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Kugler S, Hahnefeld L, Kloka JA, Ginzel S, Nürenberg-Goloub E, Zinn S, Vehreschild MJ, Zacharowski K, Lindau S, Ullrich E, Burmeister J, Kohlhammer J, Schwäble J, Gurke R, Dorochow E, Bennett A, Dauth S, Campe J, Knape T, Laux V, Kannt A, Köhm M, Geisslinger G, Resch E, Behrens F. Short-term predictor for COVID-19 severity from a longitudinal multi-omics study for practical application in intensive care units. Talanta 2024; 268:125295. [PMID: 37866305 DOI: 10.1016/j.talanta.2023.125295] [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] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The COVID-19 pandemic challenged the management of technical and human resources in intensive care units (ICU) across the world. Several long-term predictors for COVID-19 disease progression have been discovered. However, predictors to support short-term planning of resources and medication that can be translated to future pandemics are still missing. A workflow was established to identify a predictor for short-term COVID-19 disease progression in the acute phase of intensive care patients to support clinical decision-making. METHODS Thirty-two patients with SARS-CoV-2 infection were recruited on admission to the ICU and clinical data collected. During their hospitalization, plasma samples were acquired from each patient on multiple occasions, excepting one patient for which only one time point was possible, and the proteome (Inflammation, Immune Response and Organ Damage panels from Olink® Target 96), metabolome and lipidome (flow injection analysis and liquid chromatography-mass spectrometry) analyzed for each sample. Patient visits were grouped according to changes in disease severity based on their respiratory and organ function, and evaluated using a combination of statistical analysis and machine learning. The resulting short-term predictor from this multi-omics approach was compared to the human assessment of disease progression. Furthermore, the potential markers were compared to the baseline levels of 50 healthy subjects with no known SARS-CoV-2 or other viral infections. RESULTS A total of 124 clinical parameters, 271 proteins and 782 unique metabolites and lipids were assessed. The dimensionality of the dataset was reduced, selecting 47 from the 1177 parameters available following down-selection, to build the machine learning model. Subsequently, two proteins (C-C motif chemokine 7 (CCL7) and carbonic anhydrase 14 (CA14)) and one lipid (hexosylceramide 18:2; O2/20:0) were linked to disease progression in the studied SARS-CoV-2 infections. Thus, a predictor delivering the prognosis of an upcoming worsening of the patient's condition up to five days in advance with a reasonable accuracy (79 % three days prior to event, 84 % four to five days prior to event) was found. Interestingly, the predictor's performance was complementary to the clinicians' capabilities to foresee a worsening of a patient. CONCLUSION This study presents a workflow to identify omics-based biomarkers to support clinical decision-making and resource management in the ICU. This was successfully applied to develop a short-term predictor for aggravation of COVID-19 symptoms. The applied methods can be adapted for future small cohort studies.
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Affiliation(s)
- Sabine Kugler
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Fraunhofer Institute for Intelligent Analysis and Information Systems IAIS, Schloss Birlinghoven 1, St. Augustin, Germany
| | - Lisa Hahnefeld
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Goethe University Frankfurt, University Hospital, Institute of Clinical Pharmacology, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany.
