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Denkinger CM, Janssen M, Schäkel U, Gall J, Leo A, Stelmach P, Weber SF, Krisam J, Baumann L, Stermann J, Merle U, Weigand MA, Nusshag C, Bullinger L, Schrezenmeier JF, Bornhäuser M, Alakel N, Witzke O, Wolf T, Vehreschild MJGT, Schmiedel S, Addo MM, Herth F, Kreuter M, Tepasse PR, Hertenstein B, Hänel M, Morgner A, Kiehl M, Hopfer O, Wattad MA, Schimanski CC, Celik C, Pohle T, Ruhe M, Kern WV, Schmitt A, Lorenz HM, Souto-Carneiro M, Gaeddert M, Halama N, Meuer S, Kräusslich HG, Müller B, Schnitzler P, Parthé S, Bartenschlager R, Gronkowski M, Klemmer J, Schmitt M, Dreger P, Kriegsmann K, Schlenk RF, Müller-Tidow C. Anti-SARS-CoV-2 antibody-containing plasma improves outcome in patients with hematologic or solid cancer and severe COVID-19: a randomized clinical trial. Nat Cancer 2023; 4:96-107. [PMID: 36581734 PMCID: PMC9886549 DOI: 10.1038/s43018-022-00503-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/29/2022] [Indexed: 04/26/2023]
Abstract
Patients with cancer are at high risk of severe coronavirus disease 2019 (COVID-19), with high morbidity and mortality. Furthermore, impaired humoral response renders severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines less effective and treatment options are scarce. Randomized trials using convalescent plasma are missing for high-risk patients. Here, we performed a randomized, open-label, multicenter trial ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001632-10/DE ) in hospitalized patients with severe COVID-19 (n = 134) within four risk groups ((1) cancer (n = 56); (2) immunosuppression (n = 16); (3) laboratory-based risk factors (n = 36); and (4) advanced age (n = 26)) randomized to standard of care (control arm) or standard of care plus convalescent/vaccinated anti-SARS-CoV-2 plasma (plasma arm). No serious adverse events were observed related to the plasma treatment. Clinical improvement as the primary outcome was assessed using a seven-point ordinal scale. Secondary outcomes were time to discharge and overall survival. For the four groups combined, those receiving plasma did not improve clinically compared with those in the control arm (hazard ratio (HR) = 1.29; P = 0.205). However, patients with cancer experienced a shortened median time to improvement (HR = 2.50; P = 0.003) and superior survival with plasma treatment versus the control arm (HR = 0.28; P = 0.042). Neutralizing antibody activity increased in the plasma cohort but not in the control cohort of patients with cancer (P = 0.001). Taken together, convalescent/vaccinated plasma may improve COVID-19 outcomes in patients with cancer who are unable to intrinsically generate an adequate immune response.
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Affiliation(s)
- Claudia M Denkinger
- Division of Infectious Disease and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.
- Partner site Heidelberg University Hospital, German Center for Infection Research, Heidelberg, Germany.
| | - Maike Janssen
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike Schäkel
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Julia Gall
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Albrecht Leo
- Institute for Clinical Transfusion Medicine and Cell Therapy Heidelberg, Heidelberg, Germany
| | - Patrick Stelmach
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan F Weber
- Division of Infectious Disease and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Krisam
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Lukas Baumann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Jacek Stermann
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Nusshag
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jens-Florian Schrezenmeier
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Dresden and Faculty of Medicine Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Nael Alakel
- Department of Internal Medicine I, University Hospital Dresden and Faculty of Medicine Carl Gustav Carus of TU Dresden, Dresden, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre for Infectious Diseases, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Timo Wolf
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan Schmiedel
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marylyn M Addo
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Partner site Hamburg-Lübeck-Borstel-Riems, German Center for Infection Research, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Institute for Infection Research and Vaccine Development, Hamburg, Germany
| | - Felix Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center, Heidelberg, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | | | - Mathias Hänel
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Anke Morgner
- Department of Internal Medicine III, Klinikum Chemnitz, Chemnitz, Germany
| | - Michael Kiehl
- Department of Internal Medicine I, Frankfurt (Oder) General Hospital, Frankfurt (Oder), Germany
| | - Olaf Hopfer
- Department of Internal Medicine I, Frankfurt (Oder) General Hospital, Frankfurt (Oder), Germany
| | - Mohammad-Amen Wattad
- Department of Hematology, Oncology, Palliative Care and Stem Cell Transplantation, Klinikum Hochsauerland, Meschede, Germany
| | - Carl C Schimanski
- Department of Internal Medicine II, Klinikum Darmstadt, Darmstadt, Germany
| | - Cihan Celik
- Department of Internal Medicine II, Klinikum Darmstadt, Darmstadt, Germany
| | - Thorsten Pohle
- Department of Internal Medicine I, Klinikum Herford, Herford, Germany
| | - Matthias Ruhe
- Department of Internal Medicine I, Klinikum Herford, Herford, Germany
| | - Winfried V Kern
- Department of Medicine II, Division of Infectious Diseases and Travel Medicine, University Medical Centre Freiburg, Freiburg, Germany
| | - Anita Schmitt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Hanns-Martin Lorenz
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mary Gaeddert
- Division of Infectious Disease and Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Niels Halama
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Department of Translational Immunotherapy (D240), German Cancer Research Center, Heidelberg, Germany
- Helmholtz Institute for Translational Oncology, Mainz, Germany
| | - Stefan Meuer
- Institute for Clinical Transfusion Medicine and Cell Therapy Heidelberg, Heidelberg, Germany
| | - Hans-Georg Kräusslich
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Barbara Müller
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sylvia Parthé
- Department of Infectious Diseases, Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martina Gronkowski
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Jennifer Klemmer
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Schmitt
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Dreger
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Katharina Kriegsmann
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard F Schlenk
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
- NCT Trial Center, National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany.
- National Center for Tumor Diseases, Heidelberg, Germany.
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Sommerer C, Schröter I, Gruneberg K, Schindler D, Behnisch R, Morath C, Renders L, Heemann U, Schnitzler P, Melk A, Della Penna A, Nadalin S, Heeg K, Meuer S, Zeier M, Giese T. Incidences of infectious events in a renal transplant cohort of the German Center of Infectious Diseases (DZIF). Open Forum Infect Dis 2022; 9:ofac243. [PMID: 35855001 PMCID: PMC9280327 DOI: 10.1093/ofid/ofac243] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/11/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Infectious complications are a major cause of morbidity and mortality after kidney transplantation.
Methods
In this transplant cohort study at the German Center of Infectious Diseases (DZIF), we evaluated all infections occurring during the first year after renal transplantation. We assessed microbial etiology, incidence rates, and temporal occurrence of these infections.
Results
Of 804 renal transplant recipients (65.2% male, 51 ± 14 years), 439 (54.6%) had 972 infections within the first year after transplantation. Almost half of these infections (47.8%) occurred within the first three months. Bacteria were responsible for 66.4% (645/972) of all infections, followed by viral (28.9%[281/972]) and fungal (4.7%[46/972]) pathogens. The urinary tract was the most common site of infection (42.4%). Enterococcus was most frequently isolated bacteria (20.9%), followed by E.coli (17.6%) and Klebsiella (12.5%). E.coli was the leading pathogen in recipients <50 years of age, whereas Enterococcus predominated in older recipients. Resistant bacteria were responsible for at least one infection in 9.5% (76/804) of all recipients. Viral infections occurred in 201 recipients (25.0%). Of these, herpes viruses predominated (140/281[49.8%]) and cytomegalovirus had the highest incidence rate (12.3%). In the 46 fungal infections, Candida albicans (40.8%) was most commonly isolated. Other fungal opportunistic pathogens, including Aspergillus fumigatus and Pneumocystis, were rare.
Conclusions
Renal allograft recipients in Germany experience a high burden of infectious complications in the first year after transplantation. Bacteria were the predominating pathogen, followed by opportunistic infections such as cytomegalovirus. Microbial etiology varied between age groups and resistant bacteria were identified in 10% of recipients.
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Affiliation(s)
- Claudia Sommerer
- Nephrology, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Iris Schröter
- Nephrology, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Katrin Gruneberg
- Nephrology, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Daniela Schindler
- Department of Nephrology, Klinikum rechts der Isar of the Technical University Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Rouven Behnisch
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Nephrology, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Lutz Renders
- Department of Nephrology, Klinikum rechts der Isar of the Technical University Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar of the Technical University Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Andrea Della Penna
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Klaus Heeg
- Department of Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Stefan Meuer
- Department of Immunology, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Martin Zeier
- Nephrology, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Infection Research (DZIF), Germany
| | - Thomas Giese
- Department of Immunology, University Hospital Heidelberg, Heidelberg, Germany
- German Centre for Infection Research (DZIF), Germany
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3
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Neuenfeldt F, Schumacher JC, Grieshaber-Bouyer R, Habicht J, Schröder-Braunstein J, Gauss A, Merle U, Niesler B, Heineken N, Dalpke A, Gaida MM, Giese T, Meuer S, Samstag Y, Wabnitz G. Inflammation induces pro-NETotic neutrophils via TNFR2 signaling. Cell Rep 2022; 39:110710. [PMID: 35443164 DOI: 10.1016/j.celrep.2022.110710] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 10/27/2021] [Revised: 02/24/2022] [Accepted: 03/29/2022] [Indexed: 11/19/2022] Open
Abstract
Cytokines released during chronic inflammatory diseases induce pro-inflammatory properties in polymorphonuclear neutrophils (PMNs). Here, we describe the development of a subgroup of human PMNs expressing CCR5, termed CCR5+ PMNs. Auto- and paracrine tumor necrosis factor (TNF) signaling increases intracellular neutrophil elastase (ELANE) abundance and induces neutrophil extracellular traps formation (NETosis) in CCR5+ PMNs, and triggering of CCR5 amplifies NETosis. Membranous TNF (mTNF) outside-in signaling induces the formation of reactive oxygen species, known activators of NETosis. In vivo, we find an increased number of CCR5+ PMNs in the peripheral blood and inflamed lamina propria of patients with ulcerative colitis (UC). Notably, failure of anti-TNF therapy is associated with higher frequencies of CCR5+ PMNs. In conclusion, we identify a phenotype of pro-NETotic, CCR5+ PMNs present in inflamed tissue in vivo and inducible in vitro. These cells may reflect an important component of tissue damage during chronic inflammation and could be of diagnostic value.
