miR-182/183-Rasa1 axis induced macrophage polarization and redox regulation promotes repair after ischemic cardiac injury

Few therapies have produced significant improvement in cardiac structure and function after ischemic cardiac injury (ICI). Our possible explanation is activation of local inflammatory responses negatively impact the cardiac repair process following ischemic injury. Factors that can alter immune response, including significantly altered cytokine levels in plasma and polarization of macrophages and T cells towards a pro-reparative phenotype in the myocardium post-MI is a valid strategy for reducing infarct size and damage after myocardial injury. Our previous studies showed that cortical bone stem cells (CBSCs) possess reparative effects after ICI. In our current study, we have identified that the beneficial effects of CBSCs appear to be mediated by miRNA in their extracellular vesicles (CBSC-EV). Our studies showed that CBSC-EV treated animals demonstrated reduced scar size, attenuated structural remodeling, and improved cardiac function versus saline treated animals. These effects were linked to the alteration of immune response, with significantly altered cytokine levels in plasma, and polarization of macrophages and T cells towards a pro-reparative phenotype in the myocardium post-MI. Our detailed in vitro studies demonstrated that CBSC-EV are enriched in miR-182/183 that mediates the pro-reparative polarization and metabolic reprogramming in macrophages, including enhanced OXPHOS rate and reduced ROS, via Ras p21 protein activator 1 (RASA1) axis under Lipopolysaccharides (LPS) stimulation. In summary, CBSC-EV deliver unique molecular cargoes, such as enriched miR-182/183, that modulate the immune response after ICI by regulating macrophage polarization and metabolic reprogramming to enhance repair.

The Current Therapeutic Role of Chromatin Remodeling for the Prognosis and Treatment of Heart Failure

Cardiovascular diseases are a major cause of death globally, with no cure to date. Many interventions have been studied and suggested, of which epigenetics and chromatin remodeling have been the most promising. Over the last decade, major advancements have been made in the field of chromatin remodeling, particularly for the treatment of heart failure, because of innovations in bioinformatics and gene therapy. Specifically, understanding changes to the chromatin architecture have been shown to alter cardiac disease progression via variations in genomic sequencing, targeting cardiac genes, using RNA molecules, and utilizing chromatin remodeler complexes. By understanding these chromatin remodeling mechanisms in an injured heart, treatments for heart failure have been suggested through individualized pharmaceutical interventions as well as biomarkers for major disease states. By understanding the current roles of chromatin remodeling in heart failure, a potential therapeutic approach may be discovered in the future.

Abstract P1030: LIN28a-induced Metabolic Reprogramming Regulates New Myocyte Formation In The Heart Via Lncrna-H19

Developmental cardiac tissue holds remarkable capacity to regenerate after injury and consists of regenerative mononuclear and diploid cardiomyocytes (MNDCMs). Upon maturation, MNDCMs become binucleated or polyploid and exit the cell cycle. Interestingly, CM metabolism undergoes a profound shift that coincides with cessation of regeneration in the postnatal heart. However, whether reprogramming metabolism promotes persistence of regenerative MNDCMs enhancing cardiac function and repair after injury is unknown. Here, we identify a novel role for RNA-binding protein LIN28a, a master regulator of cellular metabolism, in cardiac repair following injury. LIN28a was found as primarily active during cardiac development and rapidly decreases after birth. LIN28a reintroduction at P1, P3, P5, and P7 decreased maturation-associated polyploidization, nucleation, and cell size, enhancing CM cell cycle activity in LIN28a transgenic pups compared to WT littermates. Moreover, LIN28a overexpression extended CM cell cycle activity beyond P7 concurrent with increased cardiac function 30 days after apical resection. In the adult heart, LIN28a overexpression attenuated CM apoptosis, enhanced cell cycle activity, cardiac function, and survival in mice 12 weeks after myocardial infarction compared to WT littermate controls. Alternatively, LIN28a small molecule inhibitor attenuated pro-reparative effects of LIN28a on the heart. Mechanistically, Neonatal rat ventricular myocytes (NRVMs) overexpressing LIN28a showed increased glycolysis, ATP production and levels of metabolic enzymes compared to control. LIN28a immunoprecipitation followed by RNA sequencing (RIPseq) in CMs isolated from LIN28a injured hearts identified lncRNA-H19 as its most significantly altered target. Ablation of lncRNA-H19 blunted LIN28a-induced enhancement on CM metabolism and cell cycle activity. Collectively, LIN28a reprograms CM metabolism and promotes persistence of MNDCMs in the injured heart enhancing pro-reparative processes thereby linking CM metabolism to regulation of ploidy/nucleation and repair in the heart.

