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Zenker S, Strech D, Jahns R, Müller G, Prasser F, Schickhardt C, Schmidt G, Semler SC, Winkler E, Drepper J. [Nationally standardized broad consent in practice: initial experiences, current developments, and critical assessment]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024:10.1007/s00103-024-03878-6. [PMID: 38639817 DOI: 10.1007/s00103-024-03878-6] [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: 12/14/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The digitalization in the healthcare sector promises a secondary use of patient data in the sense of a learning healthcare system. For this, the Medical Informatics Initiative's (MII) Consent Working Group has created an ethical and legal basis with standardized consent documents. This paper describes the systematically monitored introduction of these documents at the MII sites. METHODS The monitoring of the introduction included regular online surveys, an in-depth analysis of the introduction processes at selected sites, and an assessment of the documents in use. In addition, inquiries and feedback from a large number of stakeholders were evaluated. RESULTS The online surveys showed that 27 of the 32 sites have gradually introduced the consent documents productively, with a current total of 173,289 consents. The analysis of the implementation procedures revealed heterogeneous organizational conditions at the sites. The requirements of various stakeholders were met by developing and providing supplementary versions of the consent documents and additional information materials. DISCUSSION The introduction of the MII consent documents at the university hospitals creates a uniform legal basis for the secondary use of patient data. However, the comprehensive implementation within the sites remains challenging. Therefore, minimum requirements for patient information and supplementary recommendations for best practice must be developed. The further development of the national legal framework for research will not render the participation and transparency mechanisms developed here obsolete.
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Affiliation(s)
- Sven Zenker
- Stabsstelle Medizinisch-Wissenschaftliche Technologieentwicklung und -koordination (MWTek), Kaufmännische Direktion, Universitätsklinikum Bonn, Bonn, Deutschland.
- AG Angewandte Medizininformatik (AMI), Institut für Medizinische Biometrie, Informatik und Epidemiologie (IMBIE), Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland.
- AG Angewandte Mathematische Physiologie (AMP), Klinik & Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
- Stabsstelle Medizinisch-Wissenschaftliche Technologieentwicklung und -koordination (MWTek) Kaufmännische Direktion, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Daniel Strech
- QUEST Center for Responsible Research, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Roland Jahns
- Interdisziplinäre Biomaterial- und Datenbank Würzburg (ibdw), Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Gabriele Müller
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Fabian Prasser
- Center for Health Data Science, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph Schickhardt
- Sektion Translationale Medizinethik, KKE Angewandte Tumor-Immunität, Nationales Centrum für Tumorerkrankungen (NCT), Deutsches Krebsforschungszentrum (DKFZ) Heidelberg und Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Georg Schmidt
- Klinik und Poliklinik für Innere Medizin I. Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Sebastian C Semler
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin, Deutschland
| | - Eva Winkler
- Sektion Translationale Medizinethik, Abteilung Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Universität Heidelberg, Heidelberg, Deutschland
| | - Johannes Drepper
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin, Deutschland
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Brand T, Lukannek AK, Jahns V, Jahns R, Lorenz K. From "contraindicated" to "first line" - Current mechanistic insights beyond canonical β-receptor signaling. Curr Opin Pharmacol 2024; 76:102458. [PMID: 38636195 DOI: 10.1016/j.coph.2024.102458] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
β-blockers are a solid pillar in the treatment of cardiovascular diseases. However, they are highly discussed regarding effectiveness for certain indications and side-effects. Even though there are up to 20 licensed compounds, only four are used for heart failure (HF) therapy. On the receptor level several key characteristics seem to influence the clinical outcome: subtype selectivity, antagonistic vs (inverse/biased) agonistic properties and -in particular- ancillary capacities. On a molecular level, divergent and novel signaling patterns are being identified and extra-cardiac effects on e.g. inflammation, metabolism and oxidative stress are highlighted. This review discusses different well-known and newly discovered characteristics that need to be considered for HF therapy and in the context of co-morbidities.
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Affiliation(s)
- Theresa Brand
- Institute of Pharmacology and Toxicology, University of Würzburg, Germany
| | | | - Valérie Jahns
- Institute of Pharmacology and Toxicology, University of Würzburg, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biological Materials and Data Würzburg (ibdw), University Hospital Würzburg, Germany
| | - Kristina Lorenz
- Institute of Pharmacology and Toxicology, University of Würzburg, Germany; Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., Cardiovascular Pharmacology, Dortmund, Germany.
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Morbach C, Beyersdorf N, Moser N, Pelin D, Afshar B, Ramos G, Kerkau T, Kaiser E, Lamers J, Pätkau J, Sahiti F, Albert J, Güder G, Ertl G, Angermann CE, Frantz S, Hofmann U, Jahns R, Jahns V, Störk S. Prevalence of anti-beta-1 antibody 6 months after hospitalization for acute heart failure predicts adverse outcome. ESC Heart Fail 2023; 10:3227-3231. [PMID: 37688355 PMCID: PMC10567622 DOI: 10.1002/ehf2.14509] [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: 11/18/2022] [Revised: 07/13/2023] [Accepted: 08/10/2023] [Indexed: 09/10/2023] Open
Abstract
AIMS Agonistic antibodies against neurohumoral receptors can induce cardio-noxious effects by altering the baseline receptor activity. To estimate the prevalence of autoantibodies directed against the beta-1 receptor (b1-AAB) in patients admitted to the hospital for acute heart failure (HF) at (i) baseline and (ii) after 6 months of follow-up (F6) and (iii) after another 12 months of follow-up (i.e. 18 months after index hospitalization), to estimate their prognostic impact on clinical outcome (death or first hospitalization for HF). METHODS AND RESULTS In 47 patients, b1-AAB were serially determined in serum samples collected at index hospitalization and at 6 months of follow-up (F6) with a flow cytometry-based assay: median age 71 years (quartiles 60, 80), 23 (49%) women, 24 (51%) HF with preserved ejection fraction. Beta1-AAB were detected in three subjects at index hospitalization (6%), and in eight subjects at F6 (17%). There were no differences apparent between patients with and without b1-AAB at F6 with regard to age, sex, type, duration, or main cause of HF. During the 12 month period following F6 (i.e. up to month 18), eight events occurred. Event-free survival was associated with prevalence of b1-AAB at F6. Compared with patients without b1-AAB at F6, age-adjusted Cox regression indicated a higher event risk in patients harbouring b1-AAB, with a hazard ratio of 8.96 (95% confidence interval 1.81-44.50, P = 0.007). CONCLUSIONS Our results suggest a possible adverse prognostic relevance of b1-AAB in patients with acute HF, but this observation needs to be confirmed in larger patient collectives.
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Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Niklas Beyersdorf
- Institute for Virology and ImmunobiologyUniversity WürzburgWürzburgGermany
| | - Nicola Moser
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Dora Pelin
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Boshra Afshar
- Institute for Virology and ImmunobiologyUniversity WürzburgWürzburgGermany
| | - Gustavo Ramos
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Thomas Kerkau
- Institute for Virology and ImmunobiologyUniversity WürzburgWürzburgGermany
| | - Elisa Kaiser
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Janna Lamers
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Jannika Pätkau
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Floran Sahiti
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Judith Albert
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Gülmisal Güder
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Georg Ertl
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
| | - Christiane E. Angermann
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
| | - Stefan Frantz
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Ulrich Hofmann
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Roland Jahns
- Interdisciplinary Bank of biological materials and Data Würzburg (ibdw)University Hospital WürzburgWürzburgGermany
| | - Valerie Jahns
- Institute for Pharmacology and ToxicologyUniversity WürzburgWürzburgGermany
| | - Stefan Störk
- Comprehensive Heart Failure Center, Department for Clinical Research and EpidemiologyUniversity and University Hospital WürzburgAm Schwarzenberg 15WürzburgGermany
- Department of Medicine IUniversity Hospital WürzburgWürzburgGermany
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Geiger J, Fuchs J, Starke M, Neumann M, Baber R, Nussbeck SY, Kiehntopf M, Specht C, Illig T, Hummel M, Jahns R. GBA/GBN-position on the feedback of incidental findings in biobank-based research: consensus-based workflow for hospital-based biobanks. Eur J Hum Genet 2023; 31:1066-1072. [PMID: 36732662 PMCID: PMC10474025 DOI: 10.1038/s41431-023-01299-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/17/2022] [Revised: 12/12/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Incidental research findings pose a considerable challenge to hospital-based research biobanks since they are acting as intermediaries between healthcare and research. In a joint action the centralized biobank ibdw (Interdisciplinary Bank of Biomaterials and Data Wuerzburg) together with local authorities drafted a coherent concept to manage incidental research findings in full compliance with relevant ethical and data privacy regulations. The concept was developed and elaborated in close collaboration with the German Biobank Alliance (GBA). Comprehensive documentation of all steps guarantees the traceability of the process. By a mandatory assessment of the findings prior to re-identification of the individual concerned, unnecessary measures can be avoided. The individual's "right not to know" is respected according to the stipulations of the informed consent. As a general principle any communication with the individual occurs exclusively through the hospital and by competent physicians with appropriate knowledge and communication skills. We propose this scheme as a blueprint for reporting workflows for incidental research findings at hospital-based biobanks.
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Affiliation(s)
- Joerg Geiger
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Joerg Fuchs
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Madeline Starke
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael Neumann
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ronny Baber
- Leipzig Medical Biobank, University Leipzig, Leipzig, Germany
| | - Sara Y Nussbeck
- University Medical Center Goettingen, Central Biobank, UMG, Goettingen, Germany
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
| | - Cornelia Specht
- German Biobank Node, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michael Hummel
- German Biobank Node, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), University and University Hospital Wuerzburg, Wuerzburg, Germany
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Traub J, Schürmann P, Schmitt D, Gassenmaier T, Fette G, Frantz S, Störk S, Beyersdorf N, Boivin-Jahns V, Jahns R, Hofmann U, Frey A. Features of metabolic syndrome and inflammation independently affect left ventricular function early after first myocardial infarction. Int J Cardiol 2023; 370:43-50. [PMID: 36306955 DOI: 10.1016/j.ijcard.2022.10.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/13/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND A high body mass index (BMI) is often associated with metabolic syndrome, which is accompanied by systemic low-grade chronic inflammation. Here, we analyzed whether BMI, other components of metabolic syndrome, and/or inflammatory markers correlate with left ventricular geometry, function, and infarct size as assessed by serial cardiac magnetic resonance imaging (MRI) after a first (clinically evident) ST-elevation MI (STEMI). METHODS Within the Etiology, Titre-Course, and effect on Survival (ETiCS) study, cardiac MRI conducted 7-9 days and 12 months after MI enabled longitudinal characterization of patients with a first STEMI along with serial routine blood counts and multiplex cytokine measurements. RESULTS Of 91 locally included STEMI patients, 47% were overweight (25 kg/m2 < BMI < 30 kg/m2) and 24% were obese (BMI ≥ 30 kg/m2). No patient died during 12 months of follow-up. Left ventricular ejection fraction (LVEF), measured 7-9 days after STEMI, was significantly lower in overweight (49.5 ± 7.1%) and obese (45.8 ± 12.0%) patients than in the normal weight group (56.2 ± 7.7%). Along with BMI (T = -3.8; p < 0.001), hemoglobin A1c (HbA1c; T = -3.1; p = 0.004) and peak C-reactive protein (T = -2.6; p = 0.013) emerged as independent predictors of worse LVEF 7-9 days post MI (R2 = 0.45). Only peak C-reactive protein (T = -4.4; p < 0.001), but not parameters of the metabolic syndrome, predicted worse LVEF 12 months after STEMI (R2 = 0.20). CONCLUSION Both BMI and HbA1c correlated negatively with LVEF only early, but not late after STEMI. Peak CRP evolved as strongest predictor of cardiac function at all time points independent of the metabolic syndrome.
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Affiliation(s)
- Jan Traub
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany; Interdisciplinary Center for Clinical Research, University Würzburg, Germany.
| | - Paula Schürmann
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
| | - Dominik Schmitt
- Department of Internal Medicine I, University Hospital Würzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Georg Fette
- Data Integration Center, University Hospital Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
| | - Niklas Beyersdorf
- Institute for Virology and Immunobiology, University of Würzburg, Germany
| | - Valérie Boivin-Jahns
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany; Department of Pharmacology and Toxicology, University of Würzburg, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany; Interdisciplinary Bank of Biomaterials and Data Würzburg, University Hospital and University Würzburg, Germany
| | - Ulrich Hofmann
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
| | - Anna Frey
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
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Klingler C, von Jagwitz-Biegnitz M, Baber R, Becker KF, Dahl E, Eibner C, Fuchs J, Groenewold MK, Hartung ML, Hummel M, Jahns R, Kirsten R, Kopfnagel V, Maushagen R, Nussbeck SY, Schoneberg A, Winter T, Specht C. Stakeholder engagement to ensure the sustainability of biobanks: a survey of potential users of biobank services. Eur J Hum Genet 2022; 30:1344-1354. [PMID: 34031552 PMCID: PMC9712417 DOI: 10.1038/s41431-021-00905-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/28/2020] [Revised: 04/06/2021] [Accepted: 04/29/2021] [Indexed: 12/17/2022] Open
Abstract
Biobanks are important infrastructures facilitating biomedical research. After a decade of rolling out such infrastructures, a shift in attention to the sustainability of biobanks could be observed in recent years. In this regard, an increase in the as yet relatively low utilisation rates of biobanks has been formulated as a goal. Higher utilisation rates can only be achieved if the perspectives of potential users of biobanks-particularly researchers not yet collaborating with biobanks-are adequately considered. To better understand their perspectives, a survey was conducted at ten different research institutions in Germany hosting a centralised biobank. The survey targeted potential users of biobank services, i.e. researchers working with biosamples. It addressed the general demand for biosamples, strategies for biosample acquisition/storage and reasons for/against collaborating with biobanks. In total, 354 researchers filled out the survey. Most interestingly, only a minority of researchers (12%) acquired their biosamples via biobanks. Of the respondents not collaborating with biobanks on sample acquisition, around half were not aware of the (services of the) respective local biobank. Those who actively decided against acquiring biosamples via a biobank provided different reasons. Most commonly, respondents stated that the biosamples required were not available, the costs were too high and information about the available biosamples was not readily accessible. Biobanks can draw many lessons from the results of the survey. Particularly, external communication and outreach should be improved. Additionally, biobanks might have to reassess whether their particular collection strategies are adequately aligned with local researchers' needs.
