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Böning A, Kretzer JA, Arif R, Etz CD, Pöling J, Rylski B, Czerny M, Brickwedel J, Peterss S, Holubec T, Jawny P, Krueger T, Feißt M. Risk factors for long-term mortality after acute aortic dissection-results of the German registry for acute aortic dissection type a long-term follow-up. Eur J Cardiothorac Surg 2024; 65:ezae116. [PMID: 38530802 DOI: 10.1093/ejcts/ezae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/26/2023] [Accepted: 03/22/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES Several short-term analyses from German Registry for Acute Aortic Dissection Type A (GERAADA) have been published. This study investigated whether short-term risk factors are transferable to the long-term prognosis of patients. METHODS Thirty-three centres with 2686 patients participated in the long-term follow-up. A total of 1164 patients died, 1063 survived and 459 were lost to follow-up during the follow-up timeframe (mean duration: 10.2 years). Long-term mortality of the cohort was compared with an age-stratified, German population. RESULTS One, 5 and 10 years after initial surgery, the survival of the GERAADA patient cohort was 71.4%, 63.4% and 51%, respectively. Without the early deaths (90-day mortality 25.4%), survival was calculated after 1, 5 and 10 years: 95.6%, 83.5% and 68.3%. Higher age, longer extracorporeal circulation time, shorter perioperative ventilation time and postoperative neurologic deficits were predictive of long-term prognosis. In an age-divided landmark analysis, the mortality of aortic dissection surgery survivors was found to be similar to that of the general German population. If patients are sorted in risk groups according to the GERAADA score, long-term survival differs between the risk groups. CONCLUSIONS If patients have survived an acute postoperative period of 90 days, life expectancy comparable to that of the general German population can be assumed in lower- and medium-risk patients. Whether the GERAADA score can provide valuable insights into the long-term prognosis of patients undergoing surgery for acute aortic dissection type A is still unclear.
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Affiliation(s)
- Andreas Böning
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
- Medical Faculty, Justus-Liebig-University, Giessen, Germany
| | - John-Arved Kretzer
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
- Medical Faculty, Justus-Liebig-University, Giessen, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, Heidelberg University, Heidelberg, Germany
| | - Christian D Etz
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Jochen Pöling
- Department of Cardiac Surgery, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Jens Brickwedel
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg UKE, Hamburg, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital Munich, Munich, Germany
| | - Tomas Holubec
- Department of Cardiac Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Philipp Jawny
- Department of Cardiac Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Tobias Krueger
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Manuel Feißt
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
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Lörchner H, Cañes Esteve L, Góes ME, Harzenetter R, Brachmann N, Gajawada P, Günther S, Doll N, Pöling J, Braun T. Neutrophils for Revascularization Require Activation of CCR6 and CCL20 by TNFα. Circ Res 2023; 133:592-610. [PMID: 37641931 DOI: 10.1161/circresaha.123.323071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Activation of immune-inflammatory pathways involving TNFα (tumor necrosis factor alpha) signaling is critical for revascularization and peripheral muscle tissue repair after ischemic injury. However, mechanisms of TNFα-driven inflammatory cascades directing recruitment of proangiogenic immune cells to sites of ischemia are unknown. METHODS Muscle tissue revascularization after permanent femoral artery ligation was monitored in mutant mice by laser Doppler imaging and light sheet fluorescence microscopy. TNFα-mediated signaling and the role of the CCL20 (C-C motif chemokine ligand 20)-CCR6 (C-C chemokine receptor 6) axis for formation of new vessels was studied in vitro and in vivo using bone marrow transplantation, flow cytometry, as well as biochemical and molecular biological techniques. RESULTS TNFα-mediated activation of TNFR (tumor necrosis factor receptor) 1 but not TNFR2 was found to be required for postischemic muscle tissue revascularization. Bone marrow-derived CCR6+ neutrophil granulocytes were identified as a previously undescribed TNFα-induced population of proangiogenic neutrophils, characterized by increased expression of VEGFA (vascular endothelial growth factor A). Mechanistically, postischemic activation of TNFR1 induced expression of the CCL20 in vascular cells and promoted translocation of the CCL20 receptor CCR6 to the cell surface of neutrophils, essentially conditioning VEGFA-expressing proangiogenic neutrophils for CCL20-dependent recruitment to sites of ischemia. Moreover, impaired revascularization of ischemic peripheral muscle tissue in diabetic mice was associated with reduced numbers of proangiogenic neutrophils and diminished CCL20 expression. Administration of recombinant CCL20 enhanced recruitment of proangiogenic neutrophils and improved revascularization of diabetic ischemic skeletal muscles, which was sustained by sequential treatment with fluvastatin. CONCLUSIONS We demonstrate that site-specific activation of the CCL20-CCR6 axis via TNFα recruits proangiogenic VEGFA-expressing neutrophils to sites of ischemic injury for initiation of muscle tissue revascularization. The findings provide an attractive option for tissue revascularization, particularly under diabetic conditions.
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Affiliation(s)
- Holger Lörchner
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (H.L., L.C.E., M.E.G., R.H., N.B., S.G., T.B.)
- German Centre for Cardiovascular Research (DZHK), Frankfurt am Main, Germany (H.L., J.P.)
| | - Laia Cañes Esteve
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (H.L., L.C.E., M.E.G., R.H., N.B., S.G., T.B.)
| | - Maria Elisa Góes
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (H.L., L.C.E., M.E.G., R.H., N.B., S.G., T.B.)
| | - Roxanne Harzenetter
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (H.L., L.C.E., M.E.G., R.H., N.B., S.G., T.B.)
| | - Nathalie Brachmann
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (H.L., L.C.E., M.E.G., R.H., N.B., S.G., T.B.)
| | - Praveen Gajawada
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany (P.G.)
| | - Stefan Günther
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (H.L., L.C.E., M.E.G., R.H., N.B., S.G., T.B.)
| | - Nicolas Doll
- Schüchtermann-Klinik, Bad Rothenfelde, Germany (N.D., J.P.)
| | - Jochen Pöling
- Schüchtermann-Klinik, Bad Rothenfelde, Germany (N.D., J.P.)
- German Centre for Cardiovascular Research (DZHK), Frankfurt am Main, Germany (H.L., J.P.)
| | - Thomas Braun
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany (H.L., L.C.E., M.E.G., R.H., N.B., S.G., T.B.)
