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Koepf US, Scheidt S, Hischebeth GTR, Strassburg CP, Wirtz DC, Randau TM, Lutz P. Increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosis. BMC Infect Dis 2022; 22:389. [PMID: 35439971 PMCID: PMC9019970 DOI: 10.1186/s12879-022-07379-2] [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: 11/28/2021] [Accepted: 04/08/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Periprosthetic joint infections (PJI) are a major complication in joint-arthroplasty. Rifampicin is often used as an additional agent to treat PJI, because it penetrates bacterial biofilms. However, rifaximin, belonging to the same antibiotic class as rifampicin, is frequently used to prevent episodes of hepatic encephalopathy in patients with cirrhosis and may induce resistance to rifampicin. The aim of this study was to examine the microbial pattern of periprosthetic joint infections in cirrhotic patients and to test the hypothesis that intake of rifaximin increases the rate of resistance to rifampicin in periprosthetic joint infections. Methods A cohort of cirrhotic patients and PJI (n = 25) was analysed on the characteristics of bacterial isolates from sonication and tissue analysis. In a second step a subgroup analysis on the development of rifampicin resistant bacterial specimens, depending on the intake of rifaximin (8 rifaximin intake patients vs. 13 non rifaximin intake patients) was performed. Results Intestinal bacteria were found in 50% of the specimens, which was significantly more frequent than in a control cohort. By comparison of the single bacterial isolates, rifampicin resistance was detected in 69.2% (9/13) of the rifaximin-intake samples. In contrast, the non-rifaximin-intake isolates only were resistant to rifampicin in 22.2% (4/18) of the cases (p = 0.01). The odds ratio for developing a rifampicin-resistance through rifaximin intake was calculated as OR = 13.5. Conclusion Periprosthetic joint infections have a high incidence of being caused by enteric bacteria in cirrhotic patients. Due to this change in microbial pattern and the innate resistance to rifampicin of most of gram-negative bacteria, the therapy with rifampicin should be carefully considered. The association between the use of rifaximin and developed resistance to rifampicin has a major impact on the treatment of PJI.
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Affiliation(s)
- Uta S Koepf
- Department of Internal Medicine I, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Sebastian Scheidt
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Bonn, Germany
| | - Gunnar T R Hischebeth
- Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Christian P Strassburg
- Department of Internal Medicine I, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Dieter C Wirtz
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Bonn, Germany
| | - Thomas M Randau
- Department of Orthopaedics and Traumatology, University Hospital Bonn, Bonn, Germany
| | - Philipp Lutz
- Department of Internal Medicine I, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
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Fröschen FS, Randau TM, Hischebeth GTR, Gravius N, Wirtz DC, Gravius S, Walter SG. Outcome of repeated multi-stage arthroplasty with custom-made acetabular implants in patients with severe acetabular bone loss: a case series. Hip Int 2020; 30:64-71. [PMID: 32907426 DOI: 10.1177/1120700020928247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Failed reconstruction in cases of severe acetabular bone loss, with or without pelvic discontinuity, in revision total hip arthroplasty (rTHA) remains a great challenge in orthopaedic surgery. The aim of this study was to describe the outcome of a "second" rTHA with "custom-made acetabular components (CMACs)" after a previously failed reconstruction with CMACs. METHODS 4 patients with severe acetabular bone loss (Paprosky Type IIIB), who required a second rTHA after a previously failed reconstruction with CMAC, due to prosthetic joint infection (PJI), were included in our retrospective study. All prostheses had been constructed on the basis of thin-layer computed-tomography scans of the pelvis. The second rTHA was considered unsuccessful in the event of PJI or aseptic loosening (AL) with need for renewed CMAC explantation. RESULTS The treatment success rate after second rTHA with a CMAC was 50% (2 of 4). In the successful cases, the visual analogue scale (VAS) score and Harris Hip Score (HHS) after the second rTHA (VAS range 2-4; HHS range 45-58 points) did not differ from those after the first rTHA, before onset of symptoms (VAS: range 2-4; HHS: range 47-55 points). In the failed cases, the second CMACs needed to be explanted due to PJI, with renewed detection of previous pathogens. Patients with treatment failure of the second CMAC had required a higher number of revision surgeries after explantation of the first CMAC than patients with a successful outcome. CONCLUSIONS In patients with severe acetabular bone loss and previously failed rTHA with CMACs, repeat rTHA with a CMAC may be a solid treatment option for patients with an "uncomplicated" multi-stage procedure, i.e., without persisting infection after explantation of the original CMAC. While the outcome in terms of clinical function does not appear negatively affected by such a "second attempt," the complication rate and risk of reinfection, nonetheless, is high.
