiper CHZ, Poulsen A, Oosterveld FGJ, Jacobs JWG, Overmars HJA, Uytterhoeven R, Keulemans M, Dequeker J, Geusens P, Struthers TJ, Brown J, Dapper MML, Phiferons H, van der Velde EA, Janssen M, Raspe HH, Mattussek S, Deck R, Malcus-Johnson P, Sandqvist G, van Veldhoven G, Demeester V, Bird HA, Maycock J, Peeters W, Welkenhuysen M, Cartois J, Wassenaar WH, Tulleken JE, Tromp CN, Löfkvist U, Eberhardt K, Kessler S, Potthoff P, Ekdahl C, Brooks RH, Bakker CH, Rutten-van Mölken M, van Doorslaer E, Boykinov IN, Lolkema W, van Leeuwen MA, Fordham JN, Stamp J, Holwerda-Straver I, Wexsahl H, Torud Y, Eggen AE, Kruse-Jensen A, Munthe E, Lubberts EW, Lacko BJS, Theunisse HAM, van Riel PLCM, Bos AME, Brattström M, Thorsell U, Widell G, Claesson K, Karlsson L, Struthers J, Doeglas D, Suurmeijer T, Sanderman R, Krol B, Tuinstra J, Suurmeyer TPBM, Pelt RAGB, Goei The HS, Thomassen JMC, Damhuis-Friedrich E, Chikanza IC, Panayi GS, Forre O, Fredriksen B, Bakken L, Guillemin F, Larsson BM, Nived K, Eberharsdt K, Ahlund O, Briancon S, Baumann M, Kroll B, Douglas D, Suurmeijer T, Le Gallez P, Siesling M, Brown GMM, Jessop S, Ropers G, Sangha O, Kriegel W, Konietzny G, Suurmeijer TPBM, Skarulis R, Gaigaliene B, Raistenskis J, Ceremnych-Aleksejenko E, Cobotas M, Barlow JH, Macey SJ, Struthers G, Gorjaev YA, Menshikova LV, Fahmy Z, Braun B, Lohmann J. Third International Symposium for health professionals in rheumatology. Clin Rheumatol 1990. [DOI: 10.1007/bf02031982] [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: 10/25/2022]
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Leuschner G. [Stress conditions in the teaching profession]. Z Gesamte Hyg 1979; 25:18-21. [PMID: 425557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Leuschner G. [The personality of the teacher as a patient type in psychological diagnosis]. Psychiatr Neurol Med Psychol (Leipz) 1975; 27:529-33. [PMID: 1197474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The report concerns the questioning of 200 pedagogues using the questionnaire concerning introversion, neuroticism, rigidity and autonomic instability. All the patients are teachers and pupils in working relationships who were chosen from medical dispensary care with present symptoms of exhaustion and conflicting reactions, and who were transferred to psychological supervision. From the resulting data in the scales investigated, a configuration frequency analysis of the symptoms of introversion, neuroticism, rigidity and autonomic instability is given. Three oft-occurring typical configurations of scale can be found. From this a configuration type (with stikingly rigid behaviour and an otherwise unobtrusive scale constellation) can be interpreted as the "typical tacher" product of lengthy pedagogic activity.
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Bekemeier H, Leuschner G, Schmollack W. [Antipyretic, antiedematous and analgetic effects of damascenin in comparison with acetylsalicylic acid and phenylbutazone]. Arch Int Pharmacodyn Ther 1967; 168:199-211. [PMID: 6048725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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