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3
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Waechter C, Fehse L, Welzel M, Heider D, Babalija L, Cheko J, Mueller J, Pöling J, Braun T, Pankuweit S, Weihe E, Kinscherf R, Schieffer B, Luesebrink U, Soufi M, Ruppert V. Comparative analysis of full-length 16s ribosomal RNA genome sequencing in human fecal samples using primer sets with different degrees of degeneracy. Front Genet 2023; 14:1213829. [PMID: 37564874 PMCID: PMC10411958 DOI: 10.3389/fgene.2023.1213829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Next-generation sequencing has revolutionized the field of microbiology research and greatly expanded our knowledge of complex bacterial communities. Nanopore sequencing provides distinct advantages, combining cost-effectiveness, ease of use, high throughput, and high taxonomic resolution through its ability to process long amplicons, such as the entire 16s rRNA genome. We examine the performance of the conventional 27F primer (27F-I) included in the 16S Barcoding Kit distributed by Oxford Nanopore Technologies (ONT) and that of a more degenerate 27F primer (27F-II) in the context of highly complex bacterial communities in 73 human fecal samples. The results show striking differences in both taxonomic diversity and relative abundance of a substantial number of taxa between the two primer sets. Primer 27F-I reveals a significantly lower biodiversity and, for example, at the taxonomic level of the phyla, a dominance of Firmicutes and Proteobacteria as determined by relative abundances, as well as an unusually high ratio of Firmicutes/Bacteriodetes when compared to the more degenerate primer set (27F-II). Considering the findings in the context of the gut microbiomes common in Western industrial societies, as reported in the American Gut Project, the more degenerate primer set (27F-II) reflects the composition and diversity of the fecal microbiome significantly better than the 27F-I primer. This study provides a fundamentally relevant comparative analysis of the in situ performance of two primer sets designed for sequencing of the entire 16s rRNA genome and suggests that the more degenerate primer set (27F-II) should be preferred for nanopore sequencing-based analyses of the human fecal microbiome.
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Affiliation(s)
- Christian Waechter
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Leon Fehse
- Department of Mathematics and Computer Science, Philipps University Marburg, Marburg, Germany
| | - Marius Welzel
- Department of Mathematics and Computer Science, Philipps University Marburg, Marburg, Germany
| | - Dominik Heider
- Department of Mathematics and Computer Science, Philipps University Marburg, Marburg, Germany
| | - Lek Babalija
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Juan Cheko
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Julian Mueller
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Jochen Pöling
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Thomas Braun
- Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Sabine Pankuweit
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Eberhard Weihe
- Institute of Anatomy and Cell Biology, Medical Faculty, Philipps University Marburg, Marburg, Germany
| | - Ralf Kinscherf
- Institute of Anatomy and Cell Biology, Medical Faculty, Philipps University Marburg, Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ulrich Luesebrink
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Muhidien Soufi
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Center for Undiagnosed and Rare Diseases, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Volker Ruppert
- Department of Cardiology, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
- Center for Undiagnosed and Rare Diseases, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
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Wehbe MS, Pöling J, Perier P, Doll N. Mitralklappenchirurgie bei Verkalkung des Mitralanulus. Z Herz- Thorax- Gefäßchir 2023. [DOI: 10.1007/s00398-023-00560-y] [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: 02/10/2023]
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5
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Kallenbach K, Büsch C, Rylski B, Dohle DS, Krüger T, Holubec T, Brickwedel J, Pöling J, Noack T, Hagl C, Jawny P, Böning A, Chalabi K, Karck M, Arif R. Treatment of the aortic root in acute aortic dissection type A: insights from the German Registry for Acute Aortic Dissection Type A. Eur J Cardiothorac Surg 2022; 62:ezac261. [PMID: 35511255 DOI: 10.1093/ejcts/ezac261] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/04/2022] [Accepted: 04/16/2022] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Surgery of the aortic root in acute aortic dissection type A (AADA) remains a topic of vague evidence since the extend of dissection and surgeons' capability and interpretation of the disease vary remarkably. We aimed to interpret root operation strategies in the German Registry for Acute Aortic Dissection cohort. METHODS German Registry for Acute Aortic Dissection collected the data of 56 centres between July 2006 and June 2015. A total of 3382 patients undergoing operations for AADA were included and divided into 3 groups according to aortic root procedure types: supracommissural replacement (SCR), conduit replacement (CR) and valve sparing root replacement (VSRR). RESULTS Patients in SCR (2425, 71.7%) were significantly older than CR (681, 20.1%) and VSRR (276, 8.2%) (63.4 vs 57.5 vs 54.2 years; P < 0.001), more female (38.9% vs 32.0% vs 26.1%; P < 0.001) and presented with less aortic regurgitation (26.3% vs 57.1% vs 56.5%; P < 0.001). VSRR presented with slightly less multiple organ malperfusion (11.6% vs 12.0% vs 10.9%; P = 0.045) and were more often diagnosed for Marfan syndrome (2.4% vs 5.1% vs 9.1%; P < 0.001). Thirty-day mortality was lower for VSRR (11.6%) compared to SCR (16.1%) and CR (19.8%; P = 0.010). Despite longer procedural times, multivariable regression showed no influence of total arch replacement for VSRR on mortality compared to CR (odds ratio 0.264; 95% confidence interval, 0.033-2.117; P = 0.21). CONCLUSIONS SCR remains the procedure of choice in elderly and compromised patients. Extended root preservation techniques may be applied even in combination with extended aortic arch surgery for selected patients for AADA with promising early outcomes.
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Affiliation(s)
- Klaus Kallenbach
- Department of Cardiac Surgery, INCCI HaerzZenter, Luxembourg City, Luxembourg
- Department of Cardiac Surgery, University Hospital Heidelberg, German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg, Heidelberg, Germany
| | - Christopher Büsch
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel-Sebastian Dohle
- Department of Cardiac and Vascular Surgery, University Hospital Mainz, German Center for Cardiovascular Research (DZHK), Partner Site Mainz, Mainz, Germany
| | - Tobias Krüger
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, German Center for Cardiovascular Research (DZHK), Partner Site Frankfurt, Frankfurt, Germany
| | - Jens Brickwedel
- University Heart & Vascular Center Hamburg, Department of Cardiovascular Surgery, German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Hamburg, Germany
| | - Jochen Pöling
- Department of Cardiac Surgery, Schuechtermann Clinic, Bad Rothenfelde, Germany
| | - Thilo Noack
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital, LMU Munich, German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Jawny
- Department of Cardiothoracic Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Khaled Chalabi
- Department of Cardiac Surgery, INCCI HaerzZenter, Luxembourg City, Luxembourg
| | - Matthias Karck
- Department of Cardiac Surgery, University Hospital Heidelberg, German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, University Hospital Heidelberg, German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg, Heidelberg, Germany
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6
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Farag M, Büsch C, Rylski B, Pöling J, Dohle DS, Sarvanakis K, Hagl C, Krüger T, Detter C, Holubec T, Borger MA, Böning A, Karck M, Arif R. Early outcomes of patients with Marfan syndrome and acute aortic type A dissection. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01123-5. [PMID: 34446289 DOI: 10.1016/j.jtcvs.2021.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute aortic Stanford type A dissection remains a frequent and life-limiting event for patients with Marfan syndrome. Outcome results in this high-risk group are limited. METHODS The German Registry for Acute Aortic Dissection Type A collected the data of 56 centers between July 2006 and June 2015. Of 3385 patients undergoing operations for acute aortic Stanford type A dissection, 117 (3.5%) were diagnosed with Marfan syndrome. We performed a propensity score match comparing patients with Marfan syndrome with patients without Marfan syndrome in a 1:2 fashion. RESULTS Patients with Marfan syndrome were significantly younger (42.9 vs 62.2 years; P < .001), predominantly male (76.9% vs 62.9%; P = .002), and less catecholamine dependent (9.4% vs 20.3%; P = .002) compared with the unmatched cohort. They presented with aortic regurgitation (41.6% vs 23.0%; P < .001) and involvement of the supra-aortic vessels (50.4% vs 39.5%; P = .017) more often. Propensity matching revealed 82 patients with Marfan syndrome (21 female) with no significant differences in baseline characteristics compared with patients without Marfan syndrome (n = 159, 36 female; P = .607). Although root preservation was more frequent in patients with Marfan syndrome, procedure types did not differ significantly (18.3% vs 10.7%; P = .256). Aortic arch surgery was performed more frequently in matched patients (87.5% vs 97.8%; P = .014). Thirty-day mortality did not differ between patients with and without Marfan syndrome (19.5% vs 20.1%; P = .910). Multivariate regression showed no influence of Marfan syndrome on 30-day mortality (odds ratio, 0.928; 95% confidence interval, 0.346-2.332; P = .876). CONCLUSIONS Marfan syndrome does not adversely affect 30-day outcomes after surgical repair for acute aortic Stanford type A dissection compared with a matched cohort. Long-term outcome analysis is needed to account for the influence of further downstream interventions.