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Affiliation(s)
- Friederike Neuenfeldt
- Institute of Immunology, Heidelberg University, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - Jan Christoph Schumacher
- Institute of Immunology, Heidelberg University, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - Ricardo Grieshaber-Bouyer
- Department of Medicine V, Hematology, Oncology and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jüri Habicht
- Institute of Immunology, Heidelberg University, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | | | - Annika Gauss
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Beate Niesler
- Department of Human Molecular Genetics, Heidelberg University, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany; nCounter Core Facility, Department of Human Molecular Genetics, Heidelberg University, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany
| | - Niko Heineken
- Institute of Immunology, Heidelberg University, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - Alexander Dalpke
- Institute of Medical Microbiology and Virology, University Hospital Carl Gustav Carus, TU Dresden, 01069 Dresden, Germany
| | - Matthias M Gaida
- Institute of Pathology, University Medical Center Mainz, JGU-Mainz, 55131 Mainz, Germany
| | - Thomas Giese
- Institute of Immunology, Heidelberg University, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - Stefan Meuer
- Institute of Immunology, Heidelberg University, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - Yvonne Samstag
- Institute of Immunology, Heidelberg University, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany
| | - Guido Wabnitz
- Institute of Immunology, Heidelberg University, Im Neuenheimer Feld 305, 69120 Heidelberg, Germany.
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4
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Schaier M, Gottschalk C, Kälble F, Uhlmann L, Eckstein V, Müller-Tidow C, Meuer S, Mahnke K, Lorenz HM, Zeier M, Steinborn A. The onset of active disease in systemic lupus erythematosus patients is characterised by excessive regulatory CD4+-T-cell differentiation. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/cg29xj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matthias Schaier
- Department of Medicine I (Nephrology), University of Heidelberg, Germany
| | | | - Florian Kälble
- Department of Medicine I (Nephrology), University of Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - Volker Eckstein
- Department of Medicine V (Haematology, Rheumatology), University of Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Medicine V (Haematology, Rheumatology), University of Heidelberg, Germany
| | - Stefan Meuer
- Institute of Immunology, University of Heidelberg, Germany
| | - Karsten Mahnke
- Department of Dermatology, University of Heidelberg, Germany
| | - Hanns-Martin Lorenz
- Department of Medicine V (Haematology, Rheumatology), University of Heidelberg, Germany
| | - Martin Zeier
- Department of Medicine I (Nephrology), University of Heidelberg, Germany
| | - Andrea Steinborn
- Department of Obstetrics and Gynaecology, University of Heidelberg, Germany.
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5
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Sommerer C, Brunet M, Budde K, Millán O, Guirado Perich L, Glander P, Meuer S, Zeier M, Giese T. Monitoring of gene expression in tacrolimus-treated de novo renal allograft recipients facilitates individualized immunosuppression: Results of the IMAGEN study. Br J Clin Pharmacol 2021; 87:3851-3862. [PMID: 33620734 DOI: 10.1111/bcp.14794] [Citation(s) in RCA: 3] [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] [Received: 11/10/2020] [Revised: 02/06/2021] [Accepted: 02/13/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Calcineurin inhibitors (CNI) have a small therapeutic window, and drug monitoring is required. Pharmacokinetic monitoring does not correlate sufficiently with clinical outcome. Therefore, the expression of nuclear factor of activated T cells (NFAT)-regulated genes in the peripheral blood has been suggested as a potentially useful immune monitoring tool to optimize CNI therapy. NFAT-regulated gene expression (RGE) was evaluated in renal allograft recipients as predictive biomarker to detect patients at risk of acute rejection or infections. METHODS NFAT-RGE (interleukin-2, interferon-γ, granular-macrophage colony-stimulating factor) was evaluated by quantitative real-time polymerase chain reaction in whole blood samples at day 7, day 14, month 1, 3, and 6 after transplantation in 64 de novo renal allograft recipients from 3 European centres. Immunosuppression consisted of tacrolimus (Tac), mycophenolic acid, and corticosteroids. RESULTS Tac concentrations (C0 and C1.5) correlated inversely with NFAT-RGE (P < .01). NFAT-RGE showed a high interindividual variability (1-61%). Patients with high residual gene expression (NFAT-RGE ≥30%) were at the increased risk of acute rejection in the following months (35 vs. 5%, P = .02), whereas patients with low residual gene expression (NFAT-RGE <30%) showed a higher incidence of viral complications, especially cytomegalovirus and BK virus replication (52.5 vs. 10%, P = .01). CONCLUSIONS NFAT-RGE was confirmed as a potential noninvasive early predictive biomarker in the immediate post-transplant period to detect patients at risk of acute rejection and infectious complications in Tac-treated renal allograft recipients. Monitoring of NFAT-RGE may provide additional useful information for physicians to achieve individualized Tac treatment.
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Affiliation(s)
- Claudia Sommerer
- Department of Nephrology, University of Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Mercè Brunet
- Pharmacology and Toxicology Laboratory, CDB, CIBERehd, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Klemens Budde
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Olga Millán
- Pharmacology and Toxicology Laboratory, CDB, CIBERehd, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Spain
| | - Lluis Guirado Perich
- Renal Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
| | - Petra Glander
- Department of Nephrology, Charité University Hospital Berlin, Berlin, Germany
| | - Stefan Meuer
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Giese
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
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Sommerer C, Schmitt A, Hückelhoven-Krauss A, Giese T, Bruckner T, Wang L, Schnitzler P, Meuer S, Zeier M, Schmitt M. Peptide Vaccination against Cytomegalovirus Induces Specific T Cell Response in Responses in CMV Seronegative End-Stage Renal Disease Patients. Vaccines (Basel) 2021; 9:vaccines9020133. [PMID: 33562163 PMCID: PMC7915922 DOI: 10.3390/vaccines9020133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/23/2021] [Accepted: 02/04/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: Cytomegalovirus (CMV) reactivation occurs in seronegative patients after solid organ transplantation (SOT) particularly from seropositive donors and can be lethal. Generation of CMV-specific T cells helps to prevent CMV reactivation. Therefore, we initiated a clinical phase I CMVpp65 peptide vaccination trial for seronegative end-stage renal disease patients waiting for kidney transplantation. Methods: The highly immunogenic nonamer peptide NLVPMVATV derived from CMV phosphoprotein 65(CMVpp65) in a water-in-oil emulsion (Montanide™) plus imiquimod (Aldara™) as an adjuvant was administered subcutaneously four times biweekly. Clinical course as well as immunological responses were monitored using IFN-γ ELISpot assays and flow cytometry for CMV-specific CD8+ T cells. Results: Peptide vaccination was well tolerated, and no drug-related serious adverse events were detected except for Grade I–II local skin reactions. Five of the 10 patients (50%) mounted any immune response (responders) and 40% of the patients presented CMV-specific CD8+ T cell responses elicited by these prophylactic vaccinations. No responders experienced CMV reactivation in the 18 months post-transplantation, while all non-responders reactivated. Conclusion: CMVpp65 peptide vaccination was safe, well tolerated, and clinically encouraging in seronegative end-stage renal disease patients waiting for kidney transplantation. Further studies with larger patient cohorts are planned.
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Affiliation(s)
- Claudia Sommerer
- Department of Nephrology, University Hospital Heidelberg, University of Heidelberg, 69117 Heidelberg, Germany;
- German Center for Infection Research DZIF, 69117 Heidelberg, Germany; (T.G.); (S.M.)
- Correspondence: ; Tel.: +49-(0)6221-91120; Fax: +49-(0)6221-9112-990
| | - Anita Schmitt
- Department of Internal Medicine V, University of Heidelberg, 69117 Heidelberg, Germany; (A.S.); (A.H.-K.); (L.W.); (M.S.)
| | - Angela Hückelhoven-Krauss
- Department of Internal Medicine V, University of Heidelberg, 69117 Heidelberg, Germany; (A.S.); (A.H.-K.); (L.W.); (M.S.)
| | - Thomas Giese
- German Center for Infection Research DZIF, 69117 Heidelberg, Germany; (T.G.); (S.M.)