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Affiliation(s)
- Corinna Klingler
- German Biobank Node, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | | | - Ronny Baber
- grid.9647.c0000 0004 7669 9786Leipzig Medical Biobank, University Leipzig, Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany
| | - Karl-Friedrich Becker
- grid.6936.a0000000123222966Gewebebank des Klinikums rechts der Isar und der Technischen Universität München, Am Institut für Pathologie der TU München, Trogerstr. 18, 81675 München, Germany
| | - Edgar Dahl
- grid.1957.a0000 0001 0728 696XRWTH centralized Biomaterial Bank (RWTH cBMB), Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Cornelius Eibner
- grid.275559.90000 0000 8517 6224Integrated Biobank Jena (IBBJ), Institute for Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, Am Klinikum 1, D-07747 Jena, Germany
| | - Jörg Fuchs
- grid.411760.50000 0001 1378 7891Interdisciplinary Bank of Biomaterials and Data Würzburg (ibdw), University Hospital of Würzburg, Straubmühlweg 2a, building A8/A9, 97078 Würzburg, Germany
| | - Maike K. Groenewold
- Research Unit of Molecular Epidemiology/Core Facility Biobank, Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Mara Lena Hartung
- grid.6363.00000 0001 2218 4662German Biobank Node, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Hummel
- grid.6363.00000 0001 2218 4662German Biobank Node, Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Central Biobank Charité (ZeBanC), Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Jahns
- grid.411760.50000 0001 1378 7891Interdisciplinary Bank of Biomaterials and Data Würzburg (ibdw), University Hospital of Würzburg, Straubmühlweg 2a, building A8/A9, 97078 Würzburg, Germany
| | - Romy Kirsten
- grid.5253.10000 0001 0328 4908NCT Liquid Biobank, National Center for Tumor Diseases and BioMaterialBank Heidelberg (BMBH), University Hospital Heidelberg, Heidelberg, Germany
| | - Verena Kopfnagel
- grid.10423.340000 0000 9529 9877Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Regina Maushagen
- grid.4562.50000 0001 0057 2672Interdisciplinary Center for Biobanking-Lübeck (ICB-L), University of Lübeck, Lübeck, Germany
| | - Sara Yasemin Nussbeck
- grid.411984.10000 0001 0482 5331Central Biobank UMG, University Medical Center Göttingen, Göttingen, Germany
| | - Anne Schoneberg
- grid.411984.10000 0001 0482 5331Central Biobank UMG, University Medical Center Göttingen, Göttingen, Germany
| | - Theresa Winter
- grid.5603.0Integrated Research Biobank Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Cornelia Specht
- grid.6363.00000 0001 2218 4662German Biobank Node, Charité Universitätsmedizin Berlin, Berlin, Germany
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Klingenberg R, Holtkamp F, Grün D, Frey A, Jahns V, Jahns R, Gassenmaier T, Hamm CW, Frantz S, Keller T. Use of serial changes in biomarkers vs. baseline levels to predict left ventricular remodelling after STEMI. ESC Heart Fail 2022; 10:432-441. [PMID: 36271665 PMCID: PMC9871716 DOI: 10.1002/ehf2.14204] [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: 05/26/2022] [Revised: 09/01/2022] [Accepted: 10/02/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS Cellular communication network factor 1 (CCN1) is an independent predictor of MACE after ACS and elevated levels correlated with infarct size after STEMI. We compared the prognostic accuracy of baseline levels of CCN1, NT-proBNP, hsTnT, and ST2 and changes in levels over time to predict the development of structural and functional alterations typical of LV remodelling. METHODS Serial 3-T cMRI scans were performed to determine LVEF, LVEDV, LVESV, infarct size, and relative infarct size, which were correlated with serial measurements of the four biomarkers. The prognostic significance of these biomarkers was assessed by multiple logistic regression analysis by examining their performance in predicting dichotomized cardiac MRI values 12 months after STEMI based on their median. For each biomarker three models were created using baseline (BL), the Δ value (BL to 6 months), and the two values together as predictors. All models were adjusted for age and renal function. Receiver operator curves were plotted with area under the curve (AUC) to discriminate the prognostic accuracy of individual biomarkers for MRI-based structural or functional changes. RESULTS A total of 44 predominantly male patients (88.6%) from the ETiCS (Etiology, Titre-Course, and Survival) study were identified at a mean age of 55.5 ± 11.5 (SD) years treated by successful percutaneous coronary intervention (97.7%) at a rate of 95.5% stent implantation within a median pain-to-balloon time of 260 min (IQR 124-591). Biomarkers hsTnT and ST2 were identified as strong predictors (AUC > 0.7) of LVEDV and LVEF. BL measurement to predict LVEF [hsTnT: AUC 0.870 (95% CI: 0.756-0.983), ST2: AUC 0.763 (95% CI: 0.615-0.911)] and the Δ value BL-6M [hsTnT: AUC 0.870 (95% CI: 0.756-0.983), ST2: AUC 0.809 (95% CI: 0.679-0.939)] showed a high prognostic value without a significant difference for the comparison of the BL model vs. the Δ-value model (BL-6M) for hsTnT (P = 1) and ST2 (P = 0.304). The combined model that included baseline and Δ value as predictors was not able to improve the ability to predict LVEF [hsTnT: AUC 0.891 (0.791-0.992), P = 0.444; ST2: AUC 0.778 (0.638-0.918), P = 0.799]. Baseline levels of CCN1 were closely associated with LVEDV at 12 months [AUC 0.708 (95% CI: 0.551-0.865)] and infarct size [AUC 0.703 (95% CI: 0.534-0.872)]. CONCLUSIONS Baseline biomarker levels of hsTnT and ST2 were the strongest predictors of LVEF and LVEDV at 12 months after STEMI. The association of CCN1 with LVEDV and infarct size warrants further study into the underlying pathophysiology of this novel biomarker.
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Affiliation(s)
- Roland Klingenberg
- Department of CardiologyKerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of GiessenGiessenGermany,DZHK (German Center for Cardiovascular Research), partner site Rhine‐MainBad NauheimGermany
| | - Franziska Holtkamp
- Department of CardiologyKerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of GiessenGiessenGermany,DZHK (German Center for Cardiovascular Research), partner site Rhine‐MainBad NauheimGermany,Department of Internal Medicine I, CardiologyJustus‐Liebig‐UniversityGießenGermany
| | - Dimitri Grün
- Department of Internal Medicine I, CardiologyJustus‐Liebig‐UniversityGießenGermany
| | - Anna Frey
- Comprehensive Heart Failure Center (DZHI)University Hospital WürzburgWürzburgGermany,Department of Internal Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Valérie Jahns
- Comprehensive Heart Failure Center (DZHI)University Hospital WürzburgWürzburgGermany,Department of Pharmacology and ToxicologyUniversity Hospital WürzburgWürzburgGermany
| | - Roland Jahns
- Comprehensive Heart Failure Center (DZHI)University Hospital WürzburgWürzburgGermany,Interdisciplinary Bank of Biomaterials and Data Würzburg (IBDW)University and University Hospital WürzburgWürzburgGermany
| | - Tobias Gassenmaier
- Comprehensive Heart Failure Center (DZHI)University Hospital WürzburgWürzburgGermany,Institute of RadiologyUniversity Hospital WürzburgWürzburgGermany
| | - Christian W. Hamm
- Department of CardiologyKerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of GiessenGiessenGermany,DZHK (German Center for Cardiovascular Research), partner site Rhine‐MainBad NauheimGermany,Department of Internal Medicine I, CardiologyJustus‐Liebig‐UniversityGießenGermany
| | - Stefan Frantz
- Comprehensive Heart Failure Center (DZHI)University Hospital WürzburgWürzburgGermany,Department of Internal Medicine IUniversity Hospital WürzburgWürzburgGermany
| | - Till Keller
- Department of CardiologyKerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of GiessenGiessenGermany,DZHK (German Center for Cardiovascular Research), partner site Rhine‐MainBad NauheimGermany,Department of Internal Medicine I, CardiologyJustus‐Liebig‐UniversityGießenGermany
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Holtkamp F, Gruen D, Frey A, Jahns V, Jahns R, Gassenmaier T, Hamm C, Frantz S, Keller T, Klingenberg R. Does a 6-month change in circulating biomarkers improve the prognostic power of baseline values for predicting cardiac MRI pathologies in patients with STEMI? Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.221] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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9
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Schüttler C, Jahns R, Prokosch U, Wach S, Wullich B. [Biobanks, translational research and medical informatics]. Urologie 2022; 61:722-727. [PMID: 35925243 DOI: 10.1007/s00120-022-01850-3] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
When we think of medical research, one intuitively associates it with the analysis of study data collected for a specific research question or with the secondary use of patient data from routine care. However, these are not the only sources for answering scientific questions. Especially for translational research, tissue and liquid samples such as blood, DNA or other body fluids provide essential insights into disease pathogenesis, development of new therapies and treatment decisions. Access to these biomedical materials is provided by so-called biobanks. By collecting, characterizing, documenting and, if necessary, processing human biospecimens in accordance with high quality standards, they can support research of the causes of diseases, early diagnosis and the targeted treatment of diseases, or make a significant contribution to the investigation of common diseases.
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Affiliation(s)
- C Schüttler
- Central Biobank Erlangen (CeBE), Universitätsklinikum Erlangen und Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - R Jahns
- Interdisziplinäre Biomaterial- und Datenbank der Medizinischen Fakultät Würzburg, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - U Prokosch
- Lehrstuhl für Medizinische Informatik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - S Wach
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - B Wullich
- Central Biobank Erlangen (CeBE), Universitätsklinikum Erlangen und Medizinische Fakultät, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland.
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10
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Zenker S, Strech D, Ihrig K, Jahns R, Müller G, Schickhardt C, Schmidt G, Speer R, Winkler E, von Kielmansegg SG, Drepper J. Data protection-compliant broad consent for secondary use of health care data and human biosamples for (bio)medical research: Towards a new German national standard. J Biomed Inform 2022; 131:104096. [PMID: 35643273 DOI: 10.1016/j.jbi.2022.104096] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 10/31/2021] [Revised: 04/05/2022] [Accepted: 05/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The secondary use of deidentified but not anonymized patient data is a promising approach for enabling precision medicine and learning health care systems. In most national jurisdictions (e.g., in Europe), this type of secondary use requires patient consent. While various ethical, legal, and technical analyses have stressed the opportunities and challenges for different types of consent over the past decade, no country has yet established a national consent standard accepted by the relevant authorities. METHODS A working group of the national Medical Informatics Initiative in Germany conducted a requirements analysis and developed a GDPR-compliant broad consent standard. The development included consensus procedures within the Medical Informatics Initiative, a documented consultation process with all relevant stakeholder groups and authorities, and the ultimate submission for approval via the national data protection authorities. RESULTS This paper presents the broad consent text together with a guidance document on mandatory safeguards for broad consent implementation. The mandatory safeguards comprise i) independent review of individual research projects, ii) organizational measures to protect patients from involuntary disclosure of protected information, and iii) comprehensive information for patients and public transparency. This paper further describes the key issues discussed with the relevant authorities, especially the position on additional or alternative consent approaches such as dynamic consent. DISCUSSION Both the resulting broad consent text and the national consensus process are relevant for similar activities internationally. A key challenge of aligning consent documents with the various stakeholders was explaining and justifying the decision to use broad consent and the decision against using alternative models such as dynamic consent. Public transparency for all secondary use projects and their results emerged as a key factor in this justification. While currently largely limited to academic medicine in Germany, the first steps for extending this broad consent approach to wider areas of application, including smaller institutions and medical practices, are currently under consideration.
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Affiliation(s)
- Sven Zenker
- Staff Unit for Scientific & Medical Technology Development & Coordination (MWTek), Commercial Directorate, Institute for Medical Biometry, Informatics & Epidemiology, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusbergcampus 1, 53127 Bonn, Germany.
| | - Daniel Strech
- QUEST Center, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kristina Ihrig
- Department of Medicine, Hematology/Oncology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Würzburg (ibdw), University and University Hospital of Würzburg, Building A8/A9, Straubmühlweg 2a, 97078 Würzburg, Germany
| | - Gabriele Müller
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Christoph Schickhardt
- Section of Translational Medical Ethics, National Center for Tumor Diseases, German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Georg Schmidt
- Department of Internal Medicine 1, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, German Centre for Cardiovascular Research partner site Munich Heart Alliance, Munich, Germany
| | - Ronald Speer
- LIFE - Leipzig Research Center for Civilization Diseases, Medical Faculty, Leipzig University, Philipp-Rosenthal-Straße 27, 04103 Leipzig, Germany
| | - Eva Winkler
- Section for Translational Medical Ethics, Dept Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, INF 460, 69121 Heidelberg
| | | | - Johannes Drepper
- TMF - Technology, Methods, and Infrastructure for Networked Medical Research, Charlottenstrasse 42, 10117 Berlin, Germany
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11
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Heiling S, Knutti N, Scherr F, Geiger J, Weikert J, Rose M, Jahns R, Ceglarek U, Scherag A, Kiehntopf M. Metabolite Ratios as Quality Indicators for Pre-Analytical Variation in Serum and EDTA Plasma. Metabolites 2021; 11:638. [PMID: 34564454 PMCID: PMC8465943 DOI: 10.3390/metabo11090638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/17/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/18/2022] Open
Abstract
In clinical diagnostics and research, blood samples are one of the most frequently used materials. Nevertheless, exploring the chemical composition of human plasma and serum is challenging due to the highly dynamic influence of pre-analytical variation. A prominent example is the variability in pre-centrifugation delay (time-to-centrifugation; TTC). Quality indicators (QI) reflecting sample TTC are of utmost importance in assessing sample history and resulting sample quality, which is essential for accurate diagnostics and conclusive, reproducible research. In the present study, we subjected human blood to varying TTCs at room temperature prior to processing for plasma or serum preparation. Potential sample QIs were identified by Ultra high pressure liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) based metabolite profiling in samples from healthy volunteers (n = 10). Selected QIs were validated by a targeted MS/MS approach in two independent sets of samples from patients (n = 40 and n = 70). In serum, the hypoxanthine/guanosine (HG) and hypoxanthine/inosine (HI) ratios demonstrated high diagnostic performance (Sensitivity/Specificity > 80%) for the discrimination of samples with a TTC > 1 h. We identified several eicosanoids, such as 12-HETE, 15-(S)-HETE, 8-(S)-HETE, 12-oxo-HETE, (±)13-HODE and 12-(S)-HEPE as QIs for a pre-centrifugation delay > 2 h. 12-HETE, 12-oxo-HETE, 8-(S)-HETE, and 12-(S)-HEPE, and the HI- and HG-ratios could be validated in patient samples.
