1
|
Busch HJ, Wolfrum S, Michels G, Baumgärtel M, Bodmann KF, Buerke M, Burst V, Enghard P, Ertl G, Fach WA, Hanses F, Heppner HJ, Hermes C, Janssens U, John S, Jung C, Karagiannidis C, Kiehl M, Kluge S, Koch A, Kochanek M, Korsten P, Lepper PM, Merkel M, Müller-Werdan U, Neukirchen M, Pfeil A, Riessen R, Rottbauer W, Schellong S, Scherg A, Sedding D, Singler K, Thieme M, Trautwein C, Willam C, Werdan K. [Clinical acute and emergency medicine curriculum-focus on internal medicine : Recommendations for advanced training in internal medicine in the emergency department]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01113-3. [PMID: 38625382 DOI: 10.1007/s00063-024-01113-3] [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] [Accepted: 01/31/2024] [Indexed: 04/17/2024]
Abstract
In Germany, physicians qualify for emergency medicine by combining a specialty medical training-e.g. internal medicine-with advanced training in emergency medicine according to the statutes of the State Chambers of Physicians largely based upon the Guideline Regulations on Specialty Training of the German Medical Association. Internal medicine and their associated subspecialities represent an important column of emergency medicine. For the internal medicine aspects of emergency medicine, this curriculum presents an overview of knowledge, skills (competence levels I-III) as well as behaviours and attitudes allowing for the best treatment of patients. These include general aspects (structure and process quality, primary diagnostics and therapy as well as indication for subsequent treatment; resuscitation room management; diagnostics and monitoring; general therapeutic measures; hygiene measures; and pharmacotherapy) and also specific aspects concerning angiology, endocrinology, diabetology and metabolism, gastroenterology, geriatric medicine, hematology and oncology, infectiology, cardiology, nephrology, palliative care, pneumology, rheumatology and toxicology. Publications focussing on contents of advanced training are quoted in order to support this concept. The curriculum has primarily been written for internists for their advanced emergency training, but it may generally show practising emergency physicians the broad spectrum of internal medicine diseases or comorbidities presented by patients attending the emergency department.
Collapse
Affiliation(s)
- Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
| | - Matthias Baumgärtel
- Klinikum Nürnberg, Universitätsklinik für Innere Medizin 3 der Paracelsus Medizinischen Privatuniversität, Nürnberg, Deutschland
| | | | - Michael Buerke
- Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - Volker Burst
- Schwerpunkt Klinische Akut- und Notfallmedizin und Klinik II für Innere Medizin, Uniklinik Köln, Köln, Deutschland
| | - Philipp Enghard
- Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin, Berlin, Deutschland
| | - Georg Ertl
- Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Wolf Andreas Fach
- MVZ CCB am AGAPLESION Bethanien Krankenhaus, Frankfurt (Main), Deutschland
| | - Frank Hanses
- Interdisziplinäre Notaufnahme, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Hans Jürgen Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken und Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth, Deutschland
| | | | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Stefan John
- Medizinische Klinik 8, Abteilung für Internistische Intensivmedizin, Klinikum Nürnberg-Süd, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - Christian Jung
- Klinik für Kardiologie, Pneumologie und Angiologie des Universitätsklinikums Düsseldorf, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland
| | - Christian Karagiannidis
- ARDS und ECMO Zentrum Köln-Merheim, Kliniken Köln und Universität Witten/Herdecke, Köln, Deutschland
| | - Michael Kiehl
- Medizinische Klinik I, Klinikum Frankfurt (Oder), Frankfurt (Oder), Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Alexander Koch
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | | | - Peter Korsten
- Klinik für Rheumatologie und Klinische Immunologie, St. Josef-Stift Sendenhorst, Sendenhorst, Deutschland
| | - Philipp M Lepper
- Klinik für Akut- und Notfallmedizin, Universität und Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | | | - Ursula Müller-Werdan
- Medizinische Klinik für Geriatrie und Altersmedizin, der Charité - Universitätsmedizin Berlin und EGZB, Berlin, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena, Deutschland
| | - Reimer Riessen
- Internistische Intensivstation 93, Dept. f. Innere Medizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Wolfgang Rottbauer
- Klinik für Innere Medizin II (Kardiologie, Angiologie, Pneumologie, Intensivmedizin, Sport- und Rehabilitationsmedizin), Universitätsklinikum Ulm, Ulm, Deutschland
| | | | | | - Daniel Sedding
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06097, Halle (Saale), Deutschland
| | - Katrin Singler
- Universitätsklinik für Innere Medizin - Geriatrie & Institut für Biomedizin des Alterns, Klinikum Nürnberg Paracelsus Medizinische Privatuniversität & Friedrich-Alexander Universität Erlangen-Nürnberg, Nürnberg & Erlangen, Deutschland
| | - Marcus Thieme
- Abteilung Innere Medizin und REGIOMED Gefäßzentrum, REGIOMED Klinikum Sonneberg, Sonneberg und Klinik für Innere Medizin I, Universitätsklinikum Jena, Jena, Deutschland
| | | | - Carsten Willam
- Medizinische Klinik 4, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Karl Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06097, Halle (Saale), Deutschland.
| |
Collapse
|
2
|
Yee AMF, Baker MC, Frame EW, Galloway J, Korsten P. Methotrexate in Cardiac Sarcoidosis: Absence of Evidence Is Not Evidence of Absence. JACC Cardiovasc Imaging 2024; 17:465. [PMID: 38569797 DOI: 10.1016/j.jcmg.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 04/05/2024]
|
3
|
Skowasch D, Bonella F, Buschulte K, Kneidinger N, Korsten P, Kreuter M, Müller-Quernheim J, Pfeifer M, Prasse A, Quadder B, Sander O, Schupp JC, Sitter H, Stachetzki B, Grohé C. [Therapeutic Pathways in Sarcoidosis. A Position Paper of the German Society of Respiratory Medicine (DGP)]. Pneumologie 2024; 78:151-166. [PMID: 38408486 DOI: 10.1055/a-2259-1046] [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: 02/28/2024]
Abstract
The present recommendations on the therapy of sarcoidosis of the German Respiratory Society (DGP) was written in 2023 as a German-language supplement and update of the international guidelines of the European Respiratory Society (ERS) from 2021. It contains 5 PICO questions (Patients, Intervention, Comparison, Outcomes) agreed in the consensus process, which are explained in the background text of the four articles: Confirmation of diagnosis and monitoring of the disease under therapy, general therapy recommendations, therapy of cutaneous sarcoidosis, therapy of cardiac sarcoidosis.
Collapse
Affiliation(s)
- Dirk Skowasch
- Medizinische Klinik und Poliklinik II - Sektion Pneumologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Klinik für Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen, Essen, Deutschland
| | - Katharina Buschulte
- Zentrum für seltene und interstitielle Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg und Deutsches Zentrum für Lungenforschung (DZL) - Heidelberg, Deutschland
| | - Nikolaus Kneidinger
- Lungentransplantation und interstitielle Lungenerkrankungen, Medizinische Klinik und Poliklinik V, München, Deutschland
| | - Peter Korsten
- Klinische Rheumatologie und rheumatologische Intensivmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Michael Kreuter
- Lungenzentrum Mainz, Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz und Klinik für Pneumologie, Zentrum für Thoraxerkrankungen, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Joachim Müller-Quernheim
- Klinik für Pneumologie, Department Innere Medizin, Uniklinik Freiburg, Medizinische Fakultät, Freiburg, Deutschland
| | - Michael Pfeifer
- Innere Medizin, Lungen- und Bronchialheilkunde, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - Antje Prasse
- Lungenfibrose und interstitielle Lungenerkrankungen, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Bernd Quadder
- Deutsche Sarkoidose-Vereinigung, gemeinnütziger e. V. (DSV)
| | - Oliver Sander
- Klinik für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Jonas C Schupp
- Respiratory and Infectious Medicine, Hannover Medical School, Hannover, Germany
| | - Helmut Sitter
- Institut für Chirurgische Forschung, Fachbereich Medizin, Philipps-Universität Marburg, Marburg, Deutschland
| | | | - Christian Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik, Berlin, Deutschland
| |
Collapse
|
4
|
Godoy I, Korsten P, Perry SE. Mother of all bonds: Influences on spatial association across the lifespan in capuchins. Dev Sci 2024:e13486. [PMID: 38414216 DOI: 10.1111/desc.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 02/29/2024]
Abstract
In humans, being more socially integrated is associated with better physical and mental health and/or with lower mortality. This link between sociality and health may have ancient roots: sociality also predicts survival or reproduction in other mammals, such as rats, dolphins, and non-human primates. A key question, therefore, is which factors influence the degree of sociality over the life course. Longitudinal data can provide valuable insight into how environmental variability drives individual differences in sociality and associated outcomes. The first year of life-when long-lived mammals are the most reliant on others for nourishment and protection-is likely to play an important role in how individuals learn to integrate into groups. Using behavioral, demographic, and pedigree information on 376 wild capuchin monkeys (Cebus imitator) across 20 years, we address how changes in group composition influence spatial association. We further try to determine the extent to which early maternal social environments have downstream effects on sociality across the juvenile and (sub)adult stages. We find a positive effect of early maternal spatial association, where female infants whose mothers spent more time around others also later spent more time around others as juveniles and subadults. Our results also highlight the importance of kin availability and other aspects of group composition (e.g., group size) in dynamically influencing spatial association across developmental stages. We bring attention to the importance of-and difficulty in-determining the social versus genetic influences that parents have on offspring phenotypes. RESEARCH HIGHLIGHTS: Having more maternal kin (mother and siblings) is associated with spending more time near others across developmental stages in both male and female capuchins. Having more offspring as a subadult or adult female is additionally associated with spending more time near others. A mother's average sociality (time near others) is predictive of how social her daughters (but not sons) become as juveniles and subadults (a between-mother effect). Additional variation within sibling sets in this same maternal phenotype is not predictive of how social they become later relative to each other (no within-mother effect).
Collapse
Affiliation(s)
- Irene Godoy
- Department of Animal Behaviour, Bielefeld University, Bielefeld, Germany
- Lomas Barbudal Monkey Project, Lomas Barbudal Biological Reserve, Guanacaste, Costa Rica
| | - Peter Korsten
- Department of Life Sciences, Aberystwyth University, Aberystwyth, UK
| | - Susan E Perry
- Lomas Barbudal Monkey Project, Lomas Barbudal Biological Reserve, Guanacaste, Costa Rica
- Department of Anthropology, University of California, Los Angeles, California, USA
| |
Collapse
|
5
|
Hakroush S, Korsten P, Ströbel P, Tampe B. Relevance of histopathological findings for predictive scoring of short-term treatment response to plasma exchange in severe ANCA-associated renal vasculitides. Front Immunol 2024; 15:1340999. [PMID: 38380320 PMCID: PMC10878170 DOI: 10.3389/fimmu.2024.1340999] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Rapidly progressive glomerulonephritis (RPGN) is characterized by a rapid loss of kidney function, affecting both renal and overall patient survival. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a small vessel vasculitis affecting multiple organ systems including the kidney, and among most frequent causes of RPGN. We here aimed to validate a recently described scoring system for short-term treatment response to therapeutic plasma exchange (PLEX) in a well-characterized and independent cohort of severe renal AAV presenting with RPGN. Furthermore, we compared this scoring with established classification systems in renal AAV including histopathological findings. Methods We here directly compare the scoring system with retrospective data about PLEX treatment in our own clinical practice and according to current recommendations in a cohort of 53 patients with severe AAV presenting with RPGN confirmed by kidney biopsy. Results We here confirm that PLEX scoring is capable to identify patients at risk for short-term poor outcome in severe AAV presenting with RPGN (p<0.0001). Furthermore, multiple stepwise regression analysis revealed that the PLEX score with renal biopsy performed best to predict poor outcome in this patient population (p<0.0001). Conclusion Our observations underscore the relevance of performing a kidney biopsy in this patient population that is often challenged in the setting of intensive care treatment, requirement of KRT with need for anticoagulation and bleeding risk. Therefore, validation of our observations and this recent scoring system for treatment response to PLEX in independent cohorts would be of great clinical relevance in the treatment of patients with severe AAV presenting with RPGN.