| | - Jan Andreas Kloka
- Goethe University Frankfurt, University Hospital, Clinic for Anesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Sebastian Ginzel
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Fraunhofer Institute for Intelligent Analysis and Information Systems IAIS, Schloss Birlinghoven 1, St. Augustin, Germany
| | - Elina Nürenberg-Goloub
- Goethe University Frankfurt, University Hospital, Clinic for Anesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Sebastian Zinn
- Goethe University Frankfurt, University Hospital, Clinic for Anesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany; Fraunhofer Leistungszentrum TheraNova, Theodor-Stern-Kai 6, 60596, Frankfurt am Main, Germany
| | - Maria Jgt Vehreschild
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine, Infectious Diseases, 60590, Frankfurt am Main, Germany
| | - Kai Zacharowski
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Goethe University Frankfurt, University Hospital, Clinic for Anesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Simone Lindau
- Goethe University Frankfurt, University Hospital, Clinic for Anesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Evelyn Ullrich
- University Cancer Center Frankfurt (UCT), University Hospital, Goethe University Frankfurt, Frankfurt, Germany; Frankfurt Cancer Institute (FCI), Frankfurt am Main, Germany; Goethe University Frankfurt, Department of Pediatrics, Experimental Immunology and Cell Therapy, Frankfurt, Germany
| | - Jan Burmeister
- Fraunhofer Institute for Computer Graphics Research IGD, Darmstadt, Germany
| | - Jörn Kohlhammer
- Fraunhofer Institute for Computer Graphics Research IGD, Darmstadt, Germany
| | - Joachim Schwäble
- Goethe University Frankfurt, University Hospital, Institute of Transfusion Medicine and Immunohematology, German Red Cross Blood Transfusion Service Baden-Württemberg, Frankfurt, Germany
| | - Robert Gurke
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Goethe University Frankfurt, University Hospital, Institute of Clinical Pharmacology, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Erika Dorochow
- Goethe University Frankfurt, University Hospital, Institute of Clinical Pharmacology, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Alexandre Bennett
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Stephanie Dauth
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Julia Campe
- Goethe University Frankfurt, Department of Pediatrics, Experimental Immunology and Cell Therapy, Frankfurt, Germany; Goethe University Frankfurt, Biological Sciences, Frankfurt am Main, Germany
| | - Tilo Knape
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Volker Laux
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Aimo Kannt
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Fraunhofer Leistungszentrum TheraNova, Theodor-Stern-Kai 6, 60596, Frankfurt am Main, Germany
| | - Michaela Köhm
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Goethe University Frankfurt, University Hospital, Rheumatology, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Gerd Geisslinger
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Goethe University Frankfurt, University Hospital, Institute of Clinical Pharmacology, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Eduard Resch
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
| | - Frank Behrens
- Fraunhofer Cluster of Excellence Immune Mediated Diseases CIMD, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany; Goethe University Frankfurt, University Hospital, Rheumatology, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Germany
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2
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Tacconelli E, Göpel S, Gladstone BP, Eisenbeis S, Hölzl F, Buhl M, Górska A, Cattaneo C, Mischnik A, Rieg S, Rohde AM, Kohlmorgen B, Falgenhauer J, Trauth J, Käding N, Kramme E, Biehl LM, Walker SV, Peter S, Gastmeier P, Chakraborty T, Vehreschild MJ, Seifert H, Rupp J, Kern WV. Development and validation of BLOOMY prediction scores for 14-day and 6-month mortality in hospitalised adults with bloodstream infections: a multicentre, prospective, cohort study. Lancet Infect Dis 2022; 22:731-741. [PMID: 35065060 DOI: 10.1016/s1473-3099(21)00587-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The burden of bloodstream infections remains high worldwide and cannot be confined to short-term in-hospital mortality. We aimed to develop scores to predict short-term and long-term mortality in patients with bloodstream infections. METHODS The Bloodstream Infection due to Multidrug-resistant Organisms: Multicenter Study on Risk Factors and Clinical Outcomes (BLOOMY) study is a prospective, multicentre cohort study at six German tertiary care university hospitals to develop and validate two scores assessing 14-day and 6-month mortality in patients with bloodstream infections. We excluded patients younger than 18 years or who were admitted to an ophthalmology or psychiatry ward. Microbiological, clinical, laboratory, treatment, and survival data were prospectively collected on day 0 and day 3 and then from day 7 onwards, weekly. Participants were followed up for 6 months. All patients in the derivation cohort who were alive on day 3 were included in the analysis. Predictive scores were developed using logistic regression and Cox proportional hazards models with a machine-learning approach. Validation was completed using the C statistic and predictive accuracy was assessed using sensitivity, specificity, and predictive values. FINDINGS Between Feb 1, 2017, and Jan 31, 2019, 2568 (61·5%) of 4179 eligible patients were recruited into the derivation cohort. The in-hospital mortality rate was 23·75% (95% CI 22·15-25·44; 610 of 2568 patients) and the 6-month mortality rate was 41·55% (39·54-43·59; 949 of 2284). The model predictors for 14-day mortality (C statistic 0·873, 95% CI 0·849-0·896) and 6-month mortality (0·807, 0·784-0·831) included age, body-mass index, platelet and leukocyte counts, C-reactive protein concentrations, malignancy (ie, comorbidity), in-hospital acquisition, and pathogen. Additional predictors were, for 14-day mortality, mental status, hypotension, and the need for mechanical ventilation on day 3 and, for 6-month mortality, focus of infection, in-hospital complications, and glomerular filtration rate at the end of treatment. The scores were validated in a cohort of 1023 patients with bloodstream infections, recruited between Oct 9, 2019, and Dec 31, 2020. The BLOOMY 14-day score showed a sensitivity of 61·32% (95% CI 51·81-70·04), a specificity of 86·36% (83·80-88·58), a positive predictive value (PPV) of 37·57% (30·70-44·99), and a negative predictive value (NPV) of 94·35% (92·42-95·80). The BLOOMY 6-month score showed a sensitivity of 69·93% (61·97-76·84), a specificity of 66·44% (61·86-70·73), a PPV of 40·82% (34·85-47·07), and a NPV of 86·97% (82·91-90·18). INTERPRETATION The BLOOMY scores showed good discrimination and predictive values and could support the development of protocols to manage bloodstream infections and also help to estimate the short-term and long-term burdens of bloodstream infections. FUNDING DZIF German Center for Infection Research. TRANSLATION For the German translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Evelina Tacconelli
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Policlinico GB Rossi, Verona, Italy; Cluster of Excellence EXC2124: Controlling Microbes to Fight Infections, Tübingen University, Tübingen, Germany.
| | - Siri Göpel
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Beryl P Gladstone
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Simone Eisenbeis
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Florian Hölzl
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany; Institute for Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Michael Buhl
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany; Institute for Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Clinical Hygiene, Medical Microbiology, and Infectiology, Paracelsus Medical University, Nuremberg, Germany
| | - Anna Górska
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Chiara Cattaneo
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Medicine II, University Hospital and Medical Centre Freiburg, Freiburg, Germany
| | - Alexander Mischnik
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Medicine II, University Hospital and Medical Centre Freiburg, Freiburg, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Siegbert Rieg
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Medicine II, University Hospital and Medical Centre Freiburg, Freiburg, Germany
| | - Anna M Rohde
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Britta Kohlmorgen
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jane Falgenhauer
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Janina Trauth
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine II, University Hospitals of Giessen and Marburg, Giessen, Germany
| | - Nadja Käding
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Evelyn Kramme
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Lena M Biehl
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sarah V Walker
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Silke Peter
- Institute for Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Petra Gastmeier
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Trinad Chakraborty
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Maria Jgt Vehreschild
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Harald Seifert
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Jan Rupp
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Winfried V Kern
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Medicine II, University Hospital and Medical Centre Freiburg, Freiburg, Germany
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3
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Paschold L, Simnica D, Willscher E, Vehreschild MJ, Dutzmann J, Sedding DG, Schultheiß C, Binder M. SARS-CoV-2-specific antibody rearrangements in prepandemic immune repertoires of risk cohorts and patients with COVID-19. J Clin Invest 2021; 131:142966. [PMID: 33064671 DOI: 10.1172/jci142966] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/14/2020] [Indexed: 12/29/2022] Open
Abstract
A considerable fraction of B cells recognize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with germline-encoded elements of their B cell receptor, resulting in the production of neutralizing and nonneutralizing antibodies. We found that antibody sequences from different discovery cohorts shared biochemical properties and could be retrieved across validation cohorts, confirming the stereotyped character of this naive response in coronavirus disease 2019 (COVID-19). While neutralizing antibody sequences were found independently of disease severity, in line with serological data, individual nonneutralizing antibody sequences were associated with fatal clinical courses, suggesting detrimental effects of these antibodies. We mined 200 immune repertoires from healthy individuals and 500 repertoires from patients with blood or solid cancers - all acquired prior to the pandemic - for SARS-CoV-2 antibody sequences. While the largely unmutated B cell rearrangements occurred in a substantial fraction of immune repertoires from young and healthy individuals, these sequences were less likely to be found in individuals over 60 years of age and in those with cancer. This reflects B cell repertoire restriction in aging and cancer, and may to a certain extent explain the different clinical courses of COVID-19 observed in these risk groups. Future studies will have to address if this stereotyped B cell response to SARS-CoV-2 emerging from unmutated antibody rearrangements will create long-lived memory.