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Affiliation(s)
- Sven Heiling
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (N.K.); (F.S.); (M.R.)
| | - Nadine Knutti
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (N.K.); (F.S.); (M.R.)
| | - Franziska Scherr
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (N.K.); (F.S.); (M.R.)
| | - Jörg Geiger
- Interdisciplinary Bank of Biological Material and Data Würzburg (IBDW), Straubmühlweg 2a, Haus A9, 97078 Würzburg, Germany; (J.G.); (R.J.)
| | - Juliane Weikert
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, 04103 Leipzig, Germany; (J.W.); (U.C.)
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany
| | - Michael Rose
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (N.K.); (F.S.); (M.R.)
| | - Roland Jahns
- Interdisciplinary Bank of Biological Material and Data Würzburg (IBDW), Straubmühlweg 2a, Haus A9, 97078 Würzburg, Germany; (J.G.); (R.J.)
| | - Uta Ceglarek
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, 04103 Leipzig, Germany; (J.W.); (U.C.)
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103 Leipzig, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Bachstrasse 18, 07743 Jena, Germany;
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (N.K.); (F.S.); (M.R.)
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12
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Morbach C, Beyersdorf N, Kerkau T, Ramos G, Sahiti F, Albert J, Jahns R, Ertl G, Angermann CE, Frantz S, Hofmann U, Störk S. Adaptive anti-myocardial immune response following hospitalization for acute heart failure. ESC Heart Fail 2021; 8:3348-3353. [PMID: 33934554 PMCID: PMC8318503 DOI: 10.1002/ehf2.13376] [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: 12/23/2020] [Revised: 03/07/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Aims It has been hypothesized that cardiac decompensation accompanying acute heart failure (AHF) episodes generates a pro‐inflammatory environment boosting an adaptive immune response against myocardial antigens, thus contributing to progression of heart failure (HF) and poor prognosis. We assessed the prevalence of anti‐myocardial autoantibodies (AMyA) as biomarkers reflecting adaptive immune responses in patients admitted to the hospital for AHF, followed the change in AMyA titres for 6 months after discharge, and evaluated their prognostic utility. Methods and results AMyA were determined in n = 47 patients, median age 71 (quartiles 60; 80) years, 23 (49%) female, and 24 (51%) with HF with preserved ejection fraction, from blood collected at baseline (time point of hospitalization) and at 6 month follow‐up (visit F6). Patients were followed for 18 months (visit F18). The prevalence of AMyA increased from baseline (n = 21, 45%) to F6 (n = 36, 77%; P < 0.001). At F6, the prevalence of AMyA was higher in patients with HF with preserved ejection fraction (n = 21, 88%) compared with patients with reduced ejection fraction (n = 14, 61%; P = 0.036). During the subsequent 12 months after F6, that is up to F18, patients with newly developed AMyA at F6 had a higher risk for the combined endpoint of death or rehospitalization for HF (hazard ratio 4.79, 95% confidence interval 1.13–20.21; P = 0.033) compared with patients with persistent or without AMyA at F6. Conclusions Our results support the hypothesis that AHF may induce patterns of adaptive immune responses. More studies in larger populations and well‐defined patient subgroups are needed to further clarify the role of the adaptive immune system in HF progression.
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Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, D-97078, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Niklas Beyersdorf
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Thomas Kerkau
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Gustavo Ramos
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, D-97078, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Floran Sahiti
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, D-97078, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Judith Albert
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, D-97078, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Würzburg (ibdw), University Hospital Würzburg, Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, D-97078, Germany
| | - Christiane E Angermann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, D-97078, Germany
| | - Stefan Frantz
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, D-97078, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Hofmann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, D-97078, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, D-97078, Germany.,Department of Medicine I, University Hospital Würzburg, Würzburg, Germany
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13
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Frey A, Gassenmaier T, Hofmann U, Schmitt D, Fette G, Marx A, Herterich S, Boivin-Jahns V, Ertl G, Bley T, Frantz S, Jahns R, Störk S. Coagulation factor XIII activity predicts left ventricular remodelling after acute myocardial infarction. ESC Heart Fail 2020; 7:2354-2364. [PMID: 32548915 PMCID: PMC7524135 DOI: 10.1002/ehf2.12774] [Citation(s) in RCA: 5] [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: 12/09/2019] [Revised: 04/21/2020] [Accepted: 05/07/2020] [Indexed: 11/11/2022] Open
Abstract
AIMS Acute myocardial infarction (MI) is the major cause of chronic heart failure. The activity of blood coagulation factor XIII (FXIIIa) plays an important role in rodents as a healing factor after MI, whereas its role in healing and remodelling processes in humans remains unclear. We prospectively evaluated the relevance of FXIIIa after acute MI as a potential early prognostic marker for adequate healing. METHODS AND RESULTS This monocentric prospective cohort study investigated cardiac remodelling in patients with ST-elevation MI and followed them up for 1 year. Serum FXIIIa was serially assessed during the first 9 days after MI and after 2, 6, and 12 months. Cardiac magnetic resonance imaging was performed within 4 days after MI (Scan 1), after 7 to 9 days (Scan 2), and after 12 months (Scan 3). The FXIII valine-to-leucine (V34L) single-nucleotide polymorphism rs5985 was genotyped. One hundred forty-six patients were investigated (mean age 58 ± 11 years, 13% women). Median FXIIIa was 118% (quartiles, 102-132%) and dropped to a trough on the second day after MI: 109% (98-109%; P < 0.001). FXIIIa recovered slowly over time, reaching the baseline level after 2 to 6 months and surpassed baseline levels only after 12 months: 124% (110-142%). The development of FXIIIa after MI was independent of the genotype. FXIIIa on Day 2 was strongly and inversely associated with the relative size of MI in Scan 1 (Spearman's ρ = -0.31; P = 0.01) and Scan 3 (ρ = -0.39; P < 0.01) and positively associated with left ventricular ejection fraction: ρ = 0.32 (P < 0.01) and ρ = 0.24 (P = 0.04), respectively. CONCLUSIONS FXIII activity after MI is highly dynamic, exhibiting a significant decline in the early healing period, with reconstitution 6 months later. Depressed FXIIIa early after MI predicted a greater size of MI and lower left ventricular ejection fraction after 1 year. The clinical relevance of these findings awaits to be tested in a randomized trial.
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Affiliation(s)
- Anna Frey
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Tobias Gassenmaier
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Institute of Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ulrich Hofmann
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Dominik Schmitt
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Georg Fette
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department for Artificial Intelligence and Applied Computer Science, University of Würzburg, Würzburg, Germany
| | - Almuth Marx
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Sabine Herterich
- Division of Laboratory Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Valérie Boivin-Jahns
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Pharmacology and Toxicology, University of Würzburg, Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Bley
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Institute of Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Interdisciplinary Bank of Biomaterials and Data Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
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14
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Bild R, Bialke M, Buckow K, Ganslandt T, Ihrig K, Jahns R, Merzweiler A, Roschka S, Schreiweis B, Stäubert S, Zenker S, Prasser F. Towards a comprehensive and interoperable representation of consent-based data usage permissions in the German medical informatics initiative. BMC Med Inform Decis Mak 2020; 20:103. [PMID: 32503529 PMCID: PMC7275462 DOI: 10.1186/s12911-020-01138-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/22/2019] [Accepted: 05/27/2020] [Indexed: 11/14/2022] Open
Abstract
Background The aim of the German Medical Informatics Initiative is to establish a national infrastructure for integrating and sharing health data. To this, Data Integration Centers are set up at university medical centers, which address data harmonization, information security and data protection. To capture patient consent, a common informed consent template has been developed. It consists of different modules addressing permissions for using data and biosamples. On the technical level, a common digital representation of information from signed consent templates is needed. As the partners in the initiative are free to adopt different solutions for managing consent information (e.g. IHE BPPC or HL7 FHIR Consent Resources), we had to develop an interoperability layer. Methods First, we compiled an overview of data items required to reflect the information from the MII consent template as well as patient preferences and derived permissions. Next, we created entity-relationship diagrams to formally describe the conceptual data model underlying relevant items. We then compared this data model to conceptual models describing representations of consent information using different interoperability standards. We used the result of this comparison to derive an interoperable representation that can be mapped to common standards. Results The digital representation needs to capture the following information: (1) version of the consent, (2) consent status for each module, and (3) period of validity of the status. We found that there is no generally accepted solution to represent status information in a manner interoperable with all relevant standards. Hence, we developed a pragmatic solution, comprising codes which describe combinations of modules with a basic set of status labels. We propose to maintain these codes in a public registry called ART-DECOR. We present concrete technical implementations of our approach using HL7 FHIR and IHE BPPC which are also compatible with the open-source consent management software gICS. Conclusions The proposed digital representation is (1) generic enough to capture relevant information from a wide range of consent documents and data use regulations and (2) interoperable with common technical standards. We plan to extend our model to include more fine-grained status codes and rules for automated access control.
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Affiliation(s)
- Raffael Bild
- Technical University of Munich, School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Martin Bialke
- Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr 1-2, 17487, Greifswald, Germany
| | - Karoline Buckow
- TMF - Technology, Methods, and Infrastructure for Networked Medical Research, Charlottenstraße 42, 10117, Berlin, Germany
| | - Thomas Ganslandt
- Heinrich-Lanz-Center for Digital Health, University Medicine Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kristina Ihrig
- Department of Medicine, Hematology/Oncology, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Würzburg, University and University Hospital Würzburg, Straubmühlweg 2a, 97078, Würzburg, Germany
| | - Angela Merzweiler
- Department of Medical Information Systems, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sybille Roschka
- Institute for Community Medicine, Department Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr 1-2, 17487, Greifswald, Germany
| | - Björn Schreiweis
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein and Kiel University, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Sebastian Stäubert
- Institute for Medical Informatics, Statistics and Epidemiology, Universität Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Sven Zenker
- Staff Unit for Medical & Scientific Technology Development & Coordination, Commercial Directorate, University Hospital Bonn, Bonn, Germany.,Department Of Anesthesiology & Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.,Institute for Medical Biometrics, Informatics & Epidemiology, University of Bonn, Venusbergcampus 1, 53127, Bonn, Germany
| | - Fabian Prasser
- Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
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15
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Wölfel A, Sättele M, Zechmeister C, Nikolaev VO, Lohse MJ, Boege F, Jahns R, Boivin-Jahns V. Unmasking features of the auto-epitope essential for β 1 -adrenoceptor activation by autoantibodies in chronic heart failure. ESC Heart Fail 2020; 7:1830-1841. [PMID: 32436653 PMCID: PMC7373925 DOI: 10.1002/ehf2.12747] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022] Open
Abstract
Aims Chronic heart failure (CHF) can be caused by autoantibodies stimulating the heart via binding to first and/or second extracellular loops of cardiac β1‐adrenoceptors. Allosteric receptor activation depends on conformational features of the autoantibody binding site. Elucidating these features will pave the way for the development of specific diagnostics and therapeutics. Our aim was (i) to fine‐map the conformational epitope within the second extracellular loop of the human β1‐adrenoceptor (β1ECII) that is targeted by stimulating β1‐receptor (auto)antibodies and (ii) to generate competitive cyclopeptide inhibitors of allosteric receptor activation, which faithfully conserve the conformational auto‐epitope. Methods and results Non‐conserved amino acids within the β1ECII loop (compared with the amino acids constituting the ECII loop of the β2‐adrenoceptor) were one by one replaced with alanine; potential intra‐loop disulfide bridges were probed by cysteine–serine exchanges. Effects on antibody binding and allosteric receptor activation were assessed (i) by (auto)antibody neutralization using cyclopeptides mimicking β1ECII ± the above replacements, and (ii) by (auto)antibody stimulation of human β1‐adrenoceptors bearing corresponding point mutations. With the use of stimulating β1‐receptor (auto)antibodies raised in mice, rats, or rabbits and isolated from exemplary dilated cardiomyopathy patients, our series of experiments unmasked two features of the β1ECII loop essential for (auto)antibody binding and allosteric receptor activation: (i) the NDPK211–214 motif and (ii) the intra‐loop disulfide bond C209↔C215. Of note, aberrant intra‐loop disulfide bond C209↔C216 almost fully disrupted the functional auto‐epitope in cyclopeptides. Conclusions The conformational auto‐epitope targeted by cardio‐pathogenic β1‐receptor autoantibodies is faithfully conserved in cyclopeptide homologues of the β1ECII loop bearing the NDPK211–214 motif and the C209↔C215 bridge while lacking cysteine C216. Such molecules provide promising tools for novel diagnostic and therapeutic approaches in β1‐autoantibody‐positive CHF.