Collapse
Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
- SYNLAB Pathology Hannover, SYNLAB Holding Germany, Augsburg, Germany
- Institute of Pathology, Klinikum Bremen-Mitte, School of Medicine of the University of Göttingen, Bremen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
- Department of Rheumatology and Clinical Immunology, St Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
6
|
Korsten P, Hakroush S, Rödel R, Tampe B. Tongue necrosis in anti-neutrophil myeloperoxidase antibody-associated vasculitis. Rheumatology (Oxford) 2024; 63:e61-e62. [PMID: 37458489 PMCID: PMC10834935 DOI: 10.1093/rheumatology/kead342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center, Göttingen, Germany
| | - Samy Hakroush
- Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Ralph Rödel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center, Göttingen, Germany
| |
Collapse
|
7
|
Baier E, Kluge IA, Hakroush S, Korsten P, Tampe B. Serum Uric Acid Associates with Systemic Complement C3 Activation in Severe ANCA-Associated Renal Vasculitides. Int J Mol Sci 2024; 25:713. [PMID: 38255787 PMCID: PMC10815696 DOI: 10.3390/ijms25020713] [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: 11/18/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
Involvement of the complement system is key to the pathogenesis of antineutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis, but immunometabolic implications, especially on serum uric acid (UA) levels, still need to be elucidated. A total of 34 patients with biopsy-proven ANCA-associated renal vasculitis between 2015 and 2020 were retrospectively enrolled. Serum UA levels were correlated with clinical and histopathological characteristics, separated for critically ill (CI, n = 19), myeloperoxidase (MPO)-ANCA (n = 21) and proteinase 3 (PR3)-ANCA (n = 13) subgroups. We here identified inverse correlations of serum UA levels and complement C3 levels in the total cohort (p = 0.005) and the CI subgroup (p < 0.001). Intrarenal complement C4d deposition in venules correlated with serum UA levels in the total cohort (p = 0.007) and in the CI subgroup (p = 0.016). Significant associations of serum UA levels and tubulitis in areas of scarred cortex (t-IFTA) were identified in the total cohort (p = 0.008), and both subgroups of CI (p = 0.034) and MPO-ANCA (p = 0.029). In PR3-ANCA, interstitial fibrosis (ci) was observed as the strongest association with serum UA levels (p = 0.022). Our observations broaden our current understanding of contributory metabolic factors that influence the initial disease course in ANCA-associated renal vasculitis.
Collapse
Affiliation(s)
- Eva Baier
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany;
| | - Ingmar Alexander Kluge
- Institute of Pathology, University Medical Center Göttingen, 37075 Göttingen, Germany; (I.A.K.); (S.H.)
| | - Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, 37075 Göttingen, Germany; (I.A.K.); (S.H.)
- SYNLAB Pathology Hannover, SYNLAB Holding Germany, 86156 Augsburg, Germany
- Institute of Pathology, Klinikum Bremen-Mitte, School of Medicine of the University of Göttingen, 28205 Bremen, Germany
| | - Peter Korsten
- Department of Rheumatology and Clinical Immunology, St. Josef-Stift Sendenhorst, 48324 Sendenhorst, Germany;
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany;
| |
Collapse
|
8
|
Moinzadeh P, Bonella F, Oberste M, Weliwitage J, Blank N, Riemekasten G, Müller-Ladner U, Henes J, Siegert E, Günther C, Kötter I, Pfeiffer C, Schmalzing M, Zeidler G, Korsten P, Susok L, Juche A, Worm M, Jandova I, Ehrchen J, Sunderkötter C, Keyßer G, Ramming A, Schmeiser T, Kreuter A, Lorenz HM, Hunzelmann N, Kreuter M. Impact of Systemic Sclerosis-Associated Interstitial Lung Disease With and Without Pulmonary Hypertension on Survival: A Large Cohort Study of the German Network for Systemic Sclerosis. Chest 2024; 165:132-145. [PMID: 37582424 DOI: 10.1016/j.chest.2023.08.013] [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: 01/17/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pulmonary involvement is the leading cause of death in systemic sclerosis (SSc) and may manifest as interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), or in combination of both (ILD with pulmonary hypertension [ILD-PH]). The aim of this analysis was to determine prevalence, clinical characteristics, and survival of these different forms within the registry of the German Network for Systemic Sclerosis. RESEARCH QUESTION Does SSc-associated ILD-PH or ILD without PH affect survival differently, and are there any risk factors that have an additional impact? STUDY DESIGN AND METHODS Clinical data of 5,831 patients with SSc were collected in the German Network for Systemic Sclerosis registry. Kaplan-Meier estimates were used to compare overall survival in patients with SSc-associated ILD-PH and ILD without PH with patients without pulmonary involvement and those with PAH. The Cox proportional hazard model was used to analyze the influence of pulmonary involvement and other potential predictors on patient survival. RESULTS Clinical data of 3,257 patients with a mean follow-up time of 3.45 ± 1.63 years have been included in our analysis. At baseline, ILD was present in 34.5%, whereas PH without ILD had a lower prevalence with 4.5%. At the end of follow-up, 47.6% of patients with SSc had ILD, 15.2% had ILD-PH, and 6.5% had PAH. ILD was more frequent in the diffuse cutaneous form (57.3%), whereas PAH did not differ significantly between SSc subtypes. Significant differences in baseline characteristics between PAH vs ILD-PH vs ILD without PH were found for age at diagnosis, sex, SSc subsets, antibody status, FVC, diffusing capacity of the lung for carbon monoxide, and therapy. Overall survival at 5 years was 96.4% for patients without pulmonary involvement and differed significantly between patients with ILD without PH, PAH, and being worst in patients with ILD-PH. Female sex (hazard ratio [HR], 0.3), higher BMI (HR, 0.9), and higher diffusing capacity of the lung for carbon monoxide values (HR, 0.98) were associated with a lower mortality risk. INTERPRETATION ILD is the most prevalent pulmonary involvement in SSc, whereas the combination of ILD and PH is associated with the most detrimental survival.
Collapse
Affiliation(s)
- Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany.
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, Pneumonology Department, University of Duisburg-Essen, Essen, Germany
| | - Max Oberste
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Jithmi Weliwitage
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Nobert Blank
- Division of Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriela Riemekasten
- Clinic for Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | | | - Jörg Henes
- Centre for Interdisciplinary Rheumatology, Auto-inflammatory Diseases and Internal Medicine 2, University Hospital Tübingen, Tübingen, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ina Kötter
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg, Rheumatology Clinic, Bad Bramstedt, Germany
| | - Christiane Pfeiffer
- Department of Dermatology and Allergology, University Medical Center Ulm, Ulm, Germany
| | - Marc Schmalzing
- Rheumatology/Clinical Immunology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Gabriele Zeidler
- Department of Rheumatology, Osteology and Pain Therapy, Center for Rheumatology Brandenburg, Johanniter-Hospital Treuenbrietzen, Treuenbrietzen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Laura Susok
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital Bochum, Bochum, Germany
| | - Aaron Juche
- Department of Rheumatology, Immanuel Hospital Berlin-Buch, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Ilona Jandova
- Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Jan Ehrchen
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Cord Sunderkötter
- Departments of Dermatology, University Hospital Halle (Saale), Halle, Germany
| | - Gernot Keyßer
- Internal Medicine, Division of Rheumatology, University Hospital Halle (Saale), Halle, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Tim Schmeiser
- Internal Medicine - Rhematology and Osteology, Hospital St. Josef, Wuppertal, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Michael Kreuter
- Mainz Center for Pulmonary Medicine, Departments of Pneumology, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus Clinic Mainz, Mainz, Germany
| |
Collapse
|
9
|
Korsten P, Tampe B. A Transcriptome Array-Based Approach to Link SGLT-2 and Intrarenal Complement C5 Synthesis in Diabetic Nephropathy. Int J Mol Sci 2023; 24:17066. [PMID: 38069385 PMCID: PMC10707485 DOI: 10.3390/ijms242317066] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
Diabetic nephropathy is a common microvascular complication of diabetes mellitus. It is characterized by progressive chronic kidney disease (CKD) with decline of kidney function by hyperfiltration. On a mechanistic level, activation of the complement system has been implicated in the pathogenesis of diabetic nephropathy. Therefore, here we pursued a transcriptome array-based approach to link intrarenal SGLT-2 and the synthesis of distinct complement components in diabetic nephropathy. Publicly available datasets for SLC5A2 (encoding SGLT-2) and complement system components were extracted specifically from microdissected tubulointerstitial (healthy controls: n = 31, diabetic nephropathy: n = 17) and glomerular compartments (healthy controls: n = 21, diabetic nephropathy: n = 12). First, we compared tubulointerstitial and glomerular log2SLC5A2 mRNA expression levels and confirmed a predominant synthesis within the tubulointerstitial compartment. Among various complement components and receptors, the only significant finding was a positive association between SLC5A2 and the tubulointerstitial synthesis of the complement component C5 in diabetic nephropathy (p = 0.0109). Finally, intrarenal expression of SLC5A2 was associated predominantly with pathways involved in metabolic processes. Interestingly, intrarenal complement C5 synthesis was also associated with enrichment of metabolic signaling pathways, overlapping with SLC5A2 for "metabolism" and "biological oxidations". These observations could be of relevance in the pathogenesis of diabetic nephropathy and implicate a mechanistic link between SGLT-2 and intrarenal complement synthesis.
Collapse
Affiliation(s)
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany;
| |
Collapse
|
10
|
Heide M, von Figura A, Rademacher JG, Wincup C, Tampe B, Korsten P. Steroid-free flare management of a severe cutaneous lupus flare with anifrolumab. Lupus 2023; 32:1585-1587. [PMID: 37885415 DOI: 10.1177/09612033231210398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Marielle Heide
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea von Figura
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Chris Wincup
- Department of Rheumatology, King's College Hospital, London, UK
- Department of Rheumatology, Division of Medicine, Rayne Building, University College London, London, UK
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
- Department of Rheumatology and Clinical Immunology, St Josef-Stift Sendenhorst, Sendenhorst, Germany
| |
Collapse
|
11
|
Kreuter M, Bonella F, Blank N, Riemekasten G, Müller-Ladner U, Henes J, Siegert E, Günther C, Kötter I, Pfeiffer C, Schmalzing M, Zeidler G, Korsten P, Susok L, Juche A, Worm M, Jandova I, Ehrchen J, Sunderkötter C, Keyßer G, Ramming A, Schmeiser T, Kreuter A, Kuhr K, Lorenz HM, Moinzadeh P, Hunzelmann N. Anti-acid therapy in SSc-associated interstitial lung disease: long-term outcomes from the German Network for Systemic Sclerosis. Rheumatology (Oxford) 2023; 62:3067-3074. [PMID: 36708008 PMCID: PMC10473195 DOI: 10.1093/rheumatology/kead023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 12/20/2022] [Accepted: 01/06/2023] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Gastroesophageal reflux disease (GERD) occurs frequently in patients with SSc. We investigated whether the presence of GERD and/or the use of anti-acid therapy, specifically proton-pump inhibitors (PPIs), are associated with long-term outcomes, especially in SSc-associated interstitial lung disease (SSc-ILD). METHODS We retrospectively analysed patients with SSc and SSc-ILD from the German Network for Systemic Sclerosis (DNSS) database (2003 onwards). Kaplan-Meier analysis compared overall survival (OS) and progression-free survival (PFS) in patients with GERD vs without GERD (SSc and SSc-ILD), and PPI vs no PPI use (SSc-ILD only). Progression was defined as a decrease in either percentage predicted forced vital capacity of ≥10% or single-breath diffusing capacity for carbon monoxide of ≥15%, or death. RESULTS It was found that 2693/4306 (63%) registered patients with SSc and 1204/1931 (62%) with SSc-ILD had GERD. GERD was not associated with decreased OS or decreased PFS in patients in either cohort. In SSc-ILD, PPI use was associated with improved OS vs no PPI use after 1 year [98.4% (95% CI: 97.6, 99.3); n = 760 vs 90.8% (87.9-93.8); n = 290] and after 5 years [91.4% (89.2-93.8); n = 357 vs 70.9% (65.2-77.1); n = 106; P < 0.0001]. PPI use was also associated with improved PFS vs no PPI use after 1 year [95.9% (94.6-97.3); n = 745 vs 86.4% (82.9-90.1); n = 278] and after 5 years [66.8% (63.0-70.8); n = 286 vs 45.9% (39.6-53.2); n = 69; P < 0.0001]. CONCLUSION GERD had no effect on survival in SSc or SSc-ILD. PPIs improved survival in patients with SSc-ILD. Controlled, prospective trials are needed to confirm this finding.
