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Stempfl J, Schumacher F, Doering M, Wolf H, Streithoff F, Tacke J, Fahn H, Ehlermann P, Raake P, Klingel K, Elsner D, Groebner M. [Atrioventricular block and left ventricular wall mobility disorder in a 44-year-old female patient : A case report of a rarity with pitfalls]. Internist (Berl) 2019; 60:973-981. [PMID: 31123761 DOI: 10.1007/s00108-019-0608-5] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Eosinophilic myocarditis is a rare condition with good treatment options, which can be difficult to diagnose. The clinical presentation can vary from asymptomatic to life-threatening forms. This article describes the case of a 44-year-old woman who suffered from vertigo, chest pain and dyspnea. The woman presented with an intermittent atrioventricular (AV) block II Mobitz type II° and mild impairment of left ventricular ejection fraction. Hypereosinophilia in the peripheral blood, cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy led to the diagnosis of eosinophilic myocarditis, most likely as a result of an allergic reaction to Aspergillus fumigatus. A general treatment recommendation cannot be made due to the lack of evidence-based guidelines; however, recent scientific studies confirmed timely, high-dose steroid administration over several months to be the mainstay of treatment of eosinophilic myocarditis. The following article may be helpful in the early diagnosis and treatment of this underdiagnosed and insidious disease.
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Affiliation(s)
- J Stempfl
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland.
| | - F Schumacher
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - M Doering
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - H Wolf
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - F Streithoff
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - J Tacke
- Institut für diagnostische und interventionelle Radiologie/Neuroradiologie, Klinikum Passau, Passau, Deutschland
| | - H Fahn
- Klinik für Gastroenterologie, Hepatologie, Nephrologie, Rheumatologie und Stoffwechselerkrankungen, Klinikum Passau, Passau, Deutschland
| | - P Ehlermann
- Klinik für Kardiologie, Medizinische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - P Raake
- Klinik für Kardiologie, Medizinische Universitätsklinik Heidelberg, Heidelberg, Deutschland
| | - K Klingel
- Kardiopathologie, Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - D Elsner
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
| | - M Groebner
- 3. Medizinische Klinik, Klinik für Kardiologie, Herzzentrum, Klinikum Passau, Innstraße 76, 94032, Passau, Deutschland
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Nowack M, Groebner M, Wolf H. Seltene Erstmanifestation einer Sarkoidose am Herzen mit infarktähnlichem Aspekt in der Magnetresonanztomografie. ROFO-FORTSCHR RONTG 2017; 189:250-252. [DOI: 10.1055/s-0042-118959] [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: 10/20/2022]
Affiliation(s)
- Marisa Nowack
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Passau, Germany
| | | | - Herbert Wolf
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Passau, Germany
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Uebleis C, Groebner M, von Ziegler F, Becker A, Rischpler C, Tegtmeyer R, Becker C, Lehner S, Haug AR, Cumming P, Bartenstein P, Franz WM, Hacker M. Combined anatomical and functional imaging using coronary CT angiography and myocardial perfusion SPECT in symptomatic adults with abnormal origin of a coronary artery. Int J Cardiovasc Imaging 2011; 28:1763-74. [PMID: 22147107 DOI: 10.1007/s10554-011-9995-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 12/01/2011] [Indexed: 11/30/2022]
Abstract
There has been a lack of standardized workup guidelines for patients with congenital abnormal origin of a coronary artery from the opposite sinus (ACAOS). We aimed to evaluate the use of cardiac hybrid imaging using multi-detector row CT (MDCT) for coronary CT angiography (Coronary CTA) and stress-rest myocardial perfusion SPECT (MPS) for comprehensive diagnosis of symptomatic adult patients with ACAOS. Seventeen symptomatic patients (12 men; 54 ± 13 years) presenting with ACAOS underwent coronary CTA and MPS. Imaging data were analyzed by conventional means, and with additional use of 3D image fusion to allocate stress induced perfusion defects (PD) to their supplying coronary arteries. An anomalous RCA arose from the left anterior sinus in eight patients, an abnormal origin from the right sinus was detected in nine patients (5 left coronary arteries, LCA and 4 LCx). Five of the 17 patients (29%) demonstrated a reversible PD in MPS. There was no correlation between the anatomical variants of ACAOS and the presence of myocardial ischemia. Image fusion enabled the allocation of reversible PD to the anomalous vessel in three patients (two cases in the RCA and the other in the LCA territory); PD in two patients were allocated to the territory of artery giving rise to the anomalies, rather than the anomalies themselves. In a small cohort of adult symptomatic patients with ACAOS anomaly there was no relation found between the specific anatomical variant and the appearance of stress induced myocardial ischemia using cardiac hybrid imaging.