UCP2 modulates cardiomyocyte cell cycle activity, acetyl-CoA and histone acetylation in response to moderate hypoxia

Developmental cardiac tissue is regenerative while operating under low oxygen. After birth, ambient oxygen is associated with cardiomyocyte cell cycle exit and regeneration. Likewise, cardiac metabolism undergoes a shift with cardiac maturation. Whether there are common regulators of cardiomyocyte cell cycle linking metabolism to oxygen tension remains unknown. The objective of the study is to determine whether mitochondrial UCP2 is a metabolic oxygen sensor regulating cardiomyocyte cell cycle. Neonatal rat ventricular myocytes (NRVMs) under moderate hypoxia showed increased cell cycle activity and UCP2 expression. NRVMs exhibited a metabolic shift towards glycolysis, reduced citrate synthase, mtDNA, ΔΨm and DNA damage/oxidative stress while loss of UCP2 reversed this phenotype. Next, WT and UCP2KO mice kept under hypoxia for 4 weeks showed significant decline in cardiac function that was more pronounced in UCP2KO animals. Cardiomyocyte cell cycle activity was reduced while fibrosis and DNA damage was significantly increased in UCP2KO animals compared to WT under hypoxia. Mechanistically, UCP2 increased acetyl-CoA levels, histone acetylation and altered chromatin modifiers linking metabolism to cardiomyocyte cell cycle under hypoxia. Here, we show a novel role for mitochondrial UCP2 as an oxygen sensor regulating cardiomyocyte cell cycle activity, acetyl-CoA levels and histone acetylation in response to moderate hypoxia.

Abstract MP206: Cortical Bone Derived Stem Cells Modulate The Adaptive Immune Response Post-MI

Background: The inflammatory response mounted following myocardial infarction (MI) is closely coupled to myocardial wound healing processes such as angiogenesis, fibroblast maturation, and cardiomyocyte survival. A consortium of pro-reparative Tregs occupy the myocardium during ischemic injury and are essential in modulating cardiac homeostasis. However, Treg exposure to chronic, ischemic microenvironments compromises Tregs’ pro-reparative signatures and induces pathogenic remodeling of Tregs, compromising cardiac wound healing. Cortical Bone Derived Stem Cells (CBSCs) have superior engraftment capabilities compared to other stem cell types and can modulate the post-MI inflammatory response by establishing anti-inflammatory paracrine signaling dominance and the expansion of CD45+ leukocytes and CD4+ T cells residence in the MI heart. Therefore, we hypothesized CBSC cell therapy can modulate the recruitment and phenotype of Treg residence in the MI heart to permit their enhanced cardiogenic properties.

Methods and Results: Animals that received intramyocardial injection of CBSCs along the infarct border zone of the permanently ligated LAD possessed smaller infarct sizes and improved cardiac function, that paralleled pro-reparative, TNFRII+ Treg expansion and repressed pathogenic TNFRI+, Treg residence 1- and 8- weeks post-MI compared to Mesenchymal Stem Cells (MSCs) or vehicle (PBS) treated animals. Similar TNFRI/II Treg dynamics were also observed in the spleen. Diphtheria toxin (DTR) mediated Treg ablation and S1P1 agonist administration, in the presence of CBSC therapy, reverted pro-reparative Treg expansion and solicited infarct size expansion and compromised cardiac function. The exposure of CBSC paracrine secretome to naïve CD4+ T cell cultures induces pro-reparative TNFRII+ Treg expansion. Paracrine profiling of CBSC secretome identifies Osteoprotegerin (OPG) enrichment and OPG depletion, via siRNA and lentivirus, compromises T cell survival signaling and pro-reparative, TNFRII+ Treg establishment both in vitro and in the MI heart.

Conclusions: CBSCs can modulate the induction and preservation of pro-reparative TNFRII+ Tregs in the MI heart to solicit cardiac repair during acute and chronic ischemic injury.

