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Patejdl R, Demir IE, Frieling T, Goebel-Stengel M, Günther L, Keller J, Niesler B, Stengel A, Neckel PH. Curricular representation of neurogastroenterology: A survey among medical students in Germany. Neurogastroenterol Motil 2023; 35:e14557. [PMID: 36893050 DOI: 10.1111/nmo.14557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Neurogastroenterological disorders (NGDs) are highly prevalent and substantially impact patients' quality of life. Effective treatment of NGDs depends on the competence and training of medical caregivers. Students' perceived competence in neurogastroenterology and its place in medical school curricula are assessed in this study. METHODS A multi-center digital survey among medical students was conducted at five universities. Self-ratings of competence regarding basic mechanisms, diagnosis, and treatment of six chronic medical conditions were assessed. These included irritable bowel syndrome (IBS), gastroesophageal reflux disease, and achalasia. Ulcerative colitis, hypertension, and migraine were included as references. KEY RESULTS Of 231 participants, 38% remembered that neurogastroenterology was covered in their curriculum. Highest competence ratings were stated for hypertension and the lowest for IBS. These findings were identical for all institutions irrespective of their curricular model and demographic parameters. Students who remembered neurogastroenterology as a part of their curriculum reported higher competence ratings. According to 72% of students, NGDs should be highlighted more prominently in the curriculum. CONCLUSIONS & INFERENCES Despite its epidemiological relevance, neurogastroenterology is only weakly represented in medical curricula. Students report low levels of subjective competence in handling NGDs. In general, assessing the learners' perspective on an empirical basis may enrichen the process of national standardization of medical school curricula.
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Affiliation(s)
- Robert Patejdl
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Ihsan Ekin Demir
- Department of Surgery, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Thomas Frieling
- Department of Gastroenterology, Helios Hospital Krefeld, Krefeld, Germany
| | - Miriam Goebel-Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Lydia Günther
- Division of Medical Biology, Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jutta Keller
- Department of Internal Medicine, Israelite Hospital, Hamburg, Germany
| | - Beate Niesler
- Department of Human Molecular Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Peter H Neckel
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
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Klawitter F, Walter U, Axer H, Patejdl R, Ehler J. Neuromuscular Ultrasound in Intensive Care Unit-Acquired Weakness: Current State and Future Directions. Medicina (Kaunas) 2023; 59:medicina59050844. [PMID: 37241077 DOI: 10.3390/medicina59050844] [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] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
Intensive care unit-acquired weakness (ICUAW) is one of the most common causes of muscle atrophy and functional disability in critically ill intensive care patients. Clinical examination, manual muscle strength testing and monitoring are frequently hampered by sedation, delirium and cognitive impairment. Many different attempts have been made to evaluate alternative compliance-independent methods, such as muscle biopsies, nerve conduction studies, electromyography and serum biomarkers. However, they are invasive, time-consuming and often require special expertise to perform, making them vastly impractical for daily intensive care medicine. Ultrasound is a broadly accepted, non-invasive, bedside-accessible diagnostic tool and well established in various clinical applications. Hereby, neuromuscular ultrasound (NMUS), in particular, has been proven to be of significant diagnostic value in many different neuromuscular diseases. In ICUAW, NMUS has been shown to detect and monitor alterations of muscles and nerves, and might help to predict patient outcome. This narrative review is focused on the recent scientific literature investigating NMUS in ICUAW and highlights the current state and future opportunities of this promising diagnostic tool.
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Affiliation(s)
- Felix Klawitter
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Robert Patejdl
- Department of Medicine, Health and Medical University Erfurt, 99089 Erfurt, Germany
| | - Johannes Ehler
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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Wagdi A, Malan D, Sathyanarayanan U, Beauchamp JS, Vogt M, Zipf D, Beiert T, Mansuroglu B, Dusend V, Meininghaus M, Schneider L, Kalthof B, Wiegert JS, König GM, Kostenis E, Patejdl R, Sasse P, Bruegmann T. Author Correction: Selective optogenetic control of G q signaling using human Neuropsin. Nat Commun 2023; 14:58. [PMID: 36599836 PMCID: PMC9813341 DOI: 10.1038/s41467-022-35612-8] [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] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ahmed Wagdi
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany ,grid.7450.60000 0001 2364 4210Present Address: Department of Cardiology and Pulmonology, University Medical Center Göttingen, Georg August University of Göttingen, Göttingen, Germany
| | - Daniela Malan
- grid.10388.320000 0001 2240 3300Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany
| | - Udhayabhaskar Sathyanarayanan
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany
| | - Janosch S. Beauchamp
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany
| | - Markus Vogt
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany
| | - David Zipf
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Beiert
- grid.15090.3d0000 0000 8786 803XDepartment of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Berivan Mansuroglu
- grid.10388.320000 0001 2240 3300Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany ,grid.10388.320000 0001 2240 3300Research Training Group 1873, University of Bonn, Bonn, Germany
| | - Vanessa Dusend
- grid.10388.320000 0001 2240 3300Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany ,grid.10388.320000 0001 2240 3300Research Training Group 1873, University of Bonn, Bonn, Germany
| | - Mark Meininghaus
- grid.420044.60000 0004 0374 4101Bayer AG, Research & Development, Pharmaceuticals, 42096 Wuppertal, Germany
| | - Linn Schneider
- grid.420044.60000 0004 0374 4101Bayer AG, Research & Development, Pharmaceuticals, 42096 Wuppertal, Germany
| | - Bernd Kalthof
- grid.420044.60000 0004 0374 4101Bayer AG, Research & Development, Pharmaceuticals, 42096 Wuppertal, Germany
| | - J. Simon Wiegert
- grid.13648.380000 0001 2180 3484Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele M. König
- grid.10388.320000 0001 2240 3300Molecular, Cellular and Pharmacobiology Section, Institute of Pharmaceutical Biology, University of Bonn, Bonn, Germany
| | - Evi Kostenis
- grid.10388.320000 0001 2240 3300Molecular, Cellular and Pharmacobiology Section, Institute of Pharmaceutical Biology, University of Bonn, Bonn, Germany
| | - Robert Patejdl
- grid.413108.f0000 0000 9737 0454Oscar-Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Philipp Sasse
- grid.10388.320000 0001 2240 3300Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany
| | - Tobias Bruegmann
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany ,grid.10388.320000 0001 2240 3300Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany ,grid.10388.320000 0001 2240 3300Research Training Group 1873, University of Bonn, Bonn, Germany ,grid.7450.60000 0001 2364 4210Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
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Abstract
Multiple Sclerosis (MS) is a heterogeneous immune mediated disease of the central nervous system (CNS). Fatigue is one of the most common and disabling symptom of MS. It interferes with daily activities on the level of cognition and motor endurance. Motor fatigue can either result from lesions in cortical networks or motor pathways (“primary fatigue”) or it may be a consequence of detraining with subsequent adaptions of muscle and autonomic function. Programmed exercise interventions are used frequently to increase physical fitness in MS-patients. Studies investigating the effects of training on aerobic capacity, objective endurance and perceived fatigability have yielded heterogenous results, most likely due to the heterogeneity of interventions and patients, but probably also due to the non-uniform pathophysiology of fatigability among MS-patients. The aim of this review is to summarize the current knowledge on the pathophysiology of motor fatigability with special reference to the basic exercise physiology that underlies our understanding of both pathogenesis and treatment interventions.