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Affiliation(s)
- C Uebleis
- Department of Nuclear Medicine, University of Munich, Marchioninistr 15, 81377 Munich, Germany
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Dimomeletis I, Deindl E, Zaruba M, Groebner M, Zahler S, Laslo SM, David R, Kostin S, Deutsch MA, Assmann G, Mueller-Hoecker J, Feuring-Buske M, Franz WM. Assessment of human MAPCs for stem cell transplantation and cardiac regeneration after myocardial infarction in SCID mice. Exp Hematol 2010; 38:1105-14. [PMID: 20621157 DOI: 10.1016/j.exphem.2010.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Clinical studies suggest that transplantation of total bone marrow (BM) after myocardial infarction (MI) is feasible and potentially effective. However, focusing on a defined BM-derived stem cell type may enable a more specific and optimized treatment. Multilineage differentiation potential makes BM-derived multipotent adult progenitor cells (MAPCs) a promising stem cell pool for regenerative purposes. We analyzed the cardioregenerative potential of human MAPCs in a murine model of myocardial infarction. MATERIALS AND METHODS Human MAPCs were selected by negative depletion of CD45(+)/glycophorin(+) BM cells and plated on fibronectin-coated dishes. In vitro, stem cells were analyzed by reverse transcription polymerase chain reaction. In vivo, we transplanted human MAPCs (5 × 10(5)) by intramyocardial injection after MI in severe combined immunodeficient (SCID) beige mice. Six and 30 days after the surgical procedure, pressure-volume relationships were investigated in vivo. Heart tissues were analyzed immunohistochemically. RESULTS Reverse transcription polymerase chain reaction experiments on early human MAPC passages evidenced an expression of Oct-4, a stem cell marker indicating pluripotency. In later passages, cardiac markers (Nkx2.5, GATA4, MLC-2v, MLC-2a, ANP, cTnT, cTnI,) and smooth muscle cell markers (SMA, SM22α) were expressed. Transplantation of human MAPCs into the ischemic border zone after MI resulted in an improved cardiac function at day 6 (ejection fraction, 26% vs 20%) and day 30 (ejection fraction, 30% vs 23%). Confirmation of human MAPC marker vimentin in immunohistochemistry demonstrated that human MAPC integrated in the peri-infarct region. The proliferation marker Ki67 was absent in immunohistochemistry and teratoma formation was not found, indicating no tumorous potential of transplanted human MAPCs in the tumor-sensitive SCID model. CONCLUSIONS Transplantation of human MAPCs after MI ameliorates myocardial function, which may be explained by trophic effects of human MAPCs. Lack of evidence of tumorous potential in the tumor-sensitive SCID model indicates that human MAPCs may deliver an effective and safe stem cell pool for potential treatment of ischemic heart disease.