Bmi1 Augments Proliferation and Survival of Cortical Bone-Derived Stem Cells after Injury through Novel Epigenetic Signaling via Histone 3 Regulation

Ischemic heart disease can lead to myocardial infarction (MI), a major cause of morbidity and mortality worldwide. Multiple stem cell types have been safely transferred into failing human hearts, but the overall clinical cardiovascular benefits have been modest. Therefore, there is a dire need to understand the basic biology of stem cells to enhance therapeutic effects. Bmi1 is part of the polycomb repressive complex 1 (PRC1) that is involved in different processes including proliferation, survival and differentiation of stem cells. We isolated cortical bones stem cells (CBSCs) from bone stroma, and they express significantly high levels of Bmi1 compared to mesenchymal stem cells (MSCs) and cardiac-derived stem cells (CDCs). Using lentiviral transduction, Bmi1 was knocked down in the CBSCs to determine the effect of loss of Bmi1 on proliferation and survival potential with or without Bmi1 in CBSCs. Our data show that with the loss of Bmi1, there is a decrease in CBSC ability to proliferate and survive during stress. This loss of functionality is attributed to changes in histone modification, specifically histone 3 lysine 27 (H3K27). Without the proper epigenetic regulation, due to the loss of the polycomb protein in CBSCs, there is a significant decrease in cell cycle proteins, including Cyclin B, E2F, and WEE as well as an increase in DNA damage genes, including ataxia-telangiectasia mutated (ATM) and ATM and Rad3-related (ATR). In conclusion, in the absence of Bmi1, CBSCs lose their proliferative potential, have increased DNA damage and apoptosis, and more cell cycle arrest due to changes in epigenetic modifications. Consequently, Bmi1 plays a critical role in stem cell proliferation and survival through cell cycle regulation, specifically in the CBSCs. This regulation is associated with the histone modification and regulation of Bmi1, therefore indicating a novel mechanism of Bmi1 and the epigenetic regulation of stem cells.

Epidermal growth factor receptor association with β1-adrenergic receptor is mediated via its juxtamembrane domain

β1-adrenergic receptor (β1AR)-mediated transactivation of epidermal growth factor receptor (EGFR) engages downstream signaling events that impact numerous cellular processes including growth and survival. While association of these receptors has been shown to occur basally and be important for relaying transactivation-specific intracellular events, the mechanism by which they do so is unclear and elucidation of which would aid in understanding the consequence of disrupting their interaction. Using fluorescence resonance energy transfer (FRET) and immunoprecipitation (IP) analyses, we evaluated the impact of C-terminal truncations of EGFR on its ability to associate with β1AR. While loss of the last 230 amino acid C-terminal phosphotyrosine-rich domain did not disrupt the ability of EGFR to associate with β1AR, truncation of the entire intracellular domain of EGFR resulted in almost complete loss of its interaction with β1AR, suggesting that either the kinase domain or juxtamembrane domain (JMD) may be required for this association. Treatment with the EGFR antagonist gefitinib did not prevent β1AR-EGFR association, however, treatment with a palmitoylated peptide encoding the first 20 amino acids of the JMD domain (JMD-A) disrupted β1AR-EGFR association over time and prevented β1AR-mediated ERK1/2 phosphorylation, both in general and specifically in association with EGFR. Conversely, neither a mutated JMD-A peptide nor a palmitoylated peptide fragment consisting of the subsequent 18 amino acids of the JMD domain (JMD-B) were capable of doing so. Altogether, the proximal region of the JMD of EGFR is responsible for its association with β1AR, and its disruption prevents β1AR-mediated transactivation, thus providing a new tool to study the functional consequences of disrupting β1AR-EGFR downstream signaling.

Substance use disorder and the baby boomers: Does German outpatient addiction care face a change?

Background

The aging of baby boomers is expected to confront addiction care with new challenges. This study aims to investigate if German addiction care is confronted with a sustained change in its clientele that was initiated by the baby boomers.

Methods

Using data from Berlin outpatient addiction care facilities, we contrasted type of primary substance use disorder and number of comorbid substance use disorders in baby boomers with an older (n = 6524) as well as a younger cohort (n = 15677). To isolate cohort effects, two-level random-intercept regression models were applied in the overlapping age groups of the baby boomer cohort with each other cohort.

Results

Compared to the older cohort, alcohol use disorder lost importance while illicit substances use disorder gained importance in the baby boomers. Baby boomers presented a higher number of comorbid substance use disorders than the older cohort. Comparing baby boomers with the younger cohort, these relationships pointed in the opposite direction.