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Affiliation(s)
- Lisa Paschold
- Department of Internal Medicine IV, Oncology/Hematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Donjete Simnica
- Department of Internal Medicine IV, Oncology/Hematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Edith Willscher
- Department of Internal Medicine IV, Oncology/Hematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Maria Jgt Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jochen Dutzmann
- Mid-German Heart Center, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel G Sedding
- Mid-German Heart Center, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christoph Schultheiß
- Department of Internal Medicine IV, Oncology/Hematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Hematology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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4
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Abstract
The association of gut microbiota dysbiosis with various human diseases is being substantiated with increasing evidence. Metabolites derived from both, microbiota and the human host play a central role in disease susceptibility and disease progression by extensively modulating host physiology and metabolism. Several of these metabolites have the potential to serve as diagnostic biomarkers for monitoring disease states in conjunction with intestinal microbiota dysbiosis. In this narrative review we evaluate the potential of trimethylamine-N-oxide, short-chain fatty acids, 3-indoxyl sulfate, p-cresyl sulfate, secondary bile acids, hippurate, human β-defensin-2, chromogranin A, secreted immunoglobulins and zonulin to serve as biomarkers for metabolite profiling and diagnostic suitability for dysbiosis and disease.
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Affiliation(s)
- Alina M Rüb
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Anastasia Tsakmaklis
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Stefanie K Gräfe
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Marie-Christine Simon
- Department of Nutrition & Food Sciences, Nutrition & Microbiota, University of Bonn, Bonn, Germany
| | - Maria Jgt Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Irene Wuethrich
- Department of Biosystems Science & Engineering, ETH Zurich, Basel, Switzerland
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5
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Keller JJ, Vehreschild MJ, Hvas CL, Jørgensen SM, Kupcinskas J, Link A, Mulder CJ, Goldenberg SD, Arasaradnam R, Sokol H, Gasbarrini A, Hoegenauer C, Terveer EM, Kuijper EJ, Arkkila P. Donated stool for faecal microbiota transplantation is not a drug, but guidance and regulation are needed. United European Gastroenterol J 2020; 8:353-354. [PMID: 32213039 DOI: 10.1177/2050640620910847] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Josbert J Keller
- Department of Gastroenterology, Haaglanden Medical Centre, The Hague, The Netherlands.,Department of Gastroenterology, Leiden University Medical Centre, Leiden, The Netherlands.,Netherlands Donor Faeces Bank, Leiden University Medical Centre, Leiden, The Netherlands
| | - Maria Jgt Vehreschild
- Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany.,Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany.,German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Christian L Hvas
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Simon Md Jørgensen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Juozas Kupcinskas
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alexander Link
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Chris Jj Mulder
- Department of Gastroenterology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Simon D Goldenberg
- Centre for Clinical Infection and Diagnostics Research (CIDR), King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Harry Sokol
- Sorbonne Université, INSERM, Saint-Antoine Research Center (CRSA), Paris, France.,French Group of Faecal Microbiota Transplantation (GFTF), Paris, France.,INRA, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France
| | - Antonio Gasbarrini
- Gastroenterology Area, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christoph Hoegenauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Elizabeth M Terveer
- Netherlands Donor Faeces Bank, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Medical Microbiology and Netherlands Donor Faeces Bank, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ed J Kuijper
- Netherlands Donor Faeces Bank, Leiden University Medical Centre, Leiden, The Netherlands.,Centre for Microbiota Analysis and Therapeutics, Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Perttu Arkkila
- Department of Gastroenterology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
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6