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Affiliation(s)
- Mina Farag
- Department of Cardiac Surgery, Marfan Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Christopher Büsch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Bartosz Rylski
- Faculty of Medicine, Department of Cardiovascular Surgery, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Jochen Pöling
- Department of Cardiac Surgery, Schuechtermann Clinic, Bad Rothenfelde, Germany
| | - Daniel S Dohle
- Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes Gutenberg University, Mainz, Germany
| | | | - Christian Hagl
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Krüger
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital and Johann Wolfgang Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Marfan Center, University Hospital Heidelberg, Heidelberg, Germany
| | - Rawa Arif
- Department of Cardiac Surgery, Marfan Center, University Hospital Heidelberg, Heidelberg, Germany.
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7
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Keranov S, Dörr O, Jafari L, Troidl C, Liebetrau C, Kriechbaum S, Keller T, Voss S, Bauer T, Lorenz J, Richter MJ, Tello K, Gall H, Ghofrani HA, Mayer E, Wiedenroth CB, Guth S, Lörchner H, Pöling J, Chelladurai P, Pullamsetti SS, Braun T, Seeger W, Hamm CW, Nef H. CILP1 as a biomarker for right ventricular maladaptation in pulmonary
hypertension. Eur Respir J 2020; 57:13993003.01192-2019. [DOI: 10.1183/13993003.01192-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/03/2020] [Indexed: 11/05/2022]
Abstract
The aim of our study was to analyse the protein expression of cartilage
intermediate layer protein (CILP)1 in a mouse model of right ventricular
(RV) pressure overload and to evaluate CILP1 as a biomarker of cardiac
remodelling and maladaptive RV function in patients with pulmonary
hypertension (PH).
Pulmonary artery banding was performed in 14 mice; another nine mice
underwent sham surgery. CILP1 protein expression was analysed in all hearts
using Western blotting and immunostaining. CILP1 serum concentrations were
measured in 161 patients (97 with adaptive and maladaptive RV pressure
overload caused by PH; 25 with left ventricular (LV) hypertrophy; 20 with
dilative cardiomyopathy (DCM); 19 controls without LV or RV
abnormalities)
In mice, the amount of RV CILP1 was markedly higher after banding than
after sham. Control patients had lower CILP1 serum levels than all other
groups (p<0.001). CILP1 concentrations were higher in PH patients with
maladaptive RV function than those with adaptive RV function (p<0.001),
LV pressure overload (p<0.001) and DCM (p=0.003). CILP1 showed good
predictive power for maladaptive RV in receiver operating characteristic
analysis (area under the curve (AUC) 0.79). There was no significant
difference between the AUCs of CILP1 and N-terminal pro-brain natriuretic
peptide (NT-proBNP) (AUC 0.82). High CILP1 (cut-off value for maladaptive RV
of ≥4373 pg·mL−1) was associated with lower tricuspid
annular plane excursion/pulmonary artery systolic pressure ratios
(p<0.001) and higher NT-proBNP levels (p<0.001).
CILP1 is a novel biomarker of RV and LV pathological remodelling that is
associated with RV maladaptation and ventriculoarterial uncoupling in
patients with PH.
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8
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Czerny M, Siepe M, Beyersdorf F, Feisst M, Gabel M, Pilz M, Pöling J, Dohle DS, Sarvanakis K, Luehr M, Hagl C, Rawa A, Schneider W, Detter C, Holubec T, Borger M, Böning A, Rylski B. Prediction of mortality rate in acute type A dissection: the German Registry for Acute Type A Aortic Dissection score. Eur J Cardiothorac Surg 2020; 58:700-706. [DOI: 10.1093/ejcts/ezaa156] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/16/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract
OBJECTIVES
The goal was to develop a scoring system to predict the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection on the basis of the German Registry for Acute Type A Aortic Dissection (GERAADA) data set and to provide a Web-based application for standard use.
METHODS
A total of 2537 patients enrolled in GERAADA who underwent surgery between 2006 and 2015 were analysed. Variable selection was performed using the R-package FAMoS. The robustness of the results was confirmed via the bootstrap procedure. The coefficients of the final model were used to calculate the risk score in a Web-based application.
RESULTS
Age [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.009–1.026; P < 0.001; 5-year OR: 1.093], need for catecholamines at referral (OR 1.732, 95% CI 1.340–2.232; P < 0.001), preoperative resuscitation (OR 3.051, 95% CI 2.099–4.441; P < 0.001), need for intubation before surgery (OR 1.949, 95% CI 1.465–2.585; P < 0.001), preoperative hemiparesis (OR 1.442, 95% CI 0.996–2.065; P = 0.049), coronary malperfusion (OR 1.870, 95% CI 1.386–2.509; P < 0.001), visceral malperfusion (OR 1.748, 95% CI 1.198–2.530; P = 0.003), dissection extension to the descending aorta (OR 1.443, 95% CI 1.120–1.864; P = 0.005) and previous cardiac surgery (OR 1.772, 95% CI 1.048–2.903; P = 0.027) were independent predictors of the 30-day mortality rate. The Web application based on the final model can be found at https://www.dgthg.de/de/GERAADA_Score.
CONCLUSIONS
The GERAADA score is a simple, effective tool to predict the 30-day mortality rate for patients undergoing surgery for acute type A aortic dissection. We recommend the widespread use of this Web-based application for standard use.
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Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Michael Gabel
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Maximilian Pilz
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Jochen Pöling
- Department of Cardiac Surgery, Schuechtermann Clinic, Bad Rothenfelde, Germany
| | - Daniel-Sebastian Dohle
- Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes Gutenberg University, Mainz, Germany
| | | | - Maximilian Luehr
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Arif Rawa
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Wilke Schneider
- Department for Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Tomas Holubec
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Bad Krozingen, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
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Adrian-Segarra JM, Lörchner H, Braun T, Pöling J. Identification of Functional Protein Regions Through Chimeric Protein Construction. J Vis Exp 2019. [PMID: 30688304 DOI: 10.3791/58786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The goal of this protocol encompasses the design of chimeric proteins in which distinct regions of a protein are replaced by their corresponding sequences in a structurally similar protein, in order to determine the functional importance of these regions. Such chimeras are generated by means of a nested PCR protocol using overlapping DNA fragments and adequately designed primers, followed by their expression within a mammalian system to ensure native secondary structure and post-translational modifications. The functional role of a distinct region is then indicated by a loss of activity of the chimera in an appropriate readout assay. In consequence, regions harboring a set of critical amino acids are identified, which can be further screened by complementary techniques (e.g. site-directed mutagenesis) to increase molecular resolution. Although limited to cases in which a structurally related protein with differing functions can be found, chimeric proteins have been successfully employed to identify critical binding regions in proteins such as cytokines and cytokine receptors. This method is particularly suitable in cases in which the protein's functional regions are not well defined, and constitutes a valuable first step in directed evolution approaches to narrow down the regions of interest and reduce the screening effort involved.