Conclusions

Outpatient addiction care faces a sustained change to more illicit and comorbid substance use disorders. The addiction care system ought to adapt its services to address the changing needs of its clientele.

Key messages

Baby boomers differed in comparison to the older cohort regarding type of substance use disorder and comorbid substance use disorders. The changes set off by the baby boomers continued in the younger cohort.

Cortical Bone Derived Stem Cells Modulate Cardiac Fibroblast Response via miR-18a in the Heart After Injury

The adult heart following injury such as a myocardial infarction forms a fibrotic scar associated with transformation of resident cardiac fibroblasts into myofibroblast, accelerating cardiac remodeling and dysfunction. Cell therapies provide a novel direction for the enhancement of cardiac structure and function but remain poorly described in terms of the effect on resident cardiac fibroblasts. We have shown cortical bone derived stem cells (CBSCs) exhibit an ability to repair the heart after myocardial injury together with reduced scar formation. Nevertheless, whether CBSCs possess ability to modulate resident fibroblast response after myocardial injury remains untested.

Exploring socio-economic inequalities in the use of medicines: is the relation mediated by health status?

OBJECTIVES

This study evaluated mediating effects of the health status on the association between socio-economic status (SES) and medicine use. It was hypothesized that more privileged people show a reduced use of medicines, as compared with the underprivileged, because of their superior health status. It was further hypothesized that people may apply medication based on their type of health complaint (ill physical versus mental status).

STUDY DESIGN

Data were taken from the 2012 German Epidemiological Survey of Substance Abuse, a nationally representative cross-sectional study of n = 9084 individuals of the German general population aged 18-64 years.

METHODS

Direct and indirect effects of SES on weekly use of analgesics and sedatives/hypnotics were examined by applying generalized structural equation modeling. Self-rated physical and mental health statuses were considered as potential mediators. SES was measured by using educational level as a proxy. All analyses were gender-stratified.

RESULTS

Among men, both physical and mental health mediated the path from SES to the use of analgesics and sedatives/hypnotics, respectively, with a stronger effect of physical health on analgesic use and mental health on sedative/hypnotic use. These effects were only partially found among women.

CONCLUSIONS

Social inequalities in health seem to have substantial impact on the prevalence of medicine use. Identification and elimination of the reasons for poor health among people of low SES may, therefore, not only help to reduce health inequalities directly. A decline in the use of medicines would also result in less side-effects and a reduced number of people with medicine-related misuse and addiction.

Early predictive biomarkers for postpartum depression point to a role for estrogen receptor signaling

BACKGROUND

Postpartum depression (PPD) affects approximately 13% of women and has a negative impact on mother and infant, hence reliable biological tests for early detection of PPD are essential. We aimed to identify robust predictive biomarkers for PPD using peripheral blood gene expression profiles in a hypothesis-free genome-wide study in a high-risk, longitudinal cohort.

METHOD

We performed a genome-wide association study in a longitudinal discovery cohort comprising 62 women with psychopathology. Gene expression and hormones were measured in the first and third pregnancy trimesters and early postpartum (201 samples). The replication cohort comprised 24 women with third pregnancy trimester gene expression measures. Gene expression was measured on Illumina-Human HT12 v4 microarrays. Plasma estradiol and estriol were measured. Statistical analysis was performed in R.

RESULTS

We identified 116 transcripts differentially expressed between the PPD and euthymic women during the third trimester that allowed prediction of PPD with an accuracy of 88% in both discovery and replication cohorts. Within these transcripts, significant enrichment of transcripts implicated that estrogen signaling was observed and such enrichment was also evident when analysing published gene expression data predicting PPD from a non-risk cohort. While plasma estrogen levels were not different across groups, women with PPD displayed an increased sensitivity to estrogen signaling, confirming the previously proposed hypothesis of increased sex-steroid sensitivity as a susceptibility factor for PPD.

CONCLUSIONS

These results suggest that PPD can be robustly predicted in currently euthymic women as early as the third trimester and these findings have implications for predictive testing of high-risk women and prevention and treatment for PPD.

Forward scatter target strength extraction in a marine environment (L)

A 48 m rail with a moving receiver was used to measure forward scattering from a spherical shell lying on the bottom in the Gulf of Mexico. The target was mid-way between the source and rail, on a line from the source bisecting the rail. The major obstacle to the measurement of forward scattering is the much stronger source signal which overlaps the scattered signal in space and time. Here, forward scattered target strength is obtained by processing the received signals using a wavenumber filter to remove the incident wave. The result compares favorably to that obtained from numerical predictions.