- Institute of Immunology, University of Heidelberg, 69117 Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Lei Wang
- Department of Internal Medicine V, University of Heidelberg, 69117 Heidelberg, Germany; (A.S.); (A.H.-K.); (L.W.); (M.S.)
| | - Paul Schnitzler
- Department of Virology, University Hospital Heidelberg, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Stefan Meuer
- German Center for Infection Research DZIF, 69117 Heidelberg, Germany; (T.G.); (S.M.)
- Institute of Immunology, University of Heidelberg, 69117 Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University Hospital Heidelberg, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Michael Schmitt
- Department of Internal Medicine V, University of Heidelberg, 69117 Heidelberg, Germany; (A.S.); (A.H.-K.); (L.W.); (M.S.)
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7
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Schaier M, Gottschalk C, Uhlmann L, Speer C, Kälble F, Eckstein V, Müller-Tidow C, Meuer S, Mahnke K, Lorenz HM, Zeier M, Steinborn A. Immunosuppressive therapy influences the accelerated age-dependent T-helper cell differentiation in systemic lupus erythematosus remission patients. Arthritis Res Ther 2018; 20:278. [PMID: 30563559 PMCID: PMC6299578 DOI: 10.1186/s13075-018-1778-6] [Citation(s) in RCA: 6] [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: 09/10/2018] [Accepted: 11/26/2018] [Indexed: 12/16/2022] Open
Abstract
Background CD4+ T cells are of great importance in the pathogenesis of systemic lupus erythematosus (SLE), as an imbalance between CD4+ regulatory T cells (Tregs) and CD4+ responder T cells (Tresps) causes flares of active disease in SLE patients. In this study, we aimed to find the role of aberrant Treg/Tresp cell differentiation for maintaining Treg/Tresp cell balance and Treg functionality. Methods To determine differences in the differentiation of Tregs/Tresps we calculated the percentages of CD45RA+CD31+ recent thymic emigrant (RTE) Tregs/Tresps and CD45RA+CD31− mature naive (MN) Tregs/Tresps, as well as CD45RA−CD31+ and CD45RA−CD31− memory Tregs/Tresps (CD31+ and CD31− memory Tregs/Tresps) within the total Treg/Tresp pool of 78 SLE remission patients compared with 94 healthy controls of different ages. The proliferation capacity of each Treg/Tresp subset was determined by staining the cells with anti-Ki67 monoclonal antibodies. Differences in the autologous or allogeneic Treg function between SLE remission patients and healthy controls were determined using suppression assays. Results With age, we found an increased differentiation of RTE Tregs via CD31+ memory Tregs and of RTE Tresps via MN Tresps into CD31− memory Tregs/Tresp in healthy volunteers. This opposite differentiation of RTE Tregs and Tresps was associated with an age-dependent increase in the suppressive activity of both naive and memory Tregs. SLE patients showed similar age-dependent Treg cell differentiation. However, in these patients RTE Tresps differentiated increasingly via CD31+ memory Tresps, whereby CD31− memory Tresps arose that were much more difficult to inhibit for Tregs than those that emerged through differentiation via MN Tresps. Consequently, the increase in the suppressive activity of Tregs with age could not be maintained in SLE patients. Testing the Tregs of healthy volunteers and SLE patients with autologous and nonautologous Tresps revealed that the significantly decreased Treg function in SLE patients was not exclusively attributed to an age-dependent diminished sensitivity of the Tresps for Treg suppression. The immunosuppressive therapy reduced the accelerated age-dependent Tresp cell proliferation to normal levels, but simultaneously inhibited Treg cell proliferation below normal levels. Conclusions Our data reveal that the currently used immunosuppressive therapy has a favorable effect on the differentiation and proliferation of Tresps but has a rather unfavorable effect on the proliferation of Tregs. Newer substances with more specific effects on the immune system would be desirable. Electronic supplementary material The online version of this article (10.1186/s13075-018-1778-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthias Schaier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Claudius Gottschalk
- Department of Obstetrics and Gynaecology, University of Heidelberg, Research Cooperation Unit Gynaecology/Nephrology, INF 162, 69120, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Claudius Speer
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Volker Eckstein
- Department of Medicine V (Haematology, Rheumatology), University of Heidelberg, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Medicine V (Haematology, Rheumatology), University of Heidelberg, Heidelberg, Germany
| | - Stefan Meuer
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - Karsten Mahnke
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Hanns-Martin Lorenz
- Department of Medicine V (Haematology, Rheumatology), University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Andrea Steinborn
- Department of Obstetrics and Gynaecology, University of Heidelberg, Research Cooperation Unit Gynaecology/Nephrology, INF 162, 69120, Heidelberg, Germany.
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8
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Schaier M, Leick A, Uhlmann L, Kälble F, Morath C, Eckstein V, Ho A, Mueller-Tidow C, Meuer S, Mahnke K, Sommerer C, Zeier M, Steinborn A. End-stage renal disease, dialysis, kidney transplantation and their impact on CD4 + T-cell differentiation. Immunology 2018; 155:211-224. [PMID: 29722011 DOI: 10.1111/imm.12947] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/06/2018] [Accepted: 04/17/2018] [Indexed: 12/23/2022] Open
Abstract
Premature aging of both CD4+ regulatory T (Treg) and CD4+ responder-T (Tresp) cells in patients with end-stage renal disease (ESRD) is expected to affect the success of later kidney transplantation. Both T-cell populations are released from the thymus as inducible T-cell co-stimulator-positive (ICOS+ ) and ICOS- recent thymic emigrant (RTE) Treg/Tresp cells, which differ primarily in their proliferative capacities. In this study, we analysed the effect of ESRD and subsequent renal replacement therapies on the differentiation of ICOS+ and ICOS- RTE Treg/Tresp cells into ICOS+ CD31- or ICOS- CD31- memory Treg/Tresp cells and examined whether diverging pathways affected the suppressive activity of ICOS+ and ICOS- Treg cells in co-culture with autologous Tresp cells. Compared with healthy controls, we found an increased differentiation of ICOS+ RTE Treg/Tresp cells and ICOS- RTE Treg cells through CD31+ memory Treg/Tresp cells into CD31- memory Treg/Tresp cells in ESRD and dialysis patients. In contrast, ICOS- RTE Tresp cells showed an increased differentiation via ICOS- mature naive (MN) Tresp cells into CD31- memory Tresp cells. Thereby, the ratio of ICOS+ Treg/ICOS+ Tresp cells was not changed, whereas that of ICOS- Treg/ICOS- Tresp cells was significantly increased. This differentiation preserved the suppressive activity of both Treg populations in ESRD and partly in dialysis patients. After transplantation, the increased differentiation of ICOS+ and ICOS- RTE Tresp cells proceeded, whereas that of ICOS+ RTE Treg cells ceased and that of ICOS- RTE Treg cells switched to an increased differentiation via ICOS- MN Treg cells. Consequently, the ratios of ICOS+ Treg/ICOS+ Tresp cells and of ICOS- Treg/ICOS- Tresp cells decreased significantly, reducing the suppressive activity of Treg cells markedly. Our data reveal that an increased tolerance-inducing differentiation of ICOS+ and ICOS- Treg cells preserves the functional activity of Treg cells in ESRD patients, but this cannot be maintained during long-term renal replacement therapy.
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Affiliation(s)
- Matthias Schaier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Angele Leick
- Department of Obstetrics and Gynaecology, University of Heidelberg, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Volker Eckstein
- Department of Medicine V (Haematology), University of Heidelberg, Heidelberg, Germany
| | - Anthony Ho
- Department of Medicine V (Haematology), University of Heidelberg, Heidelberg, Germany
| | - Carsten Mueller-Tidow
- Department of Medicine V (Haematology), University of Heidelberg, Heidelberg, Germany
| | - Stefan Meuer
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - Karsten Mahnke
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Claudia Sommerer
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Andrea Steinborn
- Department of Obstetrics and Gynaecology, University of Heidelberg, Heidelberg, Germany
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9
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Schaier M, Leick A, Uhlmann L, Kälble F, Eckstein V, Ho A, Meuer S, Mahnke K, Sommerer C, Zeier M, Steinborn A. The role of age-related T-cell differentiation in patients with renal replacement therapy. Immunol Cell Biol 2017; 95:895-905. [PMID: 28722017 DOI: 10.1038/icb.2017.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 06/09/2017] [Accepted: 07/06/2017] [Indexed: 12/12/2022]
Abstract
Dialysis patients have deficiencies regarding the generation of immune responses and show an increased susceptibility for infections. Persisting uremic conditions are made responsible for the increased aging of their immune system. In this study, we analyzed whether age-related differences in the differentiation of both recent-thymic-emigrant-(RTE)-regulatory (Tregs) and RTE-responder T cells (Tresps) into CD31--memory Tregs/Tresps led to differences in the suppressive activity of naive and memory Tregs on autologous Tresps between healthy volunteers and dialysis patients. We found that regardless of age, the differentiation of RTE-Treg/Tresps into CD31--memory-Treg/Tresps was significantly increased in dialysis patients. By analyzing the age-related differences in the differentiation of Tregs/Tresps, we saw that in healthy volunteers RTE-Tregs differentiate via CD31+-memory Tregs into CD31--memory Tregs, which may strengthen the suppressive activity of the total Treg pool. In contrast RTE-Tresps of healthy volunteers differentiate via mature naive (MN)-Tresps into CD31--memory-Tresps, which may weaken the reactivity of the total Tresp pool. Our data revealed that this normal differentiation via MN-Tresps was lost in dialysis patients, suggesting that their Tresps are less sensitive to Treg-mediated immunosuppression. Functional analysis of Tregs on autologous Tresps showed an increasing suppressive activity with age in healthy individuals, who therefore may have a lower risk of developing autoimmune diseases but owing to decreased reactivity of their Tresps are more likely to suffer from infections. In contrast, dialysis patients exhibited a decreasing suppressive activity with age, owing to strengthened Tresp reactivity, which could explain the higher prevalence of chronic inflammatory conditions in these patients.