Collapse
Affiliation(s)
- Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik, University of Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, Pneumonology Department, University of Duisburg-Essen, Essen, Germany
| | - Norbert Blank
- Division of Rheumatology, Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriela Riemekasten
- Clinic for Rheumatology and Clinical Immunology, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | | | - Jörg Henes
- Centre for Interdisciplinary Rheumatology, Immunology and Auto-inflammatory Diseases and Department of Internal Medicine 2, University Hospital Tübingen, Tübingen, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité – Universitaetsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ina Kötter
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg, Rheumatology Clinic, Bad Bramstedt, Germany
| | - Christiane Pfeiffer
- Department of Dermatology and Allergology, University Hospital of Munich (LMU), Munich, Germany
| | - Marc Schmalzing
- Rheumatology/Clinical Immunology, Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Gabriele Zeidler
- Department of Rheumatology, Osteology and Pain Therapy, Center for Rheumatology Brandenburg, Johanniter-Hospital Treuenbrietzen, Treuenbrietzen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Laura Susok
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital Bochum, Bochum, Germany
| | - Aaron Juche
- Department of Rheumatology, Immanuel Hospital Berlin-Buch, Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité – Universitaetsmedizin Berlin, Berlin, Germany
| | - Ilona Jandova
- Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Jan Ehrchen
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Cord Sunderkötter
- Department of Dermatology, University Hospital Halle (Saale), Halle, Germany
| | - Gernot Keyßer
- Department of Internal Medicine, Division of Rheumatology, University Hospital Halle (Saale), Halle, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany
| | - Tim Schmeiser
- Department for Rheumatology, Immunology and Osteology, St. Josef Hospital Wuppertal, Wuppertal, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Oberhausen, Germany
| | - Kathrin Kuhr
- Institute of Medical Statistics and Computational Biology (IMSB), University Hospital Cologne, Cologne, Germany
| | - Hanns-Martin Lorenz
- Center for Interstitial and Rare Lung Diseases, Ruhrlandklinik, Pneumonology Department, University of Duisburg-Essen, Essen, Germany
| | - Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
12
|
Alnaimat F, Sweis NJ, Sweis JJG, Ascoli C, Korsten P, Rubinstein I, Sweiss NJ. Corrigendum: Reproducibility and rigor in rheumatology research. Front Med (Lausanne) 2023; 10:1267505. [PMID: 37654665 PMCID: PMC10466127 DOI: 10.3389/fmed.2023.1267505] [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] [Received: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fmed.2022.1073551.].
Collapse
Affiliation(s)
- Fatima Alnaimat
- Division of Rheumatology, Department of Medicine, The University of Jordan, Amman, Jordan
| | - Nadia J. Sweis
- Department of Business Administration, King Talal School of Business Technology, Princess Sumaya University for Technology, Amman, Jordan
| | | | - Christian Ascoli
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Nadera J. Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| |
Collapse
|
13
|
Korsten P, Tampe B. Avacopan improves patient perspective on steroid-related toxicity effects in a case with ANCA-associated vasculitis. Rheumatol Adv Pract 2023; 7:rkad058. [PMID: 37448621 PMCID: PMC10338134 DOI: 10.1093/rap/rkad058] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/15/2023] Open
Affiliation(s)
- Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Correspondence to: Björn Tampe, Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert Koch Street 40, 37085 Göttingen, Germany. E-mail:
| |
Collapse
|
14
|
Korsten P, Tampe B. A Transcriptome Array-Based Approach Links Proteinuria and Distinct Molecular Signatures to Intrarenal Expression of Type I Interferon IFNA5 in Lupus Nephritis. Int J Mol Sci 2023; 24:10636. [PMID: 37445814 DOI: 10.3390/ijms241310636] [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] [Received: 05/13/2023] [Revised: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
In systemic lupus erythematosus (SLE), the relevance of non-hematopoietic sources of type I interferon in human autoimmunity has recently been recognized. Particularly, type I interferon production precedes autoimmunity in early skin lesions related to SLE. However, the relevance of intrarenal type I interferon expression has not been shown in lupus nephritis. From transcriptome array datasets, median-centered log2 mRNA expression levels of IFNα (IFNA1, IFNA2, IFNA4, IFNA5, IFNA6, IFNA7, IFNA8, IFNA10, IFNA13, IFNA14, IFNA16, IFNA17, and IFNA21), IFNω (IFNW1), and IFNβ (IFNB1) in lupus nephritis were extracted specifically from microdissected tubulointerstitial (n = 32) and glomerular compartments (n = 32). We found an association between proteinuria and tubulointerstitial expression of type I interferon IFNA5 (p = 0.0142), while all others were not significantly associated. By contrast, no such correlation was observed between proteinuria and any type I interferon expression in the glomerular compartment in lupus nephritis. Interestingly, there was no difference between female and male patients (p = 0.8237) and no association between type I interferon IFNA5 expression and kidney function or lupus nephritis progression. Finally, we identified distinct molecular signatures involved in transcriptional regulation (GLI protein-regulated transcription, IRF7 activation, and HSF1-dependent transactivation) and receptor signaling (BMP signaling and GPCR ligand binding) in association with tubulointerstitial expression of type I interferon IFNA5 in the kidney. In summary, this transcriptome array-based approach links proteinuria to the tubulointerstitial expression of type I interferon IFNA5 in lupus nephritis. Because type I interferon receptor subunit I antagonism has recently been investigated in active SLE, the current study further emphasizes the role of type I interferons in lupus nephritis and might also be of relevance for mechanistic studies.
Collapse
Affiliation(s)
- Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany
| |
Collapse
|
15
|
Schäfer AK, Dierks S, Schnelle M, Korsten P, Hakroush S, Tampe B. Case Report: High-dose immunoglobulins prior to plasma exchange in severe pulmonary renal syndrome. Front Immunol 2023; 14:1210321. [PMID: 37359542 PMCID: PMC10288105 DOI: 10.3389/fimmu.2023.1210321] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
Plasma exchange rapidly depletes pathogenic anti-neutrophil cytoplasmic autoantibodies (ANCAs) and is considered for induction therapy in severe ANCA-associated vasculitis. The aim of plasma exchange is to remove putative disease mediators from the circulation, such as toxic macromolecules and pathogenic ANCAs. To our knowledge, we here provide the first report of applying high-dose IVIGs prior to plasma exchange and assessment of ANCA autoantibody elimination in a patient with severe pulmonary renal syndrome due to ANCA-associated vasculitis. After high-dose application of intravenous immunoglobulins (IVIGs) prior to plasma exchange treatment, efficacy of myeloperoxidase (MPO)-ANCA autoantibody elimination was substantially increased, associated with rapid clearance of MPO-ANCA autoantibodies. High-dose IVIGs resulted in marked reduction of MPO-ANCA autoantibody levels and did not directly affect autoantibody clearance by plasma exchange itself, as also confirmed by comparable MPO-ANCAs in the exchange fluid relative to serum levels. Moreover, measurements of serum creatinine and albuminuria confirmed that high-dose IVIGs were well tolerated and did not exacerbate kidney injury.
Collapse
Affiliation(s)
- Ann-Kathrin Schäfer
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Sascha Dierks
- Institute of Clinical Chemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Moritz Schnelle
- Institute of Clinical Chemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
16
|
Roofeh D, Brown KK, Kazerooni EA, Tashkin D, Assassi S, Martinez F, Wells AU, Raghu G, Denton CP, Chung L, Hoffmann-Vold AM, Distler O, Johannson KA, Allanore Y, Matteson EL, Kawano-Dourado L, Pauling JD, Seibold JR, Volkmann ER, Walsh SLF, Oddis CV, White ES, Barratt SL, Bernstein EJ, Domsic RT, Dellaripa PF, Conway R, Rosas I, Bhatt N, Hsu V, Ingegnoli F, Kahaleh B, Garcha P, Gupta N, Khanna S, Korsten P, Lin C, Mathai SC, Strand V, Doyle TJ, Steen V, Zoz DF, Ovalles-Bonilla J, Rodriguez-Pinto I, Shenoy PD, Lewandoski A, Belloli E, Lescoat A, Nagaraja V, Ye W, Huang S, Maher T, Khanna D. Systemic sclerosis associated interstitial lung disease: a conceptual framework for subclinical, clinical and progressive disease. Rheumatology (Oxford) 2023; 62:1877-1886. [PMID: 36173318 PMCID: PMC10152284 DOI: 10.1093/rheumatology/keac557] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/05/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To establish a framework by which experts define disease subsets in systemic sclerosis associated interstitial lung disease (SSc-ILD). METHODS A conceptual framework for subclinical, clinical and progressive ILD was provided to 83 experts, asking them to use the framework and classify actual SSc-ILD patients. Each patient profile was designed to be classified by at least four experts in terms of severity and risk of progression at baseline; progression was based on 1-year follow-up data. A consensus was reached if ≥75% of experts agreed. Experts provided information on which items were important in determining classification. RESULTS Forty-four experts (53%) completed the survey. Consensus was achieved on the dimensions of severity (75%, 60 of 80 profiles), risk of progression (71%, 57 of 80 profiles) and progressive ILD (60%, 24 of 40 profiles). For profiles achieving consensus, most were classified as clinical ILD (92%), low risk (54%) and stable (71%). Severity and disease progression overlapped in terms of framework items that were most influential in classifying patients (forced vital capacity, extent of lung involvement on high resolution chest CT [HRCT]); risk of progression was influenced primarily by disease duration. CONCLUSIONS Using our proposed conceptual framework, international experts were able to achieve a consensus on classifying SSc-ILD patients along the dimensions of disease severity, risk of progression and progression over time. Experts rely on similar items when classifying disease severity and progression: a combination of spirometry and gas exchange and quantitative HRCT.
