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Zhitomirsky S, Sy H, Yassin A, Stavropoulos C, Farkas A. 1371. Identification of Risk Factors to Predict Gram negative bacteria in Patients with Upper Extremity Infections. Open Forum Infect Dis 2021. [PMCID: PMC8644219 DOI: 10.1093/ofid/ofab466.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Gram negative bacteria (GNB) have been identified as a cause of upper extremity infections and empiric treatment directed to both gram positive and negative organisms is often recommended. Risk-based approaches to establish need for gram-negative coverage may help to minimize unnecessary drug exposure, but further information on such methods are currently lacking. The aim of this study was to identify risk factors associated with the isolation of GNB in patients with upper extremity infections. Methods We reviewed records of patients with upper extremity infections treated in two urban hospitals between March 2018 and July 2020. Prosthetic joint infections were excluded. Baseline demographic, clinical, surgical and microbiology data was collected. Multivariable logistic regression models were screened using Akaike Information Criterion to establish the best model and risk factors associated with isolation of a GNB. Results We identified 111 patients, the majority of whom were male with frequent history of IV drug use. Deep wound cultures in 30 (33.3%) individuals yielded a GNB, and 80% of these cases were polymicrobial. Among the GNB, most prevalent were Enterobacterales (10.4%), HACEK group (6.39%), and Pseudomonas spp. (4.5%) (Tables 1. and 2.). Infections were mostly limited to the soft tissue structures of the hand and the forearm, with involvements of the joint and bone being second and third most common. The final model identified the use of IV medications (OR 4.14, 95% CI 1.3 - 14.46) together with prior surgery at the site of infection within the last year (OR 5.56, 95% CI 1.06 - 30.98), and having an open wound on presentation (OR 3.03, 95% CI 1.04 - 9.47) as factors independently associated with isolation of a GNB (Table 3). AUROC of 0.702 indicates acceptable model discrimination. Table 1: Baseline characteristics ![]()
Table 2: Bacterial isolates ![]()
Table 3: Final model ![]()
Conclusion Our logistic regression model identified significant predictors for isolation of GNB in upper extremity infections within this population. Results of this study will assist clinicians in making a better informed decision for the need of empiric gram negative coverage aimed to support the reduction of patient exposure to unnecessary antimicrobial coverage. External validation of the model is warranted prior to application to clinical care. Figure 1: AUROC ![]()
Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | - Hendrik Sy
- Mount Sinai Morningside and West Hospitals, New York, New York
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Berkovitch A, Barbash IM, Finkelstein A, Assali AR, Danenberg H, Fefer P, Maor E, Zhitomirsky S, Orvin K, Zekry SB, Steinvil A, Barsheshet A, Halkin A, Guetta V, Kornowski R, Segev A. Validation of cardiac damage classification and addition of albumin in a large cohort of patients undergoing transcatheter aortic valve replacement. Int J Cardiol 2020; 304:23-28. [PMID: 32008849 DOI: 10.1016/j.ijcard.2020.01.031] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/07/2019] [Accepted: 01/13/2020] [Indexed: 11/16/2022]
Abstract
AIMS We aimed to validate a new scoring system based on extent of cardiac damage for risk stratification in patients undergoing transcatheter aortic valve replacement (TAVR) in a real-world cohort and to examine the addition of baseline albumin in risk assessment. METHODS AND RESULTS We investigated 2608 patients undergoing TAVR. Subjects were divided into five groups based on their echocardiography findings. Patients were further assessed by incorporating baseline albumin. Multivariable analysis demonstrated that each increase in stage was associated with significant increased risk of 1-year mortality (HR 1.37, 95%CI 1.23-1.54, p < .001). Among patients at increased stage (3-4), incorporation of baseline of albumin identified the highest risk group, such that each 1 decrement in albumin levels was associated with more than triple increase in mortality among patients at stage 3 and 4 (HR 2.77, 95% CI 1.48-5.18, p-value = .001). CONCLUSIONS Cardiac damage classification is validated in a real-world cohort of patients undergoing TAVR. Incorporation of low baseline albumin may further identify patients at the highest risk group. CONDENSTED ABSTRACT We evaluated 2608 patients undergoing transcatheter aortic valve replacement (TAVR) in order to validate a new scoring system dividing patients in to 5 stages (0-4) based on extent of cardiac damage. Patients were further assessed by incorporating baseline albumin. Multivariable analysis demonstrated that each increase in stage was associated with significant increased risk of 1-year mortality. Furthermore, among patients at increased stage (3-4), incorporation of baseline of albumin identified the highest risk group, such that each 1 decrement in albumin levels was associated with more than triple increase in mortality among patients at stage 3 and 4.