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Affiliation(s)
- Juan M Adrian-Segarra
- Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research
| | - Holger Lörchner
- Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research; Partner site Rhein-Main, German Centre for Cardiovascular Research (DZHK)
| | - Thomas Braun
- Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research; Partner site Rhein-Main, German Centre for Cardiovascular Research (DZHK)
| | - Jochen Pöling
- Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research; Partner site Rhein-Main, German Centre for Cardiovascular Research (DZHK);
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Pöling J, Gajawada P, Lörchner H, Hou Y, Adrian-Segarra M, Günther S, Böttger T, Braun T, Warnecke H. Ly6Chigh/CCR6high Monocytes Are Required for Collateral Artery Growth. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678870] [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: 10/27/2022]
Affiliation(s)
- J. Pöling
- Schüchtermann-Klinik, Abteilung für Herzchirurgie, Bad Rothenfelde, Germany
- Max-Planck-Institut für Herz- und Lungen-Forschung, Bad Nauheim, Germany
| | - P. Gajawada
- Max-Planck-Institut für Herz- und Lungen-Forschung, Bad Nauheim, Germany
| | - H. Lörchner
- Max-Planck-Institut für Herz- und Lungen-Forschung, Bad Nauheim, Germany
| | - Y. Hou
- Max-Planck-Institut für Herz- und Lungen-Forschung, Bad Nauheim, Germany
| | - M. Adrian-Segarra
- Max-Planck-Institut für Herz- und Lungen-Forschung, Bad Nauheim, Germany
| | - S. Günther
- Max-Planck-Institut für Herz- und Lungen-Forschung, Bad Nauheim, Germany
| | - T. Böttger
- Max-Planck-Institut für Herz- und Lungen-Forschung, Bad Nauheim, Germany
| | - T. Braun
- Max-Planck-Institut für Herz- und Lungen-Forschung, Bad Nauheim, Germany
| | - H. Warnecke
- Schüchtermann-Klinik, Abteilung für Herzchirurgie, Bad Rothenfelde, Germany
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11
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Adrian-Segarra JM, Sreenivasan K, Gajawada P, Lörchner H, Braun T, Pöling J. The AB loop of oncostatin M (OSM) determines species-specific signaling in humans and mice. J Biol Chem 2018; 293:20181-20199. [PMID: 30373773 DOI: 10.1074/jbc.ra118.004375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/08/2018] [Revised: 10/12/2018] [Indexed: 11/06/2022] Open
Abstract
The pleiotropic interleukin-6 (IL-6)-type cytokine oncostatin M (OSM) signals in multiple cell types, affecting processes such as cell differentiation, hematopoiesis, and inflammation. In humans, OSM exerts its effects through activation of either of two different heterodimeric receptor complexes, formed by glycoprotein 130 (gp130) and either OSM receptor (OSMR) or leukemia inhibitory factor receptor (LIFR). In contrast, the mouse OSM orthologue acts mainly through dimers containing OSMR and gp130 and shows limited activity through mouse LIFR. Despite their structural similarity, neither human nor mouse OSM signal through the other species' OSMR. The molecular basis for such species-specific signaling, however, remains poorly understood. To identify key molecular features of OSM that determine receptor activation in humans and mice, we generated chimeric mouse-human cytokines. Replacing regions within binding site III of murine OSM with the human equivalents showed that the cytokine's AB loop was critical for receptor selection. Substitutions of individual amino acids within this region demonstrated that residues Asn-37, Thr-40, and Asp-42 of the murine cytokine were responsible for limited LIFR activation and absence of human OSMR/LIFR signaling. In human OSM, Lys-44 appeared to be the main residue preventing mouse OSMR activation. Our data reveal that individual amino acids within the AB loop of OSM determine species-specific activities. These mutations might reflect a key step in the evolutionary process of this cytokine, in which receptor promiscuity gives way to ligand-receptor specialization.
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Affiliation(s)
- Juan M Adrian-Segarra
- From the Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, D-61231 Bad Nauheim, Germany and
| | - Krishnamoorthy Sreenivasan
- From the Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, D-61231 Bad Nauheim, Germany and
| | - Praveen Gajawada
- From the Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, D-61231 Bad Nauheim, Germany and
| | - Holger Lörchner
- From the Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, D-61231 Bad Nauheim, Germany and; the German Centre for Cardiovascular Research (DZHK), Partner site Rhein-Main, Frankfurt am Main, Germany
| | - Thomas Braun
- From the Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, D-61231 Bad Nauheim, Germany and; the German Centre for Cardiovascular Research (DZHK), Partner site Rhein-Main, Frankfurt am Main, Germany.
| | - Jochen Pöling
- From the Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, D-61231 Bad Nauheim, Germany and; the German Centre for Cardiovascular Research (DZHK), Partner site Rhein-Main, Frankfurt am Main, Germany.
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12
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Lörchner H, Widera C, Hou Y, Elsässer A, Warnecke H, Giannitsis E, Hulot JS, Braun T, Wollert KC, Pöling J. Reg3β is associated with cardiac inflammation and provides prognostic information in patients with acute coronary syndrome. Int J Cardiol 2018; 258:7-13. [PMID: 29544958 DOI: 10.1016/j.ijcard.2018.01.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/20/2017] [Accepted: 01/08/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Regenerating islet-derived protein 3 beta (Reg3β) is a cardiomyocyte-derived chemokine for macrophages that is upregulated after myocardial infarction (MI) in mice. Here, we hypothesized that monitoring Reg3β expression might provide specific information on the degree of cardiac inflammation, which is a key determinant in disease progression and prognosis of patients with acute coronary syndrome (ACS). METHODS AND RESULTS The expression of Reg3β and other inflammatory markers including C-reactive protein (CRP) and myeloperoxidase (MPO) was measured by immunoblotting at serial time points in the hearts and serum of mice with acute MI. We identified a rapid increase of Reg3β, CRP and MPO expression in cardiac tissue and serum within the first 24 h after MI. The expression of Reg3β peaked at day 4 and thereby paralleled the kinetic profile of the early immune-inflammatory response at sites of cardiac injury, which has been characterized by multicolor flow cytometry. In a retrospective analysis including 322 ACS patients and 117 apparently healthy individuals, we detected increased Reg3β serum concentrations in ACS patients on admission by ELISA. Multiple regression analysis revealed significant relationships between Reg3β and hs-CRP, age, diabetes and NT-proBNP in ACS. Moreover, elevated Reg3β levels on admission were associated with an increased risk of death independent of cardiovascular risk factors and hs-CRP. CONCLUSIONS Reg3β is a prognostic biomarker for ACS and is strongly associated with the intensity of cardiac inflammation. Accordingly, Reg3β may complement established strategies of acute risk assessment in the management of ACS.