Collapse
Affiliation(s)
- David Roofeh
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Ella A Kazerooni
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Donald Tashkin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shervin Assassi
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Fernando Martinez
- Department of Internal Medicine, Division of Pulmonary Critical Care Medicine, Weill Cornell School of Medicine, New York, NY, USA
| | - Athol U Wells
- Department of Internal Medicine, Division of Pulmonology, Royal Brompton Hospital and National Heart and Lung Institute, London, UK
| | - Ganesh Raghu
- Department of Internal Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Christopher P Denton
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Lorinda Chung
- Department of Internal Medicine, Division of Immunology and Rheumatology, Stanford University, and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kerri A Johannson
- Departments of Medicine and Community Health Sciences, Section of Respiratory Medicine, University of Calgary, Calgary, Canada
| | - Yannick Allanore
- Department of Rheumatology A, Cochin Hospital, APHP, Université de Paris, Paris, France
| | - Eric L Matteson
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Leticia Kawano-Dourado
- HCor Research Institute, Hospital do Coração, São Paulo, Brazil
- Pulmonary Division, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil
- INSERM 1152, University of Paris, Paris, France
| | - John D Pauling
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Rheumatology, North Bristol NHS Trust, Southmead, Bristol, UK
| | | | - Elizabeth R Volkmann
- Department of Internal Medicine, Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Simon L F Walsh
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eric S White
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Shaney L Barratt
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
- Bristol Interstitial Lung Disease Service, North Bristol NHS Trust, Southmead, Bristol, UK
| | - Elana J Bernstein
- Department of Internal Medicine, Division of Rheumatology, Columbia University School of Medicine, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Robyn T Domsic
- Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul F Dellaripa
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Conway
- Department of Internal Medicine, Division of Rheumatology, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Ivan Rosas
- Department of Internal Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nitin Bhatt
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vivien Hsu
- Department of Internal Medicine, Division of Rheumatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Francesca Ingegnoli
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Italy
| | - Bashar Kahaleh
- Department of Internal Medicine, Division of Rheumatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Puneet Garcha
- Department of Internal Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nishant Gupta
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Surabhi Khanna
- Department of Internal Medicine, Division of Rheumatology, University of Cincinnati, Cincinnati, OH, USA
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Celia Lin
- Genentech, Inc, San Francisco, CA, USA
| | - Stephen C Mathai
- Department of Internal Medicine, Division of Pulmonology, Critical Care and Sleep Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vibeke Strand
- Department of Internal Medicine, Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Tracy J Doyle
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Virginia Steen
- Department of Internal Medicine, Division of Rheumatology, Georgetown University School of Medicine, Washington, DC, USA
| | - Donald F Zoz
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Juan Ovalles-Bonilla
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignasi Rodriguez-Pinto
- Autoimmune Disease Unit. Deaprtment of Internal Medicine. Hospital Mutua de Terrassa, University of Barcelona, Barcelona, Spain
| | - Padmanabha D Shenoy
- Department of Rheumatology, Center for Arthritis and Rheumatism Excellence, Kochi, Kerala, India
| | - Andrew Lewandoski
- Department of Internal Medicine, Division of Rheumatology, University of Michigan-Metro Health, Grand Rapids, MI, USA
| | - Elizabeth Belloli
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alain Lescoat
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Vivek Nagaraja
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Wen Ye
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Suiyuan Huang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Toby Maher
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
17
|
Baier E, Korsten P, Strauß A, Thoms KM, Overbeck T, Ströbel P, Tampe B. Study protocol: a prospective single-center study for non-invasive biomonitoring of renal complications in cancer patients treated with immune checkpoint inhibitors. Front Immunol 2023; 14:1140677. [PMID: 37180131 PMCID: PMC10169823 DOI: 10.3389/fimmu.2023.1140677] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
Background The advent of immune checkpoint inhibitors (ICIs) has powerfully broadened the scope of treatment options for malignancies with an ongoing increase of indications, but immune-related adverse events (irAEs) represent a serious threat to treatment success. Agents directed against programmed cell death protein 1 (PD-1) or its ligand 1 (PD-L1) are known to cause renal complications with an incidence of 3%. In contrast, subclinical renal involvement is estimated to be much higher, up to 29%. We recently reported about urinary flow cytometry-based detection of urinary PD-L1-positive (PD-L1+) kidney cells correlating with tubular PD-L1-positivity that reflected susceptibility to develop ICI-related nephrotoxicity as an irAE attending ICI treatment. Therefore, we designed a study protocol to evaluate urinary detection of PD-L1+ kidney cells as a tool for non-invasive biomonitoring of renal complications in cancer patients treated with ICIs. Methods A prospective, controlled, non-interventional, longitudinal, single-center observational study will be conducted at the Department of Nephrology and Rheumatology of the University Medical Center Göttingen, Germany. We intend to enroll approximately 200 patients treated with immunotherapy from the Departments of Urology, Dermatology, and Hematology and Medical Oncology of the University Medical Center Göttingen, Germany. First, we will assess clinical, laboratory, histopathological, and urinary parameters in addition to urinary cell collection. Then, we will perform a correlative analysis between urinary flow cytometry of different PD-L1+ cell of renal origin with the onset of ICI-related nephrotoxicity. Discussion Because of growing ICI-treatment applicability with an expectable incidence of renal complications, providing cost-efficient and easily performable diagnostic tools for treatment-attendant and non-invasive biomonitoring becomes vital to improve both renal and overall survival rates in cancer patients receiving immunotherapy. Trial registration https://www.drks.de, DRKS-ID DRKS00030999.
Collapse
Affiliation(s)
- Eva Baier
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Arne Strauß
- Department of Urology, University Medical Center Göttingen, Göttingen, Germany
| | - Kai-Martin Thoms
- Department of Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias Overbeck
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
18
|
Bergner R, Weiner SM, Kehl G, de Groot K, Tielke S, Asendorf T, Korsten P. Renal disease in sarcoidosis patients in a German multicentric retrospective cohort study. Respir Med 2023; 209:107121. [PMID: 36669705 DOI: 10.1016/j.rmed.2023.107121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disease potentially affecting every organ system. Renal involvement is reportedly rare, and the evidence consists of case reports and cohort studies. Systematic investigations are scarce and show a varying prevalence ranging from <1% to 30-50%. METHODS We retrospectively analyzed data from patients with a recent diagnosis of sarcoidosis from five tertiary care centers focusing on renal sarcoidosis. RESULTS We analyzed data from 327 patients with sarcoidosis between 2001 and 2021. Of 327 patients, 109 (33.3%) had probable or definite renal sarcoidosis. 90 (27.5%) had histopathologic confirmation. 57 (64%) had an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. The most prominent associated finding was an elevated soluble interleukin-2 receptor. Patients with renal sarcoidosis more frequently received glucocorticoids than other non-renal sarcoidosis patients (92% vs. 78%, p < 0.01). Also, azathioprine (38% vs. 16%, p < 0.001) and mycophenolate mofetil (5% vs. 1%, p < 0.05) were more frequently used in renal sarcoidosis compared to non-renal sarcoidosis, whereas methotrexate was used less frequently (7% vs. 17%, p < 0.05). CONCLUSIONS Our data of the largest cohort with biopsy-confirmed renal sarcoidosis demonstrate a higher prevalence (27.5% of all patients) than previously published with a relevant disease burden. The urinary findings in most cases were only mildly abnormal, and some patients did not have renal biopsy despite abnormal urinary results. A renal workup should be performed in all patients with a new diagnosis of sarcoidosis.
Collapse
Affiliation(s)
- Raoul Bergner
- Medizinische Klinik A, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Stefan M Weiner
- Klinik für Innere Medizin II, Krankenhaus der barmherzigen Brüder and KfH-Nierenzentrum, Nordallee, Trier, Germany
| | - Gabriele Kehl
- Medizinische Klinik III, Klinikum Darmstadt, Darmstadt, Germany
| | - Kirsten de Groot
- Klinik für Nieren-, Bluthochdruck- und Rheumaerkrankungen, Klinikum Offenbach, Offenbach, Germany
| | - Sandra Tielke
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany.
| |
Collapse
|
19
|
Tampe D, Winkler MS, Korsten P, Hakroush S, Moerer O, Tampe B. Correspondence on 'Preliminary predictive criteria for COVID-19 cytokine storm'. Ann Rheum Dis 2023; 82:e71. [PMID: 33414185 DOI: 10.1136/annrheumdis-2020-219709] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Desiree Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Martin S Winkler
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Onnen Moerer
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
20
|
Hakroush S, Franz J, Larsen J, Korsten P, Winkler MS, Tampe B. Repeated false-negative tests delayed diagnosis of COVID-19 in a case with granulomatosis with polyangiitis under maintenance therapy with rituximab and concomitant influenza pneumonia. Ann Rheum Dis 2023; 82:e74. [PMID: 32669300 DOI: 10.1136/annrheumdis-2020-218491] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Jonas Franz
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Jörg Larsen
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Sebastian Winkler
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
21
|
Salazar SM, Hlebowicz K, Komdeur J, Korsten P. Repeatable parental risk taking across manipulated levels of predation threat: no individual variation in plasticity. Anim Behav 2023. [DOI: 10.1016/j.anbehav.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
22
|
Korsten P, Tampe B. Editorial: Multidisciplinary critical care medicine - Getting things done across specialties. Front Med (Lausanne) 2023; 10:1135003. [PMID: 36744137 PMCID: PMC9890145 DOI: 10.3389/fmed.2023.1135003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
|
23
|
Alnaimat F, Sweis NJ, Sweis JJG, Ascoli C, Korsten P, Rubinstein I, Sweiss NJ. Reproducibility and rigor in rheumatology research. Front Med (Lausanne) 2023; 9:1073551. [PMID: 36687429 PMCID: PMC9853178 DOI: 10.3389/fmed.2022.1073551] [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] [Received: 10/18/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
The pillars of scientific progress in rheumatology are experimentation and observation, followed by the publication of reliable and credible results. These data must then be independently verified, validated, and replicated. Peer and journal-specific technical and statistical reviews are paramount to improving rigor and reproducibility. In addition, research integrity, ethics, and responsible conduct training can help to reduce research misconduct and improve scientific evidence. As the number of published articles in rheumatology grows, the field has become critical for determining reproducibility. Prospective, longitudinal, randomized controlled clinical trials are the gold standard for evaluating clinical intervention efficacy and safety in this space. However, their applicability to larger, more representative patient populations with rheumatological disorders worldwide could be limited due to time, technical, and cost constraints involved with large-scale clinical trials. Accordingly, analysis of real-world, patient-centered clinical data retrieved from established healthcare inventories, such as electronic health records, medical billing reports, and disease registries, are increasingly used to report patient outcomes. Unfortunately, it is unknown whether this clinical research paradigm in rheumatology could be deployed in medically underserved regions.
Collapse
Affiliation(s)
- Fatima Alnaimat
- Division of Rheumatology, Department of Medicine, The University of Jordan, Amman, Jordan
| | - Nadia J. Sweis
- Department of Business Administration, King Talal School of Business Technology, Princess Sumaya University for Technology, Amman, Jordan
| | | | - Christian Ascoli
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Nadera J. Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois Chicago, Chicago, IL, United States
| |
Collapse
|
24
|
Bauch C, Boonekamp JJ, Korsten P, Mulder E, Verhulst S. High heritability of telomere length and low heritability of telomere shortening in wild birds. Mol Ecol 2022; 31:6308-6323. [PMID: 34532917 PMCID: PMC9787985 DOI: 10.1111/mec.16183] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 08/06/2021] [Accepted: 09/08/2021] [Indexed: 01/31/2023]
Abstract
Telomere length and telomere shortening predict survival in many organisms. This raises the question of the contribution of genetic and environmental effects to variation in these traits, which is still poorly known, particularly for telomere shortening. We used experimental (cross-fostering) and statistical (quantitative genetic "animal models") means to disentangle and estimate genetic and environmental contributions to telomere length variation in pedigreed free-living jackdaws (Corvus monedula). Telomere length was measured twice in nestlings, at ages 4 (n = 715) and 29 days (n = 474), using telomere restriction fragment (TRF) analysis, adapted to exclude interstitial telomeric sequences. Telomere length shortened significantly over the nestling period (10.4 ± 0.3 bp day-1 ) and was highly phenotypically (rP = 0.95 ± 0.01) and genetically (rG > 0.99 ± 0.01) correlated within individuals. Additive genetic effects explained a major part of telomere length variation among individuals, with its heritability estimated at h2 = 0.74 on average. We note that TRF-based studies reported higher heritabilities than qPCR-based studies, and we discuss possible explanations. Parent-offspring regressions yielded similar heritability estimates for mothers and fathers when accounting for changes in paternal telomere length over life. Year effects explained a small but significant part of telomere length variation. Heritable variation for telomere shortening was low (h2 = 0.09 ± 0.11). The difference in heritability between telomere length (high) and telomere shortening (low) agrees with evolutionary theory, in that telomere shortening has stronger fitness consequences in this population. Despite the high heritability of telomere length, its evolvability, which scales the additive genetic variance by mean telomere length, was on average 0.48%. Hence, evolutionary change of telomere length due to selection is likely to be slow.