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Affiliation(s)
- Robert Patejdl
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
- *Correspondence: Robert Patejdl
| | - Uwe K. Zettl
- Department of Neurology, Clinical Neuroimmunology Section, Rostock University Medical Center, Rostock, Germany
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Klawitter F, Walter U, Patejdl R, Endler J, Reuter DA, Ehler J. Sonographic Evaluation of Muscle Echogenicity for the Detection of Intensive Care Unit-Acquired Weakness: A Pilot Single-Center Prospective Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12061378. [PMID: 35741188 PMCID: PMC9221760 DOI: 10.3390/diagnostics12061378] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Qualitative assessment by the Heckmatt scale (HS) and quantitative greyscale analysis of muscle echogenicity were compared for their value in detecting intensive care unit-acquired weakness (ICU-AW). We performed muscle ultrasound (MUS) of eight skeletal muscles on day 3 and day 10 after ICU admission. We calculated the global mean greyscale score (MGS), the global mean z-score (MZS) and the global mean Heckmatt score (MHS). Longitudinal outcome was defined by the modified Rankin scale (mRS) and Barthel index (BI) after 100 days. In total, 652 ultrasound pictures from 38 critically ill patients (18 with and 20 without ICU-AW) and 10 controls were analyzed. Patients with ICU-AW had a higher MHS on day 10 compared to patients without ICU-AW (2.6 (0.4) vs. 2.2 (0.4), p = 0.006). The MHS was superior to ROC analysis (cut-off: 2.2, AUC: 0.79, p = 0.003, sensitivity 86%, specificity 60%) in detecting ICU-AW compared to MGS and MZS on day 10. The MHS correlated with the Medical Research Council sum score (MRC-SS) (r = −0.45, p = 0.004), the mRS (r = 0.45; p = 0.007) and BI (r = −0.38, p = 0.04) on day 100. Qualitative MUS analysis seems superior to quantitative greyscale analysis of muscle echogenicity for the detection of ICU-AW.
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Affiliation(s)
- Felix Klawitter
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (J.E.); (D.A.R.); (J.E.)
- Correspondence:
| | - Uwe Walter
- Department of Neurology, University Medical Center Rostock, 18147 Rostock, Germany;
| | - Robert Patejdl
- Oscar Langendorff Institute of Physiology, University Medical Center Rostock, 18057 Rostock, Germany;
| | - Josefine Endler
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (J.E.); (D.A.R.); (J.E.)
| | - Daniel A. Reuter
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (J.E.); (D.A.R.); (J.E.)
| | - Johannes Ehler
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, 18057 Rostock, Germany; (J.E.); (D.A.R.); (J.E.)
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Wagdi A, Malan D, Sathyanarayanan U, Beauchamp JS, Vogt M, Zipf D, Beiert T, Mansuroglu B, Dusend V, Meininghaus M, Schneider L, Kalthof B, Wiegert JS, König GM, Kostenis E, Patejdl R, Sasse P, Bruegmann T. Selective optogenetic control of G q signaling using human Neuropsin. Nat Commun 2022; 13:1765. [PMID: 35365606 PMCID: PMC8975936 DOI: 10.1038/s41467-022-29265-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 07/12/2021] [Accepted: 03/03/2022] [Indexed: 01/07/2023] Open
Abstract
Gq proteins are universally important for signal transduction in mammalian cells. The underlying kinetics and transformation from extracellular stimuli into intracellular signaling, however could not be investigated in detail so far. Here we present the human Neuropsin (hOPN5) for specific and repetitive manipulation of Gq signaling in vitro and in vivo with high spatio-temporal resolution. Properties and G protein specificity of hOPN5 are characterized by UV light induced IP3 generation, Ca2+ transients and inhibition of GIRK channel activity in HEK cells. In adult hearts from a transgenic animal model, light increases the spontaneous beating rate. In addition, we demonstrate light induced contractions in the small intestine, which are not detectable after pharmacological Gq protein block. All-optical high-throughput screening for TRPC6 inhibitors is more specific and sensitive than conventional pharmacological screening. Thus, we demonstrate specific Gq signaling of hOPN5 and unveil its potential for optogenetic applications.
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Affiliation(s)
- Ahmed Wagdi
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany ,grid.7450.60000 0001 2364 4210Present Address: Department of Cardiology and Pulmonology, University Medical Center Göttingen, Georg August University of Göttingen, Göttingen, Germany
| | - Daniela Malan
- grid.10388.320000 0001 2240 3300Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany
| | - Udhayabhaskar Sathyanarayanan
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany
| | - Janosch S. Beauchamp
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany
| | - Markus Vogt
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany
| | - David Zipf
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Beiert
- grid.15090.3d0000 0000 8786 803XDepartment of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Berivan Mansuroglu
- grid.10388.320000 0001 2240 3300Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany ,grid.10388.320000 0001 2240 3300Research Training Group 1873, University of Bonn, Bonn, Germany
| | - Vanessa Dusend
- grid.10388.320000 0001 2240 3300Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany ,grid.10388.320000 0001 2240 3300Research Training Group 1873, University of Bonn, Bonn, Germany
| | - Mark Meininghaus
- grid.420044.60000 0004 0374 4101Bayer AG, Research & Development, Pharmaceuticals, 42096 Wuppertal, Germany
| | - Linn Schneider
- grid.420044.60000 0004 0374 4101Bayer AG, Research & Development, Pharmaceuticals, 42096 Wuppertal, Germany
| | - Bernd Kalthof
- grid.420044.60000 0004 0374 4101Bayer AG, Research & Development, Pharmaceuticals, 42096 Wuppertal, Germany
| | - J. Simon Wiegert
- grid.13648.380000 0001 2180 3484Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele M. König
- grid.10388.320000 0001 2240 3300Molecular, Cellular and Pharmacobiology Section, Institute of Pharmaceutical Biology, University of Bonn, Bonn, Germany
| | - Evi Kostenis
- grid.10388.320000 0001 2240 3300Molecular, Cellular and Pharmacobiology Section, Institute of Pharmaceutical Biology, University of Bonn, Bonn, Germany
| | - Robert Patejdl
- grid.413108.f0000 0000 9737 0454Oscar-Langendorff Institute of Physiology, Rostock University Medical Center, Rostock, Germany
| | - Philipp Sasse
- grid.10388.320000 0001 2240 3300Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany
| | - Tobias Bruegmann
- grid.411984.10000 0001 0482 5331Institute for Cardiovascular Physiology, University Medical Center Göttingen, Göttingen, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany ,grid.10388.320000 0001 2240 3300Institute of Physiology I, Medical Faculty, University of Bonn, Bonn, Germany ,grid.10388.320000 0001 2240 3300Research Training Group 1873, University of Bonn, Bonn, Germany ,grid.7450.60000 0001 2364 4210Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
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Wittstock M, Kästner M, Kolbaske S, Sellmann T, Porath K, Patejdl R. Serial Measurements of Refractive Index, Glucose and Protein to Assess Gastric Liquid Nutrient Transport—A Proof-of-Principal Study. Front Nutr 2022; 8:742656. [PMID: 35187015 PMCID: PMC8850719 DOI: 10.3389/fnut.2021.742656] [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: 07/16/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022] Open
Abstract