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Affiliation(s)
- Ilias Dimomeletis
- Department of General and Vascular Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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Huber BC, Fischer R, Brunner S, Groebner M, Rischpler C, Segeth A, Zaruba MM, Wollenweber T, Hacker M, Franz WM. Comparison of parathyroid hormone and G-CSF treatment after myocardial infarction on perfusion and stem cell homing. Am J Physiol Heart Circ Physiol 2010; 298:H1466-71. [PMID: 20207820 DOI: 10.1152/ajpheart.00033.2010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mobilization of stem cells by granulocyte colony-stimulating factor (G-CSF) was shown to have protective effects after myocardial infarction (MI); however, clinical trials failed to be effective. In search for alternative cytokines, parathyroid hormone (PTH) was recently shown to promote cardiac repair by enhanced neovascularization and cell survival. To compare the impact of the two cytokines G-CSF and PTH on myocardial perfusion, mice were noninvasively and repetitively investigated by pinhole single-photon emission computed tomography (SPECT) after MI. Mobilization and homing of bone marrow-derived stem cells (BMCs) was analyzed by fluorescence-activated cell sorter (FACS) analysis. Mice (C57BL/6J) were infarcted by left anterior descending artery ligation. PTH (80 mug/kg) and G-CSF (100 mug/kg) were injected for 5 days. Perfusion defects were determined by (99m)Tc-sestamibi SPECT at days 6 and 30 after MI. The number of BMCs characterized by Lin(-)/Sca-1(+)/c-kit(+) cells in peripheral blood and heart was analyzed by FACS. Both G-CSF and PTH treatment resulted in an augmented mobilization of BMCs in the peripheral blood. Contrary to G-CSF and controls, PTH and the combination showed significant migration of BMCs in ischemic myocardium associated with a significant reduction of perfusion defects from day 6 to day 30. A combination of both cytokines had no additional effects on migration and perfusion. In our preclinical model, SPECT analyses revealed the functional potential of PTH reducing size of infarction together with an enhanced homing of BMCs to the myocardium in contrast to G-CSF. A combination of both cytokines did not improve the functional outcome, suggesting clinical applications of PTH in ischemic heart diseases.
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Affiliation(s)
- Bruno C Huber
- Department of Internal Medicine I, Ludwig-Maximilians-University, Campus Grosshadern, Marchioninistrasse 15, Munich, Germany
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Brunner S, Huber BC, Fischer R, Groebner M, Hacker M, David R, Zaruba MM, Vallaster M, Rischpler C, Wilke A, Gerbitz A, Franz WM. G-CSF treatment after myocardial infarction: impact on bone marrow-derived vs cardiac progenitor cells. Exp Hematol 2008; 36:695-702. [PMID: 18346841 DOI: 10.1016/j.exphem.2008.01.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 10/31/2007] [Accepted: 01/23/2008] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Besides its classical function in the field of autologous and allogenic stem cell transplantation, granulocyte colony-stimulating factor (G-CSF) was shown to have protective effects after myocardial infarction (MI) by mobilization of bone marrow-derived progenitor cells (BMCs) and in addition by activation of multiple signaling pathways. In the present study, we focused on the impact of G-CSF on migration of BMCs and the impact on resident cardiac cells after MI. MATERIALS AND METHODS Mice (C57BL/6J) were sublethally irradiated, and BM from green fluorescent protein (GFP)-transgenic mice was transplanted. Coronary artery ligation was performed 10 weeks later. G-CSF (100 microg/kg) was daily injected for 6 days. Subpopulations of enhanced GFP(+) cells in peripheral blood, bone marrow, and heart were characterized by flow cytometry. Growth factor expression in the heart was analyzed by quantitative real-time polymerase chain reaction. Perfusion was investigated in vivo by gated single photon emission computed tomography (SPECT). RESULTS G-CSF-treated animals revealed a reduced migration of c-kit(+) and CXCR-4(+) BMCs associated with decreased expression levels of the corresponding growth factors, namely stem cell factor and stromal-derived factor-1 alpha in ischemic myocardium. In contrast, the number of resident cardiac Sca-1(+) cells was significantly increased. However, SPECT-perfusion showed no differences in infarct size between G-CSF-treated and control animals 6 days after MI. CONCLUSION Our study shows that G-CSF treatment after MI reduces migration capacity of BMCs into ischemic tissue, but increases the number of resident cardiac cells. To optimize homing capacity a combination of G-CSF with other agents may optimize cytokine therapy after MI.