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Affiliation(s)
- Holger Lörchner
- Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany; German Centre for Cardiovascular Research (DZHK), Partner site Rhein-Main, Frankfurt am Main, Germany
| | - Christian Widera
- Division of Molecular and Translational Cardiology, Hannover Medical School, Hannover, Germany; Department of Cardiology und Angiology, Hannover Medical School, Hannover, Germany; Department of Cardiology, Heart Center Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Yunlong Hou
- Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Albrecht Elsässer
- Department of Cardiology, Heart Center Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Henning Warnecke
- Department of Cardiac Surgery, Schüchtermann-Clinic, Bad Rothenfelde, Germany; Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Jean-Sebastien Hulot
- Institut National de la Santé et de la Recherche Médicale (INSERM), U970, Paris, France; Cardiovascular Research Center (PARCC), Université Paris Descartes, Paris, France
| | - Thomas Braun
- Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany.
| | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Hannover Medical School, Hannover, Germany; Department of Cardiology und Angiology, Hannover Medical School, Hannover, Germany.
| | - Jochen Pöling
- Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany; Department of Cardiac Surgery, Schüchtermann-Clinic, Bad Rothenfelde, Germany.
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13
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Lörchner H, Hou Y, Adrian-Segarra JM, Kulhei J, Detzer J, Günther S, Gajawada P, Warnecke H, Niessen HW, Pöling J, Braun T. Reg proteins direct accumulation of functionally distinct macrophage subsets after myocardial infarction. Cardiovasc Res 2018; 114:1667-1679. [DOI: 10.1093/cvr/cvy126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/23/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Holger Lörchner
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Rhein-Main, Frankfurt am Main, Germany
| | - Yunlong Hou
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Juan M Adrian-Segarra
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Jennifer Kulhei
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Rhein-Main, Frankfurt am Main, Germany
| | - Julia Detzer
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Stefan Günther
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Praveen Gajawada
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Henning Warnecke
- Department of Cardiac Surgery, Schüchtermann-Clinic, Bad Rothenfelde, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Hans W Niessen
- Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands
| | - Jochen Pöling
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Rhein-Main, Frankfurt am Main, Germany
- Department of Cardiac Surgery, Schüchtermann-Clinic, Bad Rothenfelde, Germany
| | - Thomas Braun
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Rhein-Main, Frankfurt am Main, Germany
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14
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Adrian-Segarra JM, Schindler N, Gajawada P, Lörchner H, Braun T, Pöling J. The AB loop and D-helix in binding site III of human Oncostatin M (OSM) are required for OSM receptor activation. J Biol Chem 2018; 293:7017-7029. [PMID: 29511087 DOI: 10.1074/jbc.ra118.001920] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/16/2018] [Indexed: 01/11/2023] Open
Abstract
Oncostatin M (OSM) and leukemia inhibitory factor (LIF) are closely related members of the interleukin-6 (IL-6) cytokine family. Both cytokines share a common origin and structure, and both interact through a specific region, termed binding site III, to activate a dimeric receptor complex formed by glycoprotein 130 (gp130) and LIF receptor (LIFR) in humans. However, only OSM activates the OSM receptor (OSMR)-gp130 complex. The molecular features that enable OSM to specifically activate the OSMR are currently unknown. To define specific sequence motifs within OSM that are critical for initiating signaling via OSMR, here we generated chimeric OSM-LIF cytokines and performed alanine-scanning experiments. Replacement of the OSM AB loop within OSM's binding site III with that of LIF abrogated OSMR activation, measured as STAT3 phosphorylation at Tyr-705, but did not compromise LIFR activation. Correspondingly, substitution of the AB loop and D-helix in LIF with their OSM counterparts was sufficient for OSMR activation. The alanine-scanning experiments revealed that residues Tyr-34, Gln-38, Gly-39, and Leu-45 (in the AB loop) and Pro-153 (in the D-helix) had specific roles in activating OSMR but not LIFR signaling, whereas Leu-40 and Cys-49 (in the AB loop), and Phe-160 and Lys-163 (in the D-helix) were required for activation of both receptors. Because most of the key amino acid residues identified here are conserved between LIF and OSM, we concluded that comparatively minor differences in a few amino acid residues within binding site III account for the differential biological effects of OSM and LIF.
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Affiliation(s)
- Juan M Adrian-Segarra
- From the Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany
| | - Natalie Schindler
- From the Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany
| | - Praveen Gajawada
- From the Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany
| | - Holger Lörchner
- From the Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany
| | - Thomas Braun
- From the Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany
| | - Jochen Pöling
- From the Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany
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15
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Shin J, Watanabe S, Hoelper S, Krüger M, Kostin S, Pöling J, Kubin T, Braun T. BRAF activates PAX3 to control muscle precursor cell migration during forelimb muscle development. eLife 2016; 5. [PMID: 27906130 PMCID: PMC5148607 DOI: 10.7554/elife.18351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/30/2016] [Indexed: 11/13/2022] Open
Abstract
Migration of skeletal muscle precursor cells is a key step during limb muscle development and depends on the activity of PAX3 and MET. Here, we demonstrate that BRAF serves a crucial function in formation of limb skeletal muscles during mouse embryogenesis downstream of MET and acts as a potent inducer of myoblast cell migration. We found that a fraction of BRAF accumulates in the nucleus after activation and endosomal transport to a perinuclear position. Mass spectrometry based screening for potential interaction partners revealed that BRAF interacts and phosphorylates PAX3. Mutation of BRAF dependent phosphorylation sites in PAX3 impaired the ability of PAX3 to promote migration of C2C12 myoblasts indicating that BRAF directly activates PAX3. Since PAX3 stimulates transcription of the Met gene we propose that MET signaling via BRAF fuels a positive feedback loop, which maintains high levels of PAX3 and MET activity required for limb muscle precursor cell migration. DOI:http://dx.doi.org/10.7554/eLife.18351.001
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Affiliation(s)
- Jaeyoung Shin
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Shuichi Watanabe
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Soraya Hoelper
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Marcus Krüger
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Sawa Kostin
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Jochen Pöling
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Thomas Kubin
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Thomas Braun
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
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16
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Pöling J, Lörchner H, Hou Y, Gajawada P, Kulhei J, Rees W, Kostin S, Kubin T, Braun T, Warnecke H. Local Delivery of Recombinant Reg3β Attenuates Adverse Left Ventricular Remodeling after Experimental Myocardial Infarction. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571619] [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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17
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Lörchner H, Pöling J, Gajawada P, Hou Y, Polyakova V, Kostin S, Adrian-Segarra JM, Boettger T, Wietelmann A, Warnecke H, Richter M, Kubin T, Braun T. Myocardial healing requires Reg3β-dependent accumulation of macrophages in the ischemic heart. Nat Med 2015; 21:353-62. [PMID: 25751817 DOI: 10.1038/nm.3816] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 02/06/2015] [Indexed: 12/14/2022]
Abstract
Cardiac healing after myocardial ischemia depends on the recruitment and local expansion of myeloid cells, particularly macrophages. Here we identify Reg3β as an essential regulator of macrophage trafficking to the damaged heart. Using mass spectrometry-based secretome analysis, we found that dedifferentiating cardiomyocytes release Reg3β in response to the cytokine OSM, which signals through Jak1 and Stat3. Loss of Reg3β led to a large decrease in the number of macrophages in the ischemic heart, accompanied by increased ventricular dilatation and insufficient removal of neutrophils. This defect in neutrophil removal in turn caused enhanced matrix degradation, delayed collagen deposition and increased susceptibility to cardiac rupture. Our data indicate that OSM, acting through distinct intracellular pathways, regulates both cardiomyocyte dedifferentiation and cardiomyocyte-dependent regulation of macrophage trafficking. Release of OSM from infiltrating neutrophils and macrophages initiates a positive feedback loop in which OSM-induced production of Reg3β in cardiomyocytes attracts additional OSM-secreting macrophages. The activity of the feedback loop controls the degree of macrophage accumulation in the heart, which is instrumental in myocardial healing.