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Keller JJ, Vehreschild MJ, Hvas CL, Jørgensen SM, Kupciskas J, Link A, Mulder CJ, Goldenberg SD, Arasaradnam R, Sokol H, Gasbarrini A, Hoegenauer C, Terveer EM, Kuijper EJ, Arkkila P. Stool for fecal microbiota transplantation should be classified as a transplant product and not as a drug. United European Gastroenterol J 2019; 7:1408-1410. [PMID: 31839966 DOI: 10.1177/2050640619887579] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Josbert J Keller
- Department of Gastroenterology, Haaglanden Medical Center, The Hague, The Netherlands, and Leiden University Medical Center, Leiden, The Netherlands.,Netherlands Donor Feces Bank, Leiden University Medical Center
| | - Maria Jgt Vehreschild
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), German Centre for Infection Research (DZIF), partner site Bonn - Cologne, Cologne, Germany; Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christian L Hvas
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Simon Md Jørgensen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Jouzas Kupciskas
- Department of Gastroenterology and Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alexander Link
- Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany
| | - Chris Jj Mulder
- Chris Mulder, Department of Gastroenterology, Free University Medical Center, Amsterdam, The Netherlands
| | - Simon D Goldenberg
- Centre for Clinical Infection and Diagnostics Research (CIDR), King's College London and Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Harry Sokol
- Sorbonne Université, INSERM, Saint-Antoine Research Center (CRSA), Paris, France.,French Group of Fecal Microbiota Transplantation (GFTF).,INRA, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France
| | - Antonio Gasbarrini
- Gastroenterology Area, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christoph Hoegenauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Elizabeth M Terveer
- Department of Medical Microbiology and Netherlands Donor Feces Bank, Leiden University Medical Centre, Leiden, The Netherlands.,Netherlands Donor Feces Bank, Leiden University Medical Center
| | - Ed J Kuijper
- Centre for Microbiota Analysis and Therapeutics, Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands.,Netherlands Donor Feces Bank, Leiden University Medical Center
| | - Perttu Arkkila
- Helsinki University Hospital and Helsinki University, Helsinki, Finland
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7
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Peri R, Aguilar RC, Tüffers K, Erhardt A, Link A, Ehlermann P, Angeli W, Frank T, Storr M, Glück T, Sturm A, Rosien U, Tacke F, Bachmann O, Solbach P, Stallmach A, Goeser F, Vehreschild MJ. The impact of technical and clinical factors on fecal microbiota transfer outcomes for the treatment of recurrent Clostridioides difficile infections in Germany. United European Gastroenterol J 2019; 7:716-722. [PMID: 31210950 DOI: 10.1177/2050640619839918] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/25/2019] [Indexed: 01/05/2023] Open
Abstract
Introduction Fecal microbiota transfer (FMT) is highly effective in the treatment and prevention of recurrent Clostridioides difficile infection (rCDI) with cure rates of about 80% after a single treatment. Nevertheless, the reasons for failure in the remaining 20% remain largely elusive. The aim of the present study was to investigate different potential clinical predictors of response to FMT in Germany. Methods Information was extracted from the MicroTrans Registry (NCT02681068), a retrospective observational multicenter study, collecting data from patients undergoing FMT for recurrent or refractory CDI in Germany. We performed binary logistic regression with the following covariates: age, gender, ribotype 027, Eastern Co-operative Oncology Group score, immunosuppression, preparation for FMT by use of proton pump inhibitor, antimotility agents and bowel lavage, previous recurrences, severity of CDI, antibiotic induction treatment, fresh or frozen FMT preparation, and route of application. Results Treatment response was achieved in 191/240 evaluable cases (79.6%) at day 30 (D30) post FMT and 78.1% at day 90 (D90) post FMT. Assessment of clinical predictors for FMT failure by forward and confirmatory backward-stepwise regression analysis yielded higher age as an independent predictor of FMT failure (p = 0.001; OR 1.060; 95%CI 1.025-1.097). Conclusion FMT in Germany is associated with high cure rates at D30 and D90. No specific pre-treatment, preparation or application strategy had an impact on FMT success. Only higher age was identified as an independent risk factor for treatment failure. Based on these and external findings, future studies should focus on the assessment of microbiota and microbiota-associated metabolites as factors determining FMT success.