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Affiliation(s)
- Anat Berkovitch
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Israel M Barbash
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Division of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Abid R Assali
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Division of Cardiology, Rabin Medical Center, Petach-Tikva, Israel
| | - Haim Danenberg
- The Heart Institute, Hadassah Ein-Karem Medical Center, The Hebrew University, Jerusalem, Israel
| | - Paul Fefer
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sophia Zhitomirsky
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Division of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Katia Orvin
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Division of Cardiology, Rabin Medical Center, Petach-Tikva, Israel
| | - Sagit Ben Zekry
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Arik Steinvil
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Division of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Alon Barsheshet
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Division of Cardiology, Rabin Medical Center, Petach-Tikva, Israel
| | - Amir Halkin
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Division of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Victor Guetta
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Division of Cardiology, Rabin Medical Center, Petach-Tikva, Israel
| | - Amit Segev
- Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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3
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Rozenbaum Z, Finkelstein A, Zhitomirsky S, Topilsky Y, Halkin A, Banai S, Bazan S, Barbash I, Segev A, Guetta V, Danenberg H, Planner D, Orvin K, Assa HV, Assali A, Kornowski R, Steinvil A. Impact of preprocedural left ventricle hypertrophy and geometrical patterns on mortality following TAVR. Am Heart J 2020; 220:184-191. [PMID: 31862472 DOI: 10.1016/j.ahj.2019.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 11/24/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND In contrast to surgical aortic valve replacement, left ventricle (LV) hypertrophy (LVH) had not been clearly associated with mortality following transcatheter aortic valve replacement (TAVR). METHODS We performed a retrospective analysis of patients enrolled in the Israeli multicenter TAVR registry for whom preprocedural LV mass index (LVMI) data were available. Patients were divided into categories according to LVMI: normal LVMI and mild, moderate, and severe LVH. Mild LVH was regarded as the reference group. Additionally, LV geometry patterns were examined (concentric and eccentric LVH, and concentric remodeling). RESULTS The cohort consisted of 1,559 patients, 46.5% male, with a mean age of 82.2 (±6.8) years and mean LVMI of 121 (±29) g/m2. Rates of normal LVMI and mild, moderate, and severe LVH were 31% (n = 485), 21% (n = 322), 18% (n = 279), and 30% (n = 475), respectively. Three-year mortality rates for normal LVMI and mild, moderate, and severe LVH were 19.8%, 18.3%, 23.7%, and 24.4%, respectively. Compared to mild LVH, moderate LVH and severe LVH were independently associated with an increased risk for all-cause mortality (hazard ratio [HR] 1.58, 95% CI 1.15-2.18, P = .005; HR 1.46, 95% CI 1.1-1.95, P = .009; respectively). Concentric LVH was independently associated with a decreased risk for mortality compared to normal LV geometry (HR 0.75, 95% CI 0.63-0.89, P = .001). Compared to concentric LVH, eccentric LVH was independently associated with a 33% increased risk for mortality (HR 1.33, 95% CI 1.11-1.60, P = .002). CONCLUSIONS Mild concentric LVH confers a protective effect among patients with severe aortic stenosis undergoing TAVR. However, hypertrophy becomes maladaptive, and an increased baseline LVMI, eccentric pattern particularly, may be associated with all-cause mortality in this population.
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Affiliation(s)
- Zach Rozenbaum
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ariel Finkelstein
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sophia Zhitomirsky
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Halkin
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuel Bazan
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Barbash
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Danenberg
- Cardiology department, Hadassah Medical Center, Jerusalem; Affiliated to the Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Planner
- Cardiology department, Hadassah Medical Center, Jerusalem; Affiliated to the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Katia Orvin
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin Assa
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid Assali
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Steinvil
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Berkovitch A, Barbash IM, Finkelstein A, Assali AR, Denenberg H, Fefer P, Maor E, Zhitomirsky S, Orvin K, Steinvil A, Barsheset A, Halkin A, Guetta V, Kornowski R, Segev A. P3857Validation of the cardiac damage classification and additional effects of albumin levels in a large cohort of patients undergoing transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0695] [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
Background
Risk stratification in patients undergoing transcatheter aortic valve replacement (TAVR) is limited and based on clinical judgment and surgical AVR scoring systems. Recently, extent of cardiac damage using an echocardiographic classification was purposed to assess prognosis of patients undergoing TAVR. We aimed to validate this new scoring system in a real-world cohort and to examine the addition of baseline albumin in risk assessment.