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Affiliation(s)
- Angela Wölfel
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Rudolf-Virchow-Centre, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.,Rudolf-Virchow-Centre, Pierre Fabre Dermo-Kosmetik GmbH, Jechtinger Straße 13, 79111, Freiburg, Germany
| | - Mathias Sättele
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany
| | - Christina Zechmeister
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Interdisciplinary Bank of Biomaterials and Data (ibdw), University Hospital of Würzburg, Straubmühlweg 2A, D-97078, Würzburg, Germany.,Comprehensive Heart Failure Centre (CFHC), Am Schwarzenberg 11, 978078, Würzburg, Germany
| | - Viacheslav O Nikolaev
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Institute for Molecular Cardiology, Department of Cardiology and Pneumology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin J Lohse
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Rudolf-Virchow-Centre, Josef-Schneider-Str. 2, 97080, Würzburg, Germany.,Institute Max Delbrück Center for Molecular Research, Berlin-Buch, Robert-Koch-Str. 40, 1000, Berlin, Germany
| | - Fritz Boege
- Rudolf-Virchow-Centre, Institute of Clinical Chemistry and Laboratory Diagnostics, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Roland Jahns
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Interdisciplinary Bank of Biomaterials and Data (ibdw), University Hospital of Würzburg, Straubmühlweg 2A, D-97078, Würzburg, Germany.,Comprehensive Heart Failure Centre (CFHC), Am Schwarzenberg 11, 978078, Würzburg, Germany
| | - Valérie Boivin-Jahns
- Institute of Pharmacology and Toxicology, University of Würzburg, Versbacher Str. 9, D-97078, Wuerzburg, Germany.,Comprehensive Heart Failure Centre (CFHC), Am Schwarzenberg 11, 978078, Würzburg, Germany
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16
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Morbach C, Gelbrich G, Tiffe T, Eichner FA, Christa M, Mattern R, Breunig M, Cejka V, Wagner M, Heuschmann PU, Störk S, Frantz S, Maack C, Ertl G, Fassnacht M, Wanner C, Leyh R, Volkmann J, Deckert J, Faller H, Jahns R. Prevalence and determinants of the precursor stages of heart failure: results from the population-based STAAB cohort study. Eur J Prev Cardiol 2020; 28:924-934. [DOI: 10.1177/2047487320922636] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 12/16/2022]
Abstract
Abstract
Aims
Prevention of heart failure relies on the early identification and control of risk factors. We aimed to identify the frequency and characteristics of individuals at risk of heart failure in the general population.
Methods and Results
We report cross-sectional data from the prospective Characteristics and Course of Heart Failure Stages A–B and Determinants of Progression (STAAB) cohort study investigating a representative sample of residents of Würzburg, Germany. Sampling was stratified 1:1 for sex and 10:27:27:27:10 for age groups of 30–39/40–49/50–59/60–69/70–79 years. Heart failure precursor stages were defined according to American College of Cardiology/American Heart Association: stage A (risk factors for heart failure), stage B (asymptomatic cardiac dysfunction). The main results were internally validated in the second half of the participants. The derivation sample comprised 2473 participants (51% women) with a distribution of 10%/28%/25%/27%/10% in respective age groups. Stages A and B were prevalent in 42% and 17% of subjects, respectively. Of stage B subjects, 31% had no risk factor qualifying for stage A (group ‘B-not-A’). Compared to individuals in stage B with A criteria, B-not-A were younger, more often women, and had left ventricular dilation as the predominant B qualifying criterion (all P < 0.001). These results were confirmed in the validation sample (n = 2492).
Conclusion
We identified a hitherto undescribed group of asymptomatic individuals with cardiac dysfunction predisposing to heart failure, who lacked established heart failure risk factors and therefore would have been missed by conventional primary prevention. Further studies need to replicate this finding in independent cohorts and characterise their genetic and -omic profile and the inception of clinically overt heart failure in subjects of group B-not-A.
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Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Götz Gelbrich
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Germany
| | - Theresa Tiffe
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Felizitas A Eichner
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Martin Christa
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Renate Mattern
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Margret Breunig
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Vladimir Cejka
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
| | - Martin Wagner
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Germany
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Jahns R, Geiger J, Schlünder I, Strech D, Brumhard M, von Kielmansegg SG. Broad donor consent for human biobanks in Germany and Europe: a strategy to facilitate cross-border sharing and exchange of human biological materials and related data. J LAB MED 2019. [DOI: 10.1515/labmed-2017-0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Human biobanks are generally recognized as essential resources for effective biomedical research. All over the world biosamples and data from human subjects are collected in large biobanks. The biological material is stored long term for current and future (undetermined) research issues, which often require cross-border exchange of biosamples and related data.
Content
Commonly, the informed consent for research on human biospecimen is intended to cover only defined, specific research objectives. In June 2016, the biobank Task-Force of the Working Party of the German Medical Ethics Committees (WP-GMEC) updated its template for the broad use of human biological samples and related data. It complies with the current Organisation for Economic Co-operation and Development (OECD) and World Medical Association (WMA) recommendations and furnishes a framework that permits long-term storage and multi-purpose research use of human biological material and related data, including cross-border research.
However, both (i) human biobanks storing and (ii) research projects requesting “broad consent” biological samples generally require an ethical approval; in addition, “broad consent” conditions should be reciprocated by making biobank processes transparent and by fostering both donor and public involvement.
Outlook
The broad consent template of the WP-GMEC clearly states that biological samples and data donated for medical research serve to address current and future research questions. It appears perfectly suited as a template for a Europe-wide harmonized broad consent facilitating biobank-based cross-border research.
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18
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Gil-Cruz C, Perez-Shibayama C, De Martin A, Ronchi F, van der Borght K, Niederer R, Onder L, Lütge M, Novkovic M, Nindl V, Ramos G, Arnoldini M, Slack EM, Boivin-Jahns V, Jahns R, Wyss M, Mooser C, Lambrecht BN, Maeder MT, Rickli H, Flatz L, Eriksson U, Geuking MB, McCoy KD, Ludewig B. Microbiota-derived peptide mimics drive lethal inflammatory cardiomyopathy. Science 2019; 366:881-886. [DOI: 10.1126/science.aav3487] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 06/13/2019] [Accepted: 10/09/2019] [Indexed: 12/29/2022]
Abstract
Myocarditis can develop into inflammatory cardiomyopathy through chronic stimulation of myosin heavy chain 6–specific T helper (TH)1 and TH17 cells. However, mechanisms governing the cardiotoxicity programming of heart-specific T cells have remained elusive. Using a mouse model of spontaneous autoimmune myocarditis, we show that progression of myocarditis to lethal heart disease depends on cardiac myosin–specific TH17 cells imprinted in the intestine by a commensalBacteroidesspecies peptide mimic. Both the successful prevention of lethal disease in mice by antibiotic therapy and the significantly elevatedBacteroides-specific CD4+T cell and B cell responses observed in human myocarditis patients suggest that mimic peptides from commensal bacteria can promote inflammatory cardiomyopathy in genetically susceptible individuals. The ability to restrain cardiotoxic T cells through manipulation of the microbiome thereby transforms inflammatory cardiomyopathy into a targetable disease.
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Affiliation(s)
- Cristina Gil-Cruz
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Angelina De Martin
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Francesca Ronchi
- Maurice Müller Laboratories, Department of Biomedical Research, Universitätsklinik für Viszerale Chirurgie und Medizin Inselspital, University of Berne, Berne, Switzerland
| | - Katrien van der Borght
- VIB Center for Inflammation Research, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Rebekka Niederer
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Lucas Onder
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Mechthild Lütge
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Mario Novkovic
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Veronika Nindl
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gustavo Ramos
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University Hospital of Würzburg, Würzburg, Germany
| | - Markus Arnoldini
- Institute of Food, Nutrition and Health, ETH, Zurich, Switzerland
| | - Emma M.C. Slack
- Institute of Food, Nutrition and Health, ETH, Zurich, Switzerland
| | - Valérie Boivin-Jahns
- Comprehensive Heart Failure Center, University Hospital of Würzburg, Würzburg, Germany
- Institute of Pharmacology and Toxicology, University of Würzburg, Würzburg, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Center, University Hospital of Würzburg, Würzburg, Germany
- Interdisciplinary Bank of Biomaterials and Data Würzburg (IBDW), University Hospital of Würzburg, Würzburg, Germany
| | - Madeleine Wyss
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Catherine Mooser
- Maurice Müller Laboratories, Department of Biomedical Research, Universitätsklinik für Viszerale Chirurgie und Medizin Inselspital, University of Berne, Berne, Switzerland
| | - Bart N. Lambrecht
- VIB Center for Inflammation Research, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Micha T. Maeder
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Lukas Flatz
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Urs Eriksson
- Center for Molecular Cardiology University of Zurich, Zurich, Switzerland
- Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
| | - Markus B. Geuking
- Department of Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathy D. McCoy
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Burkhard Ludewig
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Boivin V, Zechmeister C, Schuetz C, Beyersdorf N, Berliner D, Bauer M, Stoerk S, Ertl G, Jahns R. P5452First data-analysis of the prospective ETiCS-study after study-end confirms acute (microbial-induced) inflammation as a key trigger for the development of cardiac GPCR-autoantibodies. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0408] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Heart failure (HF) is the leading cause of mortality and morbidity in Western countries. In the past two decades, evidence for the clinical relevance of GPCR-autoimmunity in human HF has substantially increased. Stimulating autoantibodies targeting the second extracellular loop (ECII) of the cardiac beta1-adrenoceptor (beta1-aabs) have been claimed to be involved in the pathogenesis of HF and to increase the risk of cardiovascular death by three-fold. Still, the events triggering the formation of beta1-aabs and their impact on HF-progression are unknown.
Methods
In total 13 University Hospitals (12 German, 1 Serbian) prospectively recruited 226 patients (pts.) with a first acute myocardial infarction (FAMI), and 140 pts with acute (biopsy- or cMRI-proven) myocarditis (AMitis) into the Etiology, Titer-Course and effect on Survival of cardiac autoantibodies-study (ETiCS-study). This study aimed to investigate whether the presentation of cardiac membrane antigens (e.g., the beta1-adrenoceptor) following cardiac necrosis/inflammation triggers the formation of beta1-aabs. At baseline (BL) and three follow-ups (Fup1–3), blood was sampled to analyze the time-course of beta1-aabs. Beta1-aab titers were measured by FACS using Dyna-beads® M-270-Epoxy coated with increasing amounts of beta1-ECII-peptides (2.5–100 μg/ml), checked versus scrambled peptides (a mixture of same amino-acids). After reacting, the samples were measured by FACScan flow-cytometry; obtained data were analyzed with FlowJo (Treestar). When half-maximal binding was calculable the serum was classified beta1-aab-positive.
Results
From n=366 pts (226 FAMI/140 AMitis) recruited into the ETiCS-study 45 pts had to be excluded because of unperformed cMRI's; 46 pts stopped the study before Fup-1 (month 3). Only 180/226 FAMI- and 98/140 AMitis-pts had complete Fup1–3 (after 3, 6, and 12 months with clinical assessment, echocardiograms, and cMRI's at BL and Fup-3). In all valid ETiCS-pts (197 FAMI-/123 AMitis-pts) the titer-course of beta1-aabs was compared with the development of echo-LVEF. Relevant (high-affinity) beta1-aab-titers were detected in ∼31% (37/123) of the AMitis-pts compared to only ∼21% (42/197) of the FAMI-pts. In aab-positive AMitis-pts echo-LVEF did not recover and was always significantly inferior to aab-negative AMitis-pts (BL: 38 vs. 49% LVEF; Fup-3: 49 vs. 64% LVEF) whereas such a difference was not noted in FAMI-pts. In addition, aab-positive AMitis-pts had higher NT pro-BNP-, renin-, and aldosterone-levels than aab-negative AMitis-pts.
Conclusion
The first evaluation of the completed ETiCS-study clearly suggests that acute microbial-induced rather than post-infarction myocardial inflammation triggers the formation of clinically relevant beta1-aabs. AAb-positive AMitis-patients might profit from early intensification of standard HF-therapy (including early beta-blockade) and/or novel antibody-directed experimental therapies which are currently developed.
Acknowledgement/Funding
BMBF Grant FKZ 01ES0816
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Affiliation(s)
- V Boivin
- Institute of Pharmacology and Toxicology, Wuerzburg, Germany
| | - C Zechmeister
- Institute of Pharmacology and Toxicology, Wuerzburg, Germany
| | - C Schuetz
- Institute of Pharmacology and Toxicology, Wuerzburg, Germany
| | - N Beyersdorf
- University, Institute of Immunobiology and Virology, Wuerzburg, Germany
| | - D Berliner
- Hannover Medical School, Cardiology, Angiology and Pneumology, Hannover, Germany
| | - M Bauer
- University Hospital, Comprehensive Heart Failure Center Wuerzburg, Wuerzburg, Germany
| | - S Stoerk
- University Hospital, Comprehensive Heart Failure Center Wuerzburg, Wuerzburg, Germany
| | - G Ertl
- University Hospital, Comprehensive Heart Failure Center Wuerzburg, Wuerzburg, Germany
| | - R Jahns
- University and University Hospital, Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), Wuerzburg, Germany
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20
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Boivin V, Zechmeister C, Schuetz C, Jahns R, Lohse MJ, Fassnacht MJ, Hahner S. P3561Detection and functional characterization of angiotensin receptor type 1 autoantibodies: establishment and clinical translation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0424] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Circulating AT1R autoantibodies (AT1R-aabs) directed against the ECL2 of the AT1R with agonist-like activity are supposed to play a pathophysiological role in diseases associated with vascular and renal damage, such as preeclampsia and severehypertension (HT), but they are also thought to be involved in heart failure and primary hyperaldosteronism (PHA).