Delayed gastric emptying contributes to complications as aspiration or malnutrition. Among patients suffering from acute neurological diseases, motility disorders are prevalent but poorly understood. Thus, methods to measure gastric emptying are required to allow for appropriate adaptions of individual enteral nutrition algorithms. For enterally fed patients repetitive concentration measurements of gastric content have been proposed to assess gastric emptying. This approach can be used to calculate the gastric residual volume (GRV) and transport of nutrition formula (NF), but it has not yet been implemented in clinical routine. The aim of this study was to investigate whether refractometry or other likewise straightforward analytical approaches produce the best results under in vitro conditions mimicking the gastric milieu. We measured NF in different known concentrations, either diluted in water or in simulated gastric fluid (SGF), with each of the following methods: refractometer, handheld glucose meter, and Bradford protein assay. Then, in enterally fed patients suffering from acute neurological disease, we calculated GRVs and nutrition transport and tested possible associations with clinical parameters. In water dilution experiments, NF concentrations could be assessed with the readout parameters of all three methods. Refractometry yielded the most precise results over the broadest range of concentrations and was biased least by the presence of SGF (detection range for Fresubin original fibre, given as volume concentration/normalized error of regression slope after incubation with water or SGF: 0–100 vs. 0–100%/0.5 vs. 3.9%; glucose-measurement: 5–100 vs. 25–100%/7.9 vs. 6.1%; Bradford-assay: 0–100 vs. 0–100%/7.8 vs. 15.7%). Out of 28 enterally fed patients, we calculated significant slower nutrition transport in patients with higher blood glucose (Rho −0.391; p = 0.039) and in patients who received high-dose sufentanil (Rho −0.514; p = 0.005). Also, the calculated nutrition transport could distinguish patients with and without feeding intolerance (Median 6 vs. 17 ml/h; Mann-Whitney test: p = 0.002). The results of our study prove that serial refractometry is a suitable and cost-effective method to assess gastric emptying and to enhance research on gastrointestinal complications of stroke.
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Affiliation(s)
- Matthias Wittstock
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Matthias Kästner
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Stephan Kolbaske
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Tina Sellmann
- Oscar Langendorff Institute of Physiology, University Medical Center Rostock, Rostock, Germany
| | - Katrin Porath
- Oscar Langendorff Institute of Physiology, University Medical Center Rostock, Rostock, Germany
| | - Robert Patejdl
- Oscar Langendorff Institute of Physiology, University Medical Center Rostock, Rostock, Germany
- *Correspondence: Robert Patejdl
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8
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Patejdl R, Klawitter F, Walter U, Zanaty K, Schwandner F, Sellmann T, Porath K, Ehler J. A novel ex vivo model for critical illness neuromyopathy using freshly resected human colon smooth muscle. Sci Rep 2021; 11:24249. [PMID: 34930954 PMCID: PMC8688412 DOI: 10.1038/s41598-021-03711-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/02/2021] [Indexed: 01/15/2023] Open
Abstract
Patients suffering from critical illness are at risk to develop critical illness neuromyopathy (CINM). The underlying pathophysiology is complex and controversial. A central question is whether soluble serum factors are involved in the pathogenesis of CINM. In this study, smooth muscle preparations obtained from the colon of patients undergoing elective surgery were used to investigate the effects of serum from critically ill patients. At the time of blood draw, CINM was assessed by clinical rating and electrophysiology. Muscle strips were incubated with serum of healthy controls or patients in organ baths and isometric force was measured. Fifteen samples from healthy controls and 98 from patients were studied. Ratios of responses to electric field stimulation (EFS) before and after incubation were 118% for serum from controls and 51% and 62% with serum from critically ill patients obtained at day 3 and 10 of critical illness, respectively (p = 0.003, One-Way-ANOVA). Responses to carbachol and high-K+ were equal between these groups. Ratios of post/pre-EFS responses correlated with less severe CINM. These results support the existence of pathogenic, i.e. neurotoxic factors in the serum of critically ill patients. Using human colon smooth muscle as a bioassay may facilitate their future molecular identification.
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Affiliation(s)
- Robert Patejdl
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Gertrudenstraße 9, 18057, Rostock, Germany.
| | - Felix Klawitter
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Karim Zanaty
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Gertrudenstraße 9, 18057, Rostock, Germany
| | - Frank Schwandner
- Department of General, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, Rostock, Germany
| | - Tina Sellmann
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Gertrudenstraße 9, 18057, Rostock, Germany
| | - Katrin Porath
- Oscar Langendorff Institute of Physiology, Rostock University Medical Center, Gertrudenstraße 9, 18057, Rostock, Germany
| | - Johannes Ehler
- Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
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9
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Vogt M, Schulz B, Wagdi A, Lebert J, van Belle GJ, Christoph J, Bruegmann T, Patejdl R. Direct optogenetic stimulation of smooth muscle cells to control gastric contractility. Am J Cancer Res 2021; 11:5569-5584. [PMID: 33859764 PMCID: PMC8039938 DOI: 10.7150/thno.53883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/12/2021] [Indexed: 12/21/2022] Open
Abstract
Rationale: Antral peristalsis is responsible for gastric emptying. Its failure is called gastroparesis and often caused by dysfunction of enteric neurons and interstitial cells of Cajal (ICC). Current treatment options, including gastric electrical stimulation, are non-satisfying and may improve symptoms but commonly fail to restore gastric emptying. Herein, we explore direct optogenetic stimulation of smooth muscle cells (SMC) via the light-gated non-selective cation channel Channelrhodopsin2 (ChR2) to control gastric motor function. Methods: We used a transgenic mouse model expressing ChR2 in fusion with eYFP under the control of the chicken-β-actin promoter. We performed patch clamp experiments to quantify light-induced currents in isolated SMC, Ca2+ imaging and isometric force measurements of antral smooth muscle strips as well as pressure recordings of intact stomachs to evaluate contractile responses. Light-induced propulsion of gastric contents from the isolated stomach preparation was quantified in video recordings. We furthermore tested optogenetic stimulation in a gastroparesis model induced by neuronal- and ICC-specific damage through methylene blue photo-toxicity. Results: In the stomachs, eYFP signals were restricted to SMC in which blue light (460 nm) induced inward currents typical for ChR2. These depolarizing currents led to contractions in antral smooth muscle strips that were stronger than those triggered by supramaximal electrical field stimulation and comparable to those evoked by global depolarization with high K+ concentration. In the intact stomach, panoramic illumination efficiently increased intragastric pressure achieving 239±46% (n=6) of the pressure induced by electrical field stimulation and triggered gastric transport. Within the gastroparesis model, electric field stimulation completely failed but light still efficiently generated pressure waves. Conclusions: We demonstrate direct optogenetic stimulation of SMC to control gastric contractility. This completely new approach could allow for the restoration of motility in gastroparesis in the future.
