1
|
Stein AP, Harder J, Holmes HR, Merz CNB, Pepine CJ, Keeley EC. Single Nucleotide Polymorphisms in Coronary Microvascular Dysfunction. J Am Heart Assoc 2024; 13:e032137. [PMID: 38348798 DOI: 10.1161/jaha.123.032137] [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: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024]
Abstract
Coronary microvascular dysfunction is an underdiagnosed pathologic process that is associated with adverse clinical outcomes. There are data to suggest that coronary microvascular dysfunction, in some cases, may be genetically determined. We present an updated review of single nucleotide polymorphisms in coronary microvascular dysfunction.
Collapse
Affiliation(s)
- Andrew P Stein
- Department of Medicine University of Florida Gainesville FL USA
| | - Jonathan Harder
- Department of Medicine University of Florida Gainesville FL USA
| | - Henry R Holmes
- Department of Medicine University of Florida Gainesville FL USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA
| | - Carl J Pepine
- Department of Medicine University of Florida Gainesville FL USA
- Division of Cardiovascular Medicine University of Florida Gainesville FL USA
| | - Ellen C Keeley
- Department of Medicine University of Florida Gainesville FL USA
- Division of Cardiovascular Medicine University of Florida Gainesville FL USA
| |
Collapse
|
2
|
Mirabelli C, Bragazzi Cunha J, Wotring JW, Sherman EJ, El Saghir J, Harder J, Kretzler M, Sexton JZ, Emmer BT, Wobus CE. ARF6 is a host factor for SARS-CoV-2 infection in vitro. J Gen Virol 2023; 104:001868. [PMID: 37342971 PMCID: PMC10397720 DOI: 10.1099/jgv.0.001868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/12/2023] [Indexed: 06/23/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly emerged beta-coronavirus that enter cells via two routes, direct fusion at the plasma membrane or endocytosis followed by fusion with the late endosome/lysosome. While the viral receptor, ACE2, multiple entry factors and the mechanism of fusion of the virus at the plasma membrane have been investigated extensively, viral entry via the endocytic pathway is less understood. By using a human hepatocarcinoma cell line, Huh-7, which is resistant to the antiviral action of the TMPRSS2 inhibitor camostat, we discovered that SARS-CoV-2 entry is not dependent on dynamin but on cholesterol. ADP-ribosylation factor 6 (ARF6) has been described as a host factor for SARS-CoV-2 replication and is involved in the entry and infection of several pathogenic viruses. Using CRISPR/Cas9 genetic deletion, a modest reduction in SARS-CoV-2 uptake and infection in Huh-7 was observed. In addition, pharmacological inhibition of ARF6 with the small molecule NAV-2729 showed a dose-dependent reduction of viral infection. Importantly, NAV-2729 also reduced SARS-CoV-2 viral loads in more physiological models of infection: Calu-3 cells and kidney organoids. This highlighted a role for ARF6 in multiple cell contexts. Together, these experiments point to ARF6 as a putative target to develop antiviral strategies against SARS-CoV-2.
Collapse
Affiliation(s)
- C. Mirabelli
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Present address: Institut für Virologie und Zellbiologie, University of Lübeck, Lübeck, Germany
| | - J. Bragazzi Cunha
- Department of Internal Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - J. W. Wotring
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - E. J. Sherman
- Department of Internal Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Present address: Territory Manager at Takara Bio, Inc., MI, MN, IN, KY, USA
| | - J. El Saghir
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA
| | - J. Harder
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA
| | - M. Kretzler
- Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA
| | - J. Z. Sexton
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - B. T. Emmer
- Department of Internal Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - C. E. Wobus
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Perry C, Budweg JB, Stein AP, Harder J, Gupta S, Nusbickel AJ, Smoot M, Patel K, Winchester DE. Assessment of Cardiovascular Risk for Noncardiac and Nonsurgical Activities. Am J Med 2023; 136:350-354. [PMID: 36566899 DOI: 10.1016/j.amjmed.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Cardiovascular risk stratification is a frequent evaluation performed by health professionals. Not uncommonly, requests for risk stratification involve activities or procedures that fall outside of the scope of current evidence-based guidelines. Estimating risk and providing guidance for these requests can be challenging due to limited available evidence. This review focuses on some of these unique requests, each of which are real examples encountered in our practice. We offer guidance by synthesizing the available medical literature and formulating recommendations on topics such as the initiation of testosterone and erectile dysfunction therapy, SCUBA and skydiving, polygraphy, and electroconvulsive therapy.
Collapse
Affiliation(s)
| | | | | | | | - Shishir Gupta
- University of Florida College of Medicine, Gainesville
| | | | | | - Keval Patel
- University of Florida College of Medicine, Gainesville
| | - David E Winchester
- University of Florida College of Medicine, Gainesville; Cardiology Section, Malcom Randall Veterans Affairs Medical Center, Gainesville, Fla.
| |
Collapse
|
4
|
Heinemann N, Rademacher F, Gläser R, Vollert H, Harder J. 239 A plant extract mixture rich in flavonoids shows beneficial effects in an atopic dermatitis in vitro model. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
5
|
Weingärtner A, Drerup K, Rademacher F, Gläser R, Harder J, Weidinger S. 397 Functional impact of the lesional and non-lesional atopic dermatitis microbiota on a 3D skin model. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
6
|
Mirabelli C, Sherman EJ, Cunha JB, Wotring JW, El Saghir J, Harder J, Kretzler M, Sexton JZ, Emmer BT, Wobus CE. ARF6 is a host factor for SARS-CoV-2 infection in vitro. bioRxiv 2022:2022.06.09.495482. [PMID: 35702152 PMCID: PMC9196112 DOI: 10.1101/2022.06.09.495482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
SARS-CoV-2 is a newly emerged beta-coronavirus that enter cells via two routes, direct fusion at the plasma membrane or endocytosis followed by fusion with the late endosome/lysosome. While the viral receptor, ACE2, multiple entry factors, and the mechanism of fusion of the virus at the plasma membrane have been extensively investigated, viral entry via the endocytic pathway is less understood. By using a human hepatocarcinoma cell line, Huh-7, which is resistant to the antiviral action of the TMPRSS2 inhibitor camostat, we discovered that SARS-CoV-2 entry is not dependent on dynamin but dependent on cholesterol. ADP-ribosylation factor 6 (ARF6) has been described as a host factor for SARS-CoV-2 replication and it is involved in the entry and infection of several pathogenic viruses. Using CRISPR-Cas9 genetic deletion, we observed that ARF6 is important for SARS-CoV-2 uptake and infection in Huh-7. This finding was corroborated using a pharmacologic inhibitor, whereby the ARF6 inhibitor NAV-2729 showed a dose-dependent inhibition of viral infection. Importantly, NAV-2729 reduced SARS-CoV-2 viral loads also in more physiologic models of infection: Calu-3 and kidney organoids. This highlighted the importance of ARF6 in multiple cell contexts. Together, these experiments points to ARF6 as a putative target to develop antiviral strategies against SARS-CoV-2.