Methods
High-throughput screening assays aiming at a reliable detection of AT1R-aabs in sera from patients with HT and PHA were established. The agonist-like activity of AT1R-aabs was assessed by changes in intracellular calcium-levels using Fura2-QBT dye; the AlphaLISA Assay was used to assess induction of ERK1/2-phosphorylation in stably transfected AT1R-HEK-cells or in adrenocortical NCI-H295R cells.
Results
IgG isolated from sera of n=60 patients with PHA and n=164 with HT were screened for their capacity to increase [Ca2+]i or to activate ERK1/2. Sixteen out of 60 PHA-patients increased [Ca2+]i compared to none of the HT-patients, whereas in both disease-entities we detected AT1R-aabs inducing ERK1/2-activation with a similar prevalence (PHA: 41%, HT: 42%), indicating the existence of differentially acting AT1R-aabs. PHA-patients positive for ERK1/2-activating AT1R-aabs have significantly lower serum potassium- (3,8±0,1 vs. 4,1±0,1 mmol/l, p<0,05) and renin-levels (2,7±0,5 vs. 4,5±0,7 ng/l, p<0,05) together with an increased aldosterone concentration (341±37 vs. 236±20 ng/l, p<0,01) concordant with the disease phenotype. Similarly, higher BP values are observed in AT1R-aab positive HT-patients (syst/diast: 148/85 vs. 167/93 mmHg, p<0,0001) accompanied byhigher aldosteroneserum-levels (93±7 vs. 74±3 ng/l, p<0,05).
In addition, ERK1/2-activation induced by either angiotensin II or by IgG isolated from patients with PHA or HT could be differentially blocked by the use of various signaling inhibitors.
In order to elucidate if stimulating AT1R-aabs could be involved in an over-secretion of aldosterone due to sustained receptor-activation, we investigatedtheir effects on NCI-H295R-cells. At the transcriptional level, AT1R-aabs were able to induce a time-dependent upregulation of the key steroidogenic enzymes involved in aldosterone biosynthesis CYP21A1-, HSD3B2-, CYP11B1-, and in particular CYP11B2-mRNA (2fold over basal), with the maximum level achieved after 8 to 12 hours. Concordant withan agonist-stimulated internalization of AT1R,AT1R-mRNA was downregulated by AT1R-aabs (up to 25% of basal) providing direct evidence of a chronic receptor-stimulation by AT1R-aabs.
Conclusion
Functional assays based on AT1R-activation (Ca2+ measurements & ERK1/2-phosphorylation) are able to detect AT1R-aabs in 41% or 42% of patients with HT or PHA, respectively. Moreover, our data provide evidence that AT1R-aabs stabilize a specific AT1R-conformation distinct from that induced by angiotensin II thereby triggering a different intracellular signaling pattern resulting in chronic aldosterone production.
Acknowledgement/Funding
BMBF grant
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Affiliation(s)
- V Boivin
- Institute of Pharmacology and Toxicology, Wuerzburg, Germany
| | - C Zechmeister
- Institute of Pharmacology and Toxicology, Wuerzburg, Germany
| | - C Schuetz
- Institute of Pharmacology and Toxicology, Wuerzburg, Germany
| | - R Jahns
- University and University Hospital, Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), Wuerzburg, Germany
| | - M J Lohse
- Max Delbruck Center for Molecular Medicine, Berlin, Germany
| | - M J Fassnacht
- University Hospital, Endocrinology, Wuerzburg, Germany
| | - S Hahner
- University Hospital, Endocrinology, Wuerzburg, Germany
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21
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Werner RA, Wakabayashi H, Bauer J, Schütz C, Zechmeister C, Hayakawa N, Javadi MS, Lapa C, Jahns R, Ergün S, Jahns V, Higuchi T. Longitudinal 18F-FDG PET imaging in a rat model of autoimmune myocarditis. Eur Heart J Cardiovasc Imaging 2019; 20:467-474. [PMID: 30102319 PMCID: PMC6429237 DOI: 10.1093/ehjci/jey119] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/25/2018] [Accepted: 07/24/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS Although mortality rate is very high, diagnosis of acute myocarditis remains challenging with conventional tests. We aimed to elucidate the potential role of longitudinal 2-Deoxy-2-18F-fluoro-D-glucose (18F-FDG) positron emission tomography (PET) inflammation monitoring in a rat model of experimental autoimmune myocarditis. METHODS AND RESULTS Autoimmune myocarditis was induced in Lewis rats by immunizing with porcine cardiac myosin emulsified in complete Freund's adjuvant. Time course of disease was assessed by longitudinal 18F-FDG PET imaging. A correlative analysis between in- and ex vivo18F-FDG signalling and macrophage infiltration using CD68 staining was conducted. Finally, immunohistochemistry analysis of the cell-adhesion markers CD34 and CD44 was performed at different disease stages determined by longitudinal 18F-FDG PET imaging. After immunization, myocarditis rats revealed a temporal increase in 18F-FDG uptake (peaked at week 3), which was followed by a rapid decline thereafter. Localization of CD68 positive cells was well correlated with in vivo18F-FDG PET signalling (R2 = 0.92) as well as with ex vivo18F-FDG autoradiography (R2 = 0.9, P < 0.001, respectively). CD44 positivity was primarily observed at tissue samples obtained at acute phase (i.e. at peak 18F-FDG uptake), while CD34-positive staining areas were predominantly identified in samples harvested at both sub-acute and chronic phases (i.e. at 18F-FDG decrease). CONCLUSION 18F-FDG PET imaging can provide non-invasive serial monitoring of cardiac inflammation in a rat model of acute myocarditis.
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Affiliation(s)
- Rudolf A Werner
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA.,Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany.,Else-Kröner-Forschungskolleg, Interdisciplinary Center for Clinical Research (IZKF), University of Würzburg, Josef-Schneider-Str. 2, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Jochen Bauer
- Institute for Anatomy and Cell Biology, University Würzburg, Koellikerstr. 6, Würzburg, Germany
| | - Claudia Schütz
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Christina Zechmeister
- Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Nobuyuki Hayakawa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany
| | - Mehrbod S Javadi
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD, USA
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany.,Interdisciplinary Bank of Biomaterials and Data Würzburg (IBDW), University Hospital Würzburg, Straubmühlweg 2a, Würzburg, Germany
| | - Süleyman Ergün
- Institute for Anatomy and Cell Biology, University Würzburg, Koellikerstr. 6, Würzburg, Germany
| | - Valerie Jahns
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany.,Department of Pharmacology, University Hospital Würzburg, Versbacher Str. 9, Würzburg, Germany
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacherstr. 6, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Am Schwarzenberg 15, Würzburg, Germany.,Department of Biomedical Imaging, National Cerebral and Cardiovascular Research Center, 5 Chome-7-1 Fujishirodai, Suita, Osaka Prefecture, Japan
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Schwarz N, Knutti N, Rose M, Neugebauer S, Geiger J, Jahns R, Klopp N, Illig T, Mathay C, Betsou F, Scherag A, Kiehntopf M. Quality Assessment of the Preanalytical Workflow in Liquid Biobanking: Taurine as a Serum-Specific Quality Indicator for Preanalytical Process Variations. Biopreserv Biobank 2019; 17:458-467. [PMID: 31339743 DOI: 10.1089/bio.2019.0004] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The scientific impact of translational biomedical research largely depends on the availability of high-quality biomaterials. However, evidence-based and robust quality indicators (QIs) covering the most relevant preanalytical variations are still lacking. The aim of this study was to identify and validate a QI suitable for assessing time-to-centrifugation (TTC) delays in human liquid biospecimens originating from both healthy and diseased individuals. Serum and plasma samples with varying TTCs were analyzed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) in a pilot cohort of healthy individuals to identify a suitable QI candidate. Taurine (TAU), as a TTC QI candidate, was validated in healthy individuals and patients with rheumatologic and cardiologic diseases, considering the (1) preanalytical handling temperature, (2) platelet count, and (3) postcentrifugation delay. For discrimination of high TTC (TTC >60 minutes) from low TTC serum specimens, a probability calculation tool was developed (Triple-T-cutoff-model). TTC-dependent changes in healthy individuals were observed for amino acids, particularly TAU. Validation of the TAU levels in an independent cohort of healthy individuals revealed a time-dependent increase in serum, but not in plasma, for a TTC delay of 30-240 minutes. TAU increases were dependent on the handling temperature and platelet count and volume. By contrast, no changes in TAU concentrations were observed for additional postcentrifugation delays. Validation of TAU and the Triple-T-cutoff-model, in rheumatologic/cardiologic patient collectives, allowed the discrimination of samples with TTC ≤60 min/>60 min with estimated AUROC (area under the receiver operating characteristic curve) values of 89% [78%-100%]/86% [71%-100%] and 91% [79%-100%]/84% [68%-100%], respectively. Considering the preanalytical handling temperature and platelet count and volume, TAU and the Triple-T-cutoff-model represent reliable QIs for TTC >60 minutes in serum samples from healthy individuals and selected rheumatologic/cardiologic patients. However, further studies in larger patient collectives with various diseases are needed to assess the robustness and potential of the QIs presented in this article as biobanking quality assurance/quality control tools to support high-quality biomedical research.
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Affiliation(s)
- Nicolle Schwarz
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
| | - Nadine Knutti
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
| | - Michael Rose
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
| | - Sophie Neugebauer
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
| | - Jörg Geiger
- Interdisciplinary Bank of Biomaterials and Data Würzburg (ibdw), Würzburg, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Würzburg (ibdw), Würzburg, Germany
| | - Norman Klopp
- Hannover Unified Biobank (HUB), Hannover, Germany
| | - Thomas Illig
- Hannover Unified Biobank (HUB), Hannover, Germany
| | - Conny Mathay
- Integrated BioBank of Luxembourg (IBBL), Dudelange, Luxembourg
| | - Fay Betsou
- Integrated BioBank of Luxembourg (IBBL), Dudelange, Luxembourg
| | - André Scherag
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.,Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics and Integrated Biobank Jena (IBBJ), Jena University Hospital, Jena, Germany
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Baber R, Hummel M, Jahns R, von Jagwitz-Biegnitz M, Kirsten R, Klingler C, Nussbeck SY, Specht C. Position Statement from the German Biobank Alliance on the Cooperation Between Academic Biobanks and Industry Partners. Biopreserv Biobank 2019; 17:372-374. [PMID: 31314575 PMCID: PMC6703240 DOI: 10.1089/bio.2019.0042] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Under the umbrella of the German Biobank Node (GBN), 11 biobanks and two IT development centers are funded by the Federal Ministry of Education and Research (BMBF) to work together in the German Biobank Alliance (GBA). Their common aim is to make existing biomaterials hosted by different biobanks nationally and internationally available for biomedical research. This position article reflects and summarizes contributions and comments made during a GBA workshop, on the cooperation between academic biobanks and pharmaceutical and diagnostics companies that took place in Leipzig on the 21st of June 2018. It documents key points agreed on by all participating biobanks during the workshop thereby addressing several of the challenges identified. Although there are various possibilities for cooperation between academic biobanks and industry, this position article focuses exclusively on projects where academic biobanks give access to their biosamples and related data to industry partners. In doing so it considers the general conditions/framework and procedures in the German biobanking environment and raises ethical, legal, and procedural issues to be addressed when initiating such collaborations. It intends to furnish a basis for further activities to foster cooperation with industry and to push an overarching national coordination process. The final aim is to develop GBN-recommendations. Of course, many hospitals already have clear regulations on collaboration(s) with industry partners. These naturally take precedence for the GBA biobanks. However, where interest exists, GBN/GBA recommendations could help to induce changes to existing local policies nonetheless.
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Affiliation(s)
- Ronny Baber
- 1Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig Medical Center, Leipzig, Germany.,2Leipzig Medical Biobank, University Leipzig, Leipzig, Germany
| | - Michael Hummel
- 3Institute of Pathology, Charité-Universitätsmedizin Berlin; and Central Biobank Charité (ZeBanC), Berlin, Germany.,4German Biobank Node, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Jahns
- 5Interdisciplinary Bank of Biomaterials and Data Würzburg (ibdw), University and University Hospital Würzburg, Würzburg, Germany
| | | | - Romy Kirsten
- 6Biobank of the National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Corinna Klingler
- 7QUEST-Center for Transforming Biomedical Research, Charité - University Medicine Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Sara Y Nussbeck
- 8University Medical Center Göttingen, UMG Biobank, Göttingen, Germany
| | - Cornelia Specht
- 4German Biobank Node, Charité- Universitätsmedizin Berlin, Berlin, Germany
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Gensler D, Salinger T, Düring M, Lorenz K, Jahns R, Wech T, Frantz S, Ertl G, Jakob PM, Nordbeck P. Real-time Triggered RAdial Single-Shot Inversion recovery for arrhythmia-insensitive myocardial T1 mapping: motion phantom validation and in vivo comparison. Magn Reson Med 2018; 81:1714-1725. [PMID: 30417940 DOI: 10.1002/mrm.27526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/13/2018] [Revised: 07/24/2018] [Accepted: 08/20/2018] [Indexed: 11/11/2022]
Abstract
PURPOSE Cardiac T1 mapping has become an increasingly important imaging technique, contributing novel diagnostic options. However, currently utilized methods are often associated with accuracy problems because of heart rate variations and cardiac arrhythmia, limiting their value in clinical routine. This study aimed to introduce an improved arrhythmia-related robust T1 mapping sequence called RT-TRASSI (real-time Triggered RAdial Single-Shot Inversion recovery). METHODS All measurements were performed on a 3.0T whole-body imaging system. A real-time feedback algorithm for arrhythmia detection was implemented into the previously described pulse sequence. A programmable motion phantom was constructed and measurements with different simulated arrhythmias arranged. T1 mapping accuracy and susceptibility to artifacts were analyzed. In addition, in vivo measurements and comparisons with 3 prevailing T1 mapping sequences (MOLLI, ShMOLLI, and SASHA) were carried out to investigate the occurrence of artifacts. RESULTS In the motion phantom measurements, RT-TRASSI showed excellent agreement with predetermined reference T1 values. Percentage scattering of the T1 values ranged from -0.6% to +1.9% in sinus rhythm and -1.0% to +3.1% for high-grade arrhythmias. In vivo, RT-TRASSI showed diagnostic image quality with only 6% of the acquired T1 maps including image artifacts. In contrast, more than 40% of the T1 maps acquired with MOLLI, ShMOLLI, or SASHA included motion artifacts. CONCLUSION Accuracy issues because of heart rate variability and arrhythmia are a prevailing problem in current cardiac T1 mapping techniques. With RT-TRASSI, artifacts can be minimized because of the short acquisition time and effective real-time feedback, avoiding potential data acquisition during systolic heart phase.