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Affiliation(s)
- Holger Lörchner
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Jochen Pöling
- 1] Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany. [2] Department of Cardiac Surgery, Schüchtermann-Clinic, Bad Rothenfelde, Germany
| | - Praveen Gajawada
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Yunlong Hou
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Viktoria Polyakova
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Sawa Kostin
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Juan M Adrian-Segarra
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Thomas Boettger
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Astrid Wietelmann
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Henning Warnecke
- Department of Cardiac Surgery, Schüchtermann-Clinic, Bad Rothenfelde, Germany
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Thomas Kubin
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Thomas Braun
- Department of Cardiac Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
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18
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Pöling J, Lörchner H, Hou Y, Kostin S, Kubin T, Gajawada P, Polyakova V, Richter M, Walther T, Braun T, Warnecke H. Oncostatin M controls Macrophage Invasion via Release of Chemokines from Cardiomyocytes after Myocardial Damage. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Richter M, Polyakova V, Pöling J, Kubin T, Warnecke H, Braun T, Walther T. Dedifferentiation of adult cardiomyocytes serves as a mechanism of cardiac regeneration. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367394] [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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20
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Pöling J, Kubin T, Gajawada P, Lörchner H, Polyakova V, Rees W, Richter M, Kostin S, Walther T, Braun T, Warnecke H. Cardiomyocyte dedifferentiation - A (mal)adaptive response to hypoxia. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367204] [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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21
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Szibor M, Pöling J, Warnecke H, Kubin T, Braun T. Remodeling and dedifferentiation of adult cardiomyocytes during disease and regeneration. Cell Mol Life Sci 2013; 71:1907-16. [PMID: 24322910 DOI: 10.1007/s00018-013-1535-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 11/21/2013] [Accepted: 11/25/2013] [Indexed: 12/20/2022]
Abstract
Cardiomyocytes continuously generate the contractile force to circulate blood through the body. Imbalances in contractile performance or energy supply cause adaptive responses of the heart resulting in adverse rearrangement of regular structures, which in turn might lead to heart failure. At the cellular level, cardiomyocyte remodeling includes (1) restructuring of the contractile apparatus; (2) rearrangement of the cytoskeleton; and (3) changes in energy metabolism. Dedifferentiation represents a key feature of cardiomyocyte remodeling. It is characterized by reciprocal changes in the expression pattern of "mature" and "immature" cardiomyocyte-specific genes. Dedifferentiation may enable cardiomyocytes to cope with hypoxic stress by disassembly of the energy demanding contractile machinery and by reduction of the cellular energy demand. Dedifferentiation during myocardial repair might provide cardiomyocytes with additional plasticity, enabling survival under hypoxic conditions and increasing the propensity to enter the cell cycle. Although dedifferentiation of cardiomyocytes has been described during tissue regeneration in zebrafish and newts, little is known about corresponding mechanisms and regulatory circuits in mammals. The recent finding that the cytokine oncostatin M (OSM) is pivotal for cardiomyocyte dedifferentiation and exerts strong protective effects during myocardial infarction highlights the role of cytokines as potent stimulators of cardiac remodeling. Here, we summarize the current knowledge about transient dedifferentiation of cardiomyocytes in the context of myocardial remodeling, and propose a model for the role of OSM in this process.
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Affiliation(s)
- Marten Szibor
- Max-Planck-Institute for Heart and Lung Research, Ludwigstrasse 43, 61231, Bad Nauheim, Germany
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Pöling J, Kubin T, Gajawada P, Schimanski S, Rees W, Richter M, Walther T, Braun T, Warnecke H. The anti-inflammatory Interleukin 13 and the inflammatory oncostatin M synergize and antagonize their activities in vascular smooth muscle cells. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332455] [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: 10/27/2022]
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Richter MH, Polyakova V, Pöling J, Kubin T, Warnecke H, Braun T, Walther T. Cardiomyocytes produce their own fibroblast growth factor 23 during ischemic heart failure. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332658] [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: 10/27/2022]
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Kubin T, Pöling J, Kostin S, Gajawada P, Hein S, Rees W, Wietelmann A, Tanaka M, Lörchner H, Schimanski S, Szibor M, Warnecke H, Braun T. Oncostatin M is a major mediator of cardiomyocyte dedifferentiation and remodeling. Cell Stem Cell 2012; 9:420-32. [PMID: 22056139 DOI: 10.1016/j.stem.2011.08.013] [Citation(s) in RCA: 247] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 07/29/2011] [Accepted: 08/19/2011] [Indexed: 11/16/2022]
Abstract
Cardiomyocyte remodeling, which includes partial dedifferentiation of cardiomyocytes, is a process that occurs during both acute and chronic disease processes. Here, we demonstrate that oncostatin M (OSM) is a major mediator of cardiomyocyte dedifferentiation and remodeling during acute myocardial infarction (MI) and in chronic dilated cardiomyopathy (DCM). Patients suffering from DCM show a strong and lasting increase of OSM expression and signaling. OSM treatment induces dedifferentiation of cardiomyocytes and upregulation of stem cell markers and improves cardiac function after MI. Conversely, inhibition of OSM signaling suppresses cardiomyocyte remodeling after MI and in a mouse model of DCM, resulting in deterioration of heart function after MI but improvement of cardiac performance in DCM. We postulate that dedifferentiation of cardiomyocytes initially protects stressed hearts but fails to support cardiac structure and function upon continued activation. Manipulation of OSM signaling provides a means to control the differentiation state of cardiomyocytes and cellular plasticity.
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Affiliation(s)
- Thomas Kubin
- Department of Cardiac Development and Remodelling, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, Bad Nauheim, 61321, Germany
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Pöling J, Kubin T, Kostin S, Gajawada P, Lörchner H, Szibor M, Schimanski S, Rees W, Braun T, Warnecke H. Blockage of the Oncostatin M receptor-β rescues mice from heart failure in an inflammatory model of cardiomyopathy. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297666] [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: 10/14/2022]
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Pöling J, Gajawada P, Lörchner H, Polyakova V, Szibor M, Böttger T, Warnecke H, Kubin T, Braun T. The Janus face of OSM-mediated cardiomyocyte dedifferentiation during cardiac repair and disease. Cell Cycle 2012; 11:439-45. [PMID: 22262173 DOI: 10.4161/cc.11.3.19024] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dedifferentiation is a common phenomenon among plants but has only been found rarely in vertebrates where it is mostly associated with regenerative responses such as formation of blastemae in amphibians to initiate replacement of lost body parts. Relatively little attention has been paid to dedifferentiation processes in mammals although a decline of differentiated functions and acquisition of immature, "embryonic" properties is seen in various disease processes. Dedifferentiation of parenchymal cells in mammals might serve multiple purposes including (1) facilitation of tissue regeneration by generation of progenitor-like cells and (2) protection of cells from hypoxia by reduction of ATP consumption due to changes in energy metabolism and/or inactivation of energy-intensive "specialized" functions. We recently found that an inflammatory cytokine of the interleukin 6 family, oncostatin M (OSM), initiates dedifferentiation of cardiomyocytes both in vitro and in vivo. Interestingly, activation of the OSM signaling pathway protects the heart from acute myocardial ischemia but has a negative impact when continuously activated thereby promoting dilative cardiomyopathy. The strong presence of the OSM receptor on cardiomyocytes and the unique features of the OSM signaling circuit suggest a major role of OSM for cardiac protection and repair. We propose that continuous activation or malfunctions of the cellular dedifferentiation machinery might contribute to different disease conditions.