Collapse
|
7
|
Trivanovic D, Harder J, Leucht M, Kreuzahler T, Schlierf B, Holzapfel BM, Rudert M, Jakob F, Herrmann M. Immune and stem cell compartments of acetabular and femoral bone marrow in hip osteoarthritis patients. Osteoarthritis Cartilage 2022; 30:1116-1129. [PMID: 35569800 DOI: 10.1016/j.joca.2022.05.001] [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: 11/29/2021] [Revised: 03/22/2022] [Accepted: 05/02/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Hip osteoarthritis (OA) affects all components of the osteochondral unit, leading to bone marrow (BM) lesions, and unknown consequences on BM cell functionality. We analyzed the cellular composition in OA-affected acetabula compared to proximal femur shafts obtained of hip OA patients to reveal yet not explored immune and stem cell compartments. DESIGN Combining flow cytometry, cellular assays and transcription analyses, we performed extensive ex vivo phenotyping of acetabular BM cells from 18 hip OA patients, comparing them with their counterparts from patient-matched femoral shaft BM samples. Findings were related to differences in skeletal sites and age. RESULTS Acetabular BM had a greater frequency of T-lymphocytes, non-hematopoietic cells and colony-forming units fibroblastic potential than femoral BM. The incidence of acetabular CD45+CD3+ T-lymphocytes increased (95% CI: 0.1770 to 0.0.8416), while clonogenic hematopoietic progenitors declined (95% CI: -0.9023 to -0.2399) with age of patients. On the other side, in femoral BM, we observed higher B-lymphocyte, myeloid and erythroid cell frequencies. Acetabular mesenchymal stromal cells (MSCs) showed a senescent profile associated with the expression of survival and inflammation-related genes. Efficient osteogenic and chondrogenic differentiation was detected in acetabular MSCs, while adipogenesis was more pronounced in their femoral counterparts. CONCLUSION Our results suggest that distinctions in BM cellular compartments and MSCs may be due to the influence of the OA-stressed microenvironment, but also acetabular vs femoral shaft-specific peculiarities cannot be excluded. These results bring new knowledge on acetabular BM cell populations and may be addressed as novel pathogenic mechanisms and therapeutic targets in OA.
Collapse
Affiliation(s)
- D Trivanovic
- IZKF Group Tissue Regeneration in Musculoskeletal Diseases, University Hospital Wuerzburg, Wuerzburg, Bavaria, 97070, Germany; Bernhard-Heine-Center for Locomotion Research, University Wuerzburg, Wuerzburg, Bavaria, 97070, Germany
| | - J Harder
- Bernhard-Heine-Center for Locomotion Research, University Wuerzburg, Wuerzburg, Bavaria, 97070, Germany
| | - M Leucht
- Bernhard-Heine-Center for Locomotion Research, University Wuerzburg, Wuerzburg, Bavaria, 97070, Germany
| | - T Kreuzahler
- IZKF Group Tissue Regeneration in Musculoskeletal Diseases, University Hospital Wuerzburg, Wuerzburg, Bavaria, 97070, Germany; Bernhard-Heine-Center for Locomotion Research, University Wuerzburg, Wuerzburg, Bavaria, 97070, Germany
| | - B Schlierf
- IZKF Group Tissue Regeneration in Musculoskeletal Diseases, University Hospital Wuerzburg, Wuerzburg, Bavaria, 97070, Germany; Bernhard-Heine-Center for Locomotion Research, University Wuerzburg, Wuerzburg, Bavaria, 97070, Germany
| | - B M Holzapfel
- Bernhard-Heine-Center for Locomotion Research, University Wuerzburg, Wuerzburg, Bavaria, 97070, Germany; Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Wuerzburg, Wuerzburg, Bavaria, 97070, Germany; Department of Orthopaedic Surgery, University Clinics, Ludwig-Maximilians University Munich, Munich, 81377, Germany
| | - M Rudert
- Bernhard-Heine-Center for Locomotion Research, University Wuerzburg, Wuerzburg, Bavaria, 97070, Germany; Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Wuerzburg, Wuerzburg, Bavaria, 97070, Germany
| | - F Jakob
- Bernhard-Heine-Center for Locomotion Research, University Wuerzburg, Wuerzburg, Bavaria, 97070, Germany
| | - M Herrmann
- IZKF Group Tissue Regeneration in Musculoskeletal Diseases, University Hospital Wuerzburg, Wuerzburg, Bavaria, 97070, Germany; Bernhard-Heine-Center for Locomotion Research, University Wuerzburg, Wuerzburg, Bavaria, 97070, Germany.
| |
Collapse
|
8
|
Emmert H, Rademacher F, Norsgaard H, Gerdes S, Weidinger S, Harder J. 191 Hair follicle-derived keratinocytes as a useful tool to study atopic dermatitis-related TH2 cytokine responses. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.196] [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: 12/01/2022]
|
9
|
Eddy PhD S, Mariani L, Alakwaa F, McCown P, Ju W, Harder J, Reich H, Eichinger F, Godfrey B, Boima V, Ademola A, Hodgin J, Ojo A, Kretzler M. POS-372 A PRECISION MEDICINE APPROACH IDENTIFIES NONINVASIVE BIOMARKERS ASSOCIATED WITH INTRARENAL PATHWAY ACTIVATION IN PATIENTS WITH PROTEINURIC RENAL DISEASES. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
10
|
Millett C, Harder J, Locascio J, Shanahan M, Santone G, Fichorova R, Corrigan A, Baecher-Allan C, Burdick K. TNF-α and its soluble receptors mediate the relationship between prior severe mood episodes and cognitive dysfunction in euthymic bipolar disorder. Brain Behav Immun 2020; 88:403-410. [PMID: 32272224 PMCID: PMC8577222 DOI: 10.1016/j.bbi.2020.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is one of the most disabling mental health conditions in the world. Symptoms of cognitive impairment in BD contribute directly to occupational and social deficiencies and are very difficult to treat. Converging evidence suggests that BD patients have increased peripheral markers of inflammation. The hypothesis of neuroprogression in BD postulates that cognitive deficits develop over the course of the illness and are influenced by prior severe mood episodes, leading to wear-and-tear on the brain- however, there exists a paucity of data statistically testing a mediating role of immune molecules in cognitive dysfunction in BD. METHODS This is a cross-sectional study. We measured serum levels of tumor necrosis factor alpha (TNF-α), and soluble (s) TNF receptors one and two (sTNF-R1 and sTNF-R2) in 219 euthymic BD patients and 52 Healthy Controls (HCs). Structural equation modeling (SEM) was used for the primary purpose of assessing whether TNF markers (measured by the multiple indicators TNF-α, sTNF-R1 and sTNF-R2) mediate the effect or number of prior severe mood episodes (number of prior psychiatric hospitalizations) on cognitive performance. RESULTS BD and HC groups did not differ on circulating levels of TNF molecules in the present study. However, we found higher sTNF-R1 concentration in 'late-stage' BD illness (>1 prior psychiatric hospitalization) compared to those in early stage illness. In the subsequent SEM, we found that the model fits the data acceptably (Chi-square = 49.2, p = 0.3), and had a 'close fit' (RMSEA = 0.02, PCLOSE = 0.9). Holding covariates constant (age, sex, premorbid IQ, education, and race), we found that the standardized indirect effect was significant, p = 0.015, 90%CI [-0.07, -0.01], indicating that the estimated model was consistent with peripheral TNF markers partially mediating a causal effect of severe mood episodes on executive function. CONCLUSIONS Our results indicate that circulating levels of TNF molecules partially mediate the relationship between prior severe mood episodes and executive function in BD. These results may implicate TNF variables in the neuroprogressive course of BD and could point to novel interventions for cognition.