Collapse
Affiliation(s)
- Christina Bauch
- Groningen Institute for Evolutionary Life SciencesUniversity of GroningenGroningenThe Netherlands
| | - Jelle J. Boonekamp
- Groningen Institute for Evolutionary Life SciencesUniversity of GroningenGroningenThe Netherlands,Present address:
Institute of Biodiversity Animal Health & Comparative MedicineCollege of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Peter Korsten
- Department of Animal BehaviourBielefeld UniversityBielefeldGermany
| | - Ellis Mulder
- Groningen Institute for Evolutionary Life SciencesUniversity of GroningenGroningenThe Netherlands
| | - Simon Verhulst
- Groningen Institute for Evolutionary Life SciencesUniversity of GroningenGroningenThe Netherlands
| |
Collapse
|
25
|
Rademacher JG, Korsten P. IRF6 mutation in systemic sclerosis: innocent bystander or contributing factor? Rheumatology (Oxford) 2022; 61:e383. [PMID: 35861558 DOI: 10.1093/rheumatology/keac414] [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] [Received: 06/21/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
26
|
Lilie ND, Riyahi S, Kalinowski A, Salazar SM, Kaiser S, Schmoll T, Korsten P. Male social niche conformance? Effects of manipulated opportunity for extra-pair mating on behavior and hormones of male zebra finches. Horm Behav 2022; 146:105243. [PMID: 35998552 DOI: 10.1016/j.yhbeh.2022.105243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/21/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022]
Abstract
Success in sperm competition is an important determinant of male fitness in mating systems with female multiple mating. Thus, sperm competition risk represents a key dimension of the male social environment to which individual males are expected to adaptively adjust their reproductive phenotype. Such adaptive phenotypic adjustment we here refer to as male social niche conformance. In this pre-registered study, we investigated how male zebra finches, Taeniopygia guttata, adjust their behavior to sperm competition risk. We experimentally manipulated the opportunity for extra-pair mating to create two levels of sperm competition risk: 1) Single-pair, no sperm competition risk; 2) Double-pair, sperm competition risk. We compared male courtship, mate guarding, copulation rates, and aggression between the treatment groups. To identify hormonal correlates of male behavioral adjustment, we measured plasma testosterone and corticosterone levels before and after the social treatment started. Contrary to our pre-registered predictions, males from the Double-pair treatment group decreased courtship rates compared to those from the Single-pair group, and Double-pair males responded less aggressively towards intruders than Single-pair males. Testosterone levels decreased over the breeding cycle, but social treatment had no effect on either testosterone or corticosterone levels. Our results indicate that male zebra finches do not intensify courtship or competitive reproductive behaviors, or upregulate key hormones when another breeding pair is present. Although we found no evidence for the predicted adaptive behavioral responses to sperm competition risk, we show that male zebra finches plastically adjust their behavior to their social environment.
Collapse
Affiliation(s)
- Navina D Lilie
- Department of Animal Behaviour, Bielefeld University, Konsequenz 45, 33615 Bielefeld, Germany; Evolutionary Biology, Bielefeld University, Konsequenz 45, 33615 Bielefeld, Germany.
| | - Sepand Riyahi
- Department of Animal Behaviour, Bielefeld University, Konsequenz 45, 33615 Bielefeld, Germany; Evolutionary Biology, Bielefeld University, Konsequenz 45, 33615 Bielefeld, Germany
| | - Arne Kalinowski
- Department of Animal Behaviour, Bielefeld University, Konsequenz 45, 33615 Bielefeld, Germany
| | - Stephen M Salazar
- Department of Animal Behaviour, Bielefeld University, Konsequenz 45, 33615 Bielefeld, Germany; Behavioural & Physiological Ecology, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Nijenborgh 7, 9747 AG Groningen, the Netherlands
| | - Sylvia Kaiser
- Department of Behavioural Biology, University of Münster, Badestraße 13, 48149 Münster, Germany
| | - Tim Schmoll
- Evolutionary Biology, Bielefeld University, Konsequenz 45, 33615 Bielefeld, Germany
| | - Peter Korsten
- Department of Animal Behaviour, Bielefeld University, Konsequenz 45, 33615 Bielefeld, Germany.
| |
Collapse
|
27
|
Affiliation(s)
- Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
- *Correspondence: Peter Korsten
| | - Mehdi Mirsaeidi
- Division of Pulmonary, Critical Care, and Sleep Disease, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Nadera J. Sweiss
- Division of Rheumatology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| |
Collapse
|
28
|
Plüß M, Piantoni S, Wincup C, Korsten P. Rapid Response of Refractory Systemic Lupus Erythematosus Skin Manifestations to Anifrolumab-A Case-Based Review of Clinical Trial Data Suggesting a Domain-Based Therapeutic Approach. J Clin Med 2022; 11:jcm11123449. [PMID: 35743519 PMCID: PMC9225134 DOI: 10.3390/jcm11123449] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a clinically heterogeneous autoimmune disease, and organ manifestations, such as lupus nephritis (LN) or skin disease, may be refractory to standard treatment. Therefore, new agents are required to allow for a more personalized therapeutic approach. Recently, several new therapies have been approved internationally, including voclosporine for LN and anifrolumab for moderately to severely active SLE. Here, we report a case of SLE with a predominant and refractory cutaneous manifestation despite combination treatment with glucocorticoids, hydroxychloroquine, mycophenolate mofetil, and belimumab, which had been present for more than 12 months. Belimumab was switched to anifrolumab, and the patient responded quickly after two infusions (eight weeks) with a reduction in the Cutaneous Lupus Assessment and Severity Index (CLASI) from 17 to 7. In addition, we review the available clinical trial data for anifrolumab with a focus on cutaneous outcomes. Based on phase II and III clinical trials investigating the intravenous administration, a consistent CLASI improvement was observed at 12 weeks. Interestingly, in a phase II trial of subcutaneous anifrolumab application, CLASI response was not different from placebo at 12 weeks but numerically different at 24 and 52 weeks, respectively. Thus, anifrolumab emerges as an attractive new therapeutic option suggesting a possible domain-based approach.
Collapse
Affiliation(s)
- Marlene Plüß
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany;
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, 25121 Brescia, Italy;
| | - Chris Wincup
- Department of Rheumatology, King’s College Hospital, London SE5 9RS, UK;
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany;
- Correspondence: ; Tel.: +49-551-396-0400
| |
Collapse
|
29
|
Rademacher JG, Buschfort RM, Korsten P. POS0929 MICRO VASCULAR IMAGING AS A NOVEL TOOL TO QUANTIFY BLOOD FLOW IN THE FINGERTIPS IN PATIENTS WITH SYSTEMIC SCLEROSIS VS. HEALTHY CONTROLS: A SINGLE-CENTER FEASIBILITY STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSystemic sclerosis (SSc) is characterized by tissue fibrosis and vasculopathy. Raynaud’s phenomenon is present in almost all patients (1). Nailfold video capillaroscopy is an established imaging tool for a morphologic assessment but is not able to quantify blood flow (2). Micro Vascular Imaging (MVI) is a novel ultrasound technique for blood flow quantification, especially of small vessels with low flow (3). The technique has not been used in SSc to quantify blood flow.ObjectivesTo evaluate Micro Vascular Imaging (MVI) as a novel ultrasound tool for flow quantification of small fingertip vessels in healthy controls (HC) compared to SSc patients.MethodsIn this single-center prospective cohort study MVI scans of the second to fifth fingertip were performed in 20 healthy controls vs. SSc patients. Demographic data were analyzed using descriptive statistics. For flow velocity analysis, MVI peak systolic (PS) and end-diastolic (ED) flow values were used. Receiver operator characteristics (ROC) curves were generated to detect an optimal cut-off value for each parameter to discriminate between HCs vs. SSc patients. Sensitivity and specificity were reported with 95% CI based on Youden’s J.ResultsThe median age of the 20 HCs was 26 years (19-56), and 13 (65%) were female. 19 (95%) participants were right-handed. Twenty female SSc patients were included. The median age was 60 years (24-79). All SSc patients were right-handed (100%). SSc patients were older than HCs (p<0.0001) and included more female participants (p=0.0083). Some of the recruited SSc patients were past (n=4, 20%) or current (n=2, 10%) smokers, while all HCs were non-smokers (p=0.0293). No differences were found regarding dexterity (p>0.9999). 13 SSc patients had limited cutaneous SSc, five had diffuse cutaneous SSc, one patient was diagnosed with Very Early Diagnosis of Systemic Sclerosis, and one patient had no skin involvement (sine scleroderma). Eighteen patients (90%) reported the presence of RP.It was shown that PS flow velocity and ED flow velocity were significantly higher in HCs (Figure 1). For all fingers measured, the difference of the medians (D) for PS velocity was 4.675 cm/s (95% CI 3.3-5.25, p<0.0001), for ED velocity 1.375 cm/s (95% CI 0.85-1.65, p<0.0001). No correlation with age was found, neither in HCs (r2=0.03 for PS flow, r2=0.18 for ED flow), nor in SSc patients (r2=0.08 for PS flow, r2=0.01 for ED flow).Figure 1.Comparison of peak systolic (PS) and end-diastolic (ED) blood flow of Digitus II-V in healthy controls (blue) vs. systemic sclerosis patients (red).The highest PS velocity was measured on Digitus II with 5.225 cm/s (95% CI 2.95-7.5, p<0.0001), and 2.325 (95% CI 1.1-3.1, p<0.0001) for ED flow velocitiy, while lowest values were observed at Digitus V with PS = 3.325 cm/s (95% CI 2.2-5, p<0.001), and ED = 0.875 cm/s (95% CI 0.6-1.6, p<0.001). For PS flow velocity, an optimal cut-off point of <6.13 cm/s showed excellent sensitivity (0.90, 95% CI 0.70-0.98) and specificity (0.85, 95% CI 0.64-0.95), corresponding to a LR+ of 6.0. For ED flow velocity, the optimal cut-off point was calculated at <2.13 cm/s, sensitivity was 0.85 (95% CI 0.64-0.95), specificity was 0.80 (95% CI 0.58-0.92), corresponding to a LR+ of 4.25.ConclusionWe present the first study of MVI as a novel imaging technique to measure blood flow velocity in patients with SSc. We report the method’s feasibility and discriminative cut-off points between HCs and SSc. In an extenstion of this study, we aim to longitudinally assess the results with organ manifestations or vascular complications of SSc in a larger cohort.References[1]Allanore, Y.; Simms, R.; Distler, O.; Trojanowska, M.; Pope, J.; Denton, C.P.; Varga, J. Systemic Sclerosis. Nat Rev Dis Primers 2015, 1, 15002, doi:10.1038/nrdp.2015.2.[2]Cutolo, M. Detection of Microvascular Changes in Systemic Sclerosis and Other Rheumatic Diseases. 13.[3]Deegan, A.J.; Wang, R.K. Microvascular Imaging of the Skin. Phys. Med. Biol. 2019, 64, 07TR01, doi:10.1088/1361-6560/ab03f1Disclosure of InterestsNone declared
Collapse
|
30
|
Abstract
In recent years, advances in the treatment and management of patients with systemic lupus erythematosus (SLE) have improved their life expectancy and quality of life. However, lupus nephritis (LN) still represents a major life-threatening complication of the disease. Belimumab (BEL), a fully human monoclonal IgG1λ antibody neutralizing soluble B cell activating factor, was approved more than ten years ago as add-on therapy in adults and pediatric patients with a highly active, autoantibody-positive disease despite standard of care (SoC). Recently, the superiority of the addition of BEL to SoC was also demonstrated in LN. In this review, we provide a comprehensive overview of the study landscape, available therapeutic options for SLE (focusing on BEL in renal and non-renal SLE), and new perspectives in the treatment field of this disease. A personalized treatment approach will likely become available with the advent of novel therapeutic agents for SLE and LN.