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Affiliation(s)
- Frank S Fröschen
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Thomas M Randau
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Gunnar T R Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Nadine Gravius
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Dieter C Wirtz
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Sascha Gravius
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany.,Orthopaedic and Trauma Surgery Centre, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Sebastian G Walter
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
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Wimmer MD, Hischebeth GTR, Randau TM, Gathen M, Schildberg FA, Fröschen FS, Kohlhof H, Gravius S. Difficult-to-treat pathogens significantly reduce infection resolution in periprosthetic joint infections. Diagn Microbiol Infect Dis 2020; 98:115114. [PMID: 32712505 DOI: 10.1016/j.diagmicrobio.2020.115114] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 01/17/2023]
Abstract
Periprosthetic joint infection (PJI) is a feared complication after arthroplasty. Our hypothesis was that PJI caused by difficult-to-treat (DTT) pathogens has a worse outcome compared with non-DTT PJI. Routine clinical data on 77 consecutive patients with confirmed PJI treated with 2-stage exchange arthroplasty were placed in DTT and non-DTT PJI groups and analyzed. The main outcome variable was that the patient was definitively free of infection after 2 years. We found definitive infection resolution in 31 patients in the DTT group (68.9%) and 28 patients (87.5%) in the non-DTT group (P < 0.05). The necessity for revision surgery until assumed resolution of infection was significantly more frequent in the DTT group with 4.72 ± 3.03 operations versus 2.41 ± 3.02 operations in the non-DTT group (P < 0.05). PJI caused by DTT bacteria is associated with significantly higher numbers of revision operations and significantly inferior definitive infection resolution.
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Affiliation(s)
- Matthias D Wimmer
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Gunnar T R Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.
| | - Thomas M Randau
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Martin Gathen
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Frank A Schildberg
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Frank S Fröschen
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Hendrik Kohlhof
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Sascha Gravius
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany; Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University of Heidelberg, Mannheim, Germany
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Schlabe S, Kleine CE, Hischebeth GTR, Molitor E, Pfeifer Y, Wasmuth JC, Spengler U. Reply to Godbole et al. Clin Infect Dis 2018; 66:1977-1978. [PMID: 29471433 DOI: 10.1093/cid/ciy033] [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: 11/13/2022] Open
Affiliation(s)
- Stefan Schlabe
- Department of Internal Medicine I, University Hospital of Bonn.,German Center of Infection Research, Partnerside Cologne-Bonn
| | - Carola-Ellen Kleine
- Department of Internal Medicine I, University Hospital of Bonn.,German Center of Infection Research, Partnerside Cologne-Bonn
| | - Gunnar T R Hischebeth
- German Center of Infection Research, Partnerside Cologne-Bonn.,Institute of Medical Microbiology, Immunology and Parasitology, University Hospital of Bonn
| | - Ernst Molitor
- German Center of Infection Research, Partnerside Cologne-Bonn.,Institute of Medical Microbiology, Immunology and Parasitology, University Hospital of Bonn
| | - Yvonne Pfeifer
- FG13 Nosocomial Infectious Agents and Antibiotic Resistance, Robert Koch Institute, Wernigerode, Germany
| | - Jan-Christian Wasmuth
- Department of Internal Medicine I, University Hospital of Bonn.,German Center of Infection Research, Partnerside Cologne-Bonn
| | - Ulrich Spengler
- Department of Internal Medicine I, University Hospital of Bonn.,German Center of Infection Research, Partnerside Cologne-Bonn
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Hischebeth GTR, Gravius S, Buhr JK, Molitor E, Wimmer MD, Hoerauf A, Bekeredjian-Ding I, Randau TM. Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction. J Vis Exp 2017. [PMID: 29286460 PMCID: PMC5755521 DOI: 10.3791/55147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life. The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI. We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI.