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Affiliation(s)
- Matthias Schaier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Angele Leick
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Florian Kälble
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Volker Eckstein
- Department of Medicine V (Hematology), University of Heidelberg, Heidelberg, Germany
| | - Anthony Ho
- Department of Medicine V (Hematology), University of Heidelberg, Heidelberg, Germany
| | - Stefan Meuer
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - Karsten Mahnke
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Claudia Sommerer
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Andrea Steinborn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
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10
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Wabnitz GH, Balta E, Schindler S, Kirchgessner H, Jahraus B, Meuer S, Samstag Y. The pro-oxidative drug WF-10 inhibits serial killing by primary human cytotoxic T-cells. Cell Death Discov 2016; 2:16057. [PMID: 27551545 PMCID: PMC4979520 DOI: 10.1038/cddiscovery.2016.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/05/2016] [Indexed: 12/22/2022] Open
Abstract
Cytotoxic T-cells (CTLs) play an important role in many immune-mediated inflammatory diseases. Targeting cytotoxicity of CTLs would allow to interfere with immune-mediated tissue destruction. Here we demonstrate that WF-10, a pro-oxidative compound, inhibits CTL-mediated cytotoxicity. WF-10 did not influence early steps of target-cell killing, but impaired the ability of CTLs to detach from the initial target cell and to move to a second target cell. This reduced serial killing was accompanied by stronger enrichment of the adhesion molecule LFA-1 in the cytolytic immune synapse. LFA-1 clustering requires activation of the actin-bundling protein L-plastin and was accordingly diminished in L-plastin knockdown cells. Interestingly, WF-10 likely acts through regulating L-plastin: (I) It induced L-plastin activation through phosphorylation leading to enhanced LFA-1-mediated cell adhesion, and, importantly, (II) WF-10 lost its influence on target-cell killing in L-plastin knockdown cells. Finally, we demonstrate that WF-10 can improve immunosuppression by conventional drugs. Thus, while cyclosporine A alone had no significant effect on cytotoxicity of CTLs, a combination of cyclosporine A and WF-10 blocked target-cell killing synergistically. Together, our findings suggest that WF-10 – either alone or in combination with conventional immunosuppressive drugs – may be efficient to control progression of diseases, in which CTLs are crucially involved.
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Affiliation(s)
- G H Wabnitz
- Institute of Immunology, Ruprecht-Karls-University , Im Neuenheimer Feld 305, Heidelberg D-69120, Germany
| | - E Balta
- Institute of Immunology, Ruprecht-Karls-University , Im Neuenheimer Feld 305, Heidelberg D-69120, Germany
| | - S Schindler
- Institute of Immunology, Ruprecht-Karls-University , Im Neuenheimer Feld 305, Heidelberg D-69120, Germany
| | - H Kirchgessner
- Institute of Immunology, Ruprecht-Karls-University , Im Neuenheimer Feld 305, Heidelberg D-69120, Germany
| | - B Jahraus
- Institute of Immunology, Ruprecht-Karls-University , Im Neuenheimer Feld 305, Heidelberg D-69120, Germany
| | - S Meuer
- Institute of Immunology, Ruprecht-Karls-University , Im Neuenheimer Feld 305, Heidelberg D-69120, Germany
| | - Y Samstag
- Institute of Immunology, Ruprecht-Karls-University , Im Neuenheimer Feld 305, Heidelberg D-69120, Germany
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11
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Wagner MI, Mai C, Schmitt E, Mahnke K, Meuer S, Eckstein V, Ho AD, Schaier M, Zeier M, Spratte J, Fluhr H, Steinborn A. The role of recent thymic emigrant-regulatory T-cell (RTE-Treg) differentiation during pregnancy. Immunol Cell Biol 2015; 93:858-67. [PMID: 25915117 DOI: 10.1038/icb.2015.51] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 01/01/2023]
Abstract
During pregnancy, regulatory T cells (Tregs) have a key role in maternal immune tolerance to the semi-allogeneic fetus. Our previous results showed that the naive CD45RA(+)-Treg pool is functionally improved in pregnant women compared with non-pregnant women. Therefore, we examined the thymic output and differentiation of CD45RA(+)CD31(+) recent thymic emigrant (RTE)-Tregs during normal pregnancy and in the presence of preeclampsia. With the onset of pregnancy, the composition of the total CD4(+)CD127(low+/-)FoxP3(+)-Treg pool changed in the way that its percentage of RTE- and CD45RA(-)CD31(+)-memory Tregs decreased strongly, whereas that of the CD45RA(+)CD31(-)-mature naive (MN)-Tregs did not change and that of the CD45RA(-)CD31(-)-memory Tregs increased complementary. Thereby, the ratio of RTE-/MN-Tregs decreased from 1.0 to 0.7 leading to a significant increase in the suppressive activity of the naive CD45RA(+)-Treg pool. This effect was confirmed by re-assembling separated RTE- and MN-Tregs from non-pregnant women in the ratio of pregnant women. The suppressive activity of both separated naive Treg subsets was equally high in non-pregnant and pregnant women, but considerably reduced in preeclampsia patients, who showed significantly increased percentages of CD45RA(-)CD31(+)-memory Tregs, but decreased percentages of RTE- and MN-Tregs. Our results suggest a reduced thymic output of RTE-Tregs during pregnancy, which causes a decrease in the ratio of RTE-/MN-Tregs and thus an increase in the differentiation of RTE-Tregs towards CD45RA(-)CD31(-)-memory Tregs. Presumably, this differentiation of RTE-Tregs, which was impaired in preeclampsia patients, ensures the improved suppressive activity of the CD45RA(+)-naive Treg pool and thus retains the maintenance of pregnancy.
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Affiliation(s)
- Miriam I Wagner
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Charlotte Mai
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Edgar Schmitt
- Institute of Immunology, University of Mainz, Mainz, Germany
| | - Karsten Mahnke
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Stefan Meuer
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - Volker Eckstein
- Department of Medicine V (Hematology), University of Heidelberg, Heidelberg, Germany
| | - Anthony D Ho
- Department of Medicine V (Hematology), University of Heidelberg, Heidelberg, Germany
| | - Matthias Schaier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - Julia Spratte
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Herbert Fluhr
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Andrea Steinborn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
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12
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Wagner MI, Jöst M, Spratte J, Schaier M, Mahnke K, Meuer S, Zeier M, Steinborn A. Differentiation of ICOS+ and ICOS- recent thymic emigrant regulatory T cells (RTE T regs) during normal pregnancy, pre-eclampsia and HELLP syndrome. Clin Exp Immunol 2015; 183:129-42. [PMID: 26285098 DOI: 10.1111/cei.12693] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 12/24/2022] Open
Abstract
Two different subsets of naturally occurring regulatory T cells (nTregs), defined by their expression of the inducible co-stimulatory (ICOS) molecule, are produced by the human thymus. To examine the differentiation of ICOS(+) and ICOS(-) CD45RA(+) CD31(+) recent thymic emigrant (RTE) T regs during normal pregnancy and in the presence of pre-eclampsia or haemolysis elevated liver enzymes low platelet (HELLP)-syndrome, we used six-colour flow cytometric analysis to determine the changes in the composition of the ICOS(+) and ICOS(-) T reg pools with CD45RA(+) CD31(+) RTE T regs, CD45RA(+) CD31(-) mature naive (MN) T regs, CD45RA(-) CD31(+) and CD45RA(-) CD31(-) memory Tregs. With the beginning of pregnancy until term, we observed a strong differentiation of both ICOS(+) and ICOS(-) CD45RA(+) CD31(+) RTE, but not CD45RA(+) CD31(-) MN T regs, into CD45RA(-) CD31(-) memory T regs. At the end of pregnancy, the onset of spontaneous term labour was associated with a significant breakdown of ICOS(+) CD45RA(-) CD31(-) memory T regs. However, in the presence of pre-eclampsia, there was a significantly increased differentiation of ICOS(+) and ICOS(-) CD45RA(+) CD31(+) RTE T regs into CD45RA(-) CD31(+) memory T regs, wherein the lacking differentiation into CD45RA(-) CD31(-) memory T regs was partially replaced by the increased differentiation of ICOS(+) and ICOS(-) CD45RA(+) CD31(-) MN Tregs into CD45RA(-) CD31(-) memory T regs. In patients with HELLP syndrome, this alternatively increased differentiation of CD45RA(-) CD31(-) MN T regs seemed to be exaggerated, and presumably restored the suppressive activity of magnetically isolated ICOS(+) and ICOS(-) T regs, which were shown to be significantly less suppressive in pre-eclampsia patients, but not in HELLP syndrome patients. Hence, our findings propose that the regular differentiation of both ICOS(+) and ICOS(-) CD45RA(+) CD31(+) RTE T regs ensures a healthy pregnancy course, while their disturbed differentiation is associated with the occurrence of pre-eclampsia and HELLP syndrome.