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Neuhaus O, Köhler W, Then Bergh F, Kristoferitsch W, Faiss J, Rosenkranz T, Reske D, Patejdl R, Hartung HP, Zettl UK. Glatiramer Acetate Treatment in Multiple Sclerosis-Associated Fatigue-Beneficial Effects on Self-Assessment Scales But Not on Molecular Markers. Biomolecules 2021; 11:biom11030393. [PMID: 33800033 PMCID: PMC8002075 DOI: 10.3390/biom11030393] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 01/14/2023] Open
Abstract
Although fatigue is a common symptom in multiple sclerosis (MS), its pathomechanisms are incompletely understood. Glatiramer acetate (GA), an immunomodulatory agent approved for treatment of relapsing-remitting MS (RRMS), possesses unique mechanisms of action and has been shown to exhibit beneficial effects on MS fatigue. The objective of this study was to correlate clinical, neuropsychological, and immunological parameters in RRMS patients with fatigue before and during treatment with GA. In a prospective, open-label, multicenter trial, 30 patients with RRMS and fatigue were treated with GA for 12 months. Inclusion criterion was the presence of fatigue as one of the most frequent and disabling symptoms. Before and during treatment, fatigue was assessed using the Fatigue Severity Scale (FSS), the MS-FSS, and the Modified Fatigue Impact Scale (MFIS). In addition, fatigue and quality of life were assessed using the Visual Analog Scales (VAS). Laboratory assessments included screening of 188 parameters using real-time PCR microarrays followed by further analysis of several cytokines, chemokines, and neurotrophic factors. Fatigue self-assessments were completed in 25 patients. After 12 months of treatment with GA, 13 of these patients improved in all three scales (with the most prominent effects on the MFIS), whereas 5 patients had deteriorated. The remaining 7 patients exhibited inconsistent effects within the three scales. Fatigue and overall quality of life had improved, as assessed via VAS. Laboratory assessments revealed heterogeneous mRNA levels of cytokines, chemokines, and neurotrophic factors. In conclusion, we were not able to correlate clinical and molecular effects of GA in patients with RRMS and fatigue.
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Affiliation(s)
- Oliver Neuhaus
- Department of Neurology, Klinikum der Heinrich Heine Universität, 40225 Düsseldorf, Germany;
- Department of Neurology, SRH Kliniken Landkreis Sigmaringen GmbH, 72488 Sigmaringen, Germany
- Correspondence: ; Tel.: +49-7571-1002483
| | - Wolfgang Köhler
- Department of Neurology, Fachkrankenhaus Hubertusburg, 04779 Wermsdorf, Germany;
- Department of Neurology, Universität Leipzig, 04103 Leipzig, Germany;
| | | | - Wolfgang Kristoferitsch
- Department of Neurology, SMZ-Ost-Donauspital, 1220 Vienna, Austria;
- Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, 1220 Vienna, Austria
| | - Jürgen Faiss
- Department of Neurology, Asklepios Fachklinikum Teupitz, 15755 Teupitz, Germany;
- German Stroke Society, 10117 Berlin, Germany
| | - Thorsten Rosenkranz
- Department of Neurology, Asklepios Klinik St. Georg, 20099 Hamburg, Germany;
| | - Dirk Reske
- Department of Neurology, Klinikum der Universität zu Köln, 50937 Cologne, Germany;
- Department of Psychiatry, LVR-Klinik Köln, 51109 Cologne, Germany
| | - Robert Patejdl
- Department of Physiology, Universitätsmedizin Rostock, 18057 Rostock, Germany;
| | - Hans-Peter Hartung
- Department of Neurology, Klinikum der Heinrich Heine Universität, 40225 Düsseldorf, Germany;
| | - Uwe K. Zettl
- Department of Neurology, Universitätsmedizin Rostock, 18057 Rostock, Germany;
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Patejdl R, Gromann A, Bänsch D, Noack T. Effects of ajmaline on contraction patterns of isolated rat gastric antrum and portal vein smooth muscle strips and on neurogenic relaxations of gastric fundus. Pflugers Arch 2019; 471:995-1005. [PMID: 31044280 DOI: 10.1007/s00424-019-02279-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/19/2019] [Revised: 04/03/2019] [Accepted: 04/24/2019] [Indexed: 12/23/2022]
Abstract
Class-I-antiarrhythmics like ajmaline are known to alter smooth muscle function, which may cause alterations in gastrointestinal motility. The effects of ajmaline on isolated gastric and portal vein smooth muscle and the underlying mechanisms are unknown. We studied the effects of ajmaline on the contractile patterns of isolated preparations of gastric antrum and portal vein from Wistar rats. The organ bath technique was used to measure spontaneous or pharmacologically induced isometric contractions. Changes in force observed after application of ajmaline or under control conditions are reported as % of the amplitude of an initial K+-induced contraction. Electric field stimulation was used to study neurogenic relaxations of gastric fundus smooth muscle. Ajmaline increased the amplitude of spontaneous contractions of muscle strips (portal vein: control 31.1 ± 15.2%, with 100 μM ajmaline 76.6 ± 32.3%, n = 9, p < 0.01; gastric antrum: control 9.5 ± 1.6%, with 100 μM ajmaline 63.9 ± 9.96%, n = 14, p < 0.01). The frequency of spontaneous activity was reduced in portal vein, but not in gastric antrum strips. The effects of ajmaline were not blocked by tetrodotoxin, L-nitroarginine methyl ester, or atropine. Ajmaline abolished coordinated neurogenic relaxations triggered by electric field stimulation and partly reversed the inhibition of GA spontaneous activity caused by the gap junction blocker carbenoxolone. Ajmaline enhances the amplitude of spontaneous contractions in rat gastric and portal vein smooth muscle. This effect may be accompanied, but not caused by an inhibition of enteric neurotransmission. Enhanced syncytial coupling as indicated by its ability to antagonize the effects of carbenoxolone is likely to underlie the enhancement of contractility.
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Affiliation(s)
- Robert Patejdl
- Oscar-Langendorff-Institut für Physiologie, Universitätsmedizin Rostock, Gertrudenstraße 9, 18057, Rostock, Germany.