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Affiliation(s)
- Daniel Gensler
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Tim Salinger
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Markus Düring
- Experimental Physics 5, University of Würzburg, Würzburg, Germany
| | - Kristina Lorenz
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany.,Department of Biomedical Research, Leibniz Institute for Analytical Sciences (ISAS) e.V, Dortmund, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany.,Interdisciplinary Bank of Biomaterials and Data (IBDW), University Hospital Würzburg, Würzburg, Germany
| | - Tobias Wech
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter M Jakob
- Experimental Physics 5, University of Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Comprehensive Heart Failure Center (CHFC), University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
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Morbach C, Gelbrich G, Tiffe T, Eichner F, Wagner M, Heuschmann PU, Störk S, Frantz S, Maack C, Ertl G, Fassnacht M, Wanner C, Leyh R, Volkmann J, Deckert J, Faller H, Jahns R. Variations in cardiovascular risk factors in people with and without migration background in Germany - Results from the STAAB cohort study. Int J Cardiol 2018; 286:186-189. [PMID: 30420145 DOI: 10.1016/j.ijcard.2018.10.098] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/02/2018] [Accepted: 10/29/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND About 20% of the German population have a migration background which might influence prevalence of preventable cardiovascular risk factors (CVRF). METHODS We report data of the prospective Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of inhabitants of the City of Würzburg, Germany, aged 30 to 79 years. Individuals without migration background were defined as follows: German as native language, no other native language, and/or born in Germany. All other participants were defined as individuals with migration background. RESULTS Of 2473 subjects (51% female, mean age 54 ± 12 years), 291 (12%) reported a migration background: n = 107 (37%) from a country within the EU, n = 117 (40%) from Russia, and n = 67 (23%) from other countries. Prevalence of hypertension, atherosclerotic disease, and diabetes mellitus was similar in individuals with and without migration background. By contrast, prevalence of obesity and metabolic syndrome was significantly higher in individuals with migration background, with the least favourable profile apparent in individuals from Russia (individuals without vs. with migration background: obesity 19 vs. 24%, p < 0.05; odds ratio: EU: 1.6, Russia: 2.2*, other countries: 0.6; metabolic syndrome 18 vs. 21%, p < 0.05; odds ratio: EU: 1.2, Russia: 1.7*, other countries: 1.5; *p < 0.05). CONCLUSION Individuals with migration background in Germany might exhibit a higher CVRF burden due to a higher prevalence of obesity and metabolic syndrome. Strategies for primary prevention of heart failure may benefit from deliberately considering the migration background.
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Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center and Dept. of Medicine I, University Hospital and University of Würzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Theresa Tiffe
- Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Felizitas Eichner
- Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Martin Wagner
- Institute of Clinical Epidemiology and Biometry and Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, and Clinical Trial Center, University of Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center and Dept. of Medicine I, University Hospital and University of Würzburg, Germany.
| | | | - S Frantz
- Dept. of Medicine I, Div. of Cardiology, University Hospital Würzburg, Germany
| | - C Maack
- Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Germany
| | - G Ertl
- University Hospital Würzburg, Germany
| | - M Fassnacht
- Dept. of Medicine I, Div. of Endocrinology, University Hospital Würzburg, Germany
| | - C Wanner
- Dept. of Medicine I, University Hospital Würzburg, Germany
| | - R Leyh
- Dept. of Cardiovascular Surgery, University Hospital Würzburg, Germany
| | - J Volkmann
- Dept. of Neurology, University Hospital Würzburg, Germany
| | - J Deckert
- Dept. of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Germany
| | - H Faller
- Dept. of Medical Psychology, University of Würzburg, Germany
| | - R Jahns
- Interdisciplinary Bank of Biomaterials and Data Würzburg, University Hospital Würzburg, Germany
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Jahns R, Schirmacher P. [The current ethical and legal framework for human biobanks]. Pathologe 2018; 39:445-448. [PMID: 30076434 DOI: 10.1007/s00292-018-0472-4] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- R Jahns
- Interdisziplinäre Biomaterial- und Datenbank Würzburg (ibdw), Universitätsklinikum Würzburg, Straubmühlweg 2a, 97078, Würzburg, Deutschland.
| | - P Schirmacher
- Pathologisches Institut, Universität Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland.
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Boivin-Jahns V, Uhland K, Holthoff HP, Beyersdorf N, Kocoski V, Kerkau T, Münch G, Lohse MJ, Ungerer M, Jahns R. Cyclopeptide COR-1 to treat beta1-adrenergic receptor antibody-induced heart failure. PLoS One 2018; 13:e0201160. [PMID: 30125285 PMCID: PMC6101361 DOI: 10.1371/journal.pone.0201160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/10/2018] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Despite advances in pharmacotherapy, heart failure still incurs significant morbidity and mortality. Stimulating antibodies directed against the secondextracellular loop of the human ß1-adrenergic receptor (anti-ß1EC2) cause myocyte damage and heart failure in rats. This receptor domain is 100% homologous between rats and humans. OBJECTIVE ß1EC2-mimicking cyclopeptides (25-meric) markedly improved the development and/or course of anti-ß1EC2-mediated cardiomyopathy. Further developments should be investigated. METHODS AND RESULTS The shortened 18-meric cyclic peptide COR-1, in which one of the two disulphide bonds was removed to enable reproducible GMP production, can also be used to treat cardiomyopathic rats. Echocardiography, catheterization and histopathology of the rat hearts revealed that monthly intravenous administrations of COR-1 almost fully reversed the cardiomyopathic phenotype within 6 months at doses of 1 to 4 mg/kg body weight. Administration of COR-1 resulted in markedly reduced anti-ß1EC2-expressing memory B lymphocytes in the spleen despite continued antigenic boosts, but did not significantly decrease overall peripheral anti-ß1EC2 titers. COR-1 did not induce any anti-ß1EC2 or other immune response in naïve rats (corresponding to findings in healthy human volunteers). It did not cause any toxic side effects in GLP studies in dogs, rats or mice, and the "no observed adverse effect level" (NOAEL) exceeded the therapeutic doses by 100-fold. CONCLUSION The second generation immunomodulating epitope-mimicking cyclopeptide COR-1 (also termed JNJ-5442840) offers promise to treat immune-mediated cardiac diseases.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Monoclonal/administration & dosage
- Antibody Specificity
- Disease Models, Animal
- Female
- Guinea Pigs
- Heart Failure/drug therapy
- Heart Failure/etiology
- Heart Failure/physiopathology
- Humans
- Male
- Molecular Mimicry/immunology
- Myocardium/metabolism
- Peptide Fragments/chemistry
- Peptide Fragments/therapeutic use
- Peptides, Cyclic/chemistry
- Peptides, Cyclic/therapeutic use
- Peptides, Cyclic/toxicity
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Rats
- Rats, Inbred Lew
- Rats, Wistar
- Receptors, Adrenergic, beta-1/chemistry
- Receptors, Adrenergic, beta-1/genetics
- Receptors, Adrenergic, beta-1/immunology
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Affiliation(s)
- Valérie Boivin-Jahns
- Department of Pharmacology and Toxicology, University of Würzburg, Comprehensive Heart Failure Centre (CHFC), University Hospital Würzburg, Würzburg, Germany
| | | | | | - Niklas Beyersdorf
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Vladimir Kocoski
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Thomas Kerkau
- Institute for Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | | | - Martin J. Lohse
- Department of Pharmacology and Toxicology, University of Würzburg, Comprehensive Heart Failure Centre (CHFC), University Hospital Würzburg, Würzburg, Germany
| | | | - Roland Jahns
- Department of Pharmacology and Toxicology, University of Würzburg, Comprehensive Heart Failure Centre (CHFC), University Hospital Würzburg, Würzburg, Germany
- Interdisciplinary Bank of Biomaterials and Data Würzburg, Comprehensive Heart Failure Centre (CHFC), Würzburg, Germany
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Langhof H, Kahrass H, Illig T, Jahns R, Strech D. Current practices for access, compensation, and prioritization in biobanks. Results from an interview study. Eur J Hum Genet 2018; 26:1572-1581. [PMID: 30089824 DOI: 10.1038/s41431-018-0228-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 01/10/2023] Open
Abstract
Human biological materials and related data stored in biobanks are valuable resources for biomedical research. Transparent, effective, and efficient governance structures and procedures for access, compensation, and priority setting are needed, but recent debates indicate challenges in the practical application of such governance processes. This study aimed to assess the practical experiences and attitudes of biobank experts regarding the governance of biosample access, prioritization, and compensation. Qualitative, semi-structured telephone interviews were conducted with 20 biobank directors from eight countries. Respondents highlighted the need for sound governance structures in order to ensure acceptance by all stakeholders (patients/donors, researchers, research funders, public, and others). They stressed practical difficulties in trying to make best use of biomaterials. As biobanks often form part of larger academic and clinical settings, the different and sometimes conflicting interests of researchers, clinicians, patients, funders, and biobank staff currently affect the governance of access decisions. Investments such as intellectual input, financial, and human resources need to be compensated adequately. Biobanks thereby have a dual role stewarding the hosted biosamples and acting as a service provider for local researchers from universities or hospitals. In order to facilitate efficient use of human biological materials, greater harmonization of at least minimum standards for access and compensation are required at both a national and an international level.
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Affiliation(s)
- Holger Langhof
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School (MHH), Hannover, Germany.
| | - Hannes Kahrass
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School (MHH), Hannover, Germany
| | - Thomas Illig
- Hannover Unified Biobank, Hannover Medical School (MHH), Hannover, Germany
| | - Roland Jahns
- University Hospital of Wuerzburg, Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), Wuerzburg, Germany
| | - Daniel Strech
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School (MHH), Hannover, Germany.,Charité - University Medicine Berlin, QUEST - Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Berlin, Germany
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Helluy X, Sauter M, Ye YX, Lykowsky G, Kreutner J, Yilmaz A, Jahns R, Boivin V, Kandolf R, Jakob PM, Hiller KH, Klingel K. In vivo T2* weighted MRI visualizes cardiac lesions in murine models of acute and chronic viral myocarditis. PLoS One 2017; 12:e0172084. [PMID: 28264039 PMCID: PMC5338786 DOI: 10.1371/journal.pone.0172084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 01/31/2017] [Indexed: 12/13/2022] Open
Abstract
Objective Acute and chronic forms of myocarditis are mainly induced by virus infections. As a consequence of myocardial damage and inflammation dilated cardiomyopathy and chronic heart failure may develop. The gold standard for the diagnosis of myocarditis is endomyocardial biopsies which are required to determine the etiopathogenesis of cardiac inflammatory processes. However, new non-invasive MRI techniques hold great potential in visualizing cardiac non-ischemic inflammatory lesions at high spatial resolution, which could improve the investigation of the pathophysiology of viral myocarditis. Results Here we present the discovery of a novel endogenous T2* MRI contrast of myocardial lesions in murine models of acute and chronic CVB3 myocarditis. The evaluation of infected hearts ex vivo and in vivo by 3D T2w and T2*w MRI allowed direct localization of virus-induced myocardial lesions without any MRI tracer or contrast agent. T2*w weighted MRI is able to detect both small cardiac lesions of acute myocarditis and larger necrotic areas at later stages of chronic myocarditis, which was confirmed by spatial correlation of MRI hypointensity in myocardium with myocardial lesions histologically. Additional in vivo and ex vivo MRI analysis proved that the contrast mechanism was due to a strong paramagnetic tissue alteration in the vicinity of myocardial lesions, effectively pointing towards iron deposits as the primary contributor of contrast. The evaluation of the biological origin of the MR contrast by specific histological staining and transmission electron microscopy revealed that impaired iron metabolism primarily in mitochondria caused iron deposits within necrotic myocytes, which induces strong magnetic susceptibility in myocardial lesions and results in strong T2* contrast. Conclusion This T2*w MRI technique provides a fast and sensitive diagnostic tool to determine the patterns and the severity of acute and chronic enteroviral myocarditis and the precise localization of tissue damage free of MR contrast agents.