Methods
We investigated 2,608 patients undergoing TAVR. All subjects had an echocardiography test prior to TAVR. Subjects were divided into five groups based on their echocardiography findings: stage 0 – 758 (29%) patients, stage 1 – 769 (30%), stage 2 – 730 (28%), stage 3 – 320 (12%) and stage 4 (1.2%). Patients were further assessed by incorporating baseline albumin.
Results
Mean age of study population was 82±7 years. Kaplan-Meier's survival analysis showed that the cumulative probability of mortality was significantly higher among subjects with increased stage compared to the lower stages (p<0.001). Multivariable analysis demonstrated that each increase in stage was associated with significant increased risk of 1-year mortality (HR 1.37, 95% CI 1.23–1.54, p<0.001). Among patients at increased stage (3–4), incorporation of baseline of albumin identified the highest risk group, such that each 1 decrement in albumin levels was associated with more than triple increase in mortality among patients at stage 3 and 4 (HR 2.77, 95% CI 1.48–5.18, p-value=0.001)[figure]. When added to the scoring risk prediction model, albumin allowed more accurate risk stratification: continuous NRI analysis showed an overall improvement of 11% (95% CI 6%-16%) in the accuracy of classification.
KM according to stage and albumin
Conclusions
Cardiac damage classification is validated in a real-world cohort of patients undergoing TAVR. Incorporation of low baseline albumin may further identify patients at the highest risk group.
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Affiliation(s)
- A Berkovitch
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - I M Barbash
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - A R Assali
- Rabin Medical Center, Petah Tikva, Israel
| | - H Denenberg
- Hadassah University Medical Center, The Heart Institute, Jerusalem, Israel
| | - P Fefer
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - E Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - K Orvin
- Rabin Medical Center, Petah Tikva, Israel
| | - A Steinvil
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Barsheset
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Halkin
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - V Guetta
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | - A Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel
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Finkelstein A, Rozenbaum Z, Zhitomirsky S, Halkin A, Banai S, Bazan S, Barbash I, Segev A, Guetta V, Danenberg H, Planner D, Orvin K, Assa HV, Assali A, Kornowski R, Steinvil A. Safety outcomes of new versus old generation transcatheter aortic valves. Catheter Cardiovasc Interv 2018; 94:E44-E53. [PMID: 30549227 DOI: 10.1002/ccd.28021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/18/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare procedural outcomes of transcatheter aortic valve implantation (TAVI) patients who were implanted with older versus newer generation valves. BACKGROUND The current evidence base for improved safety of the newer commercially available TAVI valves is limited. METHODS A retrospective analysis of the Israeli multicenter TAVI registry was performed. Patients were stratified by valve generation of four commercially available devices: Edwards Sapien (ESX) Edwards Sapien S3 (ES3), Medtronic CoreValve (MCV), and Medtronic Evolut R (MER). RESULTS The cohort consisted of 737 patients with new generation valves (NGVs; ES3 n = 223; MER n = 514) and 1,869 with old generation valves (OGVs; MCV n = 1,181; ESX n = 688). Device success rates were significantly higher in NGV (97.5 versus 95.4%), with less post-procedural paravalvular leak (3 versus 5.8%), and valve mal-positioning (1.2 versus 3.4%); all P-values<0.05. There were no differences in rates of permanent pacemaker implantation, stroke or acute kidney injury (AKI) of any stage between the groups, although stage ≥2 AKI was more prevalent in NGV. After adjustment to significant differences in baseline patient and procedural characteristics, device success was higher (OR 1.86, 95% confidence interval (CI) 1.09-3.18, P = 0.023) and the 1-month safety outcome was significantly lower (OR 0.72, 95% CI 0.55-0.96, P = 0.025) for NGV. Device success was driven mainly by improved rates of PVL of ES3, while the safety outcome was mainly driven by improved rates of life-threatening bleeding and valve mal-positioning of MER. CONCLUSION As compared to OGV, use of NGV for TAVI was associated with higher rates of device success and lower rates of adverse events.