| | - Alina Gromann
- Oscar-Langendorff-Institut für Physiologie, Universitätsmedizin Rostock, Gertrudenstraße 9, 18057, Rostock, Germany
| | - Dietmar Bänsch
- Department of Cardiac Electrophysiology, KMG Hospital Güstrow, Güstrow, Germany
| | - Thomas Noack
- Oscar-Langendorff-Institut für Physiologie, Universitätsmedizin Rostock, Gertrudenstraße 9, 18057, Rostock, Germany
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Kraft M, Zettl UK, Noack T, Patejdl R. The sphingosine analog fingolimod (FTY720) enhances tone and contractility of rat gastric fundus smooth muscle. Neurogastroenterol Motil 2018; 30:e13372. [PMID: 29740911 DOI: 10.1111/nmo.13372] [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: 02/26/2018] [Accepted: 04/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sphingosine and its metabolite sphingosine phosphate (S1P) regulate a multitude of biological functions, including the contractile state of smooth. Gastrointestinal side effects have been reported in patients treated with FTY720, a sphingosine analog that is approved for the treatment of multiple sclerosis. The aim of this study was to characterize the effects of FTY720 on rat gastric fundus smooth muscle under basal conditions and during activation induced by high-K+ solution. METHODS Isometric contractions of isolated circular strips of gastric fundus smooth muscle were recorded using the organ bath method. The effects of FTY720 or vehicle were recorded under control conditions and in the presence of indomethacin, L-NAME, HA-1100, nifedipine, JTE-013, and suramin. Tone and contractions recorded in the presence of FTY720 or vehicle are reported as % of the amplitude of an initial high-K+ contraction obtained under control conditions. KEY RESULTS From a concentration of 10 μmol L-1 onwards, FTY720 increased the tone, reaching 8.9% ± 7.5% at 100 μmol L-1 (P < .05). With indomethacin in the solution, the effects of FTY720 were enhanced (32.1% ± 7.7%; P < .001). The FTY720-induced increase in tone was abolished in the absence of extracellular Ca2+ and reduced by nifedipine, HA-1100, JTE-013, and suramin. Furthermore, FTY720 increased high-K+ contractions in the presence of indomethacin. CONCLUSIONS & INFERENCES FTY720 increases tone and contractile responses to depolarization in gastric fundus smooth muscle by triggering calcium entry and calcium sensitization in a S1P receptor-dependent manner. Taken together, the experimental results presented in this work suggest that FTY720 may increase gastric tone and contractility in patients.
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Affiliation(s)
- M Kraft
- Oscar Langendorff Institut für Physiologie, Universität Rostock, Rostock, Germany
| | - U K Zettl
- Klinik und Poliklinik für Neurologie, Sektion Neuroimmunologie, Universität Rostock, Rostock, Germany
| | - T Noack
- Oscar Langendorff Institut für Physiologie, Universität Rostock, Rostock, Germany
| | - R Patejdl
- Oscar Langendorff Institut für Physiologie, Universität Rostock, Rostock, Germany
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Patejdl R, Noack T. Calcium movement in smooth muscle and evaluation of graded functional intercellular coupling. Chaos 2018; 28:106311. [PMID: 30384639 DOI: 10.1063/1.5035168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
Spontaneous activity of vascular smooth muscle is present in small arteries and some venous tissues like the hepatic portal vein. Whereas the ability to generate rhythmic membrane potential changes is expressed in a high number of primary oscillators, the generation of physiological tone and phasic activity requires synchronization of specialized pacemaker activity (Interstitial Cajal-like cells) by intercellular propagation and regeneration of excitation or a strong coupling mechanism of smooth muscle cells. The aim of this study was to deduce oscillator coupling by analyzing the spatiotemporal homogeneity of calcium oscillations within a native tissue preparation. Portal vein tissue was loaded with a calcium-sensitive dye (Fluo-3). By combining confocal microscopy and computation of spatial auto- and cross-correlation of the calcium signals, temporal and spatial coupling between cells was characterized. Spontaneous oscillations of calcium signals were measured at different predefined regions of interest. Cross-correlation analysis of these signals revealed that their damping was very similar in all directions of the investigated z-plane. In single experiments, improved cell-to-cell coupling was seen when noradrenaline (1-10 μM) was added to the bath-solution. With the chosen parameters of frame refresh, the velocity of signal propagation was faster than the maximum detectable velocity, but it could be estimated to exceed 0.1 mm/s. Correlative Network Analysis is a new and very useful tool to determine the functional coupling parameters of quasi-homogenous biological networks and their temporal changes. The action and significance of pharmacological modulators can be well studied on cellular and functional aspects with this newly introduced technique in biological sciences.
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Affiliation(s)
- R Patejdl
- Department of Physiology, University of Rostock, Universitätsmedizin, Oscar-Langendorff Institut für Physiologie, Gertrudenstr. 9, D-18057 Rostock, Germany
| | - T Noack
- Department of Physiology, University of Rostock, Universitätsmedizin, Oscar-Langendorff Institut für Physiologie, Gertrudenstr. 9, D-18057 Rostock, Germany
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Abstract
Background Data on the epidemiology and risk factors of altered gastrointestinal motility (AGIM) is virtually lacking for patients suffering from non-traumatic neurologic diseases and stroke. This study investigated whether patterns of AGIM differ between patients with stroke and other severe acute brain diseases. Methods Clinical records of stroke and non-stroke patients treated at a neurological intensive care unit (ICU) were reviewed at day 1-5 and at day 10 after admission. The data was analyzed for the course of enteral/parenteral nutrition and for and for signs and symptoms of gastrointestinal dysfunction. The study included data of 76 patients, 57 with stroke (stroke group, SG) and 19 with other neurological diseases (non-stroke group, NSG). Results Basic demographic as well as clinical baseline characteristics and alimentation regime were similar in both groups. At least one sign of AGIM was seen in 33/57 (58%) SG and in 15/19 (79%) NSG patients (P = 0.099). Regurgitation was significantly more frequent among patients from the NSG (P < 0.05). Subjects from the NSG also spent a higher proportion of time with at least one symptom of AGIM present (P < 0.05). Conclusions For the first time, this study investigated the prevalence of AGIM in patients suffering from severe stroke. The prevalence of disturbed gastrointestinal function was found to be high in stroke patients, but was lower than in a group of non-stroke patients with similar general disease severity and baseline characteristics.
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Affiliation(s)
- Robert Patejdl
- a Department of Physiology , University of Rostock , Rostock , Germany
| | - Matthias Kästner
- b Department of Neurology , University of Rostock , Rostock , Germany
| | - Stephan Kolbaske
- b Department of Neurology , University of Rostock , Rostock , Germany
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Patejdl R, Zettl UK. Spasticity in multiple sclerosis: Contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions. Autoimmun Rev 2017; 16:925-936. [PMID: 28698092 DOI: 10.1016/j.autrev.2017.07.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [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: 05/19/2017] [Accepted: 05/26/2017] [Indexed: 12/19/2022]
Abstract
In contrast to other diseases that go along with spasticity (e.g. spinal cord injury), spasticity in chronic autoimmune diseases involving the CNS is complicated by the ongoing damage of neuronal networks that leads to permanent changes in the clinical picture of spasticity. Multiple sclerosis (MS) is the most frequent autoimmune disease of the central nervous system (CNS) and spasticity is one of the most disabling symptoms. It occurs in more than 80% MS patients at some point of the disease and is associated with impaired ambulation, pain and the development of contractures. Besides causing cumulative structural damage, neuroinflammation occurring in MS leads to dynamic changes in motor circuit function and muscle tone that are caused by cytokines, prostaglandins, reactive oxygen species and stress hormones that affect neuronal circuits and thereby spasticity. The situation is complicated further by the fact that therapeutics used for the immunotherapy of MS may worsen spasticity and drugs used for the symptomatic treatment of spasticity have been shown to have the potential to alter immune cell function and CNS autoimmunity itself. This review summarizes the current knowledge on the immunologic pathways that are involved in the development, maintenance, dynamic changes and pharmacological modulation of spasticity in MS.