Collapse
Affiliation(s)
- C.E. Millett
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - J. Harder
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - J.J. Locascio
- Massachusetts Alzheimer’s Disease Research Center, Massachusetts General Hospital and Harvard Medical School
| | - M. Shanahan
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,Massachusetts Alzheimer’s Disease Research Center, Massachusetts General Hospital and Harvard Medical School
| | - G. Santone
- Laboratory of Genital Tract Biology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - R. Fichorova
- Laboratory of Genital Tract Biology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - A. Corrigan
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA
| | - C. Baecher-Allan
- Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, MA 02115 USA,Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - K.E. Burdick
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| |
Collapse
|
11
|
Rodewald M, Bartels J, Harder J. 646 Characterization of platelets-derived compounds that induce antimicrobial peptides in human keratinocytes. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
12
|
Struck F, Farid Y, Rademacher F, Gerdes S, Weidinger S, Harder J. 368 The microbiota of atopic dermatitis lesions induces TSLP expression in a 3D skin equivalent. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.370] [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: 10/26/2022]
|
13
|
Lier EJ, Harder J, Oosterman JM, de Vries M, van Goor H. Modulation of tactile perception by Virtual Reality distraction: The role of individual and VR-related factors. PLoS One 2018; 13:e0208405. [PMID: 30507958 PMCID: PMC6277112 DOI: 10.1371/journal.pone.0208405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background Virtual reality (VR) has shown to be an effective distraction method in health care. However, questions remain regarding individual and VR-related factors that may modulate the effect of VR. Purpose To explore the effect of VR distraction on tactile perception thresholds in healthy volunteers, in relation to personal characteristics and interactivity of VR applications. Methods A randomized three way cross-over study was conducted to investigate the effects of active and passive VR applications in 50 healthy participants. Main outcome measures were monofilament detection thresholds (MDT) and electrical detection thresholds (EDT). Personal characteristics (e.g. age, gender, susceptibility for immersion) and immersion in the VR conditions were analyzed for their effect on VR induced threshold differences. Results The use of VR caused a significant increase in both MDT and EDT compared to the control condition (MDT: F (2, 76) = 20.174, p < 0.001; EDT F (2, 76) = 6.907, p = 0.002). Furthermore, a significant difference in favour of active VR compared to passive VR was found in MDT (p = 0.012), but not in EDT. No significant gender effect was found. There was a significant positive correlation between age and active VR distraction (r = 0.333, p = 0.018). Immersion in the VR world was positively correlated with the effect of VR, whereas visualization and daydreaming were negatively correlated with VR effects. Conclusion VR increased tactile perception thresholds, with active VR having the largest effect. Results indicate that the efficacy of VR may increase with increasing age. Gender did not affect VR susceptibility.
Collapse
Affiliation(s)
- E. J. Lier
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
| | - J. Harder
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J. M. Oosterman
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - M. de Vries
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - H. van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
14
|
Harder J, Cacciuto A. Hierarchical collective motion of a mixture of active dipolar Janus particles and passive charged colloids in two dimensions. Phys Rev E 2018; 97:022603. [PMID: 29548188 DOI: 10.1103/physreve.97.022603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Indexed: 06/08/2023]
Abstract
We use computer simulations to study the behavior of a mixture of large passive charged colloids in a suspension of smaller active dipolar Janus particles. We find that when a single charged colloid is present in solution, it acquires a rotational or translational motion depending on how the active dipoles self-assemble on its surface to form active complexes. The collective behavior of these complexes is quite remarkable, and includes swarming behavior and coherent macroscopic motion. We detail how the variety of different phenomenologies emerging in this system can ultimately be controlled by the strength of the active forces and the relative concentration of the two species.
Collapse
Affiliation(s)
- J Harder
- Chemistry Department, Columbia University, New York, New York 10027, USA
| | - A Cacciuto
- Chemistry Department, Columbia University, New York, New York 10027, USA
| |
Collapse
|
15
|
Kopfnagel V, Wagenknecht S, Brand L, Zeitvogel J, Harder J, Hofmann K, Kleine M, Werfel T. RNase 7 downregulates TH2 cytokine production by activated human T cells. Allergy 2017; 72:1694-1703. [PMID: 28378334 DOI: 10.1111/all.13173] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The antimicrobial peptide (AMP) RNase 7 is constitutively expressed in the epidermis of healthy human skin and has been found to be upregulated in chronic inflammatory skin diseases such as atopic dermatitis and psoriasis. Activated T cells in lesional skin of patients with atopic dermatitis (AD) and psoriasis (PSO) might be directly exposed to RNase 7. In addition to their antimicrobial activity, immunoregulatory functions have been published for several AMPs. In this study, we investigated immunoregulatory effects of the antimicrobial peptide RNase 7 on activated T cells. METHODS Isolated human CD3+T cells were stimulated with RNase 7 and screened for possible effects by mRNA microarray analysis. The results of the mRNA microarray were confirmed in isolated CD4+T cells and in polarized TH2 cells using skin-derived native RNase 7 and a recombinant ribonuclease-inactive RNase 7 mutant. Activation of GATA3 was analysed by electrophoretic mobility shift assay. RESULTS Treatment of activated human CD4+T cells and TH2 cells with RNase 7 selectively reduced the expression of TH2 cytokines (IL-13, IL-4 and IL-5). Experiments with a ribonuclease-inactive recombinant RNase 7 mutant showed that RNase 7 ribonuclease activity is dispensable for the observed regulatory effect. We further demonstrate that CD4+T cells from AD patients revealed a significantly less pronounced downregulation of IL-13 in response to RNase 7 compared to healthy control. Finally, we show that GATA3 activation was diminished upon cultivation of T cells with RNase 7. CONCLUSION Our data indicate that RNase 7 has immunomodulatory functions on TH2 cells and decreases the production of TH2 cytokines in the skin.
Collapse
Affiliation(s)
- V. Kopfnagel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - S. Wagenknecht
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - L. Brand
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - J. Zeitvogel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - J. Harder
- Department of Dermatology University Hospital Schleswig‐Holstein Kiel Germany
| | | | | | - T. Werfel
- Division of Immunodermatology and Allergy Research Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| |
Collapse
|
16
|
Klee M, Salgado F, Rademacher F, Simanski M, Harder J. 432 The epidermal growth factor receptor is critical for the Staphylococcus aureus-mediated induction of human beta-defensin-3 in keratinocytes. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.628] [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]
|
17
|
Gläser R, Harder J. [Research on the skin microbiome : Fascinating and challenging]. Hautarzt 2017; 68:762-765. [PMID: 28762050 DOI: 10.1007/s00105-017-4019-z] [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: 10/19/2022]
Affiliation(s)
- R Gläser
- Klinik für Dermatologie, Venerologie und Allergologie, Universitäts-Klinikum Schleswig-Holstein, Campus Kiel, Rosalind-Franklin-Str. 7, 24105, Kiel, Deutschland.