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Affiliation(s)
- Rosemarie Peri
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Bonn-Cologne, Germany
| | - Rebeca Cruz Aguilar
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Bonn-Cologne, Germany
| | - Kester Tüffers
- Department II of Internal Medicine, St. Johannes Hospital, Dortmund, Germany
| | - Andreas Erhardt
- Department II of Internal Medicine, St. Petrus Hospital, Wuppertal, Germany
| | - Alexander Link
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Philipp Ehlermann
- Department of Internal Medicine, SRH Kurpfalzkrankenhaus Heidelberg, Heidelberg, Germany
| | - Wolfgang Angeli
- Department of Gastroenterology, Kempten-Oberallgäu Clinic, Kempten, Germany
| | - Thorsten Frank
- Department of Internal Medicine II, St. Katharinen Hospital, Frechen, Germany
| | - Martin Storr
- Department of Gastroenterology, Ludwig-Maximilians-University, Munich, and Center of Endoscopy, Starnberg, Germany
| | - Thomas Glück
- Department of Internal Medicine, Trostberg Clinic, Trostberg, Germany
| | - Andreas Sturm
- Department of Internal Medicine and Gastroenterology, DRK Kliniken Westend, Berlin, Germany
| | - Ulrich Rosien
- Visceral Medical Center, Israelitic Hospital Hamburg, Hamburg, Germany
| | - Frank Tacke
- Department of Medicine III, University Hospital Aachen, Aachen, Germany
| | - Oliver Bachmann
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Centre for Infection Research (DZIF), Hannover, Germany
| | - Philipp Solbach
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,German Centre for Infection Research (DZIF), Hannover, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectiology), University Hospital Jena, Jena, Germany
| | - Felix Goeser
- German Centre for Infection Research (DZIF), Bonn-Cologne, Germany.,Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Maria Jgt Vehreschild
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Bonn-Cologne, Germany.,Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany These authors contributed equally
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8
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Hamprecht A, Buchheidt D, Vehreschild JJ, Cornely OA, Spiess B, Plum G, Halbsguth TV, Kutsch N, Stippel D, Kahl P, Persigehl T, Steinbach A, Bos B, Hallek M, Vehreschild MJ. Azole-resistant invasive aspergillosis in a patient with acute myeloid leukaemia in Germany. Euro Surveill 2012. [DOI: 10.2807/ese.17.36.20262-en] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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
We report the first culture-proven case of invasive aspergillosis (IA) caused by azole-resistant Aspergillus fumigatus in a patient with acute myeloid leukaemia in Germany. IA presented as breakthrough infection under posaconazole prophylaxis. Analysis of the resistance mechanism revealed the TR/L98H mutation in the cyp51A gene, which indicates an environmental origin of the strain. This case underscores the need for monitoring azole resistance in Aspergillus spp. and for routine susceptibility testing of moulds.
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Affiliation(s)
- A Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - D Buchheidt
- Third Department of Internal Medicine, Haematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany
| | - J J Vehreschild
- First Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - O A Cornely
- Clinical Trials Centre Cologne, ZKS Köln (BMBF 01KN1106), University of Cologne, Cologne, Germany
- First Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - B Spiess
- Third Department of Internal Medicine, Haematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany
| | - G Plum
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - T V Halbsguth
- First Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - N Kutsch
- First Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - D Stippel
- Department of General, Visceral and Cancer Surgery, University of Cologne, Germany
| | - P Kahl
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - T Persigehl
- Department of Radiology, University Hospital Cologne, Cologne Germany
| | - A Steinbach
- First Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - B Bos
- First Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - M Hallek
- First Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - M J Vehreschild
- First Department of Internal Medicine, University of Cologne, Cologne, Germany
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9
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Hamprecht A, Buchheidt D, Vehreschild JJ, Cornely OA, Spiess B, Plum G, Halbsguth TV, Kutsch N, Stippel D, Kahl P, Persigehl T, Steinbach A, Bos B, Hallek M, Vehreschild MJ. Azole-resistant invasive aspergillosis in a patient with acute myeloid leukaemia in Germany. Euro Surveill 2012; 17:20262. [PMID: 22971327] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
We report the first culture-proven case of invasive aspergillosis (IA) caused by azole-resistant Aspergillus fumigatus in a patient with acute myeloid leukaemia in Germany. IA presented as breakthrough infection under posaconazole prophylaxis. Analysis of the resistance mechanism revealed the TR/L98H mutation in the cyp51A gene, which indicates an environmental origin of the strain. This case underscores the need for monitoring azole resistance in Aspergillus spp. and for routine susceptibility testing of moulds.
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Affiliation(s)
- A Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
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