Structural-acoustic modeling for three-dimensional freefield and littoral environments with verification and validation

This paper describes a high-order, finite-element-based, three-dimensional time-harmonic model for large-scale exterior structural-acoustics problems. It is applicable to both freefield and littoral environments. For the freefield case, the infinite exterior is treated as a homogeneous linear acoustic medium. For littoral applications, the water or air and the sediment domains are each treated as linear homogeneous, semi-infinite half-spaces with piecewise-constant properties. Both domains admit complex-valued wave speeds to enable the inclusion of damping. The finite element formulation uses a variational statement which naturally incorporates the transmission-condition at the water or air-sediment interface. The truncation of the infinite exterior is realized using an infinite-element for the freefield case, and the perfectly-matched-layer approximation for littoral applications. Computation of the farfield quantities is done based on an integral representation which, for the littoral cases, uses efficient approximations for the appropriate Green's function. Numerical computations are presented for a series of progressively more complex problems, and are used to verify the model against analytic and other numerical solutions and validate it based on the experimental data for scattering from elastic scatterers as measured in freefield and sediment pool laboratory facilities.

Role of immunofluorescence microscopy in dermatology

This paper gives a survey about most of the dermatological and infectious cutaneous diseases in which immunofluorescence (IF) microscopy is an important, often decisive tool to reach diagnosis. In tabular form, bullous autoimmune disorders such as pemphigus and pemphigoid diseases, connective tissue diseases, vasculitides, mechanobullous disorders and cutaneous infectious agents and the respective IF findings are listed. Different IF methods and especially important aspects such as taking a biopsy at the right spot or how to send samples are described. Clinical pictures of a broad spectrum of cutaneous diseases are set in combination with the IF microscopic results and the value of special but still routine investigations such as the salt split skin test (SSST) or the antigen mapping (AM) method is demonstrated especially in a set of identical or atypical clinical pictures. Immunofluorescence microscopy has not lost it´s value and should be performed in each dermatological centre in the sense of "Do not miss a diagnosis by not performing IF!"

Exploiting forward scattering for detecting submerged proud/half-buried unexploded ordnance

Laboratory underwater bistatic scattering measurements are reported for free, proud, and half-buried unexploded ordnances for 0 degrees and 90 degrees source angles. Forward echoes are larger than backscattered returns, and half burial significantly decreases the latter but not the former. Results agree with analytic predictions borrowed from radar. The forward echo and source signal are separated by measurements made with and without the target, a method not possible in a target search. For this, a method is described that uses knowledge of the source location and the hyperbolic character in time-cross range of the signals received at points along a line.

Bistatic scattering from submerged unexploded ordnance lying on a sediment

The broadband bistatic target strengths (TSs) of two submerged unexploded ordnance (UXO) targets have been measured in the NRL sediment pool facility. The targets-a 5 in. rocket and a 155 mm projectile-were among the targets whose monostatic TSs were measured and reported previously by the authors. Bistatic TS measurements were made for 0 degrees (target front) and 90 degrees (target side) incident source directions, and include both backscattered and forward scattered echo angles over a complete 360 degrees with the targets placed proud of the sediment surface. For the two source angles used, each target exhibits two strong highlights: a backscattered specular-like echo and a forward scattered response. The TS levels of the former are shown to agree reasonably well with predictions, based on scattering from rigid disks and cylinders, while the levels of the latter with predictions from radar cross section models, based on simple geometric optics appropriately modified. The bistatic TS levels observed for the proud case provide comparable or higher levels of broadband TS relative to free-field monostatic measurements. It is concluded that access to bistatic echo information in operations aimed at detecting submerged UXO targets could provide an important capability.

[Acute alcohol intoxication in adolescents: preliminary results of a pilot project in Munich]

OBJECTIVE

To present preliminary results of a pilot project on the prevention of alcohol-associated problems in adolescents with acute alcohol intoxication.

METHOD

Questionnaires were filled in by 110 of 128 adolescents (85.9% response rate) who had been admitted to a hospital in Munich, Germany, between December 2007 and July 2008, because of alcohol intoxication. Data were obtained on sociodemographic characteristics, alcohol intoxication and drinking patterns, and were analysed using descriptive methods.