| | - J Harder
- Klinik für Dermatologie, Venerologie und Allergologie, Universitäts-Klinikum Schleswig-Holstein, Campus Kiel, Rosalind-Franklin-Str. 7, 24105, Kiel, Deutschland
| |
Collapse
|
18
|
Kopfnagel V, Baumert K, Wagenknecht S, Harder J, Kleine M, Werfel T. 419 RNase 7 promotes uptake and sensing of self-DNA by human keratinocytes and reduces HSV-1 infection of human keratinocytes. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Harder J. Antimikrobielle Peptid (AMP)-Forschung an der Kieler Universitäts-Hautklinik. Akt Dermatol 2016. [DOI: 10.1055/s-0041-109824] [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: 10/22/2022]
|
20
|
Bierkarre H, Harder J, Cuthbert R, Emery P, Leuschner I, Mrowietz U, Hedderich J, McGonagle D, Gläser R. Differential expression of antimicrobial peptides in psoriasis and psoriatic arthritis as a novel contributory mechanism for skin and joint disease heterogeneity. Scand J Rheumatol 2015; 45:188-96. [DOI: 10.3109/03009742.2015.1091497] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- H Bierkarre
- Department of Dermatology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - J Harder
- Department of Dermatology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - R Cuthbert
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - P Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - I Leuschner
- Department of Paediatric Pathology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - U Mrowietz
- Department of Dermatology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - J Hedderich
- Department of Medical Informatics and Statistics, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - D McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - R Gläser
- Department of Dermatology, University Hospital of Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
21
|
Harder J, Valeriani C, Cacciuto A. Activity-induced collapse and reexpansion of rigid polymers. Phys Rev E Stat Nonlin Soft Matter Phys 2014; 90:062312. [PMID: 25615098 DOI: 10.1103/physreve.90.062312] [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] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Indexed: 06/04/2023]
Abstract
We study the elastic properties of a rigid filament in a bath of self-propelled particles. We find that while fully flexible filaments swell monotonically upon increasing the strength of the propelling force, rigid filaments soften for moderate activities, collapse into metastable hairpins for intermediate strengths, and eventually reexpand when the strength of the activity of the surrounding fluid is large. This collapse and reexpansion of the filament with the bath activity is reminiscent of the behavior observed in polyelectrolytes in the presence of different concentrations of multivalent salt.
Collapse
Affiliation(s)
- J Harder
- Department of Chemistry, Columbia University, 3000 Broadway, New York, New York 10027, USA
| | - C Valeriani
- Departamento de Quimica Fisica, Facultad de Ciencias Quimicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - A Cacciuto
- Department of Chemistry, Columbia University, 3000 Broadway, New York, New York 10027, USA
| |
Collapse
|
22
|
Affiliation(s)
- J. Harder
- Department of Chemistry, Columbia University, 3000 Broadway, New York, New York 10027, USA
| | - S. A. Mallory
- Department of Chemistry, Columbia University, 3000 Broadway, New York, New York 10027, USA
| | - C. Tung
- Department of Chemistry, Columbia University, 3000 Broadway, New York, New York 10027, USA
| | - C. Valeriani
- Departamento de Quimica Fisica, Facultad de Ciencias Quimicas, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - A. Cacciuto
- Department of Chemistry, Columbia University, 3000 Broadway, New York, New York 10027, USA
| |
Collapse
|
23
|
Lichtenberger BM, Gerber PA, Holcmann M, Buhren BA, Amberg N, Smolle V, Schrumpf H, Boelke E, Ansari P, Mackenzie C, Wollenberg A, Kislat A, Fischer JW, Rock K, Harder J, Schroder JM, Homey B, Sibilia M. Epidermal EGFR Controls Cutaneous Host Defense and Prevents Inflammation. Sci Transl Med 2013; 5:199ra111. [DOI: 10.1126/scitranslmed.3005886] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
24
|
Harder J, Ihorst G, Heinemann V, Hofheinz R, Moehler M, Buechler P, Kloeppel G, Röcken C, Bitzer M, Boeck S, Endlicher E, Reinacher-Schick A, Schmoor C, Geissler M. Multicentre phase II trial of trastuzumab and capecitabine in patients with HER2 overexpressing metastatic pancreatic cancer. Br J Cancer 2012; 106:1033-8. [PMID: 22374460 PMCID: PMC3304403 DOI: 10.1038/bjc.2012.18] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [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: 12/13/2022] Open
Abstract
Background: New therapeutic options for metastatic pancreatic cancer are urgently needed. In pancreatic cancer, overexpression of the epidermal growth factor receptor 2 (HER2) has been reported in up to 45%. This multicentre phase II study investigated the efficacy and toxicity of the HER2 antibody trastuzumab combined with capecitabine in the patients with pancreatic cancer and HER2 overexpression. Methods: Primary endpoint was progression-free survival (PFS) after 12 weeks. A total of 212 patients were screened for HER2 expression. Results: Immunohistochemical (IHC) HER2 expression was: 83 (40%) grade 0, 71 (34%) grade 1, 31 (15%) grade 2, 22 (11%) grade 3. A total of 17 patients with IHC +3 HER2 expression or gene amplification could be assessed for the treatment response. Grade 3/4 treatment toxicities were: each 7% leucopenia, diarrhoea, nausea and hand-foot syndrome. Progression-free survival after 12 weeks was 23.5%, median overall survival (OS) 6.9 months. Conclusion: This study demonstrates +3 HER2 expression or gene amplification in 11% of patients. Contrary to breast and gastric cancer, only 7 out of 11 (64%) patients with IHC +3 HER2 expression showed gene amplification. Although the therapy was well tolerated, PFS and OS did not perform favourably compared with standard chemotherapy. Together, we do not recommend further evaluation of anti-HER2 treatment in patients with metastatic pancreatic cancer.
Collapse
Affiliation(s)
- J Harder
- Medizinische Klinik II, Hegau- Bodensee Klinikum, Virchowstraße 10, D-78224 Singen, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Fontenla JM, Harder J, Livingston W, Snow M, Woods T. High-resolution solar spectral irradiance from extreme ultraviolet to far infrared. ACTA ACUST UNITED AC 2011. [DOI: 10.1029/2011jd016032] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
26
|
Kullmann F, Hartmann A, Stöhr R, Messmann H, Dollinger MM, Trojan J, Fuchs M, Hollerbach S, Harder J, Troppmann M, Kutscheidt A, Endlicher E. KRAS mutation in metastatic pancreatic ductal adenocarcinoma: results of a multicenter phase II study evaluating efficacy of cetuximab plus gemcitabine/oxaliplatin (GEMOXCET) in first-line therapy. Oncology 2011; 81:3-8. [PMID: 21894049 DOI: 10.1159/000330194] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 05/02/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Genetic alterations within the epidermal growth factor receptor (EGFR) pathway, including KRAS mutations, have been demonstrated to be associated with response to EGFR inhibitors like cetuximab in colorectal cancers. Mutations in the KRAS gene have been found in 70-90% of pancreatic cancers. Unfortunately, the addition of cetuximab to chemotherapy did not increase response or survival in patients with advanced pancreatic cancer in phase II and phase III studies. The aim of this study was to evaluate the relationship between KRAS mutations and response or survival in patients with metastatic pancreatic cancer treated with cetuximab plus chemotherapy. METHODS Within a multicenter phase II trial, 64 patients with metastatic pancreatic cancer were treated with cetuximab in combination with gemcitabine and oxaliplatin until disease progression. Analyses of the EGFR pathway, including KRAS mutations, could be performed in 25 patients. Analyses were carried out following microdissection of the tumor. RESULTS Fourteen (56%) of the 25 patients examined harbored a point mutation in codon 12 of the KRAS gene. No differences between the groups were noted in median progression-free survival (104 days in KRAS wild-type patients vs. 118 days in patients with KRAS mutations). Overall survival was longer in wild-type patients compared to patients with KRAS mutations (263 vs. 162 days), but the difference did not reach statistical significance. A further analysis of our clinical phase II trial showed that the presence of a rash was significantly correlated with overall survival. CONCLUSIONS KRAS mutation in codon 12 may be associated with reduced survival compared to KRAS wild type. The role of KRAS mutations for cetuximab therapy in pancreatic cancer warrants further investigation in larger trials to exclude an epiphenomenon. Furthermore, the development of a rash is indicative of clinical benefit.