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Affiliation(s)
- Xavier Helluy
- Department of Experimental Physics V, Institute of Physics, University of Wuerzburg, Wuerzburg, Germany
| | - Martina Sauter
- Department of Molecular Pathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Yu-Xiang Ye
- Department of Experimental Physics V, Institute of Physics, University of Wuerzburg, Wuerzburg, Germany
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, United States of America
| | - Gunthard Lykowsky
- Research Center Magnetic-Resonance-Bavaria (MRB), Wuerzburg, Germany
| | - Jakob Kreutner
- Research Center Magnetic-Resonance-Bavaria (MRB), Wuerzburg, Germany
| | - Ali Yilmaz
- Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany
| | - Roland Jahns
- Comprehensive Heart Failure Centre (CHFC) and Interdisziplinary Bank of Biomaterials and Data (ibdw), University Hospital of Würzburg, Würzburg, Germany
| | - Valerie Boivin
- Institute of Pharmacology and Toxicology, University of Würzburg, Würzburg, Germany
| | - Reinhard Kandolf
- Department of Molecular Pathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Peter M. Jakob
- Research Center Magnetic-Resonance-Bavaria (MRB), Wuerzburg, Germany
| | - Karl-Heinz Hiller
- Research Center Magnetic-Resonance-Bavaria (MRB), Wuerzburg, Germany
- Fraunhofer Institute for Integrated Circuits, Magnetic Resonance and X-Ray Imaging Department, Würzburg, Germany
| | - Karin Klingel
- Department of Molecular Pathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
- * E-mail:
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Bornholz B, Benninghaus T, Reinke Y, Felix SB, Roggenbuck D, Jahns-Boivin V, Jahns R, Boege F. A standardised FACS assay based on native, receptor transfected cells for the clinical diagnosis and monitoring of β1-adrenergic receptor autoantibodies in human heart disease. Clin Chem Lab Med 2016; 54:683-91. [PMID: 26408610 DOI: 10.1515/cclm-2015-0603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/31/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Autoantibodies against β1-adrenergic receptors (β1AR) that stimulate cardiac cAMP-production play a causal role in the pathogenesis of human heart failure. Patients can be subjected to specific therapies, if the presence of potentially cardio-noxious β1AR-autoantibodies is reliably diagnosed. This requires assessment of IgG-interactions with the native β1AR because β1AR-autoantibodies target a conformational epitope inadequately presented by denatured receptors or linear peptides. Here, we report on a standardised diagnostic procedure for the assessment of β1AR-autoantibodies in heart failure patients, which is based on IgG-binding to native human β1AR. METHODS Good laboratory practice (GLP)-conform measurement of β1AR-autoantibodies was based on flow-cytometric quantification of differential IgG-binding to native HT1080 cells overexpressing biofluorescent human β1AR or not. Receptor-specific IgG-binding was derived from IgG-related median fluorescence of β1AR-positive cells corrected for background staining of β1AR-negative cells admixed to each measurement. The slope of IgG binding at two different concentrations was used as measure for the titre/avidity of β1AR-autoantibodies. RESULTS Sensitivity and specificity of the novel procedure for high β1AR-autoantibody levels in dilated cardiomyopathy patients (n=40, NYHA class III-IV) relative to n=40 matched healthy subjects was >90%. It was similar to functional assays considered the gold standard and vastly superior to existing screening-procedures employing fixed cells or linear receptor-peptides as auto-antigenic targets. Inter-assay scatter was 7%-15% and linear dilution recovery was within ±10% of expected values throughout. CONCLUSIONS The novel assay possibly provides a tool to determine true prevalence and clinical impact of β1AR-autoantibodies. Furthermore, it may serve as companion diagnostic for therapies specifically directed at β1AR-autoantibodies.
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Maya Y, Werner RA, Schütz C, Wakabayashi H, Samnick S, Lapa C, Zechmeister C, Jahns R, Jahns V, Higuchi T. 11C-Methionine PET of Myocardial Inflammation in a Rat Model of Experimental Autoimmune Myocarditis. J Nucl Med 2016; 57:1985-1990. [PMID: 27390159 DOI: 10.2967/jnumed.116.174045] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 02/17/2016] [Accepted: 06/17/2016] [Indexed: 12/30/2022] Open
Abstract
Myocarditis represents a major cause of dilated cardiomyopathy and sudden cardiac death in younger adults. Currently, definitive diagnosis of myocarditis requires endomyocardial biopsy, which is highly invasive and has the drawback of variable sensitivity due to inherent sampling error. Therefore, reliable noninvasive methods to detect and monitor cardiac inflammation are clinically relevant. In this study, we explored the potential of radiolabeled methionine to assess myocardial inflammatory activity in a rat model of experimental autoimmune myocarditis (EAM). METHODS Autoimmune myocarditis was induced by immunizing Lewis rats twice with porcine cardiac myosin and Freund complete adjuvant. Control animals were treated with adjuvant alone. Dual-tracer autoradiography was performed to assess 14C-methionine uptake and to compare the distributions of 14C-methionine versus 18F-FDG. Hematoxylin and eosin staining and anti-CD68 macrophage staining were performed for histologic analysis. Additionally, cardiac 11C-methionine PET was performed to evaluate the feasibility of in vivo imaging. 18F-FDG PET was also conducted to compare the in vivo uptake of 11C-methionine and 18F-FDG. RESULTS Multiple focal cardiac inflammatory lesions were histologically identified in myosin-immunized rats, whereas no cardiac lesions were observed in the controls. Autoradiographic images clearly showed a high-density accumulation of 14C-methionine in inflammatory lesions of EAM rats, whereas no significant uptake was observed in the control animals. 14C-methionine uptake was significantly higher in inflammatory lesions than in remote noninflammatory areas and control rat hearts. The distribution of 14C-methionine correlated well with that of 18F-FDG and with macrophage density. The contrast between inflammatory and noninflammatory areas was higher for 18F-FDG than for 14C-methionine (3.45 ± 0.68 vs. 2.07 ± 0.21, respectively; P < 0.05). In the PET imaging study, the regional 11C-methionine uptake (percentage injected dose per cubic centimeter) observed in EAM rats was significantly higher than the values obtained for control animals (0.64 ± 0.09 vs. 0.28 ± 0.02, respectively; P < 0.001). A good positive correlation between 11C-methionine and 18F-FDG uptake was found. CONCLUSION In a rat model of autoimmune myocarditis, we demonstrated the colocalization of radiolabeled methionine accumulation with 18F-FDG uptake in histologically proven inflammatory lesions. These data suggest that 11C-methionine might represent a promising candidate for the noninvasive detection and monitoring of myocarditis.
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Affiliation(s)
- Yoshifumi Maya
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.,Research Centre, Nihon Medi-Physics Co., Ltd., Chiba, Japan
| | - Rudolf A Werner
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Else-Kröner-Forschungskolleg, Interdisciplinary Center for Clinical Research, University of Würzburg,Würzburg, Germany
| | - Claudia Schütz
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Pharmacology, University of Würzburg, Würzburg, Germany; and
| | | | - Samuel Samnick
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Christina Zechmeister
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Pharmacology, University of Würzburg, Würzburg, Germany; and
| | - Roland Jahns
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Interdisciplinary Bank of Biomaterials and Data Würzburg (IBDW), University of Würzburg, Würzburg, Germany
| | - Valérie Jahns
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Pharmacology, University of Würzburg, Würzburg, Germany; and
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany .,Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
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Abstract
Particularly in the past decade which has been marked by efforts to foster individualized/personalized medicine the need for well-characterized high-quality collections of human biological material has significantly increased. When establishing and operating a human biobank the interests and the "freedom" of biomedical research must always be weighed against the interests and rights of patients and/or donors; in this process ethical aspects should be considered systematically. In addition, the importance of quality control and quality assurance has largely increased in human biobanking, both from a scientific and even more from an ethical point of view, because donated biological materials are potentially stored for decades and (on request) might serve for currently not foreseeable biomedical research purposes. In addition, the compatibility of national human biobanks with international biobank networks becomes increasingly important.
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Affiliation(s)
- Roland Jahns
- Interdisziplinäre Biomaterial- und Datenbank Würzburg (ibdw), Universitätsmedizin Würzburg, Gebäude A8/A9, Straubmühlweg 2a, 97080, Würzburg, Deutschland.
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Bornholz B, Hanzen B, Reinke Y, Felix SB, Jahns R, Schimke I, Wallukat G, Boege F. Detection of DCM-associated β1-adrenergic receptor autoantibodies requires functional readouts or native human β1-receptors as targets. Int J Cardiol 2016; 202:728-30. [DOI: 10.1016/j.ijcard.2015.10.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 11/24/2022]
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Lapa C, Reiter T, Li X, Werner RA, Samnick S, Jahns R, Buck AK, Ertl G, Bauer WR. Imaging of myocardial inflammation with somatostatin receptor based PET/CT — A comparison to cardiac MRI. Int J Cardiol 2015; 194:44-9. [DOI: 10.1016/j.ijcard.2015.05.073] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/02/2015] [Accepted: 05/14/2015] [Indexed: 12/16/2022]
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Jahns R, Boege F. Questionable Validity of Peptide-Based ELISA Strategies in the Diagnostics of Cardiopathogenic Autoantibodies That Activate G-Protein-Coupled Receptors. Cardiology 2015; 131:149-50. [DOI: 10.1159/000376546] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 11/19/2022]
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Bornholz B, Roggenbuck D, Jahns R, Boege F. Diagnostic and therapeutic aspects of β1-adrenergic receptor autoantibodies in human heart disease. Autoimmun Rev 2014; 13:954-62. [DOI: 10.1016/j.autrev.2014.08.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/16/2014] [Indexed: 01/19/2023]
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Ye YX, Basse-Lüsebrink TC, Arias-Loza PA, Kocoski V, Kampf T, Gan Q, Bauer E, Sparka S, Helluy X, Hu K, Hiller KH, Boivin-Jahns V, Jakob PM, Jahns R, Bauer WR. Response to letter regarding article, "Monitoring of monocyte recruitment in reperfused myocardial infarction with intramyocardial hemorrhage and microvascular obstruction by combined fluorine 19 and proton cardiac magnetic resonance imaging". Circulation 2014; 130:e41-2. [PMID: 25070559 DOI: 10.1161/circulationaha.114.009359] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yu-Xiang Ye
- Department of Experimental Physics 5, University of Wuerzburg, Comprehensive Heart Failure Center/Deutsches Zentrum für Herzinsuffizienz Wuerzburg, Germany
| | | | | | - Vladimir Kocoski
- Institute of Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany
| | - Thomas Kampf
- Department of Experimental Physics 5, University of Wuerzburg, Wuerzburg, Germany
| | - Qiang Gan
- Rudolf Virchow Center, University of Wuerzburg, Wuerzburg, Germany
| | - Elisabeth Bauer
- Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Xavier Helluy
- Department of Experimental Physics 5, University of Wuerzburg, Wuerzburg, Germany
| | - Kai Hu
- Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Valerie Boivin-Jahns
- Institute of Pharmacology and Toxicology, University of Wuerzburg, Wuerzburg, Germany
| | - Peter M Jakob
- Department of Experimental Physics 5, University of Wuerzburg, Research Center for Magnetic Resonance Bavaria, Wuerzburg, Germany
| | - Roland Jahns
- Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Wolfgang R Bauer
- Comprehensive Heart Failure Center/Deutsches Zentrum für Herzinsuffizienz, Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany
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Münch G, Boivin-Jahns V, Holthoff HP, Adler K, Lappo M, Truöl S, Degen H, Steiger N, Lohse MJ, Jahns R, Ungerer M. Corrigendum to ‘Administration of the cyclic peptide COR-1 in humans (phase I study):ex vivomeasurements of anti-b1-adrenergic receptor antibody neutralization and of immune parameters’ [Eur J Heart Fail 2012;14:1230-1239]. Eur J Heart Fail 2014. [DOI: 10.1093/eurjhf/hft027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Götz Münch
- Corimmun GmbH; D-82152 Martinsried Germany
| | - Valerie Boivin-Jahns
- Rudolf-Virchow-Zentrum and Department of Cardiology; Universität Würzburg; D-97978 Würzburg Germany
| | | | | | | | | | | | | | - Martin J. Lohse
- Rudolf-Virchow-Zentrum and Department of Cardiology; Universität Würzburg; D-97978 Würzburg Germany
| | - Roland Jahns
- Rudolf-Virchow-Zentrum and Department of Cardiology; Universität Würzburg; D-97978 Würzburg Germany
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Affiliation(s)
- Roland Jahns
- Department of Internal Medicine I, Cardiology; University Hospital of Würzburg; Klinikstrasse 6-8 D-97070 Würzburg Germany
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Ye YX, Basse-Lüsebrink TC, Arias-Loza PA, Kocoski V, Kampf T, Gan Q, Bauer E, Sparka S, Helluy X, Hu K, Hiller KH, Boivin-Jahns V, Jakob PM, Jahns R, Bauer WR. Monitoring of monocyte recruitment in reperfused myocardial infarction with intramyocardial hemorrhage and microvascular obstruction by combined fluorine 19 and proton cardiac magnetic resonance imaging. Circulation 2013. [PMID: 24025595 DOI: 10.1161/circulat ionaha.113.000731] [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] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Monocytes and macrophages are indispensable in the healing process after myocardial infarction (MI); however, the spatiotemporal distribution of monocyte infiltration and its correlation to prognostic indicators of reperfused MI have not been well described. METHODS AND RESULTS With combined fluorine 19/proton ((1)H) magnetic resonance imaging, we noninvasively visualized the spatiotemporal recruitment of monocytes in vivo in a rat model of reperfused MI. Blood monocytes were labeled by intravenous injection of (19)F-perfluorocarbon emulsion 1 day after MI. The distribution patterns of monocyte infiltration were correlated to the presence of microvascular obstruction (MVO) and intramyocardial hemorrhage. In vivo, (19)F/(1)H magnetic resonance imaging performed in series revealed that monocyte infiltration was spatially inhomogeneous in reperfused MI areas. In the absence of MVO, monocyte infiltration was more intense in MI regions with serious ischemia-reperfusion injuries, indicated by severe intramyocardial hemorrhage; however, monocyte recruitment was significantly impaired in MVO areas accompanied by severe intramyocardial hemorrhage. Compared with MI with isolated intramyocardial hemorrhage, MI with MVO resulted in significantly worse pump function of the left ventricle 28 days after MI. CONCLUSIONS Monocyte recruitment was inhomogeneous in reperfused MI tissue. It was highly reduced in MVO areas defined by magnetic resonance imaging. The impaired monocyte infiltration in MVO regions could be related to delayed healing and worse functional outcomes in the long term. Therefore, monocyte recruitment in MI with MVO could be a potential diagnostic and therapeutic target that could be monitored noninvasively and longitudinally by (19)F/(1)H magnetic resonance imaging in vivo.