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Affiliation(s)
- M I Wagner
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - M Jöst
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - J Spratte
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - M Schaier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - K Mahnke
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - S Meuer
- Institute of Immunology, University of Heidelberg, Heidelberg, Germany
| | - M Zeier
- Department of Medicine I (Nephrology), University of Heidelberg, Heidelberg, Germany
| | - A Steinborn
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
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13
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Szikszai T, Lasitschka F, Giese T, Greulich M, Lee YS, Ilse J, Schiessling S, Leowardi C, Al-Saeedi M, Winter J, Meuer S, Schröder-Braunstein J. Standardization of a human organ culture model of intestinal inflammation and its application for drug testing. J Immunol Methods 2014; 421:96-103. [PMID: 25556347 DOI: 10.1016/j.jim.2014.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/20/2014] [Accepted: 12/23/2014] [Indexed: 11/24/2022]
Abstract
Targeting early molecular events in intestinal inflammation may represent a useful therapeutic strategy for maintaining remission in inflammatory bowel disease. Recently, we established an intestinal organ culture model (LEL model), which allows to study the initiation of an intestinal inflammatory response in human tissue. In this model, EDTA-mediated depletion of epithelial cells of colonic mucosa results in an instantaneous inflammatory response in resident lamina propria cells, which shows features of intestinal inflammation in vivo. Furthermore, activated immune cells emigrate from the lamina propria onto the luminal side of the basement membrane. Here, we standardize the LEL model and explore its suitability for drug testing. To this end, human mucosal punches of defined surface area were prepared, depleted of epithelial cells, and cultured at an optimized ratio of medium volume/punch area. The intra-assay variability of measurements of inflammatory parameters ranged from 13% for cell migration to 19% for secretion and 30% for tissue gene expression, respectively, of the inflammatory mediators IL-8 and IL-6. Importantly, known suppressive effects of dexamethasone, a drug employed for the treatment of inflammatory bowel diseases, on leucocyte migration, IL8, IL6, and TNF-α production as well as CD86 surface expression by myeloid cells were observed in this model. In conclusion, the present results suggest that the LEL model may represent a useful human experimental system not only for studying initial activation mechanisms in intestinal inflammation but also for evaluating drug compounds for the treatment of mucosal inflammation.
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Affiliation(s)
- Timea Szikszai
- Institute of Immunology, University Hospital Heidelberg, INF 305, D-69120 Heidelberg, Germany; Department of Anesthesiology, University Hospital Heidelberg, INF 110, D-69120 Heidelberg, Germany
| | - Felix Lasitschka
- Institute of Pathology, University Hospital Heidelberg, INF 224, D-69120 Heidelberg, Germany
| | - Thomas Giese
- Institute of Immunology, University Hospital Heidelberg, INF 305, D-69120 Heidelberg, Germany
| | - Matthias Greulich
- Institute of Immunology, University Hospital Heidelberg, INF 305, D-69120 Heidelberg, Germany
| | - Young-Seon Lee
- Institute of Immunology, University Hospital Heidelberg, INF 305, D-69120 Heidelberg, Germany
| | - Juliane Ilse
- Institute of Immunology, University Hospital Heidelberg, INF 305, D-69120 Heidelberg, Germany
| | - Serin Schiessling
- Institute of Immunology, University Hospital Heidelberg, INF 305, D-69120 Heidelberg, Germany; Department of Surgery, University Hospital Heidelberg, INF 110, D-69120 Heidelberg, Germany
| | - Christine Leowardi
- Department of Surgery, University Hospital Heidelberg, INF 110, D-69120 Heidelberg, Germany
| | - Mohammed Al-Saeedi
- Department of Surgery, University Hospital Heidelberg, INF 110, D-69120 Heidelberg, Germany
| | - Johannes Winter
- Department of Surgery, St. Vincentius Hospital, Holzstr. 4a, D-67346 Speyer, Germany
| | - Stefan Meuer
- Institute of Immunology, University Hospital Heidelberg, INF 305, D-69120 Heidelberg, Germany
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14
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Berger T, Jacobi C, Haas J, Ransmayr G, Guger M, Zettl UK, Di Pauli F, Taumberger B, Wietek S, Meuer S, Reindl M, Giese T. Predicting therapeutic efficacy of intravenous immunoglobulin (IVIG) in individual patients with relapsing remitting multiple sclerosis (RRMS) by functional genomics. J Neuroimmunol 2014; 277:145-52. [DOI: 10.1016/j.jneuroim.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 12/30/2022]
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15
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Heninger AK, Wentrup S, Al-Saeedi M, Schiessling S, Giese T, Wartha F, Meuer S, Schröder-Braunstein J. Immunomodulation of human intestinal T cells by the synthetic CD80 antagonist RhuDex®. Immun Inflamm Dis 2014; 2:166-80. [PMID: 25505551 PMCID: PMC4257762 DOI: 10.1002/iid3.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/13/2014] [Accepted: 08/25/2014] [Indexed: 12/17/2022]
Abstract
Deregulated activation of mucosal lamina propria T cells plays a central role in the pathogenesis of intestinal inflammation. One of the means to attenuate T cell activation is by blocking the CD28/CD80 co-stimulatory pathway. Here we investigate RhuDex®, a small molecule that binds to human CD80, for its effects on the activation of lamina propria T cells employing a gut-culture model of inflammation. To this end, lamina propria leukocytes (LPL) and peripheral blood lymphocytes (PBL) were stimulated either through the CD3/T-cell-receptor complex or the CD2-receptor (CD2) employing agonistic monoclonal antibodies. Co-stimulatory signals were provided by CD80/CD86 present on lamina propria myeloid cells or LPS-activated peripheral blood monocytes. Results show that RhuDex® caused a profound reduction of LPL and PBL proliferation, while Abatacept (CTLA-4-Ig) inhibited LPL proliferation to a small degree, and had no effect on PBL proliferation. Furthermore, Abatacept significantly inhibited IL-2, TNF-α, and IFN-γ release from LPL, primarily produced by CD4+ T cells, where IL-2 blockage was surprisingly strong, suggesting a down-regulating effect on regulatory T cells. In contrast, in the presence of RhuDex®, secretion of IL-17, again mostly by CD4+ T cells, and IFN-γ was inhibited in LPL and PBL, yet IL-2 remained unaffected. Thus, RhuDex® efficiently inhibited lamina propria and peripheral blood T-cell activation in this pre-clinical study making it a promising drug candidate for the treatment of intestinal inflammation.
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Affiliation(s)
- Anne-Kristin Heninger
- Institute for Immunology, University Hospital Heidelberg Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Sabine Wentrup
- Institute for Immunology, University Hospital Heidelberg Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Mohammed Al-Saeedi
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Serin Schiessling
- Institute for Immunology, University Hospital Heidelberg Im Neuenheimer Feld 305, 69120, Heidelberg, Germany ; Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Thomas Giese
- Institute for Immunology, University Hospital Heidelberg Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Florian Wartha
- Medigene AG Lochhamer Str. 11, 82152, Planegg/Martinsried, Germany
| | - Stefan Meuer
- Institute for Immunology, University Hospital Heidelberg Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Jutta Schröder-Braunstein
- Institute for Immunology, University Hospital Heidelberg Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
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16
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Schröder-Braunstein J, Gras J, Brors B, Schwarz S, Szikszai T, Lasitschka F, Wabnitz G, Heidtmann A, Lee YS, Schiessling S, Leowardi C, Al-Saeedi M, Ulrich A, Engelke A, Winter J, Samstag Y, Giese T, Meuer S. Initiation of an inflammatory response in resident intestinal lamina propria cells -use of a human organ culture model. PLoS One 2014; 9:e97780. [PMID: 24841635 PMCID: PMC4026413 DOI: 10.1371/journal.pone.0097780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/22/2014] [Indexed: 01/30/2023] Open
Abstract
Resident human lamina propria immune cells serve as powerful effectors in host defense. Molecular events associated with the initiation of an intestinal inflammatory response in these cells are largely unknown. Here, we aimed to characterize phenotypic and functional changes induced in these cells at the onset of intestinal inflammation using a human intestinal organ culture model. In this model, healthy human colonic mucosa was depleted of epithelial cells by EDTA treatment. Following loss of the epithelial layer, expression of the inflammatory mediators IL1B, IL6, IL8, IL23A, TNFA, CXCL2, and the surface receptors CD14, TLR2, CD86, CD54 was rapidly induced in resident lamina propria cells in situ as determined by qRT-PCR and immunohistology. Gene microarray analysis of lamina propria cells obtained by laser-capture microdissection provided an overview of global changes in gene expression occurring during the initiation of an intestinal inflammatory response in these cells. Bioinformatic analysis gave insight into signalling pathways mediating this inflammatory response. Furthermore, comparison with published microarray datasets of inflamed mucosa in vivo (ulcerative colitis) revealed a significant overlap of differentially regulated genes underlining the in vivo relevance of the organ culture model. Furthermore, genes never been previously associated with intestinal inflammation were identified using this model. The organ culture model characterized may be useful to study molecular mechanisms underlying the initiation of an intestinal inflammatory response in normal mucosa as well as potential alterations of this response in inflammatory bowel disease.