Collapse
Affiliation(s)
- F Kullmann
- University of Regensburg, Regensburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Kreisel W, Dahlberg M, Bertz H, Harder J, Potthoff K, Deibert P, Schmitt-Graeff A, Finke J. Endoscopic diagnosis of acute intestinal GVHD following allogeneic hematopoietic SCT: a retrospective analysis in 175 patients. Bone Marrow Transplant 2011; 47:430-8. [PMID: 21706064 PMCID: PMC3296915 DOI: 10.1038/bmt.2011.137] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [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: 12/15/2022]
Abstract
Diagnosis of acute intestinal GVHD (aGVHD) following allogeneic hematopoietic cell transplantation is based on clinical symptoms and histological lesions. This retrospective analysis aimed to validate the 'Freiburg Criteria' for the endoscopic grading of intestinal aGVHD. Grade 1: no clear-cut criteria; grade 2: spotted erythema; grade 3: aphthous lesions; and grade 4: confluent defects, ulcers, denudation of the mucosa. Having excluded patients with infectious diarrhea, we evaluated 175 consecutive patients between January 2001 and June 2009. Setting a cutoff between grade 1 (no change in therapy) and grade 2 (intensification of immunosuppression), macroscopy had a sensitivity of 89.2% (95% confidence interval (CI): 80.4-94.9%), a specificity of 79.4% (95% CI: 69.6-87.1%), a positive-predictive value of 79.6% (95% CI: 70.0-87.2%) and a negative-predictive value of 89.0% (95% CI: 80.2-94.9%). In all, 20% of patients with aGVHD in the lower gastrointestinal tract (GIT) had lesions only in the terminal ileum. In all patients with aGVHD ≥2 of the upper GIT, typical lesions were also found in the lower GIT. Ileo-colonoscopy showed the highest diagnostic yield for aGVHD. In conclusion, the 'Freiburg Criteria' for macroscopic diagnosis of intestinal aGVHD provide high accuracy for identifying aGVHD ≥2.
Collapse
Affiliation(s)
- W Kreisel
- Department of Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, University Hospital Freiburg, Hugstetter Street 55, Freiburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Marsilio S, Kleinschmidt S, Harder J, Nolte I, Hewicker-Trautwein M. Numbers and distribution of immune cells in the tunica mucosa of the small and large intestine of full-thickness biopsies from healthy pet cats. Anat Histol Embryol 2010; 40:61-7. [PMID: 21029151 DOI: 10.1111/j.1439-0264.2010.01039.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study, CD3(+) T lymphocytes and IgA(+) , IgG(+) and IgM(+) plasma cells were quantified in the tunica mucosa of the intestinal tract of 12 pet cats without gastrointestinal diseases. The study included full-thickness biopsies of the duodenum, jejunum, ileum and colon. The distribution and quantification of CD3(+) T cells, IgA(+) , IgG(+) and IgM(+) plasma cells within the intestinal tunica mucosa was performed by using immunohistochemical methods and computer-aided morphometry. CD3(+) T cells were significantly prominent in the villi and their numbers increased from duodenum to ileum but decreased towards the colon. The predominant type of plasma cells was IgA(+) cells, followed by IgM(+) cells. The number of IgG(+) cells was generally low compared to the other plasma cell types investigated. The results of the vertical distribution showed that IgA(+) and IgM(+) plasma cells were most numerous in the lower crypt areas, whilst IgG(+) plasma cells accumulated in the upper crypt region with a decline towards the villi and the lower crypt areas of control cats. All types of plasma cells showed a general decline from the duodenum towards the caudal sections of the intestinal tract regarding the horizontal distribution of plasma cells. This study provides a comprehensive overview on the vertical and horizontal distribution and the number of CD3(+) T cells and IgA(+) , IgG(+) and IgM(+) plasma cells in the intestinal tunica mucosa of pet cats.
Collapse
Affiliation(s)
- S Marsilio
- Department of Pathology, University of Veterinary Medicine Hannover, Bünteweg 17, D-30559 Hannover, Germany
| | | | | | | | | |
Collapse
|
30
|
Horn P, Harder J, Lohmann C, Lanzl I. Beidseitiger Visusabfall bei einer 11-Jährigen. Ophthalmologe 2010; 107:848-51. [DOI: 10.1007/s00347-010-2168-x] [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]
|
31
|
Geissler M, Hofheinz R, Moehler MH, Bitzer M, Boeck SH, Reinacher-Schick A, Heinemann V, Harder J. Trastuzumab and capecitabine in patients with HER2-expressing metastatic pancreatic cancer: A multicenter phase II study of the German AIO Pancreatic Cancer Group (AIO PK-0204). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
32
|
Harder J, Hofheinz R, Möhler M, Büchler P, Klöppel G, Bitzer M, Endlicher E, Reinacher-Schick A, Heinemann V, Geissler M. 6597 Multicenter phase II trial of trastuzumab and capecitabine in patients with HER2 expressing metastasized pancreatic cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
33
|
|
34
|
|
35
|
Neeff H, Makowiec F, Harder J, Gumpp V, Klock A, Thimme R, Drognitz O, Hopt U. Leberresektion beim Hepatozellulären Karzinom – Eigene Ergebnisse und Literaturübersicht. Zentralbl Chir 2009; 134:127-35. [DOI: 10.1055/s-0028-1098881] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
36
|
Reithmayer K, Meyer KC, Kleditzsch P, Tiede S, Uppalapati SK, Gläser R, Harder J, Schröder JM, Paus R. Human hair follicle epithelium has an antimicrobial defence system that includes the inducible antimicrobial peptide psoriasin (S100A7) and RNase 7. Br J Dermatol 2009; 161:78-89. [PMID: 19416233 DOI: 10.1111/j.1365-2133.2009.09154.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hair follicle (HF) ostia represent a potential port of microbial entry into the skin. However, they rarely show clinical signs of infection. This suggests the presence of local, efficient, antimicrobial defence systems, which may include antimicrobial peptides (AMPs). OBJECTIVES We determined the presence and distribution of the major AMPs, RNase 7 and psoriasin (S100A7), in human scalp HFs. We investigated whether HF production of these AMPs was induced by prototypic microbial products and proinflammatory cytokines, i.e. interferon (IFN)-gamma. Finally, we examined whether the classical pathways for AMP induction, such as toll-like receptor (TLR)4 and TLR5 expression, are present in human HFs and up-regulated after stimulation with bacterium-associated ligands. METHODS Cryosections from fresh or organ-cultured full-thickness normal human scalp skin treated with lipopolysaccharide (LPS), flagellin, protein A, lipoteichoic acid (LTA) or IFN-gamma were stained for psoriasin and RNase 7 immunoreactivity (IR) as well as for TLR4 and TLR5. In addition, outer root sheath cell culture and semiquantitative analysis of mRNA expression levels of RNase 7 and psoriasin were performed. RESULTS Specific RNase 7 IR was present throughout the entire HF outer root sheath in situ and in cell culture, whereas psoriasin IR was present only in the most distal compartment and not detectable in cultured ORS cells. Upon treatment with Gram-positive (LTA, protein A) or Gram-negative bacterial (LPS, flagellin) cell wall components, or with the cytokine IFN-gamma, the IR of both psoriasin and RNase 7 was modified. TLR4 and TLR5 IR was detected in the normal HF epithelium and were upregulated after treatment with their respective ligand. The mRNA analysis confirmed the immunohistochemistry results. CONCLUSIONS This pilot study suggests that normal human scalp HF epithelium possesses a functional antimicrobial defence system, which includes the AMPs RNase 7 and psoriasin, and TLRs, and that these are induced by classical microbial products.