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Affiliation(s)
- Gunnar T R Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn;
| | - Sascha Gravius
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn
| | - Johanna K Buhr
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn
| | - Ernst Molitor
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn
| | - Matthias D Wimmer
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn
| | | | - Thomas M Randau
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn
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Kleine CE, Schlabe S, Hischebeth GTR, Molitor E, Pfeifer Y, Wasmuth JC, Spengler U. Successful Therapy of a Multidrug-Resistant Extended-Spectrum β-Lactamase–Producing and Fluoroquinolone-Resistant Salmonella enterica Subspecies enterica Serovar Typhi Infection Using Combination Therapy of Meropenem and Fosfomycin. Clin Infect Dis 2017; 65:1754-1756. [DOI: 10.1093/cid/cix652] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/25/2017] [Indexed: 11/14/2022] Open
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Hischebeth GTR, Randau TM, Molitor E, Wimmer MD, Hoerauf A, Bekeredjian-Ding I, Gravius S. Comparison of bacterial growth in sonication fluid cultures with periprosthetic membranes and with cultures of biopsies for diagnosing periprosthetic joint infection. Diagn Microbiol Infect Dis 2015; 84:112-5. [PMID: 26584961 DOI: 10.1016/j.diagmicrobio.2015.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 01/15/2023]
Abstract
Total joint arthroplasty is a common operation worldwide with infection rates between 1% and 3%. In cases of suspected periprosthetic joint infection, it is very challenging to rule out the causative microorganisms. In this study, we compared the appearance of periprosthetic membranes with the microbiological results obtained from cultures of sonication fluid and the correlation between classical microbiological cultures and cultures of sonication fluid. The results confirmed a strong correlation of bacterial growth in sonication fluid cultures with bacterial growth in classical microbiological cultures. Most importantly, however, our study documented a highly significant correlation of periprosthetic membranes typical for periprosthetic joint infection (PJI) with bacterial growth in sonication fluid. Sonication fluid cultures yielded a better sensitivity than tissue cultures (72.34-60.87%). These 3 methods are useful tools in diagnosing PJIs, and even more, sonication fluid cultures should be included in the diagnostic path of PJI.
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Affiliation(s)
- Gunnar T R Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany.
| | - Thomas M Randau
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Ernst Molitor
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Matthias D Wimmer
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
| | - Isabelle Bekeredjian-Ding
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany; Division of Microbiology, Paul-Ehrlich-Institute, Paul-Ehrlich-Str 51-59, D-63225 Langen, Germany
| | - Sascha Gravius
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany
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Hischebeth GTR, Keil VC, Gentil K, Boström A, Kuchelmeister K, Bekeredjian-Ding I. Rapid brain death caused by a cerebellar abscess with Fusobacterium nucleatum in a young man with drug abuse: a case report. BMC Res Notes 2014; 7:353. [PMID: 24915846 PMCID: PMC4062896 DOI: 10.1186/1756-0500-7-353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 06/03/2014] [Indexed: 11/13/2022] Open
Abstract
Background Fusobacterium nucleatum is a strict anaerobic microorganism that causes disease entities such as periodontal and soft tissue abscesses, pulmonary and intraabdominal infections and very rarely intracerebral infections. Case presentation Here, we report the rare case of a previously healthy 25-year-old German man with a cerebellar abscess caused by Fusobacterium nucleatum that resulted in rapid brain death. Toxicological screening showed positivity for amphetamines and cannabis. The diagnosis was obtained by polymerase chain reaction amplification of bacterial deoxyribonucleic acid in cerebrospinal fluid. Conclusions In drug users clinicians should think about rare causes of brain abscesses/meningitis. Early diagnosis is necessary and justifies the use of molecular techniques.
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Affiliation(s)
- Gunnar T R Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str, 25, D-53127 Bonn, Germany.