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Affiliation(s)
- Robert Patejdl
- University of Rostock, Department of Physiology, Germany.
| | - Uwe K Zettl
- University of Rostock, Department of Neurology, Division of Neuroimmunology, Germany
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16
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Zettl UK, Dudesek A, Rimmele F, Zettl H, Patejdl R. [Autoimmune-Mediated Encephalomyelitis: a Heterogeneous Entity in Between Neurology and Psychiatry]. Fortschr Neurol Psychiatr 2016; 84:S84-S87. [PMID: 27806421 DOI: 10.1055/s-0042-113961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Within the last decade, autoantibody-associated encephalitis and encephalomyelitis have stepped into the focus of clinical research and practice. Besides the "classic" autoantibodies against intracellular neuronal antigenes, a growing number of antibodies directed against pre- and postsynaptic surface proteins of neurons have been described since the millennium change. Whereas the "classic" are closely linked to paraneoplastic syndromes, this association is loose for most of the yet known surface antigen-antibodies. The immune-mediated encephalomyelitic syndromes are thus classified not only by their clinical symptoms, but also by their specific antibodies. The definition of the entity of N-methyl-D-aspartate-receptor encephalitis is a prominent example. The presented work gives an overview on the clinical and pathological correlates and the underlying immunologic processes of autoantibody-associated encephalitis from a neuropsychiatric perspective.
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Affiliation(s)
- U K Zettl
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
| | - A Dudesek
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
| | - F Rimmele
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
| | - H Zettl
- Tumorzentrum, Universitätsmedizin Rostock
| | - R Patejdl
- Institut für Physiologie, Universitätsmedizin Rostock
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Patejdl R, Winkelmann A, Ehler J, Zettl H, Meister S, Zettl UK. [Diagnostic Workup and Treatment of Antibody-Related Encephalomyelitis]. Fortschr Neurol Psychiatr 2016; 84:S88-S91. [PMID: 27806422 DOI: 10.1055/s-0042-113963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The results of laboratory tests for antineuronal antibodies in immune-mediated encephalitis nowadays are not only relevant for diagnostic purposes but are instead closely connected to outcome measures and treatment response. Besides the mere detection of antibodies, investigating the cerebrospinal fluid is indispensible to rule out an infectious etiology of encephalitis prior to the initiation of immunosuppressive treatment, whereas imaging studies are relevant to gain information on the temporal course of disease and for ruling out other etiologies, e. g. hippocampal gliomas. This work gives an overview on the clinical course and findings of laboratory, electroencephalography (EEG) and imaging studies in relevant types of autoimmune mediated encephalitis. Furthermore, it gives a synopsis on contemporary treatment strategies.
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Affiliation(s)
- R Patejdl
- Institut für Physiologie, Universitätsmedizin Rostock
| | - A Winkelmann
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
| | - J Ehler
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock
| | - H Zettl
- Tumorzentrum, Universitätsmedizin Rostock
| | - S Meister
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
| | - U K Zettl
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
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Patejdl R, Wittstock M, Zettl UK, Jost K, Grossmann A, Prudlo J. Neuromyelitis optica spectrum disorder coinciding with hematological immune disease: A case report. Mult Scler Relat Disord 2016; 9:101-3. [PMID: 27645353 DOI: 10.1016/j.msard.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/20/2016] [Accepted: 07/07/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Recently defined consensus criteria for the diagnosis of neuromyelitis optica spectrum disorders (NMOSD) allow establishing the diagnosis in patients without elevated AQP4-Ab and optic nerve involvement. According to the new extended definition, NMOSD is closely associated with extensive spinal cord inflammation occurring in the course of systemic autoimmune diseases as sarcoidosis or lupus erythematodes. NMOSD occurring in the course of hematological disease have not yet been reported in the literature. CASE REPORT A 38 year old male subsequently developed thrombocytopenia, hemolytic anemia and agranulocytosis over a 23 month period. Three months after an episode of agranulocytosis, he noticed ascending sensory disturbances and progressive weakness of his legs. Within two days, symptoms worsened to give almost complete paraplegia and loss of sensation below a midthoracic level. MRI revealed signal hyperintensity and edema in T2-weighted sequences reaching from the 2nd cervical to the 9th thoracic vertebral body. Two years later, he developed a second episode with lesions in the spinal cord and periventricular areas of brain stem and thalamus. CONCLUSION The relapsing time course and the topographical pattern of central nervous system lesions restricted to axial brain structures and the spinal cord fulfill the criteria that have recently been defined for AQP4-Ab-negative NMO-spectrum disease. Systematic studies on the association of hematological autoimmune phenomena and spinal cord disease are needed to clarify whether this coincidence is just a casual phenomenon or whether it points to a yet undiscovered but perhaps therapeutically interesting link of immunological mechanisms affecting both organ systems.
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Affiliation(s)
- R Patejdl
- Department of Neurology, University of Rostock, Rostock, Germany; Department of Physiology, University of Rostock, Rostock, Germany.
| | - M Wittstock
- Department of Neurology, University of Rostock, Rostock, Germany
| | - U K Zettl
- Department of Neurology, University of Rostock, Rostock, Germany
| | - K Jost
- Department of Hematology, Oncology and Palliative Medicine, University of Rostock, Rostock, Germany
| | - A Grossmann
- Institute for Diagnostic and Interventional Radiology, University of Rostock, Rostock, Germany
| | - J Prudlo
- Department of Neurology, University of Rostock, Rostock, Germany
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Patejdl R, Penner IK, Noack TK, Zettl UK. Multiple sclerosis and fatigue: A review on the contribution of inflammation and immune-mediated neurodegeneration. Autoimmun Rev 2016; 15:210-20. [DOI: 10.1016/j.autrev.2015.11.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/13/2015] [Indexed: 02/02/2023]
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Zettl UK, Rommer P, Hipp P, Patejdl R. Evidence for the efficacy and effectiveness of THC-CBD oromucosal spray in symptom management of patients with spasticity due to multiple sclerosis. Ther Adv Neurol Disord 2016; 9:9-30. [PMID: 26788128 DOI: 10.1177/1756285615612659] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Spasticity, one of the main symptoms of multiple sclerosis (MS), can affect more than 80% of MS patients during the course of their disease and is often not treated adequately. δ-9-Tetrahydrocannabinol-cannabidiol (THC-CBD) oromucosal spray is a plant-derived, standardized cannabinoid-based oromucosal spray medicine for add-on treatment of moderate to severe, resistant multiple sclerosis-induced spasticity. This article reviews the current evidence for the efficacy and safety, with dizziness and fatigue as the most common treatment-related adverse events, being mostly mild to moderate in severity. Results from both randomized controlled phase III studies involving about,1600 MS patients or 1500 patient-years and recently published studies on everyday clinical practice involving more than 1000 patients or more than,1000 patient-years are presented.