Collapse
Affiliation(s)
- K Reithmayer
- Department of Dermatology, Venereology and Allergology, University Hospital of Schleswig Holstein, Campus Lübeck, Lübeck D-23538, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Kullmann F, Hollerbach S, Dollinger MM, Harder J, Fuchs M, Messmann H, Trojan J, Gäbele E, Hinke A, Hollerbach C, Endlicher E. Cetuximab plus gemcitabine/oxaliplatin (GEMOXCET) in first-line metastatic pancreatic cancer: a multicentre phase II study. Br J Cancer 2009; 100:1032-6. [PMID: 19293797 PMCID: PMC2670003 DOI: 10.1038/sj.bjc.6604983] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [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: 12/31/2022] Open
Abstract
Targeting the epidermal growth factor receptor pathway in pancreatic cancer seems to be an attractive therapeutic approach. This study assessed the efficacy of cetuximab plus the combination of gemcitabine/oxaliplatin in metastatic pancreatic cancer. Eligible subjects had histological or cytological diagnosis of metastatic pancreatic adenocarcinoma. The primary end point was response according to RECIST. Patients received cetuximab 400 mg m−2 at first infusion followed by weekly 250 mg m−2 combined with gemcitabine 1000 mg m−2 as a 100 min infusion on day 1 and oxaliplatin 100 mg m−2 as a 2-h infusion on day 2 every 2 weeks. Between January 2005 and August 2006, a total of 64 patients (22 women (34%), 42 men (66%); median age 64 years (range 31–78)) were enrolled at seven study centres. On October 2007, a total of 17 patients were alive. Sixty-two patients were evaluable for baseline and 61 for assessment of response to treatment in an intention-to-treat analysis. Six patients had an incomplete drug combination within the first cycle of the treatment plan (n=4 hypersensitivity reactions to the first cetuximab infusion, n=2 refused to continue therapy). Reported grade 3/4 toxicities (% of patients) were leukopaenia 15%, anaemia 8%, thrombocytopaenia 10%, diarrhoea 7%, nausea 18%, infection 18% and allergy 7%. Cetuximab-attributable skin reactions occurred as follows: grade 0: 20%, grade 1: 41%, grade 2: 30% and grade 3: 10%. The intention-to-treat analysis of 61 evaluable patients showed an overall response rate of 33%, including 1 (2%) complete and 19 (31%) partial remissions. There were 31% patients with stable and 36% with progressive disease or discontinuation of the therapy before re-staging. The presence of a grade 2 or higher skin rash was associated with a higher likelihood of achieving objective response. Median time to progression was 118 days, with a median overall survival of 213 days. A clinical benefit response was noted in 24 of the evaluable 61 patients (39%). The addition of cetuximab to the combination of gemcitabine and oxaliplatin is well tolerated but does not increase response or survival in patients with metastatic pancreatic cancer.
Collapse
Affiliation(s)
- F Kullmann
- Department of Internal Medicine I, University of Regensburg, Regensburg, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Hünken M, Harder J, Kirst GO. Epiphytic bacteria on the Antarctic ice diatom Amphiprora kufferathii Manguin cleave hydrogen peroxide produced during algal photosynthesis. Plant Biol (Stuttg) 2008; 10:519-26. [PMID: 18557912 DOI: 10.1111/j.1438-8677.2008.00040.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The Antarctic ice diatom Amphiprora kufferathii Manguin is always accompanied by epiphytic bacteria in its natural habitat. To investigate the nature of this relationship, axenic cultures of A. kufferathii were obtained by ampicillin treatment. Diatom cultures without bacteria were less dense. The bacteria were shown to consume hydrogen peroxide produced by the diatom during photosysnthesis and algal photosynthesis after a hydrogen peroxide shock recovered faster in the presence of bacteria. Three proteobacterial strains isolated from a culture of A. kufferathii were phylogenetically affiliated with the alphaproteobacterial genus Sulfitobacter, the gammaproteobacterial genus Colwellia, and the genus Pibocella of the Bacteriodetes. Native protein gel electrophoresis and enzyme activity staining revealed the presence of superoxide dismutase and glutathione reductase in the isolated bacteria and in A. kufferathii cultures. Catalase was detected in bacterial extracts but not in axenic cultures of A. kufferathii. These observations indicate that the epiphytic bacteria make a significant contribution to the diatom's antioxidative defences. The relationship between the bacteria and A. kufferathii seems to be beneficial for both partners and enhances growth of Amphiprora in the sea ice.
Collapse
Affiliation(s)
- M Hünken
- Marine Botany, University of Bremen, Bremen, Germany.
| | | | | |
Collapse
|
39
|
Abstract
Recent evidence suggests that probiotic bacteria may stabilize gut barrier function via induction of anti-microbial peptides such as defensins. This study aimed to elucidate the induction mechanism of the human beta defensin-2 (hBD-2) gene by different probiotic lactobacillus strains. The expression of hBD-2 mRNA peaked at 6 h of incubation upon treatment of Caco-2 cells and increased with higher dosage of various probiotic bacteria. Deletion of nuclear factor (NF)-kappaB and activator protein-1 (AP-1) binding sites on the hBD-2 promoter resulted in a complete abrogation of promoter activation by probiotics. As revealed by the use of specific mitogen-activated protein kinase (MAPK) inhibitors the hBD-2 induction was dependent on the MAPK extracellular regulated kinase (ERK 1/2), p38 and c-Jun N-terminal kinase (JNK), although to varying degrees. Several Lactobacillus strains and VSL#3, a probiotic cocktail of four lactobacilli, three bifidum and one streptococcus species, induced the secretion of the hBD-2 peptide into the culture media as shown by enzyme-linked immunosorbent assay (ELISA). Thus, the present study suggests that lactobacilli and the VSL#3 bacterial mixture strengthen intestinal barrier functions through the up-regulation of hBD-2 via induction of proinflammatory pathways including NF-kappaB and AP-1 as well as MAPKs.