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Affiliation(s)
- Ariel Finkelstein
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zach Rozenbaum
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sophia Zhitomirsky
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Halkin
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuel Bazan
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Barbash
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Danenberg
- Cardiology department, Hadassah Medical Center, Jerusalem, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Planner
- Cardiology department, Hadassah Medical Center, Jerusalem, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Katia Orvin
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin Assa
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid Assali
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Steinvil
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Horwitz E, Krogvold L, Zhitomirsky S, Swisa A, Fischman M, Lax T, Dahan T, Hurvitz N, Weinberg-Corem N, Klochendler A, Powers AC, Brissova M, Jörns A, Lenzen S, Glaser B, Dahl-Jørgensen K, Dor Y. β-Cell DNA Damage Response Promotes Islet Inflammation in Type 1 Diabetes. Diabetes 2018; 67:2305-2318. [PMID: 30150306 PMCID: PMC6198335 DOI: 10.2337/db17-1006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/18/2018] [Indexed: 12/19/2022]
Abstract
Type 1 diabetes (T1D) is an autoimmune disease where pancreatic β-cells are destroyed by islet-infiltrating T cells. Although a role for β-cell defects has been suspected, β-cell abnormalities are difficult to demonstrate. We show a β-cell DNA damage response (DDR), presented by activation of the 53BP1 protein and accumulation of p53, in biopsy and autopsy material from patients with recently diagnosed T1D as well as a rat model of human T1D. The β-cell DDR is more frequent in islets infiltrated by CD45+ immune cells, suggesting a link to islet inflammation. The β-cell toxin streptozotocin (STZ) elicits DDR in islets, both in vivo and ex vivo, and causes elevation of the proinflammatory molecules IL-1β and Cxcl10. β-Cell-specific inactivation of the master DNA repair gene ataxia telangiectasia mutated (ATM) in STZ-treated mice decreases the expression of proinflammatory cytokines in islets and attenuates the development of hyperglycemia. Together, these data suggest that β-cell DDR is an early event in T1D, possibly contributing to autoimmunity.
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Affiliation(s)
- Elad Horwitz
- Department of Developmental Biology and Cancer Research, The Hebrew University, Jerusalem, Israel
| | - Lars Krogvold
- Paediatric Department, Oslo University Hospital HF, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sophia Zhitomirsky
- Department of Developmental Biology and Cancer Research, The Hebrew University, Jerusalem, Israel
| | - Avital Swisa
- Department of Developmental Biology and Cancer Research, The Hebrew University, Jerusalem, Israel
| | - Maya Fischman
- Department of Developmental Biology and Cancer Research, The Hebrew University, Jerusalem, Israel
| | - Tsuria Lax
- Department of Developmental Biology and Cancer Research, The Hebrew University, Jerusalem, Israel
| | - Tehila Dahan
- Department of Developmental Biology and Cancer Research, The Hebrew University, Jerusalem, Israel
| | - Noa Hurvitz
- Department of Developmental Biology and Cancer Research, The Hebrew University, Jerusalem, Israel
| | - Noa Weinberg-Corem
- Department of Developmental Biology and Cancer Research, The Hebrew University, Jerusalem, Israel
| | - Agnes Klochendler
- Department of Developmental Biology and Cancer Research, The Hebrew University, Jerusalem, Israel
| | - Alvin C. Powers
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, and Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | - Marcela Brissova
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, and Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Anne Jörns
- Institute of Clinical Biochemistry, Hannover Medical School, Hannover, Germany
| | - Sigurd Lenzen
- Institute of Clinical Biochemistry, Hannover Medical School, Hannover, Germany
- Institute of Experimental Diabetes Research and Institute of Clinical Biochemistry, Hannover Medical School, Hannover, Germany
| | - Benjamin Glaser
- Endocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Knut Dahl-Jørgensen
- Paediatric Department, Oslo University Hospital HF, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yuval Dor
- Department of Developmental Biology and Cancer Research, The Hebrew University, Jerusalem, Israel
- Corresponding author: Yuval Dor, , or Knut Dahl-Jørgensen,
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