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Affiliation(s)
- Uwe K Zettl
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, D-18147 Rostock, Germany
| | - Paulus Rommer
- Department of Neurology, University of Rostock, Germany
| | | | - Robert Patejdl
- Department of Neurology, University of Rostock, Germany Oscar-Langendorff-Institute of Physiology, University of Rostock, Germany
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Patejdl R, Leroux AC, Noack T. Phenytoin inhibits contractions of rat gastrointestinal and portal vein smooth muscle by inhibiting calcium entry. Neurogastroenterol Motil 2015; 27:1453-65. [PMID: 26265316 DOI: 10.1111/nmo.12645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 12/02/2014] [Accepted: 07/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Phenytoin is widely used as a second-line treatment for status epilepticus. Besides its well-known cardiac pro-arrhythmogenicity, side effects on other organ systems have received less attention. METHODS This study investigates the effects of phenytoin on gastrointestinal tissue function using an in vitro model of smooth muscle preparations from rats by combining registrations of pharmacological effects on mechanical contractions, electric field potentials, and dynamic intravital fluorescence microscopy. KEY RESULTS When added to the bathing solution at a concentration of 30 μM, phenytoin reduced the frequency of spontaneous activity significantly in antrum and portal vein preparations to 72.2 ± 36.5% (p = 0.022) and 80.7 ± 24.4% (p = 0.037) of control values, respectively. At a concentration of 100 μM, the height of spontaneous contractions declined to 9.8 ± 19.6% (p = 0.005) (antrum), 15.7 ± 28.2% (p = 0.004) (portal vein), and 31.8 ± 31.3% (p = 0.005) (colon) in comparison to the control conditions before the application of phenytoin. Depolarization triggered increases in calcium dependent fluorescence signals were reduced by 52.8 ± 39.1% (p = 0.012) The inhibition of spontaneous activity caused by phenytoin was reduced in the presence of the L-type calcium channel agonist BAY K8644(-). CONCLUSIONS & INFERENCES Phenytoin exerts strong inhibitory effects on the spontaneous and stimulated contractile activity of smooth muscles from both the upper and lower gastrointestinal tract. The mechanism underlying this effect is not related to the sodium channel blocking activity of phenytoin, but is rather caused by an inhibition of calcium entry through voltage dependent L-type calcium channels. The results of this study should raise vigilance to gastrointestinal complications in patients treated with phenytoin.
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Affiliation(s)
- R Patejdl
- Institut für Physiologie, Universitätsmedizin Rostock, Rostock, Germany
| | - A-C Leroux
- Institut für Physiologie, Universitätsmedizin Rostock, Rostock, Germany
| | - T Noack
- Institut für Physiologie, Universitätsmedizin Rostock, Rostock, Germany
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Patejdl R, Penner IK, Noack TK, Zettl UK. [Fatigue in patients with multiple sclerosis--pathogenesis, clinical picture, diagnosis and treatment]. Fortschr Neurol Psychiatr 2015; 83:211-20. [PMID: 25893494 DOI: 10.1055/s-0034-1399353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fatigue is a frequent and restricting symptom of multiple sclerosis (MS). Starting from its pathogenetic mechanisms, the article develops an approach to the differential diagnosis of fatigue in MS patients. Over the past years, the use of functional imaging techniques has given important information on the mechanisms of this highly variable clinical picture. Considering our improved understanding of the interdependency of immune pathology and the clinical presentation of neuropsychological disorders, the relationship between immunomodulatory treatments and fatigue is receiving increased attention. Therefore, this article not only reports on the most recent data on pharmacological, physical and psychological interventions in the symptomatic treatment of fatigue, but also puts a special accent on data concerning the interactions between the rapidly growing number of immunomodulatory treatments in MS.
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Affiliation(s)
- R Patejdl
- Institut für Physiologie, Universitätsmedizin Rostock
| | - I K Penner
- Kognitive Psychologie und Methodologie, Universität Basel
| | - T K Noack
- Institut für Physiologie, Universitätsmedizin Rostock
| | - U K Zettl
- Klinik für Neurologie und Poliklinik, Universitätsmedizin Rostock
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Patejdl R, Tesar S, Zettl U. Multiple Sklerose, Neuromyelitis optica und spastische Bewegungsstörungen: Spezifische Symptomkontrolle und Lebensqualität. Fortschr Neurol Psychiatr 2014; 82:373-85. [DOI: 10.1055/s-0034-1366536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- R. Patejdl
- Institut für Physiologie, Universitätsmedizin Rostock
| | - S. Tesar
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
| | - U. Zettl
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Rostock
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Ludwig M, Skorska A, Tölk A, Hopp HH, Patejdl R, Li J, Steinhoff G, Noack T. Characterization of ion currents of murine CD117(pos) stem cells in vitro and their modulation under AT2 R stimulation. Acta Physiol (Oxf) 2013; 208:274-87. [PMID: 23648269 DOI: 10.1111/apha.12115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/29/2013] [Accepted: 04/30/2013] [Indexed: 12/19/2022]
Abstract
AIM Hematopoietic stem cells, especially CD117(pos) cells, have been found to possess a regenerative potential in various tissues, in particular cardiac muscle. However, the characterization of the relevant ion currents of stem cells prior to implantation lacks documentation. Activation of angiotensin II type 2 receptor (AT2 R) can lead to further cell differentiation and receptor auto-expression and might thus influence electrophysiological properties of CD117(pos) stem cells. This study was designed to functionally characterize membrane currents of CD117(pos) cells under normal and AT2 R-stimulated conditions. METHODS CD117(pos) murine bone marrow stem cells were isolated with MACS technique and stimulated for the AT2 R with angiotensin II and losartan for 3-5 days prior to patch-clamp measurements. RT-PCR was used to determine channel expression. Endothelial properties were analysed with immunocytochemistry and acLDL uptake assay. RESULTS A well-expressed inward rectifying current (IKir ) was identified in cultured CD117(pos) cells. Furthermore, a ZD 7288 (HCN channel blocker)-sensitive current component was isolated. Voltage-dependent potassium currents and chloride currents were less expressed. A small fraction of cells demonstrated voltage- and time-dependent inward currents. In AT2 R-stimulated cells inward rectifying the hyperpolarization-induced inward currents were slightly attenuated on the translational level but showed increased mRNA expression. Cultured CD117(pos) cells express CD31 and VEGFR-2 and significantly increased the uptake of acLDL. CONCLUSIONS CD117(pos) cells do not have properties of action potential-generating cells and moderately change their excitability during AT2 R stimulation. Electrophysiological and molecular properties of control and AT2 R-stimulated cells point to a differentiation to vascular endothelial cells. This could increase beneficial vascularization in injured tissues.
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Affiliation(s)
- M. Ludwig
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University Rostock; Rostock; Germany
| | - A. Skorska
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University Rostock; Rostock; Germany
| | - A. Tölk
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University Rostock; Rostock; Germany
| | - H.-H. Hopp
- Oscar Langendorff Institute of Physiology; University Rostock; Rostock; Germany
| | - R. Patejdl
- Oscar Langendorff Institute of Physiology; University Rostock; Rostock; Germany
| | - J. Li
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University Rostock; Rostock; Germany
| | - G. Steinhoff
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University Rostock; Rostock; Germany
| | - T. Noack
- Oscar Langendorff Institute of Physiology; University Rostock; Rostock; Germany
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Patejdl R, Markmann S, Benecke R, Wittstock M. Severe acute motor neuropathy after treatment with triple tyrosine kinase inhibitor BIBF 1120 (Nintedanib). Clin Neurol Neurosurg 2013; 115:1851-2. [PMID: 23414813 DOI: 10.1016/j.clineuro.2013.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/22/2013] [Accepted: 01/23/2013] [Indexed: 11/27/2022]
Affiliation(s)
- R Patejdl
- Department of Neurology, University of Rostock, Rostock, Germany.