Collapse
Affiliation(s)
- M Schlee
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology and University of Tübingen, Stuttgart, Germany.
| | | | | | | | | | | |
Collapse
|
40
|
Kullmann F, Hollerbach S, Fuchs M, Messmann H, Dollinger M, Trojan J, Harder J, Gaebele E, Hinke A, Endlicher E. 3533 POSTER Cetuximab plus Gemcitabine/Oxaliplatin (GEMOXCET) in 1st line metastatic pancreatic cancer–amulticenter phase II study. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71036-4] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
41
|
Harder J, Riecken B, Kummer O, Lohrmann C, Otto F, Usadel H, Geissler M, Opitz O, Henss H. Outpatient chemotherapy with gemcitabine and oxaliplatin in patients with biliary tract cancer. Br J Cancer 2006; 95:848-52. [PMID: 16969352 PMCID: PMC2360533 DOI: 10.1038/sj.bjc.6603334] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This phase II study was conducted to determine the efficacy and toxicity of a gemcitabine (GEM) and oxaliplatin (OX) chemotherapy protocol in patients with unresectable biliary tract cancer (BTC). Patients were treated with GEM 1000 mg m−2 (30 min infusion) on days 1, 8, 15, and OX 100 mg m−2 (2 h infusion) on days 1 and 15 (gemcitabine and oxaliplatin (GEMOX-3 protocol), repeated every 28 days. The data were collected according to the Simon 2-stage design for a single centre phase II study (α=0.05; β=0.2). Primary end point was response rate; secondary end points were time-to-progression (TTP), median survival, and safety profile. Thirty-one patients were enrolled in the study between July 2002 and April 2005. Therapeutic responses were as follows: partial response in eight patients (26%, 95% confidence interval (CI) 14–44), stable disease in 14 patients (45%, 95%CI 29–62), resulting in a disease control rate of 71%. Nine patients (29%, 95%CI 16–47) had progressive disease. Median TTP was 6.5 months. Median overall survival was 11 months. Common Toxicity Criteria (CTC) Grade 3–4 toxicities were transient thrombocytopenia (23%), peripheral sensory neuropathy (19%), leucopenia (16%), and anaemia (10%). In conclusion the GEMOX-3 protocol is active and well tolerated in patients with advanced BTC. It can be applied in an outpatient setting with three visits per month only.
Collapse
Affiliation(s)
- J Harder
- Department of Gastroenterology and Hepatology, Freiburg University Hospital, Hugstetterstr. 55, Freiburg D-79106, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Gastric cancer is the fourth common cancer worldwide and the second leading cause of cancer related deaths. Although the incidence of gastric cancer is declining, gastric cancer will remain a serious medical problem due to its high mortality rates. In contrast, cancer of the gastroesophageal junction is the most increasing neoplasm in the western world. Unfortunately, the vast majority of gastric cancer is diagnosed at an advanced stage, associated with a poor prognosis where the therapeutic options are limited. Over the past 15 years advances have been made in the knowledge of risk factors as well as the pathogenesis of gastric cancer. As the most important exogenous risk factor Helicobacter pylori was categorized as a class I carcinogen by the WHO. Additionally, genetic changes associated with the risk of gastric cancer have been defined. Progress, although slow, has also been made in the non-surgical therapy of gastric cancer due to multimodal therapeutic strategies. All these advances could lead to a better identification of patients being at risk of developing gastric cancer. Furthermore, new neoadjuvant and adjuvant therapy regimes as well as targeted therapeutic approaches in the future could lead to a better prognosis of gastric cancer.
Collapse
Affiliation(s)
- J Harder
- Abteilung Innere Medizin II, Gastroenterologie, Hepatologie, Endokrinologie und Infektiologie, Albert-Ludwigs-Universität, Freiburg
| | | |
Collapse
|
43
|
Harder J, Riecken B, Kummer O, Lohrmann C, Geissler M, Otto F, Opitz O, Henss H. Outpatient chemotherapy with gemcitabine and oxaliplatin in advanced biliary tract cancer; a phase II study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14006 Background: Biliary tract cancer is a heterogeneous tumor entity with a poor prognosis if unresectable. There is a need for an effective, safe and patient friendly treatment. Methods: Patients with typical histology for cholangiocarcinoma, adequate haematological, renal and liver function, measurable tumor formation, life expectancy for more than 3 months, and written informed consent were treated with Gemcitabine 1000mg/m2 (30 min infusion) day 1, 8, 15 and Oxaliplatin 100mg/m2 (2 h infusion) day 1 and 15. Chemotherapy cycles were repeated every 28 days (GEMOX-3 protocol). The data were collected according to the Simon 2-step design for a single centre phase II study (α=0.05; β=0.2). Planned sample size 29. Primary endpoint was the response rate; secondary endpoints were time to progression, median survival and safety profile. Results: Thirty-one consecutive patients were enrolled between July 2002 and April 2005. The efficacy was as follows: partial response 8 pts (26%), stable disease 14 pts (45%). Thus, the disease control rate was 71%, while 9 pts (29%) had progressive disease. Median time to progression was 6.5 months. Median overall survival after start of treatment was 10.4 months, after initial diagnosis it was 15.6 months. National Cancer Institute Common Toxicity Criteria grade 3–4 toxicities were transient thrombocytopenia in 23% of patients, peripheral sensory neuropathy 19%, leukopenia 16% and anaemia 10%. Conclusion: The GEMOX-3 protocol is active and well tolerated in patients with advanced biliary tract cancer. It can be applied in an outpatient setting with three treatments per month only. The positive results of this and other phase II trials underscore the importance of a large controlled clinical trial to verify the data. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- J. Harder
- University Hospital, Freiburg, Germany
| | | | - O. Kummer
- University Hospital, Freiburg, Germany
| | | | | | - F. Otto
- University Hospital, Freiburg, Germany
| | - O. Opitz
- University Hospital, Freiburg, Germany
| | - H. Henss
- University Hospital, Freiburg, Germany
| |
Collapse
|
44
|
Abstract
Human skin is permanently exposed to microorganisms, but rarely infected. One reason for this natural resistance might be the existence of a 'chemical barrier' consisting in constitutively and inducibly produced antimicrobial peptides and proteins (AMPs). Many of these AMPs can be induced in vitro by proinflammatory cytokines or bacteria. Apart from being expressed in vivo in inflammatory lesions, some AMPs are also focally expressed in skin in the absence of inflammation. This suggests that non-inflammatory stimuli of endogenous and/or exogenous origin can also stimulate AMP synthesis without inflammation. Such mediators might be ideal 'immune stimulants' to induce only the innate antimicrobial skin effector molecules without causing inflammation.
Collapse
Affiliation(s)
- J M Schröder
- Department of Dermatology, University-Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105 Kiel, Germany.
| | | |
Collapse
|
45
|
Harder J, Mikesch K, Mohr L, Blum HE. [Seizures following Billroth II gastrectomy]. Dtsch Med Wochenschr 2005; 130:574-6. [PMID: 15761785 DOI: 10.1055/s-2005-865064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HISTORY A 64-year old somnolent man was admitted to the emergency department with a reported seizure half an hour earlier. Due to similar episodes the patient had been treated with antiepileptics in the past. The patient s past history revealed a partial gastrectomy (Billroth II) more than ten years ago. DIAGNOSTIC FINDINGS AND THERAPY At the time of admission blood glucose was 31 mg/dl. Other routine laboratory analyses and the clinical examination were normal. In addition, a detailed neurological examination and a cranial CT-scan were normal. Due to the hypoglycemia a dumping syndrome was suspected. A three hour oral glucose tolerance test (OGTT) resulted in a late hypoglycemia, establishing the diagnosis of late dumping. After adaptation of the patient's diet no further hypoglycemic episodes occurred. CONCLUSION Manifestation of a dumping syndrome may occur even years after gastrectomy. Therefore, in patients presenting with hypoglycemia and a history of gut surgery, a dumping syndrome should be suspected. Furthermore, seizures due to hypoglycemia may be the only manifestation of late dumping.