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Affiliation(s)
- Jochen Pöling
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
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Pöling J, Szibor M, Schimanski S, Ingelmann ME, Rees W, Gajawada P, Kochfar Z, Lörchner H, Salwig I, Shin JY, Wiebe K, Kubin T, Warnecke H, Braun T. Induction of Smooth Muscle Cell Migration During Arteriogenesis Is Mediated by Rap2. Arterioscler Thromb Vasc Biol 2011; 31:2297-305. [DOI: 10.1161/atvbaha.111.232835] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective—
Collateral artery growth or arteriogenesis is the primary means of the circulatory system to maintain blood flow in the face of major arterial occlusions. Arteriogenesis depends on activation of fibroblast growth factor (FGF) receptors, but relatively little is known about downstream mediators of FGF signaling.
Methods and Results—
We screened for signaling components that are activated in response to administration of FGF-2 to cultured vascular smooth muscle cells (VSMCs) and detected a significant increase of Rap2 but not of other Ras family members, which corresponded to a strong upregulation of Rap2 and C-Raf in growing collaterals from rabbits with femoral artery occlusion. Small interfering RNAs directed against Rap2 did not affect FGF-2 induced proliferation of VSMC but strongly inhibited their migration. Inhibition of FGF receptor-1 (FGFR1) signaling by infusion of a sulfonic acid polymer or infection with a dominant-negative FGFR1 adenovirus inhibited Rap2 upregulation and collateral vessel growth. Similarly, expression of dominant-negative Rap2 blocked arteriogenesis, whereas constitutive active Rap2 enhanced collateral vessel growth.
Conclusion—
Rap2 is part of the arteriogenic program and acts downstream of the FGFR1 to stimulate VSMC migration. Specific modulation of Rap2 might be an attractive target to manipulate VSMC migration, which plays a role in numerous pathological processes.
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Affiliation(s)
- Jochen Pöling
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Marten Szibor
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Silvia Schimanski
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Marie-Elisabeth Ingelmann
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Wolfgang Rees
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Praveen Gajawada
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Zaber Kochfar
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Holger Lörchner
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Isabelle Salwig
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Jae-Young Shin
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Karsten Wiebe
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Thomas Kubin
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Henning Warnecke
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
| | - Thomas Braun
- From the Department of Cardiac Development and Remodelling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany (J.P., M.S., S.S., M.-E.I., P.G., Z.K., H.L., I.S., J.-Y.S., T.K., T.B.); Department of Cardiac Surgery, Schüchtermann-Klinik, Bad Rothenfelde, Germany (J.P., W.R., H.W.); University Hospital Münster, Germany (K.W.)
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Rees W, Pöling J, Hübner N, Ferdosi A, Jozwicki D, Liska J, Franco-Cereceda A, Warnecke H. A novel method of cardiac microdialysis demonstrates that metabolic markers predict perioperative myocardial infarction and severe clinical events in cardiac surgery. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269137] [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: 10/18/2022]
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Pöling J, Kubin T, Szibor M, Gajawada P, Lörchner H, Rees W, Braun T, Warnecke H. The Ras related protein Rap2 is decisive for migration during arteriogenesis. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268921] [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: 10/18/2022]
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Abstract
OBJECTIVES Microdialysis allows the in vivo biochemical analysis of interstitial fluids. Our aim was to reveal in vivo reliable data of the myocardium during open beating heart surgery. DESIGN In ten patients undergoing routine beating coronary artery bypass grafting a microdialysis catheter was inserted into the left ventricle. Measurements were performed up to 45 min after anastomosis. Data were retrospectively compared with standard on-pump procedures. RESULTS The myocardial lactate remained stable during anastomosis, followed by a significant decrease of lactate after revascularisation. Myocardial glucose levels showed a slight decrease, followed by a significant increase after revascularisation. Myocardial purines showed a slight increase during anastomosis, followed by a sharp decrease during reperfusion period. CONCLUSIONS In contrast to on-pump procedures myocardial lactate and purines showed less increasing trend during the ischemic period, while myocardial glucose remained stable as a sign of preserved tissue blood flow. Myocardial microdialysis showed different values compared to the elective on-pump CABG and previous animal studies. This technique allows bedside monitoring of biochemical changes, suggesting its possible role as a clinical monitoring tool.
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Affiliation(s)
- Jochen Pöling
- Department of Cardiac Surgery, Schüchtermann-Klinik Bad Rothenfelde, Germany.
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Rees W, Kubin T, Pöling J, Hein S, Warnecke H, Braun T. Increased viability of cardiomyocytes after exposure of anti-inflammatory cytokines. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pöling J, Rees W, Klaus S, Bahlmann L, Hübner N, Heringlake M, Mantovani V, Warnecke H. Functional Recovery of Chronic Ischemic Myocardium after Surgical Revascularization Correlates with Magnitude of Oxidative Metabolism. Cardiology 2007; 110:174-81. [DOI: 10.1159/000111927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 04/22/2007] [Indexed: 11/19/2022]
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Pöling J, Rees W, Klaus S, Bahlmann L, Hübner N, Mantovani V, Warnecke H. Myocardial metabolic monitoring with the microdialysis technique during and after open heart surgery. Acta Anaesthesiol Scand 2007; 51:341-6. [PMID: 17257174 DOI: 10.1111/j.1399-6576.2006.01241.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/30/2022]
Abstract
BACKGROUND Post-operative ischemia after coronary artery bypass grafting (CABG) is well described but effective intervention requires immediate diagnosis. One possible way of increasing efficacy of peri-operative myocardial monitoring is using the microdialysis technique. METHODS In 30 patients undergoing routine CABG, a microdialysis catheter was inserted in the left heart in an area of abnormal ventricular contraction. A second catheter was placed in normal tissue of the right ventricle. Microdialysis measurements were performed at time intervals before, during and 24 h after cardiopulmonary bypass (CPB) and retrospectively compared with standard clinical monitoring and clinical course. RESULTS During CPB, both ventricles showed signs of poor tissue oxygenation. Glycerol was significantly higher in the left myocardium (146 +/- 67 vs. 72 +/- 36 micromol/l) and the glucose/lactate ratio (GLR), as a marker of nutritional disorder of the right ventricle (41 +/- 15% vs. 67 +/- 17%, P < 0.05), had significantly better values at this time point. Myocardial lactate concentrations were significantly higher in the dyskinetic segments (2.82 +/- 0.81 vs. 1.5 +/- 0.81 microM). During this period, no abnormal clinical standard monitoring results were observed. Post-operative significantly increased lactate/pyruvate ratios of three patients were clinically associated with peri-operative myocardial infarction (108 +/- 67 vs. 38 +/- 9, P < 0.05). The lactate/pyruvate ratio started rising before any other standard monitoring tools showed abnormal values. CONCLUSIONS Peri-operative microdialytic measurements of parameters related to ischemia can be safely performed in a clinical setting, resulting in faster and more reliable detection of ongoing or new ischemia.