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Affiliation(s)
- Stefan Brunner
- Ludwig-Maximilians-University, Klinikum Grosshadern, Medical Department I, Munich, Germany
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Groebner M, Deindl L, Dimomeletis I, Zaruba M, Kostin S, Deutsch M, Assmann G, Mueller-Hocker J, Feuring-Buske M, Franz W. Stem cell transplantation and cardiac regeneration after myocardial infarction in SCID mice: Human MAPCs are effective and safe. J Stem Cells Regen Med 2007; 2:205-206. [PMID: 24693003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- M Groebner
- These authors contributed equally to this work ; Medical Department I, Klinikum Groshadern, Ludwig Maximilians University (LMU) , Munich, Germany
| | - L Deindl
- These authors contributed equally to this work ; Insitute of Surgical Research , LMU, Munich, Germany
| | - I Dimomeletis
- Medical Department I, Klinikum Groshadern, Ludwig Maximilians University (LMU) , Munich, Germany
| | - Mm Zaruba
- Medical Department I, Klinikum Groshadern, Ludwig Maximilians University (LMU) , Munich, Germany
| | - S Kostin
- Max Planck Institute Bad Nauheim , Germany
| | - Ma Deutsch
- Medical Department I, Klinikum Groshadern, Ludwig Maximilians University (LMU) , Munich, Germany
| | - G Assmann
- Institute of Pathology , LMU, Munich, Germany
| | | | - M Feuring-Buske
- Medical Department III, Klinikum Groshadern , LMU, Munich, Germany
| | - Wm Franz
- Medical Department I, Klinikum Groshadern, Ludwig Maximilians University (LMU) , Munich, Germany
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Groebner M, David R, Franz WM. [Embryonic stem cells. Future perspectives]. Internist (Berl) 2006; 47:502, 504-8. [PMID: 16609891 DOI: 10.1007/s00108-006-1613-z] [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: 10/24/2022]
Abstract
Embryonic stem cells (ES cells) are able to differentiate into any cell type, and therefore represent an excellent source for cellular replacement therapies in the case of widespread diseases, for example heart failure, diabetes, Parkinson's disease and spinal cord injury. A major prerequisite for their efficient and safe clinical application is the availability of pure populations for direct cell transplantation or tissue engineering as well as the immunological compatibility of the transplanted cells. The expression of human surface markers under the control of cell type specific promoters represents a promising approach for the selection of cardiomyocytes and other cell types for therapeutic applications. The first human clinical trial using ES cells will start in the United States this year.
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Affiliation(s)
- M Groebner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, München-Grosshadern
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David R, Groebner M, Franz WM. Magnetic Cell Sorting Purification of Differentiated Embryonic Stem Cells Stably Expressing Truncated Human CD4 as Surface Marker. Stem Cells 2005; 23:477-82. [PMID: 15790768 DOI: 10.1634/stemcells.2004-0177] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Embryonic stem (ES) cells offer great potential in regenerative medicine and tissue engineering. Clinical applications are still hampered by the lack of protocols for gentle, high-yield isolation of specific cell types for transplantation expressing no immunogenic markers. We describe labeling of stably transfected ES cells expressing a human CD4 molecule lacking its intracellular domain (DeltaCD4) under control of the phosphoglycerate kinase promoter for magnetic cell sorting (MACS). To track the labeled ES cells, we fused DeltaCD4 to an intracellular enhanced green fluorescent protein domain (DeltaCD4EGFP). We showed functionality of the membrane-bound fluorescent fusion protein and its suitability for MACS leading to purities greater than 97%. Likewise, expression of DeltaCD4 yielded up to 98.5% positive cells independently of their differentiation state. Purities were not limited by the initial percentage of DeltaCD4(+) cells, ranging from 0.6%-16%. The viability of MACS-selected cells was demonstrated by reaggregation and de novo formation of embryoid bodies developing all three germ layers. Thus, expression of DeltaCD4 in differentiated ES cells may enable rapid, high-yield purification of a desired cell type for tissue engineering and transplantation studies.
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Affiliation(s)
- Robert David
- Klinikum Grosshadern, Marchioninistrasse 15, 81377 Münich, Germany
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