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Schmolders J, Hischebeth GTR, Friedrich MJ, Randau TM, Wimmer MD, Kohlhof H, Molitor E, Gravius S. Evidence of MRSE on a gentamicin and vancomycin impregnated polymethyl-methacrylate (PMMA) bone cement spacer after two-stage exchange arthroplasty due to periprosthetic joint infection of the knee. BMC Infect Dis 2014; 14:144. [PMID: 24641471 PMCID: PMC3995155 DOI: 10.1186/1471-2334-14-144] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 03/07/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Periprosthetic joint infections (PJI) are often treated by two stage exchange with the use of an antibiotic impregnated spacer. Most of the two-stage exchange algorithms recommend the implantation of an antibiotic-impregnated spacer during the first stage for a period of 2-24 weeks before reimplantation of the new prosthesis. For the spacer to have a therapeutic effect, the local antibiotic concentration must be greater than the minimal inhibition concentration (MIC) against the pathogens causing the PJI. It must remain so for the entire spacer period, otherwise recurrence of infection or resistances might occur. The question as to whether a sufficient concentration of antibiotics in vivo is reached for the entire spacer period has not been answered satisfactorily. CASE PRESENTATION We here present a case of a histologically confirmed chronic PJI 20 month after primary arthroplasty. The primary knee arthroplasty was performed due to osteoarthritis of the joint. Initial assessment did not detect a causative pathogen, and two stage exchange with a vancomycin-gentamycin impregnated spacer was performed. At the time of reimplantation, sonication of the explanted spacer revealed a multi-resistant strain of staphylococcus epidermidis on the device and in the joint. Adaption of the therapy and prolonged treatment successfully eradicated the infection. CONCLUSION According to the authors' knowledge, the case presented here confirms for the first time the surface contamination (proven through sonication) of a vancomycin-/gentamicin- impregnated Vancogenx®-spacer with a MRSE after ten weeks of implantation.This case study demonstrates the difficulties still associated with the diagnostics of PJI and the published different two stage treatment regimes with the use of antibiotic impregnated spacers.
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Affiliation(s)
| | | | | | | | | | | | | | - Sascha Gravius
- Department for Orthopaedic and Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
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Dehghani F, Hischebeth GTR, Wirjatijasa F, Kohl A, Korf HW, Hailer NP. The immunosuppressant mycophenolate mofetil attenuates neuronal damage after excitotoxic injury in hippocampal slice cultures. Eur J Neurosci 2003; 18:1061-72. [PMID: 12956706 DOI: 10.1046/j.1460-9568.2003.02821.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this study we investigated whether treatment with the immunosuppressant mycophenolate mofetil (MMF) has beneficial effects on neuronal damage after excitotoxic injury. Organotypic hippocampal slice culture (OHSC), lesioned by the application of N-methyl-d-aspartate (NMDA) after 6 days in vitro, showed an improved preservation of the hippocampal cytoarchitecture after continuous treatment with MMF for 3 further days (10 or 100 micro g/mL). Treatment with NMDA and MMF (100 microg/mL) reduced the number of damaged propidium iodide (PI)+ neurons by 50.7% and the number of microglial cells by 52%. Continuous treatment of lesioned OHSCs with MMF for 3 days almost abrogated the glial proliferative response, reflected by the 91.5% reduction in the number of bromo-desoxy-uridine (BrdU)-labelled microglial cells and astrocytes. Microglial cells in MMF-treated OHSCs contained fragmented nuclei, indicating apoptotic cell death, an effect which was also found in isolated microglial cells treated with MMF. The beneficial effect of MMF on neuronal survival apparently does not reflect a direct antiexcitotoxic effect, as short-term treatment of OHSCs with NMDA and MMF for 4 h did not reduce the number of PI+ neurons. In conclusion, MMF inhibits proliferation and activation of microglia and astrocytes and protects neurons after excitotoxic injury.
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Affiliation(s)
- Faramarz Dehghani
- Institute of Anatomy, Hospital of the Johann Wolfgang Goethe-University, Theodor-Stern-Kai-7, D-60590 Frankfurt am Main, Federal Republic of Germany.
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