Collapse
Affiliation(s)
- Marlene Plüß
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Alfred H J Kim
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA.,Division of Immunobiology, Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA.,Andrew M. and Jane M. Bursky Center of Human Immunology and Immunotherapy Programs, Washington University School of Medicine, Saint Louis, MO, USA
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
31
|
Rahbar Kooybaran N, Korsten P, Schön MP, Mössner R. Ansprechen eines mit rheumatoider Arthritis assoziierten Pyoderma gangraenosum auf den JAK1-Inhibitor Upadacitinib. J Dtsch Dermatol Ges 2022; 20:522-524. [PMID: 35446502 DOI: 10.1111/ddg.14716_g] [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: 11/27/2022]
Affiliation(s)
- Neda Rahbar Kooybaran
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Peter Korsten
- Abteilung für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen
| | - Michael P Schön
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen.,Niedersächsisches Institut für Berufsdermatologie, Universitätsmedizin Göttingen
| | - Rotraut Mössner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| |
Collapse
|
32
|
Rademacher JG, Tampe B, Borisch A, Buschfort RM, von Figura A, Asendorf T, Korsten P. Study Protocol: A Randomized Controlled Prospective Single-Center Feasibility Study of Rheopheresis for Raynaud’s Syndrome and Digital Ulcers in Systemic Sclerosis (RHEACT Study). Front Med (Lausanne) 2022; 9:871744. [PMID: 35492333 PMCID: PMC9046781 DOI: 10.3389/fmed.2022.871744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Raynaud’s phenomenon (RP) and digital ulcers (DU) are frequent manifestations of Systemic Sclerosis (SSc). Despite being very common in SSc patients, both conditions have proven to be notoriously difficult to study. There are very few available approved drugs with varying efficacy. It has been shown that the presence of DU is associated with increased whole blood viscosity (WBV). Rheopheresis (RheoP) is an extracorporeal apheresis technique used to treat microcirculatory disorders by improving blood viscosity. Improved blood flow and wound healing after RheoP treatments have been reported in single case reports. Methods and Analysis We report the clinical trial protocol of “A randomized controlled prospective single-center feasibility study of Rheopheresis for Raynaud’s syndrome and Digital Ulcers in Systemic Sclerosis (RHEACT).” RHEACT aims to investigate the efficacy of RheoP on the Raynaud Condition Score (RCS) as the primary efficacy outcome measure after 16 weeks from baseline. Thirty patients will be randomized in a 1:1:1 ratio to one of two RheoP treatment groups or assigned to the standard of care (SoC) control group (intravenous iloprost). Secondary endpoints include changes in DU, changes in nailfold video capillaroscopy and patient-reported-outcomes (Scleroderma Health Assessment Questionnaire, FACIT-Fatigue, and the Disability of Arm, Shoulder, and Hand, quick version). Discussion Apheresis techniques have been investigated in SSc but mainly in observational, retrospective studies, or single case reports. RheoP is a pathophysiologically driven potential new therapy for heavily burdened patients with SSc-associated secondary RP with or without DU. Ethics and Dissemination The study was registered at clinicaltrials.gov (Identifier: NCT05204784). Furthermore, the study is made publicly available on the website of the German network of Systemic Sclerosis “Deutsches Netzwerk Systemische Sklerodermie (DNSS).”
Collapse
Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Angela Borisch
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Rosa Marie Buschfort
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea von Figura
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
- *Correspondence: Peter Korsten,
| |
Collapse
|
33
|
Hakroush S, Kluge IA, Baier E, Korsten P, Tampe D, Ströbel P, Tampe B. pANCA autoantibody testing by indirect immunofluorescence indicates interstitial arteritis independent of MPO-ANCA immunoassays in ANCA-associated glomerulonephritis. J Nephrol 2022; 35:1251-1254. [PMID: 35381959 PMCID: PMC9107432 DOI: 10.1007/s40620-022-01320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Eva Baier
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Desiree Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany.
| |
Collapse
|
34
|
Kooybaran NR, Korsten P, Schön MP, Mössner R. Response of rheumatoid arthritis-associated pyoderma gangrenous to the JAK1 inhibitor upadacitinib. J Dtsch Dermatol Ges 2022; 20:522-524. [PMID: 35267240 DOI: 10.1111/ddg.14716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Neda Rahbar Kooybaran
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Rotraut Mössner
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
35
|
Schroeter MR, Klingel K, Korsten P, Hasenfuß G. Fulminant Lyme myocarditis without any other signs of Lyme disease in a 37-year-old male patient with microscopic polyangiitis-a case report. Eur Heart J Case Rep 2022; 6:ytac062. [PMID: 35291336 PMCID: PMC8916016 DOI: 10.1093/ehjcr/ytac062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022]
Abstract
Background Lyme disease is a tick-borne multisystem infection. The most common cardiac manifestation is an acute presentation of Lyme carditis, which often manifests as conduction disorder and rarely as myocarditis. Case summary We report the case of a 37-year-old male with a history of microscopic polyangiitis receiving immunosuppressive therapy. He was admitted for severe dyspnoea secondary to acute heart failure. Echocardiography and cardiac magnetic resonance imaging indicated a severely reduced left ventricular ejection fraction (LVEF) with global hypokinesia. Coronary heart disease was excluded, and endomyocardial biopsies (EMB) were performed. The left ventricular EMB revealed a rare case of fulminant Lyme carditis with evidence of typical lymphocytic myocarditis. Borrelia afzelii-DNA was detected without any relevant atrioventricular blockage or systemic signs of Lyme disease. The patient had no clinically apparent tick-borne infection or self-reported history of a tick bite. Immunological testing revealed a positive ELISA and Immunoblot for anti-Borrelia immunoglobulin G antibodies. After specific intravenous antibiotic therapy and optimized medical therapy for heart failure, the LVEF recovered, and the patient could be discharged in an improved condition. Repeat EMB a few months later revealed a dramatic regression of the cardiac inflammation and absence of Borrelia DNA in the myocardium. Discussion A severely reduced LVEF can be the primary manifestation of Lyme disease even without typical systemic findings and can have a favourable prognosis with antibiotic treatment. A thorough workup for Lyme carditis is required in patients with unexplained heart failure, particularly with EMB, especially in immunosuppressed patients.
Collapse
Affiliation(s)
- Marco R Schroeter
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany
| |
Collapse
|
36
|
Hakroush S, Tampe D, Kluge IA, Baier E, Korsten P, Tampe B. Comparative analysis of SGLT-2 expression in renal vasculitis and lupus nephritis. Ann Rheum Dis 2022; 81:1048-1050. [PMID: 35217513 PMCID: PMC9209668 DOI: 10.1136/annrheumdis-2022-222167] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/19/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Desiree Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Eva Baier
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
37
|
Schmidt J, Korsten P, Zechel S, Schlüter S. Introducing the international Myositis Society (iMyoS): a novel multiprofessional society to foster the care, education, and research on myositis. Clin Exp Rheumatol 2022; 40:210-213. [DOI: 10.55563/clinexprheumatol/1a7tkf] [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] [Received: 10/29/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Jens Schmidt
- Muscle Immunobiology Group, Department of Neurology, Neuromuscular Center, University Medical Center Göttingen; Department of Neurology and Pain Treatment, University Hospital of the Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf bei Berlin; and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany.
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Germany
| | - Sabrina Zechel
- Department of Neuropathology, University Medical Center Göttingen, Germany
| | - Silke Schlüter
- Diagnosegruppe Myositis, Deutsche Gesellschaft für Muskelkranke, Freiburg, Germany
| |
Collapse
|
38
|
Rademacher JG, Glaubitz S, Zechel S, Oettler M, Tampe B, Schmidt J, Korsten P. Treatment and outcomes in anti-HMG-CoA reductase-associated immune-mediated necrotising myopathy. Comparative analysis of a single-centre cohort and published data. Clin Exp Rheumatol 2022; 40:320-328. [PMID: 35225222 DOI: 10.55563/clinexprheumatol/2ao5ze] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Anti-hydroxy-methyl-glutaryl-coenzyme A reductase (HMGCR) antibody-associated myopathy was recognised as a new form of immune-mediated necrotising myopathy (IMNM) a decade ago. Due to the rarity of the disease, only limited data on clinical manifestations and therapeutic outcomes are available. METHODS We retrospectively analysed a monocentric cohort of HMGCR-associated IMNM patients treated at the University Medical Centre Göttingen. Clinical, laboratory, and biopsy data, as well as treatment outcomes, were analysed. In addition, a literature search was performed on published HMGCR IMNM cohorts in Medline and Web of Science. RESULTS We identified nine patients; five were female. The median age was 68 years (47-77). Six were statin-exposed and older than statin-naive patients (71 years [65-77] vs. 51 years [47-67]). All had muscle weakness, seven myalgias. Strength (MRC sum score) was 53/65 (46-61) at baseline and increased to 63/65 (50-65) with therapy. Creatine kinase (CK) levels decreased from a median level of 12837 U/L (range 6346-25011) to 624 U/L (35-1564 U/L). All received glucocorticoids (GC) and at least one immunosuppressive therapy. The literature review identified 26 studies comprising 691 patients. 57.9% were female, 61.3% statin exposed. 95.2% had weakness, 39.1% myalgia. Dysphagia affected 28.8%. 84.9% received GC and a median of 1.5 additional immunosuppressants. Compared to published data, our patients had higher baseline CK values (12837 [6346-25011] vs. 6951 [2539-10500], p<0.001), and we used azathioprine and intravenous immunoglobulins (p<0.001) more frequently but methotrexate and rituximab less frequently (p<0.001). CONCLUSIONS HMGCR-associated IMNM is a rare subset of myositis. With systemic treatment, patients usually achieve partial or complete remission. Optimal treatment has not been established, but glucocorticoids, azathioprine, and methotrexate are generally effective with or without intravenous immunoglobulins.
Collapse
Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - Stefanie Glaubitz
- Department of Neurology, University Medical Centre Göttingen, Germany
| | - Sabrina Zechel
- Institute of Neuropathology, University Medical Centre Göttingen, Germany
| | - Manuela Oettler
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - Jens Schmidt
- Department of Neurology, University Medical Centre Göttingen; Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Germany.
| |
Collapse
|
39
|
Trappes R, Nematipour B, Kaiser MI, Krohs U, van Benthem KJ, Ernst UR, Gadau J, Korsten P, Kurtz J, Schielzeth H, Schmoll T, Takola E. OUP accepted manuscript. Bioscience 2022; 72:538-548. [PMID: 35677293 PMCID: PMC9169896 DOI: 10.1093/biosci/biac023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Organisms interact with their environments in various ways. We present a conceptual framework that distinguishes three mechanisms of organism–environment interaction. We call these NC3 mechanisms: niche construction, in which individuals make changes to the environment; niche choice, in which individuals select an environment; and niche conformance, in which individuals adjust their phenotypes in response to the environment. Each of these individual-level mechanisms affects an individual's phenotype–environment match, its fitness, and its individualized niche, defined in terms of the environmental conditions under which the individual can survive and reproduce. Our framework identifies how individuals alter the selective regimes that they and other organisms experience. It also places clear emphasis on individual differences and construes niche construction and other processes as evolved mechanisms. The NC3 mechanism framework therefore helps to integrate population-level and individual-level research.