Collapse
Affiliation(s)
- J Harder
- Abteilung Innere Medizin I, Medizinische Klinik, Albert-Ludwigs Universität Freiburg.
| | | | | | | |
Collapse
|
46
|
Geissler M, Schwacha H, Eggstein S, Usadel H, Harder J, Opitz O, Arnold C, Grimm CF, Blum HE. [Esophageal carcinoma: non-surgical therapy]. Praxis (Bern 1994) 2004; 93:2057-2064. [PMID: 15630988 DOI: 10.1024/0369-8394.93.49.2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Esophageal carcinoma is one of the most common cancers in the world. There is a rising incidence of adenocarcinoma of the esophagus in Western countries. The present standard of care of patients with early tumors (Tis-T1 N0-N1 M0) is surgery and there is no role for chemo- or radiotherapy. Surgical treatment of stage II patients with locally resectable tumors is associated with poor survival figures due to an increase of regional and distant lymph node metastases. Adjuvant chemotherapy should be used only in the setting of clinical trials. The role of neoadjuvant chemo-radiotherapy in patients with resectable tumors is controversial. There is also evidence that some patients with a complete response after chemo-radiotherapy do not have a further benefit from surgical treatment. Therefore, the appropriate application of these varied therapeutic interventions should be performed at specialized centers. The role of chemotherapy and radiation is now established in locally advanced inoperable disease. How best to deliver these modes of therapy has yet to be defined. Prospective randomised trials are the only way to define the best therapeutic strategies for the different subgroups of patients with esophageal carcinoma. Progress with newer chemotherapy agents, optimal radiotherapy protocols and innovations are likely to improve responses to combination treatments, but may more importantly limit associated toxicity. Future trials should also assess quality of life indices as end points, that are of particular importance in populations with a median survival of approx, one year. Patients with stage IVb esophageal carcinoma have a life expectancy of less than six months and palliative teatment strategies should primarily aim at the improvement of tumor related symptoms and the maintenance of nutrition.
Collapse
Affiliation(s)
- M Geissler
- Abteilung Innere Medizin, Medizinische Universitätsklinik, Freiburg
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Wehkamp J, Harder J, Weichenthal M, Schwab M, Schäffeler E, Schlee M, Herrlinger KR, Stallmach A, Noack F, Fritz P, Schröder JM, Bevins CL, Fellermann K, Stange EF. NOD2 (CARD15) mutations in Crohn's disease are associated with diminished mucosal alpha-defensin expression. Gut 2004; 53:1658-64. [PMID: 15479689 PMCID: PMC1774270 DOI: 10.1136/gut.2003.032805] [Citation(s) in RCA: 578] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mutations in NOD2, a putative intracellular receptor for bacterial peptidoglycans, are associated with a subset of Crohn's disease but the molecular mechanism linking this protein with the disease pathogenesis remains unclear. Human alpha defensins (HD-5 and HD-6) are antibiotic effector molecules predominantly expressed in Paneth cells of the ileum. Paneth cells also express NOD2. To address the hypothesis that the function of NOD2 may affect expression of Paneth cell defensins, we compared their expression levels with respect to NOD2 mutations in Crohn's disease. METHODS Forty five Crohn's disease patients (24 with NOD2 mutations, 21 with wild-type NOD2) and 12 controls were studied. Real time reverse transcription-polymerase chain reaction was performed with mucosal mRNA for HD-5, HD-6, lysozyme, secretory phospholipase A2 (sPLA2), tumour necrosis factor alpha, interleukin 8, and human hypoxanthine phosphoribosyltransferase (housekeeping gene). Immunohistochemistry with anti-HD-5 and histological Paneth cell staining were performed in 10 patients with NOD2 mutations or wild-type genotypes. RESULTS Ileal expression of HD-5 and HD-6, but not sPLA2 or lysozyme, were diminished in affected ileum, and the decrease was significantly more pronounced in patients with NOD2 mutations. In the colon, HD-5, HD-6, and sPLA2 were increased during inflammation in wild-type but not in NOD2 mutated patients. In both the colon and ileum, proinflammatory cytokines and lysozyme were unaffected by NOD2 status. Immunohistochemistry identified Paneth cells as the sole source of HD-5. CONCLUSION As alpha defensins are important in the mucosal antibacterial barrier, their diminished expression may explain, in part, the bacterial induced mucosal inflammation and ileal involvement of Crohn's disease, especially in the case of NOD2 mutations.
Collapse
Affiliation(s)
- J Wehkamp
- Department of Internal Medicine I, Robert Bosch Hospital, Stuttgart, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Intravenous drug use (IVDU) remains a major means of hepatitis C virus (HCV) transmission. In this study, 101 drug users were studied prospectively after cessation of IVDU. Of these, 75.8% were anti-HCV positive, and 71.4% had elevated levels of alanine aminotransferase. These levels decreased significantly within 1 month of IVDU cessation (p 0.02). Liver biopsies showed minimal or mild fibrosis in 32 (71%) of 45 subjects, and severe fibrosis in two (4.4%) subjects. Anti-HCV-positive intravenous drug users in this study presented with mild liver disease and variable stages of disease progression. Biochemical disease activity might be affected by IVDU.
Collapse
Affiliation(s)
- J Harder
- University Hospital, Department of Medicine II (Gastroenterology, Hepatology and Infectious Diseases), University of Freiburg, D-79106 Freiburg, Germany.
| | | | | | | | | |
Collapse
|
49
|
Meyer JE, Hörtling P, Görögh T, Roen AM, Harder J, Maune S. Gewebsspezifische und vom Reifungsgrad der Zelle abhängige Produktion von humanem beta-Defensin-2. Laryngorhinootologie 2004. [DOI: 10.1055/s-2004-823554] [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]
|
50
|
Harder J, Blum HE. [Cholangiocarcinoma]. Praxis (Bern 1994) 2002; 91:1352-1356. [PMID: 12233266 DOI: 10.1024/0369-8394.91.34.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Cholangiocarcinomas (CCC) are rare tumors with an incidence of 2-4/100,000 per year. They are a heterogeneous group of neoplasias that include the most common perihilar or Klatskin tumor (60%), the intrahepatic (peripheral) CCC, the extrahepatic bile duct cancer, the gallbladder cancer and the cancer of the ampulla of Vater. At the time of diagnosis only 20% of patients can be treated by surgery, that offers the only chance for cure. Due to high recurrence rates liver transplantation is not indicated. Patients with advanced unresectable carcinoma have a dismal prognosis with an overall survival rate of only 6-8 months. Neither chemotherapy nor radiation therapy improves survival. In patients not eligible for curative surgery prevention or treatment of cholestatis is the main objective. This can be achieved endoscopically, percutaneously or by surgical biliodigestive anastomosis. Palliative chemotherapy results in response rates up to 20%. The most frequently used agents are 5-FU and Gemcitabine that can be combined with external or internal radiation. By combining different treatment modalities significant survival can be achieved in some patients. Evidence Based Medicine studies are needed before treatment strategies can be recommended for clinical practice.
Collapse
Affiliation(s)
- J Harder
- Abteilung Innere Medizin II, Medizinische Universitätsklinik Freiburg i. Br
| | | |
Collapse
|