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Affiliation(s)
| | - Judith Gras
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Benedikt Brors
- Division of Theoretical Bioinformatics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sonja Schwarz
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Timea Szikszai
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Lasitschka
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Guido Wabnitz
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Antje Heidtmann
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Young-Seon Lee
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Serin Schiessling
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christine Leowardi
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Mohammed Al-Saeedi
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexis Ulrich
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Johannes Winter
- Department of Surgery, St. Vincentius Hospital, Speyer, Germany
| | - Yvonne Samstag
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Giese
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Meuer
- Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
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Schlossberger V, Schober L, Rehnitz J, Schaier M, Zeier M, Meuer S, Schmitt E, Toth B, Strowitzki T, Steinborn A. The success of assisted reproduction technologies in relation to composition of the total regulatory T cell (Treg) pool and different Treg subsets. Hum Reprod 2013; 28:3062-73. [DOI: 10.1093/humrep/det316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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18
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Schaier M, Seissler N, Becker LE, Schaefer SM, Schmitt E, Meuer S, Hug F, Sommerer C, Waldherr R, Zeier M, Steinborn A. The extent of HLA-DR expression on HLA-DR+Tregs allows the identification of patients with clinically relevant borderline rejection. Transpl Int 2013; 26:290-9. [DOI: 10.1111/tri.12032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/21/2012] [Accepted: 11/12/2012] [Indexed: 01/08/2023]
Affiliation(s)
| | | | | | | | - Edgar Schmitt
- Institute of Immunology; University of Mainz; Germany
| | - Stefan Meuer
- Institute of Immunology; University of Heidelberg; Germany
| | - Friederike Hug
- Department of Nephrology; University of Heidelberg; Germany
| | | | | | - Martin Zeier
- Department of Nephrology; University of Heidelberg; Germany
| | - Andrea Steinborn
- Department of Obstetrics and Gynecology; University of Heidelberg; Germany
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Schröder-Braunstein J, Pavlov V, Giese T, Heidtmann A, Wentrup S, Lasitschka F, Winter J, Ulrich A, Engelke A, Al Saeedi M, Meuer S. Human mucosal CD4+ T cells but not blood CD4+ T cells respond vigorously towards CD28 engagement. Clin Exp Immunol 2012; 168:87-94. [PMID: 22385243 DOI: 10.1111/j.1365-2249.2011.04539.x] [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] [Indexed: 11/26/2022] Open
Abstract
Human lamina propria T lymphocytes (LPT) possess functional properties profoundly different from those of peripheral blood T lymphocytes (PBT). While they are characterized by a low proliferative response to T cell receptor (TCR)/CD3 stimulation in vitro their responsiveness to activation through the 'co-stimulatory' CD2-receptor is enhanced when compared to PBT. In this study, we demonstrate that engagement of another co-stimulatory receptor on both LPT and PBT, namely CD28, by a single monoclonal antibody (mAb), respectively, strongly activates the former but not the latter through a PI3-kinase dependent signalling pathway leading to the production of inflammatory cytokines such as interleukin (IL)-2, tumour necrosis factor (TNF)-α, interferon (IFN)-γ and granulocyte-macrophage colony-stimulating factor (GM-CSF). In addition to the high sensitivity of LPT to CD2 stimulation, this finding supports the notion that 'non-specific/innate' mechanisms to activate T lymphocytes play a predominant role vis-à-vis'TCR driven/adaptive' responses in the intestinal mucosa. Furthermore, it suggests that results from preclinical tests for therapeutic antibodies performed with human blood derived T cells are probably insufficient to predict reactivities of tissue-resident immune cells, which--given their quantitative predominance--may critically determine the in-vivo response to such compounds.
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Affiliation(s)
- J Schröder-Braunstein
- Institute for Immunology Institute for Pathology Heidelberg, Department of Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 305, Heidelberg, Germany.
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20
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Funke B, Lasitschka F, Roth W, Penzel R, Meuer S, Saile M, Gretz N, Sido B, Schirmacher P, Autschbach F. Selective downregulation of retinoic acid-inducible gene I within the intestinal epithelial compartment in Crohn's disease. Inflamm Bowel Dis 2011; 17:1943-54. [PMID: 21830273 DOI: 10.1002/ibd.21572] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [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: 10/04/2010] [Accepted: 10/11/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND A defective innate immune response may contribute to the pathogenesis of Crohn's disease (CD) and ulcerative colitis (UC). Employing a global gene expression analysis, this study was aimed at identifying specifically regulated genes within the epithelial compartment in inflammatory bowel disease (IBD). METHODS The epithelial fraction of human ileal mucosa samples from surgical specimens was obtained by laser microdissection. Gene expression was examined by global expression profiling (n = 18, Affymetrix), quantitative reverse-transcription polymerase chain reaction (RT-PCR) (n = 35), immunoblot analysis (n = 9), and immunohistochemistry (n = 25). RESULTS Global expression profiling revealed a pronounced downregulation of the retinoic acid-inducible gene I (RIG-I) within the epithelial layer of the ileum in patients with CD but not with UC. The downregulation of RIG-I was confirmed by quantitative RT-PCR, immunoblot analysis, and immunohistochemistry. CONCLUSIONS Epithelial downregulation of RIG-I, a known pattern recognition receptor for viral components, might contribute to alterations of the innate mucosal immune response, particularly in CD.
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Affiliation(s)
- Benjamin Funke
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.
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Dannewitz B, Kruck EM, Staehle HJ, Eickholz P, Giese T, Meuer S, Kaever V, Zeier M, Sommerer C. Cyclosporine-induced gingival overgrowth correlates with NFAT-regulated gene expression: a pilot study. J Clin Periodontol 2011; 38:984-91. [PMID: 21883361 DOI: 10.1111/j.1600-051x.2011.01773.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether incidence and severity of cyclosporine A (CsA)-induced gingival overgrowth (GO) is related to expression nuclear factor of activated T cells-regulated genes (NFAT-regulated genes). MATERIAL AND METHODS Expression of NFAT-regulated genes was determined in 36 transplant patients medicated with CsA by real-time PCR before and 2 h after drug intake and residual NFAT activity was estimated as ratio of both measurements. Demographic, periodontal and pharmacologic parameters were recorded and GO assessed from models. Subjects were divided into two groups according to the degree of GO (responders: GO score≥10%). Groups were compared using parametric and non-parametric tests. The association of various CsA-specific and periodontal parameters on incidence and extent of GO were determined using regression analysis. RESULTS Responders had a more than twofold lower residual NFAT activity than non-responders (7.9% and 18.1%, respectively; p<0.001). Multiple regression analysis revealed gingival inflammation, salivary CsA concentration, and residual NFAT activity to be significant factors influencing the expression of GO. Seventy-seven percent of the variability of GO could be explained by these parameters. CONCLUSIONS This study showed that pharmacodynamic parameters such as residual NFAT activity may be promising prognostic indicators to identify patients with increased risk for GO.
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Affiliation(s)
- Bettina Dannewitz
- Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Heidelberg, Germany.
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22
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Zahn A, Schott N, Hinz U, Stremmel W, Schmidt J, Ganten T, Gotthardt D, Meuer S, Zeier M, Giese T, Sommerer C. Immunomonitoring of nuclear factor of activated T cells-regulated gene expression: the first clinical trial in liver allograft recipients. Liver Transpl 2011; 17:466-73. [PMID: 21445930 DOI: 10.1002/lt.22254] [Citation(s) in RCA: 26] [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: 01/12/2023]
Abstract
Long-term calcineurin inhibitor (CNI) treatment can cause serious side effects in liver allograft recipients. An optimal risk-to-benefit ratio for CNI blood levels has not been established. Pharmacodynamic drug monitoring through the measurement of the CNI biological activity, that is, the expression of nuclear factor of activated T cells (NFAT)-regulated genes, seems to be a promising approach. The residual gene expression (RGE) of NFAT-regulated genes 2 and 1.5 hours after cyclosporine A (CsA) and tacrolimus (FK-506) intake was measured in 100 liver allograft recipients with 1 or more years of follow-up post-transplantation. The mean RGE in all patients was 62% ± 33%. A significant negative correlation between the CsA (P < 0.0001, r = -0.8026) and FK-506 peak levels (P < 0.0001, r = -0.6982) and the RGE of all NFAT-regulated genes was observed. Clinical reliability was proven too. In conclusion, the data presented in this pilot study reveal the applicability of the pharmacodynamic monitoring of CNI efficacy in liver allograft recipients. To confirm the advantage of individualized pharmacodynamic drug monitoring over pharmacokinetic drug monitoring with respect to clinical outcomes, controlled, prospective studies are needed.
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Affiliation(s)
- Alexandra Zahn
- Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany.