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Affiliation(s)
- Yu-Xiang Ye
- Department of Experimental Physics 5 (Y.-X.Y., T.K., X.H., P.M.J.) and Institute of Pharmacology and Toxicology (V.B.-J.), University of Wuerzburg, Wuerzburg, Germany; Comprehensive Heart Failure Center/Deutsches Zentrum für Herzinsuffizienz, Wuerzburg, Germany (Y.-X.Y., W.R.B.); Research Center for Magnetic Resonance Bavaria, Wuerzburg, Germany (T.C.B.-L., K.-H.H., P.M.J.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (P.-A.A.-L., E.B., K.H., R.J., W.R.B.); Institute of Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany (V.K.); Rudolf Virchow Center, University of Wuerzburg, Wuerzburg, Germany (Q.G.); and Institute of Inorganic Chemistry, Wuerzburg, Germany (S.S.)
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Ye YX, Basse-Lüsebrink TC, Arias-Loza PA, Kocoski V, Kampf T, Gan Q, Bauer E, Sparka S, Helluy X, Hu K, Hiller KH, Boivin-Jahns V, Jakob PM, Jahns R, Bauer WR. Monitoring of monocyte recruitment in reperfused myocardial infarction with intramyocardial hemorrhage and microvascular obstruction by combined fluorine 19 and proton cardiac magnetic resonance imaging. Circulation 2013; 128:1878-88. [PMID: 24025595 DOI: 10.1161/circulationaha.113.000731] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Monocytes and macrophages are indispensable in the healing process after myocardial infarction (MI); however, the spatiotemporal distribution of monocyte infiltration and its correlation to prognostic indicators of reperfused MI have not been well described. METHODS AND RESULTS With combined fluorine 19/proton ((1)H) magnetic resonance imaging, we noninvasively visualized the spatiotemporal recruitment of monocytes in vivo in a rat model of reperfused MI. Blood monocytes were labeled by intravenous injection of (19)F-perfluorocarbon emulsion 1 day after MI. The distribution patterns of monocyte infiltration were correlated to the presence of microvascular obstruction (MVO) and intramyocardial hemorrhage. In vivo, (19)F/(1)H magnetic resonance imaging performed in series revealed that monocyte infiltration was spatially inhomogeneous in reperfused MI areas. In the absence of MVO, monocyte infiltration was more intense in MI regions with serious ischemia-reperfusion injuries, indicated by severe intramyocardial hemorrhage; however, monocyte recruitment was significantly impaired in MVO areas accompanied by severe intramyocardial hemorrhage. Compared with MI with isolated intramyocardial hemorrhage, MI with MVO resulted in significantly worse pump function of the left ventricle 28 days after MI. CONCLUSIONS Monocyte recruitment was inhomogeneous in reperfused MI tissue. It was highly reduced in MVO areas defined by magnetic resonance imaging. The impaired monocyte infiltration in MVO regions could be related to delayed healing and worse functional outcomes in the long term. Therefore, monocyte recruitment in MI with MVO could be a potential diagnostic and therapeutic target that could be monitored noninvasively and longitudinally by (19)F/(1)H magnetic resonance imaging in vivo.
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Affiliation(s)
- Yu-Xiang Ye
- Department of Experimental Physics 5 (Y.-X.Y., T.K., X.H., P.M.J.) and Institute of Pharmacology and Toxicology (V.B.-J.), University of Wuerzburg, Wuerzburg, Germany; Comprehensive Heart Failure Center/Deutsches Zentrum für Herzinsuffizienz, Wuerzburg, Germany (Y.-X.Y., W.R.B.); Research Center for Magnetic Resonance Bavaria, Wuerzburg, Germany (T.C.B.-L., K.-H.H., P.M.J.); Department of Internal Medicine I, University Hospital Wuerzburg, Wuerzburg, Germany (P.-A.A.-L., E.B., K.H., R.J., W.R.B.); Institute of Virology and Immunobiology, University of Wuerzburg, Wuerzburg, Germany (V.K.); Rudolf Virchow Center, University of Wuerzburg, Wuerzburg, Germany (Q.G.); and Institute of Inorganic Chemistry, Wuerzburg, Germany (S.S.)
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Caforio ALP, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, Fu M, Heliö T, Heymans S, Jahns R, Klingel K, Linhart A, Maisch B, McKenna W, Mogensen J, Pinto YM, Ristic A, Schultheiss HP, Seggewiss H, Tavazzi L, Thiene G, Yilmaz A, Charron P, Elliott PM. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34:2636-48, 2648a-2648d. [PMID: 23824828 DOI: 10.1093/eurheartj/eht210] [Citation(s) in RCA: 1991] [Impact Index Per Article: 181.0] [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] [Indexed: 02/07/2023] Open
Abstract
In this position statement of the ESC Working Group on Myocardial and Pericardial Diseases an expert consensus group reviews the current knowledge on clinical presentation, diagnosis and treatment of myocarditis, and proposes new diagnostic criteria for clinically suspected myocarditis and its distinct biopsy-proven pathogenetic forms. The aims are to bridge the gap between clinical and tissue-based diagnosis, to improve management and provide a common reference point for future registries and multicentre randomised controlled trials of aetiology-driven treatment in inflammatory heart muscle disease.
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Affiliation(s)
- Alida L P Caforio
- Division of Cardiology, Department of Cardiological Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
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Buchhorn R, Willaschek C, Selbach J, Jahns R. Immunadsorption therapy for end stage heart failure due to Duchenne muscular dystrophy. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojped.2013.31003] [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] [Indexed: 11/20/2022]
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Caforio ALP, Marcolongo R, Jahns R, Fu M, Felix SB, Iliceto S. Immune-mediated and autoimmune myocarditis: clinical presentation, diagnosis and management. Heart Fail Rev 2012; 18:715-32. [DOI: 10.1007/s10741-012-9364-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Münch G, Boivin-Jahns V, Holthoff HP, Adler K, Lappo M, Truöl S, Degen H, Steiger N, Lohse MJ, Jahns R, Ungerer M. Administration of the cyclic peptide COR-1 in humans (phase I study): ex vivo measurements of anti-β1-adrenergic receptor antibody neutralization and of immune parameters. Eur J Heart Fail 2012; 14:1230-9. [PMID: 22968742 DOI: 10.1093/eurjhf/hfs118] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS A novel concept for the treatment of heart failure is the neutralization of antibodies against the β(1)-adrenergic receptor (anti-β(1)AR-ab). In a rat model of autoimmune cardiomyopathy, the cyclic peptide COR-1 (given i.v. once monthly) neutralized anti-β(1)AR-abs and prevented anti-β(1)AR-ab-induced myocardial damage, and completely reverted cardiac dysfunction over 3-6 months. METHODS AND RESULTS A clinical phase I trial was designed as a single-blinded, placebo-controlled study. Fifty human volunteers received COR-1 or matching placebo as a single i.v. administration with ascending doses (10-240 mg). Primary endpoints were safety and tolerability, while the pharmacokinetic profile of COR-1 was assessed as a secondary endpoint. All five investigated dose groups were well tolerated; no drug-related side effects occurred. Pharmacokinetics revealed a favourable profile with an almost complete plasma clearance within 60 min after administration. Pharmacodynamic investigation showed dose-dependent efficacy with almost complete scavenging of pathological anti-β(1)AR-abs ex vivo at the two highest doses. No anti-COR-1 autoantibodies occurred. No other effects on the immune system (such as an increase of crucial cytokines) were observed up to 43 days after drug administration, nor upon incubation of anti-β(1)AR-ab-positive patient blood samples with COR-1 ex vivo. CONCLUSIONS COR-1 was shown to be safe after i.v. administration in vivo; no relevant side effects occurred. Efficacy was estimated from ex vivo investigation of the potency to neutralize specific anti-β(1)-AR-abs. TRIAL REGISTRATION NCT 01043146, Eudra CT 2008-007745-31.
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Holthoff HP, Zeibig S, Jahns-Boivin V, Bauer J, Lohse MJ, Kääb S, Clauss S, Jahns R, Schlipp A, Münch G, Ungerer M. Detection of anti-β1-AR autoantibodies in heart failure by a cell-based competition ELISA. Circ Res 2012; 111:675-84. [PMID: 22811559 DOI: 10.1161/circresaha.112.272682] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Autoantibodies directed against the second extracellular loop of the cardiac β1-adrenergic receptor (β1-AR) are thought to contribute to the pathogenesis of dilated cardiomyopathy (DCM) and Chagas heart disease. Various approaches have been used to detect such autoantibodies; however, the reported prevalence varies largely, depending on the detection method used. OBJECTIVE We analyzed sera from 167 DCM patients (ejection fraction<45%) and from 110 age-matched volunteers who did not report any heart disease themselves, with an often used simple peptide-ELISA approach, and compared it with a novel whole cell-based ELISA, using cells expressing the full transgene for the human β1-AR. Additionally, 35 patients with hypertensive heart disease with preserved ejection fraction were investigated. METHODS AND RESULTS The novel assay was designed according to the currently most reliable anti-TSH receptor antibody-ELISA used to diagnose Graves disease ("third-generation assay") and also detects the target antibodies by competition with a specific monoclonal anti-β1-AR antibody (β1-AR MAb) directed against the functionally relevant β1-AR epitope. Anti-β1-AR antibodies were detected in ≈60% of DCM patients and in ≈8% of healthy volunteers using the same cutoff values. The prevalence of these antibodies was 17% in patients with hypertensive heart disease. Anti-β1-AR antibody titers (defined as inhibition of β1-AR MAb-binding) were no longer detected after depleting sera from IgG antibodies by protein G adsorption. In contrast, a previously used ELISA conducted with a linear 26-meric peptide derived from the second extracellular β1-AR loop yielded a high number of false-positive results precluding any specific identification of DCM patients. CONCLUSIONS We established a simple and efficient screening assay detecting disease-relevant β1-AR autoantibodies in patient sera yielding a high reproducibility also in high throughput screening. The assay was validated according to "good laboratory practice" and can serve as a companion biodiagnostic assay for the development and evaluation of antibody-directed therapies in antibody-positive heart failure.
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Angermann CE, Störk S, Gelbrich G, Faller H, Jahns R, Frantz S, Loeffler M, Ertl G. Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study. Circ Heart Fail 2011; 5:25-35. [PMID: 21956192 DOI: 10.1161/circheartfailure.111.962969] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Trials investigating efficacy of disease management programs (DMP) in heart failure reported contradictory results. Features rendering specific interventions successful are often ill defined. We evaluated the mode of action and effects of a nurse-coordinated DMP (HeartNetCare-HF, HNC). METHODS AND RESULTS Patients hospitalized for systolic heart failure were randomly assigned to HNC or usual care (UC). Besides telephone-based monitoring and education, HNC addressed individual problems raised by patients, pursued networking of health care providers and provided training for caregivers. End points were time to death or rehospitalization (combined primary), heart failure symptoms, and quality of life (SF-36). Of 1007 consecutive patients, 715 were randomly assigned (HNC: n=352; UC: n=363; age, 69±12 years; 29% female; 40% New York Heart Association class III-IV). Within 180 days, 130 HNC and 137 UC patients reached the primary end point (hazard ratio, 1.02; 95% confidence interval, 0.81-1.30; P=0.89), since more HNC patients were readmitted. Overall, 32 HNC and 52 UC patients died (1 UC patient and 4 HNC patients after dropout); thus, uncensored hazard ratio was 0.62 (0.40-0.96; P=0.03). HNC patients improved more regarding New York Heart Association class (P=0.05), physical functioning (P=0.03), and physical health component (P=0.03). Except for HNC, health care utilization was comparable between groups. However, HNC patients requested counseling for noncardiac problems even more frequently than for cardiovascular or heart-failure-related issues. CONCLUSIONS The primary end point of this study was neutral. However, mortality risk and surrogates of well-being improved significantly. Quantitative assessment of patient requirements suggested that besides (tele)monitoring individualized care considering also noncardiac problems should be integrated in efforts to achieve more sustainable improvement in heart failure outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN23325295.
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Deubner N, Berliner D, Schlipp A, Gelbrich G, Caforio ALP, Felix SB, Fu M, Katus H, Angermann CE, Lohse MJ, Ertl G, Störk S, Jahns R. Cardiac beta1-adrenoceptor autoantibodies in human heart disease: rationale and design of the Etiology, Titre-Course, and Survival (ETiCS) Study. Eur J Heart Fail 2010; 12:753-62. [PMID: 20494925 DOI: 10.1093/eurjhf/hfq072] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
AIMS Evidence for a pathophysiologic relevance of autoimmunity in human heart disease has substantially increased over the past years. Conformational autoantibodies stimulating the cardiac beta1-adrenoceptor (beta1-aabs) are considered of importance in heart failure development and clinical pilot studies have shown their prognostic significance in human 'idiopathic' cardiomyopathy. METHODS We recently developed a novel highly sensitive fluorescence-based functional assay to detect stimulating beta1-aabs. We will use this method to assess Etiology, Titre-Course, and effect on Survival (ETiCS) of beta1-aabs in a prospective multicentre study with serial follow-up of patients after a first acute myocarditis or myocardial infarction. Several European core laboratories will jointly study the hypothesis that both disorders may trigger autoimmune reactions leading to the generation of beta1-aabs and/or other heart-directed aabs. Further, sera from healthy controls and well-characterized patient cohorts with dilated, ischaemic, or hypertensive cardiomyopathy will be analysed retrospectively for beta1-aab prevalence, incidence, persistence, and/or clearance. CONCLUSION ETiCS is so far the largest clinical diagnostic study projected to address cardiac autoimmunity. It attempts to unravel the pathophysiology of cardiac autoantibody formation and persistence/clearance. ETiCS will enhance current knowledge on autoimmunity in human heart disease and promote endeavours to develop novel therapies targeting cardiac aabs.
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Affiliation(s)
- Nikolas Deubner
- Department of Internal Medicine I, Centre of Cardiovascular Medicine, University of Würzburg, University Hospital Würzburg, Klinikstrasse 6-8, 97070 Würzburg, Germany
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