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Rommer PS, Patejdl R, Zettl UK. Monoclonal antibodies in the treatment of neuroimmunological diseases. Curr Pharm Des 2013; 18:4498-507. [PMID: 22612751 DOI: 10.2174/138161212802502125] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 04/03/2012] [Indexed: 11/22/2022]
Abstract
Over the past 25 years, monoclonal antibodies (mAb) have become important elements in the therapeutic concepts for numerous clinical specialities, including oncology, gastroenterology, hemostaseology and endocrinology. One of the most dynamic fields of their use is the treatment of autoimmune diseases. Although the number of existing mAb interfering with the immune system has increased remarkably and many studies have yielded encouraging results in the treatment of neuroimmunological diseases, their clinical use is still limited compared with standard treatments. The only mAb which has been approved for a neuroimmunological disease by now is natalizumab for the treatment of relapsing-remitting multiple sclerosis (RRMS). This article gives an overview on mAb that are currently in use or under investigation for treating neuroimmunological diseases like multiple sclerosis (MS), neuromyelitis optica (NMO), chronic inflammatory demyelinating polyneuropathy (CIDP), inclusion body myositis (IBM), dermatomyositis, polymyositis, opsoclonusmyoclonus syndrome (OMS), multifocal motor neuropathy (MMN), anti-myelin-glycoprotein neuropathy (Anti-MAG), stiff person syndrome and myasthenia gravis (MG).
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Affiliation(s)
- Paulus S Rommer
- Department of Neurology, Medical University of Vienna; Department of Neurology, Währinger Gürtel 18-20, A-1090 Wien Vienna, Austria.
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Patejdl R, Mix E, K. Zettl U. Editorial: [Hot Topic: Keeping Track of an Expanding Subject - Recent Trends in Immunology and their Clinical Implications]. Curr Pharm Des 2012; 18:4441-2. [DOI: 10.2174/138161212802502242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Patejdl R, K. Zettl U. Animal Models in Neurology: Drawbacks and Opportunities. Curr Pharm Des 2012; 18:4443-52. [DOI: 10.2174/138161212802502233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 03/26/2012] [Indexed: 11/22/2022]
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Walter U, Kolbaske S, Patejdl R, Steinhagen V, Abu-Mugheisib M, Grossmann A, Zingler C, Benecke R. Insular stroke is associated with acute sympathetic hyperactivation and immunodepression. Eur J Neurol 2012; 20:153-9. [DOI: 10.1111/j.1468-1331.2012.03818.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 06/12/2012] [Indexed: 11/27/2022]
Affiliation(s)
- U. Walter
- Department of Neurology; University of Rostock; Rostock Germany
| | - S. Kolbaske
- Department of Neurology; University of Rostock; Rostock Germany
| | - R. Patejdl
- Department of Neurology; University of Rostock; Rostock Germany
| | - V. Steinhagen
- Department of Neurology; University of Rostock; Rostock Germany
| | | | - A. Grossmann
- Institute for Diagnostic and Interventional Radiology; University of Rostock; Rostock Germany
| | - C. Zingler
- Institute of Clinical Chemistry and Laboratory Medicine; University of Rostock; Rostock Germany
| | - R. Benecke
- Department of Neurology; University of Rostock; Rostock Germany
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Patejdl R, Kamm C, Zettl U. Radiologisch isoliertes Syndrom: Verlauf und Empfehlungen zum klinischen Management. Akt Neurol 2012. [DOI: 10.1055/s-0032-1304869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- R. Patejdl
- Klinik und Poliklinik für Neurologie, Universität Rostock
| | - C. Kamm
- Klinik und Poliklinik für Neurologie, Universität Rostock
| | - U. Zettl
- Klinik und Poliklinik für Neurologie, Universität Rostock
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Ehler J, Patejdl R, Junghanss C, Lehmitz R, Pahnke J, Großmann A, Vogelgesang S, Brüggemann M, Benecke R, Zettl UK. Intrathecal large granular lymphocytes as an unusual presentation of a small cell T cell lymphoma. Clin Neurol Neurosurg 2012; 114:1102-3. [PMID: 22421252 DOI: 10.1016/j.clineuro.2012.02.029] [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: 12/30/2011] [Accepted: 02/19/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Johannes Ehler
- Department of Neurology, University of Rostock, Rostock, Germany.
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Patejdl R, Borchert K, Pagumbke H, Benecke R, Grossmann A, Prall F, Kahl C, Freund M, Schmitt M, Walter U. Posterior reversible encephalopathy syndrome (PRES): An unusual primary manifestation of a diffuse large B-cell lymphoma. Clin Neurol Neurosurg 2011; 113:819-21. [DOI: 10.1016/j.clineuro.2011.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 08/17/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
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Abstract
BACKGROUND While numerous substances have been developed for the treatment of relapsing-remitting multiple sclerosis over recent years, options are still limited for patients with secondary progressive multiple sclerosis (SPMS). OBJECTIVES AND METHODS In this observational study we present clinical and CSF findings in three patients with SPMS who were treated with rituximab for at least 15 months. RESULTS During the observation period, no severe adverse effects occurred and the Expanded Disability Status Scale (EDSS) score stabilized in all patients after a dramatic increase over the previous years. In contrast to other publications, we showed that the time to reoccurrence of B cells was very variable and that serial CSF examinations in the course of treatment revealed a decline in intrathecal IgG synthesis. CONCLUSION Rituximab seems to be effective in active SPMS. Restitution of the pathogenic immune response after administration of rituximab is variable. Further studies are needed to determine the optimal dosage and timing for rituximab therapy in multiple sclerosis.
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Benecke R, Patejdl R. [New therapies for spastic movement disorders]. MMW Fortschr Med 2009; 151 Suppl 3:118-122. [PMID: 20623938] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Reiner Benecke
- Klinik und Poliklinik für Neurologie, Universität Rostock.
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Patejdl R, Schaefer S, Wladimir T, May A, Benecke R, Zettl UK, Gunson R, Carman W, Nau R. Klinisch stumme HSV-1-Infektion des Liquor cerebrospinalis bei einer Patientin mit Multipler Sklerose. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ehler J, Patejdl R, Sebb H, Großmann A, Lehmitz R, Pahnke J, Junghanß C, Vogelgesang S, Brüggemann M, Prall F, Benecke R, Zettl UK. Zerebrale Läsionen durch atypische Monozyten – eine interdisziplinäre Herausforderung. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Patejdl R, Winkelmann A, Benecke R, Zettl UK. Muscle rupture caused by exacerbated spasticity in a patient with multiple sclerosis. J Neurol 2008; 255 Suppl 6:115-8. [DOI: 10.1007/s00415-008-6021-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patejdl R, Rommer P, Winkelmann A, Grossmann A, Greim B, Köhler W, Benecke R, Zettl U. Autosomal dominante Leukodystrophie – dringender Verdacht bei einem 49-jährigen Patienten. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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