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23
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Billing H, Sommerer C, Giese T, Meuer S, Tönshoff B, Czock D. Differentielle Suppression NFAT-regulierter Gene unter Cyclosporin A-Therapie pädiatrischer vs. erwachsener Nierentransplantatempfängern. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Kisielewicz A, Schaier M, Schmitt E, Hug F, Haensch GM, Meuer S, Zeier M, Sohn C, Steinborn A. A distinct subset of HLA-DR+-regulatory T cells is involved in the induction of preterm labor during pregnancy and in the induction of organ rejection after transplantation. Clin Immunol 2010; 137:209-20. [DOI: 10.1016/j.clim.2010.07.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 06/28/2010] [Accepted: 07/24/2010] [Indexed: 11/25/2022]
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25
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Sommerer C, Giese T, Meuer S, Zeier M. New concepts to individualize calcineurin inhibitor therapy in renal allograft recipients. Saudi J Kidney Dis Transpl 2010; 21:1030-1037. [PMID: 21060169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
A maximum of efficacy with a minimum of toxicity is the ultimate goal of immunosuppressive therapy. Calcineurin inhibitors are widely used as immunosuppressive drugs, and there is still a discussion about the optimal blood levels of cyclosporine A (CsA) and tacrolimus (Tac), balancing safety and efficacy. Monitoring of calcineurin inhibitor therapy is usually performed by blood trough levels, pharmacokinetics such as measurement of two hour peak levels, or by various areas under the curve assessments (AUC, 4 to 12 hours). All these mentioned pharmacokinetic measurements cannot predict the individual biological effects of the immunosuppressive drug. Several approaches have been undertaken to measure immunosuppression by calcineurin inhibitors. In this manuscript, general and specific immune monitoring strategies of calcineurin inhibitors and their clinical benefits are discussed.
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Affiliation(s)
- Claudia Sommerer
- Department of Nephrology, University Hospital, INF 162, Heidelberg, Germany.
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26
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Billing H, Giese T, Sommerer C, Zeier M, Feneberg R, Meuer S, Tönshoff B. Pharmacodynamic monitoring of cyclosporine A by NFAT-regulated gene expression and the relationship with infectious complications in pediatric renal transplant recipients. Pediatr Transplant 2010; 14:844-51. [PMID: 20602720 DOI: 10.1111/j.1399-3046.2010.01354.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 01/11/2023]
Abstract
Pharmacokinetic monitoring of CsA is unsatisfactory, because at comparable CsA blood concentrations, the frequency and severity of adverse effects vary considerably among patients. We have therefore recently developed a precise, reliable, and robust whole-blood pharmacodynamic assay that measures the suppression of CsA-target genes in T lymphocytes. Because of the different characteristics of CsA pharmacokinetics in children and the higher propensity for infectious complications, this assay requires validation in the pediatric patient population. We therefore quantified in a prospective study of 45 pediatric renal transplant recipients the residual expression of NFAT-regulated genes in lymphocytes by RT-PCR and correlated these findings with the frequency of recurrent infections in the maintenance period post-transplant. Patients with recurrent infections showed a significantly stronger inhibition of NFAT-regulated gene expression (18.2%) than patients without recurrent infections (31.7%; p = 0.012). This difference was specific, because various PK parameters of CsA and the concomitant immunosuppressive therapy were comparable between patients. Multivariate regression analysis showed that patient age and residual NFAT-regulated gene expression were the only independent determinants of recurrent infections. By ROC curve analysis, a cutoff value of 23% residual NFAT-regulated gene expression had the highest sensitivity (71.1%) and specificity (65.4%) for the discrimination of patients with and without recurrent infections. Pharmacodynamic monitoring of CsA by measurement of residual NFAT-regulated gene expression in T lymphocytes has the potential to identify over-immunosuppressed pediatric renal transplant recipients and is therefore a useful tool for the optimization of CsA therapy.
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Affiliation(s)
- Heiko Billing
- University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, Heidelberg, Germany
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27
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Zorn M, Meuer S, Tahir MN, Tremel W, Char K, Zentel R. Orientation of polymer functionalized nanorods in thin films. J Nanosci Nanotechnol 2010; 10:6845-6849. [PMID: 21137809 DOI: 10.1166/jnn.2010.2946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A directed self assembly of anisotropic nanostructures offers a possibility to provide unique functional materials, which are e.g., important in optoelectronic devices. We use the liquid crystalline behavior of polymer functionalized TiO2 and ZnO nanorods to apply methods well known for low molecular liquid crystals to achieve oriented thin films. Convective forces in the meniscus on a structured substrate obtain thin layers of oriented nanoparticles with a ordering parameter of S = 0.7. As another method we present the orientation of polystyrene covered ZnO nanorods under an applied electric field. The method offers a perpendicular alignment of the rods to the surface.
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Affiliation(s)
- Matthias Zorn
- Institute for Organic Chemistry, Johannes Gutenberg University, Duesbergweg 10-14, 55128 Mainz, Germany
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Abstract
Long-term immunosuppression causes a significantly increased risk for the development of malignancies in transplanted patients. A link between immunosuppression and incidence of cancer is well documented and involves the effect of immunosuppression on antitumor surveillance and antiviral adaptive immune responses. Using a recently described pharmacodynamic assay, a strong correlation between the incidence of malignancies and the individual degree of immunosuppression after cyclosporin A treatment in patients with kidney transplants was observed. The availability of a quantitative and quick laboratory test for the assessment of the individual functional activity of immunocompetent cells crucial for transplant rejection, defense against viral infection and tumor surveillance, along with the ability to adjust doses of immunosuppressive agents such that patients are largely protected against malignant disease and/or viral infection while maintaining a stable allograft function, represents an enormous breakthrough in transplantation medicine and advances our attempts to individualize treatment in transplanted patients.
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Affiliation(s)
- Thomas Giese
- Department of Immunology, University of Heidelberg, Heidelberg, Germany.
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Steinborn A, Engst M, Haensch GM, Mahnke K, Schmitt E, Meuer S, Sohn C. Small for gestational age (SGA) neonates show reduced suppressive activity of their regulatory T cells. Clin Immunol 2009; 134:188-97. [PMID: 19837002 DOI: 10.1016/j.clim.2009.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 09/04/2009] [Accepted: 09/06/2009] [Indexed: 01/11/2023]
Abstract
Little information exists concerning the role of fetal regulatory T cells (Tregs) during intrauterine development. We examined whether complications such as reduced birth weight or the occurrence of preterm labor were associated with deficiencies in the number or in the immunosuppressive activity of Tregs in the fetal circulation. Their total number did not change during normal or complicated pregnancy. In contrast, their level of FoxP3 expression decreased continuously with gestational age and was significantly reduced in the presence of spontaneous term, but not preterm labor. In small for gestational age (SGA) neonates, FoxP3 expression was constantly decreased when compared to age matched healthy neonates. In accordance with the low FoxP3 expression, the suppressive activity of the Tregs from spontaneously term delivered and from SGA babies was significantly reduced. We propose that the level of FoxP3 expression in the fetal Tregs may be a potential regulator of their suppressive activity.
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Affiliation(s)
- Andrea Steinborn
- Department of Obstetrics and Gynecology, University of Heidelberg, Voss-Strasse 9, 69115 Heidelberg, Germany.
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Yella A, Tahir MN, Meuer S, Zentel R, Berger R, Panthöfer M, Tremel W. Synthesis, Characterization, and Hierarchical Organization of Tungsten Oxide Nanorods: Spreading Driven by Marangoni Flow. J Am Chem Soc 2009; 131:17566-75. [DOI: 10.1021/ja9007479] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aswani Yella
- Institut für Anorganische Chemie und Analytische Chemie, and Institut für Organische Chemie, Johannes Gutenberg-Universität, Duesbergweg 10-14, D-55099 Mainz, Germany, and Max-Planck-Institut für Polymerforschung, Ackermannweg 10, D-55128 Mainz, Germany
| | - Muhammad Nawaz Tahir
- Institut für Anorganische Chemie und Analytische Chemie, and Institut für Organische Chemie, Johannes Gutenberg-Universität, Duesbergweg 10-14, D-55099 Mainz, Germany, and Max-Planck-Institut für Polymerforschung, Ackermannweg 10, D-55128 Mainz, Germany
| | - Stefan Meuer
- Institut für Anorganische Chemie und Analytische Chemie, and Institut für Organische Chemie, Johannes Gutenberg-Universität, Duesbergweg 10-14, D-55099 Mainz, Germany, and Max-Planck-Institut für Polymerforschung, Ackermannweg 10, D-55128 Mainz, Germany
| | - Rudolf Zentel
- Institut für Anorganische Chemie und Analytische Chemie, and Institut für Organische Chemie, Johannes Gutenberg-Universität, Duesbergweg 10-14, D-55099 Mainz, Germany, and Max-Planck-Institut für Polymerforschung, Ackermannweg 10, D-55128 Mainz, Germany
| | - Rüdiger Berger
- Institut für Anorganische Chemie und Analytische Chemie, and Institut für Organische Chemie, Johannes Gutenberg-Universität, Duesbergweg 10-14, D-55099 Mainz, Germany, and Max-Planck-Institut für Polymerforschung, Ackermannweg 10, D-55128 Mainz, Germany
| | - Martin Panthöfer