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Affiliation(s)
- J Pöling
- Department of Cardiac Surgery, Schüchtermann-Klinik Bad Rothenfelde, Germany.
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Rees W, Pöling J, Hübner N, Ritter F, Coppoolse R, Ziaukas V, Warnecke H. Cardiac bypass surgery in acute myocardial infarction is not associated with higher mortality. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pöling J, Rees W, Ritter F, Mantovani V, Bahlmann L, Hübner N, Warnecke H. Detection of perioperative myocardial hypoperfusion by interstitial fluids. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
BACKGROUND Removal of xenoreactive antibodies in pig-to-human lung transplantation by columns or organ perfusions proofed to be unsatisfactory and associated with adverse effects. In an ex-vivo lung perfusion model, we evaluated the potential of a soluble trisaccharide polymer (GAS914) to bind alpha-Gal antibodies and to protect a pulmonary xenograft from hyperacute rejection (HAR) and pulmonary xenograft dysfunction. METHODS Porcine lungs were perfused with fresh human blood for 240 min. In the GAS914 treated group (n=6) the polymer was applied in three different concentrations. The control group (n=6) received no GAS914. Survival and function of perfused xenografts were monitored, and alpha-Gal antibodies as well as cytolytic anti-porcine antibodies analyzed. RESULTS In the GAS-treated group survival of lungs was significantly prolonged, pulmonary vascular resistance reduced, pulmonary edema prevented, and oxygenation improved. On histopathological evaluation application of GAS resulted in minimal graft injury and significantly less deposition of the terminal complement complex C5b-9. Following application of GAS914, up to 89.8% of IgG alpha-Gal, 79.5% of IgM and 73.6% of anti-porcine antibodies in the human blood were bound by the polymer. Subsequent perfusion of porcine lungs resulted in absorption of only 3% of the baseline IgG alpha-Gal antibodies in the GAS914 group, compared to 87% in the controls. CONCLUSIONS In this ex-vivo lung perfusion model, a trisaccharide polymer prevented immediate HAR, due to effective removal of alpha-Gal antibodies. In combination with additional strategies GAS914 may be a valuable tool in overcoming HAR and dysfunction of pulmonary xenografts.
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Affiliation(s)
- Karsten Wiebe
- Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
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Pöling J, Rees W, Mantovani V, Klaus S, Bahlmann L, Ziaukas V, Hübner N, Warnecke H. Evaluation of myocardial metabolism with microdialysis during bypass surgery with cold blood- or Calafiore cardioplegia. Eur J Cardiothorac Surg 2006; 30:597-603. [PMID: 16901714 DOI: 10.1016/j.ejcts.2006.06.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2005] [Revised: 06/07/2006] [Accepted: 06/26/2006] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For the first time, microdialysis was used to investigate in vivo and online the myocardial metabolism during and after cardiac surgery in patients treated with two different methods of myocardial protection. METHODS Thirty patients underwent standard CABG with one of two different methods of myocardial protection. The patients were randomised to receive either cold blood (COLD group) or warm modified Calafiore cardioplegia (WARM group). Microdialysis probes were implanted into the myocardium of left ventricular apical region of the heart. Cardioplegia was given antegrade only. Microdialysis measurements were performed at time intervals before, during and 24 h after cardiopulmonary bypass and analysed for glucose, lactate, pyruvate and glycerol. RESULTS Myocardial lactate concentrations were significantly higher in the WARM group compared with that of the COLD group, while serum lactate was comparable. Glycerol was significantly higher at the end of the clamping time in the WARM group. At the same time the glucose-lactate ratio as a marker of nutritional disorder had significantly lower levels in the WARM group. The cumulative CK-MB release over 24 h was significantly higher in those hearts protected with warm blood. CONCLUSIONS The oxidative stress measured was significantly higher in patients undergoing CABG using modified Calafiore cardioplegia, whereas the cold cardioplegia minimised the effects of aortic clamping. The results indicate that cold cardioplegia offers superior protection of the heart, in terms of more rapid normalisation of myocardial metabolism. In elective myocardial revascularisation, intermittent antegrade warm blood cardioplegia is a comparable safe method of myocardial protection. However, in patients referring to a long clamping time, advantages of cold cardioplegia for myocardial revascularisation may be magnified.
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Affiliation(s)
- Jochen Pöling
- Department of Cardiac Surgery, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 11, 49214 Bad Rothenfelde, Germany.
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Pöling J, Rees W, Klaus S, Bahlmann L, Gumniah M, Ziaukas V, Warnecke H. Cardiac biochemical monitoring for the detection of acute myocardial ischemia. Intensive Care Med 2006; 32:628-9. [PMID: 16511632 DOI: 10.1007/s00134-006-0074-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2006] [Indexed: 11/26/2022]
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Pöling J, Oezkur M, Kogge K, Mengel M, Niemann H, Winkler M, Haverich A, Wiebe K. Hyperacute rejection in ex vivo-perfused porcine lungs transgenic for human complement regulatory proteins. Transpl Int 2006; 19:225-32. [PMID: 16441772 DOI: 10.1111/j.1432-2277.2006.00267.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Inhibition of complement activation via human membrane-associated complement regulators is known to prevent hyperacute rejection in heart and kidney pig-to-primate transplantation. The protective effect of such strategies in pulmonary xenografts, however, seems to be insufficient. In an ex vivo perfusion, model lungs from donor pigs transgenic for human CD55 (n = 6) or human CD59 (n = 5) were perfused with fresh human blood and compared with nontransgenic organs (n = 6). In addition, a soluble complement component 1 esterase inhibitor (C1-Inh) was applied in h-CD55 transgenic lungs (n = 3). In the h-CD55 transgenic group, survival was prolonged (P < 0.05), quality and maximal time of oxygenation significantly improved and pulmonary vascular resistance reduced compared with the control group. There was a decreased sequestration of platelets, less parenchymal injury and reduced deposition of C(5b-9) in the h-CD55 transgenic group. Additional soluble complement inhibition (C1-Inh) did not prolong survival of h-CD55 transgenic lungs. Survival and pulmonary function in lungs expressing h-CD59 was not significantly different from parameters observed in nontransgenic lungs. In this ex vivo model of pig-to-primate lung transplantation, membrane-based complement inhibition resulted in significantly improved pulmonary function. However, minor histopathological injuries observed in these transgenic xenografts suggested only partial protection from pulmonary dysfunction by complement inhibition alone.
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Affiliation(s)
- Jochen Pöling
- Klinik für Herz-,Thorax- und Gefäbchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
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Pöling J, Rees W, Bahlmann L, Klaus S, Ziaukas V, Gumiah M, Röthemeyer S, Warnecke H. Intraoperative diagnosis of hibernating myocardium by means of microdialysis. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925804] [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: 10/19/2022]
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Ziaukas V, Rees W, Hübner N, Pöling J, Mahesh GM, Christmann U, Warnecke H. A new calcium sensitizer levosimendan in cardiac surgical patients with severe mitral insufficiency, poor left ventricular function and coronary artery disease. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925853] [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: 10/19/2022]
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