Collapse
Affiliation(s)
| | - Behzad Nematipour
- Center for Philosophy of Science, University of Münster, Münster, Germany
| | - Marie I Kaiser
- Department of Philosophy, Bielefeld University, Bielefeld, Germany
| | - Ulrich Krohs
- Department of Philosophy, University of Münster, Münster, Germany
| | - Koen J van Benthem
- Department of Theoretical Biology, Bielefeld University, Bielefeld, Germany, and with the Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - Ulrich R Ernst
- Universität Hohenheim, Apicultural State Institute (Landesanstalt für Bienenkunde), Stuttgart, Germany
- Institute for Evolution and Biodiversity, University of Münster, in Münster, Germany
| | - Jürgen Gadau
- Institute for Evolution and Biodiversity, University of Münster, in Münster, Germany
| | - Peter Korsten
- Department of Animal Behaviour, Bielefeld University, Bielefeld, Germany
| | - Joachim Kurtz
- Institute for Evolution and Biodiversity, University of Münster, Münster, Germany
| | - Holger Schielzeth
- Population Ecology Group, Institute of Ecology and Evolution, Friedrich Schiller University Jena, Jena, Germany
| | - Tim Schmoll
- Department of Evolutionary Biology, Bielefeld University, Bielefeld, Germany
| | - Elina Takola
- Population Ecology Group, Institute of Ecology and Evolution, Friedrich Schiller University Jena, Jena, Germany
| |
Collapse
|
40
|
Hakroush S, Schridde L, Wallbach M, Mekolli A, Korsten P, Tampe B. Low Efficacy of Chromogranin A Elimination by Therapeutic Plasma Exchange for Treatment of Chromogranin A Tubulopathy. Kidney Int Rep 2021; 6:3093-3094. [PMID: 34901579 PMCID: PMC8640534 DOI: 10.1016/j.ekir.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Laura Schridde
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Manuel Wallbach
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Ardian Mekolli
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
41
|
Tampe D, Korsten P, Bremer SCB, Winkler MS, Tampe B. Kinetics of Bilirubin and Ammonia Elimination during Hemadsorption Therapy in Secondary Sclerosing Cholangitis Following ECMO Therapy and Severe COVID-19. Biomedicines 2021; 9:biomedicines9121841. [PMID: 34944657 PMCID: PMC8698542 DOI: 10.3390/biomedicines9121841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 12/14/2022] Open
Abstract
In critically ill patients, liver dysfunction often results in coagulopathy and encephalopathy and is associated with high mortality. Extracorporeal clearance of hepatotoxic metabolites, including bilirubin and ammonia, aims to attenuate further hepatocyte damage and liver injury, resulting in decreased mortality. The efficacy of hemadsorption combined with conventional hemodialysis to eliminate bilirubin and ammonia to support the liver's excretory function in acute liver injury has been described previously. However, the optimal use of liver support systems in chronic liver dysfunction due to secondary sclerosing cholangitis in critically ill patients (SSC-CIP) has not been defined yet. We herein describe the kinetics of successful bilirubin and ammonia elimination by hemadsorption in a patient with SSC-CIP after extracorporeal membrane oxygenation (ECMO) therapy for severe acute respiratory distress syndrome (ARDS) in a patient with coronavirus disease 2019 (COVID-19). During the course of the disease, the patient developed laboratory signs of liver injury during ECMO therapy before clinically detectable jaundice or elevated bilirubin levels. A diagnosis of SSC-CIP was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) based on intraductal filling defects in the intrahepatic bile ducts due to biliary casts. The patient showed stable elevations of bilirubin and ammonia levels thereafter, but presented with progressive nausea, vomiting, weakness, and exhaustion. Based on these laboratory findings, hemadsorption was combined with hemodialysis treatment and successfully eliminated bilirubin and ammonia. Moreover, direct comparison revealed that ammonia is more efficiently eliminated by hemadsorption than bilirubin levels. Clinical symptoms of nausea, vomiting, weakness, and exhaustion improved. In summary, bilirubin and ammonia were successfully eliminated by hemadsorption combined with hemodialysis treatment in SSC-CIP following ECMO therapy and severe COVID-19. This observation is particularly relevant since it has been reported that a considerable subset of critically ill patients with COVID-19 suffer from liver dysfunction associated with high mortality.
Collapse
Affiliation(s)
- Désirée Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.)
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.)
| | - Sebastian C. B. Bremer
- Department of Gastroenterology, Gastrointestinal Oncology and Endocrinology, University Medical Center Göttingen, 37075 Göttingen, Germany;
| | - Martin S. Winkler
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, 37075 Göttingen, Germany;
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.)
- Correspondence: ; Tel.: +49-551-39-10575
| |
Collapse
|
42
|
Rademacher JG, Korsten P. Anti-Jo-1 Syndrome Often Misdiagnosed as Rheumatoid Arthritis (for Many Years)-A Single-Center Experience Think of RA-ASyS Overlap! J Clin Rheumatol 2021; 27:S861-S862. [PMID: 34348367 DOI: 10.1097/rhu.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | | |
Collapse
|
43
|
Hakroush S, Tampe D, Ströbel P, Korsten P, Tampe B. Comparative Histological Subtyping of Immune Cell Infiltrates in MPO-ANCA and PR3-ANCA Glomerulonephritis. Front Immunol 2021; 12:737708. [PMID: 34759920 PMCID: PMC8574160 DOI: 10.3389/fimmu.2021.737708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common and severe complication of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV), potentially leading to chronic kidney disease (CKD), end-stage renal disease (ESRD), or death. Pathogenic ANCAs, in particular proteinase 3 (PR3) and myeloperoxidase (MPO), trigger a deleterious immune response with intrarenal immune cell infiltration resulting in a pauci-immune necrotizing and crescentic glomerulonephritis (GN). However, a systematic analysis of intrarenal immune cell subtypes concerning neutrophils, eosinophils, plasma cells, and mononuclear cell infiltrates (macrophages, lymphocytes) in ANCA GN remains elusive. Therefore, we aimed to compare distinct immune cell infiltrates in association with clinicopathological findings in ANCA GN. Methods A total of 53 kidney biopsies with ANCA GN at the University Medical Center Göttingen were retrospectively analyzed. Histological infiltrates of neutrophils, eosinophils, plasma cells, and mononucleated cells (macrophages, lymphocytes) were quantified as a fraction of the total area of inflammation. Results Neutrophilic infiltrates were associated with glomerular necrosis and severe kidney injury in ANCA GN. Among tubulointerstitial lesions, intrarenal neutrophils correlated with interstitial inflammation, tubulitis, and inflammation in areas of interstitial fibrosis/tubular atrophy (IFTA), representing active inflammatory lesions. Concerning eosinophils, infiltrates were associated with severe kidney injury, interstitial inflammation, and cellular casts independent of glomerular lesions, implicating a distinct role in inflammation and damage in ANCA GN. Plasma cell infiltrates correlated with tubulitis and interstitial fibrosis and were associated with renal replacement therapy during the short-term disease course. Finally, mononuclear cell infiltrates correlated with severe kidney injury and active histopathological lesions (glomerular crescents, interstitial inflammation, tubulitis, inflammation, and tubulitis in areas of IFTA) besides chronic lesions (interstitial fibrosis and tubular atrophy) in ANCA GN. Interestingly, intrarenal subtypes of immune cell infiltrates differed in MPO-ANCA versus PR3-ANCA GN and were associated with distinct glomerular and tubulointerstitial lesions, implicating different pathogenic mechanisms of kidney injury in ANCA subtypes. Conclusion Our observations imply distinct pathomechanisms contributing to inflammation and renal injury in MPO vs. PR3-associated ANCA GN and potentially contribute to new therapeutic targets in specific ANCA subtypes.
Collapse
Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Désirée Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
44
|
Rademacher JG, Tampe B, Korsten P. First Report of Two Cases of Löfgren's Syndrome after SARS-CoV-2 Vaccination-Coincidence or Causality? Vaccines (Basel) 2021; 9:vaccines9111313. [PMID: 34835244 PMCID: PMC8619392 DOI: 10.3390/vaccines9111313] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023] Open
Abstract
Sarcoidosis can present as an acute form or take a chronic course. One of the acute presentations is Löfgren’s syndrome (LS), consisting of the symptom triad of bilateral hilar lymphadenopathy, erythema nodosum, and ankle periarthritis. In addition, there are occasional reports of sarcoid-like reactions following drug exposures. Nevertheless, reports of sarcoidosis or LS after vaccination have not been published. Here, we report two cases of de novo LS in a temporal association with different vaccines against the new coronavirus SARS-CoV-2. One patient developed the first symptoms three days after the second vaccination (first vaccination ChadOx-1, Astra Zeneca; second vaccination CX-024414, Moderna); in the second patient, symptoms started 28 days after the first vaccination (ChadOx-1, Astra Zeneca). Both patients eventually required treatment with glucocorticoids. Both patients achieved clinical improvement with treatment. In conclusion, we report the first two cases of LS shortly after SARS-CoV-2 vaccination.
Collapse
|
45
|
Wurm-Kuczera RI, Buentzel J, Koenig JFL, Legler T, Valk JJ, Hasenkamp J, Jung W, Rademacher JG, Korsten P, Wulf GG. Sarcoidosis Following Hematopoietic Stem Cell Transplantation: Clinical Characteristics and HLA Associations. Front Immunol 2021; 12:746996. [PMID: 34691055 PMCID: PMC8529157 DOI: 10.3389/fimmu.2021.746996] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Extrinsic factors and genetic predisposition contribute to the etiology of sarcoidosis, converging in a phenotype of altered immune response associated with multisystemic inflammatory granulomatous tissue infiltration. Immunological reconstitution after hematopoietic stem cell transplantation (HSCT) may represent a unique window for the pathogenesis of the disease. We describe the incidence, clinicopathological features, and HLA associations of sarcoidosis after HSCT in a single-center cohort of patients, together with data from previously published cases. Methods We retrospectively analyzed clinical characteristics and HLA haplotypes from allogeneic (allo) or autologous (auto) HSCT patients from January 2001 through May 2021 at the University Medicine Goettingen (UMG), and data from previously published cases. Results A total number of 19 patients was identified. These included 4 patients from our center (3 allo HSCT and 1 auto HSCT) and 15 patients from the literature review. Thirteen patients had received an allo HSCT, and six patients had received an auto HSCT. Sarcoidosis occurred after a median interval of 20 (after allo HSCT) and 7 (after auto HSCT) months, respectively. The predominant HLA allele associated with sarcoidosis was HLA DRB1*03:01. Sarcoidosis involved the respiratory tract in 15 patients (three unknown, one without pulmonary involvement), and it was associated with graft-versus-host disease in 7 of 13 patients receiving allo HSCT. None of the donors or patients had a history of sarcoidosis before transplantation. Disease manifestations resolved with standard glucocorticoid treatment without long-term sequelae. Conclusion Sarcoidosis may occur at low frequency during reconstitution of the immune system after HSCT. HLA allele associations reflect the associations observed in the general population, particularly with DRB1*03:01. Further insights into the interplay between Tcell reconstitution and the development of sarcoidosis could also provide novel approaches to an improved understanding of the pathogenesis in sarcoidosis.
Collapse
Affiliation(s)
| | - Judith Buentzel
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Tobias Legler
- Department of Transfusion Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Jan-Jakob Valk
- Department of Transfusion Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Justin Hasenkamp
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Wolfram Jung
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Gerald Georg Wulf
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| |
Collapse
|
46
|
Tampe D, Korsten P, Ströbel P, Hakroush S, Tampe B. Comprehensive Analysis of Sex Differences at Disease Manifestation in ANCA-Associated Glomerulonephritis. Front Immunol 2021; 12:736638. [PMID: 34630417 PMCID: PMC8495213 DOI: 10.3389/fimmu.2021.736638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/07/2021] [Indexed: 12/02/2022] Open
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a small vessel vasculitis affecting multiple organ systems, including the kidney. Besides investigations focusing on renal outcomes, sex differences associated with distinct clinical and histopathological findings in ANCA glomerulonephritis (GN) have not been systematically investigated. Therefore, we here aimed to systematically analyze sex differences in patients with AAV and biopsy-proven ANCA GN. We provide a comprehensive analysis of 53 kidney biopsies with ANCA GN retrospectively included between 2015 and 2020 and identified specific sex differences in ANCA GN concerning laboratory parameters and systematic scoring of renal histopathology glomerular and tubulointerstitial lesions, and extrarenal manifestations of AAV. We did not observe any correlation between sex and short-term clinical AAV course or disease severity by comparing general AAV parameters. AAV manifestations in females occurred at an older age with more joint involvement. Regarding histopathological findings, we, again, observed no sex difference among ANCA GN classification, but a significant correlation between females and distinct histopathological findings with less tubulointerstitial inflammation and vasculitis of peritubular capillaries. Finally, we here identified fewer associations between clusters of clinical, laboratory parameters, and histopathological findings in females as compared to males. These findings are of great relevance and further improve our understanding of sex differences in the pathogenesis of ANCA GN. While future studies about specific sex differences and conclusions in these clusters are crucial, our observations further support that sex differences are relevant, affect distinct parameters, and influence clinical, laboratory parameters, and histopathological findings in AAV, particularly ANCA GN.