- Institut für Anorganische Chemie und Analytische Chemie, and Institut für Organische Chemie, Johannes Gutenberg-Universität, Duesbergweg 10-14, D-55099 Mainz, Germany, and Max-Planck-Institut für Polymerforschung, Ackermannweg 10, D-55128 Mainz, Germany
| | - Wolfgang Tremel
- Institut für Anorganische Chemie und Analytische Chemie, and Institut für Organische Chemie, Johannes Gutenberg-Universität, Duesbergweg 10-14, D-55099 Mainz, Germany, and Max-Planck-Institut für Polymerforschung, Ackermannweg 10, D-55128 Mainz, Germany
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Wallwiener CW, Giese T, Staebler A, Meuer S, Solomayer E, Fehm T. Ein neues Multi-Marker RT-PCR Panel zur Detektion von Sentinel-Lymphknoten-Metastasen bei Brustkrebspatientinnen. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1239033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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34
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Drings P, Brittinger G, Gaedicke G, Heimpel H, Hossfeld D, Huber C, Meuer S, Wannenmacher M, Winkler K. Die moderne Krebsbehandlung: Wissenschaftlich begründete Verfahren und Methoden mit unbewiesener Wirksamkeit. Oncol Res Treat 2009. [DOI: 10.1159/000218579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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35
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Meuer S, Braun L, Schilling T, Zentel R. α-Pyrene polymer functionalized multiwalled carbon nanotubes: Solubility, stability and depletion phenomena. POLYMER 2009. [DOI: 10.1016/j.polymer.2008.10.039] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Schwarz S, Giese T, Lasitschka F, Wabnitz G, Sido B, Autschbach F, Lee YS, Meuer S, Schröder-Braunstein J. F.114. Mucosal Injury and Activation of NFkB in the Initiation of Intestinal Inflammation. Clin Immunol 2009. [DOI: 10.1016/j.clim.2009.03.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Sommerer C, Giese T, Meuer S, Zeier M. Pharmacodynamic monitoring of calcineurin inhibitor therapy: is there a clinical benefit? Nephrol Dial Transplant 2008; 24:21-7. [PMID: 18842676 DOI: 10.1093/ndt/gfn556] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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38
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Affiliation(s)
- S. Meuer
- Institute for Organic Chemistry, University of Mainz, Duesbergweg 10-14, 55128 Mainz, Germany, and Institute for Physical Chemistry, University of Mainz, Jakob Welder Weg 11, 55128 Mainz, Germany
| | - K. Fischer
- Institute for Organic Chemistry, University of Mainz, Duesbergweg 10-14, 55128 Mainz, Germany, and Institute for Physical Chemistry, University of Mainz, Jakob Welder Weg 11, 55128 Mainz, Germany
| | - I. Mey
- Institute for Organic Chemistry, University of Mainz, Duesbergweg 10-14, 55128 Mainz, Germany, and Institute for Physical Chemistry, University of Mainz, Jakob Welder Weg 11, 55128 Mainz, Germany
| | - A. Janshoff
- Institute for Organic Chemistry, University of Mainz, Duesbergweg 10-14, 55128 Mainz, Germany, and Institute for Physical Chemistry, University of Mainz, Jakob Welder Weg 11, 55128 Mainz, Germany
| | - M. Schmidt
- Institute for Organic Chemistry, University of Mainz, Duesbergweg 10-14, 55128 Mainz, Germany, and Institute for Physical Chemistry, University of Mainz, Jakob Welder Weg 11, 55128 Mainz, Germany
| | - R. Zentel
- Institute for Organic Chemistry, University of Mainz, Duesbergweg 10-14, 55128 Mainz, Germany, and Institute for Physical Chemistry, University of Mainz, Jakob Welder Weg 11, 55128 Mainz, Germany
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Gückel B, Kayser S, Gruber I, Wallwiener D, Meuer S, Marmé A. Allogene Vakzine auf Basis einer CD80-modifizierten, immunkompetenten Mammakarzinom-Zellinie: erste klinische Ergebnisse – Phase I-Studie für met. Brustkrebspatientinnen. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Gückel B, Moebius U, Meuer S, Kaul S, Bastert G, Wallwiener D. Entwicklung immunogener Mamma- und Ovarialkarzinomlinien nach CD80-Transfektion. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2007-1023288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sommerer C, Morath C, Giese T, Meuer S, Zeier M. Activity of Nuclear Factor of Activated T Cells Is Independent of the Number of Peripheral Lymphocytes in FTY720-Treated Patients. Transplant Proc 2008; 40:1416-8. [DOI: 10.1016/j.transproceed.2008.01.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 01/16/2008] [Indexed: 11/29/2022]
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Sommerer C, Hartschuh W, Enk A, Meuer S, Zeier M, Giese T. Pharmacodynamic immune monitoring of NFAT-regulated genes predicts skin cancer in elderly long-term renal transplant recipients. Clin Transplant 2008; 22:549-54. [DOI: 10.1111/j.1399-0012.2008.00819.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zorn M, Meuer S, Tahir MN, Khalavka Y, Sönnichsen C, Tremel W, Zentel R. Liquid crystalline phases from polymer functionalised semiconducting nanorods. ACTA ACUST UNITED AC 2008. [DOI: 10.1039/b802666a] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Meuer S, Braun L, Zentel R. Solubilisation of multi walled carbon nanotubes by α-pyrene functionalised PMMA and their liquid crystalline self-organisation. Chem Commun (Camb) 2008:3166-8. [DOI: 10.1039/b803099e] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Giese T, Sommerer C, Zeier M, Meuer S. Pharmacodynamic Controlled Tapering of Cyclosporine A: A New Step Towards Individualized Immunosuppressive Therapy in Transplanted Patients. Clin Immunol 2007. [DOI: 10.1016/j.clim.2007.03.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sido B, Autschbach F, Schroeder-Braunstein J, Giese T, Lasitschka F, Meuer S. Differential Levels of Intercellular Glutathion (GSH) Dictate the Shift From Adaptive to Innate T Cell Function in the Human Intestinal Mucosa. Clin Immunol 2007. [DOI: 10.1016/j.clim.2007.03.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Munder M, Bhairo M, Giese T, Luckner C, Ho A, Meuer S. GCN2 Kinase: An Evolutionarily Conserved Mechanism of Human T Lymphocyte Suppression Upon Arginine Depletion. Clin Immunol 2007. [DOI: 10.1016/j.clim.2007.03.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sommerer C, Konstandin M, Dengler T, Schmidt J, Meuer S, Zeier M, Giese T. Pharmacodynamic Monitoring of Cyclosporine A in Renal Allograft Recipients Shows a Quantitative Relationship Between Immunosuppression and the Occurrence of Recurrent Infections and Malignancies. Transplantation 2006; 82:1280-5. [PMID: 17130775 DOI: 10.1097/01.tp.0000243358.75863.57] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND At present it is unclear which dose and consecutive blood levels of cyclosporine A (CsA) are optimal with respect to immunosuppressive efficacy and drug specific side effects at the level of individual patients. Several pharmacodynamic measures of CsA effects have been proposed, but have not become clinical routine yet. Besides the lack of practicability, the biological relevance of these assays has not been determined so far. METHODS Residual expression of nuclear factor of activated T-cells (NFAT)-regulated genes two hours after drug intake was used as molecular pharmacodynamic marker to assess CsA effects on lymphocytes and correlated with the frequency of recurrent infections and malignancies in patients with five or more years of follow-up posttransplantation. RESULTS Recurrent infectious complications were observed in 44% and malignancies in 20% of the 133 patients studied. Patients with a strong suppression of NFAT-regulated genes by CsA--as judged by a residual level of transcription of less than 15% after drug intake--develop more frequent infections (53% vs. 29%; P = 0.005) and malignancies (22% vs. 4%; P = 0.002). The lack of correlation between the incidence of these complications and CsA blood concentration might point to the interindividual differences in the sensitivity towards calcineurin inhibition. CONCLUSION The data presented here reveal a clear relation between the frequency of infectious and malignant complications and the degree of suppression of NFAT-regulated genes by CsA in transplanted patients. Therefore, pharmacodynamic monitoring of CsA efficacy in transplanted patients might be a useful tool to adjust immunosuppressive therapy in individual patients.
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Affiliation(s)
- Claudia Sommerer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
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Berberat PO, Friess H, Schmied B, Kremer M, Gragert S, Flechtenmacher C, Schemmer P, Schmidt J, Kraus T, Uhl W, Meuer S, Büchler MW, Giese T. Differentially Expressed Genes in Postperfusion Biopsies Predict Early Graft Dysfunction After Liver Transplantation. Transplantation 2006; 82:699-704. [PMID: 16969295 DOI: 10.1097/01.tp.0000233377.14174.93] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Preservation induced injury is a major contributing factor to early graft dysfunction in liver allograft recipients. We hypothesized that changes in gene expression represent the earliest indicator of ischemia/reperfusion-related injuries measurable in the graft and could be used as prognostic marker for the occurrence of graft-related complications. METHODS We studied the expression of 67 genes, known to play a role in acute inflammatory processes by real-time polymerase chain reaction in 59 postperfusion biopsies. The level of expression was correlated with the occurrence of graft-related complications. RESULTS We identified six genes that were significantly correlated with the occurrence of early graft dysfunction (Spearman test, two-tailed; P<0.05). High C-reactive protein (CRP) gene expression levels correlated significantly with the need of therapeutic interventions due to graft-related complications (P=0,011). Furthermore, five genes related to vascular endothelial cell physiology (CTGF, WWP2, CD274, VEGF. and its receptor FLT1) showed significantly reduced expression in the postperfusion biopsies of patients with need of therapeutic interventions due to graft-related complications in the first month (P<0.05). Using a risk score based on the expression of these five genes, complications could be predicted with 96% sensitivity (ROC analysis, specificity: 74%, positive predictive value: 72%, negative predictive value: 96%). CONCLUSION Quantitative gene expression analysis in postperfusion biopsies may be a valuable tool to prospectively identify patients at risk for early clinical allograft dysfunction after liver transplantation.
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Affiliation(s)
- Pascal O Berberat
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
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