RESULTS

Half of these adolescents mainly suffered from moderate to severe degrees of alcohol intoxication. Drinking patterns leading to alcohol intoxication were characterized by relatively low drinking frequency interspersed by episodes of excessive alcohol intake (binge drinking). Thirteen (14.8%) of the adolescents reported previous hospital admissions for alcohol intoxication, nine (17.3%) did not know about the life-threatening danger of alcohol intoxication and twelve (22.2%) reported taking illegal drugs within the last 12 months.

CONCLUSION

Adolescents who had been admitted to hospital because of alcohol intoxication had a drinking pattern which put them at a higher risk for alcohol intoxication and acute alcohol-related problems than adolescents in the general population. Re-admission to hospital within 12 months because of alcohol intoxication, revealing a lack of knowledge about the life-threatening danger of alcohol intoxications and of consuming illegal drugs, may indicate an increased risk for alcohol-related problems. This points to the need for preventive action in adolescents showing these indicators, a need that was met within this pilot project by brief intervention.

Broadband acoustic scattering measurements of underwater unexploded ordnance (UXO)

In order to evaluate the potential for detection and identification of underwater unexploded ordnance (UXO) by exploiting their structural acoustic response, we carried out broadband monostatic scattering measurements over a full 360 degrees on UXO's (two mortar rounds, an artillery shell, and a rocket warhead) and false targets (a cinder block and a large rock). The measurement band, 1-140 kHz, includes a low frequency structural acoustics region in which the wavelengths are comparable to or larger than the target characteristic dimensions. In general, there are aspects that provide relatively high target strength levels ( approximately -10 to -15 dB), and from our experience the targets should be detectable in this structural acoustics band in most acoustic environments. The rigid body scattering was also calculated for one UXO in order to highlight the measured scattering features involving elastic responses. The broadband scattering data should be able to support feature-based separation of UXO versus false targets and identification of various classes of UXO as well.

Cesium uptake from aqueous solutions by bentonite: a comparison of multicomponent sorption with ion-exchange models

The removal of cesium from concentrated aqueous solutions into Ca/Mg-bentonite for a wide range of bentonite-to-water (m/V) ratios was studied experimentally and theoretically. Using the batch technique, the equilibrium of Cs uptake was measured. The nonlinear character of cesium sorption substantially influenced by the m/V ratio was observed. The experimental data were evaluated using the multicomponent Langmuir isotherm and an ion-exchange model based on the ion-exchange reaction between Cs+ and M2+ (Ca2+/Mg2+) initially sorbed on bentonite. Constants k1,Cs = 0.521 mmol.g-1, k2,Cs = 968 L.mol-1, and k2,M = 592 L.mol-1 were obtained for Cs uptake described by multicomponent Langmuir isotherm. For the ion-exchange model, the thermodynamic equilibrium constant K = 75.5 mL.g-1 with a standard deviation of sK = 17.4 mL.g-1 was determined. Using the t test, the calculated data of multicomponent Langmuir and ion-exchange isotherms were fit to experimental data, and the best agreement was obtained for the ion-exchange model. The results show that Cs uptake by bentonite could be substantially decreased in systems with a high bentonite-to-water (m/V) ratio as a consequence of the presence of desorbed divalent cations in the liquid phase.

[Psychosocial stress preceding drug-related deaths]

This article analyses drug-related deaths in the German Federal States of Bavaria (Munich, Nuremberg and Augsburg counties) during 1999 and Baden-Wurttemberg (Stuttgart and Mannheim counties) during 1999 and in the first half of 2000. The persons who had been in contact with drug care services were studied for psychosocial stress preceding drug-related deaths. Epidemiological data from different sources (police, relatives, counselling centres, detoxification clinics, therapy and substitution treatment) were collated to estimate factors of psychosocial stress preceding drug deaths. The results in both Laender indicate high prevalence rates of a history of at least one non-fatal overdose (approx. 50%) or a suicide attempt (approx. 35%). More than 40% of the deceased had been suffering from at least one additional mental disorder, in most cases from depression. At least one critical life event (in most cases, a relapse) or a period of abstinence (i.e., due to imprisonment, therapy or detoxification) during the past three months before death was reported for more than half of the addicts. The results were discussed in the light of data on opiate users and the general population. Improved specialist training of therapeutic and medical workers as well as of any other co-operating professionals is considered a necessary prerequisite for an early detection of risk factors.