Collapse
Affiliation(s)
- Désirée Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
47
|
Korsten P, Kuczera T, Wallbach M, Tampe B. The Rapid Atrial Swirl Sign for Ultrasound-Guided Tip Positioning of Retrograde-Tunneled Hemodialysis Catheters: A Cross-Sectional Study from a Single Center. J Clin Med 2021; 10:jcm10173999. [PMID: 34501447 PMCID: PMC8432454 DOI: 10.3390/jcm10173999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Chronic kidney disease (CKD) is a common medical problem in patients worldwide, with an increasing prevalence of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT). In patients requiring RRT for more than two weeks or those who develop ESKD, tunneled hemodialysis catheter (HDC) insertion is preferred, based on a lower risk for infectious complications. While the efficacy of ultrasound (US)-guided tip positioning in antegrade-tunneled HDCs has previously been shown, its application for the insertion of retrograde-tunneled HDCs has not been described yet. This is especially important, since the retrograde-tunneled technique has several advantages over the antegrade-tunneled HDC insertion technique. Therefore, we here report our first experience of applying the rapid atrial swirl sign (RASS) for US-guided tip positioning of retrograde-tunneled HDCs. Methods: We performed a cross-sectional study to assess the feasibility of applying the RASS for US-guided tip positioning of retrograde-tunneled HDCs. We performed a total number of 24 retrograde-tunneled HDC insertions in 23 patients (requiring placement of a HDC for the temporary or permanent treatment of ESKD) admitted to our Department of Nephrology and Rheumatology at the University Medical Center Göttingen, Germany. Results: The overall success rate of applying the RASS for US-guided tip positioning of retrograde-tunneled HDCs was 24/24 (100%), with proper tip position in the right atrium in 18/23 (78.3%), or cavoatrial junction in 5/23 (21.7%) when RASS was positive and improper position when RASS was negative in 1/1 (100%), confirmed by portable anterior-posterior chest radiography, with only minor post-procedural bleeding in 2/24 (8.3%). In addition, this insertion technique allows optimal HDC flow, without any observed malfunction. Conclusion: This is the first study to investigate the efficacy of the RASS for US-guided tip positioning of retrograde-tunneled HDCs in patients with ESKD. Application of the RASS for US-guided tip positioning is an accurate and safe procedure for the proper placement of retrograde-tunneled HDCs.
Collapse
|
48
|
Culina A, Adriaensen F, Bailey LD, Burgess MD, Charmantier A, Cole EF, Eeva T, Matthysen E, Nater CR, Sheldon BC, Sæther B, Vriend SJG, Zajkova Z, Adamík P, Aplin LM, Angulo E, Artemyev A, Barba E, Barišić S, Belda E, Bilgin CC, Bleu J, Both C, Bouwhuis S, Branston CJ, Broggi J, Burke T, Bushuev A, Camacho C, Campobello D, Canal D, Cantarero A, Caro SP, Cauchoix M, Chaine A, Cichoń M, Ćiković D, Cusimano CA, Deimel C, Dhondt AA, Dingemanse NJ, Doligez B, Dominoni DM, Doutrelant C, Drobniak SM, Dubiec A, Eens M, Einar Erikstad K, Espín S, Farine DR, Figuerola J, Kavak Gülbeyaz P, Grégoire A, Hartley IR, Hau M, Hegyi G, Hille S, Hinde CA, Holtmann B, Ilyina T, Isaksson C, Iserbyt A, Ivankina E, Kania W, Kempenaers B, Kerimov A, Komdeur J, Korsten P, Král M, Krist M, Lambrechts M, Lara CE, Leivits A, Liker A, Lodjak J, Mägi M, Mainwaring MC, Mänd R, Massa B, Massemin S, Martínez‐Padilla J, Mazgajski TD, Mennerat A, Moreno J, Mouchet A, Nakagawa S, Nilsson J, Nilsson JF, Cláudia Norte A, van Oers K, Orell M, Potti J, Quinn JL, Réale D, Kristin Reiertsen T, Rosivall B, Russell AF, Rytkönen S, Sánchez‐Virosta P, Santos ESA, Schroeder J, Senar JC, Seress G, Slagsvold T, Szulkin M, Teplitsky C, Tilgar V, Tolstoguzov A, Török J, Valcu M, Vatka E, Verhulst S, Watson H, Yuta T, Zamora‐Marín JM, Visser ME. Connecting the data landscape of long-term ecological studies: The SPI-Birds data hub. J Anim Ecol 2021; 90:2147-2160. [PMID: 33205462 PMCID: PMC8518542 DOI: 10.1111/1365-2656.13388] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/01/2020] [Indexed: 01/20/2023]
Abstract
The integration and synthesis of the data in different areas of science is drastically slowed and hindered by a lack of standards and networking programmes. Long-term studies of individually marked animals are not an exception. These studies are especially important as instrumental for understanding evolutionary and ecological processes in the wild. Furthermore, their number and global distribution provides a unique opportunity to assess the generality of patterns and to address broad-scale global issues (e.g. climate change). To solve data integration issues and enable a new scale of ecological and evolutionary research based on long-term studies of birds, we have created the SPI-Birds Network and Database (www.spibirds.org)-a large-scale initiative that connects data from, and researchers working on, studies of wild populations of individually recognizable (usually ringed) birds. Within year and a half since the establishment, SPI-Birds has recruited over 120 members, and currently hosts data on almost 1.5 million individual birds collected in 80 populations over 2,000 cumulative years, and counting. SPI-Birds acts as a data hub and a catalogue of studied populations. It prevents data loss, secures easy data finding, use and integration and thus facilitates collaboration and synthesis. We provide community-derived data and meta-data standards and improve data integrity guided by the principles of Findable, Accessible, Interoperable and Reusable (FAIR), and aligned with the existing metadata languages (e.g. ecological meta-data language). The encouraging community involvement stems from SPI-Bird's decentralized approach: research groups retain full control over data use and their way of data management, while SPI-Birds creates tailored pipelines to convert each unique data format into a standard format. We outline the lessons learned, so that other communities (e.g. those working on other taxa) can adapt our successful model. Creating community-specific hubs (such as ours, COMADRE for animal demography, etc.) will aid much-needed large-scale ecological data integration.
Collapse
|
49
|
Tampe D, Schridde L, Korsten P, Ströbel P, Zeisberg M, Hakroush S, Tampe B. Different Patterns of Kidney Fibrosis Are Indicative of Injury to Distinct Renal Compartments. Cells 2021; 10:2014. [PMID: 34440782 PMCID: PMC8392296 DOI: 10.3390/cells10082014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 01/20/2023] Open
Abstract
Kidney fibrosis is a common manifestation and hallmark of a wide variety of chronic kidney disease (CKD) that appears in different morphological patterns, suggesting distinct pathogenic causes. Broad macroscopically visible scars are the sequelae of severe focal injury and complete parenchymal destruction, reflecting a wound healing response as a consequence of infarction. In the kidney, chronic glomerular injury leads to atrophy of the corresponding tubule, degeneration of this specific nephron, and finally interstitial fibrosis/tubular atrophy (IF/TA). Compared to this glomerulus-induced focal replacement scar, diffuse fibrosis independent of tubular atrophy appears to be a different pathogenic process. Kidney fibrosis appears to develop in a compartment-specific manner, but whether focal and diffuse fibrosis has distinct characteristics associated with other glomerular or tubulointerstitial lesions remains elusive. In the present study, we aimed to analyze renal fibrotic patterns related to renal lesions, which directly contribute to renal fibrogenesis, to unravel fibrotic patterns and manifestations upon damage to distinct renal compartments. Patterns of kidney fibrosis were analyzed in experimental models of CKD and various renal pathologies in correlation with histopathological and ultrastructural findings. After the induction of isolated crescentic glomerulonephritis (GN) in nephrotoxic serum-nephritis (NTN), chronic glomerular damage resulted in predominantly focal fibrosis adjacent to atrophic tubules. By contrast, using unilateral ureteral obstruction (UUO) as a model of primary injury to the tubulointerstitial compartment revealed diffuse fibrosis as the predominant pattern of chronic lesions. Finally, folic acid-induced nephropathy (FAN) as a model of primary tubular injury with consecutive tubular atrophy independent of chronic glomerular damage equally induced predominant focal IF/TA. By analyzing several renal pathologies, our data also suggest that focal and diffuse fibrosis appear to contribute as chronic lesions in the majority of human renal disease, mainly being present in antineutrophil cytoplasmic antibody (ANCA)-associated GN, lupus nephritis, and IgA nephropathy (IgAN). Focal IF/TA correlated with glomerular damage and irreversible injury to nephrons, whereas diffuse fibrosis in ANCA GN was associated explicitly with interstitial inflammation independent of glomerular damage and nephron loss. Ultrastructural analysis of focal IF/TA versus diffuse fibrosis revealed distinct matrix compositions, further supported by different collagen signatures in transcriptome datasets. With regard to long-term renal outcome, only the extent of focal IF/TA correlated with the development of end-stage kidney disease (ESKD) in ANCA GN. In contrast, diffuse kidney fibrosis did not associate with the long-term renal outcome. In conclusion, we here provide evidence that a focal pattern of kidney fibrosis seems to be associated with nephron loss and replacement scarring. In contrast, a diffuse pattern of kidney fibrosis appears to result from primary interstitial inflammation and injury.
Collapse
Affiliation(s)
- Désirée Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.); (M.Z.)
| | - Laura Schridde
- Institute of Pathology, University Medical Center Göttingen, 37075 Göttingen, Germany; (L.S.); (P.S.)
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.); (M.Z.)
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, 37075 Göttingen, Germany; (L.S.); (P.S.)
| | - Michael Zeisberg
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.); (M.Z.)
| | - Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, 37075 Göttingen, Germany; (L.S.); (P.S.)
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany; (D.T.); (P.K.); (M.Z.)
| |
Collapse
|
50
|
Hakroush S, Tampe D, Korsten P, Tampe B. Impact of the COVID-19 Pandemic on Kidney Diseases Requiring Renal Biopsy: A Single Center Observational Study. Front Physiol 2021; 12:649336. [PMID: 34305628 PMCID: PMC8297651 DOI: 10.3389/fphys.2021.649336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background The coronavirus disease-2019 (COVID-19) pandemic impacted healthcare services for kidney disease patients. Lockdown and social distancing were mandated worldwide, resulting in closure of medical services. The diagnosis of various kidney diseases may have been delayed during the COVID-19 pandemic because non-urgent tests and visits were postponed due to closure of medical services during the lockdown. Methods We here report the impact of the COVID-19 pandemic on a total number of 209 native kidney diseases requiring renal biopsy for diagnosis in a retrospective observational study from a tertiary hospital in Germany. Results The lockdown period in March and April 2020 primarily affected patients admitted to the normal medical ward with a compensatory increased rate of renal biopsies in the postlockdown phase. In addition, there was a shift toward more patients admitted with hemoglobinuria during the COVID-19 pandemic. This phenomenon of an increased number of patients with hemoglobinuria during the COVID-19 pandemic was specifically observed in a subgroup with hypertensive nephropathy requiring renal biopsy and associated with increased proteinuria, not attributed to the COVID-19 lockdown period itself. Conclusion To our knowledge, this is the first report of identifying a subpopulation susceptible to closure of medical services during the COVID-19 pandemic and diagnostic delay of specific kidney diseases. Therefore, the COVID-19 pandemic should be regarded as a risk factor especially in patients with diseases other than COVID-19 primarily admitted to the normal medical ward.
Collapse
Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Désirée Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|